2024-05-15T16:47:25+00:00 2023-06-30 346565596 ERNST & YOUNG US LLP 2005 MARKET STREET PHILADELPHIA PA 19103 990 2022-07-01 990204242 Wilcox Health Foundation WILC 8082451157 3-3420 KUHIO HIGHWAY LIHUE HI 96766 JENNIE CHANANOVICH PRESIDENT 2024-05-15 true CARRIE ANN TSUTSUI 999009999 Lauren E Bennett P01787029 2154485000 2023-05-13 2022 2023-04-26 12:10:37Z JENNIE CHANANOVICH 3-3420 KUHIO HIGHWAY LIHUE HI 96766 1116878 false X HTTPS://GIVING.HAWAIIPACIFICHEALTH.ORG X 1981 HI THE MISSION OF WILCOX HEALTH FOUNDATION IS TO CREATE A HEALTHIER HAWAI'I. 7 6 0 13 0 0 3627788 888891 0 0 64356 95883 0 0 3692144 984774 454220 987452 0 0 0 0 0 0 248232 809706 839272 1263926 1826724 2428218 -841950 10028799 8461119 431834 464951 9596965 7996168 THE MISSION OF WILCOX HEALTH FOUNDATION IS TO CREATE A HEALTHIER HAWAI'I. false false 1238842 987452 0 SEE SCHEDULE O 1238842 true true false false false false false false true false true true false true true false true false false false false false false false false false true false true false false false false false false false false false false false false false true true true false false true X 0 0 0 false false false false false false false false false false false false X 7 6 false false false false true true true true true false false true true true true true true false false false HI X X CHENWEI LI 8085357434 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 Ian Jung Board of Director, Chair 0.2 0 X X 0 0 0 Trinette Kaui Board of Director, Vice Chair 0.2 0.4 X X 0 0 0 Michael Dahilig Board of Director 0.2 0 X 0 0 0 Michelle Emura Board of Director 0.2 0 X 0 0 0 Raymond P Vara Jr Board of Director 0.2 61.9 X 0 2867542 1366459 Richard Albrecht Board of Director 0.2 0 X 0 0 0 Richard M Goodale MD Board of Director 0.2 0 X 0 0 0 Carrie Ann Tsutsui Assistant Treasurer 0.1 48.3 X 0 298669 81513 Charles R Ching Secretary 0.1 39.9 X 0 964630 277063 David Okabe Treasurer 0.1 49.9 X 0 1247925 393579 Dawn Dunbar Vice President 5.0 40.0 X 0 427166 120296 Jennie Chahanovich President 3.0 53.5 X 0 856593 223586 Jessica Lewis Assistant Secretary 0.5 39.5 X 0 171486 44093 0 6834011 2506589 0 false true false 0 0 0 0 0 0 888891 3214 888891 0 0 0 0 0 84657 84657 0 0 143330 132104 11226 0 11226 11226 0 0 0 0 0 984774 0 0 95883 X 987452 987452 0 0 12697 12697 2505 2505 615308 251390 214087 149831 4373 4373 7796 5259 2537 18852 18852 19223 19223 3560 3560 7758 7758 CORPORATE ALLOCATION 97344 97344 PRINTING & DESIGN SERVICES 37063 37063 DUES 3646 3646 SUBSCRIPTIONS 3508 3508 5639 0 0 5639 1826724 1238842 339650 248232 0 0 5076869 4169213 140427 193659 0 0 0 0 0 0 0 0 1570061 1296260 2477463 2045852 753466 745137 10513 10998 10028799 8461119 59244 35951 0 0 372590 429000 431834 464951 X -1721657 -3627193 11318622 11623361 9596965 7996168 10028799 8461119 X -841950 374832 20474 -1154153 X false true X true false X 1171355 3910618 734072 3627788 888891 10332724 0 0 1171355 3910618 734072 3627788 888891 10332724 4266312 6066412 130176 30395 522500 41946 84657 809674 0 0 0 0 0 0 0 11142398 0 0.5444 0.3786 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1601930 174696 65408 4522 1706696 1842563 -161223 74109 5301 1601930 1486862 401443 40124 5618 1842563 1476555 49294 35183 3804 1486862 1457497 83415 60326 4031 1476555 0.4023 0.5977 false false LIMITED PARTNERSHIPS 2045852 F 2045852 LIMITED PARTNERSHIPS 394649 F EQUITY SECURITIES 208642 F CHARITABLE REMAINDER TRUST 58536 F CASH AND SHORT-TERM INVESTMENTS 41901 F DEBT SECURITIES 41409 F 745137 DUE TO WILCOX MEMORIAL HOSPITAL 156040 DUE TO HAWAI'I PACIFIC HEALTH 100375 Charity gift annuity & Unitrust liabilities 57309 DUE TO KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN 45682 DUE TO PALI MOMI FOUNDATION 30710 DUE TO PALI MOMI MEDICAL CENTER 17271 DUE TO KAPI'OLANI HEALTH FOUNDATION 10834 DUE TO STRAUB FOUNDATION 10779 429000 X Schedule D, Part V, Line 4 Intended uses of endowment funds ENDOWMENT FUNDS ARE MANAGED TO ENSURE THAT THE RETURNS SUPPORT THE MEDICAL CENTER'S OPERATIONS; HIRING OF STAFF; IMPLEMENTATION OF PROGRAMS; RESEARCH AND EDUCATION; AND PROVIDE QUALITY CARE FOR PATIENTS, ALL IN ACCORDANCE WITH THE DONOR'S INTENT AND THE ORGANIZATION'S MISSION. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote UNCERTAIN TAX POSITIONS AUDITED FINANCIAL STATEMENT FOOTNOTE THE COMPANY HAS NOT RECORDED ANY EXPENSE OR ACCRUED FOR ANY RELATED EXPENSE FOR ANY UNCERTAIN TAX POSITIONS. true WILCOX MEMORIAL HOSPITAL 3-3420 KUHIO WAY LIHUE HI 96766 990074635 501(c)(3) 984746 2706 FMV KOA TRAY, BICYCLES, HAIR WIGS, NEWBORN BEANIES, GIFT BASKETS, CHEMO RELIEF BAGS, BOOKS GENERAL SUPPORT 1 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. TEMPORARILY RESTRICTED FUNDS RELEASED (AND GRANTED) TO THE AFFILIATED ORGANIZATION ARE RELEASED AFTER THE SPECIFIC PURPOSE OF THE FUND HAS BEEN MET. ONCE THE AFFILIATED ORGANIZATION COMMUNICATES THE EXPENSE AND SATISFIES THE SUBSTANTIATION OF THE EXPENSE FOR THE PURPOSE THAT THE FUNDS WERE CONTRIBUTED FOR, THE FOUNDATION RELEASES THE RESTRICTION AND RECORDS THE GRANT TO THE AFFILIATED ORGANIZATION. NO FURTHER MONITORING OF THE FUNDS AFTER DISTRIBUTION IS NECESSARY. false true false false false false false false false Raymond P Vara Jr Board of Director 0 1158108 0 1199993 0 509441 0 1339031 0 27428 0 4234001 0 1178079 Jennie Chahanovich President 0 387841 0 300659 0 168093 0 210204 0 13382 0 1080179 0 267670 Charles R Ching Secretary 0 456173 0 329628 0 178829 0 261282 0 15781 0 1241693 0 311476 Dawn Dunbar Vice President 0 302499 0 85040 0 39627 0 95618 0 24678 0 547462 0 68960 Jessica Lewis Assistant Secretary 0 170929 0 0 0 557 0 17065 0 27028 0 215579 0 0 David Okabe Treasurer 0 577990 0 416750 0 253185 0 377798 0 15781 0 1641504 0 415256 Carrie Ann Tsutsui Assistant Treasurer 0 226544 0 47628 0 24497 0 68452 0 13061 0 380182 0 38265 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, HAWAI'I PACIFIC HEALTH ('HPH'), AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, FORM 990, PART VI, SECTION B, LINE 15A FOR THE PROCESS USED BY HPH TO DETERMINE COMPENSATION. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THE RESTORATION PLAN WAS DESIGNED TO RESTORE BENEFITS THAT ARE LOST DUE TO LIMITS IMPOSED BY SECTIONS 401 AND 415 OF THE INTERNAL REVENUE CODE ON COMPENSATION CONSIDERED UNDER SUCH PLANS. AMOUNTS PAID OUT DURING THE YEAR BY RELATED ORGANIZATIONS: RAYMOND P. VARA JR. - $212,216 DAVID OKABE - $141,318 CHARLES R. CHING - $56,494 JENNIE CHAHANOVICH - $32,725 ANNUAL INCENTIVE PLAN THE ANNUAL INCENTIVE PLAN IS AFFORDED TO EXECUTIVES BASED ON ANNUAL SYSTEM GOALS THAT ARE NOT BASED ON A PERCENTAGE OF NET EARNINGS. AMOUNTS PAID OUT DURING THE YEAR BY RELATED ORGANIZATIONS: RAYMOND P. VARA JR. - $1,199,993 DAVID OKABE - $416,750 CHARLES R. CHING - $329,628 JENNIE CHAHANOVICH - $280,659 DAWN DUNBAR - $85,040 CARRIE ANN TSUTSUI - $47,628 RETENTION INCENTIVE PLAN THE RETENTION INCENTIVE PLAN WAS DESIGNED TO ENCOURAGE CONTINUED INTEREST IN THE SUCCESS OF THE ORGANIZATION AND PROVIDE COMPETITIVE RETIREMENT BENEFITS. THE SOLE PLAN PARTICIPANT IS HAWAI'I PACIFIC HEALTH'S CHIEF EXECUTIVE OFFICER, RAYMOND P. VARA JR. THE PLAN DOES NOT REPLACE THE ANNUAL AND LONG-TERM INCENTIVE PLAN NOR THE SERP RESTORATION PLAN. AMOUNTS PAID OUT DURING THE YEAR BY A RELATED ORGANIZATION: RAYMOND P. VARA JR. - $331,845 Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS WILCOX MEDICAL CENTER (WILCOX) IS A NOT-FOR-PROFIT MEDICAL CENTER DEDICATED TO THE HEALTH AND WELL-BEING OF KAUA'I RESIDENTS. WILCOX, LOCATED IN LIHUE, IS THE LARGEST MEDICAL FACILITY ON KAUA'I, PROVIDING THE KAUA'I COMMUNITY WITH ACCESSIBLE, QUALITY HEALTH CARE. WILCOX IS PART OF HAWAI'I PACIFIC HEALTH, ONE OF THE STATE'S LARGEST HEALTH CARE SYSTEMS. AS A NOT-FOR-PROFIT MEDICAL CENTER, WILCOX RELIES ON PHILANTHROPIC SUPPORT FROM THE COMMUNITY TO FULFILL ITS MISSION AND CARE FOR PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. CONTRIBUTIONS, BOTH UNRESTRICTED AND DESIGNATED, HELP THE MEDICAL CENTER PROVIDE EXCEPTIONAL MEDICAL CARE IN HAWAI'I. GENEROUS DONATIONS ASSIST AND ARE NOT LIMITED TO THESE AREAS: PATIENT AND SPECIALTY CARE, CAPITAL IMPROVEMENTS, EDUCATION AND RESEARCH, COMMUNITY HEALTH AND UNCOMPENSATED CARE. CAPITAL IMPROVEMENTS EMERGENCY AND TRAUMA PROGRAMS THE WILCOX EMERGENCY DEPARTMENT REQUIRES ONGOING SUPPORT AS TRAUMA CASES HAVE INCREASED. MAJOR GIFTS AND ANNUAL DONATIONS CONTINUE TO FUND UPGRADES TO THE EMERGENCY DEPARTMENT. OVERALL IMPROVEMENTS INCLUDE CREATING TRAUMA RESUSCITATION SUITES AS WELL AS RENOVATING SPECIALTY SPACES FOR BEHAVIORAL HEALTH, INFECTIOUS CONTROL, PEDIATRIC ROOMS, AND OB-GYN CARE. SINCE WILCOX HAS LIMITED ACCESS TO BEHAVIORAL HEALTH SERVICES FOR ACUTE EMERGENCY PATIENTS, DONATIONS WILL SUPPORT KAUAI'S FIRST EMERGENCY MEDICINE TELEMEDICINE PROGRAM FOR BEHAVIORAL HEALTH. IMAGING SERVICES MAJOR GIFTS AND CAPITAL FUNDING HELPED TO PURCHASE A NEW CT SCANNER THAT REPLACES AN EXISTING MODEL INSTALLED IN 1999. EQUIPPED WITH ADVANCED FEATURES AND RELIABILITY, THE NEW CT SCANNER WILL HELP TO DETECT AND MONITOR DISEASES AND CONDITIONS, SUCH AS CANCER AND HEART DISEASE. THE NEW SCANNER REQUIRES A LOWER DOSE OF RADIATION AND IS EQUIPPED WITH SOFTWARE CAPABLE OF RECONSTRUCTING AND REFORMATTING IMAGES POST SCANNING. THIS IMAGING TECHNOLOGY WILL SUPPORT EMERGENCY AND TRAUMA CASES. GRANTS, MAJOR GIFTS AND CAPITAL FUNDING WERE SECURED TO BEGIN THE RENNOVATION OF THE NUCLEAR MEDICINE LAB. THE UPGRADED LAB WILL INCLUDE A NEW STATE OF THE ART NUCLEAR MEDICINE CAMERA AND ADJOINING HOT LAB. THE UPGRADED LAB WILL IMPROVE TREATMENT FOR CRITICALLY ILL PATIENTS ON KAUA'I. THE NEW CAMERA WILL PROVIDE CARE TO PATIENTS ON KAUA'I THAT CAN HELP ELIMINATE THE NEED FOR THEM TO TRAVEL TO O'AHU FOR NUCLEAR MEDICINE EVALUATIONS AND TREATMENT. EDUCATION AND RESEARCH SIMULATION LAB THE WILCOX SIMULATION LAB INCLUDES HIGH-TECH MANIKINS THAT THE MEDICAL STAFF USE TO PRACTICE PROCEDURES THAT THEY RARELY SEE. THE LAB OFFERS A REALISTIC AND RISK-FREE ENVIRONMENT. A STATE-OF-THE-ART TRAINING SYSTEM ALLOWS NURSE EDUCATORS TO CREATE SCENARIOS WHERE THE MANAKINS EXHIBIT VARIOUS CONDITIONS AND CARE RESPONSES. CLINICAL EDUCATION TRAINING PROGRAM WILCOX PARTNERS WITH THE DEPARTMENT OF EDUCATION TO PROVIDE HIGH SCHOOL STUDENTS THE OPPORTUNITY TO TRAIN AS CLINICAL NURSE AIDES AS PART OF THEIR HIGH SCHOOL CURRICULUM. THESE PROGRAMS ARE A STARTING POINT IN THE MEDICAL FIELD THAT ALLOW STUDENTS TO EARN MONEY WHILE EXPLORING THE HEALTH CARE INDUSTRY AND FURTHERING THEIR EDUCATION. MAJOR GIFTS AND CAPITAL INVESTMENTS SUPPORT THE PROGRAM BY FUNDING THE INSTRUCTOR POSITION AS WELL AS MEDICAL EQUIPMENT NEEDED TO TURN CLASSROOMS INTO REALISTIC CLINICAL TRAINING FACILITIES. IN ADDITION, ALL STUDENTS WHO SUCCESSFULLY COMPLETE A CLINICAL TRAINING FOR TEENS PROGRAM ARE GUARANTEED AN INTERVIEW FOR HIRE AT A HAWAI'I PACIFIC HEALTH MEDICAL CENTER OR CLINIC. COMMUNITY HEALTH AND UNCOMPENSATED CARE PATIENT ASSISTANCE FUND: MALAMA FUND THE PURPOSE OF THE PATIENT ASSISTANCE FUND IS TO ASSIST MEDICAL CENTER PATIENTS AND/OR THEIR SUPPORT SYSTEM RECEIVING SERVICES, INCLUDING EMERGENCY ROOM AND OUTPATIENT SERVICES AT THIS FACILITY. THE MANAGEMENT AND DISBURSEMENT OF THE PATIENT ASSISTANCE FUND, OR MALAMA FUND, IS LEFT TO THE DISCRETION OF THIS FACILITY TO MEET SPECIFIC PATIENT CARE NEEDS. THE FUNDS MAY BE USED FOR PATIENTS AND/OR THEIR SUPPORT SYSTEM THAT HAVE FINANCIAL BARRIERS AND NEED CONTINUED MEDICAL OR PSYCHOSOCIAL SUPPORT OR TO FACILITATE DISCHARGE. Form 990, Part V, Line 1a FORM 1096 REPORTING HAWAI'I PACIFIC HEALTH (HPH), THE ORGANIZATION'S TAX EXEMPT PARENT, PAYS ALL VENDORS. THEREFORE, HPH ISSUES FORMS 1099 UNDER ITS TAX ID. Form 990, Part VI, Line 15 PROCESS OF DETERMINING COMPENSATION THE PRESIDENT, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE NOT COMPENSATED BY THE FILING ORGANIZATION, BUT RATHER BY THE TAX-EXEMPT PARENT, HAWAI'I PACIFIC HEALTH ("HPH"). FOLLOWING IS THE PROCESS THAT THE PARENT ORGANIZATION UNDERTAKES TO APPROVE THE PRESIDENT, OFFICERS AND KEY EMPLOYEES' COMPENSATION. COMPENSATION FOR HPH EXECUTIVES (VICE PRESIDENT AND ABOVE) IS SET BY THE HAWAI'I PACIFIC HEALTH ("HPH") COMPENSATION COMMITTEE, WHICH IS COMPOSED SOLELY OF INDEPENDENT, COMMUNITY-BASED MEMBERS OF THE HPH BOARD OF DIRECTORS. ON AN ANNUAL BASIS THE HPH BOARD CHAIRPERSON (WHO IS INDEPENDENT) SELECTS A NEUTRAL THIRD PARTY EXECUTIVE COMPENSATION CONSULTANT TO REVIEW THE EXECUTIVES' COMPENSATION AND BENEFITS. THE CONSULTANT PROVIDES A WRITTEN REPORT TO THE COMPENSATION COMMITTEE AT ITS ANNUAL MEETING. INCLUDED IN THE REPORT IS MARKET BASED DATA FROM LIKE ORGANIZATIONS. THE COMPENSATION COMMITTEE MAKES FINAL DECISIONS REGARDING COMPENSATION AND BENEFITS AT THE MEETING AFTER REVIEW AND DISCUSSION OF THE CONSULTANT'S REPORT, AND SUCH DECISIONS ARE DOCUMENTED IN THE COMPENSATION COMMITTEE MEETING MINUTES. COMMUNITY BASED DIRECTORS OF THE ORGANIZATION ARE NOT COMPENSATED. CERTAIN EMPLOYED PHYSICIANS MAY BE OFFICERS OR AN IDENTIFIED KEY EMPLOYEE OF THE REPORTING OR RELATED ORGANIZATION. PHYSICIAN COMPENSATION IS ALSO HANDLED IN THE SAME MANNER AS EXECUTIVE COMPENSATION, WITH THE HPH COMPENSATION COMMITTEE RECEIVING A REPORT FROM A NEUTRAL CONSULTANT AND FOLLOWING THE SAME PROCESS AS DESCRIBED ABOVE ON AN ANNUAL BASIS. THIS PROCESS WAS LAST COMPLETED ON MARCH 02, 2023 TO REVIEW PHYSICIAN COMPENSATION AND ON JULY 25, 2023 TO REVIEW EXECUTIVE COMPENSATION. Form 990, Part VI, Line 6 Classes of members or stockholders HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER WHO HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE WITH THE RIGHT TO ELECT THE MEMBERS OF THE GOVERNING BODY AND/OR APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BOARD. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER AND HAS THE POWER TO APPOINT OR REMOVE MEMBERS OF THE GOVERNING BODY. HAWAI'I PACIFIC HEALTH, AS MEMBER, ALSO HAS THE POWER TO ELECT ONE OR MORE EX-OFFICIO VOTING MEMBERS OF THE GOVERNING BODY. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders HAWAI'I PACIFIC HEALTH, AS MEMBER, HAS EXCLUSIVE POWER TO TAKE AND DIRECT THE FOLLOWING ACTIONS OF THE CORPORATION: (I) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: VICE-PRESIDENT(S), TREASURER, SECRETARY, ASSISTANT TREASURERS AND SECRETARIES, AND ANY OTHER OFFICER, EXCEPT THE PRESIDENT, CHAIR AND VICE-CHAIR OF THE BOARD; (II) AFTER CONSULTATION WITH THE BOARD, REMOVE VICE-PRESIDENT(S), TREASURER, SECRETARY, ASSISTANT TREASURERS AND SECRETARIES, AND ANY OTHER OFFICER, EXCEPT THE PRESIDENT, CHAIR AND VICE-CHAIR; (III) REMOVE A DIRECTOR FROM THE BOARD; (IV) DELEGATE MANAGEMENT AUTHORITIES FROM THE BOARD TO OFFICERS OR COMMITTEES OF THE CORPORATION IN ACCORDANCE WITH A DELEGATED AUTHORITIES MATRIX ADOPTED BY THE MEMBER; (V) AMEND THESE BYLAWS; (VI) CAUSE THE CORPORATION'S PARTICIPATION IN ALL LONG TERM FINANCING TRANSACTIONS WHICH ARE IN EXCESS OF ONE (1) YEAR AND/OR ONE MILLION DOLLARS ($1,000,000) OR MORE; (VII) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORPORATION'S FUNDS SHALL BE DEPOSITED; (VIII) DIRECT, MANAGE AND CONTROL THE CUSTODY, ADVISORY SERVICE, AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORPORATION; (IX) DETERMINE AND EFFECT INTER CORPORATE FUND TRANSFERS BY AND BETWEEN THE CORPORATION AND ANY AFFILIATE; (X) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORPORATION'S EXECUTIVE COMPENSATION AND BENEFIT PLANS; (XI) FORM A NEW CORPORATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (XII) DEVELOP AND PROMULGATE OVERALL CORPORATE GOALS AND THE LONG-RANGE AND STRATEGIC PLAN OF THE CORPORATION; AND (XIII) DEVELOP AND IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS. THE CORPORATION SHALL NOT TAKE THE FOLLOWING ACTIONS WITHOUT FIRST OBTAINING MEMBER APPROVAL: (I) ELECT ANY DIRECTOR TO THE BOARD; (II) AMEND THE ARTICLES; (III) MERGE THE CORPORATION WITH ANY ENTITY; (IV) DISSOLVE THE CORPORATION; (V) ENTER INTO ANY UNBUDGETED CONTRACTS ON BEHALF OF THE CORPORATION WHICH REQUIRE ANNUAL PAYMENTS BY OR ON BEHALF OF THE CORPORATION EXCEEDING ONE MILLION DOLLARS ($1,000,000) IN VALUE; (VI) ACQUIRE ASSETS WORTH OVER ONE MILLION DOLLARS ($1,000,000) EXCEPT FOR THOSE ASSETS ACQUIRED BY GIFTS, GRANT, OR DONATION; (VII) ACQUIRE SHARES IN ANOTHER CORPORATION; (VIII) SELL, LEASE, EXCHANGE, ENCUMBER OR DISPOSE OF TWENTY-FIVE PERCENT (25%) OR MORE OF THE PROPERTY AND ASSETS HELD BY THE CORPORATION TO ANY ENTITY THAT IS NOT AN AFFILIATE; (IX) ISSUE THE CORPORATION'S MEMBERSHIP TO ANYONE OTHER THAN THE MEMBER; (X) FORM A JOINT VENTURE OR OTHER BUSINESS RELATIONSHIP (OTHER THAN THE ORDINARY COURSE OF BUSINESS CONTRACTS) BETWEEN THE CORPORATION AND ANY PERSON OR ENTITY; AND (XI) DEVELOP A NEW LINE OF BUSINESS OR A NEW SERVICE. Form 990, Part VI, Line 11b Review of form 990 by governing body VARIOUS SCHEDULES OF THE FORM 990 ARE PREPARED PRIMARILY BY STAFF WITHIN THE ACCOUNTING AREA OF THE ORGANIZATION WORKING WITH VARIOUS OTHER AREAS OF THE ORGANIZATION SUCH AS MANAGEMENT OF THE OPERATING UNITS, HR, LEGAL, ETC. DISCLOSURE NARRATIVES ARE WRITTEN AND COMPILED INTERNALLY BASED ON INPUT AND DISCUSSION WITH FINANCIAL ANALYSTS AND THE CHIEF OPERATING OFFICER/EXECUTIVE DIRECTOR OF THE REPORTING ENTITY. THE CHIEF OPERATING OFFICER/EXECUTIVE DIRECTOR OF EACH REPORTING ENTITY REVIEWS AND APPROVES THE DISCLOSURE NARRATIVES WHICH DESCRIBES THE MISSION/PURPOSE AND PROGRAM ACCOMPLISHMENTS OF THEIR ORGANIZATION. SENIOR MANAGEMENT OF THE HEALTH CARE SYSTEM REVIEWS THE FORM 990 OF EACH FILLING ORGANIZATION WITHIN THE HEALTH CARE SYSTEM. ONCE SENIOR MANAGEMENT HAS COMPLETED ITS REVIEW, THE FORMS 990 ARE THEN PROVIDED TO THE GOVERNANCE AND NOMINATING COMMITTEE OF THE HEALTH CARE SYSTEM'S BOARD OF DIRECTORS FOR THEIR REVIEW. THE GOVERNANCE AND NOMINATING COMMITTEE OF THE PARENT'S ENTITY (HAWAI'I PACIFIC HEALTH "HPH") BOARD PROVIDES OVERSIGHT FOR THE FORM 990 REPORTING AND REVIEWS THE FORM 990 FOR EACH ENTITY PRIOR TO FILING. IN ADDITION, THE FORM 990 FOR EACH ENTITY IS MADE AVAILABLE TO THE BOARD MEMBERS OF EACH SUBSIDIARY UNIT OF HPH AND THE HPH BOARD OF DIRECTORS THROUGH A BOARD MEMBER PORTAL FOR REVIEW PRIOR TO THE FILING OF THE FORM 990. THE FORMS 990 WILL BE POSTED TO HPH'S WEB SITE FOR PUBLIC ACCESS AFTER THE FILING OF THE RETURNS WITH THE IRS. Form 990, Part VI, Line 12c Conflict of interest policy ANNUALLY, EACH DIRECTOR, OFFICER, KEY EMPLOYEE AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) RECEIVED A COPY OF THE CONFLICT OF INTEREST ("COI") POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) AGREES TO COMPLY WITH THE POLICY; 4) HAS DISCLOSED ANY CONFLICTS OR POTENTIAL CONFLICTS OR ECONOMIC INTERESTS AS REQUIRED; AND 5) UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, THE ORGANIZATION MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. THE IN-HOUSE LEGAL DEPARTMENT DISTRIBUTES THE STATEMENT REQUEST AND REVIEWS THE COI STATEMENTS RETURNED. IDENTIFIED CONFLICTS OF INTEREST ARE PRESENTED TO THE BOARD FOR REVIEW, DELIBERATION AND CONFIRMATION/REFUTATION THAT A CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST HAS BEEN FOUND, THE INDIVIDUAL MAY ADDRESS THE BOARD AND EXPLAIN THE TRANSACTION OR ARRANGEMENT CAUSING THE CONFLICT. AFTER THE PRESENTATION, THE INDIVIDUAL IS EXCUSED FROM THE MEETING AND SHALL NOT PARTICIPATE WITH ANY DISCUSSION OR VOTE ON MATTERS PERTAINING TO THE TRANSACTION OR ARRANGEMENT. IN MEETINGS WHERE APPLICATION OF THE COI POLICY OCCURS, THE MEETING MINUTES INCLUDE NATURE OF THE FINANCIAL INTEREST/CONFLICT, NAME(S) OF THE PERSON(S) WITH THE POTENTIAL OR ACTUAL CONFLICT, ANY ACTION TAKEN TO ASSIST IN THE DETERMINATION OF WHETHER A CONFLICT EXISTED, INCLUDING ANY DISCUSSION OF ALTERNATIVE ARRANGEMENTS, THE BOARD'S DECISION(S) REGARDING THE CONFLICT AND NAMES OF PERSON PRESENT IN THE DISCUSSION AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT. Form 990, Part VI, Line 19 Required documents available to the public DISCLOSURE OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS AND STANDARDS OF CONDUCT ARE AVAILABLE ON THE HAWAI'I PACIFIC HEALTH WEBSITE. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC VIA THE HAWAI'I PACIFIC HEALTH WEBSITE. Form 990, Part IX, Line 11g Other Fees INTERNAL SVC. PROVIDED EXPENSE - Total Expense: 580579, Program Service Expense: 251390, Management and General Expenses: 188718, Fundraising Expenses: 140471; MANAGER DIRECT BONUS - Total Expense: 25369, Program Service Expense: , Management and General Expenses: 25369, Fundraising Expenses: ; GRANT WRITING - Total Expense: 9360, Program Service Expense: , Management and General Expenses: , Fundraising Expenses: 9360; Form 990, Part XI, Line 9 Other changes in net assets or fund balances EQUITY TRANSFER FROM HPH - -1167650; INTERCOMPANY TRANSFERS BETWEEN FOUNDATIONS - 13500; IMMATERIAL ROUNDING - -3; HAWAI'I PACIFIC HEALTH 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990246363 ADMIN SVCS. HI 501(c)(3) Type III-FI NA false KAPI'OLANI HEALTH FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990246364 FUNDRAISING HI 501(c)(3) 7 HPH true KAPI'OLANI MED CTR FOR WOMEN & CHILDREN 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990177350 HOSPITAL HI 501(c)(3) 3 HPH true KAPI'OLANI MEDICAL SPECIALISTS 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990322406 HEALTHCARE HI 501(c)(3) 3 HPH true KAUA'I MEDICAL CLINIC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990326099 HOSPITAL HI 501(c)(3) 3 HPH true PALI MOMI FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 383840327 FUNDRAISING HI 501(c)(3) 7 HPH true PALI MOMI MEDICAL CENTER 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990274038 HOSPITAL HI 501(c)(3) 3 HPH true PROVIDERS INSURANCE COMPANY 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 710893000 INSURANCE HI 501(c)(3) Type II HPH true STRAUB CLINIC & HOSPITAL 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 912151670 HOSPITAL HI 501(c)(3) 3 HPH true STRAUB FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990109350 FUNDRAISING HI 501(c)(3) 7 HPH true WILCOX MEMORIAL HOSPITAL 3-3420 KUHIO HIGHWAY LIHUE HI 96766 990074365 HOSPITAL HI 501(c)(3) 3 HPH true Honolulu Surgery Center LP 55 Merchant Street 24th Floor HONOLULU HI 96813 621506645 AMBU. SURG. CTR. TN NA N/A Specialty Surgical Suites LLC 1401 S Beretania St STE 750 Honolulu HI 96814 461674512 AMBU. SURG. CTR. HI NA N/A HONOLULU IMAGING CENTER LLC 55 MERCHANT STREET 27TH FLOOR HONOLULU HI 96813 871602945 DIAG. IMAGING CTR DE NA N/A HAWAI'I PACIFIC HEALTH PARTNERS INC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990318588 HOLDING COMPANY HI NA C Corporation 0 0 STRAUB PHARMACY INC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990145107 INACTIVE HI NA C Corporation 0 0 HICORD INC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990251496 INVESTMENT HI NA C Corporation 0 0 CHARITABLE REMAINDER TRUSTS (2) CHARITABLE TRUST HI WHF Trust 0 0 false true false false false false false false false false false false false false true true true true true WILCOX MEMORIAL HOSPITAL B 827841 FMV