2018-05-15T20:31:13-05:00 2017-06-30 261659234 CW ASSOCIATES CPAS 700 BISHOP STREET SUITE 1040 HONOLULU HI 96813 990 2016-07-01 990149797 KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES KOKU 8087919400 2239 NORTH SCHOOL STREET HONOLULU HI 96819 DAVID DERAUF EXECUTIVE DIRECTOR 8087919400 2018-05-15 1 MARK A HAYES P00085205 8085311040 2016 2022-09-23 18:48:47Z DAVID DERAUF 2239 NORTH SCHOOL STREET HONOLULU HI 96819 16039187 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 11 242 80 0 0 7170276 7811340 5652145 8079748 6468 12053 420298 122519 13249187 16025660 0 0 0 0 9099964 10564006 0 0 3501 4311797 4786997 13411761 15351003 -162574 674657 16176234 18880453 2104446 2161200 14071788 16719253 TOGETHER WE WORK TOWARD HEALING, RECONCILIATION AND THE ALLEVIATION OF SUFFERING IN KALIHI VALLEY, BY SERVING COMMUNITIES, FAMILIES AND INDIVIDUALS THROUGH STRONG RELATIONSHIPS THAT HONOR CULTURE AND FOSTER HEALTH AND HARMONY. 0 0 11909306 8158900 SERVICES PERFORMED TO PROVIDE ACCESS TO MEDICAL, DENTAL AND SOCIAL SERVICES IN THE KALIHI VALLEY COMMUNITY. 11909306 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 51 0 242 1 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 DALLYS VEGA CHIEF FINANCIAL OFFICE 8087919400 2239 NORTH SCHOOL STREET HONOLULU HI 96819 PUA AUYONG PRESIDENT 1.00 X X 0 0 0 RYAN LEONG VICE PRESIDENT 1.00 X X 0 0 0 EDWARD KEMPER SECRETARY 1.00 X X 0 0 0 THOMAS KUSATSU TREASURER 1.00 X X 0 0 0 KAREN KAY FOX DIRECTOR 1.00 X 0 0 0 SANDRA HARVEY DIRECTOR 1.00 X 0 0 0 RICKEY MURASHIGE DIRECTOR 1.00 X 0 0 0 DAVID NAKAMOTO DIRECTOR 1.00 X 0 0 0 GEOFFREY PANG DIRECTOR 1.00 X 0 0 0 RASELA UI DIRECTOR 1.00 X 0 0 0 MICHAEL L WAGNER DIRECTOR 1.00 X 0 0 0 FALETASI ATONIO FORMER DIRECTOR 1.00 X 0 0 0 GRACE COBB FORMER DIRECTOR 1.00 X 0 0 0 DAVID DERAUF EXECUTIVE DIRECTOR 40.00 X 178899 0 44071 DALLYS GLORIBELL VEGA CHIEF FINANCIAL OFFICER 40.00 X 93051 0 18930 JO AYERS CHIEF OPERATING OFFICER 40.00 X 78479 0 12459 LAURA DEVILBISS CLINICAL DIRECTOR 40.00 X 178893 0 20900 JASON HIRAMOTO CO - DENTAL DIRECTOR 40.00 X 128744 0 16637 MYA HLA PSYCHIATRIST, DIR OF BH 40.00 X 118963 0 38513 NATHAN TAN PHYSICIAN 40.00 X 118329 0 21079 STEPHANIE BRANDLI PEDIATRIC DENTIST 40.00 X 108623 0 26303 1003981 0 198892 6 0 1 0 MCKESSON CORP 80 SAND ISLAND ACCESS ROAD HONOLULU HI 96819 PHARMACY SUPPLIES 513732 CVS PHARMACY ONE CVS DRIVE WOONSOCKET RI 02895 PHARMACY DISPENSING FEE 276290 JJS CONSTRUCTION INC 660 AIPO STREET HONOLULU HI 96825 CONSTRUCTION PROJECT 258450 E-MDS PO BOX 2889 CEDAR PARK TX 78630 MEDICAL BILLING 244241 5 MINUTES PHARMACY 1824 DILLINGHAM BLVD SUITE B HONOLULU HI 96819 PHARMACY DISPENSING FEE 201326 9 354695 6037578 1419067 7811340 MEDICAID 624110 4667300 4667300 PHARMACY 624110 1596075 1596075 PRIVATE INSURANCE 624110 1172537 1172537 MEDICARE 624110 422248 422248 CAPITATION FEES 624110 259954 259954 -38366 -38366 8079748 12053 12053 32444 0 32444 32444 32444 24450 13527 10923 10923 79152 0 79152 79152 16025660 8158900 0 55420 X 634000 207557 426443 6732402 5916938 814716 748 431001 371368 59566 67 2155110 1810129 344770 211 611493 515069 96363 61 57811 57811 1645794 1228558 417236 1665596 1509335 153847 2414 180356 39332 141024 73796 71035 2761 849510 94223 755287 63932 10113 53819 REPAIRS AND MAINTENANCE 79799 37356 42443 TRAINING 61801 47609 14192 DUES AND SUBSCRIPTIONS 51803 29041 22762 RENTAL EQUIPMENT 32223 14563 17660 24576 7080 17496 15351003 11909306 3438196 3501 598386 1031987 3221590 3655033 986942 848995 418519 1017292 746 1314 22471223 10145391 10950051 12325832 0 16176234 18880453 1099336 1149141 1005110 1012059 2104446 2161200 X 13880544 14566449 191244 2152804 14071788 16719253 16176234 18880453 X 674657 1972808 X X 0 1 X 1 1 1 X 6493263 5445476 5884053 7170276 7811340 32804408 6493263 5445476 5884053 7170276 7811340 32804408 32804408 10053 2157 5784 6468 44497 68959 87532 187060 240687 399306 914585 33787952 29364421 0.97090 0.97230 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME AND FEES - 2012 AMOUNT: $ 40,577. 2013 AMOUNT: $ 112,686. 2014 AMOUNT: $ 119,653. 2015 AMOUNT: $ 266,076. MEDICAL RECORD CHARGES - 2013 AMOUNT: $ 73,501. CARETAKER HOUSING - 2012 AMOUNT: $ 873. 2013 AMOUNT: $ 873. 2014 AMOUNT: $ 873. 2015 AMOUNT: $ 873. INCENTIVE PAYMENTS - 2012 AMOUNT: $ 46,082. 2014 AMOUNT: $ 120,161. 2015 AMOUNT: $ 132,357. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2288000 2288000 12603236 5199760 7403476 275950 25253 250697 2155018 1806961 348057 5149019 3113417 2035602 12325832 X 16553500 410752 3597 414349 16139151 -113491 -113491 16025660 15869766 503229 15534 518763 15351003 0 15351003 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE UNCERTAIN TAX POSITIONS TO BE RECOGNIZED IN THE 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, 2017 AND 2016 AND FOR THE YEARS THEN ENDED BY REVIEWEING THEIR INCOME TAX RETURNS AND CONFERRING WITH THEIR TAX ADVISORS, AND DETERMINED THAT KKV AND AFFILIATE HAD NO UNCERTAIN TAX POSITIONS REQUIRED TO BE REPORTED IN ACCORDANCE WITH SUCH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. 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 KKV FOUNDATION (REPORTED SEPARATELY) 3,597. PART XI, LINE 4B - OTHER ADJUSTMENTS: EXPENSES NOT RECORDED NET WITH FUNDRAISING EVENT INCOME -13,527. DECREASE IN TEMPORARILY RESTRICTED NET ASSETS -99,964. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM KKV FOUNDATION (REPORTED SEPARATELY) 2,007. EXPENSES NOT RECORDED NET WITH FUNDRAISING EVENT INCOME 13,527. PART XI, LINE 2B - DONATED SERVICES AND USE OF FACILITIES CONTRIBUTED MEDICAL SERVICES: $374,265 CONTRIBUTED RENT: $36,487 PART XII, LINE 2A - DONATED SERVICES AND USE OF FACILITIES CONTRIBUTED MEDICAL SERVICES: $374,265 CONTRIBUTED RENT: $36,487 CONTRIBUTED RENT RELATED TO CAPITALIZED LEASEHOLD INTEREST: $92,477 KALIHI AHUPUAA RIDE 24450 24450 213 13314 24450 24450 213 13314 13527 10923 X X X 0 0 0 0 0 0 0 0 0 DAVID DERAUF EXECUTIVE DIRECTOR 170845 0 8054 0 0 0 15478 0 28593 0 222970 0 0 0 LAURA DEVILBISS CLINICAL DIRECTOR 170783 0 8110 0 0 0 15206 0 5694 0 199793 0 0 0 MYA HLA PSYCHIATRIST, DIR OF BH 112991 0 5972 0 0 0 11326 0 27187 0 157476 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE EXECUTIVE DIRECTOR REVIEWS THE FORM 990 IN CONJUNCTION WITH THE CFO BEFORE PRESENTING TO THE FINANCE COMMITTEE FOR REVIEW. THE FINANCE COMMITTEE REVIEWS THE FORM 990 AND MAKES A RECOMMENDATION TO THE BOARD OF DIRECTORS FOR APPROVAL. 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 EXECUTIVE DIRECTOR'S SALARY IS DETERMINED BY THE BOARD OF DIRECTORS. ALL OTHER STAFF COMPENSATION IS DETERMINED BY THE SALARY COMMITTEE AND APPROVED BY THE EXECUTIVE DIRECTOR. 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 NOVEMBER 2017. 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 IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 1,228,558. MANAGEMENT AND GENERAL EXPENSES 417,236. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,645,794. FORM 990, PART XI, LINE 9: CAPITALIZED LEASEHOLD INTEREST - NET 1,972,808. FORM 990, PART XII, LINE 2C: EXPLANATION: THE ORGANIZATION HAS NOT CHANGED EITHER ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. 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