2016-05-12T20:08:13-05:00 2015-06-30 990292355 KKDLY LLC 745 FORT ST STE 2100 HONOLULU HI 96813 990 2014-07-01 990149797 KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES KOKU 8087919400 2239 NORTH SCHOOL STREET HONOLULU HI 96819 DAVID DERAUF EXECUTIVE DIRECTOR 8087919400 2016-05-12 1 ALAN E KOBAYASHI P00370602 8085213962 2016-05-11 X 2014 2016-08-17 19:52:53Z DAVID DERAUF 2239 NORTH SCHOOL STREET HONOLULU HI 96819 12232825 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. 10 10 222 70 0 0 5445476 5884053 5049442 6102301 2158 5784 187060 240687 10684136 12232825 0 0 0 0 8135035 8563960 0 0 142123 3275739 3787791 11410774 12351751 -726638 -118926 15269722 16392462 916434 2158100 14353288 14234362 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 9191628 6342988 SERVICES PERFORMED TO PROVIDE ACCESS TO MEDICAL, DENTAL AND SOCIAL SERVICES IN THE KALIHI VALLEY COMMUNITY. 9191628 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 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 49 0 1 222 1 0 0 0 0 0 0 0 0 0 0 X 10 10 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 0 0 0 SHIGEKO BUALUAY DIRECTOR 1.00 X 0 0 0 GRACE COBB DIRECTOR 1.00 X 0 0 0 KAREN KAY FOX DIRECTOR 1.00 X 0 0 0 EDWARD KEMPER SECRETARY 1.00 X 0 0 0 THOMAS KUSATSU TREASURER 1.00 X 0 0 0 RICKEY MURASHIGE PRESIDENT 1.00 X 0 0 0 DAVID NAKAMOTO DIRECTOR 1.00 X 0 0 0 RYAN LEONG VICE PRESIDENT 1.00 X 0 0 0 SHARON ROUPPET DIRECTOR 1.00 X 0 0 0 DAVID DERAUF EXECUTIVE DIRECTOR 40.00 X 151612 0 39752 DALLYS GLORIBELL VEGA CHIEF FINANCIAL OFFICER 40.00 X 80832 0 11649 JO AYERS CHIEF OPERATING OFFICER 40.00 X 69095 0 4681 LAURA DEVILBISS CLINICAL DIRECTOR 40.00 X 155882 0 18235 JONAS NAVICKAS PHYSICIAN 40.00 X 125784 0 20268 BRADLEY CHUN PHYSICIAN 40.00 X 113035 0 14396 NATHAN TAN PHYSICIAN 40.00 X 107563 0 7413 MYA HLA PSYCHIATRIST, DIR OF BH 40.00 X 109390 0 19946 JASON HIRAMOTO DENTAL DIRECTOR 40.00 X 112133 0 14286 1025326 0 150626 8 0 1 0 MCKESSON CORP 80 SAND ISLAND ACCESS ROAD HONOLULU HI 96819 PHARMACUTICAL SUPPLIES 254277 CVS PHARMACY ONE CVS LANE WOONSOCKET RI 02895 PHARMACY DISPENSING FEE 138459 MINA PHARMACY 3375 KOAPAKA ST SUITE F245 HONOLULU HI 96819 PHARMACY DISPENSING FEE 131178 ZR SYSTEMS GROUP LLC 1953 S BERETANIA ST HONOLULU HI 96826 INFORMATION TECH SUPPORT 105694 4 103719 3945008 1835326 5884053 MEDICAID 624110 4068600 4068600 PHARMACY 624110 910570 910570 PRIVATE INSURANCE 624110 808124 808124 SELF-PAY 624110 151919 151919 MEDICARE 624110 147732 147732 15356 15356 6102301 5784 5784 INCENTIVE PAYMENTS 624110 120161 120161 OTHER INCOME AND FEES 624110 119653 119653 CARETAKER HOUSING 900099 873 873 240687 12232825 6342988 0 5784 553319 187017 366302 6062819 5249827 670869 142123 394206 343640 50566 1025028 868784 156244 528588 441506 87082 9680 9680 55393 55393 1106363 709707 396656 1189037 1089738 99299 192962 4649 188313 82355 70639 11716 849506 91502 758004 47796 5045 42751 REPAIRS AND MAINTENANCE 108568 81234 27334 MISCELLANEOUS 49210 10753 38457 DEVELOPMENT AND TRAININ 36996 21739 15257 EQUIPMENT RENTAL 35959 7349 28610 23966 8499 15467 12351751 9191628 3018000 142123 428279 2292966 832502 836029 842041 737392 734964 920539 5967 3980 16928390 5326834 12425969 11601556 15269722 16392462 916434 1160117 997983 916434 2158100 X 13638025 13947203 715263 287159 14353288 14234362 15269722 16392462 -118926 0 X X 0 1 X 1 1 1 X 4968434 9824923 6493263 5445476 5884053 32616149 4968434 9824923 6493263 5445476 5884053 32616149 291031 32325118 10489 6859 10053 2157 5784 35342 51959 25314 87532 187060 240687 592552 33244043 23397061 0.97240 0.94350 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME AND FEES - 2010 AMOUNT: $ 51,959. 2012 AMOUNT: $ 40,577. 2013 AMOUNT: $ 112,686. 2014 AMOUNT: $ 119,653. MEDICAL RECORD CHARGES - 2011 AMOUNT: $ 24,404. 2013 AMOUNT: $ 73,501. CARETAKER HOUSING - 2011 AMOUNT: $ 910. 2012 AMOUNT: $ 873. 2013 AMOUNT: $ 873. 2014 AMOUNT: $ 873. INCENTIVE PAYMENTS - 2012 AMOUNT: $ 46,082. 2014 AMOUNT: $ 120,161. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2288000 2288000 12603236 3804125 8799111 17500 17500 0 2019654 1505209 514445 11601556 X 12581577 344573 4179 348752 12232825 0 12232825 12790311 437050 1510 438560 12351751 0 12351751 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE 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 THE TAX POSITIONS OF KKV AND AFFILIATE AS OF JUNE 30, 2015 AND 2014 AND FOR THE YEARS THEN ENDED BY REVIEWING THEIR INCOME TAX RETURNS AND CONFERRING WITH THEIR TAX ADVISORS, AND DETERMINED THAT THERE WERE NO UNCERTAIN TAX POSITIONS REQUIRED TO BE REPORTED IN ACCORDANCE WITH SUCH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. SUCH RETURNS ARE OPEN FOR EXAMINATION BY TAXING AUTHORITIES UNTIL THE STATUTES OF LIMITATIONS EXPIRE. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE FROM KKV FOUNDATION (REPORTED SEPARATELY) 4,179. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM KKV FOUNDATION (REPORTED SEPARATELY) 1,510. PART XI, LINE 2 - DONATED SERVICES AND USE OF FACILITIES CONTRIBUTED MEDICAL SUPPLIES: $331,325 CONTRIBUTED RENT: $13,248 PART XII, LINE 1 - DONATED SERVICES AND USE OF FACILITIES CONTRIBUTED MEDICAL SUPPLIES: $331,325 CONTRIBUTED RENT: $105,725 SECTION 1.263(A)-1(F) DE MINIMIS SAFE HARBOR ELECTION ------------------------------------------------------------------------ KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES 2239 NORTH SCHOOL STREET HONOLULU, HI 96819 TAXPAYER IDENTIFICATION NUMBER: 99-0149797 FOR THE YEAR ENDING JUNE 30, 2015 KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES IS MAKING THE DE MINIMIS SAFE HARBOR ELECTION UNDER REG. SEC. 1.263(A)-1(F). ------------------------------------------------------------------------ X X X 0 0 0 0 0 0 0 0 0 DAVID DERAUF EXECUTIVE DIRECTOR 151612 0 0 0 0 0 0 13127 0 26625 151612 39752 0 0 LAURA DEVILBISS CLINICAL DIRECTOR 155882 0 0 0 0 0 0 13554 0 4681 155882 18235 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE EXECUTIVE DIRECTOR REVIEWS THE 990 IN CONJUNCTION WITH THE CFO BEFORE PRESENTING TO THE FINANCE COMMITTEE FOR REVIEW. THE FINANCE COMMITTEE REVIEWS THE 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 EXECUTIVE COMMITTEE OF THE BOARD AND APPROVED BY THE FULL BOARD. ALL OTHER STAFF COMPENSATION IS DETERMINED BY THE COMPENSATION COMMITTEE AND APPROVED BY THE EXECUTIVE DIRECTOR AND THE BOARD OF DIRECTORS. 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 2013. 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. 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