efile Public Visual Render
ObjectId: 202301359349318370 - Submission: 2023-05-16
TIN: 99-0246363
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
21
Open to Public Inspection
Name of the organization
Hawai'i Pacific Health
Employer identification number
99-0246363
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
First-class or charter travel
Housing allowance or residence for personal use
Travel for companions
Payments for business use of personal residence
Tax idemnification and gross-up payments
Health or social club dues or initiation fees
Discretionary spending account
Personal services (e.g., maid, chauffeur, chef)
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain
.....
1b
Yes
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a?
....
2
Yes
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
Compensation committee
Written employment contract
Independent compensation consultant
Compensation survey or study
Form 990 of other organizations
Approval by the board or compensation committee
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment?
.............
4a
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan?
.........
4b
Yes
c
Participate in, or receive payment from, an equity-based compensation arrangement?
.........
4c
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization?
....................
5a
No
b
Any related organization?
.......................
5b
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization?
..................
6a
No
b
Any related organization?
......................
6b
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III
............
7
No
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III
..........................
8
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)?
.........................
9
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2021
Page 2
Schedule J (Form 990) 2021
Page
2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees.
Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note.
The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A)
Name and Title
(B)
Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC
(C)
Retirement and other deferred compensation
(D)
Nontaxable
benefits
(E)
Total of columns
(B)(i)-(D)
(F)
Compensation in column (B) reported as deferred on prior Form 990
(i)
Base
compensation
(ii)
Bonus & incentive
compensation
(iii)
Other
reportable compensation
1
Raymond P Vara Jr
Board of Director, President & CEO
(i)
(ii)
1,088,746
-------------
0
579,773
-------------
0
621,515
-------------
0
2,470,732
-------------
0
27,410
-------------
0
4,788,176
-------------
0
615,303
-------------
0
2
Beau Nakamoto MD
Board of Director
(i)
(ii)
0
-------------
175,980
0
-------------
2,456
0
-------------
116,462
0
-------------
11,408
0
-------------
0
0
-------------
306,306
0
-------------
0
3
Monica Price MD
Board of Director
(i)
(ii)
0
-------------
238,335
0
-------------
8,670
0
-------------
65,119
0
-------------
11,600
0
-------------
25,580
0
-------------
349,304
0
-------------
0
4
Brandt Farias
Former Officer
(i)
(ii)
121,482
-------------
0
61,243
-------------
0
21,369
-------------
0
74,371
-------------
0
5,735
-------------
0
284,200
-------------
0
49,137
-------------
0
5
Gail Lerch
Former Officer
(i)
(ii)
433,599
-------------
0
0
-------------
0
52,661
-------------
0
91,102
-------------
0
7,480
-------------
0
584,842
-------------
0
176,018
-------------
0
6
Kenneth B Robbins MD
Former Officer
(i)
(ii)
236,663
-------------
0
0
-------------
0
0
-------------
0
86,322
-------------
0
14,329
-------------
0
337,314
-------------
0
78,909
-------------
0
7
Martha Smith
Former Officer
(i)
(ii)
146,322
-------------
0
124,419
-------------
0
150,303
-------------
0
258,378
-------------
0
5,438
-------------
0
684,860
-------------
0
207,350
-------------
0
8
Melinda Ashton MD
EVP & CQO
(i)
(ii)
455,308
-------------
0
194,229
-------------
0
139,244
-------------
0
244,499
-------------
0
16,006
-------------
0
1,049,286
-------------
0
168,964
-------------
0
9
Troy Branstetter
VP
(i)
(ii)
188,888
-------------
0
13,431
-------------
0
28,417
-------------
0
29,634
-------------
0
7,480
-------------
0
267,850
-------------
0
0
-------------
0
10
William Burke
VP
(i)
(ii)
231,178
-------------
0
44,764
-------------
0
26,379
-------------
0
71,139
-------------
0
17,185
-------------
0
390,645
-------------
0
16,974
-------------
0
11
Jennie Chahanovich
EVP
(i)
(ii)
372,818
-------------
0
148,018
-------------
0
160,343
-------------
0
218,488
-------------
0
13,372
-------------
0
913,039
-------------
0
143,838
-------------
0
12
Warren Chaiko
SVP
(i)
(ii)
259,893
-------------
0
67,444
-------------
0
440,149
-------------
0
92,906
-------------
0
27,704
-------------
0
888,096
-------------
0
54,113
-------------
0
13
Charles R Ching
EVP, General Counsel & Secretary
(i)
(ii)
431,400
-------------
0
135,036
-------------
0
392,695
-------------
0
252,886
-------------
0
15,769
-------------
0
1,227,786
-------------
0
185,998
-------------
0
14
Leslie Chun MD
EVP
(i)
(ii)
519,567
-------------
0
180,626
-------------
0
85,652
-------------
0
200,623
-------------
0
24,688
-------------
0
1,011,156
-------------
0
86,619
-------------
0
15
Dawn Dunbar
SVP
(i)
(ii)
290,624
-------------
0
74,468
-------------
0
38,173
-------------
0
93,610
-------------
0
24,660
-------------
0
521,535
-------------
0
59,749
-------------
0
16
Louise Fukumoto
VP
(i)
(ii)
176,638
-------------
0
17,733
-------------
0
4,777
-------------
0
20,815
-------------
0
15,106
-------------
0
235,069
-------------
0
0
-------------
0
17
Arthur Gladstone
EVP & CSO
(i)
(ii)
503,226
-------------
0
189,772
-------------
0
213,837
-------------
0
292,071
-------------
0
25,054
-------------
0
1,223,960
-------------
0
199,456
-------------
0
18
Reina (France) Graves
PRIVACY OFFICER
(i)
(ii)
248,960
-------------
0
0
-------------
0
1,099
-------------
0
12,228
-------------
0
22,540
-------------
0
284,827
-------------
0
0
-------------
0
19
Alan Ito
Information Security Officer (part year)
(i)
(ii)
144,850
-------------
0
18,144
-------------
0
38,304
-------------
0
17,782
-------------
0
14,649
-------------
0
233,729
-------------
0
0
-------------
0
20
Douglas Kwock MD
VP
(i)
(ii)
392,692
-------------
0
75,632
-------------
0
39,672
-------------
0
94,688
-------------
0
24,325
-------------
0
627,009
-------------
0
49,637
-------------
0
21
Jessica Lewis
Assistant Corporate Secretary
(i)
(ii)
167,315
-------------
0
0
-------------
0
725
-------------
0
14,873
-------------
0
25,976
-------------
0
208,889
-------------
0
0
-------------
0
22
James Lin MD
VP
(i)
(ii)
256,939
-------------
0
52,655
-------------
0
25,538
-------------
0
73,078
-------------
0
24,404
-------------
0
432,614
-------------
0
19,200
-------------
0
23
Gerard Livaudais MD
EVP (part year)
(i)
(ii)
374,236
-------------
0
126,878
-------------
0
69,675
-------------
0
172,318
-------------
0
9,160
-------------
0
752,267
-------------
0
81,450
-------------
0
24
Lorrie-Ann Luke
VP
(i)
(ii)
207,351
-------------
0
39,718
-------------
0
23,683
-------------
0
63,397
-------------
0
25,054
-------------
0
359,203
-------------
0
31,859
-------------
0
25
Susan Masumoto-Nonaka
VP (part year)
(i)
(ii)
207,594
-------------
0
51,419
-------------
0
263,295
-------------
0
74,942
-------------
0
7,431
-------------
0
604,681
-------------
0
41,245
-------------
0
26
Mavis Nikaido
System CNE (part year)
(i)
(ii)
200,524
-------------
0
42,238
-------------
0
226,910
-------------
0
64,604
-------------
0
5,574
-------------
0
539,850
-------------
0
40,137
-------------
0
27
David Okabe
EVP, CFO & Treasurer
(i)
(ii)
546,669
-------------
0
170,726
-------------
0
235,766
-------------
0
376,357
-------------
0
15,769
-------------
0
1,345,287
-------------
0
226,880
-------------
0
28
Shilpa Patel MD
Associate CQO
(i)
(ii)
129,013
-------------
21,271
991
-------------
0
79,612
-------------
85,908
16,936
-------------
6,006
9,350
-------------
13,090
235,902
-------------
126,275
0
-------------
0
29
Steven Robertson
EVP & CIO
(i)
(ii)
444,593
-------------
0
169,121
-------------
0
173,730
-------------
0
284,000
-------------
0
15,769
-------------
0
1,087,213
-------------
0
177,390
-------------
0
30
Michael Robinson
VP
(i)
(ii)
260,167
-------------
0
49,180
-------------
0
28,544
-------------
0
75,992
-------------
0
9,831
-------------
0
423,714
-------------
0
39,448
-------------
0
31
Katie Shigemitsu
Compliance Officer
(i)
(ii)
183,738
-------------
0
0
-------------
0
39,580
-------------
0
23,057
-------------
0
9,168
-------------
0
255,543
-------------
0
0
-------------
0
32
David Stumbaugh
VP
(i)
(ii)
212,851
-------------
0
40,836
-------------
0
17,570
-------------
0
62,403
-------------
0
23,440
-------------
0
357,100
-------------
0
32,756
-------------
0
33
Dean Tateyama
VP
(i)
(ii)
181,497
-------------
0
18,285
-------------
0
1,389
-------------
0
21,464
-------------
0
19,340
-------------
0
241,975
-------------
0
0
-------------
0
34
Amy Thomas RN
System CNE
(i)
(ii)
187,660
-------------
0
21,571
-------------
0
2,034
-------------
0
20,663
-------------
0
26,904
-------------
0
258,832
-------------
0
0
-------------
0
35
Sunshine Topping
SVP
(i)
(ii)
280,785
-------------
0
68,850
-------------
0
30,118
-------------
0
89,038
-------------
0
24,660
-------------
0
493,451
-------------
0
0
-------------
0
36
Carrie Ann Tsutsui
VP, System Controller
(i)
(ii)
214,570
-------------
0
41,321
-------------
0
22,396
-------------
0
65,763
-------------
0
13,048
-------------
0
357,098
-------------
0
18,347
-------------
0
37
David Underriner
EVP
(i)
(ii)
240,233
-------------
0
75,000
-------------
0
1,904
-------------
0
0
-------------
0
6,410
-------------
0
323,547
-------------
0
0
-------------
0
38
Brandon Wong
VP
(i)
(ii)
169,022
-------------
0
15,905
-------------
0
736
-------------
0
32,689
-------------
0
22,440
-------------
0
240,792
-------------
0
0
-------------
0
39
Travis Clegg
COO - SCH
(i)
(ii)
326,626
-------------
0
80,626
-------------
0
23,339
-------------
0
96,413
-------------
0
25,169
-------------
0
552,173
-------------
0
51,050
-------------
0
40
Barbara Craft
COO - PMMC
(i)
(ii)
232,764
-------------
0
65,450
-------------
0
49,763
-------------
0
91,059
-------------
0
15,596
-------------
0
454,632
-------------
0
21,234
-------------
0
41
Andy Lee MD
Medical Director - HHP
(i)
(ii)
295,998
-------------
0
36,372
-------------
0
25,000
-------------
0
21,750
-------------
0
24,925
-------------
0
404,045
-------------
0
0
-------------
0
42
Brigitte McKale
VP/CNE - PMMC
(i)
(ii)
252,259
-------------
0
49,316
-------------
0
28,631
-------------
0
76,118
-------------
0
14,269
-------------
0
420,593
-------------
0
31,541
-------------
0
43
Gidget Ruscetta RN
COO - KMCWC
(i)
(ii)
323,251
-------------
0
62,656
-------------
0
38,738
-------------
0
85,572
-------------
0
14,569
-------------
0
524,786
-------------
0
53,567
-------------
0
Schedule J (Form 990) 2021
Page 3
Schedule J (Form 990) 2021
Page
3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference
Explanation
Schedule J, Part I, Line 1a Housing allowance or residence for personal use
HOUSING ALLOWANCES WERE PAID FOR ONE OFFICER OF THE ORGANIZATION. ALL AMOUNTS HAVE BEEN INCLUDED IN THE INDIVIDUALS FORM W-2 AS TAXABLE INCOME.
Schedule J, Part I, Line 1a Health or social club dues or initiation fees
HEALTH/SOCIAL CLUB DUES WERE PAID FOR SIX OFFICERS OF THE ORGANIZATION. ALL AMOUNTS HAVE BEEN INCLUDED IN THE INDIVIDUAL'S FORM W-2 AS TAXABLE INCOME.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THE RESTORATION PLAN WAS DESIGNED TO RESTORE BENEFITS THAT ARE LOST DUE TO LIMITS IMPOSED BY SECTIONS 401 AND 415 OF THE INTERNAL REVENUE CODE ON COMPENSATION CONSIDERED UNDER SUCH PLANS. AMOUNTS PAID OUT DURING THE YEAR BY THE ORGANIZATION: RAYMOND P. VARA JR. - $193,418 DAVID OKABE - $72,983 GAIL LERCH - $7,785 STEVEN ROBERTSON - $49,068 LESLIE CHUN, M.D. - $33,229 CHARLES R. CHING - $44,945 ARTHUR GLADSTONE - $50,298 MARTHA SMITH - $58,273 MELINDA ASHTON, M.D. - $41,256 JENNIE CHAHANOVICH - $27,896 GERARD F. LIVAUDIS - $26,186 ANNUAL INCENTIVE PLAN THE ANNUAL INCENTIVE PLAN IS AFFORDED TO EXECUTIVES BASED ON ANNUAL SYSTEM GOALS THAT ARE NOT BASED ON A PERCENTAGE OF NET EARNINGS. AMOUNTS PAID OUT DURING THE YEAR BY THE ORGANIZATION: RAYMOND P. VARA JR. - $479,773 DAVID OKABE - $170,726 STEVEN ROBERTSON - $139,121 CHARLES R. CHING - $135,036 ARTHUR GLADSTONE - $159,772 MELINDA ASHTON, M.D. - $144,229 JENNIE CHAHANOVICH - $123,018 LESLIE CHUN, M.D. - $155,626 GERARD LIVAUDAIS, M.D. - $126,564 DAWN DUNBAR - $74,468 WARREN CHAIKO - $67,444 DOUGLAS KWOCK, M.D. - $75,632 SUSAN MASUMOTO NONAKA - $51,419 MAVIS NIKAIDO - $42,238 MICHAEL ROBINSON - $49,180 DAVID STUMBAUGH - $40,836 LORRIE-ANN LUKE - $39,718 JAMES LIN, M.D. - $49,164 CARRIE ANN TSUTSUI - $41,321 WILLIAM BURKE - $44,764 SUNSHINE TOPPING - $68,850 TROY BRANSTETTER - $13,431 BRANDON WONG - $15,905 MARTHA SMITH - $124,419 BRANDT FARIAS - $61,243 RETENTION INCENTIVE PLAN THE RETENTION INCENTIVE PLAN WAS DESIGNED TO ENCOURAGE CONTINUED INTEREST IN THE SUCCESS OF THE ORGANIZATION AND PROVIDE COMPETITIVE RETIREMENT BENEFITS. THE SOLE PLAN PARTICIPANT IS HAWAI'I PACIFIC HEALTH'S CHIEF EXECUTIVE OFFICER, RAYMOND P. VARA JR. THE PLAN DOES NOT REPLACE THE ANNUAL AND LONG-TERM INCENTIVE PLAN NOR THE SERP RESTORATION PLAN. AMOUNTS PAID OUT DURING THE YEAR BY THE ORGANIZATION: RAYMOND P. VARA JR. - $1,015,000
Schedule J (Form 990) 2021
Additional Data
Software ID:
21014044
Software Version:
2021v4.2