2015-05-14T22:06:03-05:00 2014-06-30 990292355 KKDLY LLC 745 FORT ST STE 2100 HONOLULU HI 96813 990 2013-07-01 990149797 KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES KOKU 8087919400 2239 NORTH SCHOOL STREET HONOLULU HI 96819 DAVID DERAUF EXECUTIVE DIRECTOR 8087919400 2015-05-14 1 ALAN E KOBAYASHI P00370602 8085213962 2015-05-13 X 2013 2016-02-25 16:41:14Z DAVID DERAUF 2239 NORTH SCHOOL STREET HONOLULU HI 96819 10684136 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 11 201 55 0 0 6493263 5445476 4349961 5049442 10053 2158 87532 187060 10940809 10684136 0 0 0 0 7612117 8135035 0 0 91059 2814313 3275739 10426430 11410774 514379 -726638 16157966 15269722 1078040 916434 15079926 14353288 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 8609098 5236502 SERVICES PERFORMED TO PROVIDE ACCESS TO MEDICAL, DENTAL AND SOCIAL SERVICES IN THE KALIHI VALLEY COMMUNITY. 8609098 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 1 201 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 SALAS CHIEF FINANCIAL OFFIC 8087919400 2239 NORTH SCHOOL STREET HONOLULU HI 96819 JEFFREY ACIDO DIRECTOR 1.00 X 0 0 0 PUA AUYONG DIRECTOR/PRESIDENT 1.00 X 0 0 0 SHIGEKO BUALUAY DIRECTOR 1.00 X 0 0 0 GRACE COBB TREASURER/DIRECTOR 1.00 X 0 0 0 INA FALETOGO DIRECTOR 1.00 X 0 0 0 KAREN KAY FOX SECRETARY 1.00 X 0 0 0 EDWARD KEMPER DIRECTOR 1.00 X 0 0 0 MISKE KONY MEMBER 1.00 X 0 0 0 THOMAS KUSATSU DIRECTOR/TREASURER 1.00 X 0 0 0 RICKEY MURASHIGE PRESIDENT/DIRECTOR 1.00 X 0 0 0 DAVID NAKAMOTO VICE PRESIDENT 1.00 X 0 0 0 GEOFFREY PANG DIRECTOR 1.00 X 0 0 0 SHARON ROUPPET DIRECTOR 1.00 X 0 0 0 MARISSAFAY WENGLER DIRECTOR 1.00 X 0 0 0 DAVID DERAUF EXECUTIVE DIRECTOR 40.00 X 152031 0 16974 DALLYS GLORIBELL SALAS CHIEF FINANCIAL OFFICER 40.00 X 80780 0 7442 JO AYERS CHIEF OPERATING OFFICER 40.00 X 29449 0 576 LAURA DEVILBISS CLINICAL DIRECTOR 40.00 X 156992 0 13962 JONAS NAVICKAS PHYSICIAN 40.00 X 128467 0 11987 BRADLEY CHUN PHYSICIAN 40.00 X 119332 0 10837 NATHAN TAN PHYSICIAN 40.00 X 112324 0 1219 MYA HLA PSYCHIATRIST, DIR OF BH 40.00 X 109589 0 11095 JASON HIRAMOTO DENTAL DIRECTOR 40.00 X 111957 0 10107 1000921 0 84199 8 0 1 0 MINA PHARMACY 3375 KOAPAKA ST SUITE F245 HONOLULU HI 96819 PHARMACY DISPENSING FEE 155184 MCKESSON CORP 80 SAND ISLAND ACCESS ROAD HONOLULU HI 96819 PHARMACUTICAL SUPPLIES 145978 ZR SYSTEMS GROUP LLC 1953 S BERETANIA ST HONOLULU HI 96826 INFORMATION TECH SUPPORT 109667 3 124427 2802106 2518943 5445476 MEDICAID 624110 3667784 3667784 PRIVATE INSURANCE 624110 618299 618299 PHARMACY 624110 590515 590515 MEDICARE 624110 104069 104069 SELF-PAY 624110 4530 4530 64245 64245 5049442 2158 2158 OTHER INCOME AND FEES 624110 112686 112686 INCENTIVE PAYMENTS 624110 73501 73501 CARETAKER HOUSING 900099 873 873 187060 10684136 5236502 0 2158 517952 174180 343772 5779782 4994687 694036 91059 339403 291906 47497 959740 805529 154211 538158 445792 92366 79 79 31727 31727 952231 579053 373178 1114566 1003364 111202 221766 207 221559 68010 64311 3699 566561 117722 448839 55085 6661 48424 REPAIRS AND MAINTENANCE 115278 78551 36727 MISCELLANEOUS 62239 4751 57488 DEVELOPMENT AND TRAININ 37898 28298 9600 EQUIPMENT RENTAL 27537 2213 25324 22762 11873 10889 11410774 8609098 2710617 91059 545064 428279 830533 832502 723456 842041 1064997 734964 79025 5967 16910797 4484828 12914891 12425969 16157966 15269722 928040 916434 150000 1078040 916434 X 14170799 13638025 909127 715263 15079926 14353288 16157966 15269722 X -726638 0 X X 0 1 X 1 1 1 X 6146036 4968434 9824923 6493263 5445476 32878132 6146036 4968434 9824923 6493263 5445476 32878132 1406224 31471908 10489 6859 10053 2157 29558 97657 51959 25314 87532 187060 449522 33357212 0.94350 0.94970 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME AND FEES - 2009 AMOUNT: $ 97,657. 2010 AMOUNT: $ 51,959. 2012 AMOUNT: $ 40,577. 2013 AMOUNT: $ 112,686. MEDICAL RECORD CHARGES - 2011 AMOUNT: $ 24,404. 2013 AMOUNT: $ 73,501. CARETAKER HOUSING - 2011 AMOUNT: $ 910. 2012 AMOUNT: $ 873. 2013 AMOUNT: $ 873. INCENTIVE PAYMENTS - 2012 AMOUNT: $ 46,082. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2288000 2288000 12603236 3104697 9498539 17500 17500 0 2002061 1362631 639430 12425969 X 11053677 363474 6067 369541 10684136 0 10684136 11867886 455612 1500 457112 11410774 0 11410774 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, 2014 AND 2013 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) 6,067. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM KKV FOUNDATION (REPORTRED SEPARATELY) 1,500. PART XI, LINE 2 - DONATED SERVICES AND USE OF FACILITIES CONTRIBUTED MEDICAL SUPPLIES: $349,899 CONTRIBUTED RENT: $13,248 OTHER CONTRIBUTED SUPPLIES: $327 PART XII, LINE 1 - DONATED SERVICES AND USE OF FACILITIES CONTRIBUTED RENT: $349,887 CONTRIBUTED MEDICAL SUPPLIES: $105,725 X X X 0 0 0 0 0 0 0 0 0 DAVID DERAUF EXECUTIVE DIRECTOR 152031 0 0 0 0 0 13127 0 3847 0 169005 0 0 0 LAURA DEVILBISS CLINICAL DIRECTOR 156992 0 0 0 0 0 13386 0 576 0 170954 0 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. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED EITHER ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. FORM 990, PART XI, LINE 8 IN PRIOR YEARS, KKV DID NOT RECORD ITS FAIR VALUE OF BELOW MARKET LEASE ON ITS BALANCE SHEET AND RECORDED THE DIFFERENCE BETWEEN THE ACTUAL LEASE RENT AND THE ESTIMATED FAIR VALUE OF THE ANNUAL LEASE RENT AS CONTRIBUTED RENT REVENUE AND LEASE EXPENSE. THE PRIOR PERIOD ADJUSTMENT WAS TO CONFORM WITH THE AICPA AAG HEALTH CARE ENTITIES, SECTION 11.25 GUIDANCE TO PROPERLY REPORT THE BELOW MARKET VALUE LEASE. 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