TY 2020 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) RAYMOND P VARA JR...................................................................... Board of Director, President	8.0 ................. 54.1	X	X		2,201,810	2,584,503
(2) DAVID OKABE...................................................................... EVP, CFO & Treasurer	9.0 ................. 41.0		X		946,332	377,896
(3) MARTHA SMITH...................................................................... BOARD OF DIRECTOR, CEO (PT YR)	50.0 ................. 10.0	X	X		876,739	308,071
(4) ARTHUR GLADSTONE...................................................................... BOD, CEO, EVP & CSO	41.2 ................. 14.6	X	X		816,310	309,387
(5) CHARLES R CHING...................................................................... EVP, GEN. COUNSEL & SECRETARY	12.0 ................. 28.0		X		770,901	282,179
(6) GAIL LERCH...................................................................... Former Officer	9.0 ................. 42.0			X	742,339	304,514
(7) STEVEN ROBERTSON...................................................................... EVP & CIO	3.0 ................. 50.0		X		746,792	292,161
(8) MELINDA ASHTON MD...................................................................... EVP & CQO	6.0 ................. 43.3		X		720,839	248,689
(9) JENNIE CHAHANOVICH...................................................................... BOD, President & CEO	42.0 ................. 14.5	X	X		660,280	228,096
(10) LESLIE CHUN MD...................................................................... EVP	8.0 ................. 52.0		X		664,477	114,056
(11) PATRICK O'DONNELL MD...................................................................... Board of Director	40.0 ................. 0.2	X			647,645	36,969
(12) RODNEY WILLIAMS MD...................................................................... Former Officer	34.0 ................. 6.0			X	579,383	96,657
(13) DAVID CHO MD...................................................................... Board of Director	40.0 ................. 0.2	X			623,988	33,672
(14) GERARD LIVAUDAIS MD...................................................................... EVP	0.1 ................. 49.9		X		523,145	123,914
(15) TODD MILLER MD...................................................................... Board of Director, Vice Chair	40.0 ................. 0.0	X	X		601,105	18,839
(16) DOUGLAS KWOCK MD...................................................................... VP	36.0 ................. 4.0		X		492,064	95,971
(17) KENNETH B ROBBINS MD...................................................................... Former Officer	24.5 ................. 30.5			X	346,070	180,365

(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) TRAVIS CLEGG........................................................................ COO	50.0 .......................0.0		X			0	406,311	96,095
(19) GIDGET RUSCETTA RN........................................................................ COO	45.0 .......................11.0		X			0	404,309	94,693
(20) DAWN DUNBAR........................................................................ SVP	0.0 .......................45.0		X			0	393,438	104,947
(21) WARREN CHAIKO........................................................................ SVP	22.0 .......................18.0		X			0	375,732	110,606
(22) MAVIS NIKAIDO........................................................................ VP & CNE	55.0 .......................1.0		X			0	371,061	77,433
(23) SUSAN MATSUMOTO-NONAKA........................................................................ VP	31.5 .......................8.5		X			0	364,629	81,441
(24) BRANDT FARIAS........................................................................ SVP - (Part Year)	10.0 .......................53.0		X			0	327,384	85,944
(25) TYLER CHIHARA DPM........................................................................ Board of Director	0.2 .......................40.0	X				0	378,989	32,931
(26) ANDY LEE MD........................................................................ BOD, Chief of Staff	8.0 .......................41.0	X	X			0	358,849	45,247
(27) MICHAEL ROBINSON........................................................................ VP	0.6 .......................49.4		X			0	327,479	74,190
(28) BRIGITTE MCKALE........................................................................ VP & CNE	55.0 .......................0.0		X			0	314,717	75,342
(29) DAWN CHING........................................................................ VP	50.0 .......................3.0		X			0	314,107	73,241
(30) JAMES LIN MD........................................................................ VP	0.4 .......................47.2		X			0	313,224	66,003
(31) CAROL FUJIYOSHI MD........................................................................ Board of Director	0.2 .......................40.0	X				0	353,186	18,715
(32) BEAU NAKAMOTO MD........................................................................ Former Officer	40.0 .......................0.4				X	0	343,709	11,550
(33) EARL INOUYE........................................................................ Former Officer	10.5 .......................37.5				X	0	285,145	69,530
(34) DAVID STUMBAUGH........................................................................ VP	32.0 .......................8.0		X			0	266,339	79,416
(35) BARBARA CRAFT........................................................................ COO	46.6 .......................7.4		X			0	281,326	63,356
(36) LORRIE-ANN LUKE........................................................................ VP	7.0 .......................34.5		X			0	259,855	82,911
(37) WILLIAM BURKE........................................................................ VP	16.0 .......................38.0		X			0	277,031	60,631
(38) MELANIE KIM MD........................................................................ Board of Director	40.0 .......................0.2	X				0	302,650	19,065
(39) ANDREW MOATS........................................................................ VP	40.0 .......................0.0		X			0	257,965	59,934
(40) SUNSHINE TOPPING........................................................................ SVP	9.0 .......................41.0		X			0	289,279	21,615
(41) JOAN KANEMORI........................................................................ VP	40.0 .......................0.0		X			0	251,867	56,330
(42) MONICA PRICE MD........................................................................ Board of Director	40.0 .......................0.4	X				0	251,956	34,427
(43) CARRIE ANN TSUTSUI........................................................................ VP & SYS. Controller	13.0 .......................35.0		X			0	230,878	53,413
(44) LAURA BONILLA........................................................................ EXEC. DIR. PEDIATRIC SRVCS.	40.0 .......................0.0			X		246,100	0	33,834
(45) KENT KIKUCHI........................................................................ DIRECTOR OF PHARMACY	40.0 .......................0.0			X		223,917	0	48,078
(46) JOY MATSUYAMA........................................................................ DIRECTOR OF PHARMACY	40.0 .......................0.0			X		225,551	0	46,243
(47) MEGAN STOBO........................................................................ ADMINISTRATOR - HSC	40.0 .......................0.0			X		227,077	0	40,238
(48) GLENN KAWABATA........................................................................ VP	50.0 .......................1.0		X			0	210,480	55,568
(49) GLORIA BROOKS........................................................................ VP	39.0 .......................1.0		X			0	225,785	39,977
(50) KATIE SHIGEMITSU........................................................................ Compliance Officer	18.5 .......................21.5		X			0	224,686	38,125
(51) LORI INGRAM........................................................................ DIR. CLINICAL SERVICE LINE	40.0 .......................0.0			X		225,878	0	26,140
(52) ALAN ITO........................................................................ Information Security Officer	3.0 .......................37.0		X			0	200,273	35,376
(53) JESSICA LEWIS........................................................................ Assistant Corporate Secretary	14.0 .......................26.0		X			0	170,876	40,404
(54) DAVID FOX........................................................................ Privacy Officer - (Part Year)	15.2 .......................24.8		X			0	163,615	32,106
(55) FRANCE GRAVES........................................................................ Privacy Officer	15.2 .......................24.8		X			0	108,993	33,530
(56) SIDNEY LEE MD........................................................................ Board of Director	0.3 .......................0.0	X				0	24,506	0
(57) STEPHEN LIN MD........................................................................ Board of Director, Chair	1.3 .......................0.4	X	X			0	12,041	0
(58) OWEN CHAN MD........................................................................ Board of Director	0.2 .......................0.0	X				0	11,000	0
(59) DAWN MIURA MD........................................................................ Board of Director, Vice Chair	0.2 .......................0.0	X	X			0	0	0
(60) JERRY PUPILLO........................................................................ Board of Director, Chair	1.2 .......................0.0	X	X			0	0	0
(61) MICHAEL YAMANE........................................................................ Board of Director, Chair	0.2 .......................0.4	X	X			0	0	0
(62) PAUL TONER........................................................................ Board of Director, Vice Chair	1.2 .......................0.0	X	X			0	0	0
(63) RICHANNE LAM........................................................................ Board of Director, Chair	0.2 .......................0.1	X	X			0	0	0
(64) TAD JACKSON MD........................................................................ BOARD OF DIR., CHAIR (PT YR)	0.2 .......................0.0	X	X			0	0	0
(65) ALANA PAKKALA........................................................................ Board of Director	0.3 .......................0.0	X				0	0	0
(66) ANDREW ROSEN........................................................................ Board of Director	0.2 .......................0.0	X				0	0	0
(67) AVI MANNIS........................................................................ Board of Director	0.2 .......................0.0	X				0	0	0
(68) CARL ACKERMAN........................................................................ Board of Director	0.2 .......................0.0	X				0	0	0
(69) CLAIRE TAMAMOTO........................................................................ Board of Director	0.2 .......................0.0	X				0	0	0
(70) CLYDE KODANI........................................................................ BOARD OF DIRECTOR (PART YEAR)	0.2 .......................0.0	X				0	0	0
(71) DENNIS FRANCIS........................................................................ Board of Director	0.2 .......................0.0	X				0	0	0
(72) DOUGLAS DUVAUCHELLE MD........................................................................ Board of Director	0.2 .......................0.0	X				0	0	0
(73) EDWARD NISHIOKA........................................................................ Board of Director	0.2 .......................0.0	X				0	0	0
(74) EMILY KURAOKA........................................................................ Board of Director	0.2 .......................0.1	X				0	0	0
(75) GERALD MCKENNA MD........................................................................ Board of Director	0.2 .......................0.0	X				0	0	0
(76) JASMINE TANIOKA........................................................................ Board of Director	0.2 .......................0.0	X				0	0	0
(77) KATHY RICHARDSON........................................................................ Board of Director	0.2 .......................0.0	X				0	0	0
(78) KIM HEHIR........................................................................ Board of Director	0.3 .......................0.2	X				0	0	0
(79) LYLE TABATA........................................................................ Board of Director	0.2 .......................0.4	X				0	0	0
(80) MARK YAMAKAWA........................................................................ Board of Director	0.3 .......................0.0	X				0	0	0
(81) MAYA ROGERS........................................................................ Board of Director	0.3 .......................0.0	X				0	0	0
(82) MICHAEL O'MALLEY ESQ........................................................................ Board of Director	0.3 .......................0.0	X				0	0	0
(83) MICHELLE HO........................................................................ Board of Director	0.3 .......................0.0	X				0	0	0
(84) NEIL MANAGO MD........................................................................ Board of Director	0.2 .......................0.0	X				0	0	0
(85) PAUL EAKIN MD........................................................................ Board of Director	0.3 .......................0.0	X				0	0	0
(86) ROBERT KURISU........................................................................ Board of Director	0.3 .......................0.0	X				0	0	0
(87) SCOTT KUROSAWA........................................................................ Board of Director	0.2 .......................0.0	X				0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
CLINICAL LABORATORIES OF HAWAI'I L, MAIL CODE NO 60300 PO BOX 1300 HONOLULU,HI968071300	MEDICAL SERVICES	25,296,209
SODEXO INC AFFILIATES, 9801 WASHINGTONIAN BLVD GAITHERSBURG,MD20878	Food & ENV. SRVCS.	9,221,847
UNIV CLINIC EDUC RESEARCH ASSOC, 677 ALA MOANA BLVD Ste 1001 HONOLULU,HI96813	MEDICAL SERVICES	8,914,190
HAWAI'I RESIDENCY PROGRAMS INC, 1356 LUSITANA ST STE 510 HONOLULU,HI96813	MEDICAL SERVICES	7,638,035
MEDEFIS INC, 2121 n 117TH AVE STE OMAHA,NE68164	MANAGEMENT SERVICES	5,192,551
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 72

- 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.
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Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

HAWAI'I PACIFIC HEALTH GROUP RETURN

Employer identification number

38-3835105

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 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) 2020

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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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 5 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 2020 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2019 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2020. 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—2019. 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—2020. 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—2019. 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) 2020

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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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 5 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 2020 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2019 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2020 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2019 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2020. 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—2019. 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) 2020

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) 2020

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 lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described in 11a above?

11b

A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2020

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	0
2	Recoveries of prior-year distributions	2	0
3	Other gross income (see instructions)	3	0
4	Add lines 1 through 3	4	0
5	Depreciation and depletion	5	0
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	0
7	Other expenses (see instructions)	7	0
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8	0

	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	0
b	Average monthly cash balances	1b	0
c	Fair market value of other non-exempt-use assets	1c	0
d	Total (add lines 1a, 1b, and 1c)	1d	0
e	Discount claimed for blockage or other factors (explain in detail in Part VI): 0
2	Acquisition indebtedness applicable to non-exempt use assets	2	0
3	Subtract line 2 from line 1d	3	0
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4	0
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5	0
6	Multiply line 5 by 0.035	6	0
7	Recoveries of prior-year distributions	7	0
8	Minimum Asset Amount (add line 7 to line 6)	8	0

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1	0
2	Enter 85% of line 1	2	0
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3	0
4	Enter greater of line 2 or line 3	4	0
5	Income tax imposed in prior year	5	0
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6	0

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) 2020

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	1	0
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2	0
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3	0
4 Amounts paid to acquire exempt-use assets	4	0
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5	0
6 Other distributions (describe in Part VI). See instructions	6	0
7Total annual distributions. Add lines 1 through 6.	7	0
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8	0
9 Distributable amount for 2020 from Section C, line 6	9	0
10 Line 8 amount divided by Line 9 amount	10	0 %

Section E - Distribution Allocations (see instructions)	(i) Excess Distributions	(ii) Underdistributions Pre-2020	(iii) Distributable Amount for 2020
1 Distributable amount for 2020 from Section C, line 6			0
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.		0
3 Excess distributions carryover, if any, to 2020:
a From 2015.......0
b From 2016.......0
c From 2017.......0
d From 2018.......0
e From 2019.......0
fTotal of lines 3a through e	0
g Applied to underdistributions of prior years		0
h Applied to 2020 distributable amount			0
i Carryover from 2015 not applied (see instructions)	0
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.	0
4Distributions for 2020 from Section D, line 7:
$ 0
a Applied to underdistributions of prior years		0
b Applied to 2020 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.	0
5 Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.		0
6 Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.			0
7 Excess distributions carryover to 2021. Add lines 3j and 4c.	0
8 Breakdown of line 7:
a Excess from 2016.....0
b Excess from 2017.....0
c Excess from 2018.....0
d Excess from 2019.....0
e Excess from 2020.....0

Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020

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) 2020

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

2020

Name of the organization

HAWAI'I PACIFIC HEALTH GROUP RETURN

Employer identification number

38-3835105

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2

Name of organization HAWAI'I PACIFIC HEALTH GROUP RETURN

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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 3

Name of organization HAWAI'I PACIFIC HEALTH GROUP RETURN		Employer identification number 38-3835105

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 4


Name of organization HAWAI'I PACIFIC HEALTH GROUP RETURN			Employer identification number 38-3835105
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) (2020)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

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

OMB No. 1545-0047

2020

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

HAWAI'I PACIFIC HEALTH GROUP RETURN

Employer identification number

38-3835105

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2020

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2020

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

61,356

Total. Add lines 1c through 1i ....................................................................................................

61,356

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART II-B	LOBBYING EXPENDITURES LOBBYING EXPENSES ARE THE PORTION OF AMOUNTS PAID TO HEALTHCARE ASSOCIATIONS THAT ENGAGED IN LEGISLATIVE LOBBYING ON BEHALF OF ITS MEMBERS.

Schedule C (Form 990 or 990EZ) 2020

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

2020

Open to Public Inspection

Name of the organization

HAWAI'I PACIFIC HEALTH GROUP RETURN

Employer identification number

38-3835105

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" 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

$ 1,794,980

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) 2020

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 ....	213,487,581	205,962,211	195,030,697	180,123,783	163,374,610
b	Contributions ...		67,736	0	0	0
c	Net investment earnings, gains, and losses	52,193,682	7,620,886	11,008,237	15,061,139	16,944,928
d	Grants or scholarships ...			0	0	0
e	Other expenditures for facilities and programs ...	29,709	163,252	76,723	154,225	195,755
f	Administrative expenses ....			0	0
g	End of year balance ......	265,651,554	213,487,581	205,962,211	195,030,697	180,123,783

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

Board designated or quasi-endowment SchDMd Bullet

99.390 %

Permanent endowment SchDMd Bullet

0.610 %

Term endowment SchDMd Bullet

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)

Yes

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

3a(ii)

Yes

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

Yes

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 .....	19,720,249		19,720,249
b	Buildings ....	669,991,137	314,713,263	355,277,874
c	Leasehold improvements	52,764,189	26,245,105	26,519,084
d	Equipment ....	313,177,568	241,046,528	72,131,040
e	Other .....	34,356,377	2,757,898	31,598,489
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				505,246,736

Schedule D (Form 990) 2020

Page 3

Part VII

Investments - Other 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 (A) BOARD DESIGNATED SECURITIES	141,858,024	F
(B) INVEST. IN UNCONSOLIDATED SUB.	4,971,708	F
(C) LIMITED PARTNERSHIPS	1,606,879	F
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	148,436,611

Part VIII

Investments - Program 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)OPERATING & FINANCE LEASE				102,574,467
(2)INT. IN NET ASSETS OF FDNS.				47,028,238
(3)DUE FROM THIRD-PARTY PAYORS				21,507,877
(4)BOARD DESIGNATED INVESTMENTS				18,487,375
(5)OTHER RECEIVABLES				10,758,371
(6)DEPOSITS & NON-CURRENT ASSETS				7,104,425
(7)INTEREST IN PERPETUAL TRUST				5,519,309
(8)DECORATIVE ARTWORK				1,794,980
(9)INTERCOMPANY TRANSFERS				949,323
(10)INVESTMENT IN JOINT VENTURES				25,000
(11)DUE FROM HAWAI'I HEALTH PRTNRS				2,895,769
(12)DUE FROM KAPI'OLANI HLTH. FDN.				626,100
(13)DUE FROM PROVIDERS INS. CORP.				580,295
(14)DUE FROM KAUA'I MEDICAL CLINIC				213,863
(15)DUE FROM KAPI'OLANI MED. SP.				172,236
(16)DUE FROM STRAUB FOUNDATION				140,108
(17)DUE FROM PALI MOMI FOUNDATION				114,457
(18)DUE FROM WILCOX FOUNDATION				52,175
(19)DUE FROM HONOLULU SURGERY CTR.				28,502
(20)DUE FROM HPH PARTNERS, INC.				11,540
(21)DUE FROM HICORD, INC.				1
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				220,584,411

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
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	225,637,698
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) 2020

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
SCHEDULE D, PART III, LINE 4	ORGANIZATION'S ART COLLECTION ARTWORK IS USED TO IMPROVE THE INTERNAL ENVIRONMENT OF THE HOSPITALS SETTING FOR BOTH FAMILIES AND PATIENTS. THIS INCLUDES CREATING AN INVITING PATIENT ATMOSPHERE IN BOTH THE ROOMS AND THE HALLS OF OUR FACILITIES. THIS ENVIRONMENT IS A KEY DIFFERENTIATING FACTOR IN IMPROVING THE OUTLOOK OF THOSE WHO UTILIZE OUR FACILITIES AS WELL AS THE STAFF WHO WORK THERE. BOTH OF WHICH LEADS TO IMPROVED PATIENT RESULTS AND POSITIVE VIEWS OF OUR SERVICES.
SCHEDULE D, PART V, LINE 4	ENDOWMENT FUNDS INTENDED USES ENDOWMENT FUNDS ARE INTENDED TO BE USED TO PROVIDE MEDICAL AND OTHER CARE TO PATIENTS WHO ARE UNABLE TO PAY FOR SUCH CARE AND FOR OTHER EXPENSES RELATED TO THE EXEMPT PURPOSE OF THE HOSPITAL.
SCHEDULE D, PART X, LINE 2	UNCERTAIN TAX POSITIONS AUDITED FINANCIAL STATEMENT FOOTNOTE THE COMPANY HAS NOT RECORDED ANY EXPENSE OR ACCRUED FOR ANY RELATED EXPENSE FOR ANY UNCERTAIN TAX POSITIONS. THE COMPANY'S 2017 THROUGH 2020 TAX YEARS REMAIN SUBJECT TO EXAMINATION FOR FEDERAL INCOME TAX PURPOSES, WHEREAS THE 2016 THROUGH 2020 TAX YEARS REMAIN SUBJECT TO EXAMINATION FOR STATE TAXING JURISDICTIONS IN WHICH THE COMPANY OPERATES.

Schedule D (Form 990) 2020

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

2020

Open to Public Inspection

Name of the organization

HAWAI'I PACIFIC HEALTH GROUP RETURN

Employer identification number

38-3835105

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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? . . . . . .

Yes

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? . . . . . . . . .

Yes

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

Yes

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		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .		19,816	5,159,423		5,159,423	0.390 %
b	Medicaid (from Worksheet 3, column a) . . . . .		235,079	262,654,394	227,100,976	35,553,418	2.650 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .		254,895	267,813,817	227,100,976	40,712,841	3.040 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	24	2,481	10,172,900	6,577,226	3,595,674	0.270 %
f	Health professions education (from Worksheet 5) . . .	8		11,330,597	2,489,129	8,841,468	0.660 %
g	Subsidized health services (from Worksheet 6) . . . .	12		62,313,531	35,801,484	26,512,047	1.980 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	25		1,711,612		1,711,612	0.130 %
j	Total. Other Benefits . .	69	2,481	85,528,640	44,867,839	40,660,801	3.040 %
k	Total. Add lines 7d and 7j .	69	257,376	353,342,457	271,968,815	81,373,642	6.080 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020

Schedule H (Form 990) 2020

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

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

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

2,122,737

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).....

151,015,343

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

165,306,410

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

-14,291,067

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) 2020

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?4Name, 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)							Facility reporting group
1	STRAUB CLINIC & HOSPITAL 888 SOUTH KING STREET HONOLULU,HI96813 www.hawaiipacifichealth.org/straub 32-H	X	X		X	X	A
2	KAPI'OLANI MEDICAL CENTER FOR WOMEN 1319 PUNAHOU STREET HONOLULU,HI96826 www.hawaiipacifichealth.org/kapiolani 6-H	X	X	X	X	X	A
3	PALI MOMI MEDICAL CENTER 98-1079 MOANALUA ROAD AIEA,HI96701 www.hawaiipacifichealth.org/pali-momi 37-H	X	X			X	A
4	WILCOX MEMORIAL HOSPITAL 3-3420 KUHIO HIGHWAY LIHUE,HI967661099 www.hawaiipacifichealth.org/wilcox 23-H	X	X			X	A

Schedule H (Form 990) 2020

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)

	A
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): SEE SCHEDULE H, PART V, SECTION C

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 19

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

Yes

If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C

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

10b

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) 2020

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	A
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 400.%

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) 2020

Page 6

Part VFacility Information (continued)

Billing and Collections

	A
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) 2020

Page 7

Part VFacility Information (continued)

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

	A
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) 2020

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
SCHEDULE H, PART V, SECTION B, LINE 3E	significant health needs of the community THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA. SCHEDULE H, PART V, SECTION B, LINE 5 INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN IN CONDUCTING KAPI'OLANI'S MOST RECENT CHNA, ISLANDER INSTITUTE CONVENED 21 COMMUNITY MEETINGS ACROSS THE ISLANDS TO ENGAGE EVERYDAY PEOPLE IN DISCUSSIONS AROUND HEALTH IN THEIR COMMUNITIES. A FULL LIST OF COMMUNITY MEETINGS CAN BE FOUND IN APPENDIX D OF THE CHNA. IN ADDITION, ISLANDER CONDUCTED INTERVIEWS WITH 200 "KEY INFORMANTS" WITH EXPERTISE IN COMMUNITY HEALTH ISSUES AND/OR POSSESSING SPECIAL KNOWLEDGE OF VULNERABLE POPULATIONS, INCLUDING (BUT NOT LIMITED TO) LOW-INCOME, MENTALLY ILL, OR PARTICULAR RACIAL/ETHNIC GROUPS. A COMPLETE LIST OF THESE KEY INFORMANTS AND THEIR ORGANIZATIONAL AFFILIATIONS CAN BE FOUND IN APPENDIX E OF THE CHNA. COMMUNITY MEETINGS AND INTERVIEWS TOOK PLACE BETWEEN JANUARY AND DECEMBER, 2018. COMMON THEMES FROM THE COMMUNITY MEETINGS AND KEY INFORMANT INTERVIEWS WERE DISTILLED AND USED TO DEVELOP A "NEW COMMUNITY PRESCRIPTION FOR HEALTH" IN HAWAI'I DERIVED FROM PEOPLE'S OWN DEFINITIONS OF HEALTH AND THE FACTORS THAT CONTRIBUTE TO ATTAINING AND MAINTAINING THAT HEALTH. THE CHNA REPORT WAS ORGANIZED AROUND THESE FACTORS AND USED TO IDENTIFY PRIORITY HEALTH NEEDS AND DEVELOP A STRATEGY FOR COMMUNITY HEALTH THAT ADDRESSES THE IMPORTANT GAPS AND TAKES ADVANTAGE OF OPPORTUNITIES TO HELP HAWAI'I'S PEOPLE LIVE HEALTHY, FULFILLING LIVES. STRAUB MEDICAL CENTER IN CONDUCTING STRAUB'S MOST RECENT CHNA, ISLANDER INSTITUTE CONVENED 21 COMMUNITY MEETINGS ACROSS THE ISLANDS TO ENGAGE EVERYDAY PEOPLE IN DISCUSSIONS AROUND HEALTH IN THEIR COMMUNITIES. A FULL LIST OF COMMUNITY MEETINGS CAN BE FOUND IN APPENDIX D OF THE CHNA. IN ADDITION, ISLANDER CONDUCTED INTERVIEWS WITH 200 "KEY INFORMANTS" WITH EXPERTISE IN COMMUNITY HEALTH ISSUES AND/OR POSSESSING SPECIAL KNOWLEDGE OF VULNERABLE POPULATIONS, INCLUDING (BUT NOT LIMITED TO) LOW-INCOME, MENTALLY ILL, OR PARTICULAR RACIAL/ETHNIC GROUPS. A COMPLETE LIST OF THESE KEY INFORMANTS AND THEIR ORGANIZATIONAL AFFILIATIONS CAN BE FOUND IN APPENDIX E OF THE CHNA. COMMUNITY MEETINGS AND INTERVIEWS TOOK PLACE BETWEEN JANUARY AND DECEMBER, 2018. COMMON THEMES FROM THE COMMUNITY MEETINGS AND KEY INFORMANT INTERVIEWS WERE DISTILLED AND USED TO DEVELOP A "NEW COMMUNITY PRESCRIPTION FOR HEALTH" IN HAWAI'I DERIVED FROM PEOPLE'S OWN DEFINITIONS OF HEALTH AND THE FACTORS THAT CONTRIBUTE TO ATTAINING AND MAINTAINING THAT HEALTH. THE CHNA REPORT WAS ORGANIZED AROUND THESE FACTORS AND USED TO IDENTIFY PRIORITY HEALTH NEEDS AND DEVELOP A STRATEGY FOR COMMUNITY HEALTH THAT ADDRESSES THE IMPORTANT GAPS AND TAKES ADVANTAGE OF OPPORTUNITIES TO HELP HAWAI'I'S PEOPLE LIVE HEALTHY, FULFILLING LIVES. PALI MOMI MEDICAL CENTER IN CONDUCTING PALI MOMI'S MOST RECENT CHNA, ISLANDER INSTITUTE CONVENED 21 COMMUNITY MEETINGS ACROSS THE ISLANDS TO ENGAGE EVERYDAY PEOPLE IN DISCUSSIONS AROUND HEALTH IN THEIR COMMUNITIES. A FULL LIST OF COMMUNITY MEETINGS CAN BE FOUND IN APPENDIX D OF THE CHNA. IN ADDITION, ISLANDER CONDUCTED INTERVIEWS WITH 200 "KEY INFORMANTS" WITH EXPERTISE IN COMMUNITY HEALTH ISSUES AND/OR POSSESSING SPECIAL KNOWLEDGE OF VULNERABLE POPULATIONS, INCLUDING (BUT NOT LIMITED TO) LOW-INCOME, MENTALLY ILL, OR PARTICULAR RACIAL/ETHNIC GROUPS. A COMPLETE LIST OF THESE KEY INFORMANTS AND THEIR ORGANIZATIONAL AFFILIATIONS CAN BE FOUND IN APPENDIX E OF THE CHNA. COMMUNITY MEETINGS AND INTERVIEWS TOOK PLACE BETWEEN JANUARY AND DECEMBER, 2018. COMMON THEMES FROM THE COMMUNITY MEETINGS AND KEY INFORMANT INTERVIEWS WERE DISTILLED AND USED TO DEVELOP A "NEW COMMUNITY PRESCRIPTION FOR HEALTH" IN HAWAI'I DERIVED FROM PEOPLE'S OWN DEFINITIONS OF HEALTH AND THE FACTORS THAT CONTRIBUTE TO ATTAINING AND MAINTAINING THAT HEALTH. THE CHNA REPORT WAS ORGANIZED AROUND THESE FACTORS AND USED TO IDENTIFY PRIORITY HEALTH NEEDS AND DEVELOP A STRATEGY FOR COMMUNITY HEALTH THAT ADDRESSES THE IMPORTANT GAPS AND TAKES ADVANTAGE OF OPPORTUNITIES TO HELP HAWAI'I'S PEOPLE LIVE HEALTHY, FULFILLING LIVES. WILCOX MEDICAL CENTER IN CONDUCTING WILCOX'S MOST RECENT CHNA, ISLANDER INSTITUTE CONVENED 21 COMMUNITY MEETINGS ACROSS THE ISLANDS TO ENGAGE EVERYDAY PEOPLE IN DISCUSSIONS AROUND HEALTH IN THEIR COMMUNITIES. A FULL LIST OF COMMUNITY MEETINGS CAN BE FOUND IN APPENDIX D OF THE CHNA. IN ADDITION, ISLANDER CONDUCTED INTERVIEWS WITH 200 "KEY INFORMANTS" WITH EXPERTISE IN COMMUNITY HEALTH ISSUES AND/OR POSSESSING SPECIAL KNOWLEDGE OF VULNERABLE POPULATIONS, INCLUDING (BUT NOT LIMITED TO) LOW-INCOME, MENTALLY ILL, OR PARTICULAR RACIAL/ETHNIC GROUPS. A COMPLETE LIST OF THESE KEY INFORMANTS AND THEIR ORGANIZATIONAL AFFILIATIONS CAN BE FOUND IN APPENDIX E OF THE CHNA. COMMUNITY MEETINGS AND INTERVIEWS TOOK PLACE BETWEEN JANUARY AND DECEMBER, 2018. COMMON THEMES FROM THE COMMUNITY MEETINGS AND KEY INFORMANT INTERVIEWS WERE DISTILLED AND USED TO DEVELOP A "NEW COMMUNITY PRESCRIPTION FOR HEALTH" IN HAWAI'I DERIVED FROM PEOPLE'S OWN DEFINITIONS OF HEALTH AND THE FACTORS THAT CONTRIBUTE TO ATTAINING AND MAINTAINING THAT HEALTH. THE CHNA REPORT WAS ORGANIZED AROUND THESE FACTORS AND USED TO IDENTIFY PRIORITY HEALTH NEEDS AND DEVELOP A STRATEGY FOR COMMUNITY HEALTH THAT ADDRESSES THE IMPORTANT GAPS AND TAKES ADVANTAGE OF OPPORTUNITIES TO HELP HAWAI'I'S PEOPLE LIVE HEALTHY, FULFILLING LIVES.
SCHEDULE H, PART V, SECTION B, LINES 6A & 6B	CHNA CONDUCTED WITH OTHER HOSPITAL FACILITIES AND ORGANIZATIONS Hawai'i Pacific Health's four hospital facilities participated with nineteen other nonprofit Hawai'i hospitals to collaborate on a CHNA in FISCAL YEAR 2019, led by the Healthcare Association of Hawai'i. Islander Institute, a firm specializing in gathering and analyzing community input from Hawai'i's communities, was retained to conduct the CHNA research. Participating hospitals were: Adventist Health Castle, Sutter Health Kahi Mohala, Kahuku Medical Center, Kaiser Permanente Medical Center, Kapi'olani Medical Center for Women & Children, Kuakini Medical Center, Kula Hospital, Lani Community Hospital, Maui Memorial Hospital, Molokai General Hospital, North Hawai'i Community Hospital, Pali Momi Medical Center, Rehabilitation Hospital of the Pacific, Shriners Hospitals for Children - Honolulu, Straub Medical Center, The Queen's Medical Center, The Queen's Medical Center - West Oahu, Wahiawa General Hospital, and Wilcox Medical Center.
SCHEDULE H, PART V, SECTION B, LINE 7A	COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE HOSPITAL FACILITY'S WEBSITE WHERE THE CHNA IS MADE WIDELY AVAILABLE: HTTPS://WWW.HAWAIIPACIFICHEALTH.ORG/ABOUT-US/COMMUNITY/ SCHEDULE H, PART V, SECTION B, LINE 7B OTHER WEBSITE WHERE THE CHNA IS MADE AVAILABLE TO THE PUBLIC HEALTHCARE ASSOCIATION OF HAWAII: https://www.hah.org/reports-and-data
SCHEDULE H, PART V, SECTION B, LINE 10A	IMPLEMENTATION STRATEGY PLAN WEBSITE KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN: https://www.hawaiipacifichealth.org/media/12311/chi-plan_kapiolani_fy2020- 2022.pdf PALI MOMI MEDICAL CENTER: https://www.hawaiipacifichealth.org/media/12312/chi-plan_pali-momi_fy2020- 2022.pdf STRAUB CLINIC & HOSPITAL: https://www.hawaiipacifichealth.org/media/12313/chi-plan_straub_fy2020- 2022.pdf WILCOX MEMORIAL HOSPITAL: https://www.hawaiipacifichealth.org/media/12314/chi-plan_wilcox_fy2020- 2022.pdf
SCHEDULE H, PART V, SECTION B, LINE 11	ADDRESSING SIGNIFICANT NEEDS IDENTIFIED IN CHNA & NEEDS NOT BEING ADDRESSED KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN: In fiscal year 2021, Kapi'olani conducted the following community benefit activities to execute year two of a three-year Implementation Strategy to address the priority community health needs identified in Kapi'olani's 2019 Community Health Needs Assessment: Strengthening Families, Building Good Food Systems, Investing in Teenagers and Healthy Starts, and Providing Accessible Proactive Support for Those with High Needs. Kapi'olani's 2016 and 2019 CHNAs and Implementation Strategies may be viewed online at: http://www.hawaiipacifichealth.org/about-us/community/ In FY21, Kapi'olani provided extensive community support to address the ongoing COVID public health emergency, including standing up community COVID testing sites and vaccination clinics as well as collaborating extensively with state agencies and other health care systems to provide expertise, assistance and public health education. Due to pandemic-related restrictions on in-person gatherings and other precautions, certain programs outlined in Kapi'olani's 2019 Implementation Strategy were suspended until they can safely be conducted. In FY21, in addition to significant clinical and public health interventions to address COVID, Kapi'olani also conducted the following community benefit initiatives: SNAP Double-Up Food Bucks Incentive Program: In Hawai'i, food insecurity increased significantly due to economic fall-out from the pandemic. Kapi'olani partnered with a multisector coalition to support a fund that offers double the value for all purchases of fresh, local produce made with SNAP-EBT. Programs such as these are demonstrated to increase consumption of fresh fruits and vegetables by SNAP recipients while supporting local farmers. Residential Youth Services & Empowerment (RYSE) is a youth-specific shelter providing temporary overnight lodging and support services to help homeless youth achieve housing, employment and self-sufficiency. Kapi'olani provided financial support to address the needs of this vulnerable population. Healthy Weight and Your Child is an intensive, family-based adolescent weight management program to combat childhood obesity. The Kidney Foundation of Hawai'i and Kapi'olani, together with the other hospitals of Hawai'i Pacific Health, partnered to provide the program at no cost to families across O'ahu. In FY21, the program was delivered in an entirely virtual format. Medical Transport Services: Kapi'olani provides inter-hospital transports from the neighbor islands to O'ahu, where Kapi'olani is located, and to the mainland, for critical neonatal and pediatric patients requiring access to specialty care not available in their communities. Cancer Research Center of Hawai'i: Kapi'olani, together with the other hospitals of Hawai'i Pacific Health, Queens Medical Center, and Kuakini Medical Center, partnered with the Cancer Research Center of Hawai'i to enhance the quality and breadth of cancer care in Hawai'i by supporting enhanced patient access to clinical trials, state-of-the-art treatment, and innovative therapies near to home. Health Professionals Education: Many areas of Hawai'i are identified as health professional shortage areas. To address this shortage and improve access to health care services for Hawai'i residents, Kapi'olani provides clinical training and residencies for medical students and residents, nursing students, and allied health professionals. Kapi'olani also supports a scholarship that provides financial assistance for local students to attend the University of Hawai'i John A. Burns School of Medicine. Significant Community Health Needs Not Being Addressed The following areas of need identified in Kapi'olani's 2019 CHNA are not being addressed in the hospital's Implementation Strategy: address financial insecurity, work together for equality and justice, restore environment and sense of place, nurture community identity and cohesiveness, shift elder care away from "sick care,strengthen trust in health care. They were not selected as priorities for Kapi'olani to address because they did not meet some or all of the following criteria: alignment with HPH's community health partnership focus areas, opportunity to leverage planned and existing HPH community partnerships and initiatives, alignment with HPH's resources and expertise, and potential to have a measurable impact on community health in collaboration with partners. PALI MOMI MEDICAL CENTER: In fiscal year 2021, Pali Momi conducted the following community benefit activities to execute year two of a three-year Implementation Strategy to address the priority community health needs identified in Pali Momi's 2019 Community Health Needs Assessment: Strengthening Families, Building Good Food Systems, Investing in Teenagers and Healthy Starts, and Providing Accessible Proactive Support for Those with High Needs. Pali Momi's 2016 and 2019 CHNAs and Implementation Strategies may be viewed online at: http://www.hawaiipacifichealth.org/about-us/community/ In FY21, Pali Momi provided extensive community support to address the ongoing COVID public health emergency, including standing up community COVID testing sites and vaccination clinics as well as collaborating extensively with state agencies and other health care systems to provide expertise, assistance and public health education. Due to pandemic-related restrictions on in-person gatherings and other precautions, certain programs outlined in Pali Momi's 2019 Implementation Strategy were suspended until they can safely be conducted. In FY21, in addition to significant clinical and public health interventions to address COVID, Pali Momi also conducted the following community benefit initiatives: SNAP Double-Up Food Bucks Incentive Program: In Hawai'i, food insecurity increased significantly due to economic fall-out from the pandemic. Pali Momi partnered with a multisector coalition to support a fund that offers double the value for all purchases of fresh, local produce made with SNAP-EBT. Programs such as these are demonstrated to increase consumption of fresh fruits and vegetables by SNAP recipients while supporting local farmers. Residential Youth Services & Empowerment (RYSE) is a youth-specific shelter providing temporary overnight lodging and support services to help homeless youth achieve housing, employment and self-sufficiency. Pali Momi provided financial support to address the needs of this vulnerable population. Healthy Weight and Your Child is an intensive, family-based adolescent weight management program to combat childhood obesity. The Kidney Foundation of Hawai'i and Pali Momi, together with the other hospitals of Hawai'i Pacific Health, partnered to provide the program at no cost to families across O'ahu. In FY21, the program was delivered in an entirely virtual format. Cancer Research Center of Hawai'i: Pali Momi, together with the other hospitals of Hawai'i Pacific Health, Queens Medical Center, and Kuakini Medical Center, partnered with the Cancer Research Center of Hawai'i to enhance the quality and breadth of cancer care in Hawai'i by supporting enhanced patient access to clinical trials, state-of-the-art treatment, and innovative therapies near to home. Health Professionals Education: Many areas of Hawai'i are identified as health professional shortage areas. To address this shortage and improve access to health care services for Hawai'i residents, Pali Momi provides clinical training and residencies for medical students and residents. Pali Momi also supports a scholarship that provides financial assistance for local students to attend the University of Hawai'i John A. Burns School of Medicine. Significant Community Health Needs Not Being Addressed: The following areas of need identified in Pali Momi's 2019 CHNA are not being addressed in the hospital's Implementation Strategy: address financial insecurity, work together for equality and justice, restore environment and sense of place, nurture community identity and cohesiveness, shift elder care away from "sick care,strengthen trust in health care. They were not selected as priorities for Pali Momi to address because they did not meet some or all of the following criteria: alignment with HPH's community health partnership focus areas, opportunity to leverage planned and existing HPH community partnerships and initiatives, alignment with HPH's resources and expertise, and potential to have a measurable impact on community health in collaboration with partners. STRAUB MEDICAL CENTER: In fiscal year 2021, Straub conducted the following community benefit activities to execute year two of a three-year Implementation Strategy to address the priority community health needs identified in Straub's 2019 Community Health Needs Assessment: Strengthening Families, Building Good Food Systems, Investing in Teenagers and Healthy Starts, and Pro
SCHEDULE H, PART V, SECTION B, LINE 16A	FINANCIAL ASSISTANCE POLICY https://www.hawaiipacifichealth.org/patients-visitors/financial-assistance -program/
SCHEDULE H, PART V, SECTION B, LINE 16B	FINANCIAL ASSISTANCE APPLICATION https://www.hawaiipacifichealth.org/patients-visitors/financial-assistance -program/
SCHEDULE H, PART V, SECTION B, LINE 16C	PLAIN LANGUAGE SUMMARY https://www.hawaiipacifichealth.org/patients-visitors/financial-assistance -program/

Schedule H (Form 990) 2020

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?29
Name and address		Type of Facility (describe)
1	PALI MOMI MEDICAL CENTER 98-1079 MOANLUA ROAD 480/590/630 AEIA,HI96701	CLINIC
2	STRAUB PEARLRIDGE CLINIC 98-151 PALI MOMI ST STE 142 AIEA,HI96701	CLINIC
3	PALI MOMI PAVILIONWOMEN'S CENTER 98-1005 MOANALUA ROAD FS4 AIEA,HI96701	CLINIC
4	STRAUB MILILANI FAMILY HEALTH CENTER 95-1249 MEHEULA PKWY UNIT 187 MILILANI,HI96789	CLINIC
5	STRAUB KAPOLEI CLINIC 91-5431 KAPOLEI PKWY SUITE 1706 KAPOLEI,HI96707	CLINIC
6	STRAUB HAWAI'I KAI FAMILY HEALTH CENTER 7192 KALANIANAOLE HIGHWAY STE A20 HONOLULU,HI96825	CLINIC
7	KAPI'OLANI WOMENS CENTER 1907 BERETANIA STREET 1ST 5TH FL HONOLULU,HI96826	CLINIC
8	STRAUB KANEOHE FAMILY HEALTH CENTER 46-056 KAMEHAMEHA HIGHWAY STE 221 KANEOHE,HI96744	CLINIC
9	STRAUB CLINIC AT FIRST INSURANCE CENTER 1100 WARD AVE STE 700 HONOLULU,HI96814	CLINIC
10	DOCS ON CALL - SHERATON 2255 KALAKAUA AVE MANOR WING LOWE HONOLULU,HI96815	CLINIC
11	PALI MOMI CANCER CENTER 98-1005 MOANALUA RD STE 4010 AEIA,HI96701	CLINIC
12	STRAUB KAILUA FAMILY HEALTH CENTER 602 KAILUA ROAD SUITE 200 KAILUA,HI96734	CLINIC
13	KAHALA CLINIC & URGENT CARE 4210 WAIALAE AVE SUITE 501 HONOLULU,HI96816	CLINIC
14	WARD VILLAGE PRIMARY CARE CLINIC 1001 QUEEN STREET SUITE 102 HONOLULU,HI96814	CLINIC
15	ARTESIAN SATELLITE 1907 SOUTH BERETANIA ST 1ST FLOOR HONOLULU,HI96826	CLINIC
16	STRAUB LANA'I FAMILY HEALTH CENTER 628-B SEVENTH STREET LANAI CITY,HI96763	CLINIC
17	HPH CANCER CENTER AT PALI MOMI MED CTR 98-1005 MOANALUA ROAD AIEA,HI96701	CLINIC
18	PALI MOMI CLINIC 98-1079 MOANALUA ROAD SUITE 600 AIEA,HI96701	CLINIC
19	OBGYN SATELLITE 1525 KALAKAUA AVENUE HONOLULU,HI96814	CLINIC
20	Kapi'olani Med CTR-Women & ChILD OBGYN 1319 Punahou Street Ste 500 HONOLULU,HI96826	CLINIC
21	KAHULUI CLINIC 33 LONO AVENUE SUITE 250 KAHULUI,HI96732	CLINIC
22	Straub med ctr - miliani sc clinic 95-390 KUAHELANI AVENUE SUITE J-1 MILILANI,HI96789	CLINIC
23	STRAUB KAPOLEI CLINIC 91-5431 KAPOLEI PKWY SUITE 1706 KAPOLEI,HI96707	CLINIC
24	straub med ctr - dt honolulu clinic 1003 BISHOP ST PAUAHI TOWER SUIT HONOLULU,HI96813	CLINIC
25	STRAUB CLINIC AT WATERFRONT PLAZA 500 ALA MOANA BLVD TOWER 7 SUITE HONOLULU,HI96813	CLINIC
26	STRAUB CLINIC - SOUTH KING STREET 826 SOUTH KING STREET HONOLULU,HI96813	CLINIC
27	KUAKINI CLINIC 321 NORTH KUAKINI STREET SUITE 504 HONOLULU,HI96817	CLINIC
28	STRAUB DOCTORS ON CALL - HILTON HAWAIIAN 2005 KALIA ROAD RAINBOW BAZAAR 2F HONOLULU,HI96815	CLINIC
29	STRAUB HILO CLINIC 75 PUUHONU PLACE SUITE 207 HILO,HI96720	CLINIC

Schedule H (Form 990) 2020

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
SCHEDULE H, PART I, LINE 3C	Financial assistance eligibility criteria N/A
SCHEDULE H, PART I, LINE 6A	preparation of community benefit report COMMUNITY BENEFITS ARE INCLUDED IN A REPORT PREPARED BY HAWAI'I PACIFIC HEALTH, THE FILING ORGANIZATIONS' PARENT.
SCHEDULE H, PART I, LINE 7	costing methodology used COST TO CHARGE RATIO AND SCHEDULE H WORKSHEET WAS USED TO CALCULATE THE COSTS. SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICES NO COSTS OF A PHYSICIAN CLINIC WERE INCLUDED AS SUBSIDIZED HEALTH SERVICES.
SCHEDULE H, PART III, SECTION A, LINES 3 AND 4	bad debt audited financial footnote PER THE CONSOLIDATED AUDITED FINANCIAL STATEMENT OF HAWAI'I PACIFIC HEALTH ("HPH"): ON JULY 1, 2018, THE COMPANY ADOPTED THE NEW REVENUE STANDARD, REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606), AND ELECTED TO USE THE MODIFIED RETROSPECTIVE ADOPTION METHOD. AS A PRACTICAL EXPEDIENT, THE COMPANY UTILIZES A PORTFOLIO APPROACH TO GROUP CONTRACTS WITH SIMILAR CHARACTERISTICS. UNDER THE NEW REVENUE STANDARD, THE MAJORITY OF WHAT WAS PREVIOUSLY CLASSIFIED AS THE PROVISION FOR BAD DEBTS IN THE CONSOLIDATED FINANCIAL STATEMENTS OF UNRESTRICTED REVENUES, EXPENSES AND OTHER CHANGES IN NET ASSETS IS NOW REFLECTED AS IMPLICIT PRICE CONCESSIONS AND IS INCLUDED AS A REDUCTION TO NET PATIENT SERVICE REVENUE FOR THE YEAR ENDED JUNE 30, 2019. PRIOR TO THE ADOPTION OF THE NEW REVENUE STANDARD, THE PROVISION FOR BAD DEBTS WAS PRESENTED CONSISTENT WITH THE PREVIOUS REVENUE RECOGNITION STANDARDS THAT REQUIRED SUCH PROVISION TO BE PRESENTED SEPARATELY AS A COMPONENT OF NET PATIENT SERVICE REVENUE.
SCHEDULE H, PART III, SECTION B, LINE 8	costing methodology BECAUSE TAX-EXEMPT HOSPITALS MUST PARTICIPATE IN MEDICARE AND MEDICAID AS A CONDITION OF MAINTAINING THEIR FEDERAL TAX-EXEMPT STATUS, MEDICARE UNDERPAYMENTS ARE NOT OPERATING EXPENSES THAT SHOULD BE EXPECTED IN THE ORDINARY COURSE OF BUSINESS. BECAUSE TAX-EXEMPT HOSPITALS MUST ACCEPT MEDICARE RATES THAT ARE IN SOME CASES BELOW COST, THEY SHOULD BE ABLE TO REPORT ANY NEGATIVE DIFFERENCES BETWEEN MEDICARE RATES AND COST AS LOSSES INCURRED BY SERVICING THE COMMUNITY. TOTAL MEDICARE COSTS WERE CALCULATED IN ACCORDANCE WITH THE FEDERAL STANDARD FORM CMS-2552.96.
SCHEDULE H, PART III, SECTION B, LINE 9B	debt collection policy PATIENTS WHO QUALIFY FOR CHARITY CARE RECEIVE EITHER 100% DISCOUNT (FREE SERVICES) OR 85% DISCOUNT (PARTIAL CHARITY) ON OUTSTANDING BALANCES. PATIENTS RECEIVING PARTIAL CHARITY THAT HAVE REMAINING ACCOUNT BALANCES AFTER THE CHARITY CARE ADJUSTMENT, FOLLOW THE SAME COLLECTION PROCEDURES AS ALL OTHER PATIENTS. PATIENTS WHO QUALIFY FOR 100% DISCOUNT HAVE THEIR PATIENT ACCOUNT BALANCES FULLY ADJUSTED AND ARE NOT SUBJECT TO ANY COLLECTION PROCEDURES. IN GENERAL THE POLICY INVOLVES SENDING FOLLOW UP STATEMENTS AND DOING FOLLOW UP PHONE CALLS. PAYMENT OPTIONS ARE ALSO PRESENTED TO THE PATIENT AS PART OF THE COLLECTION PROCESS. ACCOUNTS NOT COLLECTED WITHIN THE SPECIFIED TIME PERIOD OUTLINED IN THE POLICY (HOSPITAL AND PHYSICIAN CLAIMS) ARE SENT TO A COLLECTION AGENCY FOR COLLECTION. IN RESPONSE TO ECONOMIC IMPACTS OF THE COVID 19 PANDEMIC, HAWAI'I PACIFIC HEALTH IMPLEMENTED THE FOLLOWING CHANGES TO COLLECTION PROCEDURES ON OUTSTANDING ACCOUNTS: - SUSPENDED FORWARDING ACCOUNTS TO OUTSIDE COLLECTION AGENCIES EFFECTIVE MARCH 27, 2020 - STOPPED SENDING FINAL COLLECTION LETTERS FOR HOSPITAL ACCOUNTS EFFECTIVE MARCH 27, 2020 - REPLACED FINAL NOTICE DUNNING MESSAGE WITH REMINDER NOTICE ON PROFESSIONAL BILLING STATEMENTS EFFECTIVE APRIL 1, 2020.
SCHEDULE H, PART VI, LINE 2	additional community health needs assessment THE HOSPITALS OF HAWAI'I PACIFIC HEALTH PARTNERED WITH THE HEALTHCARE ASSOCIATION OF HAWAI'I AND THE HEALTHY COMMUNITIES INSTITUTE TO CONDUCT COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNAS) FOR EACH OF THE COMMUNITIES SERVED BY THE HOSPITALS. THE CHNAS WERE COMPLETED IN MARCH 2016. 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 SECONDARY DATA ON THE SOCIAL, ECONOMIC, AND PHYSICAL ENVIRONMENTS, AS WELL AS HEALTH RISKS AND OUTCOMES. SPECIAL ATTENTION WAS GIVEN TO IDENTIFYING HEALTH DISPARITIES, THE NEEDS OF VULNERABLE POPULATIONS, AND UNMET HEALTH NEEDS OR GAPS IN SERVICES. A BROAD ARRAY OF SECONDARY AND PRIMARY DATA WAS COLLECTED AND SYNTHESIZED TO DETERMINE COMMUNITY NEEDS. OVER 375 INDICATORS FROM OVER 20 SOURCES FROM A DATABASE MAINTAINED BY THE HAWAI'I DEPARTMENT OF HEALTH WERE ANALYZED USING A SYSTEMATIC AND QUANTITATIVE APPROACH THAT INCORPORATED MULTIPLE BENCHMARKS AND COMPARISONS. ADDITIONAL ANALYSIS INCLUDED PREVENTABLE CAUSES OF HOSPITALIZATION USING DATA PROVIDED BY THE HAWAI'I HEALTH INFORMATION CORPORATION, AND INFORMATION FROM RECENTLY PUBLISHED REPORTS ON ACCESS TO CARE, HEALTH DISPARITIES, PRIMARY CARE NEEDS, AND BEHAVIORAL HEALTH NEEDS. KEY INFORMANT INTERVIEWS WERE CONDUCTED WITH INDIVIDUALS HAVING SPECIAL KNOWLEDGE OF COMMUNITY HEALTH NEEDS, HEALTH DISPARITIES, AND VULNERABLE POPULATIONS IN THE IDENTIFIED COMMUNITIES.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE WHEN A PATIENT PRESENTS FOR SERVICES AND THE PATIENT DOES NOT HAVE INSURANCE COVERAGE FOR SERVICES TO BE PROVIDED, THE PATIENT, OR GUARANTOR IS ASKED TO SIGN THE "SELF-PAY ACKNOWLEDGEMENT" LETTER. THE LETTER DESCRIBES THE TERMS OF THE HAWAI'I PACIFIC HEALTH ("HPH") UNINSURED DISCOUNT PROGRAM, AND BY SIGNING THE LETTER, THE PATIENT ACKNOWLEDGES THAT HE/SHE UNDERSTANDS AVAILABLE UNINSURED PAYMENT TERMS. IN MOST UNINSURED CASES, THE PATIENT WILL BE OFFERED A HAWAI'I STATE MEDICAL ASSISTANCE APPLICATION. THIS IS THE APPLICATION FOR THE HAWAI'I STATE MEDICAID/QUEST PROGRAM. THE HOSPITAL CONTRACTS WITH SERVICE PROVIDERS WHO SPECIALIZE IN ASSISTING PATIENTS WITH THE MEDICAID/QUEST PROGRAM APPLICATION PROCESS. IF THE PATIENT'S APPLICATION FOR MEDICAID/QUEST IS DENIED OR IT IS DETERMINED THAT THE PATIENT IS INELIGIBLE TO APPLY FOR MEDICAID/QUEST, THE PATIENT MAY APPLY FOR HPH FINANCIAL ASSISTANCE EITHER IN THE HOSPITAL FINANCIAL SERVICES DEPARTMENT OR BY MAIL DIRECTLY TO THE HPH BUSINESS SERVICES OFFICE. FINANCIAL COUNSELORS ARE AVAILABLE ON SITE TO REVIEW PAYMENT OPTIONS WITH THE PATIENT OR THE GUARANTOR. THESE OPTIONS INCLUDE THE AFOREMENTIONED HPH UNINSURED DISCOUNT PROGRAM, THE HAWAI'I STATE MEDICAID/QUEST PROGRAM, THE HPH FINANCIAL ASSISTANCE PROGRAM, PAYMENT PLANS AND ANY GRANT OR FUNDING SOURCE THAT MAY BE APPROPRIATE FOR THE SERVICES PROVIDED. IN SOME CASES, HPH DETERMINES THAT A PATIENT OR GUARANTOR MAY NEED ASSISTANCE AFTER SERVICES ARE PROVIDED, AND FINANCIAL INFORMATION IS MAILED TO THE PATIENT. EDUCATION AND ASSISTANCE IS OFTEN PROVIDED VIA PHONE CONTACT IN THESE CASES. PAYMENT PLAN ARRANGEMENTS ARE HANDLED VIA PHONE CONTACT WITH THE PATIENT.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION HAWAI'I PACIFIC HEALTH'S MEDICAL CENTERS TREAT ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY, THUS SERVING AS SAFETY NET PROVIDERS OF HEALTH CARE FOR THE COMMUNITY. DEMOGRAPHICS OF THE STATE OF HAWAI'I INCLUDE 1.4M RESIDENTS AND 10.4M VISITORS (2019 DATA). THERE ARE MORE THAN 20 OTHER HOSPITALS IN THE STATE THAT PROVIDE ACUTE CARE SERVICES, INCLUDING THOSE THAT ARE COMMUNITY ACCESS HOSPITALS. AREAS AND POPULATIONS DESIGNATED AS MEDICALLY-UNDERSERVED BY THE FEDERAL GOVERNMENT ARE PRESENT. KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN HAS BEEN TREATING WOMEN, CHILDREN AND INFANTS FOR MORE THAN A CENTURY. IT IS HAWAI'I'S ONLY MATERNITY, NEWBORN AND PEDIATRIC SPECIALTY HOSPITAL WITH 253 BEDS. IT IS ALSO A TERTIARY CARE, TEACHING AND RESEARCH FACILITY. FOR WOMEN, KAPI'OLANI PROVIDES COMPLETE OBSTETRICAL AND GYNECOLOGICAL CARE. FOR INFANTS AND CHILDREN, IT HAS MORE THAN 100 PEDIATRIC SPECIALISTS AND SUBSPECIALISTS. IN FISCAL YEAR 2020, KAPI'OLANI HAD 6,049 DELIVERIES (BIRTHS), 46,392 WOMEN'S CENTER PROCEDURES, 37,247 ER VISITS, 53,269 IMAGING PROCEDURES, 547 TRANSPORTS AND 14,836 INPATIENT ADMISSIONS. ITS GEOGRAPHIC SERVICE AREA IS THE ENTIRE PACIFIC REGION AS MANY SPECIALTIES OFFERED ARE NOT AVAILABLE ELSEWHERE. PALI MOMI MEDICAL CENTER IS A COMMUNITY-BASED, ACUTE-CARE HOSPITAL THAT OFFERS A FULL RANGE OF SERVICES IN CARDIOLOGY, ORTHOPEDICS, EMERGENCY MEDICINE, GENERAL SURGERY AND MEDICINE, OPHTHALMOLOGY, WOMEN'S SERVICES, ONCOLOGY AND MORE. IT HAS DELIVERED MANY MEDICAL FIRSTS FOR THE COMMUNITY, INCLUDING WEST O'AHU'S ONLY INTERVENTIONAL CARDIAC CATHETERIZATION UNITS, A WOMEN'S CENTER AND RETINA CENTER, AND THE REGION'S ONLY COMPREHENSIVE CANCER CENTER. IT HAS BEEN DESIGNATED AS A LEVEL III TRAUMA CENTER BY THE STATE OF HAWAI'I AND IT IS ALSO A CERTIFIED PRIMARY STROKE CENTER. IN FISCAL YEAR 2020, PALI MOMI HAD 41,941 ER VISITS, 50,957 WOMEN'S CENTER PROCEDURES, 84,117 IMAGING PROCEDURES AND 5,492 INPATIENT ADMISSIONS. PALI MOMI'S GEOGRAPHIC SERVICE AREA IS PRIMARILY CENTRAL O'AHU, WEST O'AHU AND THE NORTH SHORE. STRAUB MEDICAL CENTER HAS SERVED THE PEOPLE OF HAWAI'I FOR NEARLY 100 YEARS. IT IS A FULLY INTEGRATED HEALTH CARE PROVIDER WITH A 159-BED HOSPITAL IN HONOLULU, A NETWORK OF NEIGHBORHOOD CLINICS, AND A VISITING SPECIALISTS PROGRAM TO IMPROVE ACCESS TO MEDICAL SERVICES FOR NEIGHBOR ISLAND RESIDENTS. STRAUB HOUSES AN ARRAY OF PHYSICIAN SPECIALISTS UNDER ONE ROOF, ENABLING PATIENTS TO RECEIVE DIAGNOSIS AND TREATMENT IN MORE THAN 32 MEDICAL SPECIALTIES. IN FISCAL YEAR 2020, STRAUB HAD 30,077 ER VISITS, 5,747 INPATIENT ADMISSIONS, 100,078 IMAGING PROCEDURES AND 856,560 CLINIC ENCOUNTERS. STRAUB IS PROUD TO PROVIDE SERVICES THAT ARE NOT OFFERED BY ANY OTHER PROVIDERS IN THE REGION. THE BURN CENTER, FOR EXAMPLE, IS THE ONLY DEDICATED BURN TREATMENT FACILITY IN HAWAI'I AND TREATS MILITARY AND CIVILIAN PATIENTS THROUGHOUT THE PACIFIC REGION. WILCOX MEDICAL CENTER HAS SERVED KAUA'I FOR MORE THAN 80 YEARS. THE ACUTE-CARE FACILITY OFFERS OVER 30 SPECIALTIES AND PROGRAMS, AND A FULL SUITE OF SERVICES INCLUDING CARDIOLOGY, EMERGENCY, FAMILY PRACTICE, GASTROENTEROLOGY, HEALTH MANAGEMENT, INTERNAL MEDICINE, NEUROLOGY, OB-GYN, ONCOLOGY, ORTHOPEDICS, PEDIATRICS AND UROLOGY. IN FISCAL YEAR 2020, WILCOX HAD 21,852 ER VISITS, 450 DELIVERIES (BIRTHS), 63,677 IMAGING PROCEDURES AND 2,946 INPATIENT ADMISSIONS. WILCOX'S GEOGRAPHIC SERVICE AREA IS THE ISLAND OF KAUA'I. DEMOGRAPHICS OF THE KAUA'I COMMUNITY IN FISCAL YEAR 2020 INCLUDE AN ESTIMATED POPULATION OF APPROXIMATELY 72,293 (2019 CENSUS BUREAU DATA) AND NEARLY 1.4M VISITORS ANNUALLY (2019 DATA). THERE ARE TWO OTHER HOSPITALS IN THE COMMUNITY, AND FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS AND POPULATIONS ARE PRESENT.
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH EACH AFFILIATE HOSPITAL OF HAWAI'I PACIFIC HEALTH IS A LEADER IN COMMUNITY HEALTH CARE EDUCATION AND ADVOCACY, AND MAINTAINS AN OPEN MEDICAL STAFF; THIS ARRANGEMENT GRANTS ADMITTING PRIVILEGES TO NONAFFILIATED PHYSICIAN SPECIALISTS AND BROADENS EACH FACILITY'S ABILITY TO OFFER HIGH-QUALITY, SPECIALIZED CARE TO THEIR RESPECTIVE COMMUNITY. EACH HOSPITAL IS GOVERNED BY A COMMUNITY BOARD COMPRISED OF PHYSICIANS, COMMUNITY MEMBERS AND KEY LEADERSHIP WITHIN HAWAI'I PACIFIC HEALTH. THESE VOLUNTEER, UNPAID MEMBERS ENSURE THAT EACH FACILITY FULFILLS ITS MISSION-DRIVEN GOALS. AS AFFILIATES OF THE NOT-FOR-PROFIT HAWAI'I PACIFIC HEALTH NETWORK, EACH HOSPITAL REINVESTS ALL SURPLUS RESOURCES BACK INTO PATIENT CARE AND TO SUBSIDIZE THOSE WHO CANNOT PAY.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM HAWAI'I PACIFIC HEALTH, ONE OF THE STATE'S LARGEST HEALTH CARE SYSTEMS, IS COMMITTED TO PROVIDING HIGH-QUALITY, ACCESSIBLE CARE AND SERVICES TO THE PEOPLE OF HAWAI'I AND THE PACIFIC REGION. THE HAWAI'I PACIFIC HEALTH SYSTEM INCLUDES FOUR MEDICAL CENTERS, 70 LOCATIONS, MORE THAN 1,400 AFFILIATED PHYSICIANS AND MORE THAN 7,200 EMPLOYEES. THE MEDICAL CENTERS PROVIDE ACUTE AND SPECIALTY CARE WITH 602 BEDS AND HANDLED 29,021 ADMISSIONS IN FISCAL YEAR 2020. KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN IS THE PRIMARY PEDIATRIC AND OBSTETRIC TEACHING HOSPITAL FOR THE UNIVERSITY OF HAWAI'I JOHN A. BURNS SCHOOL OF MEDICINE. KAPI'OLANI SUPPORTS THE TRAINING AND TEACHING OF HAWAI'I'S FUTURE DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS, AS WELL AS CLINICAL AND COMMUNITY HEALTH RESEARCH THAT BRINGS NEW THERAPIES AND TREATMENT PROTOCOLS TO THE ISLANDS. KAPI'OLANI ACTIVELY SUPPORTS COMMUNITY ORGANIZATIONS AND EVENTS THAT ARE IN LINE WITH ITS MISSION, INCLUDING THE GREAT ALOHA RUN AND KEIKI GREAT ALOHA RUN, SUSAN G. KOMEN BREAST CANCER FOUNDATION, MARCH OF DIMES, HAWAI'I CHILDREN'S CANCER FOUNDATION AND OTHERS. THE KAPI'OLANI CHILDREN'S MIRACLE NETWORK SUPPORTS THE COST OF PEDIATRIC HEALTH CARE PROGRAMS AND SERVICES AT THE HOSPITAL, AS WELL AS MEDICAL EQUIPMENT, NEIGHBOR ISLAND TRAVEL, RESEARCH AND PUBLIC AWARENESS. THE HOSPITAL ALSO OPERATES THE SEX ABUSE TREATMENT CENTER OF HAWAI'I, WHICH PROVIDES TREATMENT SERVICES FOR SURVIVORS OF SEXUAL ASSAULT, PROMOTES PREVENTION AND EDUCATION, AND ENGAGES IN PUBLIC POLICY ACTIVITIES RELATING TO SEXUAL ASSAULT, AND THE KAPI'OLANI CHILD ADVOCACY AND PROTECTION CENTER, WHICH PROVIDES EXPERTISE IN RECOGNIZING AND TREATING CHILD ABUSE AND NEGLECT. PALI MOMI MEDICAL CENTER CONTINUES TO FOCUS ON MEETING THE NEEDS OF THE COMMUNITIES OF CENTRAL AND WEST O'AHU AND THE NORTH SHORE. IN FISCAL YEAR 2020, PALI MOMI CONTINUED TO PROVIDE SERVICES AS A DESIGNATED LEVEL III TRAUMA CENTER BY THE STATE OF HAWAI'I. PALI MOMI HOLDS THIS DESIGNATION BECAUSE OF ITS KEY GEOGRAPHIC LOCATION AND ADVANCED HOSPITAL CAPABILITIES THAT ENABLE IT TO PROVIDE THIS CRITICALLY NEEDED SERVICE TO THE COMMUNITY. IT IS ALSO CERTIFIED AS A PRIMARY STROKE CENTER IN RECOGNITION OF ITS COMMITMENT TO THE CARE OF STROKE PATIENTS. IN FISCAL YEAR 2020, PALI MOMI ALSO HOSTED AND PARTICIPATED IN FREE COMMUNITY HEALTH EVENTS, HEALTH FAIRS AND HEALTH SCREENINGS, VIDEO CONFERENCES FOR EDUCATIONAL SPEAKERS' SERIES AND SUPPORT GROUPS, ALTHOUGH SOME OF ITS REGULAR ANNUAL EVENTS WERE CANCELED DUE TO THE COVID-19 PANDEMIC. STRAUB MEDICAL CENTER HAS MANY SPECIALTY CARE UNITS. THE BURN CENTER IS THE STATE'S ONLY MULTIDISCIPLINARY BURN TREATMENT CENTER, PROVIDING VICTIMS WITH IMMEDIATE AND COMPREHENSIVE CARE CLOSE TO HOME. STRAUB PHYSICIANS PROVIDE PATIENTS WITH DIAGNOSES AND TREATMENTS FOR MORE THAN 32 DIFFERENT MEDICAL SPECIALTIES, INCLUDING BONE AND JOINT, HEART, CANCER, ENDOCRINOLOGY/DIABETES, FAMILY MEDICINE, GASTROENTEROLOGY, GERIATRIC MEDICINE, INTERNAL MEDICINE, VASCULAR AND UROLOGY. IT PROVIDES CHARITY CARE, HEALTH EDUCATION AND PREVENTIVE PROGRAMS TO THE COMMUNITY. IN FISCAL YEAR 2020, STRAUB PROVIDED A VARIETY OF FREE HEALTH EDUCATION PROGRAMS, ACTIVITIES AND EVENTS, ALTHOUGH SOME OF ITS REGULAR ANNUAL EVENTS WERE CANCELED DUE TO THE COVID-19 PANDEMIC WILCOX MEDICAL CENTER IS DEDICATED TO PROVIDING KAUA'I WITH AFFORDABLE AND ACCESSIBLE HEALTH CARE. WILCOX PHYSICIANS OFFER CARE IN 30 SPECIALTIES AND PROGRAMS. WILCOX IS AN ACTIVE COMMUNITY PARTNER. IN FISCAL YEAR 2020, ITS HEALTH EDUCATION, PREVENTION PROGRAMS AND SUPPORT GROUPS FOCUSED ON DIABETES, OBESITY, CANCER, HEART ATTACK/STROKE, IMMUNIZATION, SPORTS MEDICINE, WATER SAFETY, INJURY PREVENTION, AND HEALTH FAIRS. TOGETHER WITH KAUA'I MEDICAL CLINIC, WILCOX HOSTED OR SPONSORED A VARIETY OF COMMUNITY HEALTH EDUCATION EVENTS, AND STAFF SUPPORTED THEIR COMMUNITY BY PARTICIPATING IN ANNUAL CHARITABLE ENDEAVORS. THESE INCLUDED "HAWAI'I PACIFIC HEALTH GREAT ALOHA RUN," "KIDS FEST," "KAUA'I MARATHON," SEVERAL PHYSICIAN-LED COMMUNITY WALKS, "A HEALTHIER YOU" HEALTH AND LIFESTYLE PROGRAM, "KEIKI BIKE AND SKATEBOARD SAFETY DAY," "BACK TO SCHOOL BASH,"WESTSIDE OHANA DAY." THE WILCOX HEALTH ANNUAL "KIDS SUMMER FEST" WAS CANCELED IN FISCAL YEAR 2020 DUE TO THE COVID-19 PANDEMIC.
SCHEDULE H, PART VI, LINE 7	STATE FILING OF COMMUNITY BENEFIT REPORT N/A

Schedule H (Form 990) 2020

Additional Data

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization
HAWAI'I PACIFIC HEALTH GROUP RETURN

Employer identification number
38-3835105

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) UH Foundation 1314 S King St STE B STE 2E1 BOX 3 Honolulu,HI96814	99-0085260	501(C)(3)	734,095	Scholarship PLEDGE
(2) Hawai'i Cancer Consortium 201 Merchant St STE 1830 Honolulu,HI96813	45-2280259	501(C)(3)	500,000	General Support
(3) UNIVERSAL CLINICAL EDUCATION & RSRCH ASSOC PO Box 31000 Honolulu,HI96813	99-0307152	501(C)(3)	250,006	General Support
(4) Residential Youth Services & Empowerment PO Box 11662 BACHMAN HALL 105 Kailua,HI96828	81-2102826	501(C)(3)	37,500	Scholarship Pledge
(5) Hawai'i Island's Food Bank 40 Holomua St Hilo,HI96720	26-0349476	501(C)(3)	20,000	General Support
(6) Hoola Na Pua POBox 22551 Honolulu,HI93823	46-5139164	501(C)(3)	10,000	General Support
(7) Girl Scouts of Hawai'i 410 Atkinson Drive Ste 2E1 Box 3 Honolulu,HI96814	99-0073488	501(C)(3)	10,000	General Support
(8) ST FRANCIS HEALTHCARE FDN OF HAWAI'I 2228 Liliha St STE 205 Honolulu,HI96817	99-0240060	501(C)(3)	7,500	General Support
(9) YWCA of O'ahu 1040 Richards St Honolulu,HI96813	99-0073534	501(C)(3)	6,000	General Support

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2020

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
FORM 990, SCHEDULE I, PART I, LINE 2	DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS THE HAWAI'I PACIFIC HEALTH DONATIONS COMMITTEE REVIEWS AND APPROVES DONATIONS TO 501(C)(3) & 501(C)(6) ORGANIZATIONS ON AN ANNUAL BASIS. NO FURTHER MONITORING IS DONE FOR DONATIONS MADE TO 501(C)(3) ORGANIZATIONS.

Schedule I (Form 990) 2020

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow

Attach to Form 990.
Graphic Arrow

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

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

HAWAI'I PACIFIC HEALTH GROUP RETURN

Employer identification number

38-3835105

Part I

Questions Regarding Compensation

Yes

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 .....

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? ....

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? .........

Yes

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

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) 2020

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)
1RAYMOND P VARA JR Board of Director, President	(i) (ii)	0 ------------- 1,110,173	0 ------------- 372,487	0 ------------- 719,150	0 ------------- 2,558,309	0 ------------- 26,194	0 ------------- 4,786,313	0 ------------- 593,274
2DAVID OKABE EVP, CFO & Treasurer	(i) (ii)	0 ------------- 553,990	0 ------------- 132,543	0 ------------- 259,799	0 ------------- 362,800	0 ------------- 15,096	0 ------------- 1,324,228	0 ------------- 224,487
3MARTHA SMITH BOARD OF DIRECTOR, CEO (PT YR)	(i) (ii)	0 ------------- 564,852	0 ------------- 138,435	0 ------------- 173,452	0 ------------- 292,175	0 ------------- 15,896	0 ------------- 1,184,810	0 ------------- 182,195
4ARTHUR GLADSTONE BOD, CEO, EVP & CSO	(i) (ii)	0 ------------- 516,857	0 ------------- 128,098	0 ------------- 171,355	0 ------------- 285,469	0 ------------- 23,918	0 ------------- 1,125,697	0 ------------- 195,252
5CHARLES R CHING EVP, GEN. COUNSEL & SECRETARY	(i) (ii)	0 ------------- 436,925	0 ------------- 104,835	0 ------------- 229,141	0 ------------- 262,171	0 ------------- 20,008	0 ------------- 1,053,080	0 ------------- 164,297
6GAIL LERCH Former Officer	(i) (ii)	0 ------------- 448,776	0 ------------- 107,316	0 ------------- 186,247	0 ------------- 294,796	0 ------------- 9,718	0 ------------- 1,046,853	0 ------------- 176,006
7STEVEN ROBERTSON EVP & CIO	(i) (ii)	0 ------------- 450,338	0 ------------- 108,006	0 ------------- 188,448	0 ------------- 276,365	0 ------------- 15,796	0 ------------- 1,038,953	0 ------------- 172,460
8MELINDA ASHTON MD EVP & CQO	(i) (ii)	0 ------------- 467,643	0 ------------- 111,972	0 ------------- 141,224	0 ------------- 233,089	0 ------------- 15,600	0 ------------- 969,528	0 ------------- 169,135
9JENNIE CHAHANOVICH BOD, President & CEO	(i) (ii)	0 ------------- 381,818	0 ------------- 99,404	0 ------------- 179,058	0 ------------- 215,398	0 ------------- 12,698	0 ------------- 888,376	0 ------------- 133,412
10LESLIE CHUN MD EVP	(i) (ii)	0 ------------- 532,633	0 ------------- 83,827	0 ------------- 48,017	0 ------------- 90,427	0 ------------- 23,629	0 ------------- 778,533	0 ------------- 0
11PATRICK O'DONNELL MD Board of Director	(i) (ii)	0 ------------- 628,175	0 ------------- 744	0 ------------- 18,726	0 ------------- 11,400	0 ------------- 25,569	0 ------------- 684,614	0 ------------- 0
12RODNEY WILLIAMS MD Former Officer	(i) (ii)	0 ------------- 245,576	0 ------------- 51,984	0 ------------- 281,823	0 ------------- 83,641	0 ------------- 13,016	0 ------------- 676,040	0 ------------- 47,219
13DAVID CHO MD Board of Director	(i) (ii)	0 ------------- 595,629	0 ------------- 7,474	0 ------------- 20,885	0 ------------- 11,400	0 ------------- 22,272	0 ------------- 657,660	0 ------------- 0
14GERARD LIVAUDAIS MD EVP	(i) (ii)	0 ------------- 410,238	0 ------------- 78,825	0 ------------- 34,082	0 ------------- 108,525	0 ------------- 15,389	0 ------------- 647,059	0 ------------- 71,310
15TODD MILLER MD Board of Director, Vice Chair	(i) (ii)	0 ------------- 548,029	0 ------------- 744	0 ------------- 52,332	0 ------------- 11,400	0 ------------- 7,439	0 ------------- 619,944	0 ------------- 0
16DOUGLAS KWOCK MD VP	(i) (ii)	0 ------------- 407,043	0 ------------- 48,037	0 ------------- 36,984	0 ------------- 73,862	0 ------------- 22,109	0 ------------- 588,035	0 ------------- 45,958
17KENNETH B ROBBINS MD Former Officer	(i) (ii)	0 ------------- 255,484	0 ------------- 0	0 ------------- 90,586	0 ------------- 165,414	0 ------------- 14,951	0 ------------- 526,435	0 ------------- 219,481
18TRAVIS CLEGG COO	(i) (ii)	0 ------------- 336,184	0 ------------- 49,405	0 ------------- 20,722	0 ------------- 71,416	0 ------------- 24,679	0 ------------- 502,406	0 ------------- 0
19GIDGET RUSCETTA RN COO	(i) (ii)	0 ------------- 317,467	0 ------------- 51,840	0 ------------- 35,002	0 ------------- 80,642	0 ------------- 14,051	0 ------------- 499,002	0 ------------- 48,845
20DAWN DUNBAR SVP	(i) (ii)	0 ------------- 299,741	0 ------------- 57,822	0 ------------- 35,875	0 ------------- 81,124	0 ------------- 23,823	0 ------------- 498,385	0 ------------- 65,358
21WARREN CHAIKO SVP	(i) (ii)	0 ------------- 268,426	0 ------------- 52,369	0 ------------- 54,937	0 ------------- 84,038	0 ------------- 26,568	0 ------------- 486,338	0 ------------- 59,768
22MAVIS NIKAIDO VP & CNE	(i) (ii)	0 ------------- 298,793	0 ------------- 38,843	0 ------------- 33,425	0 ------------- 70,062	0 ------------- 7,371	0 ------------- 448,494	0 ------------- 40,312
23SUSAN MATSUMOTO-NONAKA VP	(i) (ii)	0 ------------- 278,475	0 ------------- 39,915	0 ------------- 46,239	0 ------------- 71,170	0 ------------- 10,271	0 ------------- 446,070	0 ------------- 45,567
24BRANDT FARIAS SVP - (Part Year)	(i) (ii)	0 ------------- 249,279	0 ------------- 47,553	0 ------------- 30,552	0 ------------- 76,212	0 ------------- 9,732	0 ------------- 413,328	0 ------------- 50,819
25TYLER CHIHARA DPM Board of Director	(i) (ii)	0 ------------- 370,320	0 ------------- 744	0 ------------- 7,925	0 ------------- 11,400	0 ------------- 21,531	0 ------------- 411,920	0 ------------- 0
26ANDY LEE MD BOD, Chief of Staff	(i) (ii)	0 ------------- 302,715	0 ------------- 31,200	0 ------------- 24,934	0 ------------- 21,375	0 ------------- 23,872	0 ------------- 404,096	0 ------------- 0
27MICHAEL ROBINSON VP	(i) (ii)	0 ------------- 266,844	0 ------------- 38,177	0 ------------- 22,458	0 ------------- 64,458	0 ------------- 9,732	0 ------------- 401,669	0 ------------- 44,010
28BRIGITTE MCKALE VP & CNE	(i) (ii)	0 ------------- 258,755	0 ------------- 30,524	0 ------------- 25,438	0 ------------- 61,466	0 ------------- 13,876	0 ------------- 390,059	0 ------------- 28,920
29DAWN CHING VP	(i) (ii)	0 ------------- 248,122	0 ------------- 32,377	0 ------------- 33,608	0 ------------- 63,381	0 ------------- 9,860	0 ------------- 387,348	0 ------------- 33,931
30JAMES LIN MD VP	(i) (ii)	0 ------------- 262,147	0 ------------- 18,953	0 ------------- 32,124	0 ------------- 42,220	0 ------------- 23,783	0 ------------- 379,227	0 ------------- 0
31CAROL FUJIYOSHI MD Board of Director	(i) (ii)	0 ------------- 305,659	0 ------------- 7,066	0 ------------- 40,461	0 ------------- 11,400	0 ------------- 7,315	0 ------------- 371,901	0 ------------- 0
32BEAU NAKAMOTO MD Former Officer	(i) (ii)	0 ------------- 161,849	0 ------------- 5,738	0 ------------- 176,122	0 ------------- 11,400	0 ------------- 150	0 ------------- 355,259	0 ------------- 0
33EARL INOUYE Former Officer	(i) (ii)	0 ------------- 201,366	0 ------------- 40,705	0 ------------- 43,074	0 ------------- 67,586	0 ------------- 1,944	0 ------------- 354,675	0 ------------- 46,925
34DAVID STUMBAUGH VP	(i) (ii)	0 ------------- 217,152	0 ------------- 31,699	0 ------------- 17,488	0 ------------- 56,827	0 ------------- 22,589	0 ------------- 345,755	0 ------------- 34,835
35BARBARA CRAFT COO	(i) (ii)	0 ------------- 234,763	0 ------------- 20,550	0 ------------- 26,013	0 ------------- 48,375	0 ------------- 14,981	0 ------------- 344,682	0 ------------- 0
36LORRIE-ANN LUKE VP	(i) (ii)	0 ------------- 211,025	0 ------------- 30,832	0 ------------- 17,998	0 ------------- 57,735	0 ------------- 25,176	0 ------------- 342,766	0 ------------- 34,527
37WILLIAM BURKE VP	(i) (ii)	0 ------------- 237,450	0 ------------- 16,427	0 ------------- 23,154	0 ------------- 43,960	0 ------------- 16,671	0 ------------- 337,662	0 ------------- 0
38MELANIE KIM MD Board of Director	(i) (ii)	0 ------------- 250,140	0 ------------- 27,907	0 ------------- 24,603	0 ------------- 11,400	0 ------------- 7,665	0 ------------- 321,715	0 ------------- 0
39ANDREW MOATS VP	(i) (ii)	0 ------------- 224,837	0 ------------- 14,963	0 ------------- 18,165	0 ------------- 33,910	0 ------------- 26,024	0 ------------- 317,899	0 ------------- 0
40SUNSHINE TOPPING SVP	(i) (ii)	0 ------------- 261,580	0 ------------- 0	0 ------------- 27,699	0 ------------- 0	0 ------------- 21,615	0 ------------- 310,894	0 ------------- 0
41JOAN KANEMORI VP	(i) (ii)	0 ------------- 208,905	0 ------------- 15,730	0 ------------- 27,232	0 ------------- 40,275	0 ------------- 16,055	0 ------------- 308,197	0 ------------- 0
42MONICA PRICE MD Board of Director	(i) (ii)	0 ------------- 178,273	0 ------------- 12,158	0 ------------- 61,525	0 ------------- 9,800	0 ------------- 24,627	0 ------------- 286,383	0 ------------- 0
43CARRIE ANN TSUTSUI VP & SYS. Controller	(i) (ii)	0 ------------- 195,857	0 ------------- 17,756	0 ------------- 17,265	0 ------------- 41,055	0 ------------- 12,358	0 ------------- 284,291	0 ------------- 0
44LAURA BONILLA EXEC. DIR. PEDIATRIC SRVCS.	(i) (ii)	225,914 ------------- 0	17,882 ------------- 0	2,304 ------------- 0	25,599 ------------- 0	8,235 ------------- 0	279,934 ------------- 0	0 ------------- 0
45KENT KIKUCHI DIRECTOR OF PHARMACY	(i) (ii)	206,742 ------------- 0	15,300 ------------- 0	1,875 ------------- 0	23,564 ------------- 0	24,514 ------------- 0	271,995 ------------- 0	0 ------------- 0
46JOY MATSUYAMA DIRECTOR OF PHARMACY	(i) (ii)	210,187 ------------- 0	14,509 ------------- 0	855 ------------- 0	23,734 ------------- 0	22,509 ------------- 0	271,794 ------------- 0	0 ------------- 0
47MEGAN STOBO ADMINISTRATOR - HSC	(i) (ii)	194,602 ------------- 0	16,559 ------------- 0	15,916 ------------- 0	23,584 ------------- 0	16,654 ------------- 0	267,315 ------------- 0	0 ------------- 0
48GLENN KAWABATA VP	(i) (ii)	0 ------------- 197,339	0 ------------- 12,781	0 ------------- 360	0 ------------- 31,452	0 ------------- 24,116	0 ------------- 266,048	0 ------------- 0
49GLORIA BROOKS VP	(i) (ii)	0 ------------- 195,293	0 ------------- 12,293	0 ------------- 18,199	0 ------------- 32,424	0 ------------- 7,553	0 ------------- 265,762	0 ------------- 0
50KATIE SHIGEMITSU Compliance Officer	(i) (ii)	0 ------------- 221,265	0 ------------- 0	0 ------------- 3,421	0 ------------- 23,435	0 ------------- 14,690	0 ------------- 262,811	0 ------------- 0
51LORI INGRAM DIR. CLINICAL SERVICE LINE	(i) (ii)	209,196 ------------- 0	15,028 ------------- 0	1,654 ------------- 0	19,059 ------------- 0	7,081 ------------- 0	252,018 ------------- 0	0 ------------- 0
52ALAN ITO Information Security Officer	(i) (ii)	0 ------------- 185,591	0 ------------- 13,070	0 ------------- 1,612	0 ------------- 21,083	0 ------------- 14,293	0 ------------- 235,649	0 ------------- 0
53JESSICA LEWIS Assistant Corporate Secretary	(i) (ii)	0 ------------- 170,876	0 ------------- 0	0 ------------- 0	0 ------------- 15,118	0 ------------- 25,286	0 ------------- 211,280	0 ------------- 0
54DAVID FOX Privacy Officer - (Part Year)	(i) (ii)	0 ------------- 160,526	0 ------------- 0	0 ------------- 3,089	0 ------------- 16,325	0 ------------- 15,781	0 ------------- 195,721	0 ------------- 0

Schedule J (Form 990) 2020

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 3

SUPPLEMENTAL COMPENSATION INFORMATION THE ORGANIZATION'S PRESIDENT IS PAID BY ITS TAX EXEMPT PARENT, HAWAI'I PACIFIC HEALTH ('HPH'), AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, FORM 990 PART VI, SECTION B, LINE 15A FOR THE PROCESS USED BY HPH TO DETERMINE COMPENSATION.

SCHEDULE J, PART I, LINE 4B

SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THE RESTORATION PLAN WAS DESIGNED TO RESTORE BENEFITS THAT ARE LOST DUE TO LIMITS IMPOSED BY SECTIONS 401 AND 415 OF THE INTERNAL REVENUE CODE ON COMPENSATION CONSIDERED UNDER SUCH PLANS. AMOUNTS PAID OUT DURING THE YEAR BY RELATED ORGANIZATIONS: RAYMOND P. VARA JR. - $443,030 DAVID OKABE - $156,411 GAIL LERCH - $113,397 STEVEN ROBERTSON - $100,707 KENNETH B. ROBBINS, M.D. - $91,556 CHARLES R. CHING - $84,461 ARTHUR GLADSTONE - $77,843 MARTHA SMITH - $74,608 MELINDA ASHTON, M.D. - $61,798 JENNIE CHAHANOVICH - $47,714 ANNUAL INCENTIVE PLAN THE ANNUAL INCENTIVE PLAN IS AFFORDED TO EXECUTIVES BASED ON ANNUAL SYSTEM GOALS THAT ARE NOT BASED ON A PERCENTAGE OF NET EARNINGS. AMOUNTS PAID OUT DURING THE YEAR BY RELATED ORGANIZATIONS: RAYMOND P. VARA JR. - $372,488 DAVID OKABE - $132,543 GAIL LERCH - $107,316 STEVEN ROBERTSON - $108,006 CHARLES R. CHING - $104,835 ARTHUR GLADSTONE - $128,098 MARTHA SMITH - $138,435 MELINDA ASHTON, M.D. - $111,972 JENNIE CHAHANOVICH - $99,404 LESLIE CHUN, M.D. - $83,827 GERARD LIVAUDAIS, M.D. - $78,824 DAWN DUNBAR - $57,822 WARREN CHAIKO - $52,368 RODNEY WILLIAMS, M.D. - $51,984 GIDGET RUSCETTA, R.N. - $51,840 TRAVIS CLEGG - $49,405 DOUGLAS KWOCK, M.D. - $48,037 BRANDT FARIAS - $47,553 EARL INOUYE - $40,705 SUSAN NONAKA - $39,915 MAVIS NIKAIDO - $38,843 MICHAEL ROBINSON - $38,177 DAWN CHING - $32,377 DAVID STUMBAUGH - $31,700 LORRIE-ANN LUKE - $30,832 BRIGITTE MCKALE - $30,524 BARBARA CRAFT - $20,550 JAMES LIN, M.D. - $18,581 CARRIE ANN TSUTSUI - $17,756 WILLIAM BURKE - $16,427 JOAN KANEMORI - $15,730 ANDREW MOATS - $14,963 GLENN KAWABATA - $12,781 GLORIA BROOKS - $12,293 RETENTION INCENTIVE PLAN THE RETENTION INCENTIVE PLAN WAS DESIGNED TO ENCOURAGE CONTINUED INTEREST IN THE SUCCESS OF THE ORGANIZATION AND PROVIDE COMPETITVE RETIREMENT BENEFITS. THE SOLE PLAN PARTICIPANT IS HAWAI'I PACIFIC HEALTH'S CHIEF EXECUTIVE OFFICER, RAYMOND P. VARA JR. THE PLAN DOES NOT REPLACE THE ANNUAL AND LONG-TERM INCENTIVE PLAN NOR THE SERP RESTORATION PLAN. AMOUNTS PAID OUT DURING THE YEAR BY A RELATED ORGANIZATION: RAYMOND P. VARA JR: $1,015,000

Schedule J (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

HAWAI'I PACIFIC HEALTH GROUP RETURN

Employer identification number

38-3835105

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2020

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) JOY MATSUYAMA	SEE PART V	225,551	DIRECTOR OF PHARMACY		No
(2) HAWAI'I BIO WASTE	SEE PART V	147,920	WASTE MGMT SERVICES		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
FORM 990, SCHEDULE L, PART IV, COLUMN B	JOY MATSUYAMA, DIRECTOR OF PHARMACY, IS A FAMILY MEMBER OF DAWN DUNBAR, CURRENT STRAUB CLINIC & HOSPITAL SVP. MICHELLE HO, who serves on the board of directors, OWNS MORE THAN 65% DIRECTLY AND INDIRECTLY OF HAWAI'I BIO WASTE.

Schedule L (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

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

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

HAWAI'I PACIFIC HEALTH GROUP RETURN

Employer identification number

38-3835105

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......	X		18,436	FMV
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...	X	130	4,060	FMV
20 Drugs and medical supplies .	X	236	140,266	FMV
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( BOOKS )	X	2	475	FMV
26 Other ( OTHER- PREPAID GCS )	X	248	7,355	FMV
27 Other ( OTHER- TOYS )	X	270	14,639	FMV
28 Other ( HOTEL STAY )	X	2	10,000	FMV
Other ( PLANTS )	X	1	135	FMV

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2020)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE M, PART I, COLUMN B	COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED.

Schedule M (Form 990) (2020)

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

2020

Open to Public
Inspection

Name of the organization

HAWAI'I PACIFIC HEALTH GROUP RETURN

Employer identification number

38-3835105

Return Reference	Explanation
FORM 990, PART III, LINE 1	STATEMENT OF ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES HAWAI'I PACIFIC HEALTH IS A NOT-FOR-PROFIT HEALTH CARE SYSTEM WITH OVER 70 LOCATIONS STATEWIDE INCLUDING MEDICAL CENTERS, CLINICS, PHYSICIANS AND OTHER CAREGIVERS COMMITTED TO THE ORGANIZATION'S MISSION TO CREATE A HEALTHIER HAWAI'I. ITS FOUR MEDICAL CENTERS - KAPI'OLANI, PALI MOMI, STRAUB AND WILCOX - SPECIALIZE IN INNOVATIVE PROGRAMS IN WOMEN'S HEALTH, PEDIATRIC CARE, CARDIOVASCULAR SERVICES, CANCER CARE, BONE AND JOINT SERVICES AND MORE. HAWAI'I PACIFIC HEALTH IS RECOGNIZED NATIONALLY FOR ITS EXCELLENCE IN PATIENT CARE AND THE USE OF ELECTRONIC HEALTH RECORDS TO IMPROVE QUALITY AND PATIENT SAFETY.
FORM 990, PART III, LINES 4A-4D	PROGRAM SERVICE ACCOMPLISHMENTS PROGRAM SERVICE #1 OUTPATIENT OPERATING ROOMS IN FISCAL YEAR 2021, HAWAI'I PACIFIC HEALTH HOSPITALS AND CLINICS SPENT $62,130,342 IN DIRECT EXPENSES FOR OUTPATIENT OPERATING ROOMS AND SURGICAL PROCEDURES, AS PART OF OUR COMMITMENT TO PROVIDE CARE FOR ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. PEDIATRIC SURGERIES AT KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN (KAPI'OLANI) INCLUDE THORACIC/HEART; CLEFT LIP/PALATE; EAR, NOSE AND THROAT; ORTHOPEDIC; NEUROLOGIC; UROLOGIC; OPHTHALMOLOGIC; GASTROINTESTINAL; PLASTIC AND GENERAL PROCEDURES. WOMEN'S SURGERIES INCLUDE BREAST BIOPSIES, LUMPECTOMIES, MASTECTOMIES AND RECONSTRUCTION, HYSTEROSCOPIES, INTERSTIM BLADDER IMPLANT AND SUB URETHRAL SLING TO TREAT INCONTINENCE, TUBAL LIGATION AND ENDOMETRIAL ABLATION. KAPI'OLANI IS THE ONLY MEDICAL CENTER IN THE STATE PROVIDING DA VINCI ROBOT-AIDED PEDIATRIC SURGERY. ADDITIONALLY, THE ROBOT IS UTILIZED IN PERFORMING GYNECOLOGICAL SURGICAL SERVICES. THE MINIMALLY INVASIVE SURGERIES PERFORMED USING THE DA VINCI PROVIDE INCREASED BENEFITS FOR PATIENTS, INCLUDING LESS PAIN, LOWER RISK OF INFECTION AND LESS BLOOD LOSS. IN FISCAL YEAR 2021, KAPI'OLANI PERFORMED 3,864 PEDIATRIC AND ADULT OUTPATIENT SURGERIES. PALI MOMI MEDICAL CENTER (PALI MOMI) HAS A FULLY INTEGRATED, MINIMALLY INVASIVE SURGICAL SUITE EQUIPPED WITH TELEMEDICINE CAPABILITY, TOUCHSCREEN CONTROL PANELS AT THE NURSES' STATION, VOICE ACTIVATION SYSTEM, AND LIVE VIDEO FEED TO MEDICAL CENTERS AROUND THE WORLD. IN FISCAL YEAR 2021, PALI MOMI PERFORMED 3,256 OUTPATIENT SURGERIES. PALI MOMI UTILIZES THE DA VINCI FIREFLY ROBOT-AIDED SYSTEM TO ASSIST WITH MINIMALLY INVASIVE SURGERY. THE MINIMALLY INVASIVE SURGERIES PERFORMED USING THE DA VINCI PROVIDE INCREASED BENEFITS FOR PATIENTS INCLUDING LESS PAIN, LOWER RISK OF INFECTION AND LESS BLOOD LOSS. STRAUB CLINIC & HOSPITAL (STRAUB) OFFERS INTEGRATED OUTPATIENT SURGERY IN A 7-ROOM SUITE, 2-ROOM PLASTIC SURGERY SUITE, 2-ROOM GENERAL SURGERY DEPARTMENT, 2-ROOM INTERVENTIONAL CARDIAC CATHETERIZATION LABORATORY, INTERVENTIONAL RADIOLOGY SUITES, AND ENDOSCOPY DEPARTMENT. PROCEDURES PERFORMED RANGE FROM MINOR EXCISIONS TO COMPLEX PERIPHERAL INTRAVASCULAR TECHNIQUES. IN FISCAL YEAR 2021, STRAUB PERFORMED 3,291 OUTPATIENT SURGERIES. WILCOX MEMORIAL HOSPITAL (WILCOX) HAS A STATE-OF-THE-ART SURGICAL CENTER WITH 6 SURGICAL SUITES, 20 SAME-DAY SURGERY BEDS, VOICE-ACTIVATED ROBOTICS AND OTHER COMPUTER-ASSISTED TECHNOLOGIES. IN FISCAL YEAR 2021, WILCOX PERFORMED 3,038 OUTPATIENT SURGERIES. PROGRAM SERVICES REVENUE IS REPORTED ON PART III, LINE 4. PROGRAM SERVICE #2 OUTPATIENT EMERGENCY ROOMS IN FISCAL YEAR 2021, HAWAI'I PACIFIC HEALTH HOSPITALS SAW 91,513 OUTPATIENT ER CASES AND SPENT $53,537,856 IN DIRECT EXPENSES FOR OUTPATIENT ER SERVICES, AS PART OF OUR COMMITMENT TO PROVIDE CARE FOR ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. IN FISCAL YEAR 2021, KAPI'OLANI CELEBRATED THE THIRD ANNIVERSARY OF ITS NEWLY EXPANDED EMERGENCY DEPARTMENT IN THE DIAMOND HEAD TOWER. AT MORE THAN TWICE THE SIZE OF THE PREVIOUS SPACE, THE NEW ED FEATURES 24 PRIVATE TREATMENT ROOMS, INCLUDING TWO TRAUMA ROOMS AND TWO TRIAGE ROOMS; THREE ROOMS EQUIPPED AS NEGATIVE-PRESSURE ISOLATION ROOMS; ON-SITE SATELLITE RADIOLOGY SUITE FOR PLAIN X-RAYS, SEPARATE ADULT AND PEDIATRIC WAITING AREAS; CHILD-FRIENDLY DCOR; AND A CENTRAL, OPEN BUSINESS CENTER. KAPI'OLANI'S ER IS THE ONLY ONE IN THE STATE WITH PEDIATRIC SPECIALISTS AVAILABLE 24/7. IT HAS A TEAM FOR ADULTS AND ANOTHER DEDICATED TO PEDIATRICS, WHERE BOARD-CERTIFIED PEDIATRIC EMERGENCY PHYSICIANS CAN QUICKLY DIAGNOSE AND TREAT A FULL RANGE OF MEDICAL CONDITIONS IN BABIES, CHILDREN AND TEENS, FROM RARE INFECTIONS TO SPORTS INJURIES. IN FISCAL YEAR 2021, KAPI'OLANI HAD 25,197 OUTPATIENT ER CASES. THE PALI MOMI ER IS THE ONLY ONE IN THE STATE THAT USES A TEAM TRIAGE APPROACH, WHERE PATIENTS ARE PROMPTLY EVALUATED BY A PHYSICIAN. IN FISCAL YEAR 2021, THE PALI MOMI ER HAD 29,672 OUTPATIENT ER CASES. THE STRAUB ER HAS BOARD-CERTIFIED EMERGENCY PHYSICIANS ON STAFF 24/7, 365 DAYS A YEAR, WITH WHEELCHAIR TRANSPORT AND VALET SERVICES AVAILABLE. IN FISCAL YEAR 2021, THE STRAUB ER HAD 21,159 OUTPATIENT ER CASES. THE WILCOX 20-BED ER IS THE FIRST NEIGHBOR ISLAND FACILITY TO OBTAIN A LEVEL III TRAUMA DESIGNATION. IT IMPLEMENTED A TRIAGE BEST PRACTICE, "RAPID TRIAGE AND IMMEDIATE BED PLACEMENT," TO DECREASE DOOR-TO-BED AND DOOR-TO-DOC TIMES, ALLOW SOME PATIENTS TO BYPASS THE TRIAGE AREA, AND LET NURSE ASSESSMENT AND ER PHYSICIAN EVALUATION OCCUR SIMULTANEOUSLY. THIS IMPROVES SERVICE, QUALITY AND SAFETY. IN FISCAL YEAR 2021, THE WILCOX ER HAD 15,485 OUTPATIENT ER CASES. PROGRAM SERVICES REVENUE IS REPORTED ON PART III, LINE 4. PROGRAM SERVICE #3 PEDIATRICS-NEONATAL SERVICES IN FISCAL YEAR 2021, HAWAI'I PACIFIC HEALTH SPENT $50,376,770 IN DIRECT EXPENSES FOR PEDIATRIC-NEONATAL SERVICES AS PART OF ITS COMMITMENT TO PROVIDE HIGH-QUALITY MEDICAL CARE FOR ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. KAPI'OLANI IS RECOGNIZED AS HAWAI'I'S PEDIATRIC MEDICAL CENTER AND ALSO PROVIDES CARE THROUGHOUT THE PACIFIC REGION. IT HAS THE ONLY INTENSIVE CARE UNITS IN HAWAI'I TO TREAT CRITICALLY-ILL CHILDREN AND INFANTS. THE PEDIATRIC INTENSIVE CARE UNIT SERVES NEARLY 500 CHILDREN EACH YEAR RANGING IN AGE FROM ONE WEEK TO 21 YEARS OF AGE. SPECIAL SERVICES DELIVERED BY THE PEDIATRIC INTENSIVE CARE UNIT INCLUDE AN OPEN-HEART PROGRAM (FIVE TIMES PER YEAR), ECMO (EXTRACORPOREAL MEMBRANE OXYGENATION), DIALYSIS CRRT (CONTINUOUS RENAL REPLACEMENT THERAPY), AND TRAUMA AND TRANSPLANT COLLABORATION WITH OTHER MEDICAL CENTERS FOR POSTOPERATIVE CARE. THE NEONATAL INTENSIVE CARE UNIT CARES FOR MORE THAN 1,000 OF THE TINIEST AND MOST VULNERABLE INFANTS IN HAWAI'I EACH YEAR. SPECIALIZED PROCEDURES INCLUDE ECMO (EXTRACORPOREAL MEMBRANE OXYGENATION) AND WHOLE-BODY COOLING. KAPI'OLANI ALSO PROVIDES SPECIALTY PEDIATRIC CARE IN CARDIOLOGY, GASTROENTEROLOGY, NEUROLOGY, OPHTHALMOLOGY, UROLOGY, ONCOLOGY, SURGERY, ORTHOPEDICS, REHABILITATION AND OTHER SUPPORT SERVICES. IT IS A MAJOR TEACHING HOSPITAL FOR THE UNIVERSITY OF HAWAI'I JOHN A. BURNS SCHOOL OF MEDICINE'S PEDIATRIC AND NEONATAL-PERINATAL MEDICINE PROGRAMS. IN FISCAL YEAR 2021, KAPI'OLANI PROVIDED SPECIALIZED CARE FOR 3,628 PEDIATRIC-NEONATAL PATIENTS. WILCOX MEDICAL CENTER PROVIDES PREVENTIVE CARE AND TREATMENT SERVICES TO MEET THE HEALTH NEEDS OF KAUA'I'S CHILDREN. THROUGH KAUA'I MEDICAL CLINIC, WILCOX PROVIDES COMPREHENSIVE PEDIATRIC CARE FOR CHILDREN OF ALL AGES. PEDIATRICIANS AT WILCOX ALSO COLLABORATE WITH PHYSICIANS AT KAPI'OLANI OR OTHER HAWAI'I PACIFIC HEALTH FACILITIES WHEN KAUA'I CHILDREN NEED SPECIALIZED CARE. IN FISCAL YEAR 2021, WILCOX PROVIDED SPECIALIZED CARE FOR 146 PEDIATRIC-NEONATAL PATIENTS. PROGRAM SERVICES REVENUE IS REPORTED ON PART III, LINE 4.
FORM 990, PART III, LINES 4A-4D CONTINUED	PROGRAM SERVICE #4 OTHER PROGRAMS HAWAI'I PACIFIC HEALTH IS ONE OF THE STATE'S LARGEST HEALTH CARE SYSTEMS WITH FOUR MEDICAL CENTERS, MORE THAN 70 LOCATIONS, 1,500+ AFFILIATED PHYSICIANS, MORE THAN 7,000 EMPLOYEES, AND HUNDREDS OF VOLUNTEERS FROM THE COMMUNITY. HAWAI'I RESIDENTS AND VISITORS RELY ON HAWAI'I PACIFIC HEALTH FOR ITS FULL RANGE OF PRIMARY, SECONDARY AND SELECT TERTIARY CARE SERVICES. IN FISCAL YEAR 2021, THE MEDICAL CENTERS ADMITTED 28,355 PATIENTS. STRAUB CLINICS HAD 998,249 TOTAL PATIENT CLINIC ENCOUNTERS, KAUA'I MEDICAL CLINIC HAD 261,667 TOTAL PATIENT CLINIC ENCOUNTERS AND KAPI'OLANI MEDICAL SPECIALISTS HAD 125,093 PATIENT CLINIC ENCOUNTERS. AFFILIATES AND SUBSIDIARIES HAWAI'I HEALTH PARTNERS IS A PHYSICIAN-LED ACCOUNTABLE CARE ORGANIZATION WITH THE GOAL OF PROVIDING HIGH-QUALITY CARE, INCREASED EFFICIENCY AND OPTIMAL PATIENT HEALTH. KAPI'OLANI MEDICAL SPECIALISTS IS A SPECIALTY PHYSICIANS GROUP ORGANIZED TO SUPPORT KAPI'OLANI MEDICAL CENTER. THE FOUNDATIONS OF HAWAI'I PACIFIC HEALTH CONSIST OF KAPI'OLANI HEALTH FOUNDATION, PALI MOMI FOUNDATION, STRAUB FOUNDATION AND WILCOX HEALTH FOUNDATION. THESE CHARITABLE ENTITIES SUPPORT HEALTH RESEARCH, FACILITY ENHANCEMENTS, TECHNOLOGY INVESTMENTS, EDUCATIONAL PROGRAMS AND OTHER RESOURCES FOR THEIR RESPECTIVE MEDICAL CENTERS. HAWAI'I HEALTH PARTNERS, INC. IS A FOR-PROFIT SUBSIDIARY THAT SERVES AS THE JOINT VENTURE PARTNER WHEN HAWAI'I PACIFIC HEALTH WORKS WITH OTHER PROVIDERS. PROVIDERS INSURANCE CORPORATION IS A CAPTIVE INSURANCE COMPANY THAT PROVIDES PROFESSIONAL LIABILITY INSURANCE FOR HAWAI'I PACIFIC HEALTH-AFFILIATED EMPLOYED PHYSICIANS. PATIENT CARE HAWAI'I PACIFIC HEALTH HAS STRATEGIC INITIATIVES IN WOMEN'S HEALTH, PEDIATRIC CARE, CARDIOVASCULAR SERVICES, BONE & JOINT SERVICES, AND CANCER CARE. IT IS RECOGNIZED NATIONALLY FOR ITS EXCELLENCE IN HEALTH INFORMATION TECHNOLOGY, SPECIFICALLY THE USE OF ELECTRONIC HEALTH RECORDS TO IMPROVE QUALITY OF CARE AND PATIENT SAFETY. THE HAWAI'I PACIFIC HEALTH SYSTEM INCLUDES: THE PACIFIC REGION'S ONLY FULL-SERVICE WOMEN'S AND CHILDREN'S MEDICAL CENTER AND ONLY DEDICATED BURNUNIT, STATE-OF-THE-ART IMAGING CENTER ON KAUA'I, WEST O'AHU'S ONLY CARDIAC CATHETERIZATION LABS, MINIMALLY INVASIVE BONE & JOINT CENTER, SLEEP DISORDERS CENTER, STATE'S FIRST WOMEN'S CENTER, STATE'S ONLY BREAST AND WOMEN'S CANCER CENTERS, AND OTHER SPECIALIZED SERVICES CONSIDERED CRITICAL TO THE REMOTE HAWAIIAN ARCHIPELAGO. COMMUNITY ROLE/ACTIVITY AS ONE OF THE STATE'S LARGEST HEALTH CARE SYSTEMS, HAWAI'I PACIFIC HEALTH HAS A RESPONSIBILITY TO IMPROVE THE HEALTH OF HAWAI'I RESIDENTS AND, THROUGH ITS MISSION, IS COMMITTED TO CREATING A HEALTHIER HAWAI'I. EACH YEAR, HAWAI'I PACIFIC HEALTH SPONSORS HEALTH EDUCATION, TEACHING AND RESEARCH, AND SUPPORTS LIKE-MINDED ORGANIZATIONS. IN FISCAL YEAR 2021, HAWAI'I PACIFIC HEALTH SERVED AS A STATEWIDE RESOURCE TO THE COMMUNITY IN RESPONSE TO EVER-CHANGING HEALTH NEEDS BASED ON THE PANDEMIC. COVID-19 INITIATIVES BY THE SYSTEM INCLUDED FREE COMMUNITY VACCINE CLINICS, COMMUNITY TESTING SITES AT ITS MEDICAL FACILITIES AND DIRECTLY IN NEIGHBORHOODS THROUGH MOBILE OUTREACH EVENTS, RESPIRATORY CLINICS AND TELEHEALTH OPTIONS. OTHER COMMUNITY RESOURCES THAT HAWAI'I PACIFIC HEALTH PROVIDED WERE PUBLIC HEALTH EDUCATION, A FREE EMPLOYER COVID HOTLINE TO HELP NAVIGATE SAFE WORK ENVIRONMENTS AND A COHESIVE PUBLIC HEALTH RESPONSE IN COLLABORATING WITH THE DEPARTMENT OF HEALTH AND OTHER HEALTH CARE PROVIDERS. HAWAI'I PACIFIC HEALTH ALSO CONTINUED TO SUPPORT VARIOUS COMMUNITY BENEFIT PROGRAMS, INCLUDING THE KAPI'OLANI SEX ABUSE TREATMENT CENTER, KAPI'OLANI CHILD ADVOCACY AND PROTECTION CENTER, HEART DISEASE PREVENTION, BREAST AND CERVICAL CANCER SCREENING FOR UNINSURED PERSONS, WOMEN AND INFANT HEALTH AND NUTRITION, REHABILITATION SERVICES, SUPPORT GROUPS THAT MET VIRTUALLY, HEMOPHILIA PROGRAMS, AND OTHER EDUCATION AND SCREENINGS FOR HAWAI'I RESIDENTS ON HEALTH, WELLNESS AND DISEASE-PREVENTION STRATEGIES. IN FISCAL YEAR 2021, HAWAI'I PACIFIC HEALTH SPONSORED OR SUPPORTED NUMEROUS HEALTH EVENTS, INCLUDING "AHA HEARTWALK," "SUSAN G. KOMEN RACE FOR THE CURE," "ARTHRITIS FOUNDATION'S ARTHRITIS WALK," - ALL HELD VIRTUALLY THIS YEAR - AND MORE. HAWAI'I PACIFIC HEALTH ALSO SERVED AS THE PRESENTING SPONSOR FOR THE VIRTUAL GREAT ALOHA RUN AND VIRTUAL KEIKI GREAT ALOHA RUN. PROCEEDS FROM THE EVENT BENEFIT MORE THAN 150 NONPROFIT ORGANIZATIONS IN HAWAI'I. HAWAI'I PACIFIC HEALTH ALSO PARTICIPATED IN SYMPOSIA AND MEETINGS FOR HEALTH CARE PROFESSIONALS, HIRED STUDENTS AS SUMMER INTERNS, FACILITATED CLINICAL TRAINING PROGRAMS FOR PUBLIC HIGH SCHOOL STUDENTS TO EARN NATIONAL CERTIFICATION IN MEDICAL FIELDS AND SPONSORED WORKSHOPS FOR VOLUNTEERS. TO TRAIN HEALTH CARE PROVIDERS, HAWAI'I PACIFIC HEALTH HAS ALLIANCES WITH THE UNIVERSITY OF HAWAI'I JOHN A. BURNS SCHOOL OF MEDICINE AND HAWAI'I PACIFIC UNIVERSITY. HAWAI'I PACIFIC HEALTH INVESTS EACH YEAR IN TEACHING AND RESEARCH AS A PEDIATRIC AND OB-GYN TRAINING FACILITY FOR THE UNIVERSITY OF HAWAI'I. HAWAI'I PACIFIC HEALTH IS ALSO ACTIVELY INVOLVED IN CLINICAL TRIALS AND RESEARCH THROUGH ITS VAROUS FACILITIES IN PEDIATRICS, ONCOLOGY, OPHTHALMOLOGY AND CARDIOLOGY. PUBLIC POLICY HAWAI'I PACIFIC HEALTH HAS A RESPONSIBILITY TO OFFER THOUGHTFUL AND INNOVATIVE INPUT TO LAWMAKERS REGARDING HEALTH CARE POLICY AND LEGISLATION. HAWAI'I PACIFIC HEALTH LEADERS ADVOCATE FOR LEGISLATIVE REFORM AND REGULATORY ENHANCEMENTS FOR VARIOUS HEALTH CARE INDUSTRY ISSUES RANGING FROM RETAINING PHYSICIANS IN THE STATE TO PROVIDING STABILITY FOR HEALTH CARE PROVIDERS. OTHER HAWAI'I PACIFIC HEALTH MEDICAL CENTERS TREAT ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY, THUS SERVING AS A SAFETY NET PROVIDER OF HEALTH CARE FOR THE COMMUNITY. AN ESTABLISHED CHARITY CARE POLICY SETS GUIDELINES BY WHICH IT IS DETERMINED IF PATIENTS QUALIFY FOR FREE OR DISCOUNTED CARE. HAWAI'I PACIFIC HEALTH CONTRIBUTES MORE THAN $1 BILLION TO THE STATE ECONOMY EACH YEAR, SUPPORTING ITS MORE THAN 7,000 EMPLOYEES, THEIR FAMILIES, AND MANY BUSINESSES THROUGH PURCHASES MADE BY ITS MEDICAL CENTERS AND CLINICS. PROGRAM SERVICES REVENUE IS REPORTED ON PART III, LINE 4.
FORM 990, PART IV, LINE 8	COLLECTION OF WORKS OF ART, HISTORICAL TREASURES OR SIMILAR KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN (KMCWC) AND PALI MOMI MEDICAL CENTER (PMMC) MAINTAIN WORKS OF ART. STRAUB CLINIC & HOSPITAL (SCH) AND WILCOX MEMORIAL HOSPITAL (WMH) DID NOT MAINTAIN WORKS OF ART. FORM 990, PART IV, LINE 10 ENDOWMENT FUNDS KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN (KMCWC), PALI MOMI MEDICAL CENTER (PMMC) AND STRAUB CLINIC & HOSPITAL (SCH) HELD ASSETS IN ENDOWMENT FUNDS. WILCOX MEMORIAL HOSPITAL DID NOT HOLD ASSETS IN ENDOWMENT FUNDS. FORM 990, PART IV, LINE 11B INVESTMENTS - OTHER SECURITIES 5% OR MORE OF TOTAL ASSETS KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN (KMCWC) AND PALI MOMI MEDICAL CENTER (PMMC) BOTH REPORTED INVESTMENTS IN OTHER SECURITIES GREATER OR EQUAL TO 5% OF TOTAL ASSETS. STRAUB CLINIC & HOSPITAL (SCH) AND WILCOX MEMORIAL HOSPITAL (WMH) BOTH DID NOT REPORT INVESTMENTS IN OTHER SECURITIES GREATER OR EQUAL TO 5% OF TOTAL ASSETS. FORM 990, PART IV, LINE 28B BUSINESS TRANSACTION WITH A FAMILY MEMBER STRAUB CLINIC & HOSPITAL (SCH) WAS A PARTY TO A BUSINESS TRANSACTION WITH A FAMILY MEMBER OF A CURRENT OFFICER. KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN (KMCWC), PALI MOMI MEDICAL CENTER (PMMC) AND WILCOX MEMORIAL HOSPITAL (WMH) WERE NOT A PARTY TO A BUSINESS TRANSACTION WITH A FAMILY MEMBER OF A CURRENT OFFICER. FORM 990, PART IV, LINE 28C BUSINESS TRANSACTION WITH A CONTROLLED ENTITY KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN (KMCWC) WAS A PARTY TO A BUSINESS TRANSACTION WITH A 35% CONTROLLED ENTITY BY A CURRENT OFFICER. PALI MOMI MEDICAL CENTER (PMMC), STRAUB CLINICAL & HOSPITAL (SCH) AND WILCOX MEMORIAL HOSPITAL (WMH) WERE NOT A PARTY TO A BUSINESS TRANSACTION WITH A 35% CONTROLLED ENTITY BY A CURRENT OFFICER.
FORM 990, PART V, LINE 1A	FORM 1096 REPORTING HAWAI'I PACIFIC HEALTH (HPH), THE ORGANIZATION'S TAX EXEMPT PARENT, PAYS ALL VENDORS. THEREFORE, HPH ISSUES FORMS 1099 UNDER ITS TAX ID.
FORM 990, PART VI, SECTION A, LINE 6	MEMBERS AND RIGHTS HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER WHO HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE WITH THE RIGHT TO ELECT THE MEMBERS OF THE GOVERNING BODY AND/OR APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BOARD.
FORM 990, PART VI, SECTION A, LINE 7A	DESCRIPTION OF CLASSES OF PERSON AND THE NATURE OF THEIR RIGHTS HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER, AND HAS THE POWER TO APPROVE THE ELECTION OF MEMBERS OF THE GOVERNING BODY. HAWAI'I PACIFIC HEALTH, AS MEMBER, ALSO HAS THE POWER TO ELECT ONE OR MORE EX OFFICIO VOTING MEMBERS OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION A, LINE 7B	DESCRIPTION CLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL & TYPE OF VOTING RIGHTS HAWAI'I PACIFIC HEALTH, AS MEMBER, HAS THE FOLLOWING RESERVED POWERS WITH RESPECT TO KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN AND PALI MOMI MEDICAL CENTER: (I) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: THE EXECUTIVE VICE PRESIDENT/CHIEF EXECUTIVE OFFICER, TREASURER, SECRETARY, EXECUTIVE VICE-PRESIDENT/CHIEF FINANCIAL OFFICER, CHIEF OPERATING OFFICER, OTHER EXECUTIVE VICE-PRESIDENTS, SENIOR VICE-PRESIDENTS, ASSISTANT SECRETARIES, AND ALL VICE-PRESIDENTS EXCEPT THE OPERATING UNIT VICE-PRESIDENTS, AS SUCH TERM IS DEFINED IN THE BYLAWS; (II) DELEGATE MANAGEMENT AUTHORITIES FROM THE BOARD TO OFFICERS OR COMMITTEES OF THE CORPORATION IN ACCORDANCE WITH A DELEGATED AUTHORITIES MATRIX ADOPTED BY THE MEMBER BOARD; (III) AMEND THE BYLAWS; (IV) DETERMINE AND EFFECT THE CORPORATION'S PARTICIPATION IN ALL LONG TERM FINANCING TRANSACTIONS WHICH ARE IN EXCESS OF ONE (1) YEAR AND/OR FOR ONE MILLION DOLLARS ($1,000,000) OR MORE; (V) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORPORATION'S FUNDS SHALL BE DEPOSITED; (VI) DIRECT, MANAGE AND CONTROL THE CUSTODY, ADVISORY SERVICE, AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORPORATION; (VII) DETERMINE AND EFFECT INTER-CORPORATE TRANSFERS BY AND BETWEEN THE CORPORATION AND ANY AFFILIATE; (VIII) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORPORATION'S PHYSICIAN AND EXECUTIVE COMPENSATION AND BENEFIT PLANS; (IX) FORM A NEW CORPORATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (X) CLOSE THE ACUTE CARE HOSPITAL OWNED AND OPERATED BY THE CORPORATION; (XI) AFTER CONSULTING WITH THE BOARD, REMOVE THE EXECUTIVE VICE PRESIDENT/CHIEF EXECUTIVE OFFICER, EXECUTIVE VICE PRESIDENT/CHIEF FINANCIAL OFFICER, TREASURER, SECRETARY, OTHER EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, ASSISTANT SECRETARIES, AND/OR ALL VICE PRESIDENTS EXCEPT THE OPERATING UNIT VICE PRESIDENTS; (XII) AFTER CONSULTING WITH THE BOARD, DEVELOP AND PROMULGATE THE CORPORATE GOALS AND THE LONG-RANGE AND STRATEGIC PLAN OF THE CORPORATION; AND (XIII) AFTER CONSULTING WITH THE BOARD, DEVELOP AND IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS. HAWAI'I PACIFIC HEALTH, AS MEMBER, HAS THE FOLLOWING RESERVED POWERS WITH RESPECT TO STRAUB CLINIC & HOSPITAL: (I) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: THE TREASURER, SECRETARY, EXECUTIVE VICE-PRESIDENT/CHIEF FINANCIAL OFFICER, EXECUTIVE VICE PRESIDENTS OTHER THAN THE EXECUTIVE VICE-PRESIDENT/CHIEF EXECUTIVE OFFICER (THE "EVP/CEO") AND THE EXECUTIVE VICE-PRESIDENT OF THE CORPORATION WHO IS THE CHIEF MEDICAL OFFICER OF THE MEMBER (THE "EVP/CMO") OF THE CORPORATION, SENIOR VICE-PRESIDENTS, ASSISTANT SECRETARIES, AND ALL VICE-PRESIDENTS EXCEPT THE CLINIC AND HOSPITAL UNIT VICE-PRESIDENTS, AS SUCH TERM IS DEFINED IN THE BYLAWS; (II) REMOVE ANY DIRECTOR FROM THE BOARD; PROVIDED, HOWEVER, THAT THE BOARD MAY REMOVE ANY DIRECTOR FROM THE BOARD IF APPROVED BY THE MEMBER BOARD; (III) DELEGATE MANAGEMENT AUTHORITIES FROM THE BOARD TO OFFICERS OR COMMITTEES OF THE CORPORATION IN ACCORDANCE WITH A DELEGATED AUTHORITIES MATRIX ADOPTED BY THE MEMBER BOARD; (IV) AMEND THE BYLAWS; (V) CAUSE THE CORPORATION'S PARTICIPATION IN ALL LONG TERM FINANCING TRANSACTIONS WHICH ARE IN EXCESS OF ONE (1) YEAR AND/OR FOR ONE MILLION DOLLARS ($1,000,000) OR MORE; (VI) ACQUIRE ASSETS WORTH OVER ONE MILLION DOLLARS ($1,000,000); (VII) ACQUIRE SHARES IN ANOTHER CORPORATION; (VIII) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORPORATION'S FUNDS SHALL BE DEPOSITED; (IX) DIRECT, MANAGE AND CONTROL THE CUSTODY, ADVISORY SERVICE, AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORPORATION; (X) DETERMINE AND EFFECT INTER-CORPORATE TRANSFERS BY AND BETWEEN THE CORPORATION AND ANY AFFILIATE; (XI) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORPORATION'S PHYSICIAN AND EXECUTIVE COMPENSATION AND BENEFIT PLANS; (XII) FORM A NEW CORPORATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (XIII) FORM A JOINT VENTURE OR OTHER BUSINESS RELATIONSHIP (OTHER THAN THE ORDINARY COURSE OF BUSINESS CONTRACTS) BETWEEN THE CORPORATION AND ANY PERSON OR ENTITY; (XIV) CLOSE THE ACUTE CARE HOSPITAL OR CLINIC FACILITIES OWNED AND OPERATED BY THE CORPORATION; (XV) RELOCATE THE ACUTE CARE HOSPITAL OR CLINIC FACILITIES OWNED AND OPERATED BY THE CORPORATION; (XVI) CONVERT THE ACUTE CARE HOSPITAL OWNED AND OPERATED BY THE CORPORATION INTO A NON-ACUTE CARE FACILITY; (XVII) AFTER CONSULTING WITH THE BOARD, REMOVE THE TREASURER, SECRETARY, EXECUTIVE VICE-PRESIDENT/CHIEF FINANCIAL OFFICER, EXECUTIVE VICE-PRESIDENTS OTHER THAN THE EVP/CEO AND THE EVP/CMO, SENIOR VICE-PRESIDENTS, ASSISTANT SECRETARIES, AND/OR ALL VICE-PRESIDENTS EXCEPT THE CLINIC AND HOSPITAL UNIT VICE-PRESIDENTS; (XVIII) DEVELOP AND PROMULGATE THE CORPORATE GOALS AND THE LONG-RANGE AND STRATEGIC PLAN OF THE CORPORATION; (XIX) AFTER CONSULTING WITH THE BOARD, DEVELOP AND IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS; AND (XX) IMPLEMENT INDIVIDUAL PHYSICIAN COMPENSATION ARRANGEMENTS FOR EACH PHYSICIAN OPERATING UNIT IN THE CORPORATION. THE FOLLOWING ACTIONS REQUIRE APPROVAL FROM THE MEMBER BOARD: (I) ADD ANY DIRECTOR TO THE BOARD; (II) AMEND THE ARTICLES OF INCORPORATION; (III) SELL, LEASE, EXCHANGE OR DISPOSE OF FIFTY PERCENT (50%) OR MORE OF THE AMOUNT OF PROPERTY OR ASSETS HELD BY THE ORGANIZATION, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, TO ANY ENTITY THAT IS NOT AN AFFILIATE; (IV) ENTER INTO ANY UNBUDGETED CONTRACTS ON BEHALF OF THE ORGANIZATION WHICH REQUIRE ANNUAL PAYMENTS ON BEHALF OF THE ORGANIZATION EXCEEDING ONE MILLION DOLLARS ($1,000,000) IN VALUE; (V) ISSUE THE ORGANIZATION'S MEMBERSHIP TO ANYONE OTHER THAN THE MEMBER; (VI) MERGE THE ORGANIZATION WITH ANY ENTITY; (VII) DISSOLVE THE ORGANIZATION; AND (VIII) DEVELOP A NEW LINE OF BUSINESS OR A NEW SERVICE.
FORM 990, PART VI, LINE 7B CONTINUED	HAWAI'I PACIFIC HEALTH, AS MEMBER, HAS THE FOLLOWING RESERVED POWERS WITH RESPECT TO WILCOX MEMORIAL HOSPITAL: (I) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: THE PRESIDENT/CHIEF EXECUTIVE OFFICER, TREASURER, SECRETARY, EXECUTIVE VICE-PRESIDENT/CHIEF FINANCIAL OFFICER, OTHER EXECUTIVE VICE-PRESIDENTS, SENIOR VICE-PRESIDENTS, ASSISTANT SECRETARIES, AND ALL VICE-PRESIDENTS EXCEPT THE OPERATING UNIT VICE-PRESIDENTS, AS SUCH TERM IS DEFINED IN THE BYLAWS; (II) DELEGATE MANAGEMENT AUTHORITIES FROM THE BOARD TO OFFICERS OR COMMITTEES OF THE CORPORATION IN ACCORDANCE WITH A DELEGATED AUTHORITIES MATRIX ADOPTED BY THE MEMBER BOARD; (III) AMEND THE BYLAWS; (IV) CAUSE THE CORPORATION'S PARTICIPATION IN ALL LONG TERM FINANCING TRANSACTIONS WHICH ARE IN EXCESS OF ONE (1) YEAR AND/OR FOR ONE MILLION DOLLAR ($1,000,000) OR MORE; (V) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORPORATION'S FUNDS SHALL BE DEPOSITED; (VI) DIRECT, MANAGE AND CONTROL THE CUSTODY, ADVISORY SERVICE AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORPORATION; (VII) EFFECT INTER-CORPORATE TRANSFERS BY AND BETWEEN THE CORPORATION AND ANY AFFILIATE; (VIII) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORPORATION'S PHYSICIAN AND EXECUTIVE COMPENSATION AND BENEFIT PLANS; (IX) FORM A NEW CORPORATION, LIMITED LIABILITY COMPANY, OR PARTNERSHIP OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (X) EXCEPT AS OTHERWISE PROVIDED IN THE BYLAWS OR AS REQUIRED BY THE LAW OF THE STATE OF HAWAI'I, SELL, LEASE OR OTHERWISE TRANSFER FIFTY PERCENT (50%) OR MORE OF THE THEN CURRENT AMOUNT, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE TOTAL ASSETS HELD BY WILCOX MEMORIAL HOSPITAL, KAUA'I MEDICAL CLINIC AND WILCOX HEALTH FOUNDATION (THE "WILCOX AFFILIATES"); (XI) EXCEPT AS PROVIDED IN THE BYLAWS OR AS REQUIRED BY THE LAWS OF THE STATE OF HAWAI'I, SELL, LEASE OR TRANSFER OF OPERATIONS OR ACTIVITIES OF THE WILCOX AFFILIATES WHICH GENERATE FIFTY PERCENT (50%) OR MORE OF THE TOTAL NET REVENUES, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE WILCOX AFFILIATES DURING THE PRIOR FISCAL YEAR; (XII) CLOSE THE CLINICAL FACILITIES OWNED AND OPERATED BY THE CORPORATION; PROVIDED, THAT, AFTER THE EFFECTIVE DATE OF THE BYLAWS, ANY ELIMINATION OF A CLINICAL SERVICE PROVIDED BY THE CORPORATION MUST ALSO BE APPROVED BY THE BOARD; (XIII) CONVERT THE CLINIC OWNED AND OPERATED BY THE CORPORATION INTO A FACILITY NO LONGER OFFERING MEDICAL SERVICES; PROVIDED, THAT, AFTER THE EFFECTIVE DATE OF THE BYLAWS, ANY ELIMINATION OF A CLINICAL SERVICE PROVIDED BY THE CORPORATION MUST ALSO BE APPROVED BY THE BOARD; (XIV) AFTER CONSULTING WITH THE BOARD, REMOVE THE PRESIDENT/CHIEF EXECUTIVE OFFICER, EXECUTIVE VICE-PRESIDENT/CHIEF FINANCIAL OFFICER, TREASURER, SECRETARY, OTHER EXECUTIVE VICE-PRESIDENTS, SENIOR VICE-PRESIDENTS, ASSISTANT SECRETARIES, AND ALL VICE-PRESIDENTS EXCEPT THE OPERATING UNIT VICE-PRESIDENTS; PROVIDED, HOWEVER, THAT TO REMOVE OR TERMINATE THE PRESIDENT/CHIEF EXECUTIVE OFFICER WILL REQUIRE THE CHIEF EXECUTIVE OFFICER OF THE MEMBER TO FULLY COLLABORATE AND CONSULT WITH THE BOARD AND SEEK THE BOARD'S ADVANCE CONSENT FOR SUCH REMOVAL OR TERMINATION. IF THE BOARD DOES NOT CONCUR WITH THE PROPOSED REMOVAL OR TERMINATION OF THE PRESIDENT/CHIEF EXECUTIVE OFFICER, SUCH REMOVAL OR TERMINATION WILL REQUIRE THE APPROVAL OF A MAJORITY OF THE MEMBERS ON THE MEMBER BOARD; (XV) AFTER CONSULTING WITH THE BOARD, DEVELOP AND PROMULGATE THE CORPORATE GOALS AND THE LONG RANGE AND STRATEGIC PLANS OF THE CORPORATION; AND (XVI) AFTER CONSULTING WITH THE BOARD, DEVELOP AND IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS. THE CORPORATION SHALL NOT TAKE THE FOLLOWING ACTIONS WITHOUT FIRST OBTAINING MEMBER BOARD APPROVAL: (I) ADD ANY DIRECTOR TO THE BOARD; (II) REMOVE ANY DIRECTOR FROM THE BOARD; (III) AMEND THE ARTICLES; (IV) ENTER INTO ANY UNBUDGETED CONTRACTS ON BEHALF OF THE CORPORATION WHICH REQUIRE ANNUAL PAYMENTS ON BEHALF OF THE CORPORATION EXCEEDING ONE MILLION DOLLARS ($1,000,000) IN VALUE; (V) ACQUIRE ASSETS WORTH OVER ONE MILLION DOLLARS ($1,000,000); (VI) ACQUIRE SHARES IN ANOTHER CORPORATION; (VII) SELL, LEASE OR OTHERWISE TRANSFER FIFTY PERCENT (50%) OR MORE OF THE THEN CURRENT AMOUNT, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE TOTAL ASSETS HELD BY THE WILCOX AFFILIATES; (VIII) SELL, LEASE, EXCHANGE OR DISPOSE OF FIFTY PERCENT (50%) OR MORE OF THE PROPERTY AND ASSETS HELD BY THE CORPORATION TO ANY ENTITY THAT IS NOT AN AFFILIATE; (IX) SELL, LEASE OR TRANSFER OF OPERATIONS OR ACTIVITIES OF THE WILCOX AFFILIATES WHICH GENERATE FIFTY PERCENT (50%) OR MORE OF THE TOTAL NET REVENUES, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE WILCOX AFFILIATES DURING THE PRIOR FISCAL YEAR; (X) MERGE THE CORPORATION WITH ANY ENTITY; (XI) DISSOLVE OR LIQUIDATE THE CORPORATION; (XII) ISSUE THE CORPORATION'S MEMBERSHIP TO ANYONE OTHER THAN THE MEMBER (XIII) FORM A JOINT VENTURE OR OTHER BUSINESS RELATIONSHIP (OTHER THAN THE ORDINARY COURSE OF BUSINESS CONTRACTS) BETWEEN THE CORPORATION AND ANY PERSON OR ENTITY; AND (XIV) DEVELOP A NEW LINE OF BUSINESS OR A NEW SERVICE.
FORM 990, PART VI, SECTION B, LINE 11B	REVIEW OF THE FORM 990 BY THE ORGANIZATION'S GOVERNING BODY VARIOUS SCHEDULES OF THE FORM 990 ARE PREPARED PRIMARILY BY STAFF WITHIN THE ACCOUNTING AREA OF THE ORGANIZATION WORKING WITH VARIOUS OTHER AREAS OF THE ORGANIZATION SUCH AS MANAGEMENT OF THE OPERATING UNITS, HR, LEGAL, ETC. DISCLOSURE NARRATIVES ARE WRITTEN AND COMPILED INTERNALLY BASED ON INPUT AND DISCUSSION WITH FINANCIAL ANALYSTS AND THE CHIEF OPERATING OFFICER/EXECUTIVE DIRECTOR OF THE REPORTING ENTITY. THE CHIEF OPERATING OFFICER/EXECUTIVE DIRECTOR OF EACH REPORTING ENTITY REVIEWS AND APPROVES THE DISCLOSURE NARRATIVES WHICH DESCRIBES THE MISSION/PURPOSE AND PROGRAM ACCOMPLISHMENTS OF THEIR ORGANIZATION. SENIOR MANAGEMENT OF THE HEALTH CARE SYSTEM REVIEWS THE FORM 990 OF EACH FILING ORGANIZATION WITHIN THE HEALTH CARE SYSTEM. ONCE SENIOR MANAGEMENT HAS COMPLETED ITS REVIEW, THE FORMS 990 ARE THEN PROVIDED TO THE GOVERNANCE AND NOMINATING COMMITTEE OF THE HEALTH CARE SYSTEM'S BOARD OF DIRECTORS FOR THEIR REVIEW. THE GOVERNANCE AND NOMINATING COMMITTEE OF THE PARENT ENTITY'S (HAWAI'I PACIFIC HEALTH "HPH") BOARD PROVIDES OVERSIGHT FOR THE FORM 990 REPORTING AND REVIEWS THE FORM 990 FOR EACH ENTITY PRIOR TO FILING. IN ADDITION, THE FORM 990 FOR EACH ENTITY IS MADE AVAILABLE TO THE BOARD MEMBERS OF EACH SUBSIDIARY UNIT OF HPH AND THE HPH BOARD OF DIRECTORS THROUGH A BOARD MEMBER PORTAL FOR REVIEW PRIOR TO THE FILING OF THE FORM 990. THE FORMS 990 WILL BE POSTED TO HPH'S WEBSITE FOR PUBLIC ACCESS AFTER THE FILING OF THE RETURNS WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	MONITORING & ENFORCEMENT OF CONFLICT OF INTEREST POLICY ANNUALLY, EACH DIRECTOR, OFFICER, KEY EMPLOYEE AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) RECEIVED A COPY OF THE CONFLICT OF INTEREST ("COI") POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) AGREES TO COMPLY WITH THE POLICY; 4) HAS DISCLOSED ANY CONFLICTS OR POTENTIAL CONFLICTS OR ECONOMIC INTERESTS AS REQUIRED; AND 5) UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, THE ORGANIZATION MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. THE IN-HOUSE LEGAL DEPARTMENT DISTRIBUTES THE STATEMENT REQUEST AND REVIEWS THE COI STATEMENTS RETURNED. IDENTIFIED CONFLICTS OF INTEREST ARE PRESENTED TO THE BOARD FOR REVIEW, DELIBERATION AND CONFIRMATION/REFUTATION THAT A CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST HAS BEEN FOUND, THE INDIVIDUAL MAY ADDRESS THE BOARD AND EXPLAIN THE TRANSACTION OR ARRANGEMENT CAUSING THE CONFLICT. AFTER THE PRESENTATION, THE INDIVIDUAL IS EXCUSED FROM THE MEETING AND SHALL NOT PARTICIPATE WITH ANY DISCUSSION OR VOTE ON MATTERS PERTAINING TO THE TRANSACTION OR ARRANGEMENT. IN MEETINGS WHERE APPLICATION OF THE COI POLICY OCCURS, THE MEETING MINUTES INCLUDE NATURE OF THE FINANCIAL INTEREST/CONFLICT, NAME(S) OF THE PERSON(S) WITH THE POTENTIAL OR ACTUAL CONFLICT, ANY ACTION TAKEN TO ASSIST IN THE DETERMINATION OF WHETHER A CONFLICT EXISTED, INCLUDING ANY DISCUSSION OF ALTERNATIVE ARRANGEMENTS, THE BOARD'S DECISION(S) REGARDING THE CONFLICT AND NAMES OF PERSON PRESENT IN THE DISCUSSION AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT.
FORM 990, PART VI, SECTION B, LINES 15A & 15B	PROCESS OF DETERMINING COMPENSATION THE CEO OF THE ORGANIZATION IS NOT COMPENSATED BY THE FILING ORGANIZATION, BUT RATHER BY THE TAX-EXEMPT PARENT, HAWAI'I PACIFIC HEALTH ("HPH"). FOLLOWING IS THE PROCESS THAT THE PARENT ORGANIZATION UNDERTAKES TO APPROVE THE CEO'S COMPENSATION. COMPENSATION FOR HAWAI'I PACIFIC HEALTH ("HPH") EXECUTIVES (VICE PRESIDENT AND ABOVE) IS SET BY THE INDEPENDENT BOARD MEMBERS OF THE HAWAI'I PACIFIC BOARD'S COMPENSATION COMMITTEE. ON AN ANNUAL BASIS THE HPH BOARD CHAIRPERSON (WHO IS INDEPENDENT) SELECTS A NEUTRAL THIRD PARTY EXECUTIVE COMPENSATION CONSULTANT TO REVIEW THE EXECUTIVE'S COMPENSATION AND BENEFITS. THE CONSULTANT PROVIDES A WRITTEN REPORT TO THE COMPENSATION COMMITTEE AT ITS ANNUAL MEETING. INCLUDED IN THE REPORT IS MARKET BASED DATA FROM LIKE ORGANIZATIONS. THE COMPENSATION COMMITTEE MAKES FINAL DECISIONS REGARDING COMPENSATION AND BENEFITS AT THE MEETING AFTER REVIEW AND DISCUSSION OF THE CONSULTANT'S REPORT. COMMUNITY BASED DIRECTORS OF THE ORGANIZATION ARE NOT COMPENSATED. CERTAIN EMPLOYED PHYSICIANS MAY BE OFFICERS OR AN IDENTIFIED KEY EMPLOYEE OF THE REPORTING OR RELATED ORGANIZATION. PHYSICIAN COMPENSATION IS ALSO HANDLED IN THE SAME MANNER AS EXECUTIVE COMPENSATION, WITH THE HPH COMPENSATION COMMITTEE RECEIVING A REPORT FROM A NEUTRAL CONSULTANT AND FOLLOWING THE SAME PROCESS AS DESCRIBED ABOVE ON AN ANNUAL BASIS. THIS PROCESS WAS MOST RECENTLY COMPLETED ON MARCH 09, 2021 TO REVIEW PHYSICIAN COMPENSATION AND ON JULY 28, 2021 TO REVIEW EXECUTIVE COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19	DISCLOSURE OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS DISCLOSURE OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS AND STANDARDS OF CONDUCT ARE AVAILABLE ON THE HAWAI'I PACIFIC HEALTH WEBSITE. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC VIA THE HAWAI'I PACIFIC HEALTH WEBSITE.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS OBLIGATED GROUP INTERCOMPANY TRANSFERS $(128,336,883) NET ASSETS RELEASED FROM RESTRICTION $(970,502) EQUITY TRANSFERS $(178,206) WRITE-OFFS $(126) CHANGE IN INTEREST IN KHF/WHF $11,073,799 CHANGE IN INTEREST IN PERPETUAL TRUSTS $1,127,332 RESTRICTED GRANTS AND CONTRIBUTIONS $941,798 ROUNDING $127 ------------- TOTAL $(116,342,661)
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN SERVICES TOTAL FEES:21164612
FORM 990 PART IX LINE 11G	DESCRIPTION:MEDICAL SERVICES TOTAL FEES:6809899
FORM 990 PART IX LINE 11G	DESCRIPTION:CONSULTING SERVICES TOTAL FEES:794175
FORM 990 PART IX LINE 11G	DESCRIPTION:REGISTRY SERVICES TOTAL FEES:5423934
FORM 990 PART IX LINE 11G	DESCRIPTION:TEMPORARY LABOR ADMIN SERVICES TOTAL FEES:3191250
FORM 990 PART IX LINE 11G	DESCRIPTION:TEMPORARY LABOR OTHER SERVICES TOTAL FEES:946930
FORM 990 PART IX LINE 11G	DESCRIPTION:LAUNDRY SERVICES TOTAL FEES:4351387
FORM 990 PART IX LINE 11G	DESCRIPTION:CONTRACT & RECURRING SERVICES TOTAL FEES:48622861
FORM 990 PART IX LINE 11G	DESCRIPTION:FAMILY FUND SERVICES TOTAL FEES:196
FORM 990 PART IX LINE 11G	DESCRIPTION:COLLECTION FEES SERVICES TOTAL FEES:573420
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER SERVICES TOTAL FEES:18835760
FORM 990 PART IX LINE 11G	DESCRIPTION:REPAIRS & MAINTENANCE TOTAL FEES:10241099
FORM 990 PART IX LINE 11G	DESCRIPTION:INTERNAL SVCS PROVIDED EXPENSE TOTAL FEES:40111835
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER EXPENSE RECOVERY TOTAL FEES:-187709

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN, PALI MOMI MEDICAL CENTER, STRAUB MEDICAL CENTER AND WILCOX MEDICAL CENTER'S MISSION IS TO CREATE A HEALTHIER HAWAI'I.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	41
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	26
5	Total number of individuals employed in calendar year 2020 (Part V, line 2a) ......	5	5,802
6	Total number of volunteers (estimate if necessary) .............	6	570
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	2,583,864
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	1,730,039

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	41,949,556	76,350,613
9	Program service revenue (Part VIII, line 2g) .........	1,286,290,946	1,396,586,913
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	769,030	2,071,789
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	7,576,971	6,173,600
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	1,336,586,503	1,481,182,915
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,345,863	1,759,340
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)	563,104,321	489,365,766
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)....	712,337,450	848,833,987
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	1,277,787,634	1,339,959,093
19	Revenue less expenses. Subtract line 18 from line 12.......	58,798,869	141,223,822
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,068,453,240	1,165,070,529
21	Total liabilities (Part X, line 26).............	325,811,336	346,730,013
22	Net assets or fund balances. Subtract line 21 from line 20.....	742,641,904	818,340,516

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 62,130,342 including grants of $ 0 ) (Revenue $ 86,123,289 )
	SEE SCHEDULE O

4b	(Code: ) (Expenses $ 53,537,856 including grants of $ 0 ) (Revenue $ 112,350,035 )
	SEE SCHEDULE O

4c	(Code: ) (Expenses $ 50,376,770 including grants of $ 0 ) (Revenue $ 150,183,001 )
	SEE SCHEDULE O

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 999,660,030 including grants of $ 1,759,340 ) (Revenue $ 1,050,996,022 )
4e	Total program service expenses1,165,704,998

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	15,982,072	6,320,029

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	4,571,594
e	Government grants (contributions)		1e	71,600,337

f	All other contributions, gifts, grants, and similar amounts not included above		1f	178,682

g	Noncash contributions included in lines 1a - 1f:$		1g	195,366

h Total. Add lines 1a-1f.......		76,350,613

		Business Code
2a	NET PATIENT REVENUES	622110	1,219,275,836	1,219,275,836
b	INTER-ENTITY SERVICE REVENUE	900099	110,074,647	110,074,647
c	OTHER HEALTH CARE REVENUES	622110	34,625,792	32,637,110	1,988,682
d	PREMIUM REVENUE	622110	26,740,305	26,740,305
e	RENTAL INCOME	531120	5,548,091	5,484,924	63,167
f	All other program service revenue.		322,242	322,242
g	Total. Add lines 2a–2f .....		1,396,586,913

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,688,128			1,688,128
4 Income from investment of tax-exempt bond proceeds			1,803			1,803
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		128,380	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	128,380	6c
d	Net rental income or (loss).......			128,380			128,380
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	74,776	49,011,026	7a
b	Less: cost or other basis and sales expenses	262,786	48,441,158	7b
c	Gain or (loss)	-188,010	569,868	7c
d	Net gain or (loss).........			381,858	-132,202		514,060
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	544,648
b	Less: cost of goods sold ..		10b	116,292
c	Net income or (loss) from sales of inventory..			263,720			263,720
Business Code			Miscellaneous Revenue
11a	CAFETERIA REVENUE		722110	1,730,798	1,730,798
b	PARKING REVENUE		812930	1,659,154	1,659,154
c	3RD PARTY EXPENSE REIMBURSEMENT		900099	467,853	467,853
d	All other revenue ....			1,923,695	1,391,680	532,015
e	Total. Add lines 11a–11d ......			5,781,500
12	Total revenue. See instructions.....			1,481,182,915	1,399,652,347	2,583,864	2,596,091

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	1,759,340	1,759,340
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 ...........	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	383,288,691	380,028,724	3,259,967
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	26,888,474	26,599,089	289,385
9	Other employee benefits .......	51,063,329	44,287,929	6,775,400
10	Payroll taxes ...........	28,125,272	27,910,016	215,256
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	0
c	Accounting ...........	3,016,539		3,016,539
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	614,048		614,048
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	160,879,649	136,902,825	23,976,824	0
12	Advertising and promotion ....	744,874	39,957	704,917
13	Office expenses .......	7,273,690	6,987,581	286,109
14	Information technology ......	14,586,084	12,545,374	2,040,710
15	Royalties ..	0
16	Occupancy ...........	33,753,067	31,087,021	2,666,046
17	Travel ............	217,500	176,006	41,494
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	47,973	47,222	751
20	Interest ...........	17,843,838	17,843,838
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	42,708,389	42,708,389
23	Insurance ...	4,991,274	6,756,323	-1,765,049
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	CORPORATE ALLOCATION	102,784,890		102,784,890
b	OTHER PURCHASES	34,762,703	6,810,544	27,952,159
c	MEDICAL SUPPLIES	204,906,405	204,913,385	-6,980
d	INTER-ENTITY PURCHASED SVCS.	218,299,436	218,299,436
e	All other expenses	1,403,628	1,999	1,401,629
25	Total functional expenses. Add lines 1 through 24e	1,339,959,093	1,165,704,998	174,254,095	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 ........			383,274	1	121,613
2	Savings and temporary cash investments .........			1,431,865	2	6,068,345
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			135,613,760	4	157,003,874
5	Loans and other receivables from 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 ............			21,890,595	8	23,373,506
9	Prepaid expenses and deferred charges ......			1,969,245	9	2,089,905
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,090,009,530
b	Less: accumulated depreciation	10b	584,762,794	504,198,381	10c	505,246,736
11	Investments—publicly traded securities .			82,505,761	11	100,526,971
12	Investments—other securities. See Part IV, line 11 .....			117,894,162	12	148,436,611
13	Investments—program-related. See Part IV, line 11 ..			1,618,557	13	1,618,557
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			200,947,640	15	220,584,411
16	Total assets. Add lines 1 through 15 (must equal line 33)...			1,068,453,240	16	1,165,070,529

17	Accounts payable and accrued expenses .....	97,024,569	17	121,092,315
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 ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	228,786,767	25	225,637,698
26	Total liabilities. Add lines 17 through 25..	325,811,336	26	346,730,013

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	697,397,688	27	759,747,317
28	Net assets with donor restrictions ...........	45,244,216	28	58,593,199
	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 ...........	742,641,904	32	818,340,516
33	Total liabilities and net assets/fund balances ........	1,068,453,240	33	1,165,070,529

(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)PROVIDERS INSURANCE CORPORATION 55 MERCHANT STREET 24TH FLOOR HONOLULU,HI96813 71-0893000	INSURANCE	HI	501(C)(3)	12B, II	HPH	Yes
(2)KAPI'OLANI HEALTH FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU,HI96813 99-0246364	FUNDRAISING	HI	501(C)(3)	7	HPH	Yes
(3)KAPI'OLANI MEDICAL SPECIALISTS 55 MERCHANT STREET 24TH FLOOR HONOLULU,HI96813 99-0322406	HEALTHCARE	HI	501(C)(3)	3	HPH	Yes
(4)WILCOX HEALTH FOUNDATION 3-3420 KUHIO HIGHWAY LIHUE,HI96766 99-0204242	FUNDRAISING	HI	501(C)(3)	7	HPH	Yes
(5)KAUA'I MEDICAL CLINIC 55 MERCHANT STREET 24TH FLOOR HONOLULU,HI96813 99-0326099	HOSPITAL	HI	501(C)(3)	3	HPH	Yes
(6)STRAUB FOUNDATION 55 MERCHANT STREET 26TH FLOOR HONOLULU,HI96813 99-0109350	FUNDRAISING	HI	501(C)(3)	7	HPH	Yes
(7)PALI MOMI FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU,HI96813 38-3840327	FUNDRAISING	HI	501(C)(3)	7	HPH	Yes

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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	(k) Percentage ownership
(1) ASC PACIFIC VENTURES LLC 3000 riverchase galleria ste 500 birmingham,AL35244 27-0540034	AMBU. SURG. CTR.	AL	NA	N/A

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) KAPI'OLANI HEALTH FOUNDATION	C	1,963,750	FMV
(2) KAPI'OLANI HEALTH FOUNDATION	Q	266,348	FMV
(3) KAPI'OLANI HEALTH FOUNDATION	S	376,739	FMV
(4) KAPI'OLANI MEDICAL SPECIALISTS	O	167,073	FMV
(5) KAPI'OLANI MEDICAL SPECIALISTS	P	23,649,336	FMV
(6) KAPI'OLANI MEDICAL SPECIALISTS	Q	127,544,846	FMV
(7) KAPI'OLANI MEDICAL SPECIALISTS	S	4,339,620	FMV
(8) KAUA'I MEDICAL CLINIC	P	738,310	FMV
(9) KAUA'I MEDICAL CLINIC	Q	291,691	FMV
(10) KAUA'I MEDICAL CLINIC	R	637,558	FMV
(11) PALI MOMI FOUNDATION	C	354,408	FMV
(12) PROVIDERS INSURANCE CORPORATION	R	7,642,886	FMV
(13) STRAUB FOUNDATION	C	704,915	FMV
(14) WILCOX HEALTH FOUNDATION	C	446,634	FMV

(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?		(k) Percentage ownership
(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	(k) Percentage ownership