HomeMy WebLinkAboutCOM 0667.004 1998-2000Stephen K Yamashvu
MuVnr
Countp of'aWaii
DEPARTMENT OF FINANCE
25 Aupum Street. Room 118 • Hilo, Hawaii 967204252
(8081 961 8234 1 Fax (8081961-8248
HAWAII COUNTY NONPROFIT GRANTS (FY 2000-01)
HUMAN SERVICES NONPROFIT GRANTS REVIEW COMMITTEE (HSNPGRC)
FISCAL YEAR ENDING:June 30, 2001 DATE OF APPLICATION: I &/P odTID
GRANT APPLICATION FOR: V10)L1VCB �-1VJ•e>/r_nJtL10A) A01&:C
Barri A IAM, i,h,
1 .. , ,
S K Schulte
U neu
(Program Title)
Legal Name of Organization:IJP L„!/✓ie - TNG• /' p
Mailing Address: n3// A`,9111TA14Z dQ1e �i7�0 /�/ &72O
Facility/Site Address: Paha► Skil LA a,nA. ",4
Director/Site Manager:�lgy�1� 4/,I Phone: 9'3y -3a 06
Organization President: 1VgA)q4 l../'I�jji%er Phone: —Tel - 6111;—
Contact Person (Grant Writer) //11974/2 LCnb Phone:
Amount of request for County funds: $ 2!r4 -D D
Total annual budget of organization: $ 3 YK2, a-%
Has the applicant applied for any other funds from the County of Hawaii this fiscal year?
0 Yes Source/ Department: r No
Agency/Program(s):
Check Ca(egory lies)
Ybl Social Services Youth Programs
0 Culture and Arts Education
Briefly, define the program for which funding is being reques(ed:
[�J10 6c
9 .
Co rrl nn OM s9�
0 Elderly Programs
0 Other %n•0ier/ 'T
Comm. No. / ”
A -DM
Ref. To: H-5 EDG
Ref. Date FEB 2 3 2000
_-
QUALIFYING STANDARDS FOR APPLICANTS
An applicant must meet all of the following standards:
Be chartered or otherwise authorized to do business in the State for charitable purposes and
exempted from the Federal income tax by the Internal revenue Service.
Have a governing board whose members serve without compensation and have no conflict of
interest between their regular occupations and the services provided.
Have bylaws or policies which describe the manner in which business is conducted, including
management, audit, fiscal policies and procedures, policies on nepotism, and policies on
management of potential conflict of interest.
Have at least one year's experience with the service or activity for which the appropriation is
sought or can otherwise demonstrate to the satisfaction of the County sufficient expertise to
successfully carry out the service or activity.
Be licensed and accredited in accordance with applicable requirements of Federal, State and
County laws.
II. GRANT CONDITIONS
The applicant agrees to comply with the following terms & conditions prior to receiving a grant award.
A. Comply with applicable Federal and State laws prohibiting discrimination against any person on
the basis of race, color, national origin, religion, creed, sex, age, or handicap.
Agree not to use any public funds for purposes of entertainment or perquisites.
C. Comply with such other requirements as the Director of Finance may prescribe to ensure adherence
by the nonprofit organization with Federal, State, and County laws, and established standards for
fiscal and program management.
D. Allow the Director of Finance, the committees of the council and their staffs, and the Legislative
Auditor access to records, reports, files, and other related documents in order that the program,
management, and fiscal practices of the nonprofit organization may be monitored and evaluated to
assure the proper and effective expenditure of public funds.
III. RECORDS AND REPORTS
A. The applicant shall follow generally accepted accounting procedures and practices and shall
maintain books, records, documents, and other evidence, which sufficiently and properly account
for the expenditure of County funds. The books. records and documents shall be subject at all
reasonable times to inspection, reviews, or audits by the County expending agency, the Director of
Finance, and the Legislative Auditor, or by their representatives.
B The County expending agency, Director of Finance, or County Council may request periodic
written reports on the use of County funds.
The nonprofit organization shall submit a final wnuen report to the Legislative ALid uor within
sixty (60) days after June 30 of the fiscal year I he report shall include an explanation of the
public benefits derived from the awarding of the grmi and a listing of other fundm� sources and
amounts ohtamed during the award period.
IV. QUARTERLY ALLOCATION
Under no circumstances shall grant funds be disbursed in a lump sum payment. Grant funds will be
disbursed to Grantees only through a quarterly allocation process. The disbursement of grant funds can be
formulated on an equal quarterly apportionment basis.
V. GRIEVANCE PROCEDURE
The applicant will adopt and maintain a grievance procedure to assure proper accounting for any concerns
and complaints about its programs or services that may arise from its members, employees, clients or from
other members of the public.
VI. DISCLOSURE OF INFORMATION
All information, data, or any other material provided to the County by virtue of this application shall be
subject to the Uniform Information Practices Act (UIPA), ch. 92F, Hawaii Revised Statutes. All such
material is deemed government record and shall be open to the public and may be provided to other public
and/or private funding sources.
VII. CONTINUED ELIGIBILITY
Any applicant or recipient who withholds or omits any material facts or deliberately misrepresents
such facts to the County of Hawaii shall: I) Immediately be disqualified from consideration for Nonprofit
Grant funding; OR 2) be in violation of the terms of the Grant Agreement of County funds in which case a
grant agreement can be terminated by the County and the recipient or provider may be liable to reimburse all
or a portion of any funds received therein.
VIII. ACKNOWLEDGMENT
(Legal Name ofbrganization)
hereby agrees to administer the V 101 &fVCE -i-M MVV4AAt Or'
(Program Title)
in accordance with the regulations, policies and procedures prescribed by the Hawaii County Finance
Department. Distribution of grant funds is limited to grantees, which are in compliance with County
regulations, policies and procedures. The County reserves the right to withhold grant distributions at any
time the grantee is not in compliance. It is the policy of the County of Hawaii and for those who do business
with the County to provide equal employment opportunities to all persons regardless of race, physical
disabilities, color, religion, sex, age, or national origin as mandated by the Federal Civil Rights Acts, as
amended, and any other federal or state laws relating to equal employment opportunities.
IX. AMENDMENTS TO THE APPLICATION/EVALUATION
The applicant assures that it will submit to the HSNPGRC for prior review and approval, a written request
and justification for any changes, additions, or deletions to any portion(s) of the grant application or a duly
esecuted Grant Agreement of County Funds. The applicant will cooperate and assist in any effort
undertaken by the 14SNPGRC to evaluate, inspect or otherwise monitor the effectiveness, feasibility, and/or
cost efficiency of any and all practices, policies and procedures or activities pursuant to this application or
any grant designation or allocation received as a result of this application-
X. AUTHORITY AND CAPACITY OF APPLICANT
The applicant certifies that it has the authority and capacity to develop and submit this application, and to
fully administer the program(s) pursuant to this application.
UNSIGNED PROPOSALS WILL NOT BE ACCEPTED!
Signature of President/Chairperson Date
Signature of Executive Director/Manager D t2 e t
Violence Intervention Project, Bay Clinic, Inc. 1
County of Hawaii Human Services Non -Profit Grant, 2000-01
) r.
A. Overview
1) Describe the program for which funding is requested.
Funding is requested for the Violence Intervention Project,
(VIP), which provides direct services to court ordered men who
batter in the isolated rural districts of Puna and Ka'u. VIP
offers batterers' groups in both locations while tracking
compliance and providing collateral agencies,(such as the
Judiciary, Adult Probation, and CPS), with information. VIP
assists in community awareness, education and training, and is
helping to coordinate and implement victim advocacy services for
women and children.
2) What unique or significant service will be provided?
VIP is the only program in Puna and Ka'u offering direct
services to perpetrators of domestic violence. Due to lack of
public transportation and financial inability to afford cars or
insurance, many people in these isolated rural areas do not have
access to domestic violence services. Even when court ordered,
many men are unable to get to Hilo or Kailua to fulfill their
probation or CPS service plan. No other agency provides these
services.
3) What specific outcomes are to be achieved?
a. To make domestic violence services locally available to
individuals and families in the Puna and Ka'u districts.
b. To assist in training to community members of the Puna and
Ka'u districts in the development and implementation of rural
domestic violence services as directed through community response
meetings.
C. To reduce isolation from services and increase
accessibility by working in the community.
d. To increase and enhance multicultural leadership and
administrative skills among the local community members.
e. To facilitate the ability of families to identify signs of
abuse through understanding and awareness.
f. To improve the ways in which families address and resolve
family abuse concerns through education.
g. To provide for continuity of services through coordination
of necessary, needed services and programs.
4) How will the proposed program empower participants/clients
to become self-sufficient and facilitate positive social change?
The Violence Intervention Project empowers clients of the
batterer's group by giving them the tools to address and stop
violence in their relationships, and by having local access to
services. Because of rural isolation and lack of public
transportation, current services offered in Hilo and Kona are not
Bay Clinic Inc. Page 2
County of Hawaii Human Services Non -Profit Grant
easily accessible, and are often not seen as appropriate in design
for various ethnic groups found in rural Hawaii.
VIP facilitates positive social change in many ways:
*The group participants are from the community and can hold
each other responsible for their behavior.
*The visibility of consequences to batterers and of help to
victims creates a safer community. Victims are more likely to seek
help if consequences are enforced.
*The case managers and group facilitators are more accessible
to the community and participants because they live in that
community.
*Community education and training helps the community identify
abuse and have a coordinated community response which increases
public safety.
$� Problem/Need
1) What is the problem/need the proposed program is designed
to meet?
VIP answers the need for availability of domestic violence
services and education in Puna and Ka'u. Previously, court ordered
batterers had to drive to Hilo or Kailua to be in compliance with
their service plan. Many of these men have no legal transportation
or money for gas, resulting in non-attendance, violation of
probation and re -sentencing to group in a never ending cycle. This
created a hardship on the victims and families, making them less
likely to report abuse.
2) Who are the target population and what are the specific
needs?
*Men who batter and who are court ordered to attend batterer's
program and live or work in the Puna or Ka'u districts. Men who
batter may also self -refer to the program.
*Women and Children who live in the geographically isolated
districts of Puna and Ka'u and are in need of referral to court
advocacy services, victim support groups, information and resource
options.
*Individuals, community organizations, or social service
agencies requesting assistance in training or presentations on
domestic violence.
3) What are the geographical areas to be served, facility and
hours of operation?
VIP serves the Puna and Ka'u districts of the Big Island. The
program operates out of the Bay Clinic's Pahoa Family Health Center
located in Pahoa Town, P.O. Box 1455, Pahoa HI, 96778. The Puna
VIP group is held Tuesday evenings from 6PM to BPM.
The Ka'u VIP group is held Thursday evenings from 6PM to 8PM
in the Family Services Facility near the community center.
Intakes, orientation, and individuals are by appointment. The
Violence Intervention Project, Bay C11nic,Inc 3
County of Hawaii Human Services Non -Profit Grant,
staff is available for collateral services (Probation, CPS,
Judiciary) by phone and/or appointments. Trainings and
presentations are by request.
f,, Collaboration/Coordination
1) What specific measures will be taken to
collaborate/coordinate with other community resources to achieve
maximum program efficiency and cost effectiveness?
One of the Violence Intervention Project's objectives is to
provide domestic violence services in areas where none exist. We
coordinate with agencies working with victims and perpetrators such
as ATV, Hale Ohana, the Judiciary, CPS, Probation, and law
enforcement. We work with a community health center providing
screening and referrals to services.
VIP collaborates with women's support services and men's
programs in Hilo to ensure consistent services and response, while
not duplicating services. We are active members of the Domestic
Violence Inter -Agency Team and dedicated to coordinating a
community response to Domestic Violence.
2) How will these measures reduce or eliminate any existing
duplication of services to your designate target group?
No other agency or organization is providing these services in
Puna or Ka'u.
1) What are the major goals/benchmarks of the proposed
program?
*Maintain existing services (men's groups) in Puna and Ka'u.
*Assist in the establishing women's and children's services in
Puna and Ka'u.
*Create a referral network between agencies in Puna and Ka'u
to ensure all members of the family and community have access to
services.
* Implementing a Batterer's group for the Keaau/Upper Puna
District, none currently exist.
* Assist in building community awareness of domestic violence
and its effect on our community.
* Expanding our training program and materials to be more
culturally relevant.
goal? 2) What specific objectives/action steps are planned for each
* Existing services: maintaining men's groups is VIP's
priority until further funding becomes available.
* Women's and Children's services in Puna and Ka'u: continue
to advocate for these services which are NOT AVAILABLE IN KA'U OR
Violence Intervention Project, Bay Clinic,Inc 4
County of Hawaii Human Services Non -Profit Grant,
PUNA at this time and make referrals.
* Referral Network: continue to offer support to community
groups and agencies, coordinating a community response to domestic
violence.
* Batterer's group for Keaau/Upper Puna: Seek funding and
location to develop men's group.
* Building community awareness: Assist in trainings and
presentations help to educate the community on the effects of
domestic violence in the community. VIP is part of SPEAC, a
program that goes into the schools to educate teens.
* Expanding our training program and materials to be more
culturally relevant by working with the Edith Kanaka'ole Foundation
and participating in a 5 day workshop on providing culturally
appropriate services.
step? 3) What is the timeline (start and and dates) for each action
* Men's services in Ka'u and Puna are ongoing.
* Coordinating Women's Advocacy services: Women's services
for Ka'u and Puna stopped in October 99 when the Federal grant ran
out. The Domestic Violence Clearing House is starting up a
statewide program (February 100) to assess needs in rural areas,
and VIP will assist with our existing structure.
* Building community awareness is ongoing with a variety of
videos ranging from "How to make a safety plan", training for
emergency room personnel assessments, to children's education.
These tapes air on Na Leo Hawaii Public Access.
* Participating in the "Integrating Cultural Diversity in
Domestic Violence Issues" conference presented by the Sacred Circle
Institute of the Pine Ridge Reservation in February and
incorporating appropriate material into our curriculum.
4) What significant client -centered outcomes will the program
achieve? Include how many participants will:
a. Attain at least one personal program outcome; or
b. Show measurable progress towards your program goals.
Significant client centered outcomes include:
Batterer's Groups:
* All participants will have access to court ordered
Batterer's groups and therefor have a higher probability of being
in compliance with their service plan.
* Measurable progress toward program goals showed that between
7-1-99 and 12-31-99, 52 intakes were processed; 19 men completed
the program; 12 were terminated due to non-compliance; 4 started
over; and one transferred to Kona when he got a job. Current
participants in groups: Puna, 8; Ka'u, 13.
* All participants will be taught to recognize their anger
build up and how to use a "cool down" and other alternatives to
avoid violence.
* All participants will be taught to accept responsibility for
Violence Intervention Project, Bay Clinic,Inc 5
County of Hawaii Human Services Non -Profit Grant,
their violence and to not blame the victim.
Community Awareness:
* All participants will be shown how to increase their
awareness of the many faces of domestic violence along with safe
and effective responses to support the victim and hold the
perpetrator accountable. Progress will be measured with pre- and
post- post tests, and evaluation by participants.
* A coordinated community response will be outlined and
accessible to all, increasing community safety. Measurable
progress includes a list of who does what when in each district and
what resources are available.
* Community members watching Na Leo's domestic violence
programming will be able to access information and education in a
safe non -threatening manner in the privacy of their home.
Women's Program:
* Agencies and community organizations seeking support and
referrals will be able to plug into our program for victim
referrals and safety checks. Measurable progress toward these goals
will include the number of inquiries and referrals.
S. Service Delivery
What methodology will be used in the proposed programs delivery of
service?
The curriculum for the Batterer's Program is the Duluth Abuse
Intervention Project's "Education for Men Who Batter" presented by
two facilitators in weekly 2 hour groups. The program lasts 26
weeks and participants join the group in progress.
Community awareness consists of assisting agencies and
community organizations with education and information referrals.
-A variety of 40 minute presentations are used in high school
and intermediate settings.
-Broadcast of domestic violence information and education is
continuous in conjunction with Na Leo O Hawaii Public Access.
Support for Women's Services is provided by constant contact
with agencies initiating services and providing client referrals
for assessment and evaluation. VIP's men's services are victim
driven and the safety of the victim is the priority.
F. Evaluation:
1) What process will be used in the proposed program's
delivery of services?
The evaluation of this project will
program staff and program participants.
design process will include the following:
a) Defining each project objective
susceptible to measurement.
be a joint effort by
A complete evaluation
in operational terms,
b) Developing the measurements that would be
used as
Violence Intervention Project, Hay Clinic,Inc
County of Hawaii Human Services Non -Profit Grant,
indicators of achievement of objectives and impact.
c) Identifying variables that influence program performance
and outcome.
d) Specifying data requirements and identifying the source
for each type of required data.
e) Describing the data collection methods.
f) Describing the content of the final report.
g) Describing the staffing and managing of the evaluation
h) Developing a timetable for the evaluation.
2) How will this process measure the outcomes specified in
item D, (1-4)?
* Batterer's Program: Tracking attendance and participation
and providing data to probation, CPS, and Judiciary enforces
compliance with service plans and probation contracts, ensuring
participants receive the consequences of their actions while those
in noncompliance are identified and dealt with.
* Community Awareness: Pre and post tests as well a
evaluations by participants determine the effectiveness of VIP
trainings and presentations. Defining objectives always includes
the community, creating community driven trainings that are
responsive to ethnic and cultural considerations.
G. Program Fees
1) Does your organisation charge a membership fee for service
participants?
No.
2) Does the proposed program charge participants a fee for
services provided by your organisation?
There is a fee for Batterer's group participants. Community
trainings and presentations are billed by content and length.
Programs shown on Na Leo are free to the public.
a) Describe or attach fee for service information; and
b) Describe how you will ensure that all interested
participants will be included despite an inability to pay the
entire fee.
There is a sliding fee scale for the batterer's program based
on income. Fees range from $5 to $20 per group. These rates have
not changed and will remain the same. No one is turned away due to
lack of funds.
H. Viability:
1) What is your justification or rationale for the expenditure
of public funds for the proposed program?
The Violence Intervention Project helps to create safe
Communities by assisting with resources and training towards a
coordinated community response to violence.
Violence Intervention Project, Bay Clinic,Inc 7
County of Hawaii Human Services Non -Profit Grant, .
VIP is the only program offering direct services to
perpetrators of domestic violence in the isolated rural Puna and
Ka'u districts. Currently, the Pahoa group consists of 8 court
ordered men who batter. Six of them still live with their partners
(and in one case, his mother). They are in direct contact with
over 25 children and indirect contact with 12 more. Two partners
are pregnant (33% of victims are battered while pregnant); 2 men
were referred by CPS, and 3 are also receiving substance abuse
counseling.
VIP's Ka'u group has 13 men, 9 of whom are still with their
families, in direct contact with over 30 children. The separated
men have visitation with over 10 children. Three partners are
pregnant. Three participants are CPS referred, and 4 are receiving
substance abuse counseling.
Few of these men have access to legal transportation to Hilo
or Kailua, (several have a difficult time getting to Pahoa and
Naalehu) to fulfill their court mandated service plan. Failure to
comply results in more court dates and re -sentencing to group, in
a never ending cycle. Access to services in rural areas is
critical to the safety and well-being of our community.
2) What are your financial and programmatic plans to sustain
the proposed program beyond the upcoming fiscal year?
Funding sources include:
*Private foundations and business
*Contracts with related agencies to provide training to staff
*Continual fundraising
*A sliding scale fee to batterer's program participants
As primary health care providers, we plan to approach the
major insurance companies to sponsor and pay us for trainings. It
is to their benefit to prevent domestic violence which causes
stress-induced illness, injury and more emergency room visits. The
Center for Disease Control has named Domestic Violence as a
critical health issue.
Organization/Agency Information
A. Board of Directors
1) Has the Board of Directors received formal training within
the past 2 fiscal years?
Hawaii Community Services Council provided non-profit training
for our board in October of 1998 and the Board attended a United
Way Board Training on January 22, 2000.
a) What plans do you have to provide formal training to your
current Board of Directors?
A formal training was held in October of 1998, one was
attended January 22, 2000, and other opportunities will be
provided. The Board also has a yearly retreat.
Violence Intervention Project, Bay Clinic,inc 8
County of Hawaii Human Services Non -Profit Grant, '
b) When will the next board training be completed?
The next board training will be completed in the fall, 2,000.
c) How will you provide formal training to newly arriving
board members or board members who miss a scheduled training?
New members are given formal orientation and ongoing education
with regular meetings, as well as monitoring by senior board
members. Missed trainings are made up by review of notes and
written materials.
2) What are the Primary roles and responsibilities of your
organisation's Executive Director?
The primary role and responsibility of the Executive Director
is to administer the programs of the Bay Clinic as directed by the
Board of Directors. Duties include: Business administration;
public administration; managing a non-profit agency with multiple
program layers; and a commitment to the Bay Clinic mission and
community.
3) What are the primary roles and responsibilities of your
organisation's Board of Directors? (Clarify role of executive
officers vs. general membership).
The primary role of our Board is to be community directed and
be committed to improving the health and well-being of all people.
The specific duties are listed in our by-laws and include
management of the corporation, designing health care policies, and
hiring the executive director.
Executive officers perform the function of routine management
of the board and performing the duties outlined in the by-laws.
General members participate in membership activities and have the
right to elect two Board members.
B. Past Performance:
1) How effective has your organisation/agency been in
achieving program goals in the past 2 fiscal years? Include the
following information:
a) Quantitative data on numbers served; and
b) Qualitative data showing number and % if participants
achieving measurable outcomes.
Our core program is providing primary health care to rural
populations. Part of our comprehensive servicer include:
*the Family Planning Program provides low cost birth control
services and supplies to 2,637 females/males 14yrs-45yrs.
*the Primary Care Program provides general medical care to
10,135 females/males newborn to 100+yrs.
*the SPEAC Program, a consortium of educators providing
information to 7$0 intermediate and high school students.
*the Back to School project supplied 50 low income children
with school supplies donated by area businesses.
*our Women's Health Coordinator is a member of the Sexual
Assault Response Team (SART), 36 rape responses.
Violence Intervention Project, Bay C11nic,Inc 9
County of Hawaii Human Services Non -Profit Grant,
*the Wise Heart Program is a hypertension education and
outreach for 200 low income seniors in the Puna district.
* the Violence Intervention Project currently serves 21
adjudicated batterers with anger management groups.
* joint screenings with Hui Malama Na Oiwi- 179 Hawaiians.
* Needy Patient Fund- 24 indigent individuals.
* Grace Bryan Taylor Trust - 10 individuals with Angina.
* Theresa Hughes Fund - 30 needy individuals over 50 yrs.
* Tapps Coalition- 10 agencies laisoning with 6 high schools
with 5,500 teenagers.
* Breast and Cervical Cancer Control Program served 280 women
between the ages of 40 and 64.
C. Financial:
1) Have your organisation's current program operations
remained the same as last year? What major program or financial
changes will be incurred next year?
Bay Clinic was awarded a $540,000 330 grant from the federal
Bureau of Primary Health Care (prorated for the remaining nine
months of this fiscal year) allowing us to care for the uninsured.
Bay Clinic's current operations will remain the same as last year.
We do not anticipate any major program or financial changes next
year.
2) What is the status of all your organisations major
contracts or agreements for the coming year (employment agreements,
office leases, primary grant revenue/supplier, etc.)?
The federal 330 grant is a major new contract enabling Bay
Clinic to add a physician in the Puna Distric. Bay Clinic's major
contracts have remained stable and our employment agreements for
the coming year are in place. The Hilo clinic has completed
renovation.
3) How does the proposed program fit into your organization's
long range financial plan?
We think the unique combination of primary care and a domestic
violence program is a fundable idea and will generate foundation
funding for community training and maintaining existing men's
groups in Puna and Ka'u.
As primary health care providers, we plan to approach the
major insurance companies to sponsor and pay us for trainings, as
Domestic Violence causes stress induced illness, injury and more
emergency room visits.
The Center for Disease Control has defined Domestic Violence as
a major health issue which should make federal health funds
available.
Violence Intervention Project, Bay Clinic,Inc 10
County of Hawaii Human Services Non -Profit Grant, ] .Jvo0-0(
D. Monitoring
1) During the past 2 fiscal years what financial and/or
administrative monitoring has your organization received from any
and all funding sources? List all monitoring sources, contact
names and phone numbers.
Bay Clinic employs a Financial Officer, Mr. De Los Santos
(969-1427) and assistants.
We were audited by Taketa, Iwata, and Hara, CPA, for FY 1996-7
and FY1997-8. The contact person is Jeff Gerdner at 935-5404. Our
FY98-99 audit is in progress.
E.
1) How does your organisation address alcohol, tobacco, and
other drug prevention information dissemination as part of your
workplace and/or program environment?
The Bay Clinic maintains certification regarding Drug-free
workplace requirements by implementing the regulations set out in
the Drug -Free Workplace Act of 1988. Our staff has access to
information and support through our Public Health Awareness
Program.
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';tephen K Yamashtro
Mayor
County of'Wabnaii
DEPARTMENT OF FINANCE
2; Aupum Street, R,1n 118 • Hd4 Hawau 96720 4252
64081 961 &234 • Pac(808)961-8248
HAWAII COUNTY NONPROFIT GRANTS (FY 2000-01)
FINANCIAL QUESTIONNAIRE
Harry A Iakahe,hj
1) i.,,
Please include as an attachment an explanation for all "NO" answers to questions # 1 thru I 1 below:
Yes No
S- K. Schutte
D,ulu
As the gran( applicant, I certify that the agency has satisfactorily responded to each of the above questions and explained as
needed l hereby certify that this irjormalion is true and correct to the best of nry knowledge.
Agency: y �(�G� 6Qiwr _ P,hho7nee: T
Prepared by: net Qe eS Sae _S tf. F0 dy� 1 /I;g
Print Name/title ,, I Signature Dale
Certified by: S p/\19TjIF L44yl iu
Print Nam of Executive Director Stgnatu e lana /
I.
Has the agency operated continuously for the past three (3) years?
(S
(
2.
Has the agency operated with a positive cash flow for the past (3) years?
Q)
3.
Does your Board of Directors approve a detailed cash flow budget before the beginning of
each fiscal year?
0
4.
Do your Board meeting minutes show that quarterly financial statements are approved?
0
5.
Is your equity balance at least 20% of your Total Liability balance?
6.
Is your Total Current Asset balance larger than your Total Current Liability balance?
V
7.
Are bank reconciliations and accounting performed by someone other than the check signatory?
l7
8.
Are you fully insured for the agency's vehicle(s) and building(s)?
l!0
9.
Is your Workers' Compensation at least 2% of payroll?
0'
10.
Are you current (not delinquent) on all payroll and payroll tax payments?
V
11.
Is the agency free of any pending litigation, liens orjudgments?
12.
Within the past 12 months, has the agency applied for vendor or bank credit and was
denied credit? If yes, please explain.
As the gran( applicant, I certify that the agency has satisfactorily responded to each of the above questions and explained as
needed l hereby certify that this irjormalion is true and correct to the best of nry knowledge.
Agency: y �(�G� 6Qiwr _ P,hho7nee: T
Prepared by: net Qe eS Sae _S tf. F0 dy� 1 /I;g
Print Name/title ,, I Signature Dale
Certified by: S p/\19TjIF L44yl iu
Print Nam of Executive Director Stgnatu e lana /
THE BAY CLINIC, INC.
Financial Statements and Audit Opinion
For the Year Ended June 30, 1997
Table of Contents
Section Pages
Independent Auditors Report on the Basic Financial Statements 1
Financial Statements 2- 5
Notes to Financial Statements 6-10
Schedule 1 - Schedule of Grant Awards and Expenditures, State of Hawaii,
Department of Health 11
Independent Auditors Report on the Internal Control Structure Based on an
Audit of Financial Statements Performed in Accordance with Government
Auditing Standards 12- 13
Independent Auditors Report on Compliance Based on an Audit of Financial
Statements Performed in Accordance with Government Auditing Standards 14
Schedule of Findings and Questioned Costs • 15
TAKETA, IWATA, HARA & ASSOCIATES
CERTIFIED PUBLIC ACCOUNTANTS 101 AUPUNI STREET, SUITE 139, HILO, HI 96720
P.O. BOX 1759, HILO. HI 96721-1759
GREGG M. TAKETA, CPA
BRIAN M. IWATA. CPA PH. (808) 935-5404
JANET W HARA. CPA FAX (806) 9691499
INDEPENDENT AUDITOR'S REPORT ON
THE BASIC FINANCIAL STATEMENTS
The Board of Directors
The Bay Clinic, Inc.:
We have audited the accompanying statement of financial position of The Bay Clinic, Inc. (a nonprofit
organization) as of June 30, 1997, and the related statements of activities, cash flows, and functional
expenses for the year then ended. These financial statements are the responsibility of the Clinic's
management. Our responsibility is to express an opinion on these financial statements based on our
audit. The financial statements of The Bay Clinic, Inc. as of June 30, 1996, were audited by other
auditors whose report dated December 6, 1996, expressed an unqualified opinion on those statements.
We conducted our audit in accordance with generally accepted auditing standards and Government
Auditing Standards, issued by the Comptroller General of the United States. Those standards require
that we plan and perform the audit to obtain reasonable assurance about whether the financial
statements are free of material misstatement. An audit includes examining, on a test basis, evidence
supporting the amounts and disclosures in the financial statements. An audit also includes assessing
the accounting principles used and significant estimates made by management, as well as evaluating
the overall financial statement presentation. We believe that our audit provides a reasonable basis for
our opinion.
In our opinion, the financial statements referred to above present fairly, in all material respects, the
financial position of The Bay Clinic, Inc. as of June 30, 1997 and the changes in its net assets and its
cash flows for the year then ended in conformity with generally accepted accounting principles.
In accordance with Govemment Auditing Standards, we have also issued a report dated November 14,
1997 on our consideration of The Bay Clinic, Inc.'s internal control structure and a report dated
November 14, 1997 on its compliance with laws and regulations.
Our audit was made for the purpose of forming an opinion on the basic financial statements of The Bay
Clinic, Inc. taken as a whole. The accompanying Schedule of Grant Awards and Expenditures, State of
Hawaii, Department of Health (Schedule 1) is presented for purposes of additional analysis and is not a
required part of the basic financial statements. Such information has been subjected to the auditing
procedures applied in the audit of the basic financial statements and, in our opinion, is fairly stated in all
material respects in relation to the basic financial statements taken as a whole.
November 14, 1997
THE BAY CLINIC, INC.
Statements of Financial Position
June 30, 1997 and 1996
Assets
1992
1996
Liabilities and Net Assets
Current assets:
7,124
Current liabilities:
Cash and cash equivalents
$ 398,833
274,659
Accounts payable
Government grants
Accrued payroll and
receivable
13,823
143,573
related liabilities
Patient accounts receivable,
Other liabilities
net
78,356
46,275
Prepaid expenses
35,846
35,846
Total current liabilities
Deposit
13,709
12,309
Total liabilities
Total current assets
540,567
512,862
Net assets:
Noncurrent assets:
Unrestricted
Investments
535,000
347,000
Property, plant and
Total net assets
equipment, net
134,957
144,113
Total liabilities and
Total assets
$ 1,210,524
1,003,975
net assets
See accompanying notes to financial statements.
2
FRli�41rI3
$ 33,243
21,319
92,544
90,876
2,011
7,124
127,798
119,319
127,798 119,319
1,082,726 884,656
1,082,726 884,656
$ 1,210,524 1,003,975
THE BAY CLINIC, INC.
Statements of Activities
Years ended June 30, 1997 and 1996
Changes in unrestricted net assets:
Support and Revenues:
U.S. Federal Assistance
Fees and grants from Hawaii Slate government agency
Premium revenue
Net patient service revenue
Ka'u Clinic subsidy
Contributions
Interest income
Rental and other income
Total unrestricted revenue
Expenses:
Program services
Support services
Total expenses
Increase in net assets
Net assets, beginning of year
Net assets, end of year
See accompanying notes to financial statements.
3
1997 1996
$ 65,500
59,500
54,166
196,645
1,550,036
1,864,980
705,174
351,351
60,000
-
27,564
1,286
35,231
11,085
60,279
31,325
2,557,950 2,516,172
2,120,109 1,585,031
239,771 296,972
2,359,880 1,882,003
198,070 634,169
884,656 250,487
$ 1,082,726 884,656
THE BAY CLINIC, INC.
Statements of Cash Flows
Years ended June 30, 1997 and 1996
Cash flows from operating activities:
Cash received from capitation arrangements
Cash received from service recipients
Cash received from grants
Interest and other income received
Cash paid to employees
Cash paid to suppliers
Net cash provided by operating activities
Cash flows from investing activities:
Purchase of assets
Purchase of investments
Net cash provided (used) by investing activities
Cash flows from financing activities:
Repayments of long-term debt
Payments under capital lease obligations
Net cash provided by financing activities
Net increase in cash and cash equivalents
Cash and cash equivalents, beginning of year
Cash and cash equivalents, end of year
Reconciliation of change in net assets to net cash provided by operating activities:
Change in net assets
Adjustments to reconcile change in net assets to net cash provided by
operating activities:
Depreciation and amortization
Decrease (increase) in grants receivable
Increase in patient accounts receivable
Increase in prepaid expenses
Decrease (increase) in deposit
Increase(decrease)in accounts payable
Increase in accrued payroll and related liabilities
Net cash provided by operating activities
Supplemental disclosure of cash flow information'.
Cash paid during the year for interest expense
See accompanying notes to financial statements.
4
1997 1996
$ 1,550,036 1,864,980
733,093 267,709
249,416 154,835
123,074 42,410
(1,528,259) (1,185,210)
(789,214) (584,555)
338,146 560,169
(21,059) (39,731)
(188,000) (347,000)
(209,059) (386,731)
(3,937) (92,557)
(1,176) (2,233)
(5,113) (94,790)
123,974 78,648
274,859 196,211
$ 398,833 274,859
$ 198,070 634,169
30,215
34,605
129,750
(102,596)
(32,081)
(11,642)
(2,208)
(1,400)
455
11,924
(11,855)
1,668
19,241
$ 338,146 560,169
$ 705 5,746
I
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THE BAY CLINIC, INC.
Notes to Financial Statements
Years ended June 30, 1997 and 1996
Nature of Operations
The Bay Clinic, Inc. (Clinic) is a nonprofit organization incorporated under Section 416-20, Hawaii
Revised Statues on January 31, 1983. The purpose of the Clinic is to provide quality health care to
Big Island residents through direct medical care and educational activities, including low cost family
planning and primary medical and preventive health care services. The Clinic's operations are
funded predominantly by federal and state financial assistance, and from third party reimbursements
from health insurance plans. The Clinic qualifies as a Federally Qualified Health Center (FQHC).
(1) Significant Accounting Policies
The financial statements of the Clinic have been prepared on the accrual basis of accounting and in
accordance with the AICPA Industry Audit Guide for "Health Care Organizations". The significant
accounting policies followed are described below to enhance the usefulness of the financial
statements to the reader.
Cash and cash equivalents
Cash and cash equivalents is comprised of cash on hand, in savings and checking accounts, and
certificates of deposit with maturities of three months or less. At June 30, 1997, and throughout the
year then ended, the Clinic's cash balances were deposited in several banks. Management believes
the Clinic is not exposed to any significant credit risk on cash and cash equivalents. As of June 30,
1996, $80,520 was in excess of the Federal Deposit Insurance Corporation (FDIC) limits, and was
therefore considered an uncollateralized credit risk concentration.
Investments
Investments consist of certificates of deposit with maturities greater than three months, and are
carried at cost, which approximates fair value due to the short term maturity of the certificates.
Property Plant and Equipment
Property, plant and equipment are carried at cost or at the fair market value at the time of donation.
Maintenance and repairs are charged to expense, and betterments are capitalized. Depreciation is
provided over the estimated useful lives of three (3) to forty (40) years on a straight-line basis.
Equipment under capital lease obligations is amortized on the straightline method over the shorter
period of the lease term or the estimated useful life of the equipment. (See further details at note 4).
Premium Revenue
The Clinic has agreements with various qualified health plans under the State of Hawaii Health
QUEST Program to provide medical services to eligible members. Under these agreements, the
Clinic receives monthly capitation payments based on the number of each plan's eligible members
who have selected the Clinic as being their primary care provider, regardless of services actually
performed by the Clinic.
THE BAY CLINIC, INC.
Notes to Financial Statements, Continued
Net Patient Service Revenue
The Clinic has agreements with third -party payors that provide for payments to the Clinic at amounts
usually discounted from its established rates. Net patient service revenue is reported at the
estimated net realizable amounts from patients, third -party payors, and others for services rendered.
Retroactive adjustments under reimbursement agreements with third -party payors are currently not
accrued in the financial statements.
Contributions
Contributions received and unconditional promises to give are measured at their fair values and are
reported as an increase in net assets. The Clinic reports support of cash and other assets as
restricted support if they are received with donor stipulations that limit the use of the donated assets,
or if they are designated as support for future periods. When a donor restriction expires, that is, when
a stipulated time restriction ends or purpose restriction is accomplished, temporarily restricted net
assets are reclassified to unrestricted net assets and reported in the statement of activity as net
assets released from restrictions. Conditional promises to give are not included as support until the
conditions are substantially met.
Donated Services
No amounts have been reflected in the statements for donated services inasmuch as no objective
basis is available to measure the value of such services; however, a number of volunteers have
donated their time in program services.
Advertising Costs
Advertising costs are expensed as incurred.
Purchase of Ka'u Clinic
On January 1, 1997, The Bay Clinic, Inc. acquired the assets of the Ka'u Community Health Center
from Hawaii Family Medical Centers, a Hawaii corporation. (See note 6).
Income Taxes
No provision has been made for federal or state income taxes because the Clinic has obtained tax
exempt status under the Internal Revenue Code Section 501 (c)(3) and applicable provisions of the
Hawaii Revised Statutes.
Reclassifications
Certain reclassifications have been made to the 1996 financial statements to conform to the 1997
presentation. Such reclassifications had no effect on the results of activities or net assets.
THE BAY CLINIC, INC.
Notes to Financial Statements, Continued
(2) Use of Estimates in Preparation of Financial Statements
The preparation of financial statements in conformity with generally accepted accounting principles
requires management to make estimates and assumptions that effect the reported amounts of assets
and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements
and the reported amounts of revenues and expenses during the reporting period. Actual results could
differ from those estimates.
(3) Patient Accounts Receivable
Patient accounts receivable represents fees owed by patients and third party health insurance plans for
services provided. This account is comprised of the following as of June 30, 1997 and 1996
Patient fees receivable
Third party billings receivable
Fees receivable, gross
Less allowance for uncollectibles
Patient receivables. net
(4) Property, Plant and Equipment
1997 1996
$ 79,700 81,938
126,656 92,337
206,356 174,275
128,000 128,000
$ 78,356 46,275
A summary of the Clinic's investment in property, plant and equipment as of June 30, 1997 and 1996,
is set forth hereunder:
Estimated
Useful
Lives
1997
1996
Land
$ 5,983
5,983
Condominium
40
years
93,736
93,736
Leasehold improvements
5
years
12,215
12,215
Clinical equipment
5-10
years
30,256
24,508
Office furniture and equipment
3-5
years
145,808
130,497
287,998
266,939
Less accumulated depreciation
154,375
125,786
133,623
141,153
Assets under capital lease
5
years
18,295
18,295
Less accumulated amortization
16,961
15,335
1,334
2,960
Total
$ 134,957
144,113
THE BAY CLINIC, INC.
Notes to Financial Statements, Continued
(5) Operating Leases
The Clinic leases its Hilo, Pahoa and Ka'u facilities under non -cancelable operating leases that expire
in the years ending June 30, 1999, 2003, and 2012. Minimum annual rent for the Hilo facility was
$106,858 including general excise taxes. The lease term for the current Hilo facility ended June 30,
1997 and continued on a month to month basis. The minimum annual rental for the Pahoa facility is
$76,049 which includes common area maintenance and general excise taxes and increases to
$78,900 as of June 1, 2000. Minimum annual rent for the Ka'u facility is $12,000, with a 10% annual
increase effective on July 1, 1998.
In March of 1997 the Clinic executed a new lease agreement to move the Hilo facility. The
agreement was to commence in July of 1997 or at the date that the client occupies the new facility,
whichever is later. As of November 14, 1997, the client had not occupied the new facility. Initial
minimum annual rent will be $134,235, which includes general excise tax and a monthly operating
expense charge, with 10 to 12% annual increases through June 30, 2012.
Rent expense for the years ended June 30, 1997 and 1996, was $191,424 and $163,929,
respectively and its components are as follows:
Minimum rent
Month to month
1997 1996
$ 188,203 163,929
3,221 -
$ 191,424 163,929
Future minimum rental payments under the above operating leases are as follows:
Year ending June 30
1998
$ 88,000
1999
214,300
2000
220,600
2001
223,400
2002
239,500
Thereafter
1,912,500
$ 2,898,300
(6) Purchase of Ka'u Clinic
On January 1, 1997, The Bay Clinic, Inc. assumed the assets of the Ka'u Community Health Center
(KCHC) from Hawaii Family Medical Centers (HFMC), a Hawaii corporation. The Bay Clinic, Inc. was
paid $60,000 by HFMC to subsidize the initial administrative costs involved in assuming the operation
of KCHC. The assets assumed by The Bay Clinic, Inc. had no book value except for a personal
computer system which was recorded at an estimated fair value of $1,500, and patient services
receivable recorded at $20,783.
THE BAY CLINIC, INC.
Notes to Financial Statements, Continued
(7) Retirement Plan
The Clinic offers a Simplified Employee Plan (SEP) to its employees. For each of the years ended
June 30, 1997 and 1996, the Clinic contributed $5,912 to the plan.
The Clinic also offers two voluntary tax deferred annuity plans under Internal Revenue Code Section
403(b) to substantially all of its full time employees. These plans were employee contributory only
with a maximum annual contribution per employee of 20% of gross wages or $9,500, whichever is
less.
(8) Functional Classification of Expenses
The costs of providing the various programs and supporting services have been summarized on a
functional basis in the statement of functional expenses. Accordingly, certain costs have been
allocated among the programs and supporting services benefited.
(9) Medicare/Medicaid Cost Evaluations
As a Federally Qualified Health Center (FQHC) the Clinic is required to submit an annual cost
evaluation performed by a qualified firm. The cost evaluation determines the eligible costs incurred
by the Clinic to be included in the calculation of the medicare and medicaid rates used for
reimbursement. Based on cost evaluation reports submitted for years 1993 through 1996 the Clinic is
eligible for higher rates of reimbursement. The amounts due to the Clinic from these rates are still
subject to medicare/medicaid review and no revenue has been accrued in the accompanying financial
statements.
10
SChildule 1
THE BAY CLINIC. INC.
Schedule of Grant Awards and Expenditures. State of Hawaii, Department of Health
Administrative Service Office Log Numbers 96-099 and 96-135
Year ended June 30, 1997
11
Primary
Family Planning Services
Care Services
ASO Log No. 96-099
ASO Log No. 96-135
Federal
Title V State
State
Grant Award
$ 65,500 -
54,166
Expenditures charged against the
grant award during the fiscal year:
Less amounts
charged against
Total
other programs
Grant Grant
Grant
Expenses
and funds
Expenditures Expenditures
Expenditures
Salaries and related expenses:
Salaries
$ 1,302,530
1,182,864
65,500 -
54,166
Payroll taxes
141,931
141,931
- -
_
Employee fringe benefits
85,466
85,466
-
1,529,927
1,410,261
65,500 -
54,166
Occupancy expenses
270,050
270,050
- -
_
Other expenses
529,688
529,688
Depreciation and amortization
30,215
30,215
- -
-
Total expenses
$ 2,359,880
2,240,214
65,500 -
54,166
11
TAKETA. IWATA, HARA & ASSOCIATES
CERTIFIED PUBLIC ACCOUNTANTS 101 AUPUNI STREET, SUITE 139, HILO, HI 96720
P.O. BOX 1759, HILO, HI 96721-1759
GREGG M. TAKETA, CPA
BRIAN M- IWATA, CPA PH (808) 935-5404
JANET W_ HARA. CPA FAX (808) 969 1499
INDEPENDENT AUDITORS' REPORT ON THE
INTERNAL CONTROL STRUCTURE BASED ON AN
AUDIT OF FINANCIAL STATEMENTS PERFORMED IN
ACCORDANCE WITH GOVERNMENT AUDITING STANDARDS
The Board of Directors
The Bay Clinic, Inc.:
We have audited the financial statements of The Bay Clinic, Inc. (a not-for-profit organization) as of
and for the year ended June 30, 1997, and have issued our report thereon dated November 14, 1997.
We conducted our audit in accordance with generally accepted auditing standards and Government
Auditing Standards, issued by the Comptroller General of the United States. Those standards require
that we plan and perform the audit to obtain reasonable assurance about whether the financial
statements are free of material misstatement.
The management of The Bay Clinic, Inc. is responsible for establishing and maintaining an internal
control structure. In fulfilling this responsibility, estimates and judgments by management are
required to assess the expected benefits and related costs of internal control structure policies and
procedures. The objectives of an internal control structure are to provide management with
reasonable, but not absolute, assurance that assets are safeguarded against loss from unauthorized
use or disposition, and that transactions are executed in accordance with management's
authorization and recorded properly to permit the preparation of financial statements in accordance
with generally accepted accounting principles. Because of inherent limitations in any internal control
structure, errors or irregularities may nevertheless occur and not be detected. Also, projection of any
evaluation of the structure to future periods is subject to the risk that procedures may become
inadequate because of changes in conditions or that the effectiveness of the design and operation of
policies and procedures may deteriorate.
In planning and performing our audit of the financial statements of The Bay Clinic, Inc. for the year
ended June 30, 1997, we obtained an understanding of the internal control structure. With respect to
the internal control structure, we obtained an understanding of the design of relevant policies and
procedures and whether they have been placed in operation, and we assessed control risk in order to
determine our auditing procedures for the purpose of expressing our opinion on the financial
statements and not to provide an opinion on the internal control structure. Accordingly, we do not
express such an opinion.
Our consideration of the internal control structure would not necessarily disclose all matters in the
internal control structure that might be material weaknesses under standards established by the
American Institute of Certified Public Accountants. A material weakness is a condition in which the
design or operation of one or more of the internal control structure elements does not reduce to a
relatively low level the risk that errors or irregularities in amounts that would be material in relation to
the financial statements being audited may occur and not be detected within a timely period by
employees in the normal course of performing their assigned functions. We noted no matters
involving the internal control structure and its operation that we consider to be material weaknesses
as defined above
12
However, we noted certain matters involving the internal control structure and its operation that we
have reported to the management of The Bay Clinic, Inc. in a separate letter dated November 14,
1997.
This report is intended for the information of the Board of Directors and management of The Bay
Clinic, Inc., the State of Hawaii, Department of Health, and the U.S. Department of Health and Human
Services. However, this report is a matter of public record, and its distribution is not limited.
November 14, 1997
13
TAKETA, MATA, HARA & ASSOCIATES
CERTIFIED PUBLIC ACCOUNTANTS 101 AUPUNI STREET, SUITE 139, HILO. HI 96720
P.O BOX 1759, HILO. HI 967211759
GREGG M. TAKETA, CPA
BRIAN M IWATA, CPA
JANET W. HARA. CPA
INDEPENDENT AUDITORS' REPORT ON COMPLIANCE BASED
ON AN AUDIT OF FINANCIAL STATEMENTS PERFORMED IN
ACCORDANCE WITH GOVERNMENT AUDITING STANDARDS
The Board of Directors
The Bay Clinic, Inc.:
PH (808) 935-5404
FAX (808) 969 1499
We have audited the financial statements of The Bay Clinic, Inc. (a not-for-profit organization) as of
and for the year ended June 30, 1997, and have issued our report thereon dated November 14, 1997.
We conducted our audit in accordance with generally accepted auditing standards and Government
Auditing Standards, issued by the Comptroller General of the United States. Those standards require
that we plan and perform the audit to obtain reasonable assurance about whether the financial
statements are free of material misstatement.
Compliance with laws, regulations, contracts, and grants applicable to The Bay Clinic, Inc. is the
responsibility of The Bay Clinic, Inc.'s management. As part of obtaining reasonable assurance about
whether the financial statements are free of material misstatement, we performed tests of The Bay
Clinic, Inc.'s compliance with certain provisions of laws, regulations, contracts, and grants. However,
the objective of our audit of the financial statements was not to provide an opinion on overall
compliance with such provisions. Accordingly, we do not express such an opinion.
The results of our tests disclosed no instances of noncompliance that are required to be reported
under Government Auditing Standards.
We noted certain immaterial instances of noncompliance that we have reported to the management
of The Bay Clinic, Inc. in a separate letter dated November 14, 1997.
This report is intended for the information of the Board of Directors and management of The Bay
Clinic, Inc., the State of Hawaii, Department of Health, and the U.S. Department of Health and Human
Services. However, this report is a matter of public record, and its distribution is not limited.
November 14. 1997
14
THE BAY CLINIC, INC.
Schedule of Findings and Questioned Costs
Year Ended June 30, 1997
All prior year findings, as previously reported, were satisfactorily resolved in the current year.
There are no current year findings or questioned costs.
15
THE BAY CLINIC, INC.
Financial Statements and Audit Opinion
For the Years Ended June 30, 1998 and 1997
Table of Contents
Section pages
Independent Auditor's Report on the Basic Financial Statements 1
Financial Statements 2- 5
Notes to Financial Statements 6-10
Schedule 1 - Schedule of Grant Awards and Expenditures, State of Hawaii,
Department of Health 11
Independent Auditor's Report on Compliance and on Internal Control
Over Financial Reporting Based on an Audit of Financial Statements
Performed in Accordance with Government Auditing Standards 12
Schedule of Findings and Questioned Costs
13-14
TAKETA, MATA, HARA He ASSOCIATES
CERTIFIED PUBLIC ACCOUNTANTS 101 AUPUNI STREET, SUITE 139, HILO, HI 96720
P.O. BOX 1759, HILO. HI 96721-1759
GREGG M. TAKETA, CPA
BRIAN M. IWATA, CPA PH- (808) 935-5404
JANET W. HARA, CPA FAX (808) 969-1499
INDEPENDENT AUDITOR'S REPORT ON
THE BASIC FINANCIAL STATEMENTS
The Board of Directors
The Bay Clinic, Inc.:
We have audited the accompanying statements of financial position of The Bay Clinic, Inc. (a nonprofit
organization) as of June 30, 1998 and 1997, and the related statements of activities, cash Flows, and
functional expenses for the years then ended. These financial statements are the responsibility of the
Clinic's management. Our responsibility is to express an opinion on these financial statements based
on our audit.
We conducted our audit in accordance with generally accepted auditing standards and Government
Auditing Standards, issued by the Comptroller General of the United States. Those standards require
that we plan and perform the audit to obtain reasonable assurance about whether the financial
statements are free of material misstatement. An audit includes examining, on a test basis, evidence
supporting the amounts and disclosures in the financial statements. An audit also includes assessing
the accounting principles used and significant estimates made by management, as well as evaluating
the overall financial statement presentation. We believe that our audit provides a reasonable basis for
our opinion.
In our opinion, the financial statements referred to above present fairly, in all material respects, the
financial position of The Bay Clinic, Inc. as of June 30, 1998 and 1997, and the changes in its net assets
and its cash Flows for the years then ended in conformity with generally accepted accounting principles.
In accordance with Government Auditing Standards, we have also issued a report dated March 5, 1999,
on our consideration of The Bay Clinic, Inc.'s internal control over financial reporting and our tests of its
compliance with certain provisions of laws, regulations, contracts, and grants.
Our audit was performed for the purpose of forming an opinion on the basic financial statements of The
Bay Clinic, Inc. taken as a whole. The accompanying Schedule of Grant Awards and Expenditures,
State of Hawaii, Department of Health (Schedule 1) is presented for purposes of additional analysis and
is not a required part of the basic financial statements. Such information has been subjected to the
auditing procedures applied in the audit of the basic financial statements and, in our opinion, is fairly
stated in all material respects in relation to the basic financial statements taken as a whole.
,Iwai, -V 4,tiau* ft& Z, 4P
March 5, 1999, except for note 11 dated March 29, 1999.
Assets
! Current assets:
Cash and cash equivalents
Government grants
receivable
Patient accounts receivable,
net
Prepaid expenses
Deposit
Total current assets
Noncurrent assets:
Investments
Property, plant and
equipment, net
Total assets
THE BAY CLINIC, INC.
Statements of Financial Position
June 30, 1998 and 1997
1998
1997
Liabilities and Net Assets
1998
1997
Current liabilities:
$ 247,718
398,833
Accounts payable
$ 124,189
33,243
Accrued payroll and
153,345
13,823
related liabilities
167,326
92,544
Other liabilities
2,011
2,011
226,140
78,356
34,748
35,846
Total current liabilities
293,526
127,798
12,809
13,709
Total liabilities
293,526
127,798
674,760
540,567
Net assets:
Unrestricted
1,399,989
1,082,726
590,000
535,000
Total net assets
1,399,989
1,082,726
428,755
134,957
Total liabilities and
$ 1,693,515
1,210,524
net assets
$ 1,693,515
1,210,524
See accompanying notes to financial statements.
I
► 2
THE BAY CLINIC, INC.
Statements of Activities
Years ended June 30, 1998 and 1997
Changes in unrestricted net assets:
Support and Revenues:
U.S. Federal Assistance
Fees and grants from Hawaii State government agency
Fees and grants from Hawaii County government
Premium revenue
Net patient service revenue
Ka'u Clinic subsidy
Contributions
Interest income
Rental and other income
Total unrestricted revenue
Expenses:
Program services
Support services
Total expenses
Increase in net assets
Net assets, beginning of year
Net assets, end of year
See accompanying notes to financial statements.
III
1
3
1998 1997
$ 130,982
65,500
242,313
54,166
18,000
-
1,848,204
1,550, 036
991,317
705,174
-
60,000
65,106
27,564
49,779
35,231
69,616
60,279
3,415,317 2,557,950
2,788,711 2,120,109
309,343 239,771
3,098,054 2,359,880
317,263 198,070
1,082,726 884,656
$ 1,399,989 1,082,726
THE BAY CLINIC, INC.
Statements of Cash Flows
Years ended June 30, 1998 and 1997
Cash flows from operating activities:
Cash received from capitation arrangements
Cash received from service recipients
Cash received from grants
Interest and other income received
Cash paid to employees
Cash paid to suppliers
Net cash provided by operating activities
Cash flows from investing activities:
Purchase of assets
Purchase of investments
Net cash used by investing activities
Cash flows from financing activities:
Repayments of long-term debt
Payments under capital lease obligations
Net cash used by financing activities
Net increase (decrease) in cash and cash equivalents
Cash and cash equivalents, beginning of year
Cash and cash equivalents, end of year
Reconciliation of change in net assets to net cash provided by operating activities:
Change in net assets
Adjustments to reconcile change in net assets to net cash provided by
operating activities:
Depreciation and amortization
Bad debt expense
(Increase) decrease in grants receivable
Increase in patient accounts receivable
Decrease in prepaid expenses
(Increase) decrease in deposit
Increase in accounts payable
Increase in accrued payroll and related liabilities
Net cash provided by operating activities
Supplemental disclosure of cash flow information:
Cash paid during the year for interest expense
See accompanying notes to financial statements.
4
1998 1997
$ 1,848,204 1,550,036
807,344 733,093
251,773 249,416
184,501 123,074
(1,950,962) (1,528,259)
(912,139) (789,214)
228,721 338,146
(324,836) (21,059)
(55,000) (188,000)
(379,836) (209,059)
(3,937)
(1,176)
(151,115) 123,974
398,833 274,859
$ 247,718 398,833
$ 317,263 198,070
31,038
30,215
36,189
-
(139,522)
129,750
(183,973)
(32,081)
1,098
900
(1,400)
90,946
11,924
74,782
1,668
$ 228,721 338,146
$ 433 705
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5
THE BAY CLINIC, INC.
Notes to Financial Statements
Years ended June 30, 1998 and 1997
Nature of Ooerations
The Bay Clinic, Inc. (Clinic) is a nonprofit organization incorporated under Section 416-20, Hawaii
Revised Statues on January 31, 1983. The purpose of the Clinic is to provide quality health care to
Big Island residents through direct medical care and educational activities, including low cost family
planning and primary medical and preventive health care services. The Clinic's operations are
funded predominantly from third party reimbursements from health insurance plans, and by federal
and state financial assistance. The Clinic qualifies as a Federally Qualified Health Center (FQHC).
11 Significant Accounting Policies
The financial statements of the Clinic have been prepared on the accrual basis of accounting and in
accordance with the AICPA Industry Audit Guide for "Health Care Organizations". The significant
accounting policies are described below to enhance the usefulness of the financial statements to the
reader.
Cash and cash equivalents
Cash and cash equivalents is comprised of cash on hand, in savings and checking accounts, and
certificates of deposit with maturities of three months or less. At June 30, 1998, and throughout the
year then ended, the Clinic's cash balances were deposited in several banks. Management believes
the Clinic is not exposed to any significant credit risk from cash and cash equivalents.
Investments
Investments consist of certificates of deposit with maturities greater than three months, and are
carried at cost, which approximates fair value due to the short term maturity of the certificates.
Property Plant and Equipment
Property, plant and equipment are carried at cost or at the fair market value at the time of donation.
Maintenance and repairs are charged to expense, and betterments are capitalized. Depreciation is
provided over the estimated useful lives of three (3) to forty (40) years on a straight-line basis.
Equipment under capital lease obligations is amortized on the straightline method over the shorter
period of the lease term or the estimated useful life of the equipment. (See further details at note 4).
Premium Revenue
The Clinic has agreements with various qualified health plans under the State of Hawaii Health
QUEST Program to provide medical services to eligible members. Under these agreements, the
Clinic receives monthly capitation payments based on the number of each plan's eligible members
who have selected the Clinic as their primary care provider, regardless of services actually performed
by the Clinic.
THE BAY CLINIC, INC.
Notes to Financial Statements, Continued
Net Patient Service Revenue
The Clinic has agreements with third party payors that provide for payments to the Clinic at amounts
usually discounted from its established rates. Net patient service revenue is reported at the
estimated net realizable amounts from patients, third party payors, and others for services rendered.
Contributions
Contributions received and unconditional promises to give are measured at their fair values and are
reported as an increase in net assets. The Clinic reports support of cash and other assets as
restricted support if they are received with donor stipulations that limit the use of the donated assets,
or if they are designated as support for future periods. When a donor restriction expires, that is, when
a stipulated time restriction ends or a purpose restriction is accomplished, temporarily restricted net
assets are reclassified to unrestricted net assets and reported in the statement of activity as net
assets released from restrictions. Conditional promises to give are not included as support until the
conditions are substantially met.
Donated Services
No amounts have been reflected in the statements for donated services inasmuch as no objective
basis is available to measure the value of such services; however, a number of volunteers have
donated their time in program services.
Advertising Costs
Advertising costs are expensed as incurred.
Ka'u Clinic
On January 1, 1997, The Bay Clinic, Inc. assumed the assets of the Ka'u Community Health Center
from Hawaii Family Medical Centers, a Hawaii corporation. (See note 6).
Income Taxes
No provision has been made for federal or state income taxes because the Clinic has obtained tax
exempt status under the Internal Revenue Code Section 501 (c)(3) and applicable provisions of the
Hawaii Revised Statutes.
THE BAY CLINIC, INC.
Notes to Financial Statements, Continued
(2) Use of Estimates in Preparation of Financial Statements
The preparation of financial statements in conformity with generally accepted accounting principles
requires management to make estimates and assumptions that effect the reported amounts of assets
and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements
and the reported amounts of revenues and expenses during the reporting period. Actual results could
differ from those estimates.
(3) Patient Accounts Receivable
Patient accounts receivable represents fees owed by patients and third party health insurance plans for
services provided. This account is comprised of the following as of June 30, 1998 and 1997:
Patient fees receivable
Third party billings receivable
Fees receivable, gross
Less allowance for uncollectibles
Patient receivables, net
(4) Property. Plant and Equipment
1998 1997
$ 95,442 79,700
294,698 126,656
390,140 206,356
164,000 128,000
$ 226,140 78,356
A summary of the Clinic's investment in property, plant and equipment as of June 30, 1998 and 1997,
is set forth hereunder:
Estimated
Total
A
$ 428,755 134,957
Useful Lives
1998
1997
Land
$ 5,983
5,983
Condominium
40 years
93,736
93,736
Leasehold improvements
5 years
212,848
12,215
Clinical equipment
5-10 years
48,033
30,256
Office furniture and equipment
3-5 years
156,943
145,808
Computer hardware and
software
3-5 years
95,291
-
612,834
287,998
Less accumulated depreciation
184,955
154,375
427,879
133,623
Assets under capital lease
5 years
18,295
18,295
Less accumulated amortization
17,419
16,961
876
1,334
Total
A
$ 428,755 134,957
THE BAY CLINIC, INC.
Notes to Financial Statements, Continued
(5) Operating Leases
The Clinic leases its Hilo, Pahoa and Ka'u facilities under non -cancelable operating leases that expire
in the years ending June 30, 1999, and 2003. Minimum annual rent for the Hilo facility was $106,858
including general excise taxes. The lease term for the current Hilo facility ended June 30, 1997 and
continued on a month to month basis. A new lease agreement for the Hilo facility commenced on
September 1, 1998 at an annual rental of $120,000. The minimum annual rental for the Pahoa facility
is $85,668 which includes common area maintenance and general excise taxes and increases to
$88,428 as of June 1, 2001. Minimum annual rent for the Ka'u facility is $12,000, with a 10% annual
increase effective on July 1, 1998.
Rent expense for the years ended June 30, 1998 and 1997, was $206,927 and $191,424,
respectively and its components are as follows:
Minimum rent
Month to month
1998 1997
$ 204,516 191,424
2,411 -
$ 206,927 191,424
Future minimum rental payments under the above operating leases are as follows:
Year ending June 30
1999
$ 207,478
2000
205,668
2001
208,428
2002
208,428
2003
208,428
Thereafter
20,000
$ 1,058,430
(6) Ka'u Clinic Assumption of Assets
On January 1, 1997, The Bay Clinic, Inc. assumed the assets of the Ka'u Community Health Center
(KCHC) from Hawaii Family Medical Centers (HFMC), a Hawaii corporation. The Bay Clinic, Inc. was
paid $60,000 by HFMC to subsidize the initial administrative costs involved in assuming the operation
of KCHC. The assets assumed by The Bay Clinic, Inc. had no book value except for a personal
computer system which was recorded at an estimated fair value of $1,500, and patient services
receivable recorded at $20,783.
THE BAY CLINIC, INC.
Notes to Financial Statements, Continued
(7) Retirement Plan
The Clinic offers a Simplified Employee Plan (SEP) to its employees. For each of the years ended
June 30, 1998 and 1997, the Clinic contributed $5,912 to the plan.
The Clinic also offers two voluntary tax deferred annuity plans under Internal Revenue Code Section
403(b) to substantially all of its full time employees. These plans were employee contributory only
with a maximum annual contribution per employee of 20% of gross wages or $9,500, whichever is
less.
(8) Functional Classification of Expenses
The costs of providing the various programs and supporting services have been summarized on a
functional basis in the statement of functional expenses. Accordingly, certain costs have been
allocated among the programs and supporting services benefited.
(9) Medicare/Medicaid Cost Evaluations
As a Federally Qualified Health Center (FQHC) the Clinic is required to submit an annual cost
evaluation performed by a qualified firm. The cost evaluation determines the eligible costs incurred
by the Clinic to be included in the calculation of the medicare and medicaid rates used for
reimbursement. Based on cost evaluation reports submitted for years 1993 through 1997 the Clinic is
eligible for higher rates of reimbursement. $96,864 was received in February 1999 for Medicaid cost
reports submitted for years 1993 through 1997. This amount is accrued in the accompanying
financial statements as of June 30, 1998.
The amounts due to the Clinic for Medicare cost reports submitted are still subject to Medicare review
and no revenue has been accrued in the accompanying financial statements.
(10) Charity Care
The Clinic provides care to indigent patients based on criteria established by the federal government.
This care is provided without charge or at amounts less than its established rates. Because the Clinic
does not pursue collection of amounts determined to qualify as charity care, such amounts are not
reported as revenue. The Clinic maintains records to identify and monitor the level of charity care
provided. These records include the amount of charges forgone for services and supplies furnished
under its charity care policy. These records were not compiled into annual totals for reporting
purposes.
(11) Subsequent Event
On March 29, 1999, the Clinic purchased the thirty-eight year sub -leasehold interest for the Hilo Clinic
facility for $1,200,000. The purchase was partially financed by a twenty-five year mortgage for
$1,000,000 with monthly payments of $8,052, including interest at 8.5% per annum. The leasehold
agreement is for a term of thirty-eight years and includes monthly ground lease payments of $3,000
through June 30, 2002. For the period after June 30, 2002 until the end of the sub -lease term, rent
will be renegotiated by the Clinic and the lessor.
10
11
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� 11
TAKETA, IWATA, HARA & ASSOCIATES
CERTIFIED PUBLIC ACCOUNTANTS 101 AUPUNI STREET, SUITE 139, HILO, HI 96720
P.O. BOX 1759, HILO. HI 96721-1759
GREGG M. TAKETA, CPA
BRIAN M. IWATA, CPA
JANET W. HARA, CPA PH(808) 935-5404
. =
FAX (808) 969 1499
INDEPENDENT AUDITOR'S REPORT ON COMPLIANCE
AND ON INTERNAL CONTROL OVER FINANCIAL
REPORTING BASED ON AN AUDIT OF FINANCIAL
STATEMENTS PERFORMED IN ACCORDANCE
WITH GOVERNMENT AUDITING STANDARDS
The Board of Directors
The Bay Clinic, Inc.
We have audited the financial statements of The Bay Clinic, Inc. as of and for the year ended June 30,
1998, and have issued our report thereon dated March 5, 1999. We conducted our audit in accordance
with generally accepted auditing standards and the standards applicable to financial audits contained in
Government Auditing Standards, issued by the Comptroller General of the United States.
Compliance
As part of obtaining reasonable assurance about whether The Bay Clinic's financial statements are free
of material misstatement, we performed tests of its compliance with certain provisions of laws,
regulations, contracts and grants, noncompliance with which could have a direct and material effect on
the determination of financial statement amounts. However, providing an opinion on compliance with
those provisions was not an objective of our audit and, accordingly, we do not express such an opinion.
The results of our tests disclosed no instances of noncompliance that are required to be reported under
Government Auditing Standards.
Internal Control Over Financial Reporting
In planning and performing our audit, we considered The Bay Clinic's internal control over financial
reporting in order to determine our auditing procedures for the purpose of expressing our opinion on the
financial statements and not to provide assurance on the internal control over financial reporting.
However, we noted certain matters involving the internal control over financial reporting and its
operation that we consider to be reportable conditions. Reportable conditions involve matters coming to
our attention relating to significant deficiencies in the design or operation of the internal control over
financial reporting that, in our judgement, could adversely affect The Bay Clinic's ability to record,
process, summarize, and report financial data consistent with the assertions of management in the
financial statements. Reportable conditions are described in the accompanying schedule of findings
and questioned costs as items FY98-1 through FY98-6.
A material weakness is a condition in which the design or operation of one or more of the internal
control components does not reduce to a relatively low level the risk that misstatements in amounts that
would be material in relation to the financial statements being audited may occur and not be detected
within a timely period by employees in the normal course of performing their assigned functions. Our
consideration of the internal control over financial reporting would not necessarily disclose all matters in
the internal control that might be reportable conditions and, accordingly, would not necessarily disclose
all reportable conditions that are also considered to be material weaknesses. However, of the
reportable conditions described in the accompanying schedule of findings and questioned costs, we
consider all referenced items to be material weaknesses.
This report is intended for the information of the audit committee, management and the State of Hawaii,
Department of Health. However, this report is a matter of public record, and its distribution is not limited.
�R1Lt.'ca,
March 5, 1999 r
12
THE BAY CLINIC, INC.
Schedule of Findings and Questioned Costs
Year Ended June 30, 1998
FY98-1
Condition:
During our detailed testing of the patient and insurance revenue cycle, the daily encounter form log could not be
located for five of the thirty sample days selected.
Criteria:
Daily encounter form logs should be maintained as a record of all services provided to patients.
Effect:
Patient revenues may not include all services rendered.
Cause:
Unknown.
FY98-2
Condition:
During our audit procedures on year end patient and insurance receivables, two insurance reimbursements
transmittals out of a sample of eleven could not be located.
Criteria:
Insurance reimbursements transmittals should be kept as a record of all insurance claims filed.
Effect:
Insurance claims may not have been filed for all patient services. The Clinic may not be able to follow up on
outstanding claims.
Cause:
Unknown.
FY98-3
Condition:
During our control testing of a sample of twenty-five employee payroll records, we noted six timesheets that
were not authorized by a supervisor.
Criteria:
Authorized employee timesheets provide evidence that payroll costs are incurred for Clinic purposes.
Effect:
Personnel costs could be overstated.
Cause:
Unknown.
13
THE BAY CLINIC, INC.
Schedule of Findings and Questioned Costs
Year Ended June 30, 1998
FY98-4
Condition:
During our control testing of a sample of twenty-five employee payroll records, we noted a pay rate authorization
that was not signed by the executive director.
Criteria:
Employee pay rate authorizations should be signed by the executive director.
Effect:
Personnel costs could be overstated.
Cause:
Unknown.
FY98-5
Condition:
During our control testing of a sample of twenty-five employee payroll records, we found that three doctors did
not prepare timesheets for the pay periods tested.
Criteria:
Authorized timesheets provide evidence that payroll costs are incurred for Clinic purposes.
Effect:
Personnel costs could be overstated.
Cause:
Unknown.
FY98-6
Condition:
Numerous unreconciled differences were found between reconciliations and subsidiary schedules, and the
related general ledger account balances.
Criteria:
Subsidiary ledger totals and supporting schedules should be reconciled to the related general ledger account
balances on a regular basis.
Effect:
Misstatements of general ledger balances due to errors or irregularities could go undetected for an
unreasonable length of time.
Cause:
Unknown.
14
TAKETA, IWATA, HARA & ASSOCIATES LLP
Certified Public Accountants
May 12, 1999
Stephanie Launiu, Executive Director
The Bay Clinic, Inc.
311 Kalanianaole Avenue
Hilo, HI 96720
Dear Stephanie:
101 Aupuni Street, Suite 139
Hilo, Hawaii 96720
(808)935-5404
We enclose for filing your exempt organization income tax return, form 990, for the year ended
June 30, 1998. The original return should be signed, dated and filed in accordance with the filing
instructions attached to your copy of the return. Please read the return carefully. You should
retain the copy of your return permanently. All supporting information should be kept for at least
three years from the due date of the returns.
This return was prepared from information provided by you and we did not independently verify it.
Before mailing the return, please examine it for any omissions or misstatements. If any errors are
noted, please contact us immediately.
Sincerely,
TAKETA, IWATA, HARA & ASSOCIATES LLP
Gregg M. Taketa, Partner
Form Zf*t$
(Rev. May 1995)
Deo .t of M. TlM
Please type or
orint File the
Prepared for:
Certain Excise, Income, Information, and Other heturrm
jo- File a separate application for each return.
Filing Instructions
Prepared by:
UMH NO. 13,u -v wo
THE BAY CLINIC,
INC.
TAKETA, IWATA,
HARA & ASSOCIATES,
311 KALANIANAOLE
AVENUE
101 AUPUNI STREET SUITE 139
HILO, HI 96720
HILO, HAWAII
96720
1997 FORM 990
Please sign and mail on
or before May 17, 1999.
THIS COPY
Mail to -
Internal
Revenue Service Center
Ogden, UT 84201-0027
FOR
YOUR FILES
Form '17558Application for Extension of Time To File
(Rev. May 1995) Certain Excise, Income, Information, and Other Returns
D.on tot m. r.ry ► File a separate application for each return.
Pleas ori THE BAY CLINIC, INC.
p the r, street (or P.O. box no. if mail is not delivered to street address)
Zile agd Ane
copy by�fl7ue
dalefor Ing �A 311 KALANIANAOLE AVENUE
your return. � City, town, or post office, state, and ZIP code. For a foreign address, see instructions.
HILO, HI 96720
Note: Corporate income tax return filers must use Form 7004 to request an extension of time to file. Partnerships, REMICS, and
trusts must use Form 8736 to request an ext ensi of time to file Form 1065, 1066, or 1041.
1 1 request an extension of time until 02/ 1 ,19 99 to file (check only one):
OMB No. 1545-0148
Goya id.neemrlon numi .
9 0222784
0 Form 706 -GS (D) L—J Form 990-T(401(a) or 408(x) trust)
0 Form 1120 -NO (4951 taxes)
0 Form 8612
0 Form 706-GS(T) 0 Form 990-T (trust other than above)
Form 3520-A
Form 8613
® Form 990 or 990 -EZ El Form 1041 (estate)
Form 4720
Form 8725
Form 990 -BL 0 Form 1041-A
Form 5227
Form 8804
0 Form 990 -PF 0 Form 1042
Form 6069
Form 8831
If the organization does not have an office or place of business in the United States, check this box
►
2a For calendar year 19 _ ,orother tax year beginning 07/01/1997
and ending 06/30/1998
b If this tax year is for less than 12 months, check reason: E=1 Initial return
O Final return Change in accounting period
3 Has an extension of time been previously granted for this tax yeah ...............
,.
.O Yes No
4 State in detail why you need the extension
4DDITIONAL TIME IS NECESSARY TO COMPLETE THE INFORMATION TO
FILE A
COMPLETE AND ACCURATE RETURN.
5a If this form is for Form 706-GS(D), 706-GS(T), 990 -BL, 990 -PF, 990-T, 1041 (estate), 1042, 1120 -ND, 4720,
6069, 8612, 8613. 8725, 8804, or 8831, enter the tentative tax, less any nonrefundable credits. _......... $
b It this form is for Form 990 -PF, 990-T, 1041 (estate), 1042, or 8804, anter any refundable credits and
estimated tax payments made. Include any prior year overpayment allowed as a credit ................ .. .. $
c Balance due. Subtract line 5b from line 5a. Include your payment with this form, or deposit with FTD
coupon it required. s
Signature and Verification
Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief,
It is true, correct. and complete and that I am authorized to prepare this form.
Title ►
FILE OAf01NNE9NN"NEVW?TRWI&719111 YIIB1l101bliv whether or not your application Is approved and will return the copy
dice to Applicant - To Be Completed by IRS
We HAVE approved your application. Please attach this form to your return.
HAVE NOT approved your application. However, we have granted a 10 -day grace period from the later of the date
shown below or the due date of your return (including any prior extensions). This grace period is considered a valid
extension of time for elections otherwise required to be made on a timely relum. Please attach this form to your return.
0 We HAVE NOT approved your application. After considering your reasons stated in item 4, we cannot grant your request for
an extension of time to file. We are not granting the 10 -day grace period.
We cannot consider your application because it was filed after the due date of the return for which an extension was requested.
Other f4
By
Director
IONOV 1 6 1998
V _ C-- 0. w1n i � i J
If you want a copy of this form to be returned to an address other than that shown above, please enter the address to which the copy should be sent.
Please
Type
or
Print
LHA
n 39a1
050 97
11331113
Name
TAKETA, IWATA, HARA & ASSOCIATES
Number, street (or P.O. box no. t mail is not delivered to street address)
101 AUPUNI STREET, SUITE 139
City, town, or post office, state, and ZIP code. For a foreign address, see instructions.
HILO, HAWAII 96720
For Paperwork Reduction Act Notice, see separate Instructions.
753993 BCI
050 THE BAY CLINIC, INC.
Date
Form 2758 (Rev 5-95)
BCI 1
Form 990 (1991)
Part 11 Functional Expenses (4) on
Do not include amounts reported on line
6b 6t. 9b 10b or 16 of Part I.
22 Grants and allocations (attach schedule)
cash a ncash s
23 Specific assistance to individuals (attach schedule)
24 Benefits paid to or for members (attach schedule)
25 Compensation of officers, directors, etc.
26 Other salaries and wages
27 Pension plan contributions
28 Other employee benefits
29 Payroll taxes
30 Professional fundraising fees
31 Accounting fees
32 Legal fees
33 Supplies
34 Telephone
35 Postage and shipping
36 Occupancy
37 Equipment rental and maintenance
36 Printing and publications
39 Travel
40 Conferences, conventions, and meetings
41 Interest
42 Depreciation, depletion, etc. (attach schedule)
43 Other expenses (itemize):
a
b_
c _
d
e SEE STATEMENT 3
44 Tolai lunctonal e.pensee WWe ues 22 through 43)
0,,oauons completing columns (i. carry these
and section 4947(a 1) none)
(A)Tota I IB
`J`r-11L6�,oY are required for section 501(c)(3) and
of optional for others. -
C and neneal nt (D)Fundraising
c I A 1- n
1.
Repotting of Joint Costs. - Did you report In column (B) (Program services) any joint costs from a combined educational campaign and ► O Yes ® No
lundralsmg solicitation?
11 'Yes,' enter (i) the aggregate amount of these joint costs $ ; (it) the amount allocated to Program services $
(nil me amount allocated to Management and general $ and (iv) the amount allocated to Fundraising $
What is the organization's primary exempt purpose? ► SEE STATEMENT 4 ProCram Service
Expenses
nil x,anuxhons musl des«ube inert evempt purpose acluevemanls in a clear and concise
Effsfuls. served, publlcabons issues, etc. gluus (gegmme f« 501(ca3) ane
achievemenls that are not measurable (Section 501(c)(3) ane(4) «gangabons and 4941(a)(t area enter the amount of gaols and trusts, b gsopand,1 f«(a)(1) 7
allocations to others )
a SEE STATEMENT 5
7
It
r
e Other program services (attach schedule) (Grants and allocations $ 1 I
t Total of Pro ram Service Ex enses should equal line 44, column B ,Pro ram services
► 2,790,221
]23011 2
27 98 BCI_1
13450513 753993 BCI 092 THE BAY CLINIC, INC.
Form 990 (1997) THE BAY CLINIC, INC. 99-0222784 Page
Part IV Balance Sheets
Note:
Where required, attached schedules and amounts within the description column should be
(A)
(B)
for end-ol-year
amounts only.
Beginning
of year
End of year
45
Cash - non-interest-bearing _ _ _ _
1,360.
45
11470.
932
473.
46
836
248.
46
Savings and temporary cash investments
47 a
Accounts receivable _ _ 47a 390 140.
b
Less: allowance for doubtful accounts 47b 164, 000.
78
356.
47c
226,140.
48 a
Pledges receivable _ 48a
b
Less: allowance for doubtful accounts 48b
48c
13,823.
49
1-5-3,34-5.
49
Grants receivable
50 Receivables from officers, directors, trustees, and key employees (attach
Z
N
a
51 a
b
schedule)
Other notes and loans receivable 51a
Less: allowance for doubtful accounts 51b
50
51c
52
52
Inventories for sale or use
49,555.
53
47
557.
53
Prepaid expenses and deferred charges
54
54
Investments - securities (attach schedule)
55 a Investments - land, buildings, and
equipment: basis _ _ _ _ _ _ _ 553 5,983.
It
Less: accumulated depreciation (attach
schedule) STATEMENT 7 SSb
55c
5,983.
56
56
Investments - other _
57 a Land, buildings, and equipment: basis 57a 606,8 51 .
b
Less: accumulated depreciation STMT 8 57b 184 955.
133
623.
57c
421
896.
1,334.
58
876.
58
Other assets (describe ►CAPITAL LEASES — NET )
59
Total assets add lines 45 through 58 must equal line 74
1
210,524.
59
1 693,
515.
60
Accounts payable and accrued expenses
127
798.
60
293
526.
61
61
Grants payable
62
y
62
Deferred revenue _
63
=
T
J
63
64 a
It
Loans from officers, directors, trustees, and key employees
Tax-exempt bond liabilities
Mortgages and other notes payable
64a
64b
65
65
Other liabilities (describe ► )
66
Total liabilities add lines 60 through 65 ... ......
127
798.
66
293
526.
Organizations that follow SFAS 117, check here ► LXI and complete lines 67 through
69 and lines 73 and 74
n
m
C
LL
8
�
H
N
a
67 unrestricted
68 Temporarily restricted _
69 Permanently restricted ........
Organizations that do not follow SFAS 117, check here ► El and complete lines
70 through 74
70 Capital stock, trust principal, or current funds ......................................................
71 Paid -in or capital surplus, or land, building, and equipment fund„
72 Retained earnings, endowment, accumulated income, or other funds
1,082,726.
67
1 399
989.
68
69
70
71
72
1
082
726.
73
1 399
989.
°i73
z
Total net assets or fund balances (add lines 67 through 69 OR lines 70 through 72;
column (A) must equal line 19 and column (B) must equal line 21)
1
210
5 2 4 .
74
1 6 9 3
515 .
74 Total liabilities and net assets / fund balances (add lines 66 and 73)
Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization. How the public
perceives an organization in such cases may be determined by the information presented on its return. Therefore, please make sure the return is complete and accurate
and fully describes, in Part III, the organization's programs and accomplishments.
723021
03 12-9e 3
13450513 753993 SCI 092 THE BAY CLINIC, INC. BCI 1
Form 990 (1997) THE BAY CLINIC. TMC. OO—n)))7AA P.—
Part iv -A] Reconciliation of Revenue per Audited
Part IV -B I Reconciliation of Expenses per Audited
Financial Statements with Revenue per
Financial Statements With Expenses per
Return_ _
Return
a Total revenue, gains, and other support
64,450.
0.
a Total expenses and losses per
SEE STATEMENT.11
a
3 415 317.
a
3 098 054 .
per audited financial statements ►
audited financial statements ►
b Amounts included on line a but not on
b Amounts Included on line a but not on
Ilne 17, Farm 990:
line 12, Form 990:
(1) Donated services
(1) Net unrealized gains
and use of facilities $
on Investments $
(2) Prior year adjustments
(2) Donated services
reported on line 20,
and use of facilities $
Form 990 $
)3) Recoveries of prior
(3) Losses reported on
year grants $
line 20, Form 990 $
(4) Other (specify):
(4) Other (specify):
STMT 9 $ 11,130.
STMT 10 11,130.
Add amounts on lines (1) through (4) ►
b
11,130.
_$
Add amounts on lines (1) through (4) ►
If
11,130.
c
3,404,187.
e
3,086,924.
c Line a minus line b ►
c Linea minus line If ►
d Amounts Included on line 12, Form
d Amounts Included on line 17, Form
990 but not on line a:
990 but not on line a:
(1) Investment expenses
(1) Investment expenses
not Included on
not Included on
lune 6b, Form 990 $
line 6b, Form 990 $
(2) Other (specdy):
(2) Other (specify),
It
$
Add amounts on lines (1) and(2) ►
d
Add amounts on lines (1) and(2) ►
d
e Total revenue per line 12, Form 990
a Total expenses per line 17, Form 990
(line c plus line ch
el
3 404 187.
(line c plus line d) Pod
e
1 3 086 924.
part V Ltst of Officers, Directors, Trustees, and Key Employees (List each one even it not compensated.)
(A) Name and address
(B) Title and average hours
per week devoted to
position
(C) Compensation
If not ppi , enter
( v0-
(101conmbm,wsro
pl, bene°'
Pcorn ansae ntl
(E) Expense
account and
other allowances
64,450.
0.
0.
SEE STATEMENT.11
75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from youro,r99--an,ization and all related
organizations, of which more than $10,000 was provided by the related organizations? If "Yes' attach schedule. ► 7J Yes [X No
rorm oyu)iayr) I'HL; BAY CLINIC INC. 99-0222784 Page
Part VI I Other Information Yes No
76 Did the organization engage in any activity not previously reported to the IRS? If 'Yes,' attach a detailed description of each activity
77 Were any changes made in the organizing or governing documents but not reported to the IRS?
It 'Yes," attach a conformed copy of the changes.
78 a Did the orgamzation have unrelated business gross income of $1,000 or more during the year covered by this return?
b It -Yes; has it filed a tax return on Form 990-T for this year? _ N/A
79 Was there a liquidation, dissolution, termination, or substantial contraction during the year?
If 'Yes,' attach a statement;
80 a Is the organization related (other than by association with a statewide or nationwide organization) through common membership,
governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization?
b If 'Yes,* enter the name of the organization ►
and check whether it is exempt OR D nonexempt.
81 a Enter the amount of political expenditures, director indirect, as described in the
instructions for line 81 _ _ _ .,, _ _ 81a 1 0.
b Did the organization file Form 1120-POL for this year?
81b
X
82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than
lair rental value? _
82a
X
b If 'Yes.' you may indicate the value of these items here. Do not include this amount as revenue in Part I or as an
expense in Part II. (See instructions for reporting in Part III) 1 82b N/A
83 a Did the organization comply with the public inspection requirements for returns and exemption applications?
83a
X
83b
X
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions?
84a
X
84 a Did the organization solicit any contributions or gifts that were not tax deductible?
b it 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were not
tax deductible? _N/A_
84b
It
85 501(c)(4), (5), or (6) organizations. - a Were substantially all dues nondeductible by members? _ _ _ N/A„
85b
b Did the organization make only in-house lobbying expenditures of $2,000 or less? _ _ _ N/A
It 'Yes' was answered to either 85a or 851d, do not complete 85c through 85h below unless the organization received a waiver for proxy tax
owed for the prior year.
c Dues, assessments, and similar amounts from members _ „ „ _ _ 85c N A
d Section 162(e) lobbying and political expenditures _ _ _ 85d N/A
e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices _ _ _ _ _ It N/A
f Taxable amount of lobbying and political expenditures (line 85d less 85e) _ _ _ _ _ _ 851 N/A
If Does the organization elect to pay the section 6033(e) lax on the amount in 851? _ _ _ _ N/A _
85
It It section 6033(e)(1)(A) dues notice were sent, does the organization agree to add the amount in 851' to its reasonable estimate of dues
allocable to nondeductible lobbying and political expenditures for the following tax year? N/A,
85h
86 501(c)(7) organizations. - Enter:
a Initiation fees and capital contributions included on line 12 It N/A
b Gross receipts, included on line 12, for public use of club facilities B6b N/A
87 50l(c)(12) organizations. - Enter: a Gross income from members or shareholders It N/A
b Gross income from other sources. (Do not net amounts due or paid to other sources
against amounts due or received from them.) 87b N/A
88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership?
11 'Yes,' complete Part IX
88
X
89 a 501(c)(3) organizations. - Enter: Amount of lax imposed during the year under:
section 491110, 0 . ;section 4912 ► 0 . ; section 4955 ► 0.
It 501(c)(3) and 501(c)(4) organizations. - Did the organization engage in any section 4958 excess benefit
transaction during the year? If 'Yes,' attach a statement explaining each transaction ,,.
891b
X
c Enter: Amount of lax imposed on the organization managers or disqualified persons during the year under
sections 4912, 4955, and 4958 _ _ _ _ „ _ _ _ _ _ ►
0.
0.
of Enter: Amount of tax in 89c, above, reimbursed by the organization _ _ ►
90b
52
90 a List the states with which a copy of this return is filed ► NONE
b Number of employees employed in the pay period that includes March 12, 1997„
91 Thebooksareincareof ►REFUGIO DE LOS SANTOS Telephoneno.► 808-934--3218
Locatedat No 311 KALANIANAOLE AVE. , HILO HI ZIP .4 Ni 96720
92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041.- Check here It. 0
and enter the amount of tax-exempt interest received or accrued during the tax year ► 1 92 N/A
72301 1 5
03 12 99
13450513 753993 BCI 092 THE BAY CLINIC, INC. BCI 1
Foran 990 (1997) THE BAY CLINIC INC. 99-0222784 ragea
Part VII Analysis of Income -Producing Activities
Enter gro
Indicated
93 Pro
(a)
(b)
(c)
(d)
(e)
Igl
94 Me
95 Int
cas
96 Div
97 Net
(a)
(b)
98 Net
99 Ot
100 Gai
ott
101 Net
102 Gr
103 On
a
b
c
d
e
104 S
ss amounts unless otherwise
gram service revenue:
PREMIUM REVENUE
Brest
her
ler
uWest(add 6
Unrelated business income
(A) (D)
Business
code Amount
Excwdad b sechoh 512, 513, or s4
(D) (D)
ExClu.
sox Amount
(E)
Related or exempt
function income
1,848,204.
NET PATIENT SERVICE REV
_:�:—_:_,. .,.___, _._..:_ .. u.�_•v.: •,.. e. AA is hhohkeAl
991,317.
Medicare/Medicaid payments
Fees and contracts from government agencies
mbership dues and assessments
on savings and temporary
hinvestments
Idends and Interest from securities _
rental Income or(loss)from real estate:
debt-financed property
not debt-financed property
rental income or (loss) from personal property
investment income
If or (loss) from sales of assets
than inventory
t income or (loss) from special events
oss profit or floss)from sales of inventory
herrevenue:
OTHER INCOME
14 49,779.
16 2 5 8136.
32,600.
columns (B), (D), and (E))
O.
75
665.
2 872
121.
105 TOTAL (add line 104, columns (B), (D), and (E)) _ ...... ► 2 , 9
Nate: (Erne 105 plus Ilne 1 d, Part 1, should equal the amount on line 12, Part I.)
Part VIII Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
V
93 _
103
Explain how each activity for which income is reported in column (E) of Part VII contributed importantly tome accmnpiiswnew u: uw
exempt purposes (other than by providing funds for such purposes).
PROVIDING UALITY LOW-COST PRIMARY HEALTH CARE AND FAMILY PLANNING
SERVICES TO THE PUBLIC ON A SLIDING FEE SCALE BASIS .
EDICAL RECORDS AND OTHER FEES FOR SAME PURPOSE AS FOR LINE 93
_:�:—_:_,. .,.___, _._..:_ .. u.�_•v.: •,.. e. AA is hhohkeAl
Part IX I imormacuon negarunry ra�a,ro .,......._. _....... '
Name, address, and employer identification Percentage of End -of -year
number o corporation pownershipinterest
Nature of business activities Total income assets
undo penaltms of Penury I declare that I have examined this return, including amompany,nq schedules and statamenls, and to iM1e best o1 my knowtetlge and babel, it is true,
correct and complete Declerabon of preparer rather than oflicerl is based on all Information of wh.ch prepares has any knowledge
Please
Sign
Here I Signature of officer Date I Type or print name and title
SIGNED Date hec if preps«ass
PreParer s 1 self- 675-56-1400
Paid signature I - IGINQL O5 13 99 employed ► 0
PreParer's Rrm'sname(oryours TAKETA, IWATA, HARA & ASSOCIATES, LLP EIN ►
Use only it sell employed) 1101 AUPUNI STREET SUITE 139
and address HIL0 HAWAII ZIP
► 96720
121,6, 6
13450513 753993 BCI 092 THE BAY CLINIC, INC. BCI_1
SCHEDULE A
(Form 990)
Oen Nlment of me neasu,v
internal Revenue Service
Organization Exempt Under 501(c)(3)
(Except Private Foundation), and Section 501(e), 501(f), 501(k), 501(n) or Section 4947(a)(1)
Nonexempt Charitable Trust
Supplementary Information
Must be completed by the above organizations and attached to their Form 990 (or Form 99l
Name of the organization
THE BAY CLINIC, INC.
[p—art l Compensation of the Five Highest Paid Employees
(See instructions.) (List each one. If there are none, enter 'None ")
OMB No. 1565-006]
1997
Employer identification number
(a) Name and address of each employee paid
(b) Title and average hours
per week devoted to
(c) Compensation
wf Comnemiens m
pia°:a ere entero
(e) Expense
account and other
more than $50,000
position
compenSaLOn
allowances
WILLIAM K_._KAMA--------------------
MEDICAL DIR.
122 HELEMANO ST., HILO HI 96720
40 HRS./WK
109 234.
ROBERT MCCALISTER
PHYSICIAN
13-3416 POMAIKAI ST. PAHOA HI 9677840
HRS. WK
88,195.
JEAN -SWIFT -------------------------
PHYSICIAN
P.O. BOX 70, NAALEHU, HI 96772
40 HRS. WK
101 333.
_
DANIEL DIDIMIZIO_____________
PHYS. ASSIST.
P.O. BOX 1455, PAHOA, HI 96778
40 HRS. WK
70,291.
STEPHANIE_LAUNIU__________________
XEC. DIR.
P.O. BOX 2052 KEAAU HI 96749
40 HRS./WK--
RS. WKTotal
Totalnumber of other employees paid
over $50,000 ►
5
( Part III Compensation of the Five Highest Paid Independent Contractors for Professional Services
(a) Name and address of each independent contractor paid more than $50,000
NONE
Total number of others receiving over
(b) Type of service
LHA For Paperwork Reduction Act Notice, see page 1 of the Instructions to Form 990 (err Form 990 -EZ).
7
"';01,
Or V 90
13450513 753993 BCI 092 THE BAY CLINIC, INC.
(c) Compensation
Schedule A (Form 990) 1997
BCI 1
Schedule A(Form 990) 1997 THE BAY CLINIC. INC. 99—
Lart III Statement About Activities Yes No
1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence public
opinion on a legislative matter or referendum?
It 'Yes," enter the total expenses paid or incurred in connection with the lobbying activities. ► $ _
Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI -A. Other
organizations checking 'Yes,' most complete Part VI -0 AND attach a statement giving a detailed description of
the lobbying activities.
2 During the year, has the oganizabon, either directly or indirectly, engaged in any of the following acts with any of its trustees, directors,
officers, creators, key employees, or members of their families, or with any taxable organization with which any such person is
affiliated as an officer, director, trustee, majority owner, or principal beneficiary.
a Sale, exchange, or leasing of property?
b Lending of money or other extension of credit?
c Furnishing of goods, services, or facilities?
d Payment of compensation (or payment or reimbursement of expenses it more than $1,000)?
a Transfer of any part of its income or assets? _
11 the answer to any question is Nes; attach a detailed statement explaining the transactions.
3 Does the organization make grants for scholarships, fellowships, student loans, etc'?
4 Attach a statement explaining how the organization determines that individuals or organizations receiving grants or loans from it in
The organization is not a private foundation because it is (please check only ONE applicable box):
5
A church, convention of churches, or association of churches. Section 170(b)(1)(A)(i).
6
0
A school. Section 170(b)(1)(A)(u). (Also complete Part V, page 4.)
7
A hospital or a cooperative hospital service organization. Section 170(b)(1)(A)(iii).
8
A Federal, state, or local government or governmental unit. Section 170(b)(1)(A)(v).
9
A medical research organization operated in conjunction with a hospital. Section 170(b)(1)(A)(iiih Enter the hospital's name, city,
and state ►.
10 An organization operated for the benefit of a college or university owned or operated by a governmental unit. Section 170(b)(1)(A)(iv).
(Also complete the Support Schedule in Part IV -A.)
Ila ® An organization that normally receives a substantial part of its support from a governmental unit or from the general public.
Section 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV -A.)
11b E] A community trust. Sector 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV -A)
12 0 An organization that normally receives: (1) more than 33 113% of its support from contributions, membership fees, and gross
receipts from activities related to its charitable, etc., functions - subject to certain exceptions, and (2) no more than 33 173% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired
by the organization aher June 30, 1975. See section 509(a)(2). (Also complete the Support Schedule in Part IV -A.)
13 1:71 An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in:
111 lines 5 through 12 above' or (2) section 50l(c)(4) (5) or (6) it they meet the test of section 509(a)(2). (See section 509(a)(3).)
Provide the following information about the supported organizations. (See instructions on page 4.)
(b)Line number
from above
14 1 1 An organization organized and operated to test for public safetv. Section 509(a)(4). (See instructions on care 4.1
]2]111
03 ,: 98 a
13450513 753993 BCI 092 THE BAY CLINIC, INC. BCI 1
Schedule A(Form 990) 1997 THE BAY CLINIC INC. 99-0222784 Page
Part IV-ASupport Schedule (Complete only if you checked a box on line 10, 11, or 12 above.) Use cash method of accounting.
Note: You may use the wnrkshe.et in the Inctnlct ri tnr rnnvertinn rrnm the arrnul to thn rash mathnd of arrmintinn
Calendar year (or fiscal year
be innin in) ►
a 1996
6 1995
c 1994
d 1993
a Total
15 Gms. grana, and contributions received
ine2Bin`ludeunueualgante s<e
276 980.
154 835.
401 536.
705 290.
1,538,641.
16 Membership fees received
17 Gross receipts from admissions,
merchandise sold or services
performed, or furnishing of facilities
in any activity that is not a business
unrelated to the organization's
charitable, etc., purpose
2,223,129.
2 204 689.
1,247,452.
715 087.
6,390,357.
18 Gross income from interest,
dividends, amounts received from
payments on securities loans (sec-
tion 512(a)(5)), rents, royalties, and
unrelated business taxable income
(less section 511 taxes) from
businesses acquired by the
organization after June 30, 1975
35 231.
11.085.
11,702.
4,479.
62,497.
19 Net Income from unrelated business
activities not included in line 18
20 Tar revenues levied for the organization's
benefit and either paid to it Or expanded
on its behalf
21 The value of services or facilities
furnished to the organization by a
governmental unit without charge.
Do not include the value of services
or facilities generally furnished to
the public without charge
22 other income Attach. schedule Do not
SEE STATEMENT
12
include gain or (loss) from sale of call
assets
60,279.
31 325.
91,604.
23 Total of lines 15 through 22
2 595 619.
2,401:934.
1 660 690.
1,424,856 .
8 083 099.
24 Line 23 minus lme17
372 490.
197 245.
413 238.
709 769.
1,692 742.
25 Enter i%oflme23
1 25,956.1
24,019.1
16,607.
14,249.
26 Organizations described in lines 10 or 11: a Enter 2% of amount in column (e), line 24 _ _ _ ►
26a
3 3 855 .
b Attach a list (which is not open to public inspection) showing the name of and amount contributed by each person (other than a
governmental unit or publicly supported organization) whose total gifts for 1993 through 1996 exceeded the amount shown
in line 26a. Enter the sum of all these excess amounts _ _ _ _ _ _ _ ►
26b
0 .
c Total support for section 509(.)(1) test: Enter line 24, column (e) ►
26c
1,692,742 .
d Add: Amounts from column (e) for lines: 18 62,497. 19
22 91,604. 26b ►
26d
154,101 .
26e
1 538,641 .
e Public support (line 26c minus line 26d total) ►
26f
90.8964%
t Public support percentage (line 26e numerator divided by line 26c denominator ►
27 Organizations described on line 12: a For amounts included in lines 15, 16, and 17 that were received from a "disqualified person; attach a list to show the name
of, and total amounts received in each year from each "disqualified person' Enter the sum of such amounts for each year. N/A
(1996) (1995) _ (1994) _ _ (1993)
b For any amount included in line 17 that was received from a nondisqualified person, attach a list to show the name of, and amount received for each year,
that was more than thelarger of (1) the amount on line 25 for the year or (2)$5,000. (Include in the list organizations described in lines 5 through 11, as well as
individuals.) After computing the difference between the amount received and the larger amount beatified in (1) or (2), enter the sum of these differences (the
excess amounts) for each year: N/A
(1996) (1995) _ (1994) (1993)
C Add: Amounts from column (e) for lines: 15 16
17 20 21
of Add: Line 27a total and line 27b total
e Public support (line 27c, total minus line 27d total)
f Total support for section 51 test: Enter amount on line 23, column (e) _ ► 1 27f
g Public support percentage (line 27e (numerator) divided by line 271, (denominator))
►
►
►
28 Unusual Grants: For an organization described in line 10, 11, or 12, that received any unusual grants during 1993 through 1996, attach a list (which is not open to
public inspection) for each year showing the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant. Do not include
these grants in line 15. (See instructions.)
)DRI
03 12-9e 9
13450513 753993 BCI 092 THE BAY CLINIC, INC. BCI 1
Schedule A (Form 990)1997 THE BAY CLINIC INC. 99-0222784 Page
P_a_ rtV Private School Questionnaire
(To be completed ONLY by schools that checked the box on line 6 in Part IV) N/A
29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing
instrument, or in a resolution of its governing body?
30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues,
and other written communications with the public dealing with student admissions, programs, and scholarships?
31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of
solicitation for students, or during the registration period it it has no solicitation program, to a way that makes the policy known
to all parts of the general community it serves?
' It "Yes; please describe, n'No," please explain. (If you need more space, attach a separate statement.)
32 Does the organization maintain the following:
a Records indicating the racial composition of the student body, faculty, and administrative staff?
b Records documenting that scholarships and other financial assistance are awarded on a racially
nondiscriminatory basis?
c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student
admissions, programs, and scholarships?
d Copies of all material used by the organization or on its behalf to solicit contributions?
If you answered "No* to any of the above, please explain. (If you need more space, attach a separate statement.)
33 Does the organization discriminate by race in any way with respect to.
a Studentsrights or privileges?
b Admissions policies?
c Employment of faculty or administrative staff?
d Scholarships or other financial assistance?
e Educational policies?
I Use of facilities?
g Athletic programs?
h Omer extracurricular activities?
If you answered 'Yes' to any of the above, please explain. (If you need more space, attach a separate statement.)
34 a Does the organization receive any financial aid or assistance from a governmental agency? „
b Has the organization's right to such aid ever been revoked or suspended?
If you answered "Yes" to either 34a or b, please explain using an attached statement.
35 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05 of Rev. Proc. 75-50,
1975-2 C.B. 587, covering racial nondiscrimination? If'No; attach an explanation
12313,
03. 2.90 10
13450513 753993 BCI 092 THE BAY CLINIC, INC.
No
BCI 1
Schedule A (Form 990) 1997 THE BAY CLINIC INC. 99-0222784 Page
Part VI -A Lobbying Expenditures by Electing Public Charities
(To be completed ONLY by an eligible organization that filed Form 5768) TT / A
Check here ► a U If the organization belongs to an affiliated group.
Check here ► Is n If you checked "a" ahnve and'limited rnnirul' nrnviainnc nnnly
Limits on Lobbying Expenditures (a) To be comp e)ted for ALL
(The term 'expenditures' means amounts paid or incurred) Affiliated group totals electing organizations
N/A
36 Total lobbying expenditures to influence public opinion (grassroots lobbying)
37 Total lobbying expenditures to Influence a legislative body (direct lobbying)
38 Total lobbying expenditures (add lines 36 and 37)
39 Other exempt purpose expenditures
40 Total exempt purpose expenditures (add lines 38 and 39)
41 Lobbying nontaxable amount. Enter the amount from the following table -
If the amount on line 40 is - The lobbying nontaxable amount is -
Not over $500 000 20M6 of the al on line 40
Ova $500,000 but nor over $1 000 000 $100 000 plus 15% of the excess over $500,000
Ova $1 000.000 but not ova $1,500,000 $175,000 plus 1096 of the excess ova $1.000.000
Ova $ t Soo 000 but not ova $17 000 000 $225,000 plus 5% of the excess over $1,500 000
Over $17.000 000 $1.000,000
42 Grassroots nontaxable amount (enter 25% of line 41) _
43 Subtract line 42 from line 36. Enter -0- if line 42 is more than line 36
44 Subtract line 41 from line 38. Enter -o- if line 41 is more than line 38
Caution: If there is an amount on eitherhire 43 orline 44. You must file Form 4720.
4 -Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five columns
below. See the instructions for lines 45 through 50.)
Part VI -B Lobbying Activity by Nonelecting Public Charities
(For reporting only by organizations that did not complete Part VI -A) N A
During the year, did the organization attempt to influence national, state or local legislation, including any attempt to Yes No Amount
influence public opinion on a legislative matter or referendum, through the use of:
a Volunteers
to Paid staff or management (include compensation In expenses reported on lines c through h) _
c Media advertisements
it Mailings to members, legislators, or the public .
e Publications or published or broadcast statements
f Grants to other organizations for lobbying purposes
g Direct contact with legislators, their staffs, government officials, or a legislative body
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means
i Total lobbying expenditures (add lines c through h) _ 0.
If'Yes'to any of the above, also attach a statement giving a detailed description of the lobbying activities.
723141
03. 2-9e 1 1
13450513 753993 BCI 092 THE BAY CLINIC, INC. BCI 1
Lobbying Expenditures During 4 -Year Averaging Period
N/A
Calendar year(or
(a)
(b)
(c)
(d)
(e)
fiscal year beginning in) ►
1997
1996
1995
1994
Total
45 Lobbying nontaxable
amount
0.
_
46 Lobbying ceiling amount
150% of line 45(e))
0 ,
47 Total lobbying
expenditures
0 .
48 Grassroots nontaxable
amount
0 ,
49 Grassroots telling amount
150% of line 48(e))
0 ,
50 Grassroots lobbying
expenditures
1
0 ,
Part VI -B Lobbying Activity by Nonelecting Public Charities
(For reporting only by organizations that did not complete Part VI -A) N A
During the year, did the organization attempt to influence national, state or local legislation, including any attempt to Yes No Amount
influence public opinion on a legislative matter or referendum, through the use of:
a Volunteers
to Paid staff or management (include compensation In expenses reported on lines c through h) _
c Media advertisements
it Mailings to members, legislators, or the public .
e Publications or published or broadcast statements
f Grants to other organizations for lobbying purposes
g Direct contact with legislators, their staffs, government officials, or a legislative body
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means
i Total lobbying expenditures (add lines c through h) _ 0.
If'Yes'to any of the above, also attach a statement giving a detailed description of the lobbying activities.
723141
03. 2-9e 1 1
13450513 753993 BCI 092 THE BAY CLINIC, INC. BCI 1
Schedule A (Form 990) 1997 THE BAY CLINIC, INC._ 99—
Fart VII Information Regarding Transfers To and Transactions and Relationships wan Noncnancaote
Exempt Organizations
51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section
501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
a Transfers from the reporting organization to a noncharitable exempt organization of:
Yes No
(i) Cash
51a i
X
(ii) Other assets
a ii)
X
_
b Other transactions:
b i
X
(i) Sales of assets to a noncharitable exempt organization _ _ _
(ii) Purchases of assets from a noncharitable exempt organization _
b ii
X
(iii) Rental of facilities or equipment
b(iii
X _
(iv) Reimbursement arrangements _ _ _
b(iv
X
(v) Loans or loan guarantees
b v
X _
(vi) Performance of services or membership or fundraising solicitations
b(vi)
X
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees _
c
X
d If the answer to any of the above is 'Yes,* complete the following schedule. Column (b) should always indicate the fair market value of the
goods, other assets, or services given by the reporting organization. If the organization received less than fair market value in any
transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
N A
b (e) (d)
Lori
( 1
Line no. Amount mvolvetl Name of nonchantable exempt organization Description of transfers, transactions, and sharing arrangements
52 a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the ®No
Code (other than section 501(c)(3)) or in section 527? _ _ _ Ill[ Yes
]i 3151 12
03 12 98
13450513 753993 BCI 092 THE BAY CLINIC, INC.
BCI—1
Denreciation and Amortization Detail
26,N - Current year section 179 (D) - Asset disposed
12 . 1
13450513 753993 BCI 092 THE BAY CLINIC, INC.
BCI 1
Depreciation and Amortization Detail FORM 990 PAGE 2
9M
Asset
Description of property
Number
p�ctetl
in service
Method/
IRC sec.
Lde
or rate
Line
No.
Cost or
other basis
Basis
reduction
Accumulated
depreciation/amortization
_
Current year
deduction
3FIXTURES
92SL 15.00
119 1
12,215.1
1 12,215.1
0.
4FIXTURES
84SL 15.00
119 1
5,069.1
5,069.1
0.
5EQUIPMENT
92SL 15.00
119 1
12,084.1
1 12,084.1
0.
6EQUIPMENT
94SL 15.00
119 1
6,705.1
4,782.1
1,341.
7
EFRIGERATOR
120195SL 15.00
119 1
650.1
1
206.1
130.
8
UIPMENT
022897SL 5.00
17
5
749.
383.1
1,151.
9
FFICE FURNITURE AND EQUIPMENT
91SL 5.00
19
14
638.
14,638.1
0.
10
OFFICE EQUIPMENT
_
19 21S 15.00
119 1
45
317.
45,317.T
0.
11
OFFICE E UIPMENT
3SL 5.00
1
3,887.1
3,395.1
492.
12
COMPUTERS AND PRINTER
94SL 15.00
119 1
4,392.1
2,923.1
878.
13
FFICE EQUIPMENT
95SL 13.00
119 1
3,744.1
2,918.1
826.
14PHONE
SYSTEM
060195SL 5.00
19
6
969.
2,904.1
1,394.
15
COMPUTER EQUIPMENT
19 61S 3.00
119 1
26,775.1
1 14,763.1
8,925.
16
VOICEMAIL
110195SL 15.00
119 1
9,720.1
3,240.1
1,944.
17
FFICE E UIPMENT
6SL 4.00
119 1
2,586.1
17.
646.
18
OFFICE EQUIPMENT
120496SL 15.00
117 1
13,060.1
1,001.
2
612.0
19
FURNITURE AND FIXTURES
---7,478.E
91SL 5.00
19
7
478.
0.
20FUNIT
URE AND FIXTURES
92SL 15.00
119 1
1:95
1,954.1
0.
21
FURNITURE
93SL 5.00
19
1771.
1,698.
72.
22FURNITURE
95SL 5.00
19
952.
501.
190.
23
ABLE
070195SL 5.00
119 1
315.1
126.1
63.
24
CONTAINER
22897SL 15.00
117 1
2,250.1
150.
450.
25
CAPITAL LEASES
92SL 5.00
19
16
006.
16,008.1
0.
26
CAPITAL LEASE
SL 5.00
19
2
287.
952.
457.
E UZP PURCH. FROM
DR.
PESTRELLA
SL 5.00
19
11
115.
1
297•
E28E
VEDICALUIP PURCH. FROM
DR.
GILBERT
500
19
2
618
87.
E OXIMETER UNITS
SL 15.on
19 1
1
AA
169.
a.e N - Current year section 179 (D) Asset disposed
,0.07.97 13
13450513 753993 SCI 092 THE BAY CLINIC, INC.
BCI 1
Depreciation and Amortization Detail FORM 990 PAGE 2
�t
Asset
Description of property
Number
placed
in service
Method/
IRC sec.
Lde
or rate
Line
No.
Cost or
other basis
Basis
reduction
Accumulated
depreciation/amortization
Current year
deduction
30
KG MACHINE FOR KAU CLINIC
12l597SL 15.00 119 1 —2,59 9—.
303.
31PAHOA
CLINIC RENOVATIONS
052198SL 15.0019 190 676.
2,118.
32
MOVE AND INSTALL TELEPHONES PAHOA CLINIC
0 610 319 8 10 L 115.00119 1 1,260.1
7.
33
KAU CLINIC RENOVATIONS
031898 L 14.00 119 8 693 -1
725.
34
COPIER FOR PAHOA
060398SL 15.00 119 1 7,856.1
131.
35
TWO FAX MACHINES FOR PAHOA AND KAU
041498SL 15.00 119 1 1,563.1
78.
36FUNITURE
FOR PAHOA CLINIC SOFAS -END TABLES
040898SL 15.00 119 1 1,112.1
56.
3718
CU. FT. REFRIGERATOR FOR HILO CLINIC
211819 81S 5.00 19 1
50.
36
AT'L HEALTH PRO SYSTEM SOFTWARE
060198SL 13.00 119 1 39,500.1
1,097.
39
IP FUND ACCTG G L SOFTWARE
060198SL 3.00 119 1 6,760.1
187.
40
LOCAL AREA NETWORK HARDWARE
060198SL 5.00 119 1 46,083.1
768.
41
LAPTOP COMPUTER
060498SL 5.00 19 2 947.
50.
** TOTAL 990 PAGE 2 DEPRECIATION
531,406.1 1 155,622.1
28 694.
16261 a - Current year section 179 (D) Asset disposed
00 9- 14
13450513 753993 BCI 092 THE BAY CLINIC, INC.
BCI 1
THE BAY CLINIC, INC.
99-0222784
FORM 990 RENTAL INCOME STATEMENT 1
KIND AND LOCATION OF PROPERTY
CONDOMINIUM UNIT
OFFICE SUBLEASE
TOTAL TO FORM 990, PART I, LINE 6A
ACTIVITY GROSS
NUMBER RENTAL INCOME
1 8,145.
2 28,871.
37,016.
FORM 990 RENTAL EXPENSES STATEMENT 2
ACTIVITY
DESCRIPTION NUMBER AMOUNT
DEPRECIATION 2,343.
PROPERTY TAXES 770,
GENERAL EXCISE TAXES 1,226.
MAINTENANCE FEES 4,379.
- SUBTOTAL - 1
GENERAL EXCISE TAXES 307.
UTILITIES 2,105.
- SUBTOTAL - 2
TOTAL TO FORM 990, PART I, LINE 6B
TOTAL
8,718.
2,412.
FORM 990 OTHER EXPENSES STATEMENT 3
(D)
FUNDRAISING
15 STATEMENT(S) 1, 2, 3
13450513 753993 BCI 092 THE BAY CLINIC, INC. SCI 1
(A)
(B)
(C)
PROGRAM
MANAGEMENT
DESCRIPTION
TOTAL
SERVICES
AND GENERAL
CONTRACTUAL SERVICES
158,792.
158,792.
OFFICE SUPPLIES AND
EXPENSES
36,232.
32,609.
3,623.
HOSPITAL COMMISSIONS
12,397.
12,397.
RECRUITING AND
RETENTION
25,143.
25,143.
INSURANCE
22,850.
20,565.
2,285.
ADVERTISING AND
PRINTING
18,221.
16,399.
1,822.
PROFESSIONAL FEES
28,474.
25,627.
2,847.
EQUIPMENT
32,389.
29,150.
3,239.
DUES AND
SUBSCRIPTIONS
7,887.
7,098.
789.
(D)
FUNDRAISING
15 STATEMENT(S) 1, 2, 3
13450513 753993 BCI 092 THE BAY CLINIC, INC. SCI 1
THE BAY CLINIC, 1NC.
OTHER TAXES
MISCELLANEOUS
BAD DEBT EXPENSE
TOTAL TO FM 990, LN 43
5,471.
9,544. 8,591.
36,189. 36,189.
5,471.
953.
393,589. 347,417. 46,172.
99-0222784
FORM 990 STATEMENT OF ORGANIZATION'S PRIMARY EXEMPT PURPOSE STATEMENT 4
PART III
EXPLANATION
TO PROVIDE LOW COST QUALITY HEALTH CARE TO THE PUBLIC THROUGH DIRECT MEDICAL
SERVICES AND FAMILY PLANNING EDUCATIONAL ACTIVITIES.
FORM 990 STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS STATEMENT 5
DESCRIPTION OF PROGRAM SERVICE ONE
FAMILY PLANNING SERVICES - THE ORGANIZATION PROVIDES LOW-COST
BIRTH CONTROL EXAMINATIONS AND SUPPLIES FOR WOMEN AND
SCREENING FOR SEXUALLY TRANSMITTED DISEASES FOR MEN AND
WOMEN, ALL ON A SLIDING FEE SCALE. APPROXIMATELY 4540 VISITS
WERE RECORDED FOR FAMILY PLANNING SERVICES IN FY 1998.
GRANTS EXPENSES
TO FORM 990, PART III, LINE A 0. 381,101.
16 STATEMENT(S) 3, 4, 5
13450513 753993 BCI 092 THE BAY CLINIC, INC. BCI 1
THE BAY CLINIC, INC.
99-0222784
?ORM 990 STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS STATEMENT 6
DESCRIPTION OF PROGRAM SERVICE TWO
?RIMARY HEALTH CARE SERVICES - THE ORGANIZATION PROVIDES
;ENERAL MEDICAL CARE FOR ADULTS AND CHILDREN ON A SLIDING FEE
3CALE. THE PROGRAM FOCUSES ON THE MEDICALLY UNDERSERVED.
%PPROXIMATELY 23,125 VISITS WERE RECORDED FOR PRIMARY CARE
iERVICES IN FY 1998.
GRANTS EXPENSES
PO FORM 990, PART III, LINE B 2,409,120.
FORM 990 DEPRECIATION OF ASSETS HELD FOR INVESTMENT STATEMENT 7
DESCRIPTION
l� . Me
TOTAL TO FORM 990, PART IV, LN 55
COST OR ACCUMULATED
OTHER BASIS DEPRECIATION BOOK VALUE
5,983. 0. 5,983.
5,983. 0. 5,983.
FORM 990 DEPRECIATION OF ASSETS NOT HELD FOR INVESTMENT STATEMENT 8
DESCRIPTION
CONDOMINIUM UNIT
FIXTURES
FIXTURES
EQUIPMENT
EQUIPMENT
REFRIGERATOR
EQUIPMENT
OFFICE FURNITURE AND EQUIPMENT
OFFICE EQUIPMENT
OFFICE EQUIPMENT
COMPUTERS AND PRINTER
OFFICE EQUIPMENT
PHONE SYSTEM
COMPUTER EQUIPMENT
COST OR ACCUMULATED
OTHER BASIS DEPRECIATION BOOK VALUE
93,736.
18,056.
75,680.
12,215.
12,215.
0.
5,069.
5,069.
0.
12,084.
12,084.
0.
6,705.
6,123.
582.
650.
336.
314.
5,749.
1,534.
4,215.
14,638.
14,638.
0.
45,317.
45,317.
0.
3,887.
3,887.
0.
4,392.
3,801.
591.
3,744.
3,744.
0.
6,969.
4,298.
2,671.
26,775.
23,688.
3,087.
17 STATEMENT(S) 6, 7, 8
13450513 753993 BCI 092 THE BAY CLINIC, INC. BCI 1
THE BAY CLINIC, INC.
99-0222784
FORM 990 OTHER EXPENSES NOT INCLUDED ON FORM 990 STATEMENT 10
THE BAY CLINIC, INC. 99-0222784
VOICEMAIL
9,720.
5,184.
4,536.
OFFICE EQUIPMENT
2,586.
1,563.
1,023.
OFFICE EQUIPMENT
13,060.
3,613.
9,447.
FURNITURE AND FIXTURES
7,478.
7,478.
0.
FURNITURE AND FIXTURES
1,954.
1,954.
0.
FURNITURE
1,771.
1,770.
1.
FURNITURE
952.
691.
261.
TABLE
315.
189.
126.
CONTAINER
2,250.
600.
1,650.
CAPITAL LEASES
16,008.
16,008.
0.
CAPITAL LEASE
2,287.
1,409.
878.
MEDICAL EQUIP PURCH. FROM DR.
PESTRELLA
11,115.
1,297.
9,818.
MEDICAL EQUIP PURCH. FROM DR.
3ILBERT
2,618.
87.
2,531.
TWO PULSE OXIMETER UNITS
1,445.
169.
1,276.
EKG MACHINE FOR KAU CLINIC
2,599.
303.
2,296.
PAHOA CLINIC RENOVATIONS
190,676.
2,118.
188,558.
MOVE AND INSTALL TELEPHONES
PAHOA CLINIC
1,260.
7.
1,253.
KAU CLINIC RENOVATIONS
8,693.
725.
7,968.
COPIER FOR PAHOA
7,856.
131.
7,725.
TWO FAX MACHINES FOR PAHOA AND
KAU
1,563.
78.
1,485.
FUNITURE FOR PAHOA CLINIC,
SOFAS -END TABLES
1,112.
56.
1,056.
18 CU. FT. REFRIGERATOR FOR
HILO CLINIC
604.
50.
554.,,
NAT'L HEALTH PRO SYSTEM
SOFTWARE
39,500.
1,097.
38,403.
MIP FUND ACCTG G/L SOFTWARE
6,760.
187.
6,573.
LOCAL AREA NETWORK HARDWARE
46,083.
768.
45,315.
LAPTOP COMPUTER
2,947.
50.
2,897.
TOTAL TO FORM 990, PART IV, IN 57 625,142. 202,372. 422,770.
FORM 990 OTHER REVENUE NOT INCLUDED ON FORM 990 STATEMENT 9
DESCRIPTION AMOUNT
RENTAL EXPENSES NETTED AGAINST RENTAL INCOME 11,130.
DOTAL TO FORM 990, PART IV -A 11,130.
Form 4562 1997 Page 2
Part Vj Listed Property -Automobiles, Certain Other Vehicles, Cellular Telephones, Certain Computers, and Property Used for
Entertainment, Recreation, or Amusement
Note: For anv vehicle for which you are usinq the standard mileage rate or deducting lease expense, complete only 23a, 23b, columns (a)
rprm 4562 I Depreciation and Amortization
(Including Information on Listed Property) 990
oepartmem or me Tress.,
�nfe,nal Revenue serlIce 1i Attach this form to your return.
Names) snows on,ewrn I Business or activity to which this form relates
Dias No 1545 0172
1997
Attachment
Sequence No 67
idenhying number
Pali I I Election To Expense Certain Tangible Property (Section 179) (Note: If you have any 'listed property; Complete Part V before you complete Part I.)
1 Maximum dollar limitation. If an enterprise zone business, see instructions 1 18,000.
2 Total cost of section 179 property placed in service _ _ _ 2
3 Threshold cost of section 179 property before reduction in limitation 3 $200,000 _
4 Reduction in limitation Subtract line 3 from line 2. If zero or less, enter 0 4
5 Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing
separately, see Instructions 5
6 (a)Description of property (b) Cost (business use only) (r) Elected cost
THE BAY CLINIC, INC. 99-0222784
NAHE KA'IUWAILANI, ESQ. DIRECTOR
77 MOHOULI ST., HILO, HI 96720 .5 0. 0. 0.
SHEILA MURPHY, ESQ. DIRECTOR
P.O. BOX 24, PAHOA, HI 96778 .5 0. 0. 0.
BILL PARECKI DIRECTOR
P.O. BOX 726, PAHOA, HI 96778 .5 0. 0. 0..
SPIKE WERNER DIRECTOR
400 HUALANI ST. #191A, HILO, HI .5
96720 0. 0. 0.
LUCY JONES-VOISEY DIRECTOR
P.O. BOX 510, NA'ALEHU, HI 96772 .5 0. 0. 0.
STEPHANIE LAUNIU EXECUTIVE DIRECTOR
P.O. BOX 2052, KEAAU, HI 96749 40 64,450. 0. 0.
TOTALS INCLUDED ON FORM
990, PART V
64,450. 0.
0.
SCHEDULE A
OTHER INCOME
STATEMENT
12
1996 1995 1994 1993
DESCRIPTION AMOUNT AMOUNT AMOUNT AMOUNT
14562 Depreciation and Amortization
wm
1997
(Including Information on Listed Property) RENT
1
DevanmeP:i a me oeasury
miernai Re�eni,e s.rvice
hiAttach this form to your return.
Attachment
sequel No 67
Namersl shown on ,.turn
Business a acMdy to which this form relates
Identitying number
THE BAY CLINIC INC.
ONDOMINIUM UNIT
99-0222784_
Part I I Election To Expense Certain Tangible Property (Section 179) (Note: If you have any listed property; complete
Part V before you complete Part I.)
1 Maximum dollar limitation. If an enterprise zone business, see instructions _ _1
18,000.
2 Total cost of section 179 property placed in service _ ., „ _
2
3 Threshold cost of section 179 property before reduction in limitation _ „ „ „ „
3
$200,000 _
4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter 0 _ _
4
5 Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter 0 . If married filing
9
(a) Description of property I (b) Cost (business use only) I (c) Elected cost
7 Listed property. Enter amount from line 27 _, , „ ., 7
8 Total elected cost of section 179 property. Add amounts In column (c), lines 6 and 7 _________ _ _ 8
9 Tentative deduction. Enter the smaller of line 5 or line 9
10 Carryover of disallowed deduction from 1996 _ ..,,, _ _ _ _ 10
11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 _ 11
12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 12
13 Carryover of disallowed deduction to 1998. Add lines 9 and 10, less line 12 1111 13
Note: Do not use Part 11 or Part 111 below for listed property (automobiles, certain other vehicles, cellular telephones, certain computers, or,
used for entertainment, recreation, or amusement). Instead, use Part V for listed property.
Part 111 MACRS Depreciation For Assets Placed in Service ONLY During Your 1997 Tax Year (Do Not Include Listed Property.)
14 If you are making the election under section 168(i)(4) to group any assets placed in service during the tax year into one or more general asset
accounts, check this box. See instructions ......... ► 0
Section B - General Depreciation System (GDS) (See Instmctions.)
(b) Month and ic) Basis Ior depreciation (d) Recovery
W Qassiticaron of poperty yea, placed (busintau J,m esiment use period hl Convenron In Method (9) Depreciation deduction
in service only - see instructions)
e
I
yrs. I MM I 6/L
h Residential rental property / 27.5 vrs. MM S/L
i Nonresidential real property
Section C - Alternative
_ b 12 year 12rs. I I S/L
c 40year / 40 lyrs. MM S/L
Part 1111 Other Depreciation (Do Not Include Listed Property.) (See instructions.)
17 GDS and ADS deductions for assets placed in service in tax years beginning before 1997 17 2 343.
18 Property subject tosection 168(f)(1) election ,., _._ _.._ ..,.., _,. ,. ..,... .. .... 18
19 ACRS and other depreciation ..,._...,...,,,. 19
Part I Summary (See instructions.)
20 Listed properly. Enter amount from line 26 „ _ _ 20
21 Total. Add deductions on line 12, lines 15 and 16 in column (g), and lines 17 through 20. Enter here
and on the appropriate lines of your return. Partnerships and S corporations - see instructions .. 21 2 343.
22 For assets shown above and placed in service during the current year, enter the
LHA For Paperwork Reduction Act Notice, seethe separate instructions. Form 4562 (1997)
7182$1 98 2 3
132450513 753993 BCI 092 THE BAY CLINIC, INC. BCI 1
Form 4562 1997 Page 2
Part V Listed Property - Automobiles, Certain Other Vehicles, Cellular Telephones, Certain Computers, and Property Used for
-- -- Entertainment, Recreation, or Amusement
Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 23a, 23b, columns (a)
through (c) of Section A, all of Section B, and Section C if applicable.
Section A - Depreciation and Other Information (Caution: See instructions for limits for passanger automobiles.)
23a Do you have evidence to support the business/Investment use claimed? L-1 Yes No 23blf "Yes is i the evidence written? L-1Yes [:::] No
T
(h'
25 Property used 50% or less in a oualified business use:
S/L
26 Add amounts in column (h). Enter the total here and on line 20, page 1
27 Add amounts in column (i). Enter the total here and on line 7, page 1
Section B - Information on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other "more than 5%owner," or related person.
If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for
those vehicles.
28 Totalbusmessbnve�
year (DO NOT mclur
29 Total commuting
30 Total other persoi
driven
31 Total miles driven
Add lines 28 throe
32 Was the vehicle a
during off duty hi
33 Was the vehicle t
than 5% owner a
34 Is another vehicle
use?
Iment miles driven during the
e commuting miles)
moles driven during the year
cal (noncommut ng) miles
during the year.
igh 30
variable for personal use
ears?
sed primarily by a more
related person?
available for personal
(a)
Vehicle
(b)
Vehicle
(c)
Vehicle
(a)
(b) Date
(°)
(d)
lel
(t)
191
Ili)
10
'Pe of property
placed In
Business/
Cosl or
eases mr dep,eoanon
Recovery
Method/
Depreciation
Elected
1 vehicles first
service
investment
other basis
roasnessnnveafinem
period
Convention
deduction
section 179
Yes
No
use percentage
No
ase omyl
No
Yes
No
cost
25 Property used 50% or less in a oualified business use:
S/L
26 Add amounts in column (h). Enter the total here and on line 20, page 1
27 Add amounts in column (i). Enter the total here and on line 7, page 1
Section B - Information on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other "more than 5%owner," or related person.
If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for
those vehicles.
28 Totalbusmessbnve�
year (DO NOT mclur
29 Total commuting
30 Total other persoi
driven
31 Total miles driven
Add lines 28 throe
32 Was the vehicle a
during off duty hi
33 Was the vehicle t
than 5% owner a
34 Is another vehicle
use?
Iment miles driven during the
e commuting miles)
moles driven during the year
cal (noncommut ng) miles
during the year.
igh 30
variable for personal use
ears?
sed primarily by a more
related person?
available for personal
(a)
Vehicle
(b)
Vehicle
(c)
Vehicle
(d)
(e)
Vehicle
(f)
Vehicle
_
_
_Vehicle
41 Amortization of costs that began before 1997
_
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Section C - Questions for Employers Who Provide Vehicles for Use by Their Employees
Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5%
owners or related persons
35 Do you maintain a written policy statement that prohibits all personal use of vehicles, Including commuting, by your
employees,
36 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
emp loyees' See Instructions for vehicles used by corporate officers, directors, or 1%or more owners
37 Do you treat all use of vehicles by employees as personal use?
38 Do you provide more than five vehicles to your employees, obtain Information from your employees about
the use of the vehicles, and retain the Information received?
39 Do you meet the requirements concerning qualified automobile demonstration use?
Note: If your answer to 35, 36, 37, 38, or 39 is "Yes," you need not complete Section B for the covered vehicles.
Part VI I Amortization
(a)
Desanuon of cos is
(b)
rate amortization
lhoms
(c)
Amortizable
amount
(d)
Code
se<GOn
(e)
Airodabi
period of percentage
Ifl
Amwt¢alion
for this year
40 Amortization of costs that begins during your 1997 tax year.
41 Amortization of costs that began before 1997
41
42 Total. Enter here and on "Other Deductions' or "Other Expenses"
fine of your return
42
ae2a
» ,. rie 24
13450513 753993 BCI 092 THE BAY CLINIC, INC. BCI 1
/ I Part VII I Analysis of Income-rrocducing ACTIVIties
Enter gro
indicated
93 Pro
(a)
(b)
(c)
(d)
(e)
(f)
(9)
94 Me
95Int
cas
96 Div
97 Net
(a)
(b)
98 Net
99 Ed
100 Ga
at
101 Ne
102 Gr
103 Ot
a
b
c
d
e
104 Su
ss amounts unless otherwise Unrelated business income Exclu ad by SeGtmn 512.513, o, 514 (E)
(A) (B) (C) (0) Belated or exempt
Business Exclu-
gram service revenue: code Amount olpn Amount function Income
one
PREMIUM REVENUE 1,848,204.
NET PATIENT SERVICE REV 991,317.
Medicare/Medicaid payments
Fees and contracts from government agencies
mbershlp dues and assessments
Brest on savings and temporary
h Investments 14 49,7 9.
tdends and Interest from securities
rental Income or (loss) from real estate:
debt-financed property
not debt-financed property 16 25,886.
_
t rental Income or (loss) from personal property
Edit
b
ner
ner
Investment Income
m or (loss) from sales of assets
than Inventory
I Income or (loss) from special events
oss profit or (loss) from sales of Inventory
revenue.
OTHER INCOME
—
32,600.
moral (add columns (8), (D), and fl)
0.
75,665.
21872,121.
105 TOTAL (add line 104, columns (B), (0), and (E)) ► 2,947,786.
Note: (Line 105 plus line td, Part I, should equal the amount on line 12, Part I.)
Part VIII I Relationship of Activities to the Accomplishment of Exempt Purposes
Line No. Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization's
exempt purposes (other than by providing funds for such purposes).
Part IX Information Regarding Taxable Subsidiaries (Complete this Part if the 'Yei box on Be is checked.)
Name, address, and employer Identification Percentage of Nature of business activities Total Income Enasseyear
number of corporation or partnership ownership interest assets
Under penalties of pel I oeciate that I have examined this,etwn, Including accwnpanpng schedules and statements, and l
'?react. an Complete discussion Or,rw.W (.In. than OMCyI IS based on all InfiffpTi nan or which pre over has any knowled
Please % % ���,,
Sign �� I/1/ / �;i Vii (, �..(�L_(d/YWJ i ,3 c "? k AAA4L- D3J
Here Signature of officer Date if Type or print name a
te hf
Preparer's Da
h �y Sell
Paid sigf 01 13 99 em
Preparer's Firm's name (or yours fIlliKETA, IWATA, HARA & ASSOCIATES, LLP
Use Only if sell -employed) '101 AUPUNI STREET SUITE 139
and address HILO HAWAII
723181 C
.3. 2 90 6
13450513 753993 BCI 092 THE BAY CLINIC, INC.
beet of my knowledge and beLuer n Is true.
5i I �1,1 C'tur�,
tie
Prepsti s SSN
1d ► 575-56.1400
EIN ► 994MI605
ZIP .4 ► 96720
BCI 1
Internal Revenue Servlcr
District Director
P 0 BOX 2350 ROOM 5127 ATTNi E.O.
LOS ANGELES, CA 900532350
Date: FEB. 10, 1989
BAY CLINIC INC
688 KINOOLE ST SUITE 107
KILO, ill 967200000
Dear Applicant:
Dopartrnent of the Treasury
F.0 I a ts61
Employer Identification Number:
99-0222784
Case Number:
958343033
Contact Parson:
TERRY IZUMI
Contact Telephone Number:
(213) 894-4170
Our Letter Dated:
April 19, 1984
Caveat Applies:
no
This codifies our letter of the above date in which we stated that you
Hould be treated as an organization which is not a private foundation until
the expiration of your advance ruling period.
Dared on the Information you submitted, we have determined that you are
not a private foundation within the meaning of section 509(a) of the Internal
Revenue Code, because you are an organization of the type described in section
t)09(a)(I) and 170(b)(1)(A)(vi). Your exempt status under section 501(c)(3) of
the code is still in affect.
i
Grantors and contributors may rely on this determination until the
Internal Revenue Service publishes a notice to the contrary. However, a
grantor or a contributor may not rely on this determination if he or she Has
in part responsible for, or Hae aware of, the act or failure to act that
resulted in your loss of section 509(x)(1) statue, or acquired knowledge
that the Internal Revenue Service had given notice that you would be removed
from classification as a section 509(x)(1) organization.
Because this latter could help resolve any questions about your private
foundation statue, please keep it in your permanent records.
If the heading of this letter indicates that a caveat applies, the caveat
below or on the enclosure is an integral part of this letter.
If you have any questions, please contact the person whose name and
telephone number are shown above.
Sincerely yours,
C,A,,f<�- C
Frederick C. Nielson
District Director
FORM A-6 STATE OF HAWAII — DEPARTMENT OF TAXATION
(REV. 311998) TAX CLEARANCE APPLICATION
PLEASE TYPE OR PRINT CLEARLY
1. APPLICANT INFORMATION: (PLEASE PRINT CLEARLY)
Applicant 'U a6,.\4C I i m. c, Z 1-I c.
Address 311 1-CA,115k_h117tL1,!`
Zip Code t l 0 l 1
DBAI
Trade Name
2. TAX IDENTIFICATION NUMBER(S):
HAWAII GENERAL EXCISE ID # 3 L S `i- `t l
FEDERAL EMPLOYER ID # 'A - Q 2 2 Z O p SL
SOCIAL SECURITY #
3. APPLICANT IS A/AN: (CHECK ONLY ONE BOX)
❑
CORPORATION
❑
S CORPORATION TAX EXEMPT ORGANIZATION
❑
INDIVIDUAL
❑
PARTNERSHIP ❑ ESTATE ❑ TRUST
❑
LIMITED LIABILITY COMPANY
❑
LIMITED LIABILITY PARTNERSHIP
4. THE TAX CLEARANCE IS REQUIRED FOR:
X
CITY, COUNTY, OR STATE GOVERNMENT CONTRACT IN HAWAII
❑
LIQUOR LICENSE'
❑
REAL ESTATE LICENSE
❑ CONTRACTOR LICENSE
❑
BULK SALES
❑
FINANCIAL CLOSING
❑ PROGRESS PAYMENT
❑
PERSONAL
❑
HAWAII STATE RESIDENCY
FEDERAL CONTRACT
❑
LOAN
❑
SUBCONTRACT -
❑ OTHER
Per
.IRS APPROVAL STAMPIS FOR PURPOSES INOICATED BYASTERISK
5. NO. OF CERTIFIED COPIES REQUESTED: F (!
FOR OFFICE USE ONLY
BUS24FSS START DATE IN HAWAII
IF APPLICABLE
0 8 of / F3
HAWAII RETURNS FILED
IF APPLICABLE
19_ 19_ 19_
i'v_tion
Martmen
srr
INT J P:' - r ttIICE
APPROVED
District Direct(,
QC 4L�:
Per
Pacific-Norihlva;t0itt!Itt %
CERTIFIED COPY STAMP
nl I trict
Ih!$ 0" M /EMpW@ 1/ 1 MwMBItlN la
IM"1 to tlWom bsri l4wnd.
Y d
internal Revenue Service
St.e V)v,tZi>
PRJNT NAJAE PRINT SPECIFIC TITLE: Corporate Officer, General Partner, Individual (Sole Proprietor)
SIGN r -URE DAT TELEPHONE FAX
POWER OF ATTORNEY. If submitted by someone other than a Corporate Officer, General Partner, or Individual (Sole Proprietor), a power of attorney
(State of Hawaii Department of Taxation Form N848) must be submitted with this application. If a Tax Clearance is required from the Internal Revenue
Service, IRS Fornn 8821, or IRS Form 2848 is also required. Applications submitted without proper authorization will be sent to the address of record with
the taxing authority. UNSIGNED APPLICATIONS WILL NOT BE PROCESSED.
PLEASE TYPE OR PRINT CLEARLY — THE FRONT PAGE OF THIS APPLICATION BECOMES THE CERTIFICATE UPON APPROVAL
SEE PAGE 2 ON REVERSE & INSTRUCTIONS. Failure to provide required information on page 2 of this application or as required in the separate
instructions to this application will result in a denial of the Tax Clearance request _
(Page 1 of 2)
ORD CERTIFICATE OF LIABILITY INSURANCE DATE (MbyOO T
11/02/1999
WCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BISHOP INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
BO PAUA11 STREET SUITE 109 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
HILO, HI 96720
AGENT: Dennis Ancheta INSURERS AFFORDING COVERAGE
M"'R`D INSURER& WESTERN WORLD INSURANCE COMPANY/
BAY CLINIC, INC. W&URER8. I C International, Inc
311 Kalanianaole Avenue NSURER C.
Hilo, Hawaii 96778 INSURER D:
INSURER E:
CTTVFREI:FS
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWrTHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUWENT WITH
RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS.
W2
T
TYFE OF MauRANCE
FOULYNUYBER
A Y
A Y
UYR!
GENERAL LMYIry
}i
EACN OCCURRENCE t 50 O, 000
COMLIERCIAL GENERAL LUB RY
FIRE DAMAGE (My MN M) f 100, 000
A
CLNMS MADE ❑X OCCUR
-
YEDE (My w PFRwn) t Excluded
PERSONAL l AW IWURY i 500,000
NGL 753208
11/05/99
11/05/00
GE ERA AooREGATE s 11000,0001
OEN'L AOOREpATE LMR APPLIES PEI!
M
PRODUCTS - COPJOP MGG s Included
POLE -'Y J� Loc
AUTOMOBILE uAwm
AW AJfip
COMBINED SN,GLE UMrr
(EA
ALL O M AUTOS
SCNEDUIElI AUTOS
BOMLY INJURY t
Pr pNRon)
HIRED AUTOS
NOKb W AUTOS
BODILY INJURY t
(PM FaJWn[)
PROPERTY DAMAGE t
M MxWM)
GAAAGE llABA.frY
AUTO ONLY -EA ACGDEM !
ANY AUTD
OTHER THAN EA ACC t
AUTO ONLY: Aqp i
"CM LIAMUTY
EALN OCCURRENCE f
OCCUR ❑CWMS MADE
ADOREOATE j
S
DEDUCTIBLE
'This insurance cor.:ract is iss
d by an insur
which is not
s
RETEHTxJN s
he State of He
ii and is not
u to its
t
rgRN[Rl coMFEHMTiJN AND
regulation or examination. H t
e insurer is to
nso M,
T'
ELIPLOYERd LueuiY
claims under this contrail are
Ot covered by
any ear
TORYLIMRS ER-
fund of the State of Hawaii.'
EL EI AOCIDEM s
EL DMEASE-EA EMPLOYEE f
EL DISE& - POLJCY Ulla f
OTHER
(Surplus Line Broker License #
70022)
680 Iwilei Rd., Ste. 760, Honol
u, HI 96817
-JCRiTION OF OPERAT10NLlOCA710NLVEIRCLEyEACLUMON! ADDED BY ENDORSE ,,(TRPECIAL MOVNNNN
'.E: Violence Intervention Program
INANCE DEPARTMENT, COUNTY OF HAWAII (A Funding Source) is an Additional
nsured under the Dolicy to the extent set forth in the
Policy Provisions.
RTIFIC
ATE HOLDER X A)ODpNAL MWRED; MWREII LETTER: CANCFI I ATkn
Finance Department
County of Hawaii
25 Aupuni Street
Hilo, Hawaii 96720
ORD 26S (7197)
P1 W ANY OF TIIE A W DEECRMEp MO * BE CANCELLED BEFORE THE FXMF Txm
DATE THEREOF. THE MMlNG MWRER Y ENDEAVOR To MAE 030 oAYs Y,RrtTEII
WME TO THE CERTlE:ATE HOLDER NAMED TO THE LEFT. BUT FA URE TO DO SO MULL
MFOSE NO OBLJGATR]N OR LMBlJTY Of ANY NND UADN THE MWRER R! &DENTE M
OF HAWAII, INC.
BY►.AWS
OF TIIE
BAY CLINIC, INC.
ARTRAJI' I
NAME
the mune of this corporation shall be 11M 13AY CLINIC, INC
ARTICLE II
FORM OF ORGANIZATION
This corporation shall be a voluntary, nonprofit, i icorporated association.
Selection of officers, board and staff, professional and volunteer, shall be without
discrimination based on age, race, sex, religion, or national origin.
ARTICLE III
PURPOSE
The purpose of the corporation is to be commurury-directed and conuruued to
improving the health and well-being of all people.
The purpose shall be accomplished by:
(1) provining high-quality accessible healthcare in a patient -centered
environment, regardless of an indvidual's ability to pay.
(Z) Worlang xith the community in preventive healthcare and education.
(3) Ensuring our services are sensitive to the cultural aiversity of our
community.
(4) Taldng a holistic approach to the treatment of our patients.
(S) Advocating for improved healthcare and living conck ions wherever the
need is evident
(6) Cooperating and collaborating, whenever possible, »4th other me cal
providers and organizations to improve the delivery of healthcare in our community.
(2) Forming a partnership pith our patients in planning a healthy future
for themselves and their faftOies.
ARTICLE IV
MEMBERSHIP
The principal governing body of clic Corporation shall consist of the Board of
Directors of the Corporation, henceforth in the Bylaws designated the "Board".
Other members of the Corporation, knoxn as Community Members, shall consist
of all other individuals who have applied for membership and been accepted as a member
by the Board. Corrununity Members shall be kept informed of the affairs of the
Corporation as prescribed by these Bylaws or otherwise by the Board, and they may
participate in membership activities which include specifically the right to elect hvo Board
members as set out in Article X. A Community Member may be removed from
nrcnnberslup upon a majority vote of the Board.
ARTICLE,V
MEMBERSHIP MEh,TINGS
1. An Annual Meeting of the Board arid Conununiry Mcmbcrs shall be held in
the month after the end of tach fiscal year, at the time and place to be decided upon by the
Board. Notice of the meeting shall be mailed to the Board and Community Mcmbcrs at
least 15 days prior to the meeting. Attendance at the meeting will automatically waive flus
notice requirement.
2. The Board shall meet at least four times per year in addition to the Annual
Meeting.
3. Special mecting3 of the Board or Community Membership, or both, may be
called at any time by the president or by petition of three Board members.
4. Notices of both regular and special meetings, other than the Annual
Meeting, shall be given by mail or telephone to tach Board member and Community
Member at least five days in advance. This notice may be waived by agreement of two-
thirds of the Board. This notice requirement will automatically be waived by attendance at
the meeting.
5. A quorum at a meeting shall consist of the presence or proxy of one-half of
the active Board members. Once established, a quorum shall continue until the meeting is
adjourned regardless of the departure of any Board member(s). Any act or business
undertaken at the meeting must receive the approval of a majority of the quorum.
6. Proxy voting by the Board will be allowed. Absent Board members may
vote at a meeting by written proxy.
7. Any Board meeting, regular or special, may be conducted by telephone
conference so long as all Board members participating in the meeting can hear one another.
8. Executive meetings of the Board may be called by tlne President. Executive
meetings may be attended only by Officers, Board members, and other individuals whose
attendance is approved by two-thirds of the Board members present No formal voting
must take place in open session.
9. Any action which, under I Iawaii corporation Law and comislent with the
Bylaws, may be taken at a meeting of the Board may also be taken without a meeting if the
action is in writing, signed by two-thirds of the Board witlun a reasonable time and filed
with the Secretary.
ARTICLE' VI
BOARD OF DIRECI'ORS
I. Membership.
( a ) lire Board shall consist of no more than fifteen ciccicd membciti
(b) 'I cmu of office shall be two years. Board nrclubcn shall take oBicc
inuncdiatcly upon election. Terms shall be stap_vcred to allow continuity on the Board with
al Icasl three Board members being carried over.
(c) Unfilled scats shall be filled by a vote of the majority of the Board
prodded proper notice of the meeting has been given and the item is specified on the
published agenda. The person filling the seat will serve until the term of the vacating
Board member expires. u re-elected at the Annual meeting, the person may serve two
more consecutive temrs.
(d) Any Board member having served two consecutive terns (four
consecutive years) shall be ineligible for at least one year.
(e) No one may serve on the Board who has an immediate familial
relationship with either a current Board member or a paid staff mcmber. A familial
relationship is defined as parents, spouses, children, siblings, or inenrhers ojthe same
household
2. Duties and Powers:
Subject to the limitations of the Articles of incorporation, the Bylaws, and
Hawaii corporation law, and the specific duties as prescribed in the Bylaws, all corporate
powers on behalf of the Corporation shall be exercised by or under the authority of the
Board. The duties and powers of the Board include, without limitation, the following:
(a) Management of the Corporation shall be vested in the Board with full
power and authority to carry out the affairs of the organization.
(b) The Board shall be responsible for the election or appointment of the
officers, agents and Executive Director of the Corporation.
(c) The Board shall consider and adopt an annual budget for the Corporation.
A budget proposed by the Finance Committee shall be submitted to each Board member at
least 15 calendar days prior to the meeting during which the budget is to be considered.
(d) The Board shall have the exclusive power to incur indebtedness or
undertake any other liability on behalf of the Corporation and to execute and deliver all
documents required with respect to such indebtedness or liability.
(c) The Board shall be responsible for establishing and maintaining personnel
policies and practices, including without limitation, selection and dismissal procedures,
salary and benefit scales, grievance procedures and equal opportunity practices.
(f) The Board shall require periodic reports on operations from various
committees.
(g) The Board shall have the power to declare any office or position on the
Board vacant by a vote of two-thirds of the Board. Absence from three consecutive
ncefingys of the Board without satisfactory cause may be considered reason for removal
rom office.
(h) 'llrc Board shall be resporsible for designing and adopting hcaldreare
ohcics of clic Corporation.
(i) 'llic Board may perform any or all other acts necessary to carry out the
business of the Corporation and adopt such policies as are necessary to effectuate these
Bylaws.
3. Conflict of Interest-
(a) No Board member shall vote or cast proxy at any Board meeting on any
issue ui which the member has a conflict of interest. A Board nnember who has a conflict
of interest on arty issue before the Board shall disclose the nature of the conflict of interest
prior to a vote on that issue at the Board meeting, and ttre minutes of the meeting shall
record the tact that the disclosure was made. In the event of a conflict of interest, a
majority of disinterested Board members shall constitute a quorum.
(b) No Board member shall be allou ed to become an employee of the
Corporation until at least 90 days after the Board member's membership on the Board
has ended Similarly, no employee of the Corporation shall be eligible to serve as a
Board member until at least 90 days after his or her last day of employment.
4. Inspection of Corporate Records:
The books of the Corporation, the minutes of all comnuttecs, special and
general meetings of the Board and all other corporate records of the Corporation shall be
open to inspection by any Board member upon written request of the Board member to an
Officer. The purpose of the inspection must be reasonably related to the Board member's
interests as a Director of the Corporatism and it must be explained in the request for
inspection. Inspection must be during regular business hours. It may be in person or by an
agent or attorney, provided the agent or attorney shall have the same fiduciary relationslup
to the Corporation as the Board member, and it includes the right to make a copy of any
document.
ARTICLE VII
EXECUTIVE COMMITTEE
The Executive Committee shall consist of the Officers of the Corporation:
the )'resident, the Vice President(s), the Secretary and the Treasurer.
2. The Executive Conunittee shall perform the functions of the Board in its
routine management of die affairs of the Corporation during intervals between meetings of
the Board. All actions taken by the Executive Committee shall be presented at the next
meeting of the Board. Actions taken by the Executive Committee may be overruled by
two-tlurds of a quorum of the Board at the meeting.
llie Executive Committee shall meet on call of the President.
4. All actions and decisions of the Executive Committee shall require a
majority approval by the members of the Committee.
AWFICI,G VIII
OFFICERS
I . flu officers of the Corporation shall be President, one or more Vice
presidents, Secretary and Treasurer, whose duties shall be those usually performed by such
officers and those specified in these Bylaws. Additional duties may be prescribed by the
Board.
2. Officers shall serve for al Icast otic year and shall be elected accordu18 Io
Article a of these Bylaws.
3. Any officer having served Iwo full terms shall be ineligible for re-election to
the same office for at least one year.
4. To be eligible for election to any officer position, a Board member shall
have served one year on the Board. This stipulation may be waived in the event there are
not sufficient eligible members.
5. Duties:
(a) The President shall be the Chief Officer of the Corporation and
Chairperson of the Board. The President shall preside at all meetings of the Executive
Committee and the Board. The President shall be a member, ex -officio with a vole, of all
corunittees except the Nominations and Elections Committee.
(b) The Vice President(s) (in succession if more than one) shall perform
all the duties of the President if the President is absent or unable to act. If the presidency
becomes vacant, the highest Vine President shall succeed to the office for the unexpired
portion of the term. If a Vice President is unable or unavailable to act, the duties shall be
performed in succession by the Secretary and Treasurer.
(c) The Secretary shall be responsible for the records of the
Corporation, supervising elections, recording votes of the Board and keeping all minutes of
the Executive Committee and Board meetings. The Secretary shall be responsible for all
correspondence of the Executive Committee and the Board and for the issuance of the
inquired notice of all meetings of the Executive Committee and Board The Board may
name an Assistant Secretary to assist the Secretary in fulfilling the duties of the office.
(d) The Treasurer shall chair the Finance Committee and maintain
supervision of the books and records of account of the Corporation. Such books and
records shall be located physically at the staff offices of the Corporation. Subject to the
direction of the Finance Committee, the Treasurer shall have charge of and be responsible
for all funds and securities of the Corporation. The details of bookkeeping, accounting and
financial statement preparation shall be done by the staff of the Corporation under
supervision and direction of the Finance Committee. The Treasurer shall present monddy
financial statements to the Board.
6. Vacancies in the offices of Vice President, Secretary or Treasurer shall be
Hod for the remainder of die term by majority vote of the Board.
ARTICLE IX
COMMIT-FEF,S
I . Thcre shall be a Personnel Comnuttee, Finanec Comnuttee, Nominations
and Elections Committee, Quality Assurance Committee, Bylaws Comnuttee, and such
special committees as the President and Board deem necessary.
? I'hc Clmiipctsons of all such committees shall be 130ard members appointed
by the President with the approval of the Board. 'the Chairperson may also select the
committee mcinbers_
3. The Chairperson and members of the Committee shall serve until the
expiration of the fiscal year or until their successors are appointed. Vacancies on a
contmittce shall be filled in the same way committee members are regularly appointed.
4. All Board members are required to join and serve on no less than one (l )
and no more than three (3) standing committees.
ARTICLE X
NOMINATIONS AND ELECTIONS
1. The Norm"tions and Flections Committee shall prepare a slate of
nominations for Board and macer positiohs. The slate shall be Presented at the Board
meeting immediately prior to the Annual Meeting. The nominees shall be given a copy of
the duties of the office at the time of sohcitation/nornination.
2. Additional nominations may be presented by any Board or Community
Member from the floor at the Arm" Meeting.
3. When additional nominations, if any, cease, the election of Board members
and Officers shall be by secret ballot at the Annual Meeting, The Cornmunity Members
present at the Annual Meeting have the right to elect two Board members from the slate of
candidates nominated by Community Members at the meeting. The results of the elections
will be tabulated and announced at the same meeting.
ARTICLE XI
EXECUTIVE DIRECTOR
An Executive Director shall be appointed by and be responsible to the Board for
overall administration of the Corporation and implementation of policies, procedures and
programs as dcternuned by the Board. Appointment and removal of the Executive
Director shall require a two-thirds vote of the Board.
ARTICLE XII
FINANCES
1. Accounting procedures for the Corporation shall conform to generally
accepted accounting practices and procedures.
2. fhe Corporation shall maintain as its fiscal year the period July 1 - June 30.
3. The books of fhe Corporation shall be audited after the end of the fiscal
year by a certified public accountant appointed by the BoajC. The auditor's report shall be
filed with the records of the Corporation.
4. Appropriate insurance in reasonable amounts and to the extent available
shall cover all aspects of the Corporation's activities and agents of the Corporation.
S. All persons having access to the funds of the Corporation in excess of
5500.00 shall be bonded.
6. The Executive Director shall be authorized to contract for services and
materials within the provisions of the budget adopted by the Board. All other contracts,
obligations and liabilities entered into or incurred on behalf of the Corporation must be
authorized by the Board and signed by the President. No officer, agent or employee of the
Corporation shall have the power to bind the Corporation to arty contract, obligation or
liability without the express written authorization of the Board unless otherwise so
authorized in the Bylaws. Contracts shall be awarded based on economy, merit and a
comparison of estimates.
7. All funds received by the Corporation shall be deposited to the credit of the
Corporation in depositories approved by the Board. No funds of any Board member,
employee or agent of the Corporation may be co -mingled with Corporation funds.
S. The Board shall approve a list of people authorized to sign checks on behalf
of the Corporation. All checks for an amount less than $500.00 individually shall require
the signature of one authorized signatory. All other checks shall be signed by at least two
authorized signatories.
ARTICLE XIII
PARLIAMENTARY AUTHORITY
Robert's Rules of Order (Newly Revised) shall constitute ruling authority in all
cases in which they are not inconsistent with these Bylaws or with Hawaii law.
ARTICLE XIV
AMENDMENTS
Amendment of these Bylaws shall require a two-thirds vote of the Board. Notice
of any proposed amendment shall be mailed to all Board members at least fifteen days
before the amendment is considered by the Board.
Revised 9/93
Revised 7/94
Revsed 5/95
Revised 9/95
Revised 3/97
(FOR TAX-EXEMPT CORPORATION ONL)
In the Matter of the Incorporation )
of )
?1 -Le- (_-IIr11G, Tnc. )
CHARTER OF INCORPORATION
TO ALL TO WHOM THESE PRESENTS SHALL COME:
I, the undersigned Director of Regulatory Agencies of the State of Hawaii, send Greeting:
WHEREAS,�J Margot bi215rnan Sandra Pckard
and carol Kond ra tK a majority of whom are residents of the State
of Hawaii, have filed with me as Director of Regulatory Agencies a verified petition to grant to them and their associates a
charter of incorporation as a nonprofit corporation, in accordance with the provisions of Section 416.20, Hawaii Revised
Statutes;
NOW, THEREFORE, KNOW YE, That I, the said Director, in the exercise and execution of every power and authority
in anywise enabling me in this behalf, do hereby constitute the said petitioners and their associates a corporation under the
laws of the State of Hawaii for the purposes and in the form hereinafter set forth.
The name of the corporation shall be: '().Le. eay C I irl i C Sri c- .
11
The location of the principal office of the corporation shell be in H i I o
, State of Hawaii, and the specific address of its initial office shall
be 341 SII'ahl Street Hilo , Hawaii 9(020
State of Hawaii.
The corporation shall be organized exclusively for the following purposes -
To Provide, gLLality
health care- -Eo
Big Island residents
-throcjil
direct rrtedI �_'aI care,
and edur-a-tror,al
actl-ittfes.
To Provide leadership 1r1 -the. cornrnwnity ,'n Preventive health care—
and In ecdu.ca4rrl9 (rl c4 IV i'jLkals as -o the r responsi'bi*hty for -Yhe'r
owrl well - bei'n9 .
Direct medical services
will include., but not be li nited -Fo, Fawiill
Planning ser'(ices , diaynosl's a.tcJ -freatrrlen-t of sexually 4r3n5mrttec4
Jis sse5 , anal annual gyneroln't�al P+q,,itna4ibns.
The duration of the corporation shall be perpetual.
The officers shall consist of: (Titles Only)
Pres 'den t
\1i'ce- Presi dept
secre+-a"Y
IV
V
R
There shall be a board of directors consisting of not less than 3 member(s). The following persons shall be initial
officers and director(s), and shall hold office for the first year or until their successors are duly elected pursuant to the by-laws
of the corporation:
Office Held Name Residence Address
?rest dent
JI'ce- President
Secreta rj
Pe99y Nlar9ot Hefsman
Sandra Prckard
Carol Kondratlti
341 _TI ahf st. , Hrlo , HI qt -7 -2-o
II`14 Afnalako Rd , Hi lo , HI 90
1-79 6 Hol -at' St. Hilo, HI 9677c
VII
The corporation shall have only such powers as provided for by law necessary to accomplish its stated purposes.
vin
The corporation is organized for McGl l -ca I , PJur-a+(c) n a l cit ari table—
purposes only and is not organized for profit, it will not issue any stock, and no part of its assets, income, or earnings shall be
distributed to its members, directors, or officers, except for services actually rendered to the corporation. Upon dissolution, all
of the assets of the corporation after payment of its just debts shall be transferred or distributed to an organization or
organizations as shall at the time qualify as an exempt organization or organizations under Section 501(c)(3) of the Internal
Revenue Code of 1954. Notwithstanding any other provision of this Charter, this corporation shall not, except to an
insubstantial degree, engage in any activities or exercise any powers that are not in furtherance of the purposes of this
corporation.
IN WITNESS WHEREOF, I have hereunto set my hand and seal of the Department of Regulatory Agencies, at
Honolulu, this 3/4,4 day of , 19
Dire ?rr of Regulatory Agencies
By
Corporation & Securities Xdministrator
(
vin
The corporation is organized for McGl l -ca I , PJur-a+(c) n a l cit ari table—
purposes only and is not organized for profit, it will not issue any stock, and no part of its assets, income, or earnings shall be
distributed to its members, directors, or officers, except for services actually rendered to the corporation. Upon dissolution, all
of the assets of the corporation after payment of its just debts shall be transferred or distributed to an organization or
organizations as shall at the time qualify as an exempt organization or organizations under Section 501(c)(3) of the Internal
Revenue Code of 1954. Notwithstanding any other provision of this Charter, this corporation shall not, except to an
insubstantial degree, engage in any activities or exercise any powers that are not in furtherance of the purposes of this
corporation.
IN WITNESS WHEREOF, I have hereunto set my hand and seal of the Department of Regulatory Agencies, at
Honolulu, this 3/4,4 day of , 19
Dire ?rr of Regulatory Agencies
By
Corporation & Securities Xdministrator