TY 2019 Form 990

(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)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) TIMOTHY ROE MD MBA...................................................................... PRESIDENT & CEO	40.0 ................. 0.0		X			465,508	97,096
(2) WENDY MANUEL...................................................................... VP & CHIEF FINANCIAL OFFICER	40.0 ................. 0.0		X			259,737	68,125
(3) SUSAN GABRIEL...................................................................... VP, CLINICAL SERVICES	40.0 ................. 0.0		X			217,646	39,520
(4) ELUNED MUN...................................................................... NURSE PRACTITIONER	40.0 ................. 0.0			X		227,740	10,339
(5) COLBERT Y SETO...................................................................... CHIEF INFORMATION OFFICER	40.0 ................. 0.0				X	163,983	20,070
(6) SANDERS C SANDOVAL...................................................................... NURSE PRACTITIONER	40.0 ................. 0.0			X		152,922	22,592
(7) CAROLYN C UEHARA...................................................................... RN-CRRN	40.0 ................. 0.0			X		135,966	22,996
(8) JASON CHANG...................................................................... VP & CHIEF MEDICAL OFFICER	40.0 ................. 0.0				X	127,972	29,008
(9) ELVIRIA C SALINAS OSHIRO...................................................................... RN-CRRN	40.0 ................. 0.0			X		128,611	27,181
(10) BRENDA M HIROMOTO...................................................................... DIRECTOR OF NURSING	40.0 ................. 0.0			X		127,678	26,131
(11) CHERYLEE CHANG MD...................................................................... DIRECTOR	1.0 ................. 0.0	X				0	0
(12) SAI CHANTAVY...................................................................... DIRECTOR	1.0 ................. 0.0	X				0	0
(13) WILLIAM CROWLEY...................................................................... DIRECTOR	1.0 ................. 1.0	X				0	0
(14) KEITH GENDREAU...................................................................... DIRECTOR	1.0 ................. 1.0	X				0	0
(15) RONALD N S HO...................................................................... DIRECTOR	1.0 ................. 0.0	X				0	0
(16) JENNIFER ISOBE...................................................................... DIRECTOR/TREASURER	1.0 ................. 1.0	X	X			0	0
(17) CORY KUBOTA...................................................................... DIRECTOR	1.0 ................. 0.0	X				0	0

(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)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(18) BENJAMIN A KUDO........................................................................ DIRECTOR	1.0 .......................0.0	X
(19) JANICE LUKE LOO........................................................................ DIRECTOR	1.0 .......................1.0	X
(20) BRYAN K K LUKE........................................................................ DIRECTOR	1.0 .......................1.0	X
(21) E LYNNE MADDEN........................................................................ DIRECTOR/SECRETARY	1.0 .......................1.0	X	X
(22) RAYMOND S ONO........................................................................ DIRECTOR/CHAIR	1.0 .......................1.0	X	X
(23) MICHAEL W PERRY........................................................................ DIRECTOR	1.0 .......................1.0	X
(24) GLENN SEXTON........................................................................ DIRECTOR/VICE CHAIR	1.0 .......................1.0	X	X
(25) PATRICK SULLIVAN PHD........................................................................ DIRECTOR	1.0 .......................0.0	X
(26) LAURIE TOM MD........................................................................ DIRECTOR	1.0 .......................1.0	X
(27) MICHAEL J WO........................................................................ DIRECTOR	1.0 .......................0.0	X
(28) OWEN NISHIKAWA MD........................................................................ DIRECTOR	1.0 .......................0.0	X
(29) STEPHEN OISHI MD........................................................................ DIRECTOR	1.0 .......................0.0	X
(30) KEVIN CHANG........................................................................ DIRECTOR	1.0 .......................0.0	X

(A) Name and business address	(B) Description of services	(C) Compensation
DATAHOUSE, 1585 KAPIOLANI BOULEVARD SUITE 180 HONOLULU,HI96814	INFORMATION SYSTEMS	490,093
SODEXO INC AFFILIATES, DEPT 43283 LOS ANGELES,CA90088	MANAGEMENT-DIETARY	1,304,917
THE QUEENS POB PHARMACY, 1380 LUSITANA STREET HONOLULU,HI96813	MANAGEMENT-PHARMACY	665,062
ALLEGIS GROUP HOLDINGS INC, PO BOX 198568 ATLANTA,GA30384	AGENCY STAFFING	510,981
REHAB ASSOCIATES OF THE PACIFIC, 226 N KUAKINI ST HONOLULU,HI96817	MEDICAL DIRECTORSHIP	484,938
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 5

- TIN:

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

Rehabilitation Hospital of the Pacific

Employer identification number

51-0160156

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 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

Rehabilitation Hospital of the Pacific

Employer identification number

51-0160156

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization Rehabilitation Hospital of the Pacific

Part I Contributors	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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization Rehabilitation Hospital of the Pacific		Employer identification number 51-0160156

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization Rehabilitation Hospital of the Pacific			Employer identification number 51-0160156
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose 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

(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

(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

(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) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Rehabilitation Hospital of the Pacific

Employer identification number

51-0160156

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB 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.

If the organization elected, as permitted under FASB 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)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

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" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	20,028,000	10,000,000	10,000,000	10,000,000	10,000,000
b	Contributions ...	465,000	10,028,000
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	20,493,000	20,028,000	10,000,000	10,000,000	10,000,000

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

100.000 %

Permanent endowment SchDMd Bullet

0 %

Term endowment SchDMd Bullet

0 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

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" on 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 .....	1,244,244		1,244,244
b	Buildings ....	30,613,671	13,254,406	17,359,266
c	Leasehold improvements	375,370	368,102	7,269
d	Equipment ....	32,660,198	23,128,007	9,532,191
e	Other .....	3,213,809	2,283,726	930,083
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				29,073,053

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on 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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)AN EXEMPT AFFILIATE				2,424,054
(2)DEPOSITS & OTHER RECEIVABLES				1,293,874
(3)ASSETS OF FOUNDATION				10,324,744
(4)OTHER ASSETS				1,105,204
(5)DUE FROM THIRD PARTY PAYORS				0
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				15,147,876

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	4,545,868
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) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on 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 (losses) 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' on 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

PART V, LINE 4

ENDOWMENT FUNDS REHABILITATION HOSPITAL OF THE PACIFIC USES THE ENDOWMENT FUNDS FOR THE PURPOSES INTENDED BY THE BOARD.

PART X, LINE 2

BOTH THE HOSPITAL AND THE FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS THAT HAVE BEEN RECOGNIZED AS TAX-EXEMPT ORGANIZATIONS PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL AND THE FOUNDATION ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES ON INCOME UNRELATED TO THEIR RESPECTIVE TAX-EXEMPT PURPOSES. AT SEPTEMBER 30, 2020 AND 2019, THE COMPANY HAD NO UNRECOGNIZED TAX BENEFITS. THE COMPANY'S 2016 THROUGH 2019 FEDERAL AND HAWAII TAX RETURNS REMAIN OPEN TO EXAMINATION BY THE INTERNAL REVENUE SERVICE AND STATE OF HAWAII DEPARTMENT OF TAXATION. THE COMPANY'S POLICY IS TO RECOGNIZE INTEREST EXPENSE AND PENALTIES RELATED TO INCOME TAX MATTERS AS A COMPONENT OF INCOME TAX EXPENSE. THE COMPANY HAS ACCRUED $0 OF INTEREST AND PENALTIES AND THERE WERE NO UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2020 AND 2019.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Rehabilitation Hospital of the Pacific

Employer identification number

51-0160156

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other %

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: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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.

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"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

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? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	17,929		17,929	0.040 %
b	Medicaid (from Worksheet 3, column a) . . . . .	8,125,201	6,816,151	1,309,050	2.730 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	8,143,130	6,816,151	1,326,979	2.770 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	21,309	16,863	4,446	0.010 %
f	Health professions education (from Worksheet 5) . . .	66,996	65,173	1,823	0 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	12,494		12,494	0.030 %
j	Total. Other Benefits . .	100,799	82,036	18,763	0.040 %
k	Total. Add lines 7d and 7j .	8,243,929	6,898,187	1,345,742	2.810 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1,758	1,758	0 %
7	Community health improvement advocacy
8	Workforce development	9,024	9,024	0.020 %
9	Other
10	Total	10,782	10,782	0.020 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

-382,602

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. ......

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

Enter total revenue received from Medicare (including DSH and IME).....

13,930,257

Enter Medicare allowable costs of care relating to payments on line 5.....

12,574,073

Subtract line 6 from line 5. This is the surplus (or shortfall)........

1,356,184

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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 .........................

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) 2019

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?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)			Other (describe)
1	REHABILITATION HOSP OF THE PACIFIC 226 NORTH KUAKINI STREET HONOLULU,HI96817 WWW.REHABHOSPITAL.ORG	X	ACUTE CARE REHAB

Schedule H (Form 990) 2019

Page 4

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)

	REHABILITATION HOSP OF THE PACIFIC
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

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 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE SCHEDULE H, PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Yes

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	REHABILITATION HOSP OF THE PACIFIC
Name of hospital facility or letter of facility reporting group

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.%
and FPG family income limit for eligibility for discounted care of 300.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, SECTION C

The FAP application form was widely available on a website (list url):

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	REHABILITATION HOSP OF THE PACIFIC
Name of hospital facility or letter of facility reporting group

Yes

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 all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized 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?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	REHABILITATION HOSP OF THE PACIFIC
Name of hospital facility or letter of facility reporting group

Yes

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.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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? ...............................

If "Yes," explain in Section C.

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? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
PART V, SECTION B, LINE 3E	THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE SEPTEMBER 2019 CHNA. PART V, SECTION B, LINE 5 IN ORDER TO DEVELOP A COMPLETE UNDERSTANDING OF HAWAII'S HEALTH-NEEDS, A CHNA ADVISORY COMMITTEE WAS FORMED. THE ADVISORY COMMITTEE INCLUDED MEMBERS OF THE 19 PARTICIPATING HOSPITALS (SEE BELOW) AS WELL AS LEADERS IN THE POST-ACUTE CONTINUUM OF CARE, LEADERS OF PROGRAMS SERVICING LOW-INCOME AND MINORITY GROUPS, AND THE STATE OF HAWAII DEPARTMENT OF HEALTH AND HUMAN SERVICES. UTILIZING HEALTH AND HEALTH-RELATED INDICATORS, THE COMMITTEE WAS ABLE TO DETERMINE THE GREATEST HEALTH-RISKS TO ADDRESS. IN ORDER TO GAIN INSIGHT INTO THE MOST PROBLEMATIC AREAS, AND ANY AREAS WHERE GAPS OF UNDERSTANDING WERE PRESENT, 200 KEY INFORMANTS WERE SELECTED TO BE INTERVIEWED. THESE KEY INFORMANTS ARE EXPERTS IN VARIOUS AREAS OF PUBLIC HEALTH, HEALTH POLICY AND SERVICE PROVISION. THE INFORMATION GATHERED FROM THESE INTERVIEWS WAS AGGREGATED, ANALYZED AND BROUGHT BACK TO THE ADVISORY COMMITTEE. FROM THERE, THE 19 PARTICIPATING HOSPITALS DETERMINED HOW TO BEST ADDRESS THE HEALTH NEEDS OF THE STATE OF HAWAII. KEY INFORMANT INTERVIEWS WERE COMPLETED BETWEEN JULY 2018 AND NOVEMBER 2018.
PART V, SECTION B, LINE 6A & 6B	THE SEPTEMBER 2019 STATE OF HAWAII CHNA WAS A COLLABORATIVE EFFORT LED BY THE HEALTHCARE ASSOCIATION OF HAWAII, IN PARTNERSHIP WITH THE ISLANDER INSTITUTE. IT WAS COMPLETED JOINTLY WITH 19 HAWAII HOSPITALS. THE PARTICIPANTS INCLUDED: ADVENTIST HEALTH CASTLE, KAHI MOHALA, KAHUKU MEDICAL CENTER, KAISER FOUNDATION HOSPITAL - HONOLULU, KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN, KUAKINI MEDICAL CENTER, KULA HOSPITAL, LANA'I COMMUNITY HOSPITAL, MAUI MEMORIAL MEDICAL CENTER, MOLOKAI GENERAL HOSPITAL, NORTH HAWAI'I COMMUNITY HOSPITAL, PALI MOMI MEDICAL CENTER, THE QUEEN'S MEDICAL CENTER, THE QUEEN'S MEDICAL CENTER - WEST O'AHU, REHABILITATION HOSPITAL OF THE PACIFIC, SHRINERS HOSPITALS FOR CHILDREN - HONOLULU, STRAUB MEDICAL CENTER, WAHIAWA GENERAL HOSPITAL AND WILCOX MEDICAL CENTER.
PART V, SECTION B, LINE 7A	CHNA WEBSITE HTTPS://WWW.REHABHOSPITAL.ORG/AWARDS-ACCREDITATIONS
PART V, SECTION B, LINE 11	REHAB HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT THAT WAS APPROVED IN SEPTEMBER 2019. FOR FISCAL YEAR 2020, REHAB HOSPITAL ADDRESSED THE FOLLOWING PRIORITY NEEDS IDENTIFIED IN THE SEPTEMBER 2019 COMMUNITY HEALTH NEEDS ASSESSMENT: 1) FOUNDATIONS - STRENGTHEN FAMILIES 2) COMMUNITY - NURTURE COMMUNITY IDENTITY AND COHESIVENESS 3) HEALTHCARE - PROVIDE ACCESSIBLE, PROACTIVE SUPPORT FOR THOSE WITH HIGH NEEDS DURING FISCAL YEAR 2020, REHAB CONDUCTED THE FOLLOWING ACTIVITIES TO ADDRESS THE THREE PRIORITY NEEDS: PRIORITY AREA 1: FOUNDATION - STRENGTHEN FAMILIES EXPAND CANCER REHABILITATION PROGRAM OFFERINGS REHAB STRIVES TO CREATE CONDITIONS AND FACILIATE OPPORTUNITIES FOR FAMILIES TO BE HEALING FORCES FOR ITS OWN MEMBERS, ESPECIALLY WHEN SOMEONE EXPERIENCES A SIGNIFICANT ILLNESS OR UNEXPECTED TRAUMA. REHAB'S ICARE CANCER REHABILITATION PROGRAM PROVIDES ONE ON ONE SUPERVISED EXERCISE REHABILITATION THAT IS INTENDED TO IMPROVE THE CARDIOPULMONARY CONDITIONING OF OUR PATIENTS TO OVERCOME THE CARDIOPULMONARY IMPAIRMENTS THAT ARE RECOGNIZED TO OCCUR DUE TO CANCER AND THE TREATMENT OF CANCER. THESE HEALTHCARE SERVICES ARE PROVIDED FREE OF CHARGE TO THE PATIENTS. THE PROGRAM ALSO INCORPORATES TRAINING OF STUDENT INTERNS IN PARTNERSHIP WITH THE UNIVERSITY OF HAWAII KINESIOLOGY AND REHABILITATION SCIENCE DEPARTMENT. DURING FISCAL YEAR 2020, REHAB HOSPITAL RECEIVED GRANT FUNDING TO SUPPORT ITS CANCER REHABILITATION PROGRAM AND TO EXPAND THE NUMBER OF PATIENTS SERVED AND STUDENT INTERNS TRAINED. PRIORITY AREA 2: COMMUNITY - NURTURE COMMUNITY IDENTITY AND COHESIVENESS INCREASE OPPORTUNITIES FOR COMMUNITY EDUCATION AND AWARENESS REHAB HOSPITAL PARTICIPATED IN A VARIETY OF COMMUNITY HEALTH EVENTS SUCH AS THE HAWAII PARKINSON'S WALK, AND HEALTH RELATED TALK SHOWS AND PRESENTATIONS TO PROVIDE EDUCATION ON HEALTH CONDITIONS AND REHAB HOSPITAL SERVICES. REHAB HOSPITAL ALSO PROVIDED CANCER REHABILITATION PRESENTATIONS AT THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY AND AMERICAN COLLEGE OF SPORTS MEDICINE EDUCATIONAL EVENTS. ENGAGE IN RESEARCH OPPORTUNITIES REHAB HOSPITAL'S ICARE CANCER REHABILITATION PROGRAM IS A COLLABORATIVE STUDY BETWEEN REHAB HOSPITAL AND THE UNIVERSITY OF HAWAII KINESIOLOGY AND REHABILITATION SCIENCE DEPARTMENT TO BETTER UNDERSTAND HOW EXERCISE IMPROVES THE HEALTH, FITNESS AND QUALITY OF LIFE FOR CANCER PATIENTS. DURING FISCAL YEAR 2020, REHAB HOSPITAL CONTINUED TO PROVIDE SERVICES UNDER THE PROGRAM, ANALYZE DATA AND SHARE FINDINGS THROUGH EDUCATIONAL PRESENTATIONS. REHAB HOSPITAL ALSO BEGAN PLANNING FOR PUBLISHED ARTICLES REGARDING THE RESULTS OF ITS RESEARCH. PRIORITY AREA 3: HEALTHCARE - PROVIDE ACCESSIBLE, PROACTIVE SUPPORT FOR THOSE WITH HIGH NEEDS EXPAND SERVICES AND OUTREACH FOR UNIQUE AND SPECIALIZED SERVICES REHAB HOSPITAL LAUNCHED AN ANIMAL ASSISTED THERAPY PROGRAM TO SUPPORT PATIENTS, AN EVIDENCE-BASED PRACTICE FOR THE TREATMENT OF PHYSICAL AND MENTAL HEALTH CONDITIONS. THE ANIMAL ASSISTED CLINICAL THERAPIST AND THE HOSPITAL FACILITY DOG VISIT PATIENTS AND AT TIMES, UTILIZE THEIR SERVICES TO ASSIST WITH THERAPY. ANIMAL ASSISTED THERAPY HAS BEEN SHOWN TO HELP PATIENTS RELAX DURING EXERCISE SESSIONS, ASSIST WITH DIMINISHED PAIN AND REDUCE ANXIETY. INCREASE EDUCATIONAL OPPORTUNITIES FOR STUDENTS REHAB HOSPITAL CONTINUES TO BE INVOLVED WITH FELLOWSHIP PROGRAMS WITH THE JOHN A. BURNS SCHOOL OF MEDICINE, UNIVERSITY OF HAWAII AND SUPPORTS STUDENTS IN PHYSICAL MEDICINE AND REHABILITATION ROTATIONS AND GERIATRIC FELLOWSHIPS. IN ADDITION, REHAB SUPPORTS PRECEPTORSHIPS FOR NURSING STUDENTS AND THERAPY STUDENT SHADOWING. REHAB HOSPITAL ALSO HOLDS SEMINARS AT LOCAL UNIVERSITIES ON THE BENEFITS OF PHYSICAL THERAPY. REHAB HOSPITAL COLLABORATED WITH THE HEALTHCARE ASSOCIATION OF HAWAII AND OTHER COMMUNITY PARTNERS, INCLUDING THE UNIVERSITY OF HAWAII, HAWAII STATE DEPARTMENT OF EDUCATION, KAPIOLANI COMMUNITY COLLEGE AND THE CHAMBER OF COMMERCE UNDER THE HAWAII HEALTHCARE WORKFORCE INITIATIVE TO DEVELOP TRAINING PROGRAMS FOR HEALTHCARE SERVICE PROVIDERS AT THE HIGH SCHOOL, UNDERGRADUATE AND GRADUATE LEVELS. REHAB ALSO PROVIDES CLINICAL INSTRUCTION FOR NUMEROUS NURSING AND THERAPY STUDENTS, THROUGH PARTNERSHIPS WITH EDUCATIONAL INSTITUTIONS AND THROUGH OUR ICARE CANCER REHABILITATION PROGRAM. REHAB HOSPITAL ALSO COLLABORATED WITH THE UNIVERSITY OF HAWAII SCHOOL OF ENGINEERING FOR RESEARCH IN REHABILITATIVE MEDICINE AND CONTINUES TO PARTNER WITH THE UNIVERSITY OF HAWAII KINESIOLOGY AND REHABILITATION SCIENCE DEPARTMENT IN CONNECTION WITH REHAB HOSPITAL'S CANCER REHABILITATION PROGRAM. EDUCATIONAL SPEAKERS DURING FISCAL YEAR 2020, REHAB HOSPITAL HOSTED ITS ANNUAL MUSCULOSKELETAL ULTRASOUNDS WORKSHOP. LOCAL STUDENTS AND CLINICAL PROFESSIONALS EXPERIENCED HANDS-ON LAB AND INFORMATIONAL SESSIONS FROM INDUSTRY PROFESSIONALS AND SCHOLARS FROM THE U.S. AND JAPAN, INCLUDING A REVIEW OF DIAGNOSTIC TECHNIQUES FOR THE SHOULDER, ELBOW, WRIST, HIP, KNEE AND SPINE. NEEDS NOT BEING ADDRESSED THE FOLLOWING AREAS OF NEED IDENTIFIED IN REHAB'S 2019 CHNA ARE NOT BEING ADDRESSED IN ITS CURRENT IMPLEMENTATION STRATEGY BECAUSE THEY WERE NOT SELECTED AS THE HIGHEST PRIORITY FOR REHAB AS THEY ARE BEYOND REHAB'S CURRENT RESOURCES AND/OR EXPERTISE. FOUNDATIONS - ADDRESS FINANCIAL INSECURITY FOUNDATIONS - WORK TOGETHER FOR EQUALITY AND JUSTICE FOUNDATIONS - PREPARE FOR EMERGENCIES FOUNDATIONS - BUILD GOOD FOOD SYSTEMS COMMUNITY - RESTORE ENVIRONMENT AND SENSE OF PLACE COMMUNITY - INVEST IN TEENAGERS AND HEALTHY STARTS COMMUNITY - SHIFT KUPUNA CARE AWAY FROM "SICK CARE" HEALTHCARE - STRENGTHEN TRUST IN HEALTHCARE
PART V, SECTION B, LINES 16A, 16B & 16C	FINANCIAL ASSISTANCE POLICY HTTPS://WWW.REHABHOSPITAL.ORG/HOW-DOES-BILLING-WORK FINANCIAL ASSISTANCE POLICY APPLICATION HTTPS://WWW.REHABHOSPITAL.ORG/HOW-DOES-BILLING-WORK PLAIN LANGUAGE SUMMARY HTTPS://WWW.REHABHOSPITAL.ORG/HOW-DOES-BILLING-WORK

Schedule H (Form 990) 2019

Page 9

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?5
Name and address		Type of Facility (describe)
1	REHAB AT NUUANU 226 NORTH KUAKINI STREET HONOLULU,HI96817	CLINIC
2	REHAB AT AIEA 98-1005 MOANALUA ROAD SUITE 425 AIEA,HI96701	CLINIC
3	REHAB PHYSICIANS CLINIC 226 NORTH KUAKINI STREET HONOLULU,HI96817	CLINIC
4	REHAB AT HILO 76 PUUHONU PLACE HILO,HI96720	CLINIC
5	CARDIAC REHAB 226 NORTH KUAKINI STREET HONOLULU,HI96817	CLINIC
6
7
8
9
10

Schedule H (Form 990) 2019

Page 10

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
PART I, LINE 3C	ALL OF THE FOLLOWING THREE CRITERIA MUST BE MET TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER REHAB HOSPITAL 'S FINANCIAL ASSISTANCE POLICY: 1) FAMILY LIQUID ASSETS ARE EQUAL TO OR LESS THAN $50,000; 2) FAMILY INCOME IS AT OR BELOW 300% OF THE CURRENT FEDERAL POVERTY GUIDELINE FOR HAWAII; AND 3) PATIENT IS A U.S. CITIZEN OR LEGAL ALIEN WHO IS PERMANENTLY RESIDING IN HAWAII.
PART III, LINES 2 AND 4	PLEASE SEE PAGES 10 & 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8	TOTAL MEDICARE COSTS WERE CALCULATED IN ACCORDANCE WITH THE FEDERAL STANDARD FORM CMS-2552.96.
PART VI, LINE 2	NEEDS ASSESSMENT REHAB HOSPITAL PARTNERED WITH THE HEALTHCARE ASSOCIATION OF HAWAII AND THE ISLANDER INSTITUTE TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT(CHNA)FOR THE COMMUNITY SERVED BY REHAB HOSPITAL. THE CHNA WAS COMPLETED IN SEPTEMBER 2019. OUR APPROACH FOLLOWED THE PUBLIC HEALTH MODEL OF ASSESSING AND UNDERSTANDING COMMUNITY HEALTH HOLISTICALLY. A FRAMEWORK FOR ANALYSIS WAS CONSTRUCTED BASED ON DETERMINANTS OF HEALTH; THE FRAMEWORK INCLUDED A BROAD DEFINITION OF COMMUNITY HEALTH THAT CONSIDERS EXTENSIVE SECONDARY DATA ON THE SOCIAL, ECONOMIC, AND PHYSICAL ENVIRONMENTS, AS WELL AS HEALTH RISKS AND OUTCOMES. SPECIAL ATTENTION WAS GIVEN TO IDENTIFY HEALTH DISPARITIES, THE NEEDS OF VULNERABLE POPULATIONS, AND UNMET HEALTH NEEDS OR GAPS IN SERVICES. AN EXTENSIVE ARRAY OF SECONDARY AND PRIMARY DATA WAS COLLECTED AND SYNTHESIZED TO DETERMINE COMMUNITY NEEDS. THE CHNA FINDINGS ARE DRAWN FROM AN ANALYSIS OF AN EXTENSIVE SET OF QUANTITATIVE DATA AND IN-DEPTH QUALITATIVE DATA FROM KEY COMMUNITY HEALTH LEADERS AND EXPERTS FROM THE HAWAII DEPARTMENT OF PUBLIC HEALTH AND OTHER ORGANIZATIONS THAT SERVE AND REPRESENT VULNERABLE POPULATIONS AND/OR POPULATIONS WITH UNMET HEALTH NEEDS. ADDITIONAL ANALYSES INCLUDED PREVENTABLE CAUSES OF HOSPITALIZATION USING DATA PROVIDED BY HAWAII HEALTH INFORMATION CORPORATION, AND INFORMATION FROM RECENTLY PUBLISHED REPORTS ON ACCESS TO CARE, HEALTH DISPARITIES, PRIMARY CARE NEEDS, AND MENTAL HEALTH. KEY INFORMANTS INTERVIEWS WERE CONDUCTED WITH INDIVIDUALS HAVING SPECIAL KNOWLEDGE OF COMMUNITY HEALTH NEEDS, HEALTH DISPARITIES, AND VULNERABLE POPULATIONS IN THE IDENTIFIED COMMUNITIES.
PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBIILTY FOR ASSISTANCE WHEN A PATIENT PRESENTS FOR SERVICES AND THE PATIENT DOES NOT HAVE INSURANCE COVERAGE FOR SERVICES TO BE PROVIDED, PRIOR TO ADMISSION, REHAB HOSPITAL STAFF EXPLAIN TO THE PATIENT THE UNINSURED PAYMENT TERMS ON SERVICES PROVIDED. IN MOST UNINSURED INPATIENT CASES, THE PATIENT WILL BE OFFERED A HAWAII STATE MEDICAL ASSISTANCE APPLICATION FOR THE HAWAII STATE MEDICAID/QUEST PROGRAM AS WELL AS AN APPLICATION FOR REHAB HOSPITAL's FINANCIAL ASSISTANCE PROGRAM. REHAB HOSPITAL CONTRACTS WITH OUTSIDE SERVICE PROVIDERS WHO SPECIALIZE IN ASSISTING PATIENTS WITH THE MEDICAID/QUEST PROGRAM APPLICATION PROCESS. IF THE PATIENT'S APPLICATION FOR MEDICAID/QUEST IS DENIED OR IT IS DETERMINED THAT THE PATIENT IS INELIGIBLE TO APPLY FOR MEDICAID/QUEST, THE PATIENT MAY APPLY FOR REHAB's FINANCIAL ASSISTANCE PROGRAM. THE PATIENT MAY APPLY IN PERSON OR MAIL THE APPLICATION FOR FINANCIAL ASSISTANCE TO THE PATIENT FINANCIAL SERVICES OFFICE. REHAB HOSPITAL STAFF ARE AVAILABLE IN PERSON OR VIA PHONE FOR EDUCATION ON THE FINANCIAL ASSISTANCE PROGRAM AND ASSISTANCE IN COMPLETING THE APPLICATION. IN SOME CASES, REHAB HOSPITAL DETERMINES THAT A PATIENT MAY NEED ASSISTANCE AFTER SERVICES ARE PROVIDED, AND THE APPLICATION FOR FINANCIAL ASSISTANCE IS MAILED TO THE PATIENT.
PART VI, LINE 4	COMMUNITY INFORMATION REHAB HOSPITAL IS THE ONLY PROVIDER OF ACUTE INPATIENT MEDICAL REHABILITATION SERVICES AMONGST ALL ISLANDS IN THE STATE OF HAWAII AND IN THE PACIFIC REGION. MEDICAID PATIENTS COMPRISED 13% OF REHAB HOSPITAL's TOTAL PATIENT POPULATION IN 2020. IN GENERAL, THE INTENSIVE, MEDICALLY SUPERVISED REHABILITATION THAT REHAB HOSPITAL PROVIDES THROUGH ITS 82-BED ACUTE INPATIENT HOSPITAL LOCATED ON THE ISLAND OF OAHU IS UTILIZED BY THOSE IN THE COMMUNITY WHO HAVE SUFFERED A SEVERE INJURY OR ILLNESS THAT HAS RESULTED IN SIGNIFICANT FUNCTIONAL IMPAIRMENT AND DISABILITY. DURING 2020, REHAB HOSPITAL ADMITTED 1,700 PATIENTS AND PROVIDED COMPREHENSIVE CARE FOR PATIENTS SUFFERING FROM STROKES, BRAIN AND SPINAL CORD INJURIES, ORTHOPEDIC AND NEUROLOGICAL DISORDERS AND DEBILITATIVE DISEASES. IN ADDITION TO THE ACUTE INPATIENT SERVICES, DURING 2020, REHAB HOSPITAL PROVIDED OUTPATIENT REHABILITATIVE SERVICES IN ITS THREE OUTPATIENT CLINICS LOCATED IN HONOLULU AND AIEA (ON THE ISLAND OF OAHU) AND HILO (ON THE ISLAND OF HAWAII). DURING 2020, REHAB HOSPITAL TREATED 2,900 PATIENTS IN AN OUTPATIENT SETTING.
PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH REHAB HOSPITAL IS COMMITTED TO SUPPORTING THE COMMUNITY THROUGH THE FOLLOWING: - HOSTING SUPPORT GROUPS FOR FORMER REHAB HOSPITAL PATIENTS AND THE COMMUNITY-AT-LARGE, INCLUDING THE STROKE CLUB OF HONOLULU, THE TRAUMATIC BRAIN INJURY CLUB, THE SPINAL CORD INJURY SUPPORT GROUP AND THE POST-AMPUTATION SUPPORT GROUP. - PROVIDING EDUCATION AND CLINICAL ROTATIONS FOR THERAPY STUDENTS, REHABILITATIVE NURSING, AND MEDICAL PROFESSIONALS. - PARTICIPATING IN HEALTH AND FITNESS FAIRS TO FOSTER HEALTH EDUCATION IN THE COMMUNITY. - PROVIDING CONFERENCES AND PRESENTATIONS TO SPECIAL INTEREST GROUPS FOCUSED ON THE PREVENTION AND TREATMENT OF BRAIN INJURIES, SPINAL CORD INJURIES AND STROKES. REHAB HOSPITAL IS GOVERNED BY A COMMUNITY BOARD COMPRISED OF COMMUNITY MEMBERS, PHYSICIANS AND BUSINESS LEADERS. THESE UNPAID, VOLUNTEER MEMBERS REPRESENT THE DIVERSITY OF THE COMMUNITY REHAB HOSPITAL SERVES AND ENSURE REHAB HOSPITAL REMAINS COMMITTED TO SERVING ITS MISSION. REHAB HOSPITAL REINVESTS ALL SURPLUS RESOURCES BACK INTO PATIENT CARE.
PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM N/A
PART VI, LINE 7	STATE FILING OF COMMUNITY BENEFIT REPORT N/A
PART II	AS THE ONLY ACUTE-CARE MEDICAL REHABILITATION ORGANIZATION SERVING HAWAII AND THE PACIFIC, REHAB HOSPITAL IS AN IMPORTANT PROVIDER OF CARE IN THE POST-ACUTE CONTINUUM OF SERVICES. REHAB HOSPITAL IS A LEADER IN MEDICAL REHABILITATION, PARTICULARLY IN THE AREAS OF STROKE, TRAUMATIC BRAIN INJURY AND SPINAL CORD INJURY. UTILIZING ITS KNOWLEDGE AND EXPERTISE REHAB HOSPITAL PARTICIPATES IN COMMUNITY TASK FORCES, ADVOCATES ON BEHALF OF COMMUNITY HEALTH INITIATIVES AND ASSISTS IN THE RECRUITMENT AND DEVELOPMENT OF HAWAII'S MEDICAL PROFESSIONALS.

Schedule H (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Rehabilitation Hospital of the Pacific

Employer identification number

51-0160156

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on 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 .........

Yes

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 on Line 1a? ..

Yes

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on 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 ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

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 on 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 in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JASON CHANG VP & CHIEF MEDICAL OFFICER	(i) (ii)	124,222 -------------	3,000 -------------	750 -------------	3,822 -------------	25,186 -------------	156,980 -------------	3,000 -------------
2SUSAN GABRIEL VP, CLINICAL SERVICES	(i) (ii)	179,349 -------------	37,097 -------------	1,200 -------------	39,205 -------------	315 -------------	257,166 -------------	27,500 -------------
3WENDY MANUEL VP & CHIEF FINANCIAL OFFICER	(i) (ii)	206,422 -------------	52,115 -------------	1,200 -------------	45,333 -------------	22,792 -------------	327,862 -------------	40,000 -------------
4TIMOTHY ROE MD MBA PRESIDENT & CEO	(i) (ii)	358,308 -------------	100,000 -------------	7,200 -------------	77,341 -------------	19,755 -------------	562,604 -------------	100,000 -------------
5ELUNED MUN NURSE PRACTITIONER	(i) (ii)	152,324 -------------	75,416 -------------	-------------	3,375 -------------	6,964 -------------	238,079 -------------	-------------
6COLBERT Y SETO CHIEF INFORMATION OFFICER	(i) (ii)	144,983 -------------	19,000 -------------	-------------	3,189 -------------	16,881 -------------	184,053 -------------	13,000 -------------
7SANDERS C SANDOVAL NURSE PRACTITIONER	(i) (ii)	139,970 -------------	12,952 -------------	-------------	-------------	22,592 -------------	175,514 -------------	-------------
8CAROLYN C UEHARA RN-CRRN	(i) (ii)	135,966 -------------	-------------	-------------	9,380 -------------	13,616 -------------	158,962 -------------	-------------
9ELVIRIA C SALINAS OSHIRO RN-CRRN	(i) (ii)	128,611 -------------	-------------	-------------	6,919 -------------	20,262 -------------	155,792 -------------	-------------
10BRENDA M HIROMOTO DIRECTOR OF NURSING	(i) (ii)	127,678 -------------	-------------	-------------	3,339 -------------	22,792 -------------	153,809 -------------	-------------

Schedule J (Form 990) 2019

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, LINE 1A	OFFICER DR. TIMOTHY ROE RECEIVED HEALTH OR SOCIAL CLUB DUES DURING CY2019. THE BENEFIT WAS NOT TREATED AS TAXABLE COMPENSATION AS THE DUES WERE A WORKING CONDITION FRINGE AND WERE USED PRIMARILY FOR BUSINESS. ANY PERSONAL USE OF THE MEMBERSHIP WAS SO SMALL THAT IT WAS A DE MINIMIS FRINGE.
SCHEDULE J, PAR I, LINE 7	NON-FIXED PAYMENTS ARE MADE TO EMPLOYEES BASED ON PERFORMANCE THAT IS NOT BASED ON REVENUES OR NET EARNINGS.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

Rehabilitation Hospital of the Pacific

Employer identification number

51-0160156

Return Reference	Explanation
FORM 990, PART I & PART III, LINE 1	REHABILITATION HOSPITAL OF THE PACIFIC REBUILDS LIVES TOGETHER WITH INDIVIDUALS, FAMILIES AND COMMUNITIES BY PROVIDING EXEMPLARY PATIENT CARE SERVICES FOR THOSE WITH PHYSICAL AND COGNITIVE DISABILITIES IN HAWAII AND THE PACIFIC. WE UTILIZE A CONTINUUM OF REHABILITATION SERVICES THAT ARE ADVANCED THROUGH EDUCATION, TECHNOLOGY AND RESEARCH.
FORM 990, PART III, LINES 4A-4D	PROGRAM SERVICE ACCOMPLISHMENTS PROGRAM SERVICE #1 INPATIENT ACUTE-CARE MEDICAL REHABILITATION SERVICES IN FISCAL YEAR 2020, REHABILITATION HOSPITAL OF THE PACIFIC (REHAB HOSPITAL) SPENT $27,843,552 IN EXPENSES FOR INPATIENT ACUTE-CARE MEDICAL REHABILITATION SERVICES. REHAB HOSPITAL'S INPATIENT ACUTE-CARE PROGRAM OFFERS OPPORTUNITIES FOR PEOPLE WITH DEBILITATING INJURIES OR ILLNESSES TO REBUILD THEIR STRENGTH AND FUNCTION TO MAXIMIZE THEIR INDEPENDENCE. OUR PROGRAMS INCLUDE: STROKE REHABILITATION PROGRAM - INDIVIDUAL TREATMENT-PLANS DESIGNED TO HELP PATIENTS RECOVERING FROM A STROKE MAKE PHYSICAL AND PSYCHOLOGICAL ADJUSTMENTS IN COPING WITH PARALYSIS, SPEECH PROBLEMS, COGNITIVE DEFICITS, SWALLOWING DISORDERS AND VISUAL-PERCEPTION DIFFICULTIES. BRAIN INJURY PROGRAM - COMPREHENSIVE ASSESSMENTS TO HELP RESTORE FUNCTION TO THOSE EXPERIENCING DEFICITS DUE TO BRAIN-TRAUMA OR DISEASE AND TO COPE WITH DEFICITS AFFECTING THINKING, LANGUAGE, LEARNING, EMOTIONS, BEHAVIOR AND/OR SENSATION. SPINAL CORD INJURY PROGRAM - TEAM APPROACH DEDICATED TO RESTORING INDEPENDENCE THROUGH A CONTINUUM OF SERVICES INCLUDING PHYSICAL AND OCCUPATIONAL THERAPY, WHEELCHAIR SEATING AND MOBILITY, AND COMMUNITY INTEGRATION PROGRAMS. TREATMENT PLANS INCLUDE COPING WITH THE LOSS OF FUNCTION AND SENSATION, IN ADDITION TO CHANGES IN BOWEL/BLADDER FUNCTIONS AND REGULATING BLOOD PRESSURE AND BODY TEMPERATURE. ORTHOPEDIC PROGRAM - TREATMENT AND THERAPY FOR INDIVIDUALS WITH COMPLEX, MEDICAL NEEDS FOLLOWING ORTHOPEDIC SURGERY, MUSCULOSKELETAL DISORDERS AND INJURIES. AMPUTEE PROGRAM - TREATMENT AND THERAPY WHICH INCLUDES PROSTHESIS AND GAIT TRAINING FOR INDIVIDUALS WHO HAVE UNDERGONE LOWER OR UPPER LIMB AMPUTATION. GENERAL REHABILITATION PROGRAM - TREATMENT AND THERAPY FOR INDIVIDUALS WITH FUNCTIONAL DECLINE AND LIMITED MOBILITY DUE TO PROLONGED ILLNESSES, SURGERIES, OR DEGENERATIVE DISEASES TO AVOID OTHER COMPLICATIONS WHICH IMPACT FUNCTIONING IN EVERYDAY TASKS. IN FISCAL YEAR 2020, REHAB HOSPITAL ADMITTED A TOTAL OF 1,705 PATIENTS IN THE FOLLOWING PROGRAMS: - STROKE REHABILITATION PROGRAM AND OTHER NEUROLOGICAL PROGRAMS: 559 INPATIENTS - BRAIN INJURY PROGRAM: 157 INPATIENTS - SPINAL CORD INJURY AND DYSFUNCTION PROGRAMS: 187 INPATIENTS - ORTHOPEDIC AND AMPUTEE PROGRAMS: 626 INPATIENTS - GENERAL REHABILITATION PROGRAMS: 176 INPATIENTS PROGRAM SERVICE #2 OUTPATIENT CLINIC THERAPY SERVICES IN FISCAL YEAR 2020, REHAB HOSPITAL SPENT $3,079,331 IN DIRECT EXPENSES FOR OUTPATIENT CLINIC THERAPY SERVICES. REHAB HOSPITAL OFFERS OUTPATIENT CLINIC THERAPY SERVICES IN NUUANU AND AIEA ON THE ISLAND OF OAHU AND IN HILO ON THE ISLAND OF HAWAII. EACH CLINIC OFFERS COMPREHENSIVE REHABILITATION SERVICES FOR THOSE WHO NEED ADDITIONAL PHYSICAL, OCCUPATIONAL, OR SPEECH THERAPY IN ORDER TO REACH HIGHER LEVELS OF INDEPENDENCE. SPECIALTY SERVICES PROVIDED ON AN OUTPATIENT BASIS ALSO INCLUDE: - CARDIAC REHABILITATION - AQUATIC THERAPY - DRIVER'S EDUCATION AND TRAINING - WOMEN'S HEALTH REHABILITATION - URINARY INCONTINENCE PROGRAM IN FISCAL YEAR 2020, REHAB HOSPITAL PROVIDED OUTPATIENT THERAPY SESSIONS TOTALING 26,552 IN THE FOLLOWING AREAS: - PHYSICAL AND AQUATICS THERAPY: 20,974 SESSIONS - OCCUPATIONAL THERAPY: 3,995 SESSIONS - SPEECH THERAPY: 1,583 SESSIONS PROGRAM SERVICE #3 PHYSICIANS CLINIC SERVICES IN FISCAL YEAR 2020, REHAB HOSPITAL SPENT $746,125 IN DIRECT EXPENSES FOR PHYSICIANS CLINIC SERVICES. REHAB HOSPITAL OFFERS PHYSICIAN SERVICES IN A HOSPITAL BASED CLINIC LOCATED ON ITS NUUANU CAMPUS. THE CLINIC OFFERS COMPREHENSIVE PROGRAMS FOR STROKE, AMPUTEE, SPASTICITY, NEUROTRAUMA, AND OSTEOPOROSIS PATIENTS, AMONGST OTHERS. IN FISCAL YEAR 2019, REHAB HOSPITAL PROVIDED PHYSICIAN VISITS TOTALING 3,102 VISITS . PROGRAM SERVICE #4 REHAB HOSPITAL IS THE ONLY ACUTE-CARE MEDICAL REHABILITATION ORGANIZATION SERVING HAWAII AND THE PACIFIC FOR MORE THAN 65 YEARS. THE 82-BED, NOT-FOR-PROFIT HOSPITAL, THREE OUTPATIENT THERAPY CLINICS, AND HOSPITAL BASED PHYSICIANS CLINIC ON THE ISLANDS OF OAHU AND HAWAII HAVE BEEN DEDICATED TO PROVIDING COMPREHENSIVE MEDICAL REHABILITATION SERVICES. COMMUNITY ROLE/ACTIVITY IN ADDITION TO PROVIDING THE SERVICES ABOVE, REHAB HOSPITAL HAS SUPPORTED THE COMMUNITY THROUGH THE FOLLOWING: - HOSTING SUPPORT GROUPS FOR FORMER REHAB PATIENTS, AND THE COMMUNITY-AT-LARGE, INCLUDING THE STROKE CLUB OF HONOLULU, THE TRAUMATIC BRAIN INJURY CLUB, THE SPINAL CORD INJURY SUPPORT GROUP, AND THE POST-AMPUTATION SUPPORT GROUP. - PROVIDING EDUCATION AND CLINICAL ROTATIONS FOR THERAPY STUDENTS, REHABILITATIVE NURSING, AND MEDICAL PROFESSIONALS. - PARTICIPATING IN HEALTH AND FITNESS FAIRS TO HELP FOSTER HEALTH - EDUCATION IN THE COMMUNITY. - PROVIDING CONFERENCES AND PRESENTATIONS TO SPECIAL INTEREST GROUPS FOCUSED ON THE PREVENTION AND TREATMENT OF BRAIN INJURIES, SPINAL CORD INJURIES AND STROKES. - ORGANIZING VOLUNTEERS FROM THE COMMUNITY, MANY OF WHOM ARE ALSO PHYSICALLY CHALLENGED, TO PERFORM THOUSANDS OF HOURS OF VOLUNTEER WORK. IN FISCAL YEAR 2020, MORE THAN 11,100 VOLUNTEER HOURS WERE PERFORMED. THE SELECTION AND QUALITY OF PROGRAMS AND SERVICES PROVIDED BY REHAB HOSPITAL ARE OF GREAT VALUE TO THE COMMUNITY. THE FOLLOWING BENEFITS ARE A RESULT OF REHAB HOSPITAL'S PRESENCE IN THE COMMUNITY: - AVAILABILITY OF HIGHER QUALITY, COMPREHENSIVE, COST EFFICIENT, PHYSICAL AND COGNITIVE REHABILITATION WHICH PROVIDES FOR GREATER FUNCTIONAL INDEPENDENCE FOR THE PATIENTS. - EDUCATION AND TRAINING FOR THE GENERAL COMMUNITY ON REHABILITATION TECHNIQUES AND TRENDS AND PREVENTIVE MEASURES. - RETURN OF INJURED PATIENTS TO THEIR COMMUNITY AND TO THE WORKFORCE WITH GREATER FUNCTIONAL INDEPENDENCE IN A TIMELY MANNER. OTHER REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND VIABILITY OF ANY HOSPITAL. HOWEVER IN FULFILLMENT OF OUR MISSION AS A NON-PROFIT, COMMUNITY-BASED HOSPITAL, REHAB HOSPITAL HAS A FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES COMPREHENSIVE MEDICAL REHABILITATION TO INDIVIDUALS FROM WHOM WE MAY RECEIVE LITTLE OR NO COMPENSATION. IN FISCAL YEAR 2020, REHAB HOSPITAL PROVIDED VARIOUS FORMS OF FINANCIAL ASSISTANCE TO ITS PATIENTS. THE ESTIMATED UNCOMPENSATED COST OF PROVIDING CARE TO THESE PATIENTS WAS APPROXIMATELY $22,000 . REHAB HOSPITAL ALSO PROVIDED SERVICES TO APPROXIMATELY 980 INPATIENTS AND OUTPATIENTS WITH MEDICAID OR MEDICAID HMO COVERAGE. MEDICAID REIMBURSEMENT CONTINUES TO BE LOWER THAN THE COST TO PROVIDE SERVICES TO THESE PATIENTS. IT IS ESTIMATED THAT THE COST TO PROVIDE SERVICES TO THESE PATIENTS WITH MEDICAID OR MEDICAID HMO COVERAGE EXCEEDED REIMBURSEMENT, BY APPROXIMATELY $1,309,050.
FORM 990, PART VI, LINE 1A	THE EXECUTIVE COMMITTEE SHALL BE A STANDING COMMITTEE CONSISTING OF NOT LESS THAN SEVEN (7) NOR MORE THAN THIRTEEN (13) MEMBERS. MEMBERS INCLUDE THE CHAIR OF THE REHABILITATION HOSPITAL OF THE PACIFIC WHO ALSO ACTS AS THE CHAIR OF THE EXECUTIVE COMMITTEE; VICE CHAIR OF THE REHABILITATION HOSPITAL OF THE PACIFIC; CHAIRS OF THE COMPLIANCE/AUDIT COMMITTEE, FINANCE COMMITTEE, HUMAN RESOURCES/COMPENSATION COMMITTEE, INVESTMENT COMMITTEE, NOMINATING COMMITTEE AND QUALITY IMPROVEMENT COMMITTEE; CHAIR OF THE REHABILITATION HOSPITAL OF THE PACIFIC FOUNDATION AND ANY OTHER MEMBER APPOINTED BY THE BOARD OF DIRECTORS. THE COMMITTEE SHALL TRANSACT ALL REGULAR BUSINESS AND ACT ON BEHALF OF THE BOARD OF DIRECTORS DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD INCLUDING THE FOLLOWING: - AUTHORIZE DISTRIBUTIONS; - APPROVE THE DISSOLUTION, MERGER, OR THE SALE, PLEDGE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; - ELECT, APPOINT OR REMOVE DIRECTORS OR FILL VACANCIES ON THE BOARD OR ON ANY OF ITS COMMITTEES; - ADOPT, AMEND OR REPEAL THE CHARTER OF INCORPORATION OR BYLAWS.
FORM 990, PART VI, LINE 11B	THE COMPLIANCE/AUDIT COMMITTEE OF THE BOARD IS GIVEN THE AUTHORITY BY THE FULL BOARD OF DIRECTORS TO REVIEW AND APPROVE THE FORM 990 PRIOR TO FILING. A COMPLETE COPY OF THE APPROVED FORM 990 IS PROVIDED TO EACH MEMBER OF THE BOARD PRIOR TO FILING.
FORM 990, PART VI, LINE 12C	IN ACCORDANCE WITH HOSPITAL POLICY, CONFLICT OF INTEREST QUESTIONNAIRES ARE COMPLETED ANNUALLY BY ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, MEMBERS OF THE MEDICAL EXECUTIVE COMMITTEE, MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS AND OTHER DESIGNATED REHAB EMPLOYEES. THE EXECUTIVE SECRETARY DISTRIBUTES THE QUESTIONNAIRES AND COMPILES A REPORT OF THE RESPONSES. THE REPORT IS REVIEWED BY THE COMPLIANCE OFFICER AND CEO AND DISTRIBUTED TO THE COMPLIANCE/AUDIT COMMITTEE FOR REVIEW. THE COMPLIANCE/AUDIT COMMITTEE REVIEWS THE REPORT TO DETERMINE WHETHER THE TERMS OF THE IDENTIFIED CONFLICT OF INTEREST ARE FAIR TO AND IN THE BEST INTEREST OF REHAB. THE COMPLIANCE/AUDIT COMMITTEE APPROVES THE REPORT AS APPROPRIATE AND SUCH APPROVAL IS DOCUMENTED IN THE MINUTES. ANY FURTHER ACTION REQUIRED FOR UNAPPROVED CONFLICT WOULD BE RESOLVED AT THE INSTRUCTION OF THE COMPLIANCE/AUDIT COMMITTEE.
FORM 990, PART VI, LINES 15A & 15B	THE PROCESS TO REVIEW CEO COMPENSATION WAS LAST COMPLETED IN SEPTEMBER 2019 RESULTING IN A TWO YEAR EMPLOYMENT AGREEMENT. THE EMPLOYMENT AGREEMENT STIPULATES A BASE SALARY FOR THE FIRST YEAR AND THEN ADJUSTMENTS BASED ON THE U.S. BUREAU OF LABOR STATISTICS COST INDEX: WAGES AND SALARIES FOR PRIVATE INDUSTRY WORKS IN HOSPITALS FOR THE FOLLOWING YEARS. THE PROCESS TO REVIEW COMPENSATION FOR OTHER EXECUTIVES WAS LAST COMPLETED IN JULY 2016 AND OCTOBER 2017.
FORM 990, PART VI, LINE 19	UPON REQUEST, THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 9	NET CHANGE IN ACCRUED PENSION LIABILITY ($ 1,640,201) CHANGE IN BENEFICIAL INTEREST IN UNRESTRICTED NET ASSETS OF FOUNDATION $ 220,921 CHANGE IN BENEFICIAL INTEREST IN TEMPORARILY RESTRICTED NET ASSETS OF FOUNDATION ($ 39,698) CHANGE IN BENEFICIAL INTEREST IN PERMANENTLY RESTRICTED NET ASSETS OF FOUNDATION $ 7,449 ------------- TOTAL ($ 1,451,529)
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER FEES TOTAL FEES:5037258

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Rehabilitation Hospital of the Pacific

Employer identification number

51-0160156

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?
(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	Yes	No
(1)Rehab Hospital of the Pacific Foundation 226 North Kuakini Street Honolulu,HI96817 99-0241634	Support Svcs	HI	501(c)(3)	7	REHAB HOSP	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

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	(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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No

Schedule R (Form 990) 2019

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

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 .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

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) Rehab Hospital of the Pacific Foundation	c	614,254	COST
(2) Rehab Hospital of the Pacific Foundation	q	311,369	COST

Schedule R (Form 990) 2019

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	20
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	20
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	582
6	Total number of volunteers (estimate if necessary) .............	6	126
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	643,513	2,215,513
9	Program service revenue (Part VIII, line 2g) .........	50,112,752	43,713,363
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	799,080	1,003,399
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,190,459	1,126,834
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	52,745,804	48,059,109
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
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)	33,465,704	31,013,654
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	19,062,267	17,000,646
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	52,527,971	48,014,300
19	Revenue less expenses. Subtract line 18 from line 12.......	217,833	44,809
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	83,974,466	86,769,518
21	Total liabilities (Part X, line 26).............	31,364,446	35,602,335
22	Net assets or fund balances. Subtract line 21 from line 20.....	52,610,020	51,167,183

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 27,843,552 including grants of $ ) (Revenue $ 39,931,467 )
	SEE SCHEDULE O

4b	(Code: ) (Expenses $ 3,079,331 including grants of $ ) (Revenue $ 3,098,370 )
	SEE SCHEDULE O

4c	(Code: ) (Expenses $ 746,125 including grants of $ ) (Revenue $ 683,159 )
	SEE SCHEDULE O

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses31,669,008

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,007,763	0	363,058

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	614,254
e	Government grants (contributions)		1e	1,535,380

f	All other contributions, gifts, grants, and similar amounts not included above		1f	65,879

g	Noncash contributions included in lines 1a - 1f:$		1g	14,214

h Total. Add lines 1a-1f.......		2,215,513

		Business Code
2a	MEDICARE/MEDICAID PAYMENT	622310	29,302,131	29,302,131
b	PATIENT REVENUES	622310	14,411,232	14,411,232
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		43,713,363

3 Investment income (including dividends, interest, and othersimilar amounts) ......			765,283			765,283
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		909,059	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	909,059	6c
d	Net rental income or (loss).......			909,059			909,059
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		3,438,721	7a
b	Less: cost or other basis and sales expenses		3,200,605	7b
c	Gain or (loss)		238,116	7c
d	Net gain or (loss).........			238,116			238,116
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	PARKING REVENUE		812930	128,622			128,622
b	GIFT SHOP REVENUE		453220	9,306			9,306
c	PHYSICIANS CLINIC ADMIN FEES		561110	12,580			12,580
d	All other revenue ....			67,267			67,267
e	Total. Add lines 11a–11d ......			217,775
12	Total revenue. See instructions.....			48,059,109	43,713,363		2,130,233

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. 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 ...........	1,186,202	241,614	944,588
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........	23,448,899	17,560,363	5,888,536
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	394,599	285,148	109,451
9	Other employee benefits .......	4,167,464	3,027,860	1,139,604
10	Payroll taxes ...........	1,816,490	1,312,644	503,846
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	167,075	7,242	159,833
c	Accounting ...........	175,575		175,575
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	65,372		65,372
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	5,037,258	4,193,768	843,490
12	Advertising and promotion ....	247,849		247,849
13	Office expenses .......	279,742	117,487	162,255
14	Information technology ......	2,472,025		2,472,025
15	Royalties ..	0
16	Occupancy ...........	1,290,796	722,454	568,342
17	Travel ............	47,625	10,738	36,887
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	13,198	10,772	2,426
20	Interest ...........	441,031	2,296	438,735
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	3,950,056	1,940,971	2,009,085
23	Insurance ...	185,598		185,598
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	PATIENT SUPPLIES	1,149,497	1,149,497
b	HI PROVIDER TAX&RELATED PMTS	1,019,684	1,019,684
c	REPAIRS & MAINTENANCE	248,388	55,502	192,886
d	DUES	110,715	3,076	107,639
e	All other expenses	99,162	7,892	91,270
25	Total functional expenses. Add lines 1 through 24e	48,014,300	31,669,008	16,345,292	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			2,400	1	2,600
2	Savings and temporary cash investments .........			4,712,881	2	10,114,858
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			6,347,910	4	4,797,283
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			150,778	8	161,298
9	Prepaid expenses and deferred charges ......			709,457	9	890,194
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	68,107,655
b	Less: accumulated depreciation	10b	39,034,602	31,483,433	10c	29,073,053
11	Investments—publicly traded securities .			26,141,626	11	26,489,327
12	Investments—other securities. See Part IV, line 11 .....			106,010	12	93,029
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			14,319,971	15	15,147,876
16	Total assets. Add lines 1 through 15 (must equal line 33)...			83,974,466	16	86,769,518

17	Accounts payable and accrued expenses .....	16,686,752	17	17,572,313
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 any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	14,366,031	23	13,484,154
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	311,663	25	4,545,868
26	Total liabilities. Add lines 17 through 25..	31,364,446	26	35,602,335

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	45,448,022	27	44,086,847
28	Net assets with donor restrictions ...........	7,161,998	28	7,080,336
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	52,610,020	32	51,167,183
33	Total liabilities and net assets/fund balances ........	83,974,466	33	86,769,518