TY 2023 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(1) DAVID SEEHOLZER...................................................................... CHAIRMAN	0.26 ................. 0.26	X	X		0	0
(2) R KALANI FRONDA...................................................................... VICE CHAIR	0.23 ................. 0.26	X	X		0	0
(3) JOHN KAMPFER...................................................................... TREASURER	0.17 ................. 0.28	X	X		0	0
(4) NORBERTO BAYSA MD...................................................................... DIRECTOR	0.12 ................. 0.17	X			0	0
(5) BISHOP MICHAEL HENDERSON...................................................................... DIRECTOR	0.23 ................. 0.29	X			0	0
(6) WILLIAM MCKENZIE MD...................................................................... DIRECTOR	0.20 .................	X			0	0
(7) JEFFREY ALAMEIDA...................................................................... DIRECTOR	0.35 ................. 0.26	X			0	0
(8) CRAIG THOMAS MD...................................................................... DIRECTOR	0.20 ................. 0.29	X			0	0
(9) ROBERT BUNDA...................................................................... DIRECTOR	0.20 ................. 0.49	X			0	0
(10) JOSEPH FRANCHER...................................................................... SECRETARY	0.26 ................. 0.32	X	X		0	0
(11) STACIE SASAGAWA...................................................................... SECRETARY	0.20 ................. 0.35	X	X		0	0
(12) GORDON KANEMARU DDS...................................................................... DIRECTOR	0.17 ................. 0.35	X			0	0
(13) MARCUS OSHIRO...................................................................... DIRECTOR	0.20 ................. 0.39	X			0	0
(14) WENDELL ODA...................................................................... DIRECTOR	0.20 ................. 0.15	X			0	0
(15) BRIAN CUNNINGHAM...................................................................... CEO	40.00 ................. 2.00		X		0	0
(16) TAMMY KOHRER...................................................................... CHIEF NURSING OFFICER	40.00 .................			X	131,360	22,967
(17) RICHARD HAUGE...................................................................... CFO	40.00 .................			X	159,320	8,529

- TIN:

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

2023

Open to Public
Inspection

Name of the organization

WAHIAWA GENERAL HOSPITAL

Employer identification number

99-0269825

Part I

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

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

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

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

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

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

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

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

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

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

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

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

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

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990) 2023

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf ....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

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

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2023 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2022 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2023. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2022. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2023. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

10%-facts-and-circumstances test—2022. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2023

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2023 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2022 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2023 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2022 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2023. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3 % support tests—2022. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

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

Schedule A (Form 990) 2023

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

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

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

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

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

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

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

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

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

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

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

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

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

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

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).

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

Did one or more disqualified persons (as defined 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.

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.

10a

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

10a

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

10b

Schedule A (Form 990) 2023

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

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

11b

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

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

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

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

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

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

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

Activities Test. Answer lines 2a and 2b below.

Yes

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

Did the activities described 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.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

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

Schedule A (Form 990) 2023

Page 6

Part V

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

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

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

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

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

Schedule A (Form 990) 2023

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 2023 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-2023	(iii) Distributable Amount for 2023
1 Distributable amount for 2023 from Section C, line 6
2 Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2023:
a From 2018.......
b From 2019.......
c From 2020.......
d From 2021.......
e From 2022.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2023 distributable amount
i Carryover from 2018 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2023 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2023 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2023, 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 2023. 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 2024. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2019.....
b Excess from 2020.....
c Excess from 2021.....
d Excess from 2022.....
e Excess from 2023.....

Schedule A (Form 990) (2023)

Schedule A (Form 990) 2023

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) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2023

Name of the organization

WAHIAWA GENERAL HOSPITAL

Employer identification number

99-0269825

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

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

Special Rules

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

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

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

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990) (2023)

Schedule B (Form 990) (2023) Page 2

Name of organization WAHIAWA GENERAL HOSPITAL

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2023)

Schedule B (Form 990) (2023)

Page 3

Name of organization WAHIAWA GENERAL HOSPITAL		Employer identification number 99-0269825

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) (2023)

Schedule B (Form 990) (2023)

Page 4


Name of organization WAHIAWA GENERAL HOSPITAL			Employer identification number 99-0269825
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2023)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
right arrow

Attach to Form 990.
right arrow

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

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

WAHIAWA GENERAL HOSPITAL

Employer identification number

99-0269825

Part I

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

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

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after July 25, 2006, and not on a historic structure listed in the National Register ...	2d

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

Number of states where property subject to conservation easement is located right arrow

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

Yes No

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

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

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

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

Cat. No. 52283D

Schedule D (Form 990) 2022

Page 2

Part III

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

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

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

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

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

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

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

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

1a	Beginning of year balance ....	25,000	25,000	25,000	25,000	25,000
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	25,000
f	Administrative expenses ....
g	End of year balance ......		25,000	25,000	25,000	25,000

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

Board designated or quasi-endowment right arrow

Permanent endowment right arrow

Term endowment right arrow

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

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

Yes

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

3a(i)

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

3a(ii)

Yes

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

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....
b	Buildings ....
c	Leasehold improvements
d	Equipment ....
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..		0

Schedule D (Form 990) 2022

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)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

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.)

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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

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.)
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) 2022

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ...........	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ...........	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART V, LINE 4:	THE USE OF WAHIAWA GENERAL HOSPITAL'S ENDOWMENT FUNDS IS RESTRICTED TO ITS OPERATIONS.

Schedule D (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
Medium right arrow

Attach to Form 990.
Medium right arrow

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

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

WAHIAWA GENERAL HOSPITAL

Employer identification number

99-0269825

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

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

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

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

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

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

Yes

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

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

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

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

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	116,758	0	116,758	0.420 %
b	Medicaid (from Worksheet 3, column a) . . . . .	7,490,929	7,678,687	0	0 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	7,607,687	7,678,687	116,758	0.420 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .	64,725	21,333	43,392	0.150 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	64,725	21,333	43,392	0.150 %
k	Total. Add lines 7d and 7j .	7,672,412	7,700,020	160,150	0.570 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2023

Schedule H (Form 990) 2023

Page

Part II

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

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

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

1,167,233

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

2,368,854

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

4,268,392

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

-1,899,538

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2023

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	WAHIAWA GENERAL HOSPITAL 128 LEHUA STREET WAHIAWA,HI96786 HTTP://WWW.WAHIAWAGENERAL.ORG/ LICENSE#: 9-H	X	X	X	X

Schedule H (Form 990) 2023

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)

	WAHIAWA GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 21

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

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

Yes

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

Yes

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

Yes

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

Hospital facility’s website (list url): WWW.WAHIAWAGENERAL.ORG

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 22

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

Yes

If "Yes" (list url): WWW.WAHIAWAGENERAL.ORG

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

10b

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

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

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

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2023

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	WAHIAWA GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

WWW.WAHIAWAGENERAL.ORG

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

WWW.WAHIAWAGENERAL.ORG

A plain language summary of the FAP was widely available on a website (list url):
WWW.WAHIAWAGENERAL.ORG

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

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

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

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

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

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

Other (describe in Section C)

Schedule H (Form 990) 2023

Page 6

Part VFacility Information (continued)

Billing and Collections

	WAHIAWA GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2023

Page 7

Part VFacility Information (continued)

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

	WAHIAWA GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

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

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

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

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

Yes

If "Yes," explain in Section C.

Schedule H (Form 990) 2023

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
WAHIAWA GENERAL HOSPITAL	PART V, SECTION B, LINE 5: A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") WAS CONDUCTED FOR O'AHU ISLAND (HONOLULU COUNTY) BY THE HEALTHCARE ASSOCIATION OF HAWAII (HAH) AND ADAPTED BY WAHIAWA GENERAL HOSPITAL (WGH) WITH ASSISTANCE FROM COMMUNITY HOSPITAL CONSULTING (CHC CONSULTING) TO TAILOR THE REPORT TO THE NEEDS OF ITS DEFINED STUDY AREA. THIS CHNA UTILIZES RELEVANT HEALTH DATA AND STAKEHOLDER INPUT TO IDENTIFY THE SIGNIFICANT COMMUNITY HEALTH NEEDS IN O'AHU ISLAND, HI (HONOLULU COUNTY, HI)
WAHIAWA GENERAL HOSPITAL	PART V, SECTION B, LINE 6A: EIGHTEEEN OTHER HAH MEMBER HOSPITALS CONTRIBUTED TO THE PRODUCTION OF THIS CHNA. THE NAMES OF THOSE HOSPITALS FOLLOW:1. ADVENTIST HEALTH CASTLE 2. KUHI MIHALA 3. KAHUKU MEDICAL CENTER 4. KAISER FOUNDATION HOSPITAL - HONOLULU 5. KAPIOLANI MEDICAL CENTER FOR WOMEN & CHILDREN 6. KUAKINI MEDICAL CENTER 7. KULA HOSPITAL 8. LANAI COMMUNITY HOSPITAL 9. MAUI MEMORIAL MEDICAL CENTER 10. MOLOKAI GENERAL HOSPITAL 11. NORTH HAWAII COMMUNITY HOSPITAL 12. PALI MOMI MEDICAL CENTER 13. THE QUEEN'S MEDICAL CENTER 14. THE QUEEN'S MEDICAL CENTER - WEST OAHU 15. REHABILITATION HOSPITAL OF THE PACIFIC 16. SHRINERS HOSPITALS FOR CHILDREN - HONOLULU 17. STRAUB MEDICAL CENTER 18. WILCOX MEDICAL CENTER
WAHIAWA GENERAL HOSPITAL	PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED BY HEALTHCARE ASSOCIATION OF HAWAII (HAH) WITH ASSISTANCE FROM COMMUNITY HOSPITAL CORPORATION.THE FOLLOWING ORGANIZATIONS (OTHER THAN HOSPITAL FACILITIES) WERE INTERVIEWED IN CONNECTION WITH THE CHNA:1. PAPAKOLEA COMMUNITY DEVELOPMENT CORPORATION2. COUNTY OF HAWAII3. HOPE SERVICES HAWAII INC. (HOPE)4. RESIDENTIAL YOUTH SERVICES AND EMPOWERMENT (RYSE)5. HAWAII COMMUNITY FOUNDATION6. SUTTER HEALTH KAHI MOHALA7. THE INSTITUTE FOR HUMAN SERVICES8. KAMEHAMEHA SCHOOLS KAUAI COMMUNITY INVESTING9. STATE DEPARTMENT OF HEALTH, HEALTH RESOURCES DIVISION10. HAWAII APPLESEED CENTER FOR LAW AND ECONOMIC JUSTICE11. PROJECT VISION HAWAII12. KOKUA KALIHI VALLEY13. HAWAII KEIKI HEALTHY & READY TO LEARN, SCHOOL OF NURSING AND DENTAL HYGIENE14. HAWAII CHILDREN'S ACTION NETWORK15. HONOLULU CITY & COUNTY, ELDERLY AFFAIRS DIVISION16. DEPARTMENT OF HEALTH, ADULT MENTAL HEALTH DIVISION17. KUAKINI HEALTH SYSTEM18. RETIRED FROM DEPARTMENT OF HEALTH, MENTAL HEALTH DIVISION19. PACIFIC GATEWAY CENTER20. HAWAII HEALTH AND HARM REDUCTION CENTER21. MOLOKAI COMMUNITY HEALTH CENTER22. MOLOKAI MIDDLE SCHOOL23. MOLOKAI HIGH SCHOOL24. STATE DEPARTMENT OF HEALTH, KAUAI DISTRICT HEALTH OFFICE25. HAWAII STATE LEGISLATURE26. HAWAII PACIFIC HEALTH INSTITUTE27. MAUI HEALTH SYSTEM28. CITY & COUNTY OF HONOLULU, EMERGENCY SERVICES DEPARTMENT29. CHILD & FAMILY SERVICE30. KUPU31. WE ARE OCEANIA32. WAIANAE COAST COMPREHENSIVE HEALTH CENTER33. STATE DEPARTMENT OF HUMAN SERVICES34. ALU LIKE, INC.35. NATIVE HAWAIIAN HEALTH, JOHN A. BURNS SCHOOL OF MEDICINE36. COUNCIL FOR NATIVE HAWAIIAN ADVANCEMENT37. PARTNERS IN CARE38. KAMEHAMEHA SCHOOLS39. CATHOLIC CHARITIES40. ALOHA UNITED WAY41. ALZHEIMER'S ASSOCIATION42. CHRONIC DISEASE PREVENTION, DEPARTMENT OF HEALTH43. DEVELOPMENTAL DISABILITIES DIVISION, DEPARTMENT OF HEALTH44. KAISER PERMANENTE45. DEPARTMENT OF VOCATIONAL REHAB, DEPARTMENT OF HEALTH46. HUI NO KE OLA PONO47. KA HALE A KE OLA HOMELESS RESOURCE CENTER48. MOLOKAI FAMILY HEALTH CENTER49. DOMESTIC VIOLENCE ACTION CENTER50. ALOHA CARE51. WAIANAE COAST COMPREHENSIVE HEALTH CENTER52. HAWAII PUBLIC HEALTH INSTITUTE HAWAII ISLAND53. NATIVE HAWAIIAN HEALER54. CITY AND COUNTY OF HONOLULU55. PAPA OLA LOKAHI56. HEALTHY MOTHERS HEALTHY BABIES57. KTA, COMMUNITY FIRST HAWAII58. LANAI KINAOLE59. HAWAII PUBLIC HEALTH INSTITUTE KAUAI60. KAISER - MARSHALLESE, RMI TASK FORCE61. KAUAI COUNTY, DEPARTMENT OF PARKS AND RECREATION
WAHIAWA GENERAL HOSPITAL	PART V, SECTION B, LINE 11: THE SIGNIFICANT NEEDS ADDRESSED ARE TO PARTICIPATE IN INITATIVES AND CREATE OPPORTUNITIES TO INCREASE ACCESS TO MENTAL HEALTH SERVICES AND PROVIDERS IN THE SERVICE AREA, AND TO PARTICIPATE IN INITIATIVES AND CREATE OPPORTUNITIES TO INCREASE ACCESS TO AFFORDABLE CARE AND REDUCE HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS.
WAHIAWA GENERAL HOSPITAL	PART V, SECTION B, LINE 13B: PATIENTS WITH HOSPITAL BILLS THAT TOTAL MORE THAN 25% OF THE PATIENT'S GROSS INCOME WILL BE CONSIDERED FOR CHARITY ASSISTANCE. THE DIFFERENCE BETWEEN THE BALANCE OWING AND THE 25% OF THE PATIENT'S GROSS INCOME AMOUNT MAY BE CONSIDERED FOR A CHARITY ADJUSTMENT.
WAHIAWA GENERAL HOSPITAL	PART V, SECTION B, LINE 16J: THE HOSPITAL PUBLICIZED THE POLICY BY PROVIDING A SUMMARY IN THE FOLLOWING WAYS:- POSTED SUMMARY IN THE HOSPITAL'S EMERGENCY AND WAITING ROOMS- POSTED IN THE HOSPITAL'S ADMISSIONS OFFICES- PROVIDED, IN WRITING, AS PART OF THE ADMISSIONS PACKAGE TO PATIENTS ONADMISSION TO THE HOSPITAL- THE SUMMARY POLICY IS ALSO AVAILABLE ON REQUEST- POSTED POLICY AND APPLICATION ON HOSPITAL WEBSITE
WAHIAWA GENERAL HOSPITAL	PART V, SECTION B, LINE 24: SEE EXPLANATION FOR LINE 22.
SCHEDULE H, PART V, LINE 22D:	HOSPITAL CHARGES ALL PATIENTS STANDARD FULL CHARGE RATES. FAP ELIGIBLE PATIENTS ARE FIRST ASSESSED FOR MEDICAID ELIGIBILITY AND IF NOT APPLICABLE, PATIENTS' LIABILITY IS CALCULATED USING SLIDING SCALE AND IS BASED ON THE PATIENT'S ABILITY TO PAY AS A FUNCTION OF THE PATIENT'S INCOME AND AT THE FEDERAL POVERTY GUIDELINES.

Schedule H (Form 990) 2023

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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2023

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
SCHEDULE H, PART I, LINE 6A:	NO COMMUNITY BENEFIT REPORT IS GENERALLY DEVELOPED.
SCHEDULE H, PART I, LINE 7:	COST TO CHARGE RATIO AND ADDRESSES ALL PATIENT SEGMENTS.
PART III, LINE 2:	UNINSURED PATIENTS WHO CANNOT QUALIFY FOR MEDICAID OR CHARITY CARE AND ARE UNABLE TO REMIT PAYMENT IN ACCORDANCE WITH THE TIMELINE OUTLINED IN THE COLLECTION POLICY WILL BE SENT TO A COLLECTION AGENCY AND AMOUNT IS WRITTEN OFF AS BAD DEBT EXPENSE. FURTHERMORE, THE HOSPITAL ESTIMATES BAD DEBT EXPENSE FOR UNINSURED ACCOUNTS THAT HAVE YET TO BE SENT TO A COLLECTION AGENCY. ESTIMATES ARE BASED ON PRIOR COLLECTION DATA FOR UNINSURED PATIENTS.
SCHEDULE H, PART III, LINE 8:	WAHIAWA GENERAL HOSPITAL PROVIDES UNCOMPENSATED CARE TO MEDICARE AND OTHER PATIENTS IN THE AMOUNTS PROVIDED IN THIS SECTION.
SCHEDULE H, PART III, LINE 9B:	WAHIAWA GENERAL HOSPITAL NOTIFIES THE PATIENT OF THE FINANCIAL ASSISTANCE POLICY DURING ADMISSIONS AND DISCHARGE PLANNING, AND AFTER TRYING TO GET THE PATIENT QUALIFIED FOR MEDICAID. IF THE PATIENT DOES NOT QUALIFY FOR MEDICAID OR CHARITY CARE AND IF THE PATIENT IS UNABLE TO REMIT PAYMENT IN ACCORDANCE WITH THE TIMELINE OUTLINED IN THE COLLECTION POLICY. THE HOSPITAL WILL SEND THE ACCOUNT TO A COLLECTION AGENCY AND RECORD THE WRITE OFF AS BAD DEBT.
SCHEDULE H, PART III, LINE 8:	THE HOSPITAL HAS MADE THEIR BEST EFFORT TO COMPUTE THE AMOUNTS ON SCHEDULE H, LINES 5 - 7 BASED ON THE INFORMATION AVAILABLE AT THE TIME OF FILING. THE HOSPITAL DOES NOT HAVE A COMMUNITY BENEFIT REPORT. HOWEVER, BY SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS SUCH AS MEDICARE, THE HEALTH OF THE COMMUNITY IS PROMOTED AND THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES IS ALLEVIATED, THEREBY CREATING A COMMUNITY BENEFIT.
SCHEDULE H, PART VI, LINE 2:	THE COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") WAS CONDUCTED FOR O'AHU ISLAND (HONOLULU COUNTY) BY THE HEALTHCARE ASSOCIATION OF HAWAII (HAH) AND ADAPTED BY WAHIAWA GENERAL HOSPITAL (WGH) WITH ASSISTANCE FROM COMMUNITY HOSPITAL CONSULTING (CHC CONSULTING) TO TAILOR THE REPORT TO THE NEEDS OF ITS DEFINED STUDY AREA. THIS CHNA UTILIZES RELEVANT HEALTH DATA AND STAKEHOLDER INPUT TO IDENTIFY THE SIGNIFICANT COMMUNITY HEALTH NEEDS IN O'AHU ISLAND, HI (HONOLULU COUNTY, HI)
SCHEDULE H, PART VI, LINE 3:	DETERMINATION ELIGIBILITY OF FINANCIAL ASSISTANCE: DETERMINATION OF ELIGIBILITY FOR FINANCIAL ASSISTANCE WILL BE IN ACCORDANCE WITH PROCEDURES THAT WILL INVOLVE (A) AN APPLICATION PROCESS, IN WHICH THE PATIENT OR THE PATIENT'S GUARANTOR IS REQUIRED TO SUPPLY INFORMATION AND DOCUMENTATION RELEVANT TO MAKING A DETERMINATION OF FINANCIAL NEED; AND/OR (B) THE USE OF CREDIT REPORTS AND OTHER PUBLICLY AVAILABLE INFORMATION THAT PROVIDE INFORMATION ON A PATIENT'S OR A PATIENT'S GUARANTOR'S ABILITY TO PAY
SCHEDULE H, PART VI, LINE 4:	WAHIAWA IS A CENSUS-DESIGNATED PLACE(CDP) IN HONOLULU COUNTY, HAWAII, UNITED STATES, ON THE ISLAND OF OAHU. IT IS LOCATED IN THE WAHIAWA DISTRICT, ON THE PLATEAU OR "CENTRAL VALLEY" BETWEEN THE TWO VOLCANIC MOUNTAINS THAT COMPRISE THE ISLAND. LAKES AND RESERVOIRS ARE RARE IN HAWAII, AND WAHIAWA IS AT ONCE UNIQUE IN BEING SURROUNDED ON THREE SIDES BY LAKE WILSON (ALSO KNOWN AS WAHIAWA RESERVOIR OR KAUKONAHUA). THE TOWN MUST BE ACCESSED BY EITHER OF TWO BRIDGES ON KAMEHAMEHA HIGHWAY (STATE RTE. 80) ACROSS THE NARROW NORTH AND SOUTH ARMS OF THE RESERVOIR. OUTSIDE OF THE RESERVOIR, THE TOWN USED TO BE SURROUNDED BY MILITARY BASES AND AGRICULTURAL FIELDS, BUT DEVELOPMENT IS MAKING ITS WAY UP FROM THE INCREASINGLY URBANIZED SOUTHERN PORTION OF THE CENTRAL PLAIN. STILL, THERE ARE SIGNIFICANT U.S. ARMY FACILITIES HERE, INCLUDING SCHOFIELD BARRACKS, WHEELER ARMY AIRFIELD, AND EAST RANGE, AN ARMY TRAINING AREA EXTENDING INTO THE HILLS SOUTH AND EAST OF TOWN. SCHOFIELD BARRACKS ALONE IS LARGER THAN WAHIAWA
SCHEDULE H, PART VI, LINE 5:	IN WAHIAWA GENERAL HOSPITAL THE MEDICAL STAFF IS AN OPEN STAFF MODEL AND ALL BOARD MEMBERS SERVE WITHOUT COMPENSATION. WAHIAWA ALSO ACTIVELY PARTICIPATES IN COMMUNITY PROGRAMS PROMOTING HEALTH AND SERVICES THAT ARE AVAILABLE TO THE PUBLIC.
SCHEDULE H, PART VI, LINE 6:	NOT APPLICABLE: WAHIAWA IS NOT AFFILIATED WITH ANY OTHER HEALTH CARE SYSTEM
SCHEDULE H, PART VI, LINE 1:	WAHIAWA GENERAL HOSPITAL SERVES THE FINANCIALLY INDIGENT . "FINANCIALLY INDIGENT" MEANS A PATIENT WHOSE YEARLY HOUSEHOLD INCOME IS LESS THAN OR EQUAL TO 200% OF THE FEDERAL POVERTY GUIDELINES ("FPG"). THESE FINANCIALLY INDIGENT PATIENTS ARE ELIGIBLE FOR A 100% DISCOUNT ON OUTSTANDING PATIENT ACCOUNT BALANCES AS SET FORTH IN THE FINANCIAL ASSISTANCE ELIGIBILITY DISCOUNT GUIDELINES.
SCHEDULE H, PART VI, LINE 7:	NOT APPLICABLE: WAHIAWA DOES NOT HAVE COMMUNITY BENEFIT REPORT PREPARED.

Schedule H (Form 990) 2023

Additional Data

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic

Attach to Form 990.
medium right arrow graphic

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

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

WAHIAWA GENERAL HOSPITAL

Employer identification number

99-0269825

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

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

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

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

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

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

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

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

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

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

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

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

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

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

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

Cat. No. 50053T

Schedule J (Form 990) 2023

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1RICHARD HAUGE CFO	(i) (ii)	159,320 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	8,529 ------------- 0	167,849 ------------- 0	0 ------------- 0
2TYLER TERUYA ER DEPT MANAGER	(i) (ii)	133,665 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	23,198 ------------- 0	156,863 ------------- 0	0 ------------- 0
3NARINDER MAKER MANAGER PHARMACY	(i) (ii)	130,720 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	24,283 ------------- 0	155,003 ------------- 0	0 ------------- 0
4TAMMY KOHRER CHIEF NURSING OFFICER	(i) (ii)	131,360 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	22,967 ------------- 0	154,327 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2023

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 (Form 990) 2023

Additional Data

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Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

SCHEDULE N
(Form 990)

Department of the Treasury
Internal Revenue Service

Liquidation, Termination, Dissolution, or Significant Disposition of Assets
Right arrow

Complete if the organization answered "Yes" on Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.
Right arrow

Attach certified copies of any articles of dissolution, resolutions, or plans.
Right arrow

Attach to Form 990 or 990-EZ.
Right arrow

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

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization
WAHIAWA GENERAL HOSPITAL

Employer identification number
99-0269825

Part I

Liquidation, Termination, or Dissolution. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 31, or Form 990-EZ, line 36. Part I can be duplicated if additional space is needed.

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity
EQUIPMENT, PERMITS, INTANGIBLE PROPERTY, WARRANTIES, AGREEMENTS, LEASES	04-02-2024	0	OUTSTANDING OFFER	99-0238120	THE QUEEN'S HEALTH SYSTEMS 1301 PUNCHBOWL STREET HONOLULU,HI96813	501(C)(3)

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? ...........................

Become an employee of, or independent contractor for, a successor or transferee organization? .....................

Become a direct or indirect owner of a successor or transferee organization? .....................

Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? ........

If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. Right arrow

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

Cat. No. 50087Z

Schedule N (Form 990) (2023)

Page 2

Part I

Liquidation, Termination, or Dissolution (continued)

Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.

Yes

Did the organization distribute its assets in accordance with its governing instrument(s)? If "No," describe in Part III .............

Yes

Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? ......

Yes

If "Yes," did the organization provide such notice? .....................

Yes

Did the organization discharge or pay all of its liabilities in accordance with state laws? .....................

Yes

Did the organization have any tax-exempt bonds outstanding during the year? .....................

If "Yes" on line 6a, did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws?

If "Yes" on line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If "No" on line 6b, explain in Part III.

Part II

Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? .........................

Become an employee of, or independent contractor for, a successor or transferee organization? .....................

Become a direct or indirect owner of a successor or transferee organization? .....................

Receive, or become entitled to, compensation or other similar payments as a result of the organization's significant disposition of assets? ........

If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. Right arrow

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

Cat. No. 50087Z

Schedule N (Form 990) (2023)

Page 3

Part III

Supplemental Information. Provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.

Return Reference	Explanation

DISCLOSURE OF DISSOLUTION	THE INFORMATION PROVIDED TO REPORT THE DISSOLUTION PROVIDED BY THE CLIENT IS INCOMPLETE. THE TAX PREPARER PROPOSED AN ADJUSTMENT TO RECORD THE GAIN ON DISPOSITION AND LIQUIDATION. THE TAX PROFESSIONALS MADE THEIR BEST EFFORTS TO DETERMINE THE PROPER TAX TREATMENT AND REPORTING OF THE DISSOLUTION.
PART 1, LINE 5	TO THE BEST OF OUR KNOWLEDGE, THE LIABILITIES HAVE OR WILL BE DISCHARGED IN ACCORDANCE WITH STATE LAWS.

Schedule N (Form 990) (2023)

Additional Data

Software ID:
Software Version:

- TIN:

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

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization

WAHIAWA GENERAL HOSPITAL

Employer identification number

99-0269825

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 3	WAHIAWA GENERAL HOSPITAL DELEGATED CONTROL OVER MANAGEMENT DUTIES TO COMMUNITY HOSPITAL CONSULTING ("CHC"). CHC PROVIDED AN INTERIM CEO TO OVERSEE ALL OPERATIONS OF THE HOSPITAL FOR THE YEAR ENDED JUNE 30, 2024. THE INTERIM CEO PROVIDED BY CHC FOR THE YEAR ENDED JUNE 30, 2024 WAS BRIAN CUNNINGHAM.
FORM 990, PART VI, SECTION A, LINE 6	MEMBERS AND RIGHTS WAHIAWA HOSPITAL ASSOCIATION IS A SOLE MEMBER OF WAHIAWA GENERAL HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7A	DESCRIPTION OF CLASSES OF MEMBERS AND DECISIONS REQUIRING APPROVAL - WAHIAWA HOSPITAL ASSOCIATION, AS SOLE MEMBER, ANNUALLY ELECTS THE BOARD OF DIRECTORS OF WAHIAWA GENERAL HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7B	SEE EXPLANATION FOR LINE 7A ABOVE.
FORM 990, PART VI, SECTION B, LINE 11B	PROCESS USED BY MANAGEMENT AND/OR GOVERNING BODY TO REVIEW 990 - THE FORM 990 WILL BE PRESENTED TO THE BOARD OF DIRECTORS BEFORE FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	DESCRIPTION OF PROCESS TO MONITOR TRANSACTION OF CONFLICT OF INTEREST - BOARD MEMBERS COMPLETE THE CONFLICT OF INTEREST FORM ANNUALLY AND SUBMIT IT TO ADMINISTRATION. ANY CONFLICTS ARE DISCLOSED TO THE BOARD.
FORM 990, PART VI, SECTION B, LINE 15	PROCESS USED TO DETERMINE COMPENSATION COMMUNITY HOSPITAL CORPORATION ("CHC") PROVIDES AN ONSITE CEO TO OVERSEE ALL OPERATIONS OF THE HOSPITAL. CEO SALARY IS REVIEWED BY CHC AND THE BOARD EXECUTIVE COMMITTEE AND DOCUMENTED IN THE MINUTES. IT IS THROUGH A CONTRACTUAL RELATIONSHIP AND IS COMPARED TO OTHER SIMILAR CEO HEALTHCARE SALARIES AND WAGES.
FORM 990, PART VI, SECTION C, LINE 19	AVAILABILITY OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS TO THE GENERAL PUBLIC - THE FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. GOVERNING DOCUMENTS ARE NOT AVAILABLE AT THIS TIME.
FORM 990, PART IX, LINE 11G	AGENCY PT CARE: PROGRAM SERVICE EXPENSES 1,261,726. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,261,726. PROFESSIONAL FEES - PHYSICIANS: PROGRAM SERVICE EXPENSES 1,888,757. MANAGEMENT AND GENERAL EXPENSES 60,800. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,949,557. PROFESSIONAL FEES - CONSULTING: PROGRAM SERVICE EXPENSES 79,472. MANAGEMENT AND GENERAL EXPENSES 515,587. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 595,059. FOOD SERVICES: PROGRAM SERVICE EXPENSES 143,242. MANAGEMENT AND GENERAL EXPENSES 3,001. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 146,243. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 101,137. MANAGEMENT AND GENERAL EXPENSES 124,972. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 226,109. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 165,372. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 165,372. MESSENGER SERVICES: PROGRAM SERVICE EXPENSES 550. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 550. SECURITY SERVICES: PROGRAM SERVICE EXPENSES 158. MANAGEMENT AND GENERAL EXPENSES 304,311. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 304,469. TRANSCRIPTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,239. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,239. BANK FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 40,243. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,243. PATIENT FINANCIAL SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 27,307. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 27,307. GENERAL SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,155. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,155. SOFTWARE SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 617,650. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 617,650. LTC: PROGRAM SERVICE EXPENSES -940,354. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -940,354. LAB SERVICES: PROGRAM SERVICE EXPENSES 198,682. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 198,682. AUDIT CODING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,646. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,646.
FORM 990, PART XI, LINE 9:	LIQUIDATING ADJUSTMENT 4,757,635.
FORM 990 - GOOD FAITH STATEMENT	WAHIAWA GENERAL HOSPITAL ("HOSPITAL") WAS FORMED BY THE WAHIAWA HOSPITAL ASSOCIATION ("ASSOCIATION") IN 1989 TO OWN, MANAGE AND OPERATE ITS HOSPITAL-BASED HEALTHCARE SERVICES THE ASSOCIATION IS THE SOLE MEMBER OF THE HOSPITAL. THE HOSPITAL ESTABLISHED WAHIAWA HOSPITAL FOUNDATION ("FOUNDATION") IN 2000 TO SUPPORT FUND RAISING, CHARITABLE, EDUCATIONAL AND SCIENTIFIC ACTIVITIES FOR THE HOSPITAL. THE HOSPITAL IS THE SOLE MEMBER OF THE FOUNDATION. THE HOSPITAL HAS FACED LONG-STANDING FINANCIAL CHALLENGES FOR A DECADE OR MORE AND HAS PURSUED VARIOUS OPPORTUNITIES TO BECOME PART OF A LARGER HOSPITAL ORGANIZATION TO FULFILL THE HOSPITAL'S MISSION TO PROVIDE QUALITY HEALTHCARE TO THE CENTRAL OAHU AND NORTH SHORE COMMUNITIES. AS A RESULT, EFFECTIVE OCTOBER 27, 2023, THE HOSPITAL AND ASSOCIATION ENTERED INTO A PURCHASE AND SALE AGREEMENT TO SELL CERTAIN LAND, BUILDING, FURNITURE, EQUIPMENT AND INVENTORY OF THE HOSPITAL AND SKILLED NURSING FACILITY TO THE QUEEN'S HEALTH SYSTEMS (QHS), A 501(C)(3). THE SALES PRICE EXCEEDS THE CARRYING VALUE OF THE ASSETS AND THE CLOSING DATE AND THE SALE CLOSED ON APRIL 2, 2024. EFFECTIVE DECEMBER 20, 2023, THE HOSPITAL AND ASSOCIATION'S BOARD APPROVED A PLAN TO BEGIN WINDING DOWN THE OPERATIONS OF THE HOSPITAL UPON COMPLETION OF THE SALE OF CERTAIN LAND, BUILDING, FURNITURE, EQUIPMENT AND INVENTORY TO THE QHS. THE BOARD OF DIRECTORS OF THE HOSPITAL DETERMINED THAT AFTER WINDING UP THE REMAINING BUSINESS AFFAIRS OF THE HOSPITAL, THE HOSPITAL WOULD BE DISSOLVED. ARTICLES OF DISSOLUTION WERE SUBSEQUENTLY FILED WITH THE STATE OF HAWAII FOR THE HOSPITAL AND THE ENTITY IS SHOWN AS DISSOLVED AS OF JUNE 28, 2024. ON FEBRUARY 7, 2024, THE FOUNDATION'S BOARD OF DIRECTORS DETERMINED THAT WITH THE DISSOLUTION OF THE HOSPITAL, THE PURPOSE OF THE FOUNDATION WILL HAVE BEEN FULFILLED AND COMPLETED, AND THAT THE FOUNDATION SHOULD BE DISSOLVED. ON APRIL 3, 2024, THE FOUNDATION'S BOARD ADOPTED THE FINAL RESOLUTION TO DISSOLVE THE FOUNDATION AND ARTICLES OF DISSOLUTION WERE SUBSEQUENTLY FILED WITH THE STATE OF HAWAII AND THE ENTITY IS SHOWN AS DISSOLVED AS OF MAY 16, 2024. PART OF THE FOUNDATION'S ASSETS INCLUDED COOKSEY TRUST ASSETS WHICH CALLED FOR THE SUCCESSOR HOSPITAL IN WAHIAWA TO BECOME THE BENEFICIARY OF THE TRUST IN THE EVENT THAT THE HOSPITAL CEASED TO OPERATE. THE PROMISSORY NOTES OUTSTANDING, REFLECTING THE OBLIGATIONS OF THE HOSPITAL TO PAY THE FOUNDATION, WERE ASSIGNED TO QHS UPON DISSOLUTION. ACCORDING TO THE BOARD'S RESOLUTION, THE REMAINING ASSETS OF THE FOUNDATION AFTER PAYMENT OF ALL OUTSTANDING DEBTS AND OBLIGATIONS WOULD BE DONATED AND DISTRIBUTED TO THE HOSPITAL. THE ASSOCIATION PLANS TO CONTINUE ON WITH ITS OPERATIONS TO THE BEST OF ITS ABILITY. HISTORICALLY, THE ACCOUNTING PERSONNEL OF THE HOSPITAL HAD TAKEN CARE OF THE ACCOUNTING FOR THE FOUNDATION AND ASSOCIATION. UPON THE HOSPITAL'S DISSOLUTION AND SALE OF SUBSTANTIALLY ALL ASSETS TO QHS, THE ACCOUNTING PERSONNEL MOVED ON TO DIFFERENT JOBS AFTER WRAPPING UP AS MUCH AS THEY COULD OF THE BOOKS AND ARE NO LONGER WORKING WITH ANY OF THE ENTITIES. AS THE ENTITY HAS DISSOLVED, THERE IS A SUBSTANTIAL LACK OF INFORMATION AVAILABLE, AND THE RETURN WAS COMPLETED WITH AS MUCH INFORMATION AS POSSIBLE. THE ORGANIZATION HAS MADE ITS BEST EFFORTS TO COMPLY WITH TAX LAWS BASED UPON THE INFORMATION AVAILABLE AT THE TIME OF FILING. RATHER THAN FILE A DELINQUENT TAX RETURN, THE ORGANIZATION AND TAX PROFESSIONALS MADE THEIR BEST EFFORTS TO DETERMINE THE PROPER TAX TREATMENT AND REPORTING OF VARIOUS ITEMS BASED ON THE ORGANIZATION'S AUDITED FINANCIALS.

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

Cat. No. 51056K

Schedule O (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

WAHIAWA GENERAL HOSPITAL

Employer identification number

99-0269825

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)WAHIAWA HOSPITAL FOUNDATION 128 LEHUA STREET WAHIAWA,HI96786 30-0206692	FUNDRAISING	HI	501(C)(3)	LINE 12A, I	WAHIAWA GENERAL HOSPITAL	Yes
(2)WAHIAWA HOSPITAL ASSOCIATION 94 -1221 KA UKA BLVD UNIT 108-322 WAIPAHU,HI96797 99-0073529	HOSPITAL SVCS	HI	501(C)(3)	LINE 12B, II	N/A		No
(3)WAHIAWA GENERAL HOSPITAL AUXILIARY 128 LEHUA STREET WAHIAWA,HI96786 99-6009028	HOSPITAL SVCS	HI	501(C)(3)	LINE 10	N/A		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2023

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

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

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?
(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	Yes	No
(1) WAHIAWA HOSPITAL SERVICES CORPORATION 128 LEHUA STREET WAHIAWA,HI96786	INACTIVE	HI	WHA	C					No
(2) PACIFIC ADOLESCENT CENTER INC 128 LEHUA STREET WAHIAWA,HI96786	INACTIVE	HI	WHA	C					No
(3) PACIFIC HEALTH CENTER INC 128 LEHUA STREET WAHIAWA,HI96786	INACTIVE	HI	WHA	C					No
(4) WAHIAWA-PACIFIC HEALTH CENTER 128 LEHUA STREET WAHIAWA,HI96786	INACTIVE	HI	WHA	C					No
(5) PACIFIC HEALTH COMMUNITY INC 128 LEHUA STREET WAHIAWA,HI96786	INACTIVE	HI	WHA	C					No
(6) WAHIAWA-CENTRAL OAHU HEALTH CENTER INC 128 LEHUA STREET WAHIAWA,HI96786	INACTIVE	HI	WHA	C					No
(7) PACIFIC WOMEN'S CENTER INC 128 LEHUA STREET WAHIAWA,HI96786	INACTIVE	HI	WHA	C					No
(8) PACIFIC WELLNESS CENTER INC 128 LEHUA STREET WAHIAWA,HI96786	INACTIVE	HI	WHA	C					No
(9) PACIFIC BIOTECH INSTITUTE INC 128 LEHUA STREET WAHIAWA,HI96786	INACTIVE	HI	WHA	C					No
(10) PACIFIC SPORTS MEDICINE & RESEARCH CTR 128 LEHUA STREET WAHIAWA,HI96786	INACTIVE	HI	WHA	C					No
(11) PACIFIC SAGING CENTER INC 128 LEHUA STREET WAHIAWA,HI96786	INACTIVE	HI	WHA	C					No
(12) PACIFIC COMMUNITY HEALTH & WELLNESS 128 LEHUA STREET WAHIAWA,HI96786	INACTIVE	HI	WHA	C					No
(13) PACIFIC CARDIAC INSTITUTE INC 128 LEHUA STREET WAHIAWA,HI96786	INACTIVE	HI	WHA	C					No

Schedule R (Form 990) 2023

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

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

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

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

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

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

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

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

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

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

Yes

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

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

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

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) WAHIAWA HOSPITAL FOUNDATION	C	58,367	FMV
(2) WAHIAWA HOSPITAL ASSOCIATION	C	24,606,702	FMV
(3) WAHIAWA HOSPITAL ASSOCIATION	E	1,686,788	FMV

Schedule R (Form 990) 2023

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2023

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference

Explanation

DISCLOSURE OF RELATED PARTY LOAN TRANSACTION

THE INFORMATION PROVIDED TO CALCULATE THE RELATED PARTY TRANSACTIONS PROVIDED BY THE CLIENT IS INCOMPLETE. THE TAX PREPARER IS DISCLOSING THERE ARE DIFFERENCES BETWEEN THE AMOUNTS REPORTED BY WAHIAWA HOSPITAL ASSOCIATION AND THE AMOUNTS REPORTED BY WAHIAWA GENERAL HOSPITAL. THE TAX PROFESSIONALS MADE THEIR BEST EFFORTS TO DETERMINE THE PROPER TAX TREATMENT AND REPORTING OF THE RELATED PARTY LOAN TRANSACTION.

Schedule R (Form 990) 2023

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE OTO PROVIDE HEALTH SERVICES, EDUCATION, ACTIVITIES AND PROGRAMS TO SUPPORT THE SURROUNDING COMMUNITY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	14
5	Total number of individuals employed in calendar year 2023 (Part V, line 2a) ......	5	366
6	Total number of volunteers (estimate if necessary) .............	6	0
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	6,705,224	26,360,974
9	Program service revenue (Part VIII, line 2g) .........	27,747,839	16,301,069
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,248,056	-10,393,279
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	37,701,119	32,268,764
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	20,149,649	15,030,817
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	18,180,778	13,004,394
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	38,330,427	28,035,211
19	Revenue less expenses. Subtract line 18 from line 12.......	-629,308	4,233,553
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	21,110,345	0
21	Total liabilities (Part X, line 26).............	30,063,011	0
22	Net assets or fund balances. Subtract line 21 from line 20.....	-8,952,666	0

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 5,259,324 including grants of $ ) (Revenue $ 4,130,651 )
	INPATIENT - TOTAL INPATIENT DAYS 6,390. INPATIENT SERVICES INCLUDES: EMERGENCY AND INTENSIVE CARE SERVICES, ROUTINE MEDICAL AND SURGICAL CARE. INPATIENT ADMISSIONS WERE APPROXIMATELY 749 IN FY 2023.INPATIENT - TOTAL INPATIENT DAYS ESTIMATED AT APPROXIMATELY 3,200. INPATIENT SERVICES INCLUDES: EMERGENCY AND INTENSIVE CARE SERVICES, ROUTINE MEDICAL AND SURGICAL CARE. INPATIENT ADMISSIONS WERE ESTIMATED AT APPROXIMATELY 400 IN FY 2024.DUE TO THE LACK OF INFORMATION FROM THE DISSOLUTION OF THE HOSPITAL, THE FY 2024 INFORMATION IS ESTIMATED APPROXIMATELY 50% BASED ON THE FY 2023 INFORMATION. THE HOSPITAL STARTED NEGOTIATIONS OF DISSOLUTION IN DECEMBER 2023.

4b	(Code: ) (Expenses $ 14,848,867 including grants of $ ) (Revenue $ 11,662,237 )
	OUTPATIENT - TOTAL VISITS 5,874. OUTPATIENT SERVICES PRIMARILY INCLUDE: EMERGENCY SERVICES, RADIOLOGY, LABORATORY, OBSERVATION, CARDIO PULMONARY, ONCOLOGY AND HOME HEALTH. EMERGENCY VISITS WERE APPROXIMATELY 17,761 IN FY 2023. THERE WERE APPROXIMATELY 1,908 IMAGING PROCEDURES AND 1,473 CT PROCEDURES IN FY 2023.OUTPATIENT - TOTAL VISITS ESTIMATED AT APPROXIMATELY 3,000. OUTPATIENT SERVICES PRIMARILY INCLUDE: EMERGENCY SERVICES, RADIOLOGY, LABORATORY, OBSERVATION, CARDIO PULMONARY, ONCOLOGY AND HOME HEALTH. EMERGENCY VISITS WERE ESTIMATED AT APPROXIMATELY 8,900 IN FY 2024. THERE WERE APPROXIMATELY 1,000 IMAGING PROCEDURES AND APPROXIMATELY 800 CT PROCEDURES IN FY 2024.DUE TO THE LACK OF INFORMATION FROM THE DISSOLUTION OF THE HOSPITAL, THE FY 2024 INFORMATION IS ESTIMATED TO BE 50% BASED ON THE FY 2023 INFORMATION. THE HOSPITAL STARTED NEGOTIATIONS OF DISSOLUTION IN DECEMBER 2023.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ 508,181 )
	ALL OTHER PROGRAM SERVICES ARE FOR OTHER RELATED ACTIVITIES, WHICH INCLUDE GME, RENTAL, AND OTHER PROGRAM SERVICES.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses20,108,191

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	675,345	0	78,977

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)		(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
(A) Name and title
(18) NARINDER MAKER........................................................................ MANAGER PHARMACY	40.00 .......................	X	130,720	0	24,283
(19) BRANDON TOMITA........................................................................ COO	40.00 .......................	X	120,280	0	0
(20) TYLER TERUYA........................................................................ ER DEPT MANAGER	40.00 .......................	X	133,665	0	23,198

(A) Name and business address	(B) Description of services	(C) Compensation
TODD CAPRIOTTI, 10306 GUNNISON LANE CHARLOTTE,NC28277	IT SERVICES	168,269




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 1

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	54,690

f	All other contributions, gifts, grants, and similar amounts not included above		1f	26,306,284

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

h Total. Add lines 1a-1f.......		26,360,974

		Business Code
2a	OUTPATIENT REVENUE	621110	11,662,237	11,662,237
b	INPATIENT REVENUE	621110	4,130,651	4,130,651
c	ALL OTHER PROGRAM SERVICES REVENU	900009	481,341	481,341
d	RENTAL INCOME - PROGRAM SVC RELAT	531120	26,840	26,840
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		16,301,069

3 Investment income (including dividends, interest, and othersimilar amounts) ......			2,609			2,609
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
			(i) Real	(ii) Personal
6a	Gross rents	6a
b	Less: rental expenses	6b
c	Rental income or (loss)	6c
d	Net rental income or (loss).......
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a
b	Less: cost or other basis and sales expenses	7b		10,395,888
c	Gain or (loss)	7c		-10,395,888
d	Net gain or (loss).........			-10,395,888			-10,395,888
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..
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..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..

Business Code
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			32,268,764	16,301,069	0	-10,393,279

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
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........	11,793,636	9,231,275	2,562,361
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	281,551	281,551
9	Other employee benefits .......	2,009,493	636,279	1,373,214
10	Payroll taxes ...........	946,137	946,137
11	Fees for services (non-employees):
a	Management ......	452,233	452,233
b	Legal .........	174,003		174,003
c	Accounting ...........	62,719		62,719
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	4,596,653	2,898,742	1,697,911
12	Advertising and promotion ....
13	Office expenses .......	1,371,090	1,138,839	232,251
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	1,130,137	1,029,145	100,992
17	Travel ............	4,109	2,480	1,629
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	5,839	5,839
20	Interest ...........	1,240,139		1,240,139
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	837,816	837,816
23	Insurance ...	409,583		409,583
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	MEDICAL SUPPLIES	1,352,573	1,345,182	7,391
b	REPAIRS AND MAINTENANCE	670,210	669,689	521
c	PROVIDER TAX	461,972	461,972
d	MISCELLANEOUS	191,137	142,404	48,733
e	All other expenses	44,181	28,608	15,573
25	Total functional expenses. Add lines 1 through 24e	28,035,211	20,108,191	7,927,020	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			117,335	1	0
2	Savings and temporary cash investments .........				2	0
3	Pledges and grants receivable, net ......				3	0
4	Accounts receivable, net .............			3,345,831	4	0
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 .......
					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) ...
					6	0
7	Notes and loans receivable, net ...........				7	0
8	Inventories for sale or use ............			259,054	8	0
9	Prepaid expenses and deferred charges ......			328,241	9	0
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	0
b	Less: accumulated depreciation	10b	0	11,085,086	10c	0
11	Investments—publicly traded securities .				11	0
12	Investments—other securities. See Part IV, line 11 .....				12	0
13	Investments—program-related. See Part IV, line 11 ..				13	0
14	Intangible assets ...............				14	0
15	Other assets. See Part IV, line 11 ...........			5,974,798	15	0
16	Total assets. Add lines 1 through 15 (must equal line 33)...			21,110,345	16	0

17	Accounts payable and accrued expenses .....	25,922,276	17	0
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 .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	1,861,431	23	0
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	2,279,304	25	0
26	Total liabilities. Add lines 17 through 25..	30,063,011	26	0

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	-8,952,666	27	0
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	-8,952,666	32	0
33	Total liabilities and net assets/fund balances ........	21,110,345	33	0