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WAIKIKI HEALTH: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
WAIKIKI HEALTH (EIN 99-0159253)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-08
IRS object ID
201233139349302418
Schema version
2011v1.2
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

FieldValueIRS element (for citing)
Timestamp2012-11-08T17:55:21-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN990169131EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1N&K CPAS INCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11001 BISHOP ST STE 1700AddressLine1
CityHONOLULUCity
StateHIState
ZIP Code968133696ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN990159253EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WAIKIKI HEALTH CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWAIKNameControl
Phone8089224787Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1277 OHUA AVENUEAddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96815ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJEFFREY M CHAWENSONName
TitleCHIEF FINANCIAL OFFICERTitle
Phone8089224787Phone
Date Signed2012-10-30DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBRIAN S ISOBEName
PTINP00737357PTIN
Phone8085242255Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJEFFREY M CHAWENSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1277 OHUA AVENUEAddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96815ZIPCode
FieldValueIRS element (for citing)
Gross Receipts8085385GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.WAIKIKIHC.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1971YearFormation
State Legal DomicileHIStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HIGH QUALITY MEDICAL AND SOCIAL SERVICES THAT ARE AFFORDABLE AND ACCESSIBLE FOR EVERYONE REGARDLESS OF ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members17NbrIndependentVotingMembers
Total Nbr Employees169TotalNbrEmployees
Total Nbr Volunteers50TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year3628202ContributionsGrantsPriorYear
Contributions Grants Current Year4142787ContributionsGrantsCurrentYear
Program Service Revenue Prior Year3189762ProgramServiceRevenuePriorYear
Program Service Revenue CY3942267ProgramServiceRevenueCY
Investment Income Prior Year2739InvestmentIncomePriorYear
Investment Income Current Year331InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year6820703TotalRevenuePriorYear
Total Revenue Current Year8085385TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year241888GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY505027GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4545028SalariesEtcPriorYear
Salaries Etc Current Year5329725SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year394944TotalFundrsngExpCurrentYear
Other Expense Prior Year1643929OtherExpensePriorYear
Other Expenses Current Year2204994OtherExpensesCurrentYear
Total Expenses Prior Year6430845TotalExpensesPriorYear
Total Expenses Current Year8039746TotalExpensesCurrentYear
Revenues Less Expenses Prior Year389858RevenuesLessExpensesPriorYear
Revenues Less Expenses CY45639RevenuesLessExpensesCY
Total Assets BOY3875680TotalAssetsBOY
Total Assets EOY4089379TotalAssetsEOY
Total Liabilities BOY536413TotalLiabilitiesBOY
Total Liabilities EOY704473TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3339267NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3384906NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO PROVIDE HIGH QUALITY MEDICAL AND SOCIAL SERVICES THAT ARE AFFORDABLE AND ACCESSIBLE FOR EVERYONE REGARDLESS OF ABILITY TO PAY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense2985806Expense
Revenue2588584Revenue
DescriptionOUR PRIMARY CARE CLINIC OFFERS GENERAL AND PREVENTATIVE MEDICAL CARE AND CASE MANAGEMENT THAT IS INTEGRATED WITH TRADITIONAL HAWAIIAN HEALING, MEDICAL NUTRITION THERAPY AND BEHAVIORAL HEALTH COUNSELING. CHRONIC DISEASE MANAGEMENT IS A KEY COMPONENT AS WE PROVIDE A SAFETY NET TO PEOPLE WHO ARE UNINSURED, UNDERINSURED AND OFTEN HOMELESS. IN 2011, WE PROVIDED 24,742 PRIMARY CARE VISITS TO 7,016 PATIENTS, 68% OF WHOM WERE LIVING AT OR BELOW POVERTY LEVEL.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense2159534Expense
Grants370527Grants
Revenue525218Revenue
DescriptionOUR HOMELESS OUTREACH PROGRAM SERVED OVER 2,060 INDIVIDUALS WITH MORE THAN 27,998 MEDICAL AND SOCIAL ENCOUNTERS. OUR DROP-IN CENTER OFFERS HEALTH SERVICES, BEHAVIORAL HEALTH SERVICES, CASE MANAGEMENT, SUBSTANCE ABUSE TREATMENT, EMERGENCY FOOD AND CLOTHING, PHONE AND MESSAGE SERVICES, HYGIENE SUPPLIES, ASSISTANCE WITH HEALTH INSURANCE AND INTAKE SERVICES FOR THE NEXT STEP SHELTER. OUR MOBILE MEDICAL CLINIC VISITS VARIOUS PARTS OF THE ISLAND WITH A FULLY EQUIPPED EXAM ROOM.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense387846Expense
Grants134500Grants
DescriptionOUR HIV-AIDS PROGRAM IS ONE OF THE MOST COMPREHENSIVE IN HAWAII. OUR MEDICAL DIRECTOR IS A CREDENTIALED HIV SPECIALIST WITH THE AMERICAN ACADEMY OF HIV MEDICINE, ONE OF ONLY NINE IN HAWAII. IN 2011, WE PROVIDED 2,021 ENCOUNTERS CONSISTING OF PRIMARY CARE VISITS, MENTAL HEALTH ENCOUNTERS AND ANONYMOUS HIV COUNSELING/TESTING ENCOUNTERS TO 250 PATIENTS.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense1507444Expense
Revenue828465Revenue
DescriptionHO'OLA LIKE PROJECT AT HALE'IWA, WAIKIKI FRIENDLY NEIGHBORS, YOUTH OUTREACH SERVICES, FAMILY PLANNING, PHARMACY AND PATH CLINIC.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp1507444TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev828465TotalOfOtherProgramServiceRev
Total Program Service Expense7040630TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109614NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees169NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members17NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledHIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JEFFREY M CHAWENSONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8087919319TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1277 OHUA AVENUEAddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96815ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployee
ROBERT GENTRY
PRESIDENT1.00XX000
HOWARD LEE
VICE-PRESIDENT FINANCE1.00XX000
PHYLLIS DENDLE
PRESIDENT1.00XX000
TERRENCE ARATANI
VICE-PRESIDENT GOVERNANCE1.00XX000
THANH-LO SANANIKONE
SECRETARY1.00XX000
DONNA CHING
DIRECTOR1.00X000
MICHELLE TURNER
DIRECTOR1.00X000
WING YEUNG
DIRECTOR1.00X000
LESTER KANETA
DIRECTOR1.00X000
MELANIE MITO MAY
DIRECTOR1.00X000
JANET MONTGOMERY
DIRECTOR1.00X000
JP MOULIN
DIRECTOR1.00X000
PAUL SMITH
DIRECTOR1.00X000
CAROLL ANN TAKAHASHI
DIRECTOR1.00X000
GUY NATHAN YATSUSHIRO
DIRECTOR1.00X000
DANIEL HILL
DIRECTOR1.00X000
BOYD MURAYAMA
DIRECTOR1.00X000
SHEILA BECKHAM
CHIEF EXECUTIVE OFFICER40.00X136063012461
ALAN KONG
CHIEF FINANCIAL OFFICER40.00X8797206127
ELLIOT KALAUAWA
MEDICAL DIRECTOR40.00164458013756X
FieldValueIRS element (for citing)
Total Reportable Comp From Org388493TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation32344TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Government Grants3282600GovernmentGrants
All Other Contributions860187AllOtherContributions
Total Contributions4142787TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE REV62111035916573591657
PURCHASE OF SERVICE AG621110350610350610
FieldValueIRS element (for citing)
Total Program Service Revenue3942267TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column331TotalRevenueColumn
Exclusion$331ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column8085385TotalRevenueColumn
Related Or Exempt Function Income3942267RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$331ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total505027Total
Program Services505027ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total420837Total
Program Services374830ProgramServices
Management And General23445ManagementAndGeneral
Fundraising22562Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3955720Total
Program Services3523263ProgramServices
Management And General220377ManagementAndGeneral
Fundraising212080Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total118619Total
Program Services105651ProgramServices
Management And General6608ManagementAndGeneral
Fundraising6360Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total483210Total
Program Services430383ProgramServices
Management And General26921ManagementAndGeneral
Fundraising25906Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total351339Total
Program Services312930ProgramServices
Management And General19573ManagementAndGeneral
Fundraising18836Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total133377Total
Program Services75739ProgramServices
Management And General57638ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total30334Total
Program Services7444ProgramServices
Fundraising22890Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total245043Total
Program Services165654ProgramServices
Management And General24469ManagementAndGeneral
Fundraising54920Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total211323Total
Program Services181194ProgramServices
Management And General24302ManagementAndGeneral
Fundraising5827Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total311016Total
Program Services235470ProgramServices
Management And General62180ManagementAndGeneral
Fundraising13366Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total78299Total
Program Services56216ProgramServices
Management And General18747ManagementAndGeneral
Fundraising3336Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total7536Total
Management And General7432ManagementAndGeneral
Fundraising104Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total677Total
Management And General677ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total228828Total
Program Services219119ProgramServices
Management And General8985ManagementAndGeneral
Fundraising724Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total27760Total
Program Services7487ProgramServices
Management And General20273ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
MEDICAL SUPPLIES53115853106692
REPAIRS AND MAINTENANCE170086150527159903569
BAD DEBT6245062450
SMALL EQUIPMENT PURCHAS2970129701

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total137406Total
Program Services66479ProgramServices
Management And General66463ManagementAndGeneral
Fundraising4464Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total8039746Total
Program Services7040630ProgramServices
Management And General604172ManagementAndGeneral
Fundraising394944Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY47365BOY
EOY54020EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1701178BOY
EOY1952617EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY692565BOY
EOY660402EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY226273BOY
EOY368564EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY28671BOY
EOY30928EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY119370BOY
EOY111336EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1619105LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec737825LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1033776BOY
EOY881280EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY26482BOY
EOY30232EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY3875680BOY
EOY4089379EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY420329BOY
EOY484443EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY116084BOY
EOY220030EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY536413BOY
EOY704473EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3186169BOY
EOY3088075EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY153098BOY
EOY296831EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3339267BOY
EOY3384906EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3875680BOY
EOY4089379EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses45639ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2978140CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2947244CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3505929CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3628202CurrentTaxYearMinus1Year
Current Tax Year4142787CurrentTaxYear
Total17202302Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2978140CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2947244CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3505929CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3628202CurrentTaxYearMinus1Year
Current Tax Year4142787CurrentTaxYear
Total17202302Total
FieldValueIRS element (for citing)
Public Support Total17017202302PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6526CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4288CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years287CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year155CurrentTaxYearMinus1Year
Current Tax Year331CurrentTaxYear
Total11587Total
FieldValueIRS element (for citing)
Total Support17213889TotalSupport
Gross Receipts From Admissions Etc13148401GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.99930PublicSupportPertcentage170
Public Support Pertcent Prior Year0.99880PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers1Volunteers
Paid Staff Or Management1PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$3,640DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities
Total Lobbying Expenditures IIB3640TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationTHE ORGANIZATION'S EXECUTIVE DIRECTOR PROVIDED TESTIMONY TO LEGISLATORS AND THEIR STAFF REGARDING UNINSURED FUNDING, ADULT MENTAL HEALTH FUNDING CUTS, CIGARETTE TAX DISTRIBUTION, FUNDING FOR OUT-STATIONED ELIGIBILITY WORKERS, OBESITY EDUCATION, AND OTHER HEALTHCARE ISSUES OF INTEREST TO FEDERALLY QUALIFIED HEALTH CENTERS (FQHC).Explanation

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis682269OtherCostOrOtherBasis
Depreciation63105Depreciation
Book Value619164BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis431878OtherCostOrOtherBasis
Depreciation249045Depreciation
Book Value182833BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis504958OtherCostOrOtherBasis
Depreciation425675Depreciation
Book Value79283BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings881280TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
PAYABLE TO GRANT SUBRECIPIENTS$65,083
REFUNDABLE ADVANCES$154,947
FieldValueIRS element (for citing)
Total Of Amounts220030TotalOfAmounts
Total Revenue8085385TotalRevenue
Total Expenses8039746TotalExpenses
Excess Or Deficit For Year45639ExcessOrDeficitForYear
Excess Or Deficit Per FS45639ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt8119280TotRevenueEtcAuditedFinclStmt
Donated Srvc And Use Of Facilities33895DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F99033895RevenueNotRptdF990
Revenue Subtotal8085385RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9908085385TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt8073641TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities33895DonatedServicesUseOfFacilities
Expenses Not Rptd F99033895ExpensesNotRptdF990
Expenses Subtotal8039746ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9908039746TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
ExplanationFORM 990, SCHEDULE D, PART X, LINE 2: THE CENTER IS EXEMPT FROM INCOME TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE CENTER 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 CENTER HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS IN FILED RETURNS THAT REQUIRE DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE CENTER 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. WITH FEW EXCEPTIONS, THE CENTER IS NO LONGER SUBJECT TO U.S. FEDERAL AND STATE EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS ENDED DECEMBER 31, 2007 AND PRIOR.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
COMMUNITY CLINIC OF MAUI INC
1881 NANI STWAILUKUHI96793990303304501(C)(3)48526STAFFING FOR CASE MANAGEMENT AND MEDICAL SERVICES FOR PATIENTS WITH HIV/AIDS
COMMUNITY CLINIC OF MAUI INC
1881 NANI STWAILUKUHI96793990303304501(C)(3)32000STAFFING FOR MEDICAL, SOCIAL, HEALTH CARE, AND OTHER RELATED SERVICES FOR THE HOMELESS
WAIANAE COAST COMPREHENSIVE HEALTH CENTER
86-260 FARRINGTON HWYWAIANAEHI96792990148164501(C)(3)41772STAFFING FOR MEDICAL, SOCIAL, HEALTH CARE, AND OTHER RELATED SERVICES FOR THE HOMELESS
KALIHI-PALAMA HEALTH CENTER
915 N KING STHONOLULUHI96817990161221501(C)(3)84397STAFFING FOR MEDICAL, SOCIAL, HEALTH CARE, AND OTHER RELATED SERVICES FOR THE HOMELESS
BAY CLINIC INC
224 HAILI STHILOHI96720990222784501(C)(3)47833STAFFING FOR MEDICAL, SOCIAL, HEALTH CARE, AND OTHER RELATED SERVICES FOR THE HOMELESS AND UNINSURED.
HAWAII HELPING THE HUNGRY HAVE HOPE
419 SOUTH STREET STE 171HONOLULUHI96813204943817501(C)(3)221337STAFFING AND OTHER RELATED SERVICES FOR THE HOMELESS
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants5TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: THE ORGANIZATION'S GRANTEES ARE FEDERALLY QUALIFIED COMMUNITY HEALTH CENTERS WITH ANNUAL REQUIREMENTS FOR AUDITED FINANCIAL STATEMENTS, UDS REPORTS, QUALITY REVIEWS, AND HRSA OVERSIGHT OF GOVERNANCE AND OPERATIONAL ISSUES. IN ADDITION, GRANTS ARE FOR FUNDING OF SPECIFIC EXPENSES AND INVOICES ARE REVIEWED BY THE ORGANIZATION'S CFO. GRANTEES ALSO PROVIDE QUARTERLY DATA WITH INVOICES AND ANNUAL SITE VISITS ARE MADE TO EACH GRANTEE.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonELLIOT KALAUAWANamePerson
Base Compensation Filing Org164458BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org8203DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org5553NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org178214TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonHOWARD LEENamePerson
FieldValueIRS element (for citing)
RelationshipDIRECTOR AND OFFICER OF THE ORGANIZATIONRelationship
Amount Of Transaction363217AmountOfTransaction
Description Of TransactionTHE ORGANIZATION PURCHASES EMPLOYEE HEALTH INSURANCE FROM UNIVERSITY HEALTH ALLIANCE. HOWARD LEE IS THE CHIEF OPERATING OFFICER OF UNIVERSITY HEALTH ALLIANCE. HOWARD LEE WAS NOT COMPENSATED BY WAIKIKI HEALTH CENTER.THE DECISION TO PURCHASE HEALTH INSURANCE FROM UNIVERSITY HEALTH ALLIANCE WAS MADE BY USING COMPETITIVE BIDS. FULL DISCLOSURE WAS MADE TO THE BOARD ABOUT THE DECISION.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11THE 990 IS PREPARED FOR REVIEW BY THE CFO AND REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD. AN ELECTRONIC COPY IS SENT TO ALL BOARD MEMBERS PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CALL MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO SIGN THE ORGANIZATION'S CONFLICT OF INTEREST POLICY UPON BECOMING A DIRECTOR AND ALSO ANNUALLY. EMPLOYEES ARE EXPECTED TO FOREGO ANY OUTSIDE ACTIVITIES DAMAGING TO OR CONFLICTING WITH THE ORGANIZATION'S INTEREST. ACTIVITIES IN WHICH A CONFLICT OF INTEREST OCCUR INCLUDE: ACTIVITIES WHICH ADVERSELY AFFECT JOB PERFORMANCE, CUSTOMER RELATIONS OR COMMUNITY RELATIONS; ACTIONS WHICH GIVE OUR COMPETITORS AN ADVANTAGE; IMPROPER VENDOR AND SUBCONTRACTOR RELATIONS; ACCEPTANCE OF GIFTS, ENTERTAINMENT OR OTHER FAVORS OF MORE THAN A TOKEN NATURE.
FORM 990, PART VI, SECTION B, LINE 15THE COMPENSATION OF THE EXECUTIVE DIRECTOR IS APPROVED BY THE BOARD OF DIRECTORS. THE DIRECTORS MEET IN EXECUTIVE SESSION FOR DISCUSSION. THE PERSONNEL COMMITTEE OF THE BOARD IS RESPONSIBLE FOR MAKING RECOMMENDATIONS TO THE BOARD AND USES THE FOLLOWING RESOURCES: COMPARATIVE DATA FROM HAWAII EMPLOYERS COUNCIL, THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, AND THE HAWAII PRIMARY CARE ASSOCIATION (HPCA). THE CHIEF EXECUTIVE OF THE HPCA, WHO IS INDEPENDENT OF THE BOARD OF DIRECTORS, ACTED AS AN ADVISOR AND CONSULTANT DURING THE 2007 HIRING OF THE NEW EXECUTIVE DIRECTOR. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS DETERMINED BY THE EXECUTIVE DIRECTOR, USING THE AVAILABLE EXTERNAL RESOURCES LISTED ABOVE AND WITH INPUT ON COMPARABLE MARKET SALARIES FROM THE HR MANAGER.
FORM 990, PART VI, SECTION C, LINE 19ALL OF THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE AT THE OFFICE OF THE EXECUTIVE DIRECTOR. NOTICE IS MADE ON THE ORGANIZATION'S WEBSITE.
FORM 990, PART XII, LINE 2C:THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.