2020-07-09T19:13:01-05:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2019-01-01 990290103 KAHALA SENIOR LIVING COMMUNITY INC KAHA 8082187000 4389 MALIA STREET HONOLULU HI 96821 PATRICK DUARTE CEO/PRESIDENT 8082187000 2020-06-30 1 KURT BENNION CPA P01469618 4252506100 2020-06-30 67.137.57.251 2020-06-30 22:07:08 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 DB08F32496847D80FB4B06F4D3BADC3D38BCD2CD 2019 2021-01-29 14:40:06Z PATRICK DUARTE 4389 MALIA STREET HONOLULU HI 96821 57969557 0 X WWW.KAHALANUI.COM X 1989 HI TO PROVIDE A CONTINUUM OF HIGH QUALITY RESIDENTIAL AND HEALTH CARE SERVICES TO RESIDENTS. 12 12 390 150 0 0 808259 908201 28824473 29561778 6985760 9440739 339719 320929 36958211 40231647 716240 344953 0 0 12986358 13368983 0 0 0 20490920 20622469 34193518 34336405 2764693 5895242 213115761 235206759 287536859 295553409 -74421098 -60346650 X IN THE SPIRIT OF OHANA, KAHALA SENIOR LIVING COMMUNITY AND ITS ASSOCIATES ARE DEDICATED TO SERVING THE UNMET CARE NEEDS OF SENIORS IN HAWAII. WE ARE A NOT-FOR-PROFIT ORGANIZATION THAT PROVIDES A CONTINUUM OF HIGH QUALITY RESIDENTIAL AND HEALTH CARE SERVICES ENABLING OUR RESIDENTS TO LIVE A GRACIOUS HAWAIIAN LIFESTYLE IN AN ENVIRONMENT OF DIGNITY, RESPECT, TRUST, AND FRIENDSHIP. 0 0 32290627 344953 29561778 KAHALA NUI IS A SENIOR LIVING COMMUNITY LOCATED IN HONOLULU, HAWAII THAT PROVIDES A CONTINUUM OF RESIDENTIAL AND HEALTHCARE SERVICES TO SENIORS. FOUR DISTINCT LEVELS OF CARE ARE OFFERED: INDEPENDENT LIVING, ASSISTED LIVING, MEMORY SUPPORT, AND SKILLED NURSING. KAHALA NUI HAS 270 INDEPENDENT LIVING UNITS FOR SENIORS WHO DON'T REQUIRE ASSISTANCE WITH ACTIVITIES OF DAILY LIVING. HI'OLANI IS KAHALA NUI'S HEALTHCARE CENTER THAT PROVIDES ASSISTED LIVING SERVICES, MEMORY SUPPORT, AND SKILLED NURSING TO RESIDENTS WHO TRANSFER FROM INDEPENDENT LIVING AND TO INDIVIDUALS FROM THE COMMUNITY. HI'OLANI IS LICENSED FOR 67 ASSISTED LIVING BEDS (INCLUDING MEMORY SUPPORT) AND 60 SKILLED NURSING BEDS. IN ADDITION TO HEALTHCARE SERVICES, KAHALA NUI OFFERS A VARIETY OF SERVICES THAT INCLUDE CASUAL AND FORMAL IN-HOUSE DINING, WELLNESS PROGRAMS, RECREATIONAL EVENTS, HOUSEKEEPING AND LINEN SERVICES, SCHEDULED TRANSPORTATION TO ALL MAJOR SHOPPING MALLS AND VARIOUS RELIGIOUS AND MEDICAL FACILITIES, BUILDING AND GROUNDS MAINTENANCE, 24-HOUR SECURITY, AND BUSINESS SERVICES. 32290627 1 1 0 1 0 0 0 0 1 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 77 0 390 1 0 0 0 0 0 0 0 0 0 1 0 0 0 X 12 12 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 HI X HUILAN KAMITA 8082187022 4389 MALIA STREET HONOLULU HI 96821 STEVE ROBERTSON CHAIR 3.00 4.50 X X 0 0 0 FRANK TOKIOKA II VICE CHAIR 3.00 4.00 X X 0 0 0 CHUCK KELLEY MD SECRETARY 3.00 4.00 X X 0 0 0 LISA SAKAMOTO TREASURER 3.00 4.00 X X 0 0 0 CHRISTINE CAMP DIRECTOR 3.00 4.00 X 0 0 0 SHEILA CHONG DIRECTOR 2.00 1.00 X 0 0 0 SHARI KOGAN MD DIRECTOR 2.00 1.00 X 0 0 0 KAMAL MASAKI MD DIRECTOR 2.00 1.00 X 0 0 0 JON MCKENNA DIRECTOR 2.00 1.00 X 0 0 0 SHERRY MENOR-MCNAMARA DIRECTOR (THROUGH SEPTEMBER 2019) 1.00 1.00 X 0 0 0 KENNETH MILLER CFA DIRECTOR 3.00 4.00 X 0 0 0 SON-JAI PAIK DIRECTOR 3.00 4.00 X 0 0 0 ADRIENNE YOSHIHARA DIRECTOR 2.00 1.00 X 0 0 0 PATRICK DUARTE PRESIDENT/CEO 22.00 28.00 X 0 369090 27709 HUILAN KAMITA CFO 22.00 28.00 X 0 165293 15030 WENDY WONG EXECUTIVE DIRECTOR 42.00 8.00 X 0 275965 21886 DARYN MURAI INTERIM DIRECTOR OF MARKETING 40.00 0.00 X 141051 0 23876 CHRISTINE CAGUIOA DIRECTOR OF NURSING 40.00 0.00 X 123669 0 23928 SHIRLEY MORCA NURSE 40.00 0.00 X 105934 0 15118 AHMAD TADJVAR DIRECTOR OF BUILDING OPERATIONS 40.00 0.00 X 105606 0 16574 ELIZABETH BETTENCOURT ASSISTANT DIRECTOR OF NURSING 44.00 0.00 X 105293 0 5033 581553 810348 149154 6 0 1 0 KAHALA NUI SENIOR LIVING 4389 MALIA STREET HONOLULU HI 96821 MANAGEMENT SERVICES 3123518 AEGIS THERAPIES PO BOX 936653 ATLANTA GA 311936653 PHYSICAL THERAPY 593729 GUO ZHANG CHEN 1039 WILIKI DRIVE HONOLULU HI 96818 CONTRACTORS 289603 UNITED LAUNDRY SERVICES INC DEPT LA 25044 PASADENA CA 911855044 LAUNDRY SERVICES 244190 THE FLOOR STORE 120 SAND ISLAND ACCESS ROAD HONOLULU HI 96819 FLOORING SERVICES 172159 8 908201 17304 908201 MONTHLY SERVICE FEES 623000 26441290 26441290 ENTRANCE FEES 623000 1752624 1752624 SKILLED NURSING ANCILLARY & THERA 623000 1367864 1367864 29561778 6282047 6282047 51148 0 51148 51148 51148 20896602 17737910 3158692 3158692 3158692 MISCELLANEOUS REVENUE 900099 269781 269781 269781 40231647 29561778 0 9761668 344953 344953 10487923 9856550 631373 301224 280922 20302 1648131 1537754 110377 931705 868908 62797 2512755 2361487 151268 106556 105746 810 69207 68681 526 658948 658948 1730061 1721474 8587 88275 85835 2440 175213 167532 7681 174471 172884 1587 3913820 3825614 88206 57499 56805 694 2712981 2712981 4868709 4868709 188153 185707 2446 FOOD 2491756 2244906 246850 RESIDENT EXPENSES 486408 469351 17057 REPAIRS & MAINTENANCE 204397 195036 9361 MISCELLANEOUS EXPENSES 183260 158792 24468 34336405 32290627 2045778 0 5740437 6089359 2335414 3945812 637951 696798 709970 1189920 85099 71753 656927 645571 163276143 64820809 102034808 98455334 94245578 85740991 32116543 6669577 6254678 213115761 235206759 1707190 1823506 6626982 6920170 53382272 52044479 1805000 2080000 224015415 232685254 287536859 295553409 X -78090729 -65337423 3669631 4990773 -74421098 -60346650 213115761 235206759 5895242 8179206 0 X 0 1 X 1 0 X 684852 864117 1342106 808259 908201 4607535 26181240 27256848 27929030 28824473 29561778 139753369 26866092 28120965 29271136 29632732 30469979 144360904 0 0 0 144360904 2623963 2037351 2245581 1905037 6333195 15145127 2623963 2037351 2245581 1905037 6333195 15145127 396389 617393 787942 310917 269781 2382422 29886444 30775709 32304659 31848686 37072955 161888453 0.89170 0.91410 0.09360 0.06930 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 729 729 0 PART II-B, LINE 1: A PORTION OF THE MEMBERSHIP DUES PAID TO THE HEALTHCARE ASSOCIATION OF HAWAII WAS USED BY THE ASSOCIATION TO LOBBY ON BEHALF OF KAHALA NUI AND OTHER HEALTHCARE PROVIDERS IN HAWAII. 0 1 X 3352449 624687 760978 60421 4677693 3448356 185527 -210365 71069 3352449 2435246 635625 405059 27574 3448356 1788018 491245 155983 2435246 1475192 335660 -22834 1788018 0.00000 0.77770 0.22230 0 0 148494763 55185157 93309606 7592271 4004964 3587307 6933153 5630688 1302465 255956 255956 98455334 32116543 F 32116543 ENTRANCE FEE LIABILITY 231845423 ACCRUED BOND INTEREST 332150 RESIDENT LIABILITIES 164761 DUE TO RELATED ORGANIZATIONS 342920 232685254 X 30230744 332719 332719 29898025 658948 9674674 10333622 40231647 33677457 0 33677457 658948 658948 34336405 PART IV, LINE 2B: ESCROW ACCOUNTS ARE RELATED TO A $5,000 DEPOSIT RECEIVED FROM INTERESTED INDIVIDUALS WHO HAVE DEPOSITED MONEY IN ORDER TO HOLD A SPOT ON THE CCRC WAIT LIST. ASSISTED LIVING NON-LIFE CARE RESIDENTS HAVE A SECURITY DEPOSIT EQUAL TO ONE MONTH'S FEES. THESE AMOUNTS ARE HELD IN A NON-INTEREST-BEARING CHECKING ACCOUNT. RESIDENTS GET A REFUND WHEN THEY MOVE OUT OR PASS AWAY. PART V, LINE 4: THE ENDOWEMENT FUNDS SUPPORT VARIOUS PROGRAMS INCLUDING: 1. SUPPORTING RESIDENTS THAT HAVE EXHAUSTED THEIR FINANCIAL RESOURCES 2. TRAINING OF PERSONNEL 3. GENERAL SUPPORT 4. SCHOLARSHIPS 5. SUPPORTING PROGRAMS AND SERVICES IN THE HEALTH CENTER 6. SUPPORTING VARIOUS PROGRAMS IN INDEPENDENT LIVING, TRAINING IN THE HEALTH CENTER, COMMUNITY OUTREACH, AND GENERAL SUPPORT PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION, EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR INCOME TAXES IN THE FINANCIAL STATEMENTS. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS AND IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS 332,719. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS WITH DONOR RESTRICTIONS 892,883. INVESTMENT INCOME 4,862,121. REALIZED GAIN ON SALE OF INVESTMENTS 3,158,692. ENDOWMENT INVESTMENT RETURN 760,978. 1 KAHALA NUI SENIOR LIVING FOUNDATION INC 4389 MALIA STREET HONOLULU HI 96821 814851343 501(C)(3) 12670 GENERAL OPERATING SUPPORT ALZHEIMER'S ASSOCIATION 1050 ALA MOANA BOULEVARD 2610 HONOLULU HI 96814 990212360 501(C)(3) 57622 SUPPORT EDUCATION AND AWARENESS CATHOLIC CHARITIES HAWAII 1822 KEEAUMOKU STREET HONOLULU HI 96822 990073547 501(C)(3) 51518 SENIOR HOUSING ASSISTANCE HAWAII MEALS ON WHEELS PO BOX 61194 HONOLULU HI 96839 990198132 501(C)(3) 59973 38565 FAIR MARKET VALUE FOOD HOT MEALS FOR COMMUNITY SENIORS KOKUA KALIHI VALLEY 2239 N SCHOOL STREET HONOLULU HI 96819 990149797 501(C)(3) 44105 SENIOR HEALTH PROGRAM ASSISTANCE PALAMA SETTLEMENT 810 N VINEYARD BOULEVARD HONOLULU HI 96817 990074140 501(C)(3) 17256 FAIR MARKET VALUE GIFT BAGS PROVIDE HOUSEHOLD TOILETRIES AND CANNED GOODS TO HOMEBOUND SENIORS PROJECT DANA 2720 NAKOOKOO STREET HONOLULU HI 96826 990143990 501(C)(3) 54952 SUPPORT THE SENIOR PROGRAM 7 0 PART I, LINE 2: GRANTS TO RELATED ORGANIZATIONS ARE MONITORED THROUGH COMMON MANAGEMENT AND BOARD OVERSIGHT. EACH GRANT TO AN UNRELATED ORGANIZATION IS APPROVED AND INCLUDED IN THE BUDGET; ALL EXPENDITURES ARE PRESENTED TO THE BOARD OF DIRECTORS. X X X X X 0 1 0 1 1 0 0 0 0 PATRICK DUARTE PRESIDENT/CEO 0 310142 0 58948 0 0 0 27709 0 0 0 396799 0 0 HUILAN KAMITA CFO 0 145580 0 19713 0 0 0 14643 0 387 0 180323 0 0 WENDY WONG EXECUTIVE DIRECTOR 0 232522 0 43443 0 0 0 21153 0 733 0 297851 0 0 DARYN MURAI INTERIM DIRECTOR OF MARKETING 141051 0 0 0 0 0 3880 0 19996 0 164927 0 0 0 PART I, LINE 4B KAHALA NUI SENIOR LIVING CREATED A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN DURING 2019. PATRICK DUARTE, HUILAN KAMITA AND WENDY WONG PARTICIPATED IN THE PLAN. PART I, LINE 5 THE CEO/PRESIDENT RECEIVES BONUSES FROM KAHALA NUI SENIOR LIVING THAT ARE BASED ON SEVERAL VARIABLES INCLUDING FINANCIAL PERFORMANCE, RESIDENT SATISFACTION, AND GROWTH. A STATE OF HAWAII DEPARTMENT OF BUDGET AND FINANCE 990266961 41980SAY2 2012-08-15 73400000 SEE PART VI 0 0 0 A 21765000 75450742 5188205 1437467 2012 1 1 1 1 A 0 1 1 1 0 0.00150 0.00150 0 0 0 A 0 0 0 1 0 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: STATE OF HAWAII, DEPARTMENT OF BUDGET AND FINANCE DATE THE REBATE COMPUTATION WAS PERFORMED: 08/15/2017 SCHEDULE K, PART I, BOND ISSUES: (F) DESCRIPTION OF PURPOSE: I. ADVANCE REFUND THE OUTSTANDING PRINCIPLE AMOUNT OF THE DEPARTMENT'S $72,750,000 SPECIAL PURPOSE REVENUE BONDS SERIES 2003A, $68,790,000 OF WHICH WAS OUSTANDING; II. FUND A DEBT SERVICE RESERVE FUND; AND III. PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE BONDS AND THE REFUNDING OF THE SERIES 2003A BONDS. JON DUARTE DESIGN GROUP INC OWNED BY THE CEO/PRESIDENT'S SON 28680 CONTRACTED WEBSITE DESIGN 0 FORM 990, PART VI, SECTION A, LINE 1 KAHALA SENIOR LIVING COMMUNITY HAS AN EXECUTIVE COMMITTEE COMPRISED OF THE OFFICERS OF THE BOARD OF DIRECTORS AND THREE OTHER VOTING BOARD MEMBERS. THE EXECUTIVE COMMITTEE HAS AND EXERCISES THE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE ORGANIZATION; PROVIDED, HOWEVER, THAT IT DOES NOT HAVE THE AUTHORITY TO (A) AMEND, ALTER OR REPEAL THE BYLAWS; (B) ELECT, APPOINT OR REMOVE ANY MEMBER OF THE EXECUTIVE COMMITTEE OR ANY DIRECTOR OR OFFICER OF THE ORGANIZATION; (C) AMEND OR RESTATE THE ARTICLES OF INCORPORATION; (D) ADOPT A PLAN OF MERGER; (E) ADOPT A PLAN OF CONSOLIDATION WITH ANOTHER ORGANIZATION; (F) AUTHORIZE THE SALE, LEASE, EXCHANGE OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE ORGANIZATION; (G) AUTHORIZE THE VOLUNTARY DISSOLUTION OF THE ORGANIZATION OR ANY PETITION TO OR APPLICATION FOR RELIEF FROM ANY BANKRUPTCY COURT, OR REVOKE PROCEEDINGS THEREFOR; (H) ADOPT A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF THE ORGANIZATION; (I) OR AMEND, ALTER OR REPEAL ANY RESOLUTION OF THE BOARD OF DIRECTORS WHICH BY ITS TERMS PROVIDES THAT IT SHALL NOT BE AMENDED, ALTERED OR REPEALED BY SUCH COMMITTEE. FORM 990, PART VI, SECTION A, LINE 3 MOST EMPLOYEE SERVICES, INCLUDING MANAGEMENT SERVICES, ARE PROVIDED BY KAHALA NUI SENIOR LIVING, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE MEMBER IS KAHALA NUI SENIOR LIVING. FORM 990, PART VI, SECTION A, LINE 7A ALL BOARD MEMBERS ARE ELECTED BY KAHALA NUI SENIOR LIVING, THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, KAHALA NUI SENIOR LIVING, HAS THE POWER TO AMEND THE ORGANIZATION'S ARTICLES OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE CFO AND CEO PRIOR TO BOARD REVIEW. UPON THEIR APPROVAL, THE FORM WAS SUBMITTED TO THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. AFTER THE AUDIT COMMITTEE'S REVIEW, THE FORM 990 WAS REVIEWED BY THE BOARD OF DIRECTORS WITH A RECOMMENDATION FROM THE AUDIT COMMITTEE TO APPROVE THE FORM 990. IF THE BOARD OF DIRECTORS HAD ANY COMMENTS, QUESTIONS, OR SUGGESTIONS, THESE WERE CONSIDERED PRIOR TO FILING. AFTER ALL ISSUES WERE ADDRESSED, THE DRAFT WAS FINALIZED AND FILED BY THE ORGANIZATION'S ACCOUNTANTS. FORM 990, PART VI, SECTION B, LINE 12C BY SIGNING AN ANNUAL CONFLICT OF INTEREST STATEMENT, ALL OFFICERS, DIRECTORS, OR TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE WHETHER THEY HAVE CONFLICTS OF INTEREST IN REGARDS TO THE ORGANIZATION. NO MEMBER OF THE BOARD OF DIRECTORS SHALL PARTICIPATE IN ANY DISCUSSION OR VOTE ON ANY MATTER IN WHICH HE OR SHE OR A MEMBER OF HIS OR HER IMMDIATE FAMILY HAS A POTENTIAL CONFLICT OF INTEREST DUE TO HAVING MATERIAL ECONOMIC INVOLVEMENT REGARDING THE MATTER BEING DISCUSSED. WHEN SUCH A SITUATION PRESENTS ITSELF, THE DIRECTOR MUST ANNOUNCE HIS OR HER POTENTIAL CONFLICT, DISQUALIFY HIMSELF OR HERSELF, AND BE EXCUSED FROM THE MEETING UNTIL DISCUSSION IS OVER ON THE MATTER INVOLVED. FORM 990, PART VI, SECTION B, LINE 15A IN THE ORGANIZATION'S DETERMINATION OF THE CEO/PRESIDENT'S COMPENSATION, ITS EXECUTIVE COMMITTEE REVIEWED THE QUALIFICATIONS OF THE EXISTING CEO/PRESIDENT, PATRICK DUARTE, USING INDUSTRY-RELATED INFORMATION GATHERED BY AN INDEPENDENT THIRD-PARTY EXECUTIVE COMPENSATION CONSULTANT AND INTERNAL SALARIES MANAGEMENT PERSONNEL. IN 2019, THE PROCESS INCLUDED COMPARABILITY DATA, REVIEW AND APPROVAL BY INDEPENDENT PERSONS, AND CONTEMPORANEOUS SUBSTANTIATION. THE COMPENSATION OF OTHER OFFICERS IS REVIEWED AND APPROVED BY THE PRESIDENT/CEO, USING INDUSTRY-RELATED INFORMATION PROVIDED BY AN INDEPENDENT THIRD-PARTY EXECUTIVE COMPENSATION CONSULTANT. IN 2019, THE PROCESS INCLUDIED COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILALE TO THE PUBLIC THROUGH POSTING ON THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE. KAHALA NUI SENIOR LIVING INC 4389 MALIA STREET HONOLULU HI 96821 814797420 SUPPORT SUBSIDIARY ORGANIZATIONS HI 501(C)(3) LINE 12C, III-FI N/A 0 LIVE WELL INC 4389 MALIA STREET HONOLULU HI 96821 814868431 ADULT DAY CARE HI 501(C)(3) LINE 10 KAHALA NUI SENIOR LIVING 0 KAHALA NUI SENIOR LIVING FOUNDATION INC 4389 MALIA STREET HONOLULU HI 96821 814851343 FUNDRAISING HI 501(C)(3) LINE 10 KAHALA NUI SENIOR LIVING 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0