HomeMy WebLinkAboutCOM 0667.033 1998-2000Stephen K. Yamashiro
Mayor
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Couutp of 3atuaii
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DEPARTMENT OF FINANCE
25 Aupuni Street, Room 118 • Hilo, Hawaii 96720 -4252
(808) 961-8234 • Fax (808) 961-8248
HAWAII COUNTY NONPROFIT GRANTS (FY 2000 -01)
HUMAN SERVICES NONPROFIT GRANTS REVIEW COMMITTEE (HSNPGRC)
FISCAL YEAR ENDING:June 30. 2001 DATE OF APPLICATION: January 18 2000
GRANT APPLICATION FOR: West Hawaii Counseling and Supportive Living Project
(Program Tide)
Legal Name of Organization: Kapiolani Medical Center for Women and Children ( Kapi Child Protection Center)
Mailing Address: 55 Merchant St.. 72nd Floor, Rim Hawaii 96813
Facility/Site Address: 74 -5605 Alapa St. B 5 & 6 Mez. Kailua Kona HI 96740
Director /Site Manager: Mary Jo Westmoreland Phone: 329 -4020
Organization President: Frances A. Ballot Phone: 983 -8274
'C..Vice President & CEO
Contact Person (Grant Writer) Mary Jo Westmoreland Phone: 329 -4020
Amount of request for County funds: $ $20,000
Total annual budget of organization: $ $423,376
Has the applicant applied for any other funds from the County of Hawaii this fiscal year?
Yes Source /Department:
Agency /Program(s): (x Social Services �(5 Youth Programs -5 Elderly Programs
Check Category (ies) 0 Culture and Arts (S Education (.-S Other
Briefly define the program for which funding is being requested:
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pro v idds counseling, supportive living .and 'supportive services for famil where there is a risk
of child abuse or neglect.
1
Comm. No 6•47•
File No 4
Ref- To • 1
Ref. Date FEB 2 3 2000
♦t.. 4 •• 1
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I. OUALIFYING STANDARDS FOR APPLICANTS
An applicant must meet all of the following standards:
is Be chartered or otherwise authorized to do business in the State for charitable purposes and
exempted from the Federal income tax by the Internal revenue Service.
(5 Have a governing board whose members serve without compensation and have no conflict of
interest between their regular occupations and the services provided.
0 Have bylaws or policies which describe the manner in which business is conducted, including
management, audit, fiscal policies and procedures, policies on nepotism, and policies on
management of potential conflict of interest.
(5 Have at least one year's experience with the service or activity for which the appropriation is
sought or can otherwise demonstrate to the satisfaction of the County sufficient expertise to
successfully carry out the service or activity.
(5 Be licensed and accredited in accordance with applicable requirements of Federal, State and
County laws.
II. GRANT CONDITIONS
The applicant agrees to comply with the following terms & conditions prior to receiving a grant award.
A. Comply with applicable Federal and State laws prohibiting discrimination against any person on
the basis of race, color, national origin, religion, creed, sex, age, or handicap.
B. Agree not to use any public funds for purposes of entertainment or perquisites.
C. Comply with such other requirements as the Director of Finance may prescribe to ensure adherence
by the nonprofit organization with Federal, State, and County laws, and established standards for
fiscal and program management.
D. Allow the Director of Finance, the committees of the council and their staffs, and the Legislative
Auditor access to records, reports, files, and other related documents in order that the program,
management, and fiscal practices of the nonprofit organization may be monitored and evaluated to
assure the proper and effective expenditure of public funds.
III. RECORDS AND REPORTS
A. The applicant shall follow generally accepted accounting procedures and practices and shall
maintain books, records, documents, and other evidence, which sufficiently and properly account
for the expenditure of County funds. The books, records and documents shall be subject at all
reasonable times to inspection, reviews, or audits by the County expending agency, the Director of
Finance, and the Legislative Auditor, or by their representatives.
B. The County expending agency, Director of Finance, or County Council may request periodic
written reports on the use of County funds.
C. The nonprofit organization shall submit a final written report to the Legislative Auditor within
sixty (60) days after June 30 of the fiscal year. The report shall include an explanation of the
public benefits derived from the awarding of the grant and a listing of other funding sources and
amounts obtained during the award period.
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IV. QUARTERLY ALLOCATION
V. GRIEVANCE PROCEDURE
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Under no circumstances shall grant funds be disbursed in a lump sum payment. Grant funds will be
disbursed to Grantees only through a quarterly allocation process. The disbursement of grant funds can be
formulated on an equal quarterly apportionment basis.
The applicant will adopt and maintain a grievance procedure to assure proper accounting for any concerns
and complaints about its programs or services that may arise from its members, employees, clients or from
other members of the public.
VI. DISCLOSURE OF INFORMATION
All information, data, or any other material provided to the County by virtue of this application shall be
subject to the Uniform Information Practices Act (UIPA), ch. 92F, Hawaii Revised Statutes. All such
material is deemed government record and shall be open to the public and may be provided to other public
and/or private funding sources.
VII. CONTINUED ELIGIBILITY
Any applicant or recipient who withholds or omits any material facts or deliberately misrepresents
such facts to the County of Hawaii shall: I) Immediately be disqualified from consideration for Nonprofit
Grant funding; OR 2) be in violation of the terms of the Grant Agreement of County funds in which case a
grant agreement can be terminated by the County and the recipient or provider may be liable to reimburse all
or a portion of any funds received therein.
VIII. ACKNOWLEDGMENT
Kapi'oiani Mecial Center for Wcmen and Children
(Legal Name of Organization)
hereby agrees to administer the
Kapiolani Child Protection Center
West Hawaii Counseling and Supportive Living Project
(Program Title)
in accordance with the regulations, policies and procedures prescribed by the Hawaii County Finance
Department. Distribution of grant funds is limited to grantees, ,which are in compliance with County
regulations, policies and procedures. The County reserves the right to withhold grant distributions at any
time the grantee is not in compliance. It is the policy of the County of Hawaii and for those who do business
with the County to provide equal employment opportunities to all persons regardless of race, physical
disabilities, color, religion, sex, age, or national origin as mandated by the Federal Civil Rights Acts, as
amended, and any other federal or state laws relating to equal employment opportunities.
IX. AMENDMENTS TO THE APPLICATION/EVALUATION
The applicant assures that it will submit to the HSNPGRC for prior review and approval, a written request
and justification for any changes, additions, or deletions to any portion(s) of the grant application or a duly
executed Grant Agreement of County Funds. The applicant will cooperate and assist in any effort
undertaken by the HSNPGRC to evaluate, inspect or otherwise monitor the effectiveness, feasibility, and/or
cost efficiency of any and all practices, policies and procedures or activities pursuant to this application or
any grant designation or allocation received as a result of this application.
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Signature of PresidentlChairperso
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X. AUTHORITY AND CAPACITY OF APPLICANT
The applicant certifies that it has the authority and capacity to develop and submit this application, and to
fully administer the program(s) pursuant to this application.
UNSIGNED PROPOSALS WILL NOT BE ACCEPTED!
i
/L ...en 4., 0
Signatur
xecutive Director/Manager
4
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Date
74/
Date
A. Overview
1) Describe the program for which funding is being requested.
HAWAII CO HUMAN SERVICES NON - PROFIT G PROPOSAL
KAPI'OL CHILD PROTECTION CENTER - HA I ISLAND
Funding is being requested to support the West Hawaii Counseling and Supportive Living Project. This project is primarily funded
through a Federal Title IV -B Subpart 2 Family Preservation and Support Grant, administered by the State Department of Human
Services. We are requesting twenty thousand dollars ($20,000) to assist with operational support of the project.
This project has been designed to assist individuals and families in providing a safe and nurturing home for children. A primary focus
of this project is to provide services for parents who are addicted to substances and need support and assistance to recover from their
addictions so that they may appropriately care for their children. This project offers services to families who are actively involved
with Child Welfare Services because of child abuse and neglect or the threat of harm. and to families who need services as a diversion
from active CWS involvement. Services are also available to families who have not been reported to DHS -CWS, but where a risk of
child abuse and neglect has been identified.
2) What unique or significant services will be provided?
This project is unique in that it offers services aimed at improving outcomes for long -term substance abuse recovery and safety of
children in families at risk of child abuse. A flexible array of services is available to each client, with individual services being
accessed based on the specific needs of the individual and family. Services include comprehensive service needs assessment, referral
to and linkage with other community service providers, mental health assessment and counseling, medical needs assessment and
medical care coordination. The project also offers life skills education and specialized parenting classes for addicted parents in
recovery, anger management education, family home visiting and other wrap around supportive services that may be needed.
Payment of Therapeutic Living Services for substance abusing pregnant women and mothers who have entered outpatient substance
abuse treatment is also provided.
A staff core team of professionals provides many of the direct services to clients, with linkage and referral made to other agencies or
private practitioners, as appropriate. The Kapi' olani Child Protection Center (KCPC) core team consists of a Service Coordinator,
two Clinical Social Workers, a Clinical Nurse Specialist, two Clinical Care Coordinators, a Clerk Typist an Administrative Secretary
and the Branch Administrator. KCPC has established either Memorandums of Agreement or contracts for payment with a number of
agencies and professionals throughout the West Hawaii Area, so that the widest possible choice of services is available to clients.
Services are free to clients, although at times a client may be asked to share in the cost as part of their individualized service plan.
3) What specific outcomes are to be achieved?
80% of clients referred will be fully assessed to determine their status and service needs
80% of families that complete a service plan will have had no new report of child abuse or neglect at discharge
80% of families that complete a service plan will have established and implemented a child safety plan at discharge
80% of clients completing their service plans will demonstrate improvement in one or more of the following targeted areas:
Improved individual functioning
Improved problem solving skills
Improved family relationships
Improved parenting skills
Improved family support
Substance Abuse Recovery (still engaged in the recovery process)
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B. Problem/Need
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Kapi'ol Protection Center - West Hawaii
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4) How will the proposed program empower participants/clients to become self - sufficient and facilitate positive social
change?
Of most importance to this project is the willingness and ability of clients to voluntarily participate and complete services. To this end,
clients are informed at intake that they will be expected to participate in the development of their service plan and will be asked to
develop and implement a child safety plan prior to discharge. Additionally, clients are informed that they will be dismissed from the
project if they repeatedly fail to keep service appointments, are unavailable for tracking or refuse to participate in agreed upon
services. We focus most of our energy and efforts on working with families where there is a high probability of success for reducing
the risks of child abuse and neglect. Clients are required to develop an individualized service plan, identifying with project staff the
outcome goals to be met through the project, and needs that will be met through their own initiative. Throughout their time in the
project, clients are assisted in developing a clean and sober lifestyle and life skills that will serve them once their involvement in the
project has ended. Delivered services are targeted to achieve the identified positive outcomes that will reduce the risks of child abuse
and neglect. It is expected that participants will proactively advance towards outcomes they themselves identify.
1) What is the problem /need the proposed program is designed to meet?
DHS -CWS units report that up to 90 percent of CPS reports involve substance abuse by one or both of the parents or primary
caregivers. Family Crisis Shelter, Inc. reports that up to 90 percent of women seeking shelter services for themselves and their
children and 90 percent of men referred for anger management classes have problems with abuse of drugs and/or alcohol. Family
Support Services of West Hawaii reports that 75 to 90 percent of the families involved in the Healthy Start program have substance
abuse problems. Clearly, drug and alcohol abuse is the number one risk factor for child abuse and neglect in West Hawaii.
In addition to the risks created by drug and alcohol abuse, domestic violence, economic hardship, divorce and custody problems and
emotional instability of caregivers also create risks of harm to children. Where these risks are present, there is a great need for a wide
array of services to assist families in maintaining a drug free /violence free lifestyle where children are nurtured and safe.
In recent years, availability of mental health services for at risk parents has diminished. Many families have become ineligible for
QUEST insurance, because of changes in the Welfare laws, and are unable to pay regular health insurance premiums and so have lost
access to mental health services. Many other families, who do have either QUEST or regular health insurance, are unable to obtain
needed mental health services because of the limited number of providers available in the area and/or because of restrictions placed on
the number and/or type of mental health visits allowed.
The West Hawaii Counseling and Supportive Living Project is designed to address the needs of families with substance abuse
problems and provide targeted services to assist caregivers in their substance abuse recovery. The project also partially bridges the
gap between families in need of mental health services and availability of those services.
2) Who are the target population and what are the specific needs?
The primary target group for this project is families in West Hawaii who are at risk of child abuse and neglect because of substance
abuse by one or more of the primary caregivers. Most of these families are actively involved with CPS. Most services are provided
to the caregivers in the family although services are provided to children as well. Caregivers of children at risk, usually the parents,
need counseling services to address mental health issues and improve their individual functioning. They need family violence
intervention services, especially anger management counseling and education. They also need life skills education to prepare them
for living a clean and sober lifestyle and specialized parenting education to help them understand their children's need and accept
parenting responsibilities. These caregivers need to learn how the abuse of drugs /alcohol harms their children, and how substance
abuse harms their relationship with their children. Most of these caregivers need treatment for addictions and some need Therapeutic
Living Services in a safe residential environment to begin their treatment. Most of these caregivers also need long term supportive
services to help them maintain a lifestyle that ensures the safety and well being of their children.
A second target population is families who have been investigated by CPS, found to be at risk, and diverted to the project for intensive
services but without active CPS involvement. A third target group is families who are in crisis and, who have acknowledged a need
for assistance and have asked for help on their own. These families often need only short-term counseling, support or linkage with
other agencies to resolve the crisis and reduce the risk of harm to their children. A fourth target group is families who are preparing to
or have adopted a child who was abused or neglected by their biological parents. These children and the adoptive parents need
• Kap' i Child Protection Center - West Hawaii
Page 3
transition counseling as they move through the adoptive process and soinetimes crisis intervention after the adoption has been
completed.
3) What is the geographical area(s) to be served, facility and hours of operation.
The geographic area to be served covers the entire West Hawaii region, which includes the districts of North and South Kohala, North
and South Kona, and Kau to Pahala. Staff provided, or contracted, services are available throughout the region.
The Kapi'olani Child Protection Center office in West Hawaii is located at 74 -5605 Alapa Street B -5 &6 Mez, Kailua -Kona, HI
96740. The office houses all staff, with closed offices available for confidential intakes, assessments and counseling. Regular office
hours are Monday through Friday from 8:00 a.m. to 4:30 p.m.. However, staff provided services are available during the early
moming hours, and during the evening and on weekends, as needed, to accommodate the client's schedule.
Many of the services provided by the project are delivered to clients in locations other that the KCPC office. Intakes and assessments
may be completed at the client's home or another location agreeable to the client. Outside services paid for with project funds are
obtained by the client at the provider's location (e.g. Bridge House, ACCESS, BISAC, FCSI, private practitioners, etc.).
C. Collaboration /Coordination
1) What specific measures will be taken to collaborate /coordinate with other community resources to achieve maximum
program efficiency and cost effectiveness?
This project was specifically designed as a collaborative and coordinated endeavor. Regional Planning Committees were established
in 1994 to assess community needs. Members of the Regional Planning Committee included representatives from most human
service agencies in the region, as well as representatives from the business community, state agencies, and the general public. From
the RPC needs assessment, the West Hawaii Counseling and Supportive Living Project was developed.
Over the past four years, as Federal funding became available, Memorandums of Agreement and Service Contracts were developed
between KCPC and other agencies. These include DHS, DOH, Public Health Nursing, Probation, Bridge House, DASH, BISAC,
ACCESS, FCSI, FSSWH, QLCC, and CFS. These documents outline specific services available to project clients from each agency
or provider, referral mechanisms, payment options and levels of participation in the project. Several contracts have also been
developed with private counseling practitioners throughout the region. Additionally, a drug baby protocol has been developed with
Kona Hospital and North Hawaii Hospital.
One of the primary tasks of the Project Service Coordinator is to continually further collaboration, working with agencies to develop
or revise MOA's. An additional task is to ensure that services for clients are obtained efficiently and cost effectively. A
comprehensive intake is completed with each client requesting services. During the intake process, clients identify other agencies
they may currently be involved with and previous services they may have received. The Coordinator works with clients throughout
the time they are involved with the project, holding case conferences, as needed, with the client and other providers, in order to
enhance service delivery. To facilitate coordination, a confidential release of information form has been developed, that allows client
information to be shared between agencies. All clients participating in the project must voluntarily sign this release before being
accepted into the program. Discretion is used in both obtaining and disseminating sensitive client information.
As stated above, contract agreements have been established with many agencies and private practitioners. Reasonable fees for service
have been negotiated with these providers and costs are monitored closely. An extensive computer database has been developed to
track client services, involvement with other agencies and achievement of outcomes.
In 1999, the Neighborhood Place of Kona was opened. The NPK is the result of years of planning by the statewide DHS Blueprint for
Change Committee, the West Hawaii Title IV -B /2 Regional Planning Committee and the West Hawaii Neighborhood Place Steering
Committee. The NPK is a place where families can go to receive help from community agencies when a risk of child abuse or neglect
has been identified, The NPK is one of two pilot sites in the state. Numerous public and private agencies as well as private
practitioners have made a commitment to deliver services directly at the Neighborhood Place and/or to be linked with families
through the Neighborhood Place. KCPC staff members have been involved in Neighborhood Place planning from the start. Since its
opening, KCPC staff have been working closely with NPK staff, sharing service tasks on families served jointly and cross referring as
appropriate. Since September 1999 KCPC staff have been providing a parenting class for substance abusers in recovery at the
Neighborhood Place.
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C. Collaboration /Coordination (Continued)
Kapi'ol ild Protection Center - West Hawaii
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2) How will these measures reduce or eliminate any existing duplication of services to your designated target group?
Reduction or elimination of duplication of service is a primary goal of this project. All of the above measures facilitate this goal.
Client service needs are established and prioritized during the intake process. Current and former providers are then reviewed and
additional appropriate provider(s) identified to meet current service needs . Although there may at times be some overlap of service
components, duplicate services are effectively eliminated. Through tracking of client participation and progress and frequent
communication between the numerous agencies and private practitioners involved in the project, client needs are met without
duplication of services.
Joint service planning between the KCPC Title IV -B Project, the NPK, FSSWH, CFS and other private providers ensures coordinated
service delivery and prevents duplication of services.
D. Goals and Objectives
1) What are the major goals/benchmarks of the proposed program?
• Promote and participate in a collaborative community continuum of care to support the treatment of addictions, promote long
term recovery and prevent initial and subsequent incidents of child abuse and neglect.
• Promote and participate in a collaborative community continuum of care to improve the functioning of at risk caregivers and
prevent initial and subsequent incidents of child abuse and neglect.
• Promote and participate in a collaborative community continuum of care to improve the delivery and coordination of services for
families at risk for child abuse and neglect.
2) What specific objectives /action steps are planned for each goal?
• Enhance effectiveness of treatment of drug and alcohol addictions by providing access to counseling and supportive services for
long term recovery of child caregivers.
• Enhance access to and effectiveness of therapeutic support and education for at risk families leaming to develop and maintain
healthy family relationships.
• Enhance access to and effectiveness of mental health services for family members experiencing problems that interfere with
family well being.
• Enhance access to and effectiveness of service delivery for at risk families through the development of individualized service
plans and collaborative service coordination.
3) What is time timeline (start and end dates) for each action step.
This project began in October 1995 with the provision of mental health assessment and counseling services for at risk families.
Services were limited to individual counseling with contracted private practitioners. In October 1996, family and group counseling
services were added through the addition of a staff clinical social worker and a contractual agreement with ACCESS Enterprises. This
component of the program is ongoing. In January 1998, group- counseling services were started for women completing formal
substance abuse treatment and transitioning from Supportive Living. Mental health services are added or augmented when indicated
by client needs, when other service programs are established, and when providers entering the area introduce new options.
In October 1996, the Supportive Living component was added to the project when Bridge House began accepting women into their
residence. In January 1997 an in -house counseling/parenting group was started at Bridge House by the project clinical social worker.
Access through the project to anger management classes, parenting classes, childcare assistance, medical care coordination and family
home visiting began in October 1996. These components are ongoing.
Service Coordination began on a limited basis in October 1995 and has been expanded over the past four years. In July 1999 two
Clinical Care Coordinators were hired in addition to the Service Coordinator. These staff members are counseling professionals who
provide the long -term support, case management and life skills education needed by clients. We are currently in the process of hiring
• Kap•i Child Protection Center - West Hawaii
Page 5
another Clinical Social Worker with substance abuse expertise, to expand our capacity to provide in -house assessment and counseling
services.
In April 1999 we began joint service planning with the Neighborhood Place. We also began integration of outreach services into the
program with the use of the NPK outreach worker. In July, 1999 we were awarded a four year contract with DHS -CWS to provide
short term social services to families reported to CPS but assessed to be at low to moderate risk. These families are referred to the
Diversion Program. We have integrated this program with the Title IV -B project administratively to provide a continuum of care for
families. Those families needing longer than three weeks intervention (maximum service time allowed by the Diversion Contract)
can now be automatically transitioned into the Title IV -B project or to the Neighborhood Place.
In July 1999 we began development of the Adoptive Services component of the project. Working with DHS, CFS and QLCC we
developed a referral protocol and identified needed services. These are: transitional counseling for children moving from foster care
to adoption and for foster parents becoming adoptive parents; pre and post adoptive crisis intervention; long term post adoptive
support.
In September 1999 we started the first in a series of parenting classes for caregivers in substance abuse recovery. These classes are
held at the NPK and have been very successful. We are beginning our third series of classes at this time and are fully booked, as we
were with the first two sessions. These parenting classes are the only ones in West Hawaii specifically designed to address the unique
needs of substance abusers in recovery.
In October 1999 project evaluation was expanded to include both a three -month and a six -month follow -up of families who completed
a service plan and were successfully discharged. The results of these follow -up contacts should provide us with good information on
the long-term safety of the children involved.
All of the objectives of the project have been met to at least a minimal degree. At this time the action steps planned are
1) Continuous upgrading of the project database
2) Ongoing planning between the Regional Planning Committee, DHS, NPK and KCPC to develop services, ensure seamless and
timely referrals, and prevent duplication.
3) Hiring of additional counselor with substance abuse treatment expertise —Jan-Feb 2000
4) Augmenting existing direct services - Ongoing
5) Working with the state legislature to securing additional funding for long term family treatment of substance abuse - 2000
4) What significant client centered outcome(s) will the program achieve?
KCPC staff members work with each client to develop an individualized service plan that identifies the targeted personal outcomes to
be achieved and the services to be provided to achieve those outcomes. As part of the individualized service plan, each client
outcome to be achieved has corresponding behavioral objectives to be met.
80% of clients referred will be fully assessed to determine their status and service needs
85% of families that complete a service plan will have had no new report of child abuse or neglect at discharge
85% of families that complete a service plan will have established and implemented a child safety plan at discharge
85% of clients completing their service plans will demonstrate improvement in one or more of the following targeted areas:
Improved individual functioning
Improved problem solving skills
Improved family relationships
Improved parenting skills
Improved family support
50% of clients completing their service plans will still be engaged in a substance abuse recovery process at discharge
5) How many participants /clients will attain at least one personal program outcome or show measurable progress
towards program goals?
We anticipate being able to serve 125 families with available funding. We estimate that we will serve 175 individuals within these
families. Forty percent (50 families, 70 individuals) will need assessment services only or assessment services with linkage to other
services in the community. Sixty percent (75 families, 105 individuals), will establish an individualized service plan. Seventy-five
percent (56 families, 79 individuals) will complete their individualized service plan and eighty-five percent of these clients, or 67
individuals, will attain at least one personal program outcome or show measurable progress towards program goals.
•
E. Service Delivery
As described above, service delivery will be accomplished through a combination of staff delivered services, payment to contracted
service providers and linkage with other agencies. Services will be delivered in clients' homes, the KCPC office, the NPK, and other
community providers' locations. Methodologies will include any and all social service interventions identified as appropriate to meet
family member needs.
F. Evaluation
•
1) Client evaluation and progress measurement.
Kapi'ol•ild Protection Center - West Hawaii
Page 6
The Coordinator will make an initial determination with the client of the service needs, goals, objectives to be met and outcomes to be
achieved. A child safety assessment will also be completed at Intake. A discharge interview will take place at the conclusion of
services to determine a client's assessment of whether needs have been met and goals and outcomes have been achieved.
Written progress reports will be completed by staff and contracted providers to clinically assess a client's movement and progress in
meeting goals and achieving outcomes. Frequency of reports will be determined at the time the individualized service plan is
developed. Progress reports will evaluate client outcome achievement using progress measures established in the service plan.
Prior to discharge, and if indicated, during the course of service involvement, project staff will complete a second child safety
assessment to evaluate client progress in relation to child safety. Additionally, prior to discharge, each client will be asked to develop
and implement a child safety plan. The client will take responsibility for identifying each child's needs and indicating how they will
meet those needs and ensure the child's safety and well being over the long term.
Throughout a family's participation in the project, and at case closure, feedback will be solicited from DHS -CWS social workers to
determine if there have been any new CPS reports, and to determine if children have been removed from the home, reunified with
their primary caregivers or transitioned for adoption.
Three months after a family has completed their service plan and the case closed, KCPC staff will contact the family by phone to
check on the safety of the children and well being of all family members and offer additional assistance, if needed. CPS records will
also be checked again to determine if there have been any new CPS reports.
Six months after a family has completed their service plan and the case closed, KCPC staff will make a home visit to talk with family
members in person, again checking on the safety of the children and well being of all family members. A third and final check of
CPS records will also be made.
2) Project evaluation.
At the time of discharge, clients will be asked to complete a client satisfaction inventory to determine their satisfaction with services
and how they were delivered.
On a quarterly basis, the Regional Planning Committee will review service delivery.
On a yearly basis, DHS -CWS social workers will be asked to complete a project satisfaction inventory to determine their satisfaction
with services and how they were delivered.
On a yearly basis, DHS Program Development will complete a site visit to review and evaluate the project.
G. Program Fees
1) Does your organization charge a membership fee for service participants? No
2) Does the proposed program charge participants a fee for service(s) provided by your organization?
No, all services are free to the client with one exception. If it is determined, during the individualized service planning process, that it
would be beneficial for the client to share in the cost of services (such as to show their commitment to services or because services are
Court mandated) a client may be asked to pay a contracted provider a portion of the service fee. If it is determined that a client's
health insurance will cover the cost of a service, that client's health insurance will be billed.
H. Viability
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Kap • Child Protection Center - West Hakaii
Page 7
1) What is your justification or rationale for the expenditure of public funds for the proposed program?
Our main rationale for the expenditure of public funds is that we feel the community has a responsibility to promote the safety and
adequate care of children. Abuse of drugs and alcohol has become epidemic in West Hawaii, resulting in great harm both to children
and their parents. Intensive and long -term services are needed to help these families recover from substance abuse. Most of these
parents are not able to provide appropriate care for their children without life skills and parenting education, counseling and other
supportive assistance. Many of these parents do not have the financial means to obtain the help they need. Use of public funds is
therefore appropriate, especially if it saves even one child from abuse or neglect.
2) What are your financial and programmatic plans to sustain the proposed program beyond the upcoming fiscal year.
Federal funding for the project has been committed through June 200Iand will quite likely be renewed for another five years when the
current funding expires. As a member of the Child Abuse and Neglect Legislative Roundtable, the Branch Administrator is working
with DHS and DOH administration and key state legislators to develop additional funding for family treatment services. We will
continue to work with the State Department of Human Services, the West Hawaii Regional Planning Committee, the Blueprint For
Change Task Force, the County of Hawaii and other funding sources to evaluate the effectiveness of the project and obtain long-term
funding.
I. Budget
Please see attached.
ORGANIZATION /AGENCY INFORMATION
A. Board of Directors
1) Has the organization's Board of Directors received formal training within the past two (2) fiscal years?
a) What plans do you have to provide formal training to your current Board of Directors?
The Board of Directors of KMCWC meet with all Executive members as well as Board Chairpersons on a regular
basis. They are provided with "The Board Book" which is a comprehensive manual containing KMCWC
organizational information and their role and responsibility as a Board member. The manual is regularly updated to
provide the Board members apprised with the most current organizational information.
b) When will the next Board training be completed?
Board training is ongoing as members feel the need to meet with Executives about various areas of the organization.
The Board Book is also updated annually.
c) How will you provide formal training to newly arriving board members or board members who missed
scheduled training?
New Board members will meet with each Executive member and various Board Chairs and will be provided
with "The Board Book" and "The Board Book, Appendixes ".
2) What are the primary roles and responsibilities of your organization's Executive Director.
The primary roles and responsibilities of Kapi'olani Medical Center for Women and Children's Executive Vice President & CEO is to
provide leadership, direction, and administration of all aspects of hospitaWmulti- hospital activities and other corporate entities to
ensure compliance with established objectives and the realization of quality, economical health care services, and other related lines of
business. The KMCWC Executive Vice President functions as a member of the KH executive management team to fulfill the mission
of the medical center within the context of a comprehensive health care system.
The primary roles and responsibilities of the Kapi'olani Child Protection Center's Hawaii Island Branch Administrator include hiring,
supervision, evaluation, and termination of staff for both the East Hawaii and West Hawaii offices; program development and
accountability; budget preparation and accountability, grant writing; networking with other community agencies; provision of direct
consultation and coordination services and other activities to ensure that quality services are effectively delivered.
3) What are the primary roles and responsibilities of your organization's Board of Directors? (Clarify role of executive
officers vs. General membership)
The primary roles and responsibilities of Kapi'olani Medical Center for Women and Children's Board of Directors are to attend board
meetings and exercise such powers as acquire and dispose of property, elect officers and appoint agents, determine all matters
affecting finances, make rules and regulations, create committees of the Board, and generally, to do any lawful act necessary or proper
to carry into effect the powers and purposes of the medical center. The Board's role and responsibilities are further described in the
enclosed Bylaws of KMCWC.
B. Past Performance
•
1) How effective has your organization /agency been in achieving program goals in the past two (2) fiscal years? Include
the following information: a) Quantitative data on numbers served; and b) Qualitative data showing number and °A,
of participants achieving measurable outcomes.
Clients Served
Please see information listed below.
Targeted Outcomes
TITLE IVB COUNSELING & SUPPORTIVE LIVING PROJECT
Kapi'ol Protection Center - West Hawaii
Page 8
FY 1997 -98 (10/1/97- 6/30/98) FY 1998 -99 (7/1/98- 6/30/99)
(10 Month Contract Period) (12 Month Contract Period)
# Families Referred 126 107
CPS Diversion 7 5.6% 24 22.4%
Active CPS 58 46.0% 35 32.7%
Non -CPS 61 48.4% 48 44.9%
# Adults Referred 189 169
# Children Referred 247 239
# Families Who Received Direct Services 118 104
# Adults Who Received Direct Services 122 124
# Children Who Received Direct Services 26 34
# Families Who Refused Services or No
Contact established 8 7
Achievement of Proposed Outcomes (Closed Cases Only)
FY 1997 -98 (10 Month Contract) FY 1998 -99 (12 Month Contract)
Number Percent Number Percent
Total Families Closed 88 98
Families Assessed For Service Needs 58 65.9% 81 82.7%
Families Who Established a Service Plan 55 62.5% 72 73.5%
Families Who Completed a Service Plan 44 80.0% 56 ' 77.8%
Families who had no new report of child
abuse /neglect at case closure 88 100.0% 95 96.9%
Clients who maintained Substance Abuse Recovery 22 78.6% 26 74.3%
Clients who improved individual functioning 25 80.6% 41 80.4%
Clients who improved problem solving skills 16 80.0% 31 81.6%
Clients who improved family relationships 22 91.7% 26 81.3%
Clients who improved parenting skills 6 75.0% 13 92.9%
Clients who improved family support 5 83.3% 9 88.9%
Targeted outcome data is collected on individual family members who complete a service plan only.
Financial
•
Kap i Child Protection Center - West Ha&vaii
Page 9
1) Have your organization's current program operations remained the same as last year? What major program or
financial changes will be incurred next year?
On June 30, 1999, KCPC completed its subcontract agreement with Family Support Services of West Hawaii to provide services for
the Comprehensive Partnership For Families (CPFF) program. KCPC chose not to continue this contractual relationship beyond the
initial contract period. On July 1, 1999 KCPC was awarded a four year DHS contract to provide Child Abuse and Neglect Diversion
Services. This program has been integrated with the Title IV -B Counseling And Supportive Living Project to ensure a continuum of
care for families at risk.
The West Hawaii Title IV -B /2 project received a 10 percent funding increase for fiscal year 1999 -00. This increase was primarily to
allow for three and six month follow -up of families completing their service plans. We anticipate that there may be an additional small
funding increase for the Project next year, as Federal Title IV -B funds will be increased.
2) What is the status of all of your organization's major contracts or agreements for the coming year (employment
agreements, office leases, primary grant revenue /supplier, etc.)?
Our current Title IV -B Counseling and Supportive Living Project contract with DHS was renewed on July 1, 1999 and has an
automatic renewal option to June 30, 2001 if services have been effectively delivered, which they have. Our Multidisciplinary Team
contract with DHS expires on June 30, 2001. Our DHS CA/N Diversion contract was awarded on July 1, 1999 and expires June 30,
2003.
Employment agreements with staff are ongoing and expire only when an employee resigns or is terminated for cause. Contracts with
other agencies and private practitioners expire on June 30, 2000 with automatic renewal for one year if services are effectively
delivered. Our current lease with Xerox for a copier expires on June 30, 2000 and will be renewed. Our current office lease expires
on June 30, 2000, with an option to renew for two more years.
3) How does the proposed program fit into your organization's long range financial plan?
The West Hawaii Counseling and Supportive Living Project currently represents about one half of the revenue in the KCPC West
Hawaii office. As with other DHS contracts, the viability of this program is always subject to the availability of govemment funds.
Federal Funding of the Project may be renewed for another five years once the current funding period expires in 2001. The State's
commitment to long range funding for this program is yet to be determined. At this time, Kapi'olani Medical Center for Women and
Children cannot commit to long range funding of this program without government support. It is therefore not included in
KMCWC's long range financial plan.
D. Monitoring
1) During the past two (2) years, what financial and /or administrative monitoring has your organization received from
any and all funding sources?
Monitoring has been provided by the State of Hawaii Department of Human Services. Monitoring has included site visits and review
of quarterly financial and program reports. The DHS program monitor for the Title IV -B Counseling and Supportive Living Project is
Laura Giddings (phone - 974 - 4000 -6 -5692 or 1 -(808) 586 - 5692).
Monitoring has been provided by the Hawaii Island United Way. Monitoring has included a site visit by the allocations committee
prior to determination of funding approval and review of quarterly financial and program reports. Information on HIUW program
monitory may be obtained from Carol Feldman, Vice President (phone 326- 7400).
The County of Hawaii has also provided monitoring. Monitoring has include a site visit by County Council members prior to
determination of funding approval and review of semi - annual and annual reports to the County Council. Information on County of
Hawaii program monitoring may be obtained from Helen Matsui (phone 961 - 8259).
•
E. Alcohol, Tobacco and Drug -Free Workplace Policies and Information
Kapi'ola 'Id Protection Center - West Hawaii
Page 10
1) How does your organization address alcohol, tobacco and other drug prevention information dissemination as part of
your workplace and /or program environment?
Kapi'olani Health has established "House Rules" and a "Drug Free Workplace Policy ". These documents are provided to all
employees of KCPC as part of orientation.
The West Hawaii Counseling and Supportive Living project has as one of its main purposes the reduction or elimination of alcohol
and drug abuse. Substance abuse information is disseminated to clients in various ways; through counseling, literature and medical
consultation. Clients are not provided services while under the influence of drugs or alcohol.
POSITION TITLE -.'
;' ..'`PRECEDING FLSCALYEAR: ""
:r `' "a: +.` : °= :FIS =01 =;
Item
#
' Employee ' - • `„
(Last Name=First)., :: , '.
Status
' and: .
Salary,
Total Agency Budget
FY 99 -00
Total Program Budget
FY 99 -00
Total Agency Budget
FY 2000 -01
Total Program Budget
FY 2000 -01
;: & n
i t Request 'Only `
rP r d j e ctedE a ipenditures"
I.
Title: Branch Administrator
g.
F/T - 40 hours /wk
P/T - 9 hours/wk
F/T - 40 hours/wk
P/T - 11 hours/wk
Name: Mary Jo Westmoreland
$._;
$48,502
$10,992
$48,502
$13,338
2.
Title: Clinical Therapist
P
F/T - 40 hours /wk
P/T - 24 hours /wk
F/T - 40 hours /wk
P/T - 28 hours /wk
Name: Fran O'Leary Duntz
$- :
$48,376
$29,173
$48,376
$33,864
all Title:
Clinical Nurse Specialist
P ?
P /T -25 hours /wk
P/T- 10 hours /wk
P/T -25 hours /wk
P /T- 10 hours /wk
Name: Carol Dinmore
$ .
$30,004
$12,002
$3 0,004
$12,002
4.
Title: Service Coordinator
A ;
F/T - 40 hours/wk
P/T - 28 hours/wk
F /T -40 hours /wk
P/T - 28 hours /wk
Name: Lianne Masutomi
- $ : ;
$23,611
$15,635
$31,200
$20,800
5.
Title: Clinical Care Coordinator
P. .
P/T - 20 hours /wk
P/T - 6 hours /wk
P/T - 20 hours /wk
P/T - 6 hours /wk
Name: Rebecca Transue
; "$ "::
$24,720
$8,880
$20,800
$6,240
6.
Title: Clinical Care Coordinator
P '; -
P/T- 16 hours /wk
P/T - 13 hours /wk
P/T- 14 hours /wk
P/T -10 hours /wk
Name: Tonnie Bemhardson
$ - ':
$12,140
$9,384
$13,650
$9,750
7.
Title: Clinical Therapist
P''
P/T - 16 hours /wk
P/T - 16 hours /wk
P/T 16 hours /wk
P/T - 12 hours /wk
• Name:
To Be Hired
; $.
$8,320
$8,320
$16,640
$12,480
Title: Branch Secretary
F/T - 40 hours /wk
PIT- 16 hours /wk
F /T- 40 hours/wk
P/T - 16 hours/wk
Name: Barbara Eldridge
;';:S . "
$26,200
$10,425
$26,200
$10,425
9.
Title: Clerk Receptionist
P =
P/T - 15 hours /wk
P/T - 11 hours /wk
P/T - 20 hours /wk
P/T - 17 hours /wk
Name: Joy Decker
$
$7,941
$6,002
$13,728
$9,724
• TOTAL POSITION COUNT - , ,
P
9 = 6.3 FTE /wk
3.325 FTE /wk
9 = 6.775 FTE /wk
3.275 FTE /wk
.TOTAL SALARJBS ?:;:.
(to be reflected in Table 4):,
AGENCY /ORGANIZA'T'ION: Kapi'olani Child Protection Center
PROJECT NAME Title IV -B Counseling & Supportive Living Project
BUDGET TABLE 1
DETAILS OF PERSONNEL SERVICES
1. All administrative and Direct Program Salaries must be included. (Please exclude non - program positions)
2. a) P= Indicate if whether employee is -- F/T =Full Time Employed (30 -40 hours per week)
b) P /T= Part-Time Employed (20 or less hours per week)
. ;�. .:.
:POSITION 'TITLE ,; -, ' : '
i $' r t
PRECEDING FISCAL :YEA1U K 4 .,
a 2v l .'vrtis
rii':'Y: i
^= :.� ' F ' °�' ��""��''y: ° �"�` �' ��'i
FLSCAL:YEAR 41.'
Item
#
. `.::A 'a e. T ,. .,. ..
- ''.; <:`'. " ,"Emp10 ee - ` .. '': ° ;.::: ;,
p y
(test Name,. First). , - ;' >
' -
......
.: .,'
Status
_ and.,,
„ Salary-
Total Agency Budget
FY 99 -00
Total Program Budget
FY 99 -00
Total Agency Budget
FY 2000 -01
Total Program Budget
FY 2000 -01
f,S »yd.' .u+4t ": j .,... .'... «.:
;„ trea +Requ Only,)w
Pro'ected enditiires
10.
Title: Team Coordinator
P, .
P/T — 12 hours /wk
P /T— 12 hours /wk
Name: Susan Johnson
$-'
$9,000
$9,000
11.
Title: Clinical Nurse Specialist
YP: =
P/T -4 hours /wk
P/T — 4 hours /wk
•
Name: Colleen O'Sullivan
"•' $-, `
$3,500
$4,500
12.
Title: Clinical Nurse Specialist
:`.P;:' -[
P/T — 4 hours /wk
P/T — 4 hours /wk
Name: To Be Hired
= '- '$i. ";.
$4,500
P/T — 4 hours /wk
et
•
x;P
TOTAL POSITION COUNT,' : "; :
' :'P "
12 = 6.8 FTE
9 = 3.325 FTE
12 = 6.775 FTE
9 = 3.275 FTE
, , : T O T A L SAL', ARIES, ' _'''` ` ', " ""
(to be reflectediri Tabia 4
, $
$246,814
$110,813
$262,524
$125,243
AGENCY /ORGANIZATION: Kapi'olani Child Protection Center
PROJECT NAME Title IV -B Counseling & Supportive Living Project
BUDGET TABLE 1
DETAILS OF PERSONNEL SERVICES
INSTRUCTIONS:
1. All administrative and Direct Program Salaries must be included. (Please exclude non - program positions)
2. a) P= Indicate if whether employee is -- F/T =Full Time Employed (30 -40 hours per week)
P/T= Part-Time Employed (20 or less hours per week)
b) Salaries
DESCRIPTIONS " ,
.' PRECEDING FISCAL YEAR;; . ,,
AR00 =01
s, ", 's.FISCAL YE20
Item
Emplo Beaefit Taxes'",
Total Agency Budget
FY 99 -00
Total Program Budget
FY 99 -00
Total Agency Budget
FY 2000 -01
Total Program Budget
FY 2000 -01
.: Grant Request Chtly�
r;' `. 'Projected . -.. ;,i
Expendituresa< ;. ,
2,
EMPLOYEE BENEFITS
(TOTAL)
$24,411
$10,557
$10,557
$24,856
;•' °.;
$11,653
I Health
Insurance 9.05%
$18,228
$7,883
$18,560
,
$8,701
Dental Insurance (Included Above)
*
Other Benefits (Retirement) 3,07%
$ 6,183
$2,674
$6,296
$2,952
3.
PAYROLL TAXES (TOTAL)
?' :
$21,991
$ 9,873
; ''
$23,391
: "
$11,159
•
FICA 7.65%
$18,881
$8,477
$20,083
$9,581
FUI (Unemployment Ins.) .33%
$ 815
$ 366
$866
$413
SUI (Unemployment Ins,) 0%
0
0
0
0
='
Workers' Compensation .93%
$2,295
$1,031
$2,442
; -'
$1,165
; '• 7Y,
TDI (Disability) 0%
0
:,...- , ` ,
0
0
0
f:. :..':.
TQTAI . .:':'.:; ;`:,:.;:.•:..
ttj lie''ceflected.'inTalile4)` " - ". '
$46,402
$20,431
$48,247
$22,812
AGENCY /ORGANIZATION: Kapiolani Child Protection Center
d
TABLE 2
EMPLOYEE BENEFITS/PAYROLL TAXES
PROJECT NAME: Title IV -B Counseling And Supportive Living Project
= MUST itemize as attachment(s). Applicable only to the ' Grant Request Only Projected Expenditures" column
ll ESCRIPTiON': '
`P RECFI : '
EDING SGAI;sYE:4R '''a
X
....,,. .., .... .. ...'3e
<, �tr a( �. �.
is +' °r;:�:�°J- '.FSCAI.YE:AEt 2000=
A n ✓ r ,, .}, .
''K' f..� ''G� n N `.. _(.. 1{.'�tkv :.'e5: `� m�` 3 .. �4:
`�:'.$. r .....,1. ..., , .Yt, v..'4a ...._.... � > ..- ...- ..K. .r.�.xc�".:k 5 w: *!. .w ...
Item
Expeii :,. a: , : -' ,;:..
". f.,., , : =: "" "'
Total Agency Budget
FY 99 -00
Total Program Budget
FY 99 -00
Total Agency Budget
FY 2000 -01
Total Program Budget
FY 2000 -01
.Gr egitReifue%stOrk
s n pltCletxa
k:w _ . ,., ; teci , ..4, es
1 •
PROFESSIONAL FEES (TOTAL)
``
$98,329
, "; :','`'. %;
$49,592
'v'w zs : "; -.
$102,005
>; -i "- ?"
$55,743
$3,957
Legal (Incl in Admin Fees)
Accounting/Bookkeeping(Admin)
a s Audit
Fees (Incl in Admin Fees)
J
" " > " "' `
': "'' r
; "" ;:
li
Administrative Fees I5%
0
$46 264
e ..:°
$17,532
r- =;>
$48 870
'�;�µ�," t:'
$20 138
t. 1�
^-`
$1 957
*
Other (Professional Services)
$52,065
�::
$32,060
;:_ :_
$53,135
- '' ": tl;Y'< =,`:« .;
$35,605
q ya
$2,000
$1,043
2•
SUPPLIES
x` ;:'. 'r:
$3,131
°' :.t;'' "`"''
$1,500
= =? `, =, -
$4,435
"i'=
$2,260
` ".' :Pt
Office
$2 306
°� :: M,�
$1 100
.r "''
rr _ ,Fr
'.
$2 785
�
a ":' ;A:
05 ::,.'e:
$1 560
" ^ ,.
: <;:t. �-:t;.:
:''.�`s �.q #:'4":'.
$743
,st` +�•$.a^'..
Program
$125
$75
z
`:'�
$450
_c<_< -
Vii- �
$375
.'z, �,�i.
$300
Consumable
$700
s...'
$325
'
^ 'ixyi Y. �'h "{' '!tLt
$700
"t : +'
'�R'f'�: G.d ^+•�•ti i''"µ';
$325
` r %M:
��. ^��r
3.
TELEPHONE
",`a'•`.; -�
$ 4 050
`'':; "s' :, , s sx
<:;.�
$2,025
a
�,.- ��'�
$4,050
* „ k� _' .
- ;;'f. r..��'
$2,025
4.
POSTAGE & FREIGHT
629
$_
", '
� ... x'`
. e�::Y�+N..R ^•� a
$297
pw> :',:
k.
�xLt'', bfi t.''..
$726
" ! :iEry "'
-r
T�4•xY•":
$396
't is `f `.a i
Al OCCUPANCY
k
(TOTAL)
i ' : Fri:
$12,975
'';
$8,775
?
$13,530
= " <'x ;;}s74? :
$9,225
" _ - ' -:.'°
$8,000
Rent
$9,825
$7,225 $7,225
a t'.
.._- yy =.
$10,380
:; .; .._:." : €x
L
$7,675
�,
r °:::¢;
$6,500
Utilities
$3,000
':':a
$1,500
;r:ta�
�["-- �•>t•Y*
$3,000
�: µ' *'
''iS.: ,
$1,500
"'_ ``'
"AiY°'ti`. Y:'.e
$1,500
r�fi,'.?'A °S -,
Janitorial
"�::.
w
>.
•,'- :; : ° :.
ri p. t om..= .
_..
rs
*
Repairs and Maintenance
150
$150
- :` . -�
$ 50
t` "± " `
.. ?.:i.i �1 •�
$150
.a:�,'
�
� t ry'x ',Y "� ? '
$50..:_:
,xY�x' "•= '" ;.
:: •'
' A + 4...i y# . � .,
6.
EQUIPMENT (TOTAL)
$3 , 000
a.. -,� _ '
, 850
$1,850
:
s' . �:�'�
$7 300
,
'i.i ii "'w'. w
"' "' "' `
$6
$6,150
a' °ae
'� .,A
s
$5 f 000
*
Purchase
$700
r ,
$700
$5,000
'r °"
��r:n3•
$5,000
x'
.,� r�;°w r3�
$5,000
*
Rental
$2,050
w t i
$1 , 025:
{k(f� m�
$ 2 J 050
"``''
� b:4 I
$1,025
*
a
Repairs and Maintenance
$250
. :."k`. x:'4 i. �
$125
' ' ' i
�:.L'. -: .
$250
` - °xi ; ' '
' ✓k ::."f'L`�*...
$125
'.C��i�S »�•�k
e: 93.''i _nw
AGENCY /ORGANIZATION: Kapiolani Child Protection Center PROJECT NAME: Title IV -B counseling And Supportive Living Project
TABLE 3
DETAILS OF OTHER CURRENT EXPENSES
* = MUST itemize as attachment(s). Applicable only to the "Grant Request Only Projected Expenditure" column.
Y
AGENCY /ORGANIZATION: Kapi'olani Child Protection Center
Project
TABLE 3 (Continued)
DETAILS OF OTHER CURRENT EXPENSES (OPERATING COSTS)
PROJECT NAME: Title IV -B Counseling And Supportive Living
DESCRIPTION,' i
Item ,
•1I
7.
•
10.
•
12.
13.
*14.
*15.
INSURANCE (TOTAL)
General Liability (In Admin Fees)
Fire (In Admin Fees)
Auto (No Client Transport)
NDOA (Board Insurance) (Adm Fees)
PRINTING
PUBLICATION & SUBSCRIPTIONS
TRAVEL (TOTAL)
Air Fare
Per Diem
Auto Rental
AUTO MILEAGE REIMBURSEMENT
AUTO GASOLINE PURCHASES
MEMBERSHIP DUES
STAFF TRAINING
OTHER
TOTAL;(ta be reflected .ht:TableS),.
PRECEDING FISCAL'.YEAR
Total Agency Budget
FY 99 -00
$300
$180
$75
$50
$175
$555
$4,266
$3,000
$130,160
Total Program Budget
FY 99 -00
$100
$60
$25
$25
$75
$185
$1,805
$2,000
$68,129
:FISCAL NEAR20004-0
Total Agency Budget
FY 2000 -01
$300
$180
$75
$50
$175
$555
$4,375
$3,000
$140,201
Total Program Budget
FY 2000 -01
$100
$60
$25
$25
$75
$185
$2,025
$2,000
$80,109
=Grant Request Only,
xpenenifes ,
$2,000
$20,000
* = MUST itemize as attachment(s). Applicable only to the "Grant Request Only Projected Expenditure" column.
P ostuon
: PRECEDING FISCA YE � ` _ : ::
: • { FI$CA4 EAB'200
. ''> . r `• '�' '.
''):...::;�'.:G-' : .::.,.:,'- „F >:.....�. %•';?
• '
Total Agency Budget
FY 99-00
Total Program Budget
FY 99-00
Total Agency Budget
FY 2000-01
Total Program Budget
FY 2000-01
' ,GrantRequest;;: M ''
'On1y,” •pz;; ".;;;'
It 1) TOTAL POSITION COUNT (P)
6.8 FTE
3.325 FTE
6.775 FTE
3.275 FTE
(Table 3) TOTAL OF OTHER CURRENT EXPENSES
(Table 1) TOTAL SALARIES ($)
$246,814
$110,813
$262,524
$125,243
,`•'';`'• '? TOTALBUDGET ; ';�`.'';::�.;. : �y?�
(Table 2) EMPLOYEE BENEFITS/PAYROLL TAXES
$46,402
$20,431
$48,247
$22,812
.TOTAL PERSONNELCOSTS si'
$293,216
$131,244
$31Q771
$148,055
zTQ TALNUMBER'OE•,POSITIONS 4 rc -;.`' `''t`'
12
9
12
9
. .. ............ _. _.... _. _ _.
Ek rises z-. ,:, . : }
,." .Pe.. ... �
... . ». ..... .,, .. .. , 3 ''''�`- �.. •,
' RECEDIN PISC ""
a . .. .. e .
. " Total
CC ISCAI:.YEAR2000 -01
: ..£ ... �t '•:,. Sv „fin " ,i i5
Total Agency
enP Budget
g y g
FY 99 -00
Pro Budget
g g
FY 99 -00
Tota Agency Budget
Total
FY 2000.01
Total Program Budget
FY 2000 -01
":OrentReij4es{Onlp::.
(Table 4) TOTAL PERSONNEL SERVICES
$293,216
$131,244
$310,771
$148,055
(Table 3) TOTAL OF OTHER CURRENT EXPENSES
$130,160
$68,129
$140,201
$80,109
$20,000
,`•'';`'• '? TOTALBUDGET ; ';�`.'';::�.;. : �y?�
$423,376
$199,373
$45Q972
$228,164
$2Q000
AGENCY /ORGANIZATION: Kapi'olani Child Protection Center PROJECT NAME: Title IV -B Counseling And Supportive Living Proiect
TABLE 4
SUMMARY OF PERSONNEL REQUIREMENTS
Personnel Requirements: Salary ($) and Number of Positions (P)
TABLE 5
SUMMARY OF EXPENSES
Total Budget Summary of Personnel Services and Other Current Expenses
evenue Source
Rroe s'
PRECEDING- FISCAL YEAR,1999 00s:':r:;:rs.:.
; - ; ; ..BI YEAR
t2 C L
2004-0K
Total Agency Amount
Total Program Amount
Amount Requested
Amount Projected
County of Hawaii
$8,595
$8,595
$20,000
State of Hawaii
$219,879
$219,879
:
Federal Funds
$180,518
$180,518
$200,000
4
y,... „
Private FoundationsY4
United Way Funds
$7,500
$7,500
$10,000
Admissions
Donations
$500
Fundraising
; • ;• „ ; _ ,
Pay Phone
Vending Machines
Service /Program Fees
Third -party reimbursement(s)
Tuition
Charity Walk
$5,000
$2,760
MDT Incentive Carryover
$2,300
$1,500
: TOTAL REVENUES :,
$424,292.00
$199,373.00
$451,379.00
AGENCY /ORGANIZATION: Kapi'olani Child Protection Center PROJECT NAME: Title IV -B Counseling And Supportive Living
Project
x� - Please list funding source on a separate sheet and indicate the amount requested.
_ - Must correspond with Table 5.
TABLE 6
Summary of Income
i i i '''"-• ' '''''''
R evenue S ources '..p.:'
: r t, IC .."),- 2.:,? *1:r `,..,', , • ‘''''
. ,': '': • ' , . r: 7 i; '''l ? I, ":'''' .r•r •=,' ,!,;;;■
c ';; :-/: PRECEDING FISCAL YEAR :4990;06 j. :3
, ',,f,
Jen: ...,,,; PISCALYEAR '
Total Agency Amount
Total Program Amount
Amount Requested
Amount Projected
. County of Hawaii -
$8,595
$8,595
$20,000
„`P:tit.f,'
State of Hawaii
$219,879
$219,879
:i.l lc! ; ;; ; e 2 i 1) ':, • :5 :• ',:':
Federal Funds
$180,518
• $180,518
$200,000
..."
.
Private Foundations*
c;" ,fl:-.t..r.f.I.N.,
" f;6;.vg. t.:''..it':'
United Way Funds
$7,500
$7,500
$10,000
Admissions
Donations
$500
Fundraising
"/AFA.',;;;4Y':''"'-'
'
Pay Phone
;:.97 n'="M
w- 1-1114-78X-1,Vi- . i-.'1 . :""iii:.
Vending Machines
:,„:";
kv;)1•;-..fik--."'j; ;I.e. , IV.? ' 4 ' rt
. " :, : , •`; a e:.'.....f ''''.,, e Aw“ It
Service/Program Fees
!.
g :•, :fr.. ;•4,- 4
%.
...‘...4::,(s:,,- ••4;`■ ?,,C ',
Third-party reimbursement(s)
• -,4'.4,1s,'-',.-. -..,- *I v- ::,;,,, e
Tuition
-cr,:9-,-sriiiii
c ,t ,■ ,„; i,i:, ' , y7s, ,, ,',
Charity Walk
$5,000
$2,760
MDT Incentive Carryover
$2,300
$1,500
7 '7TOTAL REVENUES „.“ '','
$424,292.00
$199,373.00
$451,379.00
AGENCY/ORGANIZATION: Kapi'olani Child Protection Center PROJECT NAME: Title IV-B Counseling And Supportive Living
Project
- Please list funding source on a separate sheet and indicate the amount requested.
_ - Must correspond with Table 5.
TABLE 6
Summary of Income
Stephen K. Yamashiro
Mayor
(ountp of TOatuaii
DEPARTMENT OF FINANCE
:5 Aupum Street. Room 118 Hilo, Hawan 96720 -4252
(8081961 -8231 • Fax (8081961 -8248
HAWAII COUNTY NONPROFIT GRANTS (FY 2000 -01)
FINANCIAL OIJESTIONNAIRE
Please include as an attachment an explanation for all "NO" answers to questions tt 1 thru 11 below:
Yes No
Harry A. Takahashi
Dv;.L r
S. K. Schutte
Dcptcty
0 C5 1. Has the agency operated continuously for the past three (3) years?
d 0 2. Has the agency operated with a positive cash flow for the past (3) years?
0 05 3. Does your Board of Directors approve a detailed cash flow budget before the beginning of
each fiscal year?
(5 d 4. Do your Board meeting minutes show that quarterly financial statements are approved?
Financial statements are reviewed and discussed at the board mtgs.
C: (5 5. Is your equity balance at least 20% of your Total Liability balance?
Q 0 6. Is your Total Current Asset balance larger than your Total Current Liability balance?
7. Are bank reconciliations and accounting performed by someone other than the check signatory?
e U 8. Are you fully insured for the agency's vehicle(s) and building(s)?
cS (iac 9. Is your Workers' Compensation at least 2% of payroll?
Self — insured
0 L) 10. Are you current (not delinquent) on all payroll and payroll tax payments?
o 11. Is the agency free of any pending litigation, liens or judgments?
12. Within the past 12 months, has the agency applied for vendor or bank credit and was
As the grant applicant, I certify that the agency has satisfactorily responded to each of the above questions and explained as
needed I hereby certi that this information is true and correct to the best of my knowledge.
Agency: Kani'olani Medical Center for Women Phone: 535 -7350
Prepared by: Donna Masuda-Kam, Director of Accounting 2 VC/9v
and Children 76
Signature Date
Print Name/Title
denied credit? If yes, please explain.
Certified by: Frances Hallonquist, Executive Vice
Print Name of Executive Director President and CEO
• •
Combined Financial Statements
Kapi`olani Heal h
Years ended June 30, 1999 and 1998
• •
Kapi`olani Health
Combined Financial Statements
Years ended June 30, 1999 and 1998
Contents
Report of Independent Auditors 1
Financial Statements
Combined Balance Sheets 2
Combined Statements of Operations 4
Combined Statements of Changes in Net Assets 5
Combined Statements of Cash Flows 6
Notes to Combined Financial Statements 8
EI ERNST &YOUN•P
October 7, 1999
except for Note 10, as to which the date is
October 18, 1999
•
• 2400 Pauahi Toss
1001 Bishop Street
Honolulu, Hawaii 96813.3429
Report of Independent Auditors
• Plane: 808 531 2037
Board of Trustees
Kapi'olani Health
We have audited the accompanying combined balance sheets of Kapi'olani Health as of
June 30, 1999 and 1998, and the related combined statements of operations, changes in
net assets and cash flows for the years then ended. These financial statements are the
responsibility of the Company's management. Our responsibility is to express an opinion
on these financial statements based on our audits.
We conducted our audits in accordance with generally accepted auditing standards. Those
standards require that we plan and perform the audit to obtain reasonable assurance about
whether the financial statements are free of material misstatement. An audit includes
examining, on a test basis, evidence supporting the amounts and disclosures in the
financial statements. An audit also includes assessing the accounting principles used and
significant estimates made by management, as well as evaluating the overall financial
statement presentation. We believe that our audits provide a reasonable basis for our
opinion.
In our opinion, the financial statements referred to above present fairly, in all material
respects, the combined financial position of Kapi'olani Health at June 30, 1999 and 1998,
and the combined results of its operations and changes in net assets, and its cash flows for
the years then ended, in conformity with generally accepted accounting principles.
Ernst & Young uP is a member of Ernst &Young International, Ltd.
-t t lower-LT'
1
Assets
Current assets:
Cash and cash equivalents
Net patient accounts receivable, less allowance for
doubtful accounts (1999- $14,603,000;
1998 - 511,888,000)
Other receivables
Inventories
Funds held by trustee under bond indenture agreement
(Notes 1 and 5)
Prepaid expenses and other current assets
Total current assets
Assets whose use is limited or restricted:
Designated by Board for expansion:
Cash and cash equivalents
Accrued interest receivable
Investments (Note 2)
Rental property
2
Kapi`olani Health
Combined Balance Sheets
Project funds held by trustee under bond indenture
agreement (Notes 2 and 5)
Restricted by donor or grantor
Cash and cash equivalents
Grants and other receivables
Rental property
Investments (Note 1)
Total assets whose use is limited or restricted
Property and equipment, net (Notes 3, 5 and 7)
Other assets:
Investment in joint venture partnerships (Note 8)
Deposits and other noncurrent assets
Total assets
June 30
1999 1998
S 40,834,714 $ 15,489,629
43,395,316
3,490,544
1,659,892
8,448,618
1,762,747
99,591,831
5,084,272
700,050
116,426,434
497,430
122,708,186
105,959
1,624,913
1,366,585
959,276
4,464,844
8,415,618
131,229,763
165,756,684
53,999,437
5,762,048
1,662,519
7,565,723
1,823,253
86,302,609
6,424,938
598,078
123,043,302
497,430
130,563,748
10,736,642
1,938,379
826,411
1,084,735
3,296,487
7,146,012
148,446,402
162,228,215
1,797,226 2,606,747
7,706,636 5,361,452
9,503,862 7,968,199
$406,082,140 $404,945,425
Permanently restricted
Liabilities and net assets
Current liabilities:
Accounts payable
Payroll and related liabilities
Accrued expenses
Medical claims payable
Due to governmental agencies
Agency fiords held for others
Note payable to bank
Current portion of long -term debt (Note 5)
Total current liabilities
Accrued benefit cost (Note 4)
Long -term debt, less current portion (Note 5)
Unearned income
Other long -tens liabilities
Net assets:
Unrestricted
Temporarily restricted:
Specific purposes
Plant replacement and expansion
Total liabilities and net assets
See accompanying notes.
June 30
1999 1998
S 20,483,796
10,643,866
15,837,430
9,886,514
5,617,614
405,86.3
3,620,794
66,495,877
2,841,316
158,454,287
1,604,885
4,780,671
160,488,483
6,909,321
656,258
7,565,579
3,851,042
171,905,104
$ 20,394,752
11,612,453
12,012,813
10,815,807
3,967,027
38,457
3,000,000
2,652,740
64,494,049
2,631,847
162,056,574
1,535,107
2,633,062
161,489,768
6,064,446
651,223
6,715,669
3,389,349
171,594,786
5406,082,140 5404,945,425
3
Kapi`olani Health
Combined Statements of Cash Flows
Operating activities
Change in net assets
Adjustments to reconcile the change in net assets to
net cash provided by operating activities:
Depreciation
Amortization of bond discount
(Income) Loss on disposal of equipment
Joint venture investment loss
Net unrealized gains on investments, other than
trading securities
Decrease in restricted rental property
Restricted investment income
Changes in operating assets and liabilities:
Decrease (increase) in patient accounts receivable
Decrease (increase) in other receivables
Increase in inventories and other assets
Increase in funds held by trustee under bond
indenture agreement
Increase in accounts payable and accrued expenses
(Decrease) increase in medical claims payable
Increase (decrease) in net amounts due to third -
party payors
Increase (decrease) in liability for estimated
malpractice costs
Increase (decrease) in agency funds held for others
Increase in other long -term liabilities
Net cash provided by operating activities
Year ended June 30
1999 1998
S 310,318 S 11,625,703
16,403,011
76,929
(149,277)
278,860
(811,271)
125,459
(461,693)
10,604,121
2,271,504
(2,282,051)
(882,895)
2,917,585
(929,293)
1,650,587
27,489
367,406
2,217,387
31,734,176
14,583,586
113,368
1,894,701
440,309
(3,558,285)
131,834
(443,647)
(15,601,203)
(1,881,421)
(3,309,038)
(805,484)
9,542,746
9,036,897
(241,921)
(77,047)
(31,010)
2,633,062
24,053,150
6
• •
Kapi`olani Health
Notes to Combined Financial Statements
June 30, 1999
1. Organization and Summary of Accounting Policies
Kapi'olani Health ("KLW) controls Kapi`olani Medical Center for Women and Children
( "KMCWC"), Kapi`olani Medical Center at Pali Momi ( "KMCPM"), Kepi'olani
HealthHawai'i ( "KHH"), Kapi`olani Health Foundation and other health care related
entities located in Hawaii. KH has also organized other corporations and health care
related entities to accomplish its objectives. It controls all subsidiaries through stock
ownership (taxable corporations) and affiliates through board membership and
management (nontaxable corporations). All interorganizational transactions and balances
have been eliminated in combination.
KH is a not - for -profit support organization as described in sections 501(cx3) and
509(aX3) of the Internal Revenue Code ("IRC"). KH and all other significant combined
affiliates are not- for -profit corporations exempt from federal and state taxes on related
income pursuant to IRC Section 501(a) and the related Hawaii Revised Statutes,
respectively.
The accounting principles followed by KH, its subsidiaries and affiliates, and the
methods of applying those principles comply with generally accepted accounting
principles and general practice within the health care industry. The significant policies are
summarized below.
Inventories
Inventories are valued at the lower of cost (first -in, first -out method) or market
Property and Equipment
Property and equipment acquisitions are recorded at cost. Depreciation is computed using
the straight -line method over the estimated useful lives of the assets, ranging from 5 to 40
years for buildings and improvements and 3 to 20 years for equipment. Equipment under
capital lease obligations is amortized on the straight -line method over the shorter period
of the lease tens or the estimated useful life of the equipment. Such amortization is
included in depreciation and amortization in the financial statements. Interest cost
incurred on borrowed funds during the period of construction of capital assets is
capitalized as a component of the cost of acquiring those assets.
8
Property and Equipment (continued)
Investments
• •
Kapi`olani Health
Notes to Combined Financial Statements (continued)
1. Organization and Summary of Accounting Policies (continued)
Gins of long -lived assets such as land, buildings, or equipment are reported as
unrestricted support, and are excluded from the excess of revenues over expenses, unless
explicit donor stipulations specify how the donated assets must be used. Gifts of long -
lived assets with explicit restrictions that specify how the assets axe to be used and gifts
of cash or other assets that must be used to acquire long -lived assets are reported as
restricted support. Absent explicit donor stipulations about how long those long -lived
assets must be maintained, expirations of donor restrictions are reported when the
donated or acquired long -lived assets are placed in service.
Investments in equity securities with readily determinable fair values and all investments
in debt securities are measured at fair value in the balance sheet. Investment income or
loss (including realized gains and losses on investments, interest and dividends) is
included in the excess of revenues over expenses and reported as other revenues unless
the income or loss is restricted by donor or law. Unrealized gains and losses on
investments are excluded from the excess of revenues over expenses unless the
investments are trading securities.
Income on investments of donor - restricted funds and endowment funds is recorded as an
increase in unrestricted net assets, unless restricted by the donor. Realized gains and
losses are computed using the specific identification method.
ICH utilizes several investment managers to diversify the investment portfolios.
Investments in joint venture partnerships which are 50% or less owned are reported on
the equity method of accounting which approximates KH's equity in their underlying net
book values.
Board - Designated Assets
Board - designated assets consist of assets held by trustees under indenture agreements and
unrestricted donations and accumulated income which have been designated by the Board
of Trustees for expansion. The Board can redesignate these assets at its discretion.
9
Pledges
1. Organization and Summary of Accounting Policies (continued)
Pledges (unconditional promises to give), Tess an allowance for uncollectible amounts,
are recorded as receivables in the year made. Restricted pledges are reported as additions
to the appropriate temporarily or permanently restricted net asset balance.
Temporarily and Permanently Restricted Net Assets
Restricted net assets consist of donations and other fimds where restrictions have been
imposed as to their use by the donor for specific operating purposes. Temporarily
restricted net assets consist of those net assets whose use by KH has been limited by
donors to a specific purpose or time period Permanently restricted net assets consist of
the principal amount of net assets whose use by donors has been restricted in perpetuity.
Deferred Financing Costs
Statement of Cash Flows
Kapi`olani Health
Notes to Combined Financial Statements (continued)
Costs of issuing long -term debt have been capitalized and are being amortized over the
terms of the obligations using an interest method. The amortization is included in
depreciation and amortization expense.
Highly liquid investments with a maturity of three months or less when purchased are
considered cash equivalents.
Net Patient Service Revenue and Accounts Receivable
Net patient service revenue is reported at the estimated net realizable amounts from
patients, third-party payors, and others for services rendered. Retroactive adjustments are
accrued on an estimated basis in the period the related services are rendered and adjusted
in future periods as final settlements are determined.
Significant concentrations of gross patient accounts receivable include the Hawaii
Medical Service Association - 17 %, State of Hawaii's QUEST program - 17 %,
Medicaid - 25 %, and Medicare - 13% as of June 30, 1999.
10
• •
Kapi`olani Health
Notes to Combined Financial Statements (continued)
1. Organization and Summary of Accounting Policies (continued)
Charity Care
KH will treat patients regardless of their ability to pay. An established charity care policy
sets guidelines to determine which patients qualify for care given at no charge. Since KH
does not pursue collection from qualified charity care patients, they are not reported as
revenue. Recorded charity care provided in both 1999 and 1998 comprised less than 1%
of total revenue.
Revenues
KH's purpose is to provide diversified health care services primarily in the State of
Hawaii and secondarily in the Pacific Basin. Hence, operating revenues include those
generated from direct patient care, rentals from medical office buildings, grants,
fundraising activities, investing activities, and other revenues, all of which are either
directly related to or used in support of the operation of KH's facilities. Conversely,
unrestricted donations and disposal of equipment are reported as nonoperating gains and
losses.
HMO Premium Revenue
Premiums are billed in advance of the respective coverage period and are recorded as
revenue in the month services are provided. Group contracts are generally twelve months
in duration, subject to cancellation, and are subject to rating, benefit and other changes
negotiated on an annual basis.
HMO Medical Claims Expense
KHH contracts with various health care providers for the provision of certain medical
care services to its members. The cost of health care services provided or contracted for is
accrued in the period in which it is provided to a member based in part on estimates,
including an accrual for medical services provided but not reported to the HMO.
Reinsurance premiums are included in health care costs, and reinsurance recoveries are
reported as a reduction of related health care costs.
12
1. Organization and Summary of Accounting Policies (continued)
Fair Value of Financial Instruments
The carrying amounts reported in the balance sheet for cash and cash equivalents,
receivables, accounts payable and accrued expenses approximate fair value due to the
short -term nature of these instruments.
Fair values for long -term debt are estimated using quoted market prices of similar types
of borrowings.
Use of Estimates
Pension Disclosures
• •
- Kapi`olani Health
Notes to Combined Financial Statements (continued)
The preparation of financial statements in conformity with generally accepted accounting
principles requires management to make estimates and assumptions that affect the
amounts reported in the financial statements and accompanying notes. Actual results
could differ from those estimates.
In February 1998, the Financial Accounting Standards Board issued Statement of
Financial Accounting Standards No. 132, "Employers' Disclosure about Pensions and
Other Postretirement Benefits" (SFAS 132). SFAS 132 revises the disclosure
requirements of Statements of Financial Accounting Standards No. 87, "Employers'
Accounting for Pensions ", No. 88, "Accounting for Settlements and Curtailments of
Defined Benefit Pensions Plans and for Termination Benefits" and No. 106, "Employers'
Accounting for Postretirement Benefits Other Than Pensions." SFAS 132 does not
change the recognition or measurement of pension or postretirement benefit plans, but
standardizes disclosure requirements for pensions and other postretirement benefits. KH
adopted the provisions of SFAS 132 effective July 1, 1998.
Reclassifications
Certain 1998 balances have been reclassified to conform with 1999 presentation.
13
Acute hospital care
Managed care
Other health care related activities
Management and general
Designated by Board for expansion:
Equity securities
U.S. Treasury and agency obligations
Corporate debt securities
• •
Kapi `olani Health
Notes to Combined Financial Statements (continued)
1. Organization and Summary of Accounting Pollcin (continued)
Functional Classification of Expenses
The functional classification of expenses by major classes of program services and
supporting activities are summarized as follows:
2. Investments
Investments stated at fair value as of June 30 are as follows:
1999
1999 1998
$ 147,124,083 $ 144,722,390
55 ,371,761 29,835,324
— 2,374,327
83,890,202 82,862,577
$ 286,386,046 $ 259,794,618
$ 67,845,913
10,676,259
37,904,262
116,426,434
1998
$ 82,859,192
17,336,123
22,847,987
123,043,302
14
Notes to Combined Financial Statements (continued)
2. Investments (continued)
Project funds held by trustee under bond
indenture agreement:
Cash and short-term investments
U.S. Treasury and agency obligations
Restricted by donor or grantor.
Cash
Equity securities
Real estate
U.S. Treasury and agency obligations
Corporate debt securities
Other changes in unrestricted net assets:
Unrealized gains on other than trading
securities
Kapi`olani Health
1999
$ 599,130
7,955,447
8,554,577
676
2,808,724
53,178
1,181,779
420,487
4,464,844
1998
$ 30,607
18,271,758
18,302,365
1,019
1,764,163
53,178
1,258,053
220,074
3,296,487
Less current portion of project funds held by
trustee under bond indenture agreement 8,448,618 7,565,723
S 120,997,237 $ 137,076,431
Investment income and gains for assets limited as to use, cash equivalents, and other
investments are comprised of the following for the years ended June 30, 1999 and 1998:
1999
1998
Income:
Interest income S 6,215,919 $ 6,774,307
Realized gains on sales of securities 6,812,579 7,227,649
S 13,028,498 $ 14,001,956
$ 811,271 $ 3,558,285
15
,
3. Property and Equipment
Land
Land improvements
Buildings and improvements
Fixed equipment
Major movable equipment
Minor equipment
Capitalized leases
Construction in progress
Less accumulated depreciation and
amortization
Property and equipment, net
4. Pension Plans
•
Benefit obligation
Fair value of plan assets (primarily
marketable equity securities)
Funded status
Accrued benefit cost recognized in the
Combined Balanced Sheets
Weighted Average Assumptions:
Discount rate
Expected return on plan assets
Rate of compensation increase
Benefit cost
Employer contributions
Benefits paid
Kapi'olani Health
•
Notes to Combined Financial Statements (continued)
Property and equipment is summarised as follows:
1999
$ 15,900,255
1,183,852
164,577,657
10,272,632
91,329,311
1,954,860
2,988,956
4,877,616
293,085,139
(127,328,455)
$ 165,756,684
1998
S 15,900,255
1,166,424
154,070,505
9,927,156
82,480,478
1,825,434
2,988,956
5,386,087
273,745,295
(111,517,080)
S 162,228,215
June 30
1999 1998
$ 40,800,000 $ 36,438,000
41,971,000 39,468,000
$ 1,171,000 $ 3,030,000
$ 2,841,316 $ 2,631,847
7.50% 7.50%
8.00% 8.00%
5.00% 5.00%
$ 1,988,000 $ 2,207,000
$ 1,778,000 $ 2,665,000
$ 1,315,000 $ 2,259,000
16
• •
Kapi`olani Health
Notes to Combined Financial Statements (continued)
5. Long -Term Debt and Note Payable to Bank
Series 1996 Special Purpose Revenue Bonds (fart value
of $55,000,000 less unamortized discount of $394,731
based on effective interest rates ranging from
approximately 4.75% to 5.60%), interest payable semi-
annually at rates ranging from 4.95% to 6.25%,
principal payments in varying annual amounts ranging
from $805,000 to $2,475,000 due July 1999 through
2019; 511,780,000 due July 2020, $12,520,000 due July
2021
Series 1993 Special Purpose Revenue Bonds (face value
of $103,695,000 less unamortized discount of
$1,863,736 based on effective interest rates ranging
from approximately 4.00% to 7.00%), interest payable
semi- annually at rates ranging from 5.20% to 6.40%,
principal payments in varying annual amounts ranging
from $1,770,000 to $3,300,000 due July 1999 through
2003; $19,780,000 due July 2008; $26,890,000 due July
2013; and $45,015,000 due July 2019
1999 1998
$ 54,605,269 S 54,587,120
101,831,264 103,421,045
Series 1991 Special Purpose Revenue Bonds, interest
payable semi - annually at rates ranging from 6.80% to
7.00%, principal payments in varying annual amounts
ranging from $860,000 to $990,000 due July 1999
through 2001 2,775,000 3,585,000
Carry forward 159,211,533 161,593,165
17
Carry forward
Other
Less current portion
•
Kapi`olani Health
5. Long -Term Debt and Note Payable to Bank (continued)
Sr
Note payable with interest at 12%; principal and interest
payable in monthly installments ranging from $34,367
to $55,612 through July 2003 and the balance due on
August 1, 2003 with the option to extend the maturity
date to August 1, 2006; collateralized by all leasehold
improvements, furniture, fixtures and equipment of
KB's corporate offices with a carrying value of
approximately $4,294,000
•
Notes to Combined Financial Statements (continued)
1999
$ 159,211,533
1,990,130
873,418
162,075,081
(3,620,794)
$ 158,454,287
1998
$ 161,593,165
2,188,982
927,167
164,709,314
(2,652,740)
$ 162,056,574
The 1996, 1993, and 1991 Series Special Purpose Revenue Bonds are secured by a
security interest in the gross receipts and pledged assets of the Obligated Group (ICH -
parent company only, KMCWC, and KMCPM) as defined in the Master Indenture. The
1993 Bonds are subject to redemption on or after July 1, 2003, at redemption prices
ranging from 100% to 102% of the principal amount of the bonds being redeemed. Series
1993 term bonds have mandatory sinking fund requirements effective July 1, 2004,
payable in annual amounts ranging from $3,490,000 to $8,635,000.
In January 1993, the Obligated Group made an advance refunding of $65,665,000 of the
Series 1991 Special Purpose Revenue Bonds, by issuing Series 1993 Special Purpose
Revenue Bonds and purchasing Government Obligations deposited with an escrow agent
under an Escrow Agreement. The principal and interest on such Government Obligations
provides sufficient funds to pay the principal and interest on the Series 1991 refunded
Bonds. The outstanding principal balance on the refunded Bonds which were not
included in the accompanying financial statements amounted to $65,665,000 as of both
June 30, 1999 and 1998.
18
• •
Kapi`olani Health
Notes to Combined Financial Statements (continued)
5. Long -Term Debt and Note Payable to Bank (continued)
Approximately $15,800,000 of the Series 1993 bonds (net of discount and issuance costs)
were issued to finance renovation of and construction at KMCWC and purchase
additional equipment (the "1993 KMCWC Project") as descr in the Indenture.
KMCWC completed this project in August 1995.
In April 1996, the Series 1996 Special Purpose Revenue Bonds of $55,000,000 were
issued to assist the Obligated Group in financing or refinancing, or both, new
construction and renovation and equipment purchases (the "1996 Kapi'olani Project") as
described in the Indenture and Loan Agreement. KH completed this project in April
1999.
As of June 30, 1999 the Obligated Group had an outstanding irrevocable standby letter of
credit in the principal amount of $1,059,300, expiring July 1, 2001, to fund its Bond
Reserve Fund. An annual commitment fee is payable ranging from $8,000 to $18,600
based upon the Obligated Group's long -term debt service coverage ratio. In addition,
$8,448,618, included in current assets, is held by the Bond Trustee to fund current
principal maturities and accrued interest payable.
Long -term debt maturities for the years succeeding June 30, 1999 are:
2000
2001
2002
2003
2004
Thereafter
Interest paid during the years ended June 30, 1999 and 1998
$10,232,738 and $12,877,902, respectively.
The fair value of long -term debt as of June 30, 1999 and 1998
$171,775,070 and $181,891,332, respectively.
$ 3,620,794
3,824,735
3,925,336
4,273,399
4,536,548
141,894,269
$ 1 62,075,081
was approximately
was approximately
19
f
6. Leases
• •
Kapi`olani Health
Notes to Combined Financial Statements (continued)
5. Long -Term Debt and Note Payable to Bank (continued)
KH also has available a $10,000,000 unsecured revolving line of credit, expiring
April 17, 2000. The interest rate on the line is a floating rate based on the bank's base
rate.
KH also has available a $1,000,000 irrevocable standby letter of credit to support the
obligations of KHH as a State of Hawaii QUEST provider. The letter of credit is
automatically renewable annually at the discretion of the bank.
Leases on various types of office and storage space, office equipment and furniture are
classified as operating leases.
Future minimum lease payments under noncancelable operating leases are as follows:
Year ending June 30
2000 $ 1,806,332
2001 1,389,621
2002 1,399,966
2003 1,501,779
2004 948,165
Thereafter 2,025,507
Total minimum lease payments $ 9,071,370
Rental expense paid during the years ended June 30, 1999 and 1998 was approximately
$1,728,000 and $1,939,000, respectively.
7. Commitments and Contingencies
Unemployment Claims
KH is self - insured for substantially all of its unemployment claims. Claims for
unemployment are insignificant and expensed when incurred.
20
• •
Kapi'olani Health
Notes to Combined Financial Statements (continued)
7. Commitments and Contingencies (continued)
Workers' Compensation Claims
KH is self- insured for workers' compensation claims (effective March 1994, KMCPM
began self - insuring its workers compensation claims under KH's program). In lieu of a
bond, the System has an outstanding letter of credit in favor of the State of Hawaii in the
principal amount of $1,000,000, as required by self - insurance regulations of the State.
The letter of credit is automatically renewable annually, but not beyond February 1, 2000.
Claims administration is performed by a claims adjusting company. The claims adjusting
company provides KH with estimated claims payments which KH accrues as its workers'
compensation expense. In the opinion of management, adequate accruals have been
provided for known and incurred but not reported workers' compensation claims.
Medical Malpractice Insurance
KH is insured for medical malpractice claims. Generally, medical malpractice insurance
policies have included a shared deductible provision, which is currently 50% of the
indemnity loss, up to a $25,000 maximum deductible per claim. Primary coverage is
$1,000,000 (occurrence basis) with excess coverage of $19,000,000 for KMCWC and
$9,000,000 for KMCPM (claims -made basis, with a seven year prepaid discovery
period). Medical malpractice expense, including estimated accruals for amounts below
the deductible provisions, totaled $2,263,000 and $2,056,000 for the years ended June 30,
1999 and 1998, respectively.
Debt Service Forward Delivery Agreement
KH has executed a debt service forward delivery agreement with a financial institution
related to the semi- annual payments on the Series 1993 Special Purpose Revenue Bonds
in which it received a payment of $1,727,000 in exchange for the potential interest
earnings on the semi - annual payments placed in escrow prior to payment to the bond
holders. If KH terminates the agreement, it will be obligated to reimburse the financial
institution for its economic losses incurred as the result of the termination. Such losses
will be determined at the date of termination. The financial institution has the right to
terminate the agreement commencing in 2004. If it elects to do so, KH would be
obligated to reimburse it up to a maximum of $2,650,000. Management has no present
intention to terminate the agreement.
21
•
Health Systems Affiliation Agreement
Kapi'olani Health
Notes to Combined Financial Statements (continued)
7. Commitments and Contingencies (continued)
In March 1996, KH, Wilcox Health System ( "Wilcox) and The Qu: a's Health Systems
("QHS") entered into a Health Systems Affiliation Agreement ("Agreement') where KM
and QHS agreed to make grants of $5,750,000 to Wilcox ($3,500,000 from KH and
$2,250,000 from QHS) over the next four years provided that Wilcox satisfy certain
financial and operational conditions. In November 1997, the agreement was amended
where KH and QHS agreed to make additional grants of $1,000,000 to Wilcox ($500,000
from KH and $500,000 from QHS) in equal installments over the next four years
beginning January 10, 1998 provided that Wilcox continues to satisfy the certain financial
and operational conditions. The agreement was further amended in February 1999 to
provide for a change in the timing of cash payments, but not the total amount to Wilcox.
Under the amendments, KH will pay $63,079 per month through February 2002,
provided that Wilcox satisfies certain financial and operational conditions. As of
June 30, 1999, KH recorded an accrual of $949,000 for its obligation under the
Agreement. Additionally, KH and QHS purchased the land under the Kauai Medical
Group facilities from Wilcox for $1,085,000, which is included in the grant payments and
split equally between KB and QHS. KH and QHS were each allowed to appoint one
member to Wilcox's Board of Directors and one member to the Wilcox physician group's
board of directors.
Other
During 1998, management became aware that certain billing errors had occurred in the
Kapiolani Home Health Services and Kapiolani Extended Care subsidiaries. Settlement
of approximately S4 million was made in August 1999 and has been accrued as a charge
in the accompanying statement of operations.
An affiliate of KB filed an initial application for tax exemption which was denied. As of
June 30, 1999, the denial was on appeal. In July 1999, the tax exemption was granted by
the Internal Revenue Service subject to agreed upon changes which include the closure of
Partner's Health Hawaii in which one of Kap'iolani Health's affiliates is a partner.
22
Notes to Combined Financial Statements (continued)
8. Related Party Transactions
• •
Kapi'olani Health
A joint venture investment of KH provides laundry services to KB. Charges for services
totaled $964,000 and $944,000 in 1999 and 1998, respectively.
Premiums paid to Pacific Health Care, a 20% owned affiliate totaled $349,000 in 1998.
No premiums were paid to Pacific Health Care in 1999.
KH paid approximately $6,634,000 and $6,422,000 for laboratory services provided by a
joint venture in 1999 and 1998, respectively.
Payments made to Partners Health Hawai'i for management fees totaled $709,000 and
$829,000 in 1999 and 1998, respectively.
Notes receivable from an affiliate totaled $375,000 as of June 30, 1999 and 1998.
9. Restructuring Charges
In view of current operating trends and future projections, KH has decided to focus on its
primary lines of business, operating hospitals and operating a health plan.
Accordingly, management decided to dispose of or discontinue certain operations which
it deemed outside of the focus of operating KMCWC, KMCPM and KHH. Management
implemented a plan to exit the Home Health/Extended Care businesses, the physicians'
practice management business and the development of a new physician's office and clinic
site in Leeward Oahu. This plan was approved by management and the Board of
Directors in the fourth quarter of the year ended June 30, 1998.
In addition, a program to increase operating efficiency and reduce expenses was approved
in the fourth quarter of the year ended June 30, 1998.
Costs for termination benefits, lease obligations and fixed assets related to the
restructuring amounted to approximately $3,000,000 in 1998.
23
,
• •
Kapi`olani Health
Notes to Combined Financial Statements (continued)
10. Subsequent Event - Reorganization of Health Insurance Business
In October 1999, KH and KHH entered into a Reorganization Agreement with Hawaii
Medical Services Association, ( "HMSA'). Under the Agreement, effective November 1,
1999 substantially all of Mill's commercial health insurance contracts will be assigned
to HMSA. The assigned contracts expire at various dates through January 2001, the
majority expiring in mid -2000. KH and KHH remain contingently liable for aggregate
losses on the assigned contracts. No consideration will be exchanged in connection with
the assignment.
KHH will retain its Medicaid (QUEST) business, which will be operated under a third
party administration agreement with HMSA. The QUEST contract between KHH and the
State of Hawaii expires June 30, 2002. KHH will continue to operate the State Health
Fund contract, which expires in June 2001.
Management's assessment of the costs of the reorganization through January 2001 is
approximately $2.4 million, which will be accrued as a charge in the fiscal year ending
June 30, 2000.
11. Impact of Year 2000 (Unaudited)
General Description of the Year 2000 Issue and the Nature and Effects of the Year
2000 on Information Technology (IT) and Non -IT Systems
The Year 2000 Issue is the result of computer programs being written using two digits
rather than four to define the applicable yew. In any of KH's computer programs, date -
sensitive software or embedded chips may recognize a date using "00" as the year 1900
rather than the year 2000. This could result in a system failure or miscalculations causing
disruptions of operations, including, among other things, a temporary inability to process
transactions, bill for services, provide patient care, or engage in similar normal activities.
KH determined that it will be required to modify or replace significant portions of its
software and certain hardware so that those systems will properly utilize dates beyond
December 31, 1999. KH presently believes that with modifications or replacements of
existing software and certain hardware, the Year 2000 Issue has been mitigated.
24
• •
Kapi`olani Health
Notes to Combined Financial Statements (continued)
11. Impact of Year 2000 (Unaudited) (continued)
General Description of the Year 2000 Issue and the Nature and Effects of the Year
2000 on Information Technology (IT) and Non -IT Systems (continued)
KH's plan to resolve the Year 2000 Issue involves the following four phases: assessment,
remediation, testing, and implementation. To date, KH has fully completed its assessment
of all systems that could be significantly affected by the Year 2000. The completed
assessment indicated that most of KH's significant information technology systems could
be affected, including the general ledger, patient accounting, clinical, medical records,
and internal communication systems. That assessment also indicated that software and
hardware (embedded chips) used in medical equipment also are at risk. In addition, KH
has gathered information about the Year 2000 compliance status of its significant
suppliers and subcontractors and continues to monitor their compliance.
Status of Progress in Becoming Year 2000 Compliant
Overall, KH is approximately 92% complete with all activities to remediate, test and
implement compliant versions of its IT dependent systems, including the preparation and
testing of contingency plans.
Nature and Level of Importance of Third Parties and their Exposure to the Year
2000
KH is 100% complete with the identification of non -IT dependent business partners. KH
has identified approximately 60 mission critical business partners whose Year 2000
compliance or non - compliance could materially impact KH's ability to operate. These
range from patient care affecting clinical partners to public utilities, insurance payers,
financial institutions, and providers of governmental services. KH is monitoring the
efforts of these partners to achieve Year 2000 compliance which in nearly all cases,
appear to be substantial. In cases where certain partners do not appear to be making
substantial progress, KR has developed contingency plans so that the other party's failure
to comply will not disrupt KB's operations. The process of completing and testing the
contingency plans will continue through the remainder of 1999.
25
Costs of the Year 2000 Effort
Kapi`olani Health
Notes to Combined Financial Statements (continued)
11. Impact of Year 2000 (Unaudited) (continued)
KH is utilizing both intematand cxiernai I. wu,,,ws to reprogram, or replace, test, and
implement the software and operating equipment for Year 2000 modifications and to
work with mission critical business partners to assess and if necessary mitigate their
compliance. The total cost of the Year 2000 project is estimated at $6,500,000 and is
being funded through operating cash flows. To date, KH has incurred approximately
$5,250,000 ($4,900,000 expensed and $350,000 capitalized for new systems and
equipment), related to all phases of the Year 2000 project. Of the total remaining project
costs, virtually all will be expensed, approximately half the remaining amount being
budgeted for retention incentive to be earned in the fiscal year ending June 30, 2000.
26
•
Adorers are refry ::. ° C or A•.r.r. ta:.1.
LA: EU: 78 324
Purpose: Charitable
Accounting Period.Ending: June 30
Inte Revenue Service
Gate -to .emr reeer to- 3. Jones
FEB 1 7 1978 , L -178, Code CIE0G -2:5:
Determination Section (213) 6SS - 4553
Fapiolani- Children's Medical Center
1319 Punahou Street
Honolulu, Hawaii- 96826
Based on information supplied, and assuming your operations will
be as stated in your application for recognition of exemption. we
have determined you are exempt from Federal income tax under section
501(c)(3) of the Internal Revenue Code.
We have further determined you are not a private foundation within
the meaning of section 509(a) of the Code. because you are an
organization described in, section 170(b)(1)(A)(iii) and 509(a)(1).
You are not liable Tor social security (FICA) taxes unless you
file a waiver of exemption certificate as provided in the Federal
Insurance Contributions Act. You are not liable for the taxes imposed
under the Federal Unemployment Tax Act (FUTA).
Since you are not a private foundation, you are not subject to
• the excise taxes under Chapter 42 of the Code. However, you are not
automatically exempt from other Federal excise taxes. If you have any
questions about excise, employment. or other Federal taxes, please
let 'an ;now.
Donors may deduct contributions to you as provided in section
170 of the Code. Bequests, legacies, devises. transfers. or gifts to
you or for your use are deductible for Federal estate and gift tax
purposes if they meet the applicable provisions of sections 2055.
2106, and 2522 of the Code.
If your purposes. character, or method of operation is changed.
please let us know so we can consider the effect of the change on
your exempt status. Also, you should inform us of all changes in your
gaze or address.
(Overt Form L —:78 (Rev. E-73)
_� 4 /atin
etc rm more .nr.
:: you: g. c re.e. etch year :_re no �� �* i.
you are required to file '- 991. net_.:, of Organization Exempt
Income Tax. by the litz day of the fifth month after the end
of your annual accounting period. The law imposes a penalty of S10
a day, up to a maxi`•.,a. of 55.000, for failure to file a return on time.
You are no: required to file Federal income tax returns unless
you are subject to the tax on unrelated business income under section
;,_'_ of the Code. If you are subject to.this tax, you must file an income
tax return on Fore 290—T. Zr. this letter we are not determining whether
any of your present or proposed activities are unrelated trade or
business as defined in section 513 of the Code.
You need an employer identification number even if you have no
eloyees. If an employer identification number was not entered on
your application. a number will be assigned to you and you will be
advised of it. Please use that number on all returns you file and in .
all correspondence with the Internal Revenue Service.
Please keep this determination letter in your permanent records.
cc: William A. HcDonald
cl
Sincerely yours.
District Director
Form L —i78 (Rev.
Issued By: Truck Insurance Exchange, Los Angeles, CA
Named Kapiolani Medical Center for Women and Children
Insured
Address 1319 Punahou Street
Honolulu, Hawaii 96826
This certificate or verification of Insurance is not an insurance policy and does not amend, extend, or alter the coverage
afforded by the policy referred to above. Notwithstanding any requirement, term or condition of any contract or other
document with respect to which this certificate or verification of insurance may be issued or may pertain, the insurance
afforded by the policy is subject to all the terms, exclusions, and conditions of such policy. Insured has a Single Limit as
indicated below.
SINGLE LIMIT
$5 million Each Occurrence
Claims Made 0
Comprehensive Healthcare Professional
Liability, General Liability, Bodily Injury &
Property Damage Liability
'Modified Occurrence 0 "Occurrence
DESCRIPTION OF OPERATIONSNEHICLES /SPECIAL ITEMS /REMARKS:
Evidence of Healthcare General and Professional Liability coverage relating to Kapiolani
Child Protection Center - West Hawaii Branch's West Hawaii Counseling and Supportive
Living Project.
1170 -1066
Policy Number
Notice of cancellation of the coverage automatically terminates coverage. After cancellation this certificate becomes void
and without effect. A breakdown of the limits will be provided upon demand.
Effective
Date
Place
Other
Interest
January 6, 2000
October 1, 1999
Los Angeles, CA
County of Hawaii, Department of Finance
45 Aupuni Street, Room 118
Hilo, Hawaii 96720
Continuous until canceled
DATE TYPED Authorized Representative
FARMERS INSURANCE GROUP OF COMPANIES
CERTIFICATE OF INSURANCE
• •
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN
Certification of Assistant Secretary
I, Betty Kaneshiro, Assistant Secretary of KAPI'OLANI MEDICAL CENTER FOR
WOMEN AND CHILDREN, a nonprofit corporation duly organized and existing under and by
virtue of the laws of the State of Hawaii, do hereby certify that the Charter of Incorporation
attached hereto is a full, true and correct copy of the Charter of Incorporation of this Corporation
as amended through July 7, 1995, and that since that date said Charter of Incorporation has not
been modified, amended or rescinded and continues in full force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the corporate seal of
said KAPFOLANI MEDICAL CENTER FOR WOMEN AND CHILDREN this 7 day of
January, 2000.
Betty K eshiro
Assistant Secretary
G 2�
•
As Adopted May 18, 1976 and
• amended through July 7, 1995.
•
KAPI'OLANI
MEDICAL CENTER
for Women & Children
CHARTER OF INCORPORATION
ARTICLE I
Corporate Name
The name of the Corporation is KAPI`OLANI MEDICAL CENTER FOR WOMEN
AND CHILDREN.
ARTICLE II
Location of the Corporation
The location of the Corporation and the address of its initial office is 1319 Punahou
Street, Honolulu, Hawaii 96826.
ARTICLE III
Corporate Purposes
Section 3.1 Purposes. The corporation is organized exclusively to operate and
maintain a hospital and medical center primarily to provide comprehensive health care
services and resources to women and children and to operate exclusively for charitable,
educational and scientific purposes, within the meaning of Section 501(c)(3) of the Internal
Revenue Code, including for such purposes, the making of distributions to organizations that
qualify as tax- exempt organizations under Section 501(c)(3) of the Internal Revenue Code of
1954 (or any future corresponding provisions).
Section 3.2 Restrictions. No part of the assets or earnings of the Corporation shall
inure to the benefit of any individual. The Corporation shall not participate in or intervene
(including the publication or distribution of statements) in any political campaign on behalf of
any candidate for public office. Notwithstanding any other provision of this Charter, the
Corporation shall not carry on any activities not permitted to be carried on:
(i) By a corporation exempt from Federal Income Tax under Section
501(c)(3) of the Internal Revenue Code of 1954 (or the corresponding provi-
sion of any future United States Internal Revenue Law); or
(ii) By a corporation, contributions to which are deductible under
Section 170(c)(2) of the Internal Revenue Code of 1954 (or the corresponding
provision of any future United States Internal Revenue Law).
• •
The Corporation shall have and possess all the powers permitted to nonprofit corpora-
tions under the laws of the State of Hawaii.
KMCWC Charter of Incorporation
Page 2
ARTICLE IV
Corporate Powers
ARTICLE V
Corporate Life
The duration of the Corporation shall be perpetual.
ARTICLE VI
Trustees and Officers
Section 6.1 Board of Trustees. There shall be a Board of Trustees elected as
provided in the Bylaws who shall number 20 at the formation of the Corporation and within
three years thereafter shall be reduced to a number not less than eleven nor more than seven-
teen persons. The Board of Trustees shall have and may exercise all the powers of the Corpo-
ration except as otherwise provided by law, this Charter or the Bylaws.
Section 6.2 Officers. The officers of the Corporation shall be a chairman of the
board, a president, a secretary and a treasurer. The Corporation may have such additional
officers as determined in accordance with the Bylaws. The officers shall have the powers,
perform the duties and be appointed in the manner set forth in the Bylaws. Any person may
hold two or more offices of the Corporation unless such practice is prohibited by the Bylaws.
ARTICLE VII
Liability and Indemnification of Officers,
Directors. Employees and Agents
Section 7.1 No Liability to Corporation. No trustee, officer, employee or other
agent of the Corporation and no person serving at the request of the Corporation as a trustee,
officer, employee or other agent of another corporation, partnership, joint venture, trust or
•
•
Section 7.2 Indemnity.
• •
other enterprise and no heir, or personal representative of any such person shall be liable to
the Corporation for any loss or damage suffered by it on account of an action or omission by
such person as a trustee, officer, employee or other agent if he/she acted in good faith and in a
manner reasonably believed to be in or not opposed to the best interests of this Corporation,
unless with respect to an action or suit by or in the right of the Corporation to procure a
judgment in its favor such person shall have been adjudged to be liable for negligence or
misconduct in the performance of his/her duty to this Corporation.
(1) The Corporation shall indemnify any person who was or is a
party or is threatened to be made a party to any threatened, pending or
completed action, suit or proceeding, whether civil, criminal, administrative or
investigative (other than an action by or in the right of the Corporation) by
reason of the fact that he/she is or was a trustee, officer, employee or other
agent of the Corporation or is or was serving at the request of the Corporation
as a trustee, officer, employee or other agent of another corporation,
partnership, joint venture, trust or other enterprise, against expenses (including
attorneys' fees), judgments, fines and amounts paid in settlement actually and
reasonably incurred by him/her in connection with such action, suit or
proceeding if he/she acted in good faith and in a manner he/she reasonably
believed to be in or not opposed to the best interests of the Corporation, or,
with respect to any criminal action or proceeding, had no reasonable cause to
believe his/her conduct was unlawful. The termination of any action, suit or
proceeding by judgment, order, settlement, conviction, or upon a plea of nolo
contendere or its equivalent, shall not, of itself, create a presumption that the
person did not act in good faith and in a manner which he/she reasonably
believed to be in or not opposed to the best interests of this Corporation or,
with respect to any criminal action or proceeding, had reasonable cause to
believe that his/her conduct was unlawful.
(2) The Corporation shall indemnify each person who was or is a
party or is threatened to be made a party to any threatened, pending or
completed action or suit by or in the right of the Corporation to procure a
judgment in its favor by reason of the fact that such person is or was a trustee,
officer, employee or agent of the Corporation or is or was serving at the
request of the Corporation as a trustee, officer, employee or agent of another
corporation, partnership, joint venture, trust or other entity, against expenses
(including attorneys' fees) actually and reasonably incurred by him/her in
connection with the defense or settlement of such action or suit if he/she acted
in good faith and in a manner he/she reasonably believed to be in or not
opposed to the best interests of this Corporation, except that no
indemnification shall be made in respect of any claim, issue or matter as to
which such person shall have been adjudged to be liable for negligence or
misconduct in the performance of his/her duty to this Corporation unless and
KMCWC Charter of incorporation
Page 3
only to the extent that the court in which such action or suit was brought shall
determine upon application that, despite the adjudication of liability but in
view of all the circumstances of the case, such person is fairly and reasonably
entitled to indemnity for such expenses which such court shall deem proper.
(3) To the extent that a trustee, officer, employee or other agent of
the Corporation or of any division of the Corporation, or a person serving at
the request of the Corporation as a trustee, officer, employee or agent of
another corporation, partnership, joint venture, trust or other entity, has been
successful on the merits or otherwise in defense of any action, suit or
proceeding referred to in paragraphs (1) and (2) of this section, or in defense
of any claim, issue or matter therein, he/she shall be indemnified against
expenses (including attorneys' fees) actually and reasonably incurred by
him/her in connection therewith.
(4) Any indemnification under paragraphs (1) and (2) of this section
(unless ordered by a court) shall be made by the Corporation only if
authorized in the specific case upon a determination that indemnification of
the trustee, officer, employee or agent is proper in the circumstances because
he /she has met the applicable standard of conduct set forth in paragraphs (1)
and (2). Such determination may be made:
(i) by the Board of Trustees by a majority vote of a
quorum consisting of directors who were not parties to such
action, suit or proceedings;
(ii) if such a quorum is not obtainable, or, even if
obtainable and a quorum of disinterested directors so directs,
by independent legal counsel in a written opinion to the
Corporation;
(iii) if a quorum of disinterested trustees so directs, by
a majority vote of the members; or
(5) Expenses incurred in defending a civil or criminal action, suit or
proceeding may be paid by the Corporation in advance of the fmal disposition
of such action, suit or proceeding as authorized by the Board of Trustees in a
particular case upon receipt of an undertaking by or on behalf of the trustee,
officer, employee or agent to repay such amount unless it shall ultimately be
KMCWC Charter of Incorporation
Page 4
• •
(iv) by the court in which such proceeding is or was
pending upon application made by the Corporation or the agent
or the attorney or other person rendering services in connection
with the defense, whether or not such application by the agent,
attorney or other person is opposed by the Corporation.
4
• •
determined that he/she is entitled to be indemnified by the Corporation as
authorized in this article.
(6) The indemnification provided by this article shall not be deemed
exclusive of any other rights to which those indemnified may be entitled and
shall continue as to a person who has ceased to be a trustee, officer, employee
or agent and shall inure to the benefit of the heirs and personal representatives
of any such person.
(7) The Corporation shall have the power to purchase and maintain
insurance on behalf of any person who is or was a trustee, officer, employee or
other agent of the Corporation or is or was serving at the request of the
Corporation as a trustee, officer, employee or other agent of another
corporation, partnership, joint venture, trust or other enterprise, against any
liability asserted against him/her and incurred by him/her in any such capacity
or arising out of his/her status as such, whether or not the Corporation would
have the power to indemnify him/her against such liability under the
provisions of this Article.
ARTICLE VIII
Membership
The sole voting member of the Corporation shall be Kapiolani Health [formerly
known as Kapiolani Health Care System], a Hawaii nonprofit corporation. The sole voting
member of the Corporation shall have such rights and powers as are provided in the Charter of
Incorporation, the Bylaws and the laws of the State of Hawaii including, without limitation of
the generality of the foregoing, the exclusive power.
(a) to elect the trustees of the Corporation and to remove any of the
trustees of the Corporation from office; and
(b) to vote on all matters where the vote of members with voting
rights is required under the Charter of Incorporation, the Bylaws, or the laws
of the State of Hawaii.
The Corporation may provide in the Bylaws for one or more classes of supporting,
life, honorary, or other non -voting members, who shall have the rights set forth in the Bylaws
but who shall not be entitled to vote or to have any voice in the management of corporate
affairs.
KMCWC Charter of Incorporation
Page 5
The Corporation may provide in the Bylaws for special articles of governance for one
or more divisions, such as the Auxiliary and the Medical Staff; and the Bylaws may authorize
such divisions to adopt their own. bylaws, rules and regulations, subject to approval of the
Board of Trustees.
The Corporation is not organized for profit and it will not issue any stock, and no part
of its assets, income, or earnings shall be distributed to its trustees or officers, except for
services actually rendered to the Corporation, except that the Corporation shall be empowered
to make payments and distributions in furtherance of the exempt purposes for which it was
formed.
KMCWC Charter of Incorporanon
Page 6
• •
ARTICLE IX
Divisions
ARTICLE X
Non- Profit
ARTICLE XI
Corporate Liability
The property of the Corporation shall alone be liable in law for the payment of the
debts and liabilities of the Corporation.
ARTICLE XII
Corporate Dissolution
If the Corporation shall cease to exist or shall be dissolved, all property and assets of the
Corporation of every kind, after payment of its just debts, shall be distributed to Kapi`olani
Health [formerly known as Kapiolani Health Care System], Kapi`olani Health Foundation
[formerly known as Kapiolani Medical Center Foundation for Women and Children] or either
of them, or to any other health care organization which is then affiliated with either of them,
provided the recipient is then a tax - exempt organization described in Section 501(c)(3) of the
Internal Revenue Code of 1954 (or the corresponding provision of any future United States
Internal Revenue law), but if Kapi`olani Health [formerly known as Kapiolani Health Care
System] or Kapi`olani Health Foundation [formerly known as Kapiolani Medical Center
Foundation for Women and Children] at that time is no longer such a tax - exempt
organization, then the remaining assets shall be distributed, for the specific purposes of
prenatal and postnatal health care for women and children, only to one or more public
agencies, organizations, corporations, trusts or foundations organized and operated
exclusively for charitable, scientific, educational or literary purposes, no part of whose assets,
income or earnings may be used for dividends or otherwise withdrawn or distributed to or
inure to the benefit of any private shareholder or individual and the activities of which do not
• •
include participation or intervention (including the publication or distribution of statements)
in any political campaign on behalf of any candidate for public office.
In no event shall any distribution be made to any organization unless it qualifies as a
tax- exempt organization under Section 501(c)(3) of the Internal Revenue Code of 1954 (or the
corresponding provision of any future United States Internal Revenue Law) with purposes
similar or related to those of the Corporation. To the extent economically and socially
feasible, any such distributions shall be allocated equally between medical care for women
and medical care for children; and to the extent that any restricted funds are distributed for one
of such purposes, an equivalent amount of unrestricted funds shall be distributed for the other
purposes, so that the total distribution shall be approximately equivalent.
ARTICLE XIII
Thyjm
The power to adopt, alter, amend or repeal the Bylaws or adopt new Bylaws shall be
vested in the Board of Trustees subject to repeal or change by the action of the members.
ARTICLE XIV
Charter of Incorporation
This Charter shall be subject to amendment from time to time in the manner set forth
by law, and the Corporation shall be subject to all general laws now in force or hereafter
enacted with regard to corporations of this nature.
KMCWC C of Incorporation
Page 7
• •
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN
Certification of Assistant Secretary
I, Betty Kaneshiro, Assistant Secretary of KAPI'OLANI MEDICAL CENTER FOR
WOMEN AND CHILDREN, a nonprofit corporation duly organized and existing under and by
virtue of the laws of the State of Hawaii, do hereby certify that the Bylaws attached hereto are a
full, true and correct copy of the Bylaws as amended through October 15, 1997, and that since
that date said Bylaws have not been modified, amended or rescinded and continue in full force
and effect.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the corporate seal of
said KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN this 7 day of
January, 2000.
Assistant Secretary
As Adopted May 18, 1976 and
amended through October 15, 1997.
• •
KAPI'OLANI
MEDICAL CENTER
for Women & Children
BYLAWS
ARTICLE I
Activities
The activities of Kapi`olani Medical Center for Women and Children (the
"Corporation ") shall be those necessary and appropriate to accomplish the purposes of the
Corporation as stated in the Charter of Incorporation of the Corporation (the "Charter ").
ARTICLE II
Membership and Voting
Section 2.1 Voting Member. The sole voting member of the Corporation shall be
Kapi`olani Health [formerly known as Kapiolani Health Care System], a Hawaii nonprofit
corporation.
Section 2.2 Suunortine. Life and Honorary Members. Any individual or
corporation may be a supporting, life or honorary member of the Corporation by vote of the
Trustees at any regular, special or annual meeting, and who pays such fees and dues as may be
prescribed by the Board of Trustees, Supporting, life and honorary members shall be entitled
to the privileges prescribed by the Board of Trustees but shall not be entitled to vote or to
have any voice in the management of corporate affairs.
ARTICLE III
Meeting of Members
Section 3.1 Annual Meeting. The annual meeting of the members shall be held each
year at such time and place as the Board of Trustees determines for the purposes of electing
trustees and transacting such other business as may come before the meeting. The voting
members may dispense with the annual meeting by unanimous written consent.
Section 3.2 Special Meetings. Special meetings of the members for any purpose or
purposes may be held at any time upon the call of the President or any three trustees or upon
the written request of the majority of the voting power of the membership of the Corporation,
Section 4.1 Number and Oualification of Trustees. There shall be not less than
eleven nor more than seventeen trustees. The number of trustees for any following year shall
be determined by the voting membership at the annual meeting. The President of the
Corporation and the Chief of Staff shall be trustees. The remaining trustees shall be elected
by the membership at the annual meeting to hold office for the term elected and thereafter
until their successors are duly elected and qualified, provided that additional trustees may be
elected at any special meeting of the membership called for that purpose during the year to fill
any unfilled positions.
• •
Section 3.3 Place of Meeting. The Board of Trustees may designate any place for
any annual or special meeting of the members. If no designation is made, the place of
meeting shall be the principal office of the Corporation.
Section 3.4 Notice of Meetings. Notice of all meetings, annual or special, stating the
place, day and hour of the meeting and whether it is annual or special, and in case of a special
meeting stating the purpose or purposes thereof, shall be given personally or by mail. If by
mail, such notice shall be postage prepaid to each member.at his address as it appears on the
membership roll of the Corporation at least ten days before the meeting.
Section 3.5 Adjourned Meetings and Notice Thereof. Any meeting of the members,
annual or special, whether or not a quorum is present, may be adjourned from time to time by
the vote of a majority of the voting members present, but in the absence of a quorum no other
business may be transacted at any such meeting. When any members' meeting, either annual
or special, is adjourned for thirty days or more, notice of the adjourned meeting shall be given
as in the case of an original meeting; otherwise it shall not be necessary to give any notice of
an adjourned meeting other than by announcement at the meeting at which the adjournment is
taken.
Section 3.6 Voting. At all meetings of members, every voting member entitled to
vote shall have the right to vote in person or by written proxy,
Section 3.7 Ouorum. A majority of the voting members constitutes a quorum for the
transaction of business and any decision of a majority of the quorum of voting members shall
be valid and binding except as otherwise specifically provided with respect to particular
matters by the Charter, these Bylaws or by applicable provisions of law.
Section 4.2 Term of Membership. The initial term of each Trustee shall be for a
period of one year and thereafter the time shall be three years, except that shorter terms may
be set so that terms of approximately one -third of the total number constituting the Board
shall expire each year. The term of each President and Chief of Staff as Trustees shall
continue so long as each occupies that position. Any member of the Board may be removed
KMCWC Bylaws
Page 2
ARTICLE IV
Board of Trustees
• •
from office upon the affirmative vote of not less than three- fourths of the Board. No trustee
may serve for more than three consecutive terms.
Section 4.3. Schedule and Notice of Meetings.
(a) Organization Meeting of Board. A meeting of the Board elected
at an annual meeting of the members shall be held at the place of such annual
meeting and immediately thereafter and no notice thereof shall be necessary.
In the event that such meeting of the Board shall not be held, a special
meeting shall be called to be held as soon as practicable thereafter. The
purpose of this meeting is to elect officers of the Corporation for the coming
year.
(b) Regular Meetings. Regular meetings of the Board may be held at
least quarter annually at the place and time established by the trustees and
when any such meeting or meetings is established no further notice thereof
shall be necessary. At regular meetings, the Board, subject to any
requirements of law and of the Charter and these Bylaws, may transact any
general business brought before the meeting and take any corporate action.
(c) Snecial Meetings. Special meetings of the Board may be called
at any time by the Chairman of the Board, the President or by any three
trustees.
(d) Notice of Meetings of the Board. Except as otherwise provided
herein, the Secretary shall give notice of each meeting of the Board, either
orally or in writing by mail or delivery not less than one day before the
meeting unless otherwise prescribed by the Board. The failure of the
Secretary to give notice or the non - receipt of notice by any trustee shall not
invalidate the proceedings of any meeting of the Board at which a quorum of
the trustees is present
Section 4.4 Ouorum for the Board. A majority of the Board constitutes a quorum
for transaction of business.
Section 4.5 Vacancies on the Board. Should a vacancy occur on the Board, the
remaining members of the Board may, by a majority vote, elect a successor to fill the vacancy
to serve for the unexpired term.
Section 4.6 Attendance at Meetings of the Board. If any member of the Board is
absent from three consecutive meetings or four or more meetings per annum, without leave of
the Board for due cause, his office may be declared vacant and his removal from the Board
and from his office shall be completed when such fact is noted in the minutes of the Board by
order of the Trustees. In any such case or procedure, the Board shall fill such vacancy until
the next annual meeting.
KMCWC Bylaws
Page 3
Section 4.7 Powers of the Board. All powers and authority of the Corporation shall
be vested in and be exercised by the Board except as limited by law, the Charter or these
Bylaws: such powers including the following:
KMCWC Bylaws
Page 4
• •
(a) To acquire and dispose of property;
(b) To elect officers and appoint agents or employees of the
Corporation and to confer upon and to delegate to them by power of attorney
or otherwise such power and authority as it determines;
(c) To determine all matters affecting finances; to fix the salaries or
compensation of the agents and employees of the Corporation, and in its
discretion require security of any of them for the faithful performance of any
of their duties;
(d) To make rules and regulations not inconsistent with law or the
Charter of Incorporation or these Bylaws for the operation of the medical
center;
(e) To create committees of the Board and to designate as members
such persons as it determines and to confer upon such committees such
powers and authority as by resolution set forth for carrying on or exercising
the powers of the Corporation;
(f) To remove or suspend any officers. Any officer elected by the
Trustees may be removed with or without cause by the vote of a majority of
the Trustees.
(g) To incur indebtedness as necessary, and as security for the
payment of obligations of the Corporation, to assign, set over, transfer,
mortgage, pledge or hypothecate any and all of its real, personal, or other
property, and to execute or endorse in the name and on behalf of the
Corporation such note or notes or other obligations as the Board deems
advisable.
(h) Generally, to do any lawful act necessary or proper to carry into
effect the powers and purposes of the Corporation.
ARTICLE V
Officers
Section 5.1 Principal Officers. The principal officers of the Corporation shall be a
Chairman of the Board, a Vice - Chairman, a President, a Secretary and a Treasurer. The
officers shall be elected annually by the Board at the organization meeting or the first meeting
thereof after the annual or special meetings of the members at which the Board is elected, and
shall hold office for one year and thereafter until their successors are duly elected and
qualified. The offices of the Secretary and Treasurer may be held by the same person. The
Treasurer may be a corporation. The Chairman of the Board and any Vice Chairman or Vice
Chairmen, if elected, and the President shall be Trustees. No other officer need be a Trustee.
Section 5.2 Chairman of the Board. The Chairman of the Board shall have general
supervision over the Corporation's business and affairs and see to the proper observance and
enforcement of the Charter and these Bylaws and the rules and regulations, actions and orders
of the Board. The Chairman shall call such meetings of the members of the Corporation and
of the Board as are herein provided for and such other meetings as shall seem proper to the
Chairman.
Section 5.3 Vice Chairman of the Board. The Board at any meeting, may elect one
or more Vice Chairmen of the Board. In the absence or disability of the Chairman of the
Board, the Vice Chairmen in order of their rank as fixed by the Board, shall preside at any
meeting of the members or the Board.
Section 5.4 President. The President shall have such duties and responsibilities as the
Board shall prescribe from time to time.
Section 5.5 Vice President. The Board at any meeting, may elect one or more Vice
Presidents. In the absence or disability of the President, the Vice Presidents, in order of their
rank as fixed by the Board, or if not ranked, the Vice President designated by the Board of
Directors, shall perform all duties of the President, and when so acting shall have all power of,
and be subject to all restrictions upon, the President; the Vice Presidents shall have such other
powers and perform such other duties from time to time prescribed for them respectively by
the Board or the Bylaws.
Section 5.6 Secretary. The Secretary shall give the notices of all meetings of the
members of the Corporation and the Board and shall keep the minutes of such meetings. The
Secretary shall furnish the Treasurer with the names of all persons elected to membership in
the Corporation, keep the membership roll of the Corporation. The Secretary shall perform all
other duties assigned by the Board.
Section 5.7 Treasurer and Assistant Treasurer. The treasurer shall review the
financial status of the Corporation and recommend fiscal policies to the President, chairman
of the board and the Board of Trustees. The treasurer may be a corporation. The treasurer
shall perform all other duties assigned by the chairman of the board or the Board of Trustees.
The assistant treasurer or assistant treasurers, if elected, shall, in the order designated by the
chairman of the board of the Board of Trustees, perform all the duties and exercise all the
powers of the treasurer during the absence or disability of the treasurer or whenever the office
is vacant and shall perform all the duties assigned by the chairman of the board or the Board
of Trustees.
Section 5.8 Subordinate Officers. The Board may appoint subordinate officers who
shall hold their positions at the pleasure of the Board, and who shall have the powers and
KMCWC Bylaws
Page 5
• •
duties determined by the Board. The Number and title of subordinate officers may be changed
from time to time and subordinate officers may be appointed from time to time at any meeting
or meetings of the Board. The authority to fix the powers and duties of subordinate officers
may be delegated by the Board to any officer or officers of the Corporation. Any officer of
the Corporation may also be a subordinate officer. Subordinate officers need not be Trustees.
The Board shall appoint a Chief Executive Officer, who need not be an officer of the
Corporation, and who shall have such duties and responsibilities as the Board shall prescribe
from time to time.
All checks and other orders for payment of money, drafts, notes, bonds,
acceptances, contracts, and all other instruments shall be signed by such person or persons
designated by general or special resolution of the Board, and, in the absence of any such
general or special resolution applicable to any such instrument, then the instrument shall be
signed by the Chairman of the Board, any Vice Chairman or the President and by the
Treasurer or the Secretary.
KMCWC Bylaws
Page 6
ARTICLE VI
Chief Executive Officer
ARTICLE VII
Execution of Instruments
ARTICLE VIII
Committees of the Board
Section 8.1 Standing Committees. The Corporation shall have the following standing
committees: Executive, Finance, Nominating and Corporate Bylaws, and such other standing
committees as the Board may authorize. The Chairman and members of the standing
committees of the Board shall be appointed by the Chairman of the Board and shall serve for
at least a one -year term, which may be extended by the Chairman of the Board. There shall be
such special committees as may be appointed by the Chairman of the Board from time to
time. At a committee meeting, a quorum shall be a majority of committee members.
Activities of the committees may be recorded in minutes.
Section 8.2 Executive Committee. The Executive Committee shall consist of the
Chairman, the President, and at least one additional trustee appointed by the Board. The
Executive Committee shall have the power to transact all regular business of the Corporation
during the period between the meetings of the Board, subject to any limitations imposed by
the Board.
Section 8.3 Finance Committee. The Finance Committee shall consist of at least
three Trustees, The duties of the committee include the following:
• •
(a) Responsibility for supervising the management of all endowment
and trust funds of the medical center;
(b) Review of and approval of the capital and annual operating
budgets of the Corporation.
(c) Review of the financial feasibility of corporate projects, acts and
undertakings referred to it by the Board and making recommendations
thereon;
(d) Review and evaluate the findings and final reports of the auditors
and based thereon making recommendations to the Board concerning financial
operation of, and services required by and provided to the Corporation;
(e) Performing such other duties related to fiscal matters as maybe
assigned to it by the Board or the Chairman.
Section 8.4 Nominating Committee. The Nominating Committee shall be appointed
each year by the Chairman of the Board. This committee shall be composed of at least three
members of the Board. The Nominating Committee shall have the duty of nominating at the
annual meeting of the Corporation, and at other meetings when vacancies are to be filled,
candidates to be elected officers and members of the Board.
Section 8.5 Corporate Bylaws Committee. The Corporate Bylaws Committee shall
be appointed each year by the Chairman of the Board. The Committee shall review annually
the Bylaws, organization and general policies of the Corporation and shall submit to the
Board a report based on its review, including any recommendations for changes.
ARTICLE IX
Auxiliary
There shall be an auxiliary of the Corporation, to be known as the Kapi`olani Medical
Center for Women and Children Auxiliary. The purpose of the auxiliary shall be to assist the
medical center by voluntary services, promotion of projects and solicitation of donations and
funds for the benefit of the medical center. The Auxiliary shall adopt bylaws to govern its
activities and such bylaws shall be submitted to the Board for approval.
ARTICLE X
Medical Staff
Section 10.1 Organization and Bylaws. There shall be an organized medical staff
that has overall responsibility for the quality of all medical care provided to patients, and for
the ethical conduct and professional practices of its members as well as for accounting
ICMCWC Bylaws
Page 7
therefor to the Board. The medical staff shall develop and adopt bylaws, rules and regulations
to establish a framework for self - government and a means of accountability to the Board.
These bylaws, rules and regulations shall be submitted to the Board for approval and shall
contain procedures for satisfying the requirements of due process in conducting hearings and
appeals.
KMCWC Bylaws
Page 8
• •
Section 10.2 Medical Executive Committee.
(a) The Medical Executive Committee shall be the executive
committee of the medical staff. The chairman of the Medical Executive
Committee is the Chief of Staff and is an ex- officio member of the Board.
(b) The Medical Executive Committee shall act in an advisory
capacity to the Board when called upon, approve or disapprove the character
of medical work done in the medical center, and if necessary, limit the
activities of the members of the active and visiting staff, provided no such
member's activities shall be limited unless and until said member has had the
privilege of appearing before and being heard by the Medical Executive
Committee.
(c) The Medical Executive Committee shall advise the Board and
make such recommendations with respect to all grievances, complaints,
suggestions and criticisms regarding medical practice and ethics that are
brought to its attention.
Section 10.3 Appointments.
(a) The Board shall approve, upon the advice of the Chief of Staff of
the Medical Executive Committee of the medical staff, the persons entitled to
Medical or Dental Staff membership as evidenced by their individual
qualifications and licensed by the State of Hawaii subsequently to engage in
medical practice within the medical center and the conditions and standards
under which such practice shall be conducted.
(b) All initial appointments to the medical staff shall be for a period
of one year pursuant to formal reapplication procedures. Reappointments
shall be for two years each.
(c) When an appointment is not to be renewed, or when privileges
have been or are proposed to be reduced, altered, suspended, or terminated,
the staff member shall be afforded the opportunity of due process as outlined
in the medical staff bylaws.
• •
Section 10.4 Physicians and Dentists Employed by the Medical Center.
(a) Physicians and dentists employed by the Corporation in a purely
administrative capacity with no clinical duties are subject to the regular
personnel policies of the hospital and their contract or other terms of
employment, and need not be members of the medical staff.
(b) Physicians and dentists employed by the Corporation, either full
or part-time, whose duties are medico - administrative in nature and include
clinical responsibilities or functions with the medical staff involving their
professional capability as physicians or dentists, must be members of the
medical staff, achieving this status by the same procedure provided for other
medical staff members. Medical staff membership and clinical privileges may
or may not be made contingent on continued employment.
(c) Termination of employment of a physician or dentist in a
medico - administrative position shall be subject to review, and a hearing, if
requested, by a joint conference of Board members and representatives elected
by the voting members of the medical staff.
(d) When the reason for the action is determined to involve the
individual's medical competence, which includes competence to supervise the
professional activities of practitioners under his or her direction, the medical
staff shall provide for a review of the decision, including the right to a hearing
if requested by the individual, and a recommendation to the Board on the
action proposed.
(e) When the reason for the action is determined by the joint
conference to be purely administrative in nature and does not involve the
individual's medical competence, the Board shall follow its usual personnel
policies, or the terms of the contract, if there be one.
Section 10.5 Responsibilities of the Medical Staff. The medical staff shall have the
authority and responsibility to establish and maintain the following:
(a) To be a member of the medical staff a doctor shall qualify for the
medical privileges, and exercise the privileges granted, consistent with the
requirements of these bylaws and the bylaws, rules and regulation . of the
medical staff.
(b) The medical staff shall be organized to provide a framework for
effective performance by the members of their duties and functions. The
organization shall be in categories set forth in the medical staff bylaws, which
shall provide for the election of officers, executive committee and service
chiefs. The service chiefs may serve for a period of two years and may be re-
elected subject to the directives of the medical staff and its bylaws.
ICMCWC Bylaws
Page 9
KMCWC Bylaws
Page 10
(c) The medical staff shall strive to create and maintain an optimal
level of professional performance by its members through the appointment
procedure, delineation of medical staff privileges and the continual review and
evaluation of each member's clinical activities.
(d) The medical staff shall provide procedures by committee or
otherwise for regular review, evaluation and monitoring of practices and
functions of members for the purpose of maintaining high professional
standards of care;
(e) There shall be regular medical staff and departmental meetings to
review the clinical work of members and to complete medical staff
administrative duties;
(f) The medical staff shall provide a continuing program of medical
education; and the members shall submit or give evidence of participation in
the program or comparable programs to the medical staff.
ARTICLE XI
Conflict of Interest
(a) Trustees, officers and employees shall exercise utmost good faith
in all transactions involving the Corporation and its property, and they shall
comply with the strictest rules of honesty and fair dealing. They shall not use
their positions or information gained from such positions in any way to create
or participate in a conflict between their interest and the interest of the
Corporation.
(b) No trustee, officer or employee shall act in any manner which
affects the Corporation adversely.
(c) No trustee, officer or employee of the corporation shall accept
any favor which might influence his actions concerning the Corporation.
(d) All trustees, officers and employees of the Corporation shall use
their best efforts to avoid any new employment, activity, investment or other
interest which would compete with or be in conflict with the interest of the
Corporation and in the event any such activity, investment or other interest
becomes apparent, the trustee, officer or employee shall disclose the same to
the Board of Trustees of the Corporation.
(e) If any trustee, officer or employee prepares to undertake any
transaction for which there can be any doubt about the existence of a conflict
of interest, the trustee, officer or employee shall file a written disclosure with
• •
the Executive Committee of the Corporation before consummating the
transaction.
(f) The President of the Corporation shall prepare an appropriate
questionnaire to ascertain if any trustee, officer or employee is involved in any
transaction which may be deemed a conflict of interest with that of the
Corporation. Each trustee, officer and selected employee who receives a copy
of the questionnaire shall complete and return it to the President. The
President shall report to the Executive Committee all transactions about which
there appears to be any question of a conflict of interest. The questionnaire
procedure shall be performed at least annually.
ARTICLE XII
Auditor
The Auditor shall be elected annually by the Board. The Auditor shall audit the books
and accounts of the Corporation and shall certify its findings and report thereon, in writing, to
the members at least annually; and shall make other audits and reports as the Board shall
determine from time to time. The Auditor may be a person, copartnership, or a corporation.
No member, trustee of a corporate member, or trustee shall be eligible to serve as Auditor of
the Corporation. The Auditor may be removed from office either with or without cause at any
time at any meeting of the Board.
ARTICLE XIII
Amendments
These Bylaws may be altered, amended or repealed at any meeting of the Board
provided that written notice of the meeting shall be given in accordance with section 4.3(d) of
these Bylaws, which notice shall state that one of the purposes of the meeting is the
consideration of the amendment of these Bylaws and shall set forth the proposed amendments.
KMCWC Bylaws
Page 11
Human Resources Policy and Procedure:
EMPLOYMENT OF RELATIVES
Number: 6.6 Reviewed:
Effective Date: 11/1/85 Approva1L tt.i
Revision Date: 5/1/97
I. Purpose
Kapi'olani Health recognizes that relatives of employees may be a valuable source of recruitment
for job vacancies. However, it also recognizes employment of relatives in the same organizational
entity may cause potential conflicts and create issues of favoritism and employee morale.
II. Relatives Defined
Relatives are defined as spouses, domestic partners, parents, stepparents, parents -in -law, siblings,
stepsiblings, brothers -in law, sisters -in -law, children, stepchildren, children -in -law, grandparents,
grandparents-in -law, aunts, uncles, nieces, nephews, first cousins, and legal guardians.
III. Procedure
• •
A. Conditions prohibiting employment.
1. Relatives shall not be employed where the applicant would:
a. Directly or indirectly supervise or be supervised by a relative.
b. Be employed to work in the same entity, subsidiary, or division as a relative.
c. Where a conflict of interest or the perception of a conflict of interest could occur by the
applicant working in such areas as administration, finance, materials management,
purchasing, or security.
2. Relatives or members of the Leadership Team and other key members of management may
not be employed with Kapi olani Health.
B. Employee relationships occurring after employment.
KAPI'OLANI
HEALTH
1, When either a marriage or domestic partnership between two employees occurs in one of
the areas listed in A above, changes in employment will not be required. However, a
mutually suitable solution shall be sought to avoid continued employment of both - _
employees working in these areas. The two employees who become so involved (marriage
or domestic partnership) shall suggest the suitable solutions to the appropriate member(s)
of Management Committee, and in consultation with the Vice President of Human
Resources, the solution will be documented and implemented.
2. If a direct or indirect supervisory relationship occurs as a result of marriage or domestic
partnership, the employees so involved will determine a plan to resolve the situation within
the soonest possible time frame. This solution shall be presented to the appropriate
Employment of Relatives
Page 2
F:P•P\RELATIVE.DOC
• •
member(s) of Management Committee and the Vice President of Human Resources, and, if
approved, will be implemented as soon as practical. Should the solution not be acceptable
to management, the group will work together until a solution is found that resolves the
situation. Depending on the closeness of the supervisory relationship, management
reserves the right to require that the two affected employees determine which one of them
will remove themselves from the work environment, either by transfer, demotion, or
resignation. This is clearly the least optimal solution, and if it becomes necessary to
implement such a solution, an appropriate separation package will be offered, consistent
with separation packages given in layoff situations.
;.-
• •
1997 INCOME TAX RETURNS
KAPI'OLANI MEDICAL CENTER
FOR WOMEN AND CHILDREN
JERNST &YOUNG LLP
• Department of the Treasury
Internal Revenue Service
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A For the 1997 calendar year, OR tax
C Name of organization
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND
CHILDREN
Number and street (or P.O. box if mail is not delivered to street address)
Amended
return
ventured City, town, or post office, state, and ZIP+ 4
also for
55 MERCHANT STREET, 24TH FLOOR
P, i re ) H O N O L U L U , H I 96813
G Type of organization —la I X I Exempt under section 501(c)
may have to use a cow of this retVn to satisfy ilk
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7E1010 2.000
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99 0177350
O Employer identification number
E State registration number
10141495
F cheek le I 1
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d azernpoon application
is pending
3 ) 1 (insert number) OR ► U section 4947(a)(I) nonexempt charitable trust
Note: Section 80 /fc13) exempt organizations and 4947141) nonexempt chanrab/e mats MUST attach a mmppted Schedule A (Form 990)
H (a) Is this a group return filed for affiliates? U Yes X No I If either box in H is checked eyes' enter four
group exemption number (GEN) ►
(b) If 'Yes,' enter the number of affiliates for which this return is filed: ► J Accounting method:I 1 Cash 'XI Accrual
(c) Is this a se parale return tiled by an organization covered bya group ruling? Yes X No Other (specify) P
K Check here ► I I if the organization's gross receipts are normally not more than $25,000. The organization need not file a return with the IRS:
but it it received a Form 990 Package in the mail, it should file a return without financial data. Some states require a complete return.
Note: form 990£Z maybe used by organizations with gross receipts less than $100,000 and rota/ assets less than $250,000 at end of year.
Part I Revenue, Expenses, and Changes in Net Assets or Fund Balances (See Specific Instructions on page 11.)
1 Contributions, gifts, grants. and similar amounts received: STMT 1
a Direct public support la 2,605 445.
b Indirect public support 6,823,430.
c Government contributions (grants) 1 c 5,452,013.
d Total (add lines la through lc) (attach schedule of contributors)
(cash$ 12,256,093. noncash$ 2,624,795.)
2 Program service revenue including government fees and contracts (from Part VII, line 93)
3 Membership dues and assessments
4 Interest on savings and temporary cash investments
5 Dividends and interest from securities
6 a Gross rents 6a
b Less: rental expenses 6b
c Net rental income or (loss) (subtract line 6b from line 6a) 6c
7 Other investment income (describe ► SEE STATEMENT 3
8 a Gross amount from sale of assets other
b
c
d
9
a
b
c
10a
b
c
11
12
than inventory
Less: cost or other basis and sales expenses
Gain or (loss) (attach schedule)
Net gain or (loss) (combine line 8c. columns (A) and (8))
Special events and activities (attach schedule)
Gross revenue (not including $ of
contributions reported on line la)
Less: direct expenses other than fundraising expenses
Net income or (loss) from special events (subtract line 9b from line 9a)
lb
1,279,336,
238,771. 41
(A) Securities
5,898.161.
(B) Other
Ba 502,893.
Bb
5,898.161.8c
1,076,270.
- 573,377.
9a
9b
Gross sales of inventory, less returns and allowances lOa
Less: cost of goods sold l
Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a)
Other revenue (from Part VII, line 103)
Total revenue (add lines ld, 2, 3, 4 5, 6c, 7, 8d, 9c, 10c, and 11)
297 801.
178,681.
13 Program services (from line 44, column (B))
14 Management and general (from line 44, column (C))
15 Fundraising (from line 44, column (D))
16 Payments to affiliates (attach schedule)
17 Total expense s (add lines 16 and 44, column (A))
18 Excess or (deficit) for the year (subtract line 17 from line 12)
19 Net assets or fund balances at beginning of year (from line 73. column (A))
20 Other changes in net assets or fund balances (attach explanation) STMT 4
21 Net assets or fund balances at end of year (combine lines 18, 19, and 20)
3
2
4
5
7
9c
l ot
11
12
13
14
15
16
17
18
19
20
21
50F12E 1018 05/05/99 11:05:16 V707 10076381
14 880 888.
141 891 077.
48 254.
'5,177,025.
1 040 565.
361 114.
5,324 784.
119 120.
1 323 085.
170 165 912.
97 197 136.
44 429,094.
141 626 230.
28 539 682.
159,581 548.
235 809.
188 357 039.
Form 990 (1997)
6
•
runctuOnal EA Pc 'Deo section 4947(a)(1l nonexempt cherubic trusts but coon tbers. pee Specific Instructions on page l5.) •
Do not include amounts reported on
6b. 8b. 9b. lob, or 16 of Part I.
(A) Total
(B) Program
services
(C) Management
and general
(DI Fundraising
22 Grants and allocations (attach schedule)
(•2h, 271 •390. amosh (
22
23
7,271,390.
7.271.390,
Stt4T 25 ^.:;:. .
23 Specific assistance to individuals (attach schedule)
24 Benefits paid to or for members (attach schedule)
25 Compensation of officers. directors, etc.
26 Other salaries and wages
27 Pension plan contributions
28 Other employee benefits
29 Payroll taxes
30 Professional fundraising fees
31 Accounting fees
32 Legal fees
33 Supplies
34 Telephone
35 Postage and shipping
36 Occupancy
37 Equipment rental and maintenance ,
38 Printing and publications
39 Travel
40 Conferences, conventions, and meetings
41 Interest
42 Depreciation. depletion. etc. (attach schedule)
43 Other expenses (itemize): aSTMT 5
24
25
175,003.
175,003.
26
47,955,791.
27,976,396.
19,979,395..
27
1,486,620.
891 , 972.
594,648 .
28
5,290,616.
3,174,370.
2,116,246.
29
3 810,203.
2,286,122.
1,524,081.
30
31
32
27,724.
27.724.
33
12.607,372.
11,339.623.
1,267.749.,
34
696,684.
357.950.
238,634.
35
36
1,332,699.
799,619.
533,080.
37
751,647.
450, 988.
300, 659.
38
39
226,389.
135 233.
90,156 .
40
41
4,415.402.
2 , 649 , 241.
1.766.161.
42
6,589,251.
3,953,551.
2.635,700.
43a
49,090,539.
35,910,681.
13,179,858.
b
43b
c
43c
d
43d
e
430
44 Total functional expenses ledd tines 22 through
43) Orgenaadons completing columns (3){D),
cern1 t h e s e ! rs-ra • • • • • • •
41
141 , 626.230.
97, 197 , 136.
44, 429, 094.
• • Part p Statement of All organaations must complete column (A). Columns (B). (C). and (DI are required for section ow Irene, uuu r +r o
.1SA
Reporting of Joint Costs. - Did you report in column (B) (Program services) any joint costs from a combined
educational campaign and fundraising solicitation? ► E Yes
It 'Yes,' enter (i) the aggregate amount of these joint costs
(iii) the amount allocated to Management and general $
$ ; (lithe amount allocated to Program services $
; and (iv) the amount allocated to Fundraising $
Part III Statement of Program Service Accomplishments (See Specific Instructions on page 18.)
What is the organization's primary exempt purpose? ■ PROVIDE HEALTHCARE
All organizations must describe their exempt purpose achievements in a clear and concise manner. State the number
of clients served, publications issued, etc. Discuss achievements that are not measurable. (Section 601 (c)(3) and (4)
organizations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of grants and allocations to others.)
a ROUTINE HOSPITAL SERVICES - SEE ATTACHED STATEMENT 26
(Grants and allocations $
b ANCILLIARY SERVICES - SEE ATTACHED STATEMENT 26
(Grants and allocations $ NONE)
c KAPIOLANI MEDICAL CENTER FOR WOMEN AND CHILDREN AWARDS
VARIOUS GRANTS TO ORGANIZATIONS IN THE COMMUNITY TO PROVIDE
HEALTHCARE, SOCIAL SERVICES AND EDUCATIONAL PROGRAMS.
(Grants and allocations $ 7,271,390.)
d
7E1020 2.000
(Grants and allocations $
50F12E 1018 05/03/99 10:04:54 V707 10076381
NONE)
)
ra
No
Program Service
Expenses
(Required for 501103l and
(4) orgy. and 494740111
trusts: but optional for
others,)
45,842,963.
44,045,200.
7,308,973.
e Other program services (attach schedule) (Grants and allocations $
f Total of Program Service Expenses (should equal line 44, column (B). Program services) ► 97,197,136.
6
Note: Where required. attached scheo-nd amounts within the description
column should be for end -of -year amounts only.
(A)
Bing of year
(B)
End of year
I Assets
45 Cash - non-interest-bearing
46 Savings and temporary cash investments
47a Accounts receivable
b Less: allowance for doubtful accounts
48a Pledges receivable
b Less: allowance for doubtful accounts
47a
46,536,939.
45
5,227,362.
46
6.771.431.
24,883,949.47c
38.650 , 702.
476
7 , 886 , 237.
48a
48c
48b
49 Grants receivable
50 Receivables from officers, directors, trustees, and key employees
(attach schedule)
51a Other notes and loans receivable (attach
schedule) 151 a
794,839.
49
826,411.
50
51
b Less: allowance for doubtful accounts 151b
`
52 Inventories for sale or use
53 Prepaid expenses and deferred charges
54 Investments - securities (attach schedule) SEE. S,TATEMENT..6.....
55a Investments - land, buildings, and
equipment: basis
b Less: accumulated depreciation (attach
schedule)
56 Investments - other (attach schedule)
57e Land, buildings, and equipment basis STMT, 7,
55a
53,178.
1,343,169.
52
1,289 , 205.
1,571,692.
53
' 1 , 927 083.
95 , 889 , 066
54
1 02, 052 , 37 .
53, 178.
°
55c
53.178.
556
57a
1 29 , 493 , 746 ,
56
64,091,213.67c
...
73,011,224.
b Less: accumulated depreciation (attach
schedule)
57b
56,482,521.
58 Other assets (describe ► SEE STATEMENT 8 )
23, 503, 469.
58
21,089 918.
59 Total asset (add lines 45 through 58) (must equal line 74)
217.357.927.
59
245.671 626.
16,971,361.
Liabilities
60 Accounts payable and accrued expenses
61 Grants payable
62 Deferred revenue STMT. . 9
63 Loans from officers, directors, trustees, and key employees (attach
schedule)
64a Tax - exempt bond liabilities (attach schedule) STMT. ,10
b Mortgages and other notes payable (attach schedule)
65 Other liabilities (describe ► SEE STATEMENT 1 1 )
17,491,799.
60
61
1 , 535 , 107.
62
1,535 107 .
63
30,670,086 .
64a
29,833,065.
64b
8 . 079 , 388.
65
8,974 964 .
66 Total liabilities (add lines 60 through 65)
57,776,379.
56
67,314,487.
Net Assets or Fund Balances I
Organizations that follow SFAS 117, check here ► I X I and complete lines
67 through 69 and lines 73 and 74,
67 Unrestricted
68 Temporarily restricted
69 Permanently restricted
Organizations that do not follow SFAS 117, check here I- ❑ and
complete lines 70 through 74.
70 Capital stock, trust principal, or current funds
71 Paid-in or capital surplus, or land, building, and equipment fund
72 Retained earnings. endowment, accumulated income, or other funds
73 Total net assets or fund balances (add lines 67 through 69 OR lines
70 through 72: column (A) must equal line 19 and column (B) must
equal line 21)
74 Total liabilities and net assets /fund balances (add lines 66 and 73)
153 , 7 1 2 , 5 1 8 .
67
1 8 1 , 238 944 .
2,923,328.
68
3,728,746.
2,046,702.
69
3,389 349 .
_
70
71
72
159,581 548 ,
73
188 , 357 , 039 .
217,357,927.
74
245,671 526.
.6n
' Part IV Balance Sheets (See Specific Instructions on page 18.)
Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a
particular organization. How the public perceives an organization in such cases may be determined by the information presented
on its return. Therefore, please make sure the return is complete and accurate and fully describes, in Part Ill, the organization's
programs and accomplishments.
7E1030 1 000
50F12E 1018 05/03/99 09 :39:23 V707 10076381
7
Instructions on page LU.r
(A) Name and address
(B) Title and average
hours per week
devoted to posnio
(CI Compensation
Of not Paid. enter
ID) Contributions to
employee benefit Plans &
deferred compensation
IE) Expense
account and other
allowances
175,003.
40,951.
NONE
SEE STATEMENT 18
. Pan IV-A Reconciliation of Revenue per Audited
Financial Statements Revenue per
Return (See Specific ctions, page 20.
a Total revenue, gains, and other support
per audited financial statements •
ran iv-o necvna,,,r a aeon .,, ".r,— .. - -., r . —.
Finaryj@I Statements with Expenses pen
Ret
a
163249181.
990.829.
c
a
162258352.
361.114
162619466.
a Total expenseWd losses per
audited financial statements , ►
b Amounts included on line a but not
on line 17, Form 990:
(1) Donated services
and use of facilites $
(2) Prior year adjustments
reported on line 20,
Form 990 $
(3) Losses reported on
line 20, Form 990 $
(41 Other (specify).
STMT 14 $ 990,829.
Add amounts on lines (1) through (4) ►
c Line a minus line b
d Amounts included on line 17,
Form 990 but not on line a:
(1) Investment expenses
not included on line
6b, Form 990 ,$
(21 Other (specify):
$
Add amounts on lines (1) and (2) , ►
e Total expenses per line 17, Form 990
(line c plus line d) ►
b
d
e
b Amounts included on line a but not on
line 12, Form 990:
(1) Net unrealized gains
on investments . $
(2) Donated services
and use of facilities S
(3) Recoveries of prior
year grants $
(4) Other (specify):
STMT 12 $ 990.829.
Add amounts on lines (1) through (4) ►
c Line a minus line b ►
d Amounts included on line 12.
Form 990 but not on line a:
(1) Investment expenses
not included on line
6b Form 990 $
(2) Other(specdpC__._
STMT 13 $ 361,114.
Add amounts on lines (1) and (2) ►
e Total revenue per line 12. Form 990
(line c plus line d) ►
Part V List of Officers, Directors, Trustees, and Key Emp ogees
75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your
organization and all related organizations, of which more than $10,000 was provided by the related
SEE organizations?
STATEMENT 20
If 'Yes' attach schedule - see Specific Instructions on page 20.
AA
7e7040 7 . 000 50F12E 1018 05/03/99 09:39:23 V707 10076381
142617059.
(List each one even if not compensated; see Specific
Ix!
990,829.
141626230.
141626230.
Yes n No
8
Part VI Other Intormation twee apecnic instructions urn paye c n.I
r
76 Did the organization engage in any activity not pu reported to the IRS? If 'Yes? attach a detailed d
77 Were any changes made in the organizing or g g documents but not reported to the IRS?
If 'Yes,' attach a conformed copy of the changes.
78a Did the organization have unrelated business gross Income of $1,000 or more during the year covered by
b If 'Yes,' has it filed a tax return on Form 990-T for this year?
79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If 'Yes,' attach
80 Is the organization related (other than by association with a statewide or nationwide organization) through
membership, governing bodies, trustees. officers, etc., to any other exempt or nonexempt organization?
b If 'Yes,' enter the name of the organization ► STMT 22
and check whether it is exempt OR I I nonexempt
81a Enter the amount of political expenditures, direct or indirect, as described in the
instructions for line 81
b Did the organization file Form 1120 -POL for this year?
82a Did the organization receive donated services or the use of materials, equipment or facilities at no charge
or at substantially less than fair rental value?
b If 'Yes,' you may indicate the value of these items here. Do not include this amount
as revenue in Part I or as an expense in Part II. (See instructions for reporting in
Part III.)
83a Did the organization comply with the public inspection requirements for returns and exemption applications?
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? , ,
84a Did the organization solicit any contributions or gifts that were not tax deductible?
b If 'Yes,' did the organization include with every solicitation an express statement that such contributions
or gets were not tax deductible?
85 501(X4), (5), or (6) organizations.-a Were substantially all dues nondeductible by members?
b Did the organization make only urhouse lobbying expenditures of $2,000 or less?
If'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organize
received a waiver for proxy tax owed for the prior year.
c Dues, assessments, and similar amounts from members
d Section 162(e) lobbying and political expenditures
e Aggregate nondeductible amount of section 6033(eX1)(A) dues notices
f Taxable amount of lobbying and political expenditures (line 85d less 85e)
g Does the organization elect to pay the section 6033(e) tax on the amount in 85f?
h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount in 851 to its reasonable
estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year?
86 501(c)(7) organizations. -Enter. a Initiation fees and capital contributions included on
line 12
b Gross receipts, included on line 12. for public use of club facilities
87 501(c0 12) organizations.- Enter. a Gross income from members or shareholders
b Gross income from other sources. (Do not net amounts due or paid to other
sources against amounts due or received from them.)
88 At any time during the year. did the organization own a 50% or greater interest in a taxable corporation or
partnership? If 'Yes,' complete Part IX
89a 501(43) organizations.- Enter. Amount of tax paid during the year under.
section 4911 ► NONE ; section 4912 ► NONE ; section 4955 I
b 501(c)(3) and 501(c)(4) organizations.-Did the organization engage in any section 4958 excess benefit
transaction during the year? If 'Yes,' attach a statement explaining each transaction
c Enter: Amount of tax imposed on the organization managers or disqualified persons during the year under
sections 4912, 4955, and 4958 ►
d Enter: Amount of tax in 89c. above, reimbursed by the organization
90a List the states with which a copy of this return is filed ►
b Number of employees employed in the pay period that includes March 12. 1997 (See instructions.) I gob I 1 369
91 The books are in care of l KAPI'OLANI HEALTH Telephone no. ► 808 - 535 -7355
Located at► 55 MERCHANT STREET, 24TH FL, HONOLULU ZIP +4 ► 96813
92 Section 4 947(a)(1)nonexempt chanrable trusts filing Form 9.90 in lieu of Form 1041 -Check here
and enter the amount of tax-exempt interest received or accrued during the tax year
JsA
this return?
a statement
common
81a[
scription of each activity
• STMT 21
L82b1
ion
85c
85d
85a
85f
86a
86b
87a
87b
N/A
N/A
N/A
N/A
N/A
NONE
NONE
76
77
78a
78b
79
80a
81b
82a
83a
83b
84a
84b
85a
85b
85g
85h
88
89b
X
X
X
X
X
X
N
N
N
N
N
N
7E1041 1000
N/A
50F12E 1018 05/03/99 09:39:23 V707 10076381
► 192 I
N/A
9
A
A
A
A
A
A
Xi.
X
X
X
NON
NON
►L
VII Analysis of Income - Producing Activmes fsee Specific instructions on page c o.t
gross amounts unless otherwise •
tad.
Program service revenue:
ROUTINE SERVICES
Unrelated business income
Excluded b
eon 512, 513. or 514
(E) , ,
Related or
exempt function
income
(A)
Business
rode
(B)
Amount
(CI
Exclusion co
(p)
Amount
80,351.100.
ANCILLIARY SERVICES
8060
275,079.
123,882.523.
CONTRACTUAL ADJUST.
- 62,757,442.
OTHER PROGRAMS
Please
Sign
Here
Under pmalaes at perjoy. I declare that I tea examined this men incasing acmnparyng schedules and statemenK end to the bast of my knowledge
and belief. it is true, correct, and complete. Dacia ation of preparer (other than officer) is based on all information of which preparer has any knowledge.
(See General I a 'on U. on pap 10.)
�( ` ? 157;v4 l�
t . ,v v� �Cfr
139,817.
Date Type or print name and trek.
Paid
Preparer's
Use only
PreparPreparers
Signature - r
Dale
4 7A- 7 /f5
Check if
employed ►IC
Medicare /Medicaid payments
Fees and contracts from government agencies
Membership dues and assessments , , ,
Interest on savings and temporary cash nvertments •
Dividends and interest from securities . .
Net rental income or (loss) from real estate:
debt - financed properly
not debt-financed property
Net rental income or (loss) from personal properly
Other investment income
Gain or (loss) from sales of assets other than invemory
Net income or (loss) from special events
Gross profit or (loss) from sales inventory
Other revenue: a
Firm's for ERNST & YOUNG LLP
EIN ■ 34- 6565596
name
r ounsdsell - empbyed) 2400 PAUAH I TOWER, 1001
BISHOP ST
ZIP.4 96813
and address HONOLULU, HI
14
48,254.
14
5,177,025.
16
1,040.565.
18
361,114.
18
5,324,784.
03
119.120.
PARKING
-
03
319,163.
CAFETERIA
_
_ 03
902.569.
REIMBURSEMENTS _
48.738.
OTHER SERVICES
275,079.
_ 03
- .-. ...
52,615.
13,345,209.
141,664 736.
_
Subtotal (add columns (B).(D), and (E)). .
Part IX Information Regarding Taxable Subsidiaries (Complete this Part if the "Yes" box on line 88
is checked.)
End-of-year
:assets
Name, address, and employer identification
number of corporation or partnership
Percentage of
ownership
interest
Nature of
business activities
Total
income
Please
Sign
Here
Under pmalaes at perjoy. I declare that I tea examined this men incasing acmnparyng schedules and statemenK end to the bast of my knowledge
and belief. it is true, correct, and complete. Dacia ation of preparer (other than officer) is based on all information of which preparer has any knowledge.
(See General I a 'on U. on pap 10.)
�( ` ? 157;v4 l�
t . ,v v� �Cfr
' officer
Signature of offi
Date Type or print name and trek.
Paid
Preparer's
Use only
PreparPreparers
Signature - r
Dale
4 7A- 7 /f5
Check if
employed ►IC
Preparer's SSN
220 -62 -004,
Firm's for ERNST & YOUNG LLP
EIN ■ 34- 6565596
name
r ounsdsell - empbyed) 2400 PAUAH I TOWER, 1001
BISHOP ST
ZIP.4 96813
and address HONOLULU, HI
Pa
LA
Enter
iodi
93
e
b
c
d
e
f
g
94
95
96
97
a
b
98
99
100
101
7ElobU 1.000
102
103
b
e
d
e
104
105 Total add line 104, columns (B), (D), and (E))
Note: (Line 05 p /us line Id, Pan L should equal the amount on line 12, Part Ll
Part VIII Relationship of Activities to the Accomplishment of Exempt Purposes (See Specific Instructions on page 26.)
Line No. Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment
• of the organization's exempt purposes (other than by providing funds for such purposes).
SEE STATEMENT 23
50F12E 1018 05/03/99 09:39 :23 V707 10076381
► 155,285,024
10
. Are 1998).
hnmern of the Treasurys
nal 8evenue Service
Name
Kapi'olani Medical Center for Women and Children
re type or
File the
nal end
copy by
rue date
hog your
n. See
anions on
equest an extension
I
PIe—
Type
or
Print
Form
Form
Form
Form
Form
Number. street and room or suns no. for D.O. box no. d marl is not delivered to street address)
706 -G5(D)
706 -GSM
990 or 9904a
990-BL
990.PF
55 Merchant Street, 24th Floor
City, town or pan office. state. and ZIP code. For a foreign address. see instructions.
Honolulu, Hawaii 96813
e: Corporate income tax return filers must use Form 70044 to request an extension of time to file. Partnerships, REM /Cs, and
trust must use Form 8736 to request an extension o to file Form 1065, 1066, or 1041.
of time until May 12) 1999
99GT
(sec 401(e) or I081•) trust)
990 (nun other than above)
1041 (estate) (see instructional
1041 -A
1042
Form 1120-ND
Form 3520A
Form 4720
Form 5227
Form 6069
does not have an office or place of business in the Unit d States, check this box
July 1 1997
If this tax year is for less than 12 months. shed reason: n Initial return
Has an extension of time to file been previously granted for this tax year?
Form
Form
Fprm
Form
Form
If the organoaton
For calendar year , or other tax year beginning
state in dead why you need the extension Additional time is reguired to compile all of thg
necessary information to file a complete and proper return.
If one form is for Form 70669101 706 - iS(7), 9908L 990PF. 9904, 1041 (estate). 1042. 1120410. 4720.
6069. 8612. 8613. 8725. 8804. or 8831, enter the tentative tatt less any nonrefundable credits See instructions
H this form is for Form 990PF. 9907. 1041 Coastal, 1042. or 8804. enter any refundable credos and
eatnnted tax payments made. Include any prior year overpayment allowed as a credit $
Bolan due. Subtract line lib tom fine 6a. Include your payment with this form. or deposit with FED
coupon if required. See instructions S
Signature and Verification
er parables of perjury. I dedare that 1 have examined this form. including accompanying schedules and statements. end to the ben of my knowledge
belief. it is tree. ooneFt. and complete: and that I am authorized to prepare this brat
.tun ► P rm. ■ Executive Vice President & CFO Data • f4l49
ORIGINAL AND ONE COPY. The IRS will show below whether or not your application is approved and will return the copy.
ice to Applicant - To Be Completed by the IRS
We HAVE approved your application. Please attach this form to your return.
We HAVE NOT approved your application. However, we have granted a 10-day grace period from the later of the date
shown below or the due date of your return (including any prior extensions). This grace period is considered to be a valid
extension of time for elections otherwise required to be made on a timely return. Please attach this form to your return.
We HAVE NOT approved your application. After considering the reasons stated in item 4. we cannot grant your request for
an extension of time to file. We are not granting the 10-day grace period.
We cannot consider your application because it was filed after the due date of the return for which an extension was
requested.
Other:
Damao(
u warn a copy of this form to be ',turned to an address other than that shown above. phase enter the address
Name
Number. melt and room or sun. no. for P.O. box no. If mail is not delivered to street address)
Crry, town or pail office. nate. and LP code. For • foreign address. see instructions.
Paperwork Reduction Act Notice, ass the nest page
Certain txcise, Income, information, and voter neaurtts
ills n rate application tot each return. 6 ( �
(sec. 4951 taxes)
and ending
OMb No
99- 0177350
. to file (check only ones
Form 8612
Form 8613
Form 8725
Form 8804
Form 8831
OrlbAll 1 C
Employer rdentrhuoon number
•
June 30, 1998
II Final return 0 Change b accoumng period
Yes U No
RECEIVED
�I ' 1 9 1 9 9 9
a. Form 2758 (Rev. 698)
v. ,rune 1998)
R heft of the Treasury
xra Revenue Service
Name
aietwe or
-,1rFrie the
Waal and
COPY by
Me date
lilt your
y
lit b ns on
u
request
Number.
Form 706 -GS(D)
Form 706 -GS(T)
a Form 990 or 990-EZ
Form 990-8L
Form 990-PF
mute fl
Plane
Type
or
Print
Name
" t_.Gl tou
Kapi'olani Medical Center for Women and Children
street. and room or suite no. (or P.O. box no it mail is not delivered to street address
55 Merchant Street, 24th Floor
City. town cu post office.
Honolulu, Hawaii 96813
orporare income tax return filers must use Form 7004 to request an extension of time to file. Partnerships, REMICs. and
ust must use Form 8736 to request an extension of time to file Form 1065, 1066. or 1041.
an extension of time until February 15, 1999
Form 9904 - f ee
ec-it.jorimen
Form 990 trust other than above)
Form
Form
Form 1042
11 the organization does not have an office or place of business in the United States. check this box
For calendar year . or other tax year beginning July 1 1997
It this tax year is for less than 12 months. check reason: n Initial return
Has an extension of time to fib been previously granted for this tax year?
State m detail why you need the extension Additional time is reguested to compile all of the
necessary information to file a complete and proper return.
If this font, is for Form 7064S(D). 706-GSM. 990-BL 990 990-T, 1041 (estate). 1042. 1120NO. 4720,
6069. 8612. 8613. 8725. 8804, or 8831. enter the tentative tax. less any nonrefundable credits. See instructions
If this form is for Form 990-PF, 9904. 1041 (estate). 1042. or 8804. enter any refundable credits and
estimated tax payments made. Include any prior year overpayment allowed as a credit
S
Balance due. Subtract line Sb from line 5a. Include your payment with this form, or deposit with FTD ic
coupon if required. Sea instructions S None
Signature and Verification
der penalties of perjury II /d that I have examined this form. including accompanying schedules and statements. and to the best of my knowledge
i belief. h is true. i � / " complete: and than I em authorized to prepare this form.
,t aim
Director
Paperwork Reduction Act Notice, sae the next page
let LOX
"pa • seperete application for each return.
and ZIP code. For a foreign addrees. see instructions.
1041 (estate) (see instructions)
1041 -A
By
City. town or post office. state. and ZIP cede. For a foreign address. see instructions.
Form 1120-ND
Form 3520-4
Form 4720
Form 5227
Form 6069
Number, street and room or sure no. (or P.O. box no. it mail u not delivered to street address)
, to file (check only one):
(sec. 4951 taxes) Form 8612
Form 8613
Form 8725
Form 8804
Form 8831
Employer oenohcetion number
99- 0177350
and endmg Jure 30, 1998
II Final return E Change in accounting period
E Yes
Title ► Executive Vice President & CFO Data P /0/314 S'
E ORIGINAL AND ONE COPY. The IRS will show below whether or not your application is approved and will return the copy.
tice.to Applicant -To Be Completed by the IRS
_7 We HAVE approved your application. Please attach this form to your return.
_ We HAVE NOT approved your application. However, we have granted a 10-day grace period from the later of the date
shown below or the due date of your return (including any prior extensions). This grace period is considers
extension of time for elections otherwise required to be made on a timely return. Please attach this form
We HAVE NOT approved your application. Alter considering the reasons stated in item 4. we cannot grant
an extension of time to file. We are not granting the 10-day grace period.
We cannot consider your application because it was filed after the due date of the return for which an ext
f8pUB51ed. OGDEN
Other. i UT
request for U.
NT 1 91998 ' th
ou want a copy of this form to be returned to an address other than that shown above. please enter the address to which the copy should be sent.
Dam
No
ISA Form 2758 (Rev. 6-98)
(See instructions on page 1. List each one. It there are none, enter "None.')
N) Name and address of each employee paid more (
(Whale and average (
(e) Compensation e
(d) Contributions to (
(e) Expense
NRIQUETA MAGBANUA N
NURSE
(See instructions on page 1. ust each one (wnetner Ingmauals or firms). n mere are none, enter "None.')
fa) Name and address of each independent contractor paid more than $60.000 (b) Type of service le) Compensation
MORTENSON, M.A.
1099 ALAKEA ST #1580, HONOLULU, HI 96813CONTRACTING 5,216,503.
HAWAII OB /GYN
1319 PUNAHOU #824 ST, HONOLULU, HI 96813PHYSICIAN 471,245
KAPIOLANI INFOSERVICES
55 MERCHANT ST 23FL, HONOLULU, HI 96813 DATA PROCESSING 4,141,099.
HAWAII RESIDENCY PROGRAM C/O PKF HAWAII
1100 ALAKEA ST #2100, HONOLULU, HI 96813PHYSICIAN 2,921,428.
EMERGENCY PHYSICIANS' MEDICAL GROUP
1 MONTGOMERY ST #1360, SAN FRAN CA 94104PHYSICIAN 1,314.000.
Total number of others receiving over $50000 for
professional services ■ 23 ..' - ....' ... .. .
LA
' bet1tUULL H
(Form 990)
1
7
Department of the Treasury
Internal Revenue Service
7E1210 2.000
1 ...FL9tlflItt1L10f1 Caefllpi LJfluef OVUM-PIS 7V I !G/1J/
(Except P 'vats Foundation) and Section 501(e), 501(f). 501(k),
501 Section 4947(a)(1) Nonexempt Charitabl
Supplementary Information
See separate instructions.
► Must be completed by the above organizations and attached to their Form 990 or 990
OMB No. 15450047
Name of the organization KAP I ' OLAN I MEDICAL CENTER FOR WOMEN AND Employer identification number
CHILDREN 99- 0177350
Part I Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees
Part II Compensation of the Five Highest Paid Independent Contractors for Professional Services
For Paperwork Reduction Act Notice, see page 1 of the Instructions for Form 990 end Form 990 -EZ.
50F12E 1018 05/03/99 09:39:23 V707 10076381
1997
Schedule A Worm 990) 1997
11
LA
' bet1tUULL H
(Form 990)
1
7
Department of the Treasury
Internal Revenue Service
7E1210 2.000
1 ...FL9tlflItt1L10f1 Caefllpi LJfluef OVUM-PIS 7V I !G/1J/
(Except P 'vats Foundation) and Section 501(e), 501(f). 501(k),
501 Section 4947(a)(1) Nonexempt Charitabl
Supplementary Information
See separate instructions.
► Must be completed by the above organizations and attached to their Form 990 or 990
OMB No. 15450047
Name of the organization KAP I ' OLAN I MEDICAL CENTER FOR WOMEN AND Employer identification number
CHILDREN 99- 0177350
Part I Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees
Part II Compensation of the Five Highest Paid Independent Contractors for Professional Services
For Paperwork Reduction Act Notice, see page 1 of the Instructions for Form 990 end Form 990 -EZ.
50F12E 1018 05/03/99 09:39:23 V707 10076381
1997
Schedule A Worm 990) 1997
11
Part HI Statements About Activities
1 During the year, has the organizatio pted to influence national, state, or local legislaticjding any
attempt to influence public opinion on a legislative matter or referendum? 1
If 'Yes,' enter the total expenses paid or incurred in connection with the lobbying activities ► $
Organizations that made an election under section 501(h) by filing Form 5768 must complete Part WA. Other
organizations checking 'Yes.' must complete Part VI$ AND attach a statement giving a detailed description of
the lobbying activities.
2 During the year. has the organization. either directly or indirectly, engaged in any of the following acts with any
of ns trustees. directors, officers. creators, key employees, or members of their families, or with any taxable
organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal
beneficiary:
a Sales, exchange, or leasing of property?
b Lending of money or other extension of credit?
c Furnishing of goods, services, or facilities?
FORM 990
d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)? , p y
a Transfer of any part of its income or assets?
If the answer to any question is 'Yes,' attach a detailed statement explaining the transactions
3 Does the organization make grants for scholarships, fellowships, student loans. etc?
4 Attach a statement to explain how the organization determines that individuals or organizations receiving grants
or loans from it in furtherance of its charitable programs qualify to receive payments. (See instructions on page 2.)
Part IV Reason for Non - Private Foundation Status (See instructions on pages 2 through 4.)
The organization is not a private foundation because it is (please check only ONE applicable box):
5 _ A church, convention of churches. or association of churches. Section 170(b)(1)(A)().
6 A school. Section 1 70(b)(1)(A)(ii). (Also complete Pan V, page 4.)
7 X A hospital or a cooperative hospital service organization. Section 170(b)(1)(A)(iii).
8 _ A Federal, state, or local govemment or governmental unit Section 170(b)(1)(A)(v).
9 _ A medical research organization operated in conjunction with a hospital. Section 170(b)(1)(A)(iii). Enter the hospital's name, city,
and state ►
10 El An orpan¢ation operated for the benefit of a college or university owned or operated by a governmental unit Section 170(bX1$A)(iv).
(Also complete the Support Schedule in Part IV A.)
1la An organization that normallyreceives a substantial part of its support from a govermental unit or from the general public.
Section 170(b)(1)(AI(vi). (Also complete the Support Schedule in Part IV -A.)
11b A community trust Section 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IWA.)
12 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 charitable, etc., functions - subject to certain exceptions, and (2) no more than 33 1/3% of
its support from gross mvestnent income and unrelated business taxable income (less section 511 tax) from businesses acquired
by the organization after June 30, 1975. See section 509(0)(2). (Also complete the Support Schedule in Part IV-A.)
13 n An organization that is not control/0d by any disqualified persons (other than foundation managers) and supports organizations
described in: (1) lines 5 through 12 above; or (2) section 501(c)(4), (5), or (6). if they meet the test of section 509(a)(2). (See
section 609(a)(3).)
Provide the following information about the supported organizations. (See instructions on page 4.)
(a) Name(s) of supported organization(s)
14 n An organization organized and operated to test for public safety. Section 509(a)(4) (See instructions on page 4.)
JSA
7E12202.000 50F12E 1018 05/03/99 09:39 :23 V707 10076381
lb/Line number
from above
Yes No
X
2b X
2c X
2d X
12
Calendar year (or fiscal year beginning in) • • • • Ill (a) 1996
(b) 1995
(c)
Id) 1993
(e) Total
15 Gifts, grants, and contributions received. (Do
not include unusual grants. See line 28.)
16 Membership fees received
17 Gross receipts from admissions,
merchandise sold or services performed, or
furnishing of facilities in any activity that is
not a business unrelated to the organization's
charitable, etc., purpose
18 Gross income from interest, dividends,
amounts received from payments on securities
loans (section 512(a)(5)). rents, royalties, and
unrelated business taxable income (less
section 511 taxes) from businesses acquired
by the organization after June 30, 1975
19 Net income from unrelated business
activities not included in line 18
20 Tax revenues levied for the organization's
benefit and either paid to it or expended on
its behalf
21 The value of services or facilities furnished to
the organization by a governmental unit
without charge. Do not include the value of
services or facilities generally furnished to the
public without charge
22 Other income. Attach a schedule. Do not
include gain or (loss) from sale of capital assets
23 Total of lines 15 through 22
24 Line 23 minus line 17
25 Enter 1% of line 23
26 Organizations described in lines 10 or 11: a Enter 2% of amount in column (e), line 24 NOT, APPI -.I
b Attach a list (which is not open to public inspection) showing the name of and amount contributed by each
person (other than a governmental unit or publicly supported organization) whose total gifts for 1993 through
1996 exceeded the amount shown in line 26a. Enter the sum of all these excess amounts
c Total support for section 509(a)(1) test Enter line 24, column (e)
d Add: Amounts from column (e) for lines: 18 19
CABLE. ►
■
P.
►
►
►
26e
26b
26c
26d
22 26b
e Public support (line 26c minus line 26d total) • , •
f Public support percentage (line 26e (numerator) di vided
by line 26c (denominator))
26
26f
Part Wa Support Schedule (Complete only if you checked a box on line 10, 11, or 1 z.l use casn rrmmuu m eovvunmy. 11W r r•r r ,
27 Organizations described on line 12: a For amounts included in lines 15, 16. and 17 that were received from a 'disqualified
person.' attach a list to show the name of, and total amounts received in each year from, each 'disqualified person.` Enter the sum
of such amounts for each year NOT APPLICABLE
(1996) (1995) (1994)
b For any amount included in line 17 that was received from a nondisqualified person. attach a list to show the name of, and amount
received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000. (Include in the list
organizations described in lines 5 through 1 1. as well as individuals.)After computing the difference between the amount received
and the larger amount described in 11) or (2), enter the sum of these differences (the excess amounts) for each year:
(1996) (1995) (1994)
c Add: Amounts from column (e) for lines: 15 16
17 20 21
d Add: Line 27a total and line 27b total •
e Public support (line 27c total minus line 27d total)
f Total support for section 509(x)(2) test: Enter amount on line 23, column (e)
g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) 42711
(1993)
►
27d
27e
27g
27h
(1993)
► 27c
►
►
h Investment income percentage (line 18, column (e) (numerator) divided by line 27f (denominator))
28 Unusual Grants: For an organization described in line 10, 11, or 12 that received any unusual grants during 1993 through 1996,
attach a list (which is not open to public inspection) for each year showing the name of the contributor, the date and amount of the
grant and a brief description of the nature of the orant. Do not include these grants in line 15. (See instructions on page 4
LA
7E1221 1 oo0 50F12E 1018 05/03/99 09:39:23 V707 10076381 13
. Part V Private School Questionnaire (See instructions on paye 't.r
(To be completed ON schools that checked the box on line . art IV)
.sn
29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws,
other governing instrument, or in a resolution of its governing body?
30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its
brochures, catalogues, and other written communications with the public dealing with student admissions,
programs, and scholarships?
31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during
the period of solicitation for students, or during the registration period if it has no solicitation program, in a way
that makes the policy known to all parts of the general community it serves?
If "Yes,' please describe; if "No,' please explain. (11 you need more space, attach a separate statement.)
32 Does the organization maintain the following:
a Records indicating the racial composition of the student body, faculty, and administrative staff?
b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory
basis?
c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing
with student admissions, programs, and scholarships?
d Copies of all material used by the organization or on its behalf to solicit contributions?
34a
7E1230 2.000
If you answered 'No' to any of the above, please explain. (If you need more space, attach a separate statement)
33 Does the organization discriminate by race in any way with respect to:
a Students' rights or privileges?
b Admissions policies?
c Employment of faculty or administrative staff?
d Scholarships or other financial assistance?
e Educational policies?
f Use of facilities?
g Athletic programs?
h Other extracurricular activities?
If you answered 'Yes" to any of the above, please explain. Of you need more space, attach a separate statement.)
Does the organization
b Has the organization's
If you answered 'Yes'
receive any financial aid or assistance from a governmental agency?
right to such aid ever been revoked or suspended?
to either 34a or b, please explain using an attached statement
35 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05
of Rev. Proc. 75 -50, 1975 -2 C.B. 587, covering racial nondiscrimination ? If 'No.' attach an explanation
50F12E 1018 05/03/99 09:39:23 V707 10076381
NOT APPLICABLE
29
30
31
32a
32b
32c
32d
33e
33b
33c
33d
330
33f
330
33h
34e
34b
35
Yes No
14
(a)
Line no.
(bl
Amount involved
le)
Name of noncharnable exempt organization
(dl
Description of transfers, transactions, and sharing arrangements
51blvi)
1,619,048.
KAPIOLANI HEALTHHI
PURCHASE OF
HEALTHCARE
SERVICE
5lbivi)
333,699.
PACIFIC HEALTH CARE
PURCHASE OF
HEALTHCARE
SERVICE
51b(v)
161,593.
KAPIOLANI HEALTHHI
INTERCOMPANY
ADVANCE
HEALTH PLAN PARTNERS
501(C)14)
50% OWNED BY KAPIOLANI HEALTH
HAWAII PARENT
(a)
Name of organization
(b)
Type of organization
10
Description of relationship
PACIFIC HEALTH HI
HMO 501(C)(4)
20% OWNED BY KAPIOLANI MEDICAL
CENTER FOR WOMEN & CHILDREN
PARENT
KAPIOLANI HEALTHHI
HMO 501(C)(4)
100% OWNED - KAPIOLANI MEDICAL
CENTER FOR WOMEN & CHILDREN
PARENT
HEALTH PLAN PARTNERS
501(C)14)
50% OWNED BY KAPIOLANI HEALTH
HAWAII PARENT
, Part VII Information Regarding Transfers To and Transactions ano neianonsmps vvrari rvvrr ,a,.ta,ai
Exempt Organizatio
JSA
751250 2.000
51 Did the reporting organization diwor indirectly engage in any of the following 'y other organization described in section
501(c) of the Code (other than section 501(c)(3) organizations) or in section 527. re g to political organizations?
a Transfers from the reporting organization to a noncharitable exempt organization of:
(i) Cash
(ii) Other assets
b Other transactions:
(i) Sales of assets to a noncharitable exempt organization
(5) Purchases of assets from a noncharitable exempt organization
(iii) Rental of facilities or equipment
(iv) Reimbursement arrangements
(v) Loans or loan guarantees
(vi) Performance of services or membership or fundraising solicitations
t Sharing of facilities, equipment mailing lists, other assets, or paid employees
d If the answer to any of the above is 'Yes: complete the following schedule. Column (b) should always show the fair market value of the
goods, other assets, or services given by the reporting organization. If the organization received less than fair market value in any
transaction or sharing arrangement show in column (d) the value of the goods, other assets services received:
52a Is the organization directly or indirec ly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? •
b If ' Yes, " complete the following sc hedule:
50F12E 1018 05/06/99 13:13:31 V707 10076381
51 a(i)
Mill
b(i)
b(ii)
b(iii)
b(iv)
b(v)
b(vi)
c
Yes
x
x
16
No
x
x
x
Yes No
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND 99- 0177350
FORM 990, PART I - LIST OF CONTRIBUTORS
(NOT OPEN TO PUBLIC INSPECTION)
DIRECT INDIRECT
PUBLIC PUBLIC GOVERNMENT
NAME AND ADDRESS DATE SUPPORT SUPPORT GRANTS
F.L. LYMAN
1001 BISHOP STREET
HONOLULU, HAWAII 96813
SOPHIE OVEREND
1001 BISHOP STREET
HONOLULU, HAWAII 96813
ANNIE H. PARKE
111 SOUTH KING STREET
HONOLULU, HAWAII 96813
VARIOUS LESS THAN $5,000
TRANSFER FROM RESTRICTED FUND
FEDERAL GRANTS
RESTRICTED GRANTS AND CONTRIBUTIONS
33,357.
11,596.
7,407.
10,692.
2,542,393. 82,402.
•
HAWAII STATE /HONOLULU CITY & COUNTY 3,813,035
•
833,560
805,41E
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND 99- 0177350
FORM 990, PART I - LIST OF CONTRIBUTORS
(NOT OPEN TO PUBLIC INSPECTION)
DIRECT INDIRECT
PUBLIC PUBLIC GOVERNMENT
NAME AND ADDRESS DATE SUPPORT SUPPORT GRANTS
KAPI'OLANI HEALTH
55 MERCHANT STREET, 24TH FLOOR
HONOLULU, HAWAII 96813
TOTAL CONTRIBUTION AMOUNTS 2,605,445.
6,741,028.
6,823,430. 5,4 53
•
• •
FORM 990, PART I - OTHER INVESTMENT INCOME
DESCRIPTION AMOUNT
ENDOWMENT FUND 361,114.
TOTAL 361,114.
STATEMENT 3
50F12E 1018 05/03/99 09 :39:23 V707 10076381 19
• •
FORM 990, PART I - OTHER INCREASES IN FUND BALANCES
DESCRIPTION AMOUNT
UNREALIZED GAIN ON INVESTMENTS
UNREALIZED GAIN ON RESTRICTED INVESTMENT
153,276.
82,533.
TOTAL 235,809.
4
STATEMENT 4
50F12E 1018 05/03/99 09:39:23 V707 10076381 20
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND 99- 0177350
FORM 990, PART II - OTHER EXPENSES
DESCRIPTION
CORPORATION EXPENSE ALLOCATION
OTHER PURCHASED SERVICES
BAD DEBTS
PHYSICIAN SERVICES
DATA PROCESSING SERVICES
REPAIR AND MAINTENANCE
INSURANCE
FOOD
INVESTMENT MANAGEMENT FEE
LAUNDRY
DUES AND SUBSCRIPTIONS
OTHER DONATIONS
REGISTRY
MEDICAL SERVICES
EXPENSE RECOVERY
OTHER EXPENSES
TOTALS
PROGRAM MANAGEMENT
TOTAL SERVICES AND GENERAL
12577514.
11003137.
9,128,738.
7,793,034.
3,890,618.
1,665,353.
1,409,033.
980,977.
644,656.
643,156.
192,902.
93,958.
39,160.
21,522.
- 1047324.
54,105.
7,546,508. 5,031,006.
6,601,882. 4,401,255.
9,128,738. NONE
7.161,565. 631,469.
2,334,371. 1,556,247.
999,212. 666,141.
845.420. 563,613.
588,586. 392,391.
386,794. 257,862.
643,156. NONE
115,741. 77,161.
93,958. NONE
39,160. NONE
21,522. NONE
- 628,394. - 418,930.
32,462. 21,643.
49090539. 35910681. 13179858.
•
FORM 990, PART IV_- I STMENTS - SECURITIES
DESCRIPTION
CORPORATE STOCKS
CORPORATE BONDS
GOVERNMENT AGENCIES
US GOVERNMENT OBLIGATIONS
PREFERRED STOCKS
US TREASURY BILLS
CONVERTIBLE PREFERRED STOCKS
FOREIGN BONDS, NOTES & DEBENT.
MONEY MARKET FUNDS
TOTALS
BEGINNING
BOOK VALUE
•
38,009,030. 53,022,364.
24,555,603. 22,555,361.
1,355,689. 12,718,545.
24,606,994. 5,275,631.
NONE 5,013,674.
NONE 2,953,079.
4,073,782. NONE
961,600. 512,700.
2,326,368. 1,020.
95,889,066. 102,052,374.
50F12E 1018 05/03/99 09:39:23 V707 10076381
ENDING
BOOK VALUE
STATEMENT 6
22
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND
LAND, BUILDINGS, EQUIPMENT NOT HELD FOR INVESTMENT
FIXED ASSET DETAIL ACCUMULATED DEPRECIATION DETAIL
METHOD/ BEGINNING ENDING BEGINNING ENDING
ASSET DESCRIPTION CLASS BALANCE ADDITIONS DISPOSALS BALANCE BALANCE ADDITIONS DISPOSALS BALANCE
LAND L 285,165. 285,185. NONE NONE NONE
CONSTRUCTION IN PRO L 2,487,767. 2,481,761. NONE NONE NONE
BUILDINGS & IMPROVE SL 72445274. 72445274. 17644705. 3,072,897. 20711602.
FIXED EQUIPMENT SL 9,124,878. 9,124,818. 8,268,063. 115,264. 8,383,321. •
MAJOR MOVABLE EQUIP SL 41429089. 41429089. 22473310, 3,244,094. 25717404.
MINOR EQUIPMENT SL 683,011. 683,071. 417,369. 93,113. 510,542.
COMPUTER SOFTWARE SL 2,084,589. 2,084,589. 823,911. 191,584. 1,021.501.
LAND IMPROVEMENTS Sl 353,311. 353,311. 113,900. 18,245. 132,145.
TOTALS 129493744. 129493144. 49141264. 56482521.
99-0117330
•
Description of Property
DEPRECIATION
,
Asset description
Date
placed in
service
VAR
Unadjusted
Cost
or basis
285,765.
Bus,
%
100.000
179 exp.
reduction
in basis
ITC
reduction
in basis
Basis for
depreciation
Salvage
value
%
-'
Accumulated
depreciation
NONE
Me-
shod
Cam, .
Life _
ACRS
class
MA
CRS
class
Current -yea
179
expense
Current -year
depreciation
NONE
LAND
CONSTRUCTION IN PROG
VAR
2,481,767.
100.000
NONE
NONE
BUILDINGS A IMPROVER
VAR
72445274,
100.000
72445274.
17644705.
St
3,072,891
FIXED EQUIPMENT
VAR
9,724,818.
100.000
9
8,268,063.
5L
115,264
MAJOR MOVABLE EQUIPM
VAR
41429089.
100.000
41429089.
22473310.
SL
3,244,094
MINOR EQUIPMENT
VAR
683,071.
100.000
683,011.
417.369.
SL
93,113
COMPUTER SOFTWARE
VAR
2,084,589.
100.000
2
823,917.
SL
197,584
LAND IMPROVEMENTS
VAR
353,311.
100.000
353,311.
113,900.
SL
245
1
4
Less: Retued Assets
„ A.„
^ °;�. a,
` "
' ”
129493744, ka «
.;n
z� y. A .
^.�t^ :m3 .. fix.
v ,. sz
'`:.' <;.�:{�
". ><,
,_ >:
^ -•.
! . §'t "'`•
911126!
;� .&.h><`'i';
vr
^ " t
d:x
°,: & Yy °;
:��s'3'> °;; ;< `
<h " vi . ..c . 5 '$
r�;.,v_�;.w
„:,e'
:.!:::-
.'.'
2 y�it .�F " ',�,S , OLj lt
6 741.25
Subtotals
Listed Property
° ?.v.?a: :"i ° �. `' s.
Less* Retired Assets
,.h>
,�.vv�'.'S'
$ wz°'k
„ . •
°;
S u
ti
gu � :t.
,��,� "�
C:
^\ `>S;
,: h L
v
: va` .0:7�
a^.;%T �u�# .?.
��? � \a�3e�'a?�`
C ode
.xs cs
Life
i`isq` t"
�w :? ` �` .
�4 a e t a
: . >a.�. :,P•; "a %s
;Sy?rz� >;yas
�`� b�n?`��
a ov' 2 : vD �V> ° Q ;
> d (
, >;'y::'E.`u�,';tiE " "a'.
n
.q.,y,,Y'six:Y: i!
Subtotals
129493144,
Cost
or
basis
6,741,2'
Current -year
amortization
TOTALS
AMORTIZATION
Asset demi •lion
Date
placed in
service
,' S
`�'`
'
tS :
`
- ` ., . ;�
C,: , '`,
, Y K \
�v ::a
°i0Hs•� <
a¢ 'I �"' `<tt
!9741264.
Accumulated
amortization
s 3` 8 .,...
°i;��'°
,°+L tfvf \�,;
°v f S.o.,v
?:: y r o,., Et;e;ti:
-
:)-
'4
TOTALS
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND
Assets Retired
JSA
99-0117350
FORM 990, PART IV - 0TH SSETS
DESCRIPTION
DUE FROM AFFILIATES
OTHER RECEIVABLES
ACCRUED INTEREST RECEIVABLE
ARTWORK
TOTALS
BEGINNING
BOOK VALUE
21,237,742.
1,512,650.
608,743.
144,334.
23,503,469.
•
50F12E 1018 05/03/99 09:39:23 V707 10076381
ENDING
BOOK VALUE
19,499,430.
831,893.
592,478.
166,117.
21,089,918.
STATEMENT 8
24
FORM 990, PART IV - D BRED REVENUE
DESCRIPTION
DEFERRED INCOME
BEGINNING
BOOK VALUE
TOTALS 1,535,107.
•
1,535,107. 1,535,107.
50F12E 1018 05/03/99 09:39:23 V707 10076381
ENDING
BOOK VALUE
1,535,107.
STATEMENT 9
25
FORM 990, PART - IV - - TAX- MPT BOND LIABILITIES
DESCRIPTION
BONDS PAYABLE
UNAMORTIZED DISCOUNT
•
BEGINNING ENDING
BOOK VALUE BOOK VALUE
31,025,000. 30,170,000.
- 354,915. - 336,935.
TOTALS 30,670,085. 29,833,065.
STATEMENT 10
50F12E 1018 05/03/99 09:39:23 V707 10076381 26
Form 990, Part IV, Line 64a -
Tax-exempt bond liabilities
Issue Maturity Date or
Description of Bond Date Date Retired
Special Purpose Revenue Bonds Series 1993 Feb -93 July 1, 2008
New Money Price - Qualified Hospital Bonds Oct -88 July I, 2019
Kapiolani Medical Center for Women and Children
EIN: 99- 0177350
FYE: June 30, 1998
Purpose of Issue
Refunding of Series 1988 bonds
Capital Project None
Statement 10 (contd.)
Portion of Facility
Financed by Issue Used Original Form 8038, 8038 -0
by Third Party Issue Amount or 8038 -GC and date
None $14,525,000 Form 8038 - 03/19/1993
$16,500,000 Form 8038 - 10/20
Form 990, Part IV, Line 64a -
Tax-exempt bond liabilities
Description of Bond
Special Purpose Revenue Bonds Series 1993
New Money Price - Qualified Hospital Bond
Kapiolani Medical Center for Women and Children
EIN: 99- 0177350
Repayment terms
FYE: lune 30, 1998
Interest
Rate
Varying principal and interest 4.6 % -6.3%
Varying principal and interest 5% -6.40%
Statement 10 (contd.)
Security
Provided
Actual or
Anticipated Completion
Date of Project Unexpended Bond
Financed with Debt Proceeds
None
None
Amount of Issue
Outstanding
$ 13,670,000
$ 16,500,000
FORM 990, PART ====== IV R O LIABILITIES
DESCRIPTION
DUE TO AFFILIATES
DEFERRED PENSION CREDIT
DUE TO GOVERMENT AGENCIES
LEASE LOSS RESERVE
AGENCY FUNDS HELD FOR OTHERS
•
BEGINNING ENDING
BOOK VALUE BOOK VALUE
1,999,992.
2,789,708.
3,290,117.
NONE
-429.
4,546,557.
2,478,571.
1,818,737.
191,966.
- 60,877.
TOTALS 8,079,388. 8,974,954.
50F12E 1018 05/03/99 09:39:23 V707 10076381
STATEMENT 11
27
FORM 990, PART IV_A - OT REVENUE ON BOOKS BUT NOT N RETURN
DESCRIPTION AMOUNT
RENTAL EXPENSES
LOSS ON ASSET DISPOSAL
COST OF INVENTORY SOLD
238,771.
573,377.
178,681.
TOTAL 990,829.
STATEMENT 12
50F12E 1018 05/03/99 09:39:23 V707 10076381 28
FORM 990, PART - IV -A THER REVENUE ON RETURN BUT OT ON BOOKS
DESCRIPTION AMOUNT
ENDOWMENT FUND INCOME
361,114.
TOTAL 361,114.
STATEMENT 13
50F12E 1018 05/03/99 09:39:23 V707 10076381 29
FORM 990, PART IV -B - OT EXPENSES ON BOOKS BUT NOT ON RETURN
RENTAL EXPENSES
LOSS ON ASSET DISPOSALS
COST OF INVENTORY SOLD
DESCRIPTION AMOUNT
238,771.
573,377.
178,681.
TOTAL 990,829.
STATEMENT 14
50F12E 1018 05/03/99 09:39:23 V707 10076381 30
__...., ..c,.,cn run nuMtn ANU 99- 0177350
FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES
NAME AND ADDRESS
CLINTON R. CHURCHILL
634 KAIMALINO STREET
HONOLULU, HAWAII 96734
ROGER DRUE
4840 KAHALA AVENUE
HONOLULU, HAWAII 96816
HARVEY W. SMITH
64 WHITE SANDS PLACE
KAILUA, HAWAII 96734
FRANCES A. HALLONQUIST
2354 LILOA RISE
HONOLULU, HAWAII 96822
CHARLES A. STED
1544 IHILOA LOOP
HONOLULU, HAWAII 96821
JOHN JEFFRIES
3302 KAOHINANI DRIVE
HONOLULU, HAWAII 96817
ROSE MARY BUCHER, RN
2030 KUOLA PLACE
HONOLULU, HAWAII 96821
GREGG OISHI
29 KAUHOLU PLACE
KAILUA, HAWAII 96734
TITLE AND
TIME DEVOTED
TO POSITION COMPENSATION
CHAIR /TTEE
PART -TIME
PRES /TTEE
PART -TIME
EVP /TREAS
PART -TIME
EVP /CEO
PART -TIME
EVP /CFO
PART -TIME
SVP
PART -TIME
VP /CNE
FULL -TIME
VICE -PRES.
PART -TIME
NONE
631,572.*
374,331.*
316,150.*
123,392.*
276,260.*
94,477.*
234,194.*
CONTRIBUTIONS
TO EMPLOYEE
BENEFIT PLANS
NONE
82,550.
42,604.
38,816.
12,637.
31,132.
10,695.
30,180.
EXPENSE ACCT
AND OTHER
ALLOWANCES
NONE
NONE •
NONE
NONE
NONE
NONE •
NONE
NONE
SPSLN %s.000 50F12E 1018 05/12/99 08:11:35 V707 10076381 31 STATEMENT 15
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND 99- 0177350
FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES
NAME AND ADDRESS
TITLE AND
TIME DEVOTED
TO POSITION COMPENSATION
CONTRIBUTIONS
TO EMPLOYEE
BENEFIT PLANS
EXPENSE ACCT
AND OTHER
ALLOWANCES
PHILLIP F. MOON VICE -PRES. 189,429.* 26,325. NONE
P.O. BOX 25193 PART -TIME
HONOLULU, HAWAII 96825
WILLOW MORTON VICE -PRES. 112,044.* 17,302. NONE
3106 KAHIWA PLACE FULL -TIME
HONOLULU HAWAII 96822
RICHARD C. ROBEL VICE -PRES. NONE* NONE NON,
119 KANAPU'U PLACE PART -TIME
KAILUA, HAWAII 96734
CLAUDIA ROSENFELD VICE -PRES. 211,337.* 26,906. NONE
3032 KAHAKI PLACE PART -TIME
KAILUA, HAWAII 96734 -5900
MARTHA SMITH VICE -PRES. 133,515.* 19,763. NONE
46 -324 HAIKU ROAD #108 FULL -TIME
KANEOHE, HAWAII 96744
NEAL WINN M.D. VICE -PRES. 100,738.* 23,573. NONE
2047 NUUANU AVENUE #1104 FULL -TIME
HONOLULU, HAWAII 96817
PAULA M. SUMIDA SECRETARY NONE* NONE NON
5085 POOLA PLACE PART -TIME
HONOLULU, HAWAII 96821
BETTY KANESHIRO ASST. SEC. NONE* NONE NONE
973 KALOALOA STREET PART -TIME
HONOLULU, HAWAII 96825 ,
SPSINK 2 .uoo 50F12E 1018 05/12/99 08:11:35 V707 10076381 32 ,STATEMENT 16
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND 99- 0177350
FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES
NAME AND ADDRESS
TITLE AND
TIME DEVOTED
TO POSITION COMPENSATION
CONTRIBUTIONS
TO EMPLOYEE
BENEFIT PLANS
EXPENSE ACCT
AND OTHER
ALLOWANCES
RODNEY B. BOYCHUK M.D. TRUSTEE 128,297. ** 5,270. NONE
2131 -A ATHERTON ROAD PART -TIME
HONOLULU, HAWAII 96822
BENTON CHUN M.D. TRUSTEE NONE NONE NONE •
1329 LUSITANA STREET PART -TIME
HONOLULU, HAWAII 96813
CORA K. LUM TRUSTEE NONE NONE NONE
4820 MATSONIA DRIVE PART -TIME
HONOLULU, HAWAII 96816
MAUDE S. NISHIMOTO TRUSTEE NONE NONE NONE
2063 AKAIKAI LOOP PART -TIME
PEARL CITY, HAWAII 96782
ALLAN H. RENTON TRUSTEE NONE NONE NONE
3165 C DIAMOND HEAD ROAD PART -TIME
HONOLULU, HAWAII 96815
MRS. V.M. "TAD" SEWELL TRUSTEE NONE NONE NONE •
1635 KALANIIKI STREET PART -TIME
HONOLULU, HAWAII 96821
CALVIN C.J. SIA M.D. TRUSTEE NONE NONE NONE
656 PAIKAU STREET PART -TIME
HONOLULU, HAWAII 96816
JOHN K. TSUI TRUSTEE NONE NONE NONE
927 KOLOA STREET PART -TIME
HONOLULU, HAWAII 96816
SPSLN % 2000 50F12E 1018 05/12/99 08:11:35 V707 10076381 33 STATEMENT 17
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND 99- 0177350
FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES
NAME AND ADDRESS
JENAI SULLIVAN WALL TRUSTEE
4360 KAHALA AVENUE PART -TIME
HONOLULU, HAWAII 96816
LESS: OFFICERS COMPENSATED BY
KAPI'OLANI HEALTH
LESS: OFFICERS COMPENSATED BY
KAPI'OLANI MEDICAL SPECIALISTS
TITLE AND
TIME DEVOTED
TO POSITION COMPENSATION
N O N E
GRAND TOTALS 175,003.
CONTRIBUTIONS
TO EMPLOYEE
BENEFIT PLANS
-2622436* - 321,532.
-128,297** - 5,270.
EXPENSE ACCT
AND OTHER
ALLOWANCES
NONE NONE
40,951. NONE
•
•
SPSLN %2.000 E0F12E 1018 05/12/99 08:11:35 V707 10076381 34 STATEMENT 18
u .m.
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND 99- 0177350
FORM 990, PART V - COMPENSATION PROVIDED BY RELATED ORGANIZATION
NAME AND ADDRESS
ROGER DRUE
4840 KAHALA AVENUE
HONOLULU, HAWAII 96816
HARVEY W. SMITH
64 WHITE SANDS PLACE
KAILUA, HAWAII 96734
FRANCES A. HALLONQUIST
2354 LILOA RISE
HONOLULU, HAWAII 96822
CHARLES A. STED
1544 IHILOA LOOP
HONOLULU, HAWAII 96821
JOHN JEFFRIES
3302 KAOHINANI DRIVE
HONOLULU, HAWAII 96817
ROSE MARY BUCHER, RN
2030 KUOLA PLACE
HONOLULU, HAWAII 96821
GREGG OISHI
29 KAUHOLU PLACE
KAILUA, HAWAII 96734
PHILLIP F. MOON
P.O. BOX 25193
HONOLULU, HAWAII 96825
TITLE AND
TIME DEVOTED
TO POSITION COMPENSATION
PRES /TTEE
PART -TIME
EVP /TREAS
PART -TIME
EVP /CEO
PART -TIME
EVP /CFO
PART -TIME
SVP
PART -TIME
VP /CNE
FULL -TIME
VICE -PRES.
PART -TIME
VICE -PRES.
PART -TIME
SPSIN% 3.000 enc i nc I n i g nR / 19 /qq 08:11:35 V707 10076381
631,572.
374,331.
316,150.
123,392.
276,260.
94,477.
234,194.
189,429.
CONTRIBUTIONS
TO EMPLOYEE
BENEFIT PLANS
82,550.
42,604.
38,816.
12,637.
31,132.
10,695.
30,180.
26,325.
EXPENSE ACCT
AND OTHER
ALLOWANCES
NONE
NONE •
NONE
NONE
NONE
NONE •
NONE
NONE
35 STATEMENT 19
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND 99- 0177350
FORM 990, PART V - COMPENSATION PROVIDED BY RELATED ORGANIZATION
NAME AND ADDRESS
WILLOW MORTON
3106 KAHIWA PLACE
HONOLULU, HAWAII 96822
CLAUDIA ROSENFELD
3032 KAHAKI PLACE
KAILUA, HAWAII 96734 -5900
MARTHA SMITH
46 -324 HAIKU ROAD #108
KANEOHE, HAWAII 96744
NEAL WINN M.D.
2047 NUUANU AVENUE #1104
HONOLULU, HAWAII 96817
RODNEY B. BOYCHUK M.D.
2131 -A ATHERTON ROAD
HONOLULU, HAWAII 96822
TITLE AND ,
TIME DEVOTED
TO POSITION COMPENSATION
VICE -PRES.
FULL -TIME
VICE -PRES.
PART -TIME
VICE -PRES.
FULL -TIME
VICE -PRES.
FULL -TIME
TRUSTEE
PART -TIME
CONTRIBUTIONS
TO EMPLOYEE
BENEFIT PLANS
GRAND TOTALS 2,750,733. 326,802.
EXPENSE ACCT
AND OTHER
ALLOWANCES
51,866. 4,956. NONE
211,337. 26,906. NONE
60,305. 6,109. NONE
59,123. 8,622. NONE
128,297. 5,270. NONE
NONE •
SPSLN %2 000 50F12E 1018 05/12/99 08:11:35 V707 10076381 36 STATEMENT' 20
• •
FORM 990, PART VI - CHANGES TO ORGANIZING OR GOVERNING DOCUMENT
AMENDMENTS MADE TO NUMBER AND QUALIFICATION OF TRUSTEES AND TERM OF
MEMBERSHIP - SEE ATTACHED.
50F12E 1018 05/03/99 09:39:23 V707 10076381
STATEMENT 21
37
amended
/15/97
ARTICLE IV
BOARD OF TRUSTEES
Section 4.1 Number and Qualification of
Trustees. There shall be not less than eleven nor more
than seventeen trustees. The number of trustees for any
following year shall be determined by the voting member-
ship at the annual meeting. The President of the Corpor-
ation and the Chief of Staff shall be trustees. The
remaining trustees shall be elected by the membership at
the annual meeting to hold office for the term elected and
thereafter until their successors are duly elected and
qualified, provided that additional trustees may be
elected at any special meeting of the membership called
for that purpose during the year to fill any unfilled
positions.
Section 4.2 Term of Membership. The initial
term of each Trustee shall be for a period of one year and
thereafter the time shall be three years, except that
shorter terms may be set so that the terms of approxi-
mately one -third of the total number constituting the
Board shall expire each year. The term of each President
and Chief of Staff as Trustees shall continue so long as
each occupies that position. Any member of the Board may
be removed from office upon the affirmative vote of not
less than three - fourths of the Board. No trustee may
serve for more than three consecutive terms.
KAPIOLANI
KAPIOLANI
KAPIOLANI
KAPIOLANI
KAPIOLANI
KAPIOLANI
KAPIOLANI
KAPIOLANI
FORM 990, PART VI - NAMES OF RELATED ORGANIZATIONS
HEALTH
MEDICAL CENTER AT PAL
HEALTH FOUNDATION
HEALTHHAWAII
HOME HEALTH SERVICES
EXTENDED CARE
MEDICAL SPECIALISTS
SERVICE CORPORATION &
- EXEMPT
I MOMI - EXEMPT
- EXEMPT
- EXEMPT
- EXEMPT
- EXEMPT
- EXEMPT
SUBS. - NOT EXEMPT
STATEMENT 22
50F12E 1018 05/03/99 09:39:23 V707 10076381 38
• •
FORM 990, PART VIII - ACCOMPLISHMENT OF EXEMPT PURPOSES
LINE EXPLANATION OF HOW EACH ACTIVITY FOR WHICH INCOME
NO. IS REPORTED IN COLUMN (E) OF PART VII CONTRIBUTED
IMPORTANTLY TO THE ACCOMPLISHMENT OF EXEMPT PURPOSES
93A& ROUTINE AND ANCILLARY SERVICES COMPRISE PATIENT SERVICE
B,C REVENUES AND ARE USED TO PAY COSTS INCURRED IN PROVIDING
HOSPITAL AND SUPPORTING HEALTH SERVICES TO THE PUBLIC. THESE
REVENUES ARE PARTIALLY OFFSET BY A CONTRACTUAL ADJUSTMENT
NEGOTIATED WITH THIRD PARTY PAYORS. AN ESTABLISHED CHARITY
CARE POLICY SETS GUIDELINES TO DETERMINE WHICH PATIENTS
QUALIFY FOR CARE GIVEN AT NO CHARGE. SERVICES PROVIDED FOR
QUALIFIED CHARITY CARE PATIENTS ARE NOT REPORTED AS REVENUE.
93D MEDICAL RESIDENCY PROGRAM - REVENUES RECEIVED FROM
UNIVERSITIES HELP SUPPORT THE COST OF PROVIDING RESIDENCY
TRAINING TO PHYSICIANS.
EDUCATION COURSES & PROGRAMS - VARIOUS HEALTH EDUCATION
CLASSES AND DIETARY COUNSELING SERVICES TO ITS PATIENTS AS
PART OF THE PATIENT'S HEALTH CARE REGIMEN.
103C MISCELLANEOUS REIMBURSEMENTS - COVERS COST OF ADMINISTRATIVE
SERVICES RENDERED (E.G. PROVIDING COPIES AND HOSPITAL
RECORDS, ETC.). PURCHASE DISCOUNTS, ETC.
STATEMENT 23
50F12E 1018 05/03/99 09:39:23 V707 10076381 39
Description
Date
Acquired
Date
Sold
Gross Sales
Price
Cost or Other
Basis
Long -term
Gain /Loss
20% MAXIMUM RATE CAPITAL GAINS (LOSSES)
VARIOUS SECURITIES
VAR
VAR
5 898 161.
5,898,161.
OTHER ASSETS
VAR
VAR
502 893
1 076 270,
- 573 377.
TOTAL 20% MAXIMUM RATE CAPITAL GAINS (LOSSES)
5,324,784.
•
•
6,401,054.
1,076,270.
5,324,784
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND
Schedule D Detail of Long -term Capital Gains and Losses
99- 0177350
JSA
KAPI'OLANI MEOL CENTER FOR WOMEN AND CHILI.
SUMMARY OF C RACT AND GRANT ACCOUNTS
FOR THE FISCAL YEAR: 07/97 - 06/98
GRANT NAME
REHAB - UAP
PARKE -DAVIS PROTOCOL 960 -036
CRC -KHRI CONTRIBUTION
MOTHERSCARE - STATE
CPS WEST HAWAII - TITLE IVB
CLINICAL TRIALS CENTER (CTC)
TIP - PARENT TO PARENT
CPS WEST HAWAII - FSSWH
SATC - VOCA
SATC - HPD
SEX ABUSE TREATMENT CENTER
CLINICAL RESEARCH CENTER
NEONATAL RESEARCH - NAKAMURA
HIGH RISK INFANTS ON APNEA MONITORS
HFSC - HAROLD CASTLE FOUNDATION
HFSC - DANCE WITH YOUR BABY
CDC - HEPATITIS C VIRUS
SATC - FEE FOR SERVICE
PEDIATRIC IMMUNOLOGY PROGRAM
CPS - FEE FOR SERVICE
HCF - FISH FUND
HFSC - TRAINING FEES
HFSC - FUNDRAISING
HFSC - ALGER FOUNDATION
HFSC - FAMILY ASSESSMENT
HFSC - EWA HEALTHY START
HFSC - DIAMOND HEAD HEALTHY START
HFSC - HEALTHY START TECHNICAL ASSISSTANCE
CONCERN FOUNDATION HUMAN NEUROBLASTOMA
AWARD AMT
14,000
27,000
80,000
154,261
156,362
52,119
28,377
100,000
67,158
335,000
797,384
425,935
75,000
426,439
40,000
37,271
136,334
178,075
83,223
274,409
36,792
346,293
90,535
171,157
433,507
436,242
388,999
153,611
50,000
HPC HEALTH EDUCATOR 3 8, 5 49
QUEEN EMMA FOUNDATION 83,103
DETENTION HOME 27,766
MERCK ROTAVIRUS STUDY 26,304
AAP: PEER PROVIDER EDUCATION PROJECT 41,667
AAP - AFIX 122,000
CPS STATEWIDE - OAHU 549,237
LEAHI FUND - ACUTE LUNG INJURY 25,000
MOBILE THERAPY (0-3) 150,882
MOBILE THERAPY TEAM - MISC 377,918
NICU COORDINATION 19,616
CRC - MCKEE FUND 45,325
WCSTATE 168,539
TOTAL AWARDED 7,271,390
STATEMENT 25
KAPI'OLARfMEDICAL CENTER FOR WOMEN AND•DREN
FEDERAL I.D. NO. 99 -0177350
JUNE 30,1998
PART Ill - Statement of Program Accomplishments
Kapi olani Medical Center for Women and Children (KMCWC) provides healthcare
regardless of race, creed, sex, national origin, handicap, age or ability to pay.
KMCWC is a 232 bed /90 bassinet non - profit hospital which has been designated the
level Ill, Tertiary Care and Perinatal Center of the Pacific Basin by the State of
Hawaii. Its activities as a specialty medical center include providing for medical,
health and social services for the care of the women and children of Hawaii.
Kapi'olani also serves as the major obstetrical, gynecological and pediatric teaching
facility for the University of Hawaii John A. Burns School of Medicine.
During the fiscal year ended June 30, 1998 KMCWC engaged in the following
activities which were in the furtherance of its charitable purposes:
• Provided hospital services to 16,575 patients and provided in
excess of 115,000 outpatient services Inpatient services
included labor and delivery, neonatal ICU, pediatric ICU
admissions, and patients transported to the NICU and PICU from
other parts of Oahu, neighbor islands and the Pacific Basin.
• Obstetrics /Gynecology
Fetal Diagnostic Center
Genetic counseling services
GYN oncology services
24 hour emergency services
• Pediatrics
Pediatric Open Heart Program
Pediatric Outpatient Clinic
Pediatric Immunology Program
Surgical, medical, oncology services
• Outreach Programs
Sex Abuse Treatment Center
Child Protective Services Team
Teen Intervention Program
Healthy Mothers Healthy Babies
Family Planning Services
Mobile Service Therapy Team
Bereavement Program
• Other Programs
Kapi'olani Center for Women's Health
KMC Genetics Group
Hawaii Poison Center
STATEMENT 26
r Form �V�f
Department of the Treasury
Internal Revenue Service
A
- R -
Check box it
address changed
B Exempt under section
5011C )i3 )or
408(e) I 1220(e)
0o va ue o a assets
at end of year
For calendar year 1997 or
Please
Print or
Type
J The books are in care of ►KAP I ' OLAN I HEALTH
Part I Unrelated Trade or Business Income
1e Gross receipts or sales 875,802.
b Less returns and allowances I e Balance OP
2 Cost of goods sold (Schedule A. line 7)
3 Gross profit (subtract line 2 from line 1c)
4a Capital gain net income (attach Schedule 0)
b Net gain (loss) (Form 4797, Part II, line 18) (attach Form 4797)
c Capital loss deduction for trusts
5 Income (loss) from partnerships (attach statement)
6 Rent income (Schedule C)
7 Unrelated debt-financed income (Schedule El
B Interest annuities, royalties, and rents from controlled
organizations (Schedule F)
9 Investment income of a section 501(c(7), (9), or (17)
organization (Schedule G)
10 Exploited exempt activity income (Schedule I)
11 Advertising income (Schedule .1)
12 Other income (see page 7 of the instructions - attach schedule?
13 TOTAL (combine lines 3 through 12
.6A For Paperwork Reduction Act Notice, see instructions.
7E16103000 50F12E 1018 04/15/99
(and proxy tax under section ou.aa I,
ex year begbrning 07/01 , 1997. and *Win . 6/30 .19 9 8
• see s• .. rate instructions.
Name of organize ion
KAPI'OLANI MEDICAL CENTER FOR WOMEN AND
CHILDREN
Number. street. and room or suite no. Of a P.O. box, see page 5 of instructions)
55 MERCHANT STREET 24TH FLOOR
Crty or town, state, and ZIP code
HONOLULU, HI 96813
Telephone number P ( 808
14 Compensation of officers, directors, and trustees (Schedule K)
15 Salaries and wages
16 Repairs and maintenance
17 Bad debts
18 Interest (attach schedule)
18 Taxes and licenses
20 Charitable contributions (see page 9 of the instructions for limitation rules)
21 Depreciation (attach Form 4562) 121 I NON
22 Less depreciation claimed on Schedule A and elsewhere on return 22e
23 Depletion
24 Contributions to deferred compensation plans
25 Employee benefit programs
26 Excess exempt expenses (Schedule I)
27 Excess readership costs (Schedule J) . . .
28 Other deductions (attach schedule) SEA, , STATE►JlEJJT 3
29 TOTAL DEDUCTIONS (add lines 14 through 28)
30 Unrelated business taxable income before net operating loss deduction (subtract line 29 from line 13)
31 Net operating loss deduction
32 Unrelated business taxable income before specific deduction (subtract line 31 from line 30)
33 Specific deduction
34 Unrelated business taxable income (subtract line 33 from line 32). If line 33 is greater than line 32,
enter the smaller of zero or line 32
10:01:06 V707 10076381
D Employer identification number
(Employees' trust. see instructions for
Block D on page 6.)
99- 0177350
11097
E Unrelated business activity codes
(see instructions for Block E on page 6.)
8060
F Group exemption number Isee instructions for Block F on .age 6) ►
G Check type of organization ► X 501(c) corporation 501(c) trust Section 401(a) trust
H Describe the organization's primary unrelated business activity. ► SEE STATEMENT 1
I During the tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group? ► U Yes u No
If "Yes • enter the name and identifying number of the parent corporation. ► SEE STATEMENT 2
Section 408(a) trust 220(d) trust
535 -7355
)
1c
3
4a
4b
4c
6
6
7
8
9
10
11
12
13
(A) Income
875,802.
600,723.
275,079.
275,079.
(B) Expenses
(C) Net
275 079.
275,079.
Part II Deductions Not Taken Elsewhere (See page 8 of the instructions for Imitations on deductions.)
(Except for contributions, deductions must be directly connected with the unrelated business income.)
E
14
15
16
17
18
19
20
22b
23
24
26
26
27
28
29
30
31
32
33
166 265.
8 961.
12 250.
NONE
136 442
313 918.
-38 839.
-38 839.
1 000.
Form 990 (1997)
21
Part 11) . Tax Computation
Part IV Tax and Payments
2 Purchases
3 Cost of labor
4a Additional section 263A costs
(attach schedule)
b Other costs (attach schedule)
5 TOTAL -A
Please
Sign
Here
here
Paid
Prepare/ s
Use Only
•
at order).
,000.
35e
36
37
38
r
35 Organizations Taxable as Corpora ee instructions for tax corn utation on page 10).
Controlled group members (sections and 1583) - check here . See Instruction:
a Enter your share of the $50.000. $25,000. and $9.925.000 taxable income brackets (in th
(1)1 50,000.1 (2)1 25,000.1 (3)L 9 925
b Enter organization's share of: (1) additional 5% tax (not more than $11,750)
(2) additional 3% tax (not more than $100,000)
c Income tax on the amount on line 34
36 Trusts Taxable at Trust Rates (see instructions for tax computation on page 11) Income tax on
the amount on line 34 from: I I Tax rate schedule or Schedule D (Form 1041)
37 Proxy tax (see page 11 of instructions)
38 Total (add line 37 to line 35c or 36, whichever applies)
39a
39b
39c
39d
44a
44b
440
44d
44a
44f
attached
14,500.
9,000.
►
►
I Refunded 10.
39e
40
41
42
43
45
46
47
48
49
39a Foreign tax credit (corporations attach Form 1118; trusts attach Form 1116)
b Other credits. (see page 12 of the instructions)
e General business credit - Check if from:
pi I I Form 3800 or n Form (specify) ■
d Credit for prior year minimum tax (attach Form 8801 or 8827)
s Total (add lines 39a through 39d)
40 Subtract line 39e from line 38
41 Recapture taxes. Check if from: n Form 4255 E Form 8611
42 Alternative minimum tax
43 Total tax (add lines 40, 41, and 42)
44 Payments: a 1996 overpayment credited to 1997
b 1997 estimated tax payments , , , , , ,
c Tax deposited with Form 7004 or Form 2756 .. E.E. STf1TE)iAENT, 4,
d Foreign organizations -Tax paid or withheld at source (see instructions)
a Backup withholding (see instructions)
Other credits and payments (see instructions)
45 Total payments (add lines 44a through 44f)
46 Estimated tax penalty (see page 3 of the instructions). Check PO' n if Form 2220 is
47 Tax due. If line 45 is less than the total of lines 43 and 46. enter amount owed
48 Overpayment - If line 45 is larger than the total of lines 43 and 46, enter amount overpaid
49 Enter the amount of line 48 You want Credited to1998 estimated tax ►
Part V Statements Regarding Certain Activities and Other Information (See instructions on
1 At arty time during the 1997 calendar year. did the organization have an interest in or a signature or other authority
over a financial account in a foreign country (such as a bank account securities account or other financial account)?
If 'Yes,' the organization may have to file Form TD F 90-22.1. If 'Yes,' enter the name of the foreign country
Yes
2 During the tax year, did the organization receive a distribution from, or was it the grantor of. or transferor to, a
foreign trust?
If ryes' see page 13 of the instructions for other forms the organization may have to fife.
3 Enter the amount of tax -exempt interest received or accrued during he tax year ►
SCHEDULE A - COST OF GOODS SOLD (See instruct ons on page 14.)
Method of inventory valuation (specify) ►
1 Inventory
LA HONOLULU, HI
7E1630 ,.000 50F12E 1018 04/15/99 10:01:06 V707 10076381
NONE
23,500.
NONE
23 500.
23,500.
page 13.
at beginning of year
Firm's name for yours.
it self-employed)
and address
1
2
NONE
600,723.
3
4e
4b
Preparers
signature
6 Inventory at end of year
7 Cost of goods sold. Subtract line 6
from line 5. (Enter here and on line
2. Part I.) 7
8 Do the rules of section 263A (with respect to
property produced or acquired for resale) apply to
dd lines 1 through 4b 5 600,723. the organization?
Under penahies of penury. I declare that I have examined this return, inducting accompanying sdtedulas and statements and to the best of my knovAed
belief. h is nuucOrt. and cornda . Da 'ion at peparer (When/Ian taxpayer) is based on al idormaaon of with pepanx has any knowledge.
/ , z 4G✓t�C;�(� ' (7 c //v /4'S /TAO
Signature of officer or fiduciary Date ' Title
Dale
' ERNST & YOUNG LLP
2400 PAUAHI TOWER, 1001 BI$
Check it self -
employed ► El
N
600,7
Yea
Preparer's social security number
220 -62 -0047
EIN ► 34- 6565596
ZIP code ► 96813
22
NONE
NONE
NONE
NONE
No
ONE
23.
No
X
e and
(41
2 Rent received or accrued
3 Deductions directly connected with the income in
columns 2(a) and 2(b) (attach schedule)
la) From personal property (d the percentage of rent
for personal property is more than 10% but not
more than 50 %)
(b) From real and personal property (if the percentage
of rent for personal property exceeds 50% or if the
rent is based on profit or income)
1131 Other deductions
(attach schedule)
(b) Taxable income computed
as though not exempt under
sac. 501(a). or the amount in
col. (a). whichever a larger
(c)
column (a)
divided by
column (b)
(1)
(1)
(2)
(3)
Total
To
Total
Total deductions. Enter
here and on line 6. column
(B), Part I, page 1 • . .►
Total Income (Add totals of columns 2(a) and 2(6). Enter here
_ -..1 ..., l:.,e a rnl„mn (Al_ Part I. page 1.) • • • • • • •
" te r r
1 Description of debt - financed property
2 Gross income from or
allocable to debt - financed
property
3 Deductions directly connected with or allocable to
debttinanced property
(a) Straight line depreciation
(attach schedule)
1131 Other deductions
(attach schedule)
(b) Taxable income computed
as though not exempt under
sac. 501(a). or the amount in
col. (a). whichever a larger
(c)
column (a)
divided by
column (b)
(1)
(2)
(3)
%
(2)
(4)
4 Amount of average
acquisition debt on or
allocable to debt -financed
(attach schedule)
5 Average adjusted basis of
or allocable to
debt4inanced property
(attach schedule)
6
Column 4
divided by
column 5
7 Gross income reportable
(column 2 x column 6)
8 Allocable deductions
(column 6 x total of columns
3(e) and 3(b))
property
%
%
(
6 Gross income eportable
(column 2 x column 4(c) or
column 5(c))
%
la) Excess taxable income
(b) Taxable income, or
amount in column (a).
d n, •r b lvnnt
(
%
(3)
(1)
%
%
(
Totals •
_r J:..:a__a.._.e.ai.,ad deductions included in column 8
Enter here and on line 7,
column (A). Part I, page 1.
Enter here and on line 7,
column (B). Part I, page 1.
•
1 Name and address of controlled organizations)
2 Gross income
from controlled
organization(s)
3 Deductions of can[rolrnv
organization directly
connected with column 2
acorns (attach schedule)
4 Exempt controlled organizations
la) Unrelated
business taxable
income
(b) Taxable income computed
as though not exempt under
sac. 501(a). or the amount in
col. (a). whichever a larger
(c)
column (a)
divided by
column (b)
(
%
(2)
%
(
(4)
%
5 Nonexempt controlled organ ions
6 Gross income eportable
(column 2 x column 4(c) or
column 5(c))
7 Allowable deductions
(column 3 x column 4(c or
column 5(c))
la) Excess taxable income
(b) Taxable income, or
amount in column (a).
d n, •r b lvnnt
Ic)Column (a)
drvided by
rnhnnn (hi
(1)
%
(2)
%
(
%
(4)
Totals •
Enter here and include on
line 8, column (A), Part I,
page 1.
Enter here and include on
line 8, column (B), Part I
page 1.
JSA
S12MCUULC L.- nce. r un.....+..._ 1........... , ,,. -• • ,_•-- •_..__._. ._
(See instructions on p a gg 14.)
1 Description of property
(1)
(2)
(3)
D DEBT - FINANCED INCOME ( See instructions on page 15.)
SCHEDULE F - INTEREST, ANNUITIES, ROYALTIES, AND RENTS FROM CONTROLLED ORGANIZATIONS
1E1630 1 •000 50F12E 1018 04/15/99 10:01:06 V707 10076381
23
1 Description of income
New
2 Amount of income
3 Deductions
directly connected 4 Set-asides
fanach schedule) (attach schedule)
5 Total deductions
and set-asides (col. 3
plus col 4)
(1)
6 Expenses
attributable to
column 5
7 Excess exempt
expenses
(column 6 minus
column 5. but not
more than
column 41.
(1)
(2)
:.`si.'�
(3)
(
(4)
Totals ►
Enter here and on line 9,
column A Part I, page 1.
) P 9
•;: ;;ti '''''': %:£?:
��x� ?' %��z<` .l ' Y ' .`,.a . 3 . E'[?a
a .�o� a�.. " o:<
?!`O i<V ^� , 4Jeoo [ e> .. 2 JAN .?.: "S
,.;S:S <n:2�:i�.c...:`: [•:, »° �o< n„ 1:: o.<:.?.,, a.,< 28Yis @Y:b1$oj3:<an.oh}Z:. <
... .. ..
Enter here and on
9, column B
l ).
Part .
Par 1 page 1.
1 Description of
exploited activity
2 Gross
unrelated
business income
from trade or
busin
3 Expenses
directly
connected with
production of
unrelated
business income
4 Net income
(loss) from
unrelated trade
or business
(column 2 minus
column 3). if a
gain. compute
cols. 5 through 7.
5 Gross income
from activity that
is not unrelated
business income
6 Expenses
attributable to
column 5
7 Excess exempt
expenses
(column 6 minus
column 5. but not
more than
column 41.
(1)
(2)
:.`si.'�
(
(3)
(4)
z' >:E?,a” e >?;8\ ?et;i €F
E�;Z �� � U� a 2 a <;a.
``�.`,•`"> `3'"
�"��`
st�`� ` .kN.
�"
Enter here and
on line ge, Pan II,
page 1.
(4
Column totals O
Enter here and on
10, col. (A),
Part I. page 1.
Enter here and on
line 10, col. (B),
Pan I. page 1.
.,'`a'ae yxa��;,Tw
y� ' ' � �g ,�..,
'Y 2 . ?[:x::S'<
�3'f5'a:` . `
`3�;° c�.aa i:` <Q::
hEwk,
• line
N: �r „wY+a'u :•17
• A CrP"<.ic ::<.,
Y -•, ,, '?3a.:c., `
y r5 `$i S
<i v;,�S
:� ° € x
`xu�
�a.b a
.... � ;, , :?s...3a
SCHEDULE K - COMPENSATION OF OFFICERS, DIRECTORS, AND TRUSTEES (See instructions on pag
Enter here and
on line 26, Part II,
Pa9 e 1.
1 Name of
periodical
2 Gross
advertising
income
3 Direct
advertising costs
4 Advenbing
gain or (loss) (col
2 m inor cot 3). If
a gain. compute
cols. 5 through 7.
5 Circulation
income
6 Readership
costs
7 Excess
readership costs
(column 6 minus
column 6. but not
more than
column 41.
(2)
(2)
:.`si.'�
millstuat4W .
i
(4)
z' >:E?,a” e >?;8\ ?et;i €F
E�;Z �� � U� a 2 a <;a.
``�.`,•`"> `3'"
�"��`
st�`� ` .kN.
�"
Enter here and
on line ge, Pan II,
page 1.
a ' M
Column totals (carry
to Pan II. line (5)) •
Column totals,
Pan II ►
Enter here and on
line 11, col. (A).
Pa n L page 1.
Enter here and on
line 11, col (B).
Part I, page L
SCHEDULE K - COMPENSATION OF OFFICERS, DIRECTORS, AND TRUSTEES (See instructions on pag
17.)
(1)
(2)
(3)
i
z' >:E?,a” e >?;8\ ?et;i €F
E�;Z �� � U� a 2 a <;a.
``�.`,•`"> `3'"
�"��`
`i"':t <h' ,. , `Saaaxayrteet.,,,..,9t.14..
, a, ,..
a �s �.o'�`�.1
<3 `c ` � :(;i � .a,
�"
Enter here and
on line ge, Pan II,
page 1.
Totals from Part
Column totals,
Pan II ►
Enter here and on
line 11, col. (A).
Pa n L page 1.
Enter here and on
line 11, col (B).
Part I, page L
SCHEDULE K - COMPENSATION OF OFFICERS, DIRECTORS, AND TRUSTEES (See instructions on pag
17.)
1 Name
2 Title
3 Percent of
time devoted to
business
4Compensation attributable
to unrelated business
96
96
Total • Enter here and on line 14, Part II, page 1 ►
AA
Form 9904 (1997) Page ••
SCHEDULE G - INVESTMENT INgli E OF A SECTION 501(c)(7), (9), OR (17) GANIZATION •
(See instructions ge 16.)
SCHEDULE I - EXPLOITED EXEMPT ACTIVITY INCOME, OTHER THAN ADVERTISING INCOME
See instructions on page 16.)
SCHEDULE J - ADVERTISING INCOME (See instructions on page 17.)
Part I Income From Periodicals Reported on a Consolidated Basis
Part II Income From Periodicals Reported on a Separate Basis (For each periodical listed in Part II, fill in
7E1640 1.000
columns 2 through 7 on a line - by-line basis.)
50F12E 1018 04/15/99 10:01:06 V707 10076381
24
None end address of each member of the affiliated grow
Employer identificetan number
Tax period
3 Toranve tars (see instructions)
{ CPe�Ce
a Overpayment craned twin pmot year ..
b Estimated tea payments be the tot
y
Lass refund far the tax year y �
a e he yea NtY•
fa on Fonn 4466
4a
e:? F3EIrrns r._— rnno : : :- o :asmr_ �ni•Tfi °.•mnwc
_R -L•! _Kb:(_: ��. i -eP Pig _
-u_ " ' : t r :
[ilgia ;.,FP :4. ?:tl ° j �
nr
Pgg giiicii'.l C - . n lti� �g•wr CgS.Y'•) :t:rr :t`
^,E =n nrtuc" - ^ • _
=; : :t "_ -_ = i y : U4. ; _ : - Y �
3 23.500
_ - -__� cio,
- mil uiTga`ta�nu _ 3 u
RP�'G�ui mow:9lia: :a
i _
gEEl g RGi ('tt:JitY isit t E rat “
r i iui:� : :vuG
Mb u. y nine 4. :. :a PP
ill
yva _F•[ti. . _ ..., i4t fli''_''R' {iR'tY1
c ill: "'IndiP fy'f [`'• • t :� ••l'RAt {:
r. � L�_........
��F. - -.- i
.,.. _ r • •••.. -
.. - Fu ....... :[ yy �� (( ttnu [ ti ;• •..
der le11t.e L.,ii1LL! ;F7''iii""
, - :., °Lwow., f e4.; ° - ;' 1; ', ,
se
23,500
4t
( )
tit . '1R3'
:t :4.Y'i4llti•L���'
se 1
^
- -.--Y.:'
4d
' :fit : IL t:L •' e>_I- fgggRT tL'.sv
: • LL an R4.0 let[:
:: l4. :i�YSC- ••••_iF :3._ :__
23,500
• Credit from regulated investment Companies
1 Creek la Federal tax to fuel
5 Tota Add lines 4d through 41
3 Barone. due. Subtract fine 5 from line 3. Deposit this amount electronically or
Tax Deposit (FTD) Coupon (see inseucuons)
se
- 4f
with
a Federal
b
23,500
8
None
Y
•
vv. ei 1tw Application for Automatic Extension of Time
persilern der Tyson Application
File Corporation Income Tax Return
anal ere Hue Sane
m, 7004
are or oorporidoa
Kapi'olani Medical Center for Woven and Children
eme
oe. a '. . •• or a /mee to
meet lino loom a
55 Merchant Street, 24th Floor
ry or pen. sys erne ZIP cede
Honolulu, Hawaii 96813
Seca type of retort to be Net
Farm 1120
Form 112014
Form 1120$
5nmenre. - tk.d* pemroe,
an" b*.t /ln fWMelO
Farn 1120 -F3C
Form 1t20}{
Faro 11204.
taw. Klteot and
• • . _ ..
(Scrurcury el arks** a opera)
Few Penerwnrk Reduatan Act Nance, an hnelrapban$.
AZ /tE 3.1Vd E9ELSES9013 =n1
See
Fain 112040
Form 1120PC
Form 112DPOL
ZOoV
Form 112043W
Fan 1120•R1C
Form 11205
one 1120-F fiNrt Chock here if you do net have an office or piece of business in the United States
_Execntive.Vic.e..2res4rIenr & CFO
iTM&
I Employer idwrtfi4tlon number
99- 0177350
Farm 1120-SF
Form 990-C
Form 990-T
a 1 ra>ttest an aimomstic &month ter for serail corporations. 3- month) extension of tine
anti May 17 . - 199 . to he The income tax ratan of the corporation named above fa ► C calendar
year o r ► tax year beginning July 1 . 1997 •and ending June 30 • 199J
b if this tax year is to less than 12 months. dtedc reason:
n Ir>it r cram ! ^1 Final return 1 -'��� 1 Change in accounting period n Consolidated return to be filed
! It this application also corers subsidence to be included in a cortsohdatad rn'art complete the idloning
1 enure tn.t 1 leers been aunionnO M the altos000rrOd corporation to net tno aelicu t& and m tt e ben et ml encerreakre
CAW No. 1$460233
fan 7004113H. 1
N2D Hd7IW2H I NV'10IdVM • 1.10eld 6C • 60 66- 60 -e1V1
PHARMACY REVENUE TO THE GENERAL PUBLIC
• •
ORGANIZATION'S PRIMARY UNRELATED BUSINESS ACTIVITY.
50F12E 1018 04/15/99 10:01:06 V707 10076381
STATEMENT 1
25
NAME AND FEIN OF PARENT CORPORATION
KAPIOLANI SERVICE CORP. & SUBSIDIARIES
99- 0318588
• •
50F12E 1018 04/15/99 10:01:06 V707 10076381
STATEMENT 2
26
• •
FORM 990T - PART II - LINE 28 - TOTAL OTHER DEDUCTIONS
OVERHEAD ALLOCATION
SUPPLIES
SUBSCRIPTIONS
OTHER EXPENSE
PART II - LINE 28 - OTHER DEDUCTIONS
50F12E 1018 04/15/99 10:01:06 V707 10076381
132,063.
3,944.
350.
85.
136,442.
STATEMENT 3
27
•
Y �
I w .
TOTAL TAX DEPOSITS MADE
• •
FORM 990T - TAX DEPOSITED WITH EXTENSION
TAX DEPOSITED WITH FORM 7004
50F12E 1018 04/15/99 10:01:06 V707 10076381
28
9,000
9,000
STATEMENT 4
CONTROLLED GROUP ELECTION STATEMENT
ELECTION TO ALLOCATE $18,000 BUSINESS ASSET EXPENSE
The undersigned corporation, component members of a controlled group of corporation, as defined in Internal Revenue Code
§ I79(d)(7), hereby consent to the apportionment plan listed below with respect to the taxable year of each corporation which
includes June 30, 1998.
ELECTION TO ALLOCATE $40,000 ALTERNATIVE MINIMUM TAX EXEMPTION
The undersigned corporation, component members of a controlled group of corporation (within the meaning of Internal
Revenue Code § 1563(a)), hereby consent under IRC §1.58-1(c)(3) to the apportionment plan listed below with respect to the
taxable year of each corporation which includes June 30, 1998.
ELECTION TO ALLOCATE $150,000 ALTERNATIVE MINIMUM TAX EXEMPTION
The undersigned corporation, component members of a controlled group of corporation (within the meaning of Internal
Revenue Code §1563(a)), hereby consent under IRC §1.58-1(c)(3) to the apportionment plan listed below with respect to the
taxable year of each corporation which includes June 30, 1998.
ELECTION TO ALLOCATE TAXABLE INCOME BRACKETS
The undersigned corporation, component members of a controlled group of corporation (within the meaning of Internal
Revenue Code § I563(a)), hereby consent under IRC § 1.58- 1(c)(3) to the apportionment plan listed below with respect to the
taxable year of each corporation which includes June 30, 1998.
ELECTION TO ALLOCATE ACCUMULATED EARNINGS CREDIT
The undersigned corporation, component members of a controlled group of corporation (within the meaning of Internal
Revenue Code §1563(a)), hereby consent under JRC §1.535 -3 to the apportionment plan listed below with respect to the
taxable year of each corporation which includes June 30, 1998.
Company Employer
Number
1 99- 0318588
2 99- 0177350
3 99- 0274038
Apport. of Depr.
Business Asset
Expense
None
$18,000
None
STATEMENT OF TAX BRACKET ALLOCATION
Company Employer
Number
1 99- 0318588
2 99- 0177350
3 99- 0274038
First $50,000
of Taxable
Income
None
$50,000
None
Apport. of $40,000
Alt. Min Tax
Exemption
None
$40,000
None
The amounts in each taxable income bracket in the tax table in IRC §11(b) have been allocated to the following corporations
pursuant to §1.1563 -3(a)
Taxable Taxable
income over income over
$50,000 but $75,000 but
not over not over
$75,000 $100,000
None None
$25,000 $25,000
None None
Apport. of
$150,000 Alt. Min.
Tax Exemption
None
$150,000
None
Taxable
income over
$100,000 but
not over
$335,000
None
$235,000
None
Taxable
income over
$335,000 but
not over
$10,000,000
None
$9,665,000
None
• A ,
N
IDENTIFICATION AND SIGNATURES:
Company Employer
Number
2
3
99- 0318588
99- 0177350
99- 02474038
•
CONTROLLED GROUP ELECTION , TATEMENTS
Name and Address
Kapiolani Service Corp. & 06/30/98
Subsidiaries
55 Merchant Street, 24t Floor
Honolulu, HI 96813
Kapiolani Medical Center for 06/30/98
Women and Children
55 Merchant Street, 24t Floor
Honolulu, HI 96813
Kapiolani Medical Center at 06/30/98
Pali Momi
55 Merchant Street, 24 Floor
Honolulu, HI 96813
•
Taxable Signature and Title of Officer
Year End
• FORM
N -7 0 N P STATE OF I-ODEPARTMENT OF TAXATION
EXEMPT O BUSINESS •
(REV. 1997) INCOME TAX RETURN
• 1997
For calendar year 1997 or other taxable year beginning
VV IYV I VYIl11L vIr .ahflo Li ,i• ,,,, v •■
• M
Plea
Sign
Here
• JULY 1
Name of organization
ICAPI IOLANI MEDICAL CENTER FOR WOMEN AND CHILDREN
, 1997 and ending • JUNE 30 , 19 98 IAMD I UNP 1 008 I PNT I INT
• A Federal Employer I.D. No.
Dba or C/O
Address (number and street)
55 MERCHANT STREET, 24TH FLOOR
City or town. State and ZIP code
HONOLULU, HI 96813
ATTACH A COPY OF FEDERAL FORM 990 -T TO THIS RETURN
ENTER APPROPRIATE AMOUNTS FROM FEDERAL FORM 990-T
1 Gross receipts or sales
2 Returns and allowances
3 Cost of goods sold and /or operations
4 Capital gain net income
6 Other income
6 Total unrelated trade or business income
7 Total deductions
8 Unrelated business taxable income
Organizations Taxable as Corporations (See Instructions for Tax Computation)
9 Tax - From TAX COMPUTATION SCHEDULE on page 2, Part I, line 5
Trusts Taxable at Trust Rates (Sea Instructions for Tax Computation)
10 Tax -From TAX COMPUTATION SCHEDULE on page 2, Pan II, line 10
11 Recapture of Capital Goods Excise Tax Credit from Form N-312. Part II (attach Form N -312)
12 Total tax ladd lines 9 or 10 and 11)
Paid
Preparer s
Information
Preparer's
Signature
Finn's name Or yours
d sell-employed) and
address
13(a) •
13(6)
13(c) •
13(d)
13(e) •
99 0177350
• B Hawaii G.E. /Use I.D. No.
10141495
C This organization is a (check one):
1 •
2 •
3 •
4 •
6 •
6 •
7 •
8
9 •
10 •
11
12
14 •
875,802.
600,723.
275,079.
313,918.
- 38,839.
0.
0.
13 (a) Credit for Energy Conservation (attach Form N-157 or N-306)
(b) Credit for income tax paid to • state or foreign country by a resident estate or trust
(c) Enterprise Zone Tax Credit (attach Form x-756)
(d) Low-Income Housing Tax Credit (attach Form N -586)
(•) Credit for Employment of Vocational Rehabilitation Rebmb (attach Form 14884)
14 Total (add line 13(a) through 13(e))
16 Difference - line 12 minus line 14 (but not less than zero)
16 Credits and payments:
(a) 1996 overpayment credited to 1997
(b) Estimated tax payments
(c) Tax paid with automatic extension of time to (de (attach Form N or 14301)
(d) Credit of shareholder of regulated investment company
(e) Capital Goods Excise Tax Credit (attach Form N-312)
(f) Fuel Tax Credit for Commercial Fishers (attach Form N-308 or N -1634)
(9) Motion Picture and Film Production Income Tax Credit (attach Form (6316)
(hl Hotel Remodeling Tax Credit (attach Form 14314)
(i) Total credits and payments (add lines 16(a) through 16(h))
17 Estimated tax penalty (see Instructions). Check One: I I Form N-210 I Form 14220
18 TAX DUE • If line 16(g) is less than the total of lines 15 and 17, enter amount owed (see Instructions)
19 OVERPAYMENT - line 16(g) is larger than the total of lines 15 and 17, enter amount overpaid
20 Amount of Tine 19 •u want Credited to 1998 estimated tax X R efunded 20 (a) S S. 21303
. ra, utter IT � at t a rru m •Inp any accompanying • Si or miners ta a •n axons ma • -.tit •
• (limy knowledge rman good faith, to the taxabler natl. wsuanr to the Wwai�1 /1/I��jr11 /• Tax t Gilmour 235, W6
•
Signature o officer Date Title
5,500-
17
0.
18
0.
19
5,500.
' ERNST & YOUNG LLP - 1001 BISHOP STREET f' 34- 6565596
2400 PAUAHI TOWER, HONOLULU, HI ZIP CODE ►96813
Date Check it Preparers social securty number
7 /) / f 3 ' se6<mpbyed I I 220 - - 0097
ust
FORM N -70NP
k3 "_
- - =:
`` --
16(6)1
4,000.
x- _ --
16(c) •
1,500-
r,„-•
16(d)
16(e) •
R:, -
=i
16(f) •
tee `"�L'• -3
'_�I
_
=^ +F
.- -sue° ,t.--t ,,
16181 •
161h) •
• FORM
N -7 0 N P STATE OF I-ODEPARTMENT OF TAXATION
EXEMPT O BUSINESS •
(REV. 1997) INCOME TAX RETURN
• 1997
For calendar year 1997 or other taxable year beginning
VV IYV I VYIl11L vIr .ahflo Li ,i• ,,,, v •■
• M
Plea
Sign
Here
• JULY 1
Name of organization
ICAPI IOLANI MEDICAL CENTER FOR WOMEN AND CHILDREN
, 1997 and ending • JUNE 30 , 19 98 IAMD I UNP 1 008 I PNT I INT
• A Federal Employer I.D. No.
Dba or C/O
Address (number and street)
55 MERCHANT STREET, 24TH FLOOR
City or town. State and ZIP code
HONOLULU, HI 96813
ATTACH A COPY OF FEDERAL FORM 990 -T TO THIS RETURN
ENTER APPROPRIATE AMOUNTS FROM FEDERAL FORM 990-T
1 Gross receipts or sales
2 Returns and allowances
3 Cost of goods sold and /or operations
4 Capital gain net income
6 Other income
6 Total unrelated trade or business income
7 Total deductions
8 Unrelated business taxable income
Organizations Taxable as Corporations (See Instructions for Tax Computation)
9 Tax - From TAX COMPUTATION SCHEDULE on page 2, Part I, line 5
Trusts Taxable at Trust Rates (Sea Instructions for Tax Computation)
10 Tax -From TAX COMPUTATION SCHEDULE on page 2, Pan II, line 10
11 Recapture of Capital Goods Excise Tax Credit from Form N-312. Part II (attach Form N -312)
12 Total tax ladd lines 9 or 10 and 11)
Paid
Preparer s
Information
Preparer's
Signature
Finn's name Or yours
d sell-employed) and
address
13(a) •
13(6)
13(c) •
13(d)
13(e) •
99 0177350
• B Hawaii G.E. /Use I.D. No.
10141495
C This organization is a (check one):
1 •
2 •
3 •
4 •
6 •
6 •
7 •
8
9 •
10 •
11
12
14 •
875,802.
600,723.
275,079.
313,918.
- 38,839.
0.
0.
13 (a) Credit for Energy Conservation (attach Form N-157 or N-306)
(b) Credit for income tax paid to • state or foreign country by a resident estate or trust
(c) Enterprise Zone Tax Credit (attach Form x-756)
(d) Low-Income Housing Tax Credit (attach Form N -586)
(•) Credit for Employment of Vocational Rehabilitation Rebmb (attach Form 14884)
14 Total (add line 13(a) through 13(e))
16 Difference - line 12 minus line 14 (but not less than zero)
16 Credits and payments:
(a) 1996 overpayment credited to 1997
(b) Estimated tax payments
(c) Tax paid with automatic extension of time to (de (attach Form N or 14301)
(d) Credit of shareholder of regulated investment company
(e) Capital Goods Excise Tax Credit (attach Form N-312)
(f) Fuel Tax Credit for Commercial Fishers (attach Form N-308 or N -1634)
(9) Motion Picture and Film Production Income Tax Credit (attach Form (6316)
(hl Hotel Remodeling Tax Credit (attach Form 14314)
(i) Total credits and payments (add lines 16(a) through 16(h))
17 Estimated tax penalty (see Instructions). Check One: I I Form N-210 I Form 14220
18 TAX DUE • If line 16(g) is less than the total of lines 15 and 17, enter amount owed (see Instructions)
19 OVERPAYMENT - line 16(g) is larger than the total of lines 15 and 17, enter amount overpaid
20 Amount of Tine 19 •u want Credited to 1998 estimated tax X R efunded 20 (a) S S. 21303
. ra, utter IT � at t a rru m •Inp any accompanying • Si or miners ta a •n axons ma • -.tit •
• (limy knowledge rman good faith, to the taxabler natl. wsuanr to the Wwai�1 /1/I��jr11 /• Tax t Gilmour 235, W6
•
Signature o officer Date Title
5,500-
17
0.
18
0.
19
5,500.
' ERNST & YOUNG LLP - 1001 BISHOP STREET f' 34- 6565596
2400 PAUAHI TOWER, HONOLULU, HI ZIP CODE ►96813
Date Check it Preparers social securty number
7 /) / f 3 ' se6<mpbyed I I 220 - - 0097
ust
FORM N -70NP
e M •
1W13421.000
Form N -70NP
(REV. 1997)
TAX COMPUTATION SCHEDULE
PART I
4 (a)
(b)
1 Unrelated
2
- Corporations
(iii) Over $100.000 • Enter 6.4%
of line 3 $
•
1 Enter the amount of unrelated business taxable income as shown on page 1, line 8
2 Enter the amount of taxable net capital gain as shown on page 1, line 4
3 Line 1 minus line 2 (if less than zero, enter zero)
Tax on net capital gain - 4% of amount on line 2
Tax on all other taxable income • If amount on line 3 is:
(i) Not over $25,000 • Enter 4.4% of line 3
(ii) Over $25,000 but not over $100,000 - Enter 5.4%
of line 3 $ . Subtract
If the taxable income is:
Not over $1,500
Over $1,500 but not over $2,500
Over $2,500 but not over $3,500
Over $3,500 but not over $5,500
Over $5,500 but not over $10,500
Over $10,500
Over $15,500
Over $20,500
but not over $15,500
but not over $20,500
$250 and enter difference
. Subtract $1,250 and enter difference
TRUST TAX RATES
•
(c) Total of lines 4(a) and 4(b).
(d) Using the rates listed on line 4(b), compute tax on unrelated business taxable income as shown on line 1.
6 Total tax (enter lesser of amount on line 4(c) or 4(d))
Also, enter this amount on pegs 1. line 9.
- Charitable Trusts
business taxable income (page 1, line 8)
Net capital gain taxable to the trust. Enter the smaller of line 16 or 17, col. (b), Schedule D (Form N-40)
If this line is zero, GO TO LINE 9
3 Difference • line 1 minus line 2
4 Enter the greater of line 3 or $3,500
6 Tax on amount on line 4. If line 4 is $3,500, enter $130.00
6 Difference • line 1 minus line 4
7 Multiply the amount on line 6 by 7,25%
8 Tax. Add lines 5 and 7
9 Tax on amount on line 1 above
10 Enter the lesser of line 8 or line 9 here and on page 1, line 10
The tax rate shall be:
2% of taxable income
$30.00 plus 4% of excess over $1,500
$70.00 plus 6% of excess over $2,500
$130.00 plus L25% of excess over $3,500
Page 2
1
2
3
4 (a)
41b)li)
4 (b)(ii)
41b)liii)
4(c)
4(d)
6
- 38,839.
0.
- 38,839.
0.
0.
0.
0.
0.
0.
0.
1
2
3
4
6
6
7
8
9
10
$275.00 plus 8% of excess over $5,500
$675.00 plus 8.75% of excess over $10,500
$1,112.50 plus 9.5% of excess over $16,500
$1 587 50 plus 10% of excess over $20,500
• a C/O
102011000
STATE OF HAWAII - D V OF TAXATION •
lb1 APPLICATION FOR OMATIC EXTENSION
:O1 OF TIME TO FILE
1x97) HAWAII CORPORATION INCOME TAX RETURN
Onaadn• R .* of Forms N30. N46. N -7CelP and $310)
in year se for (en than 12 months. *ma sees==
Sad mum 0 Facer teem
Over in accounting psiod aaa°nd
en au expasaan
Kapi Medical Center for Women
dynastic smite.
had income an batty M to Inaba an (Yen may esanata this anmoant)
NOTE You must es an amass on dro 3.0 you do not sweet at owe tax. •poor tans 10)
Chet Wets amooted m *manta (man. wfot year's
wel pron•t ataxaad ea cn&U
Other faxelrh
13/93 SOVd
Ate4 e- -1(^
n eensokanha reme to be fibd
ZSCLSEseos aI
and Children
4,000
1
W rxyr a,Nhe an aw ...
N 1
urea j Goa I nu - Finn I
• Lit ALJKTFA. *mew.,
99- 0177350
Faded F•••e' lae,m aeon Maehe.
Haws G.L the Ilona amen Nontr
10141
Sou (Aanee and Set)
55 Merchant Street, 24th Floor
• at hewn. Son. eat ZIP sour
Honolulu, Hawaii 96813
k type of return to be gibed: • Fenn � • U Form N45 *Whom N 10h1P •U Form N310
(plea! bas Ra I •
0 you do not ban an office a Mom d business a tenni)
wow an automat &month ananica at tan to 6a to imam lam roue d to tee* awned above ler (fir in only anal
CALENDAR YE AR • 1g OR TAX YEAR ENDING • June 30 . 98
we ear ecolicsdee ako coos subsithetba to S aMaded in a consolidated name) . .n
al dm Waned VIM
f •yet• ads a In p,swip Me roma Shea and Federal tomb t s Isaacson Number of each meats
5,500
V `e. . ! A {yN
yule,„ 0,1- ..!?;;fi5 {�{. -+�.,r•..
Other p._ and Pads tan awe . ..t)
Tote) (add Ines 4 end 6)
Incense to balance dot F S nantr ire 6$. Pry in +w she this tore 111. 7 • 1,500
mom an ice 7 in tuL MOO dole a money ads tor feat amount payable to 'tlawai SASS la CoO.ctort Wdm yore Federal Enteleis
imfieatos Number, the table yea, and "Fate tazor on t Pat it US data dawn m US bent
DECLARATION
decant ads to pettdder eat lath b ateten 23136 tiRS that the s . . - cteaiod herr are ea. and coma std that nave Iwo tud d
• ••••••••• *Sty to wee this wpliatea all hose box took
Ace suits el Ow cerpeallan a cater way.
A Soda /', sews a an Mat tepeetarvhp the fadadsy or main ad an assap% WWI a argaa •ht• Mlle Ran N-X38.
An floated awn
Wei maw d massy.
6
4, 000
Oi 3(e
Date
REASONS FOR REJECTION OF EXTENSION•
1. Itasstes for to sa aim is opt *mad by the =Weyer a hb dal aufba Ted agent
2. The nest twat not in this cf&ce or marled an or baton the data wasc led by taw ter fling emu oven
a s , to wawa are r fired ba dads type of tea and fa each taxpayer involved.
4 The exaea in return was not filed Within the tene suedfied by the flat extension.
FORM N401
1p7V N3D HS7VsH INV70IdV)I'NOdd Cb•60 BS-BO-NV/4
THE COPY OF THIS
RETURN FILED WITH
THE STATE
CONTAINED A COPY OF
THE TAXPAYER'S
FEDERAL RETURN
(FORM 990 -T).