2023-05-15T19:34:51-05:00 2022-06-30 261659234 CW ASSOCIATES CPAS 700 BISHOP STREET SUITE 1040 HONOLULU HI 96813 990 2021-07-01 990149797 KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES KOKU 8087919400 2239 NORTH SCHOOL STREET HONOLULU HI 96819 DAVID DERAUF CHIEF EXECUTIVE OFFICER 8087919400 2023-05-15 1 DAVID DERAUF 999009999 MELANIE A KING P00220997 8085311040 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z DAVID DERAUF 2239 NORTH SCHOOL STREET HONOLULU HI 96819 25354362 0 X WWW.KKV.NET X 1972 HI KOKUA KALIHI VALLEY AND AFFILIATE (THE "CENTER") WERE INCORPORATED IN THE STATE OF HAWAII IN MAY 1972 TO PROMOTE HEALTH AND TO PROVIDE COMPREHENSIVE FAMILY SERVICES IN THE KALIHI VALLEY COMMUNITY IN THE CITY & COUNTY OF HONOLULU, HAWAII. THE CENTER IS A FEDERALLY-QUALIFIED HEALTH CENTER THAT PROVIDES A BROAD RANGE OF HEALTH AND SOCIAL SERVICES TO A LARGELY MEDICALLY-UNDERSERVED IMMIGRANT POPULATION. 11 11 308 780 0 0 14619464 13956128 9389523 11223129 8024 8342 225738 10345 24242749 25197944 0 0 0 0 14351695 15571578 0 0 0 6811598 5899055 21163293 21470633 3079456 3727311 22871872 24586907 3829066 1909267 19042806 22677640 X TOGETHER WE WORK TO ADVANCE HEALTH, TO INSPIRE HEALING, TO FOSTER RECONCILIATION, AND TO CELEBRATE ABUNDANCE IN THE AHUPUA'A OF KALIHI THROUGH STRONG RELATIONSHIPS THAT HONOR CULTURE AND PLACE. 1 0 16926309 11233474 SERVICES PERFORMED TO PROVIDE ACCESS TO MEDICAL, DENTAL AND SOCIAL SERVICES IN THE KALIHI VALLEY COMMUNITY. 16926309 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 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 1 0 0 0 1 56 0 308 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 HI X CHAN HOU LEI CHIEF FINANCIAL OFFIC 8087919400 2239 NORTH SCHOOL STREET HONOLULU HI 96819 SANDRA HARVEY PRESIDENT 1.00 X X 0 0 0 THOMAS KUSATSU VICE PRESIDENT/TREASURER 1.00 X X 0 0 0 VANESSA DACUMOS SECRETARY 1.00 X X 0 0 0 PUA AUYONG DIRECTOR 1.00 X 0 0 0 EDWARD KEMPER DIRECTOR 1.00 X 0 0 0 GEOFFREY PANG DIRECTOR 1.00 X 0 0 0 KAREN FOX DIRECTOR 1.00 X 0 0 0 RICKEY MURASHIGE DIRECTOR 1.00 X 0 0 0 PAULINA ROBERT DIRECTOR 1.00 X 0 0 0 DAVID NAKAMOTO DIRECTOR 1.00 X 0 0 0 MOMI AKIMSEU DIRECTOR 1.00 X 0 0 0 DAVID DERAUF CHIEF EXECUTIVE OFFICER 40.00 X 234475 0 54882 CHAN HOU LEI CHIEF FINANCIAL OFFICER 40.00 X 103005 0 23516 YUET MUI KONG CHIEF OPERATIONG OFFICER 40.00 X 85591 0 10383 LAURA DEVILBISS CLINICAL DIRECTOR 40.00 X 234312 0 27190 MELISSA MCKINNEY PHYSICIAN 40.00 X 182066 0 16589 NATHAN TAN PHYSICIAN 40.00 X 165181 0 28803 MYA HLA PSYCHIATRIST DIR OF BH 40.00 X 152395 0 40140 ANGELICA AGAPITO PHYSICIAN 40.00 X 163697 0 14572 JASON HIRAMOTO CO-DENTAL DIRECTOR 40.00 X 146913 0 20311 1467635 0 236386 8 0 1 0 CVS PHARMACY ONE CVS DRIVE WOONSOCKET RI 02895 PHARMACY DISPENSING FEE 400936 E-MDS PO BOX 679493 DALLAS TX 75267 MEDICAL BILLING 328167 TIMES PHARMACY 1620 NORTH SCHOOL STREET HONOLULU HI 96817 PHARMACY DISPENSING FEE 221609 ZR SYSTEMS GROUP LLC 98-810 MOANALUA ROAD SUITE H-4 AIEA HI 96701 INFORMATION TECH SUPPORT 191752 VPLS DEPT LA 25225 PASADENA CA 91185 INFORMATION TECH SUPPORT 122444 5 10389213 3566915 13956128 MEDICAID 624110 6438787 6438787 PHARMACY 624110 2500839 2500839 PRIVATE INSURANCE 624110 1468513 1468513 CAPITATION FEES 624110 632278 632278 MEDICARE 624110 157374 157374 25338 25338 11223129 8342 8342 106033 156418 -50385 -50385 OTHER INCOME 624110 60730 60730 60730 25197944 11233474 0 8342 830794 274611 556183 10348226 8919820 1428406 686025 591076 94949 2761371 2337233 424138 945162 782484 162678 46677 46677 1969337 1488020 481317 2117376 1872581 244795 230426 76154 154272 48970 46018 2952 829515 167278 662237 65877 65877 REPAIRS AND MAINTENANCE 271177 144024 127153 MISCELLANEOUS 141145 92985 48160 PATIENT SERVICES 62002 62002 DUES AND SUBSCRIPTIONS 45006 27063 17943 71547 44960 26587 21470633 16926309 4544324 0 1441478 2402536 8790391 9348482 741231 1235867 1475776 1913715 10990 1334 1643 24312651 14638977 10421662 9673674 22871872 24586907 1829066 1909267 2000000 0 3829066 1909267 X 15520674 17844933 3522132 4832707 19042806 22677640 22871872 24586907 X 3727311 -92477 X 0 1 X 1 1 1 X 9214416 8372631 8989833 14619464 13956128 55152472 9214416 8372631 8989833 14619464 13956128 55152472 18233 55134239 71391 100910 71578 35943 8342 288164 38062 27910 34980 60730 161682 55602318 48690112 0.99160 0.98850 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME AND FEES - 2017 AMOUNT: $ 38,062. 2018 AMOUNT: $ 27,910. 2019 AMOUNT: $ 34,980. 2021 AMOUNT: $ 60,730. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2288000 2288000 12693406 8393098 4300308 1232453 210700 1021753 2921495 2459378 462117 5177297 3575801 1601496 9673674 X 22326225 295017 -12576 282441 22043784 3154160 3154160 25197944 22016070 387494 157943 545437 21470633 0 21470633 PART X, LINE 2: U.S. GAAP REQUIRES UNCERTAIN TAX POSITIONS TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS IF THEY ARE MORE LIKELY THAN NOT TO FAIL UPON REGULATORY EXAMINATION. MANAGEMENT HAS EVALUATED KKV AND AFFILIATE'S TAX POSITIONS AS OF JUNE 30, 2022 AND 2021 AND FOR THE YEARS THEN ENDED, AND DETERMINED THAT KKV AND AFFILIATE HAD NO UNCERTAIN TAX POSITIONS REQUIRED TO BE REPORTED IN ACCORDANCE WITH U.S. GAAP. KKV AND AFFILIATE ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS IN PROGRESS FOR ANY OPEN TAX PERIODS. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE FROM KALIHI VALLEY COMMUNITY FOUNDATION (REPORTED SEPARATELY) -12,576. PART XI, LINE 4B - OTHER ADJUSTMENTS: INCREASE (DECREASE) IN NET ASSETS WITH DONOR RESTRICTIONS 1,310,578. COST OF GOODS SOLD -156,418. GAIN ON FORGIVENESS OF SBA PPP LOANS 2,000,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 156,418. EXPENSES FROM KALIHI VALLEY COMMUNITY FOUNDATION (REPORTED SEPARATELY) 1,525. PART XI, LINE 2B - DONATED SERVICES AND USE OF FACILITIES CONTRIBUTED MEDICAL SERVICES: $244,825 CONTRIBUTED RENT: $36,487 PART XII, LINE 2A - DONATED SERVICES AND USE OF FACILITIES CONTRIBUTED MEDICAL SERVICES: $244,825 CONTRIBUTED RENT: $36,487 CONTRIBUTED RENT RELATED TO CAPITALIZED LEASEHOLD INTEREST: $92,477 X X X 0 0 0 0 0 0 0 0 0 DAVID DERAUF CHIEF EXECUTIVE OFFICER 234475 0 0 0 0 0 19908 0 34974 0 289357 0 0 0 LAURA DEVILBISS CLINICAL DIRECTOR 234312 0 0 0 0 0 19872 0 7318 0 261502 0 0 0 MELISSA MCKINNEY PHYSICIAN 182066 0 0 0 0 0 1701 0 14888 0 198655 0 0 0 NATHAN TAN PHYSICIAN 165181 0 0 0 0 0 14019 0 14784 0 193984 0 0 0 MYA HLA PSYCHIATRIST DIR OF BH 152395 0 0 0 0 0 12930 0 27210 0 192535 0 0 0 ANGELICA AGAPITO PHYSICIAN 163697 0 0 0 0 0 0 0 14572 0 178269 0 0 0 JASON HIRAMOTO CO-DENTAL DIRECTOR 146913 0 0 0 0 0 12464 0 7847 0 167224 0 0 0 FORM 990, PART III, LINE 2 STARTED KOKUA PHARMACY, A 340B AND RETAIL PHARMACY FOR OUR PATIENTS FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C A COPY OF THIS POLICY IS GIVEN TO ALL BOARD MEMBERS UPON COMMENCEMENT OF SUCH PERSON'S RELATIONSHIP WITH THE ORGANIZATION. EACH BOARD MEMBER SIGNS AND DATES THE POLICY AT THE BEGINNING OF HER/HIS TERM OF SERVICE OR EMPLOYMENT AND EACH YEAR THEREAFTER. FAILURE TO SIGN DOES NOT NULLIFY THE POLICY. THE POLICY AND DISCLOSURE FORM MUST BE FILED ANNUALLY BY ALL SPECIFIED PARTIES. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S SALARY IS DETERMINED BY THE BOARD OF DIRECTORS. ALL OTHER STAFF COMPENSATION IS DETERMINED BY THE SALARY COMMITTEE AND APPROVED BY THE CEO. THE BOARD OF DIRECTORS APPROVES THE STAFF SALARY SCALE. COMPARABLE DATA IS OBTAINED FROM HAWAII PRIMARY CARE ASSOCIATION AND HAWAII ALLIANCE OF NONPROFIT ORGANIZATIONS (HANO). THIS PROCESS IS DOCUMENTED IN THE SALARY COMMITTEE MINUTES AND HR RECORDS. THIS WAS LAST UNDERTAKEN IN MAY 2022. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CAPITALIZED LEASEHOLD INTEREST - NET CHANGE -92,477. KALIHI VALLEY COMMUNITY FOUNDATION 2239 NORTH SCHOOL STREET HONOLULU HI 96819 990329894 PROVIDE FINANCIAL SUPPORT TO CENTER HI 501(C)(3) LINE 7 KOKUA KALIHI VALLEY COMP FAMILY SVCS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0