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 private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 07-01-2013 , 2013, and ending 06-30-2014
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 province, country, and ZIP or foreign postal code
HONOLULU, HI96813
D Employer identification number

38-3835105
E Telephone number

G Gross receipts $ 1,144,147,608
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
subordinates?
H(b)
Are all subordinates
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 2013 (Part V, line 2a) ...... 5 5,703
6 Total number of volunteers (estimate if necessary) ............. 6 775
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 598,240
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b -2,172
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 3,806,413 3,169,162
9 Program service revenue (Part VIII, line 2g) ......... 986,541,479 1,073,867,376
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 4,157,340 8,805,372
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 5,041,667 6,269,804
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 999,546,899 1,092,111,714
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 35,147 161,150
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) 458,417,077 480,111,418
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).... 433,169,327 469,819,941
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 891,621,551 950,092,509
19 Revenue less expenses. Subtract line 18 from line 12....... 107,925,348 142,019,205
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 635,052,131 720,108,195
21 Total liabilities (Part X, line 26)............. 128,207,692 128,584,262
22 Net assets or fund balances. Subtract line 21 from line 20..... 506,844,439 591,523,933
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 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line 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 $ 40,147,515 including grants of $ 0 ) (Revenue $ 0 )
SEE SCHEDULE O.
4b (Code:   ) (Expenses $ 50,415,244 including grants of $ 0 ) (Revenue $ 0 )
SEE SCHEDULE O.
4c (Code:   ) (Expenses $ 52,214,524 including grants of $ 0 ) (Revenue $ 0 )
SEE SCHEDULE O.
4d Other program services (Describe in Schedule O.)
(Expenses $ 688,734,675 including grants of $ 161,150 ) (Revenue $ 1,079,136,027 )
4e Total program service expensesMediumBullet831,511,958
Form 990 (2013)
Form 990 (2013)
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 other assistance to or for any foreign organization? 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 other assistance to or for foreign individuals? 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 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government 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 or 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 25a................
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
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, 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 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
426
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
5,703
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” to line 3b, 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 (2013)
Form 990 (2013)
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 or note to any line 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
Yes
 
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 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line 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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) DOUGLAS KWOCK MD........................................................................
Board of Director, Chair
 1.3
.......................0.0 		X   X       15,875 0 0
(2) MARK GRIEF MD........................................................................
Board of Director, Chair
 .2
.......................0.0 		X   X       0 0 0
(3) GORDON HAMMOND........................................................................
Board of Director, Chair
 .2
.......................0.0 		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) THOMAS J NORDYKE MD........................................................................
Board of Director, Vice Chair
 40.0
.......................0.0 		X   X       253,751 0 42,126
(7) JOHN CULLINEY MD........................................................................
Board of Director, Vice Chair
 .2
.......................40.0 		X   X       0 432,717 50,584
(8) BEN GODSEY........................................................................
Board of Director
 .3
.......................0.0 		X           0 0 0
(9) CHRIS ELDRIDGE........................................................................
Board of Director
 .3
.......................0.0 		X           0 0 0
(10) ELLIOT MILLS........................................................................
Board of Director
 .3
.......................0.0 		X           0 0 0
(11) JENNIFER SABAS........................................................................
Board of Director
 .3
.......................0.0 		X           0 0 0
(12) KEITH MATSUMOTO MD........................................................................
Board of Director (Part Year)
 .3
........................2 		X           0 0 0
(13) PETER MCNALLY MD........................................................................
Board of Director
 .3
.......................0.0 		X           0 0 0
(14) SHELLEY WILSON........................................................................
Board of Director
 .3
.......................0.0 		X           0 0 0
(15) STEPHEN LIN MD........................................................................
Board of Director
 1.3
.......................0.0 		X           41,500 0 0
(16) STEVEN AI........................................................................
Board of Director
 .3
.......................0.0 		X           0 0 0
(17) ANDREW DANG MD........................................................................
Board of Director
 40.0
.......................0.0 		X           368,386 0 51,299
Form 990 (2013)
Form 990 (2013)
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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) BETH HOBAN RN........................................................................
Board of Director
 .2
.......................1.0 		X           0 0 0
(19) BRYAN MATSUMOTO MD........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(20) CARLETON CHING........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(21) GORDON NIHEI........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(22) JAMES KAKUDA MD........................................................................
Board of Director
 1.2
.......................0.0 		X           36,000 3,500 0
(23) AVI MANNIS........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(24) BEAU NAKAMOTO MD........................................................................
Board of Director
 40.0
.......................0.0 		X           255,468 0 28,042
(25) KENN SARUWATARI MD........................................................................
Board of Director
 40.0
.......................0.0 		X           247,687 0 57,314
(26) RICHANNE LAM........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(27) CLYDE KODANI........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(28) DANIELLE RAMOS........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(29) GERALD MCKENNA MD........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(30) R CRAIG NETZER........................................................................
Board of Director
 .2
.......................40.0 		X           0 158,206 19,785
(31) RAMON DE LA PENA........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(32) TAD JACKSON MD........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(33) WAYNE KATAYAMA........................................................................
Board of Director
 .2
.......................0.0 		X           0 0 0
(34) MARTHA SMITH........................................................................
Board of Director, CEO
 55.0
.......................5.0 		X   X       0 525,667 135,160
(35) JENNIE CHAHANOVICH........................................................................
Board of Director, CEO
 55.0
........................4 		X   X       0 387,453 102,708
(36) RAYMOND P VARA JR........................................................................
Board of Director, President
 20.0
.......................45.0 		X   X       0 1,490,728 393,474
(37) KATHLEEN CLARK........................................................................
PRES & CEO
 40.0
.......................21.0 		X   X       0 346,014 90,511
(38) KENNETH B ROBBINS MD........................................................................
B.O.D., EVP & CMO
 40.0
.......................20.0 		X   X       0 758,614 215,955
(39) ARTHUR GLADSTONE........................................................................
B.O.D., CEO/VP & System CNE
 50.0
.......................5.0 		X   X       0 467,376 115,283
(40) DAVID OKABE........................................................................
EVP, CFO & Treasurer
 16.0
.......................39.0 		    X       0 783,672 175,363
(41) GAIL LERCH........................................................................
EVP
 14.0
.......................47.0 		    X       0 606,129 168,090
(42) VIRGINIA PRESSLER-FISHER MD........................................................................
EVP
 6.0
.......................53.0 		    X       0 586,997 184,338
(43) CHARLES R CHING........................................................................
EVP, Gen Counsel & Secretary
 13.0
.......................47.0 		    X       0 659,823 160,550
(44) STEVEN ROBERTSON........................................................................
EVP & CIO
 43.0
.......................17.0 		    X       0 627,870 177,502
(45) MELINDA ASHTON MD........................................................................
SVP & CQO
 7.0
.......................42.0 		    X       0 441,619 105,751
(46) JOHN LA FORGIA........................................................................
SVP & Chief Marketing Officer
 4.0
.......................46.0 		    X       0 117,923 31,516
(47) EARL INOUYE........................................................................
VP & System Controller
 24.0
.......................31.0 		    X       0 317,690 79,385
(48) WARREN CHAIKO........................................................................
VP
 35.0
.......................17.0 		    X       0 281,107 66,438
(49) SUSAN MASUMOTO-NONAKA........................................................................
VP
 39.0
.......................21.0 		    X       0 308,756 66,431
(50) DAWN CHING........................................................................
VP
 50.0
.......................1.0 		    X       0 251,413 59,816
(51) GIDGET RUSCETTA RN........................................................................
VP
 50.0
.......................5.0 		    X       0 264,511 58,806
(52) PAULA DIAS........................................................................
VP
 9.0
.......................45.0 		    X       0 264,517 61,429
(53) MAUREEN FLANNERY........................................................................
VP
 50.0
........................4 		    X       0 278,705 63,886
(54) MAVIS NIKAIDO........................................................................
VP & CNE
 40.0
.......................0.0 		    X       0 250,572 48,960
(55) BRIGITTE MCKALE........................................................................
VP & CNE
 40.0
.......................0.0 		    X       0 228,167 54,788
(56) PATRICIA BOECKMANN RN........................................................................
VP & CNE
 50.0
.......................2.0 		    X       0 335,955 76,140
(57) RANDY YATES MD........................................................................
CMO
 40.0
.......................0.0 		    X       0 389,821 67,299
(58) JESSICA LEWIS........................................................................
Assistant Corporate Secretary
 36.0
.......................4.0 		    X       0 122,539 27,300
(59) DAVID FOX........................................................................
Privacy & Information Security
 31.0
.......................9.0 		    X       0 123,225 42,074
(60) KATIE SHIGEMITSU........................................................................
Compliance Officer
 37.0
.......................3.0 		    X       0 169,359 38,470
(61) ANN PETERS........................................................................
VP (PART YEAR)
 4.0
.......................46.0 		    X       0 233,241 37,474
(62) CASS K NAKASONE MD........................................................................
PHYSICIAN
 40.0
.......................0.0 		        X   872,584 0 45,084
(63) HINGSON M CHUN MD........................................................................
PHYSICIAN
 40.0
.......................0.0 		        X   783,182 0 44,055
(64) KENNETH LEE MD........................................................................
PHYSICIAN
 40.0
.......................0.0 		        X   668,819 0 29,045
(65) MARK S GERBER MD........................................................................
PHYSICIAN
 40.0
.......................0.0 		        X   745,450 0 34,724
(66) ROBERT SCHULZ MD........................................................................
PHYSICIAN
 40.0
.......................0.0 		        X   750,320 0 50,411
(67) THERESA RAMEY........................................................................
FORMER OFFICER
 0.0
.......................0.0 		          X 0 116,373 29,515
(68) CHARLES A STED........................................................................
FORMER OFFICER
 0.0
.......................0.0 		          X 0 1,625,448 35,108
(69) KEOKI CLEMENTE........................................................................
FORMER OFFICER
 0.0
.......................40.0 		          X 0 150,052 19,539
(70) LYNNE JOHNSON-JOSEPH........................................................................
FORMER OFFICER
 0.0
.......................0.0 		          X 0 233,321 48,739
(71) HUGH N HAZENFIELD MD........................................................................
FORMER OFFICER
 0.0
.......................0.0 		          X 0 308,568 72,276
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 5,039,022 14,647,648 3,562,543
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet1,146
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 25,060,865
SODEXO INC AFFILIATES, 888 SOUTH KING STREETHONOLULUHI96813 FOOD & ENVIRON SVCS 8,043,250
DCK PACIFIC CONSTRUCTION LLC, 707 RICHARDS ST STE 410HONOLULUHI96813 CONSTRUCTION SVCS 7,575,017
UNIVERSITY CLINICAL EDU RESEACH, PO BOX 31000HONOLULUHI968495647 PHYSICIAN SVCS 5,892,369
HAWAI'I RESIDENCY PROGRAMS INC, 1356 LUSITANA ST STE 510HONOLULUHI96813 CONSTRUCTION SVCS 5,708,584
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet127
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 2,965,416
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		203,746
g Noncash contributions included in lines
1a-1f:$ 		74,568
h Total. Add lines 1a-1f.......MediumBullet 3,169,162
Program Service RevenueAmt Business Code
2a NET PATIENT REVENUES 622110 1,052,987,765 1,052,595,724 392,041  
b OTHER HEALTHCARE REVENUE 622110 13,718,087 13,718,087    
c RENTAL INCOME 531120 3,618,495 3,618,495    
d CAPITATION REVENUE 900099 2,630,294 2,630,294    
e RENTAL INCOME FROM AFFILIATES 622110 706,536 706,536    
f All other program service revenue . 206,199   206,199  
g Total. Add lines 2a–2f........MediumBullet 1,073,867,376
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 2,138,851     2,138,851
4 Income from investment of tax-exempt bond proceeds..MediumBullet 798,837     798,837
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 147,353  
b Less: rental expenses    
c Rental income or (loss) 147,353 0
d Net rental income or (loss).......MediumBullet 147,353     147,353
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 57,499,562 108,407
b Less: cost or other basis and sales expenses 51,486,118 254,167
c Gain or (loss) 6,013,444 -145,760
d Net gain or (loss)..........MediumBullet 5,867,684     5,867,684
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 637,609
b Less: cost of goods sold ..b 295,609
c Net income or (loss) from sales of inventory..MediumBullet 255,560     255,560
Miscellaneous Revenue Business Code
11a PARKING 812930 2,386,619 2,386,619    
b CAFETERIA 722110 2,608,217 2,608,217    
c MEDICAL RECORD COPIES 622110 68,239 68,239    
d All other revenue .... 803,816 803,816    
e Total. Add lines 11a–11d ...... MediumBullet 5,866,891
12 Total revenue. See Instructions......MediumBullet 1,092,111,714 1,079,136,027 598,240 9,208,285
Form 990 (2013)
Form 990 (2013)
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 or note to any line 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 21 161,150 161,150
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 .... 1,376,690 1,283,315 93,375  
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 383,811,431 380,757,143 3,054,288  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 28,081,530 27,734,406 347,124  
9 Other employee benefits ....... 40,912,295 33,816,758 7,095,537  
10 Payroll taxes ........... 25,929,472 25,711,842 217,630  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 14,758 -1,640 16,398  
c Accounting ........... 2,485,398   2,485,398  
d Lobbying ........... 20,593   20,593  
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 589,217   589,217  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 145,659,127 129,228,727 16,430,400  
12 Advertising and promotion .... 666,453 41,161 625,292  
13 Office expenses ....... 141,233,516 140,749,714 483,802  
14 Information technology ...... 15,047,180 2,821,090 12,226,090  
15 Royalties .. 0      
16 Occupancy ........... 28,576,337 26,901,669 1,674,668  
17 Travel ............ 1,121,785 860,056 261,729  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 131,404 111,628 19,776  
20 Interest ........... 12,093,248 12,093,248    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 33,909,266 33,908,684 582  
23 Insurance .............. 6,016,434 6,655,637 -639,203  
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 55,578,775 0 55,578,775  
b OTHER PURCHASES 22,737,388 5,997,588 16,739,800  
c LOSS-EXTINGUISHMENT OF DEBT 2,613,940 2,613,940 0  
d AFFILIATE EXPENSES 1,172,838 0 1,172,838  
e All other expenses 152,284 65,842 86,442  
25 Total functional expenses. Add lines 1 through 24e 950,092,509 831,511,958 118,580,551 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 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. -6,916,329 1 -1,018,069
2 Savings and temporary cash investments ......... 6,039,377 2 4,381,059
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 115,570,126 4 141,671,643
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 .............. 13,669,151 8 14,505,573
9 Prepaid expenses and deferred charges .......... 991,613 9 1,468,125
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 808,778,075
b Less: accumulated depreciation ..... 10b 502,453,170 280,789,445 10c 306,324,905
11 Investments—publicly traded securities .......... 94,334,164 11 87,553,785
12 Investments—other securities. See Part IV, line 11 ..... 51,503,194 12 68,788,561
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 ........... 77,452,833 15 94,814,056
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 635,052,131 16 720,108,195
Liabilities 17 Accounts payable and accrued expenses ......... 73,311,378 17 94,636,203
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.................... 54,896,314 25 33,948,059
26 Total liabilities. Add lines 17 through 25......... 128,207,692 26 128,584,262
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 .............. 462,406,697 27 536,363,153
28 Temporarily restricted net assets ........... 34,033,203 28 44,492,198
29 Permanently restricted net assets ........... 10,404,539 29 10,668,582
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 ........... 506,844,439 33 591,523,933
34 Total liabilities and net assets/fund balances ........ 635,052,131 34 720,108,195
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
1,092,111,714
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
950,092,509
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
142,019,205
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
506,844,439
5
Net unrealized gains (losses) on investments ...............
5
10,542,154
6
Donated services and use of facilities .................
6
8,858
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-67,890,723
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
591,523,933
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line 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
 
No
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
 
 
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 (2013)
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.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information. 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) 2013

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.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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 its Form 990PF, Part I, line 2, 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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
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, RESTRICTEDRESTRICTED

$RESTRICTED


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
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) (2013)

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.SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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) 2013

Schedule C (Form 990 or 990-EZ) 2013
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) 2010 (b) 2011 (c) 2012 (d) 2013 (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) 2013


Schedule C (Form 990 or 990-EZ) 2013
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
 
20,593
j
Total. Add lines 1c through 1i ...............................
20,593
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
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.
Return Reference Explanation
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) 2013

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. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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) 2013

Schedule D (Form 990) 2013
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 .... 151,507,463 135,652,768 138,278,199 114,609,981 102,107,743
b Contributions ........ 418,132 493,306 1,573,144 1,260,873 1,339,991
c Net investment earnings, gains, and losses 19,077,175 15,453,147 -4,110,118 22,509,891 11,175,215
d Grants or scholarships ..... 0 0      
e Other expenditures for facilities
and programs ........ 		0 0      
f Administrative expenses .... 20,605 91,758 88,457 102,546 12,968
g End of year balance ...... 170,982,165 151,507,463 135,652,768 138,278,199 114,609,981
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 Bullet4.000 %
c
Temporarily restricted endowment SchDMd Bullet0 %
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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. 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 ................   357,349,306 220,482,413 136,866,893
c Leasehold improvements ............   15,608,836 13,355,647 2,253,189
d Equipment ................   311,036,537 239,751,601 71,284,936
e Other .................   105,063,146 28,863,508 76,199,638
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 306,324,905
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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 		4,971,708 F

(B) LIMITED PARTNERSHIPS 		63,816,853 F







Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 68,788,561
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) OTHER RECEIVABLES 5,685,722
(2) BOARD DESIGNATED INVESTMENTS 16,908,720
(3) INT IN NET ASSETS OF FDNS 45,799,455
(4) DEPOSITS & NON-CURRENT ASSETS 6,194,438
(5) INTEREST IN PERPETUAL TRUST 4,952,842
(6) DECORATIVE ARTWORK 314,077
(7) INVESTMENT IN JOINT VENTURES 25,000
(8) THIRD PARTY PAYORS 13,154,559
(9) PALI MOMI FOUNDATION 23,728
(10) STRAUB FOUNDATION 71,335
(11) KAUA'I MEDICAL CLINIC 222,137
(12) KAPI'OLANI HEALTH FOUNDATION 821,584
(13) KAPI'OLANI MEDICAL SPECIALISTS 53,650
(14) PROVIDER INSURANCE 371,229
(15) WILCOX FOUNDATION 109,998
(16) HAWAI'I HEALTH PARTNERS 102,923
(17) HICORD 2,659
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 94,814,056
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
OTHER LONG TERM LIABILITIES 21,188,092
ESCHEAT LIABILITY 44,055
KAPI'OLANI HEALTH FOUNDATION 12,975
STRAUB PHARMACY INC 4,555,888
WILCOX HEALTH FOUNDATION 10,191
PALI MOMI FOUNDATION 3,341
THIRD PARTY PAYORS 7,332,867
KEAHONUIOKALANI 90,051
STRAUB FOUNDATION 15,710
KAPI'OLANI MEDICAL SPECIALISTS 664,238
HAWAI'I PACIFIC HEALTH PARTNERS 30,651
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 33,948,059
2. Liability for uncertain tax positions 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) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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
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.
Return Reference Explanation
SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS INTENDED USES 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) 2013

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.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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) .. 		  9,811 2,667,585 0 2,667,585 0.280 %
b Medicaid (from Worksheet 3,
column a) .... 		  114,181 229,635,989 215,688,671 13,947,318 1.470 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		  123,992 232,303,574 215,688,671 16,614,903 1.750 %
Other Benefits
 56 61,923 2,532,381 151,423 2,380,958 0.250 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		9 75 6,748,157 1,782,579 4,965,578 0.520 %
g Subsidized health services
(from Worksheet 6) .. 		11 52 29,670,420 10,732,245 18,938,175 1.990 %
h Research (from Worksheet 7) 1 0 40,469 0 40,469 0 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		8 0 277,068 0 277,068 0.030 %
j Total. Other Benefits .. 85 62,050 39,268,495 12,666,247 26,602,248 2.790 %
k Total. Add lines 7d and 7j . 85 186,042 271,572,069 228,354,918 43,217,151 4.540 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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 1   5,000   5,000 0 %
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development 3 35 415,652   415,652 0 %
9 Other            
10 Total 4 35 420,652   420,652 0 %
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
25,153,982
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
2,160,071
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
127,942,694
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
140,531,731
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-12,589,037
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

 

No
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) 2013
Schedule H (Form 990) 2013
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, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 KAPI'OLANI MEDICAL CENTER FOR WOMEN
1319 PUNAHOUR STREET
HONOLULU,HI96826
www.hawaiipacifichealth.org/kapiolani
6-H 		X X X X     X     1
2 PALI MOMI MEDICAL CENTER
98-1079 MOANALUA ROAD
AIEA,HI96701
www.hawaiipacifichealth.org/pali-momi
37-H 		X X         X     1
3 STRAUB CLINIC & HOSPITAL
888 SOUTH KING ST
HONOLULU,HI96813
www.hawaiipacifichealth.org/straub
32-H 		X X   X     X     1
4 WILCOX MEMORIAL HOSPITAL
3-3420 KUHIO HIGHWAY
LIHUE,HI967661099
www.hawaiipacifichealth.org/wilcox
23-H 		X X         X     1
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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  
If reporting on Part V, Section B for a single hospital facility 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 persons who represent the broad interests 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
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):
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) 2013
Schedule H (Form 990) 2013
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
i
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 individual’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 individual’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) 2013
Schedule H (Form 990) 2013
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 individual 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 individual an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If "Yes," explain in Part VI.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
SCHEDULE H, PART V, LINE 3 FACILITY 1 KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN (KMCWC) IN CONDUCTING KMCWC'S MOST RECENT CHNA, ADOPTED JUNE 2013, INTERVIEWS WERE HELD WITH 22 COMMUNITY REPRESENTATIVES WITH PUBLIC HEALTH EXPERTISE IN THE TOP TEN HEALTH AREAS IDENTIFIED FOR WOMEN AND CHILDREN IN THE STATE OF HAWAI'I AND/OR POSSESSING SPECIAL KNOWLEDGE OF VULNERABLE POPULATIONS, INCLUDING (BUT NOT LIMITED TO) LOW-INCOME, MENTALLY ILL, OR PARTICULAR RACIAL/ETHNIC GROUPS. THE INPUT FROM THE INTERVIEWS WAS TAKEN INTO ACCOUNT IN THE CHNA IN THE FOLLOWING WAYS: A SUMMARY QUALITATIVE ANALYSIS TOOL CALLED A "WORD CLOUD" WAS PRODUCED TO IDENTIFY THE MOST COMMON THEMES AND TOPICS RAISED BY THE COMMUNITY REPRESENTATIVES; AND RELEVANT INPUT WAS SUMMARIZED UNDER EACH HEALTH TOPIC AREA ANALYZED IN THE CHNA AND FACTORED INTO THE QUALITATIVE EVALUATION OF THE HEALTH NEED. IN ADDITION, 3 COMMUNITY LEADERS BROADLY REPRESENTING COMMUNITY HEALTH ISSUES FOR THE KMCWC SERVICE AREA WERE CONSULTED TO VALIDATE THE CHOSEN PRIORITY COMMUNITY HEALTH NEEDS. PERSONS CONSULTED STATE DIRECTOR, HAWAII NUTRITION AND PHYSICAL ACTIVITY COALITION, DEPARTMENT OF EDUCATION EXPERTISE: EXERCISE, NUTRITION & WEIGHT DEPUTY DIRECTOR, BEHAVIORAL HEALTH SERVICES ADMINISTRATION, HAWAII DEPARTMENT OF HEALTH EXPERTISE: MENTAL HEALTH & MENTAL DISORDERS ADMINISTRATOR, DEPARTMENT OF HUMAN SERVICES, MED-QUEST DIVISION EXPERTISE: ACCESS TO HEALTH SERVICES DIRECTOR, HAWAII STATE DEPARTMENT OF HEALTH EXPERTISE: MENTAL HEALTH & MENTAL DISORDERS, SUBSTANCE ABUSE/VALIDATION OF PRIORITIZED HEALTH NEEDS HEALTHCARE TRANSFORMATION OFFICER, OFFICE OF THE GOVERNOR EXPERTISE: ACCESS TO HEALTH SERVICES, ORAL HEALTH/VALIDATION OF PRIORITIZED HEALTH NEEDS STATE SENATOR, EXECUTIVE MEDICAL DIRECTOR, HAWAII INDEPENDENT PHYSICIANS ASSOCIATION, EMERGENCY ROOM PHYSICIAN. EXPERTISE: DIABETES, SUBSTANCE ABUSE CEO, HAWAII PRIMARY CARE ASSOCIATION EXPERTISE: RESPIRATORY DISEASE, SOCIAL ENVIRONMENT HEALTHY HAWAII INITIATIVE, TOBACCO SETTLEMENT PROJECT MANAGER, HAWAII DEPARTMENT OF HEALTH EXPERTISE: CANCER, EXERCISE, NUTRITION & WEIGHT, RESPIRATORY DISEASE PROFESSOR OF OBSTETRICS/GYNECOLOGY, DIRECTOR OF FAMILY PLANNING, JOHN A. BURNS SCHOOL OF MEDICINE, UNIVERSITY OF HAWAI'I EXPERTISE: FAMILY PLANNING EXECUTIVE DIRECTOR, AMERICAN DIABETES ASSOCIATION HAWAI'I EXPERTISE: DIABETES CEO, KAMEHAMEHA SCHOOLS EXPERTISE: EDUCATION/VALIDATION OF PRIORITIZED HEALTH NEEDS SUPERINTENDENT OF EDUCATION, HAWAII STATE DEPARTMENT OF EDUCATION EXPERTISE: MENTAL HEALTH & MENTAL DISORDERS DIRECTOR, MOUNTAIN-PACIFIC QUALITY HEALTH EXPERTISE: HEART DISEASE, OLDER ADULTS & AGING DIRECTOR, HAWAII INITIATIVE FOR CHILDHOOD OBESITY RESEARCH AND EDUCATION, JOHN A. BURNS SCHOOL OF MEDICINE, PEDIATRICS, UNIVERSITY OF HAWAII EXPERTISE: EXERCISE, NUTRITION & WEIGHT CHIEF MEDICAL OFFICER, HAWAII MEDICAL SERVICE ASSOCIATION EXPERTISE: MATERNAL, FETAL & INFANT HEALTH PROFESSOR, JOHN A. BURNS SCHOOL OF MEDICINE, UNIVERSITY OF HAWAI'I EXPERTISE: ACCESS TO HEALTH SERVICES, CANCER CHIEF, DISEASE OUTBREAK CONTROL DIVISION, DEPARTMENT OF HEALTH EXPERTISE: IMMUNIZATIONS & INFECTIOUS DISEASE CHIEF, EMERGENCY MEDICAL SERVICES AND INJURY PREVENTION SYSTEMS BRANCH, HAWAII STATE DEPARTMENT OF HEALTH EXPERTISE: INJURY PREVENTION & SAFETY DEPUTY DIRECTOR, HEALTH SERVICES, HAWAII STATE DEPARTMENT OF HEALTH EXPERTISE: MENTAL HEALTH & MENTAL DISORDERS ADMINISTRATOR, CAREERSOURCE HAWAII, EXPERTISE: OLDER ADULTS & AGING, TRANSPORTATION HARDY SPOEHR, EXECUTIVE DIRECTOR, PAPA OLA LOKAHI EXPERTISE: ACCESS TO HEALTH SERVICES, SOCIAL ENVIRONMENT EXECUTIVE DIRECTOR, AMERICAN HEART ASSOCIATION, HAWAII CHAPTER EXPERTISE: HEART DISEASE CHIEF STAFF OFFICER, HIGH PLAINS DIVISION, AMERICAN CANCER SOCIETY HAWAII SITE EXPERTISE: CANCER PRESIDENT & CEO, HOSPICE HAWAII EXPERTISE: OLDER ADULTS & AGING FACILITY 2 PALI MOMI MEDICAL CENTER (PMMC) IN CONDUCTING PMMC'S MOST RECENT CHNA, ADOPTED JUNE 2013, INTERVIEWS WERE HELD WITH 17 COMMUNITY REPRESENTATIVES WITH PUBLIC HEALTH EXPERTISE IN THE TOP TEN HEALTH AREAS IDENTIFIED FOR HONOLULU COUNTY AND/OR POSSESSING SPECIAL KNOWLEDGE OF VULNERABLE POPULATIONS, INCLUDING (BUT NOT LIMITED TO) LOW-INCOME, MENTALLY ILL, OR PARTICULAR RACIAL/ETHNIC GROUPS. THE INPUT FROM THE INTERVIEWS WAS TAKEN INTO ACCOUNT IN THE CHNA IN THE FOLLOWING WAYS: A SUMMARY QUALITATIVE ANALYSIS TOOL CALLED A "WORD CLOUD" WAS PRODUCED TO IDENTIFY THE MOST COMMON THEMES AND TOPICS RAISED BY THE COMMUNITY REPRESENTATIVES; AND RELEVANT INPUT WAS SUMMARIZED UNDER EACH HEALTH TOPIC AREA ANALYZED IN THE CHNA AND FACTORED INTO THE QUALITATIVE EVALUATION OF THE HEALTH NEED. IN ADDITION, 2 INDIVIDUALS BROADLY REPRESENTING COMMUNITY HEALTH CONCERNS FOR THE PMMC SERVICE AREA WERE CONSULTED TO VALIDATE THE CHOSEN PRIORITY COMMUNITY HEALTH NEEDS. PERSONS CONSULTED CHIEF OPERATION OFFICER, ALOHA UNITED WAY EXPERTISE: OLDER ADULTS & AGING, SOCIAL ENVIRONMENT PRESIDENT & CEO, YMCA OF HONOLULU EXPERTISE: EXERCISE, NUTRITION, & WEIGHT, OLDER ADULTS & AGING STATE DIRECTOR, HAWAI'I, NUTRITION AND PHYSICAL ACTIVITY COALITION, DEPARTMENT OF EDUCATION EXPERTISE: EXERCISE, NUTRITION, & WEIGHT EXECUTIVE DIRECTOR, KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES EXPERTISE: MATERNAL, FETAL & INFANT HEALTH, SOCIAL ENVIRONMENT DIRECTOR, HAWAII STATE DEPARTMENT OF HEALTH EXPERTISE: SUBSTANCE ABUSE & LIFESTYLE/VALIDATION OF PRIORITIZED HEALTH NEEDS HEALTHCARE TRANSFORMATION OFFICER, OFFICE OF THE GOVERNOR EXPERTISE: ORAL HEALTH EXECUTIVE DIRECTOR, MENTAL HEALTH AMERICA OF HAWAII EXPERTISE: MENTAL HEALTH & MENTAL DISORDERS STATE SENATOR, EXECUTIVE MEDICAL DIRECTOR, HAWAII INDEPENDENT PHYSICIANS ASSOCIATION EMERGENCY ROOM PHYSICIAN EXPERTISE: DIABETES, SUBSTANCE ABUSE & LIFESTYLE CEO, HAWAII PRIMARY CARE ASSOCIATION EXPERTISE: RESPIRATORY DISEASES DIRECTOR, EMERGENCY SERVICES, CITY AND COUNTY OF HONOLULU EXPERTISE: INJURY PREVENTION & SAFETY HEALTHY HAWAII INITIATIVE, TOBACCO SETTLEMENT PROJECT MANAGER, HAWAII STATE DEPARTMENT OF HEALTH EXPERTISE: RESPIRATORY DISEASES PROFESSOR OF OBSTETRICS/GYNECOLOGY, DIRECTOR OF FAMILY PLANNING, JOHN A. BURNS SCHOOL OF MEDICINE, UNIVERSITY OF HAWAII EXPERTISE: FAMILY PLANNING EXECUTIVE DIRECTOR, HALE NA'AU PONO EXPERTISE: MENTAL HEALTH & MENTAL DISORDERS EXECUTIVE DIRECTOR, AMERICAN DIABETES ASSOCIATION HAWAII EXPERTISE: DIABETES ADMINISTRATOR, PEARL CITY NURSING HOME, EXPERTISE: OLDER ADULTS & AGING CHIEF OF MEDICINE, PALI MOMI MEDICAL CENTER EXPERTISE: INJURY PREVENTION & SAFETY CEO, KAMEHAMEHA SCHOOLS, EXPERTISE: EDUCATION/VALIDATION OF PRIORITIZED HEALTH NEEDS PROFESSOR AND CHAIR OF PEDIATRICS, JOHN A. BURNS SCHOOL OF MEDICINE, UNIVERSITY OF HAWAII, MEDICAL DIRECTOR, KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN EXPERTISE: IMMUNIZATIONS & INFECTIOUS DISEASES CHIEF MEDICAL OFFICER, ALOHA CARE EXPERTISE: ACCESS TO HEALTH SERVICES, SOCIAL ENVIRONMENT DIRECTOR, HAWAII INITIATIVE FOR CHILDHOOD OBESITY RESEARCH AND EDUCATION, JOHN A. BURNS SCHOOL OF MEDICINE DEPARTMENT OF PEDIATRICS, UNIVERSITY OF HAWAII EXPERTISE: ACCESS TO HEALTH SERVICES, EXERCISE, NUTRITION, & WEIGHT CHIEF MEDICAL OFFICER, HAWAII MEDICAL SERVICE ASSOCIATION EXPERTISE: MATERNAL, FETAL & INFANT HEALTH, OLDER ADULTS & AGING DIRECTOR, HILOPA'A FAMILY TO FAMILY HEALTH INFORMATION CENTER EXPERTISE: IMMUNIZATIONS & INFECTIOUS DISEASES CHIEF, EMERGENCY MEDICAL SERVICES AND INJURY PREVENTION SYSTEMS BRANCH, HAWAII STATE DEPARTMENT OF HEALTH EXPERTISE: INJURY PREVENTION & SAFETY ADMINISTRATOR, CARERESOURCE HAWAII EXPERTISE: TRANSPORTATION EXECUTIVE DIRECTOR, ST. FRANCIS HOME HEALTH CARE SERVICES EXPERTISE: CANCER, OLDER ADULTS & AGING RESEARCH DIRECTOR, PAPA OLA LOKAHI EXPERTISE: CANCER, HEART DISEASE & STROKE FACILITY 3 STRAUB CLINIC AND HOSPITAL (STRAUB) IN CONDUCTING STRAUB'S MOST RECENT CHNA, ADOPTED JUNE 2013, INTERVIEWS WERE HELD WITH 22 COMMUNITY REPRESENTATIVES WITH PUBLIC HEALTH EXPERTISE IN THE TOP TEN HEALTH TOPIC AREAS IDENTIFIED FOR THE STATE OF HAWAI'I AND/OR POSSESSING SPECIAL KNOWLEDGE OF VULNERABLE POPULATIONS, INCLUDING (BUT NOT LIMITED TO) LOW-INCOME, MENTALLY ILL, OR PARTICULAR RACIAL/ETHNIC GROUPS. THE INPUT FROM THE INTERVIEWS WAS TAKEN INTO ACCOUNT IN THE CHNA IN THE FOLLOWING WAYS: A SUMMARY QUALITATIVE ANALYSIS TOOL CALLED A "WORD CLOUD" WAS PRODUCED TO IDENTIFY THE MOST COMMON THEMES AND TOPICS RAISED BY THE COMMUNITY REPRESENTATIVES; AND RELEVANT INPUT WAS SUMMARIZED UNDER EACH HEALTH TOPIC AREA ANALYZED IN THE CHNA AND FACTORED INTO THE QUALITATIVE EVALUATION OF THE HEALTH NEED. IN ADDITION, 2 COMMUNITY LEADERS BROADLY REPRESENTING COMMUNITY HEALTH CONCERNS FOR THE STRAUB SERVICE AREA WERE CONSULTED TO VALIDATE THE CHOSEN PRIORITY COMMUNITY HEALTH NEEDS: DIRECTOR OF THE HAWAII DEPARTMENT OF HEALTH, AND A STATE SENATOR. PERSONS CONSULTED STATE DIRECTOR, HAWAII NUTRITION AND PHYSICAL ACTIVITY COALITION, DEPARTMENT OF EDUCATION EXPERTISE: EXERCISE, NUTRITION & WEIGHT DEPUTY DIRECTOR, BEHAVIORAL HEALTH SERVICES ADMINISTRATION, HAWAII DEPARTMENT OF HEALTH EXPERTISE: MENTAL HEALTH & MENTAL DISORDER
SCHEDULE H, PART V, LINE 4 THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED COLLABORATIVELY BY THE FOLLOWING FACILITIES: KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN PALI MOMI MEDICAL CENTER STRAUB CLINIC & HOSPITAL WILCOX MEMORIAL HOSPITAL
SCHEDULE H, PART V, LINE 5 COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN HTTPS://WWW.HAWAIIPACIFICHEALTH.ORG/MEDIA/1716/CHNA-KAPIOLANI.PDF PALI MOMI MEDICAL CENTER HTTPS://WWW.HAWAIIPACIFICHEALTH.ORG/MEDIA/1718/CHNA-PALIMOMI.PDF STRAUB CLINIC & HOSPITAL HTTPS://WWW.HAWAIIPACIFICHEALTH.ORG/MEDIA/1715/CHNA-STRAUB.PDF WILCOX MEMORIAL HOSPITAL HTTPS://WWW.HAWAIIPACIFICHEALTH.ORG/MEDIA/1709/CHNA-WILCOX.PDF
SCHEDULE H, PART V, LINE 7 NEEDS NOT ADDRESSED IN MOST RECENTLY CONDUCTED CHNA KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN THE FOLLOWING AREAS OF NEED IDENTIFIED IN KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN'S 2013 CHNA ARE NOT BEING ADDRESSED IN ITS CURRENT IMPLEMENTATION STRATEGY BECAUSE THEY WERE NOT SELECTED AS THE HIGHEST PRIORITY FOR KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN, BASED ON THE FOLLOWING CRITERIA: MAGNITUDE/SEVERITY OF PROBLEM, OPPORTUNITY TO INTERVENE AT PREVENTION LEVEL, ALIGNMENT WITH KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN'S MISSION/STRENGTHS/ PROGRAMS, OPPORTUNITY FOR PARTNERSHIP, SOLUTION COULD IMPACT MULTIPLE PROBLEMS, FEASIBILITY OF CHANGE, AND IMPORTANCE OF PROBLEM TO COMMUNITY. CANCER DIABETES DISABILITIES ECONOMY EDUCATION ENVIRONMENT EXERCISE, NUTRITION, & WEIGHT FAMILY PLANNING HEART DISEASE & STROKE IMMUNIZATIONS & INFECTIOUS DISEASES INJURY PREVENTION & SAFETY MENTAL HEALTH & MENTAL DISORDERS OLDER ADULTS & AGING ORAL HEALTH RESPIRATORY DISEASES SOCIAL ENVIRONMENT SUBSTANCE ABUSE & LIFESTYLE TRANSPORTATION KAPI'OLANI MEDICAL CENTER CONTINUES TO REFINE ITS IMPLEMENTATION STRATEGY THROUGH THE EXPLORATION OF NEW PROGRAMS, ENHANCEMENTS TO CURRENT PROGRAMS, AND IDENTIFICATION OF NEW PARTNERSHIPS THAT CAN STRENGTHEN THE IMPACT OF KAPI'OLANI'S COMMUNITY HEALTH IMPROVEMENT EFFORTS. PALI MOMI MEDICAL CENTER THE FOLLOWING AREAS OF NEED IDENTIFIED IN PALI MOMI MEDICAL CENTER'S 2013 CHNA ARE NOT BEING ADDRESSED IN ITS CURRENT IMPLEMENTATION STRATEGY BECAUSE THEY WERE NOT SELECTED AS THE HIGHEST PRIORITY FOR PALI MOMI MEDICAL CENTER, BASED ON THE FOLLOWING CRITERIA: PALI MOMI MEDICAL CENTER'S COMMUNITY BENEFIT RESOURCES AND EXPERTISE, MAGNITUDE/SEVERITY OF PROBLEM, OPPORTUNITY TO INTERVENE AT PREVENTION LEVEL, SOLUTION COULD IMPACT MULTIPLE PROBLEMS, FEASIBILITY OF CHANGE, AND IMPORTANCE OF PROBLEM TO COMMUNITY. ACCESS TO HEALTH SERVICES CANCER DIABETES DISABILITIES ECONOMY EDUCATION ENVIRONMENT FAMILY PLANNING IMMUNIZATIONS & INFECTIOUS DISEASES INJURY PREVENTION & SAFETY MATERNAL, FETAL & INFANT HEALTH MENTAL HEALTH & MENTAL DISORDERS OLDER ADULTS & AGING ORAL HEALTH RESPIRATORY DISEASES SOCIAL ENVIRONMENT SUBSTANCE ABUSE & LIFESTYLE TRANSPORTATION PALI MOMI MEDICAL CENTER CONTINUES TO REFINE ITS IMPLEMENTATION STRATEGY THROUGH THE EXPLORATION OF NEW PROGRAMS, ENHANCEMENTS TO CURRENT PROGRAMS, AND IDENTIFICATION OF NEW PARTNERSHIPS THAT CAN STRENGTHEN THE IMPACT OF PALI MOMI'S COMMUNITY HEALTH IMPROVEMENT EFFORTS. STRAUB CLINIC & HOSPITAL THE FOLLOWING AREAS OF NEED IDENTIFIED IN STRAUB HOSPITAL AND CLINIC'S 2013 CHNA ARE NOT BEING ADDRESSED IN ITS CURRENT IMPLEMENTATION STRATEGY BECAUSE THEY WERE NOT SELECTED AS THE HIGHEST PRIORITIES FOR STRAUB, BASED ON THE FOLLOWING CRITERIA: STRAUB CLINIC AND HOSPITAL'S COMMUNITY BENEFIT RESOURCES AND EXPERTISE, MAGNITUDE/SEVERITY OF PROBLEM, OPPORTUNITY TO INTERVENE AT PREVENTION LEVEL, SOLUTION COULD IMPACT MULTIPLE PROBLEMS, FEASIBILITY OF CHANGE, AND IMPORTANCE OF PROBLEM TO COMMUNITY. IT IS EXPECTED THAT THE TWO PRIORITIES THAT WERE SELECTED WILL INCORPORATE ACTIVITIES THAT HAVE IMPACT ON MULTIPLE TOPIC AREAS, INCLUDING CANCER, DIABETES, EXERCISE, NUTRITION, AND WEIGHT, AND RESPIRATORY DISEASE. CANCER DIABETES DISABILITIES ECONOMY EDUCATION ENVIRONMENT EXERCISE, NUTRITION & WEIGHT FAMILY PLANNING IMMUNIZATIONS & INFECTIOUS DISEASES INJURY PREVENTION & SAFETY MATERNAL, FETAL & INFANT HEALTH MENTAL HEALTH & MENTAL DISORDERS OLDER ADULTS & AGING ORAL HEALTH RESPIRATORY DISEASES SOCIAL ENVIRONMENT SUBSTANCE ABUSE & LIFESTYLE TRANSPORTATION STRAUB CLINIC & HOSPITAL CONTINUES TO REFINE ITS IMPLEMENTATION STRATEGY THROUGH THE EXPLORATION OF NEW PROGRAMS, ENHANCEMENTS TO CURRENT PROGRAMS, AND IDENTIFICATION OF NEW PARTNERSHIPS THAT CAN STRENGTHEN THE IMPACT OF STRAUB'S COMMUNITY HEALTH IMPROVEMENT EFFORTS. WILCOX MEMORIAL HOSPITAL THE FOLLOWING AREAS OF NEED IDENTIFIED IN WILCOX MEMORIAL HOSPITAL'S 2013 CHNA ARE NOT BEING ADDRESSED IN ITS CURRENT IMPLEMENTATION STRATEGY, BECAUSE THEY WERE NOT SELECTED AS PRIORITIES FOR WILCOX BASED ON THE FOLLOWING CRITERIA: WILCOX MEMORIAL HOSPITAL'S CURRENT COMMUNITY BENEFIT RESOURCES AND AREAS OF EXPERTISE, MAGNITUDE/SEVERITY OF PROBLEM, OPPORTUNITY TO INTERVENE AT PREVENTION LEVEL, OPPORTUNITY FOR PARTNERSHIP, SOLUTION COULD IMPACT MULTIPLE PROBLEMS, FEASIBILITY OF CHANGE, AND IMPORTANCE OF PROBLEM TO COMMUNITY. IT IS EXPECTED THAT THE TWO PRIORITIES THAT WERE SELECTED WILL INCORPORATE ACTIVITIES THAT HAVE IMPACT ON MULTIPLE TOPIC AREAS, INCLUDING CANCER, DIABETES, HEART DISEASE, STROKE AND IMMUNIZATIONS & INFECTIOUS DISEASES. CANCER DIABETES DISABILITIES ECONOMY EDUCATION ENVIRONMENT FAMILY PLANNING HEART DISEASE & STROKE IMMUNIZATIONS & INFECTIOUS DISEASES INJURY PREVENTION & SAFETY MATERNAL, FETAL & INFANT HEALTH MENTAL HEALTH OLDER ADULTS & AGING ORAL HEALTH RESPIRATORY DISEASES SOCIAL ENVIRONMENT SUBSTANCE ABUSE & LIFESTYLE TRANSPORTATION WILCOX MEMORIAL HOSPITAL CONTINUES TO REFINE ITS IMPLEMENTATION STRATEGY THROUGH THE EXPLORATION OF NEW PROGRAMS, ENHANCEMENTS TO CURRENT PROGRAMS, AND IDENTIFICATION OF NEW PARTNERSHIPS THAT CAN STRENGTHEN THE IMPACT OF WILCOX'S COMMUNITY HEALTH IMPROVEMENT EFFORTS.
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, FINANCIAL 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 21 POSSIBLE FOR PARTIAL FINANCIAL ASSISTANCE PATIENTS, DEPENDING ON THE SIZE OF THE ACCOUNT, THE SERVICES PROVIDED, AND THE DISCOUNT PERCENTAGE FOR THE PATIENT.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. 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?20
Name and address Type of Facility (describe)
1 PEARLRIDGE CLINIC
98-151 PALI MOMI STREET
AIEA,HI96701 		CLINIC
2 PALI MOMI PAVILLIONWOMEN'S CENTER
98-1005 MOANALUA RD FS2
AEIA,HI96701 		CLINIC
3 KAPI'OLANI WOMEN'S CENTER
1907 BERETANIA STREET
HONOLULU,HI96826 		CLINIC
4 MILILANI CLINIC
95-1249 MEHEULA PKWY UNIT 187
MILILANI,HI96789 		CLINIC
5 HAWAI'I KAI CLINIC
7192 KALANIANAOLE HIGHWAY STE A200
HONOLULU,HI96825 		CLINIC
6 DOCS ON CALL-PRINCESS KAIULANI HOTEL
120 KAIULANI AVE LOBBY LEVEL
HONOLULU,HI96815 		CLINIC
7 WINDWARD MALL CLINIC
46-056 KAMEHAMEHA HWY SUITE 221
KANEOHE,HI96744 		CLINIC
8 PALI MOMI CLINIC
98-1079 MOANALUA ROAD STE 640/630/
AIEA,HI96701 		CLINIC
9 KAILUA CLINIC
602 KAILUA ROAD SUITE 200
KAILUA,HI96734 		CLINIC
10 LANAI CLINIC
628-B SEVENTH STREET
LANAI CITY,HI96763 		CLINIC
11 KONA CLINIC
75-240 NANI KAILUA DRIVE STE 6B
KAILUAKONA,HI96740 		CLINIC
12 ARTESIAN SATELLITE
1907 BERETANIA ST 5TH FLOOR
HONOLULU,HI96826 		CLINIC
13 RESTAURANT ROW CLINIC
500 ALA MOANA BLVD TOWER 7 STE 23
HONOLULU,HI96813 		CLINIC
14 DOCS ON CALL-HILTON HAWAIIAN VILLAGE
2005 KALIA ROAD 2ND FLOOR
HONOLULU,HI96815 		CLINIC
15 KAPOLEI CLINIC
590 FARRINGTTON HIGHWAY STTE 526A
KAPOLEI,HI96707 		CLINIC
16 KUAKINI CLINIC
321 NORTH KUAKINI STREET STE 504
HONOLULU,HI96817 		CLINIC
17 HILO CLINIC
75 PUUHONU PLACE STTE 207
HILO,HI96720 		CLINIC
18 KAPI'OLANI HAWAI'I COMMUNITY GENETICS
1441 KAPIOLANI BLVD 18TH FLOOR
HONOLULU,HI96814 		CLINIC
19 WINDWARD HEART CENTER
25 MALUNIU AVE SUITE 201
KAILUA,HI96734 		CLINIC
20 STRAUB'S WOMEN SERVICES
1319 PUNAHOU ST SUITE 520
HONOLULU,HI96826 		CLINIC
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
SCHEDULE H, PART V, LINE 3 FACILITY 1 KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN (KMCWC) IN CONDUCTING KMCWC'S MOST RECENT CHNA, ADOPTED JUNE 2013, INTERVIEWS WERE HELD WITH 22 COMMUNITY REPRESENTATIVES WITH PUBLIC HEALTH EXPERTISE IN THE TOP TEN HEALTH AREAS IDENTIFIED FOR WOMEN AND CHILDREN IN THE STATE OF HAWAI'I AND/OR POSSESSING SPECIAL KNOWLEDGE OF VULNERABLE POPULATIONS, INCLUDING (BUT NOT LIMITED TO) LOW-INCOME, MENTALLY ILL, OR PARTICULAR RACIAL/ETHNIC GROUPS. THE INPUT FROM THE INTERVIEWS WAS TAKEN INTO ACCOUNT IN THE CHNA IN THE FOLLOWING WAYS: A SUMMARY QUALITATIVE ANALYSIS TOOL CALLED A "WORD CLOUD" WAS PRODUCED TO IDENTIFY THE MOST COMMON THEMES AND TOPICS RAISED BY THE COMMUNITY REPRESENTATIVES; AND RELEVANT INPUT WAS SUMMARIZED UNDER EACH HEALTH TOPIC AREA ANALYZED IN THE CHNA AND FACTORED INTO THE QUALITATIVE EVALUATION OF THE HEALTH NEED. IN ADDITION, 3 COMMUNITY LEADERS BROADLY REPRESENTING COMMUNITY HEALTH ISSUES FOR THE KMCWC SERVICE AREA WERE CONSULTED TO VALIDATE THE CHOSEN PRIORITY COMMUNITY HEALTH NEEDS. PERSONS CONSULTED STATE DIRECTOR, HAWAII NUTRITION AND PHYSICAL ACTIVITY COALITION, DEPARTMENT OF EDUCATION EXPERTISE: EXERCISE, NUTRITION & WEIGHT DEPUTY DIRECTOR, BEHAVIORAL HEALTH SERVICES ADMINISTRATION, HAWAII DEPARTMENT OF HEALTH EXPERTISE: MENTAL HEALTH & MENTAL DISORDERS ADMINISTRATOR, DEPARTMENT OF HUMAN SERVICES, MED-QUEST DIVISION EXPERTISE: ACCESS TO HEALTH SERVICES DIRECTOR, HAWAII STATE DEPARTMENT OF HEALTH EXPERTISE: MENTAL HEALTH & MENTAL DISORDERS, SUBSTANCE ABUSE/VALIDATION OF PRIORITIZED HEALTH NEEDS HEALTHCARE TRANSFORMATION OFFICER, OFFICE OF THE GOVERNOR EXPERTISE: ACCESS TO HEALTH SERVICES, ORAL HEALTH/VALIDATION OF PRIORITIZED HEALTH NEEDS STATE SENATOR, EXECUTIVE MEDICAL DIRECTOR, HAWAII INDEPENDENT PHYSICIANS ASSOCIATION, EMERGENCY ROOM PHYSICIAN. EXPERTISE: DIABETES, SUBSTANCE ABUSE CEO, HAWAII PRIMARY CARE ASSOCIATION EXPERTISE: RESPIRATORY DISEASE, SOCIAL ENVIRONMENT HEALTHY HAWAII INITIATIVE, TOBACCO SETTLEMENT PROJECT MANAGER, HAWAII DEPARTMENT OF HEALTH EXPERTISE: CANCER, EXERCISE, NUTRITION & WEIGHT, RESPIRATORY DISEASE PROFESSOR OF OBSTETRICS/GYNECOLOGY, DIRECTOR OF FAMILY PLANNING, JOHN A. BURNS SCHOOL OF MEDICINE, UNIVERSITY OF HAWAI'I EXPERTISE: FAMILY PLANNING EXECUTIVE DIRECTOR, AMERICAN DIABETES ASSOCIATION HAWAI'I EXPERTISE: DIABETES CEO, KAMEHAMEHA SCHOOLS EXPERTISE: EDUCATION/VALIDATION OF PRIORITIZED HEALTH NEEDS SUPERINTENDENT OF EDUCATION, HAWAII STATE DEPARTMENT OF EDUCATION EXPERTISE: MENTAL HEALTH & MENTAL DISORDERS DIRECTOR, MOUNTAIN-PACIFIC QUALITY HEALTH EXPERTISE: HEART DISEASE, OLDER ADULTS & AGING DIRECTOR, HAWAII INITIATIVE FOR CHILDHOOD OBESITY RESEARCH AND EDUCATION, JOHN A. BURNS SCHOOL OF MEDICINE, PEDIATRICS, UNIVERSITY OF HAWAII EXPERTISE: EXERCISE, NUTRITION & WEIGHT CHIEF MEDICAL OFFICER, HAWAII MEDICAL SERVICE ASSOCIATION EXPERTISE: MATERNAL, FETAL & INFANT HEALTH PROFESSOR, JOHN A. BURNS SCHOOL OF MEDICINE, UNIVERSITY OF HAWAI'I EXPERTISE: ACCESS TO HEALTH SERVICES, CANCER CHIEF, DISEASE OUTBREAK CONTROL DIVISION, DEPARTMENT OF HEALTH EXPERTISE: IMMUNIZATIONS & INFECTIOUS DISEASE CHIEF, EMERGENCY MEDICAL SERVICES AND INJURY PREVENTION SYSTEMS BRANCH, HAWAII STATE DEPARTMENT OF HEALTH EXPERTISE: INJURY PREVENTION & SAFETY DEPUTY DIRECTOR, HEALTH SERVICES, HAWAII STATE DEPARTMENT OF HEALTH EXPERTISE: MENTAL HEALTH & MENTAL DISORDERS ADMINISTRATOR, CAREERSOURCE HAWAII, EXPERTISE: OLDER ADULTS & AGING, TRANSPORTATION HARDY SPOEHR, EXECUTIVE DIRECTOR, PAPA OLA LOKAHI EXPERTISE: ACCESS TO HEALTH SERVICES, SOCIAL ENVIRONMENT EXECUTIVE DIRECTOR, AMERICAN HEART ASSOCIATION, HAWAII CHAPTER EXPERTISE: HEART DISEASE CHIEF STAFF OFFICER, HIGH PLAINS DIVISION, AMERICAN CANCER SOCIETY HAWAII SITE EXPERTISE: CANCER PRESIDENT & CEO, HOSPICE HAWAII EXPERTISE: OLDER ADULTS & AGING FACILITY 2 PALI MOMI MEDICAL CENTER (PMMC) IN CONDUCTING PMMC'S MOST RECENT CHNA, ADOPTED JUNE 2013, INTERVIEWS WERE HELD WITH 17 COMMUNITY REPRESENTATIVES WITH PUBLIC HEALTH EXPERTISE IN THE TOP TEN HEALTH AREAS IDENTIFIED FOR HONOLULU COUNTY AND/OR POSSESSING SPECIAL KNOWLEDGE OF VULNERABLE POPULATIONS, INCLUDING (BUT NOT LIMITED TO) LOW-INCOME, MENTALLY ILL, OR PARTICULAR RACIAL/ETHNIC GROUPS. THE INPUT FROM THE INTERVIEWS WAS TAKEN INTO ACCOUNT IN THE CHNA IN THE FOLLOWING WAYS: A SUMMARY QUALITATIVE ANALYSIS TOOL CALLED A "WORD CLOUD" WAS PRODUCED TO IDENTIFY THE MOST COMMON THEMES AND TOPICS RAISED BY THE COMMUNITY REPRESENTATIVES; AND RELEVANT INPUT WAS SUMMARIZED UNDER EACH HEALTH TOPIC AREA ANALYZED IN THE CHNA AND FACTORED INTO THE QUALITATIVE EVALUATION OF THE HEALTH NEED. IN ADDITION, 2 INDIVIDUALS BROADLY REPRESENTING COMMUNITY HEALTH CONCERNS FOR THE PMMC SERVICE AREA WERE CONSULTED TO VALIDATE THE CHOSEN PRIORITY COMMUNITY HEALTH NEEDS. PERSONS CONSULTED CHIEF OPERATION OFFICER, ALOHA UNITED WAY EXPERTISE: OLDER ADULTS & AGING, SOCIAL ENVIRONMENT PRESIDENT & CEO, YMCA OF HONOLULU EXPERTISE: EXERCISE, NUTRITION, & WEIGHT, OLDER ADULTS & AGING STATE DIRECTOR, HAWAI'I, NUTRITION AND PHYSICAL ACTIVITY COALITION, DEPARTMENT OF EDUCATION EXPERTISE: EXERCISE, NUTRITION, & WEIGHT EXECUTIVE DIRECTOR, KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES EXPERTISE: MATERNAL, FETAL & INFANT HEALTH, SOCIAL ENVIRONMENT DIRECTOR, HAWAII STATE DEPARTMENT OF HEALTH EXPERTISE: SUBSTANCE ABUSE & LIFESTYLE/VALIDATION OF PRIORITIZED HEALTH NEEDS HEALTHCARE TRANSFORMATION OFFICER, OFFICE OF THE GOVERNOR EXPERTISE: ORAL HEALTH EXECUTIVE DIRECTOR, MENTAL HEALTH AMERICA OF HAWAII EXPERTISE: MENTAL HEALTH & MENTAL DISORDERS STATE SENATOR, EXECUTIVE MEDICAL DIRECTOR, HAWAII INDEPENDENT PHYSICIANS ASSOCIATION EMERGENCY ROOM PHYSICIAN EXPERTISE: DIABETES, SUBSTANCE ABUSE & LIFESTYLE CEO, HAWAII PRIMARY CARE ASSOCIATION EXPERTISE: RESPIRATORY DISEASES DIRECTOR, EMERGENCY SERVICES, CITY AND COUNTY OF HONOLULU EXPERTISE: INJURY PREVENTION & SAFETY HEALTHY HAWAII INITIATIVE, TOBACCO SETTLEMENT PROJECT MANAGER, HAWAII STATE DEPARTMENT OF HEALTH EXPERTISE: RESPIRATORY DISEASES PROFESSOR OF OBSTETRICS/GYNECOLOGY, DIRECTOR OF FAMILY PLANNING, JOHN A. BURNS SCHOOL OF MEDICINE, UNIVERSITY OF HAWAII EXPERTISE: FAMILY PLANNING EXECUTIVE DIRECTOR, HALE NA'AU PONO EXPERTISE: MENTAL HEALTH & MENTAL DISORDERS EXECUTIVE DIRECTOR, AMERICAN DIABETES ASSOCIATION HAWAII EXPERTISE: DIABETES ADMINISTRATOR, PEARL CITY NURSING HOME, EXPERTISE: OLDER ADULTS & AGING CHIEF OF MEDICINE, PALI MOMI MEDICAL CENTER EXPERTISE: INJURY PREVENTION & SAFETY CEO, KAMEHAMEHA SCHOOLS, EXPERTISE: EDUCATION/VALIDATION OF PRIORITIZED HEALTH NEEDS PROFESSOR AND CHAIR OF PEDIATRICS, JOHN A. BURNS SCHOOL OF MEDICINE, UNIVERSITY OF HAWAII, MEDICAL DIRECTOR, KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN EXPERTISE: IMMUNIZATIONS & INFECTIOUS DISEASES CHIEF MEDICAL OFFICER, ALOHA CARE EXPERTISE: ACCESS TO HEALTH SERVICES, SOCIAL ENVIRONMENT DIRECTOR, HAWAII INITIATIVE FOR CHILDHOOD OBESITY RESEARCH AND EDUCATION, JOHN A. BURNS SCHOOL OF MEDICINE DEPARTMENT OF PEDIATRICS, UNIVERSITY OF HAWAII EXPERTISE: ACCESS TO HEALTH SERVICES, EXERCISE, NUTRITION, & WEIGHT CHIEF MEDICAL OFFICER, HAWAII MEDICAL SERVICE ASSOCIATION EXPERTISE: MATERNAL, FETAL & INFANT HEALTH, OLDER ADULTS & AGING DIRECTOR, HILOPA'A FAMILY TO FAMILY HEALTH INFORMATION CENTER EXPERTISE: IMMUNIZATIONS & INFECTIOUS DISEASES CHIEF, EMERGENCY MEDICAL SERVICES AND INJURY PREVENTION SYSTEMS BRANCH, HAWAII STATE DEPARTMENT OF HEALTH EXPERTISE: INJURY PREVENTION & SAFETY ADMINISTRATOR, CARERESOURCE HAWAII EXPERTISE: TRANSPORTATION EXECUTIVE DIRECTOR, ST. FRANCIS HOME HEALTH CARE SERVICES EXPERTISE: CANCER, OLDER ADULTS & AGING RESEARCH DIRECTOR, PAPA OLA LOKAHI EXPERTISE: CANCER, HEART DISEASE & STROKE FACILITY 3 STRAUB CLINIC AND HOSPITAL (STRAUB) IN CONDUCTING STRAUB'S MOST RECENT CHNA, ADOPTED JUNE 2013, INTERVIEWS WERE HELD WITH 22 COMMUNITY REPRESENTATIVES WITH PUBLIC HEALTH EXPERTISE IN THE TOP TEN HEALTH TOPIC AREAS IDENTIFIED FOR THE STATE OF HAWAI'I AND/OR POSSESSING SPECIAL KNOWLEDGE OF VULNERABLE POPULATIONS, INCLUDING (BUT NOT LIMITED TO) LOW-INCOME, MENTALLY ILL, OR PARTICULAR RACIAL/ETHNIC GROUPS. THE INPUT FROM THE INTERVIEWS WAS TAKEN INTO ACCOUNT IN THE CHNA IN THE FOLLOWING WAYS: A SUMMARY QUALITATIVE ANALYSIS TOOL CALLED A "WORD CLOUD" WAS PRODUCED TO IDENTIFY THE MOST COMMON THEMES AND TOPICS RAISED BY THE COMMUNITY REPRESENTATIVES; AND RELEVANT INPUT WAS SUMMARIZED UNDER EACH HEALTH TOPIC AREA ANALYZED IN THE CHNA AND FACTORED INTO THE QUALITATIVE EVALUATION OF THE HEALTH NEED. IN ADDITION, 2 COMMUNITY LEADERS BROADLY REPRESENTING COMMUNITY HEALTH CONCERNS FOR THE STRAUB SERVICE AREA WERE CONSULTED TO VALIDATE THE CHOSEN PRIORITY COMMUNITY HEALTH NEEDS: DIRECTOR OF THE HAWAII DEPARTMENT OF HEALTH, AND A STATE SENATOR. PERSONS CONSULTED STATE DIRECTOR, HAWAII NUTRITION AND PHYSICAL ACTIVITY COALITION, DEPARTMENT OF EDUCATION EXPERTISE: EXERCISE, NUTRITION & WEIGHT DEPUTY DIRECTOR, BEHAVIORAL HEALTH SERVICES ADMINISTRATION, HAWAII DEPARTMENT OF HEALTH EXPERTISE: MENTAL HEALTH & MENTAL DISORDER
SCHEDULE H, PART V, LINE 4 THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED COLLABORATIVELY BY THE FOLLOWING FACILITIES: KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN PALI MOMI MEDICAL CENTER STRAUB CLINIC & HOSPITAL WILCOX MEMORIAL HOSPITAL
SCHEDULE H, PART V, LINE 5 COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN HTTPS://WWW.HAWAIIPACIFICHEALTH.ORG/MEDIA/1716/CHNA-KAPIOLANI.PDF PALI MOMI MEDICAL CENTER HTTPS://WWW.HAWAIIPACIFICHEALTH.ORG/MEDIA/1718/CHNA-PALIMOMI.PDF STRAUB CLINIC & HOSPITAL HTTPS://WWW.HAWAIIPACIFICHEALTH.ORG/MEDIA/1715/CHNA-STRAUB.PDF WILCOX MEMORIAL HOSPITAL HTTPS://WWW.HAWAIIPACIFICHEALTH.ORG/MEDIA/1709/CHNA-WILCOX.PDF
SCHEDULE H, PART V, LINE 7 NEEDS NOT ADDRESSED IN MOST RECENTLY CONDUCTED CHNA KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN THE FOLLOWING AREAS OF NEED IDENTIFIED IN KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN'S 2013 CHNA ARE NOT BEING ADDRESSED IN ITS CURRENT IMPLEMENTATION STRATEGY BECAUSE THEY WERE NOT SELECTED AS THE HIGHEST PRIORITY FOR KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN, BASED ON THE FOLLOWING CRITERIA: MAGNITUDE/SEVERITY OF PROBLEM, OPPORTUNITY TO INTERVENE AT PREVENTION LEVEL, ALIGNMENT WITH KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN'S MISSION/STRENGTHS/ PROGRAMS, OPPORTUNITY FOR PARTNERSHIP, SOLUTION COULD IMPACT MULTIPLE PROBLEMS, FEASIBILITY OF CHANGE, AND IMPORTANCE OF PROBLEM TO COMMUNITY. CANCER DIABETES DISABILITIES ECONOMY EDUCATION ENVIRONMENT EXERCISE, NUTRITION, & WEIGHT FAMILY PLANNING HEART DISEASE & STROKE IMMUNIZATIONS & INFECTIOUS DISEASES INJURY PREVENTION & SAFETY MENTAL HEALTH & MENTAL DISORDERS OLDER ADULTS & AGING ORAL HEALTH RESPIRATORY DISEASES SOCIAL ENVIRONMENT SUBSTANCE ABUSE & LIFESTYLE TRANSPORTATION KAPI'OLANI MEDICAL CENTER CONTINUES TO REFINE ITS IMPLEMENTATION STRATEGY THROUGH THE EXPLORATION OF NEW PROGRAMS, ENHANCEMENTS TO CURRENT PROGRAMS, AND IDENTIFICATION OF NEW PARTNERSHIPS THAT CAN STRENGTHEN THE IMPACT OF KAPI'OLANI'S COMMUNITY HEALTH IMPROVEMENT EFFORTS. PALI MOMI MEDICAL CENTER THE FOLLOWING AREAS OF NEED IDENTIFIED IN PALI MOMI MEDICAL CENTER'S 2013 CHNA ARE NOT BEING ADDRESSED IN ITS CURRENT IMPLEMENTATION STRATEGY BECAUSE THEY WERE NOT SELECTED AS THE HIGHEST PRIORITY FOR PALI MOMI MEDICAL CENTER, BASED ON THE FOLLOWING CRITERIA: PALI MOMI MEDICAL CENTER'S COMMUNITY BENEFIT RESOURCES AND EXPERTISE, MAGNITUDE/SEVERITY OF PROBLEM, OPPORTUNITY TO INTERVENE AT PREVENTION LEVEL, SOLUTION COULD IMPACT MULTIPLE PROBLEMS, FEASIBILITY OF CHANGE, AND IMPORTANCE OF PROBLEM TO COMMUNITY. ACCESS TO HEALTH SERVICES CANCER DIABETES DISABILITIES ECONOMY EDUCATION ENVIRONMENT FAMILY PLANNING IMMUNIZATIONS & INFECTIOUS DISEASES INJURY PREVENTION & SAFETY MATERNAL, FETAL & INFANT HEALTH MENTAL HEALTH & MENTAL DISORDERS OLDER ADULTS & AGING ORAL HEALTH RESPIRATORY DISEASES SOCIAL ENVIRONMENT SUBSTANCE ABUSE & LIFESTYLE TRANSPORTATION PALI MOMI MEDICAL CENTER CONTINUES TO REFINE ITS IMPLEMENTATION STRATEGY THROUGH THE EXPLORATION OF NEW PROGRAMS, ENHANCEMENTS TO CURRENT PROGRAMS, AND IDENTIFICATION OF NEW PARTNERSHIPS THAT CAN STRENGTHEN THE IMPACT OF PALI MOMI'S COMMUNITY HEALTH IMPROVEMENT EFFORTS. STRAUB CLINIC & HOSPITAL THE FOLLOWING AREAS OF NEED IDENTIFIED IN STRAUB HOSPITAL AND CLINIC'S 2013 CHNA ARE NOT BEING ADDRESSED IN ITS CURRENT IMPLEMENTATION STRATEGY BECAUSE THEY WERE NOT SELECTED AS THE HIGHEST PRIORITIES FOR STRAUB, BASED ON THE FOLLOWING CRITERIA: STRAUB CLINIC AND HOSPITAL'S COMMUNITY BENEFIT RESOURCES AND EXPERTISE, MAGNITUDE/SEVERITY OF PROBLEM, OPPORTUNITY TO INTERVENE AT PREVENTION LEVEL, SOLUTION COULD IMPACT MULTIPLE PROBLEMS, FEASIBILITY OF CHANGE, AND IMPORTANCE OF PROBLEM TO COMMUNITY. IT IS EXPECTED THAT THE TWO PRIORITIES THAT WERE SELECTED WILL INCORPORATE ACTIVITIES THAT HAVE IMPACT ON MULTIPLE TOPIC AREAS, INCLUDING CANCER, DIABETES, EXERCISE, NUTRITION, AND WEIGHT, AND RESPIRATORY DISEASE. CANCER DIABETES DISABILITIES ECONOMY EDUCATION ENVIRONMENT EXERCISE, NUTRITION & WEIGHT FAMILY PLANNING IMMUNIZATIONS & INFECTIOUS DISEASES INJURY PREVENTION & SAFETY MATERNAL, FETAL & INFANT HEALTH MENTAL HEALTH & MENTAL DISORDERS OLDER ADULTS & AGING ORAL HEALTH RESPIRATORY DISEASES SOCIAL ENVIRONMENT SUBSTANCE ABUSE & LIFESTYLE TRANSPORTATION STRAUB CLINIC & HOSPITAL CONTINUES TO REFINE ITS IMPLEMENTATION STRATEGY THROUGH THE EXPLORATION OF NEW PROGRAMS, ENHANCEMENTS TO CURRENT PROGRAMS, AND IDENTIFICATION OF NEW PARTNERSHIPS THAT CAN STRENGTHEN THE IMPACT OF STRAUB'S COMMUNITY HEALTH IMPROVEMENT EFFORTS. WILCOX MEMORIAL HOSPITAL THE FOLLOWING AREAS OF NEED IDENTIFIED IN WILCOX MEMORIAL HOSPITAL'S 2013 CHNA ARE NOT BEING ADDRESSED IN ITS CURRENT IMPLEMENTATION STRATEGY, BECAUSE THEY WERE NOT SELECTED AS PRIORITIES FOR WILCOX BASED ON THE FOLLOWING CRITERIA: WILCOX MEMORIAL HOSPITAL'S CURRENT COMMUNITY BENEFIT RESOURCES AND AREAS OF EXPERTISE, MAGNITUDE/SEVERITY OF PROBLEM, OPPORTUNITY TO INTERVENE AT PREVENTION LEVEL, OPPORTUNITY FOR PARTNERSHIP, SOLUTION COULD IMPACT MULTIPLE PROBLEMS, FEASIBILITY OF CHANGE, AND IMPORTANCE OF PROBLEM TO COMMUNITY. IT IS EXPECTED THAT THE TWO PRIORITIES THAT WERE SELECTED WILL INCORPORATE ACTIVITIES THAT HAVE IMPACT ON MULTIPLE TOPIC AREAS, INCLUDING CANCER, DIABETES, HEART DISEASE, STROKE AND IMMUNIZATIONS & INFECTIOUS DISEASES. CANCER DIABETES DISABILITIES ECONOMY EDUCATION ENVIRONMENT FAMILY PLANNING HEART DISEASE & STROKE IMMUNIZATIONS & INFECTIOUS DISEASES INJURY PREVENTION & SAFETY MATERNAL, FETAL & INFANT HEALTH MENTAL HEALTH OLDER ADULTS & AGING ORAL HEALTH RESPIRATORY DISEASES SOCIAL ENVIRONMENT SUBSTANCE ABUSE & LIFESTYLE TRANSPORTATION WILCOX MEMORIAL HOSPITAL CONTINUES TO REFINE ITS IMPLEMENTATION STRATEGY THROUGH THE EXPLORATION OF NEW PROGRAMS, ENHANCEMENTS TO CURRENT PROGRAMS, AND IDENTIFICATION OF NEW PARTNERSHIPS THAT CAN STRENGTHEN THE IMPACT OF WILCOX'S COMMUNITY HEALTH IMPROVEMENT EFFORTS.
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, FINANCIAL 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 21 POSSIBLE FOR PARTIAL FINANCIAL ASSISTANCE PATIENTS, DEPENDING ON THE SIZE OF THE ACCOUNT, THE SERVICES PROVIDED, AND THE DISCOUNT PERCENTAGE FOR THE PATIENT.
Schedule H (Form 990) 2013
Additional Data


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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
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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
(1) UNIVERSITY OF HAWAI'I FOUNDATION
2444 DOLE STREET
BACHMAN HALL 105
HONOLULU,HI96822 		99-0085260 501(C)(3) 50,000       GENERAL SUPPORT
(2) CENTRAL UNION PRESCHOOL
1660 S BERETANIA ST
HONOLULU,HI96826 		99-0076013 501(C)(3) 21,000       GENERAL SUPPORT
(3) UCERA
677 ALA MOANA BLVD 1001
HONOLULU,HI96813 		99-0307152 501(C)(3) 23,450       GENERAL SUPPORT


















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
3
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2013

Schedule I (Form 990) 2013
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. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
FORM 990, SCHEDULE I, PART I, LINE 2 DESCR OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS 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. ORGANIZATIONS.
Schedule I (Form 990) 2013


Additional Data


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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, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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
directors, trustees, officers, including 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
Yes
 
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
 
No
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) 2013

Schedule J (Form 990) 2013
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)THOMAS J NORDYKE MDBoard of Director, Vice Chair (i)
(ii)		 242,203
0 		8,000
0 		3,548
0 		27,111
0 		15,015
0 		295,877
0 		0
0
(2)JOHN CULLINEY MDBoard of Director, Vice Chair (i)
(ii)		 0
406,395 		0
24,000 		0
2,322 		0
33,200 		0
17,384 		0
483,301 		0
0
(3)ANDREW DANG MDBoard of Director (i)
(ii)		 364,305
0 		3,000
0 		1,081
0 		27,700
0 		23,599
0 		419,685
0 		0
0
(4)BEAU NAKAMOTO MDBoard of Director (i)
(ii)		 236,613
0 		15,435
0 		3,420
0 		27,697
0 		345
0 		283,510
0 		0
0
(5)KENN SARUWATARI MDBoard of Director (i)
(ii)		 222,324
0 		23,000
0 		2,363
0 		32,973
0 		24,341
0 		305,001
0 		0
0
(6)R CRAIG NETZERBoard of Director (i)
(ii)		 0
154,776 		0
0 		0
3,430 		0
13,961 		0
5,824 		0
177,991 		0
0
(7)MARTHA SMITHBoard of Director, CEO (i)
(ii)		 0
340,763 		0
112,419 		0
72,485 		0
119,970 		0
15,190 		0
660,827 		0
53,953
(8)JENNIE CHAHANOVICHBoard of Director, CEO (i)
(ii)		 0
272,266 		0
60,418 		0
54,769 		0
90,318 		0
12,390 		0
490,161 		0
42,599
(9)RAYMOND P VARA JRBoard of Director, President (i)
(ii)		 0
780,906 		0
445,327 		0
264,495 		0
372,504 		0
20,970 		0
1,884,202 		0
267,684
(10)KATHLEEN CLARKPRES & CEO (i)
(ii)		 0
232,849 		0
73,134 		0
40,031 		0
84,561 		0
5,950 		0
436,525 		0
26,779
(11)KENNETH B ROBBINS MDB.O.D., EVP & CMO (i)
(ii)		 0
423,048 		0
175,124 		0
160,442 		0
198,028 		0
17,927 		0
974,569 		0
142,030
(12)ARTHUR GLADSTONEB.O.D., CEO/VP & System CNE (i)
(ii)		 0
303,773 		0
94,105 		0
69,498 		0
95,116 		0
20,167 		0
582,659 		0
43,420
(13)DAVID OKABEEVP, CFO & Treasurer (i)
(ii)		 0
429,188 		0
177,313 		0
177,171 		0
161,473 		0
13,890 		0
959,035 		0
131,479
(14)GAIL LERCHEVP (i)
(ii)		 0
339,750 		0
178,172 		0
88,207 		0
153,400 		0
14,690 		0
774,219 		0
98,708
(15)VIRGINIA PRESSLER-FISHER MDEVP (i)
(ii)		 0
332,773 		0
137,886 		0
116,338 		0
164,622 		0
19,716 		0
771,335 		0
116,500
(16)CHARLES R CHINGEVP, Gen Counsel & Secretary (i)
(ii)		 0
325,455 		0
173,692 		0
160,676 		0
155,468 		0
5,082 		0
820,373 		0
103,184
(17)STEVEN ROBERTSONEVP & CIO (i)
(ii)		 0
348,031 		0
144,488 		0
135,351 		0
158,680 		0
18,822 		0
805,372 		0
114,115
(18)MELINDA ASHTON MDSVP & CQO (i)
(ii)		 0
316,112 		0
61,720 		0
63,787 		0
94,270 		0
11,481 		0
547,370 		0
38,079
(19)EARL INOUYEVP & System Controller (i)
(ii)		 0
236,093 		0
41,827 		0
39,770 		0
59,398 		0
19,987 		0
397,075 		0
25,156
(20)WARREN CHAIKOVP (i)
(ii)		 0
214,407 		0
35,180 		0
31,520 		0
45,308 		0
21,130 		0
347,545 		0
19,056
(21)SUSAN MASUMOTO-NONAKAVP (i)
(ii)		 0
203,579 		0
45,404 		0
59,773 		0
52,261 		0
14,170 		0
375,187 		0
17,791
(22)DAWN CHINGVP (i)
(ii)		 0
197,909 		0
33,714 		0
19,790 		0
41,544 		0
18,272 		0
311,229 		0
16,857
(23)GIDGET RUSCETTA RNVP (i)
(ii)		 0
192,006 		0
30,618 		0
41,887 		0
45,965 		0
12,841 		0
323,317 		0
15,309
(24)PAULA DIASVP (i)
(ii)		 0
200,559 		0
32,971 		0
30,987 		0
48,494 		0
12,935 		0
325,946 		0
16,524
(25)MAUREEN FLANNERYVP (i)
(ii)		 0
199,441 		0
61,095 		0
18,169 		0
46,887 		0
16,999 		0
342,591 		0
33,460
(26)MAVIS NIKAIDOVP & CNE (i)
(ii)		 0
195,101 		0
36,380 		0
19,091 		0
43,045 		0
5,915 		0
299,532 		0
18,190
(27)BRIGITTE MCKALEVP & CNE (i)
(ii)		 0
186,436 		0
28,453 		0
13,278 		0
42,284 		0
12,504 		0
282,955 		0
14,227
(28)PATRICIA BOECKMANN RNVP & CNE (i)
(ii)		 0
262,152 		0
44,438 		0
29,365 		0
57,268 		0
18,872 		0
412,095 		0
27,722
(29)RANDY YATES MDCMO (i)
(ii)		 0
315,788 		0
49,131 		0
24,902 		0
61,349 		0
5,950 		0
457,120 		0
24,566
(30)DAVID FOXPrivacy & Information Security (i)
(ii)		 0
123,225 		0
0 		0
0 		0
23,498 		0
18,576 		0
165,299 		0
0
(31)KATIE SHIGEMITSUCompliance Officer (i)
(ii)		 0
169,283 		0
0 		0
76 		0
25,170 		0
13,300 		0
207,829 		0
0
(32)CASS K NAKASONE MDPHYSICIAN (i)
(ii)		 863,726
0 		7,000
0 		1,858
0 		27,700
0 		17,384
0 		917,668
0 		0
0
(33)HINGSON M CHUN MDPHYSICIAN (i)
(ii)		 718,792
0 		63,000
0 		1,390
0 		27,700
0 		16,355
0 		827,237
0 		0
0
(34)KENNETH LEE MDPHYSICIAN (i)
(ii)		 649,226
0 		3,000
0 		16,593
0 		27,700
0 		1,345
0 		697,864
0 		0
0
(35)MARK S GERBER MDPHYSICIAN (i)
(ii)		 739,362
0 		4,846
0 		1,242
0 		27,700
0 		7,024
0 		780,174
0 		0
0
(36)ROBERT SCHULZ MDPHYSICIAN (i)
(ii)		 711,978
0 		23,071
0 		15,271
0 		33,200
0 		17,211
0 		800,731
0 		0
0
(37)CHARLES A STEDFORMER OFFICER (i)
(ii)		 0
144,326 		0
0 		0
1,481,122 		0
32,947 		0
2,161 		0
1,660,556 		0
28,913
(38)KEOKI CLEMENTEFORMER OFFICER (i)
(ii)		 0
136,276 		0
13,776 		0
0 		0
2,665 		0
16,874 		0
169,591 		0
0
(39)ANN PETERSVP (PART YEAR) (i)
(ii)		 0
181,463 		0
28,390 		0
23,388 		0
18,625 		0
18,849 		0
270,715 		0
14,195
(40)LYNNE JOHNSON-JOSEPHFORMER OFFICER (i)
(ii)		 0
169,102 		0
26,761 		0
37,458 		0
36,388 		0
12,351 		0
282,060 		0
13,381
(41)HUGH N HAZENFIELD MDFORMER OFFICER (i)
(ii)		 0
250,258 		0
44,196 		0
14,114 		0
60,483 		0
11,793 		0
380,844 		0
27,005
(42)THERESA RAMEYFORMER OFFICER (i)
(ii)		 0
116,373 		0
0 		0
0 		0
23,040 		0
6,475 		0
145,888 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
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.
Return Reference Explanation
SCHEDULE J, PART I, QUESTION 3 SUPPLEMENTAL COMPENSATION INFORMATION THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, HAWAI'I PACIFIC HEALTH, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O FORM 990 PART VI, LINE 15A FOR THE PROCESS USED BY HAWAI'I PACIFIC HEALTH TO DETERMINE COMPENSATION.
SCHEDULE J, PART I, QUESTION 4A SEVERANCE PAY THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT FROM A RELATED ORGANIZATION: CHARLES A. STED - $999,598
SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THE RESTORATION PLAN WAS DESIGNED TO RESTORE BENEFITS THAT ARE LOST DUE TO LIMITS IMPOSED BY SECTIONS 401 AND 415 OF THE INTERNAL REVENUE CODE ON COMPENSATION CONSIDERED UNDER SUCH PLANS. THE CAPITAL ACCUMULATION ACCOUNT (CAA) IS A SECTION 457(F) PROGRAM THAT WAS PREVIOUSLY AFFORDED TO EXECUTIVE OFFICERS OF THE ORGANIZATION TO PROVIDE BENEFITS ON A TAX DEFERRED BASIS. AMOUNTS PAID OUT DURING THE YEAR BY RELATED ORGANIZATION: MARTHA SMITH - $14,743 JENNIE CHAHANOVICH - $12,390 RAYMOND P. VARA JR. - $70,020 KATHLEEN CLARK - $2,712 KENNETH B. ROBBINS, M.D. - $54,468 ARTHUR GLADSTONE - $11,367 DAVID OKABE - $42,822 GAIL LERCH - $29,622 VIRGINIA PRESSLER-FISHER, M.D. - $47,557 CHARLES R. CHING - $36,337 STEVEN ROBERTSON - $41,870 MELINDA ASHTON, M.D. - $12,219 EARL INOUYE - $4,242 WARREN CHAIKO - $1,466 SUSAN MASUMOTO-NONAKA - $89 PATRICIA BOECKMANN, R.N. - $5,503 HUGH N. HAZENFIELD, MD - $4,907 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: MARTHA SMITH - $78,419 JENNIE CHAHANOVICH - $60,418 RAYMOND P. VARA JR. - $395,327 KATHLEEN CLARK - $48,134 KENNETH B. ROBBINS, M.D. - $175,124 ARTHUR GLADSTONE - $64,105 DAVID OKABE - $177,313 GAIL LERCH - $138,172 VIRGINIA PRESSLER-FISHER, M.D. - $137,886 CHARLES R. CHING - $133,692 STEVEN ROBERTSON - $144,488 MELINDA ASHTON, M.D. - $51,720 EARL INOUYE - $41,827 WARREN CHAIKO - $35,180 SUSAN MASUMOTO-NONAKA - $35,404 DAWN CHING - $33,714 GIDGET RUSCETTA, R.N. - $30,618 MAUREEN FLANNERY - $33,459 MAVIS NIKAIDO - $36,380 BRIGITTE MCKALE - $28,453 PATRICIA BOECKMANN, R.N. - $44,438 RANDY YATES, M.D. - $49,131 ANN PETERS - $28,390 LYNNE JOSEPH - $26,761 HUGH N. HAZENFIELD, MD - $44,196
SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS ARE MADE TO EXECUTIVES BASED ON SYSTEM GOALS THAT ARE NOT BASED ON A PERCENTAGE OF NET EARNINGS.
Schedule J (Form 990) 2013

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.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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) 2013
Schedule L (Form 990 or 990-EZ) 2013
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 1,034,678 PAYMENT FOR LAUNDRY SERVICES   No
(2) PACIFIC MEDICAL COLLECTIONS SEE PART V 311,008 PAYMENT FOR MEDICAL COLLECTION   No
(3) UNITED LAUNDRY SEE PART V 1,119,306 PAYMENT FOR LAUNDRY SERVICES   No
(4) PACIFIC MEDICAL COLLECTIONS SEE PART V 174,744 PAYMENT FOR MEDICAL COLLECTION   No
(5) UNITED LAUNDRY SEE PART V 1,179,504 PAYMENT FOR LAUNDRY SERVICES   No
(6) PACIFIC MEDICAL COLLECTIONS SEE PART V 179,380 PAYMENT FOR MEDICAL COLLECTION   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
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) 2013

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.
Right pointing arrow large imageInformation about Schedule M (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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 ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
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 .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( MISCELLANEOUS ITEMS ) X 2 74,568 FMV
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 through 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) (2013)
Schedule M (Form 990) (2013)
Page 2
Part II
Supplemental Information. 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.
Return Reference Explanation
SCHEDULE M, PART I, COLUMN B THE NUMBER LISTED IN COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED.
Schedule M (Form 990) (2013)
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.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
HAWAI'I PACIFIC HEALTH GROUP RETURN
 
Employer identification number

38-3835105
Return Reference Explanation
FORM 990, PART I, LINE 1 STATEMENT OF ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES 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 THE PACIFIC REGION.
FORM 990, PART III, LINE 1 STATEMENT OF ORGANIZATION'S MISSION 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 IS BASED IN WEST O'AHU AND DEDICATED TO THE HEALTH AND WELL-BEING OF ALL HAWAI'I RESIDENTS. STRAUB 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 SERVES THE KAUA'I COMMUNITY WITH ACCESSIBLE, QUALITY HEALTH CARE THAT SURPASSES EXPECTATIONS.
FORM 990, PART III, LINES 4A-4D PROGRAM SERVICE ACCOMPLISHMENTS PROGRAM SERVICE #1 WOMEN'S SERVICES - OBSTETRICS/GYNECOLOGY IN FISCAL YEAR 2014, HAWAI'I PACIFIC HEALTH SPENT $40,147,515 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 AND GYNECOLOGICAL 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 2014, KAPI'OLANI DELIVERED 6,050 BABIES, OR 55% OF AVAILABLE REPORTED O'AHU BIRTHS. THE WOMEN'S CENTER PERFORMED 36,330 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 2014, PALI MOMI'S WOMEN'S CENTER PERFORMED 44,205 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 WITH TOMOSYNTHESIS AND STEREOTACTIC CAPABILITIES, BONE DENSITY SCREENING, ULTRASOUND AND OTHER PREVENTIVE HEALTH SERVICES. THROUGH KAUA'I MEDICAL CLINIC, WILCOX PROVIDES COMPREHENSIVE OB/GYN CARE: DELIVERY, SURGERY AND OTHER SERVICES. PROGRAM SERVICE #2 OUTPATIENT OPERATING ROOMS IN FISCAL YEAR 2014, HAWAI'I PACIFIC HEALTH HOSPITALS AND CLINICS SPENT $50,415,244 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, LUMPECTOMIES, MASTECTOMIES AND RECONSTRUCTION, HYSTEROSCOPIES, INTERSTIM BLADDER IMPLANT AND SUB URETHRAL 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 GYNECOLOGICAL 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 2014, KAPI'OLANI PERFORMED 5,611 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 2014, STRAUB PERFORMED 3,267 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 2014, PALI MOMI PERFORMED 4,571 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 2014, WILCOX PERFORMED 6,555 OUTPATIENT SURGERIES. PROGRAM SERVICE #3 OUTPATIENT EMERGENCY ROOMS IN FISCAL YEAR 2014, HAWAI'I PACIFIC HEALTH HOSPITALS SAW 164,482 ER PATIENTS AND SPENT $52,214,524 IN DIRECT EXPENSES FOR OUTPATIENT ER SERVICES, AS PART OF OUR MISSION TO PROVIDE CARE FOR ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. THE KAPI'OLANI ER IS THE ONLY ONE IN THE STATE WITH PEDIATRIC SPECIALISTS AVAILABLE 24/7. IT HAS A TEAM FOR ADULTS AND ANOTHER DEDICATED TO PEDIATRICS, WHERE BOARD-CERTIFIED PEDIATRIC EMERGENCY 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 2014, THE KAPI'OLANI ER RECEIVED 44,424 PATIENTS. THE STRAUB ER HAS BOARD-CERTIFIED EMERGENCY PHYSICIANS ON STAFF 24/7, 365 DAYS A YEAR, WITH WHEELCHAIR TRANSPORT AND VALET SERVICES AVAILABLE. IN FISCAL YEAR 2014, THE STRAUB ER RECEIVED 29,571 PATIENTS. THE PALI MOMI ER IS THE ONLY ONE IN THE STATE THAT USES A TEAM TRIAGE APPROACH, WHERE PATIENTS ARE PROMPTLY EVALUATED BY A PHYSICIAN. IN FISCAL YEAR 2014, THE PALI MOMI ER RECEIVED 66,009 PATIENTS. THE WILCOX 20-BED ER IS THE FIRST NEIGHBOR ISLAND FACILITY TO OBTAIN A LEVEL III TRAUMA 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 ER PHYSICIAN EVALUATION OCCUR SIMULTANEOUSLY. THIS IMPROVES SERVICE, QUALITY AND SAFETY. IN FISCAL YEAR 2014, THE WILCOX ER RECEIVED 24,478 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, 1,800 AFFILIATED PHYSICIANS, 6,400+ 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 2014, THE HOSPITALS ADMITTED 34,268 PATIENTS FOR A TOTAL OF 175,175 PATIENT DAYS. KAUA'I MEDICAL CLINIC HAD 311,746 TOTAL CLINIC ENCOUNTERS. KAPI`OLANI MEDICAL SPECIALISTS HAD 88,286 PATIENT VISITS. AFFILIATES AND SUBSIDIARIES KAPI'OLANI MEDICAL SPECIALISTS ARE 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 IS RECOGNIZED NATIONALLY FOR ITS EXCELLENCE IN HEALTH INFORMATION TECHNOLOGY, SPECIFICALLY THE USE OF ELECTRONIC HEALTH RECORDS TO IMPROVE QUALITY OF CARE AND PATIENT SAFETY. THE HAWAI'I PACIFIC HEALTH NETWORK INCLUDES: THE PACIFIC REGION'S ONLY FULL-SERVICE CHILDREN'S HOSPITAL AND ONLY DEDICATED BURN CENTER, 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 2014, 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 HE
FORM 990, PART VI, LINE 6 MEMBERS AND RIGHTS 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.
FORM 990, PART VI, LINE 7A DESCRIPTION OF CLASSES OF PERSON AND THE NATURE OF THEIR RIGHTS 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.
FORM 990, PART VI, LINE 7B DESCR CLASSES OF PERSONS, DECISIONS REQ APPROVAL & TYPE OF VOTING RIGHTS 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. 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 CORPORATI
FORM 990, PART VI, LINE 11B REVIEW OF THE 990S BY THE ORGANIZATION'S GOVERNING BODY 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.
FORM 990, PART VI, LINE 12C MONITORING & ENFORCING CONFLICT OF INTEREST POLICY 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.
FORM 990, PART VI, LINES 15A & 15B OFFICES AND POSITIONS WHICH PROCESS WAS USED & YEAR PROCESS WAS BEGUN 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 INDEPENDENT BOARD MEMBERS OF THE HAWAI'I PACIFIC BOARD'S COMPENSATION COMMITTEE. ON AN ANNUAL BASIS THE HPH BOARD CHAIRPERSON (WHO IS INDEPENDENT) SELECTS A NEUTRAL THIRD PARTY EXECUTIVE COMPENSATION CONSULTANT TO REVIEW THE EXECUTIVE'S 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. 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 MOST RECENTLY COMPLETED ON MARCH 3, 2014 TO REVIEW PHYSICIAN COMPENSATION AND ON AUGUST 22, 2014 TO REVIEW EXECUTIVE COMPENSATION.
FORM 990, PART VI, LINE 19 DISCLOSURE OF GOV DOCS, CONFLICT OF INTEREST POLICY & FINANCIAL STMTS 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.
FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES $ 26,829,390 - PHYSICIAN SERVICES $ 4,818,499 - MEDICAL SERVICES $ 723,125 - CONSULTING SERVICES $ 4,165,826 - REGISTRY SERVICES $ 496,145 - TEMPORARY LABOR ADMIN SERVICES $ 648,537 - TEMPORARY OTHER LABOR SERVICES $ 4,733,143 - LAUNDRY SERVICES $ 40,498,932 - CONTRACT AND RECURRING SERVICES $ 1,194,056 - COLLECTION SERVICES $ 10,398,583 - OTHER SERVICES $ 17,436,069 - REPAIRS & MAINTENANCE $ 37,497,120 - INTERNAL SERVICES PROVIDED EXPENSE $ (3,811,433)- OTHER EXPENSE RECOVERY $ 31,135 - BUS PASS SERVICES ------------- $145,659,127 - TOTAL OTHER FEES FOR SERVICES
FORM 990, PART XI, LINE 9 RECONCILIATION OF NET ASSETS OBLIGATED GROUP INTERCOMPANY TRANSFERS $ (78,143,432) CHANGE IN INTEREST IN KHF/WHF $ 10,019,304 CHANGE IN INTEREST IN PERPETUAL TRUSTS $ 233,401 ROUNDING $ 4 ------------- TOTAL $ (67,890,723)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
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" on 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" on 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) 2013
Schedule R (Form 990) 2013
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on 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

 
 
AMBU. SURG. CNTR AL NA
  		                 












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on 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 COMPA HI NA
  		C CORP       Yes  
(2) STRAUB PHARMACY INC

888 SOUTH KING STREET
HONOLULU,HI96813
99-0145107 		INACTIVE HI SCH
  		C CORP -17,437 4,971,708 100.000 % Yes  
(3) HICORD INC

55 MERCHANT STREET 24TH FLOOR
HONOLULU,HI96813
99-0251496 		INVESTMENT HI NA
  		C-CORP          
(4) CHARITABLE REMAINDER TRUST (1)

 
 
    NA
  		          No






Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on 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 related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) PROVIDERS INSURANCE CORPORATION

 R 1,951,239 FMV
(2) KAPI'OLANI HEALTH FOUNDATION

 C 1,400,483 FMV
(3) KAPI'OLANI MEDICAL SPECIALISTS

 Q 7,822,121 FMV
(4) KAPI'OLANI MEDICAL SPECIALISTS

 S 130,151 FMV
(5) KAPI'OLANI MEDICAL SPECIALISTS

 P 281,133 FMV
(6) KAUA'I MEDICAL CLINIC

 S 88,768 FMV
(7) PROVIDERS INSURANCE CORPORATION

 R 515,091 FMV
(8) WILCOX HEALTH FOUNDATION

 C 320,712 FMV
(9) KAUA'I MEDICAL CLINIC

 S 64,083 FMV
(10) KAUA'I MEDICAL CLINIC

 P 1,683,344 FMV
(11) PROVIDERS INSURANCE CORPORATION

 R 3,214,547 FMV
(12) KAPI'OLANI MEDICAL SPECIALISTS

 R 56,742 FMV
(13) STRAUB FOUNDATION

 C 218,522 FMV
(14) KAUA'I MEDICAL CLINIC

 Q 122,391 FMV
(15) KAUA'I MEDICAL CLINIC

 R 124,468 FMV
(16) HAWAI'I HEALTH PARTNERS

 S 94,752 FMV
(17) PROVIDERS INSURANCE CORPORATION

 R 815,292 FMV
(18) PALI MOMI FOUNDATION

 C 73,034 FMV
(19) KAUA'I MEDICAL CLINIC

 Q 62,822 FMV
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on 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 sections 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) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
SCHEDULE R, PART III RELATED ORG. TAXABLE AS PARTNERSHIP ASC PACIFIC VENTURES, LLC EIN: 27-0540034 ADDRESS: 3000 RIVERCHASE GALLERIA, STE 500 BIRMINGHAM, AL 35244
Schedule R (Form 990) 2013
Additional Data


Software ID:  
Software Version:  






TY 2013 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