Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 07-01-2012 , 2012, and ending 06-30-2013
BCheck if applicable:
CName of organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
55 MERCHANT STREET 24TH FLOOR
Suite
Room/suite
City or town, state or country, and ZIP + 4
HONOLULU, HI96813
D Employer identification number

38-3835105
E Telephone number

G Gross receipts $ 1,075,571,358
F Name and address of principal officer:
RAYMOND VARA
55 MERCHANT ST 24TH FLOOR
HONOLULU,HI96813
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.hawaiipacifichealth.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions) Click to see attachment
H(c)
Group exemption number MediumBullet5834
K Form of organization:
 
L Year of formation:  
M State of legal domicile:
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 38
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 23
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 5,499
6 Total number of volunteers (estimate if necessary) ............. 6 572
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 692,643
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 109,637
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 2,190,441 3,806,413
9 Program service revenue (Part VIII, line 2g) ......... 899,617,949 986,541,479
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 6,322,631 4,157,340
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 4,572,187 5,041,667
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 912,703,208 999,546,899
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 724,282 35,147
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 412,002,473 458,417,077
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 418,903,052 433,169,327
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 831,629,807 891,621,551
19 Revenue less expenses. Subtract line 18 from line 12....... 81,073,401 107,925,348
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 563,325,142 635,052,131
21 Total liabilities (Part X, line 26)............. 123,403,397 128,207,692
22 Net assets or fund balances. Subtract line 21 from line 20..... 439,921,745 506,844,439
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: SEE SCHEDULE O.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 40,474,023 including grants of $ 0 ) (Revenue $ 0 )
SEE SCHEDULE O.
4b (Code:   ) (Expenses $ 51,792,829 including grants of $ 0 ) (Revenue $ 0 )
SEE SCHEDULE O.
4c (Code:   ) (Expenses $ 96,172,550 including grants of $ 0 ) (Revenue $ 0 )
SEE SCHEDULE O.
4d Other program services (Describe in Schedule O.)
(Expenses $ 599,433,689 including grants of $ 35,147 ) (Revenue $ 991,174,358 )
4e Total program service expensesMediumBullet787,873,091
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV..................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..Click to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............. Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
420
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
5,499
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
38
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
23
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
HI
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletANN HO55 MERCHANT STREET 24TH FLOORHONOLULUHI96813 (808) 527-2520
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) MARK GRIEF MD........................................................................
Board of Director, Chair
 .2
.......................0.0 		X   X       0 0 0
(2) GORDON HAMMOND........................................................................
Board of Director, Chair
 .2
.......................0.0 		X   X       0 0 0
(3) KEITH MATSUMOTO MD........................................................................
Board of Director, Chair
 .3
........................2 		X   X       0 0 0
(4) LYNN MCCRORY........................................................................
Board of Director, Chair
 .2
........................6 		X   X       0 0 0
(5) VIOLETA ARNOBIT RN........................................................................
Board of Director, Vice Chair
 .2
........................1 		X   X       0 0 0
(6) JOHN CULLINEY MD........................................................................
Board of Director, Vice Chair
 .2
.......................40.0 		X   X       0 455,107 49,951
(7) THOMAS J NORDYKE MD........................................................................
Board of Director, Vice Chair
 40.0
.......................0.0 		X   X       248,324 0 36,276
(8) RAYMOND P VARA JR........................................................................
Board of Director, President
 20.0
.......................45.0 		X   X       0 1,183,271 318,255
(9) KENNETH B ROBBINS MD........................................................................
Board of Director, EVP & CMO
 40.0
.......................20.0 		X   X       0 737,654 190,882
(10) ARTHUR GLADSTONE........................................................................
Bd of Dir, CEO/VP & System CNE
 51.0
.......................4.0 		X   X       0 399,942 75,634
(11) MARTHA SMITH........................................................................
Board of Director, CEO
 55.0
.......................5.0 		X   X       0 481,844 99,117
(12) JENNIE CHAHANOVICH........................................................................
Board of Director, CEO
 55.0
........................1 		X   X       0 371,849 68,023
(13) KATHLEEN CLARK........................................................................
Board of Director, Pres & CEO
 40.0
.......................21.0 		X   X       0 291,712 45,173
(14) STEVEN AI........................................................................
Board of Director
 .3
.......................0.0 		X           0 0 0
(15) SHIRLEY AKITA........................................................................
Board of Director (PART YEAR)
 .2
.......................0.0 		X           0 0 0
(16) CARLETON CHING........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(17) ANDREW DANG MD........................................................................
Board of Director
 40.0
.......................0.0 		X           375,882 0 47,059
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) RAMON DE LA PENA........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(19) DOUGLAS DUVAUCHELLE MD........................................................................
Board of Director (PART YEAR)
 .2
.......................0.0 		X           0 0 0
(20) CHRIS ELDRIDGE........................................................................
Board of Director
 .3
.......................0.0 		X           0 0 0
(21) MICHAEL GIBSON ESQ........................................................................
Board of Director (PART YEAR)
 .2
........................2 		X           0 0 0
(22) BEN GODSEY........................................................................
Board of Director
 .3
.......................0.0 		X           0 0 0
(23) BETH HOBAN RN........................................................................
Board of Director
 .2
........................1 		X           0 0 0
(24) TAD JACKSON MD........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(25) CHRISTOPHER JORDAN........................................................................
Board of Director
 .2
.......................40.0 		X           0 344,716 44,278
(26) JAMES KAKUDA MD........................................................................
Board of Director
 1.2
.......................0.0 		X           35,000 6,000 0
(27) WAYNE KATAYAMA........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(28) CLYDE KODANI........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(29) DOUGLAS KWOCK MD........................................................................
Board of Director
 1.3
.......................0.0 		X           15,375 8,000 0
(30) RICHANNE LAM........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(31) STEPHEN LIN MD........................................................................
Board of Director
 1.3
.......................0.0 		X           41,000 1,625 0
(32) BRYAN MATSUMOTO MD........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(33) GERALD MCKENNA MD........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(34) PETER MCNALLY MD........................................................................
Board of Director
 .3
.......................0.0 		X           0 0 0
(35) ELLIOT MILLS........................................................................
Board of Director
 .3
.......................0.0 		X           0 0 0
(36) BEAU NAKAMOTO MD........................................................................
Board of Director
 40.0
.......................0.0 		X           258,158 0 27,435
(37) GORDON NIHEI........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(38) DANIELLE RAMOS........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(39) JENNIFER SABAS........................................................................
Board of Director
 .3
.......................0.0 		X           0 0 0
(40) KENN SARUWATARI MD........................................................................
Board of Director
 40.0
.......................0.0 		X           241,647 0 53,266
(41) SHELLEY WILSON........................................................................
Board of Director
 .3
.......................0.0 		X           0 0 0
(42) CHARLES A STED........................................................................
Board of Director (PART YEAR)
 10.0
.......................50.0 		X           0 1,733,229 45,535
(43) DAVID OKABE........................................................................
EVP, CFO & Treasurer
 16.0
.......................39.0 		    X       0 735,788 156,303
(44) CHARLES R CHING........................................................................
EVP, Gen Counsel & Secretary
 13.0
.......................47.0 		    X       0 561,651 117,352
(45) EARL INOUYE........................................................................
VP & System Controller
 24.0
.......................31.0 		    X       0 306,408 75,801
(46) VIRGINIA PRESSLER-FISHER MD........................................................................
EVP
 6.0
.......................53.0 		    X       0 594,421 149,714
(47) GAIL LERCH........................................................................
EVP
 14.0
.......................46.0 		    X       0 604,506 143,372
(48) STEVEN ROBERTSON........................................................................
EVP & CIO
 43.0
.......................17.0 		    X       0 601,432 148,329
(49) MELINDA ASHTON MD........................................................................
VP
 7.0
.......................42.0 		    X       0 401,315 70,584
(50) ANN PETERS........................................................................
VP
 4.0
.......................46.0 		    X       0 215,560 47,705
(51) KEKA SANBORN........................................................................
VP
 8.0
.......................50.0 		    X       0 276,522 2,032
(52) MAUREEN FLANNERY........................................................................
VP
 50.0
........................1 		    X       0 210,099 64,475
(53) MAVIS NIKAIDO........................................................................
VP & CNE
 40.0
.......................0.0 		    X       0 202,413 18,533
(54) BRIGITTE MCKALE........................................................................
VP & CNE
 40.0
.......................0.0 		    X       0 194,297 16,866
(55) DAWN CHING........................................................................
VP
 40.0
.......................0.0 		    X       0 235,253 49,793
(56) GIDGET RUSCETTA RN........................................................................
VP
 50.0
.......................5.0 		    X       0 230,028 55,017
(57) PATRICIA BOECKMANN RN........................................................................
VP & CNE
 50.0
.......................2.0 		    X       0 337,230 60,733
(58) PAULA DIAS........................................................................
VP
 9.0
.......................45.0 		    X       0 245,882 42,343
(59) RANDY YATES MD........................................................................
CMO
 40.0
.......................0.0 		    X       0 309,820 25,095
(60) SUSAN MASUMOTO-NONAKA........................................................................
VP
 39.0
.......................21.0 		    X       0 257,284 44,923
(61) WARREN CHAIKO........................................................................
VP
 35.0
.......................17.0 		    X       0 282,180 53,128
(62) DAVID FOX........................................................................
Privacy & Information Security
 31.0
.......................9.0 		    X       0 118,231 40,863
(63) JESSICA LEWIS........................................................................
Assistant Corporate Secretary
 36.0
.......................4.0 		    X       0 112,417 15,739
(64) KATIE SHIGEMITSU........................................................................
Compliance Officer
 37.0
.......................3.0 		    X       0 173,263 37,971
(65) THERESA RAMEY........................................................................
Compliance Officer
 24.0
.......................16.0 		    X       0 120,896 34,381
(66) HINGSON M CHUN MD........................................................................
Physician
 40.0
.......................0.0 		        X   933,647 0 43,422
(67) CASS K NAKASONE MD........................................................................
Physician
 40.0
.......................0.0 		        X   790,864 0 44,451
(68) MARK S GERBER MD........................................................................
Physician
 40.0
.......................0.0 		        X   743,437 0 34,107
(69) WESLEY J KAI MD........................................................................
Physician
 40.0
.......................0.0 		        X   689,329 0 46,092
(70) STEPHEN KB CHINN MD........................................................................
Physician
 40.0
.......................0.0 		        X   664,613 0 48,203
(71) HUGH HAZENFIELD MD........................................................................
FORMER OFFICER
 0.0
.......................0.0 		          X 0 301,869 51,917
(72) KEOKI CLEMENTE........................................................................
FORMER OFFICER
 0.0
.......................0.0 		          X 0 144,405 19,464
(73) LYNNE JOHNSON-JOSEPH........................................................................
FORMER OFFICER
 0.0
.......................0.0 		          X 0 220,624 41,840
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 5,037,276 14,008,743 2,901,432
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet968
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
CLINICAL LABORATORIES OF HAWAII LL, PO BOX 1300HONOLULUHI968071300 LABORATORY SERVICES 22,620,589
DCK PACIFIC CONSTRUCTION LLC, 707 RICHARDS ST STE 410HONOLULUHI96813 CONSTRUCTION SVCS 15,885,284
SODEXO INC AFFILIATES, 888 SOUTH KING STREETHONOLULUHI96813 FOOD & ENVIRON SVCS 7,937,986
UNIVERSITY CLINICAL EDU RSRCH AS, PO BOX 31000HONOLULUHI968495647 PHYSICIAN SVCS 5,695,055
GATESIDE INC, 522 AHUI STREETHONOLULUHI96813 CONSTRUCTION SVCS 5,131,005
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet124
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 3,694,983
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		111,430
g Noncash contributions included in lines
1a-1f:$ 		213,455
h Total. Add lines 1a-1f.......MediumBullet 3,806,413
Program Service Revenue Business Code
2a NET PATIENT REVENUES 622110 968,057,247 967,667,844 389,403  
b OTHER HEALTHCARE REVENUE 622110 10,933,293 10,933,293    
c RENTAL INCOME 531120 3,361,905 3,358,419 3,486  
d PREMIUM REVENUE 900099 2,501,684 2,501,684    
e RENTAL INCOME FROM AFFILIATES 622110 1,400,242 1,400,242    
f All other program service revenue . 287,108   287,108  
g Total. Add lines 2a–2f........MediumBullet 986,541,479
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 2,160,781     2,160,781
4 Income from investment of tax-exempt bond proceeds..MediumBullet 797,917     797,917
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 145,285  
b Less: rental expenses 0  
c Rental income or (loss) 145,285 0
d Net rental income or (loss).......MediumBullet 145,285     145,285
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 76,771,388 67,030
b Less: cost or other basis and sales expenses 72,903,690 2,736,086
c Gain or (loss) 3,867,698 -2,669,056
d Net gain or (loss)..........MediumBullet 1,198,642     1,198,642
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a 634,787
b Less: cost of goods sold ..b 384,683
c Net income or (loss) from sales of inventory..MediumBullet 250,104     250,104
Miscellaneous Revenue Business Code
11a PARKING 812930 2,395,569 2,395,569    
b CAFETERIA 722110 1,596,328 1,596,328    
c MEDICAL RECORD COPIES 622110 60,146 60,146    
d All other revenue .... 594,235 580,836 12,646 753
e Total. Add lines 11a–11d ...... MediumBullet 4,646,278
12 Total revenue. See Instructions......MediumBullet 999,546,899 990,494,361 692,643 4,553,482
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 35,147 35,147
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 834,886 743,386 91,500  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 364,191,764 361,024,615 3,167,149  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 30,964,003 30,624,664 339,339  
9 Other employee benefits ....... 37,891,092 37,434,263 456,829  
10 Payroll taxes ........... 24,535,332 24,334,254 201,078  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 24,269 6,855 17,414  
c Accounting ........... 2,431,810   2,431,810  
d Lobbying ........... 79,946   79,946  
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 556,130   556,130  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 131,540,955 116,252,474 15,288,481  
12 Advertising and promotion .... 792,637 76,850 715,787  
13 Office expenses ....... 130,164,832 129,536,549 628,283  
14 Information technology ...... 13,304,459 1,809,583 11,494,876  
15 Royalties .. 0      
16 Occupancy ........... 27,994,903 26,660,126 1,334,777  
17 Travel ............ 1,052,785 862,415 190,370  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 225,637 174,134 51,503  
20 Interest ........... 12,039,346 12,039,346    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 33,928,172 32,990,950 937,222  
23 Insurance .............. 8,274,324 8,647,539 -373,215  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a CORPORATE ALLOCATION 52,197,972 0 52,197,972  
b OTHER PURCHASES 17,241,643 4,558,072 12,683,571  
c AFFILIATE EXPENSES 1,025,392   1,025,392  
d ALL OTHER EXPENSES 294,115 61,869 232,246  
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 891,621,551 787,873,091 103,748,460 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. -5,021,997 1 -6,916,329
2 Savings and temporary cash investments ......... 3,970,707 2 6,039,377
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 97,448,717 4 115,570,126
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 13,207,541 8 13,669,151
9 Prepaid expenses and deferred charges .......... 865,412 9 991,613
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 751,739,579
b Less: accumulated depreciation ..... 10b 470,950,134 263,196,774 10c 280,789,445
11 Investments—publicly traded securities .......... 81,674,668 11 94,334,164
12 Investments—other securities. See Part IV, line 11 ..... 50,789,794 12 51,503,194
13 Investments—program-related. See Part IV, line 11 ..... 1,618,557 13 1,618,557
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 55,574,969 15 77,452,833
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 563,325,142 16 635,052,131
Liabilities 17 Accounts payable and accrued expenses ......... 69,150,141 17 73,311,378
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 54,253,256 25 54,896,314
26 Total liabilities. Add lines 17 through 25......... 123,403,397 26 128,207,692
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 406,574,477 27 462,406,697
28 Temporarily restricted net assets ........... 23,395,339 28 34,033,203
29 Permanently restricted net assets ........... 9,951,929 29 10,404,539
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 439,921,745 33 506,844,439
34 Total liabilities and net assets/fund balances ........ 563,325,142 34 635,052,131
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
999,546,899
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
891,621,551
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
107,925,348
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
439,921,745
5
Net unrealized gains (losses) on investments ...............
5
8,898,883
6
Donated services and use of facilities .................
6
683,761
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-50,585,298
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
506,844,439
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
 
Employer identification number

38-3835105
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
 
Employer identification number

38-3835105
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
  		Employer identification number

38-3835105
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
  		Employer identification number

38-3835105
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
  		Employer identification number

38-3835105
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
 
Employer identification number

38-3835105
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
79,946
j
Total. Add lines 1c through 1i ...............................
79,946
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
LOBBYING EXPENDITURES SCHEDULE C, PART II-B LOBBYING EXPENSES ARE THE PORTION OF AMOUNTS PAID TO HEALTHCARE ASSOCIATONS THAT ENGAGED IN LEGISLATIVE LOBBYING ON BEHALF OF ITS MEMBERS.
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
 
Employer identification number

38-3835105
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 135,652,768 138,278,199 114,609,981 102,107,743 123,858,456
b Contributions ........ 493,306 1,573,144 1,260,873 1,339,991 3,027,713
c Net investment earnings, gains, and losses 15,453,147 -4,110,118 22,509,891 11,175,215 -24,767,339
d Grants or scholarships ..... 0        
e Other expenditures for facilities
and programs ........ 		0        
f Administrative expenses .... 91,758 88,457 102,546 12,968 11,087
g End of year balance ...... 151,507,463 135,652,768 138,278,199 114,609,981 102,107,743
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet96.000 %
b
Permanent endowment SchDMd Bullet2.000 %
c
Temporarily restricted endowment SchDMd Bullet2.000 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
Yes
 
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   19,720,249 19,720,249
b Buildings ................   348,046,393 207,528,546 140,517,847
c Leasehold improvements ............   15,530,328 11,987,387 3,542,941
d Equipment ................   303,309,865 245,136,162 58,173,703
e Other .................   65,132,745 6,298,040 58,834,705
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 280,789,445
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) INVESTMT IN UNCONSOLIDATED SUB 		4,989,145 F

(B) LIMITED PARTNERSHIPS 		46,514,049 F







Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 51,503,194
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) OTHER RECEIVABLES 5,546,088
(2) BOARD DESIGNATED INVESTMENTS 16,090,217
(3) INT IN NET ASSETS OF FDNS 35,780,151
(4) DEPOSITS & NON-CURRENT ASSETS 5,502,062
(5) INTEREST IN PERPETUAL TRUST 4,719,441
(6) DECORATIVE ARTWORK 305,906
(7) INVESTMENT IN JOINT VENTURES 25,000
(8) THIRD PARTY PAYORS 8,553,457
(9) PALI MOMI FOUNDATION 2,599
(10) STRAUB FOUNDATION 129,351
(11) KAUA'I MEDICAL CLINIC 109,934
(12) KAPI'OLANI HEALTH FOUNDATION 676,789
(13) KAPI'OLANI MEDICAL SPECIALISTS 8,982
(14) WILCOX HEALTH FOUNDATION 2,856
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 77,452,833
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
OTHER LONG TERM LIABILITIES 898,698
ALLOCATION OF GROUP TAX EXEMPT BONDS 19,223,681
ESCHEAT LIABILITY 2,067
NEGATIVE LEASE RENT LIABILITY 3,354,376
457B PLAN 2,770,200
COVENANT NOT TO COMPETE 1,278,328
GOVERNMENTAL AGENCIES 2,164,559
KAPI'OLANI HEALTH FOUNDATION 16,128
STRAUB PHARMACY INC 4,555,888
WILCOX HEALTH FOUNDATION 11,018
PALI MOMI FOUNDATION 3,341
HAWAI'I PACIFIC HEALTH PARTNERS 26,484
KEAHONUIOKALANI 22,386
STRAUB FOUNDATION 15,710
KAPI'OLANI MEDICAL SPECIALISTS 624,747
PROVIDERS INSURANCE CORPORATION 2,922,513
THIRD PARTY PAYORS 3,967,423
SCHI HOLDINGS 13,038,767
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 54,896,314
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
ENDOWMENT FUNDS INTENDED USES SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS ARE INTENDED TO BE USED TO PROVIDE MEDICAL AND OTHER CARE TO PATIENTS WHO ARE UNABLE TO PAY FOR SUCH CARE AND FOR OTHER EXPENSES RELATED TO THE EXEMPT PURCHASE OF THE HOSPITAL.
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
 
Employer identification number

38-3835105
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		  10,246 2,844,193 0 2,844,193 0.320 %
b Medicaid (from Worksheet 3,
column a) .... 		  166,093 196,280,477 177,551,623 18,728,854 2.100 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		  176,339 199,124,670 177,551,623 21,573,047 2.420 %
Other Benefits
 11 3,956 1,442,192 293,583 1,148,609 0.130 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		2   3,968,257 1,463,238 2,504,929 0.280 %
g Subsidized health services
(from Worksheet 6) .. 		3   26,159,062 10,095,404 16,063,658 1.800 %
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    168,215 0 168,215 0.020 %
j Total. Other Benefits .. 16 3,956 31,737,726 11,852,225 19,885,411 2.230 %
k Total. Add lines 7d and 7j . 16 180,295 230,862,396 189,403,848 41,458,458 4.650 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development     267,177   261,177 0.030 %
9 Other     4,353   4,353 0 %
10 Total     271,530   265,530 0.030 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
27,299,917
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
2,344,258
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
127,160,180
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
139,937,701
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-12,777,521
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?4
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 KAPI'OLANI MED CTR FOR WMN & CHILDREN
1319 PUNAHOU STREET
HONOLULU,HI96826 		X X X X     X     1
2 PALI MOMI MEDICAL CENTER
98-1079 MOANALUA ROAD
AIEA,HI96701 		X X         X     1
3 STRAUB CLINIC & HOSPITAL
888 SOUTH KING STREET
HONOLULU,HI96813 		X X   X     X     1
4 WILCOX MEMORIAL HOSPITAL
3-3420 KUHIO HIGHWAY
LIHUE,HI967661099 		X X         X     1
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
1
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?17
Name and address Type of Facility (describe)
1 PEARLRIDGE CLINIC
98-151 PALI MOMI STREET
AIEA,HI96701 		CLINIC
2 KAPI'OLANI WOMEN'S CENTER
1907 BERETANIA STREET 1st 5th FL
HONOLULU,HI96826 		CLINIC
3 MILILANI CLINIC
95-1249 MEHEULA PKWY UNIT 187
MILILANI,HI96789 		CLINIC
4 HAWAI'I KAI CLINIC
7192 KALANIANAOLE HIGHWAY SUITE A2
HONOLULU,HI96825 		CLINIC
5 DOCS ON CALL-PRINCESS KAIULANI HOTEL
120 KAIULANI AVE LOBBY LEVEL
HONOLULU,HI96815 		CLINIC
6 WINDWARD MALL CLINIC
46-056 KAMEHAMEHA HWY SUITE 221
KANEOHE,HI96744 		CLINIC
7 PALI MOMI CLINIC
98-1079 MOANALUA ROAD SUITE 640/630
AIEA,HI96701 		CLINIC
8 KAILUA CLINIC
602 KAILUA ROAD SUITE 200
KAILUA,HI96734 		CLINIC
9 LANAI CLINIC
628-B SEVENTH STREET
LANAI CITY,HI96763 		CLINIC
10 KONA CLINIC
75-240 NANI KAILUA DRIVE SUITE 6B
KAILUAKONA,HI96740 		CLINIC
11 RESTAURANT ROW CLINIC
500 ALA MOANA BLVD TOWER 7 SUITE
HONOLULU,HI96813 		CLINIC
12 ARTESIAN SATELLITE
1907 BERETANIA ST 5TH FLOOR
HONOLULU,HI96826 		CLINIC
13 KAPOLEI CLINIC
590 FARRINGTON HIGHWAY STE 526A
HONOLULU,HI96707 		CLINIC
14 PALI MOMI WOMEN'S CENTER
98-1025 MOANALUA ROAD
AIEA,HI96701 		CLINIC
15 DOCS ON CALL-HILTON HAWAIIAN VILLAGE
2005 KALIA ROAD 2ND FLORR
HONOLULU,HI96815 		CLINIC
16 HILO CLINIC
75 PUUHONU PLACE STE 207
HILO,HI96720 		CLINIC
17 HAWAII COMMUNITY GENETICS
1441 KAPIOLANI BLVD 18TH FLOOR
HONOLULU,HI96814 		CLINIC
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
SCHEDULE H, PART I, LINE 3C   N/A
SCHEDULE H, PART I, LINE 6A   COMMUNITY BENEFITS ARE INCLUDED IN A REPORT PREPARED BY HAWAI'I PACIFIC HEALTH, THE FILING ORGANIZATION'S PARENT.
SCHEDULE H, PART I, LINE 7G   NO COSTS OF A PHYSICIAN CLINIC WERE INCLUDED AS SUBSIDIZED HEALTH SERVICES.
SCHEDULE H, PART I, LINE 7   COST TO CHARGE RATIO AND SCHEDULE H WORKSHEET WAS USED TO CALCULATE THE COSTS.
COMMUNITY BUILDING ACTIVITIES SCHEDULE H, PART II WHEN DISCHARGING PATIENTS, PALI MOMI MEDICAL CENTER FOLLOWS THE GUIDELINES OF THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. THE PROCEDURES INVOLVED WITH PROVIDING A SAFE DISCHARGE PLAN INCLUDE DESIGNATING A PERMANENT OR TRANSITIONAL DESTINATION FOR ALL PATIENTS LEAVING THE HOSPITAL. HOWEVER, IN SOME CASES, PATIENTS HAVE NO INSURANCE OR ARE PENDING APPROVAL UNDER THE MEDICAID PROGRAM FOR PAST SERVICES PROVIDED. THESE PATIENTS DO NOT REQUIRE FURTHER HOSPITAL-GRADE CARE BUT RATHER, FOLLOW-UP CARE AT A TRANSITIONAL CARE FACILITY, SUCH AS A LICENSED FOSTER CARE HOME OR REHABILITATION CENTER. IN THESE SPECIAL CIRCUMSTANCES, PALI MOMI WILL PAY AN INDEPENDENT CASE MANAGER FROM THE COMMUNITY, USUALLY A NURSE REPRESENTATIVE OF AN INDEPENDENT CASE MANAGEMENT COMPANY, TO ASSUME CARE OF THE PATIENT. THE CASE MANAGER IDENTIFIES AN APPROPRIATE FACILITY, HELPS THE PATIENT TRANSITION THERE, AND MONITORS THE PATIENT. PALI MOMI ASSUMES RESPONSIBILITY FOR THE FINANCIAL COST UNTIL INSURANCE APPROVAL UNDER MEDICAID IS ESTABLISHED. PALI MOMI DOES THIS TO ENSURE THAT A SAFE DISCHARGE PLAN IS BEING FOLLOWED, AND TO MAKE AVAILABLE A HOSPITAL BED FOR AN ACUTE OR CRITICALLY-ILL PATIENT WHO REQUIRES HOSPITAL-GRADE CARE. STRAUB CLINIC & HOSPITAL IS COMMITTED TO ATTRACTING AND RETAINING TOP-QUALITY PHYSICIANS IN HAWAI'I, WHERE LOSING PHYSICIANS TO THE U.S. MAINLAND IS A CONSTANT THREAT. ACCORDING TO HAWAI'I MEDICAL JOURNAL AND HAWAI'I PHYSICIAN WORKFORCE ASSESSMENT PROJECT, BY 2020, HAWAI'I WILL HAVE 1,500 FEWER PHYSICIANS THAN NEEDED TO MEET THE COMMUNITY'S HEALTH CARE NEEDS. SHORTAGES WILL BE PARTICULARLY SEVERE IN PRIMARY CARE, CARDIOLOGY, GASTROENTEROLOGY, ORTHOPEDICS, GENERAL SURGERY, AND OTHER SPECIALTIES. IN FISCAL YEAR 2011, STRAUB SPENT $409,912 TO ATTRACT PHYSICIANS TO HAWAI'I. THIS INCLUDED HIRING A FULL-TIME RECRUITER AND PHYSICIAN SERVICES MANAGER, PURCHASING A LAPTOP COMPUTER AND "PRACTICE MATCH SERVICES" DATABASE, HIRING PHYSICIAN CONSULTANTS TO RECRUIT MAINLAND PHYSICIANS, OFFICE AND TRAVEL EXPENSES, TRAVEL EXPENSES OF PHYSICIAN CANDIDATES, GENERAL RECRUITMENT ACTIVITIES, AND MOVING EXPENSES OF PHYSICIANS AND THEIR FAMILY MEMBERS. STRAUB COVERS THESE COSTS TO HELP ENSURE THAT THE COMMUNITY'S FUTURE HEALTH CARE NEEDS WILL BE MET. WHEN DISCHARGING PATIENTS, WILCOX MEMORIAL HOSPITAL FOLLOWS THE GUIDELINES OF THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. THE HOSPITAL STRIVES TO ENSURE THAT A SAFE DISCHARGE PLAN IS PROVIDED TO ALL PATIENTS. THIS MAY INVOLVE PROVIDING SOME PATIENTS 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 OR HOUSING, MEDICATIONS AND MEDICAL EQUIPMENT, SPECIFIC FOODS REQUIRED AS PART OF A RESTRICTED DIET, OR A NURSE ESCORT DEEMED MEDICALLY NECESSARY. IN THESE SPECIAL CIRCUMSTANCES, WILCOX WILL TEMPORARILY COVER THESE COSTS. BY HELPING ITS MOST VULNERABLE POPULATION OVERCOME FINANCIAL BARRIERS, WILCOX IS HELPING TO ENSURE A 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.
SCHEDULE H, PART III, LINE 4   THE ESTIMATE FOR BAD DEBT THAT COULD HAVE POTENTIALLY QUALIFIED FOR CHARITY CARE WAS CALCULATED BY FIRST COMPUTING THE BAD DEBT ASSOCIATED WITH THE UNINSURED, THEN CALCULATING THE COST USING A COST TO CHARGE RATIO (PER SCHEDULE H WORKSHEET 2) AND THEN APPLYING MANAGEMENTS ESTIMATE FOR PORTION OF UNINSURED THAT COULD HAVE QUALIFIED FOR CHARITY CARE. MANAGEMENT CONSERVATIVELY ESTIMATES THAT 15-20% OF THE UNINSURED BAD DEBT COULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE IF SUFFICIENT INFORMATION WAS OBTAINED TO DEMONSTRATE FINANCIAL NEED. PER THE CONSOLIDATED AUDITED FINANCIAL STATEMENT OF HAWAI'I PACIFIC HEALTH ("HPH"), THE 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 AND 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 THE 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. SCHEDULE H, PART III, LINE 8: BECAUSE TAX-EXEMPT HOSPITALS MUST PARTICIPATE IN MEDICARE AND MEDICAID AS A CONDITION OF MAINTAINING THEIR FEDERAL TAX-EXEMPT STATUS, MEDICARE UNDERPAYMENTS ARE NOT OPERATING EXPENSES THAT SHOULD BE EXPECTED IN THE ORDINARY COURSE OF BUSINESS. BECAUSE TAX-EXEMPT HOSPITALS MUST ACCEPT MEDICARE RATES THAT ARE IN SOME CASES BELOW COST, THEY SHOULD BE ABLE TO REPORT ANY NEGATIVE DIFFERENCES BETWEEN MEDICARE RATES AND COST AS LOSSES INCURRED BY SERVICING THE COMMUNITY. TOTAL MEDICARE COSTS WERE CALCULATED IN ACCORDANCE WITH THE FEDERAL STANDARD FORM CMS-2552.96. SCHEDULE H, PART III, LINE 9B: 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 COLLECTION.
SCHEDULE H, PART V, LINE 14G   HPH PUBLISHES THE AVAILABILITY OF A FINANCIAL AID POLICY ON ITS WEB SITE AND VIA TENT CARDS DISPLAYED IN ADMISSION, FINANICAL SERVICES AND PATIENT CARE DEPARTMENTS.
SCHEDULE H, PART V, LINE 20D   ALL BILLS AND PATIENT STATEMENTS ARE BASED ON GROSS CHARGES. FAP-ELIGIBLE PATIENTS RECEIVED FIXED PERCENTAGE DISCOUNTS FROM GROSS CHARGES BASED ON INCOME LEVEL AND DO NOT PAY GROSS CHARGE.
SCHEDULE H, PART V, LINE 22   ALL INSURANCE BILLS AND PATIENT STATEMENTS ARE BASED ON GROSS CHARGES, HOWEVER, FAP-ELIGIBLE PATIENTS DO NOT PAY FULL CHARGES. THEY RECEIVE A DISCOUNT BASED ON INCOME LEVEL.
NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 THE HOSPITALS OF HAWAI'I PACIFIC HEALTH ARE CURRENTLY IN THE PROCESS OF DEVELOPING A PLAN TO ASSESS THE COMMUNITY NEEDS IN ACCORDANCE WITH IRC SECTION 501(R).
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 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. THE 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 HAWAI'I STATE MEDICAL ASSISTANCE APPLICATION. THIS IS THE APPLICATION FOR THE HAWAI'I 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 INELIGIBILE 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 HAWAI'I STATE MEDICAID/QUEST PROGRAM, THE HPH FINANCIAL ASSISTANCE PROGRAM, PAYMENT PLANS AND ANY GRANT OR 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 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.
COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 THE AFFILIATE HOSPITALS OF HAWAI'I PACIFIC HEALTH TREAT ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY, THUS SERVING AS SAFETY NET PROVIDERS OF HEALTH CARE FOR THE COMMUNITY. DEMOGRAPHICS OF THE STATE OF HAWAI'I INCLUDE 1,392,313 RESIDENTS AND 7.9 MILLION VISITORS (2012 DATA). UNINSURED PATIENTS EQUAL 1.41 PERCENT OF HAWAI'I PACIFIC HEALTH'S TOTAL AND 23.15 PERCENT ARE MEDICAID RECIPIENTS. THERE ARE 12 OTHER HOSPITALS IN THE STATE THAT PROVIDE ACUTE SERVICES. AREAS AND POPULATIONS DESIGNATED AS MEDICALLY-UNDERSERVED BY THE FEDERAL GOVERNMENT ARE PRESENT. KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN HAS BEEN TREATING WOMEN, CHILDREN AND INFANTS FOR MORE THAN A CENTURY. IT IS HAWAI'I'S ONLY MATERNITY, NEWBORN AND PEDIATRIC SPECIALTY HOSPITAL WITH 207 BEDS. IT IS ALSO A TERTIARY CARE, TEACHING AND RESEARCH FACILITY. FOR WOMEN, KAPI'OLANI PROVIDES COMPLETE OBSTETRICAL AND GYNECOLOGICAL CARE. FOR INFANTS AND CHILDREN, IT HAS MORE THAN 100 PEDIATRIC SPECIALISTS AND SUBSPECIALISTS. IN FISCAL YEAR 2013, KAPI'OLANI HAD 55,244 IMAGING PROCEDURES, 33,942 WOMEN'S CENTER PROCEDURES, 42,431 ER VISITS, AND 17,495 INPATIENT ADMISSIONS. ITS GEOGRAPHIC SERVICE AREA IS THE ENTIRE PACIFIC BASIN, SINCE MANY SPECIALTIES OFFERED ARE NOT AVAILABLE ELSEWHERE. THE PEDIATRIC INTENSIVE CARE UNIT, FOR EXAMPLE, IS THE ONLY PICU BETWEEN LOS ANGELES AND HONG KONG. KAPI'OLANI'S BONE MARROW TRANSPLANT PROGRAM, ECMO PROGRAM, AND CARDIAC AND CRANIOFACIAL PROGRAMS PROVIDE ADDITIONAL MEDICAL SERVICES TO THE COMMUNITY. PALI MOMI MEDICAL CENTER IS A COMMUNITY-BASED, ACUTE-CARE HOSPITAL THAT OFFERS A FULL RANGE OF SERVICES IN CARDIOLOGY, ORTHOPEDICS, EMERGENCY MEDICINE, GENERAL SURGERY AND MEDICINE, OPHTHALMOLOGY, WOMEN'S SERVICES, ONCOLOGY AND MORE. IT HAS DELIVERED MANY MEDICAL FIRSTS FOR THE COMMUNITY, INCLUDING WEST O'AHU'S ONLY INTERVENTIONAL CARDIAC CATHETERIZATION UNIT, A WOMEN'S CENTER AND RETINA CENTER. IN FISCAL YEAR 2013, PALI MOMI HAD 112,846 IMAGING PROCEDURES, 61,400 ER VISITS, 40,493 WOMEN'S CENTER PROCEDURES, AND 6,581 INPATIENT ADMISSIONS. PALI MOMI'S GEOGRAPHIC SERVICE AREA IS PRIMARILY CENTRAL, WEST O'AHU AND THE NORTH SHORE. HOWEVER, FOR A FEW SELECT SERVICES, PALI MOMI IS ONE OF JUST A HANDFUL OF PROVIDERS ACROSS THE REGION. THE RETINA CENTER, FOR EXAMPLE, OFFERS HIGHLY SPECIALIZED CARE SOUGHT BY RESIDENTS ACROSS THE STATE AND FROM AS FAR AWAY AS JAPAN. STRAUB CLINIC & HOSPITAL HAS SERVED THE PEOPLE OF HAWAII FOR 90+ YEARS. THE FULLY INTEGRATED HEALTH CARE SYSTEM HAS A 159-BED HOSPITAL IN HONOLULU, NETWORK OF NEIGHBORHOOD CLINICS, AND A VISITING SPECIALISTS PROGRAM THAT SERVICES THE NEIGHBOR ISLANDS IN AN EFFORT TO IMPROVE ACCESS TO MEDICAL SERVICES. STRAUB HOUSES AN ARRAY OF PHYSICIAN SPECIALISTS UNDER ONE ROOF, ENABLING PATIENTS TO RECEIVE DIAGNOSIS AND TREATMENT IN MORE THAN 32 MEDICAL SPECIALTIES. IN FISCAL YEAR 2013, STRAUB HAD 112,875 IMAGING PROCEDURES, 28,077 ER VISITS, AND 7,697 INPATIENT ADMISSIONS. STRAUB IS PROUD TO PROVIDE SERVICES THAT ARE NOT OFFERED BY ANY OTHER PROVIDERS IN THE REGION. THE BURN UNIT, FOR EXAMPLE, IS THE ONLY DEDICATED BURN TREATMENT FACILITY IN HAWAII AND TREATS MILITARY AND CIVILIAN PATIENTS FROM THROUGHOUT THE PACIFIC REGION. WILCOX MEMORIAL HOSPITAL HAS SERVED KAUA'I FOR 75+ YEARS. THE ACUTE-CARE FACILITY OFFERS 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 2013, WILCOX HAD 53,191 IMAGING PROCEDURES, 24,601 ER VISITS, AND 3,378 INPATIENT ADMISSIONS. WILCOX'S GEOGRAPHIC SERVICE AREA IS THE ISLAND OF KAUA'I. DEMOGRAPHICS OF THE KAUA'I COMMUNITY IN FISCAL YEAR 2013 INCLUDE A POPULATION OF APPROXIMATELY 68,000 (AND MORE THAN 900,000 VISITORS ANNUALLY). REGARDING WILCOX PATIENTS, 1.7 PERCENT ARE UNINSURED AND 16.7 PERCENT ARE MEDICAID RECIPIENTS. THERE ARE TWO OTHER HOSPITALS IN THE COMMUNITY, AND FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS AND POPULATIONS ARE PRESENT.
PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 WHEN DISCHARGING PATIENTS, PALI MOMI MEDICAL CENTER FOLLOWS THE GUIDELINES OF THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. THE PROCEDURES INVOLVED WITH PROVIDING A SAFE DISCHARGE PLAN INCLUDE DESIGNATING A PERMANENT OR TRANSITIONAL DESTINATION FOR ALL PATIENTS LEAVING THE HOSPITAL. HOWEVER, IN SOME CASES, PATIENTS HAVE NO INSURANCE OR ARE PENDING APPROVAL UNDER THE MEDICAID PROGRAM FOR PAST SERVICES PROVIDED. THESE PATIENTS DO NOT REQUIRE FURTHER HOSPITAL-GRADE CARE BUT RATHER, FOLLOW-UP CARE AT A TRANSITIONAL CARE FACILITY, SUCH AS A LICENSED FOSTER CARE HOME OR REHABILITATION CENTER. IN THESE SPECIAL CIRCUMSTANCES, PALI MOMI WILL PAY AN INDEPENDENT CASE MANAGER FROM THE COMMUNITY, USUALLY A NURSE REPRESENTATIVE OF AN INDEPENDENT CASE MANAGEMENT COMPANY, TO ASSUME CARE OF THE PATIENT. THE CASE MANAGER IDENTIFIES AN APPROPRIATE FACILITY, HELPS THE PATIENT TRANSITION THERE, AND MONITORS THE PATIENT. PALI MOMI ASSUMES RESPONSIBILITY FOR THE FINANCIAL COST UNTIL INSURANCE APPROVAL UNDER MEDICAID IS ESTABLISHED. PALI MOMI DOES THIS TO ENSURE THAT A SAFE DISCHARGE PLAN IS BEING FOLLOWED, AND TO MAKE AVAILABLE A HOSPITAL BED FOR AN ACUTE OR CRITICALLY-ILL PATIENT WHO REQUIRES HOSPITAL-GRADE CARE. STRAUB CLINIC & HOSPITAL IS COMMITTED TO ATTRACTING AND RETAINING TOP-QUALITY PHYSICIANS IN HAWAI'I, WHERE LOSING PHYSICIANS TO THE U.S. MAINLAND IS A CONSTANT THREAT. ACCORDING TO HAWAII MEDICAL JOURNAL AND HAWAI'I PHYSICIAN WORKFORCE ASSESSMENT PROJECT, BY 2020, HAWAI'I WILL HAVE 1,500 FEWER PHYSICIANS THAN NEEDED TO MEET THE COMMUNITY'S HEALTH CARE NEEDS. SHORTAGES WILL BE PARTICULARLY SEVERE IN PRIMARY CARE, CARDIOLOGY, GASTROENTEROLOGY, ORTHOPEDICS, GENERAL SURGERY, AND OTHER SPECIALTIES. STRAUB FOCUSED ON BOTH RECRUITING AND RETAINING PHYSICIANS IN FISCAL YEAR 2013, WHO WERE TRAINED IN OR FROM THE STATE OF HAWAI'I. THERE WAS A STRONG EMPHASIS ON RECRUITING PHYSICIANS WITH BACKGROUNDS IN PRIMARY CARE AND PREVENTION. STRAUB ALSO ESTABLISHED A SPORTS MEDICINE FELLOWSHIP PROGRAM IN FISCAL YEAR 2013, IN CONJUNCTION WITH THE UNIVERSITY OF HAWAI'I. ADDITIONALLY, STRAUB SUPPORTED OFFICE AND TRAVEL EXPENSES, TRAVEL EXPENSES OF PHYSICIAN CANDIDATES, GENERAL RECRUITMENT ACTIVITIES, AND MOVING EXPENSES OF PHYSICIANS AND THEIR FAMILY MEMBERS. STRAUB COVERS THESE COSTS TO HELP ENSURE THAT THE COMMUNITY'S FUTURE HEALTH CARE NEEDS WILL BE MET. WHEN DISCHARGING PATIENTS, WILCOX MEMORIAL HOSPITAL FOLLOWS THE GUIDELINES OF THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. THE HOSPITAL STRIVES TO ENSURE THAT A SAFE DISCHARGE PLAN IS PROVIDED TO ALL PATIENTS. THIS MAY INVOLVE PROVIDING SOME PATIENTS 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 OR HOUSING, MEDICATIONS AND MEDICAL EQUIPMENT, SPECIFIC FOODS REQUIRED AS PART OF A RESTRICTED DIET, OR A MEDICALLY NECESSARY NURSE ESCORT . IN THESE SPECIAL CIRCUMSTANCES, WILCOX WILL TEMPORARILY COVER THESE COSTS. BY HELPING ITS MOST VULNERABLE POPULATION OVERCOME FINANCIAL BARRIERS, WILCOX IS HELPING TO ENSURE A 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.
AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 THE HAWAI'I PACIFIC HEALTH SYSTEM INCLUDES FOUR HOSPITALS, 49 OUTPATIENT CLINICS AND SERVICE SITES, AND 1,372 AFFILIATED PHYSICIANS. THE HOSPITALS PROVIDE ACUTE AND SPECIALTY CARE WITH 566 BEDS AND 76 BASSINETS, AND HANDLED 35,151 ADMISSIONS IN FISCAL YEAR 2013. HAWAI'I PACIFIC HEALTH, THE STATE'S LARGEST HEALTH CARE PROVIDER, IS COMMITTED TO PROVIDING HIGH-QUALITY, ACCESSIBLE CARE AND SERVICES TO THE PEOPLE OF HAWAI'I AND THE PACIFIC REGION. KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN IS THE PRIMARY PEDIATRIC AND OBSTETRIC TEACHING HOSPITAL FOR THE UNIVERSITY OF HAWAI'I JOHN A. BURNS SCHOOL OF MEDICINE. IN FISCAL YEAR 2013, KAPI'OLANI INVESTED $3,050,000 IN TEACHING PEDIATRICIANS AND OBSTETRICIANS AND FOR RESEARCH, INCLUDING CLINICAL TRIALS. KAPI'OLANI STRIVES TO INFLUENCE PUBLIC POLICY TO BENEFIT HAWAI'I'S WOMEN AND CHILDREN. IT ACTIVELY SUPPORTS THE SUSAN G. KOMEN BREAST CANCER FOUNDATION, MARCH OF DIMES, HAWAI'I CHILDREN'S CANCER FOUNDATION AND MORE. THE KAPI'OLANI CHILDREN'S MIRACLE NETWORK SUPPORTS THE COST OF PEDIATRIC HEALTH CARE, MEDICAL EQUIPMENT, NEIGHBOR ISLAND TRAVEL, RESEARCH AND PUBLIC AWARENESS. THE HOSPITAL ALSO OPERATES THE KAPI'OLANI SEX ABUSE TREATMENT CENTER, WHICH AIMS TO REDUCE SEXUAL VIOLENCE AND ENABLE THE STATE'S FORENSIC TEAMS TO INVESTIGATE AND PROSECUTE SEX OFFENSES, AND THE KAPI'OLANI CHILD PROTECTION CENTER, WHICH PROVIDES EXPERTISE IN RECOGNIZING AND TREATING CHILD ABUSE AND NEGLECT. IN FISCAL YEAR 2013, PALI MOMI MEDICAL CENTER RECEIVED THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION GET WITH THE GUIDELINES GOLD AWARD FOR STROKE AND TARGET STROKE AWARD. PALI MOMI FOCUSES ON MEETING THE NEEDS OF CENTRAL AND WEST O'AHU AND THE NORTH SHORE. IN FISCAL YEAR 2013, IT HOSTED FREE COMMUNITY HEALTH EVENTS, FROM FAMILY AND SENIOR HEALTH FAIRS TO SUPPORT GROUPS TO GLUCOSE MONITORING AND BLOOD PRESSURE SCREENINGS. STRAUB CLINIC & HOSPITAL HAS MANY SPECIALTY CARE UNITS. THE BURN UNIT IS THE STATE'S ONLY MULTIDISCIPLINARY BURN TREATMENT CENTER, PROVIDING VICTIMS WITH IMMEDIATE AND COMPREHENSIVE CARE, CLOSE TO HOME. STRAUB HAS AN OPEN MEDICAL STAFF IN 19 SPECIALTIES AND AN OPEN/MANAGED MEDICAL STAFF IN 14 SPECIALTIES. IT PROVIDES CHARITY CARE, HEALTH EDUCATION AND PREVENTATIVE PROGRAMS TO THE COMMUNITY. IN FISCAL YEAR 2013, STRAUB PROVIDED FREE HEALTH EDUCATION PROGRAMS ON PREVENTING AND MANAGING HEART ATTACKS, CANCER, ARTHRITIS, ASTHMA, ALLERGIES, OSTEOPOROSIS, OBESITY AND DRUG ABUSE. EVENTS INCLUDED "KIDS FEST", "LIVING HEALTHY IN PARADISE", "WOMEN'S WAY TO HEALTH", "CANCER CARE", "BREATHE WITH EASE", "VALENTINE IN PARADISE" AND "GETTING A GRIP ON ARTHRITIS". "THE WOMEN'S 10K RACE" IS HAWAII'S PREMIER FEMALE-ONLY FITNESS EVENT, NOW IN ITS 36TH YEAR. WILCOX MEMORIAL HOSPITAL IS DEDICATED TO PROVIDING KAUA'I WITH AFFORDABLE AND ACCESSIBLE HEALTH CARE. IN 2013, THE AMERICAN HEART ASSOCIATION ONCE AGAIN RECOGNIZED IT FOR EXCELLENCE IN CARDIAC CARE. IT MAINTAINS AN OPEN MEDICAL STAFF IN MORE THAN 20 SPECIALTIES. ALSO, WILCOX IS AN ACTIVE COMMUNITY PARTNER. IN FISCAL 2013, ITS HEALTH EDUCATION, PREVENTION PROGRAMS AND SUPPORT GROUPS FOCUSED ON DIABETES, SPORTS MEDICINE, WATER SAFETY, INJURY PREVENTION, AND HEALTH FAIRS. TOGETHER WITH KAUA'I MEDICAL CLINIC, WILCOX 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", SEVERAL PHYSICIAN LED COMMUNITY WALKS, "THE OLD KOLOA SUGAR MILL RUN", "RELAY FOR LIFE", "HOEDOWN FOR HOPE", "KAUAI KEIKI BIKE AND SAFETY DAY", KAUAI LIFE GUARD ASSOCIATION'S "FIRST WAVE," KAUAI DIABETES TODAY'S "SUMMER BASH" AND MALAMA PONO HEALTH SERVICES' "PARADISE RIDE". WILCOX ALSO PROVIDED PHYSICIAN SUPPORT FOR LOCAL HIGH SCHOOL FOOTBALL TEAMS. EACH AFFILIATE HOSPITAL OF HAWAI'I PACIFIC HEALTH IS A LEADER IN COMMUNITY HEALTH CARE EDUCATION AND ADVOCACY, AND MAINTAINS AN OPEN MEDICAL STAFF; THIS ARRANGEMENT GRANTS ADMITTING PRIVILEGES TO NONAFFILITATED PHYSICIAN SPECIALISTS AND BROADENS EACH FACILITY'S ABILITY TO OFFER HIGH-QUALITY, SPECIALIZED CARE TO THEIR RESPECTIVE COMMUNITY. EACH HOSPITAL 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 EACH FACILITY FULFILLS ITS MISSION-DRIVEN GOALS. AS AFFILIATES OF THE NOT-FOR-PROFIT HAWAI'I PACIFIC HEALTH NETWORK, EACH HOSPITAL REINVESTS ALL SURPLUS RESOURCES BACK INTO PATIENT CARE AND TO SUBSIDIZE THOSE WHO CANNOT PAY.
STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 N/A
FACILITY REPORTING GROUP 1 SCHEDULE H, PART VI, LINE 8 ALL REQUIRED NARRATIVES FOR PART V, SECTION B ARE THE SAME FOR EACH HOSPITAL IN FACILITY REPORTING GROUP 1. PLEASE SEE ABOVE NARRATIVES FOR RESPONSES TO LINES 14G, 20D AND 22.
Schedule H (Form 990) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
 
Employer identification number
38-3835105
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS FORM 990, SCHEDULE I, PART I, LINE 2 KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN AWARDS QUALIFIED STUDENTS SCHOLAYSHIPS FROM THE RICHARD DAVI SCHOLARSHIP FUND. AN AWARD LETTER IS MAILED TO THE RECIPIENT TO INFORM THEM OF THIS HONOR, AND TO INSTRUCT THE RECIPIENT THAT A CHECK IN THE AMOUNT OF THE SCHOLARSHIP AWARD WILL BE MADE OUT TO THE SCHOOL. ADDITIONALLY, INSTRUCTION IS GIVEN THAT THE STUDENT SHOULD SUBMIT RECEIPTS FOR TUITION, BOOKS, LABS, ETC. UP TO THE TOTAL AMOUNT OF THE SCHOLARSHIP. A CONTACT TELEPHONE NUMBER FOR THE SCHOLARSHIP COMMITTEE IS PROVIDED FOR QUESTIONS. 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.
Schedule I (Form 990) 2012


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
 
Employer identification number

38-3835105
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
 
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)JOHN CULLINEY MDBoard of Director, Vice Chair (i)
(ii)		 0
428,107 		0
27,000 		0
0 		0
32,500 		0
17,451 		0
505,058 		0
0
(2)THOMAS J NORDYKE MDBoard of Director, Vice Chair (i)
(ii)		 231,620
0 		13,604
0 		3,100
0 		19,861
0 		16,415
0 		284,600
0 		0
0
(3)RAYMOND P VARA JRBoard of Director, President (i)
(ii)		 0
645,920 		0
325,816 		0
211,535 		0
296,596 		0
21,659 		0
1,501,526 		0
220,993
(4)KENNETH B ROBBINS MDBoard of Director, EVP & CMO (i)
(ii)		 0
413,181 		0
165,485 		0
158,988 		0
170,943 		0
19,939 		0
928,536 		0
154,812
(5)ARTHUR GLADSTONEBd of Dir, CEO/VP & System CNE (i)
(ii)		 0
291,734 		0
65,399 		0
42,809 		0
55,333 		0
20,301 		0
475,576 		0
45,145
(6)MARTHA SMITHBoard of Director, CEO (i)
(ii)		 0
330,345 		0
79,494 		0
72,005 		0
82,865 		0
16,252 		0
580,961 		0
69,671
(7)JENNIE CHAHANOVICHBoard of Director, CEO (i)
(ii)		 0
259,355 		0
65,256 		0
47,238 		0
54,511 		0
13,512 		0
439,872 		0
48,376
(8)KATHLEEN CLARKBoard of Director, Pres & CEO (i)
(ii)		 0
208,738 		0
53,844 		0
29,130 		0
38,692 		0
6,481 		0
336,885 		0
24,637
(9)ANDREW DANG MDBoard of Director (i)
(ii)		 369,782
0 		3,000
0 		3,100
0 		27,000
0 		20,059
0 		422,941
0 		0
0
(10)CHRISTOPHER JORDANBoard of Director (i)
(ii)		 0
300,966 		0
43,750 		0
0 		0
32,500 		0
11,778 		0
388,994 		0
0
(11)BEAU NAKAMOTO MDBoard of Director (i)
(ii)		 234,635
0 		15,043
0 		8,480
0 		27,000
0 		435
0 		285,593
0 		0
0
(12)KENN SARUWATARI MDBoard of Director (i)
(ii)		 214,697
0 		23,850
0 		3,100
0 		32,087
0 		21,179
0 		294,913
0 		0
0
(13)CHARLES A STEDBoard of Director (PART YEAR) (i)
(ii)		 0
766,059 		0
451,050 		0
516,120 		0
28,913 		0
16,622 		0
1,778,764 		0
552,685
(14)DAVID OKABEEVP, CFO & Treasurer (i)
(ii)		 0
431,997 		0
183,650 		0
120,141 		0
143,391 		0
12,912 		0
892,091 		0
121,653
(15)CHARLES R CHINGEVP, Gen Counsel & Secretary (i)
(ii)		 0
326,252 		0
144,862 		0
90,537 		0
115,097 		0
2,255 		0
679,003 		0
94,292
(16)EARL INOUYEVP & System Controller (i)
(ii)		 0
231,900 		0
36,374 		0
38,134 		0
54,068 		0
21,733 		0
382,209 		0
28,392
(17)VIRGINIA PRESSLER-FISHER MDEVP (i)
(ii)		 0
340,354 		0
132,739 		0
121,328 		0
128,412 		0
21,302 		0
744,135 		0
121,235
(18)GAIL LERCHEVP (i)
(ii)		 0
342,097 		0
148,764 		0
113,645 		0
127,620 		0
15,752 		0
747,878 		0
98,482
(19)STEVEN ROBERTSONEVP & CIO (i)
(ii)		 0
349,025 		0
149,873 		0
102,534 		0
126,027 		0
22,302 		0
749,761 		0
108,848
(20)MELINDA ASHTON MDVP (i)
(ii)		 0
307,135 		0
55,871 		0
38,309 		0
49,992 		0
20,592 		0
471,899 		0
36,079
(21)ANN PETERSVP (i)
(ii)		 0
168,985 		0
25,875 		0
20,700 		0
24,722 		0
22,983 		0
263,265 		0
13,931
(22)KEKA SANBORNVP (i)
(ii)		 0
209,817 		0
41,503 		0
25,202 		0
0 		0
2,032 		0
278,554 		0
12,469
(23)MAUREEN FLANNERYVP (i)
(ii)		 0
190,231 		0
0 		0
19,868 		0
43,454 		0
21,021 		0
274,574 		0
0
(24)MAVIS NIKAIDOVP & CNE (i)
(ii)		 0
191,090 		0
11,323 		0
0 		0
18,190 		0
343 		0
220,946 		0
0
(25)BRIGITTE MCKALEVP & CNE (i)
(ii)		 0
179,853 		0
14,444 		0
0 		0
14,227 		0
2,639 		0
211,163 		0
0
(26)DAWN CHINGVP (i)
(ii)		 0
192,063 		0
25,756 		0
17,434 		0
27,978 		0
21,815 		0
285,046 		0
0
(27)GIDGET RUSCETTA RNVP (i)
(ii)		 0
188,807 		0
26,460 		0
14,761 		0
41,946 		0
13,071 		0
285,045 		0
5,246
(28)PATRICIA BOECKMANN RNVP & CNE (i)
(ii)		 0
258,025 		0
37,784 		0
41,421 		0
39,635 		0
21,098 		0
397,963 		0
27,174
(29)PAULA DIASVP (i)
(ii)		 0
194,166 		0
29,346 		0
22,370 		0
28,225 		0
14,118 		0
288,225 		0
17,622
(30)RANDY YATES MDCMO (i)
(ii)		 0
267,218 		0
39,502 		0
3,100 		0
24,566 		0
529 		0
334,915 		0
17,973
(31)SUSAN MASUMOTO-NONAKAVP (i)
(ii)		 0
203,875 		0
30,942 		0
22,467 		0
29,691 		0
15,232 		0
302,207 		0
14,027
(32)WARREN CHAIKOVP (i)
(ii)		 0
211,391 		0
34,490 		0
36,299 		0
30,968 		0
22,160 		0
335,308 		0
25,928
(33)DAVID FOXPrivacy & Information Security (i)
(ii)		 0
118,231 		0
0 		0
0 		0
22,066 		0
18,797 		0
159,094 		0
0
(34)KATIE SHIGEMITSUCompliance Officer (i)
(ii)		 0
173,263 		0
0 		0
0 		0
24,676 		0
13,295 		0
211,234 		0
0
(35)THERESA RAMEYCompliance Officer (i)
(ii)		 0
114,067 		0
6,829 		0
0 		0
22,760 		0
11,621 		0
155,277 		0
0
(36)HINGSON M CHUN MDPhysician (i)
(ii)		 867,547
0 		63,000
0 		3,100
0 		27,000
0 		16,422
0 		977,069
0 		0
0
(37)CASS K NAKASONE MDPhysician (i)
(ii)		 780,187
0 		7,577
0 		3,100
0 		27,000
0 		17,451
0 		835,315
0 		0
0
(38)MARK S GERBER MDPhysician (i)
(ii)		 736,337
0 		4,000
0 		3,100
0 		27,000
0 		7,107
0 		777,544
0 		0
0
(39)WESLEY J KAI MDPhysician (i)
(ii)		 679,498
0 		2,000
0 		7,831
0 		32,500
0 		13,592
0 		735,421
0 		0
0
(40)STEPHEN KB CHINN MDPhysician (i)
(ii)		 623,850
0 		32,663
0 		8,100
0 		32,500
0 		15,703
0 		712,816
0 		0
0
(41)HUGH HAZENFIELD MDFORMER OFFICER (i)
(ii)		 0
257,330 		0
38,430 		0
6,109 		0
38,917 		0
13,000 		0
353,786 		0
24,598
(42)KEOKI CLEMENTEFORMER OFFICER (i)
(ii)		 0
133,601 		0
10,804 		0
0 		0
2,565 		0
16,899 		0
163,869 		0
0
(43)LYNNE JOHNSON-JOSEPHFORMER OFFICER (i)
(ii)		 0
175,677 		0
32,435 		0
12,512 		0
27,675 		0
14,165 		0
262,464 		0
12,469
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, QUESTION 3 THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, HAWAII PACIFIC HEALTH, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE HAWAII PACIFIC HEALTH'S SCHEDULE O FORM 990 PART VI, LINE 15A FOR THE PROCESS USED 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. AMOUNTS PAID OUT DURING THE YEAR BY RELATED ORGANIZATION: MELINDA ASHTON $14,409 CHARLES CHING $41,295 DAVID OKABE $50,005 CHARLES A. STED $364,357 RAYMOND P. VARA, JR. $89,128 EARL INOUYE $10,333 VIRGINIA PRESSLER-FISHER $70,464 GAIL LERCH $43,101 STEVEN ROBERTSON $50,529 KENNETH B. ROBBINS $86,050 WARREN CHAIKO $6,665 SUSAN MASUMOTO-NONAKA $96 ART GLADSTONE $17,455 MARTHA SMITH 37,079 JENNIE CHAHANOVICH $16,730 PATRICIA BOECKMAN $10,577 HUGH HAZENFIELD $6,109 KATHLEEN CLARK $4,772 PAULA DIAS $423 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: ART GLADSTONE $55,399 CHARLES STED $451,050 CHARLES CHING $131,362 DAVID OKABE $171,650 DAWN CHING $25,756 EARL INOUYE $36,374 GAIL LERCH $135,764 GIDGET RUSCETTA $26,460 HUGH HAZENFIELD $38,430 JENNIE CHAHANOVICH $55,256 KATHLEEN CLARK $43,844 KEALA PETERS $25,875 KEKA SANBORN $31,503 KENNETH ROBBINS $165,485 LYNNE JOHNSON-JOSEPH $32,435 MARTHA SMITH $69,494 MELINDA ASHTON $45,871 PATRICIA BOECKMANN $37,784 PAULA DIAS $29,346 RANDY YATES $37,502 RAYMOND VARA $305,816 STEVEN ROBERTSON $139,873 SUSAN MASUMOTO-NONAKA $30,942 VIRGINIA PRESSLER-FISHER $132,739 WARREN CHAIKO $34,490
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
 
Employer identification number

38-3835105
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) UNITED LAUNDRY SEE PART V 1,089,818 PAYMENT FOR LAUNDRY SERVICES   No
(2) PACIFIC MEDICAL COLLECTIONS SEE PART V 161,308 PAYMENT FOR MEDICAL COLLECTION   No
(3) UNITED LAUNDRY SEE PART V 1,065,027 PAYMENT FOR LAUNDRY SERVICES   No
(4) PACIFIC MEDICAL COLLECTIONS SEE PART V 110,407 PAYMENT FOR MEDICAL COLLECTION   No
(5) UNITED LAUNDRY SEE PART V 1,165,577 PAYMENT FOR LAUNDRY SERVICES   No
(6) PACIFIC MEDICAL COLLECTIONS SEE PART V 150,147 PAYMENT FOR MEDICAL COLLECTION   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
BUSINESS TRANSACTION WITH INTERESTED PERSONS FORM 990, SCHEDULE L, PART VI, COLUMN B 1) TREASURER IS EVP/CFO/TREAS OF SCH - OKABE 2) DIRECTOR IS EVP/CIO OF SCH - ROBERTSON 3) TREASURER IS EVP/CFO/TREAS OF PMMC - OKABE 4) DIRECTOR IS EVP/CIO OF PMMC - ROBERTSON 5) TREASURER IS EVP/CFO/TREAS OF KMCWC - OKABE 6) DIRECTOR IS EVP/CIO OF KMCWC - ROBERTSON
Schedule L (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large imageComplete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
 
Employer identification number

38-3835105
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art .... X   2,700 COST/SELLING PRICE
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications .. X 400 COST/SELLING PRICE
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies . X   3,589 COST/SELLING PRICE
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( MISCELLANEOUS DONATIONS ) X 0 206,766 COST/SELLING PRICE
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
 
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
 
No
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ..........................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2012)
Schedule M (Form 990) (2012)
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Identifier Return Reference Explanation
SCHEDULE M, PART I, COLUMN B   THE NUMBER OF ITEMS DONATED IS NOT AVAILABLE FOR ALL CONTRIBUTIONS.
Schedule M (Form 990) (2012)
Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
 
Employer identification number

38-3835105
Identifier Return Reference Explanation
STATEMENT OF ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES FORM 990, PART I, LINE 1 THE AFFILIATE, NOT-FOR-PROFIT HOSPITALS OF HAWAI'I PACIFIC HEALTH - KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN, PALI MOMI MEDICAL CENTER, STRAUB CLINIC & HOSPITAL, AND WILCOX MEMORIAL HOSPITAL - ANCHOR A HEALTH CARE SYSTEM THAT IS COMMITTED TO PROVIDING HIGH-QUALITY, ACCESSIBLE MEDICAL PROGRAMS AND SERVICES FOR THE PEOPLE OF HAWAI'I AND PACIFIC REGION.
STATEMENT OF ORGANIZATION'S MISISON FORM 990, PART III, LINE 1 KAPI'OLANI MEDICAL CENTER'S MISSION IS TO IMPROVE AND ADVOCATE FOR THE HEALTH AND WELL-BEING OF WOMEN AND CHILDREN OF HAWAI'I AND THE PACIFIC REGION. PALI MOMI MEDICAL CENTER IS BASED IN WEST O'AHU AND DEDICATED TO THE HEALTH AND WELL-BEING OF ALL HAWAI'I RESIDENTS. STRAUB CLINC & HOSPITAL IS A HEALTH CARE SYSTEM WHOSE MISSION IS TO PROVIDE INTEGRATED HEALTH AND MEDICAL SERVICES THAT ARE COMPREHENSIVE, CARING, CONTINUOUSLY IMPROVING AND OF THE HIGHEST QUALITY. WILCOX MEMORIAL HEALTH SERVES THE KAUA'I COMMUNITY WITH ACCESSIBLE, QUALITY HEALTH CARE THAT SURPASSES EXPECTATIONS.
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINES 4A-4D PROGRAM SERVICE #1 WOMEN'S SERVICES - OBSTETRICS/GYNECOLOGY IN FISCAL YEAR 2013, HAWAI'I PACIFIC HEALTH SPENT $40,474,022 IN DIRECT EXPENSES FOR WOMEN'S OB/GYN SERVICES AS PART OF ITS MISSION TO PROVIDE MEDICAL CARE FOR ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. KAPI'OLANI IS THE ONLY HOSPITAL IN HAWAI'I SPECIALIZING IN MATERNITY CARE. IT IS THE REGIONAL PERINATAL CENTER FOR THE STATE. IT HAS SPECIALTY AND SUB-SPECIALTY OB/GYN PHYSICIANS ON STAFF 24/7, SUCH AS MATERNAL FETAL MEDICINE SPECIALISTS TO MANAGE HIGH-RISK PREGNANCIES AND DELIVERIES. IT PROVIDES GYNECOLOGIC ONCOLOGY SERVICES AND FEATURES A HIGH-RISK BREAST PROGRAM. IT IS A MAJOR TEACHING HOSPITAL FOR THE UNIVERSITY OF HAWAI'I JOHN A. BURNS SCHOOL OF MEDICINE'S OB/GYN RESIDENCY PROGRAM. IN FISCAL YEAR 2013, KAPI'OLANI DELIVERED 6,110 BABIES, OR 55% OF O'AHU BIRTHS. THE WOMEN'S CENTER PERFORMED 33,942 PROCEDURES. STRAUB'S MAIN HOSPITAL AND ALL FAMILY HEALTH CENTERS HAVE UPGRADED TO DIGITAL MAMMOGRAPHY. THE WOMEN'S CLINIC PROVIDES HIGH-QUALITY CARE IN A CALMING, HEALING, ENVIRONMENT. BOARD-CERTIFIED SPECIALISTS PROVIDE OB/GYN CARE, FAMILY PLANNING, LASER SURGERY, LAPAROSCOPY AND COLPOSCOPY, MENOPAUSE, HORMONE REPLACEMENT THERAPY, AND INFERTILITY TREATMENT. MANY OF STRAUB'S PRIMARY CARE PHYSICIANS ALSO SPECIALIZE IN WOMEN'S HEALTH WITH PERSONAL, COMPREHENSIVE AND CONTINUING CARE. PALI MOMI HAS GYNECOLOGY SERVICES, PRIMARILY FOR THE CENTRAL, WEST O'AHU AND NORTH SHORE COMMUNITIES, INCLUDING HYSTERECTOMIES, OB/GYN ULTRASOUNDS, UROLOGY, AND INFUSION CHEMOTHERAPY. IN FISCAL YEAR 2013, PALI MOMI'S WOMEN'S CENTER PERFORMED 40,493 PROCEDURES, NEARLY DOUBLE THE NUMBER PERFORMED IN FISCAL YEAR 2012. THE SIGNIFICANT GROWTH IN PROCEDURES REFLECTS THE WOMEN'S CENTER'S FIRST FULL YEAR AS AN EXPANDED FACILITY AT THE NEW PALI MOMI MEDICAL PAVILION. IN ORDER TO ACCOMMODATE THE INCREASE IN PATIENTS IN FISCAL YEAR 2013, PALI MOMI PURCHASED A SECOND TOMOSYNETHESIS MACHINE. THE ADDITIONAL MACHINE LOWERED WAIT TIME FOR PATIENTS IN NEED OF THIS TYPE OF BREAST EVALUATION. THE WILCOX WOMEN'S CENTER PROVIDES DIAGNOSIS, TREATMENT, MAMMOGRAPHY, BONE DENSITY SCREENING AND OTHER PREVENTIVE HEALTH SERVICES. THROUGH KAUA'I MEDICAL CLINIC AND COMMUNITY PHYSICIANS WITH ADMITTING PRIVILEGES, WILCOX PROVIDES COMPREHENSIVE OB/GYN CARE: DELIVERY, SURGERY AND OTHER SERVICES. PROGRAM SERVICE #2 OUTPATIENT OPERATING ROOMS IN FISCAL YEAR 2013, HAWAI'I PACIFIC HEALTH HOSPITALS AND CLINICS SPENT $51,792,828 IN DIRECT EXPENSES FOR OUTPATIENT OPERATING ROOMS AND SURGICAL PROCEDURES, AS PART OF OUR MISSION TO PROVIDE CARE FOR ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. PEDIATRIC SURGERIES AT KAPI'OLANI INCLUDE THORACIC/HEART, CLEFT LIP/PALATE, EAR NOSE THROAT, ORTHOPEDIC, NEUROLOGIC, UROLOGIC, OPHTHALMOLOGIC, GASTRO-INTESTINAL, PLASTIC AND GENERAL PROCEDURES. WOMEN'S SURGERIES INCLUDE BREAST BIOPSIES AND LUMPECTOMIES, HYSTEROSCOPIES, INTERSTIM BLADDER IMPLANT AND SUBURETHRAL SLING TO TREAT INCONTINENCE, TUBAL LIGATION AND ENDOMETRIAL ABLATION. KAPI'OLANI IS THE ONLY HOSPITAL IN THE STATE PROVIDING DA VINCI ROBOT-AIDED PEDIATRIC SURGERY. ADDITIONALLY, THE ROBOT IS UTILIZED IN PERFORMING GYNOCOLOGICAL SURGICAL SERVICES. THE MINIMALLY INVASIVE SURGERIES PERFORMED USING THE DA VINCI PROVIDE INCREASED BENEFITS FOR PATIENTS INCLUDING LESS PAIN, LOWER RISK OF INFECTION, AND LESS BLOOD LOSS. IN FISCAL YEAR 2013, KAPI'OLANI PERFORMED 5,628 OUTPATIENT SURGERIES. STRAUB OFFERS INTEGRATED OUTPATIENT SURGERY IN A 7-ROOM SUITE, 2-ROOM PLASTIC SURGERY SUITE, 2-ROOM GENERAL SURGERY DEPARTMENT, 2-ROOM INTERVENTIONAL CARDIAC CATHETERIZATION LABORATORY, INTERVENTIONAL RADIOLOGY SUITES, AND ENDOSCOPY DEPARTMENT. PROCEDURES PERFORMED RANGE FROM MINOR EXCISIONS TO COMPLEX PERIPHERAL INTRAVASCULAR TECHNIQUES. IN FISCAL YEAR 2013, STRAUB PERFORMED 2,978 OUTPATIENT SURGERIES. PALI MOMI HAS A FULLY INTEGRATED, MINIMALLY INVASIVE SURGICAL SUITE EQUIPPED WITH TELEMEDICINE CAPABILITY, TOUCHSCREEN CONTROL PANELS AT THE NURSES' STATION, VOICE ACTIVATION SYSTEM, AND LIVE VIDEO FEED TO MEDICAL CENTERS AROUND THE WORLD. IN FISCAL YEAR 2013, PALI MOMI PERFORMED 6,804 OUTPATIENT SURGERIES. PALI MOMI ADDED THE DA VINCI FIREFLY ROBOT-AIDED SYSTEM TO THEIR SURGICAL SERVICES. THE MINIMALLY INVASIVE SURGERIES PERFORMED USING THE DA VINCI PROVIDE INCREASED BENEFITS FOR PATIENTS INCLUDING LESS PAIN, LOWER RISK OF INFECTION, AND LESS BLOOD LOSS. WILCOX HAS A STATE-OF-THE-ART SURGICAL CENTER WITH 6 SURGICAL SUITES, 20 SAME-DAY SURGERY BEDS, VOICE-ACTIVATED ROBOTICS AND OTHER COMPUTER-ASSISTED TECHNOLOGIES. IN FISCAL YEAR 2013, WILCOX PERFORMED 4,626 OUTPATIENT SURGERIES. PROGRAM SERVICE #3 OUTPATIENT EMERGENCY ROOMS IN FISCAL YEAR 2013, HAWAI'I PACIFIC HEALTH HOSPITALS SAW 156,519 E.R. PATIENTS AND SPENT $96,172,550 IN DIRECT EXPENSES FOR OUTPATIENT E.R. SERVICES, AS PART OF OUR MISSION TO PROVIDE CARE FOR ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. THE KAPI'OLANI E.R. IS THE ONLY E.R. IN THE STATE WITH PEDIATRIC SPECIALISTS AVAILABLE 24/7. IT HAS A TEAM FOR ADULTS AND ANOTHER DEDICATED TO PEDIATRICS, WHERE BOARD-CERTIFIED PEDIATRIC E.R. PHYSICIANS CAN QUICKLY DIAGNOSE AND TREAT A FULL RANGE OF MEDICAL CONDITIONS IN BABIES, CHILDREN AND TEENS, FROM RARE INFECTIONS TO SPORTS INJURIES. IN FISCAL YEAR 2013, THE KAPI'OLANI E.R. RECEIVED 42,431 PATIENTS. THE STRAUB E.R. HAS BOARD-CERTIFIED E.R. PHYSICIANS ON STAFF 24/7, 365 DAYS A YEAR, WITH WHEELCHAIR TRANSPORT AND VALET SERVICES AVAILABLE. IN FISCAL YEAR 2013, THE STRAUB E.R. RECEIVED 28,077 PATIENTS. THE PALI MOMI E.R. EXPANDED CAPACITY TO PROVIDE BETTER SERVICE TO PATIENTS IN FISCAL YEAR 2013. EIGHT NEW E. R. BAYS WERE ADDED TO THE EMERGENCY DEPARTMENT SO THAT PHYSICIANS COULD ATTEND LESS CRITICAL PATIENTS IN A TIMELY MANNER. PALI MOMI HAS THE ONLY E.R. IN THE STATE THAT UTILIZES A TEAM TRIAGE APPROACH, WHERE PATIENTS ARE PROMPTLY EVALUATED BY A PHYSICIAN. IN FISCAL YEAR 2013, THE PALI MOMI E.R. RECEIVED 61,400 PATIENTS. THE WILCOX 20-BED E.R. IS THE FIRST NEIGHBOR ISLAND FACILITY TO OBTAIN A TRAUMA III DESIGNATION. IT IMPLEMENTED A TRIAGE BEST PRACTICE, "RAPID TRIAGE AND IMMEDIATE BED PLACEMENT," TO DECREASE DOOR-TO-BED AND DOOR-TO-DOC TIMES, ALLOW SOME PATIENTS TO BYPASS THE TRIAGE AREA, AND LET NURSE ASSESSMENT AND E.R. PHYSICIAN EVALUATION OCCUR SIMULTANEOUSLY. THIS IMPROVES SERVICE, QUALITY AND SAFETY. IN FISCAL YEAR 2013, THE WILCOX E.R. RECEIVED 24,601 PATIENTS.
PROGRAM SERVICE #4   HAWAI'I PACIFIC HEALTH IS THE STATE'S LARGEST HEALTH CARE PROVIDER WITH FOUR HOSPITALS, MORE THAN 50 OUTPATIENT CLINICS AND SERVICE SITES, 1,600 AFFILIATED PHYSICIANS, 6,900+ EMPLOYEES, AND HUNDREDS OF VOLUNTEERS FROM THE COMMUNITY. HAWAI'I RESIDENTS AND VISITORS RELY ON HAWAI'I PACIFIC HEALTH FOR ITS FULL RANGE OF PRIMARY, SECONDARY AND SELECT TERTIARY CARE SERVICES. IN FISCAL YEAR 2013, THE HOSPITALS ADMITTED 35,151 PATIENTS FOR A TOTAL OF 175,175 PATIENT DAYS. KAUA'I MEDICAL CLINIC HAD 217,025 TOTAL PATIENT VISITS. KAPI`OLANI MEDICAL SPECIALISTS HAD 93,013 PATIENT ENCOUNTERS. AFFILIATES AND SUBSIDIARIES KAPI'OLANI MEDICAL SPECIALISTS IS A SPECIALTY PHYSICIANS GROUP ORGANIZED TO SUPPORT KAPI'OLANI MEDICAL CENTER. THE FOUNDATIONS OF HAWAI'I PACIFIC HEALTH CONSIST OF KAPI'OLANI HEALTH FOUNDATION, PALI MOMI HEALTH FOUNDATION, STRAUB FOUNDATION AND WILCOX HEALTH FOUNDATION. THESE CHARITABLE ENTITIES SUPPORT HEALTH RESEARCH, FACILITY ENHANCEMENTS, TECHNOLOGY INVESTMENTS, EDUCATIONAL PROGRAMS AND OTHER RESOURCES FOR THEIR RESPECTIVE HOSPITALS. HAWAI'I PACIFIC HEALTH PARTNERS, INC. IS A FOR-PROFIT SUBSIDIARY THAT SERVES AS THE JOINT VENTURE PARTNER WHEN HAWAI'I PACIFIC HEALTH WORKS WITH OTHER PROVIDERS. PROVIDERS INSURANCE CORPORATION IS A CAPTIVE INSURANCE COMPANY THAT PROVIDES PROFESSIONAL LIABILITY INSURANCE HAWAI'I PACIFIC HEALTH-AFFILIATED EMPLOYED PHYSICIANS. PATIENT CARE HAWAI'I PACIFIC HEALTH HAS STRATEGIC INITIATIVES IN WOMEN'S HEALTH, PEDIATRIC CARE, CARDIOVASCULAR SERVICES, BONE & JOINT SERVICES, AND CANCER CARE. IT RANKS AMONG THE TOP HOSPITALS NATIONWIDE IN THE ADOPTION OF ELECTRONIC MEDICAL RECORDS, WHICH ENABLE COORDINATED CARE THROUGHOUT THE STATE. THE HAWAI'I PACIFIC HEALTH NETWORK INCLUDES: THE PACIFIC REGION'S ONLY FULL-SERVICE CHILDREN'S HOSPITAL AND ONLY DEDICATED BURN UNIT, STATE-OF-THE-ART IMAGING CENTER ON KAUA'I, WEST O'AHU'S ONLY CARDIAC CATHETERIZATION LAB, MINIMALLY INVASIVE BONE & JOINT CENTER, SLEEP DISORDERS CENTER, STATE'S FIRST WOMEN'S CENTER, STATE'S ONLY BREAST AND WOMEN'S CANCER CENTERS, AND OTHER SPECIALIZED SERVICES CONSIDERED CRITICAL TO THE REMOTE HAWAIIAN ARCHIPELAGO. COMMUNITY ROLE/ACTIVITY HAWAI'I PACIFIC HEALTH HAS A RESPONSIBILITY TO IMPROVE THE HEALTH OF HAWAI'I RESIDENTS. EACH YEAR, IT SPONSORS HEALTH EDUCATION, TEACHING AND RESEARCH AND SUPPORTS LIKE-MINDED ORGANIZATIONS. IN FISCAL YEAR 2013, HAWAI'I PACIFIC HEALTH SPENT $8.4 MILLION ON COMMUNITY BENEFIT PROGRAMS, INCLUDING THE KAPI'OLANI SEX ABUSE TREATMENT CENTER, KAPI'OLANI CHILD PROTECTION CENTER, HEART DISEASE PREVENTION, BREAST AND CERVICAL CANCER SCREENING FOR UNINSURED PERSONS, WOMEN AND INFANT HEALTH AND NUTRITION, REHABILITATION SERVICES, SUPPORT GROUPS, FREE GLUCOSE MONITORING AND BLOOD PRESSURE SCREENING, HEMOPHILIA PROGRAMS, AND OTHER EDUCATION AND SCREENINGS FOR HAWAI'I RESIDENTS ON HEALTH, WELLNESS AND DISEASE-PREVENTION STRATEGIES. HAWAI'I PACIFIC HEALTH SPECIALISTS DELIVERED FREE PUBLIC HEALTH EDUCATION PROGRAMS THAT HELPED THOUSANDS OF PEOPLE LEARN WAYS TO PREVENT OR MANAGE HEART ATTACKS, CANCER, ARTHRITIS, ASTHMA, ALLERGIES, STRESS, OBESITY, OSTEOPOROSIS AND DRUG ABUSE. THEY INCLUDE "KIDS FEST", "LIVING HEALTHY IN PARADISE", "WOMEN'S WAY TO HEALTH", "CANCER CARE", "BREATHE WITH EASE", "VALENTINE IN PARADISE", AND "GETTING A GRIP ON ARTHRITIS". IN FISCAL 2013, HAWAI'I PACIFIC HEALTH SPONSORED OR SUPPORTED NUMEROUS HEALTH EVENTS, INCLUDING "THE WOMEN'S 10K RACE", "GREAT ALOHA RUN", "HEARTWALK", "RACE FOR THE CURE", "RELAY FOR LIFE", "ARTHRITIS WALK", AND MORE. HAWAI'I PACIFIC HEALTH PARTICIPATED IN SYMPOSIA AND MEETINGS FOR HEALTH CARE PROFESSIONALS, HIRED COLLEGE STUDENTS AS SUMMER INTERNS, AND SPONSORED WORKSHOPS FOR VOLUNTEERS. TO TRAIN HEALTH CARE PROVIDERS, HAWAI'I PACIFIC HEALTH HAS ALLIANCES WITH THE UNIVERSITY OF HAWAII JOHN A. BURNS SCHOOL OF MEDICINE AND HAWAI'I PACIFIC UNIVERSITY. HAWAI'I PACIFIC HEALTH INVESTS MORE THAN $3,000,000 EACH YEAR IN TEACHING AND RESEARCH AS A PEDIATRIC AND OB/GYN TRAINING FACILITY FOR THE UNIVERSITY OF HAWAII. KAPI'OLANI IS ACTIVELY INVOLVED IN CLINICAL TRIALS AND RESEARCH IN PEDIATRICS, ONCOLOGY, OPHTHALMOLOGY AND CARDIOLOGY. PUBLIC POLICY HAWAI'I PACIFIC HEALTH HAS A RESPONSIBILITY TO OFFER THOUGHTFUL AND INNOVATIVE INPUT TO LAWMAKERS REGARDING HEALTH CARE POLICY AND LEGISLATION. HAWAI'I PACIFIC HEALTH LEADERS ADVOCATE FOR LEGISLATIVE REFORM AND REGULATORY ENHANCEMENTS TO RETAIN PHYSICIANS IN THE STATE AND PROVIDE STABILITY FOR HEALTH CARE PROVIDERS. DURING THE MOST RECENT STATE SESSION, HAWAI'I PACIFIC HEALTH SUPPORTED LEGISLATION TO: DETER ASSAULTS AGAINST MEDICAL SERVICE WORKERS FOR A SAFER HOSPITAL ENVIRONMENT, ESTABLISH STANDARDS FOR ACCESS TO CONTRACEPTIVES IN EMERGENCY ROOMS FOR VICTIMS OF SEX ASSAULT, ELIMINATINE STATUATORY LIMITATIONS IN ORDER TO ENCOURAGE EMPLOYEES TO PARTICIPATE IN EMPLOYER WELLNESS PROGRAMS, AND URGED THE CONVENING OF A TASK FORCE TO DEVELOP A STATEWIDE SYSTEM OF STROKE CARE OTHER HAWAI'I PACIFIC HEALTH HOSPITALS TREAT ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY, THUS SERVING AS A SAFETY NET PROVIDER OF HEALTH CARE FOR THE COMMUNITY. AN ESTABLISHED CHARITY CARE POLICY SETS GUIDELINES BY WHICH IT IS DETERMINED IF PATIENTS QUALIFY FOR FREE OR DISCOUNTED CARE. HAWAI'I PACIFIC HEALTH CONTRIBUTES MORE THAN $1 BILLION DOLLARS TO THE STATE ECONOMY EACH YEAR, SUPPORTING ITS 5,000+ EMPLOYEES, THEIR FAMILIES, AND MANY BUSINESSES THROUGH PURCHASES MADE BY ITS HOSPITALS AND CLINICS.
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 BOARD.
DESCRIPTION OF CLASSES OF PERSONS AND THE 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.
DESCRIPTION OF CLASSES OR PERSONS, DECISIONS REQUIRING APPROVAL & TYPE OF VOTING RIGHTS FORM 990, PART VI, LINE 7B HAWAI'I PACIFIC HEALTH, AS MEMBER, HAS THE FOLLOWING RESERVED POWERS WITH RESPECT TO KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN AND PALI MOMI MEDICAL CENTER: (I) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: THE EXECUTIVE VICE PRESIDENT/CHIEF EXECUTIVE OFFICER, TREASURER, SECRETARY, EXECUTIVE VICE-PRESIDENT/CHIEF FINANCIAL OFFICER, CHIEF OPERATING 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) 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 DOLLARS ($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) DETERMINE AND 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, PARTNERSHIP, OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (X) CLOSE THE ACUTE CARE HOSPITAL OWNED AND OPERATED BY THE CORPORATION; (XI) AFTER CONSULTING WITH THE BOARD, REMOVE THE EXECUTIVE VICE PRESIDENT/CHIEF EXECUTIVE OFFICER, EXECUTIVE VICE PRESIDENT/CHIEF FINANCIAL OFFICER, TREASURER, SECRETARY, OTHER EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, ASSISTANT SECRETARIES, AND/OR ALL VICE PRESIDENTS EXCEPT THE OPERATING UNIT VICE PRESIDENTS; (XII) AFTER CONSULTING WITH THE BOARD, DEVELOP AND PROMULGATE THE CORPORATE GOALS AND THE LONG-RANGE AND STRATEGIC PLAN OF THE CORPORATION; AND (XIII) AFTER CONSULTING WITH THE BOARD, DEVELOP AND IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS.
DESCRIPTION OF CLASSES OR PERSONS, DECISIONS REQUIRING APPROVAL & TYPE OF VOTING RIGHTS (CONTINUATION) HAWAI'I PACIFIC HEALTH, AS MEMBER, HAS THE FOLLOWING POWERS RESERVED TO APPROVE THE FOLLOWING WITH RESPECT TO STRAUB CLINIC & HOSPITAL: (I) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: THE TREASURER, SECRETARY, EXECUTIVE VICE-PRESIDENT/CHIEF FINANCIAL OFFICER, EXECUTIVE VICE PRESIDENTS OTHER THAN THE EXECUTIVE VICE-PRESIDENT/CHIEF EXECUTIVE OFFICER (THE "EVP/CEO") AND THE; EXECUTIVE VICE-PRESIDENT/CHIEF MEDICAL OFFICER (THE "EVP/CMO") OF THE CORPORATION, SENIOR VICE-PRESIDENTS, ASSISTANT SECRETARIES, AND ALL VICE-PRESIDENTS EXCEPT THE CLINIC AND HOSPITAL UNIT VICE-PRESIDENTS, AS SUCH TERM IS DEFINED IN THE BYLAWS; (II) REMOVE ANY DIRECTOR FROM THE BOARD; PROVIDED, HOWEVER, THAT THE BOARD MAY REMOVE ANY DIRECTOR FROM THE BOARD IF APPROVED BY THE MEMBER BOARD; (III) 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; (IV) AMEND THE BYLAWS; (V) THE CORPORATION'S PARTICIPATION IN ALL LONG TERM FINANCING TRANSACTIONS WHICH ARE IN EXCESS OF ONE (1) YEAR AND/OR FOR ONE MILLION DOLLARS ($1,000,000) OR MORE; (VI) ACQUIRE ASSETS WORTH OVER ONE MILLION DOLLARS ($1,000,000); (VII) ACQUIRE SHARES IN ANOTHER CORPORATION; (VIII) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORPORATION'S FUNDS SHALL BE DEPOSITED; (IX) DIRECT, MANAGE AND CONTROL THE CUSTODY, ADVISORY SERVICE, AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORPORATION; (X) DETERMINE AND EFFECT INTER-CORPORATE TRANSFERS BY AND BETWEEN THE CORPORATION AND ANY AFFILIATE; (XI) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORPORATION'S PHYSICIAN AND EXECUTIVE COMPENSATION AND BENEFIT PLANS; (XII) FORM A NEW CORPORATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (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; (XIV) CLOSE THE ACUTE CARE HOSPITAL OR CLINIC FACILITIES OWNED AND OPERATED BY THE CORPORATION; (XV) RELOCATE THE ACUTE CARE HOSPITAL OR CLINIC FACILITIES OWNED AND OPERATED BY THE CORPORATION; (XVI) CONVERT THE ACUTE CARE HOSPITAL OWNED AND OPERATED BY THE CORPORATION INTO A NON-ACUTE CARE FACILITY; (XVII) AFTER CONSULTING WITH THE BOARD, REMOVE THE TREASURER, SECRETARY, EXECUTIVE VICE-PRESIDENT/CHIEF FINANCIAL OFFICER, EXECUTIVE VICE-PRESIDENTS OTHER THAN THE EVP/CEO AND THE EVP/CMO, SENIOR VICE-PRESIDENTS, ASSISTANT SECRETARIES, AND/OR ALL VICE-PRESIDENTS EXCEPT THE CLINIC AND HOSPITAL UNIT VICE-PRESIDENTS; AND (XVIII) DEVELOP AND PROMULGATE THE CORPORATE GOALS AND THE LONG-RANGE AND STRATEGIC PLAN OF THE CORPORATION. THE FOLLOWING ACTIONS REQUIRE APPROVAL FROM THE MEMBER BOARD: (I) ADD ANY DIRECTOR TO THE BOARD; (II) AMEND THE ARTICLES OF INCORPORATION; (III) SELL, LEASE, EXCHANGE OR DISPOSE OF FIFTY PERCENT (50%) OR MORE OF THE AMOUNT OF PROPERTY OR ASSETS HELD BY THE ORGANIZATION, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, TO ANY ENTITY THAT IS NOT AN AFFILIATE, EXCEPT THAT IF THE GFS HEALTH PHYSICIAN ADVISORY GROUP (THE "PAG") ELECTS TO INITIATE A SEPARATION ACTION PURSUANT TO ARTICLE XIII OF THE AFFILIATION AGREEMENT BY AND AMONG THE MEMBER, THE ORGANIZATION, AND STRAUB CLINIC AND HOSPITAL, INC., DATED AS OF DECEMBER 23, 2001, THE ORGANIZATION SHALL BE ALLOWED, BY A MAJORITY VOTE OF A QUORUM OF THE BOARD, TO SELL, LEASE, EXCHANGE OR DISPOSE OF FIFTY PERCENT (50%) OR MORE OF THE AMOUNT OF THE PROPERTY OR ASSETS HELD BY THE ORGANIZATION, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, AND SHALL NOT BE REQUIRED TO RECEIVE DIRECTION OR APPROVAL TO DO SO FROM THE MEMBER; (IV) IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS; (V) IMPLEMENT INDIVIDUAL PHYSICIAN COMPENSATION ARRANGEMENTS FOR EACH PHYSICIAN OPERATING UNIT IN THE ORGANIZATION; (VI) ENTER INTO ANY UNBUDGETED CONTRACTS ON BEHALF OF THE ORGANIZATION WHICH REQUIRE ANNUAL PAYMENTS ON BEHALF OF THE ORGANIZATION EXCEEDING ONE MILLION DOLLARS ($1,000,000) IN VALUE; (VII) ISSUE THE ORGANIZATION'S MEMBERSHIP TO ANYONE OTHER THAN THE MEMBER; (VIII) MERGE THE ORGANIZATION WITH ANY ENTITY; (IX) DISSOLVE THE ORGANIZATION; AND (X) DEVELOP A NEW LINE OF BUSINESS OR A NEW SERVICE. HAWAI'I PACIFIC HEALTH, AS MEMBER, HAS RESERVED POWERS TO APPROVE THE FOLLOWING WITH RESPECT TO WILCOX MEMORIAL HOSPITAL: (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.
DESCRIPTION OF CLASSES OR PERSONS, DECISIONS REQUIRING APPROVAL & TYPE OF APPROVAL (CONTINUATION) 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 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 RETURNS WITH THE IRS.
MONITORING & ENFORCING CONFLICT OF INTEREST 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: 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 AND POSITIONS FOR WHICH PROCESS WAS USED, AND YEAR PROCESS WAS LAST COMPLETED FORM 990, PART VI, LINES 15A & 15B THE CEO OF THE ORGANIZATION IS NOT COMPENSATED BY THE FILING ORGANIZATION, BUT RATHER BY THE TAX-EXEMPT PARENT, 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 MARCH 5, 2013 TO REVIEW PHYSICIAN COMPENSATION AND ON AUGUST 7, 2013 TO REVIEW EXECUTIVE COMPENSATION.
DISCLOSURE OF GOV DOCS, CONFLICT OF INTEREST POLICY & FINANCIAL STMTS FORM 990, PART VI, LINE 19 THE CONFLICT OF INTEREST POLICY AND STANDARD 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.
RECONCILIATION OF NET ASSETS FORM 990, PART XI, LINE 9 OBLIGATED GROUP INTERCOMPANY TRANSFERS $(61,561,107) NET ASSETS RELEASED FROM RESTRICTIONS $( 1,605,864) CHANGE IN INTEREST IN KHF/WHF $ 10,615,513 CHANGE IN INTEREST IN PERPETUAL TRUSTS $ 215,934 RESTRICTED GRANTS AND CONTRIBUTIONS $ 1,611,936 REVERSAL OF GRANT EXPENSE FROM PREVIOUS YEAR $ 66,171 OTHER CHANGES $ 72,119 ------------- TOTAL $(50,585,298)
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN SERVICES TOTAL FEES:23797609
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL SERVICES TOTAL FEES:4299663
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING SERVICES TOTAL FEES:907851
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:REGISTRY SERVICES TOTAL FEES:3542802
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:TEMP LABOR ADMIN SERVICES TOTAL FEES:124654
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:TEMP LABOR OTHER SERVICES TOTAL FEES:387074
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:LAUNDRY SERVICES TOTAL FEES:4232168
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT & RECURRING SERVICES TOTAL FEES:37938751
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:FAMILY FUND SERVICES TOTAL FEES:615
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION FEE SERVICES TOTAL FEES:1013497
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:OTHER SERVICES TOTAL FEES:10640368
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:REPAIRS & MAINTENANCE TOTAL FEES:15703775
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:INTERNAL SERVICES PROVIDED EXP TOTAL FEES:33254418
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:OTHER EXPENSE RECOVERY TOTAL FEES:-4337395
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:BUS PASS SERVICES TOTAL FEES:35105
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
 
Employer identification number

38-3835105
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) PROVIDERS INSURANCE CORPORATION

55 MERCHANT STREET 24TH FLOOR

HONOLULU,HI96813
71-0893000 		NFP INSURANCE HI 501(C)(3) 11B TYPE II NA
 
Yes
 
(2) KAPI'OLANI HEALTH FOUNDATION

55 MERCHANT STREET 24TH FLOOR

HONOLULU,HI96813
99-0246364 		FUNDRAISING HI 501(C)(3) 7 NA
 
Yes
 
(3) KAPI'OLANI MEDICAL SPECIALISTS

55 MERCHANT STREET 24TH FLOOR

HONOLULU,HI96813
99-0322406 		HEALTHCARE HI 501(C)(3) 9 NA
 
Yes
 
(4) WILCOX HEALTH FOUNDATION

55 MERCHANT STREET 24TH FLOOR

HONOLULU,HI96813
99-0204242 		FUNDRAISING HI 501(C)(3) 7 NA
 
Yes
 
(5) KAUA'I MEDICAL CLINIC

55 MERCHANT STREET 24TH FLOOR

HONOLULU,HI96813
99-0326099 		HOSPITAL HI 501(C)(3) 3 NA
 
Yes
 
(6) STRAUB FOUNDATION

55 MERCHANT STREET 24TH FLOOR

HONOLULU,HI96813
99-0109350 		FUNDRAISING HI 501(C)(3) 7 NA
 
Yes
 
(7) PALI MOMI FOUNDATION

55 MERCHANT STREET 24TH FLOOR

HONOLULU,HI96813
38-3840327 		FUNDRAISING HI 501(C)(3) 7 NA
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) ASC PACIFIC VENTURES LLC

3000 RIVERCHASE GALLERIA STE 500
BIRMINGHAM,AL35244
27-0540034 		AMBU. SURG. CNTR AL NA
  		                 












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) HAWAI'I PACIFIC HEALTH PARTNERS INC

55 MERCHANT STREET 24TH FLOOR
HONOLULU,HI96813
99-0318588 		HOLDING COMPANY HI NA
  		C CORP 0 0 0 % Yes  
(2) STRAUB PHARMACY INC

888 SOUTH KING STREET
HONOLULU,HI96813
99-0145107 		INACTIVE HI SCH
  		C CORP -3,564 4,989,145 100.000 % Yes  
(3) HICORD INC

55 MERCHANT STREET 24TH FLOOR
HONOLULU,HI96813
99-0251496 		INVESTMENT HI NA
  		C-CORP          








Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) KAPI'OLANI HEALTH FOUNDATION

 C 1,317,771 FMV
(2) PALI MOMI FOUNDATION

 C 213,230 FMV
(3) STRAUB FOUNDATION

 C 344,345 FMV
(4) WILCOX HEALTH FOUNDATION

 C 1,172,822 FMV
(5) KAPI'OLANI MEDICAL SPECIALISTS

 P 371,352 FMV
(6) KAUA'I MEDICAL CLINIC

 P 2,690,659 FMV
(7) PALI MOMI FOUNDATION

 P 77,499 FMV
(8) KAPI'OLANI MEDICAL SPECIALISTS

 Q 7,395,725 FMV
(9) KAUA'I MEDICAL CLINIC

 R 94,166 FMV
(10) PROVIDERS INSURANCE CORPORATION

 R 10,128,270 FMV
(11) KAPI'OLANI MEDICAL SPECIALISTS

 S 268,383 FMV
(12) KAUA'I MEDICAL CLINIC

 S 53,857 FMV
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
RELATED ORG. TAXABLE AS PARTNERSHIP SCHEDULE R, PART III ASC PACIFIC VENTURES, LLC EIN: 27-0540034 ADDRESS: 3000 RIVERCHASE GALLERIA, STE 500 BIRMINGHAM, AL 35244

Additional Data


Software ID:  
Software Version:  






TY 2012 AffiliateListing
Name:
HAWAI'I PACIFIC HEALTH GROUP RETURN
EIN: 38-3835105

Name Address EIN Name control
Kapiolani Medical Ctr Women Childr 55 Merchant St 24th floor
Honolulu,  HI  96813
99-0177350
 KAPI
Pali Momi Medical Center 55 Merchant St 24th Floor
Honolulu,  HI  96813
99-0274038
 PALI
Straub Clinic & Hospital 55 Merchant St 24th Floor
Honolulu,  HI  96813
91-2151670
 STRA
Wilcox Memorial Hospital 3-3420 Kuhio Hwy
Lihue,  HI  96766
99-0074365
 WILC