{ "schemaVersion": 1, "generatedAt": "2026-07-02T17:31:14.077Z", "state": "HI", "stateName": "Hawaii", "slug": "hawaii", "files": { "json": "/data/states/hawaii-impact-summary.json", "csv": "/data/states/hawaii-hospital-impact-2026-07-02.csv", "workbook": "/data/states/hawaii-state-impact-2026-07-02.xlsx" }, "methodology": { "baseline": "Acquisition-anchored before/after where a documented acquisition date and compatible pre/post HCRIS periods exist; otherwise earliest-to-latest context is labeled as non-causal.", "quality": "Quality trend fields are reserved for CMS HAI, mortality, readmission, and related measure series. Missing fields are shown as not_available rather than inferred.", "debt": "Documented debt events are separated from HCRIS financial-stress signals. Financial stress is not labeled asset stripping unless filings document a debt, dividend, leaseback, asset-sale, bankruptcy, or bond event.", "causation": "These are descriptive before/after signals, not proof that ownership caused the change." }, "counts": { "hospitals": 33, "currentPeCount": 0, "formerPeCount": 0, "peBefore2010Count": 0, "closuresAfterPeCount": 0, "worseningQualityCount": 0, "worseningFinancialCount": 23, "unresolvedCount": 6, "documentedDebtEventCount": 0, "ceoCompensationStructuredCount": 0 }, "statusCounts": { "verified_independent": 18, "signal": 6, "corporate_chain": 9 }, "tierDefinitions": [ { "tier": "Tier 1", "definition": "Confirmed PE ownership/control or closed after documented PE acquisition." }, { "tier": "Tier 2", "definition": "PE-backed contract, former PE ownership, documented debt/bankruptcy/asset-sale concern, or transaction warning." }, { "tier": "Tier 3", "definition": "Corporate-chain or major-system exposure without PE proof." }, { "tier": "Independent/Unresolved", "definition": "No documented PE exposure, verified independent, unknown, or evidence incomplete." } ], "topFinancialDeclines": [ { "hospitalId": "120014", "hospital": "WILCOX MEMORIAL HOSPITAL", "city": "LIHUE", "status": "Declining", "leadMetric": "Direct-care contract labor", "percentChange": 162859.24528301886, "display": "Direct-care contract labor +162859.2%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "120006", "hospital": "ADVENTIST HEALTH CASTLE", "city": "KAILUA", "status": "Critical", "leadMetric": "Direct-care contract labor", "percentChange": 2773.5288988105617, "display": "Direct-care contract labor +2773.5%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "120022", "hospital": "STRAUB CLINIC AND HOSPITAL", "city": "HONOLULU", "status": "Critical", "leadMetric": "Direct-care contract labor", "percentChange": 1027.5949751299286, "display": "Direct-care contract labor +1027.6%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "121305", "hospital": "LANAI COMMUNITY HOSPITAL", "city": "LANAI CITY", "status": "Critical", "leadMetric": "Net income", "percentChange": -880.9677069535783, "display": "Net income -881.0%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "120026", "hospital": "PALI MOMI MEDICAL CENTER", "city": "AIEA", "status": "Critical", "leadMetric": "Direct-care contract labor", "percentChange": 404.4161948595707, "display": "Direct-care contract labor +404.4%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "121308", "hospital": "KULA HOSPITAL", "city": "KULA", "status": "Critical", "leadMetric": "Net income", "percentChange": -324.4850728997917, "display": "Net income -324.5%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "120007", "hospital": "KUAKINI MEDICAL CENTER", "city": "HONOLULU", "status": "Declining", "leadMetric": "Direct-care contract labor", "percentChange": 230.74870603863204, "display": "Direct-care contract labor +230.7%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "0000696720", "hospital": "HILO MEDICAL CENTER", "city": "HILO", "status": "Critical", "leadMetric": "Direct-care contract labor", "percentChange": 144.2021681665365, "display": "Direct-care contract labor +144.2%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. 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shown as earliest-to-latest context only." }, { "hospitalId": "120028", "hospital": "NORTH HAWAII COMMUNITY HOSPITAL", "city": "KAMUELA", "metric": "total_assets", "label": "Total assets", "baselineType": "earliest_latest_no_acquisition_date", "beforePeriod": "06/30/2021", "afterPeriod": "06/30/2024", "beforeValue": 240269004, "afterValue": 211541500, "percentChange": -11.956392011347415, "direction": "down", "sourceIds": [ "source-cms-hcris" ], "note": "No documented acquisition date is present in this public dossier; shown as earliest-to-latest context only." } ], "documentedDebtEvents": [], "financialStressSignals": [ { "hospitalId": "120014", "hospital": "WILCOX MEMORIAL HOSPITAL", "city": "LIHUE", "status": "Declining", "leadMetric": "Direct-care contract labor", "percentChange": 162859.24528301886, "display": "Direct-care contract labor +162859.2%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "120006", "hospital": "ADVENTIST HEALTH CASTLE", "city": "KAILUA", "status": "Critical", "leadMetric": "Direct-care contract labor", "percentChange": 2773.5288988105617, "display": "Direct-care contract labor +2773.5%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "120022", "hospital": "STRAUB CLINIC AND HOSPITAL", "city": "HONOLULU", "status": "Critical", "leadMetric": "Direct-care contract labor", "percentChange": 1027.5949751299286, "display": "Direct-care contract labor +1027.6%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. 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This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "120001", "hospital": "THE QUEEN'S MEDICAL CENTER", "city": "HONOLULU", "status": "Declining", "leadMetric": "Total liabilities", "percentChange": 32.49431640924883, "display": "Total liabilities +32.5%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "120001", "hospital": "THE QUEEN'S MEDICAL CENTER - HALE PULAMA MAU", "city": "HONOLULU", "status": "Declining", "leadMetric": "Total liabilities", "percentChange": 32.49431640924883, "display": "Total liabilities +32.5%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "120028", "hospital": "NORTH HAWAII COMMUNITY HOSPITAL", "city": "KAMUELA", "status": "Declining", "leadMetric": "Total liabilities", "percentChange": 20.30256102884035, "display": "Total liabilities +20.3%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "0002496817", "hospital": "REHABILITATION HOSPITAL OF THE PACIFIC", "city": "HONOLULU", "status": "Declining", "leadMetric": "Payroll employees", "percentChange": -18.61111111111111, "display": "Payroll employees -18.6%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "120002", "hospital": "MAUI MEMORIAL MEDICAL CENTER", "city": "WAILUKU", "status": "Declining", "leadMetric": "Net income", "percentChange": -12.881416732554394, "display": "Net income -12.9%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." }, { "hospitalId": "121300", "hospital": "KAUAI VETERANS MEMORIAL HOSPITAL", "city": "WAIMEA", "status": "Declining", "leadMetric": "Net income", "percentChange": -11.397114215229298, "display": "Net income -11.4%", "baselineType": "earliest_latest_no_acquisition_date", "sourceIds": [ "source-cms-hcris" ], "note": "Financial stress signal from HCRIS trend fields. This is not a documented debt-extraction claim and is not causal evidence." } ], "compensationRows": [ { "hospitalId": "0196784423", "hospital": "15TH MEDICAL GROUP", "city": "HICKAM AFB", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "0195696859", "hospital": "TRIPLER ARMY MEDICAL CENTER", "city": "TRIPLER AMC", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "0196784557", "hospital": "WARRIOR OHANA MEDICAL HOME", "city": "KAPOLEI", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "120006", "hospital": "ADVENTIST HEALTH CASTLE", "city": "KAILUA", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "0000296727", "hospital": "HALE HO'OLA HAMAKUA", "city": "HONOKAA", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "0000596744", "hospital": "HAWAII STATE HOSPITAL", "city": "KANEOHE", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "0000696720", "hospital": "HILO MEDICAL CENTER", "city": "HILO", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "124001", "hospital": "KAHI MOHALA", "city": "EWA BEACH", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "121304", "hospital": "KAHUKU MEDICAL CENTER", "city": "KAHUKU", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "120011", "hospital": "KAISER FOUNDATION HOSPITAL", "city": "HONOLULU", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "0001096826", "hospital": "KAPIOLANI MEDICAL CENTER FOR WOMEN AND CHILDREN", "city": "HONOLULU", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "120019", "hospital": "KONA COMMUNITY HOSPITAL", "city": "KEALAKEKUA", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "120007", "hospital": "KUAKINI MEDICAL CENTER", "city": "HONOLULU", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "121308", "hospital": "KULA HOSPITAL", "city": "KULA", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "0001896816", "hospital": "LEAHI HOSPITAL", "city": "HONOLULU", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "120002", "hospital": "MAUI MEMORIAL MEDICAL CENTER", "city": "WAILUKU", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "120026", "hospital": "PALI MOMI MEDICAL CENTER", "city": "AIEA", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "0002496817", "hospital": "REHABILITATION HOSPITAL OF THE PACIFIC", "city": "HONOLULU", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "121306", "hospital": "SAMUEL MAHELONA MEMORIAL HOSPITAL", "city": "KAPAA", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "123301", "hospital": "SHRINERS HOSPITAL FOR CHILDREN", "city": "HONOLULU", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "120022", "hospital": "STRAUB CLINIC AND HOSPITAL", "city": "HONOLULU", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "120001", "hospital": "THE QUEEN'S MEDICAL CENTER", "city": "HONOLULU", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "120001", "hospital": "THE QUEEN'S MEDICAL CENTER - HALE PULAMA MAU", "city": "HONOLULU", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "0000496706", "hospital": "THE QUEEN'S MEDICAL CENTER - WEST OAHU", "city": "EWA BEACH", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "0002896786", "hospital": "WAHIAWA GENERAL HOSPITAL", "city": "WAHIAWA", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "120014", "hospital": "WILCOX MEMORIAL HOSPITAL", "city": "LIHUE", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "121301", "hospital": "KAU HOSPITAL", "city": "PAHALA", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "121300", "hospital": "KAUAI VETERANS MEMORIAL HOSPITAL", "city": "WAIMEA", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "121302", "hospital": "KOHALA HOSPITAL", "city": "KAPAAU", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "121305", "hospital": "LANAI COMMUNITY HOSPITAL", "city": "LANAI CITY", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "121303", "hospital": "MOLOKAI GENERAL HOSPITAL", "city": "KAUNAKAKAI", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "120028", "hospital": "NORTH HAWAII COMMUNITY HOSPITAL", "city": "KAMUELA", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." }, { "hospitalId": "0174496819", "hospital": "SPARK M. MATSUNAGA VA MEDICAL CENTER", "city": "HONOLULU", "leaderName": "unknown_not_public", "title": "unknown_not_public", "compensationLatestYear": "", "compensationLatestAmount": "", "status": "unknown_not_public", "sourceId": "", "sourceUrl": "", "note": "No Form 990, SEC, official, or public-filing compensation amount is structured for this hospital in the current state package." } ], "closureRows": [], "timelineRows": [], "sourceCoverage": { "sourceBackedRows": 33, "notAvailableRows": 0, "totalSourceIds": 15 } }