Loading...
HomeMy WebLinkAboutCOM 0122.003 2000-2002 BAY CLINIC, INC. A /amt[y of professsonals camr~:tted to mtprcr rn.~ ~ " the health of their commumtrec Hilo Bay Cltmc Ka`u Family Health Center Pahoa Family Health l enter ill Kalanianaole laenue PO Box iQ Pt) Bux la-~'. Hilo, H1 96720 Va`alehu, HI 9bi72 Pahoa, HI')67-x xt)x•~ 969 1k2 i (8081 929 7.111 (xn8' 'N~ ~ I I Fax xOx'~ vr~l 1795 Fax (808i'J299087 Fay •xnx` ~ ~kn January 30, 20001 County of Hawan Department of Finance ~5 Aupuni Street, Room 118 Hilo, Hawan 96720-4252 Dear County of Hawan, Please accept the Violence Intervetrtton Project, Bay Cltntc Hilo's application for the Hawan Courrty Nonprofit Grartt (FY 2001-02) Thank you for your time and consideration of our program If you have any questions, please call Mary Furlong at 934-327 Sincerel_ti, tilary Furlong Violence Intervention Protect Program Coordinator ate. xa ~ z 2.3 Flle No. BVD ~ ~Mf~d HSECG. Ref. To: '~crvrdg I~ou Ui1H ,4/nlia' + f 2 ~Q Ret. Dam r,~~~,. • Stephen K Yemashuo Harry A Takahashi Mayor Dvecror r COUNTY Of iiAt1K~4I'I DEPARTMENT OF FINANCE 25 Aupuni Street Roam 118 Hilo, Hawaii %720.4252 (808) %I-8234 • Fu (808) %I-8248 HAWAII COUNTY NONPROFIT GRANTS (FY 2001-02) HUMAN SERVICES NONPROFIT GRANTS REVIEW COMMITTEE FISCAL YEAR ENDING June 30, 2002 DATE OF APPLICA170N 3/ .TOd GRANT APPLICATION FOR VIOI£NCE ~ItJ~TcK~£/I~T70XJ IRDTZ~GI C~ (Peesraa. Tw) Legal Name of Orgatuuhon: 13 R~ C.Qlmx.~ . ~A)L Mailmg Address: n3~~ /(CA~f~N/ANRD~L ~ ~~1~/0 f/7 1~ 72p ,L , ~ / Facthty/Site Address. /"A/~OIr Fpgt4 ~ /Y C.~n~t ~ Fi4Altlli 7~[ ~ ~F~l Duxtor/SrteManagc ~h/i7~i~ ~.A!/A//U Organuauon President: _ C d f S ~ V R Contact Person (Crrant Writer): ~ TrV iL ~Ony Amount of Request for County Funds: S ~6 Total Annual Budget of OrgamzaUon S 3 i ygq 1 Has the applicant applied for any other funds from the County of Hawan this fiscal year! ? Yes SourcdDepartment• ~No Agency/Prognm(s): Social Sernces ? Youth Prognuns ? Elderly Programs Check Categories: ? Culture and Arts ? Education ? Other Briefly, define the program for which fending is being requested: n . . _ p B ~ c s ~ K~/~ [to B e - Oa7 i~ G G/ on d . -1- I. QUALIFYII~IG STANDARDS FOR APPLICANTS An a~ppLcant must meet all of the following standards lJ Be chartered or otherwise authonzed to do business in the State for chenuble purposes end exempted from ~y the federal mcomc to by the Internal Revenue Service L7 Have a governurg board whose members sine without compensatron sad have no contlrct of interest between then regular occupanoas and the semces provided. L~J Have bylaws or pohcrea which deacnbe the roamer m whrch btumeas a conducted, mcludtrtg mensgement, audit, fiscal pohcres and procedures, policies on nepotism, and pohcres on management of potential confiwt of interest Ld Have at least one year's expeneace with the aernce or scnvrry for which the appropnanon u Bought or can otherwise demonstrate to the aatrafsetron of the County suffieieat expertise W succeestully tarty out the serrate or acavrry Be licensed end acmedrted m accordance with spplicable requrremean of Federal, Snte sad County laws II. GRANT CONDITIONS The applicant agrees to comply with the followurg terms and conditions prior to recavtng a grant award. A Comply with applicable Federal and State laws prolubrtaig drscnminatron against any person on the basis of race, color, natronel ongin, rohgion, creed, sax. age, or haadreap B Agra not to toe any public fuada for purposes of entertsinment or perqursitea C Comply with such other roqurremmn as the Duector of Finance may preecnbe to ensure adherence by the nonprofit orgamaaoa wtt6 Federal, State, and County ]awe, and establrahed standards for fiscal and program management D Allow the Director of Finance, the committees of the wiincil and their staffs, sad the Legulatrve Auditor access w raorda, repotta, file, and other related documean in order that the program, management, and focal practices of the nonprofit organrzaaon may be monitored sad evaluated to usure the proper and effectrve expeaditrue of public funds III. RECORDS AND REPORTS A The applicant shall follow genanlly accepted eccouamg procedure sad practrcea sad shall meinnin boolu, rocords, documean sad other evidence which auffimmily and properly accotiat for the expeoditiire of Cowry foods The baola, records sad deicumean shall be subject at all reasonable tiros to mapeeaon, reviews, or audin by the County expending agency, the Duector of Fiaaace, sad the 1.eguLnve Auditor, or by then rcpreeenuuves B The Cowry expending agency, Duector of Firuace, or Cowry Council may request penodie wntten reporo on the use of County (ands C The nonprofit organizaaon shall submit a final wntten report to the Legulatrve Auditor within sury (60) days sfter June 30 of the fiscal year The report dull include as explaoanon of the public benefiu denved from the awarding of the grant, a luting of other funding sources sad emounn obtemed during the groat penod, and a complete acwuntutg of all expenditures supported by Cowry of Hawur great funds {per Chapter 2, Article 25, Section 2-142(d), Hawsri County Code, amended August, 1999} -2: IV. QUARTERLY ALLOCATION Under no cucumetmces shall grmt Cunda be disbursed m a lump sum payment Gant funds aril be disbursed to Grantees only through a quarterly allocation process The disbursement of grmt funds can be fom[uhued on an equal quarterly apportrottment buw V. GRIEVANCE PROCEDURE The apphcmt wdl adopt and mamtam a gnevmce procedure to assure proper accounting for my concern and compleinw about [w program or serv[cee that may anse from [w members, employees, cbenb or from other members of the public VI. DISCLOSURE OF INFORMATION All information, dw or other material prov[ded to the County by virtue of thw application shall be subloct to the Umform Information Practices Act (UIPA), Chapter 92F, Hawaii Revved Statutes All each matenat u deemed government record and shell be open to the public and may be provided to other public md/or pnvate Cundu[g sources VII. CONTINUED ELIGIBILTI'Y Any applkant or reelplent who wtthholde or omit any material fast or deUberateiy misrepresent sac6 fast to the County of Hawaii shall: (I) Lamedtately be dtequahfied from conerderation for Nonprofit Grwt funding; OR (2) be m v[olation of the terms of the Gant Agreement of County [ands in whtch case a grant agreement can be termurated by the County and the rec[pieat or prov[der may be labia w rc[mburae all m a portion of my funds received theism VIII. ACKNOWLEDGEMENT dgY G~-fN~G, ZN~• (Legal Name of Organ[mnon) 1 hereby agrees to admmwter the V I ~ N ~ rQ ~,2n ~rc~-.. pR01 (Program T[tle) m accordance anti the rcgulano>m, pohe[ea end procedures preacr[bed by the Hswau County Finance Department Dretnbution of gran[ funds w limited to grmtxa which are in complrmce w[th County rogu4noru, policies and procedwes The County reserves the tight to w[thhold grant dutnbutiotie u any time the gtaatee u not in comphmce It u the policy of the County of Hawn[ and for those who do baseness w[th the County to provide equal employment opportun[tia to all peraotie rcgardleu of race, physrsal dreabtlitiee, color, rohpon, sea. age, or ruttional ongin as mandated by the Federal Crvrl Rrghis Acts, es emended, and any other fadenl or state laws relating to equal employment opportumties IX. AMENDMENTS TO THE APPLICATION/EVALUATION The apphcmt assures that rt aril submit to the Humm Serv[ces Nonprofit Granis Review Committee (HSNPGRC) for poor review and approval a wntten request and justification for any changes, additions, or dektioae to my porooa(s) of the grmt appLcatioa or a duly executed Gant Agreement of Coimry Funds. The apphcmt will cooperate and assist in my effort undertal[ea by the HSNPGRC to evahiase, inspect or otherwise monitor the effecnveneas, feasibibry, mdlor coat effic[eocy of my and all practices, polte[p and piocadtues or ecnvities pursuant to ilia application or any grant designation or allocation received ae a Iseult of this apphanon. -3- ' X. AUTHORITY AND CAPACITY OF APPLICANT The applicant certifies that a lies the authority and capecrry to develop and submit thrs apphcauon, and to fully admmtster the Program(s) pursuant to this apphcauoa UNSIGNED PROPOSALS WII,L NOT BE ACCEPTED! I Srgna of PrardendCharrpason D ~ i Sr ofExecuuveDuectodMaruger D -4- VIP, Bay Clinic Inc. County of Hawaii Human Services Non-Profit Grant, 2001-02 PROGRAM/SERVICE DESCRIPTION A. Overview 1) Describe the program for which funding is requested. Funding is requested for the Violence Intervention Protect, (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 commumty 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 m 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 aze unable to get to Hilo or Kailas to fulfill their Probation or CPS semce plan. No other agency provides these services 3) Whst 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 riual 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 the community and families to identify signs of abuse through understanding and awareness. f. To improve the ways in which the community and 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 Protect empowers clients of the battere~'s group by giving them the tools to address and stop violence in their relationships, and by having focal access to services Because of rural isolation and lack of public transportation, current services offered in Page 1 of 9 VIP, Bay Clinic Inc. County otHawaii Human Services Non-Profit Grant, 2001-02 Hilo and Kona aze not easily accessible, and aze often not seen as appropnate in design for vanous 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 hve in that community *Community education and training helps the community identify abuse and have a coordinated community response, which increases public safety B. 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 dnve to Hilo or Kailas to be m compliance with them 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 hazdship on the victims and families, making them less likely to report abuse 2) Who is the target population and what are the specific needs? *Men who batter and who aze court ordered to attend batterei's program and live or work in the Puna or Ka'u distracts. Men may also self-refer to the program. *Women and Children who live in the geographically isolated distracts of Puna and Ka'u and aze in need of referral to court advocacy services, victim support groups, information and resource options. *Idividuals, 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 distracts 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. The Ka'u ViP group is held Thursday evenings in the Family Services Facility near the community center Intakes, onentation, and individuals are by appointment The staff is available for collateral services (Probation, CPS, Judiciary) by phone and/or appointments Training and presentations are by request Page 2 of 9 VIP, Bay Clinic Inc. County of Hawaii Human Services Non-Profit Grant, 2001-02 C. Collaboration/Coordieation 1) What specific measures will be taken to collsborate/coordioate with other community resources to achieve maximum program efficiency and cost effectiveness? One of the Violence Intervention Project's oblectives is to provide domestic violence services in azeas where none exist We coordinate with agenctes working with victims and perpetrators such as ATV, Hale Ohana, the Judiciazy, CPS, Probation, and law enforcement Bay Clinic, a coriununity health center provides screening and referrals to servtces. VIP collaborates with women's support servtces and men's programs in Hilo to ensure consistent servtces and response, while not duplicating servtces We are active members of the Domestic Vrolence Inter-Agency Team and the Rural Community Response Project of the Hawaii State Coalition Against 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. D. Goals and Objgg 'ves 1) What are the major goals/benchmarks of the proposed program? *Matntain existing servrces (men's groups) in Puna and Ka'u. *Assist rn the establishing women's and children's servtces to Puna and Ka'u *Create a referral network between agenctes 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/Uppsir Puna District, none currently exist * Assist in building community awazeness of domestrc violence and its effect on our community * Expanding our training program and matenals to be more culturally relevant 2) What specific objectives/action steps are planned for each goal? * Existing services maintaining men's groups is VIP's pnonty 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 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 * Bwiding community awareness Create an advisory board of Puna community members to develop a community response to Domestic Violence Page 3 of 9 Violence Intervention Project, Bay Clinic Inc. County of Hawaii Human Services Non-Profit Grant, 2001-02 * Expanding our training program and matenals to be more culturally relevant by working with the Edith Kanaka'ole Foundation and participating in a S day workshop on providing culturally appropnate services 3) What is the timeline (start and end dates) for each action step? * Men's servtces to Ka'u and Puna are ongoing. * Coordinating Women's Advocacy services The Rural Community Response Project of the Hawaii State Coalition against Domestic Violence (began August 2000), is assessing rural needs and VIP is assisting with our existing structure * Building community awazeness is ongoing An advisory board was formed in October 2000 to begin the Healthy Intentions Project, (funded through Vista, HMSA, and Bay Clinic) to pnontize community need and develop a plan * Participated in the "Integrating Cultural Diversity in Domestic Violence Issues" conference and incorporating appropnate matenal into our cumculum 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 6-31-00, 37 intakes were processed, 28 men completed the program, 5 were terminated due to non-compliance, 4 started over, and 9 transfers Current participants in-groups Puna, l0, Ka'u, 14 * 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 their violence and to not blame the victim Community Awaremess: * 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 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 Page d of 9 Violence Intervention Project, Bay Clinic Inc. County of Hawaii Human Services Non-Profit Grant, 2001-02 Women's Program: • Agencies and community organizations seeking support and referrals well be able to plug into our program for victim referrals and safety checks Measurable progress toward these goals will include the number of inquines and referrals E. Service Delivery What methodology will be used in the proposed programs delivery of service? The cumculum for the Batterer's Program is the Duluth Abuse intervention Protect's "Education for Men Who Batter" presented by two facilitators in weekly 2 hour groups The program lasts 26 weeks and participantstoin the group in progress Community awareness consists of assisting agencies and community organizations with education and information referrals -A vanety of 40-minute presentations is used in high school and intermediate settings -Support for Women's Services is provided by constant contact with agencies initiating services and providing client referrals for assessment amd evaluation VIP's men's services are victim dnven and the safety of the victim is the pnonty F. Evaluation: I) What process will be used in the proposed program's delivery of services? The evaluation of this protect will be a Joint effort by program staff and program participants A complete evaluation design process will include the following a) Defining each protect obtective in operational terms, susceptible to measurement b) Developing the measurements that would be used as indicators of achievement of obtectives and impact c) Identifying vanables 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) Descnbing the content of the final report g) Descnbing 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 as evaluations by participants delcmune the effectiveness of VIP training and picsentauons Dcfinur~ obJcctives always nicludcs the comnttmHy c.reatuig cnnunwuty drnui uainnr~ Ihat iti responsive to ethnic and wltuial umsulci.itiom Pagr 5 0l ~l Violence Intervention Project, Bay Clinic Inc. County of Hawaii Human Services Non-Profit Grant, 2001-02 G. Proeram Fees 1) Does your organization charge a membership fee for service participants? No 2) Does the proposed program charge participants a fee for services provided by your organization? There is a Cee for Batterer's group participants Community training and presentations are billed by content and length 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. Vi i 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 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 11 court ordered and 2 volunteer men who batter Six of them still live with their partners (and in one case, his mother) They are in direct contact with over 31 children and indirect contact with 7 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 14 men, 10 of who are still with their families, in direct contact with over 30 children The separated men have visitation wrth 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 anever-ending cycle Access to services in rural areas is critical to the safety and welt 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 'Pnv~ite lomulalions .uxl business ¦C onh.ats.vrth tcl.tlcd .tgcnucti to provulc uanung to ~tatl unUnu.il lun[lnutiut_ Paq[• b of 9 Violence Intervention Project, Bay Clinic Inc. County of Hawaii Human Services IVon-Profit Crant, 2001-02 •A sliding scale fee to batterer's program participants As pnmary health care providers, we plan to approach the maJor insurance companies to sponsor and pay us for training 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 cntical health issue Organization/Aeencv Information A. Board of Directors 1) Has the Board of Directors received formal training within the past 2 fiscal years? The Boazd 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 offered January 22, 2000,~and other opportunities will be provided The Board also has a yearly retreat and is scheduled to participate in a Hawaii Community Foundation event in Mazch 2001 b) When will the next board training be completed? The next board training will be completed in January 26, 2001 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 onentation and ongoing education with regulaz meetings, as well as monitonng by senior board members Missed trainings are made up by review of notes and wntten matenals 2) What are the Primary roles and responsibilities of your organization's Executive Director'! The pnmary 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 organization's Board of Directors? (Clarify role of executive officers vs. general membership). The pnmary role of our Board is to be community directed and he commuted to improving the health and well being of all people The specific duties arc fisted in our by-laws and include management of the corpondion, designing health c.ire policies, and hinng the c~ecuuve director Bxccuuve olliccrs pcrlorm the IUnUIOn of iouUnc ni,uiagcnrcnt of the bo.ud .ind pcrlomimg the duties outluiul m the h~-Lmti (,cncial members pauiupatc ui nicmbci,hip auivWcs and ha~'c the naht b clot twu lioanl nicnihcn P,igi• 7 ~il 4 Violence Intervention Project, Bay Clintc Inc. County of Hawaii Human Services Non-Profit Grant, 2001-02 B. Past Performance: l) How effective has your organization/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 pnmary health care to rural populations Part of our comprehensive services include *the Family Plaoniog 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 750 intermediate and high school students •the Back to School project suppltCd SO low-income children with school supplies donated by area businesses *our Women's Health Coordinator is a member of the Sexual Assault Response Team (BART), 36 rape responses *the Wise Heart Program is a hypertension education and outreach for 200 low-income seniors in the Puna distnct * the Violence Intervention Project cuttently serves 24 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 - l0 individuals with Angina * Theresa Hughes Fund - 30 needy individuals over 50 yrs * Tapps Coalition- ] 0 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 organization'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 lire federal Bureau of Primary Health Care (prorated for the remaining nine months of This fiscal ye.ir) allowing us to care for the uninsured 2) What is the status of all sour oi;;aniiauons major contracts or aKrccments (or the commR vcar (cmplosment a);rcemcnts, office Ic.iscs, pnm:irs {;rant rcvcnuelsupphci, etc.)? Page A of 9 Violence Intervention Project, Bay Clinic Inc. County of Hawaii Human Services Non-Profit Grant, 2001-02 The federal 330 grant is a mayor new contract Bay Clinic's major contracts have remained stable and our employment agreements for the coming year are in place 3) How does the proposed program fit into your organization's long range financial plan? We think the unique combination of pnmary care and a domestic violence program ~s a fundable idea and will generate foundation funding for community training and maintaining ex~stmg men's groups in Puna and Ka'u As pnmary health care providers, we plan to approach the major insurance companies to sponsor training, 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 D. Monitorine 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 Clm~c employs a Fmanctal Officer, Mr De Los Santos (969-1427) and assistants Taketa, Iwata, and Hara, CPA audited us, for FY 1997-8 and FY1998-9 The contact person ~s Jeff Gerdner at 935-5404 Alex Smith, CPA, (301 Nene St ,Hilo, HI 96720, (877) 257-6484) did an independent audit as of June 30, 2000 and 1999 E. Alcohol. Tobacco and Dru~Free Workplace Policies and Information: 1) How does your organization address alcohol, tobacco, and other drug prevention information dissemination as part of your workplace and/or program environment? The Bay Clink 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 infonnat~on and support through our Public Health Awareness Program Page 9 of 9 ~t~ 4• • • ~S Y Stephen K Yatnaahuo Harry A •I'akaha~ht Mayor Orrec[or `a - 000NTY Of fI~l1!!l~lI'I DEPARTMENT OF FINANCE 25 Aupum Street, Room 118 • Hilo, Havvau %720-4252 (808) %1-8234 Fax (808) %I-8248 HAWAII COUNTY NONPROFIT GRANTS (FY 2001-02) FINANCIAL QUESTIONNAIRE Please include as an attachment an explanation for all "NO" answers to questions # 1 thtu # 11 below: Yes No Q ? 1 Has the agency operated continuously for the past three (3) years? r~ ? 2 Haa the agency operated with a positive cash flow for the past three (3) years? LJ ? 3 Does your Board of Directors approve a detailed cash flow budget before the beginning of each Sscal yearl ? 4 Do your Board meeting mmutea show that quarterly fineacul statements are approved? Lr'~~- ? 5 Is your equity balance at laser 20'/0 of your Total Liability balance? L'J ? 6 Is your Total Curtmt Asset balance larger than your Total Current Liabihty balance? ? 7 Are bank reconcilretiona end accounting performed by someone other than the check ergrratory? ? 8 Are you fully insured for the agency's vehicle(s) and building(s)? ? 9 Is your Workers' Compensation at It~st 2% of payrollT ? 10. Are you current (non-delinquent) on all payroll and payroll tax payments? ? 11 Is the agency free of any pendutg litigation, limy or~udgmtmts? ? ~ 12. Within the past 12 mtmahs, has the agency applied for vendor or beak credit a~ wsa denied credit? If yes, please explain .1s the grant applicant, ! cernfy that the agency has sat[sjactonly responded ro each oJth about quernonr and apla[ned err needed ! hertby cemfyQthat thu [nforrnanon u true and comeet to the best ojmy browledge Agency k~ v, 1~ i- Ph~o)ne. 6 Jam' ~Ya 7 Preparod by /Jr ~ of /roS .Sa..Tr'S_ G Fc' _ ,1t~.~-~ ~ 9~c'/ - PnmNamdT~de I ' Srpuawe I ~Dat~e - 1' ~I CeRtfied by e n G, aa.a,L~ L d~. ~1.~ t--~'~`~" ~ O Pnnt N of Execuove Duator ~i D.te r b 9^ ~ U A W N ~ Q ~y'Sf ~ ~Y. ~ ~ ~ ~ ~ ~ ~ ~ z~ ~o N ~ ~ s ~ ~ " y ~ a ~e ~ 6 ~ z ~ s ~ ~ ~ ~ av § z ~r ~ s 5 ~ R C ~ N ~ ~ ~A C 5? N 6 A ~ ~ a ~ ~ ~ Q b ~ ~ N W W ~ a, ~ ~ g ~ ~ ~ S ~ ~ ~ ~ ~ ~ x ~ y A ~ ~ f~A 3 Cai 'O y~ • p~ J N N _N ~ O A d ~ ~ ~ y~ ~ ®~a7 A N O O H b~ a °g d ~ ~ ~ N N OyC lA g° !S ~ ~ 2S b W ? N ~ O Q ' ~ ~ c > o ~ ~ ~ ~ za ' g ~ m ~ e ~ a~~ ~ ~ o ~ ~ ~Oz v Y r e `.Q > A 8 ~ e r ~ 5' ~ ~ tWI~ G~ A ~~Jy W Q S N 'V ~ `d 00 L ~ L N ~ ~ 3 o ~ ~ ~ N Q 4 m e. m A 8. 0 0 0 0 0 0 0 o g x b C C ~ N O. ~ a a ~ o r ~ ~ ~ ~ ~ ~ ~ 8 ~ y N N ~ N ~ H 6. C ~ W O O O O O O O N O 8 O N 6 O m 0 0 0 0 o q o o ~a. o ~ j$~ 0 • _r • • • p. • tw A w N • • ~ ~ O A r 9 s ~ ~ ~ ~ ~ ~ ~ ~ 3 " y z~ m • .c ~ ~ c x .C ~ "3 w ~ v~ 2 Y A`E n ~ ~ ~ 4 r ~ ~p y p _ _ ~ ~ ^0` tI~ G1 t8o pOC W 8d O VNi A ~ J O~ N iS O O O O 1Wi. O ~ O N w O b ~ A OWC y b ~A W O. ~ ~ 's O N G G Ow0 ~ ~i@~ fA• a ~ r pp y~ p ppW NN ApN pN ~ ~ ~ a O O O O O O O O O O O O O O O GYl b a n ~ ~ ~ ~ ~ 8 H Q~ 8N tJJ. y N W SN ~ ~OWpO ~Np W N vpW~ m' [G O O ~ Vmi O a O ~ Vii O O O N C ~ p yZ pa, N '1R VR17 yA ? 8J 8W ~ N O ~ O O ONO R 0 0 0 `N6' 0 8 25 8 Q ZS o~ 0 0 0 0 b y~ p p N ~ O O O O N N O O O O O O O O O O O O O O O O O O O 1 • r ~ u A W N C ~p Oo J ~ O y ~ ~ ~ O ~ ~ O ~ ~ ~ ~ ~ S ~ H ~ r n r Z 7e ~ ~p~~~~ ~ny ~ r, o O O O Z Z ~ y ~ n 'O y ~ ~ A o' ~ ~ n J Q A J lNn ~ '1 O O J g 1~i~ O 00 ~ 'G~ ~~~o~ A pp~ A t' 7i v O O O O O O O p~ W S b w W N 0 0 0 0 Pn° o o g O p yp~ 8 t~ -i ~iY A O O O O O ~ to O v J b~ N ''SS'ff ~~JJ N tad ~l. a O O O O O O O ~iSS{ O N A ppW. V~1 tN/~ O O O O O O O O O N O O a ~ o n~ W a N ~ "C s~~ .a z ~ o w N $ ~ z s ~ ~ ~ ~ y ~ a~ ~ ~ m ~ a ~ ~ c `OOO ~O ~ ~ O C'. 9A0 J ~ ~ W J b ~ V U _N Wp~ ~ O N A 0~0 ^ '~i ~ N 0~0 N O. N ~ 'd 3 ~ -t~ ro ~ zm~ U p Q~ r ~ ~C oy'o b ~ L Y ~ b ~g ~ A y 3 ~ o~~ Al ~ N A S o~ A R H y y , y y Q O SOIG ~ ~ ~ ~ g ~ y W W H W N ~1 J b ~ ~ N J t/G b CCU i1 J G1 O N p. V _N N N N 0}93 O O q p ~ N G1 A ~O A N 'I7 ~ b a ~ ~ J pQpN pyQAp N Q~ p~ OAO N g v v A O O S A R N H N pq~ N SN N O ~ N O O S N ~ ~ ~ o ~ ~ c ~ n s ~ a ~ ~ ~ ~ ~ ~ ~ ~ 3 z~ Q ~ 4 C r~` d ~ ~ ~ r ~ O b ~ 7 O u u =z -a ~ n ~ .b n a~ E 6 Cn O. A ~ p0 N p ~ 1~. ~ app W O ~ O O O O O O O O O O ~ ~ O N C 3 3 y tD °n ~ ~ ~ a pN_~ O O O O O O O O O O O O O O O w w O O O O O O O O O Hawaii County Non-Profit Grant Violence Intervention Project, Bay Clinic, Inc Attachmert to Table 3, Item #I, adaurustrative fees• Bay Clinic taicea a i0'/o aministrative fee and 52,600 is ] 0% of the amount requested of the County of Hawaii i Alex J. Smith CERTIFIED PUBLIC ACCOUNTANT INDEPENDENT AUDITOR'S REPORT The Board of Directors The Bay Clinic, Inc [ have audited the accompanying statement of financial position of The Bay Clinic, Inc (a nonprofit organization) as of June 30, 2000 and 1999, and the related statements of activities, cash flows, and functional expenses for the years then ended These financial statements are the responsibility of The Bay Clinic, Inc 's management. My responsibility is to express an opinion on these financial statements based on my audits. 1 conducted my audits in accordance with generally accepted auditing standards and the standards applicable to financial audits contained in C~ovemment Auditin¢ Standards, issued by the Comptroller General of the United States. Those standards require that I plan and perform the audits to obtain reasonable assurance about whether the financial statements are free of matenal misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and d(sclosures in the financial statements. An audit also includes assessing the accounting pnnciples used and significant estimates made by management, as well as evaluating the overall financial statement presentation. I believe that my audits provide a reasonable basis for my opinion th my opinion, the financlal statements referred to above present fairly, in all matenal respects, the financial position of The Bay Clinic, Inc. as of June 30, 2000 and 1999, 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, I have also issued a report dated October 27, 2000 on my consideration of The Bay Clinic, Inc.'s internal control structure over financlal reporting and my tests of its compliance with certain provisions of laws, regulations, contracts, and grants. My audit was performed for the purpose of forning an opinion on the basic financlal statements of The Bay Clinic, Inc taken as a whole The Schedule of Grant Awards and Expenditures, State of Hawaii, Department of Health (Schedule I) is presented for purposes of additional analysis and is not a required part of the basic financial statements. The accompanying schedule of expenditures of federal awards is presented for purposes of additional analysis as required by U S Office of Management and Budget Circular A-133, "Audits of States, Local Goverunents, and Non-Profit Organizations," and is also 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 my opinion, is fairly stated in all material respects in relation to the basic financial statements taken as a whole f, ~P~ october 27.2000 (1 \III -24l4111t1)IN~ND AVI NIII IIl7NU1 UI l1 IIA W~I146622 187712571dN91 AJ( Iy1/Nl 4c1.4527 1111 O - Jlll NI NI 1I RI I I IIII U IIAWAII 46'RU THE BAY CLINIC. INC Statements of Financial Position June 30.2000 and 1999 Assets 2000 1999 Current assets Cash and cash egwvalents (Note 1) $ 384,164 $ 243,486 Government grants receivable (Note 1 8 3) 131,579 115,866 Patrent accounts receivable, net (Note 1 & 4) 169,044 334,202 Other receivable 94,418 39,586 Prepexl expenses 43,119 5,782 Deposit 5,164 4,664 Total current assets 827,486 743,386 Noncurrent assets Investments (Note 1) 91,891 98,000 Property, plant and equipment, net (Note 1 & 5) 1,773,424 1,737,814 Total assets $ 2,892,801 $ 2,579,200 Llabllkles and Net Assets Current haMlrbes Curtest rnstaNment of long-tens debt (Note 6) $ 13,442 $ 77,350 Accounts payable 106,270 111,366 Accrued payroll and related habdrbes 184,103 175,599 Other liabrlrhes 1,200 1,200 Total current liabdrhes 305,015 365,515 Noncurrent IrabOrtres Long-term debt, excluding current installments (Note 8) 971,281 984,723 Total habddies 1,276,296 1,350,238 Net assets Unrestricted 1,308,706 1,228,962 Temporarily restricted (Note 1 8 7) 107,799 - Total net assets 1,416,505 1,228,962 Total liabtldies and net assets $ 2,692,801 $ 2,579,200 The accompanying notes are an integral part of these financial statements 2 THE BAY CLINIC. INC. Statements of Activrtres Years Ended June 30.2000 and 1999 Changes In Unrestricted Net Assets 2000 1999 Revenues U S Federal Assistance $ 804,892 $ 331,469 Fees and grants from Hawau State government agency 336,096 66,624 Fees and grants from Hawair County govemment 17,190 18,000 Premium revenue (Note 1) 1,441,443 1,248,731 Nat patient service rovenue (Note 1) 885,381 1,496,168 Contributions (Note 1) 82,924 171,416 Interest income 18,501 27,622 Rental and other rncome 151,465 56,825 Total unrestricted revenue 3,737,892 3,414,855 Net assets released from restrictions Setisfactron of program restrictions (Note 8) 157,714 - Total unrostnded revenue and other support 3,895,806 3,414,855 Expenses Program servrces 2,757,562 2,689,167 Support services 1,058,300 896,715 Total expenses 3,815,862 3,585,882 Increase (decrease) rn unrestricted net assets 79,744 (171,027) Changes In Temporeriy ResMcted Net Assets Contnbutrons restricted for Tel-Comm 200,000 - Other 65,513 - Net assets released from restrictions (157,714) - Increase in temporarily restricted net assets 107,799 - Change m net assets 187,543 (171,027) Net assets, beginrnng of year 1,228,962 1,399,989 Net assets, end of year $ 1,416,505 S 1,228,962 The accompanying notes are an integral part of these financial statements 3 THE BAY CLINIC. INC. Statements of Cash Flows Years Ended June 30, 2000 and 1999 2000 1999 Cash flows from operating activtes Cash received from ceprtatton arrangements $ 1,441,443 $ 1,246,731 Cash received from service reciprents 1,050,539 1,283,712 Cash received from grants 1,142,265 453,772 Contnbutions, interest and other income received 483,573 255,863 Cash paid tb empbyees (2,535,345) (2,390,248) Cash paid to supplrers (1,186,070) (1,004,301) Net cash provided by operating activities 376,405 (154,471) Cash flows from investing activities Purchase of assets (164,486) (1,403,834) Purchase of investments (91,891) - Sale of investments 98,000 492,000 Net cash provided (used) by investing activities (158,377) (911,834) Cash flows from financing activities Proceeds from long-term debt - 1,065,000 Repayments of bng-term debt (77,350) (2,927) Net cash provided by financing activities (77,350) 1,082,073 Net increase in cash and cash equivalents 140,678 (4,232) Cash and cash equivalents, beginning of year 243,486 247,718 Cash and cash equivalents, end of year $ 384,184 $ 243,486 Reconciliation of change in net assets to net cash provided (used) by operating activities Change in net assets S 187,543 $ (171,027) Adjustments to reconcile change in net assets to net cash provided (used) by operating activities Depreaatbn and amortaatwn 128,876 94,775 Bad debt expense/recovery (74,283) 103,000 Decrease (increase) in government grants receivable (15,913) 37,679 Decrease (increase) in patient accounts receivable 239,441 (212,456) Increase in other receivable (54,830) (38,192) Decrease (increase) in prepaid expenses (37,337) 28,966 Decrease (increase) in deposit (500) 8,145 Decrease in accounts payable (5,096) (12,823) Increase in accrued payroll and related liabilities 8,504 8,273 Decrease in other Iiabilties - (811) Net cash provided (used) by operating activities $ 376,405 $ (154,471) Suoolemental discbsure of cash flow information Cash paid during the year for interest expense $ 86,695 $ 22,571 The accompanying notes are an integral part of these financial statements 4 moro IoW v oina ro WoN~e rr ~~iomcc~'i~~ir N ~ m W N m r ~y N n N N ~i 0 0 m ~ 0 O~ n ~ m~ N R O W E m m r 1a ~ O n N N O n 0 0 m lac vimei m n? macronin~ ai .=oimvievoi~ y~ W np ~ r n O N~ N O) ie N m o m N ro~ ~ N l7 ~ ~ N ~ N~ N N N ' 1~i m N M x W O W O O W m W N m m m~ O W ~ ro m n r ~p h r O m n r W m N m m O N r N m r r N l7 r 0 m W~ m S of W O m~ ro W m fp lya- O r W r W m N O ~m~p m N th m 0 0 m p rp m 10 r 1~ m N W ~ N W a7 N ~ N h~ Q frl N T m m N N M 1+1 A N N N N O' f`1 Y Pi R~ m (V fV ~ ' 17 w w W V~ r W ro W O ~~pp m m W r W ~p aa N N N W N m v) m ('f m ro N N p C M N O W N aD Pf O m v) 1+f 11] ~ ro ro W m r m ~ m m n ~ ro O g E O mvmn ~YONt~i ON ~Yfrm Nvf b N ro1A m O~ mN ro C ~c V (V m [V l7 1~ O r m r O PI HI ~ ~ IC C v Q Hi ri O G G p ,x ~ m N a^1 fh N O N W l7 N ~ N r C y W ~ AVVA N N N C N r 0 N r v m r 1p h m r r f 7 N O Y m v r ~p N E p` E ro~~ ~ Nnn n~nn NRmaDN V~~~mNNbVmaD ~ m 1~ ro m m l7 N ro N A P W h W W p m n n C~ l0 ^ viN ~ O mri (V ron NO ~ viNmO~y ME7nh~y ~Q m ~ t'1 t+i~ h W p~ H DO O ~ t9 W^ O m In m N W Y O m M N ~ N N N r ^ N O O d N N A ~ w a u W m c c_ ~ W Pl O N 11pp WW n m N t0 ~ n N v1 V) W N m V~ ~ W W QQt0~pfp m~O~ N mp O m m ~nrm W 0 N N d C m <m 71A m W W~O m ~NOI mr~8 ~ r mro mN ~ N ~ ~i r ~ N O r P'f ~ ~ N O f V ~ ~ f~ r N Ci R m G ~ ~ W O V ,A ~ ~ ~y n O V N r 0 v) ~ O fD 19 Of O O t'1 O r N N m W m ~ a~ C" Y m mm m O roN O pu7 m fV m O U ~ L m~ O m W~ ~ N f7 N O ~ C N m ~ ~ N m Q ~ ~ ~ 10 ~ N C a V ~ n vi ~ d ~ vi ~i of o ~ ~ ~ ro o d W = ~ ~ C ~.n LL ~ V„~ Y ~ ~ c ~ w w A ~.y C W T u ~ ~ ~ ~ Y m m{p W m Q m N hpp r VI N W u7 m p ~p m m W W F"'i E 'r 7 fn U N~ N N V O r N aD l`m') m ro~ 0 N m O W i i^ N~ i ~ i i ~ N ~ d ~ (J Pi fV fV a7 ~ V aU f~i ~ ^ ! O O ~ ~ ~ m ~ ~ ^ N R m ~ O a N N C J a t mmm WNW~p ~p Wroa mmnm m~prrWmNWr W E T C m ro N m W W GD t'1 O N ~i m t") I~ m r t7 Ol N V n W Y n r W O O 3 v~ m m Ul ro v t~l m m O Y W m O m W O^I ~ r (O m N f~1 N N E 1f1 ~ E C ~~pp O C/ _Q 1~ a N fV W fV Vi ~ fV (V Q (V fV ~ lV fV ~ r r A W O r ~ ~ ~ Y N N ^ N N LL a N ' W L r mmn Nm~n W ~ vm mW m W m nv aomm o t7 Nr ~~ppn mhro V ~ O rpmOro r roNml7 ODm! vr~i ~ir W r Q N W m Y O ~ ~ m N O N aD O V P W W W m N ~ V 7 t0 m m m W 7 A d VI Oi ((pp VIA N ai l7 O O n g V1 m V7 W r? W O ~ m m ~ N c'i m W E A r O n N n m N 0 n t9 I r N ~ m N N ~ ~ m V 1 a U ~ N O N w w N N d N N C y ~ N U J N Y U d ~ A N ~ % N D C q G W Y C O c x c c E w ai ~ _ pN d N .Y. A d d 9 O _N N N d N C W U N vYi C A N Y d C W c g E n d~° u v E v ~ E m c ~ A~ T A V A~ J 0 C Y C A J~ U C U V d A K C d A Y- O C ~ y N % A U A N A Y L C~ C r p A W E~ b A ro A j. OL 6 C 6_ `y Y$ G C O Y` U> N U J y y~ 7 6 Y L N H mina W ~~¢7 ~ c~OU o_i-mtY-~nQ TnWW cnn iQ rv (~E THE BAY CLINIC. INC Notes to Financial Statements Years ended Jtme 30.2000 and 1999 NATURE OF OPERATIONS The Bay Clinic, Inc. (the 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 pnmary medical and preventive health care services The Clinic operates health clinres in Hilo, Pahoa, and Ka'u The Clinic qualifies as a Federally Qualified Health Center (FQHC) The Clinic is governed by a Boazd of Drrectots, wrth fourteen (14) and thirteen (13) members as of June 30, 2000 and 1999, respectively The minimum required members as of June 30, 2000, is nine (9) and the maximum is fifteen (IS) with Directors serving two (2) year terms. The Executive Drrector is appointed by and is responsible to the Board of Directors for overall administration of the Clinrc. The Clinrc's operations are funded predominantly from thud party reimbursements from heath insurance plans, and by federal and state financial assistance. NOTE 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 composed of cash on hand, in savings and checking accounts, and in money market accounts. At June 30, 2000 and 1999, and throughout the years 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. 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 matunty of the certificates ProQertv. slant and eouipment Property, plant and equipment are corned at cost or at the fair market value at the time of donation Maintenance and repairs are charged to expense, and betterments are capitalized Depredation 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 straight-line method over the shorter period of the lease term or the estimated useful life of the equipment (See further details at NOTE 5) 6 THE BAY CLINIC, INC. Notes to Financial Statements, Continued Years ended June 30.2000 and 1999 NOTE 1 SIGNIFICANT ACCOUNTING POLICIES, Continued Property. plant and equipment, continued If donors stipulate how long contributions of property, plant and equipment are to be maintained, the contributions are recorded as restricted support. In the absence of such stipulations, contributions of property, plant and equipment are recorded as unrestricted support. Temnotanly restricted net assets Temporarily restricted net assets are those whose use by the Clinic has been limited by donors to a specific time period or purpose (See further details at NOTE 7) 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 servtces actually performed by the Clinic Net Qatient service revenue The Clinic has agreements with third-party payors that provrde for payments to the Clinic at amounts usually discounted from its established rates Net patient service revenue rs reported at the estimated net realizable amounts from patients, third-party payors, and others for services rendered. Contributions Contributions received and uncondtttonal promises to gyve 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 tf they are designated as support for future periods When a donor restriction expires, that ts, 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 gyve are not included as support until the conditions are substantially met Donated services No amounts have been reflected to the statements for donated servtces inasmuch as no objective basis is available to measure the value of such servtces; however, a number of volunteers have donated their time to program servtces Adverttstne costs Advertising costs are expensed as incurred. 7 THE BAY CLINIC. INC Notes to Financial Statements. Continued Years ended June 30, 2000 and 1999 NOTE 1 SIGNIFICANT ACCOUNTING POLICIES, Continued Income taxes No provision has been made for federal or state income taxes because the Clinic has obtazned tax-exempt status under the Internal Revenue Code Section 501 (c)(3) and applicable provisions of the Hawaii Revised Statutes. NOTE 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 dunng the reporting penod Actual results could differ from those estimates. NOTE 3 GOVERNMENT GRANTS RECEIVABLE Government grants receivable represents condrt~onal contributions directly from or passed through the State for which the conditions had been substantially met as of year-end A summary as of June 30, 2000 and 1999, follows: 2000 1999 State of Hawaii - Pnmary Care funds $ 42,992 S 21,449 Federal funds - Title X Family Planning Grant 9,940 4,500 Federal funds - Title X Health Educator 10,078 11,354 Federal funds - Title V Maternal and Child Health Services Block Grant - 20,000 Federal funds -Breast and Cervical Cancer Control Program 24,103 30,648 Federal funds -Women, Infants and Children (WIC) 20,824 27,71 S Others 23,642 S 131,579 $ 115,666 8 THE BAY CLINIC. INC. Notes to Financial Statements, Continued Years ended June 30, 2000 and 1999 NOTE 4. 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, 2000 and 1999: 2000 1999 Patient fees receivable $ 106,495 $ 135,767 Thud party billings receivable 196,919 319,898 Medicaid cost report recovery 26,619 86,619 Medicaid wrap around fund 24,701 49,191 Medicare cost report recovery 1,159 3,859 Other 5,868 5,868 Fees receivable, gross 361,761 601,202 Less allowance for uncollectibles 192,717 267,000 Patent receivables, net $ 169,044 $ 334,202 NOTE 5. PROPERTY, PLANT AND EQUIPMENT A summary of the Clinic's investment in property, plant and equipment as of June 30, 2000 and 1999, is set forth hereunder: Estimated Useful Lives 2000 1999 Land N/A $ 5,983 $ 5,983 Building 38 years 1,203,586 1,203,586 Condominium 40 years 93,736 93,736 Leasehold improvements 5-38 years 366,479 359,617 Clinical equipment 5-10 years 145,721 48,033 Office furniture and equipment 3-5 years 172,194 164,263 Computer hardware and software 3-5 yeazs 132,885 119,500 Automobile 5 years 60,566 21,950 2,181, L 50 2,016,668 Less accumulated depreciation 407,726 278,854 1,773,424 1,737,814 Assets under capital lease 5 years 16,009 16,009 Less accumulated amortization 16,009 16,009 Total $1,773,424 $1,737,814 9 THE BAY CLINIC,INC Notes to Financial Statements. Continued Years ended June 30, 2000 and 1999 NOTE 6. LONG-TERM DEBT Long-term debt at June 30, 2000 and 1999, consisted of the following: 2000 1999 Bank of Hawaii, $100,000 revolving credit line for short-term working capital needs, 9.5% interest as of June 30, 2000, secured by blanket security interest in accounts receivable, furniture, fixtures, equipment, and Bank of Hawaii deposit accounts Drawings are due not longer than sixty (60) days from the date of disbursement Expires December 1, 2000. $ - $ 65,000 Shelby Rose, LTD, mortgage loan, 8.5% interest, payable rn monthly installments of 58,052 including interest through April 1, 2024; collateralized by a mortgage on the Hilo Bay Clinic building. 984,723 997,073 984,723 1,062,073 Less current installments of long-term debt 13,442 77,350 S 971,281 $ 984,723 NOTE 7. TEMPORARILY RESTRICTED NET ASSETS Temporarily restricted net assets are available for the following purposes of future penods at June 30, 2000 and 1999. 2000 1999 Tel-Comm (Weinberg) $ 89,614 $ - Teen ROAR-Pizza Hut 14,969 - Theodore A. V~erra grant 1,000 - ROAR/FLAB - HCF(Wemberg) 857 - Lill~an Kimball Wilder grant 667 - Grace Bryan Taylor grant 580 - Alice M.G. Soper grant 66 - Medicme gift bank fund 46 - $ 107,799 $ - 10 THE BAY CLINIC. INC. Notes to Financial Statements. Continued Years ended June 30.2000 and 1999 NOTE 8. SATISFACTION OF PROGRAM RESTRICIONS Satisfaction of program restnctions represents the use of funds for the purpose or period restricted by the donor. A detail of those funds by program for the year ended Jwe 30, 2000 follows. 2000 Tel-Comm (Weinberg) $ 110,386 Theresa F. Huges grant 14,000 Teen ROAR-Pizza Hut 10,031 ROAR/FLAB - HCF(Weinberg) 9,143 Atherton Family fund 3,000 Alice M.G. Soper grant 2,434 Kitaro Watanabe grant 2,000 Grace Bryan Taylor grant 1,670 Theodore A. Viers grant 1,500 Sexual Assault (TAPPPS) 1,230 Medicine gift bank fund 1,087 Lillian Kimball Wilder grant 833 Healthy Moihedliealthy Babies 400 $ 157,714 NOTE 9. OPERATING LEASES The Clinic leases its Pahoa and Ka'u facilities wder operating leases that wrll expire rn the fiscal years ending Jwe 30, 2003 and 2001, respectively. The Pahoa lease rncludes an option to renew for an additional five years. Minrmum awual rent for the Pahoa facility rs $85,669, which rncludes common area maintenance and general excise taxes and increases to $88,432 as of Jwe 2000 The minimum annual rental for the Ka'u facility is $]3,200 with a 10% annual increase every year efI'ectrve July 1. Minimum annual rent for the Hilo facility was $106,858, including general excise taxes, on a month to month basis until a lease agreement was signed on September 1, 1998 at an annual rental of $120,000 The Clinic purchased the thirty-eight (38) yeaz sub-leasehold interest rn the Hilo facility on March 29, 1999 The leasehold agreement includes monthly ground lease payments of 53,000 through June 30, 2002. For the period after Jwe 30, 2002 through the end of the sub-lease term, ground rent will be renegotiated by the Clinic and the lessor Rent expense for the years ended June 30, 2000 and 1999, was $140,706 and $175,181, respectively ll THE BAY CLINIC, INC Notes to Financial Statements. Continued Years ended June 30.2000 and 1999 NOTE 9. OPERATING LEASES, Continued Future minimum rental payments for the next five (5) years under the above operating leases as of June 30, 2000, are as follows: Year endin¢ June 30: 2001 $ 107,404 2002 91,432 2003 91,432 2004 3,000 2005 3,000 Total minimum rental payments $ 296,268 NOTE 10. RETIREMENT PLAN The Clinic offers a Simplified Employee Plan (SEP) to tts employees. For each of the years ended June 30, 2000 and 1999, the Clinic contributed $33,897 and $21,858, respectively, to the plan The Clinic also offers two voluntary tax deferred annuity plans under Internal Revenue Code Section 403(6) to substantially all of its full time employces These plans are employee contnbutory only with a maximum annual contribution per employee of 20% of gross wages or $9,500, whichever is less NOTE 11. FUNCTIONAL CLASSIFICATION OF EXPENSES The costs of providing the various programs and supporting services have been summarized on a functional bans in the statement of functional expenses Accordingly, certain costs have been allocated among the prognuns and supporting services benefited The management and general expenses are made up of both supporting services and direct administrative costs. The allocation as of June 30, 2000, is as follows 2000 Supporting services $ 580,812 Administrative expenses 477,488 Total management and general expenses $1,058,300 12 THE BAY CLINIC. INC Notes to Financial Stauments. Continued Years ended June 30.2000 and 1999 NOTE 12 CHARITY CARE The Clinic provides care to indigent patients based on cnteria 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 chanty care provided These records include the amount of charges forgone for services and supplies furnished under its chanty care policy. These records were not compiled into annual totals for reporting purposes. NOTE 13 MEDICARE/MEDICAID COST EVALUATIONS As a Federally Qualified Health Center (FQHC) the Clinic is required to submit an annual cost evaluation performed by a firm The cost evaluation determines the eligible costs incurred by the Clinic to be included m the calculation of the Medicare and Medicaid rates used for reimbursement Based on cost evaluation reports submitted for years 1993 through 1999 the Clinic is eligible for higher rates of reimbursement. $77,536 and $34,083 were accrued in the year ended June 30, 1999 for Medicaid cost reports submitted for the years 1999 and 1998, respectively. $60,000 was received in fiscal year 2000 as a partial payment for the 1999 report. $25,000 was received in fiscal year 1999 as a partial payment for the 1998 report. $1,147 and 54,712 were accrued m the year ended June 30, 1999 for Medicare cost reports submitted for the years 1999 and 1998, respectively. $2,000 was received in fiscal year 1999 as a partial payment for the 1998 report. The 1998 balance was settled vnth a reimbursement to the Federal goverunent of $1,094 m fiscal year 2000 No activity was recorded related to the 1999 Medicare cost report in fiscal year 2000 NOTE l4 RECLASSIFICATIONS Certain reclassifications have been made to the 1999 financial statements to conform to the 2000 presentation 13 W O y N pg M Cl t0 gy~pp Y a0 O O d O N 00 ~ O ~ 01 r vN1 y ~ d g y ~ C a0 O N ~ 'V y N p C C J d ~ ~ x c Tj c s Q~ LL ~ W y w w w w N rj U ~ E m y ~ M u~ cn ao ro a ~ c Z rn d ao ro~ ~ rn n ~ ° ~ ~Ua g~ ~ W C~ ~aN N Y T vii N N ffpp N W ~ d U Q ~ W ~ ~ cx m d O Q W U U w w w w w O O O y N T C~ Zp pN ~0 N 7 ~ h V O N N 1A ~ 'r' O C 2 O 1 N Dd ~ ~ C ~ ~ O N 4-. W R J d y N ~ -p LLay~Y LL ~ B~ a w u'f w w w w ~o ~ ~ d ° rn ~ o . ~ y ~ F a e Y Q ~ ~ co c~ co N y N ~ c N N N O 3 0 ~ ^ w w w w w w x o M °o m d ° " o 0 C ~ N (n } O 7 O. p . . p . ' h h N •r ~O" u ~ Z ~ N ~ C N N N ~ v ~ J ~ X 9 A N~ w W w N w w ~ E 00 v a °o m Q o 0 z e x o ~ 25 °o °o ~ ~ ~ ~ c = ui vi v~ F- w U u'S w w w w ~v O C y QO h 01 Y N ~f1 V C E fD r^ y r o y 3 N W y r N ~ W O Y Q ~ p W~ C N Oi C N fV O a0 m 10 ~ ° ~ ~ ~i W t~0 d a0 L p~ J rL.7 o w q d C y~ y W N ~ O Cm0 Vl y n 1(I e" ~ W C f0 I~ Op f~ N f~ ¢ O n ~ ~ O1 1~ CO ~ K O N t'1 l") 00 N W N N Cl w w m T A y d N y N O C .L-. C ~ d ~ W m = ~ ~ E c o - 7 N ~ y N ~ d N V o W U; ~ y C G y N A LL ~ ~ X~ X N C ~ O m ~ C N C y 'O~' d c m m a Q ~ ~ ~ ~ ~ T Q G ~ ; W ~ d t~ A w E ~ `y n a_ - rnaw ~ ~ rn X m U - - Alex J. Smith CERTIFIED PUBLIC ACCOUNTANT 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 I have audited the financial statements of The Bay Clinic, Inc. as of and for the year ended June 30, 2000, and have issued my report thereon dated October 27, 2000. I conducted my audit in accordance with generally accepted auditing standards and the standards applicable to financial audits contained in Government Auditin¢ Standards, issued by the Comptroller General of the United States Compliance As part of obtaining reasonable assurance about whether The Bay Clinic, Inc.'s financial statements are free of material misstatement, I 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 my audit, and accordingly, I do not express such an opinion. The results of my tests disclosed no instances of noncompliance that are required to be reported under Govemment Auditing Standards. Internal Control Over Financial Reporting In planning and performing my audit, I considered The Bay Clinic, Inc 's intemal control over financial reporting in order to determine my auditing procedures for the purpose of expressing my opinion on the financial statements and not to provide assurance on the intemal control over financial reporting However, 1 noted certain matters involving the internal control over financial reporting and its operation that I consider to be reportable conditions Reportable conditions involve matters coming to my attention relating to significant deficiencies in the design or operation of the internal control over financial reporting that, in my judgment, could adversely affect The Bay Clinic, Inc '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 (pages 22 through 28) as Findings 00-1 through 00-4 OAllll-2CJ911-ROINANU AVENUE IIONOL ULU I1AWAl196R221R771257-6i841A% IROR1951-9527 1111.0-J0I NI NI tiIRI I:7 1111.0 IIAWAl196720 A matenal weakness is a reportable 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 My consideration of the internal control over financial reporting would not necessarily dlsc{ose all matters In the mtemal control that might be reportable condittons and, accordingly, would not necessarily disclose all reportable conditions that are also considered to be material weaknesses. However, I believe that none of the reportable conditions described above Is a matenal weakness. This report is intended solely for the information and use of the Board of Directors and management of The Bay Clinic, Inc., and federal awarding agencies and pass-through entities and is not Intended to be and should not be used by anyone other than these specified parties. c P/~ October 27, 2000 16 Alex J. Smith CERTIFIED PUBLIC ACCOUNTANT INDEPENDENT AUDITOR'S REPORT ON COMPLIANCE WITH REQUIREMENTS APPLICABLE TO EACH MAJOR PROGRAM AND ON INTERNAL CONTROL OVER COMPLIANCE fN ACCORDANCE WITH OMB CIRCULAR A-133 The Board of Directors The Bay Clinic, Inc Compliance I have audited the compliance of The Bay Clinic, Inc with the types of compliance requirements described in the U.S. Office of Mana¢ement and Bud¢et (OMB) Circular A-133 Compliance Supplement that are applicable to its major federal program for the year ended June 30, 2000. The Bay Clinic, Inc 's maJor federal program is identified in the summary of auditor's results section of the accompanying Schedule of Findings and Questioned Costs (pages 22 through 28). Compliance with the requiremenu of laws, regulations, contracts, and grants applicable to its major federal program is the responsibility of The Bay Clinic, Inc 's management My responsibility is to express an opinion on The Bay Clinic, Inc 's compliance based on my audit I conducted my audit of compliance in accordance with generally accepted auditing standards, the standards applicable to financial audits contained in Government Audittn¢ Standards, issued by the Comptroller General of the United States; and OMB Circulaz A-133, Audits of States, Local Governments, and Non-Profit Or¢anizations. Those standards and OMB Circular A-133 require that I plan and perform the audit to obtain reasonable assurance about whether noncompliance with the types of compliance requirements referred to above that could have a direct and material effect on a mayor federal program occurred An audit includes examining, on a test basis, evidence about The Bay Clinic, Inc 's compliance with those requirements and performing such other procedures as 1 considered necessary in the circumstances I believe that my audit provides a reasonable basis for my opinion. My audit does not provide a legal determination of The Bay Clinic, Inc.'s compliance with those requirements. In my opinion, The Bay Clinic, Inc complied, in all material respects, with the requirements referred to above that are applicable to its mayor federal program for the year ended June 30, 2000 However, the results of my auditing procedures disclosed instances of noncompliance with those requirements, which are required to be reported in accordance with OMB Circular A-133 and which are described in the accompanying Schedule of Findings and Questioned Costs as Finding 00-5 ()\Illi 2a 1411 HnINANI)AVI Nlll II()N()111111 IIAWAl14GN22 IN7712\7 M1N41 ~4 IN(IN14S1 4527 1111(1-]III NI NI Silt(( I IIII I) IIA W/~114fi7211 Internal Control Over Compliance The management of The Bay Clinic, Inc. ~s responsible for establishing and maintaining effective mtemal control over compliance with the requirements of laws, regulations, contracts, and grants applicable to the federal programs In planning and performing my audit, I considered The Bay Clinic, Inc.'s mtemal control over compliance with requirements that could have a direct and matenal effect on a major federal progratrt in order to determine my auditing procedures for the purpose of expressing my opinion on compliance and to test and report on the mtemal conVol over compliance in accordance with OMB Circular A-133 I noted certain matters involving the mtemal control over compliance and its operations that I consider to be reportable conditions Reportable conditions involve matters coming to my attention relating to significant deficiencies in the design or operation of the mtemal control over compliance that, in my judgement, could adversely affect The Bay Clinic, Inc.'s ability to administer a mayor federal program in accordance with the applicable requirements of laws, regulations, contracts, and grants Reportable conditions are descnbed in the accompanying Schedule of Findings and Questioned Costs as Finding 00-6 A material weakness is a reportable condition in which the design or operation of one or more of the mtemal control components does not reduce to a relatively low level the ask that noncompliance with the applicable requirements of laws, regulations, contracts, and grants that would be material in relation to a major federal program being audited may occur and not be detected within a timely penod by employees in the normal course of performing their assigned functions. My consideration of the mtemal control over compliance would not necessarily disclose all matters in the mtemal control that might be reportable conditions and, accordingly, would not necessarily disclose all reportable conditions that aze also considered to be material weaknesses However, I believe that none of the reportable conditions descnbed above is a matenal weakness This report is intended solely for the information and use of the Board of Directors and management of The Bay Clinic, Inc., and federal awazding agencies and pass-through entities and is not intended to be and should not be used by anyone other than these specified parties. f cP~F J October 27, 2000 18 THE BAY CLINIC. INC Schedule of Expenditures of Federal Awards Year Ended June 30. 2000 Federal Agency or CFDA Passthrough Federal Federal Grantor/PassThrough Grantor/Program Title Number Number Expenditures U.S. Department of Health and Human Services: Communty Health Centers (330) 93 224 N/A S 450,000 PassThrough Programs From State of Hawau. Department of Health Breast and Cervical Cancer Screening Program 93 919 98-385 99,579 Community-Based Health Education Family Planning and Reprodudwe Health 93 217 YO-202 24,500 Comprehensive Pnmary Health Care Services (idle X -Family Planning Proled) 93 217 Y0.173 45,000 Comprehensive Pnmary Health Care Services (Tale V - Maternal and Child HeaNh Services) 93 994 YO-173 25,000 Hamakua Health Center Rural Healih Outreach (Tel-Mad) 93 912 - 8,423 Total U S Department of Health and Human Services 852,502 U.S. Department of Agricuhure PassThrough Program From State of Hawau. Department of Health Speaal Supplemental Nutrition Program for Women, Infants and Children (WIC) 10 557 Y0.220 134,453 U.S. Department of Defense Pass-Through Program From University of Hawau at Manoa UH Telemediane Cumculum Research Protect 12 420 - 11,937 Corporation for National and Community Service VISTA Protect Support 94 013 N/A 6,000 Total Expenditures of Federal Awards 3 804,892 The accompanying notes are an integral pan of this schedule 19 'The Bav Clinic. Inc Schedule of Expenditures of Federal Awards. Continued Prourams selected for Audit rn Accordance with OMB Circulaz A-133 Year Ended June 30.2000 Federal CFDA Amount of Federal Grantor Number Program Title Expenditures U S Department of Health and Human Services 93 224 Commundy Health Centers (330) S 450,000 Total Expenddures of Federal Awards tested S 450,000 Total Expenddures of Federal Awards S 804,892 of total Expenditures of Federal Awards tested 56% The accompanying notes are an integral part of this schedule 20 THE BAY CLINIC. INC Notes to Schedule of Expenditures of Federal Awards Year ended June 30.2000 NOTE I BASIS OF PRESENTATION The accompanying schedule of expenditures of federal awards includes the federal grant actrviry of The Bay Cl~mc, Inc (The Clinic) and is presented on the accrual bans of accounting. The mfortnation in this schedule is presented m accordance with the requirements of OMB Circular A-133, Audrts of States. Local Governments. and Non-Profit Oraani~ations. Therefore, some of the amounts presented in this schedule may differ from amounts presented in, or used rn the preparation of, the basic financial statements. NOTE 2 OVERSIGHT AGENCY The U S Department of Health and Human Services has been designated as The Clin?c's oversight agency NOTE 3. SUBRECIPIENTS The Clrmc did not provide any of the federal awards listed in the schedule of expenditures of federal awards to subrec~pients NOTE 4 INDIRECT COST ALLOCATION The Clrmc has not entered into an approved indirect cost negotiation agreement covering fiscal year 2000 The Clinic did not charge federal programs for indirect costs during fiscal year 2000 21 THE BAY CL[N[C, INC Schedule of Findmas and Questioned Costs Year Ended June 30.2000 Section 1-Summary of Auditor's Results 1 The Independent Auditor's Report on the basic financial statements expressed an unqualified opmwn 2 Reportable condtt~ons in internal control over financial reporting were ~dent~fied, none of which are considered to be matenal weaknesses 3 No instances of noncompliance considered matenal to the financial statements were disclosed by the audit. 4. Reportable conditions in internal control over compliance with requirements with applicable to mayor federal award programs were identified, none of which are considered to be matenal weaknesses. 5 The Independent Auditor's Report on compliance with requirements applicable to major federal award programs expressed an unqualified opinion. 6. The audit disclosed findings required to be reported by OMB Circular A-133 7 The Bay Clinic, Inc.'s maJor program was as follows. CFDA Number Name of Federal Program 93 224 Community Health Centers 8 A threshold of $300,000 was used to distinguish between Type A and Type B programs as those are defined in OMB Circular A-133 9 The Bay Clinic, Inc. did not qualify as a low-risk auditee as that term is defined in OMB Circular A-133 22 THE BAY CLINIC. INC Schedule of Findings and Ouesttoned Costs. Continued Year Ended June 30. 2000 Section II -Financial Statement Findings Section Pattent Donattons Ftndtn¢ No. 00-1 Cnterta: "Pattent donattons" should first be applied to any appltcable outstanding balances and then properly classified in the general ledger Condition It was indicated to me that the above step to performed, however, 1 found nothing to document the process and leave a trail for proper classification in the general ledger Context. Donattons only represent approximately 514,500 out of $4 million in total revenue in fiscal year 2000, however patient fees receivable is over 5100,000 and is currently fully reserved for Effect The effect is possibly misclasstfytng "patient donattons" in the general ledger Cause The cause appears to be not documenting the process noted above Recommendation I recommend that the above process be documented to order to leave a clear paper trarl to determine proper classification of "patient donations" rn the general ledger. The documentation could include a printout of the patient's receivable balance at the date of the donation attached to the appltcable receipts log ~3 THE BAY CLINIC. INC Schedule of Findings and Questioned Costs. Continued Year Ended June 30, 2000 Cash Manartement Findinc No 00-2 Cntena Proper cash management includes investing excess funds in safe and high interest earning products Condition The funds in the money mazket account earned approx~matety 3.0 - 4.5% dunng fiscal year 2000. Context Funds held in the money market account have increased by almost $200,000 dunng fiscal year 2000 Effect. The effect is not maximizing interest earnings on excess funds Cause. The cause of the above condrt~on appears to be due to a change in investment advisor personnel. Recommendation. 1 recommend that management research the altematrves for investment of excess funds, and combined with the budgeted needs and investment policy of the Board, maximize the interest earnings available to the Climc. 24 THE BAY CLINIC. INC Schedule of Findin¢s and Questioned Costs. Continued Yeaz Ended June 30.2000 Fixed Assets Finding No. 00-3 Cntena Fixed assets aze to be depredated over their estimated useful life Condition: I noted that computer hazdwaze is being depredated over 5 yeazs, when most computer equipment becomes obsolete within 3 years Context. There ~s almost $75,000 in cap~tal~zed computer hazdware on the books as of June 30, 2000. The difference in depredation expense from a useful life of 5 years to 3 years, ~s a timing difference of $10,000 per yeaz Effect. The effect is under depreciating the computer equipment in the finandal statements Cause: The cause of the above condition is due to carrying over the useful I~fe of 5 years used in the past Recommendation I recommend that future computer hardware purchases be depredated over an estimated useful life of 3 yeazs. 25 THE BAY CLINIC. INC Schedule of Findings and Questioned Costs. Continued Yeaz Ended June 30.2000 Fixed Assets Findina No. 00-4 Cnteria. The fixed asset detail schedule should be updated on a regulaz basis Condtuon. There aze many older assets on the fixed asset schedule that may or may not still be used Effect Most of these old assets are fully depredated, therefore there ~s no effect on the bottom line, however, the gross fixed asset and accumulated depreciation accounts may be overstated Cause The cause of the above condmon appears to be due to not ut~l~zing a complete physical inventory already performed (including non-capitalized assets) and updating the detail fixed assets schedule accordingly Recommendation I recommend that the fixed asset detail schedule be reviewed and updated in the neaz future for assets no longer in use. I also recommend that the tagging and logging from the physical inventory be applied to the detailed fixed assets schedule for better identification in the future 26 THE BAY CLINIC. INC Schedule of Findings and Ouestioned Costs. Continued Year Ended June 30.2000 Section III -Federal Award Findings and Questioned Costs Obiectrves - Community Health Centers CFDA# 93.224 FmdmQ No. 00-5 Criteria• One of the objectives of the Community Health Centers Program is the maximization of third-party reimbursement levels. Condition While there has been definite improvement m this area, the third-party reimbursements aze still not being maximized Effect The effect of this condition is greater dependence on government and private grants and a higher allowance for doubtful accounts Cause. The cause of the above condition is partly due to medical leaves in the billing department in the past year, and the inherent complexity of collections in the industry Recommendation I recommend that the accounts receivable aging schedule be reviewed on a regular bans, and old accounts are followed up in a timely basis An incentive system could also be considered to improve collections ~7 THE BAY CLINIC. INC Schedule of Findings and Questioned Costs. Continued Year Ended June 30. 2000 Reconciliation -All Federal Programs Finding No 00-6 Cntena Expenditures should be equal to revenue for reimbursement grants Condition I noted that expenditures were not equal to reimbursements in the general ledger for some of the reimbursement grants Effect• The effect of this condition is general ledger does not support the grant revenues. Cause The cause of the above condition is due to assets purchased under grants being capitalized, and adJustments to grant billings not being reflected m the general ledger Recommendation. I recommend that fixed assets purchased under a grant aze first expensed to that grant, and then reversed (under a General Fund Funding Source) to properly capitalize the asset. I also recommend that reconciliations aze performed penodically to ensure expenditures are equal to revenues m the general ledger for the reimbursement grants. 78 _ BAY CLINIC, INC. _ A famtry afprofesstonals commt[[ed [o tmprnatnq [he heal[h of [herr communi[tes Hrlo Bay Clrnic Ka`u Family Health Center Pahoa Famrly Health Center ,ill Kalanianaole Avcnue P(~ Box 7U P(7 Box 14i i Hilo, HI!)1iT211 Na'alchu, lil')(i771 Pahoa, l-I1'11i77H (H(IH)')li')- I M117 (HUH)')1')-74I I (HIIH) 'lli i ')71 I 1•ux (HIIH)'llil 47'1 i Fax (HIIH)'12')'IUH7 I•ax (HIIHI')1~ i 1~'1~11 November 22, 2000 Alex J Smith Certified Public Accountant 2439 Ferdinand Avenue Honolulu, HI 96822 Dear Mr Smith, Thank you, for performing our organizational fiscal year 1999-2000 single audit Below are the responses to the financial findings you listed in Fiscal Year 99/00 Audit, as well as the corrective actions taken for Fiscal Year 98/99 Audit findings Summary of Schedule of Prior Audit Findtnes - FY 98/99 Finding No 99-1 Corrective action was taken Finding No 99-2 Corrective action was taken Finding No 99-3 Corrective action was taken Finding No 99-4 Corrective action was taken Finding No 99-5 Corrective action was taken Finding No 99-6 Corrective action was taken Finding No 99-7 Corrective action was taken Finding No 99-8 Corrective action was taken Finding No 99-9 Corrective action was taken Fording No 99-10 Corrective action was taken Finding No 99-1 I Corrective action was taken 'Srriieg 1/nu lUda ~1/ntia' Financial Statements Findines Section Finding No. 00-1 Patient Donations - A patient history account will be printed to assure that the patient does not have a balance If a balance is shown, the donation will be applied to their account if there is no balance, it will be recorded as a donation Finding No. 00-2 Cash Management -The Financial Officer will research alternatives for investments in order to maximize Bay Clinic's interest earnings The Financial Officer will present the finding to the Executive Director and the Finance Committee Finding No. 00-3 Fixed Assets -Any future purchases of computer hardware will be depreciated over an estimated useful life of 3 years Finding No. 00-4 Fixed Assets -The Finance Department will conduct annual reviews of the Fixed Asset Schedule to updated and remove any assets no longer in use The tagging and logging from the annual physical inventory will be applied to the fixed assets schedule for better identification Finding No. 00-5 Objectives -Community Health Centers CFDA# 93-224 Patient and Third Party receivable aging is currently being reviewed on a regular basis and any old accounts are followed up in a timely manner in order to maximize clinic revenue An incentive system is a possibility and will be researched Finding No. 00-6 Reconciliation All Federal Programs -All Capital Expenditures are currently being recorded, first to expense accounts (Equipment Purchase Depreciated and Contra Equipment Purchase Depreciated) in order to recognize the purchase The purchase is then recorded through normal GAAP procedures to the Balance Sheet for capitalization Statements of activities for all grants are currently generated to ensure expenditure equal to grant reimbursement reports Thank you, for allowing us to respond to your recommendations Sincerely, ~ Del De Los Santos Financial Officer Cc Stephanie Laumu, Executive Director Board of Directors Co P`~' OMB Na ,515 Da,7 Farm 990 Return of Organization Exempt From Income Tax 1999 Under section 501(e) of the Inbtnal Revenue Code (except black lung benefit trust or private toundatlon) or eectlon 4947(x)(1) nonexempt charitable trust rhb Form is a T~~~ Note 7h0 MQabdi Ille ha W M ate 1 C OpM to hblk F,ie,Ni ae.erwr s...ca o+D Y Opy o/ flus return f0 sehs/y shfe reportnp requrentenfs Inapedbn A For the 7999 calendsr year, OR Ux year period beginning JULY 1 , 1999, and ending JUNE 3 0 2 0 0 0 B Check iI playa C Name dOfgeniZehOrr D Employer Itlentlflcetbn number ? chinpio1tl°"" ~~eee, BAY CLINIC INC. 99-0222789 ? Initial return pint a Number entl ebeet (or PO Dor it mail ie rat Wlnere0 to street atltlress) Roomleuiro E Telephone number ? Finelrawrn ~ 311 [CALANIANAOLE AVE. (808) 969-1927 ? Amentle0 return epeemc Crry or Iwvn elate a ceunby antl ZIP+4 (regwretl nao ror ti.wc y I LO H I 9 6 7 2 0 F Check? ? it exemplron appiuuon sate raponing) acne is I]entlirq G Type of organixatxxi Exempt under eedxxt 501(c) ( 3 1 ~ Unsen number) OR ? seetxn 4947(e)(1) nonexempt eharilabk trust Note Secfxur 507(c)(3) exempt orperiaaMns end 4947(eJ(1) nonexempt chantebb Wsts MUST attach a cronpbfed Schadub A (Farm 990) Hp) b tlru a group return fled ror alfilubs7 ?Yes ®NO I x either box m H is checketl'Yes' enter lour-0igll group axamplion number (GEN) ? (b) x'Yee, cola the number or enlrNes ror whim tole return ie fileo ? J Accounbnp menro0 ? Cash ~ Accrual (c) IS Nis a separate return aletl W an orpanizaaon co~eretl try a group ruling9 ?Yes ®No ? Ggyy (epepN) ? K Check here ? ? 11 are organirabon's prose receipts are normslly nd moro eren S25 000 The orpaninam rieatl nd file a return with iM IRS but H rt racaneo a Form 960 Package rn iM marl, a shoultl fiN a return wxlaul finanraal tlata Some etalee roquln ¦ complNe return Note Farm 994EZ maybe used agan¢ebons wAh gross receph bss than 5100,000 end tofsl assets bss then 5250,000 et end o/year Part I Revenue, Expenses, and Changes in Net Assets or Fund Balances (See Specific Instructions on page 15 ) 1 Contributions, gifts, grants, and similar amounts received a Dlrectpublicsupport 1a 306, 199 b Indirect public support tb cGovernmentcontributlons(grants) 1c 1,200,966 d Total (add Imes 1a through 1c) (attach schedule of contributors) (cash S 1, 506, 615 noncash 5 ) SSk', STATEEMENT 1 td 1 506 615 2 Program service revenue Including government fees and contracts (from Part VII, line 93) 2 2 326 824 3 Membership dues and assessments 3 4 Interest on savings and temporary cash Investments 4 16 501 5 Dlwdends and Interest from secuntles 5 6a Gross rents S6E STATEMENT 2 6a 32 100 b Less rental expenses SEE STATEMENT 3 6b 7, 917 c Net rental income or (loss) (subtract Ilne 6b from Ilne 6a) 6c 2 9 68 3 7 Other Investment Income (describe ? 7 8a Gross amount from sales of assets other iN Securiues (e) other ~ thanlnventory Ba b Less cost or other Da9a end sales expenses 9b c Gain or (loss) (attach schedule) 8c d Net gain or (loss) (combine Ilne fic, columns (A) and (B)) 8d 9 Special events and activities (attach schedule) a Gross revenue (not lnctuding S of contributions reported on Ilne 1a) 9a b Less direct expenses other than fundraising expenses 9b c Net Income or (loss) from special events (subtract Ilne 9b from Ilne 9a) 9c t0a Gross sales of inventory, less returns and allowances 10a b Less cost of goods sold tOb e Gross profit or (bss) from sales of inventory (attach schetlule) (subtract line tOb from line t0a) 10e 11 Other revenue (from Part VII, line 103) 11 119 365 12 Tobl revenue add Imes 1d, 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 11) 72 3 995 988 13 Program services (from Ilne 44, column (B)) 13 2 770 038 14 Management and general (from IIne44, column (C)) 74 1 038 407 8 15 Fundraising (from Ilne 44, column (D)) 15 w 16 Payments to aKllates (attach schedule) 76 77 Total ex ensea (add Imes 16 and 44, column (A)) 17 3 8 08 9 4 5 78 Excess or (defial) for the year (subtract Ilne 17 from line 12) 18 18 7 5 4 3 ~ 19 Nel assets or fund balances at beginning of year (from line 73, column (A)) 19 1 22 B 9 6~ a 20 Other changes In net assets or fund balances (attach explanation) 20 ~ 21 Net assets or fund balances at end of ear combine Imes 18, 19, and 20 21 1 9 16 505 For Paperwork Reduction Act Nolrce, see page 1 0l the separate inslructrons isM Form 990 (t999i Srr FE DteP]F i Fpm 990 (1999) Papa 2 Partll Statement of AlloryanlzanonamuatrAmplaleodumn(A)Columns(B)(C),ene(D)arersqureClpsec6on$p1(c)(J)an0(/)pparvraLOns Functional Ex enaes eno aec9an /e/7(e)(t) noneampi oharnaWe iruais Dui opiionei for others (See Spepfic 9lavuclrons on Pape t9 ) ~O not a9C)Ilde 8n10Unfa reported On Irne (p) Total IB) Program (C) Management 66, 86, 9b, 10b, oI 15 0/ PBA I sansua ant penerei ID) Funareis,np 22 Grants and allocations (attach schedule) (cash S noricash S ) 22 T3 Specilk assistance to i11d149d11a15 (attach schedule) 23 24 Benefits pad to a br members (a0ach schedule) 24 25 Compensation of officers, directors, etc 25 60 000 60 000 25 Other salaries and wages 26 2 127 759 1 515 132 612 627 27 Pension plan contributions 27 3 3 8 97 2 6 18 7 7 710 28 Other employee benefits 29 118 2 9 3 7 3 2 60 4 4 98 3 29 Payroll taxes 29 203 950 135 591 68 909 30 Professional fundraising tees 30 37 Accounting fees 31 20 800 18 600 2 000 32 Legal fees 32 1 239 359 880 33 Supplies 33 136 688 135 621 1 067 34 Telephone 34 50 003 38 171 11 832 35 Postage and shipping 35 18 710 19 565 9 19 5 35 Occupancy 36 371 608 281 577 90 031 37 Equipmenlrentalandmatntenance 37 12 287 8 129 4 163 36 Printing and publications 39 39 Travel 39 69 639 95 085 29 559 40 Conferences, conventions, and meetings 40 37 688 22 956 15 232 41 Interest 47 9 904 1 828 3 076 42 Depreciation, depletion, etc (attach schedule) 42 12 8 8 7 6 12 8 8 7 6 47 Other expenses (itemize) aSEE STMT. 9 43a 912 159 329 956 87 698 b 43b c 43c d 43d e 43e 44 Twl lurictloral a:panas (add lam 2t enough 13) Orpankafxw mWasua• n»ratuakmune+f3•fs 44 3 808 445 2 770 038 1 038 907 Raporting of Joint Costs. -Did you report in column (B) (Program services) any toinl costs from a wmbined educational rampatgn and fundraising solicitations ~ ~ Yes ®No If'Yea; enter p? the aggregate amount of these pmt costs S , pq the amount allocated ro Program services S pIq the amaunl allocated to Maragernenl and general S ,and (ir) the amount allocated to Fundraising S Part III Statement of Program Service Accomplishments (See Specific Instructions on page 22 ) What is the organization's pnmary exempt purpose9 ? SEE S ATEMENT Program Sarviee All onganralansmusldescribetheirraerriplpurposeachievemertsmacleaandcalcisemannerSlatethenumberofclientsserved,piblicahoils ( Ea,a,,,~°x r,°~,~a,l issued, etc Discuss achievements Thal are rat measurable (Sedan 501(c)(3) and (1) olganizabons and /947(a)(1) nonexempt chantable Irusls ..e p9s rns must also enter the amount of grants and albcalans to others 1 ~r(~ tar aii,:,. a PRIMARY CARE - THE ORGANIZATION PROVIDES GENERAL MEDICAL CARE FOR ADULTS AND CHILDREN ON A SLIDING FEE SCALE. THE PROGRAM FOCUSES ON THE MEDICALLY UNDERSERVED. APPROX. 29,882 VISITS IN FY 2000. (Grants andallocations5 ) 2,098,340 b FAMILY PLANNING - THE ORGANIZATION PROVIDES LOW-COST BIRTH CONTROL EXAMINATIONS AND SUPPLIES FOR WOMEN AND SCREENING FOR STD'S FOR MEN AND WOMEN, ALL ON A SLIDING FEE SCALE APPROX. 9,390 VISITS IN FY 2000. (Grants andallocalions 8 ) 225,793 c BREAST AND CERVICAL CANCER SCREENING PROGRAM (BCCCP) - TO REDUCE THE DISPROPORTIONATELY HIGH BREAST AND CERVICAL CANCER MORTALITY RATES, ESPECIALLY AMONG ELDERLY, POOR, AND MINORITY WOMEN 175 PATIENTS IN FY00.(Grantsandallocations $ ) 75, 534 d SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, CHILDREN (WIC)- SAFEGUARD THE HEALTH OF LOW INCOME WOMEN, INFANTS, CHILDREN WHO ARE AT NUTRITIONAL RISK, THROUGH NUTRIOUS FOODS TO SUPPLEMENT DIETS.9, 951 VISITS IN FY00.(Granlsantlallocations $ ) 105, 642 e Other program services (attach schedule) (Grants and allocations $ ) 2 64 , 7 2 9 f Total of Program Service Expenses (should equa_I line_44_ column (B) Program services) ~ 2 , 7 7 0 , 0 3 8 Form 990 119991 9TF FE Dr9~]f Z Fpm Ba0 (1Daa) Page 3 Part IV Balance Sheets (See Spectflc Instructions on page 22 ) Note l1?ie/s raqurrod, adsGfisd scMdubs end amounts wxlrai fife dascrpfxm (A) (B) cohxrin aliouM be /ar arrd-o/--year amounts ony Begmnmg of year End of year 45 Cash -non-interest-bearing 1 , 62 0 45 1, 9 7 0 46 Savings and temporary cash investments 3 3 9, 8 6 6 46 9 7 9, 0 8 5 47a Accounts receivable 47a 9 5 6 , 17 7 b Less allowance for doubtful accounts 47b 192 717 373,788 47c 263,460 48a Pledges receivable 48a b less allowance for doubtful accounts 48b 48c 49 Grants receivable 115 666 49 131,579 50 Recewables from oRcers, directors, trustees, and key employees (attach schedule) 50 51a Other notes and loans receivable (attach schedule) 51a ~ b Less allowance for doubtful accounts 51b Stc 52 Inventories for sale or use 52 53 Prepaid expenses and deferred charges 10 9 9 6 53 9 8 2 8 3 54 Investments - secunties (attach schedule) 54 55a Investments -land, buildings, and equipment basis 55a 5, 983 b Less accumulated depreaalion (attach schedule) SEE STATEMENT 6 55b 5, 983 55c 5, 983 56 Investments -other (attach schedule) 56 57a Land, buildings, and equipment basis 57a 2, 175 167 b Less accumulated deprecation (attach schedule) SEE STATEMENT 7 57b 907 726 1 731 831 57c 1 767 991 58 Other assets (describe ? ) 58 58 Totalassats add lines 45throu h58 must ualline74 2 579 200 59 2 692 801 60 Accounts payable and accrued expenses 2 8 B 165 60 2 91 5 7 3 61 Grants payable 61 62 Deterred revenue 62 63 Loans from officers, directors, trustees, and key employees (attach a schedule) 63 w 64a Tax-exempt band liabilities (attach schedule) 64a ~ b Mortgages and other notes payable (attach schedule) 1, 0 62 0 7 3 64b 98 9 , 7 2 3 65 Other habihbes (descnbe ? ) 65 66 Total liabilities add lines 60throu h65 1 350 238 66 1 276 296 Oiganizations that follow SFAS 117, cheek here ? ?X and complete lines Fa 67 through 69 and lines 73 and 74 ~ 67 Unrestricted 1, 228, 962 67 1, 916, 505 e 68 Temporarily restricted 68 69 Permanently restricted 69 ~ Organizations that do not follow SFAS 117, check here ? ~ and ' complete lines 70 through 74 LL o` 70 Capital stock, trust principal, or current funds 70 ~ 71 Paid-in or capital surplus, or land, building, and equipment fund 71 e 72 Retained earnings, endowment, accumulated income, or other funds 72 a 73 Total net assets or fund balances (add lines 67 through 69 OR lines 70 through 72, column (A) must equal line t9 and column (B) must equal line 2l) 1 228 962 73 1 916 505 74 Total liabilities and net assets I fund balances add lines 66 and 73 2 57 9 2 00 74 2 692 B O 1 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 Pan III the organization's programs and accomplishments 5TF FED193]F ] Form ppp (tppp) papa 4 Part IV-A Reconciliation of Revenue per Audited Pert IV-B Reconciliation of Expenses per Audited Flnaneial Statements with Revenue per Ftnanctal Statements with Expenses per Return (See Speuf(c Instructions, page 24) Return a Total revenue, gams, and other support a Total expenses and losses per perauddedfinancialstatements ? a 003,905 auditedfinanaalstatements ? a ,815,862 b Amounts included on line a but not b Amounts included on line a but not on line 12, Form 990 on Ime 17, Form 990 (1) Net unrealized yams (1) Oonaled services on investments s and use of facilities S (2) Donated services (2) Prior year adjustments and use of facilities S reported on line 20, (3) Recoveries of prior Form 990 s year grants S (3) Losses reported on (4) Other (specify) Ime 20, Form 990 S RENTAL EXP NETTED (4?Other(specify) AGAINST INC s 7,917 RENTAL EXP NETTED Add amounts on Imes (1) through (4)? b 7 917 AGAINST INC s 7 , 917 Add amounts on lines (1) through (4)? b 7 , 917 c line a minus line b ? c 995 988 c Lme a minus Ime b ? c 808 4 9 5 d Amounts induded on Ime 12, d Amounts included on Ime 17, Form 990 but not on Ime a Form 990 but not on Ime a: (1)Investmentexpenses (1)Investmentexpenses not induded on Ime not included on Ime 6b, Form 990 S 6b, Form 990 S (2) Other (spemty) (2) Other (specify) s s Add amounts on Imes (1) and (2) ? d Add amounts on lines (1) and (2) ? d e Total revenue per Ime 12, Form 990 a Total expenses per Ime 17, Form 990 (Imeepluslined) ? e ,995,988 linec luslmed) ? e 808 945 Part V Llat o1 Officers, Directors, Trustees, and Key Employees (List each one even if not compensated, see Specific Instructions on page 24 ) (B) Title end aranpe iWUre per IL1 Compenaahm (D) taandaa.r b (E) Egienae (A) Name and address week demoted to posWOn P/not pakl, ampbyaa t,wrrn pna s acwuM and other anNr -0- 1 Mamid companFalm allowarxxs SEE_STATEMENT 9____________ 75 Od any odicer, director, trustee, or key txnpbyee receive aggre9ale canpensalwn of more than E700,000 from your organization and all related (xganiuhons, of which mare than 510,(100 was provided by the related organizations ? ? Yes ®No II'Yes,' attach schedule -see Specific Instructions on page 25 Form 990 (19991 STF FEpi9ilF a Form 9W (1YDY) Faye 5 Part VI Other Information (See Specific Instructions on page 25) Yes No 76 Dd the prganlralan engage n any admry not prenaisly reposed to the IRS If'Yes,' attach a delaled descnptwn of axh achnty 76 X 77 Were any changes matle in the organizing or governing documents but not reported to the IRS 77 X If 'Yes,' attach a conformed Dopy of the changes 78a Dx1 the aganlzalwn have unrelated business gross Income of 51,000 or more dunng the year covered by This relum~ 78a X b If'Yes,' has it filed a tax return on Form 990-T for this years N/A 78b 79 Was there a Iquxlallon, dissdutwn, lerminalwn, a wbstanhal coniractwn dunng the yr~ If'Yes,' attach a statement 79 X BOa Is the organization related (other than by assoaation with a statewide or nationwide organization)through common membership, governing bodies, trustees, officers, etc , to any other exempt or nonexempt organization' 80a X b If 'Yes,' enter the name of the organization ? antl check whether it Is ? exempt OR ? nonexempt Bta Enter the amount of political expenditures, direct or indirect, as described In the instructions far Ilse 81 61a NONE b DId the organization file Form 1120-POL for this years 81b X 82a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or al substantially less than fair rental values 82a X b If'Yes,' you may indicate the value of these Items here Do not incude this amount as revenue In Pan I or as an expense In Part II (See Instructions for reporting in Part III) 82b NOT VALUED 83a DId the organization comply with the public inspection requirements for returns and exemption applications? 83a X b Did the organization comply with the disGosure requirements relating to quid pro quo contributions 83b X 84a Did the organization sollat any contributions or gilts that were not tax deductible? 84a X b If "Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? N!A 84b 85 50f(cJ(4), (5), or (6) organrzefans a Were substantially all dues nondeductible by members N /A 65a b Did the organization make only in-house lobbying expenditures of 52,000 or less N ~A 85b If "Yes' was answered to either 85a or BSb, do not complete BSc 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 85e N /A f Taxable amount of lobbying and political expenditures (line 85d less 85e) 85f 0 g Dces the organization elect to pay the section 6033(e) tax on the amount in 85f~ NlA 85 h If seWwn 6033(e)(1)(A) dues nohces were sent, does the organization agree to add the amount m 85f to ds reasonable esbmale of dues allocable to nondedugible lobbying and polmcal egieriddures for the blowing tax year' N / A 85h 86 501(c)(7) Digs Enter a Initiation fees and capital contributions Included on Ilse 12 86a N/A b Gross receipts, included on line 12, for public use of club facilities 86b N /A 67 50f(c)(12) Digs Enter a Gross income from members or shareholders 87a N /A b Gross Income from other sources (Do not net amounts due or paid to other sources against amounts due or reserved 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, or an entity disregarded as separate from the organization under Regulations sections 301 7701-2 and 301 7701-3~ If 'Yes," complete Pan IX 88 X 89a 50f(cJ(3J organrzafrons Enter Amount of tax imposed on the organization dunng the year under section 4911 ? NONE ,section 4912 ? NONE , section 4955? NONE b 501(c)(3) and 501(c)(4) Digs Did the organization engage in any section 4958 excess benefit transaction during the year or did It become aware of an excess benefit transaction from a prior years If 'Yes; attach a statement explaining each transaction 89b X c Enter Amount of tax imposed on the orgamzallon managers or disqualified persons during the year under sections 4912, 4955, and 4958 ? NONE d Enter Amount of tax in 89c, above, reimbursed by the organization ? N /A 90a List the states with which a copy of this return is flied ? NONE b Number of employees employed in the pay periotl that includes March 12, 1999 (See inst) 90b 62 91 The books are in care of?MR. DEL DE LOS SANTOS Telephone no ? (806) 934-3218 Locatedat? 311 KALANIANAOLE AVE HILO, HI _ZIP + 4?96720 92 Secton 4947(a)(1) nonexempt chanrable trusts (ding Fonn 990 rn I~eu of Form 1041 -Check here ? ? and enter the amount Dt tax-exempt interest received or accrued dunng the tax year ? ~ 92 ~ N /A Form 990 09991 SiF FEDt91]F Farm ago (7899) Page 6 Part VII Analysis of Income-Producing Activities (See Specific Instructions on page 29 ) Enter gross amounts unless otherwise Unrelated business Income Exclutled by section 512 51~ or 51~ (E) IA) IBI ICI ID) Related or Indicated exempt funuion 93 Pro ram service revenue Business code Amount Exclusion code Amount IPCOrne a PR~MIUM REVENUE 1 991 943 b NET PATIENT SERVICE REV. 885 381 c d e f Medlcare/Medlcaid payments g Fees and contracts horn gavemment agelxles 94 Membership dues and assessments 95 Interest on savrrgs and temporary rash nvesunents 14 18 5 O 1 96 Dividends and interest from secunhes 97 Net rental Income or (loss) from real estate a debt-financed property b not debt-financed property 16 29 683 98 Net rental income or (bu) from personal property 99 Other Investment Income 100 Gana (bss) hen sales of assets other than inventory 101 Net Income or (loss) from special events 102 Gross profit or (loss) from sales of Inventory 103 Other revenue a OTHER INCQME 119 365 b c d e 104 Subtotal (add columns (B), (D), and (E)) 4 3 16 9 9 9 6 18 9 105 Total (add Ilne 104, columns (B), (D), and (E)) ? 2, 469, 373 Note: Lrne 105 plus Nne fd, PaR 1, should equal the amount on hne 12, Part 1 Part VIII Relationship of Activities to the Accomplishment of Exempt Purposes (See Specific Instrudlons on page 30 ) Lins No Explain how each admy for whx;h income Is reported in column (E) d Pan VII cdntrlbuled anponady to the accomphshmenl d the ? organlzalion's exempt purpaes (dher than by progMirq funds far such purposes) 93A B PROVIDING UALITY LOW-COST PRIMARY HEALTH CARE AND FAMILY PLANNING SERVICES TO THE PUBLIC ON A SLIDING FEE SCALE BASIS. 103 BAD DEBT RECOVERY MEDICAL RECORDS AND OTHER FEES FOR THE SAME PURPOSE AS FOR LINE 93. Part IX Information Regarding Taxable Subsidiaries and Disregarded Entities (See Specific Instructions on page 30.) (A) (B) (C) (D) (E) Name, address, and EIN d corporatxxi, Percentage d Nature d admties Tdal income End-01•year pannershlp, or disregaNed entlry ownership interest assets N A % a~ a~ o~ Under penaleeS of peryury I tlaGare Thal I ha`e examined this return inclutling accompanying schedules antl sUlemenls antl to Ina Oesl of my knowledge Please arM 1 it is Irue correct aril complete Dedlaraaon or preparer (ocher Inan oa¢er) is basso on all inlormatan or which preparer has any Fnowletlge Sign (Im an Sx Gen 1 str U e u ) Here Signature of olricar Dale Type or print name and idle Dale Check it Preparer s SSN a PTIN yard Preparers sell Preparer's signature ! ~ ~ employed?© 563-65-9689 UseOnl Firmsname(or ALEX J SMITH CPA EIN ? Y yoursilsell-employed) 2g39 FERDINAND AVE, HONOLULU HI ZIPFa 96822 and address , ? Farm 990 ii9991 S IF FEnl9[JF E SCHEDULE A Organization Exempt Under Section 501(c)(3) OMB Ne ,S15~00.7 (Form 990) (Eaeept Privau Foundation) and Sedlon 501(e), S07(~, 501(k), 501(n), or Section 19q(a)(1) Nonszempt Chadtabk Trust Supplementary Information - (See separate inatructtona.) 1999 OapNmsm d Via TnuW 11i.I11Y n.w.r swvca ? MOST tN completed tyy the above orpanlzatlona and attached to their Form 990 or 990-EZ Name d ea orpenaabon Empbyer WanlOkallon number BAY CLINIC INC. 99-0222789 Part I Compensation of the Five Highest Paid Employees Other Than Officers, DireMors, and Trustees (See page 1 of the Instructlons Llst each one If there are none, enter "None (a) Neme and atldrcas or aadl employee paid more Ib) 7iile end aserspe hours Id) La+ih,daam a (e) 2pense (c) Compensation ampbrw G,rrn pru a account and other than S50 000 per weak tlewled to posieon Mla,r,q Cempamauen allowances RICARDO CUSTODIO MEDICAL DIRECT R 197 PUHILI ST. HILO HI 96720 90 140 000 0 0 RACHEL TORTOLINI PHYSICIAN P.O.BOX 9339 HILO HI 96720-0339 90 117 033 0 0 JEAN SWIFT________________ PHYSICIAN P.O.BOX 35 NAALEHU HI 96772 90 107 975 0 0 MELANIE KIM PHYSICIAN 101 AUPUNI ST., #607 HILO HI 96720 90 101 333 0 0 ROBERT McALISTER PHYSICIAN 13-396 POMAIKAI ST. PAHOA HI 96778 40 100 350 9 923 0 Total number of other employees paid over 550,000 ? 5 Part II Compensation of the Flve Hlgheat Paid Independent Contractors for Professional Services (See page 1 of the Instructlons Llst each one (whether Individuals or firms) If there are none, enter "None p) Name and address d each mtlepentleni conVador peed more Nm S50 000 (b) Type d aennce (c) Companution NONE Total number of others receiving over 550,000 for professional services ? NONE For Paperwork Reduction Acl Notice, see page 7 0l the Instructions for Form 990 antl Form 990-EZ Schedule A (Form 990) 1999 5A ST<FEp1955F r SchWula A 1F«m a90) 1DBa p~e1 Part III Statements About Activities Yes No 1 Dunng the year, has the «ganu!etion attempletl to influence nalanal, stale, a local bgislation, including any attempt to influence public egnxm m a lagnlalive manor or relerentlum~ 1 X If 'Yes 'enter the Idol expenses paid « incurred m connection wdh the lobbying xhvihes ? S N / A Organu:alions that made an electron under sxtan 501(h) by filing Form 5768 must eomplele Pan VI-A Other «gan¢alions diediing'Yes' must complete Part VI-B AND attxh a statement gmrg a detailed descnphon d the Idrbying xtivdies 2 Dunng the year, has the «ganaation, either direly a indirecty, engaged in any of the fdwwirg xis wdh any d its Wstees direct«s, oflroers, creators, key employees, «memlxxs of their lamellas, «wdh any taxable «ganaalan wdh which any such person is aHelialed es an ottroer, dirxl«, trustee, ma)onty owner, a pnnapal beneficiary a Sale, exchange, a leasing of property? ya X b Lending d money or dher extensan d credit? 2b X c Furnishingdgoods, servroes, «fxililies7 2c X d Payment of compensation payment «reimbursement d expenses d m«e than 57,000) FORM 990 , PART V 2d X a Transfer d any pan d ds income a assets 2e X If the answer to any questan is'Yes " attach a detailed statement explaining the transactions 3 Does the oiganu:alion make pranls 1« schdarships, fellowships, student loans, etc ~ S X da Do you have a eedron 403(b) annudy plan la your employees 4a X b Attxh a statement to explain how the arganzation determines Ihat mdmduals or «gan¢ations recemrg grants a loans Irom d m lurttierarice d ds chardable propnms quality to receive payments (See page 2 d the aistructxlna ) Part IV Reason for Non-Private Foundation Status (See pages 2 through 4 of the Instructions ) Tha «genaalan is rat a private foundation because n is (Please check ony ONE applicable box ) S ~ A church, convention of churches, «associalxln d churches Section 170(b)(1)(A)(i) 6 ~ A schod Section 170(b)(1)(A)(ii) (Also complete Parl V, page 4 ) 7 ~ A hosPelal « a cooperalne hospdal service organzation Section 170(b)(t)(A)(ui) e ~ A Federal, stale, «local government «governmental unit Sxtion 170(b)(1)(A)(v) • ~ A medical research «gan¢alion operated m conjunction with a hospdal Sedan 770(b)(t)(A)(n0 Enter the hoapital9 name, city, and scats ? 10 ~ An organization operated la tM benefit of a cdlege or univaretly owned «aperaled by a governmental and Section 170(b)(1)(A)(iv) (Also complete the Support Schedule in Pan IV-A ) 11a ®An organ elan Ihat normaly receives a substantial part d es support from a governmental unit «from the general pubis Sedan 170(b)(1)(A)Ivi) (Also complete the Support Schedule in Part IV-A ) 11b Q A commundy trust Sedan 170(b)(1)(A)(vi) (Also campble the Support Schedule in Part IV-A ) 12 ~ An organization that normally recanes (1) more than 77'h%d ds support from cantnbulrons, memberehq fees, and gross receipts from adivnies related to As chardabk, Nc , lunetans - aubjera to certain exceptana, and t2) no more than 77'hX d ds aujlp«t horn gross xivaetment aicame and unrelated business laxabb income (less section 511 lax) Iram businesses acquired by the organu:etion aNer June 30, 1975 See sedan 509(a)(2) (Also complete the Support Schedule in Part IV-A ) 11 ~ An organization that is nd contrdbd by any duqualdad persons (dher Than foundation managere) and supports «ganu:alans descnbed in (1) hoes 5 tnrough 72 above, «(z) sedan 501(c)(d), (5), a (6), d they meal the teal d sedan 509(•)(2) (See sedan 509(ax3) ) Provide the Idlowing inlomtnron about the supported agan¢Nions (See Page d d tta msiruclioru ) (a) Name(s) d supported «ganaalion(s) (b) Line number Iram above td ~ An «gan¢alion organized and operated to test la pubis safely Section 509(a)(d) (See page 4 of the instructions ) Schedule A (Form 990) 1999 S iF fEDi955f Z SchMUb A (Form aaa) taa9 Pape $ Part IV-A Support Schedule (Complete only tf you checked a box on Irne 10, 11, or 12) Use cash method of accounting Hole: You may use the worksheet rn the mstructans for converting from the accrual to the cash method of accounting Calwdar ywr (or fiscal ywr baglnnlnq In) ? (a) 7998 (b) 7997 (c) 1996 (d) 1995 (s) Tdal 18 GMs, grants, and conldbutlans nycelved (Do nd Irxlude unusual grants Sw hne ZB) 625 1B6 316 879 276 980 154 835 1 373 882 18 Membenhlp fees received 77 Gross recepls from adrnisardu, merchandise sob or services perlormad, u furnnhing of Ixlllles In any acirvlly that Is not a business unrelated to Ilia ugan¢alron's chaMabb, dc, purpose 2 530 443 2 655 598 2 223 129 2 204 689 9 613 809 18 Gross income Iron alsrast, dlvdentla, amounts received from payments an securAres bans (sedan 512(a)(5)), rents, roya8es, and unrelated business taxable muxne (less sedion 511 laxw) tram busitesses aequlretl by the arganlzatan sryer June 30, 7975 27 622 99 779 35 231 11 OBS 123 717 19 Net income from unrelated business actrvllles not Included In Irne 18 20 Tax retinues Nvled Id the uganlzalan's benefA antl eArer pad to A or e~eritled on ns beha8 21 The value or earvlces or facrlltec furnished to Ilia arganrzalwn by s govenurlental unA without charge Do rat xakde the value d wrvices or locates gereraly furnched to the publa wahout charge 22 Other Income Arysch a schedule Do nd Include gain u (bss)trom saladeapdal assets 56 B25 69 616 60 279 31 325 218 045 23 Tdaldllnes75thragh22 3 240 078 3 091 822 2 595 619 2 901 939 11 329 453 24 Lue23mmushne77 709 635 936 279 372 990 197 245 1 715 699 25 EMer7%dllne29 32 401 30 918 25 956 29 019 26 Organlzatlona dwulbsd on Ilnss 10 or 11 ¦ Enter 2% d amount in cdumn (e), line 24 ? 28a 3 4 31 3 b Aryxh a list (wliah a nq open to publa Irtspectan) slawirg the name d and amount eontrlbuled by each person (dher than a governmemal and or publaly supported organaalion) whose idol glrys lu 1995 through 1998 exceetled the amount shown m hne 28a Enter the sum d au these excess amounts ? 28b c Tdal suppoA for setters 509(x)(1) test Enter line 24, cdumn (e) ? 28c 1 715 69 9 d Add Amaunls from dJltann (e) ld hrtes 18 12 3, 717 19 22 218, 095 z6b ? 28d 391 762 e Publa support (Irne 26c minus line 26d idol) ? 2fia 1 3 7 3 8 8 2 f Public support psruntage (Ilns 26e (numerator) dlvlded by Ilne 26c (denominator)) ? 28( 8 0.08 % 27 Organizattone deserlbsd on Ilne 12. a Fu amounts Included In lines 15, 76, and 17 Thal were received Irom a'dlsqualrfad person; attach a Ilst to show the name d, and tdal amounts racaved m each ywr from, each'dtsquddaxl person' Enter Ilia sum d such amounts tar each year NOT APPLICABLE (1998) (1997) (1996) (1995) b Fu any amount induded m hne 771ha1 was received tram a nondlsqualdbd person, attach a list to show the named, antl amount rocerved tar each year, that was mare Than the larger d (1) the amount on hne 25 for Ilia year d (2) 55,000 (Include m the list ugan¢alans desulbed In hoes 5 ihrotgh 71, as well as Indmduals) After camputap the dMeronce behvean the amount recer°ed end the 4rger amount tlescnlxsd m (1) or (2), enter the sum d These ddlerences (the excess amounts) lu each year (1998) (1997) (1996) (1995) c Add Amounts tram cdumn (e) lu Imes 75 16 n zo zt ? 27a d Add Llne 27e tdal and Irne 27b Idol ? 27d e Publa support (line 27c Idol menus Ilna 27d total) ? 27e 1 Tdal support Tu section 509(a)(2) test Enter amount on Irne 23 cdumn (e) ? 27f g Public support psruntaps (line 27s (numerator) drvldsd by tine 27f (denommator)1 ? 27g h Investment income psresnuga (Irne 18, column (s) (numerator) divided by Irne 271 (denominator)) ? 27h 28 Unusual Grants Fa an ugan¢allon described In Irne 10 11 a 12 that received any unusual grants during 1995 through 1996, attach a Ilse (whah Is nd open to public mspectxxrl ra axh year showing the name d the contraulor the dale and amount d the grant and a beer descrplron d the nature d the grant Do nd Inclutle These grants In Irne 15 (See page 4 0l the Instructions) NON E Schedule A (Form 990) 1999 SrF FEa1955F J ScneeWe A (Form 990) 7999 Pa a 4 9 Part V Private School Questionnaire (See page 4 of the Instructions ) (To be completed ONLY by schools that checked the box on line 6 in Part IV) NOT APPLICABLE Yss No 29 Daes the arpantzetxxi have a racialy nondisenmmatory pdx;y toward stutlents by statemenN m ds charier bylaws, dher gowermng Instrument, M In a resdutlon of its governing body? 29 30 Does the orpanlzallon mclude a statement d Its raaaly nondtscnmmatory polx:y toward atudenls In all 9s brochures, catalogues, and dher wriHen eommunicalxxis wdh the public dealing wdh student admissions, programs, and schdarehlps~ 30 31 Has the organtzalian pubkclzed Os rxialy nontllscnminalory pdicy through newspaper or broatlcast metlla dunng the penod d sdlcsallon far stutlents, or dunng ilia regotralton paned d It has no sdx;dation program, m a way that makes iM pdicy known to all pens d the geliaral commundy d serves? 37 II "Yea,' please describe, II 'No,' please explain (II you need more space, a0xh a separate statement ) 32 Does the organ¢atton mainlam the Idlowing a Records mdx:Nmg the rxial campasdxxi d the student body, Ixuky, entl adminntretne staM~ 32a b Retards documenting that schdarships and dher 6nancW assistance are awarded on a rxlaly nondlscnmmalary basls9 32b e Copies d all catalogues, brochures, announcements, and deer wmten canmunleallons to the public dealing wdh slutlent atlmisslans, programs, and schdarships~ $2c d Capld d all material usetl by the organization or on its behaH to sollca conirlbutions~ 32d If you answeretl'NO to any d the above, please explain (If you need more space, aaxh a separate statement ) 13 Does the organizalxxt dlscrlmmate by race m any way wsh respxt to a Students' rghts ar prmbges~ 33e b Admissions pdirxs7 33b c Employment d lxulry or admmislratne staH9 33e d Schdarshlps or dher flnanelal asslstance9 33d e Educational pdx:xn7 33e 1 Use d faclldles7 33f g Athletic programs'+ 33g h Other axlrxumeular xlmlles7 33h If you answeretl'Yes'to any d the above, please explain (If you need more space, a0ach a separate statement ) 31a Does the organlxatlon receive any Ilnanclal aid a assistance Irom a governmental agency? 34a b Has the organzation s rght to such aItl ever been revoked or suspended 34b II you ansvreretl'Yes' to either 34a orb please explain using an attached statement 35 Does the organixallon ceAAy that a has complied with the applx:abk requuemenls d sections 4 O7 through 4 OS d Rev Prot 75-50, 1975-2 C B 587 covering racial nontllscriminallon~ II'NO' attxh an explanation 35 Schedule A (Form 990) 7999 Srr FED~S`+sF ~ Schedule A (Form BBB) 1888 Page 5 Part VI-A Lobbying Expenditures by Electing Public Charities (See page 6 of the lnstructlons ) (To be completed ONLY by an eligible organlzatlon that flied Form 5768) NOT APPLICABLE Check hero ? a ~ d the organiulan bebrgs to an atlihaled group Cheek hero? b ~ d you eheeketl "s" above and'hmaed eonlyd" provisxxis appty Llmib on Lobbying Expenditures AailialsC Broup ro be ~rtipeted (The term bxpenddufes' means amounts paid d Ineuned) Idele for ALL eleearq oryanizeuons 36 Tdal IDbbying expenditures to influence public opinxxi (prassrode lobbying) 76 37 Tdal lobbying expenditures to influence a legislative body (direct lobbying) 37 38 Tdal IDI)byiflg expenditures (add lines 38 and 37) 38 S9 Other exempt purpose expenditures 3g 40 Tdel exempt purpose expendturec (add hrtes 38 and 39) 40 41 Ld7bying nontaxable amount Enter the amount from the fdlwvnng table - If the amount on line 40 Is - Tha lobbying nontaxabN amount is - Ndover f500,000 20% d the amount on hne 40 Over 5500,000 but nd over f1,000,000 f100,000 plus 15% d the excess over s500,000 Over f1,000,000 but nd over f1 500,000 E775 000 plus 10°.6 d the excess over f1,Olx),000 41 Over f1,500,000 but nd over f11,000,000 s225 000 plus 5% d the excess over s1,500,000 Ovcr 577,000,000 f1,000,000 42 Grassroots nontaxable amount (enter 25% d line 4f) 42 I3 Subtrod Ime 42 Iron Bne 36 Enter ~ d laic 42 is mde Than hne 36 43 44 Subtrxl line 41 Iron line 38 Enter -0- d line 41 is more than line 38 44 Caution N there a en amount on edMr sne 43 w drie 44, you must (ife Form 1720 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 Soe the instructions for Imes 45 through 50 on page 7 of the Instructions ) Lobbying Expsndlturss During 4-Year Averaging Poriod Calendar year (or (a) (b) (e) (d) (e) fiscal year beginning In)? 1999 1998 1997 7998 Tdal 45 Lobbying nontaxable amount 46 Lobbying ceihrp amount (150% d hne 45(e)) 47 Tdal lobbying expenditures 48 GrassroDts nontaxable amount 49 Grassraxs ceiling amount (150% d line 48(e)) 50 Gnssrods lobbying expenditures Part VI-B Lobbying Activity by Nonelecting Public Charities (For reporting only by organlzatlons that did not complete Part VI-A) (See page 8 of the Instructions ) Dunng the year, did the dganization attempt to influence nalxnal, stale or local legislalian, including any attempt to influence y„ No Amount public ognian on a legislative matter or relarendum, through the use d a Vdunteers X b Paxr stall a management (Include compensation in expenses reported on lines c through h) X c Media advertoemenls X d Mailings to members, legislators, d the public X e Publications or published or broadcast statements X 1 Grants to dher organizations for lobbying purposes X g Direct contact with legislators their s1aHs government officials, or a legislative body X h Rallies demonslralions seminars conventans speeches lectures or any dher means X i Tdal lobbying expenditures (atld lines c Through h) NONE II "Yes" to any of the above also attach a statement giving a detailed description of the lobbying activities Schedule A (Form 990) 1999 $iF FEm955F 5 SchatlUN A (Form 9a0) 19a6 Page s Part VII Information Regarding Transfers 7o and Transactlona and Relattonshipa Wlth Noncharitable Exempt Organizations (See page 8 of the tnstructtons ) 51 Dx1 the reporting vryan¢aan Oxeely a tnduecly engage m any d the fdtwving wdh any dhar organaaion descnbed m section 501(c) d the Cade (dhar Than sedan 501(c)(3) organizations) a in sectx7n 527, reNtrng to pohUCal organizations a Transfer Iron the repatmg aganizabon to a nanchantabb exempt organvatan d Yea No (I) Cash 51a(q X (II) Other assets a(II) X b Other transactions (I) Sales or exchanges d assets to a nonchazitabk exempt organ¢ahon b(I) X pl) Purchases d assets tram a nonchantabb exempt organaaion p(g) X (Id) Rental d IacddNS, er?utpntent, ar dhar assets b(III) X (Iv) Rembursemant arrangements a)v) X (v) Loans or loan guazantees blvl X (vl) Perlormante d services or memberhip ar tundragmg sdadaans b(vi) X c Shanng d fxildtes, equipment, mating fists, dhar assets, or paxi employees c X d If the answer to any d the above is'Yes; complete the fdlaving schedule Cdumn (b) should ahvays show the tar market value d the goads dhar assets, or sevices given by the rpartmg organaahon If the aganaalan received less Than far marhd value m any transaction or shanng arrangement shoes m eolumn (d) the value d the goods, dhar assets, or services received N /A lal Ibl Icl Itl) Line no Amount inwlratl Name of noncharnabie exempt organization lkecripUOn of Uanslen transactions and sharing arrangements 52a Is the organ¢alian dveclly a mtlirecty aRdtated wdh, a related to, one or more tax-0xempt organizations described m senior 501(c) d the Cade (dhar Than section 507(c)(3)) or to secuon 527 ? ~ Yes ®No 6 II'Yes ; canpkte the fdlaving schedule N /A Isl Ibl Icl Name of organizaUOn Type of organiration Description of rNtionarup Schedule A (Form 990) 1999 56 FEDr9%F 6 Form 4562 Depreciation and Amortization onre"o ,s.5-d,72 (Including InfortnaUon on Listed Property) ~ 999 o.P.lm.e a w rnuwy Attachment I+iemel Revenue bwrce fee) ? Sea separate Instructions ? Attach this form to your return Sequence No 87 Name(s) mown on return Business or acawy b which Ihls lorm relates Identllylnp number BAY CLINIC, INC- FORM 990 PAGE 2 99-0222789 Part I Election 7o Expense Certain Tangible Property (Section 179) (Note: If you have any 'listed property," complete Part V before you comp/e[e Part I ) 1 Maximum dollar Ilmilation If an enterprise zone business, see page 2 of the Instructions 1 S19 000 2 Total cost of section 179 property placed in service See page 2 of the Instructions 2 3 Threshold cost of section 179 property before reduction In Ilmllatlon 3 5200 000 4 Reduction 1n Ilmllatlon Subtract 11ne 3 from 11ne 2 II zero or less, enter -0- 4 5 Dollar Ilmllatlon for tax year Subtract Ilne 4 from Ilne 1 It zero or less, enter -0- If married filing separately, see page 2 of the Instructions 5 (al DesrlpUOn or piopery (b) 0061 (Duemese use only) (cl Electatl coal 6 7 Listed property Enter amount from Ilne 27 7 8 Total elected cost of section 179 property Add amounts In column (c), Imes 6 and 7 8 9 Tentative deduction Enter the smaller of line 5 or Ilne 8 9 10 Carryover of disallowed deduction from 1998 See page 2 of the Instrucllons 10 11 Business income limdelion Enter the smelbr d business inctxne (nd bss than zero) or 11ne 5 (sea inslrudana) 11 12 Section 179 expense deduction Add lines 9 and 10, but do not enter more than Ilne 11 12 13 Carryover d disallowed deductxm l0 2000 Add lines 9 and 10, bss line 12 ? 13 Nola: Do not use Pan 11 or Part 111 bebw for Nsted propeny (automobiles, certain other vehx:les, ceNular telephones, certarn computers, or property used for entertaufinent, recreatan, or amusement) Instead, use Part V for ksted property Part II MACRS Depreciation for Assets Placed to Service ONLY During Your 1999 Tax Year (Do Not Include Listed Property ) SecUOn A -General Asset Account Election 14 If you are making the election under section 168(1)(4) to group any assets placed In service during the tax year Into one or more general asset accounts, check this box See page 3 of the Instructions ? Section B -General De reclation S lain GDS See a e 3 of the Instructions (bl and (c) Basra for depreaaeon Rewvery (a) Cissslaubon d propeny year paced m (busmaaa/mvesenent use d cenod la) Convenuon Ifl Me9ioe Ial paPrecieUOn daduclwn SeMFA Ony - eee IneIN0909e) 15a 3- ear ro en b 5- ear ro rt c 7- ear ro rt d 10- ear ro en e 15- ear ro ert f 2Q ear ro ert 25- ear ro ert 25 s S/L h Resldentlal rental 27 5 s MM S/L ro ert 27 5 s MM S/L I Nonresidential real 39 s MM S/L ro ert MM S/L Secbon C -Alternative De reclation S stem ADS See a e 5 of the Instructions 16a Class Ilfe S/L b 12- ear 12 s S/L c 40- ear 40 yrs MM S/L Part III Other Depreciation (Do Not Include Listed Property.) (See page 5 of the Instrucllons ) 17 GDS and ADS deductions for assets placed In service In tax years beglnning before 1999 17 116 7 57 18 Property subject to secllon 168(f)(1) election 16 19 ACRS and other depreciation 19 9 7 7 6 Part IV Summary (See page 6 of the Instructions ) 20 Listed propeny Enter amount from 11ne 26 20 21 Total Adtl deductions on Ilne 12, hoes 15 and 16 in column (g) and Imes 17lhrough 20 Enter here and on the appropriate lines d your return Pannerships and S corporations -see insiruclions 21 1 2 6 5 3 3 22 For assets shown above and placed 1n service during the current year, enter the ponion of the basis attributable to section 263A costs 22 For Paperwork Reduction Act Notice, see page 9 or the instructions Isn Form 4562 119981 STF FED` SF I Farm 458711999) Page 2 Part V Listed Property - Automobllea, Certain Other Vehicles, Cellular Telephones, Certain Computers, and Property Used for Entertainment, Recreation, or Amusement Note• For any vehicle /or which you are using the standard nrdeage rate or deducting lease expense, complete onty 23a, 23b, columns (a) through (c) o/Secfan A, a/ o/Secfan B, and Secfron C d app4cable Section A - De reclatfon and Other Information Caution: See a e 7 0/the insfrucfrons /or 4mifs /or assen r aulomobdes 23a Do you have evidarice to support the busiriessrinvestment use cWimed9 ? Yes ? No 23b If'Yes,' is the evidence wnllen~ ? Yas ? No c lal Ibl Buatnaesi Idl l°I 10 191 Ibl lit Basis /or dapreGabon FAeckd Type of propary (list Date paced In Investrnenl Cost or omer Recaery Medwdi Depreaalion vehicles first) seMG use Das~s (Dusmeselinvaeimenl period ComenUOn deduction aecUan 179 can a use only) cosi 24 Pro art used more than 50% in a ualified business use See a e 6 of the inslruGions ) e~ 25 Pro rt used 50°~ or less in a ualified business use See a e 6 of the instruGions ) S/L - S/L - S/L - 26 Add amounts 1n column (h) Enter the total here and on line 20, page 1 26 27 Add amounts in column r Enter the total here and on line 7, a e 1 27 Section B -Information on Use of Vehleles Complete this secfan /or vehicles used by a sole proprietor, partner, or other'more than 5% owner,"or related person f7 you provxbd vehcbs fo your empbyees (rsf answer the questxxis n Secfxxi C fo see d you meet an exceptgri to compbtap Nos sedan for ffase vehcbs IU Ibl Iel Idl let Ih VehirAe 1 VehiUe 7 Neh,cie 3 1k411c1e ? ~khick 5 1,MirJe 8 28 Total busiriessfmvPStment miles dnven dunng the year (DO NOT include commuting m11es -see page 1 of the instructans) 29 Total lwmmugrg mdes dnven dunng the year 30 Total other personal (noncommuling) m11es dnven 31 Total miles driven during the year Add lines 28 through 30 Yes No Yes No Yes No Yes No Yes No Yes No 32 Was the vehlGe available for personal use during oB-duty hours? 33 Was the vehide used primarily by a more than 5% owner or related person? 34 Is another vehicle available for personal use9 Secfron C - Queshons for Employers VYho Provide Vehicles for Use by Their Employees Answer these ques[rons to delemxne d you meet an exception to completing Secfan B for vehxes used by employees who are not more than 5% owners or related persons Yea No 35 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your employees? 36 Do you mantan a wntten pdiq statement that prohibds personal use of vehicles, exept commuting, by your empbyees~ See page B of the mslniclans fir vehicles used by corporate olricars, directors, or 1 % or more owners 37 Do you treat all use of vehicles by employees as personal uses 36 Do you provide more than five vehlGes to your employees, obtain information from your employees about the use of the vehicles, and retain the information received? 39 Do you meet the regwremenls wriceming qualified autlxndbile demonstralan uses See page B of the msWGions Note: 1/your answer to 35, 36, 37, 38, or 39 is `Yes," you need not complete Seclron B /or the covered vehicles Part VI Amortization Ibl (cl Idl 1°I 111 lal Dale amortization Amortizable Code AmoNzahan Amortization for Description of costs begins amount section period or Ihis year percentage 40 Amortization of costs That begins dunng your 1999 lax year 41 Amortization of costs that began before 1999 41 42 Total Enter here and on "Other Deductions' or 'Other Expenses line of your return 42 Form 4562 119991 SrF FED`A95F 7 Form 4562 Depreciation and Amortization OMB NO tses-ot~z (Including Information on Listed Property) 1999 Oeprtmuni al Yr Tneawy Atlachnelx ktemei n..ww, S.~.c. laa) ? See separate Instructions ? Attaeh this form to your return $e7iieilte No 67 Nema(e) ehorm on rclum Business or ewny to wnicb This form relates Idenllfying number BAY CLINIC, INC. CONOMINIUM UNIT 99-0222789 Part I Election To Expense Certain Tangible Property (Section 179) (Note. if you have any "l~sfed property," complete Part V before you complete Part I ) 1 Maximum dollar 1lmitatlon It an enlerprlse zone business, see page 2 of the Instrucllons 1 S 19 000 2 Total cost of section 179 property placed In service See page 2 of the instructions 2 3 Threshold cost of section 179 property before reduction 1n Ilmitation 3 5200 000 4 Reduction 1n Ilmitation Subtract line 3 from line 2 If zero or less, enter -0- 4 5 Dollar Ilmitation for tax year Subtract line 4 from 11ne 1 If zero or less, enter -0- If married filing separately, see page 2 of the instructions 5 p) Desmpbw d propeny (b) Cosl fusiness use only) (o) FJeded wsl 6 7 Listed property Enter amount from 11ne 27 7 B Total elected cost of section 179 property Add amounts in column (c), Imes 8 and 7 8 9 Tentative deduction Enter the smaller of line 5 or Ilne 8 9 10 Carryover of disallowed deduction from 1998 See page 2 of the Instructions 10 11 Business income limdatxin Enter the smalbr d business income (nd bss than zero) ar line 5 (see instructions) 11 12 Secllon 179 expense deduction Add Imes 9 and 10, but do not enter more than Ilne 11 12 13 Certyover al duallowetl deduclan to 2000 Add Ones 9 and 10, bss line 12 ? 13 Note: Do not use PaR ll or PaR 111 bebw /or Osted property (automobiles, certain other vehicles, ceNular telephones, certain computers, or property used for entertainment, recreatan, or amusement) Instead, use PaR V (or asted propeR Part II MACRS Depreclatton for Assets Placed to Service ONLY During Your 1999 Tax Yesr (Do Not Include Listed Property.) Section A -General Asset Account Election 14 If you are making the elecllon under section 166(1)(4) to group any assets placed 1n service during the tax year into one or more general asset accounts, check this box See page 3 of the Instrucllons ? Seeflon B -General De reclahon S fain GDS See a e 3 of the lnstrudions (b) Month and let easia fn Depreciation (a) Classieubon d proparry year gated in (buaneesenvesbnent usa (tl) Racorery let Convanbon (0 Meeatl 191 Dapreuabon Daduaion eerxce only-see insbuwons) penotl 16a 3- ear ro b 5- ear ro c 7- ear ro rt d 1Q ear ro rt e 15- ear ro art (2a ear ro art 25- ear ro 25 s S/L h Resldentlal rental 27 5 s MM S/L ro eA 27 5 s MM S/L i Nonresidenltal real 39 s MM S/L ropert MM S/L Section C - Alternative De recfatlon S lain ADS (See a e 5 of the lnstrudions 16a Class Ilfe S/L b 12- ear 12 s S/L c 40- ear 40 s MM S/L Part III Other Daprectatlon (Do Not Include Listed Property.) (See page 5 of the Instructions ) 17 GDS and ADS dedudlons for assets placed In service 1n tax years beginning before 1999 17 2 34 3 18 Property sub)ecl to section 168(f)(1) elecllon 18 19 ACRS and other depreciallon 19 Part IV Summary (See page 6 of the Instrucllons ) 20 Listed property Enter amount from Ilne 26 20 21 Total Add deductions on line 12 lines 15 and 16 in cdumn (g), and lines 17 through 20 Enter here and on the appropriate lines d your return Partnerships and S wrlyoralions -see Instructions 21 2 3 4 3 22 For assets shown above and placed in service during the current year, enter the portion or the basis attributable to section 263A costs 22 For Paperwork Reduction Acl Notice, see page 9 or the instructions isn Form 4562 (19991 STF FED'A95F I Farm /Se2 (1999) Page 2 Part V Llated Property - Automobiles, Certain Other Vehicles, Cellular Telephones, Certain Computers, and Property Used for Entertainment, Recreation, or Amusement Note: For any vehale for which you are using the standard mAeage rate or deducting lease expense, complete only 23a, 23b, columns (a) through (c) o/Secfan A, aM o/Secfan B, and Secfan C rl eppMcebb Section A - De reclation and Other Information (Caution: See Pa e 7 0l the msfrucfans for dmds for passen r aufomobrles ) 23a Do you have evldPnce to wppal the bua~nveslment use damed~ ? Yes ? No 23b II'Yes; is the evdence wnlten~ ? Yes ? No t.) rot eua~esr rd) a) to m) Ili) I') Basis for depranabon Elected Typo of property Qisl Dala pacetl fn mvaa9nanl Cosl or other Reco~bry sAe9iotlr Depreciason uee (bualnessflmmimenl section t79 vehiGes finq eervita rctfi basin uaa only) pariotl Comenhm deoucuo° cost 24 Pro en used more than 50°~ Ina ualified business use See a e 6 at the Instructions o~ o~ 25 Pro ert used 50°/a or less Ina uallfied business use See a e 6 of the Instrudlons S/L - S/L - S/L - 26 Add amounts In column (h) Enter the total here and on Ilne 20, page 1 26 27 Add amounts in column I Enter the total here and on Ilne 7, a e 1 27 Section B -Information on Use of Vehicles Complete this sedan for vehabs used by a sole proprietor, partner, or other'more than 5% owner,"or related person Myou pvovxbd vehcbs M your empbyees, fast answer tfie questans n Becton C fo see 1 you meet an excepton a compbtatp tfxs seetan /or f/ase wfix:bs lal IDI Icl Idl lei 10 Vehicle 1 Vehice Z Vehicle a Vehicle 4 Vehicle 5 Vehicb 6 28 ToUI businesslmvestmenl mdrx driven dunng the year (DO NOT Iftdude canmuhrg miles -see page 10(the nsWClans) 29 Total canmutng miles driven dunng the year 30 Total other personal (noncommuting) miles driven 31 Total miles driven during ilia year Add Imes 28 through 30 Yes No Yes No Yes No Yas No Yes No Yes No 32 Was the vehicle available for personal use dunng oR-duty hours 33 Was the vehice used primarily by a more than 5°~ owner or related person? 34 Is another vehicle available for personal uses Section C - Questions for Employare Who Provide Vehicles for Use by Their Employees Answer these questans to defermfne fl you meet an exceptan fo completing Sectan B /or vehabs used by ernpbyees who are not more than 5% owners or related persons Yes No 35 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your employees 36 Do you mantan a wnden policy slatemenl that prohibits personal use of vehicles, except wmmusng, by your Pmpbyees~ See page B of the mstnfcllons br vehides used by crxporate othcers, directors, or t% or more owners 37 Do you treat all use of vehicles by employees as personal uses 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 meal the requirements containing qualfied automodle demonstretton uses See page B of the instructions Note: ll your answer fo 35, 36, 37, 38, or 391s "Yes," you need not complete Sectan B for the covered vehales Part VI Amortization Ib) Ic) Itl) Ia) Iq Ia) Dale amorlizalion Amonizable Gotle Amonizauon Amonirauon for Description of costs tiepins amount section peno0 or Ihis year percentage 40 Amortization of costs that begins during your 1999 tax year 41 Amortization of costs that began before 1999 41 42 Total Enter here and on "Other Deductions- or'Other Expenses' Ilne of your return 42 Form 4562 f 1999) SrF FE050s5F ] THE BAY CLINIC. INC 99-0222784 Form 990 Schedule of Contributors Statement 1 Direct Indirect Government Public Public Contributions Name and Address Support Support (Grants) Total The Harry & Jeanette Weinberg Foundation, Inc 3660 Waialae Ave ,Suite 400 Honolulu, HI 96816-3260 200,000 200,000 Hawau Community Foundation 900 Fort Street, Swte 1300 Honolulu, HI 96813 62,750 62,750 Hamakua Health Center P O Box 509 Honokaa, HI 96727 26,093 8,423 34,516 Stefanie A Delmont 73-1265 Kaloko Dr Kailua-Kona, HI 96740 8,000 8,000 U S Department of Health and Human Services Bureau of Pnmary Health Care Health Resources and Services Administration Bethesda, MD 20814 450,000 450,000 State of Hawau Department of Health Pnmary Care 363,499 363,499 Women, Infants Children (WIC) 134,453 134,453 Breast and Cervical Cancer Screening Prog 99,579 99,579 Family Planning 24,500 24,500 TAPPPS 2,500 2,500 Department of Human Services CM Intake Worker 11,000 11,000 Grant + Program 7,800 7,800 Medicare Eligibility Grant 42,288 42,288 Hawau Sfate Pnmary Care Association 345 Queen Street, Suite 702 Honolulu, HI 96813718 21,297 21,297 County of Hawau 101 Aupuni St , # 342 Hilo, HI 96720 17,190 17,190 UH Telemediane Curriculum Research Project 11,937 11,937 VISTA Mileage 6,000 6,000 Other Contributions < 35,000 9,306 9,306 Total to Form 990, Part I, line 1a - d 306 149 0 1,200,466 1,506,615 THE BAY CLINIC. INC 99-0222784 Form 990 Rental Income Statement 2 Gross Activity Rental Kind and Location of Prooertv Number Income Condominium Rental 1 9,900 Office Sublease 2 22,200 Total to Form 990, Part I, line 6a 32,100 Form 990 Rental Expenses Statement 3 Activity Kind and Location of Procertv Number Amount Total Maintenance/Management Fees 5,369 GE Taxes 1,529 Property Taxes 519 Subtotal 1 7,417 Subtotal 2 0 Total to Form 990, Part I, line 6b 7,417 Form 990 Other Expenses Statement 4 (A) (B) (C) (D) Program Management Descnption Total Services and General Fundraising Contractual Services 97,273 97,237 36 Consulting Fees 61,281 26,215 35,066 Bad Debt Expense 59,071 58,277 794 Office Supplies and Expenses 36,797 13,205 23,592 Advertising 32,666 18,985 13,681 Hospdal Commissions 27,887 27,887 Recrwting and Retention 27,006 25,727 1,279 Insurance 24,335 22,953 1,382 Dues and Subscriptions 20,797 14,229 6,568 Equipment 17,605 12,950 4,655 Other Taxes 3,137 3,024 113 Miscellaneous 4,299 3,767 532 Total to Form 990, Part II, line 43a 412,154 324,456 87,698 THE BAY CLINIC. INC 99-0222784 Form 990 Statement of Organization's Pnmary Exempt Purpose Statement 5 Exolartat+on To prowde low cost quality health care to the publ+c through direct medical serv+ces and family planning educational actiwt+es Form 990 Schedule of Assets held for Investment Statement 6 Date Placed Cost Accumulated Net Book Asset Descr+pGOn +n Service Basis Deprecation Value Land 12/1/90 5,983 5,983 Total to Form 990, Part IV, I+ne 55a - b 5,983 0 5,983 Form 990 Schedule of Land, Buildings, and Equipment Statement 7 Date Placed Cost Accumulated Net Book Asset Descnpt+on +n Service Basis Deprecation Value Build+ng 3!26!99 1,203,586 39,592 1,163,994 Condominium 12/1190 93,736 22,744 70,992 Leasehold Improvements Varous 366,479 81,555 284,924 Clinical Equipment Various 145,721 45,262 100,459 Office Fun+ture and Egwpment Various 172,194 148,042 24,152 Comuter Hardware and Software Various 132,885 64,312 68,573 Automobile 2/9/99 60,566 6,219 54,347 Total to Form 990, Part IV, I+ne 57a - b 2,175,167 407,726 1,767,441 Form 990 Schedule of Depreciation Statement 8 Estimated Basis for Current Year Asset Descr+pbon Method Useful L+fe Depreciation Depreciation Building SLMM 38 1,203,586 31,673 Condominum ADS 40 93,736 2,343 Leasehold Improvements SLMM 3 - 38 366,479 34,248 Clinical Equipment SLMM 5 - 10 145,721 13,248 Office Furniture and Eqwpmenl SLMM 3 - 5 172,194 10,990 Computer Hardware and Software SLMM 3 - 5 132,885 31,984 Automobile SLMM 5 60,566 4,390 Total to Form 990, Part II, line 42 2,175 167 128,876 THE BAY CLINIC. INC 99-0222784 Form 990 List of Officers, Directors, Trustees and Key Employees Statement 9 Title and Contribution Expense Acct Time Devoted to Employee and Other Name and Address to Posdion Compensation Benefit Plan Allowances Nathan (Nate) Chang President NONE NONE NONE Prince Kuhio Plaza Part-Time 111 E Puanako St #610 Hilo, HI 96720 Clyde Silva Vice-President NONE NONE NONE PO Box 128 Part-Time Pahala, HI 96777 Carol Salis Treasurer NONE NONE NONE 2706 B Kilauea Ave Part-Time Hilo, HI 96720 Edna Baldado Secretary NONE NONE NONE 2300 Kilauea Ave Part-Time Hilo, HI 96720 Lema'ala Enos Director NONE NONE NONE PO Box 52 Part-Time Na'alehu, HI 96772 Teddy Bell Director NONE NONE NONE RR2 Box 4042 Part-Time Pahoa, HI 96778 Nahe Ka'wwadani Director NONE NONE NONE 56 Waianuenue Ave Part-Time Hilo, HI 96720 Charlene Hart Director NONE NONE NONE PO Box 853 Part-Time Na'alehu, HI 96772 Moarnkeala Akaka Director NONE NONE NONE 11 -Kou Lane Part-Time Hilo, HI 96720 Debbie Soares Director NONE NONE NONE P O Box 1807 Part-Time Pahoa, HI 96778 Diane Gentry Director NONE NONE NONE P O Box 1761 Part-Time Pahoa, HI 96778 Toddy Martin Director NONE NONE NONE RR2 Box 3963 Part-Time Pahoa, HI 96778 THE BAY CLINIC, INC_ 99-0222784 Form 990 List of Officers, Directors, Trustees and Key Employess Statement 9 Title and Contnbuhon Expense Acct Time Devoted to Employee and Other Name and Address to Position Compensabon Benefit Plan Allowances Ernest Bade Director NONE NONE NONE 400 Hualam St ,Suite 191 B Part-Time Hilo, HI 96720 Samuel (Kelu) Kahele Director NONE NONE NONE P O Box 5875 Part-Time Hdo, Hi 96720 Stephanie Launw Executive 60,000 2,850 NONE 6A Machida Lane Director Hilo, HI 96720 Full-Time Internal Revenue Ssrvlcr ~ Department of the Treasury District Director P 0 BOX 2350 ROOM 5127 ATTN: E.O, r~ 3 8 156 LOS ANGELES, CA 900532350 Eaployer Identification Nuaber: 99-0222784 - Date: FEB. 10, 1989 Case Nuaber: 958343033 BAY CLINIC INC Contact Person: 688 KINODLE ST SUITE 107 TERRY IZUMI HILO, HI 967200000 Contact 7elaphons Nuebsr: 1213) 894-4170 Our Letter Dated: April 19, 1984 Caveat Applisas no Oear Applicant: This sodifies our letter of the above date in which we stated that you would ba treated as an organization which Is not a private foundation until the expiration of your advance ruling period. Based on the Inforsatlon you subsittad, ws have detersined that you are not • private foundation within the meaning of seetlon 509 (e) of the Internal Revenue Code, because you are an organization of the type deeeribed in seetlon 509(a)(1) ¦nd 170(b)(1)(A)(vi). Your except status under section 501 (e1(3> of the code ie still In effect. i Grantors and contributors say rely on this datereination until the Internal Revenue Service publishes a notice to the contrary. However, a grantor or a contributor may not rely on this detarsination if he or she was in part responsible for, or was aware of, the sct•or failure to act that resulted in your loss of section 509(a)(1) status, or acquired knowledge that the ]nternal Revenue Service had green notice that you would bs reaoved from classification as a ¦eetion 509(e)(1) organization. Because this latter eoulr~ help resolve any questions about your private foundation statue, please keep it in your psreanent records. If the heading of this letter indicates that a caveat applies, the caveat below or on the eneloeurs is en integral part of this letter. If you have any questions, please contact the person whose nacre and telephone nusbsr are shown above. Sincerely yours, Frederick C. Nielsen District Director letter 1050<CG> FORM A~ STATE OF HAWAII - DEPAAT!<IENi OF TAXATION TAX CLEARANCE APPLICATION PLEASE T1TE OR P/tlNT CLEARLY R U Y 1. APPLICMITINFORNATION: (PLEASE PRINT CLEARLY) BUSWEC95TAATDATETNHAWAD Appeoard G >F/AF e % i`~ ~3 RAWAU RETTIRNS FIIFD Addrasa 3/ kt(antr.,~ao~P.c. /Q~J~ >FArrLC~eu,E O 19_ 19_- 19 ~In rT7 9G7~a ATE APPROVAL STAMP DBA/ Tratla Nartla a 2 TAX IDENTIFICATION NUNBER(Sk FED - ~ nnM HAWAII GENERAL EXCISE ID! 3, ~ ~ ~ 7 y ~ 7 GUW ' Q `f - Q ~ ~ 2 7 ~ ~ AaT v• ~,G~t.~ FEDERAL FAIPLOYEA ID! 0 ertment o Thzst n SOCULL SECURITY ! - YALSTAA(p---~ Ir1T"fwh P,~Y' ; F . ";~'JICE ~ 3. APPLJCANTISA/AN: (CHECK ONLY ONE BOX) APPROVED D'slact O:rcctcr ? CORPORATION ? S CORPORATION ~ TAX EXEMPT ORGANIZATION f I ? INDIVIDUAL ? PARTNERSHIP ? ESTATE ? TRUST JAi ~ 1~~JU ? UMffED LIABILITY COMPANY ? LIMn'ED UABILIT'Y PARTNERSHIP 4. THE TAX CLEARANCE IS REOUSTED FOR: I\`~t<~:>!=_. CITY, COUNTY, OR STATE GOVERNMENT CONTRACT IN HAWAII • ? LKXK)R LICENSE' 'y ? REAL ESTATE LICENSE ? CONTRACTOR LICENSE ? BULK SALES ? FlNANCIAL CLOSING ? PROGRESS PAYMENT ? PERSONAL ? HAWAII STATE RESIDENCY ? FEDERAL CONTRACT ? LOAN ? SUBCONTRACT ? OTHER ~ ~y ~ ~ ~ e elAslMNe la the afyklel ut cleeurla aNAcau beuld. -D0.fMPA0YK STAVP/ffMPLIi1Pl.URK1\d7IDIYAT78YSK 5. NO.OF CERTIFlED COPIE6 REQUESTED: ® e, cl -N(~TIIR s_~nhr<rN(F r~va~v ~LxY~v ~tv~ ~/2e~DrZ PR~~ F-~`~""~ ~ - PRINT SPECIFlC TITLE: Corporate OfTaar, Garwral PaMar, Indviduel (SoN Prgglpor] ( 8Os) q3~ 3s/8' (80P) ~YS / -y 7~S- SIGNA RE DAT TELEPHONE FAX POWER OF ATTORNEY. tl nLrrdeatl by aornaona o11Nw ftam • Caporals Olewr, General PaMar, or IndNduel (Bola PmpAMOr), • power d atbmay (State d Hawae DapartrrwR d Toatlon Farm N84e) rtnst W srbnitted weh tt9s app9oella~ tl ¦ Tax Clarana Y rpulrad barn !r 4rtertW Raverxra Samoa, IRS Form tiSZ1, Or IRS Ferrrl2M1! b ala0 ragYral Applbetlorre arbnlittad welqut prapar aulhortratlon wm ba aarR b e,. addrw d Woad wfer fM tudrg aWnrlry. UNSIGNED APPLIGTIONS WILL NOT BE PROCESSED. PLEASE TYPE OR PRINT CLEARLY -THE FRONT PAQE OF THIS APPLICATION BECOMES THE CERTIFICATE UPON APPROVAL SEE PAOE Z ON REVERSE i INSTRUCTIONS. FNura b prwka ragriad Informaean on papa 2 d tIM applealbrr a• n requlrW H iM saparab Urstructiors b iHs aypealbn wel raarll In a denial d en Tax Clwarca request . (Papa 1 d ~ ACORD„ CERTIFICATE OF LIABILITY INSURANCE 11/01/2000 RaouW TNW CERTffICATE R KSUED AS A MATTER OF WFORMATION BISHOP INSURANCE AGENCY OIJLY CONFERf NO RWNTf UPON THE CERTIFICATE lIOL.OER TWf CERTIFICATE DOEf NOT AMEND, EXTEND OR BO PAUAHI STREET SUITE 109 ALTER THE COVERAGE AFFORDED Br THE POLICIEf BELOW, HILO, HI 96720 INSURERSAFFORDWDCOVERAOE AGENT: Dennia Ancheta ' ,tuRm MEURERA WESTERN WORLD INSURANCE COMPANY/ BAY CLINIC, INC. Ea11111E11E I C International inc. ATTN: Del De Los Santos wuRwa 311 Kalanianaole Avenue •ulAlalr Hilo Hawaii 96778 R1E{RIER E. ;ovERAOt:a THE POUpEi OF WUR/1NCE LISTED aELOW IMVE EEEN ISSUED TO THE WURED NAMED AaOVE POR THE POLICY PERDD MDICATED. NOTWERfiTANDINO AMY REOIAREMENT, TOW OR COI~ORION Of ANY CONTRACT OR OTHER DOCt.KM WfTN RliPECT TO WNKJf Tlat CCRTExJ1TE RMY aE IiiUED OR RMY PERTAaI, THE WURANOE APPORDaD aY TIR POLICIEf DEaCRIam 1lREW ¦ aUa.IECT TO ALL THE TlRMi, E%CLUigNi AND CONpT10N8 OF iUCN POLICI[f AOOREOATE lAfTi NIOwH MAY NAVE a[[N RlDUCED aY PAD CLAMi ~ 7rRWMWRMIL7 MRL"I11Wa1 1AfT• T aiwaRAL U~•anr EAa~aocuRRaw~e r 1 000 000 X p011YEROKOEMnUllueEnr AIFONEtlEIAnVwR~) • 100 000 aAAUrne QX onalR rmExPlAgw•..«,) • Exclude rERSO,auAAwwLwr • 1 000 000 NPP 708250 11/OS/00 11/05/01 OlNERRLADOREWTE • 2 000 000 oerL AooRto•TE LAxr ~rrLeE roE rROOUen- oDNrw Aoo E I n e lode rover Loc AUTDYOW LMWIr cowrNEO woLE Lrar AM-AUTO R•~pO~p • •ORY ruuRr D'R rw,en) • i0llatA®Yf~Oi ~•RED •~DE eoDEr rwRr Ih~ w~n9 • NON-OVRItp AUTOE IM ~GWAE t aARAaE wEUrr Avro owr- Ea AOC~lM'T t AMV AUTO OTHER 71NN G ADC i AUTO ONLY ,ip0 i Exuu uuurr EAON OCCURREMIxi i ODOUR ~CWW WIDE AGOREWTE t t °E01C°'s 'T .s fnsaranoa contract Ia ifs by an In•ur which b not ' REIDRIDN • r eoR~rnDR.RD R~;:latan M axan?ination. M • Inaunr V f nd InaoMant ToRr cla::ni under this coMrad aro oovand by any guaranty E.L EAON ADDIOlwT • {end d the State of Hawall• c~ DueAaE-uo,rLOrEE s E L OL1FJ~•E • rOL,cY L14R i OTHER LI y~ tSurpWa Lino Blotter Liania i 10022) 680 Iwllal Rd, Sta. 760, Hono , HI ti68t7 DUCRITION OF OIF1tAi1DNMOCAfIDMN'ORC1fA'QCLYaDR•ADDED iYf110aREEWMINRECLL MWTtCNE RE: Violence Intervention Program I FINANCE DEPARTMENT, County of Hawaii (A Funding Source) is an Additional Insured under the policy to the extent set forth in the policy provisions. CERTIFICATE HOLDER X Aonrww MMJRED; •,•uRER li'ITY. CANCELLATION M10{1LD AM1' OF THE AROYE DE•CRi1ED rDUCIEE EE CAIICELLED aVaRE TM EftEIAIERI pAT( 1NW0•, THE WIMa MNIROI IYEI EMDEAr011 TO rAA, 030 DATE rA1RTOl Finance Department 1pTE:[TO TNECaTrcATE NDLxa RArm ro THE Urt. wTrAawtTem ED tNUr. County of Hawaii r/WlROWLR:IITEMIWY~7T'IPH~AyCu~TE~ ER.mAwrrEw 25 Aupuni Street RErREN,RATN[L C~~/N1DO Hilo, Hawaii 96720 •I^"oR®wREE+"*•TME ...:ORD 7fi (TA7) PHaa FtiT -1, TqN tfta ,4 I (fOfi TA:( ExEnSPT colt^OitAT10;J OfJLYI In cite Matter of tho Incorporation 1 1 of 1 1 'fhe (day Cltnl'G , lrlc_. 1 C}IART[iT OF INCORPOItATIO(J TO ALL TO WHOM THESE Pf1E5GNTS SHALL COME: I, the urxlersigned Daactor of Regulatory Agenaas of the State of liawan, send Greeting: WIIEREAS, '<3!~„J N~r~rq~i~ flel_t,~sirl .~nrlra I'~cl-~tr,~ and Cc'trn I knr1,~ r'A f Ft , a malorny of whom are residents of the State of Hawau, have filet wrth ma as Dveetor of Rcy~tlatory Ayrncies a vnnficd patitwn to grant to them arxl thc~r assaaates a charter of incorpora[ton u a nonprofit mrporanon, m accordance with the provisions of Section 41G-20, Ilawaii Reused Statutes, NOW, TIiCREFORE, KNOW YE, Thai I, the said Director, in the exercise and execution of every power and authority m anywise enabhny me m this behalf, do hereby consinute the said paUtlonars and thmr assaaates a corporation under the laws of the State of liavaii for the purposes and in rile form hereinafter sat forth, I Ths name of the corporation shall ties: '(hy Ba ~1 0, I i A i G , SY1 G . I I The location of the prinapal office of the corporation shall be in FI t I o ,State of Hewed, and the speritic address of its initial office shell be 34} Sliahl Street Hilo flawaii 9~'IZo State of Hawaii. III , The corporation shall be organized exclusively for the following purposes: iC~ _r , _._1_i IV Ths durstlon of ilia eorporaoort shall be perpetual. V Tha officers shall consist ot: (Titles Only) Prestdcr~ Jice- Pre-~IClcr~t 5ec.re-t ~ r/ vl Thcre shall ba a board of dlrcctors consisting of nut lass titan 3 member(s). The lullowing parsons shall be initial otficen and director(s), and shall Itolrl offico for ilia first year or uttul their successors ere duly elected pursuant to the by-law: otthe corporation. Office Held Namo flesidCnCr AddrrsS Presldcn•t Per~c~~ Marmot ticrsman 3~F1 31~a1,~ st , u~lo, Ill ~1~~zo J1ce.•Preslden-t Sandra Pickard II"14 Alnalako Rd, Hr lo,111967zo Secretar,/ Carol KondrBt~t I"t9 8 Halal st N~lo, fal 9b92o ~ • ~ I, ~ s t VIII Thscorfsoratronisorganrzedfor rn[dl'caI u CC~u[a+ronal c.)ta~rtablF. purposes only enJ rs rtot organized for protrt, rt wdl net rs:tre any stock, artJ no part of tts assets, utcoma, or aarninys shall tx drstnbuted to ns members, directors, or officers, oxcept for services actually rendered to the corporauon. Upnn drssuluhon, all of tho assets of Uta corporauon after payment of its lust debts shall be transferred or drstnbuted to en orgamzauon or organrxationt as shall at the time quarry as en exempt organizatrort or organieatrorrs under Section 5011c)~3) of the Internal Revenue Code of 1954. Notwnhstandmg any other pronsu~n of this Charter, this corporation shall not, oxcept to an uuubstanoal degree, engaye in any acuviucs or axercne any powers that are not m furtherance of the purposes of this corporatron IN WITNCSS WIiCREOF, I have hereunto sot my hand and seal of the Department of Reyulatory Agencies, at Honolulu, this day of nn(J_A~,._ 10 ~j . w +-e , Unr~tnr of Reyulatory AgJnnues t fly `:~.•r[.'•; .K./• Cur porauun & Setuuues dmuustralur Bay Clinie, Ine. Bylaws BYLAWS OF THE BAY CLINIC, INC. - ARTICLE I NAME AND PRINCIPAL OFFICE Sec. 1 Name The name of this Corporation shall be THE BAY CLINIC, INC. Sec. 2 Princinal Office The principal office for the transaction of business of the Corporation shall be in the State of Hawaii, County of Hawaii, at 311 Kalanianaole Avenue, Hilo, until the Boazd of Directors by resolution entered in the minutes shall otherwise direct. ARTICLE II FORM OF ORGANIZATION Sec. 1 Not for Profit This Corporation shall be anot-for-profit corporation ARTICLE III PURPOSE Sec. 1 Charitable and Educational Bay Clinic, Inc. has incorporated to obtain all of the power, benefits and privileges secured by law to incorporated bodies in order to hold property and do and perform such acts as may be necessary to operate exclusively for charitable and educational purposes Sec. 2 Purpose The purpose of the Corporation is to be cornmuniry-directed and committed to improving the health and well-being of all people. The purpose shall be accomplished by: 1) Providing high-quality accessible healthcaze in apatient-centered environment, regazdless of an individual's ability to pay. 2) Working with the community in preventive healthcare and education 3) Ensuring our services aze sensitive to the cultural diversity of our community 4) Taking a holistic approach to the treatment of our patients. 5) Advocating for improved healthcare and living conditions wherever the need ~s evident. 6) Cooperating and collaborating, whenever possible, with other medical providers and organizations to improve the delivery of healthcare in our community. 7) Forming a partnership with our patients m planning a healthy future for themselves and their families. Sec. 3 Not for Profit LaN~s Nothing herein shall authorize this Corporation to go beyond the 1~mits of the law(s) governing not-for-profit corporations. Bey Clinie, Inc. Bylaws Sec. 4 Political Activity No substantial part of the activities of this Corporation shall be for the purpose of carrying on propaganda or otherwise attempting to influence _ legislation. None of the activities of this Corporation shall consist of participating in, or intervening in (including the publishing or distributing of statements), any political campaign on behalf of any candidate for public office. The Corporation is apolitical and non-partisan and is committed to taking a neutral position among aU candidates for political office. Board Members may freely express their personal convictions on any political or social issue but must make it clear that they speak as private citiuns and not as representatives of Bay Clinic, Inc. Sec. 5 Assets Dedicated to Charitable Purposes No part of the net earning of this Corporation shall inure to the benefit of any private shareholder or any individual. The property of this Corporation is irrevocably dedicated to charitable purposes and upon liquidation, dissolution or abandonment and after providing for the debts and obligations thereof, the remaining assets will not inure to the benefit of any private person but will be distributed to a nonprofit fund, foundation or corporation which is organized and operated exclusively for charitable purposes and which has established its tax-exempt status under the Internal Revenue Code. ARTICLE IV MEMBERSHIP Sec. 1 Members Defined The members of the Corporation shall consist of: 1) The principal governing body of the Corporation, otherwise known as the Board of Directors, henceforth in the bylaws designated the "Board". 2) Community Members, all other individuals who have applied for membership and been accepted as a member by the Board. Sec. 2 Terms for Communiri Members The term of membership shall be continuous until the member resigns in writing, is removed by a majority vote of the Board, or otherwise becomes ineligible. Sec. 3 Benefits of Membershia Members shall be kept informed of the affairs of the Corporation as prescribed by these Bylaws or otherwise by the Boazd, and may participate in membership activities which include specifically the right to elect two Boazd members as set out rn Article X. ARTICLE V MEA4BERSHiP MEETINGS Sea 1 Anirua! Meellirp An Annual ).Qeeting of the Board and Community Membcrs shall be held in the month after the end of each fiscal ~~ear, at the time and place to be decided upon by the Board Notice of the meeting shall be mailed to the Board and Community Members at (east 15 days prior to the meeting Attendance at the meeting will automatically waive this notice requirement. The Annual Meeting shall include: Bay Clinic, lnc. Bylaws a Electing Board Members nominated for a second term b. Electing the officers of the Board _ c. Hearing the annual report of the Corporation In the event of postponement or failtue to call an Annual Meeting, a meeting may be called later to perform the duties required of the Annual Meeting. All acts of the Corporation or its officers performed in the interim shall be of full force and effect. Sec. 2 Board Meetin¢s The Boazd shall hold a regular business meeting at least once per month. Sec. 3 Special roeetin¢s Special meetings of the Board or Community Membership, or both, may be called at any time by the President or by petition of three Board Membcrs. Sec. 4 Notice of Meetines Notices of both regular and special meetings, other than the Annual Meeting, shall be given by mail, a-mail, telephone or fax to each Board Member at least five days in advance. Notices of such meetings posted in public view at each clinic shall suffice for notice to Community Members, except that rf a member specifically requests direct notification, this shall be made as set forth above. This notice requirement will automatically be waived by attendance at the meeting Sec. 5 uoruro A quorum at a Board meeting shall consist of the presence or proxy of one more than half the number of active Boazd Members. Once established, a quorum shall continue until the meetrn¢ is adjourned regardless of the departure of any Boazd Member(s). Any act or business conducted at the meeting must receive the approval of a malonty of the quorum Sec. 6 Proary Votin¢ Proxy voting by the Boazd will be allowed. Absent Boazd Members may vote at a meeting by written proxy. Sec. 7 Method(sl of Coromunicatin¢ Any Boazd meeting, regular or special, may be conducted by telephone conference so long as all Board members participating in the meeting can heaz one another. Aeetings may also be held by videoconference as long as all Boazd members participating rn the meeting can see one another. Sec. 8 Executive Sessions Executive sessions of the Board may be called by the President. Executive sessions may be attended only by Officers, Boazd Members, and other mdiv~duals whose attendance rs approved by two-thuds of the Board Membcrs present. No formal voting shall take place in open session Sec. 9 Action 1~Vithout a)\ieetin¢ Any action ++~hrch, under Hai+•ari corporation law and consistent ++•ith the ByIaNS, may be taken at a meeting of the Board may also be taken without a meeting if the action is m ti•ritmg, signed by two-thirds of the Board +vrthm a reasonable time and filed with the Secretary 3 Bay Clinie, Ine Bylaws ARTICLE VI BOARD OF DIRECTORS A. Membership: Sec. 1 Number of Board Members The Boazd shall consist of no less than nine (9) nor more than fifteen (15) elected members. Sec. 2 Terms of Office Board Members shall take office immediately upon election. Terms of office shall be for two years except that, since regular elections take place in July each year at the Annual Meeting, each initial term shall be construed to have begun at the Annual Meeting of the calendar year in a~hich the Board Member is first seated so that an initial term may be slightly more than or less than two years; more if the member is seated earlier than the Annual Meeting, and less tf the member is seated later in the year than the Annual Meeting.. Sec. 3 Vacsnt Seats Vacant seats shall be filled by a vote of the majority of the Board Members present, provided that proper notice of the meeting has been given and the item is specified on the published agenda. Sec. 4 Ineli¢ibiliri Any Board Member having served tvo consecutive terms (four consecutive years) shall be ineligible for at least one yeaz; however, such members are encowaged to return to Board service and are encowaged to remain actively involved with Bay Clinic during their off yeaz by participating as non-voting community members at a Committee level. Sec. 5 Nepotism No one may serve on the Board who has an immediate familial relationship with ether a current Board Member or a paid staff member. A fazniltal relationship is defined as parents, spouses, children, siblings, or members of the same household. Sec. 6 Consumer Maioriri At least 50% of Board Members shall be current users of Bay Clinic programs or services No more than 50% of non-user Board Members shall derive more than ] 0% of their income from the healthcare industry. Board membership should reflect the demographic characteristics of the user population with regard to gender, age, race, economic status and area of residence Sec. 7 Board Compensation Board Members shall not receive any monetary payment or services in exchange for membership on the Board Reimbursement or stipends for reasonable expenses, incurred .+hile conducting official Corporation business or while travelling to and from Board meetings, shall be pem~issible. 4 Bay Clinie, Inc. Bylaws Sec. 8 Attendance Absence from three consecutive meetings of the Board without satisfactory cause may be considered reason fot removal from office. _ Sec. 9 Removal of Board Member Any Officer or Board Member may be removed from office or from membership on the Board of Directors by a vote oftwo-thirds of the remaining members, whenever in their judgment the interests of the Corporation will be served thereby. There shall be no right of appeal by a Board Member who has been removed by such two-thirds vote. B. Duties and Powers: Subject to the limitations of the Articles of Incorporation, the Bylaws, Iiawaii corporation law, and the specific duties as prescnbed 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: 1) Management of the Corporation shall be vested in the Board with full power and authority to carry out the affairs of the organization. 2) The Board shall be responsible for the election, appointment and/or removal of the officers, agents and Executive Director of the Corporation. 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 and adopted. 4) The Boazd 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. 5) 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. 6) The Board shall require periodic reports on operations from various cornmrttees. 7) The Boazd shall have the authority to determine and change the location of the principal office of the Corporatton, establish subsidiary offices, adopt and use a corporate seal, and prescribe certificate of membership fotTrrs, as provided for by law 8) The Board shall adopt policy for financial management practices, including a system to assure accountability for center resources, approval of the annual budget, financial pnontres, eligibility for services including criteria for partial payment schedules. and long-range financial planning. 9) The Board shall adopt healthcaze policies including scope and availability of services, location and hours of services, and quality of care audit procedures 10J The Board shall evaluate health center activities including service utilization panerns, productr~ rty of center sites, patient satisfaction, achievement of project ob~ecu~ es, and development of a process for hearing and resolving patient grievances 5 Bay Clinic, Inc. Bylaws 1 I) The Board shall asstue that health center(s) are operated in compliance wtth applicable federal, state, and local laws and regulations. _ 12) The Board may perform any or all other acts necessary to carry out the business of the Corporation, and adopt such policies as mey be necessary to effectuate these Bylaws. C. Conflict of Interest: Sec. I Disclosure No Board Member shall vote or cast proxy at any Board meeting on any issue in which the member has a conflict of interest. "Conflict of interest" shall mean situations where an individual's judgment or loyalty is or may be affected by his/her own financial, business, property or personal interest A Board Member who has a conflict of interest on any issue before the Board shall disclose the natttre of the conflict of interest prior to a vote on that issue at the Boazd meeting, and the minutes of the meeting shall record the fact that the disclosure was made. In the event of a conflict of interest, a majonty of disinterested Boazd Members shall constitute a quorum. Sec. 2 Uncertainri If a Boazd Member is uncertain as to whether he/she has a duality or conflict of interest which requires abstention, or tf a Board Member asserts that another Board Member has such a duality or conflict, the Board by majority vote of those present other than the Board Member having the possible conflict, shall decide whether abstention is required. If so, the Board Member WWII be deemed to have abstained. Sec. 3 Purchases From Board Member(s) Ato purchase involving $100 or more from any Board Member or any entity of which the Board Member is an Officer, Board Member, partner or owTer shall be made without prior approval of the Boazd of Directors. Sea 4 Previous Staff or Board Member No Boazd Member shall be allowed to become an employee of the Corporation until at least 90 days after the Boazd 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 ARTICLE VII EXECUTIVE COMMITTEE Sec. 1 Committee Members The Executive Committee shall consist of the Officers of the Corporation: the President, the Vice President(s), the Secretary and the Treasurer. Sec. 2 Immediate Past President The Immediate Past President shall sere as an e~- officiomember ofthe Executive Committee in an advisory capacity. Sec. 3 Function The Executive Committee shall perform the functions of the Board in its routine management of the affairs of the Corporation during intervals between meetings of the Board All actions taken by the Executive Committee shall be presented 6 Bay Clinic, lne. Bylaws at the next meeting of the Board. Actions taken by the Executive Committee may be overruled by two-thirds of a quorum of the Boazd at the meeting. _ Sec. 4 Meetine Csll The Executive Committee shall mect on call of the President. Sec. 5 Actions All actions and decisions of the Executive Committee shall require a majority approval by the members of the Committee. ARTICLE VIII OFFICERS Sec. 1 Positions The 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 in similar organizations and those specified in these Bylaws. Additional duties may be prescribed by the Board. Sec. 2President-Elect The Vice-President (or First Vice-President) shall bePresident- Elect for the following year. Sea 3 Terms of Office Officers shall serve for at least one year and shall be elected according to Article X of these Bylaws. Any officer having served two consecutive terms in the same office shall be ineligible for re-election to that office for at least one year, unless there is no other Board Member t;~lling to serve in that office. Sec. 4 Elieibilitv To be eligible for election to any Officer position, a Boazd Member shall have served one yeaz on the Board. This stipulation may be waived rn the event there aze not sufficient eligible members. Sec. 5 Duties of Officers a) The President shall be the Chtef Officer of the Corporation and Chairperson of the Board. The Prestdent shall preside at all meetings of the membership, Executive Committee and the Board. The President shall be a member, ex- officro with avote, of all committees except the Nominations and Electrons Committee. The President shall have the general powers and duties usually vested rn the office of President of a corporation, and shall have other poH•ers and duties as may be prescribed by the Board of Directors or the Bylaws b) The Vice Presrdentfsl, in succession if more than one, shall perform all the duties of the President if the President rs absent or unable to act If the presidency becomes vacant, the highest Vice President shall succeed to the office for the unexpired portion of the feint If a Vrce President rs unable or unavailable to act, the duties shall be performed in succession by the Secretary and Treasurer The Vice President shall have such other powers and duties as from time to time may be prescribed by the Board of Directors or the B}•lau•s c) The Secretary shall be responsible for the records of the Corporation, supervising electrons at the Annual Meeting, recording votes of the Board and keeping all minutes of the Executive Committee and Board meetings. The Bay Clinic, Inc. Bylaws Secretary shall be responsible for all correspondence of the Executive Committee and the Board, and for the issuance of the required notice of all _ meetings of the Executive Committee and Board. The Secretary shall ensure that the seal of the Corporation is in safe custody. The Secretary shall have such other powers and duties as may be prescribed by the Board or the Bylaws. The Board may name an Assistant Secretary to assist the Secretary in fulfilling the duties of the office. Corporation staff may record and transcribe minutes and correspondence for approval of the Secretary. d) The Treastuer 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 at the principal office of the Corporation. Subject to the dtrection 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 performed by the staff of the Corporation under supervision and direction of the Finance Committee. The Treasurer shall present monthly financial statements to the Board. The Treasurer may have other duties and powers as prescribed by the Board or these Bylaws Sec. 6 Vacancies Vacancies in the offices of Vice President, Secretary or Treasurer shall be filled for the remainder of the term by majonry vote of the Board. ARTICLE IX COMMITTEES Sec. 1 Standin¢ Committees Standing Committees shall be: Finance, Personnel, Nominations and Elections, Resource Development, Community Relations/Mazketing, Quality Assurance, Bylaws, and Facilities. Ad hoc committees shall be created as the Boazd and President deem necessary from time to trine. Sec. 2 Committee Chairs The Chairpersons of all such commtttees shall be Board Members appointed by the President with the approval of the Board. The Chairperson may also select the committee members. Sec. 3 Terms and Vacancies The Charrperson and members of the Committee shall serve until the expiration of the fiscal yeaz or until their successors are appointed. Vacancies on a committee shall be filled in the same way committee members aze regulazly appointed Sec. 4 Requirements for Board )•4embers All Board Members are required to~om and serve on no less than one (1) and no more than three (3) standing committees 8 Bey Clm~c, Inc. Bylaws Sec. 5 Resuonsibilities of Committees a) Finance The Finance Committee shall have the responsibility for _ establishing policies for financial management of the Corporation, including but not limited to budgeting, investing, financial reporting, and long-range fittencial planning. The Finance Committee shall review montl?ly financial statements of the financial position of the Corporation, and shall report on such to the Board. The Finance Committee shall ensure that an annual financial audit is performed. b) Personnel The Personnel Committee shall have the responsibility for establishing policies and practices for the employment and retention of staff and volunteers. c) Nominations and Elections The Nominations and Elections Corrunittee shall have the responstbility for preparing an annual slate of Officers and Board Members for election at the Annual Meeting, and for recruitment of applicants for Board Member vacancies occurring during the year. The Committee shall ensure that there is an adequate orientation process for new Board Members d) Resource Development The Resource Development Committee shall have the responsibility for establishing a Resource Development Plan, and short and long-range fund development objectives to assist the Corporation in meeting tts financial goals. e) Community Relations/Mazketin¢Tha Community Relations & Marketing Committee shall have the responsibility for approving and evaluating the Marketing Plan of the Corporation, and for establtshing objectives for strengthening the Corporation's identity within the community. f) Oualitv Assurance The Quality Assurance Committee shall have the responsibility for evaluating health center activities and servrces, tncluding patient satisfaction and achievement of annual and longterm objectives. g) Bvlaws The Bylaws Committee shall have the responsibility for reviewing the Bylaws at least annually for compliance with federal, state and local requirements, and reconunending amendments to the Bylaws. h) Facilities The Facilities Conunittee shall have the responstbility for evaluating the adequacy of the Corporation's burldtngs for compliance with federal, state and local requirements, and to meet the needs of employees, patients and the general public. The Committee shall also be responsible for reseazchmg the feasrbrl~ty of proposed renovations and additional new service delivery sites Sec. 6 Board Approval A ma~onty vote of the Board is required to approve any policy recommendations established in Committees At no time will a policy established m a Committee take full effect w ithout a majority vote of the Board of Directors 9 Bey Clinie, Inc. Bylsws ARTICLE X NOMINATIONS AND ELECTIONS _ Sec. I Slate of Officers The Nominations and Elections Committee shall prepare a slate of nominations for Board and Officer positions. Nomination of more than one person for tech oflce is encouraged, except that there is no election for President unless the sitting Vice President resigns. In arriving at the slate of nominees, the Committee shall canvas the Board for member input regarding opinions of leadership potential and personal willingness to serve. 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(s) for which they have been nominated at the time of nomination or solicitation. At no time shall an individual be nominatcd for an OfTcer position without his/her previous consent. Sec. 2 Additional Nominations Additional nominations may be presented by any Board or Community Member from the floor at the Annual Meeting. Sec. 3 Election Process Whcn additional nominations, if any, cease, the election of Board Members and Oflicers shall be by secret ballot at the Annual Meeting. The Community 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. Sec. 4 Multiple Nominations If an indivrdual is nominated for more than one office, and receives the highest number of votes for more than one office, she/he shall be elected to the highest office for which she/he shall have received the highest number of votes. The person receiving the next highest number of votes shall be named the successful candidate for the lower oflce. ARTICLE XI EXECUTIVE DIRECTOR Sec. 1 Appointment 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 determined by the Board. The Executive Director shall be a paid staff member of the Corporation Appointment and removal of the Executive Director shall require atwo-thirds vote of the Board. Sec. 2 Evaluation The Board shall review the v~ork performance of the Executi~ e Director at least annually ARTICLE XII FINANCES Sec. 1 Accountine Procedures Accounting procedures for the Corporation shall conform to generally accepted accounting practices. 10 Bay Clinie, Inc. Bylaws Sec. 2 Fiscal Yesr The Corporation shall maintain as its fiscal year the period July 1 to _ June 30. Sec. 3 Audit The financial records and books of the Corporation shall be audited after the end of each fiscal yeaz by a certified public accountant appointed by the Board. The auditor's report shall be filed with the records of the Corporation. Sec. 4 Insurance Appropriate insurance in reasonable amounts and to the extent available shall cover all aspects of the Corporation's activities and agents of the Corporation. Sec. 5 Bondin All persons having access to the funds of the Corporation in excess of $500.00 shall be bonded. Sec. 6 Contracts The Executive Director shall be authorized to contract for services and materials within the provisions of the budget adopted by the Boazd. 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 any 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. Sec. 7 Deaosits All funds received by the Corporation shall be deposited to the credit of the Corporation in depositones approved by the Board. No funds of any Boazd Member, employee or agent of the Corporation may be co-mingled with Corporation funds. Sec. 8 Si¢natories 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 authonzed signatory. All other checks shall be signed by at least two authonzed signatories. ARTICLE XIII PARLIAMENTARY AUTHORITY Sec. 1 Robert's Rules of Order Robert's Rules of Order (Newly Revised) shall constitute ruling authority in all cases in which they are not inconsistent Hith these Bylaws or with Hawaii law ARTICLE XIV A)•7ENDMENTS Sec. 1 Aoaroval Required Amendment of these B}~laws shall require atwo-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 I - Bay Clinic, Inc. Bylaws Sec. 2 Oriairtal Purpose No amendment shall change substantially the original purpose _ ofthe Corporation. ARTICLE XV INDEMNIFICATION Sec. 1 Pertairtip¢ to Directors The Corporation shall, to the fullest extent permitted or required by Hawaii Revised Statutes, indemnify its Board Members and Officers against any and al! liabilities, and advance any and all reasonable expenses incurred thereby in any proceeding to which any Board Member or Officer is a party because he/she is a Board Member or Officer of the Corporation. 77re Corporation may indemnify its employees and authorized agents, acting within the scope of their duties as such, to the same extent as Board Members or Officers hereunder. Sec. 2 D & O Irtsurapce The Corporation shall keep in full force and effect a Directors and Officers (D & 0) Insurance policy for the protection of its Directors (Board Members) and Officers of the Board. ARTICLE XVI NONDISCRIMINATION Sec. 1 Policv Consideration for and selection of candidates for services, membership on the Board of Directors, vendors, employee recruitment and relations, and all other business transactions shall be without discrimination based on race, color, religion, national origin, gender, age, sexual preference, marital status, veteran/military status, arrest/court record, disability or any other discriminatory practice prohibited by law. ARTICLE XVII INSPECTION OF BYLAWS Sec. 1 By Members The Corporation shall keep in its principal office the original or a copy of the Bylaws of the Corporation, as amended or otherwise altered to date, and such Bylaws shall be open to inspection by the members of the Corporation at all reasonable times during regular business hours. Revised 9/93 Revised 7/94 Revised 5/95 Revised 9/95 Revised 3/97 Revised 4/00 Revised 5/00 Revised 9/00 13