2022-04-28T12:52:05-05:00 2021-06-30 990169131 N&K CPAS INC 999 BISHOP ST STE 2200 HONOLULU HI 96813 990 2020-07-01 990303304 COMMUNITY CLINIC OF MAUI INC COMM 8088717772 1881 NANI STREET WAILUKU HI 96793 BETTY J OTT CHIEF EXECUTIVE OFFICER 8088717772 2022-04-25 1 BETTY OTT 999009999 MICHAEL I TANAKA P00412914 8085242255 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z VANESSA MEDEIROS 1881 NANI STREET WAILUKU HI 96793 16287033 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 9 168 9 0 0 5798354 5336799 8537030 10888882 22299 175 289 61177 14357972 16287033 0 0 0 0 11959152 11162900 0 0 0 5203857 5222344 17163009 16385244 -2805037 -98211 15976338 16006248 5856227 5984348 10120111 10021900 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 7051695 7430926 PRIMARY CARE (ADULT, PEDIATRICS AND INTEGRATED HEALTH) PREVENTIVE HEALTH CARE INCLUDING PHYSICAL EXAMS, IMMUNIZATIONS, COMPREHENSIVE HEPATITIS B & C CARE, DIABETES EDUCATION & MANAGEMENT, HIV CARE, MANAGEMENT OF CHRONIC AND ACUTE ILLNESS, NUTRITION COUNSELING, TRANSGENDER CARE AND URGENT CARE. BEHAVIORAL MANAGEMENT OF CHRONIC MEDICAL CONDITIONS, PAIN MANAGEMENT, BEHAVIOR CHANGE AND TOBACCO CESSATION. PSYCHIATRIC CONSULTATION. 3382975 1865570 WOMEN'S HEALTH (OB/GYN & WIC) INCLUDES PERINATAL CASE MANAGEMENT, PRENATAL AND POSTPARTUM CARE, BREAST & CERVICAL CANCER SCREENING. FAMILY PLANNING EDUCATIONAL & CLINICAL SERVICES INCLUDES CONFIDENTIAL COUNSELING, PREGNANCY TESTING, CONTRACEPTIVE DISPENSING, PELVIC EXAMS, PAP SMEARS AND STD SCREENING. 1205887 783417 ORAL HEALTH (DENTAL) 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. 549955 808969 OTHER PROGRAM SERVICES: PHARMACYTHE HEALTH CENTER PARTICIPATES IN THE 340B PRESCRIPTION DISCOUNT PROGRAM. THE CLINIC OFFERS DISCOUNTED PRICES TO PATIENTS AT THEIR IN-HOUSE PHARMACY AND CONTRACTED PHARMACIES: WALGREENS AND CVS/LONGS. 549955 808969 12190512 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 34 0 1 168 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 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 CHARLES KEOHO TREASURER 1.00 X X 0 0 0 SHARON LUND SECRETARY 1.00 X X 0 0 0 FARAH MIKHAIL 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 KAREY KAPOI DIRECTOR 1.00 X 0 0 0 JOHANA RUBLES LUNA DIRECTOR 1.00 X 0 0 0 RUSSELL ERIK MD INTERNAL MEDICINE 40.00 X 229142 0 0 OTT BETTY J CHIEF EXECUTIVE OFFICER 40.00 X 291060 0 0 VAZ JOHN R MD CHIEF MEDICAL OFFICER 40.00 X 303914 0 0 SAVELL CASSANDRA CHIEF OPERATING OFFICER/DEPUTY DIRECTOR 40.00 X 203147 0 0 WHITNEY LINDA KAY CHIEF HUMAN RESOURCES OFFICER 40.00 X 127821 0 0 AARONOFF MICHAEL C MD OB/GYN 40.00 X 385938 0 0 CASEY DUFFY M MD OB/GYN 40.00 X 370888 0 0 MONJI ZENA MD OB/GYN 40.00 X 376463 0 0 ALTURA AARON M MD OB/GYN 40.00 X 376478 0 0 VAN DER AA MONIQUE CHIEF FINANCIAL OFFICER 40.00 X 201455 0 0 2866306 0 0 10 0 1 0 CORONIS HEALTH RCM LLC PREVIOUSLY PRIORI 700 SCHOOL STREET PAWTUCKET RI 02860 BILLING SERVICES 356856 ALLIANCE OF CHICAGO COMMUNITY HEALTH SVC 215 W OHIO 4TH FLOOR CHICAGO IL 60654 IT SERVICES 280661 ACCESS 91-238 KAUHI STREET KAPOLEI HI 96707 FILE STORAGE, SCANNING & DESTRUCTION SVC 199331 TORKILDSON KATZ HETHERINGTON ET AL 700 BISHOP ST 15TH FLOOR HONOLULU HI 96813 LEGAL SERVICES 113085 EMPLOYERS OPTIONS 140 HOOHANA HIGHWAY SUITE 201 KAHULUI HI 96732 TEMPORARY EMPLOYMENT AGENCY 111922 5 4278351 1058448 5336799 PROGRAM SERVICES REVENUE 621400 10888882 10888882 10888882 175 175 207 0 207 207 OTHER INCOME 900099 60970 60970 60970 16287033 10888882 0 61352 1116605 928859 187746 8494855 7058206 1436649 773349 668930 104419 778091 628541 149550 1564343 908249 656094 116261 96725 19536 163410 142877 20533 50483 48402 2081 42292 29015 13277 171014 171014 1050447 1050447 93897 65133 28764 SUPPLIES AND MATERIALS 1297520 1166898 130622 REPAIRS AND MAINTENANCE 174375 147134 27241 UTILITIES 151714 127216 24498 PROFESSIOANL FEES - CLI 81081 81081 265507 93246 172261 16385244 12190512 4194732 0 264244 204920 1941721 1811931 303897 414467 1031322 875441 50837 40034 20494032 10166199 11246009 10327833 1138308 2331622 15976338 16006248 1083023 1041716 623487 700675 4149717 4241957 5856227 5984348 X 10120111 10021900 10120111 10021900 15976338 16006248 -98211 0 X X 0 1 X 1 1 1 X 2893548 3235051 3509963 5798354 5336799 20773715 2893548 3235051 3509963 5798354 5336799 20773715 20773715 6511 36457 59541 22299 175 124983 404 369 327 289 207 1596 20900294 48277137 0.99390 0.99350 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2883991 2883991 15651548 8429453 7222095 407428 407428 0 1551065 1329318 221747 10327833 ESTIMATED MEDICARE AND MEDICAID SETTLEMENTS 1268806 MEDICAL INVENTORY 17021 CASH HELD FOR LOAN RESERVES 126900 CONSTRUCTION IN PROGRESS 30865 INCENTIVE RISK POOL RECEIVABLE 888030 2331622 X 16287033 0 16287033 0 16287033 16385244 0 16385244 0 16385244 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 X 0 0 0 0 0 0 0 1 0 AARONOFF MICHAEL C MD OB/GYN 375493 0 4317 0 6128 0 0 0 0 0 385938 0 0 0 ALTURA AARON M MD OB/GYN 369183 0 1167 0 6128 0 0 0 0 0 376478 0 0 0 MONJI ZENA MD OB/GYN 365843 0 4492 0 6128 0 0 0 0 0 376463 0 0 0 CASEY DUFFY M MD OB/GYN 360443 0 4317 0 6128 0 0 0 0 0 370888 0 0 0 VAZ JOHN R MD CHIEF MEDICAL OFFICER 286994 0 10792 0 6128 0 0 0 0 0 303914 0 0 0 OTT BETTY J CHIEF EXECUTIVE OFFICER 284932 0 0 0 6128 0 0 0 0 0 291060 0 0 0 RUSSELL ERIK MD INTERNAL MEDICINE 217764 0 5250 0 6128 0 0 0 0 0 229142 0 0 0 SAVELL CASSANDRA CHIEF OPERATING OFFICER/DEPUTY DIREC 197019 0 0 0 6128 0 0 0 0 0 203147 0 0 0 VAN DER AA MONIQUE CHIEF FINANCIAL OFFICER 193883 0 0 0 7572 0 0 0 0 0 201455 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 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 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 XII, LINE 2C: NO CHANGES FROM PRIOR YEAR.