2024-11-15T11:19:38-06:00 2023-12-31 421539623 KMH LLP 1003 BISHOP STREET SUITE 2400 HONOLULU HI 96813 990 2023-01-01 990073521 PALOLO CHINESE HOME PALO 8087372555 2459 10TH AVENUE HONOLULU HI 96816 DARLENE NAKAYAMA CHIEF EXECUTIVE OFFICER 8087372555 2024-11-15 1 0 DANIELLE A HARANO P01258470 8085262255 2023 2024-10-15 13:58:12Z DARLENE NAKAYAMA 2459 10TH AVENUE HONOLULU HI 96816 21418468 0 X WWW.PALOLOHOME.ORG X 1920 HI TO EDUCATE, SUPPORT AND CARE FOR SENIORS AND THEIR FAMILIES BY PROVIDING A CONTINUUM OF QUALITY CARE. 15 14 217 110 0 0 342562 2890519 17707100 17880324 61406 110895 312 222001 18111380 21103739 0 0 0 0 10915809 10736468 0 0 67302 10269685 9919760 21185494 20656228 -3074114 447511 30648968 31600065 7450419 7656473 23198549 23943592 X TO EDUCATE, SUPPORT, AND CARE FOR SENIORS AND THEIR FAMILIES BY PROVIDING A CONTINUUM OF QUALITY CARE IN A CULTURALLY SENSITIVE FAMILY SETTING. 0 0 15324213 14833369 ICF/SNF - PALOLO CHINESE HOME IS LICENSED AS AN ICF/SNF UNIT AND PROVIDES 113 NURSING HOME BEDS TO ELDERLY RESIDENTS, REGARDLESS OF RACE. 1301519 1252192 ADULT RESIDENTIAL HOME - PALOLO CHINESE HOME IS LICENSED AS AN ADULT RESIDENTIAL CARE HOME TYPE II FACILITY (EARCH II) THAT HOUSES 18 ELDERLY RESIDENTS, REGARDLESS OF RACE. 838005 667334 ADULT DAY CARE - PALOLO CHINESE HOME IS LICENSED AS AN ADULT DAY CARE CENTER FOR 40 ELDERLY PARTICIPANTS, REGARDLESS OF RACE. 1045161 1127429 OTHER PROGRAM SERVICES INCLUDE COMMUNITY OUTREACH PROGRAMS SUCH AS MEALS HOME DELIVERY, HOME CLEANING, COMPANIONSHIP, PERSONAL CARE AND CATERING. 1045161 1127429 18508898 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 39 0 217 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 15 14 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 HI X BRANDON TRAN 8085645228 2459 10TH AVENUE HONOLULU HI 96816 PATRICIA BLANCHETTE MD MPH SECRETARY & MEDICAL DIRECTOR 4.00 X X 36000 0 0 PETER FONG ESQ CHAIR/PRESIDENT 2.00 X X 0 0 0 RENA HWANG 1ST VICE PRESIDENT 2.00 X X 0 0 0 ELVIRA LO VICE PRESIDENT 2.00 X X 0 0 0 ISOO OSHIMACPA TREASURER 2.00 X X 0 0 0 GORDON AU DIRECTOR 2.00 X 0 0 0 PETER BACKUS CPA DIRECTOR 2.00 X 0 0 0 ANDREW FONG MD DIRECTOR 2.00 X 0 0 0 FRANCES GOO DIRECTOR 2.00 X 0 0 0 RUSSELL LAU DIRECTOR 2.00 X 0 0 0 GLADYS LEE DIRECTOR 2.00 X 0 0 0 ROGER LIU CPA DIRECTOR 2.00 X 0 0 0 ANDREW MOATS DIRECTOR 2.00 X 0 0 0 JEFFREY SCHMIDT ESQ DIRECTOR 2.00 X 0 0 0 GARY SIMON DIRECTOR 2.00 X 0 0 0 DOUGLAS SMITH ESQ DIRECTOR 2.00 X 0 0 0 SANDRA SOUZA DIRECTOR 2.00 X 0 0 0 LAWRENCE TSEU DDS DIRECTOR 2.00 X 0 0 0 ERIC WATANABE ASSISTANT TREASURER 2.00 X 0 0 0 STACEY WONG DIRECTOR 2.00 X 0 0 0 BENJAMIN WOO DIRECTOR 2.00 X 0 0 0 REGINALD YEE ESQ DIRECTOR 2.00 X 0 0 0 DARLENE NAKAYAMA CEO 40.00 X 248344 0 17719 AGNES DELOS REYES REGISTERED NURSE 40.00 X 127126 0 12865 JAMIE SUZUKI REGISTERED NURSE 40.00 X 129615 0 10334 JUAN GONZALEZ DIRECTOR OF NURSING 40.00 X 129247 0 13741 RACHAEL YOUNG DIRECTOR OF HR 40.00 X 118432 0 10501 EVA HIDALGO PROGRAM AIDE (COMPANIONSHIP) 100.00 X 108107 0 6360 896871 0 71520 7 0 1 0 KAHU MALAMA NURSES INC 1357 KAPIOLANI BOULEVARD SUITE 915 HONOLULU HI 96814 STAFFING 739783 PROLINK STAFFING 4600 MONTGOMERY ROAD SUITE 300 CINCINNATI OH 45212 STAFFING 525752 PRIME TIME HEALTHCARE LLC 15380 WEIR STREET OMAHA NE 68137 STAFFING 488042 GENESIS ELDERCARE REHABILITATIONLLC PO BOX 821322 PHILADELPHIA PA 191821322 THERAPY 483949 EXPRESS EMPLOYMENT PROFESSIONALS 1130 N NIMITZ HIGHWAY SUITE A135 HONOLULU HI 96817 STAFFING 359547 11 8851 2576144 305524 2890519 ICF/SNF UNIT AND NURSING HOME 623000 14833369 14833369 ADULT RESIDENTIAL CARE HOME 623000 1252192 1252192 OTHER - COMM. OUTREACH, ETC. 624200 1127429 1127429 ADULT DAY CARE CENTER 621400 667334 667334 17880324 114787 114787 89348 35005 54343 54343 54343 246559 250451 -3892 -3892 -3892 111708 29273 82435 82435 MISCELLANEOUS REVENUE 900099 58183 58183 CHANGE IN VALUE OF PERM TRUST 900099 27040 27040 85223 21103739 17880324 0 332896 X 284344 36000 198675 49669 8429090 7757639 671451 215686 187975 27711 1148408 1033440 114968 658940 595429 63511 27923 27923 50092 50092 21539 21539 4127156 3735583 391573 61783 61783 116466 17834 95506 3126 296076 164062 132014 502062 483387 17273 1402 25896 22411 3485 20513 8507 12006 170671 170671 929500 799495 124751 5254 219362 199357 16261 3744 NURSING & DIETARY SUPPL 1838616 1838616 0 0 TAXES & LICENSES 541343 538486 944 1913 BAD DEBT EXPENSE 528879 528879 0 0 REPAIRS & MAINTENANCE 232720 222213 9398 1109 209163 168914 39164 1085 20656228 18508898 2080028 67302 411910 498529 1614119 3305897 14695 14000 3206700 3046387 143619 122455 203022 94836 36816360 14834836 22867105 21981524 1900702 2222301 283096 310136 4000 4000 30648968 31600065 1565673 2206622 64372 0 500 500 5819874 5449351 7450419 7656473 X 22437448 23098012 761101 845580 23198549 23943592 30648968 31600065 447511 285484 12048 0 X 0 1 X 1 0 X 457023 788531 3171734 342562 2890519 7650369 457023 788531 3171734 342562 2890519 7650369 125711 7524658 191920 145480 152173 145890 204135 839598 29654 2791 18674 34816 169973 255908 8745875 87070365 0.86040 0.82890 X SCHEDULE A, PART II, LINE 10, EXPLANATION FOR OTHER INCOME: OTHER INCOME SPECIAL FUNDRAISING EVENT PROCEEDS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 761101 25301 93991 88250 792143 521322 222652 96790 79663 761101 439074 120100 54648 92500 521322 393294 19550 34130 7900 439074 223102 132875 42417 5100 393294 0.00000 1.00000 0.00000 0 0 395050 395050 28926766 10067492 18859274 1911553 1911553 5384276 4767344 616932 198715 198715 21981524 X 20903083 285484 64278 349762 20553321 21539 528879 550418 21103739 20170094 64284 64284 20105810 21539 528879 550418 20656228 PART IV, LINE 2B: THE ORGANIZATION HOLDS SECURITY DEPOSITS FOR TWO COMPANIES LEASING SPACE. THE TENANT'S SECURITY DEPOSIT IS REFUNDED UPON TERMINATION OF THE LEASE, LESS ANY REPAIRS AND MAINTENANCE. PART V, LINE 4: EARNINGS FROM THE ENDOWMENT FUNDS ARE USED TO SUPPLEMENT THE OPERATIONS OF THE HOME'S PROGRAMS IN ACCORDANCE WITH THE HOME'S MISSION STATEMENT. PART X, LINE 2: THE HOME IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND COMPARABLE STATE LAW. ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR FEDERAL INCOME TAX IN THE ACCOMPANYING FINANCIAL STATEMENTS. MANAGEMENT EVALUATED THE HOME'S TAX POSITIONS AND CONCLUDED THAT THE HOME HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. THE HOME'S 2020 THROUGH 2022 FEDERAL TAX RETURNS REMAIN OPEN TO EXAMINATION BY THE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 29,273. RENTAL EXPENSES 35,005. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 528,879. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 29,273. RENTAL EXPENSES 35,005. ROUNDING 6. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 528,879. GOLF TOURNAMENT 111708 111708 9105 9034 9676 1459 111708 111708 9105 9034 9676 1459 29274 82434 X 1 1 X X X X 0 0 0 0 0 0 0 0 0 DARLENE NAKAYAMA CEO 248344 0 0 0 0 0 10023 0 7696 0 266063 0 0 0 PART I, LINE 1B THE ORGANIZATION PROVIDES GROSS-UP PAYMENTS FOR THE ANNIVERSARY AWARDS AND EMPLOYEE OF THE YEAR AWARDS GIVEN TO EMPLOYEES, WHICH MAY INCLUDE EMPLOYEES LISTED IN FORM 990, PART VII, SECTION A. THESE GROSS-UP PAYMENTS ARE INCLUDED IN TAXABLE COMPENSATION. FORM 990, PART VI, SECTION A, LINE 1A PATRICIA BLANCHETTE, MD IS A DIRECTOR AND IS ALSO THE MEDICAL DIRECTOR FOR PALOLO CHINESE HOME. SHE IS COMPENSATED FOR HER WORK AS MEDICAL DIRECTOR BUT HER POSITION ON THE BOARD IS VOLUNTARY. SHE RECUSES HERSELF DURING BOARD MEETINGS ON ISSUES THAT MAY CAUSE A POTENTIAL CONFLICT OF INTEREST (ONLY WHEN IT RELATES TO HER DUTIES AS MEDICAL DIRECTOR). FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPRISED OF THE CHIEF EXECUTIVE OFFICER, THE OFFICERS OF THE BOARD, THE IMMEDIATE PAST PRESIDENT, AND ONE OTHER DIRECTOR ELECTED BY THE BOARD OF DIRECTORS. ALL ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE ARE SUBJECT TO RATIFICATION BY THE BOARD OF DIRECTORS. A MAJORITY OF THE MEMBERS OF THE EXECUTIVE COMMITTEE CONSTITUES A QUORUM TO TRANSACT BUSINESS, AND THE MAJORITY APPROVAL OF SUCH QUORUM ON ANY MATTER IS DEEMED VALID AND BINDING. FORM 990, PART VI, SECTION A, LINE 2 PETER FONG, ESQ., AND ANDREW FONG, MD, BOARD MEMBERS, HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE BUSINESS OFFICE MANAGER REVIEWED THE FORM 990. THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWED THE FORM 990 AND UPON APPROVAL MADE A RECOMMENDATION TO THE BOARD OF DIRECTORS FOR FINAL APPROVAL. THE BOARD OF DIRECTORS REVIEWED AND APPROVED THE FORM 990 BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C PALOLO CHINESE HOME HAS A WRITTEN CONFLICT OF INTEREST POLICY THAT WAS CREATED BY AND FOR DIRECTORS AND OFFICERS OF THE ORGANIZATION. IF IT IS UNCLEAR WHETHER A CONFLICT EXISTS, THE DETERMINATION IS MADE BY THE OFFICERS AND BOARD OF DIRECTORS. IF A CONFLICT EXISTS, THE DIRECTOR OR OFFICER ABSTAINS FROM VOTING ON THE MATTER. THE BOARD OF DIRECTORS HAS THE AUTHORITY TO REMOVE A BOARD MEMBER WHO KNOWINGLY AND INTENTIONALLY DOES NOT DISCLOSE A CONFLICT OF INTEREST. ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE REQUIRED TO BE COMPLETED AND SIGNED BY ALL DIRECTORS AND OFFICERS. FORM 990, PART VI, SECTION B, LINE 15 PALOLO CHINESE HOME REVIEWS ANNUAL COMPENSATION ADJUSTMENTS AT THE EXECUTIVE BOARD MEETING BY DISCUSSING APPROPRIATE COMPENSATION AMOUNTS IN LIGHT OF MARKET COMPARABLES. RECOMMENDATIONS ARE MADE TO THE BOARD OF DIRECTORS, WHO HAVE FINAL APPROVAL, AS WELL AS APPROVAL OVER ANY ADDITIONAL OR EXTRAORDINARY COMPENSATION. THIS PROCESS WAS LAST COMPLETED IN 2020. FORM 990, PART VI, SECTION C, LINE 19 PALOLO CHINESE HOME'S ORGANIZING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. PALOLO CHINESE HOME PUBLISHES AN ANNUAL REPORT CONTAINING FINANCIAL INFORMATION. THE ANNUAL REPORT IS AVAILABLE ON PALOLO CHINESE HOME'S WEBSITE. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES AND CONTRACT LABOR: PROGRAM SERVICE EXPENSES 3,735,583. MANAGEMENT AND GENERAL EXPENSES 391,573. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,127,156. PCH MANAGEMENT LLC 2459 10TH AVENUE HONOLULU HI 96816 461019166 MANAGEMENT & CONSULTING HI 0 0 PALOLO CHINESE HOME PCH LANDHOLDING LLC 2459 10TH AVENUE HONOLULU HI 96816 462398671 REAL ESTATE HOLDING HI 0 0 PALOLO CHINESE HOME