Civic Intelligence

Pali Momi Foundation

990 • Fiscal year 2014 • EIN 38-3840327

Jul 01, 2013 to Jun 30, 2014 • Filed on May 12, 2015

55 Merchant Street 24th FloorSuiteHonolulu, HI 96813-4333

(808) 535-7100

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

60th percentile

0.10x

Higher debt load relative to assets than 60% of similar nonprofits.

2014 filings • 501(c)3 • $500k-$1M nonprofits • Source year 2014

Liabilities / Revenue

74th percentile

0.22x

Higher debt load relative to revenue than 74% of similar nonprofits.

2014 filings • 501(c)3 • $500k-$1M nonprofits • Source year 2014

Net Margin

68th percentile

11%

Higher net margin than 68% of similar nonprofits.

2014 filings • 501(c)3 • $500k-$1M nonprofits • Source year 2014

Top Officer Pay

100th percentile

$1,884,202

Higher top officer pay than 100% of similar nonprofits.

Top officer pay equals 610.2% of source-year revenue.

2014 filings • 501(c)3 • $500k-$1M nonprofits • Source year 2014

Asset Growth

81st percentile

23%

Faster asset growth than 81% of similar nonprofits.

2014 filings • 501(c)3 • $500k-$1M nonprofits • Annualized from 2013 to 2014

Revenue Growth

10th percentile

-29%

Faster revenue growth than 10% of similar nonprofits.

2014 filings • 501(c)3 • $500k-$1M nonprofits • Annualized from 2013 to 2014

Assets

Up

$664,569

Up $124,704 (+23%) from 2013

Net Assets

Up

$595,709

Up $58,680 (+11%) from 2013

Liabilities

Up

$68,860

Up $66,024 (+2328%) from 2013

Revenue

Down

$308,784

Down $125,890 (-29%) from 2013

Expenses

Down

$273,855

Down $131,375 (-32%) from 2013

Net Income

Up

$34,929

Up $5,485 (+19%) from 2013

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$3.0M$2.0M$1.0M$0Assets 2012: $563,427Liabilities 2012: $2,002Net Assets 2012: $561,4252012Assets 2013: $539,865Liabilities 2013: $2,836Net Assets 2013: $537,0292013Assets 2014: $664,569Liabilities 2014: $68,860Net Assets 2014: $595,7092014Assets 2015: $1,078,559Liabilities 2015: $107,608Net Assets 2015: $970,9512015Assets 2016: $577,042Liabilities 2016: $299,387Net Assets 2016: $277,6552016Assets 2017: $654,458Liabilities 2017: $392,745Net Assets 2017: $261,7132017Assets 2018: $484,043Liabilities 2018: $307,777Net Assets 2018: $176,2662018Assets 2019: $902,983Liabilities 2019: $180,776Net Assets 2019: $722,2072019Assets 2020: $770,659Liabilities 2020: $151,669Net Assets 2020: $618,9902020Assets 2021: $2,722,738Liabilities 2021: $258,666Net Assets 2021: $2,464,0722021Assets 2022: $2,413,734Liabilities 2022: $205,662Net Assets 2022: $2,208,0722022Assets 2023: $2,036,777Liabilities 2023: $295,329Net Assets 2023: $1,741,4482023Assets 2024: $1,202,821Liabilities 2024: $221,048Net Assets 2024: $981,7732024

Highlighted filing

2014

Assets$664,569
Liabilities$68,860
Net Assets$595,709

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$3.0M$2.0M$1.0M$0-$1.0MExpenses 2012: $203,2692012Revenue 2013: $434,674Expenses 2013: $405,230Net Income 2013: $29,4442013Revenue 2014: $308,784Expenses 2014: $273,855Net Income 2014: $34,9292014Revenue 2015: $880,394Expenses 2015: $502,605Net Income 2015: $377,7892015Revenue 2016: $273,296Expenses 2016: $971,434Net Income 2016: -$698,1382016Revenue 2017: $915,243Expenses 2017: $1,305,037Net Income 2017: -$389,7942017Revenue 2018: $383,689Expenses 2018: $1,200,225Net Income 2018: -$816,5362018Revenue 2019: $684,187Expenses 2019: $1,405,943Net Income 2019: -$721,7562019Revenue 2020: $531,902Expenses 2020: $1,396,019Net Income 2020: -$864,1172020Revenue 2021: $2,927,500Expenses 2021: $1,336,242Net Income 2021: $1,591,2582021Revenue 2022: $983,623Expenses 2022: $1,183,025Net Income 2022: -$199,4022022Revenue 2023: $929,785Expenses 2023: $1,454,981Net Income 2023: -$525,1962023Revenue 2024: $1,275,961Expenses 2024: $1,963,413Net Income 2024: -$687,4522024

Highlighted filing

2014

Revenue$308,784
Expenses$273,855
Net Income$34,929
Jump To
Filing Snapshot
Filing Period
Jul 1, 2013 to Jun 30, 2014
Signed
May 12, 2015
Return Version
2013v4.0
Gross Receipts
$335,700
Mission and Program Overview

Mission

The mission of pali momi foundation is to create a healthier hawai'i.

The mission of the pali momi foundation is to improve the health of hawai'i's people through funding of medical care, health education & research at pali momi medical center.

Balance Sheet Detail
LineBeginningEndChange
Assets
Savings and Temporary Cash Investments$275,291$406,131▲ $130,840
Accounts Receivable$134,721$121,806▼ $12,915
Investments in Publicly Traded Securities$76,377$76,806▲ $429
Investments Other Securities$40,991$54,780▲ $13,789
Cash and Non-Interest-Bearing Accounts$0$0→ $0
Other Notes and Loans Receivable, Net$0$0→ $0
Pledges and Grants Receivable$0$0→ $0
Receivable From Disqualified Prsn$0$0→ $0
Receivables From Officers Etc$0$0→ $0
Investments Program Related$0$0→ $0
Land, Buildings, and Equipment, Net$0$0→ $0
Intangible Assets$0$0→ $0
Inventories for Sale or Use$0$0→ $0
Loans From Officers Directors$0$0→ $0
Prepaid Expenses and Deferred Charges$0$0→ $0
Total Assets$539,865$664,569▲ $124,704
Other Assets Total$12,485$5,046▼ $7,439
Liabilities
Other Liabilities$0$59,456▲ $59,456
Accounts Payable and Accrued Expenses$2,836$9,404▲ $6,568
Grants Payable$0$0→ $0
Mortgage Notes Payable Secured by Investment Property$0$0→ $0
Unsecured Notes Loans Payable$0$0→ $0
Deferred Revenue$0$0→ $0
Escrow Account Liability$0$0→ $0
Tax Exempt Bond Liabilities$0$0→ $0
Total Liabilities$2,836$68,860▲ $66,024
Net Assets / Fund Balance
Temporarily Rstr Net Assets$647,901$773,679▲ $125,778
Permanently Rstr Net Assets$0$0→ $0
Unrestricted Net Assets$-110,872$-177,970▼ $67,098
Total Net Assets Fund Balance$537,029$595,709▲ $58,680
Total Liabilities and Net Assets / Fund Balance$539,865$664,569▲ $124,704

Asset Categories

AssetBook ValueDepreciationBasis
Other Securities$54,780--
Compensation and Service Providers

Employees

NameTitleOtherTotal
Jessica LewisAssistant Secretary$149,839$149,839

Board Members and Trustees

NameTitle
Beth Hoban RnBoard of Director, Chair
Michael RobinsonPresident
Virginia Pressler-fisher MdVice President
Emily KuraokaBoard of Director
Gregg T Kokame MdBoard of Director
Raymond P Vara JrBoard of Director
Renee GomesBoard of Director
Vicki GaynorBoard of Director
Violeta Arnobit RnBoard of Director
Earl InouyeAssistant Treasurer
Charles R ChingSecretary
David OkabeTreasurer
Revenue and Support

Revenue Composition

Contributions and Grants
$247,846
Program Service Revenue
$0
Investment Income
$10,328
Other Revenue
$50,610
All Other Contributions
$245,896
Change in Net Assets
$34,929
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Grants and Similar Amounts Paid$232,118
Other Expenses$41,737
Total Fundraising Expense$9,793
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Grants to Domestic Orgs$232,118--$232,118
Fees for Services Other$0$15,864$1,242$17,106
Insurance$0$7,887$0$7,887
Information Technology$0$0$6,951$6,951
Office Expenses$0$3,078$29$3,107
Other Expenses$0$2,776$0$2,776
Travel$0$0$743$743
Advertising$0$0$628$628
Fees for Services Accounting-$348$0$348
Fees for Service Investment Mgmnt Fees-$292-$292
Conferences and Meetings$0$0$200$200
Total Functional Expenses$233,817$30,245$9,793$273,855
International Activity

Grant and Assistance Recipients

RecipientLocationCategoryPurposeAmount
99-0274038-501(c)(3)General Support$218,088
Fundraising, Events, and Gaming
Fundraising activities
Yes
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Fundraising Gross Income$76,440
Fundraising Direct Expenses$25,830
Professional Fundraising Fees$0

Fundraising Events

EventGross ReceiptsGross RevenueDirect ExpensesNet Income
Event 1$78,390$76,440$5,448$70,992
Total Events$78,390$76,440$25,830$50,610
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Loans from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Receivables from Disqualified Persons$0$0→ $0
Receivables from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
HAWAI'I PACIFIC HEALTH$35,664
Pali Momi Medical Center$22,939
KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN$789
Wilcox Health Foundattion$64
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Backup withholding compliance
Yes
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
Yes
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Line 6

Members and rights hawai'i pacific health is the sole member who has the right to participate in the organization's governance with the right to elect the members of the governing body and/or approve significant decisions of the governing board.

Form 990, Part VI, Line 7A

Description of classes of person and the nature of their rights hawai'i pacific health is the sole member, and has the power to approve the election of members of the governing body. Hawai'i pacific health, as member, also has the power to elect one or more ex officio voting members of the governing body.

Form 990, Part VI, Line 7B

Descr classes of persons, decisions req approval & type of voting rights hawai'i pacific health, as member, has exclusive power to take and direct the following actions of the corporation: (i) nominate candidates to the board for the following positions: president, vice-president(s), treasurer, secretary, assistant treasurers and secretaries, and any other officer, except the chair and vice-chair of the board; (ii) after consultation with the board, remove the president, vice-president(s), treasurer, secretary, assistant treasurers and secretaries, and any other officer, except the chair and vice-chair; (iii) remove a director from the board; (iv) delegate management authorities from the board to officers or committees of the corporation in accordance with a delegated authorities matrix adopted by the member; (v) amend these bylaws; (vi) cause the corporation's participation in all long term financing transactions which are in excess of one (1) year and/or one million dollars ($1,000,000) or more; (vii) select banks, trust companies, or other depositories to which the corporation's funds shall be deposited; (viii) direct, manage and control the custody, advisory service, and asset management of the financial assets of the corporation; (ix) determine and effect inter-corporate fund transfers by and between the corporation and any affiliate; (x) develop and implement the general policies regarding the corporation's executive compensation and benefit plans; (xi) form a new corporation, limited liability company, partnership, or other organization that is owned solely by the corporation; (xii) develop and promulgate overall corporate goals and the long-range and strategic plan of the corporation; and (xiii) develop and implement the annual capital, operating, and cash flow budgets. The corporation shall not take the following actions without first obtaining member approval: (i) elect any director to the board; (ii) amend the articles; (iii) merge the corporation with any entity; (iv) dissolve the corporation; (v) enter into any unbudgeted contracts on behalf of the corporation which require annual payments by or on behalf of the corporation exceeding one million dollars ($1,000,000) in value; (vi) acquire assets worth over one million dollars ($1,000,000) except for those assets acquired by gifts, grant, or donation; (vii) acquire shares in another corporation; (viii) sell, lease, exchange, encumber or dispose of twenty-five percent (25%) or more of the property and assets held by the corporation to any entity that is not an affiliate; (ix) issue the corporation's membership to anyone other than the member; (x) form a joint venture or other business relationship (other than the ordinary course of business contracts) between the corporation and any person or entity; and (xi) develop a new line of business or a new service.

Form 990, Part VI, Line 11B

Review of the 990s by the organization's governing body various schedules of the 990s are prepared primarily by staff within the accounting area of the organization working with various other areas of the organization such as management of operating units, hr, legal, etc. Disclosure narratives are written and completed internally based on input and discussion with financial analysts and the chief operating officer/executive director of the reporting entity. The chief operating officer/executive director of each reporting entity reviews and approves the disclosure narratives which describe the mission/purpose and program accomplishments of their organization. Senior management of the health care system reviews the 990s of each filing organization within the health care system. Once senior management has completed its review, the 990s are then provided to the governance and nominating committee of the health care system's board of directors for their review. The governance and nominating committee of the parent entity's (hawai'i pacific health "hph") board provides oversight for the 990 reporting and reviews the 990s for each entity prior to filing. In addition, the 990s for each entity are made available to the board members of each subsidiary unit of hph and the hph board of directors through a board member portal for review prior to the filing of the 990. The 990s will be posted to hph's website for public access after the filing of the return with the irs.

Form 990, Part VI, Line 12C

Monitoring & enforcing of conflict of interest policy annually, each director, officer, key employee and member of a committee with board delegated powers shall annually sign a statement which affirms that such person: 1) received a copy of the conflict of interest ("coi") policy; 2) has read and understands the policy; 3) agrees to comply with the policy; and 4) understands that the organization is a charitable organization, and that in order to maintain its federal tax exemption, the organization must engage primarily in activities which accomplish one or more of its tax-exempt purposes. The in-house legal department distributes the statement request and reviews the coi statements returned. Identified conflicts of interest are presented to the board for review, deliberation and confirmation /refutation that a conflict of interest exists. If a conflict of interest has been found, the individual may address the board and explain the transaction or arrangement causing the conflict. After the presentation, the individual is excused from the meeting and shall not participate with any discussion or vote on matters pertaining to the transaction or arrangement. In meetings where application of the coi policy occurs, the meeting minutes include nature of the financial interest/conflict, name(s) of the person(s) with the potential or actual conflict, any action taken to assist in the determination of whether a conflict existed, including any discussion of alternative arrangements, the board's decision(s) regarding the conflict and names of person present in the discussion and votes relating to the transaction or arrangement. Board's decision(s) regarding the conflict and names of person present in the discussion and votes relating to the transaction or arrangement.

Form 990, Part VI, Lines 15A & 15B

Offices & positions which process was used & year process was begun the ceo, officers and key employees of the organization are not compensated by the filing organization, but rather by the tax exempt parent hawai'i pacific health ("hph"). Following is the process that the parent organization undertakes to approve the ceo, officers and key employees' compensation. Compensation for hawai'i pacific health ("hph") executives (vice president and above) is set by the hph compensation committee, which is composed solely of independent, community-based members of the hph board of directors. On an annual basis the hph board chairperson (who is independent) selects a neutral third party executive compensation consultant to review the executives' compensation and benefits. The consultant provides a written report to the compensation committee at its annual meeting. Included in the report is market based data from like organizations. The compensation committee makes final decisions regarding compensation and benefits at the meeting after review and discussion of the consultant's report, and such decisions are documented in the compensation committee meeting minutes. Community based directors of the organization are not compensated. Certain employed physicians may be officers or an identified key employee of the reporting or related organization. Physician compensation is also handled in the same manner as executive compensation, with the hph compensation committee receiving a report from a neutral consultant and following the same process as described above on an annual basis. This process was last completed on march 5, 2014 to review physician compensation and on august 7, 2014 to review executive compensation.

Form 990, Part VI, Line 19

Disclosure of gov docs, conflict of interest policy & financial stmts the conflict of interest policy and standards of conduct are available on the hawai'i pacific health website. The consolidated audited financial statements are available to the public via the hawai'i pacific health website.

Filing and Contact Details

Filer

EIN
38-3840327
In Care Of
% ANN HO
Phone
8085357100

Signing Officer

Name
Earl Inouye
Title
Vice President
Signed
2015-05-12

Organization Details

Principal Officer
Michael Robinson
Formed
2010
Legal Domicile
Hi
Voting Board Members
7
Independent Board Members
6
Employees
0
Volunteers
7

Preparer

Preparer
Cindy White
Supplemental Narrative

Additional Explanations

Form 990, Part III, Line 4

Program service accomplishments the mission of pali momi foundation the mission of the pali momi foundation (the foundation) is to improve the health of hawai'i's people by funding medical care, health education and research at pali momi medical center (pali momi). Pali momi is a not-for-profit hospital located in west o'ahu and dedicated to the health and well-being of all hawai'i residents. With 128 beds, more than 1,200 employees and more than 400 affiliated physicians, pali momi offers a full range of services. Pali momi opened on july 31, 1989. Since its opening, the hospital has delivered many medical firsts for central and west oahu, including: - the first interventional cardiac catheterization unit to detect and treat heart disease - first retina center in hawaii - minimally invasive surgical technology featuring the da vinci robot-aided system - a comprehensive women's center - hawaii's only team triage approach to emergency medicine - a complete bariatric surgery program - the most advanced diagnostic imaging technology available pali momi is the only facility in hawai'i that uses a team triage approach in its emergency room, where patients are promptly evaluated by an emergency physician. Today, pali momi continues to provide award-winning care to thousands of patients each year. Pali momi has been recognized by the american heart association and american stroke association for its stroke care program. The bariatric surgery program offers complete patient care, lifestyle transition and support, and has received metabolic and bariatric surgery accreditation and is recognized as a quality improvement program accredited center, a joint program of the american college of surgeons and the american society for metabolic and bariatric surgery. Pali momi is a not-for-profit hospital and an affiliate of hawai'i pacific health, the state's largest health care provider. As a not-for-profit hospital, pali momi relies on community support to fulfill its mission and care for patients regardless of their ability to pay. In fiscal year 2014, the foundation focused its fundraising efforts on critical programs and unrestricted support of the hospital. Areas with the greatest need were innovation and new technology, the pali momi women's center and the ohana fund. Innovation and technology funds support new state-of-the-art initiatives, equipment and special projects that advance innovations in health care. With your help, our patients will continue to have the best medical care possible using some of the latest technology available. Keeping pali momi at the cutting edge of innovation is essential to ensuring high-quality care for its patients. Until recently, there were only two traditional options for patients requiring surgery - a large open incision, or laparoscopy. Philanthropic gifts helped to provide a minimally invasive choice for urology, thoracic and general surgeries. The da vinci firefly surgical robot-aided system allows surgeons to perform major surgery through small incisions. Patients experience decreased blood loss, less pain and a faster recovery time. The system is also a recruiting tool for physicians who specialize in this new technology. Pali momi women's center the pali momi women's center is located in the pali momi medical pavilion, which was built in 2012 to help meet the health care needs of the growing population in central and west o'ahu. It provides services that address women's unique health care needs. Funds help us continue providing important services and programs including some of the latest technology in 3-d breast imaging and breast mri. Donations also fund patient educational materials, from breast self-exam teaching models to guided imagery cds for relaxation during chemotherapy. The ohana fund pali momi's donor-supported ohana fund impacts the lives of patients who are not covered by insurance, or who are waiting to be approved for insurance. Upon discharge, this fund provides patients with a 30

Form 990, Part XI, Line 5

Other changes in net assets $ (1,537) - equity transfer with hph $ (182) - other changes in tr net assets $ 20,028 - equity transfer with affiliates ---------- $ 18,309 - total ==========

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IRS990/MissionDesc0THE MISSION OF THE PALI MOMI FOUNDATION IS TO IMPROVE THE HEALTH OF HAWAI'I'S PEOPLE THROUGH FUNDING OF MEDICAL CARE, HEALTH EDUCATION & RESEARCH AT PALI MOMI MEDICAL CENTER.
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IRS990/PrincipalOfficerNm0MICHAEL ROBINSON
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Document Assets

No mirrored PDF or thumbnail assets are attached yet.

Filings

Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2024Detailed filing. Detailed filing data is available for this year.$1.20$0.22$0.98$1.28$1.96$0.69
2023XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$2.04$0.30$1.74$0.93$1.45$0.53
2022XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$2.41$0.21$2.21$0.98$1.18$0.20
2021Import issue. A filing source exists for this year, but detailed import did not complete cleanly.$2.72$0.26$2.46$2.93$1.34$1.59
2020XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$0.77$0.15$0.62$0.53$1.40$0.86
2019Detailed filing. Detailed filing data is available for this year.$0.90$0.18$0.72$0.68$1.41$0.72
2018Detailed filing. Detailed filing data is available for this year.$0.48$0.31$0.18$0.38$1.20$0.82
2017XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$0.65$0.39$0.26$0.92$1.31$0.39
2016XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$0.58$0.30$0.28$0.27$0.97$0.70
2015Detailed filing. Detailed filing data is available for this year.$1.08$0.11$0.97$0.88$0.50$0.38
2014Detailed filing. Detailed filing data is available for this year.$0.66$0.07$0.60$0.31$0.27$0.03
2013Facts available. Structured filing facts are available, but richer extracted sections are limited.$0.54$0.00$0.54$0.43$0.41$0.03
2012Facts available. Structured filing facts are available, but richer extracted sections are limited.$0.56$0.00$0.56$0.20