2012-05-15T16:16:26-05:00 2011-06-30 STILLWAGGON & MCGILL LLC 10 WOODLAND CENTER DRIVE GROVE CITY PA 16127 990 2010-07-01 990249327 MAUNALANI NURSING AND REHABILITATION CENTER MAUN 8087320771 5113 MAUNALANI CIRCLE HONOLULU HI 96816 SAI CHANTAVY 8087320771 2012-05-15 1 JOHN C STILLWAGGON CPA 7244587490 2012-05-15 2010 2016-02-24 21:20:13Z SAI CHANTAVY 5113 MAUNALANI CIRCLE HONOLULU HI 96816 11168610 0 X N/A X 1950 HI COMMITTED TO PROVIDING EXCELLENCE IN NURSING CARE AND REHABILITATION SERVICES BY BEING READY TO MEET THE CHANGING NEEDS OF THE COMMUNITY. MAUNALANI NURSING AND REHABILITATION CENTER IS THE PROVIDER AND EMPLOYER OF CHOICE IN THE INDUSTRY. RESIDENTS AND GUESTS WILL EXPERIENCE A CULTURE OF CARING THAT IS LIFE AFFIRMING, SATISFYING AND MEANINGFUL. 8 7 155 3 0 0 13740 278082 10407341 10882784 2602 7744 0 0 10423683 11168610 0 0 0 0 6509304 6212305 0 0 0 4709562 3513120 11218866 9725425 -795183 1443185 22416295 25690011 3589374 3205660 18826921 22484351 MAUNALANI NURSING AND REHABILITATION CENTER IS A PRIVATE NON-PROFIT HEALTH CARE ORGANIZATION FOUNDED IN 1950. THE ORGANIZATION IS COMMITTED TO PROVIDING EXCELLENCE IN NURSING CARE AND REHABILITATION SERVICES BY BEING READY TO MEET THE CHANGING NEEDS OF THE COMMUNITY. 0 0 8717285 10882784 MAUNALANI NURSING & REHABILITATION CENTER IS A 100-BED FACILITY LICENSED TO PROVIDE SKILLED, INTERMEDIATE, AND REHABILITATIVE CARE SERVICES. DAILY OCCUPANCY RATE FOR 2010/2011 IS 97.33% WITH AN AVERAGE PER DIEM RATE OF $251.16. 8717285 1 1 0 0 0 0 1 1 0 1 0 0 1 1 1 1 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 0 1 17 0 1 155 1 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 X THE ORGANIZATION 8087320771 5113 MAUNALANI CIRCLE HONOLULU HI 968164019 X HOWARD H HAMAMOTO 1.00 X X 0 0 0 JOSEPH H GOLDCAMP 1.00 X X 0 0 0 SAI CHANTAVY 53.00 X X 167297 0 12575 DAVID DEVENOT 1.00 X 0 0 0 JAMES WRISTON JR 0.50 X 0 0 0 SUSAN KOSASA 0.50 X 0 0 0 JAMES PIETSCH 0.50 X 0 0 0 BARBARA STANTON 0.50 X 0 0 0 ROBERT HIDANO 38.00 X 107654 0 6704 274951 0 19279 2 0 1 0 SUNDANCE REHABILITATION CORP 6549 PAYSPHERE CIRCLE CHICAGO IL 60674 REHAB SERVICES 500024 UNIVERSITY HEALTH ALLIANCE 700 BISHOP STREET SUITE 300 HONOLULU HI 96813 EMPOYEE HEALTH INSURANCE 351707 KING & NEEL INC 1164 BISHOP ST 1710 HONOLULU HI 96819 INSURANCE SERVICE 347423 HFM FOODSERVICE 716 UMI STREET HONOLULU HI 96819 FOOD SERVICE 293173 PHARMERICA 3375 KOAPAKA STREET SUITE H-435 HONOLULU HI 96819 LONG TERM CARE PHARMACY 140706 5 278082 278082 NET PATIENT REVENUE 623000 10840562 10840562 MISCELLANEOUS PATIENT 623000 42222 42222 10882784 7744 7744 11168610 10882784 0 7744 161465 56513 104952 4931264 4503754 427510 326225 292117 34108 401696 359697 41999 391655 350706 40949 29196 29196 48900 48900 679365 617384 61981 174380 158834 15546 490716 466180 24536 11416 11416 209245 198783 10462 371993 333100 38893 FOOD AND SUPPLIES 926971 924217 2754 GENERAL ADMINISTRATION 570938 456000 114938 9725425 8717285 1008140 0 1050 1050 1766202 2504820 1036546 1928030 64875 62912 125546 176167 3954294 2201917 1942784 1752377 17479292 19264655 22416295 25690011 3060111 2666881 464476 461736 644 461 64143 76582 3589374 3205660 X 18826921 22484351 18826921 22484351 22416295 25690011 X 1443185 2214245 X 0 1 1 X 0 X 2935 486402 484740 493740 278082 1745899 8473145 9043432 9525758 10407341 10882784 48332460 8476080 9529834 10010498 10901081 11160866 50078359 0 0 0 50078359 69836 67994 21465 2602 7744 169641 69836 67994 21465 2602 7744 169641 8545916 9597828 10031963 10903683 11168610 50248000 0.99660 0.99550 0.00340 0.00450 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X DECORATIONS 0 1 644 184 460 1 1176102 669640 506462 2525231 1532277 992954 252961 252961 1752377 BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 19264655 19264655 RESERVE FOR PROFESSIONAL FEES 76582 76582 11168610 9725425 1443185 2214245 2214245 3657430 11168610 0 11168610 0 11168610 9725425 0 9725425 0 9725425 PART III, LINE 4: ALL THE ARTWORKS ARE USED AS DECORATIONS IN THE ORGANIZATION. PART IV, LINE 1B: THE ORGANIZATION IS TRUSTEE FOR THE RESIDENTS' PERSONAL FUNDS. THE FUNDS ARE RECEIVED FROM THE RESIDENTS FROM VARIOUS SOURCES AND DISBURSED AS THE RESIDENTS' NEEDS WARRANT. THESE FUNDS ARE RESTRICTED AND ARE NOT AVAILABLE FOR OPERATIONS. PART IV, LINE 2B: THE ORGANIZATION MAINTAINS RESIDENTS' PERSONAL FUNDS WHEN REQUESTED BY THE RESIDENTS. AT 6/30/11, ONE RESIDENT HAD HIS PERSONAL FUNDS ON ACCOUNT. THE RESIDENT TRUST FUNDS IS IN A SEPARATE BANK ACCOUNT AT AMERICAN SAVINGS BANK. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IN ACCORDANCE WITH ASC NO. 740 AS IT RELATES TO UNCERTAIN TAX POSITIONS FOR THE YEAR ENDED JUNE 30, 2011, THE COMPANY HAS EVALUATED ITS TAX POSITIONS TAKEN FOR ALL OPEN YEARS. CURRENTLY, 2009, 2010, AND 2011 TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. HOWEVER, THE COMPANY IS NOT CURRENTLY UNDER AUDIT NOR HAS THE COMPANY BEEN CONTACTED BY THE INTERNAL REVENUE SERVICE. BASED ON THE EVALUATION OF THE COMPANY'S TAX POSITIONS, MANAGEMENT BELIEVES ALL POSITIONS TAKEN WOULD BE UPHELD UNDER EXAMINATION. THEREFORE, NO ASSET OR LIABILITY FOR THE EFFECTS OF UNCERTAIN TAX POSITIONS HAS BEEN RECORDED IN THE FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2011. PART XI, LINE 8 - OTHER ADJUSTMENTS: LOSS ON ITEMS NOT YET RECOGNIZED AS A COMPONENT OF NET PERIODIC PERIODIC PENSION COST 428,882. CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF MAUNALANI FOUNDATION 1,785,363. X X X 0 0 0 0 0 0 0 0 0 SAI CHANTAVY 142500 0 7500 0 17297 0 4784 0 7791 0 179872 0 79754 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WILL BE REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED, READ AND UNDERSTANDS, AND AGREED TO COMPLY WITH THE POLICY. FORM 990, PART VI, SECTION B, LINE 15A THE SALARY AND PERQUISITES OF THE EXECUTIVE DIRECTOR AND SENIOR MANAGEMENT STAFF WILL BE BASED ON HIS/HER PERFORMANCE AND REVIEWED ANNUALLY. IN APPROVING OR RECOMMENDING ANY SALARY OR PERQUISITE ADJUSTMENT, THE COMMITTEE WILL CONSIDER THE RESPONSIBILITY, QUALIFICATIONS, EXPERIENCE, PERFORMANCE RECORD OF THE INDIVIDUAL, AND THE SALARY RANGES PAID TO A SIMILAR POSITION IN THE MARKETPLACE. THE COMPENSATION WILL BE REASONABLE AND IN ACCORDANCE WITH THE RULES OF IRS. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 990 IS AVAILABLE TO THE PUBLIC UPON REQUEST FOR A PERIOD OF THREE YEARS FROM THE DATE FILED.IT IS AVAILABLE IN THE ADMINISTRATIVE OFFICE OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 PERSON MUST SUBMIT REQUEST IN WRITING TO THE EXECUTIVE DIRECTOR. COPYING FEES MAY APPLY. FINANCIAL STATEMENTS ARE FOR INTERNAL USE ONLY. AVERAGE HOURS PER WEEK (DESCRIBE HOURS FOR RELATED ORGANIZATIONS IN SCH. O) FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (B) SAI CHANTAVY WORKS 55 HOURS A WEEK. SHE IS CONSIDERED AN EMPLOYEE OF THE MAUNALANI NURSING AND REHABILITATION CENTER. APPROXIMATELY, 53 HOURS PER WEEK ARE SPENT PERFORMING HER DUTIES AS THE ADMINISTRATOR OF THE CENTER. FOR THE REMAINING 2 HOURS PER WEEK, SHE ASSISTS THE MAUNALANI FOUNDATION PRIMARILY IN REGARDS TO OVERSIGHT AND MANAGEMENT OF THE INVESTMENTS HELD BY THE FOUNDATION. ROBERT HIDANO WORKS 40 HOURS A WEEK. HE IS CONSIDERED AN EMPLOYEE OF THE MAUNALANI NURSING AND REHABILITATION CENTER. APPROXIMATELY, 38 HOURS PER WEEK ARE SPENT PERFORMING HIS DUTIES AS THE FINANCE DIRECTOR OF THE CENTER. FOR THE REMAINING 2 HOURS PER WEEK, HE ASSISTS THE MAUNALANI FOUNDATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: LOSS ON ITEMS NOT YET RECOGNIZED AS A COMPONENT OF NET PERIODIC PERIODIC PENSION COST 428,882. CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF MAUNALANI FOUNDATION 1,785,363. TOTAL TO FORM 990, PART XI, LINE 5: 2,214,245. METHOD OF DETERMING AMOUNT INVOLVED IN SHARING OF PAID EMPLOYEES. FORM 990, SCHEDULE R, PART V, LINE 2, COLUMN (D) SAI CHANTAVY WORKS 55 HOURS A WEEK. SHE IS CONSIDERED AN EMPLOYEE OF THE MAUNALANI NURSING AND REHABILITATION CENTER. APPROXIMATELY, 53 HOURS PER WEEK ARE SPENT PERFORMING HER DUTIES AS THE ADMINISTRATOR OF THE CENTER. FOR THE REMAINING 2 HOURS PER WEEK, SHE ASSISTS THE MAUNALANI FOUNDATION PRIMARILY IN REGARDS TO OVERSIGHT AND MANAGEMENT OF THE INVESTMENTS HELD BY THE FOUNDATION. THEREFORE, THE AMOUNT AMOUNT WAS DETERMINED BY TAKING THE TOTAL SALARY OF $161,465 AND ALLOCATING 53/55TH TO THE CENTER = $155,594. ROBERT HIDANO WORKS 40 HOURS A WEEK. HE IS CONSIDERED AN EMPLOYEE OF THE MAUNALANI NURSING AND REHABILITATION CENTER. APPROXIMATELY, 38 HOURS PER WEEK ARE SPENT PERFORMING HIS DUTIES AS THE FINANCE DIRECTOR OF THE CENTER. FOR THE REMAINING 2 HOURS PER WEEK, HE ASSISTS THE MAUNALANI FOUNDATION. THEREFORE, THE AMOUNT AMOUNT WAS DETERMINED BY TAKING THE TOTAL SALARY OF $107,065 AND ALLOCATING 38/40TH TO THE CENTER = $ 101,712. MAUNALANI FOUNDATION 5113 MAUNALANI CIRCLE HONOLULU HI 96816 990075234 NON-HEALTHCARE ACTIVITIES WHICH INCLUDE LEASING LAND AND A BUILDING HI 501(C)(3) 509(A)(3) MAUNALANI NURSING AND REHABILITATION CENTER 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 MAUNALANI FOUNDATION P 136502 CONSTRUCTION COST MAUNALANI FOUNDATION J 480000 COST MAUNALANI FOUNDATION N 155594 SEE SCHEDULE O MAUNALANI FOUNDATION N 101712 SEE SCHEDULE O