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COM 0122.027 2000-2002
HOSPICE of HILO I`LDRiTI ~I, IIIL Ui5 H1 Uil NU\NU UE UINLITU0.1 UffICEXi January 30, 2001 r nJ. a 4Jru 9 Fu:. i„ /q.rJ,n ~~lu, 1 bnnnap Hawati County Council .[,.,,"[r. c/o Office of Legislative Audit County of Hawaii ME4X[RS 25 Aupuni Street Pnin'~W IbxX+"+ F.y Hilo, HI 96720 Po.a.,em uui~inp Ev, Deaz Councll Members: Lm i D, Yes L.rtn { AlnrnJU UTR \IXr, E VXUl+shl X4 With this letter Hospice of Hilo respectfully submits its application for FY 2001-02 II]N[ Rrrn+rJin„ funding support from the County of Hawaii Human Services Nonprofits Grants qo¢m 1 LN+he r ~mlr, L 4.L+,..+ program. Our $ 15,000 request is tazgeted to two principal areas: E]rnE\, (l) Staff development (2) Outlier Expenses (i.e cost-0verruns m those cases where X'enG II'. X{ M~ „„,,,,,,,,m,., extraordinary medical needs outpace our Medicare or other msurance reimbursements) ioiLSORY mL.uL L".nX These are areas m which a moderate mvestment by the County will yield large LrrilJ L UrMrlln dividends to the community. We look forward to the opportunity to meet with the JN L IIn4,v ND members of the Council to further clarify our request and to provide any additional "~""X'L'"' information that might be useful in your deliberations. Thank you very much for DmN C qe&r X{ tl64 your consideration. Y[I[T C Cuhnu Ey pmn T Lmhrdl VD Sincerely, •urcn llf Ler PE &IhM p+n 4rnhL]J TnJJ Fp Qmhu Xnrtmnn ,\`I//~/\/i LLvnuJ 5 TXn]XN SIr1111[n r Yvnahmn Eq Brenda Ho, RN, MS ieenre T Ynshln"i E+y Executive Dvector LvW1T 4N"!IN Penn, Jr l^nX Encl• FY 2001-02 Grant Application .iNn IlLlnd+ Comm. No. I.2-z . Z 7 `"L..'w`IL Q U D 1011 WAIAVI'EVUE AV ENUE, HILO, HI 967?0 )"`ll@ NU• ® TELEPHONE (8081 969 1713 FACSIMILE 18081 969 4861 4f SED ~ E mad hospice@hospl~c of lido org www hospice of lido or¢ Ref. To: Ref. Date FEB 2 GRANT APPLICATION Stephen K Yamashrro Harry A Takahashi Mat or Dvector COUNTY Of f~I~1Kl4I'I DEPARTMENT OF FINANCE 25 Aupunt Strxt, Room 1 l8 • Htlo, Hewau 96720252 (808)961-8234 • Fax(808)961-8248 HAWAlI COUNTY NONPROFIT GRANTS (FY 2001-02) HUMAN SERVICES NONPROFIT GRANTS REVIEW COMMITTEE FISCAL YEAR ENDING June 30, 2002 DATE OF APPLICATION Jan. 31, 2001 GRANT APPLICATION FOR Hospice (Prv{nm lltle) Legal Name of Organization Hospice of Hilo Mailing Address 1011 Waianuenue Avenue, Hilo, HI 96720 Facility/Site Address 1011 Waianuenue Avenue, Hilo, HI 96720 Director/St[eManager Brenda Ho, RN, MS, Executive Director Orgattuation President. Sidney M. Puke Contact Person (Grant Wnter). Ron Hart, Director of Development and Public Relations Amount of Request for County Funds• S 15 , 000.00 'total Annual Budget of Organization: S 1 .331.420.00 Has the applicant applied for any other funds from the County of Hawau this fiscal year'? ? Yes Souroe/Department: ® No Agency/Program(s): ? Social Sernces ? Youth Programs ? Elderly Programs Check Categones• ? Culture and Arts ? Education ?x Other Health Services Briefly, define the program for which tnnding is bdug requested: Hospice is a program of compassionate palliative, in-home care for the dying, provided at no coat to patient or family. An Interdisciplinary Team of physician, 24-hour on-call RNs, Certified Nurse Aides, Medical Social Worker Spir rust S B reav ment r t ~~p i iii * i d vnl,n ar or^vide hospice care. Medications, medical equipment b medical supplies provided per insurance coverage. Client input to Plan of Care inusres patient control, autonomy and dignity. -1- L QUALIFYING STANDARDS FOR APPLICANTS An applicant must meet all of the foliowtng standards ® Be chartered or otherwise authonzed to do busmess m the State for chartable purposes and exempted from the federal income tax by the Internal Revenue Service Q Have a govemmg board whose member serve without compenution and have no conflict of interest between their regular occupanons and the services provided ® Have bylaws or policies which descnbe the manner m wroth busmess is conducted, including management, audit, fiscal policies and procedures, policies on neponsm, and policies on management of potennal conflict of interest 0 Have at least one year's expenence with the semce or actrhry for whrch the sppropnanon is sought or can otherwise demonstrate to the unsfactroa of the County etifficient expertise to auccesafully carry out the sernce or acuviry ® Be licensed and accredited m accordance with applicable rcgturemenis of Fedcal, State and County laws Il. GRANT CONDITIONS The applicant agrees to cornply with the foliowtng tams and condthons pnor to receiving a grant award A Comply with apphcsble Federal and State laws prohibumg d,.rn+m •hon against any person on the bests of race, color, natrorial tmgm, religion, creed, sex, age, or handicap B Agra not to use my public funds for ptrrpoaes of ear ent a perquisites C Comply with such other requirernenis as the Director of Fitiaoce may prescribe to etuiire adherence by the nonprofit orgamutron wtt6 Federal, State, and County Iowa, and established standards for fiscal and pcognm management D Allow the Director of Finance, the committees of the council and their staffs, and the Legislative Auditor scceu to records, tepotU, files, and other rcLted dtxwnenis m order this the program, management, and focal prutrca of the nonprofit organization may be momtoced end evaluated to assure the proper and efftxtive expwdttiue of public funds. III. RECORDS AND REPORTS A The applicant shall follow generally accepted accounting procedures sad practices and shall rtisintain books, records. documenu and other evidence which aufficteaily a~ propcly atxount for the expeiidtturc of County funds The boob, records and documenb shall be subJact at ap reasonable nines to uiapahon, rcvrewa, or audio by the County eicpeedtng agtmcy, the Director of Finaae, aisd the Leguhttrve Attdttor, or by thew representative B The County expeaduig agency, Director of Finance, or County Council may request penadic writer repona on the use of County funds C. The nonprofit organianon shall submit a final written report m the I.egulative Auditor within Bury (60) days lifter Jtine 30 of the fiscal yea. The rcpoR shall include an eitplaoatron of the publrc benefice derived from the awarding of the grmt, a listing of other funding soiirca and ainamb obtained during the grant period, end a complete accountutg of all eicptmdittues appated by Cauaty of Hawail great funds {per Chapter 2, Amcle 25, Sation 2-142(d), Hawaii County Coda, amended Augiut, 1999} -2: N. QUARTERLY ALLOCATION Under no crrctunstances shall grant funds be disbursed in a lump sum payment Grant funds will be disbtused to Grantees only through a quarterly allocation process The disbursement of grant funds can be formulated on an equal quarterly apportionment bests GRIEV~1iYCE PROCEDURE The applicant will adopt and maintain a grievance procedure to assure proper accounting for any concern and complaints about its program or services that may arise from its members, employees, clienu or from other members of the public VI. DISCLOSURE OF INFORMATION All infonnauon, data or other material provided to the County by value of this application shall be subject [o the Uniform Information Practices Act (UIPA), Chapter 92F, Hawaii Revised Statutes All such material a deemed government record and shall be open to the public and may be provided to other public and/or private funding SOarceS VII. CONTINUED ELIGIBQ.ITY Any applleaat or recipient who withholds or omlb nay material tech or deliberately misrepreseab sash faab to the County of Hawall shall: (1) Lnmediately be disqualified from consideration for Nonprofit Grant funding, OR (2) be in violation of the tertna of the Grant Agreement of County funds in which cue a grant agreement can be terminated by the County sad the recipient or provider may be ]able to rcimbtine all or a portion of my funds received therein VIiI. ACIINOWLEDGEMENT Hospice of Hilo (Legal Name of Orgenizstioa) hereby agrees to administer the Hospice (Program Title) in accordance with the regulations, policies and procedures pnacnbad by the Hawau County Finance Department. Dismbution of grant funds u limited to goatees which are m compliance vnth Cauary rcgtilatiooa, pohcia and procedures The Couary raavea the right to withhold great dutnbutions at nay time the grandee u not m compheace It u the polity of the County of Hawan sad for those who do bwmeu with the County to provide equal employment opportumtia to all periods rcgssdless of race. physical disebilitim, color, rchgioq act, age, or national origin u mmdated by the Federal Civil Righu Acts, u amended, and nay other fedmal or state laws relating to equal employmwt oppottumties IX. AMENDMENTS TO THE APPLICATION/EVALUATION _ The applicant usurea that rt will submit to the Human Services Nonprofit Grants Review Committee (IiSNPGRC) for poor review and approval a written requtat and ~tutificatioa for any changes, additions, a deletions to nay portion(s) of the grant application or s duty executed Grant Agreement of County Funds. The applipat will cooperate and asaut in any e@'ort underbkm by the HSNPGRC to evaluate, iospeet m othawue monitor the effectiveness, feuibihry, anNor cos[ efficiency of any sad ail piuuces, pohcia and procedurd or aetivitia pursuant to ilia application or nay grant daigmtion or allocation received u a reach of thin application. -3- X. AUTHORITY AND CAPACITY OF APPLICANT The applicant cernfies that tt has the authonty and capacity to develop and submit this appltcatton, and to fully administer the program(s) pursuant to this application UNSIGNED PROPOSALS WQ.L NOT BE ACCEPTED! ~~~0-~~ Signature of rcsident/Chairperson Date Signature of Executive Dtrtxtor/Managc Date -4- NARRATIVE ANSWERS I. PROGRAM /SERVICE DESCRIPTION A. Overview 1) Describe the program for which funding is being requested. Hospice of Hilo provides a single program of integrated services called hospice Funding is being requested to enhance selected components of this overall program Hospice is a comprehensive system of care that provides palliative and supportive health servtces to terminally ill pattents The program also provtdes an array of social, psychologtcal and spiritual care and logtstcal support servtces to both the terminally ill patient and members of the patient's family Our Medical Director, a licensed physician, directs the program of care Hosptce care is provided by an Interdtsctplinary Team consisting of the physician, registered nurse case- managers, certified nurse aides, medical social worker, spiritual and bereavement counselor, therapists (physical, occupattorial, speech and dietary), volunteer coordinator, and specially trained volunteers Hosptce care is typically provtded in the patient's own home Nurses are on call 24 hours a day In addition to the servtces of the Interdtsctpltnary Team, hosptce pattents are also provtded medications and treatments for pain and symptom management, medical equipment and supplies, short-stay hospitalization for respite and acute care needs, and lab servtces as outlined by their insurance coverage Hospice also provtdes free community education and professional training on end-of-life issues We are requesting County of Hawaii funding to enhance our program in two areas a) Staff Development. The competency of our staff is the key to our success Even small investments to staff development pay exponentially large dividends In order to remain current, responsive and competitive we need to constantly upgrade the proficiency of our staff to meet higher standards of care and adapt to new methods of doing business b) Outlier Expenses (Patient expenses exceeding the reimbursement rate). Hosptce of Hilo receives a fixed per diem reimbursement established by The Health Care Finance Administration (Medicare) When acrual patient expenses exceed the budgeted per diem, the excess costs are borne by the agency In many cases the cost of providing care to patients with extraordinary medical needs exceeds the reimbursement rate We are seeking funding to partially offset these losses and decrease the impact on other cost centers 2) What unique or significant service will be provided? The hosptce program of care is unique to three ways First, it includes both the patient and the entire household as primary clients Second it is comprehensive, focusing not only on medical issues but on the needs of the whole person body, mind, and spirt Hospice addresses the medical and nursing needs of the patient as well as the overall physical, social, psychological, spintual and logistical needs of both patient and family Third, hospice is client- centered care as distinct from the typical medical model of phystciancentered care The wishes, values and beliefs of the patient and family are carefully considered and integrated as integral components of the Plan of Care 3) What specific outcomes are to be achieved? Patient outcomes include: _ a) Optimized physical health through pain managemeirt, symptom control, nutntional counseling, and speech, physical and occupational therapy as needed b) Enhanced psychologtcal /emotional health through increased capacity to (L) control of their own situation, (2) remain in the familiar environment of their own home, (3) be less of a burden on their family, (4) be less isolated and more mobile, (5) have access to psychologtcal, bereavement and spintual counseling, (fi) have a sense of living and dying with dignity, acid (7) have a sense of completion, meaning, and resolution c) Reduced likelihood of suicide due to unbearable pain, or feelings of worthlessness, helplessness, or hopelessness d) Reduced likelihood of overtreatment Hospiu of HJo l Coumy of H~w~u Nonprofit OntLL Appl~eauao F5' 1001-1002 Faintly outcomes include: a) Reduced phvstcal stress due to having hospice assistance in caring for the patient b) Reduced levels of fear and psychological distress due to (1) having input to the plan of care, (2) receiving explicit pattent care instruction that lets them know what to expect and how to cope, (3) having more quality time to spend wnh their loved one, (4) recetvtng spintual counseling, and (5) recetvtng guidance on end-of-life tssues such as advance directives, funeral plans, death cemficates, they dying process, etc c) Reduced expenditures required for medtcal and nursing care vs hospttalvaaon d) Strengthening of the faintly umt as members are gwded through their reactions to the dying process (dental, anger, bargaining, acceptance), and are helped to develop more open communications, resolve coriflicts and to reconcile broken relationships e) Reduced potential for abuse of faintly members due to reduction in stress levels fl A less protracted and disabling gneving process, and a sense of completion and closure Communtty outcomes include: a) Lower overall public costs associated with medtcal, hospital, and mental health services b) Lower absenteeism and higher worker productivity from employees who receive support in, and respite from, canng for a dying faintly member c) Lower levels of mental stress in the Communtty due to (1) the availability ofcornmuntty-wide gnef counseling and (2) gnef support training offered to teachers, counselors, social workers, nurses and other health/mental health professionals d) An enhanced sense of Communtty and civic responsibility as the ctttzeiiry collaborates to taking care of their ow•n e) Improved understanding of end-of-life tssues and the unportance of planning for same f) Enhanced understanding of palliative care 4) How will the proposed program empower participants/clients to become self- sufficient and facilitate positive social change? The Hospice program empowers participants to the following ways a) Hospice is aclient-centered program of care that affirms the principle of patent self-determination and autonomy Hospice empowers the pattent by ensuring that the plan of care is specifically tailored to reflect her/his wishes and values, and those of the family b) Hospice teaches faintly members the skills needed for effective pattent care m the home, then supports this regimen of care with regulaz home visits by a registered nurses and by a 24-hour a day on-call nursing sernce as needed Thts empowers the family to remain m control of their own situation c) Reinatmng at home as distinct from being institutiorialtzed is perhaps the single most important way m which patients are empowered d) Patients are empowered through the management of their pain and symptoms e) Hospice provides supportive social services, volunteer support servces, psychological counseling, spiritual care and bereavement support services, all of w•htch help the patient and family members cope with their ever-cttarigtng situation Hospice empowers it clients by helping them to maintain their equilibrium during a very challenging period, and to utilize their own personal capabilities as much as possible f) Patients are empowered and their self-sufficiency is enhanced as a result of the increased mobility permitted by the wheelchairs, walkers, and portable oxygen bottles made available through the Hospice program Mobility outside the home is increased by transportation sernces provided by volunteers Hospice facilitates positive social change by a) Educating the local commumty and allied professionals through lectures and workshops about gnef and bereavement, advance directives, preparations for a death m the family, funeral plaiwng, wills, Hoeprce of HJo 2 County of Hawarr Nonprofit Grant Appltcatran PY 3001-1002 long-term care planning, palliative care and other end-of-I+fe +ssues that help to people do dcal wHh these issues more effectively b) Offenng periodic tratntngs for other health and mental health professionals (such as the local chapter of the Hawaii Nurses Assoctat+on and the Hilo Med+cal Society) through a senes of public education seminars on palliat+ve care and other end-of-I+fe options and +ssues c) Working as an active member of the state-wide coalition Qncludmg the State of Haw•au Executive Office on Aging- University of Haw•an Center on Aging, Saint Francs Intemat+onal Center on Healthcare Ethics and the Hawaiian Islands Hospice Organization) called Kokua Mau (Continuous Care) that +s work+ng to improve end-of-life care through public and profess+onal education and through advocacy for changes m public attitudes and policies related to death and dying, palliative care, and home care of the dying d) Working to make the dying process a healthy process Although w•e cannot change the fact that people die, hospice can help people to function better in their dally living Even negative aspect such as depression, emotional instability and psychosomat+c diseases are ameliorated by hospice interventions Thts has consequences for employees' sick leave e) Providing in[emship oppoitunities for Master of Social Work students and BSN nursing students at the University of Hawaii at Fltlo and the Johns Hopkins School of Medicine B. Problem /Need: 1) What is the problem/need the proposed program is designed to meet? Patient needs include the need to a) Accept a change to the focus of medical care from curative to palliative (comfort) care b) Control pain and other symptoms c) Maintain physical health for as long as possible d) Remain as self-sufficient and autonomous for as long as poss+ble e) Maintain a positive mental attitude f) Settle personal affaus g) Ftnd spintual comfort h) Avoid isolation, enjoy a sense of inclusion and belonging Family needs include the need for a) Guidance and instrnction to cantig for the dying person b) information about, and roferral to, other sources of support in the community c) Assistance in feeding, bathing, moving and comforting the patient d) Respite from the ngors of providing care to the pattent e) Emotioiial and sptntual support in dealing with the impact of loss, and bereavement support following the death f) Guidance m handling practical issues before and after the death (e g advance diroctives, wills, funeral anangements, death certificates, social secunty, firtanctal management), Community needs tnclude the need for a) Compassionate, clientcentered, home-based end-of-life care Today, over ZO% of our people still die in a hospital Governor Ben Cayetano has noted that " tt is cntically important to indrvtduals to control every moment of their Itves up to the final days " As the Governor's Blue Ribbon Panel on Living and Dying wrth Drgntty noted in their June 1998 report, "We told the governor 'dying has not bcen managed as well as it could be The evidence of overtreatment is compelling ' We made a strong unanimous recortimendation for hospice care where oveitreatment is rephtced by palliative care armed at presernng comfort aitd dignity for dying patierits" Horp~ce of Hilo 3 Coumy of H~wu~ Nonprofit Onnt Appliuuon FY 3001-7007 2) Who is the target population and what are the specific needs? The target population includes a) Any person who is diagnosed by a licensed physician as having a terminal illness and a prognosis of 6 mon[hs or less to Itve. w•ho is no longer seeking curative treatment for the illness, w•ho has an identified primary care giver, and who resrdes within our servrce area b) The families of such pauents c) Members of the commumt~-at-large w•ho are grieving the death of a loved one d) Members of the communtn-at-large who are tn[erested to leamtng about death and dying the Hospice program, and/or end-of--life issues e) Alhcd professionals interested m improving their skills m dealing with dying and/or grtc~mg pauents The needs of the pauents, family members and the community-at-lazge are detailed to Section B(I) above 3) What is the geographic area(s) to be served, and hours of operation? a) Our service area includes that portion of the Island of Hawazt between Laupahcehoe Point and South Point Road, an area of 2,184 square: miles b) Our facility is located at 101 I Watanuenue Avenue to Hilo Office hours are 8 00 a m to 4 30 p m Monday through Friday Our nursing staff is available 24 hours a day, every day C. Collaboration /Coordination: 1) What specific measures will be taken to collaboratdcoordinate with other community resources to achieve maximum program efficiency and cost effectiveness? To assure that the needs of our clients are met to the most efficient and cost effective manner, Hospice staff are actively involved to coordinating services with other wtitmuntty-based programs including County of Hawatt Office of Aging, Coordinated servtces for the Elderly, servtces for Seniors, Setuor Helpers, Btg Island AIDS Project, Case Mariagement Coordtttated servtces, Hawau Island Adult Caze, American Cancer Society, County of Hawaii Nutrition Program, Home Health servtces, Legal Atd and DHS Adult Protective servtces Our contractual arrangements with Kokua Nurses for the provision of Certified Nurse Atde servtces, and with Htlo Medical Center for provision of to-house hospice servtces, ensure maximum program efficiency and cost-effectiveness As a member of the Hawau Islands Hospice Organrzatton (HII-IO), an alliance of all the hosptce programs to the State of Hawau, we are sharing the evaluation of a Patient Data Collection System and compliance procedures required by Medicare We tiro exploring the feasibility of sharing staff, data inarragement systems and other resources We are also collaborating with over hr;o dozen other Btg Island nonprofit agencies in the Create a Living Legacy initiative to promote support of chartable programs through wills, trusts and estate Plane 2) How will these measures reduce or eliminate any existing duplication of services to your designate target group? No other agency to East Hawatt is specifically designed and operated to provide comprehensive hosptce care for the tei•mttially ill and their families Although we coordtrtate with allied cornmuntty organtrations to ensure a continuum of care for our designate target group, there is no duplication of servtces as such Hospice or Hdo 4 CoumY of H~wu Nonprofit Grim Appl~cWan FY 1001-100] D. Goals and Obrectrves: 1) What are the major goals/benchmarks of the proposed program? 2) What specific objectives/acttan steps are planned for each goal? 3) What is the timeline (start and end dates) for each action step? Goal #1: Improve the projessronnl competence ojstnjfbv sendrng our Execrrrrve Drrecfor or Clrnrcal Drrecfor ro the Natronnl Hosprce and Pallratrve Cnre Organrzatron Senror Manngement & Leadershrp Conference .September 21-16, 2001 Oblectrves a Obtain funding for registration, travel and accommodations (Start Jamrarv 100! End August 2001) b Register Executive Drrecfor for the Conference (Start: End Julv 100// Goal #2: Improve projessronnl competence ojstajf by co-sponsoring the Apn[ 1001 Hosprce Foundntron of Amenca National Bereavement Teleconference at UHH Objectives a Obtain funding for the teleconference [Start January 200( End August 1001) b Apply to be a Teleconference Stte [Starr November 200! End December 2001) c Prepare and disseminate educational matenals (Start January 1002 End February 2001) d Enroll Hosprce of Hdo clinical staff to attend the teleconference (Stare%End March 100lJ Goal #3: Improve professional competence of staff by sending four RN Casemanagers to Pam Management Conference led by Margo McCaffery, RN, MS, FAAN, an mtemationally recognized consultant in the nursing care of patients with paui, and co-author of Pam Clinical Manual, in Honolulu, HI, September 28, 2001 Objectives a Obtain funding for conference (Start January 100/ End August 2001) b Register RN Casemanagers for conference (Start/End August 2001) Goal #4: Ertsure efjedive pain and symptom management ojall Hospice ojHilo patiarts Objectives a Estimate outlier costs for pain and symptom management for the penod July I, 2001 through June 30, 2002 (Start/End January2001J b Obtain community funding to partially cover estimated outlrer costs (Start Jnnuary 100/ End August 2001) c Procure medicines and other treatments for the management of pain and symptoms for those instances in which actual costs exceed budgeted reimbursement rate [Start July 200! End June 2001) Ho~ptce of Hdo 5 Camrty of Hrwu, Nonprofit Onm Appltca4on fY 1001-]003 4) What significant client-centered outcome(s) will the program achieve? Include rn your answer how many participants/clients will: (a) Attatn at least one personal program outcome; or (b) Show measurable progress towards your program goals. a) 90%of client famtltes who respond wdl evaluate the hospice program as "good-to-eecellent" m terms of managing the patient's pain b) 90°%of client famtltes who respond will evaluate the hosptce program as "good-to-eticellent" m terms of managing the patient s symptoms c) 90%of client famtltes who respond will evaluate hosptce servtces as satisfactory d) 90°%0 of phi stctans who respond wdl evaluate hosptce servtces as satisfactory E. Service Delivery: I) What methodology will be used in the proposed program's delivery of service(s)? The methodology utilized to the hosptce program is Inherent rn the hosptce model of comprehensive care The principal components of this model are a) AssessmenUScreenin¢ An assessmem of the patient's medical condition, psychosoctal status, faintly support system, financial, legal, nutritional, sprnttial and other needs rs wnducted by the RN Casemananger and the Medical Social Worker The assessment also evaluates the array of support needed by faintly members to effectively cope with their situation b) Plan of Care Under the direction of the Hospice Medical Director and/or the patient's personal phystctan, acltent-centered, palliative Plan of Care is developed based on the initial assessment and on Input from the patient and faintly regarding their wishes and values The Plan of Care is updated continuously as the condttton of the pattent and/or faintly changes c) Case Manattement Our staff of specially trained RN Casemanagers. in conjunction with the patient's Primary Caregiver, Implement the Plan of Care in the patient's home, carefully momtonng the patient's condttton and providing constant Iratson with the physician(s) Nurses make scheduled visits to the home and are accessible 24 hours a day as needed Certified Nurse Aides provide assistance with the patient's personal care Therapists (physical, speech, art, occupational and dietary) are scheduled as needed d) Social Work/Counseltn~ Our Itcensed Medical Social Worker provtdes social work servtces and counseling servtces to pattent and faintly as needed e) Volunteer Support servtces A corps of specially trained volunteers, under the dtrectton of our Coordinator of Volunteers, provtdes an array of supportive servtces to the pattent and faintly Including personal care, compantonshtp, transportation, respite care, housekeeping, etc E) Sptntual Care Wtthrn the hosptce model, Sptntual care is not necessarily regarded as synonymous with religious or pastoral care Many people regard themselves as Sptntual even though they are not affiliated with any relrgtous organization or have any particular religious training or doctrinal beltefs The arm of Sptntual care within hosptce rs to facilitate the expression of the client's Sptntual beltefs, to support the client's exploration of meaning in their life and beyond, to encourage participation to meaningful rituals, and to assist the cltent to come to a point of reconcrliatron, completion and peace with herself/himself, with others and with God or Ultimate Reality as they perceive [t g) Bereavement Counselinna A Masters level counselor, assisted by specially trained volunteers, provtdes grief wunseling to hosptce faintly members for up to one year after the patient's death Counseling is also offered to the cornmunrty-at-large who are grieving the loss of a loved one Counseling can consist of individual one-on-one sessions and/or support group meetings h) Interdisci~narv Coordrnatron The members of the lnterdrsctplrnary Team meet weekly to review cases, update the plan of care as needed, and coordinate interventions among the staff i) Residential Hosmce Care For those patients without an adegtrate caregiver system, we are seeking to establish a residential hosptce care program at Hilo Medical Center The residential hosptce care program would be staffed by Hospice of Hllo nurses, social workers and spintiral/bereavement counselor (Note residential care is distinct from respite hospice care and acute hospice care, both of which are also provided at Hrlo Medical Center) Horyice °(Hilo 6 Cg1Ny of H~wu~ Nonprorit Cant Applianm FY 2001-1007 F. Evaluation: l) What process will be used to evaluate the program and service(s)? a) Follow•tng the death of each patten[ the attending physician completes a Discharge Summary that includes an evaluation of the hosptce servtces rendered b) Following the death of each patten[ each hosptce faintly is asked to complete a !'omrly Evnlunrron ojHosprce l'rogrnm Outcomes form (See attachment) c) Following the death the Interdisciplinary Team (IDT) of hosptce chmcal staff assess their own results b} completing the /DT Evnlirarron ojHosprce Program Outcomes form (See attachment) d) A Central Pathtta}'s Commtttee of staffconGnually monitors program quality standards e) The Hawaii Department of Health Medicare Certification Officer conducts periodic on-site mspecUOns f) The Agenn Pantctpatton and Allocation Commtttee of Hawatt Island United Way evaluates the program annually HIUW member agencies are novv required to identify specific program outcomes and measurable outcome indicators 2) How will this process measure the outcomes specified in Item D, (1-4)? Quarterly benchmark reviews will measure whether the stated program ob~ecttves detailed m Items D(1-3) are being met Data from the Faintly Evaluation of Hospice Program Outcomes form and from the lDT Evaluation of Hosptce Program Outcomes form will be compiled on an ongoing basis At the end of the year all of these data will be summanzed to measure the client outcomes identified to Item D(4) G. Program Fees: 1) Does your organization charge a membership fee for service participants? No Hosptce of Htlo has no membership fees 2) Does the proposed program charge participants a fee for service(s) provided by your organization? No Hosptce of Htlo's servtces aze provided at no cost to the patient or faintly Our pnncipal sources of revenue are Medicare and pnvate medical insurance No pattent is dented admission or core servtces even tf not covered by such insurance programs H. Viabili 1) What is your justification or rationale for the a:penditure of public funds for the proposed program? a) The federal and state governments have already recognized the logic of expending public funds for hosptce care through the Medicare and Medicazd programs b) In their Fuial Report, the Governor's Blue Ribbon Panel on Living & Dying Wrth Dignity recommended "that Hosptce care be triode more available and offered more expediently to the dying " The Panel sought "support to change policies, both administrative and legislative, to facilitate good palliative care " The program of Hosptce of Hilo is congruent with the Panel's recommendations acrd publtc policy ob~ecuves c) Although histoncally death has been seen largely as a pnvate matter in our society, we are coming to recognize that how people die has profound public significance Every death affects the whole As a civil society we can reasonably expect that our terminally ill citizens be afforded the opportunity to meet death in a dignified and peaceful manner No one should be denied the nght to a good death, regardless of his or her status or ability to pay Hosptce of HJo Coumy of H~wu Nottprofit aunt Appltcnton FY 2001-1002 d) The bonds of community are strengthened through public and pnvate mniatives that ensure the possibility of dignified death to all The public has an interest m strengthening the bonds of community e) Families are strengthened through hospice programs that support and empower them in the process of caring for a dying member The public has an interest in strengthening families f) Medical costs are significantly reduced when d}+ng people are provided hospice care at home The public has an interest in reducing such costs g) Working families are able to continue working ~~hen they have hospice help m caring for a dying member The public has an interest m maintaining the productivity and eammg power of its citizens h) The emotional health of families is safeguarded ~~hen hospice and grief support are provided The public has an interest In maintaining the mental health of its citizenry 2) What are your financial and programmatic plans to sustain the proposed program beyond the upcoming fiscal year? Financial plans to sustain the program include a) Reimbursement for services from private health insurance programs, Medicare and Medicaid b) Hawaii Island United Wav annual allocation c) County of Hawaii Non-Profit Grant d) Combined Federal Campaign annual allocation e) Fundraising events including (I) annual Friendship Mazling, (2) Light Up A Life, (3) Homes For the Holidays, (4) Chanty Walk, (5) Cookbook sales f) Donations and Memorials g) An on-going cost-review and cost-containment program h) Solicitation of in-kind goods and services Cont+nued development and implementation of a Planned Giving, Ma)or Gifts and Endowment program Programmatic plans to sustain the program Include a) Expand our patient census through a sustained marketing program targeted to physicians, nurses and the general public b) Maintain a strong volunteer base through an on-going program of recruitment, trawng, motivation and development c) Improve the professional competence of our staff through external training courses and In- house In-service trauung seminars d) Expand our community outreach In the areas of public education, bereavement counseling and professionaleducaUOn e) Develop a residential hospice component of our program I. Budeet 1) Complete the attached Budget tables [See Budget Tables 2) Provide appropriate attachments, as Indicated [See Budget Attachments] - Hoiptce of Hdo $ cwmy of Hawn Nonprofit Gram Appl,nnon FY 2001-3001 II. ORGANIZATION / AGENCY INFORMATION A. Board of Dtrectors 1) Has the organization's Board of Directors received formal training within the past two (2) fiscal years? Yes, the Board of Dtrectors participated in the following formal tratntngs (See Narrative Attachments for specifics) a) Long Range Financial Forecast conducted by CPA Ann Fukuhara, August 24, 1999 b) Essenttals of Successful Boards, by Newton Chu and Steven Bader, January 22, 2000 c) Essenttals of A Successful Hospice of Hilo Board, b~ Steven Bader, May 16, 2000 d) Planning ObJectives of the New Hilo Medical Cen[er CEO, by Ron Schurra July I I, 2000 e) Fund Development A Bnef Overview, by Ron Hart, November 2l, 2000 f) Orientation for new board members, by Brenda Ho and Ron Hari Januan• 16-19, 2000 2) What are the rime roles and responsibilities of your organization's Executive Director? a) Overall Management and Admtntstratton including (I) formulauon of goals, obJectives and procedures, (2) compliance with laws and licensing certification, (3) Quality Assurance, (4) program development b) Financial Management including (1) develop annual budget, (2) oversee collection of receivables and disbursement of funds, (3) oversee audit process c) Personnel Administration d) Community Relations/ Community EducaLOn e) Fund Development 3) What are the rip marv roles and responsibilities of your organization's Board of Directors? (Clarify role of executive officero vs. general membership) a) Executive Officers: -[lie Executive Cornmtttee of the Board oversees the operation of the board, sets the agenda for board meetings, makes intenm decisions as necessary, as serves as a resource to staff m key platimng strategies b) General Membership: The board as a whole is responsible for (1) oversight of agency, (2) defining the vision and mission of the agency and setting goals and policies, (c) appointing and evaluating the Executive Director, (d) mid- and long-range strategic planning, (e) representing the agency in the community, and (f) fimd-development B. Past Performance 1) How effective has your otganization/sgency been in achieving program goals in the past two (2) fiscal yearo? Include the following information: a) Quantitative data on numbers served. 1999 2000 Hosptce Patients Servt~ 175 170 Household Members Served 428 340 Hospice Volunteers Tromso 41 22 Cottimumty (non-hospice program) Gnef Cirents Served 138 l76 Commumty Education provided on End-of--Life Issues 461 576 Hospice of Htlo 9 Cautny of Hswui Nonprofit dent Applwa0on FY 2001-1003 b) Qualitative data showing number and % of participants achieving measurable outcomes: 1999 2000 Number / Percent Number / Percent Client Satisfaction with Pam Control 62/64 96 9% 65/71 91 5% Client Sattsfactton tth Control of Other Symptoms 64166 97 0% 70/77 90 9% Cltent Satisfaction with overall Hospice Services 84/84 100 0% 80/80 95 2% Physician Satisfaction with Hosptce Sen•ices 12~/l25 l00 0% l00/l02 98 0% C. Financial: 1) Have your organization's current program operations remained the same as last year? What major program or financial changes will occur next year? In terms of the types of patient services provided, our program operations reinamed the essentially the same as the previous year In 2000 we expanded our efforts in the area of public and professional education on end-of--fife issues While the number of patients served remained essentially the same (175 in 1999 vs 170 in 2000), the total number of patient~ays increased) by L S% (from 9,261 pattent-days to 1999 to 10,660 pattentdays in 2000) In the coming yeaz we anticipate that the number of hospice patients will remain more or less stable, while the number of patient days will increase due to earlier referrals by physicians, due in part to our efforts to educate physicians about the need enrolling patients m hospice Barber m their disease process 2) What is the status of all of your oiganization's major contracts or agreements for the coming year (employment agreements, office leases, primary grant revenue/supplier, etc.)? a) The ina~onty of pattent care contracts are automatically renewed from year to year b) The biennial contract with Hilo Medical Center to provide hospice in-pattent acute care and hospice m-patient respne care w•as renewed m October 2000 c) We are currently in the final stages of negotiating a contract with Hilo Medical Center to designate 2 beds as permanent hospice residential care beds These will be in addition to acute care and respite care beds 3) How does the proposed program fit into your organization's long range financial plan? The comprehensive hospice program described in this application is the sole program admimstered by Hospice of Hilo This is the only program for which funding is being proposed Our orgaiuzation's long range financial plan is essentially a plan to maintazn and expand this program See Item H 2 above for a more detailed discussion of our long-range financial plan D. Monitorina• 1) During the past two (2) fiscal years, what financial and/or administrative monitoring has your organization received from any and all funding sources? Please list all monitoring soureea, contract names and phone numbers. a) Hawaii Island United Way, Helen Hemmes, CPO Phone 935-6393 - E. Alcohol, Tobacco and Drv¢-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? As stipulated in the Employce Handbook, smoking is prohibited on the premises of Hosptce of FLIo except m designated arras Staff and volunteers are also prohibited from smokmg m patients' homes or wlulc transporting patients It is forbidden to introduce, possess, use, or report for duty under the influence of any intowcating liquors and/or illegal drugs EAP sernces are available for assessment and referral for drug and alcohol problems Hospice of Htlo I Q C°unty of Hawui Nonprofit Gn,n Appl~c~don FY 2001-3003 NARRATIVE ATTACHMENTS i Tire Cast Itawau Ilcalth & Ituman Semces Council and liawail Island l;nited Way ..Proudly ~ Present. 'f~~1 ~ 1 lil~~j'; 1 ~ ~ YA~ ~fL~01L ~ 1 1-Si~01~1 i ~ Saturday, January 22, 2000 at the ~ UH-Hilo Campus Center - Marriot Dining Room 200 West kawili Street -Hilo, Hawaii 96720 volunteers and staff (or non-profit organizations are encouraged to attend a seminar on Board development. We are excited to offer these workshops with such outstanding and Nighty experienced presenters: Steven Bader - is the Faecutive Dtredor of the East Hawall Coalltlon for the Homeless. Prior to assuming his posltlon Mr. Bader worked as a Development and Organlzatlonal PIarNUlg OCicer with the Hawaiian Chinese Museum N Honolulu. Since returning to Hawaii he has provided board development training to over I5 non-profit organizatlons. He is a WeLtberg Fellow, and recently Joined the board of dtrectors for the Downtown Improvement Assodatlon in Hllo. •i Newton Chu, Fsq. -Director (Partner) of the Firm and Managing Attorney, Hilo o®ce of Torktldson, Kam FonBeca, Jaffe, Moore ~ Hetherington. Mr. Chu's pwctlce indudes general business/corporate lew, labor and employment law representing management, Iltlgatlon and immigratlon law. Mr. Chu serves as general counsel (or numerous dosely held companies on the island of Hawaii. I Workshop Agenda: Mall/FAX Reglstratlon form and Payment to: ~ 30 - g:oo am - Registratlon YWG of Newell Island s.00 - 9:45 am Session I Fssentlals of Successful Boards Break - (IS Mtn.) 145 Ululanl St. 10.00 - t 2:00 Session 2 Hilo, Hawall 98720 12.00 - Workshop ends Phone: (808) 935-7141 FAX: (808) 935.5150 Fee per person: S to.oo Repaatlon roan br •FSSentlris of Successnil 9ouds• Name of Organization reprt~enting Name of person attending Job Title For (ImfJal Use Onfy: # Attending X S 10.00 =Total amount Due S Date Recd: Recpt. # Check # Recd By: Hospice of Hilo Board Training Module: Fund Development Program I. Components of an integrated fund development program. A Afully-developed fund development program typically integrates the following three components I Annual Giving. This is the primary fund-raising method used to broaden support, upgrade giving levels and provide operating support on a regular basis for ongoing operations 2 Capital /Major Giving. Capital gifts are gifts for specific capital needs or protects, and are typically executed within a specific capital campaign time period Major Gifts may be gifts for ongoing operations or for specific protects, and may be solicited/given at any time The definition of what level of giving constitutes a "mator" gift varies from organization to organization Capita(/ Major Gifts may be paid in a lump sum or paid in installments over several years 3 Planned Giving. Planned Gifts are grfts based on financial and estate planning using legal instruments such as wills, annuities, trusts or life insurance and are typically deferred until a specified time (e g the demise of the donor) B These three approaches to charitable giving can be depicted as the "Pyramrd ojGrvrng" Estate or Planned Giving Gifts, typically from Individual Donors Given via Bequests / Ttust /Insurance Capital /Major Giving Major Gifts from Individuals, Corporations & Foundations For Capital Campaigns, Endowments and/or Current Operations ANNUAL GIVING Gifts of any size, typically from individuals to support core operations Annual Fund Drives, Fund Raising Events, Memonals & Donations, In-Kind Gifts, United Way Allocations, Combined Federal Campaign, Government Grants, etc toizvoo i C The appropriate mix" of these three fund development approaches vanes, depending on the needs of the organization D Most organizations beg+n with annual fund raising to meet immediate operating needs As organizations develop additional needs, they may ask donors to help meet cap+taUmalor needs in addition to operating support Finally, as donor files become more extensive and relationships are solidified, donors become more interested and willing to make larger planned (deferred) gifts from their estate assets E Act+ve +nvolvement and panic+pat+on by the Board of Directors +s cr+t+cal +n all three fund- development approaches II. Sources of Funding. The principal source of funding for Hospice of Htlo is third party reimbursements from insurance providers such as HMSA, Kaiser, and Medicare Reimbursement rates are set by the Health Care Finance Administration (HCFA), the federal agency that funds Medicare Currently our regular reimbursement rate is $ l 1 1 00 per patient per day All of our personnel expenses and patient care expenses (medications, equipment, medical supplies, acute care, respite care, etc) theoretically are to be covered by these reimbursements ff fact, the amount we receive from third-party retmbursements covers only about 80% of our operational expenses Consequently we have instituted a fund development program to raise the additional 20% from other sources In addition, Hospice of Hilo is currently in the final phases of a 5-year $2 3 million capital campaign for construction of the facility at lOl l Waianuenue Avenue (Pohar Malura a Harry Jeanette Wernberg) The pnncipal sources of funding (other than and party reimbursements) are Hawaii Island United Way Allocation Annual Gtvtng Hawaii Island United Way Designated Gifts Annual Gtvtng County of Hawaii Nonprofit Grant Annual Giving Combined Federal Campaign Allocation Annual Grvtng Hotel Industry Charity Walk Annual Giving Homes for the Holidays fundraiser Annual Giving Light Up a Life fundraiser Annual Gtvtng Annual Friendship Drive Annual Gtvtng Memonal Gifts Annual Gtvtng Unsolicited Donations Annual Giving Capital Campaign (OlaMe Ka Ha aheo Ltfe with Dignity) Capital / Mayor Giving Planned Gifts Planned Giving [II. The Fund Development Function The ultimate responsibility for ensuring the financial health and viability of the organization rests with the Board of Directors (The chief responsibilities of nonprofit boards are typically defined as (l) Oversrght, i e ensuring that the interests of the community are safeguarded by overseeing the legal, moral and cost-effective operation of the organization, (2) Gurdarrce, i e establishing the organization's vision, mission, policies and procedures, (3) F~ducrary, + e ensuring that the funds toizvoo z and other resources of the organization are used and invested appropriately and are appropriately accounted for, (4) Srrntegrc P/annurg, i e analyzing the dynamics of the environment m which the organization operates, and developing plans to position the organization to effectively respond, and (5) (arid Derelopmern, i e ensuring that the organ¢aUOn has sufficient financial resources to operate effectively) The Board hires the Executive Director, who is responsible for the day-to-day administration of the organization, including implementation of the fund development program This does not mean, however, that the board simply delegates the fund development function to the Executive Dtrector Rather, both board and staffhave important roles in this regard IV. Fund Development Roles and Responsibilities of Staff and Volunteer Board Members A Chief Development Officer (CDO) /Director of Development 1 The chief development officer typically has responsibilities delegated directly from the Chief Executive Of;:icer (CEO) and is the principal planner and manager for development 2 The CDO is responsible for ensuring that development activities happen in a timely, efficient, cost-effective and ethical manner 3 Provides guidance, leadership and support to staff; board, donors and the community regarding philanthropic giving 4 Typically serves as a member of the institution's senior management team 3 Helps to orient and train board members and other fund raising volunteers regarding fund development, donor cultivation and solicitation Axiom "The fast task oJa development offrcer every srngle day rs to empower a volunteer board member " 6 Assists boazd members and other volunteers in making appropriate calls and delivering appropriate messages related to fund development 7 Provides feedback to board members and other volunteers on their fund development performance 8 Established donor data base and other related information systems 9 Develops educational and prospecting materials B Chief Executive Officer (Executive Dtrector) 1 Develops fob description for the chief development officer 2 Recruits chief development officer 10/22/00 3 3 Provtde tratnmg opportumues, resources, support, gwdance, supernston and evaluation for chief development officer 4 1\4akes htmself•'herself available to make calls on mayor prospects 5 Keeps staff and volunteer boar members focused on tasks that support the vision and fund development program of the organization 6 Evaluates the fund development program C Volunteer Board Members and other Fund-Raising Volunteers 1 Agree to fund raising ttme/task commitments and fulfill them 2 Keep fund-ratstng tnformatton confidential and ensure that Itsts of donors and prospective donors do not travel on to their next "event" or another agency 3 Rectutt other volunteers to serve in fund-development capacities as needed 4 Assist to identifying and qualifying potential donors S Open doors to prospective donors (individuals as well as corporations and foundations) Axiom "In [he anal people gyve to people, peers gyve to peers " 6 Asstst with cultivation of prospective donors 7 Provtde insight and counsel to staff and others regarding the ways the organization is perceived in the community at lazge 8 Provtde tnformatton about community trends and issues related to fund development 9 Attend fund development related meetings/events 10 Exhtbtt enthusiasm and passion about the issues/problemstha agency is confronting I 1 Support the agency with contnbutions, as they are able Axiom" "There are no more effective jurrd raisers than committed i~lunteers who have pledged themselves sacrificially Rarely will a staff person enjoy such effectiveness " l2 Prospective donors (individual, corporate and foundation) typically ask about the giving record of the Board of Directors Such prospecttve donors are interested to know whether 100°/a of the Board has made an annual contribution each year and what percentage of the Board has made a capital/major or planned gift Adapted and condensed Gom the National Society of Fund Raismg Executives Survey Co~~ on Fund Ra~ma_ Rcvtsed 1999 Edmon lo[2voo BUDGET TABLES i ~ i a s N C W i o~~ ~ ~ ~ N ~ O ti S ~ N Q F m LL W ~ u V y H H ~ LL e O ~ m C N C ~ Q R a°'g 8 $ ~ W = m N `C r1 O~ p~ Z ~ u O W O~ V1 \ i/1 ~ ~ F N ~ 3 F ~ ~ c ~ U y Q ~ W ~ U It1 ~ 4 E a > ~ S~$ W J 7 ~n ~o y Q ~ y an y fib W _U ~ ~ W Z LL ~ c° 2 m N Z u L > u a YY a F aW W 3 0~ ~ O O O O W ~ ~ N ,p ~ ~ ~ ~ ~ ~ O~ 7 „ y a F LL F O F ~o F ~ F a F v1 F v~ J M r ~ ~ ~ ~ ~ N ~ N ~ u 3 F e Y W ~ C D ~ ~ ~ E < i ~ N N Co O ~ • r . `n . w . w . w . r ~ P7 m ~ N a o ~ H d u y ~ a N d ¦ Ca0 W ~ W ~ 1~d p y~ ~ '~8 F 'r' c 6 O H V 7 H d q O 61 Zp ~ Z p~ ~ Y G Q O O Ov0 Z t O OF O Y > .ppa M ~ W O ~ ~ L° f' to W R ~ H CI u ~ ~ fN l,,o- m °c_ Q a ~ 'ri u V Y H p N ~ W ~ ~ ~ W U A U ~ ~ Q N rv p ° A = ~ ~ a u A " ~ ° ~ _ ~ ~ Q O > Z F- Z F- Z F Z Z H Z f- Z y f" U J U Q ~ f F- ~ Y i ~ N l+f V ~f1 t0 1~ Q O Z -1---7- - - i -1--~ ~ - ~ I~ ~ ~ i i i u N c ~u O I ~ ~ 0 o N ~ ° O o l•7 a a ~ ~ W a`ap I ~ W } amN i C 4 J o LL _ N Q ~ U ~ d n M H a ~ LL ~ ~ I C ~ ~ O • Q ~ W 5 m~ ~ ~ d ~O O O ~ a , GO ~D O~ ~D ~~DD N Y Q ~ " ~ N F N F ~O F d F F F e•1 Z W N W N W P4 N W W d W ~ 3 H c n U 4 ~ w ~ E ° r Q e LLI n a > } o° v ~ n ° 0: d ~ $ ~ `o y Q imp ao .a U ~ ~ $ Z y ~ ~ 2 W W ~ c J O C7 uu m H Z x Q W 0 Nt' H d W o~o O O $ O $ d O W 7 m •^i ~ v1 N v j d ~ ~ ~ ~~r \ ~ p ~ ~ ~ ~ Q W W W O W 74 c 3 - a G ~ ~ • > > L a E ° i m y e m w ~ [ o m • N N ? N • H • N • N M N r T~~ m LL p < o w J1 W M o n ~ r01 E V = ~ ~ F- ~ a W C v u J a y w u m u u b ~ ~ a o F- tp W Z d a'ai m ~0 u d h_ a q g N F- Z d , W ~ it S b +i R N < ~Cy~ y W Q O i PC 'L' .L' N Q p~ - •V H (7 u u u u u u u f ..1 Z D: O = o n_. A ro ~ = A b ~ y O Y ~ Z ~ Z H Z ~ Z F- Z F- Z F- Z ~ U Z Q 5 W . . . . ~ O n U u a 0) O~ O .r N t•1 d Q .r ..n F z - ~ - I ~ i i o ` I I I a°~ ~ I I I oe~ I I I _ a ¢ ° ° I O ~ W I I I I ~ I O I N e rv o ~ ~ I a o uo = i W a` 00 0 W } Q m N Q I a ~ ~ r d al w ~ a IL - rv ~ c' C O 3.1 op0 V ~ O n H W ~ m N Ifl v1 N L d O~ 01 ~ y Z ~ LL ~ ~ ~ ~ ~ ~ W U D ~ ~ 3 ^ u F c n U ~ U W ~ E ~ a N a U ~ • ~ ` ~ o ~ ~ ' u ~ Y 6~ 0 ~ O y ~ • m ; G N J V ~ LL c 7 r Z y y 7 'L ~ V 6 C V V tay Z > Y ~ LL Cl Q~~ O v01 v01 f0 N m N ~ n n J ~ ~ W P\4 d h\i ~ W ~ W D ~ ~ ~ ~ ? 3 F V1 u c ~ W y 6 Q L N r ~ w t i L • ~ fA ~ N ~ v W P'I C ~ C O m v e~I • N ? H ? 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O O O Q C O O O O O O Q N N O v NI ~ u'1 ~O M J U V u _y ~ O LL u m R' ~ O O C O ~ w O O O f a ~ a z U W O 0: ~ d W O r O a U ~p 2 m W LL O J O ~ i u m Y ~ u Q ~ F c H ~ ~ ^ V y ~ o ~ e e = E L G a g g o g A ~ c 00 O O O ~ Q O N p u W u , `d n e+1 V~ ~O O c m p d ~ .may ~ .~.i .Q O N N v: v o ~ ~ u u W ti H O u d A n u n 0 q ~ W N ~ V v W 2 ~ 'c Z O ~ u W 7 Q VO! ? ~ y W m N W H u 5 ~ 2 ~ 'n o $ ~ E _ J ~ = c (7 ; n ~ ~ 'q7 i u ~ ~ v d ~ 7 O V ~ > > n C ~ ~ o T Y @~ r~ O Y ~ ~ = 4' LL 3 O C H G o0 .rd d @ ltl F- i U ~ o ~ 'v ~ ~ ~ y ,o = ~ o W W CJ U N li L ~ Q 0 ? d ~ Vl f- .7 O Q BUDGET ATTACHMENTS Budget Attachment A STAFF DEVELOPMENT FY 2001-02 Grant Request Financial Table No. Budget Item Projected Expenditure 1 National Hospice and Palltattve Care Orgamzatton Senior Management and Leadership Conference 2001 (Executive Director or Clinical Director) Table 3, Item 10 Airfare $ 800 Table 3, Item 10 Per Dtem $ 200 Table 3, Item 14 Registration $ 500 Table 3, Item 14 Hotel Accommodations $ 500 STAFF DEVELOPMENET GRAND TOTAL $2,000 Hospice of Flilo County of Hewan Nonprofit Gtaru Appl~puon E'Y 2001-02 01/30/01 Budget Attachment B OUTLIER EXPENSES FY 2001-02 Grant Request Financial Table No. Budget Item Projected Expenditure Table 3, Item 2 Durable Medical Equipment $2,000 Table 3, Item 2 Medications $7,000 Table 3, Item 2 Patient Services $2,000 Table 3, Item Patient Supplies $2.000 OUTLIER EXPENSES GRAND TOTAL $13,000 Hospice of Hilo County of Hawau Nonprofit Grant Appl~canon Fl' 2001-02 01/30/01 Budget Attachment C GRANT REQUEST SUMMARY I Staff Development $ 2,000 2 OutlterExpenses $13,000 TOTAL GRANT REQUEST $15,000 Hospice of Htlo County of Hawazr Nonprofit Grant Appltcatron FY 2001-02 OI/30/OI FINANCIAL QUESTIONNAIRE Stephen K \'amashtro H a+T7 A Takahashi ;Navor Director COUM'Y Of ii~kllll~l'1 DEPARTMENT OF F[NANCE 25 Aupum Street, Room I I B Hilo, Hawsu 96720A252 (808)961-8274 Fac (808)961-6248 HAWAII COUNTY NONPROFIT GRANTS (FY 2001-02) FINANCIAL QUESTIONNAIRE Please include as an attachmrnt an explanation for all "NO" answers to questions # t thru # L l below Yes No ® ? I Has the agency operated continuously for the past three (3) years? ® ? 2 Has the agency operated with a postttve cash flow for the past three (3) years? ® ? 3 Does your Board of Directors approve a detailed cash flow budget before the begtnntng of each 5sca1 year tonthly accepted and filed ® ? 4 Do your Board mtxtmg minutes show that t~R firtanctal statemrnts aze appsomedR for audit ® ? 5 [s your egwty balance at least 20% of your Total Lrabthty balance? ® ? 6 Is your Total Ctureat Asset balance larger than your Total Currertt Lrabthty balance ® ? 7 Are bank reconcdtahom end accountwg performed by someone other than the check slgnatory~ ® ? 8. Are you fully Insured for the agency's vehicle(s) and butldutg(s)~ ® ? 9 [s your Workers' Compensation at least 2% of payroll ® ? 10. Are you current (non-delrnquent) on all payroll and payroll tax paymems~ ® ? t 1. Is the agency Cree of any pending Ilttgatton, liens or ludgmrnts? ? ® l2. W tthin the past 12 months, has the agency applied for vrntlor or bank credo and was derued credit? If yes, please explain. As the gmnt applicant, I cerhjy that the agency liar satujactonly responded to each ojthe aboNe questions and erplatned as needed 1 hereby certify that thtr injornwhon is live and correct to the best ojmy biow(edge Agency HOSPICE OF HIIA Pho~ 969-1733 p~~ by Shirley Castro. Full Charge Bookkeeper _ t~19~0/ Pent N~mdrtde Stpanee DNe Certified by Brenda Ho, BN. lIS. B:ecutive Director ~ 18 0 root M.me or Btetub~e Daersor S one CURRENT AUDIT (1999) WITH ANNUAL FINANCIAL STATEMENTS FOR 1998 AND 1999 HOSPICE OF HILO FINANCIAL STATEMENTS FOR THE YEARS ENDED DECMEBER 31,1999 AND 1998, AND INDEPENDENT AUDITOR'S REPORT I i ~ Alex,T. Smith ' ChI:TIFICDPUBIICA000UNTANT 1 1 INDEPENDENT AUDITOR'S REPORT 1 1 The Board of Directors 1 Hospice of Hilo 1 I have audited the accompanying statements of financial position of Hospice of Hilo (a not- 1 for-profit organization) as of December 31, 1999 and 1998, and the related statements of 1 activities, cash flows, and functional expenses for the years then ended These financial 1 statements are the responsibility of Hospice of Hllo's management My responsibility Is to 1 express an opinion on these financial statements based on my audits 1 I conducted my audits in accordance with generally accepted auditing standards Those 1 standards require that I plan and perform the audit to obtain reasonable assurance about 1 whether the financial statements are free of material misstatement An audit includes 1 examining, on a test basis, evidence supporting the amounts and disclosures in the 1 financial statements An audit also includes assessing the accounting principles used and 1 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 1 - 1 In my opinion, the financial statements referred to above present fairly, in all material 1 respects, the financial position of Hospice of Hilo as of Decmeber 31, 1999 and 1998, and the 1 changes in net assets and its cash flows for the year then ended in conformity with 1 generally accepted accounting principles 1 1 ~~o~i c PA 1 ~ r 1 March 3, 2000 1 1 1 / 1 / / OAHU - 2439 FERDINAND AVENUE, HONOLULU, HAWAII 96622 (877) 257-64&1 FAX (808) 951-9527 1 HILO-301 NENE STREET, HILO,HAWAII %720 / • ~ HOSPICE OF HILO ~ Statements of Ftnanctal Posttton ~ December 31,1999 and 1998 • . Assets 1999 1998 Current assets ~ Cash and cash equivalents (Note 1) $ 202,936 $ 235,524 . Accounts receivable, net (Note 3) 215,270 245,993 Grant receivable (Note 4) 1 910 787 Other receivables 1 127 - . Promises to give (Note 1) 1 205 5,621 . Prepaid expenses 5,468 8,063 ~ Total current assets 427,916 495,988 ~ Noncurrent assets ~ Restricted cash and cash equivalents (Note 1) 56,767 9,508 . Restricted grant receivable (Note 4) - 15,000 Investments 3,098 - ~ Restricted promises to give, net (Note 1 & 5) 164,055 277,458 . Restricted security deposit (Note 1) 1,460 1,460 Bwldings and egwpment, net (Notes 1 8 6) 1,846,590 1,910,341 . Total noncurrent assets 2,071,970 2,213,767 ~ Total assets $ 2,499,886 $ 2,709,755 . Liabilities and Net Assets Current liabilities ~ Accounts payable $ 71,064 $ 39,685 . Accrued payroll and related liabilities 34,166 33,904 Advances (Note 7) 6,630 80,000 ~ Total current liabdibes 111,860 153,589 ~ Long-term debt (Note 8) - 185,000 Totalliabdities 111,860 338,589 ~ Net assets ~ Unrestncted Board designated - 20,835 ~ Undesignated 2,331,259 2,340,823 ~ 2,331,259 2,361,658 ~ Temporarily resfncted (Notes 1 & 9) 56,767 9,508 • Total net assets 2,388,026 2,371,166 ~ Total liabilities and net assets $ 2,499,886 $ 2,709,755 1 ~ The accompanying notes are an integral part of these finanaal statements 2 • ~ HOSPICE OF HILO ~ Statements of Activ~t~es ~ Years Ended December 31, 1999 and 1998 • Changes m Unrestricted Net Assets: 1999 1998 Revenues, contributions, and other support Revenues • Patient service revenue (Note 1) $ 1,006,705 S 1,10d,537 Fees from governmental agencies 14,878 11,456 1,021,583 1,115,993 . Contributions Donations 80,626 61,174 Hawau Island United Way 19,310 24 683 Combined Federal Campaign 5,589 6.790 • Beanie baby contribution - 6,500 Other contributions 97 252 105,622 99,399 • Other support interest and investment income 6,286 10,900 Fundraising 50,439 39,214 . Other income 4,429 3,248 61,154 53,362 ~ Net assets released from restncbons (Note 9) • Expenditures under budding campaign - 1,675,379 • Expenditures under restricted grants 17,286 242 Total unrestncled revenues, contributions, and other support 1,205,645 2,944,375 Expenses ~ Program services 1,040,198 973,545 . Supporting services Management and general 145,658 149,588 ~ Fundraising 50,188 68,681 Total expenses 1,236,044 1,191,814 . Increase (decrease) in unrestricted net assets (30,399) 1,752,561 ~ Changes In Temporarily Restricted Nst Assets (Note 9): ~ Contributions restricted for budding campaign, net 37,545 1,191,558 • Planned gwmg restricted grant 25,000 9,750 Merger restricted grant 15,000 - ~ Bereavement restricted grant 2,000 - . Return restricted merger grant (15,000) - Net assets released from restrictions (17,286) (1,675,621) . Increase (decrease) in temporarily restricted net assets 47,259 (474,313) ~ Change m net assets 16,860 1,278,248 Net assets, begmmng of year 2,371,166 1,092,918 ~ Net assets, end of year $ 2,388,026 $ 2,371,166 ~ The accompanynng notes are an integral part of these financial statements ~ 3 I ~ HOSPICE OF HILO ~ Statements of Cash Flows ~ Years Ended December 31, 1999 and 1998 ~ lsss 1ss6 Cash flows from operating activities Cash received from service recipients and governmental fees $ 977,813 $ 1 076,669 . Cash received from contributors 107,848 91,588 Interest and other income received 60,027 53.362 Cash paid to employees (657,434) (582,732) . Cash paid to suppliers (473,210) (599.470) . Net cash provided by operating activities 15,044 39,417 Cash flows from investing activities Purchase of capital additions (5,223) (1 741,939) Change in restricted cash and cash equivalents (47,259) 114.655 Receipt of investments (3,098) - . Net cash used by investing activities (55,580) (1,627,284) Cash flows from financng activities . Proceeds from capital campaign 165,948 1,258,758 Cash received from restricted grants 42,000 9,750 ~ Cash returned from restricted grant (15,000) - ' Proceeds From long-term debt - 300.000 . Payments on long-term debt (185,000) (115,000) Net cash provided by financing activities 7,948 1,453,508 . Net change in cash and cash equivalents (32,588) (134,359) ~ Cash and cash equivalents, beginning of year 235,524 369.883 ~ Cash and cash equivalents, end of year $ 202,936 $ 235,524 ~ Reconciliation of change in net assets to net cash provided by operating activ~ies . Change in net assets $ 16,860 $ 1,278,248 Adjustments to reconcile change in net assets to net ~ cash provided by operating activities . Increase in restricted net assets (64,545) (1,201,308) Depreciation 68,974 27,848 ~ Decrease (increase) in accounts receivable 30,723 (119,725) ' Decrease (increase) in grant receivable (1,123) 401 Increase in other receivables (1,127) - Decrease (increase) in promises to give 4,416 (5,621) ' Decrease (increase) in prepaid expenses 2,595 (4,307) Increase in restricted security deposit - (1,460) increase (decrease) in accounts payable 31,379 (24,421) ~ Increase in accrued payroll and related liabilities 262 9,762 Increase (decrease) in advances (73,370) 80,000 ~ Net cash provided by operating activities $ 15,044 S 39,417 Suoolemental disclosure of cash flow information ~ Non~ash contributions $ 30,103 $ 2,190 ~ The accompanying notes are an integral part of these financial statements 4 0 y 1~ V 1~ 00 O O N O f0 W 01 V I~ Q N 1~ O f0 t~] N 01 O OD Of Q Q y [7 n o r OD V O a N (h O (h Q n N t0 W O aO f~ CO f0 f7 N_ y 01 (O ~O OO O N N 0I aD m r f0 fD N OD N 01 O l0 O O) OO f7 r aD G CO 1~ t7 t~ N (O c7 r M ~ Q f7 ~ cO D1 M ~ r r lD ~ _ O O O (O N N r ~ r y 0I F-w ~ v C [`7 <O t0 N N _N n 10 Cp (7 Of N r N Of r ' OD (O NN N M rn ' M 1 ' N , r ' O U V r' M 7 (O C / T fA W O C / ~ C ~p m O O O Q O O fp 4] ~O r O O f`l N Q i0 r GO th m O y ~ N r 1~ f0 n N f0 (O f0 N M 7 OJ (O O l7 ~ OD f0 O 00 E C O f~u'1 V , v) Qti Q ~O ao/•7 Y7 OONr , P'1 , f7 i0 vi of ui r v r ~i r m i ~ rn r sI 1 y 1 ~ ~ E / n ~p cony O)r NNnQ)RNOI OD c0 ~fiO 10 N E y r~ f~7 n O r N N ~p r l'7 M N O N n O N N 4s ,L„ N O~pp fO ~~~lpp1N fh0 Q V O ~Oth NU7 (O W ~~O aOn a0 00 u'1 y / O~ ~j Z ~ O OiOfON N n , (O fhN V f7N r ~ iON r ~ ~ ~ jp 1 y a`inxv Ma ~ ~ N w vi w 1 ~ ~ rnaonvrn nwaorninnvin rnMrnNn~nao v 1 x ~ ~ NO+~p nMw`c~oMO coor~~ov~r~p .nn N w ~ OOmO)N OINr O M V On Of r Ol N V NdDh , O) ' r+ C rntAm Nnl~t~l~N OfOh QQ Yc7 l~t7NNr (p O O non ao fONr rr~-rr ~ rl ~ In C1 N ~ 1 u. ~ W ~ _o. ~ ~ C en w m _U w ~ ~ t O M CD fD OD ~O~ppf c0 ~O ch N OD OD N N O CO O aD C ~ p ~j V! 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' _ ~C Y cq fD ~ N rr Q r r ~ N (n N ~ O~ r r O. 1 ~ c E N H W U 1 N ~ n OD O r [O r n a0 n M O oD 00 CD 0I Y7 N O1 N N (D ao N E N O W NNW r S ~D ODa iONNn OI~Om.-N W F- W ~ na0 ~n ~n Nt+f 01 ~O~n NC'f 01 t0 .-t+1nO rO~tp ep , , ~ r p~ ~ Y1~ GDOrN r r r0 MAO ~ P'1 al+)[~)fhN O ~ O t y V v~fp fONr r ~ ain= N 1A UU yyy y y~ c C G d N N ~ G ~ c E c m axi ~ ~ ~ ~ N~ ~ C~ H ~ Cg C C p~ N C ~nycaEg'~' m~ ° ~c-~~ cadoEv$ip an yc ~ c}a°xE R c d x ~ d N y'~ o ~ $ ~ o ~ ~ ~i d y ~a ~i~cQ~~~~.N na~m~~~5~1 ~~a c~~`m ~ m c!o a,ng~a m m~ W ~~acio~~3~~~ ~a`4aa~~~~a~~O ~ Hof-a`ama~~> `aSmO w i ' HOSPICE OF HILO i Notes to Financial Statements Years ended December 31, 1999 and 1998 ~ NATURE OF OPERATIONS ~ Hospice of Hilo (Hospice) is a private, not-for-profit organization which began • providing services in 1983 Hospice provides medical, nursing, counseling and other supportive services necessary for individuals with life-limiting illnesses and their ~ families Hospice a certified by the Department of Health as a qualified :vledicaie ~ Hospice Program . Hospice is governed by a Board of Directors, with thirteen (13) and fourteen (14) . members as of December 31, 1999 and 1998, respectively The maximum number of Directors is fifteen (15) with two (2) three (3) year term limits on the elected Directors ~ The Executive Director is appointed by and is responsible to the Board of Directors ~ for the day-to-day management of Hospice • NOTE 1 SIGNIFICANT ACCOUNTING POLICIES ~ The financial statements of Hospice have been prepared on the accrual bans of ~ accounting in accordance with the AICPA Audit and Accounting Guide, "Not-for- ~ Profit Organizarions " 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 include cash held in checking accounts, and in money ~ market accounts managed by an investment management firm. Management believes ~ Hospice is not exposed to any significant credit risk on cash and cash equivalents . Restricted cash and cash equivalents Restricted cash and cash equivalents represents the remaining funds luruted by donor ~ restrictions for grants and the building campaign, and are held in checking accounts, ~ and in money market accounts managed by an investment management firm ~ Promises to give . Unconditional promises to give that are expected to be collected within one year are recorded at net realizable value (See also NOTE 5) Due to materiality, ~ unconditional promises to give that are expected to be collected in future years are ~ also recorded at the net realizable value rather than the present value of their ~ estimated future cash flows. Conditional promises to give are not included as ~ support until the conditions are substantially met ~ Unrestricted promises to give represents pledges from donor designated funds ~ through Hawaii Island United Way, Inc ,and the Combined Federal Campaign ~ 6 HOSPICE OF HILO 1 Notes to Financial Statements, Continued Years ended December 31,1999 and 1998 NO"rE 1 SIGNIFICANT ACCOUNTING POLICIES, Continued ~ Restricted security deposit ' The restricted security deposit represents a security deposit on the land lease (See NOTE 10), held in a joint certificate of deposit between the Department of Land and Natural Resources, and Hospice The certificate cannot be accessed ~~ithout ~ authorization from both parties, and interest earned on the certificate is paid to ~ Hospice Buildings and equipment Buildings and equipment are carried at cost, or at fair market value at the time of a donation Maintenance and repairs are charged to expense, and betterments are ~ capitalized Depreciation is provided over the estimated useful lives of three (3) to ~ forty (40) years on a straight-line basis (See details at NOTE 6) ~ [f donors stipulate how long contributions of buildings and equipment are to be ~ maintained, the contributions are recorded as restricted support In the absence of ~ such stipulations, contributions of buildings and equipment are recorded as ~ unrestricted support Temporarilyrestricted net assets Temporarily restricted net assets are those whose use by Hospice has been limited by ~ donors to a specific time period or purpose ~ Patient services revenue . Patient services revenue is reported at the estimated net realizable amounts from • patients, third-party payors, and others for services rendered, including estimated retroactive adjustments under reimbursement agreements with third-party payors ~ Retroactive adjustments are accrued on an estimated basis in the period the related ~ services are rendered and adjusted in subsequent periods as final settlements are ~ determined • Contributions ~ Contributions received and unconditional promises to give are measured at their fair values and are reported as an increase in net assets. Hospice reports support of cash and other assets as restricted support if they are received with donor stipulations that ~ limit the use of the donated assets, or if they are designated as support for future . periods When a donor restriction expires, that is, when a stipulated time restriction ends or purpose restriction is accomplished, temporarily restricted net assets are reclassified to unrestricted net assets and reported in the statement of activity as net assets released from restrictions ~ Advertising_costs ' Advertising costs are expensed as incurred. ~ ~ • HOSPICE OF HILO Notes to Financial Statements, Continued ~ Years ended December 31,1999 and 1998 i ~ NOTE 1 SIGNIFICANT ACCOUNTING POLICIES, Continued Income taxes No provision has been made for federal or state income taxes because Hospice has ~ obtained tax exempt status under Internal Revenue Code Section ~O1 (c)(3) and ~ applicable provisions of the Hawai i Revised Statutes . Donated services . No amounts have been reflected in the statements for donated services inasmuch as no objective basis is available to measure the value of such services, however, a ~ substantial number of volunteers have donated their time in program and support activities • 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 ~ affect the reported amounts of assets and liabilities and disclosure of contingent assets ~ and liabilities at the date of the financial statements and the reported amounts of . revenues and expenses during the reporting period Actual results could differ from . those estimates ~ NOTE 3 ACCOUNTS RECEIVABLE ~ Accounts receivable represents fees owed by patients and third party health insurance . plans for services provided A summary of accounts receivable as of December 31, 1999 and 1998, follows 1999 1998 ~ Medicaze receivable $ 155,208 $ 110,062 ~ Medicaid receivable (See also NOTE 7) 10,027 95,478 ~ HMSA 37,604 26,795 . Other commercial insurance receivable 14,931 16,158 217,770 248,493 Less allowance for uncollectible receivables 2,500 2,500 Patient accounts receivable, net $ 215,270 $ 245,993 ~ NOTE 4. GRANTS RECEIVABLE Unrestricted grants receivable represents amounts due for services provided under a ~ contract with the County of Hawaii Office of Aging. Restricted grant receivable represented the final payment due under CDBG program funds through the County of Hawaii Office of Housing and Community Development The restricted grant ~ receivable was paid in full in 1999 8 HOSPICE OF HILO Notes to Financial Statements, Continued ~ Years ended December 31, 1999 and 1998 NOTE 5 RESTRICTED PROMISES TO GIVE Restricted promises to give represent pledges restricted by donors for the building campaign as of December 31, 1999 and 1998 Management has taken a conservative ~ approach and set up a provision of 20% of the pledges as uncollechble for 1998 For 1999, a provision of 15% was maintained after writing off pledges with at least 18 ~ months of no activity A recovery on bad debt will be recognized m the future if less • than the provision is ultimately found to be uncollechble ~ At December 31, 1999, restricted promises to give and the expected hnung of receipts ~ were as follows ~ To be received m less than one year $ 104,875 • To be received m one to five years 88,180 . 193,05> Less allowance for uncollechble pledges 29,000 ~ $ 164,055 ~ NOTE 6 BUILDINGS AND EQUIPMENT ~ A summary of the Hospice's investment to buildings and equipment as of December . 31,1999 and 1998, is set forth hereunder . Estimated Useful ~ Lives 1999 1998 ~ Building 40 years $ 1,776,168 $ (,776,168 . Furniture and fixtures 10 yeazs 118,656 116,559 . Machinery and equipment 7-3 years 44,961 44,960 . Leasehold improvements 15 years 6,941 6,941 Computer software 5 years 8,668 5,543 ~ 1,955,394 1,950,171 ~ Less accumulated depreciation 108,804 39,830 ~ $ 1,846,590 $ 1,910,341 ~ NOTE7 ADVANCES Advances represent an advance from Medicaid for payments due to Hospice. During ~ 1999, Medicaid also paid many of the receivables covered by the advance. ~ Subsequently, the Medicaid advance has been applied to Medicaid billings, with the ~ remarrung balance to be paid back, d requested ~ 9 HOSPICE OF HILO Notes to Frnanctal Statements, Continued ~ Years ended December 31, 1999 and 1998 ~ NOTE 8 LONG-TERM DEBT Set forth hereunder rs a summary of Hospice's long-term debt as of December 31,1999 and 1998 ~ 1999 _ 1998 t Bank of Hawaii, revolving Itne of credit up to $300,000, interest at 8 25% at December 31, 1998 (floating rate based on Hawai base rate plus 0 50%), interest payable monthly, matures June 30, ~ 2002, collateralized by security tterest to capital ~ campaign pledges, buildings and equipment, . accounts receivable, and BOH deposit accounts $ - $ 185,000 ~ NOTE 9 TEMPORARILY RESTRICTED NET ASSETS ~ Hospice's temporartly restrtcted net assets relate to the butldrng campaign and a ~ restricted grant Earnings on butldrng campaign contributions are not restrtcted, uriless spectfrcally so restrrcted by the donor. Net assets are released from donor i restrtcrions by rncurrrng expenses sarisfytng the restrrcted purposes or by occurrence of other events specified by donors ~ Acttvrties related to temporartly restricted net assets for the years ended December 31, ~ 1999 and 1998, are as follows: 1999 1998 Temporarily restricted net assets, beginning of year $ 9,508 $ 483,821 Contributions restricted by donors for the budding ~ Campaign (pledges and direct donations) 12,968 1,170,558 Provision for uncollectible pledges 24,577 21,000 ~ 37,545 1,191,558 ~ Grant restricted by donor for Planned Giving 25,000 9,750 ~ Grant restricted by donor for Merger 15,000 - ~ Retum Merger grant (15,000) - ' Grant restricted by donor for Bereavement 2,000 - 74,053 1,685,129 Less temporarily restricted net assets released for• Planned givrng expenses 15,369 242 ~ Bereavement expenses 1,917 - ~ Construction in progress -budding - 1,629,240 Budding campaign expenses - 46,139 ~ 17,286 1,675,621 Temporarily restricted net assets, end of year $ 56,767 $ 9,508 10 ~ HOSPICE OF HILO Notes to Financial Statements, Continued ~ Years ended December 31, 1999 and 1998 r NOTE 10 OPERATING LEASES Hospice entered into a month-to-month lease for office space as of June 1, 1997, as a transition to the new building Rent under this lease was $2,000 per month The new ~ building was occupied m August 1998 ~ Hospue also entered into a lease for approximately t~vo (2) acres as the site for the ~ new building, with the State of Hawaii, Department of Land and Natural Resources • (DLNR), under General Lease No 5-5513 The term of the lease is 65 years, beginning on October 1, 1997 and ending September 30, 2062 Minimum annual rent under the ~ lease is initially $730, with the annual rent being reopened and redetermined every 10 ~ years under the ]ease According to an independent appraisal obtained by DLNR, the annual rent for the new building site represents 25% of the its fair mazket value rent Accordingly, m 1999 and 1998, Hospice recorded additional rent expense of $2,190, offset by ~ contribution support of an equal amount ~ Hospice also rented its office coprer at $313 per month under an agreement from . March 1996 through March 1999. Management had deterrruned that treatment of the . copier agreement as an operating lease rather than capital lease does not have a material effect on the finanaal statements The copier was purchased for $1 upon ~ completion of the lease agreement Rental expense under the above leases for the year ended December 31, 1999 and 1998 was $3,563 and $19,496, respectively ~ Future minimum lease payments under the above DLNR lease for the next five (5) ~ years, as of December 31,1999, are as follows• ~ 2000 $ 730 2001 730 2002 730 2003 730 ~ 2004 730 $ 3,650 11 i . HOSPICE OF H[LO Notes to Financial Statements, Continued ~ Years ended December 31, 1999 and 1998 ~ NOTE it FUNCTIONAL CLASSIFICATION OF EXPENSES The costs of providing the various programs and supporting services have been summarized on a functional basis m the statement of functional expenses ~ Accordingly, certain costs have been allocated among the programs and supporting ~ services benefited NOTE 12 RECLASSIFICATIONS ' Certain reclassifications have been made to the 1998 financial statements to conform to the 1999 presentation 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ~ 12 f IRS FORM 990 OM9 NO r5a5 OOa' r~~m 990 Return of Organization Exempt From Income lax 1999 Under section 601(c) of the Internal Revenue Code (except black lung benefit trust or private foundation) or section 4947(a?(1) nonexempt chartable trust Tnis Form is Cepa~me~~ o• me reasm. NOIe The 0 en DPen (o Pubbc . ie~.~a ae.en~e sev~ce rg aarun may have (o use a copy or this return ro sa(rsry state reportmq repwremenls Inspection A For the 1999 calentlar year, OR tax year penotl beginning , 1999, and entling B Caecx Piuaa C Name of organ¢aeon D Employer idenUbcabon number 'J `'a"B`°'"="" ~~;,~"a HOSPICE OF HILO 99-021851[ r1 In' al relu'n pnni a Number and etreet (a PO ltox it mail i9 not tlelnere0 to street adtlress) Room/style E Telephone number rl Frai~eiurn s• 1011 WAIANUENUE AVE. (808) 969-1733 AmenOed return Sprudc Ciry or town stale or country and ZlP}a F CneU? ~I, deaem treCUired d~5o IOr H I LO H I 9 6 7 2 0 ~s cen0 n~ aPDhrauor state reporrngi 9 G Type of organization Exempt under section 501(c) ( 3 1 ~ (InsM number) OR ? Q section 4947(a)(1) nonexempt charilabk bust Note Secrgn 50f(c)(3) exempt organ¢a(xns eM 0947(eJ(1) rioriexempl cherxabb (rusts MUST attach a completed ScMduk A (Form 990J Hfa) Is iMS a group return fite0 iq aediaks~ ~ Yes ®No I H ertner Doe m H is CnlCkld'Yes enter torn di5it group exemption number (GEN) ? (h) It'Ves enter ire number or alaliale5 /or which Nis return is fled ? J AccounUnq method ~ Cash 0 Ptcrual Icl Is this a separate return flied try an orgeninbon wsered M a group iuling7 ~ Yes ®No Omer (speury) ? K Check nere? ? A the aganRaUOn s pmaa receipU aro normaty not more than tY5 000 The orgamzalron need trot Rte a rMUm vnU Vie IRS but ii R recened a Form 990 Pacluge in the mail, it siroul0 fib a realm caiman ananaal dab Sortie atataa raquln a compkea ntum Note Forrn 990.EZ may be used by orgertaetms wdh gross receipts bss than 5100,000 and lots(assets bss then 5250,000 er erxl 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 relx~ved a Direct public support 1a 19 5, 171 b Indirect public support 1b 24 , c Government contributions (grants) 1c 19 , 878 d Total (add lines 1a through tc) (attach schedule of contributors) (casng 159,992 noncesh5 30,103 )SEE STMT 1 1d 185 095 2 Program service revenue inducting government tees and contracts (from Part VII, Ilne 93) 2 1 006 705 3 Membership dues and assessments 3 4 Interest on savings and temporary cash investments 4 6 7 3 9 5 Dividends and interest from securities 5 6a Gross rents 6a b Less rental expenses 6b c Net rental income or (loss) (subtract line 6b from line 6a) 6e 7 Other Investment income (descnbe ? 7 8a Gross amount from sales of assets other IN 5awrmes (el omen z° than inventory 953 8a b Less cost a aher basis and sobs expenses Sb c Gain or (loss) (attach schedule) 9 53 Be d Net gain or (loss) (combine line 8c, columns (A) and (B)) 8d (9 5 3 ) 9 Special events and activities (attach schedule) SEE STMT 2 a Gross revenue (not inducting S of contributions reported on Itne 1a) 9a 50 9 3 9 b Less direct expenses other than fundraising expenses 9b c Net Income or (loss) from special events (subtract Itne 9b from Itne 9a) 9c 50 4 39 t0a Gross sales of inventory, less returns and allowances 10a b Less cost of goods said 10b C Gross profit a (loss) from sobs d irnenlary (attxh schedule) (sublrxt line fOb trap line 10a) 10e 11 Other revenue (from Part VII, Itr>e 103) 11 4 4 2 9 12 Total revenue add lines 1d, 2, 3, 4, 5. 6c, 7, 8d, 9c, 10c, and 11 12 1 252 909 13 Program services (from Ime 44, column (B)) 13 1 040 198 14 Management and general (from Ilne 44, column (C)) 14 14 5 65 B `a 15 Fundraismg (trom Ime 44, column (D)) 15 50 188 w 16 Payments to aRllates (attach schedule) 16 17 Total ex arses add hoes 16 and 44, iblumn A 17 1 2 3 6 0 9 4 ~ 16 Excess or (deficit) for the year (subtract line 17 from Ime 12) 18 16 8 60 19 Net assets or Lund balances at beginning of year (horn line 73, column (A)) 19 2 371 166 20 Other changes in net assets or fund balances (attach explanation) 20 = 21 Net assets or fund balances at end of ear combine lines 18 19 and 20 21 2 388 02 6 For Paperwork Reduction Act Notles, sae page 1 of the separate Instructions IsA Form 990 (+9991 9fi FE019]]F 1 "9,r•~5C:i3991 Page 2 Part II i Statement of Ail organ,zauons muse complete coNmn(A) Cowm~s (B) (C) and fD)are'equ~•ed'or sece~ 5G c)q:ar,7 •a; c,ga-•,a~ors _ Functional Ex enses a"Q ~t~on 494rya)(1)nonex¢mpl crtanlaole trusts out optional ror pUers ($ee 5peolc lnslr~C Ons or page l5, Do not )nclude amounts reported on Irne fe) pr ram 66, fib, 96 10b, or 16 O( Part I IAl Total sen,~ es (eantl gene aen1 ID) F,;r.p~a~s rg 22 Grants and allocations (attach schedule) icash S noncash f 22 23 Specific assistance to ~ndihduals (attach schedule) 23 24 Benefits paid to or for members (attach schedule) 24 25 Compensauonofofficers directors etc 25 56 224 56 224 26 Olnersalariesandwages 26 515 605 959 797 37 799 23 020 27 Pension plan contributions 27 26 Otneremployeebenefits 28 35 550 28 723 5 084 1 '93 29 Payroll taxes 29 50 317 39 797 8 360 ? i6C 30 Professional fundraising fees 30 31 Accounting tees 31 13 707 1 500 12 20~ 32 Legal fees 32 33 Supplies 33 19 610 19 610 34 Telephone 34 13 038 11 848 1 002 188 35 Postage and shipping 35 3 219 2 19 2 5 7 8 4 9 9 36 Occupancy 36 15 229 13 357 1 469 403 37 Egwpmentrentalandmaintenance 37 88 022 82 279 5 176 572 38 Printing andpublrcahons 38 8 069 7 179 895 39 Travel 39 2 462 989 1 973 40 Conferences, conventions, and meetings 40 2 217 1 612 605 41 Interest 41 6 085 5 340 563 182 42 Depreciatron,depletron,etc (attach schedule) 42 68 979 60 521 6 065 2 388 43 Other expenses(rtemtze) aSEE STMT 3 43a 342 716 315 969 6 169 19 083 b 43b c 43c d 43d e 43e 44 Total lutxhonel eitpenees (add kns 22 tretHn 13) Oryenaaeons can columns • o ater.mrx,rowwu•fs 44 1 236 094 1 090 198 195 658 50 188 Reporting of Joint Costs. -Did you report in column (B) (Program services) any lornt costs from a combined educational campaign and fundraising soliatation~ ? ~ Yes ©No If'Yes ' enter p) the aggregate amount of these pint costs S , (d) the amount albpled to Program services f (nq the amount allocated to Management and general f ,and (rv) the amount agocaled to Fund S Part III Statement of Pro tam Service Accomplishmsnb (See Specific Instnxxions on page 22 ) What is the organization's pnmary exempt purposes ? EE ST T ME Pr ram Ssrvtce AllorgaruzatansmusldesrnmbetltetradnplpurposeadxevemenlsmaGearandcorkasemannarSWethenumbero(Grertlssened,pud~ca6ons ExpQ^s05 rssiied etc ascussachievementstlialarenotrtieaaxabk (Section50t(cN3)and(4)oryanizahorisand4917(aNt)rtorteiwmpldiarrlableWSts tab w~+~s) must also enter the amount of grans and albea6ottt b agrers) so~p,',o~:i a°UWU'r,. i a THE TERMINALLY ILL WERE ASSISTED IN LIVING IN COMFORT AND DIGNITY AND THEIR FAMILIES WERE PROVIDED WITH RESPITE CARE, COUNSELING AND EMOTIONAL SUPPORT. (Grants and allocations S ) 1, 0 9 0 , 19 8 b (Grants and allocations S ) c (Grants and allocettons S ) d (Grants and allocations S ) e Other pr ram services attach schedule) (Grants and allocations S ) f Total of Program Servica Expenses (should equal line 44, column (B), Program services) ? 1, 0 9 0 , 19 8 Form 990 (19991 STF FEUr93)F ] Forte 390;'399' Pag¢ 3 Part IV Balance Sheets (See Specific Instructions on page 22 ) Note Where required attachuW schedubs and amounts wRhrn fire descrpfun (q) (g) column should be ror endvl-year amounts ony l3egnnrng d year EnC of year 45 Cash -non-interest-beanng 45 64 46 Savings and temporary cash investments 245,032 46 259,639 47a Accounts receivable 47a 217 , 7 7 0 b Less allowance for doubtful accounts 47b 2 5 0 0 2 4 5, 9 9 3 47c 215 , 2~ 48a Pledges receivable 48a 199 260 b Less a~iowancefordoubtfulaccounts 48b 29 000 283 079 48c 165 260 49 Grantsrecervable 15 787 49 1,g-_0 50 Receivables from officers directors, trustees, and key employees (attach schedule) 50 51a Other notes and loans receivable (attach schedule) 51a 1 127 d b Less allowance for doubtful accounts 51b 0 51c 1, 127 a 52 Inventories for sale or use 52 53 Prepaid expenses and deferred charges 8 063 53 5 4 68 54 Investments -securities (attach schedule) 54 3 0 98 55a Investments -land buildings, and egwpment basis 55a b Less accumulated deprecation (attach schedule) SSb 55c 56 Investments -other (attach schedule) 56 57a land bwldfngs, and equipment basis 57a 1 955 399 b Less accumulated deprecation (attach schedule)SEE STMT 5 57b 108 804 1 910 341 57c 1 846 590 58 Other assets(describe? SECURITY DEPOSIT ) 1 460 58 1 960 59 Total assets add Imes 45 throw h 58 must ual Ime 74 2 7 0 9 7 5 5 59 2 4 9 9 8 8 6 60 Accounts payable and accrued expenses 73 589 60 105 230 61 Grants payable 61 62 Deferred revenue 62 m 63 Loans from officers, directors, trustees, and key employees (attach schedule) 63 e 64a Tax-exempt bond liabilities (attach schedule) 64a ~ b Mortgages and other notes payabe (attach schedule) 18 5 0 0 0 t34b 65 Other liabilities (descnbe?MEDICAID ADVANCE ) 80 000 66 6 630 Bfi TotalliahiliUea add linest30throu h65 338 589 66 111 660 Organizations that follow SFAS 117, check hen ? ?X and complete Imes 67 through 69 and lines 73 and 74 u 67 Unrestricted 2 361 658 67 2 331 259 ~ 68 Temporarily restricted 9 508 68 56 767 m 69 Permanently restricted 69 ~ Organizations that do not follow SFAS 117, check here ? ~ and ii complete lines 70 through 74 `0 70 Capital stock, trust principal, or current funds 70 ~ 71 Paid-in or capital surplus, or land, building, and egwpment fund 71 72 Retained earnings, endowment, accumulated income, or other funds 72 73 Total net asseb or fund balances (add Imes 87 through 89 OR lines = 70 through 72, column (A) must equal Ime 19 and column (B) must equal line 2l) 2 371 166 73 2 388 026 74 Total IiabiliUas and net asseb /fund balances add hoes 66 and 73 2 7 0 9 7 5 5 74 2 4 9 9 8 8 6 Form 990 is available for public inspecbon and, for some people, serves as the pnmary or sole source of fn}ormation about a particular organization How the publfc 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 PaA III, the organization's programs and accomplishments S1F FEDi9ZaF rr 950 '~3y) rage 4 Part IV-A Reconciliation of Revenue per Audited Part IV-B Reconciliation of Expenses per Audited Financial Statements with Revenue per Financial Statements with Expenses per Return (See Specific Instructions page 24) Return a Total revenue gains and other support a Total expenses and losses per per audited financial statements ~ a , 904 audited financial statements ? a , t s 4 4 b Amounts Included on line a but not b Amounts included on line a but not on Ilne 12 Form 990 on line 17, Form 990 (s) Net unrealized gains (1) Donated services on investments E and use of facilities 5 (2) Donated services (2) Prior year ad)ustments and use of tac1111es 5 reported on Ilne 20 (3) Recoveries of prior Form 990 S year grants b (3) Losses reported on (4) Other (specify) Ilne 20, Form 990 5 (4) Other (specify) 5 Add amounts on Imes (1) through (4)? b S Add amounts on lines (1) through (4)? b c Llne a minus Ilne b ? c 2 52 90 9 c Line a minus line b ? c 2 3 6 C 4 4 d Amounts incuded on line 12, d Amounts inGUded on line 17 Form 990 but not on Ilne a. Form 990 but not on Ime a• (1) Investment expenses (1) Investment expenses not Included on Ime not included on Ime 6b Form 990 5 6b. Form 990 S (2) Other (speufy) (2) Other (speufy) S S Add amounts on Imes (1) and (2) ? d Add amounts on Imes (1) and (2) ? d e Total revenue per Ilne 12 Form 990 a Total expenses per Ime 17, Form 990 (Ime c plus Ime d) ? e , 2 52 , 90 9 (line a lus lined ? e 2 3 6 0 9 4 Part V List of OfTicers, Directors, Trustees, and Key Employees (Lest each one even if not compensated see Speclflc Instructions on page 24 ) lB) Title antl asera9e hours per (C) Canpensaeon (Dl Caw~eWOr~ w (EI F]~ense (a Name an0 atlOress week tlMletl to pm19on (H not palq .mpMs Mmfi1 parr 8 aLC-0uni and oNer ~nGr-0.) eArrstl compiri331rOn allowances SEE STATEMENT 7 75 Did any otfioer, director, trustee, or key employee receive aggregate comperisatlon d more than 5100,000 Gorri your organizahori and all rented organizations, of whirh mae than S10.OOD was provided by the related oiganlratxuis~ ? ? Yes ~ No It "Yes," attach schedule -see Speafic Instrualons on page 25 Form 990 119991 SR FEO~9d]F ~ -r a•m 590 i ; c"v5. ua~e 5 PaR VI Other Information (See Specific Instructions on page 25) Yes . No 76 Did the organization engage in any acfiwry not previously reponed to the IRS If'Yes' attach a detailed description or each activity 76 { 77 Were any changes made in the organizing or governing documents but not reported to the IRS 77 r I( Yes attach a conformed copy of the changes 78a Ditl the o~ganizalion nave unrelated business gross income of St 000 or more dunng the year covered by this retum~ 7ga b If Yes has it filed a tax return on Form 990-T for this years 78b 79 Was there a liquidation dissolution termination, or substantial contraction dunng the yeah If'Yes' attach a statement 79 X BOa Is the organization related (other than by association with a statewide or nationwide organization) through common membership governing bodies trustees officers etc to any other exempt or nonexempt organizations SOa X b If "Yes enter the name of the organization ? .and check whether it is ? exempt OR nonexempt 81a Enter the amount of political expenditures, direct or indirect, as described in the instructions for line 81 81a NONE b Did the organization file Form 1120-POL for this years 61 b X 82a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fair rental values 82a X b If -Yes,' you may indicate the value of these hems here Do not indude this amount as revenue in Part I or as an expense in Part II (See instructions for reporting in Part III) 82b NOT VALUED 83a Did the organization comply vnth the public inspection requirements for returns and exemption appliwtions~ 83a X b Did the organization comply with the disdosure requirements relating to quid pro quo contributions 83b X 84a Did the organization solicit any contributions or gifts that were not tax deductibles 84a X b if "Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductibles 84b 85 501(c)(4), (5), or (6) organrzafans a Were substantially all dues nondeductible by members BSa b Did the organization make only in-house lobbying expenditures of 52,000 or less? 85b If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the prior year c Dues, assessments, and similar amounts from members BSc 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 BSd less 85e) 65f 0 g Does the organization elect to pay the section 6033(e) tax on the amount in 851 85 h Ii section 6033(e)(1)(A) dues notices were sent. does Oie organzation agree to add 8ie amount m 85i la its reasonable estimate of dues allocable to rrondedudiMe lobbying and political ei~eriddures fa Oie blloiniq hz year7 85h 86 501(c)(7) orgs Enter a Initiation fees and capital contributions included on Ilne 12 86a N /A b Gross receipts, included on line 12, for public use of dub facilities 88b N /A 87 501(c)(12) orgs Enter a Gross income from members or shareholders 87rr N /A b Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) 87b N /A 88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 301 7701-2 and 301 7701-3~ If'Yes,' complete Part IX 86 X 89a 501(c)(3) organrzatrons Enter Amount of tax imposed on the organization during the year under section x911 ? NONE ,section 4912 ? NONE ,section 4955 ? NONE b 501(c)(3) and 501(c)(4) orgs Did the organization engage in any section 4958 excess tieriefit transaction dunng the year or did it become aware of an excess benefit transaction from a prior yeafr If'Yes' attach a statement explaining each transaction 89b X c Enter Amount of tax imposed on the organization 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 filed ? b Number of employees employed in the pay period that indudes March 12, 1999 (See inst) 90b 20 91 The books are inwreot?MONICA BURNETT Telephone no ? (808) 969-1733 Locatedat? 1011 WAIANUENUE AVE. , HILO, HI ZIP + 4? 96720 92 Secton 4947(a)(1) nonexempt charitable trusts hang Form 990 rn 6eu o1 Form 1041- Check here ? ? and enter the amount of tax-exempt interest received or accrued during the tax year ? 192 Form 990 (i999i SrF FEOi 92lf 5 PaR VII Analysts of Income-Producing Acttvtttes (See Speaftc Instructlons on page 29 ) Fnter toss amounts unless OlhefWlSe unrelated business income E¢IUCeo by Section 517 St3 or She T (Ej 9 ~elatc~ o• indicated IA) (Bj ICj ID) ~ exemp; lunc•~on 97 Proggram service revenue Business code Amount E%cIU$IM cone Amount I income a ;=-T•1h1ERCIAL_INS _REiMB _ _ b _ _ _ c d _ _ e _ _ f PAedicare/Medicaid payrnenis c l'3 g Fees and contracts from government agencies _ 94 A4embershlp dues and assessments 95 Interest on savings and temporary cash investments 14 6 7 3 9 96 D~vldends and interest from securities 97 Nel rental income or (loss) from real estate a debt-financed property b not debt-financed property 98 Net rental income or (loss) imm personal ploptsly 99 Other Investment income 100 Gam or (bss) horn sales of assets other than inventory 18 9 5 3 101 Net Income or (loss) from special events O1 50 9 39 102 Gross profit or (loss) from sales of Inventory 103 Otherrevenue a 9 92 9 b c d e 104 Subtotal (add columns (B), (D), and (E)) 56 72 5 G 11 139 105 Total (add Ilne 104, columns (B). (D), and (E)) ? 1, 0 67 , 8 S 9 Note Lrne 105 plus One id, Part 1, should equal the amount on fine 12, Part I Part VIII Relationship of Activities to the Accomplishment of Exempt Purposes (See Specific Instructlons on page 30 ) Line No Explain how each aarvrty fa wtuch rricarne Is reported rn cdumn (E) d Pan VII cantnbuled mPptantN to the aGCprtplghment of the ? organrzallan's exempt purpwes (aher than Iry prwldmg funds fa such purpose) 93A REIMBURSEMENTS RECEIVED FROM COMMERCIAL INSURANCE ORGANIZATIONS FGR THE SERVICES PROVIDED TO PATIENTS. 93F REIMBURSEMENTS RECEIVED FROM MEDICARE/MEDICAID FOR THE SERVICES PROVIDED TO PATIENTS. 103A REIMBURSEMENTS FOR MATERIAL AND OTHER COSTS FOR EDUCATIONAL SEMINARS. Part IX Information Regarding Taxabls Subsidiaries and Dtertygarded Entities (See Specific InstrueUons on page 30 ) (A) (8) (C) (D) (E) Name, address, and EIN d corporaDOri, P«centiige d Nature d adiveres Taal Income End-of-year partnership, a disregarded coley ownership iaeresl assets Please Unoer IxnalDee W ury 1 oedare cut 1 hawee ermined thrs return mdudinp accompanrrp sdxsouNa arW statememe arxf m IM Dent d my tnowletlge antl n is true a uatran or prepar« (Whey W n oificen a Dated on NI inremtation W whirJi Ixeperer rNe any Impwledge Sign Pm runt Saa al U 1~1 (n~ Here ;')G L'C L~0~11` E:f~('iAA ~Op1L~~VCCF]US"Y M daTCer Dau Type «Ixint name Date CMrk d Repar«'a SSN or P7iN Paid Pieper«i sNf- Preparer's t'9nature S Q emplgEO?® 563-65-4684 UseOml F~rmsnama(or EX J. S ITH CPA EIN ? Y yours d ssa-ampoyeo) and aeorest 439 FERDINAND AVE. HONOLULU H zIP«~ ? 96822 Form 990 1`999) $TF FEDr97]r fi SCHEDULER Organization Exempt Under Section 501(c)(3) orne no 1545 dG.) (Form 990) (Except Private Foundation) and Sectlon 501(e), 501(fJ, 501(k), 501(n), or Sectlon 1947(a)(1) Nonexempt Charitable Trust Supplementary Informatrorl - (See separate instrucbons ) 1 999 Oepa'~-e~~~:.1 i^e r~easury Inb~na, Re.e~ve s.rNre ? MUST be completed by the above organizations and attached to their Form 990 or 990-FZ Name of Ine organization Employerltlentl/lcatlon number 4CSrI~E ^ve HILO 99-021851L PaR I Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See page 1 of the instructions Ltst each one If there are none, enter "None p oRe paid more (b) 7111e and aerage hours Itl) CmindACn. to (e) Egense (at Name and address of each em I Ici Compensation enployea awl o~anF 8 account and oine~ Ilan f50 000 per week demoted to position aebnaa cornpmsal on allowances NARY ANN CROSSON RN CASE MNGR 26-2561 A. KAIW:KI RD. HILO HI 96720 FT 59 953 0 SHANNON_KANUHA RN CASE MNGR. 25-3352 PAKELEKIA ST. HILO HI 96720 FT 57 562 0 0 MISAE AKIONA______________ CLINICAL DIR. PO BOX 1673 HILO HI 96720 FT 59 117 0 0 Total number of other employees paid over 550,000 ? NONE Part II Compensation of the Five Highest Paid Independent Contnctors for Professional Services (See page 1 of the tstructtons List each one (whether tndtvtdua{s or firms) It there are none, enter "None (a) Name and address o1 eatli rtMapandent tdntriCbr yard more than f50 000 (bl Typa of seruca (c) Compensation KOKUA NURSES 1210 AUAHI ST., SUITE 223 HONOLULU HI 96825 NURSING SERVICES BS 911 Total number of others receiving over 550,000 for prolessional services ? NON E Fa Paperwork Rsduetlon Act Notles, fes pa9~ t of tM tmtructlw» Tor Form 990 and Form 990-EZ Scheduls A tForm 990) 1999 ifs f TF FE019%F I RneCWe A iF^•^ 99ci '999 Pale 2 -Part III Statements About Activities Yes No 1 During the year has the organization altemple0 to influence national state Or local legislation including any attempt to influence public Opinion on a IEgislalne matter or referendums 1 )r II Yes ewer the total expenses paid or mcurretl m connection wdh the lobbying acbvihes ? E _N1 A Organizations that made an election under seclim 501(h) by filing Form 5768 must comDlele Pan VIA Other organizations checking Yes must complete Pan VI-B AND attach a statement giving a detailed description of the lobbying activiues 2 During the year has the organization ether dxeclly or indirectly engaged in any of the fdlowing acts with any of as trustees directors officers creators key employees or members d their families a wah any taxable organzation with which any such person is aHil~aled as an officer director trustee mafway Goner or pnnopal Ixnerx;iary a Sale exchange or leasing of propeny~ 2a b Lending of money or dher extension d credits Yb X c Furnishing of goods services a facllxies~ Zc X d Payment d compensation (or payment or reimbursement d expenses A more than 51,000) FORM 9 9 0 , PART V 2d X e Transfer of any part of Its Income w asselso Ie X If the answer to arty glazllon Is 'Yes ' attxh a detalbd statement e~laining the transadans 3 Does the organ¢alipn make grants for schdarships felloMShips student bans, etc ~ 3 X 4a Do you have a section 403(b) annuay plan for your emplvyees~ 4a b Attach a statement to explain hwv the organaatan Oelermirtes Thal indmduals d apanl:atlons recemng grants d loans Irom a In furtherance of as chardabk programs qualAy to recene pafinenls (See page 2 d the Inslnxtans ) Part IV Reason for Non-Pnvate Foundation Status (See pages 2 through 4 of the Instructions ) The orgait¢atim is nd a pn'rate foundation because 4 is (Please check ony ONE app4cabb box ) 5 ~ A church convention d churches a associatan d churches Sedan 1T0(bX1)(A)p) 6 ~ A schod Section 170(b)(1)(A)(ii) (Also complete PaA V, page 4 ) 7 ~ A hosptal or a cooperethe hospital service organizaton Sedion 170(b)(t)(A)(xi) 8 ~ A Federal state or local government a govemmenlal una Section 170(b)(1)(A)(v) 9 ~ A medical research organization operated in con)undan with a hospaal Sedan 170(b)(1)(A)(iri) Enter the hospital's name, city, and state ? 10 ~ An organvatan operated for the beneta d a college ar unnersiry Gvned ar aperMd by a garerrrmental unq Sedan 170(b)(1)(Axrv) (Also complete the Support Schedule In Part IV-A ) 11a ®An arganixaran oral normally receives a subalantW pandas support tram a governmental una or tram the general pubkc Sedan 170(b)(1)(AHvI) (Also cpmpbte tM Support Schedule in Part IV-A ) 11b Q A canmunay trust Sedan 770(bl(1)(A)(vl) (Abo complete the Support SehWub In Pan IV-A ) 12 ~ An oigarxzatan that norrne9y reserves (1) mon than 33'h%d as support from oaarawtans, membershp fees, and gross receipts tram admlies related to As charAabb. etc ,functions - subpcl to tMaa exceptans, and (2) no mon than 33'h%d b support from gross Investment income and unrNatetl busaess laxabb Income (bss sedan 51f tax) from businesses acquired ty the argan¢atlan after June 30 1975 See sedan 509(a)(2) (Also Compble the Support Schedule in Pan IV-A ) 13 ~ An organization that Is nd contrdled by any disqualdied persons (dher than fauitdatan managers) and supports organuatans descnbed m (t) Lees 5 through 7 2 atiGe, ar (2) sedan 501(c)(4), (5), a (6), A they meet the lest d sedan 509(a)(2) (See sedan 509(a)(3) ) Provga the ldloanng information about the supported oryaneatlons (See page 4 d the matrudans ) (a) Name(s) d supported organ¢alan(s) (b) Une number from above U ~ An organization organ¢ad and operated to test la pubkc safety Becton 509(a)(4) (Sae page 4 d the inatructlana ) Schedule A (Form 990) 1999 S R FEa1955F T Scneouie a ;worm 9901 1999 Page 3 Part IV-A Support Schedule (Complete only if you checked a box on line 70 11 or 12) Use cash method o/accounting Note You may use the worksheet rn fhe rnsfruchons for converting lrom the accrual to (he cash method of accounting Calendar year (or fiscal year begrnnrng tn) ? (a) 1998 Ib) 1997 (c) 1996 (d) 1995 (e) total 15 Gdts grants antl coninbuttons reccvvetl (Do nd include unusual grants see line 26) 360 096 401 027 142 480 56 906 960 503 t6 Membership toes received 17 Gross receipts Irom atlmiss~ons merchantlrse soltl « services performed or furnishing of lacilrttes in any activity Thal is not a business unrelaletl to the organizations charrtaDle etc purpose 076 669 924 788 839 592 165 914 006 403 16 Gross incomefrom interest d~vitlentls amounts recened from payments on securities loans (section 512(x)(5)) rents royalties and unrelatW business taxable tncame (less section 511 taxes) Irom businesses acgwred by the organizatan after June 30, 1975 5 0 119 2 7 8 9 9 2 5 5 5 6 19 9 9 2 118 0 61 19 Nel income from unrelated business aclivrtie5 not included in Ime 18 20 Tax revenues reused Id the «ganaalan's benefA and either paxf to rt or exgxlded on its behalf 21 The value of sernces « facilities furnished to the organ¢ahon by a governmental unit without chage Do na include the value a services « lacdntes gerteraly furnished to the public wdhoul charge 22 Other income Attach a schedule Dona mcludegarn « (bss)from saledcapnal assets 3 298 2 950 1 577 2 271 9 596 2s raaldlinesl5tnraph22 490 127 356 169 009 205 239 083 094 579 24 Line 23 minus line l7 413 458 931 376 169 613 73 669 068 116 zs Enters%olline 23 29 901 13 562 10 092 12 391 26 Organizations desedbad on Imes 10 or 11 a Enter 2°~ d amount in cdumn (e) line 24 ? 2W 9 1 7 62 b Attxh a list (which is nd open to public tnspedan) ahoxnng the name d and amount contributed by each person (dher than a gaernmental unit « pubhcy supported organiratan) whose tdN gttts far 1995 through 1996 exceeded the amount sham in line 26a Enter the sum d all these aticesa amounts ? 26b c Taal support I« secbon 509(x)(1) test Enter ItM 24, cdumn (e) ? 28c 0 8 8 116 d Atltl Amounts lien cdumn (e) t« hoes 18 118 , 0 61 19 u 9, 546 ~b ? 26d 127 607 a Publx: support (hne 26c minus hne 26d total) ? Z6s 9 6 0 5 0 9 } Public support parentage (line 26s (numerator) dWlded by line 2& (denominator)) ? 2af 9 3. 8 9 % 27 Organl]:atioro dsecribed on Iles 12. a F« am0urds included m Itrtas 15, 18, and 17 that were recawed Iran a'dtsgtwldted person,' attach a Ins to stow the name d, and 101x1 amouds rocaited'n cash year Iran, each'dtspuaNlsd person' Enter Ste sum d such amourds i« each year (1998) (1997) (1996) (1995) b Fa any amount included in hne 17 that was receved fran a nontltsqualdred person, attach a list to show the name d, and amount recetvad fa each year, that was mac than the larger d (1) the amourd an arts 251« the year a (2) f5,11f1D (Include m the tat agent7alana descnbed h lutes 5 through 11 as we9 as individuals) ARer compWrtg the drRarottce belreen the amount received arW the larger amount deacnbed in (1) «(2), enter the sum dthese dMerences (the excess amdlms) f« each year (1998) (1997) (1996) (1995) e Add Amounts from cdumn (e) fa tines 15 16 17 20 21 ? 27c d Add Lute 27a teal artd hne 27b total ? 27d s PudK support (line 27c Idol minus hrte 27d tdap ? Z7s f Tdal support for sedan 509(x)(2) test Enter amount Oft hne 23, cdumn (e) ? 27f g Public support peruntags pln. 27s (numerator) dWided by Ilrre 27f (denominator)) ? 27g % h Investment Income psrcerttags (Ilse 18, column (s) (numerator) dWlded by Ilrts 27f (dsnaminatorp ? 17h % 28 Unusual Grams Fa an oryantlattm deaenbad n lets 10, 11, a 121ha1 raeetvad arty umisual grant diattlp 19951hrough 1998, attests a het (which a na open to public tnspeaan) f« each year sltorrutg the nartte d the cadribt]ta, Sts dale and amoum d the grant, and a brief deacriptan d the nature d the grant Dona include these grants in hne 15 (See page 4 d the inatrudans ) ScheduN A (Form 990) 1999 SIF FED1955i ] 5;,nedule A :FO~m 990i 1999 Pave Q Part V Private School Questlonnalre (See page 4 of the Instructions ) (To be completed ONLY by schools that checked the box on 6ne 6 fn Part IV) VCT SFP:, I C ~C ~ Yes ~ No 29 Does the organization haF'e a racully nondiscriminatory policy (award atutlenis by statement in Os charter bylaws finer governing ~ msVUmen1 a .n a resdulron of its governmg body 29 ~ 30 Does the organization include a statement d As racialy nondiscriminatory pdicy lowartl students in all ns brocnures catalogues and other written communrcatans vAth the public dealing w~ih student admtsslons programs and schdarshtps~ 7p 11 Has the organization publicu:ed ns rattily nondiscriminatory policy Through newspaper a broadcast medu during the per~otl of sdicdatton for students or durrrg the regrslratgn perro0 A n has no sdicitation program in a way that makes the pdtcy knarm to all pans or the general community n serves 31 It'Yes' please describe, d'No' please er~lain (11 you need more space attach a separate slalement ) 32 Does the organization maintain the Idlawing a Recatls indicabrrg the recut eomposnion d the student body, faculty, and admmislrative staff? 3y b Records documenting that schdarshlps and dhaz financial assistance are awarded M a racially nondisenminalory basis 326 c Copses of all catalogues DrochurM announcements, and dher wmten canmunicatans to Ne public dealing wnh student admissgns programs, and schdarshlps? 32c d Copies of all material used by the organization ar pr Rs behalf to sdicn eontnbutidns9 32d II you ansvrered'No to any d the abae please errpWrn (If you need mare space, attxh a separate shtemenl ) 77 Does the organization tlRCnmmate by race m any vray with respect to a Students rights a prmbgas9 ]7a b Admissions pdicies7 33b c Employment of faculty a administrative staff? 33c d schdarshlps or fine financial assistanu7 33d s Edueatianal pdirxs7 33s f Use d IacrlaiM~ 73t g Athletic programsv 33g h Other e>dracurricular adrvtltM? 37h If you answered'Yn' b any d the abae, plane aviptaar (If you need more space, attach a separate statement ) Ssa Does the organu:ation recena arty finanaal aid a nsstance from a governmental aparcy7 34a b Has the organ¢atiori's right to such aid ever bear rewired a suspendetlv 31b II you answtred'Ya' to Mho 34e ar b please ergaain using an attaetied statenieM 75 Does the organization cerldY that a has complied wdh the applicable regwremenla d sedans 4 01 through 105 d Rev Prot 7550, 19752 C B 587, tearing racial nondrsdrsnmauona rf'NO' a0.lach an er~lanalion 75 Sehedufe A (Form 9901 1999 STF FE01955F ~ Scnepuie A IFOrm 990) 1999 Page $ Part VI-A Lobbying Expenditures by Electing Public Charities (See page 6 of the Instructions ) (To be completed ONLY by an eligible organization that flied Form 5768) NGT HEEL I CABi.r• Check here ? a ~ d the «ganiiation belongs to an aHlkaled group Check Here ? b IJ n you checked "a" atwoe and'IImAeO contrd' provisions apply Limtts on Lobb m Ex ndttures (a) l°I Y 9 ~ AlRlialeE group 7o ce compleleo Iotal! lOr ALL eleotirtg (The term expenditures" means amounts pad «Incurretl) organitabons 76 Total lobbying expenditures to Influence public opini«t (grassrcds lobbying) 36 77 Tdal lobbying expenditures to influence a legislative body (direct lobbying) 37 78 Total lobbying expenditures (adtl lines 36 and 37) 38 39 Other ezempl purpose expenditures 79 40 Total exempt purpose expenditures (adtl lines 3B and 39) 40 It Lobbying nontaxable amount Enter the amount from the Idlotv'ing IaDb - If the amount on line 40 is - Ths lobbying nonhxabk amount Is - Not over 5500 000 20% d the amount on hne 40 Over 5500.000 but nd over S7 000 000 f 100 000 plus 15% d the excess Doer 5500 000 OvM E7 000,000 but nd over f 7500 000 5175,000 plus 109r. d the excess Doer 51,000,000 d1 Over E 1,500,000 but nd over f 77000 000 5225 000 plus 5X d the extess over 51,500,000 Over S7 7000 000 51,000,000 12 Grassrods nontaxable amount (enter 2594 d hne 41) 12 47 Subtract line 42 from line 36 Enter -0- rf Ilne 42 is m«e than line 36 13 M Subtract Ilne 41 from Tine 3B Enter -0~ rf line 41 rs more than line 38 44 Caution h them n en amount on eRher fns I3 or rite 4., you must Re Farm 1720 4-Year Averaging Period Under Ssctlon 501(h) {Some organizations that made a section $01(h) elecDon do not have to complete all of the five columns below See the instructions for Imes 45 through 50 on page 7 of the instructions ) Lobbying Expenditure During 4-Year Averaging Periotl Calendar year (or (a) (b) (c) (d) (e) fiscal year bpinning In)? 1999 1998 1997 1996 Tdal 45 Lobbymg nontaxable amount L6 Lobbying titling amount (150% d hne 45(e)) 47 Tdal bbbying experWiluras 48 Grassrods nontaxabN amount 49 Grassrods Cestllg emaim 5044 d hne 48(e)) 50 Grassrods e~ddauros Part VI-B Lobbying Activity by Noneleetlng Public Charitlea (For reporting only by o ntzattons that did not complete PaR V(-A) (See page 8 of the tnstntctions ) Dunng the year, dd the Organizalron albmpt to nfluerioe nalr«ial, stale «beal bgrs4tlon, ncludmg any aawnq to influence pubic opinxrn on a legrs(atrve matlM « referendum, through fife use d Ye No Amount a Vdunteers X b Pad start « managrmenl (Include cmtpensatwn n errpenses reported on Irrms c through h) X c Media advertisemenlt X d Madtngs to mcnDers leglslalors «ttre pubhc X e Publlwttms, «puWtstxd «Droadcast statemeds X f Grants to dher oryanrxatans 1« iobbyvq purposes X g DxeU contact wxn kgrslalm their starts govatm+erM drrerais, « a kgslatwe body X h Ralhes dcnonstratxxrs semnars convenlana speedre!r 1eUUres, « wy drier rrtrans X 1 Tdat iobbyxg et~eida«es (add knee c through h) NON E II'Yes' to arty d the oboe, also attxh a stalenreM gnrag a detarbd descngion d the labbyilg admtxss Schedule A (Form 990) 1999 S1F FEbt955F 5 Screaule ~ (Form 990)1999 Pave 6 Part VII Information Regarding Transfers To and Transactions and Relattonshtps Wtth Noncharttable Exempt Organizations (See page 8 of the instructions ) St Did the reporting organ,zal,on O,rectly a ,nd,reclly engage ,n any of the Idlownng w,lh any dher organizal,on tlescr,bea .n sectior, 507(c) o! the Code (other than section 501(c)(3) organuatwns) a m section 527 relating to political organiiahons~ a 7ranslers from the reposing agan,zation io a noncharnable exempt organization of Yes No (p Cash 51ap) pQ Omer assets a(n) ~ ~ b Other transact,ons Ir) Sales or exchanges d assets to a nonchamabk exempt agan¢alron b(r) ~ Purchases d assets Iran a noncharnabk exempt agan¢auon b(u) ~ (u,) Rental of tac,Lt,es egwpmem a other assets bps) R (rv) Rexnbursement arrangements b(rv) f (v) Loans d ban guarantees b(v) X (vr) Pertamance d semces or membership a fundraautq sdaM1abons b(vr) y c Shanng d facddtes equ,pment madrng fists dher assets, a paa employees c x d II the answer to any d the above rs 'Yes ' complete the fd~rg schedule Cdumn (b) should ahvays show the tau market value d the goods dher assets a sernces gnvm by the repoA,ng dgan¢al,on If the organaatron received kss than fart madtet value ,n any transaction a shar,ng arrangement show m cdumn (d) the value of the goods dher assets a services retched la) (bl Icl let Use ro Amount mwlred Name of ranWnlsae exempt agan,raum Descr,pem of Vanslen vansacaons and shanng arrangements 52a Is the dganvatan directly a nMrtedy at(araled wdh, a related to one a more tax-0xempt dgan¢atans deathbed m sedan 501(c) d the Code (dher than sedan 501(cH3)) a a sedan 527? ? ~ Yes ©No b II'Yes; camWeis the ftlldnrq achedub (al lbl (d Name d aganriaeon Typo d aganiraoon Dssaipbon d ralatanfh,p Schedule A (Form 990) 1999 STF FEOr955F 6 HOSPICE OF HILO 99-0218512 Form 990 Schedule of Contnbutors Statement 1 Direct Indirect Government Date Public Public Contnbutions Name and Address Received Support Support (Grants) Total Hawan Commundy Foundation 900 Fort Street Mall Pioneer Plaza Suite 1300 Honolulu H196813 5/27/99 25,000 25,000 Ms Ah Ying Ung Wong 1422 Kinoole St Hilo HI 96720 12/13/99 22,695 22,695 Harold Schwartz 1086 Apono Place Hilo, HI 96720 12128/99 5,000 5,000 Hawau Island United Way 29 Shipman Street, #102 Hilo, HI 96720 Vanous 19 310 19,310 Hawau Pacific Area Combined Federal Campaign PO Box 1096 Honolulu HI 96808 Vanous 5,589 5,589 County of Hawan Office of Aging 101 Aupuni St , # 342 Hilo. HI 96720 Vanous 14,878 14,878 Other Bwlding Campaign Contrlbuhons less than 55,000 Vanous 32,545 32,545 Other Contributions < $5,000 Vanous 59,931 97 60,028 Total to Form 990, Part I, Ime 1a - d 145,171 24,996 14,878 185,045 HOS'1CE OF HILO 99-0218512 Form 990 Schedule of Special Events and Activities Statement 2 Gross Contribution Gross Direct Net Description Receipts Included Revenue Expenses Income Friendship Drive 29 834 29 834 29 834 Home For the Holidays 10 252 10,252 10,252 Light Up A Life 8 924 8,924 8,924 Other 1 429 1,429 1,429 Total to Form 990 Part I line 9a - c 50,439 50,439 50,439 Form 990 Schedule of Other Expenses Statement 3 (A) (B) (C) (D) Program Management Description Total Services and General Fundraising Patient Medications 137,015 137,015 Contracted Services 86,995 86,995 Patient Services 23,617 23,617 Mileage Reimbursement 22,239 21,293 820 126 Restricted Program Expenses 17,286 1,917 15,369 Patient Acute Care 15,112 15,112 Patient Short Stay 11,150 11,150 Office Expenses 10,419 3,283 4 143 2 993 Insurance 5,707 4,958 581 168 Dues and Subscriptions 4,974 3,628 1 318 28 Taxes License and Fees 4,845 4,128 575 142 Volunteer Training 1,855 1,822 5 28 Bad Debts Expense 578 578 Miscellaneous 924 546 149 229 Total to Form 990, Part II, line 43a 342,716 315,464 8,169 19,083 Form 990 Statement of Organization's Pnmary Exempt Purpose Statement 4 Explanation Hospice of Hilo's primary exempt purpose is to provide medical, nursing, couseling and other supportive services necessary for individuals with life-limiting illnesses and for their families HOSPICE OF HILO 99-0218512 Form 990 Schedule of Land Buildings and Equipment Statement 5 Date Placed Cost Accumulated Net Book Asset Descnpnon in Service Basis Deprecation Value Building 8/1/98 1,776,168 62906 1713,262 Funiture and Fixtures Various 118,656 16 542 102,114 Machinery and Equipment Various 44,961 24,680 20,281 leasehold Improvements Various 6,941 1,080 5,861 Comuter Software Various 8,668 3,596 5,072 Total to Form 990, Part IV Ilne 57a - b 1,955,394 108,804 1,846,590 Form 990 Schedule of Deprecation Statement 6 Estimated Basis for Current Year Asset Description Method Useful Life Depreciation Deprecation Building SLMM 40 1,776,168 44,404 Furndure and Fixtures SLMM 10 118,656 11,768 Machinery and Equipment SLMM 7 - 3 44,961 9,528 Leasehold Improvements SLMM 15 6,941 Computer Software SLMM 5 8,668 3,274 Total to Form 990, Part II, line 42 1,955,394 68,974 HOSPICE OF H1L0 99-02195~~ Form 990 List of Officers Directors Trustees and Key Employees Statement 7 Title and Contribution Expense Acct Time Devoted to Employee and Other Name and Address to Position Compensation Benefit Plan Allowances Gary Hagerman Esq President NONE NONE NONE PO Boz 609 Part-Time Honokaa HI 96727 David L Hammes PhD Vice-President NONE NONE NONE 155 Alohalani Dr Part-Time Hilo HI 96720 John F Roney Treasurer NONE NONE NONE 401 Wainaku Ave Part-Time Hilo HI 96720 Ronny de Jong Secretary NONE NONE NONE PO Box 40 Part-Time Pepeekeo, HI 96763 Gerald T Nagata Director NONE NONE NONE 1190 Waianuenue Ave Part-Time Hilo, HI 96720 Sarah E Cope Dvector NONE NONE NONE 276 Lahi St Part-Time Hilo HI 96721 Cora-May Jensen Director NONE NONE NONE 145 Honolu PI Part-Time Hilo, HI 96720 Catherine D Campainha Director NONE NONE NONE 135 Hoaloha St Part-Time Hilo, HI 96720 A Stephen Woo Jr M D Director NONE NONE NONE 193 Halai St Part-Time Hilo, HI 96720 Sidney M Fuke Director NONE NONE NONE 100 Pauahi St ,Suite 212 Part-Time Hilo HI 96720 Wes Kimura Director NONE NONE NONE 21 Kapaa St Part-Time Htlo, HI 96720 HOSPICE OF HILO 99-0218512 Form 990 List of Officers, Directors Trustees and Key Employess Statement 7 Title and Contribution Expense Acct Time Devoted to Employee and Other Name and Address to Position Compensation Benefit Plan Allowances Gladys Y Sonomura Director NONE NONE NONE 440 Naniakea St Part-Time Hilo HI 96720 Carol L Winegarden Director NONE NONE NONE 1190 Waianuenue Ave Part-Time Hilo, HI 96720 Raymond Hasegawa Director NONE NONE NONE 668 Kinoole St ,Suite 203 Part-Time Hilo, HI 96720 Brenda Ho Executive 56 224 NONE NONE 17-604 Paahana St Director Keaau HI 96749 Full-Time INTERNAL REVENUE (IRS) LETTER Internal Revenue Service Depzriment of ~h+ i•.~a,, u r`Lh ' OMB Clearance Number. 1545-0056 Date: MAY 31, 1985 Employer IdentLfication Number• 99-0218512 HAWAII PATIENT ENRICHMENT INC Contact person: 440 WEST LANIKAULA STREET HOWARD, RANDY LEE HLLO, HI 967200000 Contact Telephone Number: 213-688-4170 Our Letter Dated: - March 17, 1963 Dear Applicant: This modifies our letter of the above date in which we stated that you would be treated as an organization which is not a private foundation until the expiration of your advance ruling period. Based on the Information you submitted, we have determined that you are not a private foundation within the meaning of section 509(a) of the Internal Revenue Code, because you are an organization of the type described in section 509(a)(1) and 170(b)(1)(A)(vi). Your exempt status under section 501(c)(31 of the code is still in effect. Grantors and contributors may rely on this determination until the Internal Revenue Service publishes a notice to the contrary. However, a grantor or a contributor may not rely on this determination if he or she vas rn part responsible for, or was aware of, the sot or failure to act that resulted in your loss of section 509(a)(1) and 170(b)(1)(A)(vi) status, or acquired knowledge that the Internal Revenue Service had given notice that you would be removed from classification as a section 509(a)(1) and 170(b)(1)(A)(vr) organization. Because ttus Letter could help resolve any questions about your private Foundation status, please keep it in your permanent records. If you have any questions, please contact the person whose name and telephone number are shown above. Sl``ncerely yours, i_ i - rj Letter 1050(CG) IIIrCllldl l\G•uluv Jo,•w~. •~~Il:ul VI uIC I ICO.>ulY OISIfICI Dlreclor Person to Contact > Ron Hart Entity Control Un>.[ Director of Development and Telephone Number Public Relations (209) 452-4010 101 Aupun> St. , PH 1014 B Reler Repty to Hilo, HI 96720 Name Change Verification Date May 22, 1998 re: Employer ID. 99-0218512 fka: Hawaii Patient Enrichment, Inc. •Dear Ron Hart: This letter will serve as your ackowledgement of your organizations name change with the Internal Revenue Service. On or about March 1986, Hawaii Patient Enrichment, Inc. FEIN: 99-0218512 became known as Hospice of Hilo. The FEIN vas retained and is currently valid. Further verification was required to meet your funding needs as Letter 141C, attached, did not specify acknowledged name change. This letter is being sent to you per telephone verification with the Fresno Service Center Entity Control Unit on May 8, 1998. I hope that this information provided is sufficient. Please visit our office in The Hilo Lagoon Center, Suite 229-B during normal walk-in office hours ii we may be of further assistance. Sinc rely, Mine Taxpa er Service/Office Collection Representative LIABILITY INSURANCE CERTIFICATE INCLUDING AUTOMOBILE INSURNCE CI RTII IC4TF OF IVSL'FLn:sl } Uatt Scptrntbcr 18 1000 lhu Ccn,f care n issued as a mans of mfomianon onl) and con4n no nghls upon the crniGute holds Thrs ccrtd¢LLe does not ammd ea~md ar Companies AQordmg Co\eragc alter the coverage afforded by the polices below Company A. Lcglon Insuranec Company Producer Company B• NHO Insuranec Agency, Inc Insured Hospice of lido Cusud HOF}iIL PO Bw. 988 101 I Watanucnuc Avcnuc St Hclcna, CA, 94574 Hllo, HI 96720 Cover~ecs Thu rs to certify Out the pohne of rruurance listed below have bem issued la the insured tamed above Car the pohq• pmod mdiuleQ notwiihslanding .ny regwremmC term or condition of any eonVact or other docvmml with repot to which Ihu certifiule may De iuued or may pcrlaiR Ih< uuunnu afforded by the pobnes dcsnibed harem is sub)e Y to dl the tettrss exdusiore and oondmota of such pohnes I imils shown may have barn reduced by paid claims CO LTR Ty pe of lruurance En Dal< Erp Da4 IJsrula A GENERAL LIABILrrY PL6-000p428 08/01/2000 08/01/2001 BIAPD CO\(BMED X COMP FORM-Claims Madc SINGIE I1MiTS OCC SI,l10o,00p PREMISES/OPERATIONS BI k PD COMBMED CONTRACTUAL-LA4r[ED SMCIF L[MffS AGG 8),000,000 B F PROPERTY DAMAGE PERSONAL Ml AGG 21,000,000 A AUTO LIABILIlY PL6-0000428 08(01/2000 08/01/2001 BI do PD COMBQdED X HIRED AUTOS SAIGLE L0.41' OCC S 1,000,000 X NON-0WNED AUTOS A OTHER BIaPD COMBMED X MEDICAL PROF PL6-0000428 08/01/2000 08/01/2001 SMGI.E LIMITS OCC 81,000,000 LL4BII,ITY-CLAIMS MADE B14 PD COMBMED SMGI.E LIMITS AGG 2),000,000 A EXCESS L(ABII.IlY UM6-0000428 08/01/2000 08/01/2001 EA OCCURRENCE l1MBRELLA FORM X OTHER THAN Retention S25,000 A DIRECTORS DO- 2-0773917 - 08/01/1999 ~ 08/01/2000 Lintlt 51,000,000. Jr OFFICERS Deductible $2, SOON _ A FIDELITY CP6-0000428 08/Ol/2000 08/01/2001 Lumt 550,000. Deductible 1 °/a oC /unit A BUH,DDVG CP6-0000428 08/01/2000 08/0//2001 Gnat $970,000 Deductible S 1,000 A CONTENT'S CP6-0000428 08/01/2000 08/01/2001 Lvmt $140,000. Special Form- including theft Deductible 1250 Drsrnption of Operation please note that any coverage showing a zero limit is not in forces HOSPICERIOME HEALTH CerlincateHolder County of Hawaii, Finance Department, Attn: Helen Hatsul Company Address 25 Aupuni Street Hilo HI 96720 Cdy/StalrlLip - - - - CANCELLATION Should any oCihe above described pohcia be cancelled before Ne expiation date thereof, the issuing company will endeevw to mad 30 days wnuen notice to the certificate holder named shove, but failure to mad such notice shall unpose no obligation or lmbdtly oC any kind upon the company, its agent, or representatives Authorized r:ia~aru~rrr a nhola912200091657 Representative • - ° " ear sit a,rttlile http //www cla-Insurance com/tesdNfiOIA_Certlficate_of Insurance asp 9/18/00 ARTICLES OF INCORPORATION STATE OF HAWAII DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS Business Registration Division 1010 Richards Street Mailing Address: P, O, Box 40, Honolulu, HI 96810 3 m In the Matter of the Amendment of ) the Charter of Incorporation of ) A ~ HAWAII PATIENT ENRICHMENT, INC. ) _ ~ " - c o<•.- ) F ~ Z•^`J 1 r to A t --1 3~ CERTIFICATE OF AMENDMENT The President and Secretary, respectively, of HAWAII PATIENT ENRICHMENT, INC., a Hawaii non-profit corporation, do hereby certify that at a special meeting of the members of said corporation duly called and held at 1190 Wa!anuenue Avenue, Hilo, Hawaii 96720, on the 12th day of March, 1986, for the purpose of changing the name of the said corporation, it was voted by not less than two-thirds of the members present at the meeting to amend the Charter of Incorporation of said corporation by deleting the name 'HAWAII PATIENT °NRIC'iM~NT, INC,' wh°rever !t aFpears i~ the Garter of Incorporation, and inserting in lieu thereof the name 'HOSPICE OF HILO'. IN WITNESS WHEREOF, the~,,u~nd~e"rs'i/gne'd have hereunto set their hands th!s r~~ day of /i.(~~i~/ , 1986. ice Held: esident ~~~1 ^ce H ld: Secre ry -1- STATE OF HAWAII ) SS: COUNTY OF HAWAII ) s C JUDITH~FOX and MARILYN,SERFASS, being first duly sworn on oath, depose and say, that they are the President and Secretary, respectively, of HAWAII PATIENT ENRICHMENT, INC.; that as such officers they are duly authorized to sign the foregoing Certificate of Amendment; and that they have read the said Certificate, know the contents thereof, and that the same is true. G resident w X Secre a y Subscribe~/d and sworn~~t'o"before me this 1a )v` day of y~.(S(,~C-~.J 1986. a:~~~ Not r Public, State of Hawaii. My commission expires: l0 I hereby ap rove the foregoing amendment this ~ day of ~11It.f~ , 1986. Directo of Comme a and Consumer Affairs By ~~%~c ~ l~ ~L .c[inq Corporation an Secur ties inistratot -2- nEl~Altrrlrur• or I+ECUr,A~•oav AGENCIES In Che Matte[ oC the Licolr,n,ation ) oC ) IIAIJAI I PATIENT ENRIClif1EN'C, INC. ) CIiARTER OF INCORPORATIO~J 1'O ALL ,TO wlJOrt THESE PRESENTS SHALL COME: I, the undersigned Director of Regulatory Agencies of the State of Nawai>, send GreetLng: WHEREAS, SUSUMU YAMANE, DEWITT N. SMITH and MIMI WARSH a majority of whom are residents of the State of Hawaii, have filed with me as Director of Regulatory Agenc>es a verified petition to grant to them and their associates a charter of incorporation as a non-profit corporat>on, >.n accordance with the provisions of Section 416-20, Hawaii Revised Statutes; NOW, THEREFORE, KNOW YE, That I, the said Director, in the exerc>_se and execution of every power and authority Ln anywise enabl>.ng me in this behalf, do hereby constitute the said petitioners and their associates a corporation under the laws of the State of Hawaii for the purposes and in the form hereinafter set forth. I The name of the corporation shall be: HAWAII PATIENT ENRICHMENT, INC. IZ The location of the principal office of the corporat>on shall be Hilo, County and State of Hawaii, and the specific dress o` _ts 1n:t:sl ~ff:ce shall he ~:1~ lio~pit~l, 1190 waianuenue Avenue ll~c• •,,i•;,•; _ f~>~ :I~rru lire ~urr,c~ralrun r~. ~:~r.r•~~~e~l .ir 1 1'o provrde socr.rl, educational, psycholoyical, health and ie~realronal tac.r lrtros and services to the termrnally ill, 2 To mrtiyate the earn suffered by terminally rll palrents throuyh the administration of various drug combinations, 3 To provide psycholoyrcal and physical support to the Camrl~es and relatives oC terminally ill patLents, 4 To provide and maintain a dignified and peaceful environment for the terminally ill, 5. To carry on any other lawful activities whatsoever which are consistent with the provisions of the corporation's Charter of Incorporation which may seem to the corporation capable of being carried on in connection with the foregoing purposes and powers, and which are calculated directly or indirectly to promote the interests of the corporation and the community. IV The duration of the corporation shall be perpetual. V There shall he a Board of Directors consisting of not less than three nor more than twenty-five directors and ' the initial Board of Directors shall consist of three directors. The Following persons shall be the initial officers and directors, and shall hold office Eor the First year or until their successors are duly elected pursuant to the By-Laws of the corporation I Offices Ileld Names Residence nddress_ Presrdent-Director SUSUMU YAMANE 440 Lanikaula Street Hilo, riawaii 96120 ~ ~ ~ ~ Iii ti 1 tlr _nLC %\(~•J; r••,• i~ lr~~ r.l f~IK,I I'~li%\(HI-It r~/n i'n ~.,,'i.f "-ll S'_l n„~ CIIU Ill iU, ~'-f'?~li [ rJGJ10 cr [r•i•f[)' SI11 (,I KU (_IiANG 1190 L-Jd lanuCnU~ A•denu[• Hilo, Hawaii 96720 f[rasufcr JOHN MAIiRACK 26 waianuenue Avenue Hilo, liawati 96720 D[rector DF_WI7"f H St1ITl1 101 wail;ahe Road Hilo, Hawaii 96720 Ui[cclor MIMI WARSH P. O. Box 1919 Hilo, Hawaii 96720 IV In the furtherance of the foregoing purposes, the corporation shall have and exercise any and all powers, rights, priv[leyes and immunities which are now or may hereinafter be secured by the laws of the State of Hawaii. VII The corporation is organized exclusively for charitable, educational, and/ot scientific purposes, including, for such purposes, the making of distributions to organizations that qualify as exempt organizations under Section SO1(c) of the Internal Revenue Code of 1954 (or the corresponding provision of any future United States Internal Revenue Law). VIII No part of the net earnings of the corporation shall inure to the benefit of, or be distributable to, its members, directors, officers, or other private persons, except that the corporation shall be authorized and empowered to pay ~ I reasonable compensation for services rendered and to make I payments and distributions in furtherance of the purposes set forth in Article Third hereof No substantial part of the activities of the corporation shall be the carrying on oC propaganda, or olTlerwise attempting to influence leyislation, ,n ~ i,~,1i n~~ .I,i ,•.li, ii,~ :~i ~`i •,1t 11xil ..I ,t,, t••• ,t any ),,,1,' ,gal <,+•~~~.,i )n on !u•h~,11 uC any c.uncl„lale Coc I~ul,l,c oCC,r r• Notwrlh~,t n<i uiy any other provtsrun ~f these LLCIes, the co,),uration shall not car,y un any olhec activit,es not perm,lled Lo be ca,rred on (a) by a corporation exempt Crom Fedccal ,ncome tax under Section SO1(c) of the Internal Revenue Code of 1954 (or corLes{~onding provrsron of any future United Stales Internal Revenue Law) or (b) by a corporatron, contributions to which are deductible under Section 170(c)(Z) of the Internal Revenue Code of 1954 (or the corresponding provision of any future United States Internal Revenue Law). lx Upon the dissolution of the corporat>on, the Board of Uirectors shall, after paying or making provision for the payment of all of the liabilities of the corporation, d>spose of all of the assets of the corporation exclusrvely for the purposes of the corporation in such manner, or to such organization or organizations organized and operated exclusively for charitable, educational, religious, or scientific purposes as shall at the tLme qualify as an exempt organLZatLOn or organ>,zat>ons under Section SO1(c) of the Internal Revenue Code of 1954 (or the corresponding provision of any future United States Internal Revenue Law), as ttie Board of Directors shall determine. Any such assets not so disposed of shall be disposed of by the DLStrict Court of the county >n which the princrpal office of the cocporation is then located, exclusively for such purposes or to such organization or organizatrons, as said Court shall determine, which are oryanized and operated exclusively for such purposes. - -4 - i'~i ~ t li.r tr•+ may .n• ,uar•ncird .N 1 he vpl c of nit l~ ~'~+i~~ .wo ~li~i~l; c~C thc• mc•mhers oC ii~c corporation, in wr i1 my yr al .i ~~~eetrny duly called and held for that purl>ose xl The corpocatron >,s not organized for proEtt, rt will not issue any stock, and no part of its assets, income, or earnings shall be distributed to its members, directors, or officers. IN lJI1'NESS WI{EREOF, I have hereunto set my hand and seal of the Department of Regulatory Agencies, at Honolulu, tla~+ai>„ this ~(~f~ day of 1980. s- ~'f~`~ DIRECTOR OF REGULATORY AGENCIES l' ey ~ ~ Corporation G Securltiee A istrator -S- BY-LAWS CERTIFICATION BY SECRETARY OF HOSPICE OF HII,O I HEREBY CERTIFY that I am the duly elected, qualified and acting Secretary of the above-named corporation and that the attached By-laws were duly adopted by said corporation on ~ and are currently effective. Date: ~ Ronny de Jo ecre BY LAWS OF HOSPICE OF HILO A NON-PROFIT CORPORATION ARTICLE I SECTION 1. NAME. The name of ti~is Corporation shall be the Hospice of Hdo, hereinafter referred to as Hospice. SECTION 2. PURPOSE. The purposes, goals and objectives of Hospice shall be as spedfiplly set forth in its Charter of Incorporation. SECTION 3. NON PROFIT CHARACTER. Hospice shall be a non-profit Corporation, and any net income or earnings which may be derived from its operations, in pursuance of tfie purposes of Hospice shall not be distributed to any member, director or office, or any private individual, but shall be used to promote the purposes of Hospice. ARTICLE II SECTION 1. PRINCIPAL OFFICE. The prirxipal office of Hospice shall be maintained at 1011 Waianuenue Avenue, Hilo, Hawaii, or at such other place in the City of Hib, State of Hawaii, as the Board of Direttiors may determine. Hospice may have other offices within the State of Hawaii as the Board of Directors shail determine. Ravi setl/Adopted July 1998 I of 12 ARTICLE III Board of Directors SECTION 1. GENERAL POWERS. The directors shall oversee the general management and control of the business and affairs of the Corporation and shall exerase all the powers that may be exercised or performed by the Corporation, under the laws statutes of the State of Hawaii, the Articles of incorporation and the By-Laws. SECTION 2. NUMBER AND TERM. There shall be a Board of Directors of the Corporation to consist of fifteen (15) members. SECTION 3. REGULAR MEETINGS. A regular meeting of the Board of Directors shall be held monthly without other notice than these By-Laws, at such date and time as the Board shall determine. The place for the monthy meeting of the Board of Directors shall be the Board Room of Hospice of Hib, unless otherwise determined by the Executive Committee of the Board of Directors. SECTION 4. SPECIAL MEETINGS. Special meetings of the Board of Dir~ecbors shall be called by or at the request of the President or any two Directors. Any spedal meeting shall be held in the board Room of Hospice of Hilo. SECTION 5. NOTICE. Notice shall be given of any special meeting of the Board of Directors at least two days previous thereto by written notice delivered personally or sent by mail, telegram or facsimile m each director at his or her address as shown by the records of the Corporation. If mailed, such notice shall be deemed b be delivered when deposited in the United States mall in a sealed envelope so addressed, with postage thereon prepaid. If notice is given by telegram, such notice shall be deemed tp be Revised/Atlopteo July 1998 2 of 12 delivered when the telegram is delivered to the telegraph company. If notice is given by facsimile such notice shall be deemed to be delivered when the facsimile transmission is successfully completed. Any director may waive notice of any meeting. The attendance of a director at any meeting shall constitute a waiver of notice of such meeting, except where a director attends a meeting for the express purpose of objecting to the transaction of any business because the meeting is not lawfully called or convened. Neither the business to be transacted at, nor the purpose of, any regular or spenal meeting of the Board need be specified in the notice or waiver of notice of such meeting, unless specifically required by law or by these By-Laws. SECTION 6. QUORUM. A majority of the Board of Directors shall constltube a quorum for the transaction of business at any meeting of the Board, except as provided differently in these By-Laws. SECTION 7. MANNER OF ACTING. The act of a majonty of the Directors present at a meeting at which a quorum is present shall be the act of the Board of Directors, except where otherwise provided by law or by these By-Laws. SECTION 8. VACANCIES. A vacancy on the Boani of Directors occurs when there are less than fifteen (15) members. SECTION 9. TERMS. A. LENGTH. A term consists of a period of thn.e (3) consecutive years. B. COMMENCEMENT OF TERM. A teen commences on January 1`~ following the members election la the Board. Revised/Pdopted July 1998 3 Of 12 C. MAXIMUM TERMS. A member may serve no more than two (2) consecutive terms. A person is eligible for reelection to the board of Directors one (1) year after the rnmpletion of two (2) consecutive terms. SECTION 10. COMPENSATION. Directors shall receive no compensation for their services, provided that nothing herein contained shall be construed to prelude any director from serving the Corporation in any other capaaty and recemng compensation therefore. SECTION 11. REMOVAL OF DIRECTORS. A. Any Director may fie removed from the Board with or without cause, by a vote of three quarters (75%) of the Directors present at a meting at which the quorum is composed of at feast three quarters (759/0) of the complete Board of Directors. B. Any Board member who fails to attend three consecutive Board meetings and is no excused from attendance by the Secretary shall be automatically dropped from the Board of Directors. C. Any board member who does not attend on-half (50%) of the regularly scheduled board meetings in each calendar year shall be automatically dropped from the Board of Directors. Excused absences do not count as attendance. D. Aboard member on be exempted from the provisions of paragraphs B or C by the affirmative vote of three quarters (75%) of the members of the Board of Directors. A quorum at a meeting of the Board of Directors cannot exempt a Board member from the provisions of paragraphs A or B unless said quorum is composed of at least three quarters p5%) of the complete Board of Directors. Aevlaed/lWop[ad July 1998 4 of 12 ARTICLE IV Officers SECTION 1. OFFICERS. The officers of the Corporation shall be a President, a vice President, a treawrer, a secretary and such other officers as may be elected in accordance with the provisions of this Amide. The Board of Directors may elect or appoint such other officers, induding one or more assistant secretaries and one or more assistant treasurers, as it shall deem desirable, such officers to have file authority and perform the duties prescribed, from time to time, by the Board of Directors. Any two or more offices may be held by the same person, except that the same person may not hold the offices of President and secretary. SECTION 2. ELECTION AND TERM OF OFFICE. The offloers of the Corporation shall be elected at the mouthy Board of Directors meeting held in December. If the election of officers shall not be held at such meeting, such election shall be held as soon thereafter as may be conveNent. Vacandes may be filled or new offices created and filled at any meeting of the Board of Direc.~brs. Each officer shall hold office rx>Irtll a wooessor shall have been duly elected. SECTION 3. REMOVAL Any officer or agent elected or appointed by the Board of Directors may be removed by the Board with a without cause by a w6e of three quarters (759'0) of the Directors present dt a meeting at whidi the quorum is wmposed of at least three quarters (75%) of the complete Board of Directors. SECTION 4. VACANCIES. A vacancy In any office because of the death, resignation, removal, disqualification or otherwise, may be filled fry the Board of Directors. Revised//WOptsd July 1998 S of 12 SECTION 5. PRESIDENT. The President shall be the pnncrpal executive officer of the Corporation and shall, in general, supervise and contrd ali of the business and affairs of the Corporation. The President shall preside at all meetings of the members and of the Board of Directors. He or she shall have full charge of the business office of the Corporation. The President may sign with the secretary or any other proper officer of the Corporation authorized by the Board of Directors, any deeds, contracts, or other instruments which the Board of Directors have authorized to be executed, except in cases where the signing and exeardon thereof shall be expressly delegaked by statute to some other officer or agent of the Corporation; and in general, shall perform all duties incident to the office of President and such other duties as may be prescribed by the Board of Directors form time to lime. SECTION 6. VICE PRESIDENT. In the absence of the President or in the event of his inability or refusal to act, the vice President shall perform the duties of the President, and when so acting, shall have all the powers of and be subject to all the restrictions upon the President. The Vice Pi'eslderit shad perform other dudes as from time to time may be assigned by the President or by the Board of Directors. SECTION 7. TREASURER. The Treasurer shall have charge and custody of and be responsible for all funds and securities of the Corporation; and reserve and give receipts for moneys due and payable to the Corporation from any source whatsoever, and deposit all suds moneys in the name of the Corporation in such banks, trust companies or other depositaries as shall be selected by the Board of Directors; prepare periodic finandal statements of the Corporation's fiscal affairs and operations; and in general, perform all Revised/Atloptetl July 1998 6 of 12 the duties incident to the office of treasurer and such other duties as from time to time may be assigned to the Treasurer by the President or by the Board of Directors. ARTICLE 8. SECRETARY. The Secretary shall keep the minutes of the meetings of the members and of the Board of Directors in one or more books provided for that purpose; see that all notices are duly given in accordance with the provisrons of these By- laws or as required by law; be custodian of the corporate records and keep a register of the post office address of each member which shall be furnished to the secretary by such member; and in general, perform all duties inadent to the office of Secretary and such other duties as from lime to time may be assigned b the secretary by the President or by the Board of Directors. SECTION 9. ASSISTANT TREASURERS AND ASSISTANT SECRETARIES. If required by the Board of Directors, the assistant treasurers and assistant secretaries, in general, shall perform such duties as shall be assigned to tfiem by the Treasurer or the Secretary or by the President or the Board of Directors. SECTION 10. DELEGATION OF DUTIES. Upon request by any officer of the Corporation, the Board of Directors may delegate some or all of the duties and responsibilities of the officer to another officer or to an employee or agent of the Corporation for such time and subject to such terms and conditions, if any, as may be Imposed by the Board of Directors. Ravi eetl/Atlap[atl July 1998 7 of 12 ARTICLE V Committees SECTION 1. COMMITTEES OF DIRECTORS. The Board of Duectors may designate one or more committees, each of which shall include one or more directors, to exerr95e the powers and functions presrnbed by the Board of Directors; but the designation of such committees and the delegation thereto of the authority shall not operate to relieve the Board of Directors, or any individual director, of any responsibility imposed upon it or him by law. SECTION 2. STANDING COMMITTEES. The standing committees shall be (i) Executive, (2) Finance, (3) Nominating, (4) Human Resources, (5) Community Relations and Publk Education, (6) Planning and (7) By-Laws. These committees shall have such duties and responsibilities as shall be established by the board. The chairpersoru of all such committees shall be appointed by the President with the approval of the Board. The chairperson, in consultation with the President, shall select the committee members. The chairperson and members shall serve until the expiration of the fiscal year or until their successors are appointed. SECTION 3. OTHER COMMITTEES. The Board of Directors may create such other standing or spedal committees as it deems necessary to carry on file business and purposes of the Corporation. The President of the Corporation shall appoint the members thereof. Any member of a standing or speaal commtttee may be removed by the person or persons authorized to appoint suds member or by the Board of Directors whenever, in their lodgment; the best interests of the Corporation shall be served by such removal. Revlaed/Adopted July 1998 8 Of 12 SECTION 4. TERM OF OFFICE. Each member of a standing committee shall continue as such until his successor is appointed, unless the committee shall be sooner terminated, or unless such member be removed from such committee, or unless such member shall cease to qualify as a member thereof. Every member of other committees shall contnue upon such terms as are prescribed by the Board of Directors. ARTICLE VI Advisory Council There shall be an Advisory Coundl of fifteen (15) members. Members of the Advisory Council shall be chosen from various fields related to tfie purpose of Hospice, indudirg finarxial wpport. Members of the Advisory Coundi shall be proposed to the Board of Directors by the Nominating Committee and voted upon at Board meetings at which at least three fourths (75%) of the Board members are present. Members of the Board of Directors are encouraged to wbmit names for people to be on the Advisory Coundl b fire Nominating Committee. The term of members of the Adviscxy Coundl shall be one (i) year from the date of their appointment by the Board of Directors. ARTICLE VII Contracts, Checks, Deposits and Funds SECTION 1. CONTRACTS. The Board of Directors may authorize any officer or officers, agent or agents of the Corporation, in addition to the officers so authorized by these 8y-Laws, to enter into any contract or execute and deliver any instrument in the Revised/Adopted July l9aB 9 of 12 name of and on behalf of the Corporation. Such authority may be general or confined to specific instances SECTION 2. CHECK, DRAFTS, ETC. All decks, drafts or other orders for payment of money, notes or other ev~denoes of indebtedness issued rn the name of the Corporation, shall be signed by such officer or officers, agent or agents of the Corporation and rn such manner as shalt from time to time be determined by resolution by the Board of Directors. SECTION 3. DEPOSITS. All funds of the Corporation shall be deposited from time to time to the credit of the Corporation in such banks, trust companies or other depositaries as the Board of Directors may select. SECTION 4. FINANCES AND AUDIT. Accounting procedures shah conform to generally accepted accounting practices and procedures. The books of the Corporation may be audited after the end of the fiscal year by a certified public accountant appointed by the Board of Directors. The auditor's report shall be filed with the records of the Corporation. A summary of the report shall be presented for action as soon as possible. The Exea~live Director shall be authorized tp contract for services and materials within the provisions of the budget adopted by the Board of Directors. All funds received by the Corporation shall be deposited to tfie credit of the Corporation in depositories approved by the Board of Directors. No officer or employee shall obligate the Corporation beyond the limits of items in the approved budget without specific authority from the Board. Revised/Adopted July 1998 10 of 12 ARTICLE VIII Books and Records The Corporatan shall keep correct and complete books and records of account and shall also keep minutes of the proceedings of its members, Board of Directors and committees having any of the authority of the Board of Directors. ARTICLE IX Fiscal Year The fiscal year of the Corporation shall begin on the first day of January and end on the last day of December in each year. ARTICLE XIV Waiver of Notice Whenever any notice whatsoever Is required to be given under the provisbns of the laws of the State of Hawaii or under the provisions of the Artldes of Inoorporatlon or By- laws of the Corporation, a waiver thereof in writing signed by the persons or persons entitled to such notice, whether before or after the time stated therein shall be deemed equivalent to the giving of such notice. ARTICLE XV Nepotism No two or mare members of a family or kin of the first and second degrees shall be Revised/AdopCad July 1998 11 Of 12 employed or under contrail by the Corporation unless specifically permitted in writing by the Board of Directors. ARTICLE XI Confl+ct of Interest Members of the Board of Directors shalt not engage in any activity, practice or act which conflicts with the interests of Hospice of Hdo. It a matter arises in which a member of the Board has, or appears to have, a conflict on interest the member shall promptly disclose it to the Board of Directors. Dunng a meeting of the Board, the Chair shall rule on whether the Member shall be excused or shall be allowed to participate in the issue at hand. ARTICLE XIII Amendment to ev-Laws These By-Laws may be altenzd, amended or repealed and new By-Laws may be adopted by a majority of the Board of Directors at a meeeting of the Board of Directors at which at least three quarters (7540) of the members of file Board arse present. Changes to the By-Laws shall be proposed to the Board of Directors by the By-Laws Committee and shall be submitted in writing to each Board member no less than two (2) weeks before file Board Meeting at which such changes are to tie voted upon. Revised/Adopted July 1998 12 of 12