2018-05-09T17:27:41-05:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2017-01-01 990290103 KAHALA SENIOR LIVING COMMUNITY INC KAHA 8082187000 4389 MALIA STREET HONOLULU HI 96821 PATRICK DUARTE CEO/PRESIDENT 8082187000 2018-05-05 1 KURT BENNION CPA P01469618 4252506100 2017 2022-09-23 18:48:47Z PATRICK DUARTE 4389 MALIA STREET HONOLULU HI 96821 36104014 0 X WWW.KAHALANUI.COM X 1989 HI TO PROVIDE A CONTINUUM OF HIGH QUALITY RESIDENTIAL AND HEALTH CARE SERVICES TO RESIDENTS. 12 12 445 147 0 0 864117 1342106 27256848 27929030 2051901 3133358 5530219 2403117 35703085 34807611 301017 397098 0 0 13847765 14563547 0 0 16851 17969281 17470215 32118063 32430860 3585022 2376751 195472981 208217862 271491140 276612485 -76018159 -68394623 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 28071033 397098 27929030 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. IN OCTOBER 2015, KAHALA NUI OPENED AN ADULT WELLNESS CENTER THAT CAN SERVE UP TO 50 INDIVIDUALS. 28071033 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 1 1 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 69 0 445 1 0 1 CJ 0 0 0 0 0 0 0 1 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 HI X HUILAN KAMITA 8082187022 4389 MALIA STREET HONOLULU HI 96821 PHILIP CHING CHAIR 10.00 0.50 X X 0 0 0 STEVE ROBERTSON VICE CHAIR 5.00 0.50 X X 0 0 0 ROY KING JR SECRETARY (THROUGH FEB 2017) 1.00 0.10 X X 0 0 0 FRANK TOKIOKA II SECRETARY 5.00 0.50 X X 0 0 0 LISA SAKAMOTO CPA TREASURER 5.00 0.50 X X 0 0 0 WENDELL BROOKS JR DIRECTOR 3.00 0.50 X 0 0 0 EVELYN CHAR RN MS DIRECTOR (THROUGH FEB 2017) 1.00 0.10 X 0 0 0 SHEILA CHONG DIRECTOR 3.00 0.50 X 0 0 0 CHARLES KELLEY MD DIRECTOR (THROUGH FEB 2017) 1.00 0.10 X 0 0 0 SHARI KOGAN MD DIRECTOR 3.00 0.50 X 0 0 0 KAMAL MASAKI MD DIRECTOR 3.00 0.50 X 0 0 0 JON MCKENNA DIRECTOR 3.00 0.50 X 0 0 0 KENNETH MILLER CFA DIRECTOR 3.00 0.50 X 0 0 0 SON-JAI PAIK DIRECTOR 3.00 0.50 X 0 0 0 ADRIENNE YOSHIHARA DIRECTOR 3.00 0.50 X 0 0 0 PATRICK DUARTE CEO/PRESIDENT 44.00 6.00 X 331356 0 5666 WENDY WONG EXECUTIVE DIRECTOR 40.00 10.00 X 254640 0 6628 HUILAN KAMITA CFO 43.00 7.00 X 153615 0 4773 JAY DUQUETTE ADMINISTRATOR 49.00 1.00 X 137342 0 16712 DARLENE CANTO DIRECTOR OF MARKETING 38.00 12.00 X 123680 0 10465 DARYN MURAI SENIOR LIVING COUNSELOR 39.00 1.00 X 120777 0 22811 CHRISTINE CAGUIOA DIRECTOR OF NURSING 50.00 0.00 X 116888 0 22915 1238298 0 89970 10 0 1 0 UNITED LAUNDRY SERVICES INC PO BOX 31000 HONOLULU HI 968495757 LAUNDRY SERVICES 240092 GUO ZHANG CHEN 1039 WILIKI DR HONOLULU HI 96818 CONTRACTORS 186405 SYSTEMS ENGINEERING GROUP LLC 1314 S KING STREET SUITE 1554 HONOLULU HI 96814 CONTRACTORS 156684 ZIEGLER CAPITAL MANAGEMENT LLC 70 W MADISON ST STE 2400 CHICAGO IL 60602 ASSET MANAGEMENT 143044 HEIDE & COOK LTD 1714 KANAKANUI STREET HONOLULU HI 96819 EQUIPMENT MAINTENANCE 116216 6 1342106 17499 1342106 MONTHLY SERVICE FEES 623000 24140288 24140288 ENTRANCE FEES 623000 1963834 1963834 SKILLED NURSING ANCILLARY & THERA 623000 1824908 1824908 27929030 2215871 2215871 29710 0 29710 29710 29710 2213890 1296403 917487 917487 917487 FUTURE SERVICE OBLIGATIONS 900099 1585465 1585465 MISCELLANEOUS REVENUE 900099 787942 787942 2373407 34807611 27929030 0 5536475 358323 358323 38775 38775 598290 128934 452505 16851 10734850 9377073 1357777 202987 177313 25674 2165243 1891376 273867 862177 753126 109051 107919 107919 69616 4766 64850 249846 249846 1293102 1263015 30087 225481 51485 173996 1260580 1082571 178009 70938 23453 47485 3435340 3435340 9136 9136 2828200 2828200 4849810 3685856 1163954 378320 378320 FOOD 2340863 2324544 16319 REPAIRS & MAINTENANCE 291201 250012 41189 RESIDENT & COMMUNITY RE 40393 40393 EXCISE TAX EXPENSE 16153 16153 3317 2398 919 32430860 28071033 4342976 16851 2660294 6963899 3725172 3025980 685724 684544 260714 554712 35740 52736 625210 682012 160801512 55137987 108998497 105663525 71629974 83909933 6851656 6680521 195472981 208217862 1770146 2119784 5979601 6257541 55773740 54713587 1270000 1470000 206697653 212051573 271491140 276612485 X -78729130 -72418620 519085 1196486 2191886 2827511 -76018159 -68394623 195472981 208217862 2376751 5246785 0 X 0 1 X 1 0 X 1192117 510905 684852 864117 1342106 4594097 26091793 25845141 26181240 27256848 27929030 133304052 27283910 26356046 26866092 28120965 29271136 137898149 0 0 0 137898149 1396709 1816234 2623963 2037351 2245581 10119838 1396709 1816234 2623963 2037351 2245581 10119838 421675 431270 396389 617393 787942 2654669 29102294 28603550 29886444 30775709 32304659 150672656 0.91520 0.92470 0.06720 0.06000 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 1 274 274 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 2435246 635625 405059 27574 3448356 1788018 491245 155983 2435246 1475192 335660 -22834 1788018 1059178 356736 59278 1475192 1008245 50933 1059178 0.00000 0.82000 0.18000 0 0 148494763 47760418 100734345 5572870 2553295 3019575 6492251 4824274 1667977 241628 241628 105663525 ENTRANCE FEE LIABILITY 211623806 ACCRUED BOND INTEREST 348056 RESIDENT LIABILITIES 79711 212051573 X 29180821 402493 402493 28778328 249846 5779437 6029283 34807611 32181014 0 32181014 249846 249846 32430860 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. THE ORGANIZATION HOLDS PETTY CASH FOR RESIDENTS, JUST TO PROTECT THE MONEY. THE MONEY IS HELD IN A SEPARATE BANK ACCOUNT. INDIVIDUALS CAN ACCESS THEIR MONEY DURING REGULAR BUSINESS HOURS. 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 STATMENTS. 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 RESTRICTION FOR OPERATIONS 402,493. PART XI, LINE 4B - OTHER ADJUSTMENTS: TEMPORARILY RESTRICTED CONTRIBUTIONS 674,835. PERMANENTLY RESTRICTED CONTRIBUTIONS 635,625. EARNING ON ENDOWMENTS 405,059. INVESTMENT INCOME 1,560,966. DECREASE IN OBLIGATION TO PROVIDE FUTURE SERVICES 1,585,465. REALIZED GAIN ON SALE OF INVESTMENTS 917,487. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS 0 0 INVESTMENTS 3099453 0 0 0 0 0 0 3099453 0 3099453 0 0 0 0 0 0 0 ALZHEIMER'S ASSOCIATION 1050 ALA MOANA BLVD 2610 HONOLULU HI 96814 990212360 501(C)(3) 47097 TO SUPPORT EDUCATION AND AWARENESS CATHOLIC CHARITIES HAWAII 1822 KEEAUMOKU STREET HONOLULU HI 96822 990073547 501(C)(3) 48065 SENIOR HOUSING ASSISTANCE HAWAII MEALS ON WHEELS PO BOX 61194 HONOLULU HI 96839 990198132 501(C)(3) 51445 82541 FAIR MARKET VALUE FOOD HOT MEALS FOR COMMUNITY SENIORS HELPING HANDS HAWAII 2100 N NIMITZ HIGHWAY HONOLULU HI 96819 237365077 501(C)(3) 7050 FAIR MARKET VALUE REFRIGERATORS, STOVES, MICROWAVES, WASHER/DRYER HELP INDIVIDUALS AND FAMILIES STABILIZE THEIR LIVING CONDITION TO WORK TOWARDS SELF-SUFFICIENCY KAPIOLANI COMMUNITY COLLEGE 4303 DIAMOND HEAD ROAD HONOLULU HI 96816 996000354 501(C)(3) 7209 OCCUPATIONAL THERAPIST TRAINING KOKUA KALIHI VALLEY 2239 N SCHOOL ST HONOLULU HI 96819 990149797 501(C)(3) 27680 16602 FAIR MARKET VALUE RESOURCE BOOKLET SENIOR HEALTH / PROGRAM ASSISTANCE PALAMA SETTLEMENT 810 N VINEYARD BLVD HONOLULU HI 96817 990074140 501(C)(3) 14942 FAIR MARKET VALUE GIFT BAGS PROVIDE HOUSEHOLD TOILETRIES AND CANNED GOODS TO HOMEBOUND SENIORS PROJECT DANA 2720 NAKOOKOO ST HONOLULU HI 96826 990143990 501(C)(3) 37885 SUPPORT SENIOR PROGRAMS SAINT MARY STAR OF THE SEA SCHOOL 4469 MALIA STREET HONOLULU HI 96821 990078514 501(C)(3) 11407 SPONSOR THE EAST HONOLULU FOOD FESTIVAL 9 0 SCHOLARSHIP PROGRAM 14 38775 PART I, LINE 2: EACH GRANT TO AN UNRELATED ORGANIZATION IS APPROVED AND INCLUDED IN THE BUDGET; ALL EXPENDITURES ARE PRESENTED TO THE BOARD OF DIRECTORS. THE HAWAII COMMUNITY FOUNDATION MONITORS THE USE OF SCHOLARSHIP FUNDS ON BEHALF OF KAHALA SENIOR LIVING COMMUNITY. X 0 1 X X X X X 0 0 0 1 0 0 0 0 0 PATRICK DUARTE CEO/PRESIDENT 287356 0 44000 0 0 0 5666 0 0 0 337022 0 0 0 WENDY WONG EXECUTIVE DIRECTOR 214640 0 40000 0 0 0 6034 0 594 0 261268 0 0 0 HUILAN KAMITA CFO 135796 0 17819 0 0 0 4566 0 207 0 158388 0 0 0 JAY DUQUETTE ADMINISTRATOR 119280 0 18062 0 0 0 3627 0 13085 0 154054 0 0 0 PART I, LINE 1A SOCIAL CLUB DUES ARE PROVIDED FOR PATRICK DUARTE, CEO/PRESIDENT, AND ARE NOT INCLUDED IN THIS TAXABLE COMPENSATION. PART I, LINE 1B NO WRITTEN POLICY IS FOLLOWED; HOWEVER, THE SOCIAL CLUB MEMBERSHIP WAS APPROVED BY THE EXECUTIVE COMMITTEE AND THE ORGANIZATION REQUIRES SUBSTANTIATION PRIOR TO REIMBURSEMENT FOR SOCIAL CLUB EXPENSES. PART I, LINE 5 THE CEO/PRESIDENT AND EXECUTIVE DIRECTOR RECEIVE BONUSES 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 19220000 75450742 5188205 1437467 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. 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 THE CEO. 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 B, LINE 11B A FORM 990 DRAFT WAS PROVIDED TO OFFICERS AND KEY MANAGEMENT PRIOR TO BOARD REVIEW. UPON THE APPROVAL OF OFFICERS AND KEY MANAGEMENT, THE FORM WAS SUBMITTED TO THE BOARD OF DIRECTORS. 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 DISCLOSURE 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 MEMBER OF HIS OR HER IMMDIATE FAMILY HAS 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 CURRENT CEO/PRESIDENT'S COMPENSATION, ITS EXECUTIVE COMMITTEE REVIEWED THE QUALIFICATIONS OF THE EXISTING CEO/PRESIDENT, PATRICK DUARTE, ALONG WITH INDUSTRY-RELATED INFORMATION GATHERED FROM AN INDEPENDENT THIRD-PARTY EXECUTIVE RECRUITER AND INTERNAL SALARIES MANAGEMENT PERSONNEL. IN 2017, THE PROCESS INCLUDED COMPARABILITY DATA, REVIEW AND APPROVAL BY INDEPENDENT PERSONS, 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 HOME- AND COMMUNITY-BASED PROGRAMS FOR THE ELDERLY HI 501(C)(3) LINE 10 KAHALA NUI SENIOR LIVING INC 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 INC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0