2019-04-08T17:11:56-05:00 2018-06-30 990169131 N&K CPAS INC 1001 BISHOP ST STE 1700 HONOLULU HI 968133696 990 2017-07-01 990303304 COMMUNITY CLINIC OF MAUI INC COMM 8088717772 1881 NANI STREET WAILUKU HI 96793 BETTY J OTT CHIEF EXECUTIVE OFFICER 8088717772 2019-03-23 1 CHAD K FUNASAKI P01755832 8085242255 66.135.240.105 2019-03-23 17:56:45 HS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 2E0D5E6773B774D82CD9742AB4D5E7C59ABC548A 2017 2019-02-21 02:37:17Z VANESSA MEDEIROS 1881 NANI STREET WAILUKU HI 96793 12736901 0 X N/A X 1993 HI TO PROVIDE CULTURALLY SENSITIVE, COORDINATED PRIMARY CARE SERVICES ON MAUI EMPHASIZING EDUCATION, PREVENTION AND ADVOCACY, REGARDLESS OF ABILITY TO PAY. 9 9 155 9 0 0 3016798 3235051 9344541 9465024 6511 36457 404 369 12368254 12736901 0 0 0 0 7384145 8733037 0 0 0 4432223 4968621 11816368 13701658 551886 -964757 21593769 20803567 5479814 5654369 16113955 15149198 X 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. 0 0 6207499 6870090 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. 2302950 922947 PERINATAL PROGRAM COMPREHENSIVE PRENATAL, DELIVERY, POST-PARTUM HEALTH CARE, & CASE MANAGEMENT SERVICES. 1790559 1378928 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. 513661 293059 FAMILY PLANNING EDUCATIONAL & CLINICAL SERVICES INCLUDING CONFIDENTIAL COUNSELING, PREGNANCY TESTING, CONTRACEPTIVE DISPENSING, PELVIC EXAMS, PAP SMEARS, & STD SCREENING. 513661 293059 10814669 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 53 0 1 155 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 HI X X BETTY J OTT 8088717772 1881 NANI STREET WAILUKU HI 96793 VANESSA MEDEIROS PRESIDENT 1.00 X X 0 0 0 LORRIN PANG MD VICE PRESIDENT 1.00 X X 0 0 0 ELLEN GOKCAN TREASURER 1.00 X X 0 0 0 SHANNON O'BRIEN SECRETARY 1.00 X X 0 0 0 FARAH MIKHAIL DIRECTOR 1.00 X 0 0 0 CHARLES KEOHO DIRECTOR 1.00 X 0 0 0 MARIA SOLOMON DIRECTOR 1.00 X 0 0 0 ELPIDIO BUCANEG JR DIRECTOR 1.00 X 0 0 0 SARAI STRICKLIN DIRECTOR 1.00 X 0 0 0 BETTY J OTT CHIEF EXECUTIVE OFFICER 40.00 X 182178 0 6873 CASSANDRA SAVELL CHIEF OPERATING OFFICER 40.00 X 144094 0 8044 JOHN R VAZ CHIEF MEDICAL OFFICER 40.00 X 135326 0 6614 AARON M ALTURA MD OB/GYN 40.00 X 329029 0 15872 DUFFY M CASEY MD OB/GYN 40.00 X 356743 0 24326 JAIMIE JOHNSON MD OB/GYN 40.00 X 301942 0 19138 JASON M LAIRD MD INTERNAL MEDICINE 40.00 X 227041 0 18050 ALEX PIJPAERT DENTAL DIRECTOR 40.00 X 184895 0 6712 1861248 0 105629 8 0 1 0 PRIORITY MANAGEMENT GROUP 700 SCHOOL STREET PAWTUCKET RI 02860 BILLING SERVICES 344452 ALLIANCE OF CHICAGO COMMUNITY HEALTH SVC 215 W OHIO 4TH FLOOR CHICAGO IL 60654 IT SERVICES 223526 VANTAGGIO HR 31726 RANCH VIEJO ROAD SUITE 202 SAN JUAN CA 92675 HR SERVICES 203775 COMPHEALTH PO BOX 972651 DALLAS TX 753972651 LOCUM TENENS 128398 TORKILDSON KATZ MOORE & HETHERINGTON 700 BISHOP ST 15TH F HONOLULU HI 96813 LEGAL SERVICES 115414 5 3024113 210938 3235051 PROGRAM SERVICES REVENUE 621400 9465024 9465024 9465024 36457 36457 369 0 369 369 12736901 9465024 0 36826 621252 529124 92128 6909307 5887673 1021634 579507 486809 92698 622971 564865 58106 143506 143506 1056971 658426 398545 96912 77599 19313 399919 354124 45795 190342 172254 18088 174335 125598 48737 79159 33918 45241 174084 174084 1044317 847252 197065 90829 4624 86205 SUPPLIES AND MATERIALS 1112648 864678 247970 REPAIRS AND MAINTENANCE 163514 154568 8946 MISCELLANEOUS 119821 25821 94000 RECRUITMENT AND RETENTI 89066 7671 81395 33198 19665 13533 13701658 10814669 2886989 0 X 34889 114385 4025293 4272801 525514 388796 864789 938700 45290 4809 19875743 7163036 12319713 12712707 3778281 2371369 21593769 20803567 919415 878768 105242 423685 4455157 4351916 5479814 5654369 X 16113955 15149198 16113955 15149198 21593769 20803567 -964757 0 X X 0 1 X 1 1 1 X 6089055 3040479 4062907 2893548 3235051 19321040 6089055 3040479 4062907 2893548 3235051 19321040 19321040 244 25 99 6511 36457 43336 50 317 314 404 369 1454 19365830 42635652 0.99770 0.99960 X 2628086 2628086 15525451 5902637 9622814 471405 166778 304627 1131833 1065897 65936 118968 27724 91244 12712707 ESTIMATED MEDICARE AND MEDICAID SETTLEMENTS 1065000 OTHER RECEIVABLES 491 OTHER 142275 CASH HELD FOR LOAN RESERVES 122728 CONSTRUCTION IN PROGRESS 179711 INCENTIVE RISK POOL RECEIVABLE 861164 2371369 X 12736901 0 12736901 0 12736901 13701658 0 13701658 0 13701658 PART X, LINE 2: 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. X X 0 0 0 0 0 0 0 1 0 BETTY J OTT CHIEF EXECUTIVE OFFICER 182178 0 0 0 0 0 0 0 6873 0 189051 0 0 0 CASSANDRA SAVELL CHIEF OPERATING OFFICER 144094 0 0 0 0 0 0 0 8044 0 152138 0 0 0 AARON M ALTURA MD OB/GYN 329029 0 0 0 0 0 0 0 15872 0 344901 0 0 0 DUFFY M CASEY MD OB/GYN 356743 0 0 0 0 0 0 0 24326 0 381069 0 0 0 JAIMIE JOHNSON MD OB/GYN 301942 0 0 0 0 0 0 0 19138 0 321080 0 0 0 JASON M LAIRD MD INTERNAL MEDICINE 227041 0 0 0 0 0 0 0 18050 0 245091 0 0 0 ALEX PIJPAERT DENTAL DIRECTOR 184895 0 0 0 0 0 0 0 6712 0 191607 0 0 0 PART I, LINE 7 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. 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.