Form990


Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
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MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
A For the 2021 calendar year, or tax year beginning 07-01-2021 , and ending 06-30-2022
BCheck if applicable:
CName of organization
Hawai'i Pacific Health Group Return
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
55 MERCHANT STREET 24TH FLOOR
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
HONOLULU, HI96813
D Employer identification number

38-3835105
E Telephone number

G Gross receipts $ 1,640,409,693
F Name and address of principal officer:
RAYMOND P VARA JR
55 MERCHANT STREET 24TH FLOOR
HONOLULU,HI96813
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.HAWAIIPACIFICHEALTH.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. See instructions. Click to see attachment
H(c)
Group exemption number MediumBullet5834
K Form of organization:  
L Year of formation:  
M State of legal domicile:
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: 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 MediumBullet
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 2021 (Part V, line 2a) ...... 5 5,790
6 Total number of volunteers (estimate if necessary) ............. 6 463
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 554,209
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 147,335
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 76,350,613 44,311,085
9 Program service revenue (Part VIII, line 2g) ......... 1,396,586,913 1,518,032,914
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 2,071,789 6,567,509
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 6,173,600 6,917,435
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 1,481,182,915 1,575,828,943
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,759,340 1,648,527
14 Benefits paid to or for members (Part IX, column (A), line 4).....   0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 489,365,766 488,909,912
16a Professional fundraising fees (Part IX, column (A), line 11e) .....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 848,833,987 933,849,097
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 1,339,959,093 1,424,407,536
19 Revenue less expenses. Subtract line 18 from line 12....... 141,223,822 151,421,407
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 1,165,070,529 1,155,436,693
21 Total liabilities (Part X, line 26)............. 346,730,013 295,936,316
22 Net assets or fund balances. Subtract line 21 from line 20..... 818,340,516 859,500,377
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2021)
Form 990 (2021)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: SEE SCHEDULE O
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 69,730,044 including grants of $ 0 ) (Revenue $ 100,035,660 )
SEE SCHEDULE O
4b (Code:   ) (Expenses $ 62,964,812 including grants of $ 0 ) (Revenue $ 143,234,219 )
SEE SCHEDULE O
4c (Code:   ) (Expenses $ 46,024,292 including grants of $ 0 ) (Revenue $ 65,486,627 )
SEE SCHEDULE O
(Code:   ) (Expenses $ 1,063,570,269 including grants of $ 1,648,527 ) (Revenue $ 1,213,621,327 )
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 2022, THE MEDICAL CENTERS ADMITTED 29,681 PATIENTS. STRAUB CLINICS HAD 1,083,521 TOTAL PATIENT CLINIC ENCOUNTERS, KAUA'I MEDICAL CLINIC HAD 312,256 TOTAL PATIENT CLINIC ENCOUNTERS, KAPI'OLANI MEDICAL SPECIALISTS HAD 202,527 PATIENT CLINIC ENCOUNTERS AND PALI MOMI CLINIC HAD 73,061 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. KAUA'I MEDICAL CLINIC IS A SPECIALTY PHYSICIANS GROUP ORGANIZED TO SUPPORT WILCOX 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 BURN UNIT, STATE-OF-THE-ART IMAGING CENTER ON KAUA'I, WEST O'AHU'S ONLY CARDIAC CATHETERIZATION LABS, CENTRAL AND WEST O'AHU'S ONLY COMPREHENSIVE CANCER CENTER, MINIMALLY INVASIVE BONE AND JOINT CENTER, STATE'S FIRST WOMEN'S CENTER, SPECIALIZED BREAST AND WOMEN'S CANCER CENTERS, AND OTHER 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 2022, HAWAI'I PACIFIC HEALTH CONTINUED TO SERVE 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, MOBILE VACCINE OUTREACH EVENTS, DRIVE-THROUGH VACCINE AND BOOSTER SHOT EVENTS FOR CHILDREN AND FAMILIES, DEDICATED PEDIATRIC VACCINE AND BOOSTER CLINICS AND TELEHEALTH OPTIONS. OTHER COMMUNITY RESOURCES THAT HAWAI'I PACIFIC HEALTH PROVIDED WERE PUBLIC HEALTH EDUCATION, AND A COHESIVE PUBLIC HEALTH RESPONSE IN COLLABORATING WITH THE DEPARTMENT OF HEALTH, DEPARTMENT OF EDUCATION, HONOLULU FIRE DEPARTMENT, HAWAII HEALTHCARE ASSOCIATION OF HAWAII 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, HEMOPHILIA PROGRAMS, AND OTHER EDUCATION AND SCREENINGS FOR HAWAI'I RESIDENTS ON HEALTH, WELLNESS AND DISEASE-PREVENTION STRATEGIES. IN FISCAL YEAR 2022, HAWAI'I PACIFIC HEALTH SPONSORED OR SUPPORTED NUMEROUS HEALTH EVENTS, INCLUDING "AMERICAN HEART ASSOCIATION HAWAI'I HEART WALK," "SUSAN G. KOMENMORE THAN PINK WALK," "ARTHRITIS FOUNDATION'S WALK TO CURE ARTHRITIS," - THAT WELCOMED PARTIPATION IN-PERSON AND VIRTUALLY THIS YEAR - AND MORE. HAWAI'I PACIFIC HEALTH ALSO SERVED AS THE PRESENTING SPONSOR FOR THE VIRTUAL 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.
4d Other program services (Describe in Schedule O.)
(Expenses $ 1,063,570,269 including grants of $ 1,648,527 ) (Revenue $ 1,213,621,327 )
4e Total program service expensesMediumBullet1,242,289,417
Form 990 (2021)
Form 990 (2021)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C, Part III..
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part IIIClick to see attachment..............
8
Yes
 
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I. See instructions. ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or 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? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....Click to see attachment
28b
Yes
 
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV..................... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..Click to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
Form 990 (2021)
Form 990 (2021)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
5,790
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. See instructions.
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2021)
Form 990 (2021)
Page 6
Part VI
Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
41
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
26
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
HI
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletANN HO55 MERCHANT STREET 24TH FLOOR   HONOLULU,HI96813 (808) 527-2520
Form 990 (2021)
Form 990 (2021)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the
organization and any related organizations.

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

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

See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Andrew Rosen
 
Board of Director, Chair
 0.2
.................
0 		X   X       0 0 0
(2) Arthur Gladstone
 
BOD, CEO, EVP CSO
 0.0
.................
55.0 		X   X       0 906,835 317,125
(3) David Underriner
 
Board of Director, CEO
 30.0
.................
10.0 		X   X       0 317,137 6,410
(4) Dawn Miura MD
 
Board of Director, Vice Chair
 0.2
.................
0 		X   X       0 11,168 0
(5) Jennie Chahanovich
 
BOD, President CEO
 42.0
.................
14.5 		X   X       0 681,179 231,860
(6) Jerry Pupillo
 
Board of Director, Chair
 0.2
.................
0 		X   X       0 0 0
(7) Michael Yamane
 
Board of Director, Chair
 0.2
.................
0.4 		X   X       0 0 0
(8) Paul Toner
 
Board of Director, Vice Chair
 0.2
.................
0 		X   X       0 0 0
(9) Raymond P Vara Jr
 
Board of Director, President
 8.0
.................
54.1 		X   X       0 2,290,034 2,498,142
(10) Richanne Lam
 
Board of Director, Chair (part year)
 0.2
.................
0.1 		X   X       0 0 0
(11) Stephen Lin MD
 
Board of Director, Chair
 0.3
.................
0.4 		X   X       0 1,777 0
(12) Todd Miller MD
 
Board of Director, Vice Chair
 40.0
.................
0 		X   X       0 582,498 19,211
(13) Alana Pakkala
 
Board of Director
 0.3
.................
0 		X           0 0 0
(14) Andy Lee MD
 
Board of Director (part year)
 8.0
.................
41.0 		X           0 357,370 46,675
(15) Avi Mannis
 
Board of Director
 0.2
.................
0 		X           0 0 0
(16) Carl Ackerman
 
Board of Director
 0.2
.................
0 		X           0 0 0
(17) Carol Fujiyoshi MD
 
Board of Director
 0.2
.................
40.0 		X           0 404,892 19,080
Form 990 (2021)
Form 990 (2021)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Claire Tamamoto
 
Board of Director
 0.2
.......................0 		X           0 0 0
(19) David Cho MD
 
Board of Director
 40.0
.......................0.2 		X           0 552,034 34,040
(20) Dennis Francis
 
Board of Director
 0.2
.......................0 		X           0 0 0
(21) Douglas Duvauchelle MD
 
Board of Director
 0.2
.......................0 		X           0 0 0
(22) Edward Nishioka
 
Board of Director
 0.2
.......................0 		X           0 0 0
(23) Elizabeth (Lisa) Ubay
 
Board of Director
 0.2
.......................0 		X           0 0 0
(24) Emily Kuraoka
 
Board of Director
 0.2
.......................0 		X           0 0 0
(25) Gerald McKenna MD
 
Board of Director (part year)
 0.2
.......................0 		X           0 0 0
(26) Jasmine Tanioka
 
Board of Director
 0.2
.......................0 		X           0 0 0
(27) Jason Isa MD
 
Board of Director
 0.2
.......................0 		X           0 11,000 0
(28) Kathy Richardson
 
Board of Director
 0.2
.......................0 		X           0 0 0
(29) Kim Hehir
 
Board of Director
 0.3
.......................0 		X           0 0 0
(30) Lyle Tabata
 
Board of Director
 0.2
.......................0 		X           0 0 0
(31) Mark Yamakawa
 
Board of Director
 0.3
.......................0.4 		X           0 0 0
(32) Maya Rogers
 
Board of Director
 0.3
.......................0 		X           0 0 0
(33) Melanie Kim MD
 
Board of Director
 40.0
.......................0 		X           0 282,036 18,633
(34) Michael O'Malley Esq
 
Board of Director
 0.3
.......................0 		X           0 0 0
(35) Michelle Ho
 
Board of Director
 0.3
.......................0 		X           0 0 0
(36) Monica Price MD
 
Board of Director
 0.2
.......................40.4 		X           0 312,124 37,180
(37) Nathan Tokuda MD
 
Board of Director
 0.2
.......................0 		X           0 0 0
(38) Neil Manago MD
 
Board of Director
 0.2
.......................0 		X           0 0 0
(39) Owen Chan MD
 
Board of Director
 0.2
.......................0 		X           0 12,750 0
(40) Patrick O'Donnell MD
 
Board of Director
 0.3
.......................40.0 		X           0 591,063 35,040
(41) Paul Eakin MD
 
Board of Director
 0.3
.......................0 		X           0 0 0
(42) Robert Kurisu
 
Board of Director
 0.3
.......................0 		X           0 0 0
(43) Scott Kurosawa
 
Board of Director
 0.2
.......................0 		X           0 0 0
(44) Sidney Lee MD
 
Board of Director
 0.3
.......................0 		X           0 41,500 0
(45) Tyler Chihara DPM
 
Board of Director
 0.2
.......................40.0 		X           0 422,397 34,040
(46) Alan Ito
 
Information Security Officer (part year)
 3.0
.......................37.0 		    X       0 201,298 32,431
(47) Andrew Moats RN
 
VP
 40.0
.......................0 		    X       0 292,520 87,896
(48) Barbara Craft
 
COO (part year)
 46.6
.......................7.4 		    X       0 347,977 106,655
(49) Brandon Wong
 
VP
 7.0
.......................40.0 		    X       0 185,663 55,129
(50) Brigitte McKale
 
VP CNE (part year)
 55.0
.......................0.0 		    X       0 330,206 90,387
(51) Carrie Ann Tsutsui
 
VP Controller
 13.0
.......................35.0 		    X       0 278,287 78,811
(52) Charles R Ching
 
EVP, General Counsel Secretary
 12.0
.......................28.0 		    X       0 959,131 268,655
(53) Darla Sabry RN
 
VP CNE
 40.0
.......................0 		    X       0 202,664 30,909
(54) David Okabe
 
EVP, CFO Treasurer
 9.0
.......................41.0 		    X       0 953,161 392,126
(55) David Stumbaugh
 
VP
 32.0
.......................8.0 		    X       0 271,257 85,843
(56) Dawn Ching
 
VP
 50.0
.......................3.0 		    X       0 311,205 106,648
(57) Dawn Dunbar
 
SVP
 0.0
.......................45.0 		    X       0 403,265 118,270
(58) Dean Tateyama
 
VP
 4.0
.......................36.0 		    X       0 201,171 40,804
(59) Douglas Kwock MD
 
VP
 36.0
.......................4.0 		    X       0 507,996 119,013
(60) Gerard Livaudais MD
 
EVP (part year)
 0.1
.......................49.9 		    X       0 570,789 181,478
(61) Gidget Ruscetta RN
 
COO
 45.0
.......................11.0 		    X       0 424,645 100,141
(62) Glenn Kawabata
 
VP
 50.0
.......................1.0 		    X       0 266,514 82,939
(63) Gloria Brooks
 
COO
 39.0
.......................1.0 		    X       0 268,941 68,283
(64) James Lin MD
 
VP
 0.4
.......................47.2 		    X       0 335,132 97,482
(65) Jessica Lewis
 
Assistant Corporate Secretary
 14.0
.......................26.0 		    X       0 168,040 40,849
(66) Joan Kanemori
 
VP
 40.0
.......................1.0 		    X       0 285,749 302,318
(67) John McNamara
 
SVP CMO
 16.0
.......................24.0 		    X       0 47,283 1,584
(68) Katie Shigemitsu
 
Compliance Officer
 18.5
.......................21.5 		    X       0 223,318 32,225
(69) Leslie Chun MD
 
EVP
 8.0
.......................52.0 		    X       0 785,845 225,311
(70) Lorrie-Ann Luke
 
VP
 7.0
.......................34.5 		    X       0 270,752 88,451
(71) Louise Fukumoto
 
VP
 16.0
.......................24.0 		    X       0 199,148 35,921
(72) Mathew Loughlin
 
VP
 40.0
.......................0 		    X       0 169,600 38,330
(73) Mavis Nikaido
 
VP CNE (part year)
 55.0
.......................1.0 		    X       0 469,672 70,178
(74) Melinda Ashton MD
 
EVP CQO
 6.0
.......................43.3 		    X       0 788,781 260,505
(75) Michael Robinson
 
VP
 0.6
.......................49.4 		    X       0 337,891 85,823
(76) Peter Lewis
 
VP Chief Information Security Officer
 3.0
.......................37.0 		    X       0 135,377 330
(77) Reina (France) Graves
 
Privacy Officer
 15.2
.......................24.8 		    X       0 250,059 34,768
(78) Robyn Kalahiki RN
 
VP CNE
 40.0
.......................0 		    X       0 202,621 37,119
(79) Shilpa Patel MD
 
Associate CQO
 6.4
.......................33.6 		    X       0 316,795 45,382
(80) Steven Robertson
 
EVP CIO
 3.0
.......................50.0 		    X       0 787,444 299,769
(81) Sunshine Topping
 
SVP
 9.0
.......................41.0 		    X       0 379,753 113,698
(82) Susan Masumoto-Nonaka
 
VP (part year)
 31.5
.......................8.5 		    X       0 522,308 82,373
(83) Travis Clegg
 
COO
 50.0
.......................0.0 		    X       0 430,591 121,582
(84) Troy Branstetter
 
VP
 40.0
.......................18.0 		    X       0 230,736 37,114
(85) Warren Chaiko
 
SVP
 22.0
.......................18.0 		    X       0 767,486 120,610
(86) William Burke
 
VP
 16.0
.......................38.0 		    X       0 302,321 88,324
(87) Amparo Arquines RN
 
Registered Nurse
 40.0
.......................0 		        X   260,865 0 25,441
(88) Kathryn Reyes RN
 
Registered Nurse
 40.0
.......................0 		        X   259,394 0 21,918
(89) Keith-Ann Lum RN
 
Registered Nurse
 40.0
.......................0 		        X   265,913 0 26,549
(90) Myrna Natividad RN
 
Registered Nurse
 40.0
.......................0 		        X   265,789 0 25,919
(91) Susana Pascua RN
 
Registered Nurse
 40.0
.......................0 		        X   260,373 0 23,288
(92) Beau Nakamoto MD
 
Former Officer
 40.0
.......................0.4 		            0 294,898 11,408
(93) Brandt Farias
 
Former Officer
 10.0
.......................53.0 		            0 204,094 80,106
(94) Gail Lerch
 
Former Officer
 9.0
.......................42.0 		            0 486,260 98,582
(95) Kenneth B Robbins MD
 
Former Officer
 21.0
.......................34.0 		            0 236,663 100,651
(96) Martha Smith
 
Former Officer
 50.0
.......................10.0 		            0 421,044 263,816
(97) Rodney Williams MD
 
Former Officer
 5.0
.......................35.0 		            0 259,188 7,008
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 1,312,334 25,063,333 8,288,586
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet1,644
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
CLINICAL LABORATORIES OF HAWAII LLP

MAILCODE NUMBER 60300
PO BOX 1300
HONOLULU,HI968071300 		Medical Services 30,282,549
SODEXO INC AND AFFILIATES

9801 WASHINGTONIAN BLVD
GAITHERSBURG,MD20878 		Food Environment Services 9,847,635
MEDEFIS INC

2121 N 117TH AVE STE 200
OMAHA,NE68164 		Management Services 7,770,066
HI RESIDENCY PROGRAMS INC

1356 LUSITANA STREET STE 510
HONOLULU,HI96813 		Medical Services 7,170,354
UNIV CLINICAL EDUDUCATION AND RESEARCH ASSOCIATES

677 ALA MOANA BLVD STE 1001
HONOLULU,HI96813 		Medical Services 7,012,928
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet68
Form 990 (2021)
Form 990 (2021)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 5,014,711
e Government grants (contributions)1e 39,124,647
f All other contributions, gifts, grants, and similar amounts not included above1f 171,727
g Noncash contributions included in lines 1a - 1f:$ 1g 106,959
h Total. Add lines 1a-1f.......MediumBullet 44,311,085
Program Service RevenueAmt Business Code
2a NET PATIENT REVENUES 622110 1,340,615,772 1,340,615,772    
b INTER-ENTITY SERVICE REVENUE 900099 101,996,043 101,996,043    
c OTHER HEALTH CARE REVENUES 622110 42,156,310 42,076,421 79,889  
d PREMIUM REVENUE 622110 28,504,313 28,504,313    
e RENTAL INCOME 531120 4,438,234 4,371,147 67,087  
f All other program service revenue. 322,242 322,242 0 0
g Total. Add lines 2a–2f .....MediumBullet 1,518,032,914
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 2,591,244     2,591,244
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   126,307 6a
b Less: rental expenses     6b
c Rental income or (loss) 0 126,307 6c
d Net rental income or (loss).......MediumBullet 126,307     126,307
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 176,206 68,124,878 7a
b Less: cost or other basis and sales expenses 1,785,665 62,539,154 7b
c Gain or (loss) -1,609,459 5,585,724 7c
d Net gain or (loss).........MediumBullet 3,976,265 -1,690,432   5,666,697
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
10a 457,500
b Less: cost of goods sold .. 10b 255,931
c Net income or (loss) from sales of inventory..MediumBullet 201,568     201,568
Business Code Miscellaneous Revenue
11a PARKING REVENUE 812930 2,407,767 2,407,767    
b CAFETERIA REVENUE 722110 2,143,318 2,143,318    
c HMSA settlement payment 900099 716,581 716,581    
d All other revenue .... 1,321,894 914,661 407,233 0
e Total. Add lines 11a–11d ...... MediumBullet 6,589,560
12 Total revenue. See instructions.....MediumBullet 1,575,828,943 1,522,377,833 554,209 8,585,816
Form 990 (2021)
Form 990 (2021)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 1,648,527 1,648,527
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ...........    
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............    
4 Benefits paid to or for members .......    
5 Compensation of current officers, directors, trustees, and key employees ...........        
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........        
7 Other salaries and wages........ 388,873,065 382,090,252 6,782,813  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 21,924,892 21,640,244 284,648  
9 Other employee benefits ....... 49,443,609 45,659,414 3,784,195  
10 Payroll taxes ........... 28,668,346 28,251,644 416,702  
11 Fees for services (non-employees):        
a Management ......        
b Legal .........        
c Accounting ........... 2,925,372   2,925,372  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 736,819   736,819  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 208,316,517 182,498,895 25,817,622 0
12 Advertising and promotion .... 706,007 60,493 645,514  
13 Office expenses ....... 7,808,922 7,485,042 323,880  
14 Information technology ...... 15,575,405 13,308,909 2,266,496  
15 Royalties ..        
16 Occupancy ........... 36,926,305 34,179,839 2,746,466  
17 Travel ............ 344,801 283,270 61,531  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 188,919 187,496 1,423  
20 Interest ........... 17,529,505 17,529,505    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 43,550,659 43,550,659    
23 Insurance ... 12,353,689 8,556,030 3,797,659  
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 INTER-ENTITY PURCHASED SERVICES 107,452,528   107,452,528  
b MEDICAL SUPPLIES 31,158,354 7,156,806 24,001,548  
c CORPORATE ALLOCATION 223,374,379 223,302,934 71,445  
d OTHER PURCHASES 224,895,824 224,895,824    
e All other expenses 5,092 3,634 1,458 0
25 Total functional expenses. Add lines 1 through 24e 1,424,407,536 1,242,289,417 182,118,119 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2021)
Form 990 (2021)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 121,613 1 -242,188
2 Savings and temporary cash investments ......... 6,068,345 2 12,158,026
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 157,003,874 4 161,636,075
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 ...........   7  
8 Inventories for sale or use ............ 23,373,506 8 22,738,972
9 Prepaid expenses and deferred charges ...... 2,089,905 9 2,165,577
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 1,102,423,131
b Less: accumulated depreciation 10b 599,176,620 505,246,736 10c 503,246,511
11 Investments—publicly traded securities . 100,526,971 11 84,848,049
12 Investments—other securities. See Part IV, line 11 ..... 148,436,611 12 135,893,269
13 Investments—program-related. See Part IV, line 11 .. 1,618,557 13 1,618,557
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 220,584,411 15 231,373,845
16 Total assets. Add lines 1 through 15 (must equal line 33)... 1,165,070,529 16 1,155,436,693
Liabilities 17 Accounts payable and accrued expenses ..... 121,092,315 17 123,921,889
18 Grants payable ...   18  
19 Deferred revenue .........   19  
20 Tax-exempt bond liabilities .........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
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 ..   23  
24 Unsecured notes and loans payable to unrelated third parties ..   24  
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 225,637,698 25 172,014,427
26 Total liabilities. Add lines 17 through 25.. 346,730,013 26 295,936,316
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 759,747,317 27 781,319,809
28 Net assets with donor restrictions ........... 58,593,199 28 67,769,741
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29 10,410,827
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 ........... 818,340,516 32 859,500,377
33 Total liabilities and net assets/fund balances ........ 1,165,070,529 33 1,155,436,693
Form 990 (2021)
Form 990 (2021)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
1,575,828,943
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
1,424,407,536
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
151,421,407
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
818,340,516
5
Net unrealized gains (losses) on investments ...............
5
-30,906,940
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-79,354,606
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
859,500,377
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
 
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2021)
Form 990 (2021)
Additional Data


Software ID: 21014044
Software Version: 2021v4.2
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
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.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
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) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (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) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (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  
12
12
 
13
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
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
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) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose            
3 Gross receipts from activities that are not an unrelated trade or business under section 513 .....            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge            
6 Total. Add lines 1 through 5            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support. (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (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 on 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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
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
No
1
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.
1
 
 
2
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).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
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.
3b
 
 
c
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.
3c
 
 
4a
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.
4a
 
 
b
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.
4b
 
 
c
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.
4c
 
 
5a
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).
5a
 
 
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
 
 
7
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) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).
8
 
 
9a
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.
9a
 
 
b
Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined on 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.
9c
 
 
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
 
 
b
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) 2021

Schedule A (Form 990) 2021
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described on 11a above?
11b
 
 
c
A 35% controlled entity of a person described on 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
No
1
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.
1
 
 
2
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.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
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.
2a
 
 
b
Did the activities described on 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.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
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.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by 0.035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
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  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity 		2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions 		8  
9 Distributable amount for 2021 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2021 		(iii)
Distributable
Amount for 2021
1 Distributable amount for 2021 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2021:
a From 2016.......  
b From 2017.......  
c From 2018.......  
d From 2019.......  
e From 2020.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2021 distributable amount  
i Carryover from 2016 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2021 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2021 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2021, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions. 		 
6 Remaining underdistributions for 2021. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions. 		 
7 Excess distributions carryover to 2022. Add lines
3j and 4c. 		 
8 Breakdown of line 7:
a Excess from 2017.....  
b Excess from 2018.....  
c Excess from 2019.....  
d Excess from 2020.....  
e Excess from 2021.....  
Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021
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) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Name of the organization
Hawai'i Pacific Health Group Return
 
Employer identification number

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






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that 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) (2021)
Schedule B (Form 990) (2021) Page 2
Name of organization
Hawai'i Pacific Health Group Return
  		Employer identification number
38-3835105
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


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

$  


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

$  


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

$  


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

$  


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

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)
Schedule B (Form 990) (2021)
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) (2021)
Schedule B (Form 990) (2021)
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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990) (2021)
Additional Data


Software ID: 21014044
Software Version: 2021v4.2
SCHEDULE C
(Form 990)

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 BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
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.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

2
Political campaign activity expenditures. See instructions ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities. See instructions ..................................................................
 

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

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

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990) 2021

Schedule C (Form 990) 2021
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ........................    
c Total lobbying expenditures (add lines 1a and 1b) ............................................................    
d Other exempt purpose expenditures ...............................................................................    
e Total exempt purpose expenditures (add lines 1c and 1d) ..................................................    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................................................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ...................................................................................................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2018 (b) 2019 (c) 2020 (d) 2021 (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) 2021


Schedule C (Form 990) 2021
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
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
70,340
j
Total. Add lines 1c through 1i ....................................................................................................
70,340
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures. See Instructions .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, 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, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY 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) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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
2021
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 ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
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.
b
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
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds.
Complete if the organization answered "Yes" 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 .... 265,651,554 213,487,581 205,962,211 195,030,697 180,123,783
b Contributions ...     67,736    
c Net investment earnings, gains, and losses -24,147,357 52,193,682 7,620,886 11,008,237 15,061,139
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		  29,709 163,252 76,723 154,225
f Administrative expenses ....          
g End of year balance ...... 241,504,197 265,651,554 213,487,581 205,962,211 195,030,697
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet99.33 %
b
Permanent endowment SchDMd Bullet0.67 %
c
Term endowment SchDMd Bullet0 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
Yes
 
(ii) Related organizations .................
3a(ii)
Yes
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" 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 ....   692,972,439 337,798,529 355,173,910
c Leasehold improvements   53,539,204 29,369,327 24,169,877
d Equipment ....   296,743,204 229,266,675 67,476,529
e Other .....   39,448,035 2,742,089 36,705,946
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 503,246,511
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
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		 129,453,865 F

(B) INVESTMENT IN UNCONSOLIDATED SUB.		 4,971,708 F

(C) LIMITED PARTNERSHIPS		 1,467,696 F
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 135,893,269
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
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)OPERATING FINANCE LEASE RIGHT OF USE ASSETS 100,635,338
(2)INTEREST IN NET ASSETS OF FOUNDATIONS 68,249,440
(3)DUE FROM THIRD-PARTY PAYORS 24,387,986
(4)BOARD DESIGNATED INVESTMENTS 16,318,352
(5)OTHER RECEIVABLES 6,661,580
(6)DEPOSITS NON-CURRENT ASSETS 6,055,996
(7)INTEREST IN PERPETUAL TRUST 4,627,155
(8)DECORATIVE ARTWORK 1,794,980
(9)DUE FROM PROVIDERS INSURANCE CORPORATION 612,183
(10)INTERCOMPANY TRANSFERS 605,440
(11)DUE FROM KAPI'OLANI HEALTH FOUNDATION 524,007
(12)DUE FROM STRAUB FOUNDATION 202,784
(13)DUE FROM KAUA'I MEDICAL CLINIC 196,167
(14)DUE FROM KAPI'OLANI MEDICAL SPECIALISTS 157,560
(15)DUE FROM WILCOX FOUNDATION 116,515
(16)HONOLULU IMAGING CENTER 93,143
(17)DUE FROM HONOLULU SURGERY CENTER 53,319
(18)DUE FROM PALI MOMI FOUNDATION 45,350
(19)INVESTMENT IN JOINT VENTURES 25,000
(20)DUE FROM HAWAI'I PACIFIC HEALTH PARTNERS 11,365
(21)DUE FROM HICORD, INC. 185
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 231,373,845
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  
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 172,014,427
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) 2021

Schedule D (Form 990) 2021
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 Collections of art - description of collections 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 Intended uses of endowment funds 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 FIN 48 (ASC 740) 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) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet 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
2021
Open to Public Inspection
Name of the organization
Hawai'i Pacific Health Group Return
 
Employer identification number

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

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		  26,147 3,544,010   3,544,010 0.25 %
b Medicaid (from Worksheet 3, column a) . . . . .   266,637 313,082,312 295,005,724 18,076,588 1.27 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .         0 0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 0 292,784 316,626,322 295,005,724 21,620,598 1.52 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 29 2,085 4,816,639 1,199,690 3,616,949 0.25 %
f Health professions education (from Worksheet 5) . . . 8 1,721 11,143,599 2,568,916 8,574,683 0.60 %
g Subsidized health services (from Worksheet 6) . . . . 12   61,068,667 35,686,758 25,381,909 1.78 %
h Research (from Worksheet 7) .         0 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . . 40   1,555,452   1,555,452 0.11 %
j Total. Other Benefits . . 89 3,806 78,584,357 39,455,364 39,128,993 2.75 %
k Total. Add lines 7d and 7j . 89 296,590 395,210,679 334,461,088 60,749,591 4.26 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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         0 0 %
2 Economic development 3   25,000   25,000 0 %
3 Community support         0 0 %
4 Environmental improvements         0 0 %
5 Leadership development and
training for community members		         0 0 %
6 Coalition building         0 0 %
7 Community health improvement advocacy         0 0 %
8 Workforce development         0 0 %
9 Other         0 0 %
10 Total 3 0 25,000 0 25,000 0 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
10,306,616
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
817,176
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
154,163,583
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
170,853,216
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-16,689,633
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

 

No
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) 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) 2021
Schedule H (Form 990) 2021
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 No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 21
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): (SEE STATEMENT)
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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) 2021
Schedule H (Form 990) 2021
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
A
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
HTTPS://WWW.HAWAIIPACIFICHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE-PROGRAM/
b
HTTPS://WWW.HAWAIIPACIFICHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE-PROGRAM/
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 6
Part VFacility Information (continued)

Billing and Collections
A
Name of hospital facility or letter of facility reporting group  
Yes No
17 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?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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 No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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 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 Facility A, 1 Facility A, 1 - REPORTING GROUP A. IN CONDUCTING THE JOINT FY2022 CHNA, THE RESEARCHERS CONVENED 18 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 E OF THE CHNA. IN ADDITION, 82 INTERVIEWS WERE CONDUCTED WITH "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 F OF THE CHNA. ADDITIONALLY, THE RESEARCHERS CONVENED THREE PANELS OF EXPERTS FROM THE UNIVERSITY OF HAWAI'I THOMPSON SCHOOL OF SOCIAL WORK PUBLIC HEALTH, AND CONDUCTED FOUR FOCUS GROUPS EACH FOCUSED ON A SIGNIFICANT COMMUNITY HEALTH NEED THAT EMERGED FROM THE COMMUNITY CONVERSATIONS. ALL COMMUNITY MEETINGS AND INTERVIEWS TOOK PLACE FROM AUGUST TO DECEMBER, 2021. A COMMUNITY ADVISORY COMMITTEE, MADE UP OF LEADERS REPRESENTING UNDER-SERVED POPULATIONS WITH HEALTH DISPARITIES, PROVIDED INPUT TO THE RESEARCH TEAM THROUGHOUT THE CHNA PROCESS. A LIST OF COMMUNITY ADVISORY COMMITTEE MEMBERS CAN BE FOUND IN APPENDIX D OF THE CHNA.
Schedule H, Part V, Section B, Line 6a Facility A, 1 Facility A, 1 - REPORTING GROUP A. HAWAI'I PACIFIC HEALTH'S FOUR HOSPITAL FACILITIES PARTICIPATED WITH FIFTEEN OTHER NONPROFIT HAWAI'I HOSPITALS TO COLLABORATE ON A JOINT CHNA LED BY THE HEALTHCARE ASSOCIATION OF HAWAI'I. RESEARCH WAS COMPLETED IN DECEMBER 2021. WARD RESEARCH WAS RETAINED TO CONDUCT THE CHNA RESEARCH. PARTICIPATING HOSPITALS WERE: ADVENTIST HEALTH CASTLE, SUTTER HEALTH KAHI MOHALA, KAHUKU MEDICAL CENTER, KAISER PERMANENTE MOANALUA MEDICAL CENTER, KAPI'OLANI MEDICAL CENTER FOR WOMEN CHILDREN, KUAKINI MEDICAL CENTER, KULA HOSPITAL, LANAI 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 6b Facility A, 1 Facility A, 1 - REPORTING GROUP A. THE HEALTHCARE ASSOCIATION OF HAWAI'I, WARD RESEARCH, SOLUTIONS PACIFIC AND THE UNIVERSITY OF HAWAI'I THOMPSON SCHOOL OF SOCIAL WORK PUBLIC HEATH COLLABORATED TO CONDUCT THE HOSPITALS' JOINT CHNA.
Schedule H, Part V, Section B, Line 11 Facility A, 1 Facility A, 1 - KAPI'OLANI MEDICAL CENTER FOR WOMEN CHILDREN. IN FISCAL YEAR 2022, KAPI'OLANI CONDUCTED THE FOLLOWING COMMUNITY BENEFIT ACTIVITIES TO EXECUTE THE FINAL YEAR OF THE HOSPITAL'S 2020-2022 IMPLEMENTATION STRATEGY THAT ADDRESSED PRIORITY COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 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. (DUE TO COVID-RELATED RESTRICTIONS ON IN-PERSON GATHERINGS AND OTHER PRECAUTIONS, CERTAIN PROGRAMS OUTLINED IN THIS IMPLEMENTATION STRATEGY WERE SUSPENDED.) COMMUNITY BENEFIT ACTIVITIES TO ADDRESS THE IMPLEMENTATION STRATEGY FOR KAPIOLANI'S 2022 CHNA WILL BE CONDUCTED IN FISCAL YEARS 2023 TO 2025. IN FISCAL YEAR 2022, KAPI'OLANI CONDUCTED THE FOLLOWING COMMUNITY BENEFIT INITIATIVES: STRENGTHEN FAMILIES HAWAII COMMUNITY LENDING: KAPI'OLANI PARTNERED WITH HAWAI'I COMMUNITY LENDING, A LOCAL COMMUNITY DEVELOPMENT FINANCIAL INSTITUTION, TO PROVIDE EMERGENCY MICRO-LOANS, ALONG WITH FINANCIAL COUNSELING, TO AID LOW-INCOME FAMILIES EXPERIENCING HARDSHIP, PREVENTING HOMELESSNESS AND INCREASING FINANCIAL STABILITY. KAHAUIKI VILLAGE IS AN AFFORDABLE RENTAL COMMUNITY FOR FAMILIES WHO PREVIOUSLY EXPERIENCED HOMELESSNESS. KAPI'OLANI PROVIDED SUPPORT FOR INITIATIVES TO INCREASE ACCESS TO HEALTH SERVICES FOR THESE HOUSEHOLDS. BUILD GOOD FOOD SYSTEMS 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. FEED THE HUNGER FUND: KAPI'OLANI SUPPORTED FEED THE HUNGER FUND'S PROGRAMS FOR SMALL FOOD ENTREPRENEURS IN UNDERSERVED COMMUNITIES, MAINLY WOMEN, IMMIGRANTS, AND PEOPLE OF COLOR, WITH BUSINESSES RANGING FROM FARMING TO DISTRIBUTION TO RETAIL SALES. BY PROVIDING TECHNICAL ASSISTANCE, BUSINESS DEVELOPMENT, CONNECTIONS TO RESOURCES AND MARKETS, AND SUPPLYING LOANS TO SMALL BUSINESSES, FTHF ENSURES THAT THESE SMALL FOOD ENTREPRENEURS HAVE THE RESOURCES TO GROW THEIR BUSINESSES, SUPPORT THEIR FAMILIES, AND CREATE HEALTHY, SUSTAINABLE AND EQUITABLE REGIONAL FOOD SYSTEMS. INVEST IN TEENAGERS AND HEALTHY STARTS 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. KAPI'OLANI AND THE OTHER HPH HOSPITALS ALSO COLLABORATED WITH RYSE AND LILIUOKALANI TRUST TO PROVIDE JOB TRAINING IN HEALTH CAREERS FOR VULNERABLE YOUTH, OFFERING PROGRAM GRADUATES CAREER PATHWAYS IN THE HEALTH CARE SYSTEM. FARM TO KEIKI: THE HOSPITALS OF HAWAI'I PACIFIC HEALTH PARTNERED WITH KAMEHAMEHA SCHOOLS AND OLAPONO, A NONPROFIT SPECIALIZING IN CHILD NUTRITION, TO PILOT A HEALTHY EATING CURRICULUM IN TWO KAUAI PRESCHOOLS TO IMPROVE ACCESS TO HEALTHY FOODS FOR PRESCHOOL-AGED CHILDREN AND BUILD NEW AVENUES FOR HEALTHY FARM TO TABLE FOOD NETWORKS. HEALTHY TOGETHER IS A FAMILY-BASED ADOLESCENT WEIGHT MANAGEMENT PROGRAM TO COMBAT CHILDHOOD OBESITY. THE NATIONAL 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, MAKING IT ACCESSIBLE THROUGH AN ONLINE FORMAT. PROVIDE ACCESSIBLE, PROACTIVE SUPPORT FOR THOSE WITH HIGH NEEDS MEDICAL TRANSPORT SERVICES: KAPI'OLANI PROVIDES INTER-HOSPITAL TRANSPORTS FROM THE NEIGHBOR ISLANDS TO O'AHU, WHERE KAPI'OLANI IS LOCATED, AND TO THE CONTINENT, 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 FOCUSED ON HAWAI'I'S UNIQUE POPULATION. 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 WERE NOT ADDRESSED IN THE HOSPITAL'S 2020-2022 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, AND 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.
Schedule H, Part V, Section B, Line 11 Facility A, 2 Facility A, 2 - PALI MOMI MEDICAL CENTER. IN FISCAL YEAR 2022, PALI MOMI CONDUCTED THE FOLLOWING COMMUNITY BENEFIT ACTIVITIES TO EXECUTE THE FINAL YEAR OF THE HOSPITAL'S 2020-2022 IMPLEMENTATION STRATEGY THAT ADDRESSED PRIORITY COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 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. (DUE TO COVID-RELATED RESTRICTIONS ON IN-PERSON GATHERINGS AND OTHER PRECAUTIONS, CERTAIN PROGRAMS OUTLINED IN THIS IMPLEMENTATION STRATEGY WERE SUSPENDED.) COMMUNITY BENEFIT ACTIVITIES TO ADDRESS THE IMPLEMENTATION STRATEGY FOR PALI MOMI'S 2022 CHNA WILL BE CONDUCTED IN FISCAL YEARS 2023 TO 2025. IN FISCAL YEAR 2022, PALI MOMI CONDUCTED THE FOLLOWING COMMUNITY BENEFIT INITIATIVES: STRENGTHEN FAMILIES HAWAII COMMUNITY LENDING: PALI MOMI PARTNERED WITH HAWAI'I COMMUNITY LENDING, A LOCAL COMMUNITY DEVELOPMENT FINANCIAL INSTITUTION, TO PROVIDE EMERGENCY MICRO-LOANS, ALONG WITH FINANCIAL COUNSELING, TO AID LOW-INCOME FAMILIES EXPERIENCING HARDSHIP, PREVENTING HOMELESSNESS AND INCREASING FINANCIAL STABILITY. KAHAUIKI VILLAGE IS AN AFFORDABLE RENTAL COMMUNITY FOR FAMILIES WHO PREVIOUSLY EXPERIENCED HOMELESSNESS. PALI MOMI PROVIDED SUPPORT FOR INITIATIVES TO INCREASE ACCESS TO HEALTH SERVICES FOR THESE HOUSEHOLDS. BUILD GOOD FOOD SYSTEMS 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. FEED THE HUNGER FUND: PALI MOMI SUPPORTED FEED THE HUNGER FUND'S PROGRAMS FOR SMALL FOOD ENTREPRENEURS IN UNDERSERVED COMMUNITIES, MAINLY WOMEN, IMMIGRANTS, AND PEOPLE OF COLOR, WITH BUSINESSES RANGING FROM FARMING TO DISTRIBUTION TO RETAIL SALES. BY PROVIDING TECHNICAL ASSISTANCE, BUSINESS DEVELOPMENT, CONNECTIONS TO RESOURCES AND MARKETS, AND SUPPLYING LOANS TO SMALL BUSINESSES, FTHF ENSURES THAT THESE SMALL FOOD ENTREPRENEURS HAVE THE RESOURCES TO GROW THEIR BUSINESSES, SUPPORT THEIR FAMILIES, AND CREATE HEALTHY, SUSTAINABLE AND EQUITABLE REGIONAL FOOD SYSTEMS. INVEST IN TEENAGERS AND HEALTHY STARTS 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. PALI MOMI AND THE OTHER HPH HOSPITALS ALSO COLLABORATED WITH RYSE AND LILIUOKALANI TRUST TO PROVIDE JOB TRAINING IN HEALTH CAREERS FOR VULNERABLE YOUTH, OFFERING PROGRAM GRADUATES CAREER PATHWAYS IN THE HEALTH CARE SYSTEM. FARM TO KEIKI: THE HOSPITALS OF HAWAI'I PACIFIC HEALTH PARTNERED WITH KAMEHAMEHA SCHOOLS AND OLAPONO, A NONPROFIT SPECIALIZING IN CHILD NUTRITION, TO PILOT A HEALTHY EATING CURRICULUM IN TWO KAUAI PRESCHOOLS TO IMPROVE ACCESS TO HEALTHY FOODS FOR PRESCHOOL-AGED CHILDREN AND BUILD NEW AVENUES FOR HEALTHY FARM TO TABLE FOOD NETWORKS. HEALTHY TOGETHER IS A FAMILY-BASED ADOLESCENT WEIGHT MANAGEMENT PROGRAM TO COMBAT CHILDHOOD OBESITY. THE NATIONAL 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 FY22, THE PROGRAM WAS DELIVERED IN AN ENTIRELY VIRTUAL FORMAT. PROVIDE ACCESSIBLE, PROACTIVE SUPPORT FOR THOSE WITH HIGH NEEDS 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 FOCUSED ON HAWAI'I'S UNIQUE POPULATION. 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 WERE NOT ADDRESSED IN THE HOSPITAL'S 2020-2022 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, AND 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.
Schedule H, Part V, Section B, Line 11 Facility A, 3 Facility A, 3 - STRAUB MEDICAL CENTER. IN FISCAL YEAR 2022, STRAUB CONDUCTED THE FOLLOWING COMMUNITY BENEFIT ACTIVITIES TO EXECUTE THE FINAL YEAR OF THE HOSPITAL'S 2020-2022 IMPLEMENTATION STRATEGY THAT ADDRESSED PRIORITY COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 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. (DUE TO COVID-RELATED RESTRICTIONS ON IN-PERSON GATHERINGS AND OTHER PRECAUTIONS, CERTAIN PROGRAMS OUTLINED IN THIS IMPLEMENTATION STRATEGY WERE SUSPENDED.) COMMUNITY BENEFIT ACTIVITIES TO ADDRESS THE IMPLEMENTATION STRATEGY FOR STRAUB'S 2022 CHNA WILL BE CONDUCTED IN FISCAL YEARS 2023 TO 2025. IN FISCAL YEAR 2022, STRAUB CONDUCTED THE FOLLOWING COMMUNITY BENEFIT INITIATIVES: STRENGTHEN FAMILIES HAWAII COMMUNITY LENDING: STRAUB PARTNERED WITH HAWAI'I COMMUNITY LENDING, A LOCAL COMMUNITY DEVELOPMENT FINANCIAL INSTITUTION, TO PROVIDE EMERGENCY MICRO-LOANS, ALONG WITH FINANCIAL COUNSELING, TO AID LOW-INCOME FAMILIES EXPERIENCING HARDSHIP, PREVENTING HOMELESSNESS. KAHAUIKI VILLAGE IS AN AFFORDABLE RENTAL COMMUNITY FOR FAMILIES WHO PREVIOUSLY EXPERIENCED HOMELESSNESS. STRAUB PROVIDED SUPPORT FOR INITIATIVES TO INCREASE ACCESS TO HEALTH SERVICES FOR THESE HOUSEHOLDS. BUILD GOOD FOOD SYSTEMS SNAP DOUBLE-UP FOOD BUCKS INCENTIVE PROGRAM: IN HAWAI'I, FOOD INSECURITY INCREASED SIGNIFICANTLY DUE TO ECONOMIC FALL-OUT FROM THE PANDEMIC. STRAUB 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. FEED THE HUNGER FUND: STRAUB SUPPORTED FEED THE HUNGER FUND'S PROGRAMS FOR SMALL FOOD ENTREPRENEURS IN UNDERSERVED COMMUNITIES, MAINLY WOMEN, IMMIGRANTS, AND PEOPLE OF COLOR, WITH BUSINESSES RANGING FROM FARMING TO DISTRIBUTION TO RETAIL SALES. BY PROVIDING TECHNICAL ASSISTANCE, BUSINESS DEVELOPMENT, CONNECTIONS TO RESOURCES AND MARKETS, AND SUPPLYING LOANS TO SMALL BUSINESSES, FTHF ENSURES THAT THESE SMALL FOOD ENTREPRENEURS HAVE THE RESOURCES TO GROW THEIR BUSINESSES, SUPPORT THEIR FAMILIES, AND CREATE HEALTHY, SUSTAINABLE AND EQUITABLE REGIONAL FOOD SYSTEMS. INVEST IN TEENAGERS AND HEALTHY STARTS 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. STRAUB PROVIDED FINANCIAL SUPPORT TO ADDRESS THE NEEDS OF THIS VULNERABLE POPULATION. STRAUB AND THE OTHER HPH HOSPITALS ALSO COLLABORATED WITH RYSE AND LILIUOKALANI TRUST TO PROVIDE JOB TRAINING IN HEALTH CAREERS FOR VULNERABLE YOUTH, OFFERING PROGRAM GRADUATES CAREER PATHWAYS IN THE HEALTH CARE SYSTEM. FARM TO KEIKI: THE HOSPITALS OF HAWAI'I PACIFIC HEALTH PARTNERED WITH KAMEHAMEHA SCHOOLS AND OLAPONO, A NONPROFIT SPECIALIZING IN CHILD NUTRITION, TO PILOT A HEALTHY EATING CURRICULUM IN TWO KAUAI PRESCHOOLS TO IMPROVE ACCESS TO HEALTHY FOODS FOR PRESCHOOL-AGED CHILDREN AND BUILD NEW AVENUES FOR HEALTHY FARM TO TABLE FOOD NETWORKS. HEALTHY TOGETHER IS AN INTENSIVE, FAMILY-BASED ADOLESCENT WEIGHT MANAGEMENT PROGRAM TO COMBAT CHILDHOOD OBESITY. THE NATIONAL KIDNEY FOUNDATION OF HAWAI'I AND STRAUB, TOGETHER WITH THE OTHER HOSPITALS OF HAWAI'I PACIFIC HEALTH, PARTNERED TO PROVIDE THE PROGRAM AT NO COST TO FAMILIES ACROSS O'AHU. IN FY22, THE PROGRAM WAS DELIVERED IN AN ENTIRELY VIRTUAL FORMAT. PROVIDE ACCESSIBLE, PROACTIVE SUPPORT FOR THOSE WITH HIGH NEEDS CANCER RESEARCH CENTER OF HAWAI'I: STRAUB, 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 FOCUSED ON HAWAI'I'S UNIQUE POPULATION. 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, STRAUB PROVIDES CLINICAL TRAINING AND RESIDENCIES FOR MEDICAL STUDENTS AND RESIDENTS. STRAUB ALSO SUPPORTS A SCHOLARSHIP THAT PROVIDES FINANCIAL ASSISTANCE FOR LOCAL STUDENTS TO ATTEND THE UNIVERSITY OF HAWAI'I JOHN A. BURNS SCHOOL OF MEDICINE. VISITING PHYSICIANS: SPECIALTY PHYSICIANS FROM STRAUB REGULARLY TRAVEL TO FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED POPULATION AREAS LOCATED THROUGHOUT THE STATE OF HAWAI'I TO PROVIDE ACCESS TO MEDICAL CARE FOR SPECIALTIES THAT ARE NOT OTHERWISE AVAILABLE IN THESE REGIONS. SIGNIFICANT COMMUNITY HEALTH NEEDS NOT BEING ADDRESSED THE FOLLOWING AREAS OF NEED IDENTIFIED IN STRAUB'S 2019 CHNA WERE NOT ADDRESSED IN THE HOSPITAL'S 2020-2022 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, AND STRENGTHEN TRUST IN HEALTH CARE. THEY WERE NOT SELECTED AS PRIORITIES FOR STRAUB 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.
Schedule H, Part V, Section B, Line 11 Facility A, 4 Facility A, 4 - WILCOX MEDICAL CENTER. IN FISCAL YEAR 2022, WILCOX CONDUCTED THE FOLLOWING COMMUNITY BENEFIT ACTIVITIES TO EXECUTE THE FINAL YEAR OF THE HOSPITAL'S 2020-2022 IMPLEMENTATION STRATEGY THAT ADDRESSED PRIORITY COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 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. (DUE TO COVID-RELATED RESTRICTIONS ON IN-PERSON GATHERINGS AND OTHER PRECAUTIONS, CERTAIN PROGRAMS OUTLINED IN THIS IMPLEMENTATION STRATEGY WERE SUSPENDED.) COMMUNITY BENEFIT ACTIVITIES TO ADDRESS THE IMPLEMENTATION STRATEGY FOR WILCOX'S 2022 CHNA WILL BE CONDUCTED IN FISCAL YEARS 2023 TO 2025. IN FISCAL YEAR 2022, WILCOX CONDUCTED THE FOLLOWING COMMUNITY BENEFIT INITIATIVES: STRENGTHEN FAMILIES HAWAII COMMUNITY LENDING: WILCOX PARTNERED WITH HAWAI'I COMMUNITY LENDING, A LOCAL COMMUNITY DEVELOPMENT FINANCIAL INSTITUTION, TO PROVIDE EMERGENCY MICRO-LOANS, ALONG WITH FINANCIAL COUNSELING, TO AID LOW-INCOME FAMILIES EXPERIENCING HARDSHIP, PREVENTING HOMELESSNESS AND INCREASING FINANCIAL STABILITY. BUILD GOOD FOOD SYSTEMS SNAP DOUBLE-UP FOOD BUCKS INCENTIVE PROGRAM: IN HAWAI'I, FOOD INSECURITY INCREASED SIGNIFICANTLY DUE TO ECONOMIC FALL-OUT FROM THE PANDEMIC. WILCOX 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. FEED THE HUNGER FUND: WILCOX SUPPORTED FEED THE HUNGER FUND'S PROGRAMS FOR SMALL FOOD ENTREPRENEURS IN UNDERSERVED COMMUNITIES, MAINLY WOMEN, IMMIGRANTS, AND PEOPLE OF COLOR, WITH BUSINESSES RANGING FROM FARMING TO DISTRIBUTION TO RETAIL SALES. BY PROVIDING TECHNICAL ASSISTANCE, BUSINESS DEVELOPMENT, CONNECTIONS TO RESOURCES AND MARKETS, AND SUPPLYING LOANS TO SMALL BUSINESSES, FTHF ENSURES THAT THESE SMALL FOOD ENTREPRENEURS HAVE THE RESOURCES TO GROW THEIR BUSINESSES, SUPPORT THEIR FAMILIES, AND CREATE HEALTHY, SUSTAINABLE AND EQUITABLE REGIONAL FOOD SYSTEMS. MALAMA KAUA'I: WILCOX SUPPORTED MALAMA KAUA'I'S PROGRAMS TO INCREASE ACCESS TO HEALTHY FOODS ON KAUA'I, INCLUDING THE VILLAGE HARVEST GLEANING PROGRAM WHICH COLLECTS FOOD LEFT OVER FROM HARVESTS ON PERSONAL PROPERTIES AND SMALL FARMS AND DONATES IT TO FOOD PANTRIES AND YOUTH PROGRAMS. INVEST IN TEENAGERS AND HEALTHY STARTS HALE OPIO: WILCOX SUPPORTED HALE OPIO'S PROGRAMS TO PROVIDE OUTREACH AND SUPPORT SERVICES TO HOMELESS YOUTH ON KAUA'I. REACH OUT AND READ: WILCOX SUPPORTED THE REACH OUT AND READ PROGRAM, A NATIONAL CDC-APPROVED BEST PRACTICE TO PROMOTE LITERACY FOR YOUNG CHILDREN THAT PROVIDES FREE AGE-APPROPRIATE CHILDREN'S BOOKS TO PATIENTS TO TAKE HOME AFTER VISITING THEIR PEDIATRICIAN'S OFFICES. FARM TO KEIKI: THE HOSPITALS OF HAWAI'I PACIFIC HEALTH PARTNERED WITH KAMEHAMEHA SCHOOLS AND OLAPONO, A NONPROFIT SPECIALIZING IN CHILD NUTRITION, TO PILOT A HEALTHY EATING CURRICULUM IN TWO KAUAI PRESCHOOLS TO IMPROVE ACCESS TO HEALTHY FOODS FOR PRESCHOOL-AGED CHILDREN AND BUILD NEW AVENUES FOR HEALTHY FARM TO TABLE FOOD NETWORKS. PROVIDE ACCESSIBLE, PROACTIVE SUPPORT FOR THOSE WITH HIGH NEEDS CANCER RESEARCH CENTER OF HAWAI'I: WILCOX, TOGETHER WITH THE OTHER HOSPITALS OF HAWAI'I PACIFIC HEALTH, QUEENS MEDICAL CENTER, AND KUAKINI MEDICAL CENTER, PARTNERED WITH THE UNIVERSITY OF HAWAI'I'S CANCER RESEARCH CENTER OF HAWAI'I TO ENHANCE THE QUALITY AND BREADTH OF CANCER CARE IN HAWAI'I, SUPPORTING ENHANCED PATIENT ACCESS TO CLINICAL TRIALS, STATE-OF-THE-ART TREATMENT, AND INNOVATIVE THERAPIES FOCUSED ON HAWAI'I'S UNIQUE POPULATION. CHEMOTHERAPY: WILCOX'S CHEMOTHERAPY CENTER, SUBSIDIZED BY THE MEDICAL CENTER, IS THE ONLY ONE AVAILABLE ON THE ISLAND, LESSENING THE NEED FOR ISLAND RESIDENTS WITH CANCER TO FLY TO O'AHU OR TO THE CONTINENT FOR CARE. AFTER HOURS PHARMACY: WILCOX'S AFTER HOURS PHARMACY IS THE ONLY PHARMACY OPEN AFTER NORMAL BUSINESS HOURS ON THE ISLAND OF KAUA'I. IT PROVIDES CRITICAL AND TIME SENSITIVE MEDICATIONS TO THE COMMUNITY WHEN THE OTHER PHARMACIES ON THE ISLAND ARE CLOSED. WILCOX SUBSIDIZES PROVISION OF SERVICE DURING THESE HOURS. SIGNIFICANT COMMUNITY HEALTH NEEDS NOT BEING ADDRESSED THE FOLLOWING AREAS OF NEED IDENTIFIED IN WILCOX'S 2019 CHNA WERE NOT ADDRESSED IN THE HOSPITAL'S 2020-2022 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, AND STRENGTHEN TRUST IN HEALTH CARE. THEY WERE NOT SELECTED AS PRIORITIES FOR WILCOX 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.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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?28
Name and address Type of Facility (describe)
1 STRAUB MEDICAL CENTER-PEARLRIDGE CLINIC
98-151 PALI MOMI ST SUITE 142
AIEA,HI96701 		CLINIC
2 PALI MOMI MEDICAL CENTER
98-1079 MOANLUA RD STE 300/480/490/
630/570/460/680
AEIA,HI96701 		CLINIC
3 PALI MOMI PAVILIONWOMEN'S CENTER
98-1005 MOANALUA ROAD FS4
AIEA,HI96701 		CLINIC
4 STRAUB MEDICAL CENTER-KAPOLEI CLINIC URGENT CARE
91-5431 KAPOLEI PKWY SUITE 1706
KAPOLEI,HI96707 		CLINIC
5 STRAUB MEDICAL CENTER-MILILANI TOWN CENTER CLINIC
95-1249 MEHEULA PKWY UNIT 187
MILILANI,HI96789 		CLINIC
6 KAPIOLANI WOMENS CENTER
1907 BERETANIA STREET 1ST 5TH FL
HONOLULU,HI96826 		CLINIC
7 STRAUB MEDICAL CENTER-DOCTORS ON CALL AT SHERATON WAIKIKI
2255 KALAKAUA AVE MANOR WING LOWER
LEVEL
HONOLULU,HI96815 		CLINIC
8 STRAUB MEDICAL CENTER-HAWAI'I KAI CLINIC
7192 KALANIANAOLE HIGHWAY SUITE A20
0
HONOLULU,HI96825 		CLINIC
9 STRAUB MEDICAL CENTER-KANEOHE CLINIC
46-056 KAMEHAMEHA HWY SUITE 221
KANEOHE,HI96744 		CLINIC
10 STRAUB MEDICAL CENTER-KAHALA CLINIC URGENT CARE
4210 WAIALAE AVE SUITE 501
HONOLULU,HI96816 		CLINIC
11 STRAUB MEDICAL CENTER-FIRST INSURANCE CENTER CLINIC
1100 WARD AVE STE 700
HONOLULU,HI96814 		CLINIC
12 PALI MOMI CANCER CENTER
98-1005 MOANALUA RD STE 4010
AEIA,HI96701 		CLINIC
13 STRAUB MEDICAL CENTER-WARD VILLAGE CLINIC URGENT CARE
1001 QUEEN ST SUITE 102
HONOLULU,HI96814 		CLINIC
14 STRAUB MEDICAL CENTER- KAILUA CLINIC
602 KAILUA ROAD SUITE 200
KAILUA,HI96734 		CLINIC
15 STRAUB MEDICAL CENTER-LANA'I CLINIC
628-B SEVENTH STREET
LANAI CITY,HI96763 		CLINIC
16 STRAUB MEDICAL CENTER-ARTESIAN SATELLITE
1907 SOUTH BERETANIA ST 1ST 5th FLO
ORS
HONOLULU,HI96826 		CLINIC
17 STRAUB MEDICAL CENTER-PALI MOMI CLINIC
98-1079 MOANALUA ROAD SUITE 600
AIEA,HI96701 		CLINIC
18 STRAUB MEDICAL CENTER-MILILANI SHOPPING CENTER CLINIC
95-390 KUAHELANI AVENUE SUITE J-1
MILILANI,HI96789 		CLINIC
19 HPH CANCER CENTER AT PALI MOMI MEDICAL CENTER
98-1005 MOANALUA ROAD
AIEA,HI96701 		CLINIC
20 STRAUB MEDICAL CENTER-DOWNTOWN HONOLULU CLINIC
1003 BISHOP ST PAUAHI TOWER SUITE 3
95
HONOLULU,HI96813 		CLINIC
21 STRAUB MEDICAL CENTER-KAHULUI CLINIC
33 LONO AVENUE SUITE 250
KAHULUI,HI96732 		CLINIC
22 STRAUB MEDICAL CENTER-OBGYN SATELLITE
1525 KALAKAUA AVE
HONOLULU,HI96814 		CLINIC
23 STRAUB MEDICAL CENTER-DOCTORS ON CALL AT HILTON HAWAIIAN VILLAGE
2005 KALIA ROAD RAINBOW BAZAAR 2F
HONOLULU,HI96815 		CLINIC
24 Kapiolani Medical Center for Women Children OBGYN
1319 Punahou Street Ste 500
HONOLULU,HI96826 		CLINIC
25 STRAUB RESPIRATORY EVALUATION CLINIC
826 SOUTH KING STREET
HONOLULU,HI96813 		CLINIC
26 CARDIOLOGY CLINIC-KUAKINI MEDICAL PLAZA
321 NORTH KUAKINI ST SUITE 504
HONOLULU,HI96817 		CLINIC
27 STRAUB MEDICAL CENTER-MOBILE CLINIC
888 S King St
HONOLULU,HI96813 		CLINIC
28 STRAUB MEDICAL CENTER-HILO CLINIC
75 PUUHONU PLACE SUITE 207
HILO,HI96720 		CLINIC
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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 V, Section B, Line 10 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 III, 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. DUE TO IMPROVED ECONOMIC CONDITIONS, HAWAI'I PACIFIC HEALTH REINSTATED COLLECTION PRACTICES ON OUTSTANDING ACCOUNTS AS FOLLOWS: - FORWARDING ACCOUNTS TO OUTSIDE COLLECTION AGENCIES EFFECTIVE APRIL 19, 2021 - SENDING FINAL COLLECTION LETTERS FOR HOSPITAL ACCOUNTS EFFECTIVE APRIL 17, 2021 - REPLACED REMINDER NOTICE ON PROFESSIONAL BILLING STATEMENTS WITH FINAL NOTICE DUNNING MESSAGE EFFECTIVE APRIL 24, 2021
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 VI, Line 7 STATE FILING OF COMMUNITY BENEFIT REPORT N/A
Schedule H, Part I Line 3C HPH FINANCIAL ASSISTANCE POLICY INCLUDES PRESUMPTIVE ELIGIBILITY CRITERIA: PATIENT IS HOMELESS, PATIENT CURRENTLY QUALIFIES FOR MEDICAID, PATIENT IS SEX ABUSE TREATMENT CENTER (SATC)/CRIME VICTIM, PATIENT HAS DECLARED BANKRUPTCY, AND PATIENT IS DECEASED WITH NO SPOUSE, PROPERTY OR PROBATE. HPH ALSO EMPLOYS AN ANALYTICS ENGINE THAT MAY DETERMINE ELIGIBILITY IN ABSENCE OF OTHER DOCUMENTATION.
Schedule H, Part I, Line 6a Community benefit report prepared by related organization COMMUNITY BENEFITS ARE INCLUDED IN A REPORT PREPARED BY HAWAI'I PACIFIC HEALTH, THE FILING ORGANIZATIONS' PARENT.
Schedule H, Part II Community Building Activities IN THE JOINTLY CONDUCTED 2019 CHNA, "BUILDING HEALTHY FOOD SYSTEMS" WAS IDENTIFIED AS A SIGNIFICANT COMMUNITY HEALTH PRIORITY FOR ALL THE HOSPITALS OF HAWAI`I PACIFIC HEALTH. HPH PARTNERED WITH FEED THE HUNGER FUND TO PROVIDE SUPPORT TO SMALL LOW-INCOME FARMERS IN OUR SERVICE AREAS TO STRENGTHEN COMMUNITY FOOD SYSTEMS AND IMPROVE ACCESS TO HEALTHY FOODS FOR ALL, PARTICULARLY THOSE IN FOOD INSECURE HOUSEHOLDS.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology In calculating the estimated FY22 bad debt, HPH applied the calendar year percentage of No Insurance to the total bad debt expense in order to determine the bad debt related to no insurance. HPH also applied the calendar year percentage of charity care to bad debt related to no insurance to determine the amounts eligible for financial assistance.
Schedule H, Part III, Line 4 Bad debt expense - financial statement 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, Line 8 Community benefit methodology for determining medicare costs 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 V, Section B, Line 16a FAP website A - STRAUB CLINIC HOSPITAL: Line 16a URL: HTTPS://WWW.HAWAIIPACIFICHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE-PROGRAM/;
Schedule H, Part V, Section B, Line 16b FAP Application website A - STRAUB CLINIC HOSPITAL: Line 16b URL: HTTPS://WWW.HAWAIIPACIFICHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE-PROGRAM/;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website A - STRAUB CLINIC HOSPITAL: Line 16c URL: HTTPS://WWW.HAWAIIPACIFICHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE-PROGRAM/;
Schedule H, Part VI, Line 2 Needs assessment HAWAI'I PACIFIC HEALTH'S FOUR HOSPITAL FACILITIES PARTICIPATED WITH FIFTEEN OTHER NONPROFIT HAWAI'I HOSPITALS TO COLLABORATE ON A JOINT CHNA LED BY THE HEALTHCARE ASSOCIATION OF HAWAI'I. RESEARCH WAS COMPLETED IN DECEMBER 2021 AND EACH HPH HOSPITAL FACILITY ADOPTED ITS CHNA IN 2022 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 NCLUDED 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 2022, KAPI'OLANI HAD 5,784 DELIVERIES (BIRTHS), 57,790 WOMEN'S CENTER PROCEDURES, 37,893 ER VISITS, 57,275 IMAGING PROCEDURES, 438 TRANSPORTS AND 14,562 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 2022, PALI MOMI HAD 38,628 ER VISITS, 59,297 WOMEN'S CENTER PROCEDURES, 87,433 IMAGING PROCEDURES AND 5,534 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 2022, STRAUB HAD 28889 ER VISITS, 6,160 INPATIENT ADMISSIONS, 106,679 IMAGING PROCEDURES AND 1,083,521 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 2022, WILCOX HAD 21,428 ER VISITS, 478 DELIVERIES (BIRTHS), 73,370 IMAGING PROCEDURES AND 3,425 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 29,681 ADMISSIONS IN FISCAL YEAR 2022. 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 2022, 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 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 2022, STRAUB PROVIDED A VARIETY OF FREE HEALTH EDUCATION PROGRAMS, ACTIVITIES AND EVENTS. 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, AND "WESTSIDE OHANA DAY."
Schedule H (Form 990) 2021
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Software Version: 2021v4.2

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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
2021
Open to Public
Inspection
Name of the organization
Hawai'i Pacific Health Group Return
 
Employer identification number
38-3835105
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to 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 (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) UH Foundation
1314 S King St
B
Honolulu,HI96814 		99-0085260 501(C)(3) 715,486       SCHOLARSHIP PLEDGE
(2) Hawaii Cancer Consortium
201 Merchant St
Honolulu,HI96813 		45-2280259 501(C)(3) 500,000       General Support
(3) UNIVERSAL CLINICAL ED RSRCH ASSOC
PO BOX 31000
HONOLULU,HI96813 		99-0307152 501(C)(3) 83,334       General Support
(4) Hawaii Community Lending Inc
200 N Vineyard Blvd
Honolulu,HI96817 		47-3100005 501(C)(3) 50,000       General Support
(5) Residential Youth SVCS Empowerment
PO Box 11662
Kailua,HI96828 		81-2102826 501(C)(3) 43,500       General Support
(6) Olapono
PO Box 508
Koloa,HI96756 		85-3025920 501(C)(3) 40,000       General Support
(7) National Kidney Foundation of Hawaii
1314 S King St
Honolulu,HI96814 		99-0266733 501(C)(3) 32,500       General Support
(8) Feed the Hunger Fund
100 Montgomery St
San Francisco,CA94129 		26-2975093 501(C)(3) 25,000       General Support
(9) IHS The Institute for Human Services Inc
546 Kaaahi Street
Honolulu,HI96817 		99-0199107 501(C)(3) 25,000       General Support
(10) Hawaii Island's Food Bank
40 Holomua St
Hilo,HI96720 		26-0349475 501(C)(3) 20,000       General Support
(11) Ho'ola Na Pua
PO Box 22551
Honolulu,HI96823 		46-5139164 501(C)(3) 10,000       General Support
(12) Hospice Hawaii Inc
860 Iwilei Road
Honolulu,HI96817 		99-0203930 501(C)(3) 10,000       General Support
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
12
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021

Schedule I (Form 990) 2021
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
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. THE HAWAI'I PACIFIC HEALTH DONATIONS COMMITTEE REVIEWS AND APPROVES DONATIONS TO IRC SECTIONS 501(C)(3) ORGANIZATIONS ON AN ANNUAL BASIS. NO FURTHER MONITORING IS DONE FOR DONATIONS MADE TO 501(C)(3) ORGANIZATIONS.
Schedule I (Form 990) 2021



Additional Data


Software ID: 21014044
Software Version: 2021v4.2


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Hawai'i Pacific Health Group Return
 
Employer identification number

38-3835105
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes 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 .....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
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:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2021

Schedule J (Form 990) 2021
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, 1099-MISC compensation, and/or 1099-NEC (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
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1Jennie Chahanovich
 
BOD, President CEO 		(i)

(ii)		 0
-------------
372,818 		0
-------------
148,018 		0
-------------
160,343 		0
-------------
218,488 		0
-------------
13,372 		0
-------------
913,039 		0
-------------
143,838
2Arthur Gladstone
 
BOD, CEO, EVP CSO 		(i)

(ii)		 0
-------------
503,226 		0
-------------
189,772 		0
-------------
213,837 		0
-------------
292,071 		0
-------------
25,054 		0
-------------
1,223,960 		0
-------------
199,456
3Todd Miller MD
 
Board of Director, Vice Chair 		(i)

(ii)		 0
-------------
504,248 		0
-------------
2,501 		0
-------------
75,749 		0
-------------
11,600 		0
-------------
7,611 		0
-------------
601,709 		0
-------------
0
4David Underriner
 
Board of Director, CEO 		(i)

(ii)		 0
-------------
240,233 		0
-------------
75,000 		0
-------------
1,904 		0
-------------
0 		0
-------------
6,410 		0
-------------
323,547 		0
-------------
0
5Raymond P Vara Jr
 
Board of Director, President 		(i)

(ii)		 0
-------------
1,088,746 		0
-------------
579,773 		0
-------------
621,515 		0
-------------
2,470,732 		0
-------------
27,410 		0
-------------
4,788,176 		0
-------------
615,303
6Tyler Chihara DPM
 
Board of Director 		(i)

(ii)		 0
-------------
411,472 		0
-------------
2,096 		0
-------------
8,829 		0
-------------
11,600 		0
-------------
22,440 		0
-------------
456,437 		0
-------------
0
7David Cho MD
 
Board of Director 		(i)

(ii)		 0
-------------
513,626 		0
-------------
15,773 		0
-------------
22,635 		0
-------------
11,600 		0
-------------
22,440 		0
-------------
586,074 		0
-------------
0
8Carol Fujiyoshi MD
 
Board of Director 		(i)

(ii)		 0
-------------
342,002 		0
-------------
6,902 		0
-------------
55,988 		0
-------------
11,600 		0
-------------
7,480 		0
-------------
423,972 		0
-------------
0
9Melanie Kim MD
 
Board of Director 		(i)

(ii)		 0
-------------
12,784 		0
-------------
34,505 		0
-------------
234,747 		0
-------------
10,949 		0
-------------
7,684 		0
-------------
300,669 		0
-------------
0
10Andy Lee MD
 
Board of Director (part year) 		(i)

(ii)		 0
-------------
295,998 		0
-------------
36,372 		0
-------------
25,000 		0
-------------
21,750 		0
-------------
24,925 		0
-------------
404,045 		0
-------------
0
11Patrick O'Donnell MD
 
Board of Director 		(i)

(ii)		 0
-------------
557,044 		0
-------------
2,957 		0
-------------
31,062 		0
-------------
11,600 		0
-------------
23,440 		0
-------------
626,103 		0
-------------
0
12Monica Price MD
 
Board of Director 		(i)

(ii)		 0
-------------
238,335 		0
-------------
8,670 		0
-------------
65,119 		0
-------------
11,600 		0
-------------
25,580 		0
-------------
349,304 		0
-------------
0
13Melinda Ashton MD
 
EVP CQO 		(i)

(ii)		 0
-------------
455,308 		0
-------------
194,229 		0
-------------
139,244 		0
-------------
244,499 		0
-------------
16,006 		0
-------------
1,049,286 		0
-------------
168,964
14Troy Branstetter
 
VP 		(i)

(ii)		 0
-------------
188,888 		0
-------------
13,431 		0
-------------
28,417 		0
-------------
29,634 		0
-------------
7,480 		0
-------------
267,850 		0
-------------
0
15Gloria Brooks
 
COO 		(i)

(ii)		 0
-------------
205,553 		0
-------------
39,653 		0
-------------
23,735 		0
-------------
60,083 		0
-------------
8,200 		0
-------------
337,224 		0
-------------
12,703
16William Burke
 
VP 		(i)

(ii)		 0
-------------
231,178 		0
-------------
44,764 		0
-------------
26,379 		0
-------------
71,139 		0
-------------
17,185 		0
-------------
390,645 		0
-------------
16,974
17Warren Chaiko
 
SVP 		(i)

(ii)		 0
-------------
259,893 		0
-------------
67,444 		0
-------------
440,149 		0
-------------
92,906 		0
-------------
27,704 		0
-------------
888,096 		0
-------------
54,113
18Charles R Ching
 
EVP, General Counsel Secretary 		(i)

(ii)		 0
-------------
431,400 		0
-------------
135,036 		0
-------------
392,695 		0
-------------
252,886 		0
-------------
15,769 		0
-------------
1,227,786 		0
-------------
185,998
19Dawn Ching
 
VP 		(i)

(ii)		 0
-------------
241,916 		0
-------------
35,207 		0
-------------
34,082 		0
-------------
96,654 		0
-------------
9,994 		0
-------------
417,853 		0
-------------
33,456
20Leslie Chun MD
 
EVP 		(i)

(ii)		 0
-------------
519,567 		0
-------------
180,626 		0
-------------
85,652 		0
-------------
200,623 		0
-------------
24,688 		0
-------------
1,011,156 		0
-------------
86,619
21Travis Clegg
 
COO 		(i)

(ii)		 0
-------------
326,626 		0
-------------
80,626 		0
-------------
23,339 		0
-------------
96,413 		0
-------------
25,169 		0
-------------
552,173 		0
-------------
51,050
22Barbara Craft
 
COO (part year) 		(i)

(ii)		 0
-------------
232,764 		0
-------------
65,450 		0
-------------
49,763 		0
-------------
91,059 		0
-------------
15,596 		0
-------------
454,632 		0
-------------
21,234
23Dawn Dunbar
 
SVP 		(i)

(ii)		 0
-------------
290,624 		0
-------------
74,468 		0
-------------
38,173 		0
-------------
93,610 		0
-------------
24,660 		0
-------------
521,535 		0
-------------
59,749
24Louise Fukumoto
 
VP 		(i)

(ii)		 0
-------------
176,638 		0
-------------
17,733 		0
-------------
4,777 		0
-------------
20,815 		0
-------------
15,106 		0
-------------
235,069 		0
-------------
0
25Reina (France) Graves
 
Privacy Officer 		(i)

(ii)		 0
-------------
248,960 		0
-------------
0 		0
-------------
1,099 		0
-------------
12,228 		0
-------------
22,540 		0
-------------
284,827 		0
-------------
0
26Alan Ito
 
Information Security Officer (part year) 		(i)

(ii)		 0
-------------
144,850 		0
-------------
18,144 		0
-------------
38,304 		0
-------------
17,782 		0
-------------
14,649 		0
-------------
233,729 		0
-------------
0
27Robyn Kalahiki RN
 
VP CNE 		(i)

(ii)		 0
-------------
180,734 		0
-------------
20,195 		0
-------------
1,692 		0
-------------
21,570 		0
-------------
15,549 		0
-------------
239,740 		0
-------------
0
28Joan Kanemori
 
VP 		(i)

(ii)		 0
-------------
222,535 		0
-------------
32,296 		0
-------------
30,918 		0
-------------
285,749 		0
-------------
16,569 		0
-------------
588,067 		0
-------------
16,254
29Glenn Kawabata
 
VP 		(i)

(ii)		 0
-------------
205,253 		0
-------------
38,465 		0
-------------
22,796 		0
-------------
56,986 		0
-------------
25,953 		0
-------------
349,453 		0
-------------
13,207
30Douglas Kwock MD
 
VP 		(i)

(ii)		 0
-------------
392,692 		0
-------------
75,632 		0
-------------
39,672 		0
-------------
94,688 		0
-------------
24,325 		0
-------------
627,009 		0
-------------
49,637
31Jessica Lewis
 
Assistant Corporate Secretary 		(i)

(ii)		 0
-------------
167,315 		0
-------------
0 		0
-------------
725 		0
-------------
14,873 		0
-------------
25,976 		0
-------------
208,889 		0
-------------
0
32James Lin MD
 
VP 		(i)

(ii)		 0
-------------
256,939 		0
-------------
52,655 		0
-------------
25,538 		0
-------------
73,078 		0
-------------
24,404 		0
-------------
432,614 		0
-------------
19,200
33Gerard Livaudais MD
 
EVP (part year) 		(i)

(ii)		 0
-------------
374,236 		0
-------------
126,878 		0
-------------
69,675 		0
-------------
172,318 		0
-------------
9,160 		0
-------------
752,267 		0
-------------
81,450
34Mathew Loughlin
 
VP 		(i)

(ii)		 0
-------------
151,581 		0
-------------
17,019 		0
-------------
1,000 		0
-------------
16,464 		0
-------------
21,866 		0
-------------
207,930 		0
-------------
0
35Lorrie-Ann Luke
 
VP 		(i)

(ii)		 0
-------------
207,351 		0
-------------
39,718 		0
-------------
23,683 		0
-------------
63,397 		0
-------------
25,054 		0
-------------
359,203 		0
-------------
31,859
36Susan Masumoto-Nonaka
 
VP (part year) 		(i)

(ii)		 0
-------------
207,594 		0
-------------
51,419 		0
-------------
263,295 		0
-------------
74,942 		0
-------------
7,431 		0
-------------
604,681 		0
-------------
41,245
37Brigitte McKale
 
VP CNE (part year) 		(i)

(ii)		 0
-------------
252,259 		0
-------------
49,316 		0
-------------
28,631 		0
-------------
76,118 		0
-------------
14,269 		0
-------------
420,593 		0
-------------
31,541
38Andrew Moats RN
 
VP 		(i)

(ii)		 0
-------------
228,736 		0
-------------
43,072 		0
-------------
20,712 		0
-------------
60,921 		0
-------------
26,975 		0
-------------
380,416 		0
-------------
15,462
39Mavis Nikaido
 
VP CNE (part year) 		(i)

(ii)		 0
-------------
200,524 		0
-------------
42,238 		0
-------------
226,910 		0
-------------
64,604 		0
-------------
5,574 		0
-------------
539,850 		0
-------------
40,137
40David Okabe
 
EVP, CFO Treasurer 		(i)

(ii)		 0
-------------
546,669 		0
-------------
170,726 		0
-------------
235,766 		0
-------------
376,357 		0
-------------
15,769 		0
-------------
1,345,287 		0
-------------
226,880
41Shilpa Patel MD
 
Associate CQO 		(i)

(ii)		 0
-------------
150,284 		0
-------------
991 		0
-------------
165,520 		0
-------------
22,942 		0
-------------
22,440 		0
-------------
362,177 		0
-------------
0
42Steven Robertson
 
EVP CIO 		(i)

(ii)		 0
-------------
444,593 		0
-------------
169,121 		0
-------------
173,730 		0
-------------
284,000 		0
-------------
15,769 		0
-------------
1,087,213 		0
-------------
177,390
43Michael Robinson
 
VP 		(i)

(ii)		 0
-------------
260,167 		0
-------------
49,180 		0
-------------
28,544 		0
-------------
75,992 		0
-------------
9,831 		0
-------------
423,714 		0
-------------
39,448
44Gidget Ruscetta RN
 
COO 		(i)

(ii)		 0
-------------
323,251 		0
-------------
62,656 		0
-------------
38,738 		0
-------------
85,572 		0
-------------
14,569 		0
-------------
524,786 		0
-------------
53,567
45Darla Sabry RN
 
VP CNE 		(i)

(ii)		 0
-------------
182,714 		0
-------------
19,027 		0
-------------
923 		0
-------------
17,360 		0
-------------
13,549 		0
-------------
233,573 		0
-------------
0
46Katie Shigemitsu
 
Compliance Officer 		(i)

(ii)		 0
-------------
183,738 		0
-------------
0 		0
-------------
39,580 		0
-------------
23,057 		0
-------------
9,168 		0
-------------
255,543 		0
-------------
0
47David Stumbaugh
 
VP 		(i)

(ii)		 0
-------------
212,851 		0
-------------
40,836 		0
-------------
17,570 		0
-------------
62,403 		0
-------------
23,440 		0
-------------
357,100 		0
-------------
32,756
48Dean Tateyama
 
VP 		(i)

(ii)		 0
-------------
181,497 		0
-------------
18,285 		0
-------------
1,389 		0
-------------
21,464 		0
-------------
19,340 		0
-------------
241,975 		0
-------------
0
49Sunshine Topping
 
SVP 		(i)

(ii)		 0
-------------
280,785 		0
-------------
68,850 		0
-------------
30,118 		0
-------------
89,038 		0
-------------
24,660 		0
-------------
493,451 		0
-------------
0
50Carrie Ann Tsutsui
 
VP Controller 		(i)

(ii)		 0
-------------
214,570 		0
-------------
41,321 		0
-------------
22,396 		0
-------------
65,763 		0
-------------
13,048 		0
-------------
357,098 		0
-------------
18,347
51Brandon Wong
 
VP 		(i)

(ii)		 0
-------------
169,022 		0
-------------
15,905 		0
-------------
736 		0
-------------
32,689 		0
-------------
22,440 		0
-------------
240,792 		0
-------------
0
52Amparo Arquines RN
 
Registered Nurse 		(i)

(ii)		 88,924
-------------
0 		0
-------------
0 		171,941
-------------
0 		13,750
-------------
0 		11,691
-------------
0 		286,306
-------------
0 		0
-------------
0
53Keith-Ann Lum RN
 
Registered Nurse 		(i)

(ii)		 93,075
-------------
0 		26,880
-------------
0 		145,958
-------------
0 		14,129
-------------
0 		12,420
-------------
0 		292,462
-------------
0 		0
-------------
0
54Myrna Natividad RN
 
Registered Nurse 		(i)

(ii)		 89,665
-------------
0 		0
-------------
0 		176,124
-------------
0 		14,628
-------------
0 		11,291
-------------
0 		291,708
-------------
0 		0
-------------
0
55Susana Pascua RN
 
Registered Nurse 		(i)

(ii)		 75,424
-------------
0 		30,720
-------------
0 		154,229
-------------
0 		15,381
-------------
0 		7,907
-------------
0 		283,661
-------------
0 		0
-------------
0
56Kathryn Reyes RN
 
Registered Nurse 		(i)

(ii)		 80,104
-------------
0 		29,952
-------------
0 		149,338
-------------
0 		14,566
-------------
0 		7,352
-------------
0 		281,312
-------------
0 		0
-------------
0
57Brandt Farias
 
Former Officer 		(i)

(ii)		 0
-------------
121,482 		0
-------------
61,243 		0
-------------
21,369 		0
-------------
74,371 		0
-------------
5,735 		0
-------------
284,200 		0
-------------
49,137
58Gail Lerch
 
Former Officer 		(i)

(ii)		 0
-------------
433,599 		0
-------------
0 		0
-------------
52,661 		0
-------------
91,102 		0
-------------
7,480 		0
-------------
584,842 		0
-------------
176,018
59Beau Nakamoto MD
 
Former Officer 		(i)

(ii)		 0
-------------
175,980 		0
-------------
2,456 		0
-------------
116,462 		0
-------------
11,408 		0
-------------
0 		0
-------------
306,306 		0
-------------
0
60Kenneth B Robbins MD
 
Former Officer 		(i)

(ii)		 0
-------------
236,663 		0
-------------
0 		0
-------------
0 		0
-------------
86,322 		0
-------------
14,329 		0
-------------
337,314 		0
-------------
78,909
61Martha Smith
 
Former Officer 		(i)

(ii)		 0
-------------
146,322 		0
-------------
124,419 		0
-------------
150,303 		0
-------------
258,378 		0
-------------
5,438 		0
-------------
684,860 		0
-------------
207,350
62Rodney Williams MD
 
Former Officer 		(i)

(ii)		 0
-------------
0 		0
-------------
0 		0
-------------
259,188 		0
-------------
233 		0
-------------
6,775 		0
-------------
266,196 		0
-------------
0
Schedule J (Form 990) 2021

Schedule J (Form 990) 2021
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'IPACIFIC 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 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 THE ORGANIZATION: RAYMOND P. VARA JR. - $193,418 DAVID OKABE - $72,983 GAIL LERCH - $7,785 STEVEN ROBERTSON - $49,068 CHARLES R. CHING - $44,945 ARTHUR GLADSTONE - $50,298 MARTHA SMITH - $58,273 MELINDA ASHTON, M.D. - $41,256 JENNIE CHAHANOVICH - $27,896 GERARD F. LIVAUDIS - $26,186 LESLIE CHUN, M.D. - $33,229 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 THE ORGANIZATION: RAYMOND P. VARA JR. - $479,773 DAVID OKABE - $170,726 STEVEN ROBERTSON - $139,121 CHARLES R. CHING - $135,036 ARTHUR GLADSTONE - $159,772 MELINDA ASHTON, M.D. - $144,229 JENNIE CHAHANOVICH - $123,018 LESLIE CHUN, M.D. - $155,626 GERARD LIVAUDAIS, M.D. - $126,564 DAWN DUNBAR - $74,468 WARREN CHAIKO - $67,444 GIDGET RUSCETTA, R.N. - $62,656 TRAVIS CLEGG - $80,626 DOUGLAS KWOCK, M.D. - $75,632 SUSAN MASUMOTO NONAKA - $51,419 MAVIS NIKAIDO - $42,238 MICHAEL ROBINSON - $49,180 DAVID STUMBAUGH - $40,836 LORRIE-ANN LUKE - $39,718 BRIGITTE MCKALE - $49,316 JAMES LIN, M.D. - $49,164 CARRIE ANN TSUTSUI - $41,321 WILLIAM BURKE - $44,764 SUNSHINE TOPPING - $68,850 BARBARA CRAFT - $65,450 DAWN CHING - $35,207 JOAN KANEMORI - $32,296 ANDREW MOATS, R.N. - $43,072 GLENN KAWABATA - $38,465 TROY BRANSTETTER - $13,431 BRANDON WONG - $15,905 GLORIA BOOKS - $39,653 MARTHA SMITH - $124,419 BRANDT FARIAS - $61,243 RETENTION INCENTIVE PLAN THE RETENTION INCENTIVE PLAN WAS DESIGNED TO ENCOURAGE CONTINUED INTEREST IN THE SUCCESS OF THE ORGANIZATION AND PROVIDE COMPETITIVE 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 THE ORGANIZATION: RAYMOND P. VARA JR. - $1,015,000
Schedule J (Form 990) 2021

Additional Data


Software ID: 21014044
Software Version: 2021v4.2
Schedule L
(Form 990)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
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 (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e) Original principal amount (f) Balance due (g) In default? (h) Approved by board or committee? (i) Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance 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) 2021
Schedule L (Form 990) 2021
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) HAWAI'I BIO WASTE
  		SEE PART V 381,038 WASTE MANAGEMENT SERVICES   No
(2) JOY MATSUYAMA
  		SEE PART V 229,544 DIRECTOR OF PHARMACY   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L, Part IV HAWAI'I BIO WASTE MICHELLE HO, WHO SERVES ON THE BOARD OF DIRECTORS, OWNS MORE THAN 65% DIRECTLY AND INDIRECTLY OF HAWAI'I BIO WASTE.
Schedule L, Part IV JOY MATSUYAMA JOY MATSUYAMA, DIRECTOR OF PHARMACY, IS A FAMILY MEMBER OF DAWN DUNBAR, OFFICER OF STRAUB AND SENIOR VICE PRESIDENT OF PHILANTHROPY.
Schedule L (Form 990) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large imageComplete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
Right pointing arrow large imageGo to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
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 28,999 Market value
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 6 6,517 Market value
20 Drugs and medical supplies . X 5 8,766 Market value
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( TOYS ) X 15 46,668 Market value
26 Other Right pointing arrow large image ( PREPAID GIFT CARDS ) X 11 16,009 Market value
27 Other Right pointing arrow large image ( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement
29
 
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?
31
 
No
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ..........................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization 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) (2021)
Schedule M (Form 990) (2021)
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) (2021)

Additional Data


Software ID: 21014044
Software Version: 2021v4.2
SCHEDULE O
(Form 990)

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
2021
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 ORGANIZATION'S MISSION 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, Line 4a PROGRAM SERVICE DESCRIPTION OUTPATIENT OPERATING ROOMS IN FISCAL YEAR 2022, HAWAI'I PACIFIC HEALTH MEDICAL CENTERS AND CLINICS SPENT A TOTAL OF $69,730,044 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 2022, KAPI'OLANI PERFORMED 4,368 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 2022, PALI MOMI PERFORMED 3,718 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 2022, STRAUB PERFORMED 3,432 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 2022, WILCOX PERFORMED 3,052 OUTPATIENT SURGERIES.
Form 990, Part III, Line 4c PROGRAM SERVICE DESCRIPTION WOMEN'S SERVICES: OBSTETRICS IN FISCAL YEAR 2022, HAWAI'I PACIFIC HEALTH SPENT A TOTAL OF $46,024,292 IN DIRECT EXPENSES FOR WOMEN'S SERVICES FOR OBSTETRICS, AS PART OF OUR COMMITMENT TO PROVIDE CARE FOR ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. HAWAI'I PACIFIC HEALTH MEDICAL CENTERS HAD A TOTAL OF 6,559 CASES TO SUPPORT WOMEN FOR THEIR CARE DURING PREGNANCY, LABOR, AND BIRTH TO HELP MAINTAIN HEALTHY PREGNANCIES AND DELIVERIES OF BABIES. KAPI'OLANI IS RECOGNIZED AS HAWAI'I'S ONLY FULL-SERVICE SPECIALTY HOSPITAL FOR WOMEN AND CHILDREN, AND ALSO PROVIDES CARE FOR WOMEN AND CHILDREN THROUGHOUT THE PACIFIC REGION. IT HAS THE ONLY OPEN INTENSIVE CARE UNITS IN HAWAI'I TO TREAT CRITICALLY-ILL CHILDREN AND INFANTS. IN FISCAL YEAR 2022, KAPI'OLANI PROVIDED SPECIALIZED CARE FOR 6,045 OBSTETRICS PATIENTS. IN FISCAL YEAR 2022, WILCOX PROVIDED OBSTETRIC SERVICES FOR 493 PATIENTS TO MEET THE HEALTH NEEDS ON KAUA'I. IN FISCAL YEAR 2022, PALI MOMI PROVIDED OBSTETRIC SERVICES FOR 12 PATIENTS AND STRAUB PROVIDED OBSTETRICS SERVICES FOR NINE PATIENTS.
Form 990, Part III, Line 4b PROGRAM SERVICE ACCOMPLISHMENTS OUTPATIENT EMERGENCY ROOMS IN FISCAL YEAR 2022, HAWAI'I PACIFIC HEALTH MEDICAL CENTERS SPENT A TOTAL OF $62,964,812 IN DIRECT EXPENSES FOR OUTPATIENT ER SERVICES, AS PART OF OUR COMMITMENT TO PROVIDE CARE FOR ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. KAPI'OLANI IS THE ONLY LEVEL III PEDIATRIC TRAUMA CENTER SERVING HAWAI'I AND THE PACIFIC REGION. KAPI'OLANI'S EXPANDED EMERGENCY DEPARTMENT 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 DECOR; 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 2022, KAPI'OLANI HAD 36,341 OUTPATIENT ER CASES. PALI MOMI IS THE ONLY LEVEL III TRAUMA CENTER SERVING CENTRAL AND WEST O'AHU. IN FISCAL YEAR 2022, THE PALI MOMI ER HAD 33,755 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 2022, THE STRAUB ER HAD 24,276 OUTPATIENT ER CASES. WILCOX IS THE FIRST AMERICAN COLLEGE OF SURGEONS VERIFIED LEVEL III TRAUMA CENTER IN THE STATE OF HAWAI'I. 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 2022, THE WILCOX ER HAD 19,030 OUTPATIENT ER CASES.
Form 990, Part III, Line 4d Description of other program services (Expenses $ 1,063,570,269 including grants of $ 1,648,527)(Revenue $ 1,213,621,327) 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 2022, THE MEDICAL CENTERS ADMITTED 29,681 PATIENTS. STRAUB CLINICS HAD 1,083,521 TOTAL PATIENT CLINIC ENCOUNTERS, KAUA'I MEDICAL CLINIC HAD 312,256 TOTAL PATIENT CLINIC ENCOUNTERS, KAPI'OLANI MEDICAL SPECIALISTS HAD 202,527 PATIENT CLINIC ENCOUNTERS AND PALI MOMI CLINIC HAD 73,061 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. KAUA'I MEDICAL CLINIC IS A SPECIALTY PHYSICIANS GROUP ORGANIZED TO SUPPORT WILCOX 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 BURN UNIT, STATE-OF-THE-ART IMAGING CENTER ON KAUA'I, WEST O'AHU'S ONLY CARDIAC CATHETERIZATION LABS, CENTRAL AND WEST O'AHU'S ONLY COMPREHENSIVE CANCER CENTER, MINIMALLY INVASIVE BONE AND JOINT CENTER, STATE'S FIRST WOMEN'S CENTER, SPECIALIZED BREAST AND WOMEN'S CANCER CENTERS, AND OTHER 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 2022, HAWAI'I PACIFIC HEALTH CONTINUED TO SERVE 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, MOBILE VACCINE OUTREACH EVENTS, DRIVE-THROUGH VACCINE AND BOOSTER SHOT EVENTS FOR CHILDREN AND FAMILIES, DEDICATED PEDIATRIC VACCINE AND BOOSTER CLINICS AND TELEHEALTH OPTIONS. OTHER COMMUNITY RESOURCES THAT HAWAI'I PACIFIC HEALTH PROVIDED WERE PUBLIC HEALTH EDUCATION, AND A COHESIVE PUBLIC HEALTH RESPONSE IN COLLABORATING WITH THE DEPARTMENT OF HEALTH, DEPARTMENT OF EDUCATION, HONOLULU FIRE DEPARTMENT, HAWAII HEALTHCARE ASSOCIATION OF HAWAII 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, HEMOPHILIA PROGRAMS, AND OTHER EDUCATION AND SCREENINGS FOR HAWAI'I RESIDENTS ON HEALTH, WELLNESS AND DISEASE-PREVENTION STRATEGIES. IN FISCAL YEAR 2022, HAWAI'I PACIFIC HEALTH SPONSORED OR SUPPORTED NUMEROUS HEALTH EVENTS, INCLUDING "AMERICAN HEART ASSOCIATION HAWAI'I HEART WALK," "SUSAN G. KOMENMORE THAN PINK WALK," "ARTHRITIS FOUNDATION'S WALK TO CURE ARTHRITIS," - THAT WELCOMED PARTIPATION IN-PERSON AND VIRTUALLY THIS YEAR - AND MORE. HAWAI'I PACIFIC HEALTH ALSO SERVED AS THE PRESENTING SPONSOR FOR THE VIRTUAL 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.
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 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, Line 7b DECISIONS REQUIRING APPROVAL BY MEMBERS OR STOCKHOLDERS - 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, Line 15 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, 2022 TO REVIEW PHYSICIAN COMPENSATION AND ON JULY 26, 2022 TO REVIEW EXECUTIVE COMPENSATION.
Form 990, Part VI, Line 2 Family/business relationships amongst interested persons JESSICA LEWIS AND PETER LEWIS - Family relationship
Form 990, Part VI, Line 6 Classes of members or stockholders HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER WHO HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE WITH THE RIGHT TO ELECT THE MEMBERS OF THE GOVERNING BODY AND/OR APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BOARD.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER, AND HAS THE POWER TO APPROVE THE ELECTION OF MEMBERS OF THE GOVERNING BODY. HAWAI'I PACIFIC HEALTH, AS MEMBER, ALSO HAS THE POWER TO ELECT ONE OR MORE EX OFFICIO VOTING MEMBERS OF THE GOVERNING BODY.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders 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 11b Review of form 990 by 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, Line 12c 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, Line 19 Required documents available to the public 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 VIII, Line 2f Other Program Service Revenue RENTAL INCOME FROM AFFILIATES - Total Revenue: 322242, Related or Exempt Function Revenue: 322242, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue MEDICAL RECORD COPIES MEDICAL RECORD COPIES - Total Revenue: 55342, Related or Exempt Function Revenue: 55342, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; OTHER OTHER - Total Revenue: 789342, Related or Exempt Function Revenue: 382109, Unrelated Business Revenue: 407233, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; 3RD PARTY EXPENSE REIMBURSEMENT - Total Revenue: 477210, Related or Exempt Function Revenue: 477210, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part IX, Line 11g Other Fees PHYSICIAN SERVICES - Total Expense: 18896602, Program Service Expense: 15723660, Management and General Expenses: 3172942, Fundraising Expenses: ; MEDICAL SERVICES - Total Expense: 5332977, Program Service Expense: 5269364, Management and General Expenses: 63613, Fundraising Expenses: ; CONSULTING SERVICES - Total Expense: 735029, Program Service Expense: 650758, Management and General Expenses: 84271, Fundraising Expenses: ; REGISTRY SERVICES - Total Expense: 40014148, Program Service Expense: 40014148, Management and General Expenses: , Fundraising Expenses: ; TEMPORARY LABOR ADMIN SERVICES - Total Expense: 5952616, Program Service Expense: 5951785, Management and General Expenses: 831, Fundraising Expenses: ; TEMPORARY LABOR OTHER SERVICES - Total Expense: 3939999, Program Service Expense: 3939999, Management and General Expenses: , Fundraising Expenses: ; LAUNDRY SERVICES - Total Expense: 4565828, Program Service Expense: 4558283, Management and General Expenses: 7545, Fundraising Expenses: ; CONTRACT RECURRING SERVICES - Total Expense: 49820494, Program Service Expense: 46454431, Management and General Expenses: 3366063, Fundraising Expenses: ; FAMILY FUND SERVICES - Total Expense: 30, Program Service Expense: 30, Management and General Expenses: , Fundraising Expenses: ; COLLECTION FEES SERVICES - Total Expense: 670694, Program Service Expense: 670694, Management and General Expenses: , Fundraising Expenses: ; OTHER SERVICES - Total Expense: 21370080, Program Service Expense: 17837807, Management and General Expenses: 3532273, Fundraising Expenses: ; REPAIRS MAINTENANCE - Total Expense: 10079997, Program Service Expense: 10005925, Management and General Expenses: 74072, Fundraising Expenses: ; INTERNAL SERVICE PROVIDED EXPENSE - Total Expense: 47021367, Program Service Expense: 31499883, Management and General Expenses: 15521484, Fundraising Expenses: ; OTHER EXPENSE RECOVERY - Total Expense: -87798, Program Service Expense: -82326, Management and General Expenses: -5472, Fundraising Expenses: ; SERVICES WRITER PRODUCER - Total Expense: 4454, Program Service Expense: 4454, Management and General Expenses: , Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances OBLIGATED GROUP INTERCOMPANY TRANSFERS - -99486379; NET ASSETS RELEASED FROM RESTRICTION - -5529063; EQUITY TRANSFERS - -167154; CHANGE IN INTEREST IN KHF/WHF - 21221201; CHANGE IN INTEREST IN PERPETUAL TRUSTS - -892155; RESTRICTED GRANTS AND CONTRIBUTIONS - 5498966; ROUNDING - -22;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Hawai'i Pacific Health Group Return
 
Employer identification number

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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


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

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)PROVIDERS INSURANCE COMPANY
55 MERCHANT STREET 24TH FLOOR

HONOLULU,HI96813
71-0893000 		INSURANCE HI 501(c)(3) Type 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
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



 		(k)
Percentage
ownership
Yes No Yes No
(1) HONOLULU SURGERY CENTER LP

55 MERCHANT STREET
24TH FLOOR
HONOLULU,HI96813
62-1506645 		AMBU. SURG. CTR. TN NA
  		N/A                
(2) SPECIALTY SURGICAL SUITES LLC

1401 S BERETANIA ST STE 750
HONOLULU,HI96814
46-1674512 		AMBU. SURG. CTR. HI NA
  		N/A                










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

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

888 SOUTH KING STREET
HONOLULU,HI96813
99-0145107 		INACTIVE HI SCH
  		C Corporation 0 4,971,708 100 % Yes  
(3) HICORD INC

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








Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) KAPIOLANI MEDICAL SPECIALISTS

 P 20,857,152 FMV
(2) KAPIOLANI MEDICAL SPECIALISTS

 Q 142,894,689 FMV
(3) KAPIOLANI MEDICAL SPECIALISTS

 R 128,151 FMV
(4) KAPIOLANI MEDICAL SPECIALISTS

 S 117,508 FMV
(5) KAPI'OLANI HEALTH FOUNDATION

 C 2,622,582 FMV
(6) KAPI'OLANI HEALTH FOUNDATION

 Q 57,174 FMV
(7) KAPI'OLANI HEALTH FOUNDATION

 S 294,807 FMV
(8) KAUA'I MEDICAL CLINIC

 P 737,985 FMV
(9) KAUA'I MEDICAL CLINIC

 Q 89,282 FMV
(10) KAUA'I MEDICAL CLINIC

 R 1,007,272 FMV
(11) PALI MOMI FOUNDATION

 C 107,253 FMV
(12) PROVIDERS INSURANCE CORPORATION

 R 8,375,082 FMV
(13) STRAUB FOUNDATION

 C 803,858 FMV
(14) STRAUB FOUNDATION

 P 52,647 FMV
(15) WILCOX HEALTH FOUNDATION

 C 362,171 FMV
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

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




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






























Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
Schedule R (Form 990) 2021

Additional Data


Software ID: 21014044
Software Version: 2021v4.2