KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES (EIN 99-0149797)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-04-12
IRS object ID
201241039349300339
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-04-12T17:01:14-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CW ASSOCIATES CPASBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1700 BISHOP STREET SUITE 1040AddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96813ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN990149797EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlKOKUNameControl
Phone8087919411Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12239 NORTH SCHOOL STREETAddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96819ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAVID DERAUFName
TitleCHIEF EXECUTIVE OFFICERTitle
Phone8087919411Phone
Date Signed2012-04-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMARK A HAYESName
Phone8085311040Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDAVID DERAUFNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12239 NORTH SCHOOL STREETAddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96819ZIPCode
FieldValueIRS element (for citing)
Gross Receipts8919741GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.KKV.NETWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1972YearFormation
State Legal DomicileHIStateLegalDomicile
Activity Or Mission DescriptionKOKUA 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees176TotalNbrEmployees
Total Nbr Volunteers18TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year6164036ContributionsGrantsPriorYear
Contributions Grants Current Year4968434ContributionsGrantsCurrentYear
Program Service Revenue Prior Year3949395ProgramServiceRevenuePriorYear
Program Service Revenue CY3888859ProgramServiceRevenueCY
Investment Income Prior Year0InvestmentIncomePriorYear
Investment Income Current Year10489InvestmentIncomeCurrentYear
Other Revenue Prior Year97657OtherRevenuePriorYear
Other Revenue Current Year51959OtherRevenueCurrentYear
Total Revenue Prior Year10211088TotalRevenuePriorYear
Total Revenue Current Year8919741TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6463049SalariesEtcPriorYear
Salaries Etc Current Year7030483SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year99479TotalFundrsngExpCurrentYear
Other Expense Prior Year2272362OtherExpensePriorYear
Other Expenses Current Year2360767OtherExpensesCurrentYear
Total Expenses Prior Year8735411TotalExpensesPriorYear
Total Expenses Current Year9391250TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1475677RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-471509RevenuesLessExpensesCY
Total Assets BOY11828455TotalAssetsBOY
Total Assets EOY11268361TotalAssetsEOY
Total Liabilities BOY726887TotalLiabilitiesBOY
Total Liabilities EOY638302TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY11101568NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY10630059NetAssetsOrFundBalancesEOY
Mission DescriptionTOGETHER 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense7562733Expense
Revenue3888859Revenue
DescriptionSERVICES PERFORMED TO PROVIDE ACCESS TO MEDICAL, DENTAL AND SOCIAL SERVICES IN THE KALIHI VALLEY COMMUNITY.Description
Total Program Service Expense7562733TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109622NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees176NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledHIStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDALLYS SALAS CHIEF FINANCIAL OFFICNamePerson
Telephone Number8087919411TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12239 NORTH SCHOOL STREETAddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96819ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
EDWARD KEMPER
PRESIDENT/DIRECTOR1.00XX000
MARISSA FAY WENGLER
VICE PRESIDENT/DIRECTOR1.00XX000
DAVID NAKAMOTO
TREASURER/DIRECTOR1.00XX000
JOVY ARREOLA
SECRETARY/DIRECTOR1.00XX000
RICKEY MURASHIGE
DIRECTOR1.00X000
GRACE COBB
DIRECTOR1.00X000
GEOFFREY PANG
DIRECTOR1.00X000
MARYROSE MCCLELLAND
DIRECTOR1.00X000
SHARON ROUPPET
DIRECTOR1.00X000
SEKAP ESAH
DIRECTOR1.00X000
KAREN FOX
DIRECTOR1.00X000
ROSEMARIE SANCHEZ
DIRECTOR1.00X000
JOHN R VAUGHN
DIRECTOR1.00X000
MICHAEL EPP
DIRECTOR (FORMER)1.00X000
DAVID DERAUF
CHIEF EXECUTIVE OFFICER40.00X146239026603
CYNTHIA STURDEVANT
CHIEF OPERATING OFFICER40.00X63348015153
DALLYS SALAS
CHIEF FINANCIAL OFFICER40.00X7553704301
LAURA DEVILBISS
CLINICAL DIRECTOR40.00161390017871X
DAVID R BREESE
DENTIST40.00107135013770X
BRADLEY CHUN
PHYSICIAN40.00116851019636X
JASON Y HIRAMOTO
DENTIST40.00107108013759X
JONAS NAVICKAS
PHYSICIAN40.00119676019777X
FieldValueIRS element (for citing)
Total Reportable Comp From Org897284TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation130870TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Government Grants3197401GovernmentGrants
All Other Contributions1771033AllOtherContributions
Noncash Contributions17188NoncashContributions
Total Contributions4968434TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAID62411025546882554688
PRIVATE INSURANCE624110603877603877
MEDICARE624110335175335175
SELF-PAY624110256567256567
CAPITATION FEES624110138552138552
FieldValueIRS element (for citing)
Total Program Service Revenue3888859TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column10489TotalRevenueColumn
Exclusion$10,489ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUS INCOMEDescription
Business Code900099BusinessCode
Total Revenue Column51959TotalRevenueColumn
Exclusion$51,959ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue51959TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column8919741TotalRevenueColumn
Related Or Exempt Function Income3888859RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$62,448ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1049707Total
Program Services704181ProgramServices
Management And General345526ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4043563Total
Program Services3470610ProgramServices
Management And General487361ManagementAndGeneral
Fundraising85592Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total537394Total
Program Services438733ProgramServices
Management And General98661ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total936750Total
Program Services730374ProgramServices
Management And General206376ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total463069Total
Program Services381615ProgramServices
Management And General81454ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total8574Total
Management And General8574ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total62000Total
Management And General62000ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total475002Total
Program Services319511ProgramServices
Management And General155491ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total848232Total
Program Services721947ProgramServices
Management And General118002ManagementAndGeneral
Fundraising8283Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total192505Total
Program Services158963ProgramServices
Management And General31847ManagementAndGeneral
Fundraising1695Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total64362Total
Program Services49285ProgramServices
Management And General15077ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total217783Total
Program Services168932ProgramServices
Management And General46026ManagementAndGeneral
Fundraising2825Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total53599Total
Program Services41121ProgramServices
Management And General11744ManagementAndGeneral
Fundraising734Fundraising

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
BAD DEBT261437261437
REPAIRS AND MAINTENANCE540523107422978
TRAINING45021400454976
BUSINESS EXPENSE35493814027353
RENTAL EQUIPMENT25519195775592350

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total17188Total
Program Services17188ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9391250Total
Program Services7562733ProgramServices
Management And General1729038ManagementAndGeneral
Fundraising99479Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3094967BOY
EOY942579EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY795111BOY
EOY2536042EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY942985BOY
EOY865922EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY750468BOY
EOY592171EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY20029BOY
EOY16186EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis9456689LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3141228LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6224895BOY
EOY6315461EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11828455BOY
EOY11268361EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY485114BOY
EOY638302EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY241773BOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY726887BOY
EOY638302EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY9194722BOY
EOY8795925EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1906846BOY
EOY1834134EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11101568BOY
EOY10630059EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11828455BOY
EOY11268361EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-471509ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3601971CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3630049CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3450251CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6146036CurrentTaxYearMinus1Year
Current Tax Year4968434CurrentTaxYear
Total21796741Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3601971CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3630049CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3450251CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6146036CurrentTaxYearMinus1Year
Current Tax Year4968434CurrentTaxYear
Total21796741Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total1052636AmountsSubstContributorsTotal
Public Support Total17020744105PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years96172CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years87876CurrentTaxYearMinus3Years
Current Tax Year10489CurrentTaxYear
Total194537Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years18688CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years107463CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years101151CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year97657CurrentTaxYearMinus1Year
Current Tax Year51959CurrentTaxYear
Total376918Total
FieldValueIRS element (for citing)
Total Support22368196TotalSupport
Gross Receipts From Admissions Etc19708743GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.92740PublicSupportPertcentage170
Public Support Pertcent Prior Year0.96980PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170
General ExplanationSCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOMEGeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis2288000OtherCostOrOtherBasis
Book Value2288000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4932795OtherCostOrOtherBasis
Depreciation2181503Depreciation
Book Value2751292BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis17500OtherCostOrOtherBasis
Depreciation16511Depreciation
Book Value989BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1143026OtherCostOrOtherBasis
Depreciation943214Depreciation
Book Value199812BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1075368OtherCostOrOtherBasis
Book Value1075368BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings6315461TotalOfBookValueLandBuildings
Total Revenue8919741TotalRevenue
Total Expenses9391250TotalExpenses
Excess Or Deficit For Year-471509ExcessOrDeficitForYear
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS-471509ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt9295476TotRevenueEtcAuditedFinclStmt
Donated Srvc And Use Of Facilities303023DonatedSrvcAndUseOfFacilities
Other Revenues72712OtherRevenues
Revenue Not Rptd F990375735RevenueNotRptdF990
Revenue Subtotal8919741RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9908919741TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt9694273TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities303023DonatedServicesUseOfFacilities
Expenses Not Rptd F990303023ExpensesNotRptdF990
Expenses Subtotal9391250ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9909391250TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:MANAGEMENT HAS EVALUATED THE TAX POSITIONS OF KKV AND AFFILIATE AS OF JUNE 30, 2011 AND 2010 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 UNTIL THE STATUTE OF LIMITATIONS EXPIRES.
PART XII, LINE 2D - OTHER ADJUSTMENTS:DECREASE IN TEMPORARILY RESTRICTED NET ASSETS 72,712.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DAVID DERAUF
14623900000126560139470172842000
LAURA DEVILBISS
1613900000013516043550179261000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE EXECUTIVE DIRECTOR REVIEWS THE REPORT IN CONJUNCTION WITH THE CFO BEFORE PRESENTING TO THE FINANCE COMMITTEE FOR REVIEW. AFTER THE FINANCE COMMITTEE REVIEWS THE 990 REPORT, AN ELECTRONIC COPY IS SENT TO ALL BOARD MEMBERS FOR REVIEW AND APPROVAL; A HARD COPY IS ALSO PROVIDED AT THE FOLLOWING BOARD OF DIRECTORS MEETING.
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 12C
THE COMPENSATION COMMITTEE USES SALARY GRADE AND RANGE TO MAKE SURE OUR SALARIES ARE COMPARABLE WITH COMMUNITY STANDARDS. THE HAWAII PRIMARY CARE ASSOCIATION DOES REGULAR ASSESSMENTS OF THE COMMUNITY HEALTH CENTERS SO WE CAN MAKE SURE OUR SALARIES ARE COMPARABLE WITH OTHER HEALTH CENTERS. THE SALARY RANGE FOR EACH INDIVIDUAL IS DEPENDENT ON EXPERIENCE AND EDUCATION. THE EXECUTIVE DIRECTOR'S SALARY IS DETERMINED BY THE COMPENSATION COMMITTEE AND APPROVED BY THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE RECOMMENDS THE SALARY RANGES TO THE EXECUTIVE DIRECTOR, WHO APPROVES THE SALARIES FOR OFFICERS AND KEY MANAGEMENT EMPLOYEES.FORM 990, PART VI, SECTION B, LINE 15
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1KALIHI VALLEY COMMUNITY FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12239 NORTH SCHOOL STREETAddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96819ZIPCode
FieldValueIRS element (for citing)
EIN990329894EIN
Primary ActivitiesPROVIDE FINANCIAL SUPPORT TO CENTERPrimaryActivities
Legal Domicile StateHILegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusLINE 7PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1KOKUA KALIHI VALLEY COMP FAMILY SVCSBusinessNameLine1
FieldValueIRS element (for citing)
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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