2025-05-15T22:26:00-05:00 2024-06-30 421539623 KMH LLP 1003 BISHOP STREET SUITE 2400 HONOLULU HI 96813 990 2023-07-01 990269825 WAHIAWA GENERAL HOSPITAL WAHI 8086218411 128 LEHUA STREET WAHIAWA HI 96786 BRIAN CUNNINGHAM CEO 8086218411 2025-05-15 1 0 CHRISTOPHER CASSIDY P01237316 8085262255 2023 2025-03-06 01:10:19Z X JOE FRANCHER 128 LEHUA STREET WAHIAWA HI 96786 42664652 0 X WWW.WAHIAWAGENERAL.ORG X 1968 HI SEE SCHEDULE OTO PROVIDE HEALTH SERVICES, EDUCATION, ACTIVITIES AND PROGRAMS TO SUPPORT THE SURROUNDING COMMUNITY. X 14 14 366 0 0 0 6705224 26360974 27747839 16301069 3248056 -10393279 0 0 37701119 32268764 0 0 0 0 20149649 15030817 0 0 0 18180778 13004394 38330427 28035211 -629308 4233553 21110345 0 30063011 0 -8952666 0 X TO PROVIDE HEALTH SERVICES, EDUCATION, ACTIVITIES AND PROGRAMS TO SUPPORT THE SURROUNDING COMMUNITY. 0 0 5259324 4130651 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. 14848867 11662237 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. 508181 ALL OTHER PROGRAM SERVICES ARE FOR OTHER RELATED ACTIVITIES, WHICH INCLUDE GME, RENTAL, AND OTHER PROGRAM SERVICES. 20108191 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 1 11 0 1 366 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 HI X BRIAN CUNNINGHAM 8084592722 128 LEHUA STREET WAHIAWA HI 96786 X DAVID SEEHOLZER CHAIRMAN 0.26 0.26 X X 0 0 0 R KALANI FRONDA VICE CHAIR 0.23 0.26 X X 0 0 0 JOHN KAMPFER TREASURER 0.17 0.28 X X 0 0 0 NORBERTO BAYSA MD DIRECTOR 0.12 0.17 X 0 0 0 BISHOP MICHAEL HENDERSON DIRECTOR 0.23 0.29 X 0 0 0 WILLIAM MCKENZIE MD DIRECTOR 0.20 X 0 0 0 JEFFREY ALAMEIDA DIRECTOR 0.35 0.26 X 0 0 0 CRAIG THOMAS MD DIRECTOR 0.20 0.29 X 0 0 0 ROBERT BUNDA DIRECTOR 0.20 0.49 X 0 0 0 JOSEPH FRANCHER SECRETARY 0.26 0.32 X X 0 0 0 STACIE SASAGAWA SECRETARY 0.20 0.35 X X 0 0 0 GORDON KANEMARU DDS DIRECTOR 0.17 0.35 X 0 0 0 MARCUS OSHIRO DIRECTOR 0.20 0.39 X 0 0 0 WENDELL ODA DIRECTOR 0.20 0.15 X 0 0 0 BRIAN CUNNINGHAM CEO 40.00 2.00 X 0 0 0 TAMMY KOHRER CHIEF NURSING OFFICER 40.00 X 131360 0 22967 RICHARD HAUGE CFO 40.00 X 159320 0 8529 NARINDER MAKER MANAGER PHARMACY 40.00 X 130720 0 24283 BRANDON TOMITA COO 40.00 X 120280 0 0 TYLER TERUYA ER DEPT MANAGER 40.00 X 133665 0 23198 675345 0 78977 26 0 1 0 TODD CAPRIOTTI 10306 GUNNISON LANE CHARLOTTE NC 28277 IT SERVICES 168269 1 54690 26306284 26360974 OUTPATIENT REVENUE 621110 11662237 11662237 INPATIENT REVENUE 621110 4130651 4130651 ALL OTHER PROGRAM SERVICES REVENU 900009 481341 481341 RENTAL INCOME - PROGRAM SVC RELAT 531120 26840 26840 16301069 2609 2609 10395888 -10395888 -10395888 -10395888 32268764 16301069 0 -10393279 X 11793636 9231275 2562361 281551 281551 2009493 636279 1373214 946137 946137 452233 452233 174003 174003 62719 62719 4596653 2898742 1697911 1371090 1138839 232251 1130137 1029145 100992 4109 2480 1629 5839 5839 1240139 1240139 837816 837816 409583 409583 MEDICAL SUPPLIES 1352573 1345182 7391 REPAIRS AND MAINTENANCE 670210 669689 521 PROVIDER TAX 461972 461972 MISCELLANEOUS 191137 142404 48733 44181 28608 15573 28035211 20108191 7927020 0 117335 0 0 0 3345831 0 0 0 0 259054 0 328241 0 0 0 11085086 0 0 0 0 0 5974798 0 21110345 0 25922276 0 1861431 0 2279304 0 30063011 0 X -8952666 0 -8952666 0 21110345 0 X 4233553 -38522 4757635 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 25000 25000 25000 25000 25000 25000 25000 25000 25000 25000 0 1 1 0 PART V, LINE 4: THE USE OF WAHIAWA GENERAL HOSPITAL'S ENDOWMENT FUNDS IS RESTRICTED TO ITS OPERATIONS. 1 1 X 1 X 1 X 1 1 1 0 0 116758 0 116758 0.00420 7490929 7678687 0 0.00000 7607687 7678687 116758 0.00420 64725 21333 43392 0.00150 64725 21333 43392 0.00150 7672412 7700020 160150 0.00570 1 1167233 2368854 4268392 -1899538 X 1 1 1 1 WAHIAWA GENERAL HOSPITAL 128 LEHUA STREET WAHIAWA HI 96786 HTTP://WWW.WAHIAWAGENERAL.ORG/ LICENSE#: 9-H X X X X WAHIAWA GENERAL HOSPITAL 1 0 0 1 X X X X X X 21 1 1 1 1 X WWW.WAHIAWAGENERAL.ORG 1 22 1 WWW.WAHIAWAGENERAL.ORG 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X 1 X WWW.WAHIAWAGENERAL.ORG X WWW.WAHIAWAGENERAL.ORG X WWW.WAHIAWAGENERAL.ORG X X X X X X 0 0 X X 1 X 0 1 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, 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. X X 0 0 0 0 0 0 0 0 0 RICHARD HAUGE CFO 159320 0 0 0 0 0 0 0 8529 0 167849 0 0 0 TYLER TERUYA ER DEPT MANAGER 133665 0 0 0 0 0 0 0 23198 0 156863 0 0 0 NARINDER MAKER MANAGER PHARMACY 130720 0 0 0 0 0 0 0 24283 0 155003 0 0 0 TAMMY KOHRER CHIEF NURSING OFFICER 131360 0 0 0 0 0 0 0 22967 0 154327 0 0 0 EQUIPMENT, PERMITS, INTANGIBLE PROPERTY, WARRANTIES, AGREEMENTS, LEASES 2024-04-02 0 OUTSTANDING OFFER 990238120 THE QUEEN'S HEALTH SYSTEMS 1301 PUNCHBOWL STREET HONOLULU HI 96813 501(C)(3) 0 0 0 0 1 1 1 1 0 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. 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. WAHIAWA HOSPITAL FOUNDATION 128 LEHUA STREET WAHIAWA HI 96786 300206692 FUNDRAISING HI 501(C)(3) LINE 12A, I WAHIAWA GENERAL HOSPITAL 1 WAHIAWA HOSPITAL ASSOCIATION 94 -1221 KA UKA BLVD UNIT 108-322 WAIPAHU HI 96797 990073529 HOSPITAL SVCS HI 501(C)(3) LINE 12B, II N/A 0 WAHIAWA GENERAL HOSPITAL AUXILIARY 128 LEHUA STREET WAHIAWA HI 96786 996009028 HOSPITAL SVCS HI 501(C)(3) LINE 10 N/A 0 WAHIAWA HOSPITAL SERVICES CORPORATION 128 LEHUA STREET WAHIAWA HI 96786 INACTIVE HI WHA C 0 PACIFIC ADOLESCENT CENTER INC 128 LEHUA STREET WAHIAWA HI 96786 INACTIVE HI WHA C 0 PACIFIC HEALTH CENTER INC 128 LEHUA STREET WAHIAWA HI 96786 INACTIVE HI WHA C 0 WAHIAWA-PACIFIC HEALTH CENTER 128 LEHUA STREET WAHIAWA HI 96786 INACTIVE HI WHA C 0 PACIFIC HEALTH COMMUNITY INC 128 LEHUA STREET WAHIAWA HI 96786 INACTIVE HI WHA C 0 WAHIAWA-CENTRAL OAHU HEALTH CENTER INC 128 LEHUA STREET WAHIAWA HI 96786 INACTIVE HI WHA C 0 PACIFIC WOMEN'S CENTER INC 128 LEHUA STREET WAHIAWA HI 96786 INACTIVE HI WHA C 0 PACIFIC WELLNESS CENTER INC 128 LEHUA STREET WAHIAWA HI 96786 INACTIVE HI WHA C 0 PACIFIC BIOTECH INSTITUTE INC 128 LEHUA STREET WAHIAWA HI 96786 INACTIVE HI WHA C 0 PACIFIC SPORTS MEDICINE & RESEARCH CTR 128 LEHUA STREET WAHIAWA HI 96786 INACTIVE HI WHA C 0 PACIFIC SAGING CENTER INC 128 LEHUA STREET WAHIAWA HI 96786 INACTIVE HI WHA C 0 PACIFIC COMMUNITY HEALTH & WELLNESS 128 LEHUA STREET WAHIAWA HI 96786 INACTIVE HI WHA C 0 PACIFIC CARDIAC INSTITUTE INC 128 LEHUA STREET WAHIAWA HI 96786 INACTIVE HI WHA C 0 0 0 1 1 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 WAHIAWA HOSPITAL FOUNDATION C 58367 FMV WAHIAWA HOSPITAL ASSOCIATION C 24606702 FMV WAHIAWA HOSPITAL ASSOCIATION E 1686788 FMV 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.