COMMUNITY CLINIC OF MAUI INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY CLINIC OF MAUI INC (EIN 99-0303304)
- Tax period
- 2017-07-01 to 2018-06-30
- Filed
- 2019-04-08
- IRS object ID
- 201940989349300709
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-04-08T17:11:56-05:00 | ReturnTs |
| Tax Period End | 2018-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 990169131 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | N&K CPAS INC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1001 BISHOP ST STE 1700 | AddressLine1Txt |
| City | HONOLULU | CityNm |
| State Abbreviation | HI | StateAbbreviationCd |
| ZIP | 968133696 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 990303304 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY CLINIC OF MAUI INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 8088717772 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1881 NANI STREET | AddressLine1Txt |
| City | WAILUKU | CityNm |
| State Abbreviation | HI | StateAbbreviationCd |
| ZIP | 96793 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BETTY J OTT | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 8088717772 | PhoneNum |
| Signature | 2019-03-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CHAD K FUNASAKI | PreparerPersonNm |
| PTIN | P01755832 | PTIN |
| Phone | 8085242255 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 66.135.240.105 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-03-23 | IPDt |
| IP Tm | 17:56:45 | IPTm |
| IP Timezone | HS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 2E0D5E6773B774D82CD9742AB4D5E7C59ABC548A | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | VANESSA MEDEIROS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1881 NANI STREET | AddressLine1Txt |
| City | WAILUKU | CityNm |
| State Abbreviation | HI | StateAbbreviationCd |
| ZIP | 96793 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $12,736,901 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1993 | FormationYr |
| Legal Domicile State | HI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE CULTURALLY SENSITIVE, COORDINATED PRIMARY CARE SERVICES ON MAUI EMPHASIZING EDUCATION, PREVENTION AND ADVOCACY, REGARDLESS OF ABILITY TO PAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 155 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,016,798 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,235,051 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,344,541 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $9,465,024 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6,511 | PYInvestmentIncomeAmt |
| CY Investment Income | $36,457 | CYInvestmentIncomeAmt |
| PY Other Revenue | $404 | PYOtherRevenueAmt |
| CY Other Revenue | $369 | CYOtherRevenueAmt |
| PY Total Revenue | $12,368,254 | PYTotalRevenueAmt |
| CY Total Revenue | $12,736,901 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,384,145 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,733,037 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,432,223 | PYOtherExpensesAmt |
| CY Other Expenses | $4,968,621 | CYOtherExpensesAmt |
| PY Total Expenses | $11,816,368 | PYTotalExpensesAmt |
| CY Total Expenses | $13,701,658 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $551,886 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$964,757 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,593,769 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,803,567 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,479,814 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,654,369 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,113,955 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $15,149,198 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PROVIDING PRIMARY HEALTH CARE SERVICES, HEALTH PROMOTION AND DISEASE PREVENTION SERVICES, AND COMPREHENSIVE DENTAL SERVICES (EXCEPT ORTHODONTICS) WITH EMPHASIS ON ORAL HYGIENE AND PREVENTION TARGETING UNDERSERVED CHILDREN, PREGNANT WOMEN AND NURSING MOTHERS, THE HOMELESS AND HIV/AIDS POPULATIONS OF MAUI COUNTY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $6,207,499 | ExpenseAmt |
| Revenue | $6,870,090 | RevenueAmt |
| Desc | PRIMARY CARE PREVENTIVE HEALTH CARE SERVICES INCLUDING PHYSICAL EXAMS AND IMMUNIZATIONS. CONTINUED HEALTH CARE THROUGH THE DIAGNOSIS AND TREATMENT OF ACUTE ILLNESS AND CHRONIC DISEASE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,302,950 | ExpenseAmt |
| Revenue | $922,947 | RevenueAmt |
| Desc | PERINATAL PROGRAM COMPREHENSIVE PRENATAL, DELIVERY, POST-PARTUM HEALTH CARE, & CASE MANAGEMENT SERVICES. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,790,559 | ExpenseAmt |
| Revenue | $1,378,928 | RevenueAmt |
| Desc | ORAL HEALTH CARE PROGRAM CONSISTING OF DIAGNOSTIC EXAMINATIONS AND X-RAYS; PREVENTIVE SERVICES SUCH AS CLEANINGS, FLUORIDE, AND SEALANTS; RESTORATIVE SERVICES SUCH AS FILLINGS AND CROWNS; REHABILITATIVE SERVICES INCLUDING ENDODONTICS, PERIODONTICS, AND PROSTHODONTICS SUCH AS BRIDGES AND DENTURES; ORAL SURGERY SUCH AS EXTRACTIONS AND PALLIATIVE CARE; AND EMERGENCY TREATMENT FOR ORAL INFECTIONS AND INJURIES WHICH THREATEN OR HAVE THE POTENTIAL TO THREATEN A PATIENT'S LIFE. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $513,661 | ExpenseAmt |
| Revenue | $293,059 | RevenueAmt |
| Desc | FAMILY PLANNING EDUCATIONAL & CLINICAL SERVICES INCLUDING CONFIDENTIAL COUNSELING, PREGNANCY TESTING, CONTRACEPTIVE DISPENSING, PELVIC EXAMS, PAP SMEARS, & STD SCREENING. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $513,661 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $293,059 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $10,814,669 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 53 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 155 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | HI | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BETTY J OTT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8088717772 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1881 NANI STREET | AddressLine1Txt |
| City | WAILUKU | CityNm |
| State Abbreviation | HI | StateAbbreviationCd |
| ZIP | 96793 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| VANESSA MEDEIROS | |||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| LORRIN PANG MD | |||||||
| VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ELLEN GOKCAN | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SHANNON O'BRIEN | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| FARAH MIKHAIL | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CHARLES KEOHO | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARIA SOLOMON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ELPIDIO BUCANEG JR | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SARAI STRICKLIN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BETTY J OTT | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | Yes (X) | $182,178 | $0 | $6,873 | ||
| CASSANDRA SAVELL | |||||||
| CHIEF OPERATING OFFICER | 40.00 | Yes (X) | $144,094 | $0 | $8,044 | ||
| JOHN R VAZ | |||||||
| CHIEF MEDICAL OFFICER | 40.00 | Yes (X) | $135,326 | $0 | $6,614 | ||
| AARON M ALTURA | |||||||
| MD OB/GYN | 40.00 | $329,029 | $0 | $15,872 | Yes (X) | ||
| DUFFY M CASEY | |||||||
| MD OB/GYN | 40.00 | $356,743 | $0 | $24,326 | Yes (X) | ||
| JAIMIE JOHNSON | |||||||
| MD OB/GYN | 40.00 | $301,942 | $0 | $19,138 | Yes (X) | ||
| JASON M LAIRD | |||||||
| MD INTERNAL MEDICINE | 40.00 | $227,041 | $0 | $18,050 | Yes (X) | ||
| ALEX PIJPAERT | |||||||
| DENTAL DIRECTOR | 40.00 | $184,895 | $0 | $6,712 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,861,248 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $105,629 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PRIORITY MANAGEMENT GROUP | |||||
| 700 SCHOOL STREET | PAWTUCKET | RI | 02860 | BILLING SERVICES | $344,452 |
| ALLIANCE OF CHICAGO COMMUNITY HEALTH SVC | |||||
| 215 W OHIO 4TH FLOOR | CHICAGO | IL | 60654 | IT SERVICES | $223,526 |
| VANTAGGIO HR | |||||
| 31726 RANCH VIEJO ROAD SUITE 202 | SAN JUAN | CA | 92675 | HR SERVICES | $203,775 |
| COMPHEALTH | |||||
| PO BOX 972651 | DALLAS | TX | 753972651 | LOCUM TENENS | $128,398 |
| TORKILDSON KATZ MOORE & HETHERINGTON | |||||
| 700 BISHOP ST 15TH F | HONOLULU | HI | 96813 | LEGAL SERVICES | $115,414 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $3,024,113 | GovernmentGrantsAmt |
| All Other Contributions | $210,938 | AllOtherContributionsAmt |
| Total Contributions | $3,235,051 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PROGRAM SERVICES REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $9,465,024 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,465,024 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $9,465,024 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,457 | TotalRevenueColumnAmt |
| Exclusion | $36,457 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $369 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $369 | TotalRevenueColumnAmt |
| Exclusion | $369 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,736,901 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,465,024 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $36,826 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $621,252 | TotalAmt |
| Program Services | $529,124 | ProgramServicesAmt |
| Management And General | $92,128 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,909,307 | TotalAmt |
| Program Services | $5,887,673 | ProgramServicesAmt |
| Management And General | $1,021,634 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $579,507 | TotalAmt |
| Program Services | $486,809 | ProgramServicesAmt |
| Management And General | $92,698 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $622,971 | TotalAmt |
| Program Services | $564,865 | ProgramServicesAmt |
| Management And General | $58,106 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,506 | TotalAmt |
| Management And General | $143,506 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,056,971 | TotalAmt |
| Program Services | $658,426 | ProgramServicesAmt |
| Management And General | $398,545 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,912 | TotalAmt |
| Program Services | $77,599 | ProgramServicesAmt |
| Management And General | $19,313 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $399,919 | TotalAmt |
| Program Services | $354,124 | ProgramServicesAmt |
| Management And General | $45,795 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190,342 | TotalAmt |
| Program Services | $172,254 | ProgramServicesAmt |
| Management And General | $18,088 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $174,335 | TotalAmt |
| Program Services | $125,598 | ProgramServicesAmt |
| Management And General | $48,737 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,159 | TotalAmt |
| Program Services | $33,918 | ProgramServicesAmt |
| Management And General | $45,241 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $174,084 | TotalAmt |
| Management And General | $174,084 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,044,317 | TotalAmt |
| Program Services | $847,252 | ProgramServicesAmt |
| Management And General | $197,065 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,829 | TotalAmt |
| Program Services | $4,624 | ProgramServicesAmt |
| Management And General | $86,205 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES AND MATERIALS | $1,112,648 | $864,678 | $247,970 |
| REPAIRS AND MAINTENANCE | $163,514 | $154,568 | $8,946 |
| MISCELLANEOUS | $119,821 | $25,821 | $94,000 |
| RECRUITMENT AND RETENTI | $89,066 | $7,671 | $81,395 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,198 | TotalAmt |
| Program Services | $19,665 | ProgramServicesAmt |
| Management And General | $13,533 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,701,658 | TotalAmt |
| Program Services | $10,814,669 | ProgramServicesAmt |
| Management And General | $2,886,989 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,889 | BOYAmt |
| EOY | $114,385 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,025,293 | BOYAmt |
| EOY | $4,272,801 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $525,514 | BOYAmt |
| EOY | $388,796 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $864,789 | BOYAmt |
| EOY | $938,700 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,290 | BOYAmt |
| EOY | $4,809 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $19,875,743 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,163,036 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,319,713 | BOYAmt |
| EOY | $12,712,707 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,778,281 | BOYAmt |
| EOY | $2,371,369 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,593,769 | BOYAmt |
| EOY | $20,803,567 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $919,415 | BOYAmt |
| EOY | $878,768 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $105,242 | BOYAmt |
| EOY | $423,685 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,455,157 | BOYAmt |
| EOY | $4,351,916 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,479,814 | BOYAmt |
| EOY | $5,654,369 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,113,955 | BOYAmt |
| EOY | $15,149,198 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,113,955 | BOYAmt |
| EOY | $15,149,198 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,593,769 | BOYAmt |
| EOY | $20,803,567 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$964,757 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,089,055 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,040,479 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,062,907 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,893,548 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,235,051 | CurrentTaxYearAmt |
| Total | $19,321,040 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,089,055 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,040,479 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,062,907 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,893,548 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,235,051 | CurrentTaxYearAmt |
| Total | $19,321,040 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $19,321,040 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $244 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $25 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $99 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,511 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $36,457 | CurrentTaxYearAmt |
| Total | $43,336 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $50 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $317 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $314 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $404 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $369 | CurrentTaxYearAmt |
| Total | $1,454 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $19,365,830 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $42,635,652 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.99770 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99960 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,628,086 | OtherCostOrOtherBasisAmt |
| Book Value | $2,628,086 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,525,451 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,902,637 | DepreciationAmt |
| Book Value | $9,622,814 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $471,405 | OtherCostOrOtherBasisAmt |
| Depreciation | $166,778 | DepreciationAmt |
| Book Value | $304,627 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,131,833 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,065,897 | DepreciationAmt |
| Book Value | $65,936 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $118,968 | OtherCostOrOtherBasisAmt |
| Depreciation | $27,724 | DepreciationAmt |
| Book Value | $91,244 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,712,707 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (6 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ESTIMATED MEDICARE AND MEDICAID SETTLEMENTS | $1,065,000 |
| OTHER RECEIVABLES | $491 |
| OTHER | $142,275 |
| CASH HELD FOR LOAN RESERVES | $122,728 |
| CONSTRUCTION IN PROGRESS | $179,711 |
| INCENTIVE RISK POOL RECEIVABLE | $861,164 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,371,369 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $12,736,901 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $12,736,901 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $12,736,901 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $13,701,658 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $13,701,658 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $13,701,658 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | COMMUNITY CLINIC OF MAUI, INC. (CLINIC) IS EXEMPT FROM INCOME TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE CLINIC RECOGNIZES THE FINANCIAL STATEMENT BENEFIT OF A TAX POSITION ONLY AFTER DETERMINING THAT THE RELEVANT TAX AUTHORITY WOULD MORE LIKELY THAN NOT SUSTAIN THE POSITION AFTER AN AUDIT BASED ON THE TECHNICAL MERITS OF THE POSITION. THE CLINIC HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS IN FILED RETURNS THAT REQUIRE DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE CLINIC IS NOT SUBJECT TO INCOME TAXES IN THE U.S. FEDERAL JURISDICTION AND THE STATE. TAX REGULATIONS WITHIN EACH JURISDICTION ARE SUBJECT TO INTERPRETATION OF THE RELATED TAX LAWS AND REGULATIONS AND REQUIRE SIGNIFICANT JUDGMENT TO APPLY. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BETTY J OTT | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $182,178 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $6,873 | $0 | $189,051 | $0 | $0 | $0 |
| CASSANDRA SAVELL | ||||||||||||||
| CHIEF OPERATING OFFICER | $144,094 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $8,044 | $0 | $152,138 | $0 | $0 | $0 |
| AARON M ALTURA | ||||||||||||||
| MD OB/GYN | $329,029 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $15,872 | $0 | $344,901 | $0 | $0 | $0 |
| DUFFY M CASEY | ||||||||||||||
| MD OB/GYN | $356,743 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $24,326 | $0 | $381,069 | $0 | $0 | $0 |
| JAIMIE JOHNSON | ||||||||||||||
| MD OB/GYN | $301,942 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $19,138 | $0 | $321,080 | $0 | $0 | $0 |
| JASON M LAIRD | ||||||||||||||
| MD INTERNAL MEDICINE | $227,041 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $18,050 | $0 | $245,091 | $0 | $0 | $0 |
| ALEX PIJPAERT | ||||||||||||||
| DENTAL DIRECTOR | $184,895 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $6,712 | $0 | $191,607 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 7 | FormAndLineReferenceDesc |
| Explanation | FEDERAL PER DIEM RATES FOR TRAVEL, CONFERENCE EXPENSE REIMBURSEMENTS (TRANSPORTATION, CONFERENCE FEES), LICENSURE AND PROFESSIONAL ASSOCIATION DUES REIMBURSEMENTS. OUT OF POCKET REIMBURSEMENTS FOR SMALL ITEM PURCHASES. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | IN MAY 2018, THE ORGANIZATION MADE SIGNIFICANT CHANGES TO ITS BY-LAWS, WHICH INCLUDES (1) AN EXPANDED DUTIES OF THE BOARD, EXECUTIVE COMMITTEE, AND OTHER COMMITTEES, (2) EXPANDED DUTIES OF THE CHIEF EXECUTIVE OFFICER, WHO SHALL BE AN EX-OFFICIO, NONVOTING MEMBER OF THE BOARD, (3) THE DISTRIBUTION OF ASSETS UPON DISSOLUTION, AND (4) ADOPTING AND PERIODICALLY REVISING THE CONFLICT OF INTEREST POLICY. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CFO AND CEO REVIEWS THE FORM 990 FOR ACCURACY PRIOR TO FILING. A COPY OF THE FORM 990 IS DISSEMINATED TO ALL BOD MEMBERS FOR THEIR REVIEW AND COMMENT PRIOR TO THE FILING OF THE RETURN. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS REVIEW CONFLICT OF INTEREST AND PROCUREMENT CODE OF CONDUCT POLICIES ANNUALLY AND SIGN AN ACKNOWLEDGEMENT. DISINTERESTED DIRECTORS DETERMINE WHETHER ANY CONTRACT, AGREEMENT, TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND IS FAIR AND REASONABLE TO THE CORPORATION AND FURTHER DECIDE WHETHER TO ENTER INTO CONTRACT, AGREEMENT, TRANSACTION OR ARRANGEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE SALARY OF THE CEO, AND THE RANGE OF SALARIES FOR KEY EMPLOYEES, IS DETERMINED BY THE BOARD OF DIRECTORS. THE PROCEDURE FOR DETERMINING COMPENSATION IS AS FOLLOWS: 1. THE FISCAL HEALTH OF THE ORGANIZATION IS DOCUMENTED BY THE CFO AND VALIDATED BY THE FINANCE COMMITTEE, AS WELL AS THE INDEPENDENT AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS. 2. THE PERSONNEL COMMITTEE WILL RESEARCH COMPARATIVE DATA OF CEO, COO, CFO AND CMO SALARIES FROM AT LEAST THREE COMPARABLE COMMUNITY HEALTH CENTERS IN THE STATE OF HAWAII AND FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS. THE COMMITTEE MAY REQUEST THE ASSISTANCE OF CCM'S COO TO RESEARCH THIS INFORMATION. THE DATA WILL BE PROVIDED IN WRITING TO ALL BOARD MEMBERS PRIOR TO DISCUSSION OF THE RECOMMENDATION FOR SALARY INCREASE, IF MERITED. THE PERSONNEL COMMITTEE MAY ALSO CONSIDER COMPENSATION SURVEYS PREPARED BY INDEPENDENT FIRMS AND WRITTEN EMPLOYMENT OFFERS FROM SIMILAR ORGANIZATIONS. 3. THE PERCENTAGE OF INCREASE FOR THE CEO, CFO, COO AND CMO WILL BE GUIDED BY THE PERCENTAGE INCREASE OFFERED TO OTHER EMPLOYEES OF CCM, AS RECOMMENDED BY THE FINANCE COMMITTEE AND THE CFO. 4. THE PERFORMANCE EVALUATION OF THE CEO (AND AS APPLICABLE WHEN ASSESSING THE KEY EMPLOYEES THEIR PERFORMANCE EVALUATIONS) SHOWS PROGRESS IN ACTUALIZING THE ORGANIZATION'S GOALS AND THE CEO'S GOALS OVER THE PREVIOUS YEAR. 5. ALL FORMS OF COMPENSATION PROVIDED TO THE CEO (AND AS APPLICABLE TO KEY EMPLOYEES THEIR COMPENSATION) WILL BE TAKEN INTO ACCOUNT, INCLUDING SALARY, BONUSES AND BENEFITS. 6. ALL BOARD MEMBERS PARTICIPATE IN THE EVALUATION PROCESS, BUT THE FINAL DOCUMENT WILL BE PREPARED BY THE PERSONNEL COMMITTEE. THE FINAL DOCUMENT WILL BE PRESENTED AT A CLOSED, FULL BOD MEETING. RECOMMENDATION FOR SALARY INCREASE, IF MERITED, WILL BE PRESENTED AT THAT TIME. 7. DISCUSSION AND VOTE TO ACCEPT THE CEO'S PERFORMANCE EVALUATION AND DETERMINATION OF THE ACTUAL COMPENSATION WILL FOLLOW. 8. MEETING MINUTES WILL BE PREPARED AND APPROVED BEFORE THE LATEST: OF THE NEXT MEETING OF THE BOD OR SIXTY DAYS AFTER APPROVAL OF CEO'S COMPENSATION (AND THE RANGE OF SALARY FOR THE KEY EMPLOYEES) BY THE BOD. THE MINUTES WILL INCLUDE: (I) THE TERMS OF THE APPROVED COMPENSATION ARRANGEMENT AND THE DATE OF APPROVAL; (II) THE BOARD MEMBERS PRESENT DURING DISCUSSION OF THE ARRANGEMENT AND THOSE WHO VOTED ON IT; (III) THE COMPARATIVE DATA USED AND HOW IT WAS OBTAINED; (IV) ANY ACTIONS TAKEN BY BOARD MEMBERS WHO MIGHT HAVE POTENTIAL CONFLICT OF INTEREST REGARDING THE COMPENSATION ARRANGEMENT; AND (V) THE RATIONALE FOR DETERMINING THAT THE ARRANGEMENT IS REASONABLE IF IT EXCEEDS THE RANGE OF THE COMPARABILITY DATA. |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABLE UPON REQUEST. |
| FORM 990, PART X, LINES 4, 19 AND 27: | THE PREVIOUSLY ISSUED FINANCIAL STATEMENTS OF THE CLINIC AS OF JUNE 30, 2017 HAVE BEEN RESTATED TO CORRECT THE FOLLOWING ERRORS: REFUNDABLE ADVANCES AT JUNE 30, 2017 WAS OVERSTATED, AND BEGINNING NET ASSETS WAS UNDERSTATED, BY $67,253 DUE TO AN OVERSIGHT THAT RESULTED IN THE DEFERRAL OF REVENUE RECOGNITION ON CERTAIN GRANTS THAT SHOULD HAVE BEEN RECOGNIZED PRIOR TO JUNE 30, 2016. MEANINGFUL USE INCENTIVE RECEIVABLE AND REVENUE WERE UNDERSTATED BY $123,250 AS OF JUNE 30, 2017 DUE TO AN UNDER ACCRUAL OF REVENUE ATTRIBUTED TO THREE NEW PROVIDERS HIRED DURING THE FISCAL YEAR ENDED JUNE 30, 2017 AND MISCELLANEOUS ADJUSTMENTS THAT ERRONEOUSLY REDUCED THE RECEIVABLE BALANCE. THE CUMULATIVE EFFECT WAS AN INCREASE OF $67,253 TO NET ASSETS AS OF JUNE 30, 2016. THE EFFECT OF THE PRIOR PERIOD RESTATEMENT RESULTED IN AN INCREASE OF $123,250 TO THE CHANGE IN NET ASSETS AS OF JUNE 30, 2017 AND A DECREASE OF $190,503 TO THE CHANGE IN NET ASSETS AS OF JUNE 30, 2018. |
| FORM 990, PART XII, LINE 2C: | NO CHANGES FROM PRIOR YEAR. |