Hawaiian Jewelry

Na Hoku Hawaiian Jewelry Collection - White and Gold As Advertised New From Na Hoku Hawaiian Slippers Na Hoku Solitaires Flowers of Hawaii Island Lifestyle Jewelry Tanzanite Jewelry Palm Tree Collection Sea Life Jewelry Na Keiki Collection Tahitian Pearls Pearl Jewelry Kabana LeVian Collection Steven Douglas Asch/Grossbardt Na Hoku Watches Body Jewelry Bracelets Chains Earrings Necklaces Pendants Rings Watches Anklets Our Policies Contact Customer Service Customer Comments Free Shipping Offer Free Gift Wrapping Shopping Cart 0 Items in Cart Contact Us E-mail : Customer Service Telephone : 1-800-260-3912 ext. 1 Customer Login: Create New Account Forgot password? E-Mail Address: * Password: * | Login | Shop by Collection As Advertised Na Hoku Collections Have you seen our Na Hoku advertisements in newspapers and magazines? Browse through this section to see all of our advertised collections. New Designs From Na Hoku Featuring exciting new additions to the Na Hoku collection of Hawaiian and Island lifestyle jewelry. Hawaiian Slipper Collection The 14K Slipper Pendant is a Na Hoku original. This unique jewelry offering represents the casual island lifestyle and attitude. Made in Hawaii. Na Hoku Diamond Solitaires Na Hoku Diamond Solitaires. Subtle elegance in 18K gold and platinum designs available only from Na Hoku. Each ring showcases our exclusive Na Hoku diamond that is cut for optimal size and brilliance. Flowers of Hawaii Jewelry The Na Hoku Flowers of Hawaii Collection captures the essence of our island flowers in unique and exciting 14K gold jewelry designs. Made in Hawaii. Island Lifestyle Collection The allure and romance of the island lifestyle is discovered in these designs that add the right touch for any occasion. Palm Tree Collection Uniquely Na Hoku; our Palm Tree collection will sway the hearts of all those who wish to enjoy the island lifestyle everyday of the year. Made in Hawaii. Sea Life Jewelry As the World's premier marine life artist, Wyland's Sea Life Jewelry Collection portrays in each 14K gold and sterling silver representation, the beauty and diversity found in nature itself. Made in Hawaii. Na Keiki Collection Na Keiki (the child); a special collection of our popular Na Hoku jewelry designs created for our children; made with Na Hoku style and quality. Made in Hawaii. Tanzanite Jewelry The brilliance of Tanzanite gives radiance and life to our contemporary and traditional 14K gold jewelry designs. Our Tanzanite jewelry will please even the most discriminating wearer. Tahitian Pearl Jewelry Our Tahitian pearl jewelry represents the finest offering from the sea. Na Hoku Tahitian pearls are selected for their superior color and luster that set them apart from all others. Pearl Collection The natural beauty of our pearls and our distinctive 14K gold designs create a sophistication and style that becomes an essential part of the woman who wears it. Kabana Collection Masterful inlay work and the selection of the finest gemstones are essential in creating this remarkable jewelry from the renown Kabana Collection. Le Vian Collection The Le Vian family has been producing jewelry of grandeur for centuries using only the finest precious gemstones in 18kt gold. LeVian® designs are known for their uniqueness and quality as well as their pervasive use of princess cuts and baguettes. Steven Douglas Collection Exclusive designs and timeless styling create jewelry representing love, excitement, and passion. The detail in every Steven Douglas piece transforms 14K gold and precious gemstones into wearable three dimensional art. Asch/Grossbardt Collection The Asch/Grossbardt Company is world renowned as the premier manufacturer of fine inlaid gold jewelry. Body Jewelry Collection Island-casual fashion… Na Hoku body jewelry designs fit your lifestyle like the feeling of sand between your toes and the warmth of the sun and the waves. Made in Hawaii. Na Hoku Watches Time is like a dream...capture the moment with an exclusive Na Hoku timepiece. Quality and precision combined with classic and contemporary designs make the Na Hoku watches timepieces for the island lifestyle. Home | Collections | Jewelry Types | Na Hoku Story | Store Locations | Sitemap --| Resources

Hawaiian Food

Traditional Foods The Settlement of Polynesia Part I The Settlement of Polynesia Part II The Spirit of `Ohana and the Polynesian Voyagers Provisions for Micronesian Voyage Provisions for Polynesian Voyages Traditional Foods and Preparation Plants Introduced to Hawaii Hawaii Proverbs Sin at Awarua Story History & Culture Traditional Foods and Their Preparation by Chad Baybayan The land and sea provided the Hawaiian with everything he needed to sustain himself. His diet helped him maintain a healthy, disease-free body. Today, it is our modern diet that produces many of the problems that ails Hawaiians. A dietary reform back to a traditional diet is the cure to some of the Native Hawaiian's health problems. Preserving food was essential to providing nourishment during a voyage. Drying and fermenting were the two techniques used in food preservation. Fresh foods were eaten at the start of the trip. Fishing along the way also supplemented food the voyagers brought with them. The Polynesians had to be excellent horticulturist also if they expected to survive once they got to land. Plants were transported as slips, cuttings, tubers and seedlings. The traditional diet is everything the doctor ordered for a long trip--compact, light, and nutritious. Here is what they brought: Plant Food--'ulu (breadfruit); niu (coconut, meat and drink); uhi (yam); 'uala (sweet potato); mai'a (banana); kalo (taro); kukui (candlenut); ko (sugar cane); hala (pandanus flour, paste) Animal Food--i'a (fish, dried and fresh); pua'a (pig); moa (chicken); 'ilio (dog) Preparing Foods for Voyaging by Paige Kawelo Barber, Moku Froiseth, and June Gutmanis Pepeie'e 'Ulu (Breadfruit and Coconut Cream)--Use the commercial variety of coconut cream or make your own by grating ripe coconut meat. Cover with warm water, let set, then squeeze through fine sieve. Liquid is coconut cream. Thoroughly mash very ripe 'ulu, mix in a great deal of coconut cream, wrap in ti leaves and cook thoroughly. Set oven at 350 degrees, bake until firm. Cool, slice and dry in sun so that a hard oily film forms on the surface. Kukui (Candlenut)--Remove outer husk and roast in barbecue pit over medium coals or in oven at 350 degrees for about one hour. Crack shell, remove nut, mash, add rock salt. Use as a flavoring in raw fish dishes. Oil of the nut serves as light fuel and body oil to prevent sunburn. Ki or Ti--Cut stalk two to four feet long. About the time the stalk starts to sprout new leaf buds, which will take about three months, cut the top of the stalk off. Wrap in green ti leaves and cook. Use the lowest temperature setting on your oven. Cook 24 hours. Dry. Limu (Seaweed)--Clean and wash well, set out to dry. Takes one to two days for drying. Reconstitute with water when ready to eat. Sea water is acceptable. Mai'a (Banana)--Select firm-ripe mai'a with slight green tinge remaining on skin. Peel and slice lengthwise into three or four strips. Arrange on drying rack; turn once a day. Dries between four and fourteen days depending on area; faster drying occurs in Makaha and slower drying in Manoa. Do not be concerned with the change of color of the mai'a during the process of drying. Mai'a is ready when consistency resembles dried apples. Ko (Sugar Cane)--Select mature cane which has not begun to 'sprout;' cut at base and bottom of leafy top. Wrap exposed ends to prevent cane from drying out. Store in cool, dry place. Cut off bark and cut again in stick-like pieces for eating. Niu (Coconut)--Life expectancy of fresh niu is quite good; the entire nut is useful as food, drink, and fuel. The a a niu (coconut cloth) is not used to wrap things. It substitutes for toilet paper; is not as rough when wet. 'Ulu (Breadfruit)--Select 'ulu which has reached the o o (mature) stage of ripeness, picking those still on the tree. 'ulu has reached the o'o stage when white sap appears on skin of fruit, and 'browning' of the skin can be seen. Bake for one-and-a-half hours, or steam for one hour. Let cool. Remove skin and seeds; mash into pulp. Spread on sheet of wax paper; place similar length of wax paper over 'ulu pulp. Using rolling pin or bottle, spread 'ulu out as you would when preparing dough for pie. Remove top wax paper. Place 'ulu on lower wax paper on drying rack; save the other piece of wax paper for later. When surface of 'ulu dries, turn entire sheet of 'ulu onto the first wax paper. Repeat until drying process is complete, turning once a day. 'Ulu assumes a deep reddish brown color when dried; takes four days in hot area to dry completely. Tuck in one end of dried 'ulu, and roll as you would a jelly roll. Wrap in plastic wrap. Hapu'u or ama'uma'u (Ferns)--Cook the butt ends of the fern stalk. Store when cool. The Hawaiians considered ki and hapu'u to be famine foods. When food was scarce, due to drought, these plants were eaten. I'a (Fish)--Immediately after catching, keep the fish cool and under cover. As soon as possible after catching, cut and salt fish for drying. Cut fish on one side of dorsal line through the head, leaving the belly line intact. If fish are large, cut through bones parallel to spinal column, and cut flesh to allow salt to penetrate. Spread open the cut fish, remove gills, viscera, and the coagulated blood along the spinal column and wash the cavity clean. Hawaiians in the past rubbed the exposed flesh on both cut sections with the blood. Slap the cut portion onto the salt which should be evenly distributed over the exposed flesh. The skin section need not be treated in this manner, as it will receive an adequate amount of salt when the fish is stacked in the container. Place the fish in a wide container with the salted portion down and stack in layers as evenly as possible. The fish in each layer should be laid vertically to those on the bottom layer. After all the fish have been salted, place container under cover and allow to stand overnight. The next morning wash salted fish thoroughly and soak in water for one or two hours. During this period the water should be changed two or three times. When salt can barely be tasted, fish is ready for drying. 'Uala (Sweet Potato) and Uhi (Yam)--Rinse and cook, preferably by steaming. Test for readiness by piercing with fork; do not overcook. Let stand to cool, then slice into l / 2 inch pieces; arrange on drying rack, turning once a day. Dries within three to four days. He'e (Octopus)--Keep freshly caught he'e cool and damp. Before drying, remove the ala ala (ink bags) and salt them for drying (usually to be used for other purposes although it is used as a flavoring ingredient when prepared for raw consumption). Pound the he'e thoroughly with approximately two handfuls of salt. Add more salt as it dissolves. Pound in an up-and-down motion, grasping the central or head portion and pounding it on the rest of the body and tentacles. After as much as seven hundred strokes and intermittent washing, the whole he'e becomes tender enough so that the flesh tears easily with a minimum of effort. The process of pounding in salt serves two purposes: (1) removing mucus and (2) tenderizing. After pounding and rinsing off the extraneous matter, hang up the he'e to dry for three or more days. Kalo (Taro)--Wash and cook thoroughly, preferably by boiling. Best to leave skin on while cooking, removing skin as soon as kalo is cooked and cool enough to handle. When dried after pounding, kalo is similar to hard-tack, especially if rolled out into thin layers or sliced. To prepare pa'i'ai, follow the above cooking instructions, wet board and pounder lightly with water. With even strokes, begin mashing kalo while still warm from cooking, producing a doughy mass. Lightly wet board and pounder to prevent sticking. Be careful not to use too much water; the less water the better. Be sure to mash thoroughly so you have a smooth, heavy poi. Fermentation of pa'i'ai acts as a preservative, as it does in regular poi. The process of fermentation is much slower in pa'i'ai.

Hawaii Rental

Lihue, Hawaii Rental Cars, Auto/Car Rentals BreezeNet.com Guide to Great Rental Car Deals RentalCarGuide.com Bnm.com Home Compare Guide Airports Intl Airports NonAirport/Local Rental Car Deals SUV/Vans Luxury Lihue Rental Cars & Auto Rentals Online Reservation Center to Car Rental Agencies Serving the Lihue Airport Car Rentals Serving Lihue Airport (LIH) (Lihue, HI) Search Great Rates with Our Compare Guide Alamo, Avis, Budget, Dollar, Enterprise, Fox, Hertz, National, Thrifty, and more Search for Cars At an airport In or near a city Pick-up City/Airport My pick-up and drop-off locations are different. Drop-off City/Airport Pick-up Date/Time Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2006 2007 - Time - 12:05 AM 12:30 AM 1:00 AM 1:30 AM 2:00 AM 2:30 AM 3:00 AM 3:30 AM 4:00 AM 4:30 AM 5:00 AM 5:30 AM 6:00 AM 6:30 AM 7:00 AM 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM 5:30 PM 6:00 PM 6:30 PM 7:00 PM 7:30 PM 8:00 PM 8:30 PM 9:00 PM 9:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM Drop-off Date/Time Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2006 2007 - Time - 12:05 AM 12:30 AM 1:00 AM 1:30 AM 2:00 AM 2:30 AM 3:00 AM 3:30 AM 4:00 AM 4:30 AM 5:00 AM 5:30 AM 6:00 AM 6:30 AM 7:00 AM 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM 5:30 PM 6:00 PM 6:30 PM 7:00 PM 7:30 PM 8:00 PM 8:30 PM 9:00 PM 9:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM Car Type ( Details ) No Preference Economy Compact Mid-Size Standard Full-Size Premium Luxury Convertible MiniVan SUV Compact Pickup View existing itinerary » Sample Car Rental Reservation Ratesfor Lihue Airport (LIH) These deals are SAMPLES ONLY for the period 1/16-1/23. For specific real timeprices for Lihue Airport check our Compare Guide above. COMPANIES ECONOMY MIDSIZE FULLSIZE MINIVAN SUV Priceline.com Guaranteed Best Rental Car Rates Alamo $129+-/wk $146+-/wk $186+-/wk $276+-/wk $255+-/wk Budget $129+-/wk $146+-/wk $160+-/wk $299+-/wk $255+-/wk Dollar $116+-/wk $131+-/wk $252+-/wk $248+-/wk $229+-/wk Hertz $158+-/wk $173+-/wk $204+-/wk $380+-/wk $340+-/wk National $152+-/wk $165+-/wk $210+-/wk $348+-/wk $323+-/wk Thrifty $116+-/wk $131+-/wk $252+-/wk $248+-/wk $229+-/wk Snapshots clarified. Rates are in US Dollars and do not include taxes, fees,coverages or car options. See why rates change. Suppliers are not responsible for inaccuracies on the rates listed ifrates are out of date or were incorrectly posted. Rates are based on UScountry of residence and may not be available at time of booking. Check with rentalcar agency. Rates do not include taxes, airport fees or other surcharges. Generally has long/late hours, frequentairport shuttle, unlimited mileage, counter and/or cars usually inairport terminal, emergency roadside service. » Honolule Intl Airport » Maui Intl Airport » Kona Intl Airport Alamo | Avis | Budget | Hertz | National | Dollar | Thrifty More Great Rental Car Savings · Lowestfare.com | Priceline.com | RentalCars.com Helpful Reviews and Research on All Things Travel · LihueHotels Top || Car Rental FAQs & Tips || More Cities Brought to you by BreezeNet All material herein © 1998-2005 Lowestfare.com Incorporated, all rights reserved.

Lahaina • Hawaiian Monarch

Aston Mahana Lahaina - Maui, HI Lahaina Hotels, HI Cheap Hotel Reservations In Lahaina Hotels, HI Cheap Hotel Rooms : Cheapest Hotels Reservations Online at Cheapesthotels.com Home Cheap Hotels US Destinations International Destinations Cheapest Hotels in Hawaii • Aston Coconut Plaza • Aqua Marina • Maui Seaside • Aston Mahana Lahaina • Hawaiian Monarch Hotel Oahu • The New Otani Kaimana Beach • The Imperial Hawaii Resort Cheap Hotels in . . . • New York • Anaheim • Las Vegas • San Diego • Chicago • Boston • Orlando • Kissimmee • Cancun • Philadelphia • Denver • New Orleans Travel Tips Hotel Tips Hotel Rooms • Picking the right room is important for that perfect vacation. Although an exterior room might offer a great view, it might prove noisy if it overlooks a highway. • Rooms next to the restaurants, elevators or lobby might be convenient, but the constant activity might make this a noisy proposition. • For those of you on business travel, ensure the room has a writing desk and data ports for an internet connection. • Check for safety measures when booking your hotel room. Fire extinguishers and alarms, safes and safety measures for the heating and ventilation devices are some of the measures you should ensure before booking your hotel room. • Enquire about the amenities offered by the hotel rooms. Apart from bed sizes and other such arrangements, check for features such as kitchenettes and whirlpool baths. You will end up paying extra for these features but it'll make your stay worthwhile. cheapest hotels .com Wed,January 25, 2006 Home : USA : Hawaii : Lahaina : Aston Mahana Lahaina - Maui, HI Aston Mahana Lahaina - Maui, HI - Maui-Lahaina Cheap Hotels Address: 110 KAANAPALI SHORES PL Maui-Lahaina, HI, 96761 USA -- :: Choose Preferences: Nights Rooms Arrival month Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 3 4 2006-January 2006-February 2006-March 2006-April 2006-May 2006-June 2006-July 2006-August 2006-September 2006-October 2006-November 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st --------------------------------------------------------------------------------------------------------------- Adults: ( 18+) Children: (0-18) Smoking or Non-Smoking: 1 2 0 1 No Preference Non-Smoking Smoking Aston Mahana Lahaina - Maui, HI : Description : Aston Mahana 110 Kaanapali Shores Place Lahaina / Maui, HI 96761 This secluded oceanfront resort on Kaanapali Beach offers panoramic views of the beautiful Pacific from every suite. Just 2 miles from Kapalua Airport, 23 miles from Kahului Airport. ROOMS Refrigerators Air Conditioning Telephone Microwave Balcony Bathtub Cable TV Clock Radio Coffee maker Data Port Daily Maid Service Kitchens and private lanais Hairdryer Iron Ironing Board General Amenities Activity Desk Security Garage/ Parking Sauna Laundry Facilities Pool (Heated) Dry Cleaning Bar General Information Check-in Time: 3:00 P.M. Check-out Time: 12:00 P.M. Dining Canton Chef Hard Rock Cafe The Big Island Steak House Da Kitchen Seawatch Tropica Fire and Ice Attractions Iao Valley Whalers Village Museum Haleakala National Park Hana & Hana Cultural Center Maui Tropical Plantation Transportation Kapalua Airport City Cab Shopping Ka`Ahumanu Center Azeka Place Sale Confirmation Instructions Buyer will receive an email confirmation from us, Inc following approval of the credit card payment by the bank. Hotel will reconfirm this reservation within hours of its being made. Terms and Conditions Aston Mahana Lahaina / Maui, HI - Ocean Front Studio for up to 2 Guests. 3-Night Minimum Stay Required. "ASTONishing Kids - Stay, Play & Eat FREE!" Children staying with any ASTON property will receive FREE activities, FREE meals and FREE merchandise (when accompanied by a paying adult): KIDS STAY FREE: Children 17 years and younger stay FREE at any Aston Hawaii property with parents while utilizing existing bedding. KIDS PLAY FREE: Kids 12 & younger receive FREE ADMISSIONS at top attractions like Hawaiian Adventure Park, Atlantis Submarines, Sea Life Park, Honolulu Zoo, Waikiki Aquarium, Waikiki Trolley, Creations Luau, Magic of Polynesia Show, Smiths Boat Ride/Fern Grotto, Parker Ranch Museum, Dave & Busters, Hilo Hatties, Maui Ocean Center, Maui Tropical Plantation, Sugar Cane Train, and more! 7 KIDS EAT FREE: Kids 12 and younger receive FREE MEALS at popular family friendly restaurants like Sizzlers Restaurants, KFC Hawaii, Dennys ( Oahu ), Pizza Hut Hawaii , Hard Rock Cafi, Dixie Grill, Tony Romas, and more! Children up to 12 years of age, sharing room with parents in existing bedding, are free. General Restrictions We provide a 100% refund of your stay if canceled within the no penaltyperiod, which is generally until 72 hours prior to the hotel arrival time.Our refund is provided in the form of a voucher that you may use to pay forfuture stays. Within the penalty period the cancellation or change penalty is equal tothe full first night's charge. For a no show without a cancellation numberthe penalty is the entire amount of the booking. Some hotels in resort areas have more strict cancellation policies as notedin the hotel restrictions. For example: the penalty period for bookings atMexican resorts is generally 9 days prior to arrival. Please note any additional restrictions as provided by the hotel on thispage. All transactions are conducted in United States currency. Credit card is charged in full at the time of booking. No prices are guaranteed until full payment is received. Changes and cancellations, must be requested directly from cheapesthotels.com and not from the hotels. Reservations ordered less than 48 hours before check-in are subject to reconfirmation by the hotels. To avoid fraudulent use of the network, the hotel will confirm the identity of the guest at time of check-in through pictureID and take an imprint of the guest's credit card. cheapesthotels.com Disclaimers: cheapesthotels.com shall not be liable for personal injury or property loss or damage resulting from the acts, omissions, or negligence of any person providing accommodations, transportation, or any other service or product on this site. cheapesthotels.com shall not be liable for cancellation or overbooking of reservations beyond it's control and without notice. TOP Feedback | About us | Contact us | Privacy Policy | Travelinfo | Restrictions | Site Map | Blogs cheapesthotels.com, Inc. © 2004-2005 All rights reserved.

Hawaiian City Garden

StopMoskowitz :: The Coalition for Justice in Hawaiian Gardens and Jerusalem Support the Coalition with your Donation Donation Amount $25.00 $50.00 $100.00 $250.00 $500.00 $1000.00 thank you The Coalition for Justice in Hawaiian Gardens and Jerusalem P.O. 67903, Los Angeles CA 90067 310 553-1146 email -- Tri-City Hospital's Tax-Exempt Status - An Abuse of Public Trust? An organization is not a non-profit simply because it says so. There are state and federal standards that non-profit entities must meet in order to maintain their legal status -- and to qualify for tax-exemption. A review of California state health care data, Internal Revenue Service non-profit guidelines as well as Tri-City Regional Medical Center's lease with owner Irving Moskowitz all strongly suggest that rather than serving the health needs of Hawaiian Gardens and the surrounding community, the hospital is mainly operating as a private surgical facility for a wealthy physician's stomach stapling practice. Meeting the Community Benefit Standard Providing health care is not enough to qualify as a non-profit. According to IRS guidelines, a hospital may qualify for tax-exemption only if it is organized and operated exclusively for charitable purposes and if it meets the community benefit standards. 1 Tri-City fails on both scores. The IRS defines community benefit as the operation of a hospital in a way that helps the community as a whole. For the IRS, Tri-City's failure to provide charity care to poor patients should be a red flag. The IRS gives points to organizations that have a formal policy to provide free care to patients who are too poor to pay. 2 Tri-City has such a policy - it just doesn't follow it. When it applied for 501c(3) status, the hospital's application declared, "With regard to charity cases, the Hospital's policy is simple. The Hospital will not turn away any patient for financial reasons. When a charity patient is admitted, the case is handled individually on a case by case basis. In some cases, the Hospital absorbs costs associated with providing services to charity patients." 3 But in 2000 and 2001 the hospital provided zero charity care, despite net income of over $2 million in 2001 alone. Tri-City also reneged on another policy it presented to the IRS when it filed for tax-exempt status - its commitment to pre-natal care. The hospital's administration promised that, "Prenatal Services will provide care for the female patient during pregnancy, labor, delivery and the post-partum period." 4 There were no babies delivered in Hawaiian Gardens in 2000 and 2001. 5 Tri-City's administration might argue that its failure to provide obstetric services is the result of a lack of demand from the community. But by the IRS' lights, it would be hard for the hospital to know what the health care needs of the surrounding area are unless it consults with the community. As part of its review, the IRS looks for a governing or community board composed of civic leaders rather than ones dominated by hospital administrators, physicians and other professionals connected to the hospital. 6 Again, Tri-City looks good on paper but failed to live up to its promises. In its application for 501c(3) status, the hospital touted its 25 member community advisory board which consisted of "school officials, clergymen, business owners, city government and community organizations. The board assesses and determines the prevalent health care problems in the community." 7 According to one former city official who sat on the hospital's community board, the advisory board ceased meeting soon after it was formed. Citing the high cost of treatment at Tri-City and the lack of charity care, he said few residents of Hawaiian Gardens use the hospital now. State health care data backs that assertion up - despite its proximity only 13.7% of all Hawaiian Gardens residents who were hospitalized in Los Angeles County last year were admitted to Tri-City Regional Medical Center. Hawaiian Garden residents admitted to the hospital represented an even smaller percentage of Tri-City's total patient census - just 5.4% (Less than a fifth of the patients treated by Tri-City lived within a five-mile radius of the hospital). 8 Hospital charges were also higher than the norm - no one from Hawaiian Gardens was discharged with less than $2,900 in charges, less than one in ten left with charges under $5,000. 9 This includes patients who used the emergency room for relatively simple complaints such as a cut, chest pains or a child's broken bone. On average - Tri-City patients from Hawaiian Gardens were charged well over $10,000. 10 Many of the residents of Hawaiian Gardens are immigrants without insurance to cover their health care costs, so for them, Tri-City's high charges are all but unaffordable. Beyond the degree to which a hospital serves the community, the IRS also considers whether or not the majority of its activities promotes a tax-exempt purpose. 11 Arguably, Tri-City is doing more to advance the business of Dr. Mathias Fobi than it is to promote the health of the surrounding community. The for-profit Center for the Surgical Treatment of Obesity is located within the Tri-City Hospital campus. The center, which provides surgical stomach shrinking services to the morbidly obese, generates at least one quarter of the hospital's surgical cases and probably a good deal more. Last year, 439 of Tri-City's patients underwent the stomach stapling procedure and on average, they racked up $50,000 in hospital charges each. Total charges for those patients totaled $21,936,400 - representing close to a third of the hospital's gross charges for the year. 12 Another 15 patients received "tummy tucks," their total charges ranged $24,000 to $100,344. 13 And more than 200 of the hospital's other patient discharges involved some sort of abdominal procedure such as an abdominal CAT-Scan, a procedure which is often associated with stomach stapling. 14 The hospital discharge data strongly suggests that perhaps as much as half of Tri-City's surgical practice is tied to the Obesity Center. Insiders, Disqualified Persons and Private Benefit While Fobi charges for the surgeries he performs, the hospital also would typically bill patients for the use of its operating and recovery rooms and other medical services it provides. Tri-City's IRS form 990 from 2001 (the most recent one that is publicly available) indicates that year it paid Fobi's private firm, FOCA Management Company, $2,293,044 -- more than its next four highest paid contractors combined. 15 Stomach stapling accounts for a large part of Tri-City Hospital's tiny patient census. Whether the firm is managing all or just part of the hospital's patient care - $2.3 million is an extraordinarily large amount for a non-profit of Tri-City's size (the hospital has less than 130 licensed beds) to pay for an administrative service. At minimum, it suggests the potential for a conflict of interest on Fobi's part, particularly if the firm's fees are based on revenues. 16 At worst, it could represent a violation of federal anti-kickback laws governing doctor-hospital relationships. The payment to the management firm also has the potential to put Tri-City's tax-exempt status in jeopardy. IRS guidelines expressly forbid those having an interest in the hospital from benefiting from its net earnings. 17 A public trust? The same rule that draws into question the large payment Fobi received also applies to the hospital's former for-profit owner, Irving Moskowitz. Moskowitz is neither a board member nor a Tri-City executive and, at least technically, he does not maintain ownership of the hospital. But Cerritos Gardens General Hospital Company, a private firm run by Moskowitz, has received more than a million dollars in annual rent from Tri-City since it spun off the hospital as a non-profit in late 1996. 18 The rental agreement alone does not necessarily jeopardize the hospital's tax-exempt status. However, both members of Tri-City's two-person governing board and the hospital's president (who is also one of the two board members) are long-time Moskowitz associates. And, a review of Tri-City's financial circumstances indicates that Moskowitz retains a level of de facto control over Tri-City. Immediately after Tri-City Regional Medical Center was converted into a non-profit, the Irving I. Moskowitz Foundation 19 donated $4.9 million in tax-free proceeds from its Hawaiian Gardens bingo to the hospital. 20 California state financing records show that in 2000 the foundation made an additional transfer of funds to Tri-City. The state financing statement does not record the amount of the loan but it does indicate that the hospital pledged its accounts receivable as collateral. 21 Two additional state financing records, dated February 2, 1999 and January 25, 2001, show the hospital also is indebted to its landlord - Cerritos Gardens General Hospital Company. What's more, a clause in the lease signed between Tri-City and Cerritos Gardens grants Moskowitz's private firm the right to resume control of the property at any time, regardless of whether the lease remains in effect or not. It states that the "Lessor may re-enter or resume possession of the Hospital, and remove Lessee and Lessee's property there from, and at its option either terminate this lease, or without terminating it, lease the Hospital for the account of the Lessee for the remainder of the term or terms as Lessor shall see fit." 22 The social contract of tax exemption for charitable organizations is based on the assets of those organizations being held in trust for the public - not for the benefit of an individual or a group that controls a charity. A case could be made for Moskowitz and his firm making a calculated decision to rid themselves of the inconvenience of paying state and federal tax on the facility while continuing to reap a profit through sizable rent payments (subsidized first by a grant from his own foundation and later, from the net earnings derived from business generated by the for-profit obesity center). All the while he and his firm would be able to maintain control through the hospital's financial obligations to the company and his foundation. And, if that did not work or was no longer the optimal business model, the for-profit firm could resume possession of the land and the building at any time. It is a classic case of having one's cake and eating it too. It is also an affront to the basic tenets of public trust and hardly what the federal government had in mind when it established tax-exempt status for non-profits. 1 J.E. Gitterman and M. Friedlander, "Health Care Provider Reference Guide," Internal Revenue Service, 2003, p. 2, "The promotion of health for the benefit of the community is a charitable purpose. Engaging in health care activities alone does not necessarily further charitable purposes." and p. 9 "The test used fro determining if a health care provider satisfies the IRC 501c(3) operational test is the "community benefit standard" enunciated in Revenue Ruling 68-545, 1969-2 C.B. 117, and court cases that apply Rev. Rul. 69-545. The community benefit standard is the test used to determine whether a hospital, clinic or other health care provider is operated to promote health in a way that accomplishes a charitable purpose." 2 J.E. Gitterman and M. Friedlander, "Health Care Provider Reference Guide," Internal Revenue Service, 2003. p. 9, "Prior to Rev. Rule 69-545, tax-exempt hospitals were required by rev. Rul 56-185, 1956-1 C.B. 202 to admit and treat patients who were unable to payAlthough a formal policy to provide charity care is still relevant, the new standard also takes into account a number of additional factors indicating that the operation of the hospital benefits the community as a whole." 3 Gardens Regional Hospital and Medical Center, Inc. 1023 IRS application for Recognition of Exemption Under Section 501c3 of the Internal Revenue Code Addendum to Schedule C - Hospital and Medical Research Organizations, November 25, 1997. 4 Gardens Regional Hospital and Medical Center, Inc. 1023 IRS application for Recognition of Exemption Under Section 501c(3) of the Internal Revenue Code -Exhibit B "Statement of Activities," November 25, 1997. 5 California Office of Statewide Health Planning and Development (OSHPD), Patient Discharge Database, 2000 and OSHPD Annual Utilization Report of Hospitals, 2001. 6 J.E. Gitterman and M. Friedlander, "Health Care Provider Reference Guide," Internal Revenue Service, 2003, p. 10, "As used with regard to a hospital, the "Community benefit standard" in Rev. Rul. 69-545 includes the following factors: Does the hospital have a governing board, community board, board of trustees, or board of directors composed of prominent civic leaders rather than exclusively members who are hospital administrators, physicians or other professionally connected to the hospital?" 7 Gardens Regional Hospital and Medical Center, Inc. 1023 IRS application for Recognition of Exemption, Exhibit B, November 25, 1997. 8 According to the 2002 OSHPD Public Patient Discharge Data, 136 Tri-City discharges came from the Hawaiian Gardens zip code (90716) and Tri-City Regional Medical Center discharged a total of 2519 patients that year. Less than 500 patients discharged from Tri-City lived in zip codes that were within a five-mile radius of the hospital. 9 2002 OSHPD Public Patient Discharge Data 10 Ibid. 11 J.E. Gitterman and M. Friedlander, "Health Care Provider Reference Guide," Internal Revenue Service, 2003, p. 33, "Each director, principal officer and member of a committee with board delegated powers shall annually sign a statement which affirms that such person understands that the Corporation is a charitable organization and that in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes." 12 2002 OSHPD Public Patient Discharge Data and OSHPD Annual Utilization Report of Hospitals and 2001 OSHPD financial data. and The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), National Center for Health Statistics, 2002. 13 2002 OSHPD Patient Discharge Data and The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), National Center for Health Statistics, 2002. 14 Ibid. 15 Gardens Regional Hospital - DBA Tri-City Regional Medical - 2001 federal tax return. 16 J.E. Gitterman and M. Friedlander, "Health Care Provider Reference Guide," Internal Revenue Service, 2003, p. 18, "If compensation is based on revenues, the potential for unreasonable compensation warrants a close review." 17 J.E. Gitterman and M. Friedlander, "Health Care Provider Reference Guide," Internal Revenue Service, 2003, p. 4, "IRC 501 c(3) expressly provides that to qualify for exemption, no part of an organization's net earnings shall to the benefit of private shareholders or individualsin practice the inurement prohibition applies to insidersIn the health care setting physicians may be insiders depending upon whether they exercise control." p. 8 also notes that insider status is not necessarily a pre-requisite for a violation of the inurement prohibition, "if the charity confers a private benefit on non-insiders, the charity is nor operating exclusively in the public interest and its exemption may be jeopardized if the private benefit is substantial." 18 According to Los Angeles County property records Cerritos Gardens Hospital Company currently owns the property at the hospital's address. Irving Moskowitz is identified as the company's managing general partner in his casino application submitted to the city of Hawaiian Gardens. Hawaiian Gardens Card Club, Inc., Information in Support of Application for Card Club License, January 25, 1995. 19 Moskowitz and his wife Cherna have presided over the Foundation as President and Secretary Treasurer since at least as far back as 1988. Irving I. Moskowitz Foundation 990s, 1987-2001. 20 The Irving I. Moskowitz Foundation 1997 990, Statement 7, p. 28 (On p. 23 the Foundation notes that, "Concerning grants and allocations to Gardens Regional Hospital and American Friends of Mercaz Harav which are listed on statement 7: the donees have agreed under specified circumstances to return a portion of the grant to the Irving Moskowitz Foundation."). 21 UCC Record, California Secretary of State, May 15, 2000, debtors: Gardens Regional Hospital and Medical Center, Inc. and Tri-City Regional Medical Center, Secured Parties: Irving I. Moskowitz Foundation. 22 Gardens Regional Hospital and Medical Center, Inc. 1997 1023 IRS application for Recognition of Exemption Under Section 501c3 of the Internal Revenue Code - Exhibit E, "Lease by and Between Cerritos Gardens General Hospital Company, a CA limited partnership and Gardens Regional Hospital and Medical Center," November 25, 1997. The lease agreement notes that the hospital's dba (doing business as) name is Tri-City Regional Medical Center. p. 36, Para 25.1. J.E. Gitterman and M. Friedlander, "Health Care Provider Reference Guide," Internal Revenue Service, 2003, p.17 - Retained Rights - A review of the underlying docs is necessary to determine if there is retained authority by the seller and on p. 11 it states, "Financial control may include the right to approve annual operating and capital budgets, strategic planning initiatives, and significant sales, leases, mortgages, or other transfers of encumbrances of real estate or personal property." It is worth noting that the lease between and Between Cerritos Gardens General Hospital Company and Tri-City includes a demand for an annual review of the non-profits financial statements. View all news reports 2003 the Coalition for Justice in Hawaiian Gardens and Jerusalem