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HomeMy WebLinkAboutCOM 0122.032 2000-2002 Stzphen K `lamashuo Ham q Takahashi lfai or Director COUNTY Of ~I~k1K~t1`I DEPARTMENT OF FINANCE 25 Aupum Street, Room 118 Hilo, Hawau 96720-4252 (808)961-8234 • Fax(808)961-8248 HAWAII COUNTY NONPROFIT GRANTS (FY 2001-OZ) HUMAN SERVICES NONPROFIT GRANTS REVIEW COMMITTEE January 29, 2001 FISCAL YEAR ENDING June 30, 2002 DATE OF APPLICATION GRANT APPLICATION FOR Rona lidnlt Dav Center. Inc. (ProRam Title) Legal Name of Orgamzatton Rona 1,dnlt Day Center . Inc . MatlmgAddress p• O. Boz 1360 Realakekna BI 96750 Faclltty/StteAddress. 81-989 Ealekii St., Realakekua B7 Dtrec[or/Sue Manager iCen Ono, Bzecutive Director Organtzatton President Eatela Balverson Contact Person (Grant Wnter)• Rowena L. Tiaui Amount of Request for County Funds. f 20,000 Total Annual Budget of OrganizaLOn S 33,5, ~ Has the applicant applied for any other fiords from the County of Hawau this fiscal year ? Yes Source/Department: ~ No Ageucy/Program(s). ~ Social Services ? Youth Programs ®Eldaly Programs Check Categones: ? Culture and Arts ? Educattou ®Other Respite for Faaily/Caregivers Briefly, define the program for which tnnding to being requested: Dav Care encoispasees uni4ue services rangLo frog social aad recreational therayhv to medical care therapy and aaintenance at the highest level of functioning. Comru 1!ie, (2 2 . 3 Z FSIe No. ~ ~ ~ -1- Ref. Tot Pr°s°°IM7 µf E D L xer. nave FEB 2 0 2001 L QtiAI.IFtTNG STANDARDS FOR APPLICAuYTS A~njappltcant must meet all of the following standards BUJ Be chartered or otheru•tse authorized to do business m the State for charitable purposes and exempted from the federal income tax by the Internal Revenue Service Hose a governing boazd whose members serve without compensation and have ao conflict of mtercst between their regular occupations and the srnices provided Have bylaws or policies which describe the manner m which business is conducted, including management, audit, fiscal policies and procedures, policies on nepotism, and pohaes on management of potential conflict of mterest Have at least one year's experience with the service or activity for which the appropnanoa is sought or can otherwise demonstrate to the satisfaction of the County sufficient expertise to successfully carry out the service or acnwty Be hceaaed and accredited m accordance with applicable rcquuemeab of Federal, State and County laws II. GRANT CONDITIONS The applicant agrees to comply with the following terms and conditions poor to recnvirig a giant award A. Comply with applicable Federal and State laws prohibiting dtscrtmmanoa agacast nay person on the basis of race, color, national ongm, rchgioq creed, sex, age, or handicap H Agree not to use any public foods for proposes of eai~*~~~Tent or perquisites C Comply with such other requvemenn as the Duector of Finaace may prescribe to cnaure adhenmce by the nonprofit orgaauatioa with Federal, State, sad County laws, and established standards for fiscal and program management D Allow the Director of Finance, the committees of the council and then staffs, end the Legislative Auditor access to records, reports, files, and oilier related documenn m order that the program, management, and fiscal practices of the nonprofit organization iaay be monitored and evaluated to assure the proper and effective expenditure of public fiords III. RECORDS AND REPORTS A The applicant shell follow generally accepted accounting ptocedura and pnchces and shall maintain books, records, documenn and other evidence which aiif5cimtly and properly account for the expenditure of County funds. The books, records cad documean shall be subject st all reasonable times to inspection, reviews, or audio by the County expeedmg agency, the Director of Finance, end the Legiskmve Auditor, or by their represrntanves B The County expending agency, Director of Finance, or County Council may regiiat periodic wnttrn reports oa the use of County funds. C The a~profit orgeiivaaon shell submit s final wnttea report to the [,egislanve Auditor within sixty (60) days after Juae 30 of the focal year The report shell include an explanation of the public beaefin derived from the awarding of the gismt, a listing of other funding sources and amounts obtained during the grant pmod, and a complete acwuntmg of all expeadrttua supported by County of Hawui grant funds {per Chapter 2, Article 25, Section 2-142(d), Hawau County Code, emended August, 1999} -2: IV. QUARTERLY ALLOCATION Under no cacumstances shall grant funds be disbursed m a lump sum payment Grant funds will be disbursed to Grantees only through a quarterly allocation process The disbursement of grant funds can be formulated on an equal quarterly apportionment bans V. GRIEVANCE PROCEDURE The applicant will adopt and maintain a gnevance procedure to assure proper accounting for any concern and complaints about its program or services that may arse from its members, employees, clients or from other members of the publtc VI. DISCLOSURE OF INFORMATION All information, data or odier material provided to the County by virtue of this apphcaaon shall be subject to the Uniform Informattan Pracnces Act (UIPA), Chapter 92F, Hawaii Revised Statutes. All such matenal is deemed goverttmrnt record and stroll be open to the publtc and may be provided to other public md/or pnvate funding SOUtCe9 VII. CONTINUED ELIGIBILTfY Any applicant or recipient who wlt66olds or omits any material facts or deliberately mLrepraeuta such facb to the Couery of Heweli shall: (1) Immedutely be disqualified from wmrderanon for Nonprofit Grant funding, OR (2) be in nolanon of the terms of the Grant Agreement of Comry funds in which cau a grant agreement cm tie terminated by the Couary and the recipient or provider may be liable to reimburse all or a pomon of any funds recnved Utaem VIII. ACIINOWLEDGEMENT Rona Adult Day Center, Inc. (Legal Neme of Orgmtzation) hereby agrees to admtiuster the Adult Day Care (Program TWe) in accordance wtt6 the negttlmons, pobraea and procedures preacnbed by the Hawed County Finance Depsrtmrnt. Distnbuuon of grmt funds is limited to grantees which are m wmpliattce anth County regula4oos, policies and procedures The County rcservd the nght to withhold grant distnbunons u my time the grantee u not in comphmce it is the policy of the County of Hawaii and for those who do bustnns with the County to provide equal employment opportwha W all persons regardless of race, physical dtsebihnes, color, rohgion, sex, age, or national ongm o mmdued by the Federal Cml Righta Acts, as amended, and my other federal or state laws relating to equal etrtployment opporNmues. IX. AMENDMENTS TO THE APPLICATION/EVALUATION The apphcmt assures that tt will sutimtt to the Humm Semces Nonproft Grmb Review Committee (HSNPGRC) for pnor renew and approval a antten recpiest and lush5cahon for my changes, additions, or deletions to my portion(s) of the grmt epplianon or a duly executed Gant Agreement of County Funds. 'Ibe applicant will cooperate and assist m mY effiM tmdertaken by ilie HSNPGRC to evaluate, iospact or otherwise monitor the effecnveness, feaerbihry, and/or wet efficiency of my end all pncnces, pobcia sad procedures or acnvma pursuant to this application or my gtmt dptgiisnon or alloi:anou received as a result of thu apphcanon. -3- X. AtiTHORITY AND CAPACITY OF APPLICANT The applscant certsfies that st has the authonty and capacity to develop and submst thss appiscatson, and to fully admsnsster the program{s) pttrsuant to thts applscauon UNSIGNED PROPOSALS WII,L NOT BE ACCEPTED! \?.9t1~..~.~ 2~ t7 3 D© I Stgnat~ure of PrestdeaUChnupersoa Dau t e O/- 3/- o / Stgna of Execuuve Dtrector/Manager Date -4= Kona Adult Day Curter, Inc Hawau County Nonprofit Grants FY 2001-2002 PROGRAM/SERVICE DESCRIPTION ' NARRATIVE QUESTIONS A. OVERVIEW 1 Descn'be the program for whrch finding ~ being requested Funding is being requested for Adult Day Caze services which is described es suppomve services provided m a protective setting for part of a day by an organized progttun for elderly and disabled adulb The basic objective of the program is two-folded: 1) provide en mnchmeot program for churls through the sacio-medical model adult day care program and 2) provide respite tlrom comintros caregtvmg for pommy caregivers anti rhea temtlies. Kotis AduB Day Cere (KADC) is a commumry- based, freestanding eduh day center, conceived in 1986 and unplernenred in Detxmber 1988, to provrded an alteroative for caregivers that would eoabk an im~aired family member to remain m the home as long u appropriate. Thus far, the need for respite to greatest among caregivers of person with Alzheuner's dtseese or related dememia Until Kom Aduh Day Center opened, there were no community-based adult day somas for residents of West Hawarr/Kom. The cammmrry has benefited tremendously by having this long term care ahertiatrve available to thox m need. TheCenter provides supervision, psotatlve care, soctslization and health monitorutg for rb particrpmb The impact of KADC within the cotnintmrty n very positive. Heahh and social semces provides within the long-term care network have imerfaced with the progrton, with referrals flouring beck and forth between venous provrders oa a routine basis. Physicians who utilize adult day services for they petieob have looked upon the program, u a necessary heaNh intervention, which nab the socutl, welhxss ®d functional mamtmtenence, needs of their petimb. Local phyaiclaats agree that, then patiem load of these aged 60 plus is mcreasmg rapidly and that the ttumber of patiems diagnosed with Alzheimer's disease and related demmtra rs imm~sifyiug. ARer twelve (12) yeah of opemtioq KADC, has made a niche for itself in the community end within the long-berm are canbinutmt. 2. What unique or significmt service will be provrded? At a minimum, KADC'S stink dsy care services shell inchtde the following attivitias. • Development end Dominus! monttormg of individual service plans, which are consistent with medical report of the eduh's health condition end sctlvity limrtadone. • Provision of leadership, assistance and supervision by staff in the individual's participation in all appropriate program ecavities. • Provision of leisure, reereationel end scetalization activities thin provides mterscdon between stsff and pertieipems and among participant • Provtion of mdividtal m group physical conditioning exercises and srmple caltsthenice, constructive gams or crofts that maximize the individual's physical and mental capabilities anti help w strengthen and improve limb sad motor coordioatiam. • Provision of reminders, encouragement and assiatanoe by staff m eaabk the individual to mamtam a bo improve person! hygiene, xlfi;ae and atremion to heelTh care needs, mchniing the provision of staff supervision of self-admmimted oral and ~ra1 medications. PROGRAM/SERVICE DESCRIPTION NARRATIVE QUESTIONS A. OVERVIEW (continue) • Provision of counseling by staff to indmdual and to the indivrduel's family caregivers, rf any, to assist m smrple decrston-making and problem solving, to resolve adjustment problems, to bmld upon available family support and to mcreax awareness on the put of the indmdual utd/or family caregiver of appropriate soetal semtxs and healtb/medical care resources in the community, including the provision of referral services to secure needed services 3 What specific outcomes ere to aclneved~ • Partcipaat's hygteoelselfcerc will be maintained or improved. • Participant's socutlvabon/interachon skills will be mamtatned or improved. • Perticrpent's tamilid will express satisfaction wish KADC services • Partrcipents will be maintained at home and within the commwrty for 6 months with adult day care sernces. 4 How vnll the proposed prognto empower puticipents/cliems to become self-sufficiem end facilitate posrtive socul chmge7 I{ADC participmts will empower to become more self-sufficiem by constam encouragement end rcinfor+cemem of independent care by Center staff: Participant's persoml hygiene, socialiuaon sktLLs and general well being will a rmproved thtoug6 attendance of the adult day care program Positive social change seems whin cuegivers arc relieved on the burden of fWl- tmte ceregiving, allowing them to continue with job, family matters and persoml goals with the knowledge that they loved ones ue card for in a saPo, secure and encouraging envtrooment B. PROBI.EM/NEED 1. What rs the problem/need the Proposed program u designed to meet? Adult who attend It.ADC carrot be adequately cared for in the home setting but arc not yet ready for nursing home placement. l{ADC is dedicated to providhtg a heallb, social and recreational program that enables impsirod eduhs to experience feednp of belonging, friendship, accomplishment and mdepeadevice in . cring and sectae social mv;reomeot. KADC u ao essential link m the continuum of long term sue within the wart Hawed comm~mtty 2 Who is the targd population and whu arc the specific needsT KADC provides services to the unpaved adult, 18 yeah m older, who meet the eligibility rcquiremems for adult dry care services. These persons inchtde the ~ vuhterabk elderly and other adult who requtrc protective and/or supervised cue in s sate envirotattent In specific terms, these include the following persons: those with Al~teimuu's disease a [elated dattantia disorder, thou with physical disabilities, such as stroke a Peklnsoo's disease, those with mevral rotardadan or other stable chronic menW conditions avd these [squiring socialiation and stimulation in order m remain firnctieoal and active mambas of their home .nd comm,intty 2 PROGRAM/SERVICE DESCRIPTION NARRATIVE QUESTIONS B. PROBLEMMEED (continue) 3 What are the geographic area(s) to be served and hours of operation? The geographic areas served by KADC include north to Kona Palisades area and south to Kealia The 6,000 sgttere foot facility is located in Ktxlakekua, across form the Kealal.ekua post office on Halekii Strut The tearer is open Monday through Fnday from 7.30 am to 5.00 p m , excludtitg holidays C. COLLABORATION/COORDQYATION 1. Whet specific measures will be taken to collaborateJcoordtmte with other commtmiry resources to achieve maximum program effictency end cost effectiveness? KADC coordinates sernces for older adults through perticipstion in the "Inhrdisciplmary Team" Coordinated through the Depttrmtem of Health Case Meoagemem Coordination protect, the Iroerdisctplinsry Team meets once a month m the KADC conference room to confidentially discuss "at nsk" adults. The Team bas many diems in common sod works to efficiently ~d cost effectively wprove their hues through coordination of commtmoy service. Members of the Team include Public Health Ntasmg, Sernrxs for Seniors, Coordimted Service for the Elderly, West Hawaii Home Health Services, Winn's Claims, Legal Aid Society Hawaii, Carc Resources Hawaii, Veterans Admutistraaoq Hospiu of Kona, Cetmr for Indepeadem Ltvtag and Kona Athtk Day Center The Team representatives assts[ clients and whin appropriate, then famthe, with issues of heahh, social, recrewoml, financial, adaptive medical equipment, legal and traitsponaaon In August 1998, the KADC Board of Directors took the opportmiry with the resigttadon of the Executive Duector to reassess KADC's tnaoegetnem and clinical sttttcaoe with [fie goal of strengthening both elemeon at a reduced finmctal cast. KADC eittered eo agmement m September 1998 with Kona HeaNh Services to provide m Executive Director (Ku Oao~ all cluural musing services and a Medical Director, at s savings of approximately 51,100 pa month Robm Seto, M D ,aboard cenified intemtst and board certified gerontologist is the Medical Dtrcctor. 2 How will these measure reduce or eliminate any ezisang duplrtxhon of services to your designated ttirget group? Through the Interdisciplinary Team's collabotsave etfarts, exh diem's needs are idmtlfied end proxssed on an indrnduel bests. The Team's case inaoagement el~ittaaw any duplication of services or funding D. GOALS AND OBJECTIVES 1 What are the mayor goals/benc6marks of the Proposed program? The Kona Adult Day Center has established the following program goals and objectives: a. P~Str dam Goals for the Ltdividusl. 1 The diem will be able to axsoctate with a place and a group corresponding to his or her own sense of identity 3 PROGRAM/SERVICE DESCRIPTION NARRATIVE QUESTIONS D. GOALS AND OBJECTIVES (continue) 2 The cliem's maximum level of indepeadrnce will be assessed and maimained through the uidmdual Program pltuming 3 Mrntslly and physically unpsved adults will be mauitauud at they highest level of fimcuonmg, thus preventing or delaying further detenoradon. 4 Health monitonng as well as protective aced supportve care for the frail and disables adults will be mchuled m care ptatming and sernces 5 The participant's knowledge of and access to elderly services available m the community will facilitate. 6 Premature or inappropriate msdtu[iomlvanon m anursing home or hospital will be prevented 7 Socializing, peer intersction end continued rclatiooshry with the community will be ensured 8 Isolation and prejudice often associated with Gail ~d disabled adulh will be reduced b Program Goela for Families and Other Carearvers: I Families that desire to keep elderly members m the home will be given relief from Gill-time cats of an impaued older aduh 2 Family members will be enabled to commue productive careers instead of being homebound wrth an elderly, disabled spouse. Parent or oche temity member. 3 Fenulies and other caregivers will be assured that elders dependent upon them are being cared for appropriately during the day. c. Proaam goals for the West Hawau Comtaimitr: 1 Ace integral component of the community service network sod of the longterm care continuum will be made available to the West Hawaii community. 2 The medical covununity and other resources statewide will be provided a liaiwo in the genatncs, especially Alzhemer's disease and other related disorders. 2 What speci5c objectiveslaction steps are planned for each goe1T laving the initial assessment of each participant, ao individual plan of care is devebped. This plan of care, approved by the client's personal physician is shared with the partlcipmt's family and s updated on a six month basis. The individual plan of care clearly deBad the goal plumed for the partcipsrn. Each mdtvidual plan of care will specify how the objective arc to be carried out, who will oversee esch objective and will record the resuln of each step. 3 What is the timeline (start and end date) for each action stepT a. Intake and As9es~~• The program director and nursing coordmatar receive referrals form various sources (hospital ducherge Planner. physicians, Mane haah6 txae agencies, Nursing Home Without Walls, Public Health Nursttig/Ceae Maoa®emrat Coordioetion Projtct, families, Department of Humor Services casetvorlcer, Coordmarod Services far the Elderly aed others). The intake assessmem processes include avc m: g pertinent information for social end medical assessmems, baseline survey for caregiver burden, physici® history and physical, determinatwn of appropriateness for day care services, and home, hospital, m offix visit with the client ®d titmi7y. 4 PROCRAM/SERVICE pISCRIPTION NARRATIVE QUESTIONS E. GOALS AND OBJECTIVES (continue) a Intake and Assessment• (continue) • Assessment needs result wnh the formulation of a plea of care before enrollment. The care plan wtll include the need to coordinate other agency/community services to meet the tdentified needs of the cltmt. • Nursing coordinator must receive TB clearance, history and physical report from client's physician before then[ enrollmrnt • After completion on intake paperwork by diem, family, physician end appropnate resources, dent is admimed to KADC b ResnitdVacahon. A slant's position may remain open during a period not m exceed tin (l0) consecutive days for vacahom or tf the caregiver in need of respite should arrange care for the chew at another locatton c. Dt a Discharge is based on the broad gaaLs of the slant, family or referral source and in most cases, will be included in the individual's care plan. When discharge is anticipated or t:minrnt, the nursing coordinator and case manager will imipletmrnt the discharge plan Discharges ere frequemly influenced by a chntge in the stehis of the client, in the social/home support system or in the prrnery caregiver's abilrry to continue to provide for the needs of the client. Discharge procedures include, at a mmimiml: a discharge summary including recommendations for cominued care; refenaLs to community service agencies, care homes, mstidmioms and the li7ce, and afollow-up cell ar letter by the KADC program director on the clirnt's ststus one month or sooner after discharge. 4 What signtficam cheat-cemered outcome(s) will the program aclueveT a. 90% of the particrpamt's hygiene/self care will be maintained or unproved, b 90%. of the pertieipent's socialilation/imteractionakills will 6e maimained ar improved, c 90e/. of the participmt's families will expross satisfaction with Kona Adult Dey Center serviees, d 90% of the participams will be ~+•t~*•~~ed at home for a minimum of sus (6) months wmh adult day care services F. SERVICE DELIVERY 1. Whet methodology will be used in the proposed proglam's delivery of service(s)? a individaaltaed Plan of Care; KADC develops an mdtvidualimd phm of care for all of its clie~ The care play sirnmarizes fitdmgs from 1) Physician History amd Physical, 2) Nursing Assessment, 3) Social Assessment, 4) Recreational Assessment, S) other sur®eriee sod referral information. The tare plan is dtveloped through a case mamagemeot approach involving the nursimg coerdmator, aetivities director, program director, other staff member kind the psrtimpam's family when appropriate. Goal setting and develapmemt of objective form the cornerstone of the care phm development. Semces pronded within the adult day tamer determined ib be sigmifieamt m achieving goals end ob)etxives are identified in the caze plm These services often include exercise, attention to toileting routine, assistance with eating and the Ilse. In addition, clients are evaluated for [lieu functional acuity level, which help staff identity cleats that require more tare end supervision. M applityble goal for all clients is W maintain the highest functional level possible and to prevent premature tieterioratioa 5 PROGRAM/SERVICE DESCRIPTION E. SERVICE DELIVERI' (contmue) 1 Indtwdualuxd Plan of Cam (contmue) KADC has Implemented dual prograrrnttmg, ~ e , programmmg acuvihes that benefit two dtstmct types of chetro those wdh cogoinve impairments -Alzheimer's disease w other related disorders and those with physical impairmems The care plan is tailored fw [hex two broad types of clients, thereby making the expenence az KADC more meaningful w epproprlaze fw each chem. 2 Individualized Discharge Plan. KADC develops end indtvidualiad discharge plan, es all diems enrolled az the Crnter will be discharged The reasons for eventual dixhatge may be identified az the begirmmg of enrollment, especially if enrollment is for a specific length of time. In all cases, discharge is based an the broad goals of the cliam, family w referral solute emd m most cases, will be mclided m the mdividual's cere plan When dischvges ere anticipated or rnuneut, the ntgsing coardmazor and the program director will tmpletnent the discharge plat[ Discharge procedures mclude az a minimum: a) a discharge summary mcludmg recommendations fw continued care, b) refertals to community servia agencies, can homes, mstituhons cad the lake, and c) follow up call w letter from KADC program director w nuusmg coordimtor oo the cGem's status one momh w sooner after drscharge. F. EVALUATION 1. Whet medtodobgy wall be used in the proposed program's delivery of setvice(sY1 Program effecuvrness is measured through annual suirveys, one specific to caregiver ~d one specific to refi;rrsl sources. These surveys desrnbe strengttu anti weakness of the program and assist KADC stag' end Board of Directors in preparing Cudtve short and laog-rntge gwls• QrurtedY and annual evalushon reports ate roquired by most KADC flmdmg sources, mcluidiog Deperunem of Humor Servitxs, Hawaii Ishund United Way, Hawaii Couimy and May Templeton Hopper Foundation. The S7artdmd+ mId Gatdepnes jor Adult Ibv Servrcer developed by the Naioml Lutkuue o0 Aduh Day Service, a braltch of the National Cotmcil on Aging, provide imporlam benchmarks that Kona Adult Day Cemer has elected to follow. 2. How wdl thi+ process irreasrtre the outcomes specified in Item D, (!-4)7 The sutrveys, site vfsib and quarterly/annual reports will provide K.ADC ste$ administratico and Board of Director with information to ensure the quality of ib program. G. PROGRAM FEES 1. Does youir arganiadon charge a membership fee for service perticipams7 There are no "memberahtp" fees fw KADC participator 2. Does the proposed program charge perticipmb a fee fw service(s) provided by Your orgaurimtionT a A participam's fee rate sheet ua attached. (Attachment k 1) b Describe how you will ensure that all interested partieipenb will a included deapioe m inability to pay the euttue fee. 6 Attachment ill KONA ADULT DAY CENTER FEES Note: I{ADC has established the following rates according to the general level of caze required. Please see the attached sheet for a description of Levels I, II and III Special Hourly Rate: $ 10 00/hr Daily Rate: Level I $ 48 00/day Level II $ 53.00/day Level III (rates may vary subject to assessment of care needs by RN) Full-time monthly rate: (five days per week, eacludiag holidays*) Level I $768 OOlino Level II $821 00lino Level III (rates tray vary subject to assessment of care needs by R'~ Intake and Trial Dav Fees: One-tune fee for pre-enrollment appointments and processing $ 40 00 Trial day fee $ 30 00 (the "teal day" fee is applied toward the regular intake fee of $40.00 when the paztrcrpant enrolls in the program) Additional Services: Bathing $ 20.00/bath Feeding $ 35.00/month Active Therapy $ 65.00/month Transportation by I{ADC Van: One way $ 5.00 Round Trip $ 10.00 Note: Some individuals who meet income and other criteria may qualify for short or long term tuition assistance. Contact Program Director for more information. (Effective O1/01/01) PROGRAM/SERVICE DESCRIPTION NARRATIVE QUESTIONS C. PROGRAM FEES (continue) b Finenc~al access may include use of available funding sources through the Department of Health, the Deparmtent of Human Sernces, scholarship through the May Templeton Hopper Foundation, xholarship through ilia Theresa Hughes Foundsdon, partial or full tuition payment through Services for Seniors, the Salvatiop Army. The Alzbetmer's Association, and mot importantly through the KADC Tuition Assistance corporate donesion, used as xholeship money for Vow-income eligible participants. The TAF is oversern by a commrttro comprised of four memba9 of the KADC Board of Directors and funds apptoximatety 548,000 in scholarship momry annually. As proven by the number of applicants im the recent yeaz, more scholarship money is needed This need is rcflacted in the attached budget. H. VIABII.ITY 1 Whet is your ~ushfication or retionak for the expenditiQe of public funds for the proposed Prol?~? Public dollars era saved. Hy meeting ffie physical, medical end social needs of older aduks, especuiliy those with AI>bmmer's disea9e, Kona Adult Day Gainer cam help prevent acute care coats and nursing home pleammt Dry cane services are acost-effective, providing taro for a flail and depmdem age group and providing support and respite for caregivers who can continue with their lives and their jobs, as well. As life expectaory increases, the Ir7celihood of xquuing disability or Alzbeimer's diseaxJrclated dementies increaves sigmficamty. The need for KADC's specialized prognun will undoubtedly contnue 3. What arc your financial and programmatic plans to sustain the proposed program beyond the upcoming fixal year? KADC Board of Dvectors amd Executive Director will continue to monitor the program finances and quality of service, enstving that the program wi0 be sustained through the upcoming fiscal year and beyond L BUDGET See attached budget Corms. ORGANIZATIONALAGENCY INFORMATION A. BOARD OF DIRECTORS 1. Has the organization's Board of Directors received formal training within the past two (Z) fiscal years? See attached certification of training from Help for Non-Profib in October 1997 7 ORGANIZATIONAUAGENCY INFORMATION NARRATIVE QUESTIONS A. BOARD OF DIRECTORS (continue) What are the pruoary roles and responsrbihties of your organvation's Executive Director a Serve as Chief Operations Executive of the organvatim, b Serve as Professional Advisor to the Board; c. Recommend appropriate policies for coiisideration, d Implement effectively all policies adopted by the Board, e. lnforat the Board fully and accurately regarding the program; f. Interpret fire needs of the program sect present professional recommendations on all problems and issues considered by the Board g Develop a budget (m conjunction with the finance committee) and keep the Board up-to- date on budget; h Recndt the best personnel and develop a competent sniff and supervise it, ~ Devote time to improving staff, ~ Assist the Board m developing and conducting community mformatron programs, k Asset the committees of the Board to achieve then objectives, the Executive Duector is an ex oficio member of the following cormmttees: fimace, fiord develognent and marketing What are the primary roles and responsibilities of your wgaoiTatiods Board of Directors? a Set policies, evaluate overall program and set strategic directions for the Center b Counsel end advise-giving the benefit of its judgment, expertise and familiarity with the local c. Conwlt with the Executive Duectw m all matters which the Board is considering; d Delegate tespotuibdity for all executive fimctrons; e. Refrain from heodlmg administrative details; f. Make all the staff responsble to the Executive Director, g. Share all communication with the Executive Director; h. Provide support to the Executive Director and staff m cairymg out their professional dunes; i Support the Executive Drector m all decisions and actions coavisteat with the policies of the Board and the standards of the otgmiation; j Hold the Executive Director accoimteble for the supervision of the orgeniation; k. Evahiate the work of the Executive Director Set Stmderds of Performance fix Exennive Director. 1. Actively take pert m the Hoard committees to assure that die committees achieve tbev objectives. Clarify role of executive officers vs general membership. ~tRG. a Prprdes at all meeting of the corporation and the board of dQectors; b. Chews the Executive Committee; c Assices that all policies dtablished by the board of dDrcors and provision of the orgtimation's by-laws ere tamed out; d. Assures that the treavimer, secretary. committee chairs, executive director end other officers perform ihev duties and provide timety reports are determined necessary; a Signs such dacummts es ainhorized by the board and/or by the office; f Chain the amual performance review of the executive director; 8 ORGANIZATION/AGENCY INFORMATION NARRATIVE QUESTIONS Vice-President: a Assumes the dunes of the president in his/her absence or inabtlrty to act, b Provides oversight and support for a designated cornmtttee or group of committees as appourted by the prestdeM, c Cheus major committees and/or achvthes as appointed by the president, d Assumes other duties and rtsponsrbthties as appointed by the president md/or as authorized by the board Seeregrv: a. Assures the accurate anti timely preparation of the minutes of all mewing of the corporation ®d board of directors and signs them; b Assures the timely distribution of minutes of board meetings to all members of the board of daectors; c. Assures the timely and proper notification about meetings of the board of dvectors t the respective members; d Maintains a record of attendance at meetings of the board of directors, e Assures the safekeeping of the official records anti documents of the organuatron, except those covered under die responsibilities ofthe treasurer; Trt±asarcr• a Assures the proper receipt and custody of all monies received by the orgmtzntton in accordance with sound and generally accepted business practices, b Assures the timely deposit of all payroll withholding as required by Isw and in accordance with sound and generally accepted business practices and assures the board that such practices are occurring; c. Provides and attests to the accuracy of a firtaactal report to the board of dQectors at each meeting, clearly reflecting the financial position of the orgawetton including all current and long-term mdebtedaess, cash position and other such details as are feasble and requited; d. Assures that the organvation's fnmcial records are externally audited on ao amuel bests coaltsteat whh acceptable standards of acwtinting; e. Serves a chair of the finance wmmtttee B. PAST PERFORMANCE I. How effective has your organrattodsgency been in achieving program Boats m the pmt two (2) 5sca1 years? Include the following information: a Qutmtitative date an nurtrben served: and b Qualitative data showing nttmba and of partictpaats achievtttg measurable outcomes See attached information sheet Mle "Past Perfammce". C. FINANCIAL: 1 Have your orgaoizetion's current program operations remained the same as last yeaf? What melor program or financial cherrges will be incurred next yeat't At KADC we have three (3) levels of perttcipmt rsre• (1) the group with ALfieimer's disease whose functional level is low, (2) the group wdh physical disabilities whose fimctiorul level rs limned in range of activity but whose cognitive level Is high, and (3) the group of physically fit and mgmtively aware who need socializeaioa anti stimulating recreational activitks. Over the 9 Kona Adult Day Center, Inc Past Performance Kona Adult Day Center, Inc. has been very effective m achieving program goals m the past two (2) years. Listed under Program/Service Descnpnon, D. Goals and Objectives the narrative itemizes the goals of Ne program (indindusl, family end community), the objecdves/acnon steps planned for each goal; the timeline for each action step; and, the client centercd outcomes to be achieved. KADC ha realized then goals, objernves, and client centered outcomes. Quanhtahve Data. New adtnrssions from 1/1(00 through 12/31/00 totaled thuty nme (39) panticipmts, an average of then (3) per tnonth Because of the frail nature of the panttcipents, rt rs not unusual for there to be an average of two (2) discharges per month as well. The average emollmem for that twelve (12) momh penod was 39 The average dmty attendmce wav 25 Qualitative Dale Program achievements can be found under #4 What srgni5cant client centered outcome(s) will the program achieve? a) 90% of the panc~rpent's hygtendself~are will be mantained or unproved; b) 90'/0 of the partcipant's socral~tion/mterecuon skills will be mamtamed; c) 90% of the participeat's families will express satisfaction with Kona Aduh Day Center, d) 90% of the paiticipents will be maintained at home for a nunimum of six (6) months with eduh health services I2 ORGANIZATION/AGENCY INFORMATION C FINANCIAL (continue) past year our level of participant care and fiinctron has changed. Gmup one and two have increased while group three has decreased Tlus increase m lower limited functional group requires mdmdualvxd attention and increased staffing Our supple and equtpmem needs have changed resulting m higher cost We plan to continue community outings The increase in- group two will rcquve more specialized transportation It is our goal to provide quality health and activity program for each of thex three groups. 2 What rs the status of all of your otganr~troo's major contracts or agreements for the coming Year (employment agreements, office leases, Primary grants/rcvenue, etc )T State Department of Human Services, P O S • contract effective through Jane 30, 2000 Nursing Home Without Walls: effective through June 30, 2000 Coumy of Hawaii: effective through June 30, 2000 Services for Seniors. effective while fiindmg available Hawatr Island United Way fimdmg through December 31, 2000 May Templeton Hopper ttmdmg through December 31, 2000 Twnon Assistance Fund Commitments equaling Kona Health Services, Inc provides administrative, clutical and medical director semces for three (3) years effective September 1, 1998. 3 How does the proposed program 5t into your organization's long-range financial plan? The development of the adult day care program is essential to achrevurg sufficient volume and aux of clients to enable the Center to be self-suf5cient on a long-term basis D. MON17'ORING 1 During the past two (2) 5scal years. whaz financial and/or administrative mooimrmg has you orgeniratron received from aay end all finding sources? See attached list titled "Monitoring" E. ALCOHOL, TOBACCO AND DRUG-FREE WORKPLACE POLICIES AND IQYPORMATON I How does yore organrretion address alcohol, tobacco and other drug prevention information dis<~~~~*on as part of your workplace and/or program environment? Kona Adult Day Center Persomtel Policies address the issue of alcohol, tobacco and drugs in the following mintier: Policy 606 6 ,~jpQ: To maintain health and pleasant warl®g caadttion. smoking will not be permitted withrrr the building or progam offices in which Kom Aduh Day Center conduct business. "No Smoking" sign will be viable m all program and common areas. Policy 613 2 Qnra Free Wort Place: It is ®possibk for any staff member to efficiently perform she responsbilities of his or her pwition whik under the infltrace of alcohol and drugs. Staff members ate prohbited from working while under the influence of alcohol and/or dings. The possession of such substance on the premises is strictly forbidden Either offence nerassitates termination. 10 Koaa Adult Day Center, Inc. Financial and Administrative Mooitonog State of Hawan Deparm~eat of Hinnm Services Piuchax of Service l.aiaa Giddings, Program Specialist 8101Lchards Street Room 400 Honoluh4 HI 96813 Telephone: (808) 586-5669 Fax (808) 58b5700 Hawmi Islmd United Way Helen Hemmer, President and CPO P O Box 745 Hib, HI %720 Telephone: (808) 935.6393 County of Hawed Department of Finance Dixie Kaetsa, Director 25 Aupum Street Raom 118 Hilo, HI %720 Telephone• (808) 961-8234 Fax• (808) 961-8248 Il T Z O r 3 s r7 ~ ~ e~'1 r-+ V1 N N ~ @i ~ O O 00 ty~1 ey~1 Q E W rl .-I ~I f• f.FG7 i ~ O ~ ~ ~~g 1 1 1 F J omLL I I I t I I I g Q 5 o ~ q T ~ ry G Q ~ ~ N ~ ~ ~ P'1 • p ~D f~1 .~1 ~I ~ n II 8 ~O a N N v1 n ~ ~O O O n u1 u1 n y Q ~ LL N N N .a .r Z 3 F _ U 3 y O W S ~ ~s e~ ~ ~ a a ~ y ~ I 1 I I I I I e o ~ ~ W c LL d 9 G Z 00 y Z K` Q~ a O u L W • N ~ N n n n a0 Y a 00 n a0 N O~ T O~ Y~ ~ Y. 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E W H N W e y d ~ ~ ~ ~ c Z ~ro o 'v u ~ E ^ q J Q 2 3 - ~ 3 c 8 u ~ p i..~ ~ W 3 ~ a cc~ m ~ A m N O ' A > > A G a C N L ~ A N Sri m Q W ~ _ ~ 3 ° c = c ~ a ~ ~ ~ d F u C.1 ~ T G ~ ~ .6 ~ ~ ` t C u Q C 4 d W O N ? 'Q 9C ~ ~e a+ y ~ ~ t_ q G Q U N i O a ? u. a > rn F H J ~ ~ Kona :adult Day Center, lnc Table 6 Summary of Income Supplement Private Foundations Fiscal Year 2000-2001• May Templeton Hopper $15,550 Hawaii Community Foundations $5,000 Atherton Foundation $3,500 Miscellaneous $5,950 Total $30,000 Fiscal Year 2000-2001 May Templeton Hopper $17,500 Hawau Community Foundation $5,000 Miscellaneous $7,500 Total $30,000 Stephen K Yamashuo _ . Harry A Takahashi :bfavor = Drrecror COUNTY O~ iiiRlKi4I`I DEPARTMENT OF FINANCE 25 Aupum Street, Room 118 • Hilo, Hawur 96720252 (808) %I-8234 • Fax (808) %I-8248 HAWAII COUNTY NONPROFIT GRANTS (F'Y 2001-02) FINANCIAL QUESTIONNAIRE Please include as an attachment an explanation for all "NO" answers to questions # 1 thru # 1 l below Yes No ® ? 1 Has the agency operated continuously for the past three (3) years? ® ? 2 Has the agency operated with a posmve cash flow for the past three (3) years ® ? 3 Does your Boazd of Duectms approve a detailed cash flow budget before the beginning of each 5sca1 year? 0 ? 4 Do your Board meeting minutes show that quarterly financial statements are approved ® ? 5 Is your equity balance at least 20% of your Total Liability balance? ? 6 [s your Total Current Asset balance larger than your Total Current Liability balance? ® ? 7. Are bank recoacihahona and accounnng performed by someone other than the chxk sigoatory~ ® ? 8 Are you fiilly insured for the agency's vehicle(s) and building(s)? ® ? 9 Is your Workers' Compensation at least 2% of payroll? ® ? l0. Are you current (non-delinquent) on all payroll and payroll tax payments? ® ? 11 Is the agency free of any pending liUgatroq hens orludgmmts? ? ~ l2. Within the past 12 months, has the agency applied for vendor or bank credit and was denied credit? If yes, please explain. As the grunt applicant, !terrify that the ogency liar satujacronly responded to each ojthe above quaaont and erpfatned err needed 1 hereby cernfy that thu tnjornratton u true and correct to the bar ojmy knowledge. Agency Bona Adult Day Center, Inc. Pho (808 322-7977 Prepazedby r~+t fzefer•1 Secretary/BoQ~ener 1/29/01 PnM Nradhtle Dtle Certified by Kenneth T. Ono 1/29/01 PnM Nrme of Fsecutire dreemr Srprnue Due KONA ADULT DAY CENTER INC. A HAWAII NON-PROFIT ORGANIZATION FINANCIAL STATEMENTS JUNE 30, 1999 RONALD G. HAWKES CERTIFIED PUBLIC ACCOUNTANT RONALD G. HAWKES CERTIFIED PUBLIC ACCOUNTANT 73-4353 MALALO PLACE KAILUA-KONA, HAWAII 96740 KONA ADULT DAY CENTER INC P.O. BOX 1360 KEALAKEKUA, HAWAII 96750 WE HAVE COMPILED THE ACCOMPANYING STATEMENT OF FINANCI.AL POSITION OF KONA ADULT DAY CENTER INC., A HAWAII NON-PROFIT ORGANIZATION, AS OF JUNE 30, 1999, AND THE RELATED STATEMENT OF ACTIVITIES FCR THE TWELVE MONTHS THEN ENDED, IN ACCORDANCE WITH STATEMENTS ON STAAIDARDS FOR ACCCL~TTING AND REVIL'W SERVICES ISSUED BY THE A?~IERIC.~I INSTT_TUTE CF CERTIFIED PUBLIC PCCOL"NTAAITS. A COMPILATION IS LIMITED TO FRESENTING IN THE FORM OF FINANCIAL STATEMENTS, INFORMATION THAT IS THE REPRESENTATION OF MANAGEMENT. WE NAVE NOT AUDITED OR REVIEWED THE ACCOMPANYING FINANCIAL STATEMENTS AIdD, ACCORDINGLY, DO NCT EXPRESS AN OPINION GR ANY OTHER FGRM OF ASSURANCE ON THEM. MANAGEMENT HAS ELECTED TO OMI''_' SUBST.~~ITIP.LLY ALL OF T E DISCLOSURES PND STATEMENTS OF CASH FLOWS REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PR_TNCIPLES. Ie THE OMITTED DISCLOSURES AND STATEMENT OF CASH FLOWS WERE ;NCLUDED IN THE FINANCIAL STATEMENTS, THEY MIGHT INFLUENCE THE USER'S CONCLUSIONS ABC[TT THE ORGANIZATION'S FINANCIAL POSITION, RESULTS OF OPERATIONS, AND CASH FLOWS. ACCORDINGLY, THESE FINANCIAL STATEMENTS ARE NOT DESIGNED FOR THOSE WHO PJ2E NOT INFORMED ABOUT SUCH MATTERS SINCERELY, ~ ~ RONALD G. HAWKES CERTIFIED PUBLIC ACCOUNTANT AUGUST 9, 1999 KONA ADIILT DAY CENTER INC. A HAWAII NON-PROFIT ORGANIZATION STATEMENT OF FINANCIAL POSITION AS OF JIINE 30, 1999 COMPILED ASSETS CIIRRENT ASSETS PETTY CASH $ 50.00 CASH IN BANK-CHECKING 1,237.75 CASH IN BANK-FUND RAISING 55.87 CASH IN SANK-CAPITAL FUND 5,504.02 CASH IN BANK-TUITION FD SN-1 117.26 CASH IN BANK-TUITION FD SM-1 3,383.51 CASH IN SAVINGS-CD 40,249.54 SECURITIES 1,055.53 ACCOUNTS RECEIVABLE-CLIENTS 12,742.00 ACCTS RECEIVABLE-UNITED WAY 7,500.00 PREPAID INSURANCE 4,661.08 PREPAID W/C-TDI 1.560.48 TOTAL CIIRRENT ASSETS $ 78,117.04 PROPERTY AND EOIIIPMSNT LEASEHOLD IMPROVEMENTS 118,512.61 EQUIPMENT 14,634.03 OFFICE EQUIPMENT 10,300.00 VEHICLES 28,146.00 LESS ALLOW FOR DEPRECIATION (58,576.00) TOTAL PROPERTY & EQUIPMENT $ 113,016.64 OTHER ASSETS ORGANIZATION EXPENSE 22,043.86 LESS ALLOW FOR AMORTIZATION (22,043.86) TOTAL ASSETS $ 191.133.68 SEE ACCOUNTANT'S COMPILATION REPORT. BONA ADDLT DAY CENTER INC. A HAWAII NON-PROFIT ORGANIZATION STATEMENT OF FINANCIAL POSITION AS OF JIINE 30, 1999 COMPILED LIABILITIES CVRR7s'Nf LIABILITIES ACCOUNTS PAYABLE $ 13,488.88 ACCRUED VACATION 2,224.81 FICA & WH PAYABLE 1,346.50 STATE WH PAYABLE 527.60 SUTA PAYABLE 378.33 STATE GE TAX PAYABLE 221.64 DEFERRED REVENUE 14,912.11 TOTAL CQRRENT LIABILITIES $ 33,099 87 LONG-TERM LIABILITIES TOTAL LIABILITIES $ 33,099.87 NET ASSETS NET A33ETS BEGINNING UNRESTRICTED 167,081.89 REVENUE OVER (UNDER) EXPENSE (9,048.08) TOTAL NET A99ETS S 158.033.81 TOTAL LIABILITIES & NET A33ETS S 191,133.68 SEE ACCOUNTANT'S COMPILP.TION REPORT. nr nr~ KONr. ADULT DAY CENTER INC. A HAWAII NON-PROFIT ORGANIZATION STATEMENT OF ACTIVITIES FOR THE 12 MONTHS ENDED JUNE 30, 1999 COMPILED 1 Month Ended 12 Months Ended June 30. 1999 Pct June 30. 1999 Pct REVENUE AND OTHER SUPPORT DHS POS PROGRAM $ 2,326.58 6.32% $ 27,919.00 7.46% DHS NHWW 1,367.00 3.71% 16,374.19 4.37% HCOA-SERVICES FOR SRS 800.00 2.17$ 7,565.98 2.02% COUNTY OF HAWAII 0.00 0.00 15,000.00 4.01% MAE TEMPLETON HOPPER 2,471.00 6.71% 18,897.00 5.05% HI ISLAND UNITED WAY 8,750.00 23.77% 15,000.00 4.01% OTHER GRANTS 0.00 0.00% 2,000.00 0.53% TUITION 6,827.99 18.55% 116,469.31 31.10% TUITION ASSISTANCE 3,996.25 10.86% 27,449.39 7.33% TUITION ADJUSTMENTS (1,038.74) -2.82% (15,401.87) -4.11% TRANSPORTATION FEES 1,190.00 3.23% 12,228.08 3.27% BATHING FEES 0.00 0.00% 1,975.00 0.53% FEEDING FEES 160.00 0.43% 2,247.00 0.60% THERAPY FEES 65.00 0.18% 780 00 0.21°s INTAKE FEES 80.00 0.22% 1,123.00 0.30% FUND RAISING DONATIONS 25.00 0.07% 16,583.56 4.43% FUND RAISING MEMBERSHIP 0.00 0.00% 5,285.00 1.41% FUND RAISING SPECIAL EVENTS 0.00 0.00% 2,565.00 0.69% FUND RAISING SALES 2,497.00 6.78% 14,412.00 3.85% IN KIND VOLUNTEERS 525.00 1.43% 6,300.00 1.68% IN KIND MEALS/TRANSPORTATIO 1,541.00 4.19% 18,492.00 4.94% IN KIND RENT 5,043.00 13.70% 60,516.00 16.16% SALE OF ASSETS 0.00 0.00% (1,145.40) -0.31% INTEREST INCOME 187.71 0.51% 1.818.20 0.49% TOTAL REVENUES 36.813.79 100.00% 374.452.44 100.00% EXPENSES PROGRAM SERVICES AUTO EXPENSE 779.49 2.12$ 4,334.84 1.16% THERAPY CONSULTANT 0.00 0.00% 210.00 0.06% VOLUNTEER LABOR 525.00 1.43% 6,300.00 1.68% PERSONNEL RECRUITMENT 0.00 0.00 27.12 0.01% TRAINING 35.00 0.10 50.00 0.01% PROGRAM SUPPLIES 17.44 0.05 1,367.52 0.37% DIETARY SUPPLIES 203.74 0.55 1,027.51 0.27% MEDICAL SUPPLIES 67.64 0.18% 387.76 0.10% MEALS & TRANSPORTATION 1,652.75 4.49$ 18,137.75 4.84% MANAGEMENT CONTRACT 6,075.98 16.50% 58,898.79 15.73% SALARIES & WAGES 8,172.86 22.20% 110,006.85 29.38% PAYROLL TAXES 333.45 0.91% 13,514.92 3.61% EMPLOYEE BENEFITS 1,899.96 5.16% 12,212.58 3.26% TRAVEL 0.00 0.00 93.87 0.03% TOTAL PROGRAM SERVIC83 19.763.31 53.68 226.569.51 60.51%- SEE ACCOUNTANT'S COMPILATION P.EPORT. n-.... ~ BONA ADIILT DAY CENTER INC. A HAWAII NON-PROFIT ORGANIZATION STATEMENT OF ACTIVITIES FOR THE 12 MONTHS ENDED JANE 30, 1999 COMPILED 1 Month Ended 12 Months Ended June 30. 1999 Pct June 30, 1999 Pct GENERAL AND ADMINISTRATION BANK CHARGES 8.00 0.02$ 69.00 0.02% COMM EDUCATION/PROMOTION 0.00 0.00$ 289.79 0.08% DEPRECIATION 1,095.17 2.97$ 11,426.00 3.05% DUES & SUBSCRIPTIONS 24.75 0.07$ 519.71 0.14% INSURANCE 1,035.06 2.81$ 6,396.50 1.71% JANITORIAL 975.57 2.65$ 10,122.70 2.70% LEGAL & ACCOUNTING 2,749.99 7.47$ 6,364.59 1.70% MISCELLANEOUS (7.50) -0.02$ 251.67 0.07% OFFICE SUPPLIES 39.28 0.11$ 617.87 0.17% PRINTING & COPYING 145.91 0.40$ 1,596.05 0 43's POSTAGE & FREIGHT 41.80 0.11$ 712.81 0.19s PUILDING RENT 2,475.00 6.72$ 6,600.00 1.7E°s RENT-IN KIND 5,043.00 13.70$ 60,516.09 16 16s REPAIRS & MAINTENANCE 248.76 0.68$ 2,311.49 0.62"s SALARIES & WAGES 1,662.90 4.52$ 18,707.78 5.00°s PAYROLL TAXES (75.36) -0.20$ 3,003.60 0.80% EMPLOYEE BENEFITS 681.72 1.85$ 4,294.16 1.153 TELEPHONE 1,004.74 2.73% 4,121.18 1.10s UTILITIES 1,929.72 5.24$ 9,012.55 2.41% SECURITY 181.77 0 49$ 545.31 0.15% TOTAL GENERAL ~ ADMIN 19,260.28 52.32$ 147,478.76 39.39s FUND RAISING FUND RAISING EXPENSES 0.00 0.00% 5,224.39 1.40% FUND RAISING-SPECIAL EVENTS 1,340.72 3.64$ 3,620.42 0.97% GE TAX EXPENSE & LICENSES 100 84 0.27$ 607.44 0.16% TOTAL FIIND RAISING 1,441.56 3.92% 9.452.25 2.52% TOTAL EBPEN9E 40.465.15 109.92% 383.500.52 102.42% REV OVER (IINDER) ERP S (3.651.36) -9.92$ S (9.048.08) -2.42% SEE ACCOUNTANT'S COMPILATION REPORT. xOW ADCLS oAt C)M701 IHC A BAMAII xoN-Ix0lIT OxGAH1IA?ION 97AT~rCrl Oa ACSI7ISlx! MItx DODGxT lox TPO 11 IIOtr1'aa a9msn JONx 90, 1999 COIOSLID 1 Month Ended 1 Month Ended 12 Months Ended T2 Mon[hs Ended June 30. 1999 Budget Variance June 30. 1999 Budget Variance isavmx Ala] ora>a smroer DXS POS PROGRAM S 2,327 S 2,325 f 2 S 27,919 S 27,900 f 79 DHS NXW 1,367 1,650 (283) 16,374 19,800 (3,425) HCOA-SERVICES FOR SRS 800 192 608 7,566 2,300 S,Z66 COUNTY OF HAYAII 0 1,250 (1,250) 15,000 15,000 0 MAE TE)IPLETOM HOPPER 2,471 1,296 1,175 18,897 15,550 3,347 HI ISLAND UXI TED YAT 8,750 1,250 7,500 15,000 15,000 0 OTHER GRANTS 0 3<6 (346) 2,000 4,150 (2,150) TUITION 6,828 10,625 (3,797) 116,469 127,500 (11,031) iUf iION ASSISTANCE 3,996 2,000 7,996 27,449 24,000 3,449 TUITION ADJUSTMENTS (1,039) (1,400) 361 (15,402) (16,800) 1,398 TRANSPORTATION FEES 1,190 592 598 12,228 7,100 5,128 BATHING FEES 0 308 (308) 1,975 3,700 (1,725) FEEDING fEES 160 188 (28) 2,247 2,250 (3) THERAPY FEET 65 63 2 780 750 30 MASSAGE FEES 0 42 (42) 0 500 (500) INTAKE FEES 80 63 17 1,123 750 373 FUND RAISING DONATIONS 25 1,567 (1,542) 16,584 18,800 (2,2151 FUND RAISING MEMBERSHIP 0 288 (288) 5,285 3,450 1,835 FUND RAISING SPECIAL EVENTS 0 833 (833) 2,565 10,000 (7,435) FUND RAISING SALES 2,497 21 2,476 14,412 250 14,162 IN KIND VOLUNTEERS 525 525 0 6,300 6,300 0 IN KIND MEALS/TRANSPORTATION 1,541 1,542 (1) 18,492 18,500 (9) IN KIND RENT 5,043 5,042 1 60,516 60,500 15 SALE OF ASSETS 0 0 0 (1,145) 0 (1,145) INTEREST INCOME 188 42 146 1.818 500 1,318 Sore xsvomss S 36.814 S 30 650 S 6.164 S 374.452 f 367.750 S 6.702 :m9nux axooxAr sav7cxs AUTO EXPENSE f 779 S 500 S 279 S 4,335 f 6,000 f (1,665) STAFF MILEAGE 0 29 (29) 0 350 (350) THERAPY CONSULTANT 0 42 (42) 210 500 (290) ACTIVITIES CONSULTANT 0 8 (8) 0 100 (100) VOLUNTEER LABOR 525 525 0 6,300 6,300 0 PERSpIMEL RECRUITNEIIT 0 4 (4) ZT 50 (23) TRAINING 35 29 6 50 350 C300) PROGRAM SUPPLl ES 17 125 (108) 1,368 1,500 (132) DIETARY SUPPLIES 204 83 121 1,028 1,000 28 MEOIGL SUPPLIES 68 46 22 388 550 (162) DAY XEALTX EXPENSE 0 38 (38) 0 450 (450) MEALS i TRANSPORTATION 1,653 1,542 111 18,138 18,500 (362) MANAGEMENT CONTRACT 6,076 0 6,076 58,899 0 58,899 SALARIES i YAGES 8,173 10,333 (2,160) 110,007 124,000 (13,993) PAYROLL TAKES 333 900 (567) 13,515 10,800 2,715 EMPLOYEE BENEFITS 1,9y0 1,500 400 12,213 18,000 (5,7877 SEE ACCOUNTANTS COMPILATION REPORT e cola Aoacr nAr camas xrc A aArAxx Nor-ssorxr oRCArxzAxxoN arAramrr os Arrxvirxss Mars soaart eOR rss 11 NONrb7 CRIID JQNR ]e, 1999 CONII II,ID TRAVEL 0 13 (13) 94 150 (56) 1 Month Ended 1 Month Ended 12 Months Ended 12 Months Ended June 30. 1999 Budget Variance Jwe 30. 1999 Budget Variance rorar. ssamar ssrvxess S 19.763 S 15.777 f 4.046 S 226.572 S 788.600 S 37.972 cst(wr. Alm ADmifrsarzoa BANK CHARGES S 8 S 8 S 0 S 69 f 700 S (31) COMM EDUG77ON/PROMOTION 0 92 (92) 290 7,100 (810) DEPRECIATION 7,095 0 1,095 77,426 0 17,426 DUES i SUBTCR IPTIONS 25 58 (33) 520 700 (180) INSURANCE 1,035 333 702 6,397 4,000 2,397 JANITgIIAL 976 950 26 70,123 11,400 (1,277 LEGAL i ACCp1MTING 2,750 1,417 7,333 6,365 17,000 (70,635) XlTCELLANEOUT (8) 42 (50) 252 500 (248) OFFICE SUPPLIES 39 67 (28) 618 800 (182) PRINTING i COPYING 146 177 29 1,596 1,400 196 POTTAGE d fRE1GNT 42 75 (33) 773 900 (1B7) BUIlDfNG RENT 2,475 850 1,625 6,600 7,650 (7,050; RENT-IN KIND 5,043 5,042 1 60,516 60,500 76 REPAIRS i MAINTENANCE 249 383 (734) 2,377 4,600 (2,289) SALARIES 6 PAGES 1,663 3,500 (1,837) 78,708 42,000 (23,292` PAYROLL TA%ET (75) 617 (692) 3,004 7,400 (4,396) EMPLOYEE BENEFl Tf 682 175 507 L, 294 2,700 2,794 TEIEPNOME 1,005 333 672 4,121 4,000 121 UTILITIES 1,930 938 992 9,013 11,250 (2,237; SECURITY 782 58 124 545 700 (155) roru eslraua a Ao9mr S 19.262 f 75.055 S 4.207 f 1L7.481 f 178.700 f (30.619; sorb RAxsxra FUND RAISING E%PENTET S 0 S 75 S (75) f 5,224 S 900 S 4,324 FUNO RAffING-SPECIAL EVENT 1,347 8 1,773 3,620 100 3,520 GE TA% EXPENTE i LICENSES 701 4 97 607 50 557 rorAr, smm uxsxom 1.442 87 7.355 9.451 1.050 8.401 ir)raa msrrr 40.667 30.859 9.608 783.504 767.750 75.754 >ar ovss (soma) m S (3.653) S (209) S (3.444) f (9.052) f 0 S~ .052) TEE ACLOUNTANT~T COMP II.ATION REPORT. DAGE 6 KONA ADULT DAY CENTER INC A HAWAII NON-PROFIT ORGANIZATION FINANCIAL STATEMENTS JUNE 30, 2000 RONALD G. HAWKES CERTIFIED PUBLIC ACCOUNTANT RONALD G fiAWii?S CERTIFIED PUBLIC ACCOLLITANT P 0. BCX 1620 iC~ILUA-KGNA,r_~WAIi 96715-1420 KONA ADULT DAY CENTER INC P.O. BOX 1360 KEALAKEKUA, HAWAII 96750 WE HAVE COMPILED THE ACCOMFA.NYING STATEMENT OF FINr`VC.?T, POSITION OF KONA ADULT DAY CENTER INC., A HAWAII NC•N-PROF.T ORGANIZATION, P.S OF JUNE .0, 2000, AND THE RSLATSD STATEMENT OF ACTIVITIES FO~c THE TWELVE MGNTHS THEN ~~1DEii, IN ACCORDANCE WITH STATEMENTS ON STA_VDF?.DS FOR ACCOUNTING AND REVIEW SERVICES ISSUE^ BY T::E A.MERICAN =NSTITU'"_ C= CERTIFIED PUBLIC ACCOUVTA.ti'_'c. A CGMPILATION IS LIM=TAD TO FRESENTING ITT THE :CR:~ OF FINANCIAL STATEMENTS, INFGRMATICN THAT IS THE REFRSSENmpm_;•N OF MANAGEMENT WE HAVE NC'_' AUDITED CR REVIEWED THE ACCOMPANYING FINA.'~ICi.~T STA"_'EMENTS AND, ACCORDINGLY, ;'O NCT EXFRESS AN GFiNION OR P.N°_ OTHER =GRM OF ASSURA.~ICE C•N T EM Mt.D1AGEMENT EAS EJECT=~ TC C:d?T SUBSTPV^.ALLY CF _ DISCLOSURES AND STATEMF'dTS OF C?_SH FLOWS REQUIRED BY GENERr~.iLY ACCEPTED ACCOUNTING PRINC.FLES. IF THE GMITTED DISCLOSURES AND STATEMENT OF CASH FLOWS WERE iNCLiJDED IN THE FIVANCIP_, STATEMENTS, THEY MIGHT INFLUENCE THE USER'S CCNCLUSiCNS AECUT THE ORGPNIZATION'S FINANCI?S, POSITION, RESULTS OF OPERATIONS, AND CP.SH FLOWS. ACCORDINGY, T::ESE FINANCIAL STATEMENTS P.RE NOT DESIGNED FOR THOSE WHO P.RE NOT INFORMED ABOUT SUCH MATTERS. SINCERELY, ~ ~ RGNALD 'G . I-:AWKES CERTIFIED PUBLIC ACCOUNTP.NT SEPTEMBER 26, 2000 KONA ADULT DAY CENTER INC. A HAWAII NON-PROFIT ORGANIZATION STATEMENT OF FINANCIAL POSITION AS OF JUNE 30, 2000 COMPILED ASSETS CURRENT ASSETS PETTY CASH $ 50.00 CASH IN BANK-CHECKING 1,599.97 CASH IN BANK-FUND RAISING 56.95 CASH IN BANK-CAPITAL FUND 378.67 CASH IN BANK-TUITION FD SN-1 120.71 CASH IN BANK-TUITION FD SM-1 1,063.69 CASH IN SAVINGS-CD ~ 43,789.89 SECURITIES 1,055.53 ACCOUNTS RECEIVABLE-CLIENTS 10,524.54 ACCTS RECEIVABLE-UNITED WAY 7,500 00 PREPAID INSURANCE 4,678.75 PREPAID W/C-TDI 2,098.98 TOTAL CURRENT ASSETS $ 72,917.68 PROPERTY AND EQUIPMENT BUILDINGS 394,000.00 EUILDING IMPROVEMENTS 118,512.61 EQUIPMENT 15,048.61 OFFICE EQUIPMENT 11,867.34 VEHICLES 28,146.00 LESS ALLOW FOR DEPRECIATION (78,791.00) TOTAL PROPERTY & EQUIPMENT $ 488,783.56 ETHER ASSETS ORGANIZATION EXPENSE 22,043.86 LEASEHOLD 56,000.00 LESS ALLOW FOR AMORTIZATION (28,460.86) TOTAL OTHER ASSETS S 49.583.00 TOTAL ASSETS S 611,284.24 SEE ACCOUNTANT'S COMPILATION REPORT. ..o , KONA ADULT DAY CENTER INC. A HAWAII NON-PROPIT ORGANIZATION STATEMENT OF FINANCIAL POSITION AS OF JUNE 30, 2000 COMPILED LIABILITIES CURRENT LIABILITIES LINE OF CREDIT $ 9,055.99 ACCOUNTS PAYABLE 17,738.72 ACCRUED VACATION 1,598.70 SUTA PAYABLE 466.63 STATE GE TAX PAYABLE 276.76 DEFERRED REVENUE 1,426.16 TOTAL CURRENT LIABILITIES $ 30,562.56 LONG-TERM LIABILITIES TOTAL LIABILITIES $ 30,562.90 NET ASSETS NET ASSETS BEGINNING UNRESTRICTED 158,081.81 REVENUE OVER (UNDER) EXPENSE 422,639.47 TOTAL NET ASSETS S 580,721.28 TOTAL LIABILITIES & NET ASSETS $ 611,284.24 SEE ACCOUNTANT'S COMPILATION REPORT. KONA ADULT DAY CENTER INC. A HAWAII NON-PROFIT ORGANIZATION STATEMENT OF ACTIVITIES FOR THE 12 MONTHS ENDED JUNE 30, 2000 COMPILED 1 Month Ended 12 Months Ended June 30. 2000 Pct June 30, 2000 Pct :VENUE AND OTHER SUPPORT DHS POS FROGRAM $ 2,183.16 0.46% $ 23,381.37 3.03% DHS NHWW 2,364.90 0.49$ 24,418.12 3.17% HCOA-SERVICES FOR SRS 195.75 0.04$ 4,902.75 0.64% COUNTY OF HAWAII 0.00 0.00$ 14,325.00 1.86% MAE TEMPLETON HOPPER 1,296.00 0.27$ 22,353.00 2.90$ HI ISLAND UNITED WAY 1,250.00 0.26$ 15,000.00 1.95% TUITION 7,365.00 1.54$ 74,229.46 9.63% TUITION ASSISTANCE ~ 9,207.17 1.93% 53,736.17 6.97% TUITION ADJUSTMENTS 0.00 0.00$ (3,116.22) -0.40% TRANSPORTATION FEES 1,465.00 0.31$ 12,394.59 1.61% BATHING FEES 580 00 0.12$ 2,860.00 0.37% FEEDING FEES 160.00 0.03% 1,718.00 0.22% THERAPY FEES 0.00 0.00$ 325.00 0.04% INTAKE FEES 80.00 0.02$ 1,054.00 0.143 SPECIAL DONATIONS 450,000.00 94.09% 450,000.00 58.36% FUND RAISING DONATIONS 0.00 0.00% 4,217.40 0.55% FUND RAISING MEMBERSHIP 0.00 0.00$ 4,475.00 0.58% FUND RAISING SPECIAL EVEN 0.00 0.00% 7,898.00 1.02% FUND RAISING SALES 0.00 0.00% 8,228.37 1.07$ IN KIND VOLUNTEERS 525.00 0.11$ 6,300.00 0.82% IN KIND MEALS/TRANSPORTAT 1,541.00 0 32$ 18,492.00 2.40% IN KIND RENT 0.00 0.00s 20,172.00 2.62% INTEREST INCOME 30 45 0.01% 3.738.40 0 48% TOTAL REVENUES S 478,243 43 100.00$ S 771,102 41 100 00$ CPENSES GROGRAM SERVICES AUTO EXPENSE $ 910.21 0.19$ $ 4,279.40 0.55$ STAFF MILEAGE 0.00 0.00$ 33.28 0.00$ ACTIVITIES CONSULTANT 194.52 0.04$ 745.86 0.10$ VOLUNTEER LABOR 525.00 0.11$ 6,300.00 0.82$ PERSONNEL RECRUITMENT 0.00 0.00$ 115.83 0.02$ TRAINING 0.00 0.00$ 6.13 0.00$ PROGRAM SUPPLIES 195.02 0.04$ 2,284.06 0.30$ DIETARY SUPPLIES 11.05 0.00$ 202.72 0.03$ MEDICAL SUPPLIES 159.21 0.03$ 749.33 0.10$ MEALS & TRANSPORTATION 2,121.00 0.44$ 20,274.22 2.63$ NURSING CONTRACT 7,898.30 1.65$ 37,911.84 4.92$ SALARIES & WAGES 7,367.38 1.54$ 97,230.90 12.61$ PAYROLL TAXES 1,524.68 0.32$ 12,197.39 1.58$ EMPLOYEE BENEFITS 1.178.28 0.25$ 12.148.38 1.58$ TOTAL PROGRAM SERVICES S 22.084.65 4.62$ S 194,479.34 25.22$ SEE ACCOUNTANT'S COMPILATION REPGRT. KONA ADULT DAY CENTER INC. A HAWAII NON-PROFIT ORGANIZATION STATEMENT OF ACTIVITIES FOR THE 12 MONTHS ENDfiD JUNE 30, 2000 COMPILED 1 Month Ended 12 Months Ended June 30. 2000 Pct June 30. 2000 Pct :ENERAL AND ADMINISTRATION BANx CHARGES $ lo.oo o.oo$ $ lzs.oo 0.02% COMM EDUCATION/PROMOTION 0.00 0.00% 43.59 0.01% DUES & SUBSCRIPTIONS 0.00 0.00% 112.00 0.01$ INSURANCE 691.68 0.14$ 6,924.43 0.90% INTEREST EXPENSE ~ 86.21 0.02$ 963.76 0.12% JANITORIAL 1,017.58 0.21$ 9,129.02 1.18% LEGAL, & ACCOUNTING 781.25 0.16$ 3,656.25 0.47$ MANAGEMENT CONTRACT 7,291.65 1.52$ 34,999.92 4.54% MISCELLANEOUS 108.43 0.02% 285.96 0.04$ GFFICE SUPPLIES 168.69 O.C4% 983 96 0.13$ PRINTING & COPYING C.00 0.00% 476.10 0.06& POSTAGE & FREIGHT 51.70 0.01$ 405.17 0.05% FROPERTY TAX 0.00 0.00% 12.50 0 00% 9UILDING RENT/LAND LEASE 457.60 0 10% 6,593.40 0.86$ RENT-IN KIND 0.00 0.00% 20,172.00 2.62% REPAIRS & MAINTENANCE 302.76 0.06& 1,753.17 0.23% SALARIES & WAGES 1,262.31 0.26$ 16,385.80 2.12$ PAYROLL TAXES 259.66 0.05$ 2,180.40 0.28% EMPLOYEE BENEFITS 340 86 0.07% 3,749.46 0.49% TELEPHONE 534 83 0.11$ 4,172.37 0.54% liTILITIES 2,787.52 0.58% 11,398.92 1.48$ SECURITY 125 78 0.03% 678.79 0.09% TOTAL GENERAL & ADMIN S 16,278 51 3.40$ S 125,201.97 16.24% 'UND RAISING FUND RAISING EXPENSES $ 502.16 0.11$ $ 1,767.50 0.23% GE TAX EXPENSE & LICENSES 0 00 0.00$ 334.13 0.04% TOTAL FIIND RAISING S 502.16 0.11$ $ 2,101.63 0.27$ TOTAL EXPENSES S 38.865 32 8.13$ ,5L 321.782.94 41.73$ OPERATING REV (LOSS) S~ 439,378.11 91.87$ S 449,319.47 58.27$ DEPRECIATION DEPRECIATION S 10,010.08 2.09$ $ 20,263.00 2.63$ SEE ACCOUNTANT'S COMPILATION REPORT. KONA ADULT DAY CENTER INC. A HAWAII NON-PROFIT ORGANIZATION STATEMENT OF ACTIVITIES FOR THE 12 MONTHS ENDED JUNE 30, 2000 COMPILED 1 Month Ended 12 Months Ended June 30. 2000 Pct June 30, 2000 Pct AMORTIZATION 6.417.00 1.34% 6,417.00 0.83% TOTAL, DEPRECIATION S (16,427.08) -3.43% S (26.680.00) -3 46% REVENIIE OVER/IINDER EXPENSES 422,951.03 88.44% S 422.639.47 54.81% SEE ACCOLN'PANT'S COMPIi~P.TIGN kEFORT. KONA ADOLS DAY C101xDA INC A RAMAII AON-PROPIx OAGANIZAiION SxA'fOfIIlx' OP ACxIVIxID9 NISR DiJDOD7 POR x1ID 13 NON7A9 1QiDID JOKE 10, 3000 COl~I:,ED Actual For Budgeted For Variance Total 12 Months Ended 12 Nonths Ended Over/(Under) Annual Budget June 30. 2000 June 30. 2000 Budget Budget Remaining '100 ,V ID OTI[LR 9IIP POAx JHS POS PROGRAM S 23,381 37 S 27,900 00 S (4,518.63) S 27,900.00 S 4,518.63 )HS NNW 24,418.12 21,780 00 2,638.12 21,780.00 (2,638.12) 4COA-SERVICES FOR SRS 4,902.75 10,800.00 (5,897.25) 70,800.00 5,897.25 COUNTY OF HAWAII 14,325.00 14,325.00 0.00 14,325.00 0 00 HAE TEMPLETON HOPPER 22,353.00 15,550.00 6,803.00 15,550.00 (6,803 00) HI ISLAND UNITED VAY 15,000.00 15,000.00 0.00 15,000.00 0 00 STATE KAPUNA CARE 0.00 5,075 00 (5,075.00) 5,075.00 5,075 00 ]T XER GRANTS 0 00 (20,000.00) 20,000.00 (20,000.00) (20,000 00) TUITION 74,229.46 121,900.00 (47,670.54) 121,900.00 47,670.54 'UiT10N ASSISTANCE 53,736.17 36,000.00 17,736.17 36,000.00 (17,736 17) TUITION ADJUSTMENTS (3,116 22) (15,600 00) 12,483.18 (15,600.00) (12,483.78) iRANSPCRTATION FEES 12,394.59 10,800.00 1,594 59 10,800 00 (1,594 59) BATHING FEES 2,860.00 2,400.00 460.00 2,400.00 (460 00) rE EOING FEES 1,718 00 2,280 00 (562.00) 2,280.00 562.00 •HERAPT FEES 325.00 1,200.00 (875.00) 1,200 00 875 CO MASSAGE FEES 0.00 600 00 (600 00) 600.00 600.00 INTAKE FEES 7,054 00 1,440.00 (386.00) 1,440.00 386.00 SPECIAL DONATIONS 450,000.00 0 00 450,000 00 0.00 (450,000.00) rUND RAISING DONATIONS 4,217.40 15,000 00 (10,782 60) 15,000.00 10,782 60 FUND RAISING MEMBERSHIP 4,475.00 4,000.00 475.00 4,000.00 (475 00) rUND RpI SI NG SPECIAL EYENi 7,898 00 6,000 00 1,898 00 6,000.00 (1,898.00) rUND RAISING SALES 8,228.37 9,000 00 (771.63) 9,000 00 771.63 )N KIND VOLUNTEERS 6,300.00 6,300.00 0.00 6,300.00 0.00 .N KiNO HEALS/TRANSPORTATION 18,492 00 18,500 00 (8.00) 18,500.00 8 00 'N KIND RENT 20,172.00 60,500 00 (40,328 00) 60,500 00 40,328.00 'NTEREST INCOME 3.738 40 2.400 00 1,338.40 2.400.00 (1.338.40) xoxAr. AAimmss Sl 771.102.41 S 413.150 00 f 357.952.41 S 413.150.00 S (357.952.41) vsxs i1L~ya ( ?Z~~oL cAAN Dsavxesa AUTO E%PENSE f 4,279.40 S 6,000.00 S (1,80.60) S 6,000.00 S 1,720.60 STAFF MILEAGE 33.28 350.00 (316.72) 350.00 316.72 THERAPY CONSULTANT 0.00 500 00 (500 00) 500.00 500.00 ACTIVITIES CONSULTANT 745.86 100.00 645.86 100.00 (645.86) VOLUNTEER LABOR 6,300.00 6,300.00 0 00 6,300.00 0.00 PERSONNEL RECRUITMENT 115.83 50.00 65.83 50.00 (65.83) TRAINING 6.13 500.00 (493.87) 500.00 493 i7 PROGRAM SUPPLIES 2,284.06 1,750.00 534.06 1,750.00 (534.06) DIETARY SUPPLIES 202.72 1,000.00 (797.28) 1,000 00 797.28 MEDIGL SUPPLIES 749.33 600.00 149.33 600.00 (149.33) DAY HEALTH EXPENSE 0.00 750.00 (750.00) 750 00 750.00 HEALS i TRANSPORTATION 20,274.22 18,500.00 1,774.22 18,500.00 (1,774.22) NURSING CONTRACT 37,911.84 37,912.00 (0.16) 37,912.00 0.16 SALARIES d NAGES 97,230.90 117,900.00 (20,669.10) 117,900.00 20,669.10 PAYROLL TAXES 12,197.39 16,536.00 (4,338.61) 16,536.00 4,338.61 EMPLOYEE BENEFITS 12,148.38 18,000.00 (5,851.62) ~ 18,000.00 5,851.62 TRAVEL 0.00 180.00 (180 00) 180.00 180.00 SEE ACCOUNTANT'S COMPILATION REPORT. %C4A AJ[Rr JAY CEN'E1t INC A NANAII NON-iROf3r ORGANIJAiICN SrAril2fllxf Ol ACiICIiIEE NI7x EIIDGE7 70A 7.4E 23 NCNT89 ESIDED JUNE 70, SOJO CC~ILLD Actual For Budgeted For Variarce Total 12 Months Ended 12 Nonths Ended Over/(Under) Annual Budget June 30. 2000 June 30. 2000 Budget Budget Remai Wino AL vsocEAN sERVxcas S 194.679 34 S 226.928 00 S (32.448.66) S 226.928 00 S 32.448 66 nAt AxD AmaxISrRArrox ANK CHARGES S 125.00 S 96.00 S 29.00 S 96.00 S (29,00) OMM EDUCATION/PROMOTION 43.59 1,500 00 (1,456.41) ~ 1,500 00 1,456,41 UES d SUBSCRIPTIONS 112.00 700 00 (588.00) 700.00 588.00 N SURANCE 6,924.43 6,498.00 426.43 6,498.00 (426.43) N7EREST E%PENSE 963.76 0 00 963.76 0 00 (9E3.76) ANITOR IAL 9,129 02 11,400.00 (2,270.98) ~ 11,400.00 2,270.98 E CAL 8 ACCOUNTING 3,656 25 10,475.00 (6,818.75 ) 10,475 00 6,818.75 ~ANAGENENT CONTRACT 34,999.92 0 00 34,999 92 0 00 (34,999 92) iI SCEL LANEOUS 285 96 600 00 (314 04) 600 00 314 OL ~FICE SUPPLIES 983 96 900.00 83.96 500 00 (83.96) 'R INTiNG 8 COPYING 476 10 1,740.00 (1,263 90) 1,740.00 1,263.90 OSTAG'c 8 FREIGHT 405 17 840 00 (434 83) 840.00 434 83 ~ROPERTY TA% 1c 50 0.00 12.50 0.00 (12.50) U ILD ING RENT/LAND LEASE 6,593 40 9,900.00 (3,306.60)I,IJq 9,900 00 3,306.60 ENT-IN KING 20,172 00 60,500 00 (40,328.00) E0,500,00 40,328.00 E~AIRS 8 MAINTENANCE 1,753.17 3,000 00 (1,246.83 ) 3,000 00 1,246.83 ~ALA0.3E5 8 PAGES 16,385.80 11,544,00 4,841.80 11,544 00 (4,841 80) 'AYROLL TA%ES 2, 180 40 1,620.00 560.40 1,620.00 (560,40) YP!OYEE BENEFITS 3,749 46 1,560.00 2,189.46• 1,560. C0 (2,189 G6) 'E LEPHONE 4,172.37 3,960 00 212.37 3,9E0.00 (212 37) :T ILI TIES 11,398.92 8,375 00 3,023.92 ( 8,375 00 (3,023.92) 'ECURITY 678.79 696.00 (17.21) 696 00 17 21 :AL GENERAL A ADxllrzsrRArxox f 125.201 97 S 135.904 00 S (10.702 03) S 135.904.00 S 10.702.03 7 EAisrbc FUNO RAISING E%PENSES S 1,767.50 S 900.00 S 867.50 S 900.00 5 (867.50) rUND RAISING-SPECIAL EVENT 0.00 1,000.00 (1,000.00) 1,000.00 1,000.00 FUND RAISING SALES 0 00 2,000.00 (2,000.00) 2,000.00 2,000 00 GE TAX E%PENSE d LICENSES 334,13 150 00 184.13 150.00 (184.13) rAL smm EAISIRO 2.101.63 4.050.00 (1.948.37) 4.050.00 1.948.37 rosAL Ennrsss 321,782.94 366.882.00 (45.099 06) 366.882.00 45.099 06 xsr oEERArxRO asvExvE S 449.319.47 s~,2~ s 403.051.47 S 46.26A.00 s (403.051.47) SEE ACCDUMTAHT'S COMPILATION 0.E'ORT INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY DISTRICT DIRECTOR 2 CUPANIA CIRCLE MONTEREY PARK, CA 91755-7406 Emplcyer Identification Number Date 99-0273644 ~A~ 2 6 Case Number 954003189 KONA ADULT DAY CENTER INC Contact Person PO BOX 1360 CAROLYN TSCHOPIK KEALAKEKUA, HI 96750-1360 Ccntact Telephone Number (213) 725-7002 Our Letter Dated. May 22, 1990 Addendum Applies Nc Dear Applicant: This modifies our letter of the above date in which we stated that you would be treated as an organization that is not a private foundation until the expiration of your advance ruling period Your exempt status under section 501(a) of the Internal Revenue Code as an organization described in section 501(c)(3) is still in effect Based on the information you submitted, we have deternined that you are not a private foundation within the meaning of section 509 (a) of the Code because you are an organization of the type described in section 509(a)(2) Grantors and contributors may rely on this determination unless the Internal Revenue Service publishes notice to the contrary. However, if you lose your section 509(a)(2) status, a grantor or contributor may not rely cn this determination if he or she was in part responsible for, or was aware of, the act or failure to act, or the substantial cr material change on the part cf the organization that resulted in your loss of such status, or if he or she acquired knowledge that the Internal Revenue Service had given notice that you would no longer be classified as a section 909(a)(2) organizatien If we have indicated in the heading of this letter that an addendum applies, the addendum enclosed is an integral part of this letter Because this 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. Sin~cer~ely yours,/n Richard R. Oroeco District Director Letter 1050 (DO/CG) A. Laura Waldo Certified Public Accountant January 29, 2001 Mr Kenneth Ono Kona AduR Day Center P O Box 1380 Kealakekua, HI 98750 Dear Mr Ono As you are aware an emergency family situation has pushed back the completion date of my audit for Kona Aduk Day Cenler. 1 apologize for the delay and any incomremence it may have caused you. I hwe resumed work toward the completion of the audit and bamng and other drfflcultles I expect to hwe my audit report delivered to you by February 15"' at the latest Sincerely, o 75.5708 Hanema Plaee Suite 108A • Kadua-Kona, HI 98740 • Tel 800-329083 • Fax 808-329-8344 www.laurawaldo-coe com • emefl ~nfoE~laurarraldo-cpa oom Ann N. Fukuhara, CPA 714 Kanoelehua Avenue P O Box b691 Hilo, Haaa~~ %721 (808) %1-5532 Fax (808) 934-8589 Independent Auditor's Report March 4, 1999 To the Boazd of Du~ectors Kona Adult Day Center, Inc. Kealakeltua, Hawatt I have audited the accompanymg statement of financial positron of the Kona Adult Day Center, Inc (a non-profit organvadon) as of June 30, 1998 and 1997 and the related statements of activities, functional expenses and cash flows for the yeaz then ended These financial statements are the responsibility of the Qrgam7ation's management My responsibility is to express an opinion on these financials based on my audi[ I conducted my audit m accordance with generally accepted auditing standazds Those standazds require that I plan and perfonn the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement .4n audi[ includes examining, on a test basis, evidence supporting the amounts and disclosures m the financial statements An audit also includes assessing the accounting ptmciples used and s>rttnificant estimates made by management, as well as evaluating the overall financial statement presentation I believe that my audit provides a reasonable basis for my opimon In my opinion, the financial statetents refeiTed to above present fault', in all maunal respects, the financial position of the Kona Adult Day Center, Inc as of June 30, 1998, and the results of its operations for the yeaz then rnded in confornuty with generally accepted accounting principles. U~2 0~~~ Ann Fukuhara, CPA 1 Kona Adult Day Center, Inc. Statement of Financial Position As of June 30, 1998 (with comparative amounts for 1997) ASSETS 1998 1997 Current Assets: Cash and cash equivalents $ 6,943 $ 11.552 Accounts receivables, note 3 2,106 6,348 United Way receivable 7,500 p Prepaid expenses 6,557 5,122 Total current assets 23,106 23,022 Office and Other Equipment 169,273 146,374 net of accumulaud depreciation of $17,525, note 4 (46,686) (49,246) Orsanizadonal expenses of $22,044 -fully amortized - - Land, note 5 40,000 Total assets $ 185,693 $ 120.150 LIABILITIES AND NET ASSETS Current liabilities: Accounts payable and accrued expenses $ 6,176 $ 2,676 Accrued vacation 2,600 3.581 Unearned revenues 9,372 398 Total current Itabilittes 18,148 6,655 Net Assets: Unrestncted, note 2 114,798 111,629 Temporarily restricud, note 2 52,747 1,866 Total net assets 167,545 113,495 Total liabilities and net assets $ 185,693 $ 120,150 The accompanying notes aze an integral part of these financral statements 2 Kona Adtilt Day Center, Inc. Statement of Activities For the Year Ended June 30, 1998 (with comparative totals for 1997) Temporarily Total Total Unrestricted Restricted 1998 1997 SUPPORT AND REVENUES Support: Grants and contracts $ 55,062 $ 40,934 S 95,996 $ 78,286 Contnbutrons 92,897 61,375 154,272 107,758 Special Events 12,399 12,399 7,686 Total Support 160,358 102,309 262,667 193,730 Revenues: Private tuition 129,598 10,881 140,479 150,721 Transportaaon, bathing and other fees 14.761 14,761 20.511 Interest income 766 766 196 Sale of assets 3,000 3,000 - Total Revenue 148.125 10,881 159,006 171,428 Net assets released from restrictions - - restncttons satisfied by payments 62.309 (62,309) - - Total support, revenues and gains 370.792 50,881 421,673 365.158 Expenses: Program services -Adult day services 307,172 307,172 312,206 General and administrative 59,476 59,476 62.870 Fundraising 975 975 2,215 367,623 - 367,623 377,291 Change m netassets 3,169 50,881 54,050 (12,133) Net assets, beginning of year 111,629 1,866 113,495 125,628 Net assets, end of year $ 114,798 $ 52,747 $ 167,545 $ 113,495 The accompanying notes are an inttgral part of these financial statements. 3 L. R O1 {1Y = IV ~ 1/i ' y rn A C ~ G1 f~ N ^ .Y G. ~ n u C d O fy OC y y O A ry O ^r'. ~ ~ y ~-1~ ~ o ~ c cc'O" ~ "'jay y w H y y ~ n y ~ 7 n C~ tie ~ y y A~ ~ 7 < N c R ~ U 7 ~ C d w d 0o x io - _ ~ R N ~ y R C y y O n a N 6 - w~ N n '-L ~ R ~ 7 w n 3 m °f o ~ o - c ~ ~ ~ x ~ o H 19 w 7 1 ry ~ ~ A 7 W N a- N C `7 6 .0.1 d ~ n J J ~ 70 00 - w - tin .V 0o N T J 0o O ~ ,t = C O A 3 m N ~nao J:~xi., ~nw W ooappppT wv~CJ n A 3 L7 n J~ O~ J- O 7~ U In W J- N A J O- J- C A N A OC ~:+V In In J C N 7~ 70 A ~p N V7 OD U O OO J ; A ^ ~ 7 ~ d y~ o C nr ~ a ?.hY7d n 3 ! ~ C C a ~ m A ~ A ~ ~ JNppa~.~°o a~ ~ f1 1 O~ J W T U~ J ! ; W K '~3T1 A dl °q ~~p ~ „'i V b ~ A v pp ~ ~ O J J J tI1 lI1 lA y~ H W W _ pN ~r r j v .ppl ~ 00 OD W ~ tin ~O 00 N A ~O A O ~p w W ? , ~O J U ~O ~D tppo N~ J 00 W J Vi W W 00 L 00 O~ N V~ O~ ~O 00 N N J J ~O O $ N 0~0 O~ 0o A ~O N b oJ0 T U~ A 61 SA J ~D J N OD J W N J Oo W ~ O. O. A b N U S J W N ~p A ~ ~D ~JO ~.1 A W W O~ W O~ J W A N ~O J ~ p ~ tUi~ to tr ~ Vii t~i~ a ~O ~ A b a ~ V w b N OOe tOi~ ~ O Kona Adult Day Center, Inc. Statement of Cash Flows For the Year Ended June 30, 1998 (with comparative totals for 1997) 30-Jun-98 30~iun-47 Cash Flows Frotn Operating Activities: Change in net assets $ 54,050 $ (12,133) Adjustments to reconctle change in net asseu to net cash provided by operating acuvtttes. Donated land (40,000) - Depreciation & amortuauon 7,904 9,580 (Increase) decrease in accounts recetvable 4,242 2,528 (Increase) decrease ingrant-contract receivable (7,500) 833 (Increase) decrease to prepaid expenses (1,435) 368 Increase (decrease) in accounts payable 3,738 (862) Increase (decrease) to accrued expenses (1,683) (4) Increase (decrease) in unearned revenues 8,974 (1,007) Net cash provided by operating acttvtties 28,290 (697) Cash Flows Frotn Investing Activities: Purchase of equipment (32,899) (5,428) Net cash used by tnvestm¢ acttvtues (32,899) (5,428) Net decrease in cash and cash equivalents (4,609) (6,125) Cash and cash equivalents -beginning of year 11,552 17,677 Cash and cash equivalents -end of year $ 6,943 $ 11,552 Supplemental data• Noncash investing acnvtty Donated land $ 40,000 The accompanying notes aze an integral part of these financial statements 5 Kona Adult Day Center, Inc. Notes to Financial Statements June 30, 1998 i Organization Kona Adult Day Center, Inc. is a non-profit organisation mcorporated on September 19, 1989 pursuant to the laws of the State of Hawaii to provide adult day health care and respite caze to members of the community, including care for persons suffering from Alzheimer's disease and related dementia Kona Adult Day Center's operations are pnmarily funded through pnvate fees, contracts with the State of Hawaii-Deparnnent of Human Sernces as well as other grants and foundations 2 Summary of Significant Accounting Policies Basis of accountinc -The financial statements of the Kona Adult Day Center, Inc have been prepazed on the accrual basis of accounting Basis of Presrntation Net assets of the Organisation are classified and reponed as follows Unrestncted net assets -Net assets that are not subiect to donor-imposed stipulations Temporarily restricted net assets - Net assets subject to donor unposed stipulations that will be met either by actions of the Organisation and /or the passage of tune Contributions -Contributions includmg unconditional promises to give, are recorded as made. All connibutions are available for unrestricted tine unless specifically restricted by the donor Conditional promises to give are recognized when the conditions on which they depend are substantially met. Unconditional promises to give due m the next year are tncorded at net realisable value. Unconditional promises to give due m subsequent years aze repotted at the presrnt value of their net realizable value, using risk-free interest rates applicable to the yeats m which the promises are to be received 6 Kona Adult Day Center, Inc. Notes to Financial Statements, Continued Contnbuted factlities and transportation & meals - Contnbuted rent, transpottanon and meals represent the estimated fair rental of space and goods provided Contnbuted facilities aze provtded on an annual basis and amount to $60,516 for the yeaz ended June 30, 1998 Coattibuud ttattsportanon and goods are reflecud in the financial staumrnts at the fair value of the goods and services received Total for the yeaz ended June 30, 1998, amounted to $18,422. Expense allocation -The costs of providing various programs and other activities have been s~,m~,a.,~rd on a Cucaonal basis in the Staumrnt of Activities and in rite Statement of Functional Expenses. Accordingly, certain costs have been allocaud among the progtaats and supporting services benefited. Income tax status -Kona Adult Day Center, Inc is exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code Property and equipment -Property and equipment are staled at cost or, tf donated, at the fair value a[ the date of donation. Depreciation is computed prtmanly on the strught ltne basis Esatnates -The prepanaon of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures Accordingly, actual results could differ from those esnmates Reclasstficatiotu -Certain 1997 amounts have been reclassified to conform to the 1997 presentation 3 Accounts Receivable Accounts receivable as of June 30, 1998 consists of the following• 1998 Accounts receivable -nation $2,106 Allowance for doubtful accounts - Net receivable $z•lo6 No allowance for doubtful accounts deemed necessary. Management believes receivables are fully collectible 7 Kona Adult Day Center, Inc. Notes to Financial Statements, Continued 4 Property and Equipment As of June 30, 1998 property and equipment conszsted of the followmg- 1998 Equipment, furniture & fixtures $22,114 Vehicles 28,646 Leasehold unprovements 118,513 169,273 Less accumulated depreciation (46.686) Net property 5122.587 5. Donated Land Dunng the fiscal yeaz, Kona Adult Day Center and another not-for-profit organuatton were reaprents of donated land The faa market value of the land at the date of donation was 580,000 Kona Adult Day Cen[er's shaze of the value of the land rs $30,000 The donor did not place any restncuons on the propem Land - Kailua View Estates Subdivision $40.000 5 Leases On November 15, 1992, Kona Adult Day Center, Inc entered mto a lease agreement with The Queen Emma Foundation The lease may be revocable by etcher parry at any time by giving a least one yeaz nonce. Under the perms of the lease, Kona Adult Day Center will pay a monthly irnt of 51,650 and to pay costs such as in~~*ance and maintenance during the term of the lease Further, the lease allows the premises to be used for adult day center. On August 23, 1996, The Queen Etntna Foundation approved the reduction of rent as of August 1, 1996 to 5825 8 '18•A Potentul Ad)umnrnrs and Relcassdincaru FYE 6l30/9B Adluswent Lxreue Remarks Drsposrnon W/P Ref A¢owt Title Dr Cr (Decrease) AJE Amowt C A/R 210 AIE I Deferted revenues 210 7o adjust A/R and m reclassify amormts m deferted ttvmua - F 2 land 40,000 AlE Z Doruaom -land 40,000 40 000 40,000 Record donated land BB Accrued sxk leave fi 189 Salanes 6,189 6.189 AJE 3 6,189 To revme uc:ued sxk lave 101 Domuons 77,000 ONer grans -temp resmcr 70 300 R1E I No erfeci Orher grants - unratna 2,300 Umttd Way I7 873 Donanoro 17,875 Reclusdy donanons [o grants and UW m donanons 10 7 Tn land volwteers 6 200 Volwtter labor 6,700 AIE a Reverse conmibuied services 10 7 Reteivablet • United Way % 300 Conmbuoom 7 300 AlE S % 300 Record 1998 aliounom -per nonfinoon 7Z gegwung net users d63 Muc expenses 463 AlE 6 463 Adjust begtnnmg ne[ uua m audriM balance RJE t Work ComplTDl 4,612 RJE 2 No efts[ Payroll oxa 4 612 7ou1 112,131 112,131 a6, 189 34,ISa Less eRec[ of AJES 0 PRL Effect of toW irernt waived 0 Extesa (defici0 unad7uated (IM) FINAL A9 ADlUSIED: 34,030 ~rcm .2758 Application for Extension of Time To File ,Rev )tire 19?El Certain Excise, Income, Information, and Other Returns OL1a No `scs ciao Oepanment of •~c ',casurv imnnal aevenvc sc~~ce ? File a separate application for each return NameJ/ / Employer itlenlihcauon nunDer Please type or O ?~T ~ J pnnt File the ~ original and one Number s•reei and room or suite no la P O ox no d mail is rqt Cel•veretl to s•reet atlbessl copy by the Cue ^ Bate for fling / your return See insVUClions on ~ ly)~town or pos} olhtJ Slate antl ZIP~'c/g~tle for/~a lorei9n atltlress see instruc•ions back ~ KC11Ar~Cl~Na 7~~•,~ 4L ~1SD Note Corporate Income tax return Tilers must useForm 7004 to request an extenson or ume to ale Partnershrps REMICs, and trusts mustuse'Form 8738 to quest n of Dsm~e ~tao ~frle, Form 7065, 1966, or 70x7 - t I request an extension of tl a ~[e!n!~A. /d ..4iN./, to file (check only one) ? Form 706-GS(DI aT'dT'4Ra(>llZrti arm 1120-ND (sec 4951 taxes) ? Form 6612 ? Form 706-GS(T) ? Form 990-T (trust other than above) ? Form 3520 A ? Form 8613 Form 990 or 990 EZ ? Form 1041 testate) (see instructions) ? Form 4720 ? Form 6725 ? Form 990-8[ ? Form 1041-A ? Form 5227 ? Form 6804 ? r;,rm :..0 ^F ? r^`n '042 ? Form 6059 ? Fo•m QP31 If the organiiahon does no[ have an office or place of uuslness~n }{he United States check this bay.. . ? ? 2a For calendar year , or other tax year beginning -.:slfJ.(~l. , /yy !r- and ending - >!UKG.3(J., ,ZQO-d b If this [ax year is for less than 12 months check reason ? Initial return ? Final return ? Change In accounting period 3 Has an extenslon o! ume [o file been previous) gran dA for this tax years ` - Yes i~t NO 4 St to In detail why you need [he extenslon -"/7~ .Q.O~GS. ~ ~G . N ~KA~I Lect{ ~,I _ ~Ar ,Galin;_ G'-alA:2C AA C~4~4_1t-7 ~t-~Cafir rc~urf? cpn bs. - Y~t' - - - - . - - - - 6a If this form is for Form i06-GS(D), 706-GS(Tj, 990-BL, 990-PF, 990-T, 1041 (estate), 1042, 1120•ND 4720 ~ 6069,6612 6613, 6725, 8804, or 8631 enter thetentauvetax IessanynonrefundaWersedits Seeinsuuc[ions S b If this form is for Form 990-PF, 990-T, 1041 (estate). 7042,_or 8804, enter any refundable credits and D estimated tax payments made Include any poor year overpayment allowed as a credit - 5 c Balance due Subtract line 6b Irom line Sa Include your payment with this form, or deposit with FTD coupon if required See instructions - j ~ Signature and Verification Untler penalties of penury I tleclare Ihet i Dave examined Ih~S lam including etcompanying scixkh4es antl statements arq tot ne best of my krgvAetlge antl Deliel k is true correct ntl complete antl IDdI I am a thbriietl to prepare tDii form/r /J d signetve j6~~ T•ne ? C!?e9 Date ? /D'/J ~JbU FILE ORIGI LAND E C The IRS well sfrow below whether ar not your apphcauon is approved and Hull return the rnpy o ice to Applicant-To Be Completed by the IRS We HAVE approved your application Please attach this form to your retixn RECEIVED We HAVE NOT approved your application However, we have granted a 10-day grace p I from the later of the [e71 shown below or the due date of your return (including any prior extensions) Thls grace ~ d Q/egriy~t~ed7j{hpe lid extenslon of Ume fur elections ulheiwlse ieywred to be made on u bmeiy return Please cil`(h77s io u et ~ ? We HAVE NOT approved your application ARer considering the reasons stated in Item wnC~nut,R-l~~li~iJl for an extension of time to rile We are not granting the 10-day grace penod OLDEN, U I I ? We cannot consider your application because it was filed after the due date of [he return or w i ITtlrt'e1Ren51D requested ? Other • r - Directs ' `S /~a n _ Date II ou want a cap of this form to be returned io Lan address other than Ih own above, lease ante De address to which the co should be Beni Pleesa Type bar SVxL slid room ar su[e ro (ar P O box rq d men b rpt tlelniered to SVeel atltlressl or y EXTENSI Pont Coy town post ice, ute sad ZiP cod a fneigi editasa, iMDUCtlarts ~u - G 7 For Paperwork Reduction Act Notice, see beck of loan cal rb 119768 v 0 ~F~~T58 ,Rev a 9a) F'I~IIaRD CR~gMER, Director cc__sing Cenie• ana No +ss mat F«m 990 Return of Organization Exempt From Income Tax ~~9 9 Under section 501(cl of the Internal Revenue Code (except black lung benefit trust or private foundation) or Section 4947(a)(1) nonexempt charitable trust This Fenn is Depsnmeni of me •~eawry Open to PuDlie cinemas Revenue 9enca Note The or anriarrpn ma have to use a cap o1 this return ro salrsl stale reportrn requirement ins +wn A For the 1999 colander ear, OR tax ear ariod bs innin , 7999, end endin ~j ~QQ 8 Check it PMaaa C Na of «gemzeti v/ / r ~ D Emploh leamrncatlon number uaa IRS r1 V ? Cbng! of ea~7rzss heal a ? Initial return p~iga Number arxl str¢el PO box d roast Is delivered la sheet etldressl RooMwne E Telephone number ? Final return Su ? AmentlM rat«n infMS` Qty « town slat « c ntry ana 21PH r ' n D F Check ? ? it exemption applitauon (re4ueetl also I« +lena Y state repanirgl 's Pend~'n9 G Type Df organization-?~ Exetnpt under section SOtlcf 3 ) ~ fmsert number) ORf ~ sectmn A9A7(a)(tti nonexempt charitable crust Note section fal(e)(JI exempt ar anlzations and 1917(a)(i) nonerempt ehartrt+pb.(e trusts MUST attach a completed Schedule A (Form 990) H(e) Is IMS a group ret«n fAed I« alrilielea~ ? Yes l/p No 1 II eiuier ppx in N is clKtkea'Yes' enter lour tl~g•t group ro) Ir'Ves "enter iIN rxrmber of amliales for which dvs refum is flea ? exemplxm nuniler (GENT ? _ J ACCp{inling ttielh00 ? C05h ~ ACCNiI- IS Ihn a separate rattan filed trJ an «ganizalion coveretl D a oup ruing'+ ? Ves No ? Other (specs ) ? K Check here ? ? d the «gani:ation s gross receipts sra rxamaiy not m«e ltYn [25000 The orgarvzation reed n« fie a return wnh the iR5 Wt d recervetl a F«m 990a F 990 Peclu~m Ne mac n shoulO fiia a rerun vnthtwl financial dale font crates requua a complete relumNe mail n shoul0 Rla a rerun vntMUt financial date Spnr slams requna a tomplate rerum Nora. Fain 990 £Z me be used b ru anrzalrons with ross receipts less than f 100 000 and total assets less then 5250 000 ar end ar Revenue, Ex enses, and Chan es in Net Assets or Fund Balances See 5 ecific Instructions on oa a 15 1 Contributions, gilts, grants, and similar amounts received a Direct public support _ 1a y$07,3 b Indirect public support 1b D c Government contributions (grants) 1c d Total (add Imes la through 1c) (attach schedule of ctmbibulors) (cash S rtoncash S ) 1d S~G3 D~ 2 Program service revenue inUUding government fees and contracts (tram Pan VII one 93) 2 ~ ) 3 Membership dues and assessments 3 4 Interest on savings and temporary cash investments 4 5 Dividends and interest from securities 5 / 6a Gross rents _ 6a b Less rental expenses _ 6b c Net rental income or (loss) (subVact Ilne 6b from line 6a) 6c 7 Other investment Income (describe? 7 8a Gross amount from sales of assets oche (AI sec«iues let oln« ~ than inventory 8a b Less cost a other basis and sales experees. Bb c Gain or (loss) (attach schedule) _ 8c d Ne[ gam rx (loss) (combine fine cdurms W and (B)) 8d 9 Special events and activities (attach schedule) a Gross revenue (not including f of contributions reported on line 1a) 9a b Less direct expenses other than fundraising expenses _ 9b ) c Net income or poss) from special events (subtract line 9b from line 9a) 9c 10a Gross sales of inventory, less returns and allowances _ 10a b Less cos[ of goods sold tOb c Gross profit a poss) from sales d nventory (attach schedule) (subVact Ime tOb from Ime 10a) 1oc 11 Other revenue (from Part VII, lute 103) _ 11 12 Total revarxJe (add lutes 1d, 2. 3, 4, 5. 6c. 7, 8d, 9c. 10c, and 11) 12 - ' ?-~/d ii 13 Program services (from line 44, column (B)) 13 7i 14 Management and general (from line 44, column (C)) 14 15 Fundraising (from line 44, column (D)) 16 ~ 16 Payments to affiliates (attach schedule) 16 17 Total ex enses (add lines 16 and 44 c n ( D 17 18 Excess or (deltic) for the year (subtract li f e t8 ZZT 19 Net assets or fund balances at beginning of year (from line 73, column (A)) 19 ~ O b ~ 20 Other changes In net assets or fund balances (attach explanation) _ 20 = 21 Net assets or turd balances at aril of (cotrixre Imes 18. 19, and 201 21 O Far Paperwork Reduction Act Notice, sea page 1 of the separate inslrvctans Cat Na 1i262v F«m 990 n9991 Form 990 n9991 Paqe 2 Statement of All organi:auons must complete calunn IAI Columns IBI ;C) and rDl a•e repueetl for seurcn SOlkg71 a^d Iq organtaiwrs Functional Expenses and section r917(all1J nonesempt chariuhle ousts but ophonal for others (See Spealw Inst••xtwns on page 79; Do no[ include amounts reported on line Ul ?Dial (Bl Progam (q Management 6b, 86, 96, TOb, or 16 0I Part I services and general (D) Furwraising 22 Grants and allocations (attach schetlule) (USh S norxash S ) 22 23 Specific assistance to individuals (attach schedule) 23 24 8enefi[s paid to or for members (attach schedulel 24 25 Compensation of officers dvectors etc 25 26 Other salaries and wages _ 2B ~ 72 ~ 27 Pension plan contributions 27 28 Other employee benefits 26 ~ 29 Payroll taxes _ 29 ~ ~ 30 Professional fundraising fees _ 30 31 Accotmting fees 31 32 Legal fees 32 33 Supplies 33 34 Telephone _ 34 35 Postage and shipping 35 D 36 Occupancy 36 Lr ' G 37 Equipment rental and maintenance 37 ? 38 Printing and publications 38 (i 39 Travel 39 40 Conferences, conventions, and meetings _ 40 41 Interest 41 42 Depreciation, depletion, etc (attach schedule) 42 43 Other expenses litemize) a 43a b 43b 43c d 43d q,, tt e . s~i!1... :V..~.... 43e 44 TatYhnctianler-0emet(atldGrest2lhagh4~ ()'gtnutgra mbrars(B}wll peatotYstoiet7J-7f, 44 jiD?Jfr1 D (ia Reporting of Joint Costs. Did you report in column (B) (Program services) any~oint costs from a combined educational campaign and fundraising solici[ation~ ? ? Yes ~ IVo If 'Yes' enter the aggregate amount at these )Dint costs f (ii) the amount allocated to Program services S (ii7 the amount allocated to Maria ement antl eneral f ,and (iv) the amount allocated to Fundraisin S Statement of Pr ram Service Accom lishments See S ecific Instructions on a e 22 What Is the organizations primary exempt purpose?? Program Service Ex~ensas All organlzallons must describe their exempt purpose achievements in a clear and concise manner Slate the numb IRe9urrl ter salkllal aria Of Chests Served, pubhcapons issued, etc Discuss achievements that are no[ measurable (Sechon 501(c)(3) antl OIq Digs aM nu(ilpl organizations and 4947(al(1) nonexempt charita I trusts must alsp nter the amount of grants and allocations to othe ) ersu ma orWUi im email a ~Q ...Q.raA!/ .f,J.... t:A... +!:.I.:Ga( )..G....GrAyG....d.~_,M,e.?.c_...,~J:l~ ~.Q..?... ~ll~...m.Cm~ ~.......~i~r...x»rrru~~,;e~~y..:.. ,DL...f~.~xLS... t'4Yl Cd..,G.R.r.4.....0. Crt.id!Y.~..3.<.! . ~!?I fx......_.R -~-~t~f.M.r.!f._~1t~.. (Grants and ailocatlons S ) ~ (Grants and allocations S ) (Grants and allocations f ) (Grants and allocations f ) e Other ro ram services (attach schedule) IGrants and allocations f ) f Totel of m Service Ex nses(stwuld a ual line 44, column (B), Pro rem services) . ? Fnm 990 (1999) FIXm 990 (1999) gage 3 Balance Sheets (See Specdic Instructions on page 22 ) Note• Where required attached schedules and amounts within the descriprron (ql (B) column should De !or end-o!•year amounts only Beginning of year End or year 45 Cash-non-interest•bearing - 45 (e 46 Savings and temporary Cash investments - 46 47a Accounts receivable 47a b Less allowance for doubtful accounts _ 47b ~/.Z 47c / ~b~ 48a Pledges receivable 48a b Less allowance for doubtful accounts - 48b 48c 49 Grants receivable - 49 50 Receivables from officers, directors, trustees, and key employees (attach schedule) 50 Sta Other notes and loans receivable (attach schedule) 51a N b Less allowance for doubtful accounts - 51b 51c a 52 Irnentories for sale or use 52 53 Prepaid expenses and deferred charges 53 54 Investments-securities (attach schedule) 54 55a Investments-land buildings, and equipment basis 55a b Less accumulated deprecation (attach schedule) _ SSb SSc 56 Investments-other (attach schedule) _ 56 S7a Land, buildings, and equipment basis _ 57a 7 ~ b Less accumulated depreciation (attach ~ schedule) 57b 1 57c yrb 58 Ocher assets (descnbef S ) 58 59 Total assets (add Imes 45 [hrou h 58) (must a ual Ime 74) / b Z 59 60 Accounts payable and accrued expenses - 60 61 Grants payable 61 ~ 62 Deferred revenue 62 63 Loans from officers, directors, trustees, and key employees (attach y schedule) - 63 64a Tax-exempt bond liabilities (attach schedule) 64a b Mortgages and other notes payable (attach scheCulel 64b 65 Other liabilities (descnbe? ) 65 68 Total Itabtlrtros add tines 60 [hrou h 65) l b0 66 Orgardreuons that follow SFAS 117, click here ? Q and complete llnes N 67 through 69 and tines 73 and 74 67 Unrestiicted - L 67 3 68 Temporarily resVicted 68 m 69 Permanently restricted - 69 t7rgsnizaGans that do not fdlow SFAS 117, check here ? ? and complete lines 70 through 74 0 70 Capital stock, trust principal, or current funds 70 ~ 71 Paid-in or capital surplus, or land, bullding, end equlpment fund 71 72 Retained earnings. endowment, accumulated income, or other funds 72 73 Total net assets or fund balances(add lines 67 through 69 OR tines Z 70 through 72, column (A) must equal Ilne 19 and column (B) must i equal line 21) _ Z 73 74 Total Iiadlities and net assets /![rid balances (add hoes 66 and 73) 74 / Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a partlrvlar organization How the public perceives an organization in such cases may be determined by [he information presented on its return Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organizaat's programs and accomplishments Form 990 (1999) _ page 4 Reconciliation of Revenue per Audited Reconclllatlon of Expenses per Audited Financial Statements with Revenue per Financial Statements with Ezpenses per Return (See 5 enfic Instructions. a e 24 I Return a total revenue, gains and other wpport a Total expenses and losses per per audited finanual statements ? a audited (inanoal statements ? a b Amounls included on linea but not on b Amounts mcludeo on Ime a but not line 12 Form 990 on line 17, Form 990 (1) Net urvealized gains (1) Donated services on investments - f and use of facdnles f (2) Donated services (2) Pna year adpavrients and use of facilities f reposed on line 20 c: ~ (3) Recoveries of prior Fain990 - year grants f (3) Losses reported an (4) Other (specfy) line 20, Farts 990. f (4) Other (specify) f Add amouns on fines (1) through (4)? b f Add artlouras on fines (1) through (4)? b c line a mows line b ? c c Line a minus pne b ? c d Amounts included on line 12, d Amounts included on line 17. Form 990 but not on tine a• Farm 990 but not on Ilnea• (1) trrvestmerlt expatses (1) Irnrestmentexpenses r1IX included an one not included on fine 6b, Form 990 f 6b, Farts 990 f (2) Other (specfy) (2) Other (specfy) f f Add amounts on lines (1) and (2) ? d Add amourns on tines (1) and 12) ? d a Total revenue per line 12, Form 990 a Total expenses per line 17, Form 990 Ilse c lus line d) ? e (line c lus line d) ? e List of Officers, Directors, Trustees, and Key Employees (OSt each one even d not compensated see Specific Instructions on page 24 ) lAl Name era eotlress tai nne anO a~eraye nws per (Illnotmerd~ Coral emrobCrneMai ~Nm i account a ee other weer oewtea to povtan P 0 P 0 -0• eelnrt/roe espies anowances u.f._.... 75 pd arty officer, erector, trustee, a key emplgee receive aggregate compensation d more than f10p,000 from your aganizaum and all related agamzatims. of vlkuch more than (10,000 was prontiad by the related ugarozations7 ? ? Yes ? No If 'Yes." attach schedule-see Specific Instructions on page 25 Fain 990 11999V Form 990 (1999) _ _ _ _ _ _ _ _ _ Page 5 Other Information See S ecific Instructions on a e 25 I Yes No 76 Pd Ute arganira9on engage m arty acoviry not pre~ously reported to the IRS It 'Yes," arach a detailed desrnpom d each acn~ry 76 77 Were any changes made in the organizing or governing documents l;ut not reported to the IRS 77 If "Yes " attach a conformed copy of the changes 78a Did the rngarozatlm have unrelated txlsiness gross irxmlle of 51,000 a more dining the year covered by this retum~. 78a b If "Yes, has it filed a tax return on Form 990-T for this years _ 78b 79 Was there a liquidation dissolwon, termnation, or substantial canvacaon tluring the years If 'Yes " attach a statemern 79 80a Is the organization related (other than by association with a statewide or nationvnde organzation) through common membership governing tx7dies, trustees, officers, etc , to any other exempt or nonexempt organizations , _ BOa b If 'Yes." enter the name of [he organiza[ion? . and check whether it is ? exemptOR ? nonexempt 81a Enter the amount of political expenditures d+rect or indirect, as described +n [he instructions for line 81 9ta b Did [he organization fileFOrm 1120-POLfor [his years _ 81b ~ 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 b If "Yes,"you may indicate the value of these items Here Do not include this amount as revenue in Part I or as an expense +n Part II (See insvucuons for reporting +n Part III j - 82b U 83a Did the organization comply with the public inspection requirements for returns and exemption applications 83a b Did the organization comply with the disclosure requirements relating to quid pro quo contributions 83b 84a Dld [he organization solicit any contributions or gifts that were not tax detluctible7 _ 84a b If 'Yes,' did the organization include with every sollci[atlon an express statement that such contributions ' or gifts were not tax deductible? 84b .A 85 501(cJ(4), (5), ar (6) crgarvrauons a Were wbstarnially all dues nondeductible by menitxrs~ 85a b Did the organization make only in-house lobbying expenditures o/ E2,000 or less? 85b If "Yes" was answered to either 85a or 85b.do not complete BSc through 85h below unless the organization received a waiver for proxy tax owed for the prior year c Dues, assessments, and similar amounts from members _ 85c d Section 162(e) lobby+ng and political expenditures _ BSd A e Aggregate nondeductible amount of section 6033(e)(1)(A) dues no[Ices _ 85e f Taxable amount of lobbying and political expenditures (line 85d less 85e) _ B5f -A g Does the organization elect to pay the section 6033(e) tax on the amount in 85f7 - 85 h If section 6033(e)(1)(A) dues fKxiCeS were sent, does the agernzatirxl agree to add the amount in 85f to its reasonable estimate of dues aaocatHe to nondeductible lobbying and polNCai expenditures for the fdlovnng tax yeah _ 85h 88 501(c)(7J Digs Enter a Inuation fees and cagtal contntxAOns included Oil Ixie 12 B6a b Gross receipts. included on line 12 for public use of club facilities _ 88b A) J 87 5O1(c)(12) crgs Enter a Gross income from members a shareholders 87a b Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) _ B7b 88 At any time during the year, did the organization own a 505'0 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 7701.37 If'Yes," complete Part IX - 88 89a 507(c/(3J organizations Enter Amount of tax imposed on the organlza[ion during the year under section 4911 ? ,section 4912 ? ,section 4955 ? b 501(c)(3) and 501(c)(4) Digs Did the organization engage in any section 4958 excess benefit vansac[ion during the year or did it become aware of an excess benefit transaction from a prior years BYes." attach a statement expla+niry each transaction 89b c Enter Amount of tax +mposed on the organization managers qr disqualified persons during the year under sections 4912, 4955, and 4956 ? d Enter Amount of tax on line 89c, above, reimbursed by the organs trod ? 90a List the states with which a copy of this return is fled? .e~D~~... b Number of employees employyegd in [he qri that inf(Iydes~darch 12. 1999 (See lost) 190b I 1 b 97 The books ore care of? KG.R.9.-f.*.cc~~!1T.. y~/ L.~~7~,~_ Telephone no 13u:7y77...._ Located at ? ~Q BbX..l3b0...1:Gr~l,!~ ....t!....N..t ZIP , a ? .!`~..7..S1a2...................---•'- 92 Sec[ron 4947(a)(7) nonexempt charitable wsrs ll~ng form 990 in heu oForm 1041--Check here ? ? _ and enter the amount of tax-exempt interest received or accrued durlng the tax vear ? 192 I Form 99U t1997i Form 99011999) Page 6 _ _ Anal sis of Income-Producin Acuvides (See 5 eclhc Instructions on a e 29) Enter gross amounts unless otherwise Unrelated business income t,cLtlea oy se[iwnst7 sta ci si+ (E) Indicated (a) (e) (C) (p) Related or e_s~eess c:de Amount Excuswn cotle Pmounl exempt lunc•i0n 93 P ram s rvice ever7t~a income a Yh/?A~G ~ur'tlbrr / D b c d e t Medicare/Medicaid payments g Fees and convects tram government agencies 94 Membership dues and assessments 96 Interest on savings and temporary cash investments 96 Dividends and interest lrom securities 97 Ne[ rental income or (loss) from real estate a debt-financed property b not debt financed property 98 Net rental income or (loss) from personal property 99 Other investmentincame 100 Gain or (loss) from sales al assets other than inventory 101 Net income or (loss) from special events 102 Gross profit or poss) Irom sales of Inventory. 103 Other revenue a b c d e 104 Subtotal (add columns (B). (D), and (E)) 7 105 Total (add Ilne 104, columns (B), (D), and (E)) ? Nots: Lrne 705 lus Ime ld, Pan should a ual the amount on line T2, Part / Relationshl of Activities to the Accom Ilshment of Exem t Pur oses (See S ecific Instrucuons on a e 30 ) Line No Explain how each activity for which income is reported in column IEI of Part VII contributed importantly to the accomplishment ~ oft o ganization s exempt purposes lolher than by providing lands for such purposes) r r /n o ua, Yo~lc tr GI L Information Re ardin ia:atrle Subsidiaries and Dlsre arded Entitles (See 5 ecdic Instructions on a e 30 ) Name, address, and EIN of cdfporauon. Percentage o! Nature of activities Total income End (of~year artnershl p tlme anted enlst tyNnershl interest assets o~ o~ Urasar tl Pe7~Y 1 • oinked Uss own lnc4Gng etoompanyeq s srq w s ono b Ua oast d my Please and per , cmecL eiim d Papsnw (Diner oleo drwerl Is d oil inrarmetlon o~'`~'`Pever nf~airy amwi Sign ~ 0/ r~l~11/ UNd C~~_ _ /~l'~ Here , the d r 0ete r Type ar pnm rams and ark Preisarer s Oale ~In Ca it Reparer s SSN a PTIN Patd agnatura am ? ~ ~ 3 Preparer's Flmssnarne (a , EIN ? USG Only your d sea empkye~ sod address - ZIP . ~ ? ® Form 990 (7999) SCHEDULE A O~gaflization Exempt Under Section,5Q1(c)($) on+e vo [s<s ao~T (FOrm 990) (Except Prrvata Foundation) and Seetton 501(e), 5010, 501(k), SOt(nl, or 5ectton ~9<y(s)(11 Nonexempt Cttantable Ttust ~ 0p Supplementary Information-(See separate Instructions.) U~.7 9 peperoneni of me Treeaury Internet Revenue Serwce ? MUST be tom toted b the above or anizallons end a[[achetl to them Fortn 990 or 990.EZ Nome d the erg nixatlon ff ~ Employer Idanuncauon number n A ~v ~T ~,q G Compensation of [he Flve ghost Pald Employees Other Than Officers, Directors, and Trustees (See a e 1 of the Instructions Llst each one If there are none, enter 'None (a) Nsme ano aetlress d each employee paid more NI Hoe ano average Hours (ol ConbiGniam [o te) E,pense tnan S50 000 per week dewte0 [o pomtlon fcl Compensation mpkryee lene0[ plm a account ano other j /1 /J~~ OrlMea co lion allowances -.J-S-:.C- - Total number of other employees paid over 550.000 ~ Compensation of the five Highest Paid Independent Conttatxtxs ttx Proftllrssfonsl Services (See a e 1 of the Instructions Llst each one (whether individuals or Iirmsl If there are none, enter "None (a) Name aM atltress d each inoependeni contractor W b more men [50,000 N) Type d servka (c) Compensa0on KaNr -.NG..!-I.~~1...-~~.Yes-....1~-...~---------------- -vurstriy rsvcs 70 ; 67b~1 mn~ ~ ~ svgs ~S~z. Total number of others recerving over 550.000 for professional servKes ror Paparrork Reduction Act Nahca, see papa 1 0l the Instructions Ior Form !g0 and Form I!0•EZ. Gt. No 112e5F SrJWe A (Farm erA teaa Schetlule A (Form 9901 7999 Gage 2 _ _ _ Statements About Activities ves No t During the year has the organization attempted to influence national, state or local legislation including any attempt to influence public opinion on a legislative matter or referendums - 1 If 'Yes,' enter the total expenses paid ar incurred in connection with the lobbying activrtie: ? S Organizations that made an election under section 501(h) by filing Form 5766 must complete Part VI-A Other organ~zalions checking Yes muss complete Part VI-B At;D attach a statement giving a derailed description of the lobbying activNes 2 During the year, has the organization, either dvectly or indirectly engaged ~n any of the following acts with any of as trustees, directors otf~cers creators, key employees or members of lhev families. or with any taxable organization with which any such person is afhlmted as an officer dvector, trustee majority owner or principal Denef iuary - a Sale, exchange, or leasing of property - 2s b Lending of money or other extension of credit? - 2b Jt e Furnishing of goods, services. or faalities~ 2c d Payment of compensation (or payment or reimbursement of expenses d more than f1,0001° - 2d k a Transfer of any part of its income or assets? - 2e If the answer to any question is Yes." attach a detailed statement explaining the transacUOns 3 Does the organization make grants for scholarships, felltnvsh7ps, student loans, etc ~ - 3 X da Do you have a section 403(b) annw[y plan for your employees?, - da b Altech a statement to explain how the orgenizatlon determines that intlrvitluels or organizaUOns receiving grants br loans from it in furtherance o! its charitable ro rams ualn to receive a menu (See a e 2 of the instructions I Reason for Non-Private Foundation Status (See pages 2 through 4 of the ins[rucUOns ) The organization is not a private foundation because it is (Please check onI~NE applicable box } 5 ? A church, convenUOn of churches or association of churches SecUOn 170(b)(1)(AJ(i) 6 ? A school Section 1701b)(1)(A)Qi) (Also complete Part V, page 4 ) 7 ? A hospital or a cooperative hospital service organization Section 170(b)(1)(A)(nf) 8 ? A Fede21, state, or local government or govemmental unit SecUOn 170(b)(1)(A)(v) 9 ? A medical research organization operated in con/unction with a hospital Section 170(b)(1)(A)(n7Enter the hospitals name, city, and state ? 10 ? An organization operated for the benefit of a college or university owned or operated by a govemmental unit Section 170(blfA)(M (Also complete the Support Schedule in Pan IV-A } 17a~J An organization that normally receives a substantial part of its support from a govemmental unit or from the general public Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A) 17b ? A community trust Section 170(D)(1)(A)(w) (Also complete theSuppon Schedule in Part IV-A ) 12 ? An organization that normally receives (1) more than 33'h% of its -support from convibuGdns, membership fees, and gross rece~pls from acnwties related to its charitable, etc functions-sub/ect to cenarr7 exceptrons, and (2) no more than 3M% of its support from grass investment income and unrelated business taxable income (less section 571 tax) from businesses acquired by [he organization after June 30. 1975 See section 509(al(2) (Also complete thrbupport Schedule 7n Part IV-A ) 73 ? An organization That is not controlled by any disqualdied persons (other than foundation managers) and supports organ7zauons described in (1) lines 5 through 12 above, or (2) section 501(c)(4), (51, or (6), d they meet Ute test of section 509(x)(2) (See section 509(x)(3) ) Prowde the follownn iMormaUOn about the su oned a amzatrons (Sea a e 4 of the rtlstruttiars ) (s) Name(s) M supported organ7zatron(s) (b) Line number from above 14 ? An organization organized and operated to test for public safety Section 509(x)(4) (See page 4 of the insUUCtions ) Sehr.dulr A (Form 999) 1999 ScraOrxe A (FIXm 9901 1999 - - - - - Page 3 Support Schedule (Complete only it you checked a boz on line 10 11 or 12 )Use cash method of accounrng Note: You may use the worksheet m the rnstnrchons /or converting /rom the accrual to [he cash method o/ accounhng Calendar ear (or fiscal ear be innin in) ? (a) 1998 (b) 1997 (c) 1996 (d) 1995 (e) Total 15 Gilts grants and contributions received (Do not include unusual grants See line 281 D b5 Z ,s / 16 Membershi fees received 17 Gross receipts from admissions merchandise sold or services pertormed, or furnishing of facilities in any activity that is not a business urvelated to the organizations charitable, etc , purpose / ~ ~ Z 18 Gmss income Irom interest dividends amounts received Irom payments on securities loans (secuon Sti(al(5)1 rents royalties, and unrelated business taxable income (less sectwn 511 lases) from businesses acquved b the or anizalion alter June 30 1975 / ~ /i~i 19 Ne[ income Irom unrelated business actmhes no[ included m line 18 20 Tax revenues leveed for the organizahons benefit and either paid to it or expended on its behalf 21 The value of services or faulibes furnished to the organization by a governmental unit without charge Oo not include the value of services or facilities generally furnished to the puDhc wMdut charge, 22 Other income Attach a schedule Do not include am or poss) Irom sale of ca ital assets b 23 Total of lines 15 throw h 22 ~ 2/ Line 23 minus line 17 25 Enter 1% of line 23 Z 26 Organrxatrons descnbed on Imes 10 or 11 a Enter 2% of amount in column (el. line 24 ? 28a b Allach a list (which is no[ open to public inspection) showing the name of and amount conmbuted by each person (other than a governmental unit or publicly supported organization) whose total gilts for 1995 through 1998 exceedetl the amount shown in line 26a Enter the sum of all these excess amounts ? 286 c Total support for secuon 509(a)(1) test Enter line 24, column (e) ? 28e d Add Amounts from column (e) for lines 18 19 22 ~ 2fib ? 284 e Public support (line 26c minus line 26d total) ? 28s / f Pubbc su on. ercenta a (line 2fie (numeratrn3 drvlded b line 2lic (denominator)) ? 281 % 27 Organrxations descnbed on line 12: a For amounts included In hoes 15, 16, and 77 that were received Irom a"disqualdied person,' attach a list to show the name of, 8nd total amounts recewed in each year from, eaclldisqualdied person' Enter the sum o! Such amounts for each year (1998) (1997) (19961 (19951 b For any amount included in line 17 that was recervetl from a nondisqualdied person, attach a list to show the name of, and amoo received for each year, that was mac than thelarger Of (t) lhB amount On line 25 for the year Of (2) f5,000 pnclude in thB Irsl organizations descnbed in Imes 5 through 11, as web as indrvrduals) Alter computing the dtllerence between the amount reo®d and the target amount described in(7) or (2), enter [he sum of these ddferences (the excess amounts) for each year (1998) (1991) (1996) (1995) e Add Amounts /rom column (e) for Imes 75 16 , 17 20 21 ? 27e d Add Una 27a total and Ime 27b total ? 2Td e Public support pine 27c total minus line"27d tota0 ? ' 27e t Total support for sechon 509(a)(2) test Enter amount on line 23 column (e) ? 27f g Public support percentage (line 27e (numerator) divided by Ilna 27f (denominator)) ? 27 % h Investment income ercenta a (Irns 18, column (e) (numerator) divided b line 27f (denominator))? 27h % 28 Unusual Grants For an organization described in Ime 10. 17, or 12 that received arty unusual grants during 1995 through 1998 attach a list (which is not open to public inspection) for each year showug the name of the contributor, the date and amountlehe grant, and a brief description tN the nature of the grant Do na include these grants in hne 15 (See page 4 of the 1nslNOas ) SeMAtle A (Form 990) 1999 ScMNe A (Fam 990) 1999 Page Q Private School Questtonnatre (See page 4 of the rnstructlons ) - tTo be•com IetedOMLY b schools that checked the box on brie 6 ttti'Part IV) z )1~ Yes No 29 Does the organization have a racia/Illy/n(ontliscriminalory policy toward students by statement in its charter bylaws other governing instrument or in a resolution o! its governing body? - 29 30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures catalogues, and ocher written communications with the public dealing wnh student admissions programs, and scholarships - 30 31 Has [he organization publiuzed its racially nondiscrarunatory policy through newspaper or broadcast media during the perwd of_sokutation fot students, or during the regisvatwn period d rthas no sollcttation program. m a way that makes the policy known to all parts of the general community it serves 31 If Yes please describe, d'NO please explain (If you need more space, attach a separate statement ) 32 Does the organization maintain the following a Records indicating [he raaal composition of the student body lacully, and administrative staffs 32a b Records documenting that scholarships and other financial assistance are awarded on a racially nondrscnminatory basis - 32b e Copies of all catalogues. brochures announcements and other wr~llen communications to the public dealing with student admissions programs and scholarships"? - 32c d Copres o! all material used by the organization or on its behalf to solicit contribullons7 - 32d II you answered'No' to any of the above please explain (If you need more space, attach a separate statement ) 33 Does the organization discriminate by race in any way with respect to a Students' rights or prrvlleges~ - 33a b Admissions poliaes7 _ 33b c Employment of faculty or administrative stafl~ - - 33d d Scholarships or other financial assrslance7 - 33d e Educational pollcresv - 33e f Use of facilities? 33f g AU[letlc programs _ 33 h Other exvacurrlcuWr activlbes7 _ 33h If you answered'Yes to any of the above please explain (11 you need more space, attach a separate statement ) 31e Does the organrzallon receive any financial aid or asststance from a governmental agency? - - 34a b Has the organixanon's right to such aid ever been revoked or suspended? - 34b If you answered'Yes' to either 34a or b, please expain using an attached statement 35 Dces the organization certRy that rt has complied with the applicable requirements of sections 4 O7 through 4 OS oT Rev Proc 75-50, 1975-2 C B 587, coverm rectal nondtscnmmalion7 IfNO.' attach an ex lanalron 35 ScMera~ A (Fam 9fr0) 1B9a Sthe0lAe A (Fpm 990) 1999 Pa 5 Lobbying Expenditures by Electing Public Chances (See page 6 0( [he Ins[ructtons ) (To be completed ONLY by an ellglble organtzatron that filed Form 5769) Check here ? a ? d the orgamzauon belongs to an afnlmted group ~ 1 Check here ? h ? if ou checked "a" above and' limned control- provisions a pl N let Llmtts on Lobbying Expenditures AlfAiaieit group To be cso ~pierea locals Ip ALL eleClirxJ (The term -expenditures means amounts paid w incurred 1 pganiza4m: 36 Total lobbying expenditures to innuence public opinion (grassroors lobbying) - 36 37 Total lobbying expenditu: es to influence a legislative body (duet[ lobbying) - 37 38 Total lobbying expenditures (add lines 36 and 37) - 38 39 Other exempt purpose expenditures 39 40 Total exempt purpose expenditures (add lines 38 and 39) 40- 41 Lobbying nontaxable amount Enter the amount from the following [able- If the amount on line 40 rs- The lobbyrng nontaxable amount is- Not over 5500,000 209', oT the amount on line 40 - Over 3500000 but not over 31,001) 000 ft00 000 plus 1f% of the excess over 3500 000 Over f1 000,000 but not over 31.500,000 f 175 000 plus 10% of the excess over 31 000 000 41 Over 31 SOO,OOD but not aver 317 000,1100 1225 000 plus 5% of the excess over 31,500 DDO Over f i i 000,000 51 000,000 - 42 Grassroots nontaxable amount (enter 25°/, of line 41) 42 43 Subtract line 42 from line 36 Enter -0• if line 42 is more than line 36 - 43 44 Subtract I,ne 41 from hne 38 Enter -0- d line 41 Is more than bne 3B - 44 Caution I/ there rs an amount on errher Irne 43 or Ime 14, you must file Form 4720 4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the fve columns below See the instructions for lines 45 throw h 50 on a e 7 of the instructions ) Lobbying Expendrtures Dunng 1-Year Averaging Period Calendar year (or (a) (b) (c) (d) (e) fiscal ear b inning in) ? 7999 1998 1997 1996 Total 45 Lobbying nontaxable amount 46 Lobbying ceiling amount 1150% oT line 451e)1. 47 Total lobbying expenditures 48 Grassroots nontaxable amount 49 Grassroots ceiling amount (150% of line 48(e)) 50 Grassroots lobbying expenditures - Lobbying Acttvlty by Nonelecting Public Chanties (For re rtln onl b or anlzations that did not complete Part VI-A) (See a e 8 of the Inscuc[lons ) Dunng the year, did the orgamzauon attempt to influence national stale or local legislation, including arty yes No Amount attempt to m8uence public opxnon on a leglslatrve matter or referendum through the use of a Volunteers b Pard staff or management (Include compensation in expenses reported on lines: through h ) e Media atlvertisements d Mailings to members, IegisWtors, or the public e Pubbcauons, or published or braadcaslstatements f Grants to other organizations for IobDying purposes . g Direct contact with legislators [here staTfs, government officials, or a legislative body h Rallies, demonstrations, seminars, conventions, speeches, lectures. or any other means I Total lobbying expenditures (adtl linesc through hl If "Yes' to any of the above also attach a statement giving a detailed destnption of the lobbying activities SciieEUie A (Form 990) 1999 Sched+/e A (Fam 9901 1999 Pa e s _ tnformatton Regarding Transfers To and Transactions and Relattonshtps With Noncharltable _ _ Exempt Organizations (See page 8 of the lnstructlons ) 51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described inec[ion 501(c) of the Code (other than section 501(CI(]) organizations) or in section 527, relating to political organizalions7 a Transfers from the reporting organization to a noncharitabfe exempt organization of Yes No (1) Cash - 51a i (u) Other assets - a b Other transactions Sales or exchanges of assets with a noncfiaritable exempt organization b + (ri) Purchases of assets from a noncharitable exempt organization b 11 (iii) Rental of facilities, equipment, or other assets _ b ni (iv) Reimbursement arcangements - b iv (v) Loans or ban guarantees - b v (vB Performance of services or membership or fundraising solicitations b vi c Sharing of fantiues equipment, maihrig I+sts other assets, a pout employees c d Ir the answer to any of the above is 'Yes,' complete the following schedule Column (b) should always show the fair market value al the goods other assets ar services given by the reporting orgenitauon II the organization received less than lair market value in any transaction or sharing arrangement, show in column (dl the value of the goods, other assets or services received (el !Dl (cl (d1 tine ro Amoum invOnltl Name d rbnChanlepie exempt agarvzabon Dascnptlon of varisfcs vansaaions arM snanrig amargemerxs 52a Is the organization directly or indirectly affiliated with, or related to, one or more lax-exempt organizations descnbed in section 501(c) of the Code (other than section 501(c)(3)) or in Section 5277 ? ? Ves ? No b If Yes' com fete the followin schedule (e) Ib) Icl Nartw d organtelpn Type d agenrzauan Descnpllm or relaaamnp ® SCIrdYa A IFam 1901 1999 4562 Depreciation and Amortization OMB NO tads or;z r~ (Including Iniormatlon on Listed Property_)__ ~~99 _ DeWNriem of L1e ireewry Aitacnment NvurrW Reverru SeMCe l9Bl ? See 52 uate instructions ? Alteeh this farm to DUf retUm $epUenCe YO 67 Na Isl srovn o rei n l) I ~ B ness a ecbnty t icn tNS la elates leentrrymq number na v/11 7j~, c. r ArC ~4 6? V~/ Election To Expense Certain Tangible Property (Section 79) (Note• If you have any "lrsted roperty,' com fete Part V before ou com lete Pan I ) 1 Maximum dollar limitation If an enterprise zone business, see page 2 of the instructions - 1 19 000 2 Total cost of section t79 properly placed In service See page 2 of the instructions 2 3 Threshold cost of section 179 property before reduction in limitation _ 3 200 000 4 Reduction In limitation Subtract line 3 from line 2 If zero or less, enter -0- - 4 5 Dollar limitation for tax year Subtract Ime 4 from line 1 II zero or less, enter -0- If married film se aratel ,see a e 2 of the lnsVUCtions 5 (al Dexnglm d popeny A) Cost Ibus~ness use onlyl Icl Elected cm[ 6 7 Listed property Enter amount from fine 27 7 8 Total elected cost of section 779 property Add amounts In column (c). lines 6 and 7 6 9 Tentative deduction Enter the smaller of tine 5 or line 0 9 10 Carryover o! disallowed deduction from 1999 See page 2 of the lns[rucbons - 10 11 Business income hmtahon Enter the smaller of business income (no[ less flan zero) or tine 5 (see msmxuixrs) 11 12 Section 179 expense deduction Add lines 9 and 10, but do no[ enter more than line 11 12 13 Ca er of disallowed deducvon to 2000 f,dd hoes 9 and 10, less line 1> 13 Note: Do not use Part !I or Part Ill below Ior lrsted property (automobiles, certain other vehicles. cellular telephones. certain com urers, or pro ert used Ior entettarnmenL recreation, or amusement) Instead, use Part V !or tared ro ert MACRS Depreciation for Assets Placed to Service ONLY During Your 1999 Tax Year (Do Not Include listed Property.) Section A-General Asset Account Election 14 It you are making the election under section 166(1)(4) to group any assets placed In service during the tax year into one or more general asset accounts, check [his box See page 3 of the lnsVUCtlons ? ? Section e-General De reciatlon S stem (GDSNSee a e 3 of [he instructions ) NI Monih and Ic) Bas+s ror depretlailon Id) Recoxry la) Clasei![euon or properly veer paced in Ibuvness/imeslmerx use penod (e) Canvemlon Ih Aaelibd ly Depeaaum deduction saints see knuun+onsl 16a 3- ear ro ert b 6- ear ro ert c 7- ear ro ert d 10- ear ro ert q e 16- ear ro ert f 20- ear ro en 1 26- ear t0 rt 25 rs S/L h Residential rental 27 5 rs MM S/L ro ert 27 5 rs . MM S/L i Nonresidential real 39 rs MM S/L ro ert 'U G MM S/L Section C-Alternative De reciatlon 5 ate (ADSJ(See a e 5 of the instructions ) 16a Class life S/L b 12- ear 12 rs S/L C 40- Ear 40 rs MM S/L Other De reciatlon Do Not Include Listed Pro ert . See a e 5 of the insVUCtrons 17 GDS and ADS deductions for assets placed In service in tax years beglnnln before 1999 . -17 16 Properly subject to section 16B(~(1) election -I~ 18 19 ACRS and other de recmeron r~ J - - 19 - Summa See a e 6-of the instructions - - 20 Listed property Enter amount from tine 26 - 20 21 Total. Add detltxvons on tine 12, lines 15 and 16 In cdurm (gl, and hoes 17 through 20 Enter lwe aril on the apprnpnate fines of yax rettxn Partnerskps and S corporatron~see instructroix 21 22 for assets shown above and placed In service during the current year, enter the onion of the basis attributable to section 263A costs 22 For Paperwork Reduction Aet Notice, sae page 9 of the instructions Cat No 1290aN Form 4562 (t99e1 Form X662119991 Page 2 Listed Property-Automobiles, Certain Other Vehicles, Cellular_Telephones, Certain Computers, and Property Used for Entertainment, Recreation, or Amusement Note For any vehicle tar which you are using the standard mileage rate or deducting lease expense, completenly 73a, 236, columns (al through (c) o/ Section A, all 01 Section B, and Section C it applicable section A-De rec7auon and Other information Caution.See a e 7 0/ the instructions rot Emits rot assen er automobile 23a Do have evidence to the husirless(rnestmerit use clalrtied~ Yes ? No 23b If 'Yes,' is the evidence wrltten~~ Yes ~ No to ml aaunU,r tin tel to t9) ml rl T d n list Daie iacetl in ,nvestment BesN for oapeaatwn E~ec[etl ypa props y ( p Cost ar oiner Fecosery Me[hotl,' Depreciation us. IbuLMSSIIrnaHatenl secaon 119 veNClas rust) s¢rnce parentage oasts ~e Oni periotl Convention tletlucCan cos[ 24 Pro ert used more than 50% in a ualified business use (See a e 6 of the insVUCtions ) o~ a~ 26 Pro ert used 509'0 or less in a ualified business use See a e 6 of the InsVUCtions % S L - % S L - % S L - 26 Add amounts in column (h) Enter the total here and on line 20, page 1 _ 26 27 Add amounts in column (i) Enter the total here and on line 7, a e 1 27 Section B-Information on Use o! Vehicles Complete this section /or vehicles used by a sole praprieto~ partner, or othelmare than 5% owner," or related person I!}w p~wided [~IrcleS ro yw eTipltly<+es rrst arrsxa the griewoils n Sarim C to see d you meet an excrpocri to cmy.Yetmg tMS secnm la those vehUes 28 Total businesslmestment miss dnvei during U) N) td (al lei 10 theyear (DO NOT Include convnning miss- Vencie 7 vancie z venicie 7 veNCie ~ vemcie s Vehcie s see page 1 of the mstrucnore) _ 29 Total commamg miss dram dtring the year 30 Total other personal (noncommuting) miles driven 31 Total miles cloven during the year Add lines 28 through 30 _ Yes No Yes No Yes No Yes No Yes No Yes No 32 Was the vehicle available for personal . Use during O(f-ditty hOU(s~ _ 33 Was Ne vehicle used primanly by a more than 5%Owrier or related person 34 Is another vehicle available for ersonal uses Section ~Quastians for Employers Who Provide Vehicles for Use by Their Employees Answer these questions to determine if you meet an exception to comp/sting Section B for vehicles used by employees who are not more than 5% owners or related persons Yes No 36 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your employees? 36 Do yw maintain a written pdity statement that prohibits personal use of vehicles, except commmrg, by your employees? See page 8 of the mstrtltXwrts for veludes used Dy crxptxa[e officers, drectors, or t % or more awTiers , 37 Do you treat all use of vehicles Dy employees as personal usel , 38 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the vehicles, and retain the Information received? . 39 lb yw meet the requirements corxemng qualified autombdle demaisVauon usev See page 8 of the ir[slfUCtlOnS , Note: II answer to 35. 36, 37, 38, tx 39 is "Yes,' need rxx ere Sedan B /cr the mvered [elacles Amortization tel w tin ai m Description d costs Daia amoruxauon MlRiliad. Cotla q~[a~art Amartiiapon tar oepris srnpax seatlan inn yet 40 Arnpti bon c 56 that ms d 1999 tax ar 41 Amortization of costs that began before 1999 41 42 Total. Enter here and on'O[her Deductions" or 'Other Expenses line of our return q2 ® Farm 4562 119991 /1 / 2~ /~~j Y:,uce 0; i YJILSON DOVES u':O]:u ,.+.on. ~ - I I ~ i I IL II r yl I' S wc.el 6r- I. li: I ,I ,I,;, I. _r -em ' ~ ~ I- it------ 21 I I I ~ 3'I CI! ~ I i ~ I i ' ' 6 G~v~s~eo>7ti „ ! I ili I '~~,1.6-; IIIiI , ' G-so i .-I-I-~-~-I it I '~~l' ~ I ' ~ e ~ I i I I I i I S 4rAwr S`u !c! I' I ~ I, I I~ I I i I ~ ,o r i I I I 3 I I ,I „ /G ~ ~ . ~ i I :5[51 I I' i t2 1 ~ ' I I I~I~Z_ l l ~ I ~ I~ "3 UY1 r ' I I 13~cL'L~ I ~ „ ~ ~jAVC(Q II I it ~I I ~I_' ; IJ, I ~ 'LZ ,5 - ,---r -~---r . I I ~ I-.-~1 I I ,c ~1~7~ ~ I I I I I I I~ LLs~I ~ ,e ! {~h ITOI/A I ~I ' I ~I I I JQ~ i I 19 N ~ r j-I ~d0'~ I zo I I' ~ I' I I ~ ~I 23 J I ~ ly_9 i t 2d ur I II I ~ l i l i~ ~ i~ , 25 I :I I I _ I :6 ~ I ~ ' I ~ ~I 27 II ~ I ' i I 2s I II I I II I 29 I II. I I 3o I I I I 31 I ~ I I i I I I ~ I ~ 33 u v ~ I _.I Q ~ I _r I ~ ~ / ~ II I 0 /b / ~c 6r. I I I V/ J7 G.r~--~ dD0 ~ II ~ L i lc I ~ lZ I I I dU ~ k ,a s,t I ' I ~ ~ i .I I I ~ I ~ WILSON JONES a^ce ens:n r~:e Darr v r1 S _ - _ ,i - I _ _ i ' b S I is tJ i ('pm f~!Ntl,~~~ 'I i I I i' ; I _ I I! I ! l ~ I ~a rS ~ I I I ! I. DI ~ I :I i 'b ' I I I II `I I I II .III I I ~ 'I 3 i? r I' I I I I I d' 'd !i ' • _ C I I I I i it I I I I I i I C I I 31 I ~ I III D ! D I I I 9 i I I •I i I I I I I I ~ i ~ 'I 10 I 1 I I I I r~`I-1 I I I II I j1 i L gBYIL Z' I ~ rr, I ~ ! I ~ ~ O 'I_I `D { D I I'. T , I. v b II II 1~- ~II O• D.I II III ,5 I d I I ~ I I I ~yj 16 ' I I ~ I I I' ~I i i! I I 11 i I~ I II I I I I :I I I I i i I - re G j I~! II! I I I:I ' 19 I I ~ I I I I ~I I I I I I I m I !II dl i~~lt7 ~i I i l i l f i l i ~I~ III I I I ~ I yl~. ~ i Q' I ' _d• i I ss I I I II IT I zs L jID 'd i I: n D g ~ I! II ~ II ~ i ! I Or e ~ 'I I ~D:i I 6 Bvx . I ~ I I 31 III i,' I rII li: ~ I I i I I it I I I ~ ~r I ~ I _ I I I , -i- ~ I I I i~ I I I I I I ~ ! I I l i i 37 ~ I ~ I ~ I i I I I I I I ~ I I I I I! I I I I~ i it ' I I I I , ~ I' ~ ' ~ m i i i a r; I I I I ` ~ I~I I r~ \ C a ~ ~ j ~ ~ ~ ~ i ~ ~ ~ D ~ I ~ i i i i~ y Vim. ° ;o I m ~ ° D I ~ i s ~ r I I I ~ Iµ'~ ~ n> 1Q• n'n I f+ \ o a P ~ p v. ~ > ~ i O ~ ~LN 6 Q ~ U i m { ~ N m i ~ I ~ ~ a ~ ~ m ~ m x i 1 cmi 4 ° m i aox ~ ° C - ~ ~ rn O z LJ rod )~1 ohm ~ ~ m{I~I~ °a m ~ i9< ~ 0 ~a> m ~ I~ _ m a ~ ~ S m D C I 'r ~ O ` m z I,,_ m a m m 0~3 mop fix r z 0 r W W ~ ~nov i ~ t ona ' ~ asa N ~ ~ r x A c° Vl ; m m ~ ~ ~ H I ~ o I~~ „g; r m n° 1 ~ ° ~9 N ~n m xa _ ~ a ` ~ ~ V > '^n t D ~ I I ' I n o I I i I1 ~ r, ~ ' ^ ~n ~ 3 ~ ~ n I i I I ~(f~~ ._~-3 n ~ C ~ - is ~-Iq~l? V y ~ i I I ' ~ S<~ T i~ I ~ z I I i r ~ ~ ~ ~ I\, n 3 ,o ~ ~ (7 r i ~ C T1 V' ~ w a o O i ~'S \ Q~ ~ \ D I I t` n I ~ I .o r _ i? 'i I I _ , , W ~c ~ ~ ~ po 4Ic o ~ • 31 , Ul nr C ~ ~ ~ ° n vJ ''AA H _1 ~ ` > t L Q a~ AA 1_ U~ j` \ ~j~ ~ I ~ I I ~ I ~ D I I ~ i ~ = n I~ ~ m z Ll~ o I i i nn~ C p 1 rox m >wr ~ z ~ ron r~N 0 1 Eoy m I nD> ~ I I1 I ~ n a ~ r _ ,u N D IO C) ~ sr _ ci O O ^ Z m T A m ~ 0~3 m0> a_ )yZ ~ r i _ noa u D ~ r x n - A I' c' r ~ \ r _ < O Q \V' < < t < <C ~aa u I w ~ ~ Do (z1.1 W ~ ~ ^ ~ n z a ~ I I I I I I I ~ I I I I I I I ~ I I-I i - _ T r~~ ~ i i I I I I I I I I I a- ~ ~ ~ i I~ I I I i t j l i I }o~ O~l~;~~~i~~!oi j l l i i i I l i l i l i I- III Ij I F J ~ I I I mac ' haw n ~ ¢w0 a~W 4 I j Z J F¢ N foo I J I = ` ~ ~ y O Z uw `~I ° I Q ~ N0 ¢ I ~ I ~ \i ~ W Z ~ ~ I I o~ YW< ~ I I I j M ~w; W ~F ~ o ~ ( \ aryl Z V LL 4 w = <wW Q f¢~ Z = U4 W f~ ~ ¢ U 4 } I °uoy OIQI~1~~~ ~ I ~ r Oo u w ~ ~ ~ ~ ~ p ~ Q O ~ ~ o > o w \1 ~ - ~ F N W ~ ¢ `V ¢ \ F a 1 0 R 1 4 VJ a ~ ~ J ` F 11 = ~ W QO ~,J ~ G I i i ~~~'t ~ j f z g~ W ¢ 4 ¢ W ~ I I I ~ II I I I I c ~yl~ r i I ~ I I I ~ 1 I ~ v, `~il~il~ll~ I1;1~14~ ~I~ } , I F I IJ 1 W J E N I o W x J I W ( N ~C¢ _CW ¢WO 6JW 4 u x J ire NNW SOW W W ¢ 1~ `V2' I Z VW 1 ~ O ~1 ^ Q N W ¢ W <¢V WCZ ~ ~ }W~ //\R W W r O; ' \1~ ~ Coo ~ ( J 4_ x ~ L.L. " ~ ( O i W r( - ~ wl W .J xo¢ 1 `I ~ (WW 1 W r¢C ~ 0 ~ W 4:i x W W4 U ~I ~ 1~1 } v~ I , W r N J N¢- ~ r m 00~ ~ ( V m F p ~ i 1. r ¢ ~ o<~ ~ 1 1 I i J ,r ~ u r I a ~ i r ¢ ¢ o ~ ~ v' w! o ~ ~ r x 1 x tj 6 i G W ~ , .J FW o< r¢ 4 INTERNAT. REVENUE SERVICE DEPARTMEN': OF THE TREASURY DISTRICT DIRECTOR 2 CUPANIA CIRCLE MONTEREY PARK, CA 91755-7406 nn, Emplcyer Idertificat=cn Number Date ~Aq Z 6 lia7) Case9Number644 954003189 KONA ADULT DAY CENTER INC Contact Person PO BOX 1360 CAROLYN TSCHOPIK u~nT.nuvKUp, HI 96750-1360 Contact Telephone Number (213) 725-7002 Our Letter Dated May 22, 1990 Addendum Applies: Nc Dear Applicant: _ This modifies our letter of the above date in which we stated that ycu would be treated as an organization that is not a private foundation until the expiration of your advance ruling period Your exempt status under section 501(a) of the Internal Revenue Code as an organization described in section 501(c)(3) is still in effect Based cn the information you submitted, we have determined that you are not a private foundation within the meaning of section 509 (a) of the Code because you are an organization of the type described in section 509(a)(2) Grantors and contributors may rely on this determination unless the Internal Revenue Service publishes notice to the contrary However, if you lose your section 509(a)(2) status, a grantor or contributor may not rely cn this determination if he or she was in part responsible for, or was aware cf, the act or failure to act, or the substantial or material change on the part of the organization that resulted in your loss of such status, or if he or she acquired knowledge that the Internal Revenue Service had given notice that ycu would no longer be classified as a section 509(a)(2) crganization If we have indicated in the heading of this letter that an addendum applies, the addendum enclosed is an integral parc of this letter Because this 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 Sincerely yours, Richard R. Orosco District Director Letter 1050 (DO/CG) 'Internal Revenue Service +artment of the Treasury District Director RECEIVED MAY 2 g I,gp f' rl BOX 2 i5rl fvulll 51 A I T11: T ,II, t OG ANGFLE_;, I_r, _~01;5'.'?' I) I rep lnt,ai I I~nl if 71 rrni ii~~mhni r1r1 f~; /~I q 1 Hahn: MAY i?, 1~9~1 I -,q.. linmh..~ 'r5f~l,•;'rn 4 PUMA ADULT Or1V r'Fr1TFP irll. I nnl a•:t T'ei ;•,n; f0 BLIk 1360 ILII E;;, t~f7RMh 11 AI: tEALAY,EUA, NI '1f;i5r1 t.nnl'3r'F lel..l,l,niro Nriiob••r !mil?) Rr~,t 4°'.? P+r_count I n~J Pr+n nd End i n~: OPCenbnr 'tl Tnundatirnr',ialn, flve~ilriali,ri' SFE ATTAr;Htil Ad~.anre Ruling f?rro,l BegrTa: Sept, 1?, 1.1%19 nd~.anre Ruling f'erinri Lnrl DPC 71 , 1'113 Addrnrlun AT~p l I P^.: n.i Dear nppl irairt: Based nn infornaFron supplied, arnl a;snnnrrl vnur ~rpernti„n: will h~ a•- ctaterl in yore- application for rerognrtion of r•~~nptir~n, Ili ha•r dPlnrinri~.+,l ~,rr qrP exenpt fine Federal InrnOP_ tati under ,ect u,n rOl iii of the Inl oi~i,l Re,•anue Code as an ergonization desr_rrbed In ^rrllon '~Olfr~(3). Beranse 4nn arP a nrwly tree tnd or gaol cal loci. rm are ne} rn~w nnl inu a final dPtrrninaFr•rn of your foundation ;taFns nrnler <^rtl•m 50'I~a) „i I1,•, in.l.•. Ilowe~er, NP ha4e. deternrned that yr,u r_an reasnnal•ly br n+cprcteJ to t•r.• a Kuhl i, ly supported organization described m seetions'r03(a)(1) and 1/Orb)U)4'1>hir5. Accordingl•r, you will he tr.ated a, ~ ~nhli:ly anp~orted nrgani orlon, ami nqt as a prl•ate foundation, during an ad••~nrP n~ling I•eri~„I. Ilu^ advance ruling period beyins and ends nn the daF,n; shown above. Nilh m 90 davs aFtei the end of your advance ruling pnrio,l, yin mill subnlt to us infornation needed to detr•rnine wlrethor you have nit tlrc re,nnrr n•_nts of the applicable support test during thP..idvance coring per in•1. if y,n establish that you have been a publicly supperteri organization, you Irrll I,e classified as a section 509fa)(1) or 509ra)[2) oiganiiatinn as long a: vnu con- tinue to nest the requlrnnents of the applicable support test, [f gnu r1c, nor nest the public support requiianents during the vlvance ruling I•eilorl, yuu will be classified as a private foundation for future periods. Also, if yore am classified as a private Forindation, you Hill bn heated as a pi ivatP foiindatir,n from the date of your inception for purposes of cectlnns 5071d~ and Ar1A0. Grantors acrd contributors nay rely en the dr term nail nn tint ynrr err irvl ~ private fmrmlaLron until 90 days after the end eT yore advance ruling period. [ f you subnlt the r equi rod i nforea t i on within thr• 90 clays, granters anri r Doti i - ' butors nay cnntinrle to rely on the advance deterninali~n until the 5elvr•:e • I sttrr l0.1`•fCG1 h I]NA Af]lIL f [lAY r EtiTFR 1Ni' nakes a final deterninatron of your fo~nrdatrnn slate„ [f nntrre that yon mll no longer be tr ea te•I a, a pull rely suCl~orteri nr ~~anrzatron r, publishe! in hhn_ ]nlernal Revenue Rnllnlrn, yranl"r3 vvi rnn to butors naY not rely en this deternrnattrnt aftrr thr datr of •urh pwblrca- trnn. In ad~irl•rort, +f you lose yrnrr statu3 as a publicly ,nppor tnd ni roan i7a trop and a grantor nr rontrrbutnr uas resprntsrhlr for, or nos aware of, 1Ar apt nr failure to art, that resulted rn your lo3s of ^,rrclt 3tal.rrg, Iltat person nati• not rely nn hhi e: deternnratren frnn the da tr. „f +hn art or fai li•rn rn ~r 1. Also, if a gr antnr or •ontr rbotor learned that tlte_ 5nr ++u• had •i+van notice, that you Mould he rennved frnn classi f+catron as a pnbl rely sur,f~or trd orrranr•~- )rnn, then that parson nay not rely nn this delernutal ion as of the dale sn•ai kno~+ledge r+as arrlurred. If your sour res of suphor t, nr your per pose. char ar_hrr, ni nell~nd nt npPraF,ron c~tanye, please let, rrs tnnw so ++A r_art r•irt3r~lrr thr effr~4 •tF hhir• r.hartge on 4ntrr r,rempt statics and fr,undatinn status. In tltr ra•.r of art arierrd rent to yarn nrganrzal+onal dncunnnt or bvlat+s, plea^~ serni us a cort,r nF the anended deruuwtt or bylaws. f11so, yeu should inform ns of all rhanges in ym~r rtann, or address. A3 of Jnnna rv 19)14, ~~ou are li~h le for Lanes ender the Fedaial lnsnr ante Contrrt•utrons Ar_t f•:ocral sacurr ty taxes) ten renuneratron of EIDU r:r owrr VoU pay to e:tcht of your rnplovees durrrtg a r31nn.13r ,rear. you rrP rtnt li3blr: for the tav tnp~sed under the Federal Unenploynrerrt f~•• Ach fFUlft). ?rnanrzatrnns That are not pr+vatn fnundahinns ore not ~ul•iPCt to 11ie prr- rate fonndatron e`rCrse taxes unde+ Chapter 42 the t'ode. H~nrvrr, yon v+e rtOt autnnatirally e:renpt frnn nthnr Ferleral e•rr^e taxes. If ~,ri.r h,avn a~~y qun3ttons abnul. e~C t3e, enp layaenh., nr other frd••ral lar._s, pl••ase Inl, u- I. nor+. Donors uay dedur_t rnntnbutrnns to you a•; prnvirlyd in 3ntiron IfD nl Lhr ~or1e. PP.1rre;ts, legar~es, devises, transfers. nr q+Fls tit you •,r for- ynrir u•,n are deductible for Federal estate and gift tax pr.rrpo-,es rf they neel the appl+- cable provisions of snctr•ans Z_055, 2105, and 75~:' of lfte r~)de. Contrrbntrnn deductions are allowable to donors only Lo thf nxl,ent lhat them contrrbutrons arr. grits, r+ith no consideral+on reserved, Trcl•et pnr- chasRS and ernrlar paynents rn con )unction t+ilh fundrars nx1 events nay not rter_essar r h y r{ua I r f y as dedur}, b l a contr r but r orts, deper rd r ng ort f lte c r rcun stances. San Revenue Ruling 67-245, prrblrshe+J rn Cun+rlatr•,re 8+rlletrn 1957 c^, on page l0+1, t+ltlr•h sets forth guidelines regarcirrtg the deductrbllrty, as rltarr- ta61e eontr•rbulrorts, of pavnents node by taxpayers For adrarssrnrt to or other partrcrpatron rn fundraising activities for chanty. You are required to file Forn 990, Return of Urgarrrvatron f~~npt Freu lncone fax, only tf your gross re~etpts each ,neat aro nnrnally note than E25,000. Iionever, rf you receive a Fern 990 parkage rn tl+r, earl, please file F.he return e•{Pn +F you do not exceed }Ite gross rrcerpl^, tact. !f you arc nnl I Akter l01!~f[:G+ . - 1- f:OtiA ADULT DAY r'FtifER 1W~ requrred to file, sr reply attach the Jabal pr ovr dr•d, Mier l• Ihn I,..•• rn Ilrr+ Irea•I rug to rndreatn that your annual gross re•'erpts ire n~~rnally 3"~,QOrt nr {e•;,, and sign the return. [f a return rs requrred, rt oust he fried by the lSih day r•f tlin frfi•h month after thr• end of your annual accounting p~i,od. A penall,~ of 310 rh;~ rs charged Hlreu a return r:> filed late, unless there rs reasonable r 7rr^.r for the delay. NoHever, the naxrnun penalty charged cannot exceed 45,OV0 or 5 per- cent of year- gross recnrpts for the year-, µhrrhe•er r•- le-^. Ilir~ 1,nnaity nay also be charged rf a return rs not Comp lets, so pleas•• be s~.ire ;our rntnrn i> complete before you frle rt. You are net requrred to file federal rnr_nne tax returns unleGS yr+ri .rn subject to the ta•• on unrelated bnsrnesa inr.one ender section S11 0l Ilie rode, [f you are sub~nct to this tav, you oust file an rrrrr,ne }a•; return nn Inrn 99tl-T, ExPnpl_ fFrg~nrzatrnn 8usrnesa Intone Tax Pr•Fnrn. In thr~ Intler rn• nr.~ no} deternr nr nq uhefhPr any of your present or pr oposnd actrarFiez am vrn-e- laled tradr_ •,r husrne~s as define<I rn section 5]i of Ihn f•,de. You neeri an employer rdentrfi~atinn nunbnr .•ren rf y.~n ha no erepl•ynr.. [f an enpl oyrr rden}rfrr_atr on number was net nn+rr-nd on yr.rrr ar`I•licii inn, a rv~nher H r l l he asa i geed t o you and you w i l l be a.I • i ,r~1 o f r t. i' I ea^r n~~+ l hn1 number en all r returns yea f r l e and i n all r_erresl~nndence rn th I Ise Jul nr n, l Revo_nue Service. ]f we have indicated in th<_ heading of thr- Intl.,r th-,t an aJdnrninn applies, the addendum enclosed rs an integral part et this Irtlnr. Ber•ause }hrc le}tor r_nul~i help resolae any ~prr_5)ions about your a+t:upf. Gtatus and foundation status, you should ~e?p rt in your pcrnannnL rn~orria, If VOrr have any queetrons, plna4e r_on}net Elie pnr,nn rihnsn name an•i telephone number- are choun rn the lieadrng of thr. leifer, Sincerely yours, Mrchaal J. On inn District Drrer.tor Fnrlosurals): torn 872-C letter I04!,fCG) -4 - F',DNA pDULi DiIY ['ENTCR IN[: F•DUMDpTlf]N STATUS: 170(b)(1)(p)(vi) end 503(a)fl) I otter (0~1'~fC(i) Oli09i01 HO~~ 09 59 F~l' 909 3:6 00 I~SLR~VCE H~IF~II Ial00a co CERTIFICA _ c OF LIABILIT1(INSUR NC SR r! v-1 o1/oe/oi rROWtG THIS CERTIFICATE I$ SEUED A AMA R OF IN OR TION Bishop Insurance-Kona ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE IASUranCe Hawa11 HOLDER. THIS CERTIFIGTE DOES NOT AMEND, EXTEND OR 75-1675 Hualalai Rd 9usia Nl AL7ER THE COVERAGE AFFORDED 0Y 7NE POLICES !!FLOW. Kaslua-Kenn HI 96740 i Phone: BOB-329-48d4 INSURERS AFFORDING COVERAGE IN{IN1ED INaURCRA Scottsdale Insurance C an flcuR[R e, lireaan' a iUnd ins . Co . peon Apu~c1136~y Center Inc INwRaa Reala~okua NI 96750 INauR[xo- wfuRlR4 COVERAGFJ TN[ POLICaa a WUIYwCC LaTi01[LOW IMYG a[fNJaaU[D TO T11[ a+aAaD NAIq;D AaOK Fp1 THC POLICY PGIOD INpC17ED NOT1MTNa7ANDDq AIM R[W WWIM, 7[IW ON CONORION OF.N1' CONTRIC70R O11KIi OOCIM[NT1MM Rf0lC7T0 NMK/1 THIa C[RTpIfJISi. WT f[ WYiO OR _ Wr P[RTAIN T!a Y1at11ANGl AFFORD[D 0r TH[ rOLCp 0[xRefD H[R[01 W SURaCTTO ALl TN! TlRM{. UICLUaION{ AAD CORDRDN{ OF suCH POLICILL A97~lMTi urra 910MM WY IIAV! 0f W RfDI1Cl0 [r PAD fJAYa T7![NINWRINO[ POLIRMWI[D1 Y D1 MW Ua1Tt ~C,ur,w, fuH OCCLwRwce {1,000,000 7? X wLalueulLGiN[RALUAe1Lm CLS0398d26 10/13/00 10/13/01 FlRIOAwO[INpraran) { SO 000 etARa woe X ~ occtlR IAeo av Irya.wr.~) a 1 000 P[RaowualDVlNruRr {1 000,000 GfN[RnL AOGR[WT! i l DDD,DDD GIRL AGC~I[OA7[LIM(71PRla rCR. I PROOUCie-CO4v1DP ACn {eateludad POCICr P LOC ~d10aLa l1Al1~1Tr COM[INOD SfIDLC WIR B wMAUro J7CA5602208 06/27/OOI 06/27/01 R••~"") { ALLaw«fDAUTO{ i eooarlN~uRr X xllsouuDAUroe IwP.,.elq s]00,000 Hem AlllOt I 00DLLY RRlRY NON.ONlaDAV7o{ IP.«eu.e1 { 600,000 PnoreRTrDANUC[ { SO 000 cw.vaw.t ~ au.wulsuTV AurooNLr-GACCIDENT s 1Nr A{RO OTHpR lIN11 f/ACC { AUTO olfr AGO 1 LtpYLIleLnr H~CH OCCUMCNCi a OCWR ~ CUMS WDf AdORiWT! f { D[DUCTI[li { R[TSMDN { { wORtOte0a001YTDN 111D T WRe1'a[r •IYMdTI !L EACH ACCD[N7 { CC pa[A{C-[A W { L 01{[1{[ • POLIC7 LIIAtT t eF 100!0 K Day Care Centers-Other than sot !es ptolit. RS: DNS9S-POS-6048 The aestilieate holder is nosed as additional insured but only as their interest say appear. CERTIFICATE NOL,D[R M 1DD17nr1L wNlRml nauRa uRnle GNCEIiATION DOBaVCi [NDIaslsraP 71e Y011l Ot{CRe00 POLC1[a 0[C11L71L[D 0[PORa TIa @IYIIOr wnnlav.ix[R[uwwllRaiwa~~D[wGRTOraa ]0 wrarwrrDl aepastseat e! Bamaa Services No+e[fonlsctxfstr,.nNxaRR.r[s~oTN[~vi,[G*r1A1~T000fosHUL purahue o! Service Unit IwwsaNOOaoITwRaRLIPSRma/wRreuPOllna[wslstrtflGartaoR 510 >flieharde St Sane 301 Noeeluln BI 9651] ar H aii A 2 nl9n sroERT-ss 01~08~01 H0~' 08 58 FiY 808 J:8 2i30 I~'SLR~\CE H~Ii~II C~00: Co CERTIFICA- . OF LIABILITY INSUR NC sR UF1 °Aoiiae/ol ?POOUCaR THIS CERTIFICAT IS ISSUED AS A MATTER OF INFORMA ON Elsshop Insurance-Rona ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance Haraii HOLDER THIS CERTIFICAT!' DOES NOT AMEND, EXTlND OR 75-167E Hualalal Rd 9uste N3 ALTER THE COVERAGE AFFORDED 0Y THE POLICIES BELOW Icailua-Kena HI 967d0 Phone: SOS-329-d844 INSURERS AFFORDING COVERAGE IRiUREO WtUReRA Scottsdale Insurance Co an s INSURfRQ Fireman's hsnd Ina. co. PoOaM8ooi 1360y Center Ise tauauc X•alakekua HI 96750 IR6URdR0 MtURiR L' COVERAGES TIIaPOLU:Itt u MtuRARee wTeoliLOw wive teeN ICtUeD To TnE IMi1R1f0 wweo ADOVf cOR Tne roucr ve11IDD pDICATiO noTwrniaTAMOIMD ARr 11[WIRWiNT YlRM as COMDITIDR a ANr COM1113Y'7 CR OTXOI DoeUMQlT wm+ ResKGT ro wMICH Tine uamua wr e[ IMUCD OR w.r PfJITAr, 711e IWIM\ANCf A.POtroeD ~1'7Nf /otlCllt oeacRaeo MlIWM a twlCT TO AlL TMf TlRIIf, uausloRf AMD CONORION7 Of BUCK POUCO AOORWfR 1a11TS 6NONe MAr w1VI IfiM R[DUClD M PAM) CUIMf I Trgpq•DIUYq POLIDT MIIIIaG M OA W LIW77 L • eenlwLLUrLm ePUloccuRRfRCe s L, 000 000 A X eoMMO~OISLGiMeRULwNM CLS0398426 10/13/00 10/1]/01 tWaONMOeWry~rrq s SO 000 eWwwn aOCCUR MiDP7VlaryfIlPP~~1 s 1 000 PcRSOwILaAbvPUURr x1,000 000 c[rawALAooRtwn s1 000,000 DfeNL AGO{CwT[LMMRAPPIJef PlR fFWOUCrs-eoMProP ACC tsrCluded POLM1 fR LDC AY7DMOaLlLWaJT' LOMlINID SwGL[WIT t g AMAVfD JXA5602208 06/27/00 06/27/01 I°•'0s0R'I ALL OWlIGD AUTO( tooar lRAlRr s300,000 X tCllDULlD AUTOt 1?~ Pysuq HweoAUrof I eoofrlRw:Rr s 600,000 R0140AMfD Al1T0f IPr P•delrl PROPaRrroowAar (50,000 (Pw rrrerfJ wltAalLwlLnr AuTeorar-rwAeelDeRr s ARrAUrD oTr,eRTww eAAte s AUTO OMLY; f ~I,y Ly,~r rArn OCCURWNGf f OCCUR ~ CWwMADI I AOGREwTE i s OQWCRaL I f tllTiMTgM t i t YYDRP{OII e911MNM770M aMD T r I aafLeflRt L4R7Ir EL iACN ACCIDiMi f C L DatAte -!A [LIPI f CL mflJLle-roLICr WR 1 ones fRON a TIDtIfIIOCA m r BIDO~ lRTIIPaCC1AL PtlOnalOla pay Care Centers-Other rhea not !or prolit CERTIFlCATENOID/R K AOmIWRALINMIttDRftaYllaILARTeR CANCELLATNfN CC8JI1081 fR01f.e AIR OF 1Re AaW~OpCR1seD Pq,Ipea of GMCalID MlOR[7K mIM Ceua~ o! Haraii wTSnsaor~nwwRRSrRS~twLLtRe[awstowla 30 wrawwmr ' 8arai County Ottiu e! 7?ginq ,rono[roneeat,ISteATeRaaawrmTetRSLan.rrraMLUeTeooaofwu i Stab e! 8asra1l IMPOtanootafwnoRDauusmoP+unlolouPORt+swupR.R+roans State rsae. O!lioe of 7Lgiaq RaPRaterratl~lw. e/o Insured Of HAWAII, INC nsur • A r si ACORD 2s3 Pn'n O ION 1iN P EsID[MT-2t O1/O8/O1 JION 08 59 FMS 808 J?" 2i30 I~SLR9\CE HA{FjII 00] ACORD CERTIFICAI c OF LIABILITY INSURtiNC~~U 1 °'oi;Qe o ~WaR H TIFl A 1 SUEDA A OF IN OR TION Bishop Insurance-Kona ONLY ANDCWIFLaql10RIGNTSUPONTNECERTIFICATE Insurance Haxaai HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTENO OR 75-167E Hualalai Rd Suite NS ALTERTNECOVWGEAFFORDEDEYTNGPOLICIESEELOW. Kaalua-Kona HI 96740 phone: 505-329-4544 INSURERS AFFORDING COVERAGE ,INfWeo IN6URlRA Scottsdale Insurance Co an iNeuRiR¦ Fireman's Fund ins. Co. Kona Ayydult Day Center Iaa wsuRER C. lptealakoi~cua3HI 96750 iwwRER o- wwRER e COVERAGES TM! roLICRe a IeIIRAMC! LaTED iiLOW HAVE BEEN lifla0 TO rME W6UR{D wY~O AeOV! FOR 7Ni MLICY ?iRgD IwDIGTED NOTMT11ffN1DIN0 ANr RiWweNENr, 7EI1M OR cowaraw a?~NV eowrR.er oR onNR ooaweNi w~iN Riarecr To wNKN n+lf eeRTViun M?r ee ~6euW oR wr rurANL rN! WwRAwci AnoROSD pTwi ?alclee osiulien NEREW a fuuser ro ALL THi Tcme l1lCLUilows AN0 eowomowi or such routes AooRSDAre Lrm twoMil wr NAVE qOi Rsoueeo K ruD cola rR rrreorwsuRAwu roL1C1'NUMER N NWD uam oewmuu.wswn f,.uloeeuRRiwu s 1 000 000 A .X CDMMERCML6iNfAALLIMNT7 CLS0398426 I 10/13/00 10/13/0} FR+sD.MAOeunroA.Rq s 50,000 CWM6 MMDi OOCCUR MED E7r 1.M aw pwr~) f 1,DDD reneoNALaAww,uRr i 1 000 000 cENERALASaRiwre s 1,000 000 ri!lILA00Ri6fr1WRA/?LliiPaR GRODUCTe-CDMYmrAGG fereluded roI.ICY T LOC aUTOeOeLe Ll~m CDMi1Nl0 7wGLE UM? 8 ANrAUro JXAS602208 06/27/00 06/27/01 1E••°'"•"'I ; s Au owNeD Auroi eoDh.r IN~uRr X eeNEDU~wAUroe Iv.,n,..n x300,000 NRED AUTDi I wolLr w~unr Irx.~a.sl (600,000 NDN.OYWED AUrDi rRRro?E~~DAMAC.e s S0, 000 DIUMOELWa1T' Auro oNLr-GACCeeNr t AwrAUro orNiRrNaw EA ACC f AVfO ONIr ,p0 f QCpi WMllTr ~ EACH OCCURRENCE f OCCLM ~ CUWAi MaDe AOORIOAri f f DEg1DTIaJ i RiTlNTION f f WORKab COYrO1YTOM WD ~ TO R' aerLOYPI n•~' E.L iYCN ACCaiNT i GL D16iAf¦•[A [MrlOr f [ L DeEAii • rcucr tlMlr i Orllnl d orOU w Day Care Ceatera-OtDee tLam net for pretit The aestiliaate holdez is named as additional insured hnat only as Lheis iatereat may appear. CiRT1FK:ATfHOLDER N •DUnoRilanuREOIRauRSRLmme CANCELLATION CODNTYl a~ouwAwranmawYiopaa{~rouaUa[~•°•••'•^siwrorxeevou ormmsuor,nmefuwowwRwluao[.roR*orAa 30 o•nwurrw Couaty of Haxaii wonearorNCeaRnwureNOL,oaewrearoTNau~r,aurF.awuroooaomuu Director e! lrinaaae IVp[NO~~~NORiysyn•osaRrRWDUroNrNiwsuocR.mAOS~noR 26 Aupuni 9t., Itm. 118 ~ Hilo HI 96720 Of NAWA4 INC. I uran Hex i 955 Aco 2F5 ITnT) P ESIOENT•25 _..._...~,,._n _ _ {~R ''C ~ M NSA_~_ MRl,i~hlh~~~,_1~~N~L~AMC_~QL1G~ s. ~\1 ~ ~ Policy Number A NCCI Co No 35920 I ~ " WC100-0001678-2000A Naunit employers• Mwual Prior Policy Number /nsurance Company, lnt WC100-0001678-1999A 1. INSURED: Kona Adult Day Center, Inc P O Box 1360 Federal ID Number 990273644 Producer Name Kealakekua, HI 96750 Risk ID Number 520386602 Bishop Insurance Agency of Hawan(Kona) SIC 8322 75-167E Hualalai Road Swte Business Type Corporation INDIVIDUAL AND FAMILY SERVICES #1 Other Named Insured Other Work Places See WCE-107 2. POLICY PERIOD: The Policy Penod Is From 12/15/2000 To 12/15/2001 12 01 A M Standard Time at The Insured Marling Address 3. COVERAGES: A Workers Compensation Insurance Part One of the policy applies to the Workers Compensation Law of the states listed here HI B Employers Liability Insurance Part Two of the policy applies to work in each state listed m dem 3A The limits of our liability under Part Two are Bodily Inlury by Accident $ 100,000 each accident Bodily Inlury by Disease $ 500,000 policy limit Bodily Inlury by Disease $ 100,000 each employee C Other States Insured Part Three of the policy applies to the states, if any, listed here D This policy includes these endorsements and schedules WC 00 04 O6, , WC 00 00 01 A, WCE-107, WC 52 O6 02, WC 00 04 03, WC 00 04 14, 4. COVERAGES' The premium forthrs policy wtll be determined by our Manual of Rules, Class~catrons, Rates 8 Rabng Plans All information required below rs sub/ect ro verrlkabon and change by audit Code Promium Basb Total Rab Psr Estimated Claaaiflcatlons No Estimated Annual 5100 of Annual RemunsraHon Remunsrotion Premium Salespersons, Collectors Or Messengers 8742 0 0 97 0 College Professional Employees 8 8868 111,087 0 78 866 College All Other Empbyees 9101 7,281 4 BS 353 Minimum Premwm Deposit Premium ~ Manual Premwm 1,219 $331 $2,309 ~ Subject Premium 1,219 High Risk Drviswn Surcharge 56% 683 i Exp Modifier 1 13, Moddfed Premium 2,149 IntenmAdlustment Annually ~ Standard Premium 2,149 ' Normal Premwm 2,149 Serv~ang Office ~ Expense Constant 160 1132 Bishop Street Swte 1660 Total Estimated Premwm $2,309 Honolulu, HI 96801 I Issue Date 12/26/2000 Countersigned By: Date r,^. ..-4..a°~ ~h~,...,.,i r,.,,,.,.d r,,,,,,,....ee.,,. i„n,.ann. F^rrr 1L 11RTICLB I I I eeation 1. Fublia Beasfit. This corporation is cganized as a nonprofit corporation under Chapter 4158, Hawaii Revised Statutes, as amended. Tha purposes for which this corporation is organized and its powers in connection therewith are exclusively for scientific, charitable and educational purposes, including !or such purposes the making o! distributions to organisations under Section 501(c)(3) of the internal Revenue Code. Tha specific purpose o! this corporation is to provide adult day health care and respite care to members o! the community, including cars for persons suffering from Alzheimer's disease and related dementia. Bastion Z. And in furtherance of said purposes, the corporation shall have all powers, rights, privileges and immunities, and shall be subject to all of the liabilities conferred or imposed by law upon corporations o! this nature, and shall be subject to and have all the benefits of all general laws with respect to nonprofit corporations. Subject to and without limiting the generality of the foregoing, the corporation shall have the following powers: (a) To have succession by its corporate name perpetually; (b) To sue and be sued in any court; (c) To make and use a common seal, and alter it at its pleasure; (d) To hold, purchase and convey such property as the purposes of the corporation require, without limit, and to mortgage, pledge and hypothecate the same to secure any debt o! the corporation; (e) To appoint such subordinate officers and agents as the business of the corporation requires; To sell, convey, mortgage, pledge, lease, exchange, transfer and otherwise dispose o! all or any part o! its property and assets; (g) To purchase, take, receive, subscribe for or otherwise acquire, own, hold, vote, uaa, employ, sell, mortgage, lend, pledge or otherwise dispose o!, and otherwise use and deal in and with, shares or other interests in, or obligations of, other domestic or foreign corporations, associations, partnerships or individuals, or direct or indirect obligations o! the United States 3 or of any other government, state, territory, governmental district or municipality or of any instrumentality thereof; (h) To conduct its business, carry on its operations, and have offices and exercise the powers granted by this section in any state, territory, district or possession of the United States, or in any foreign country; (i) To elect or appoint officers and agents of the corporation, and define their duties; (j) To make and alter bylaws, not inconsistent with these Articles of Incorporation or with the laws oP the State of Hawaii; (k) To make donations for the public welfare or for charitable, scientific or educational purposes; (1) In time oP war to transact any lawful business; (m) To indemnify any person who was or is a party or is threatened to be made a party to any threatened, pending or completed action, suit or proceeding, whether civil, criminal, administrative or investigative, (other than an action by or in the right of the corporation) by reason of the fact that such person is or was a director, officer, employee or other agent of the corporation against expenses (including attorneys' Pees), judgments, fines, settlements and other amounts actually and reasonably incurred in connection with such proceeding if such person acted in good faith and in a manner such person reasonably believed to be in or not opposed to the best interests of the corporation, and, with respect to any criminal proceeding, had no reasonable cause to believe the conduct of such person was unlawful. The termination of any proceeding by judgment, order, settlement, conviction or upon a plea oP nolo contenders or its equivalent, shall not, of itself, create a presumption that the person did not act in good Paith and in a manner which the person reasonably believed to be in or not opposed to the best interests of the corporation or that the person had reasonable cause to believe that the person's conduct was unlawful; (n) To indemnify any person who was or is a party or is threatened to ba made a party to any threatened, pending or completed action by or in the right of the corporation to procure a judgment in its favor by reason of the fact that such person is or was a director, officer, employee or other agent of the corporation against expenses (including attorneys' Pees) actually and reasonably incurred by such person in connection with the defense or settlement ol,euch action i! such person acted in good faith and in a manner such person reasonably believed to be in or not opposed to the best interests of the corporation and, except that no 4 indemnification shall be made in respect of any claim, isaue or matter as to which such parson shall have been adjudged to be linble Lor negligence or misconduct in the performance of such person's duty to the corporation unless and only to the extant that the court in which such action or suit was brought shall determine upon application that, despite the adjudication o! liability but in view of all circumstances o! the case, such person is fairly and reasonably entitled to the case, such person is fairly and reasonably entitled to indemnity for such expenses which such court shall deem proper; (o) To purchase and maintain insurance on behal! of any person who is or was a director, officer, employee or other agent of the corporation against any liability anaerted against or incurred by such person in any such capacity or arising out o! such parson's status ae such, whether or not the corporation would have the power to indemnity such person against such liability under the provisions o! this Article. (p) To cease its corporate activities and surrender its corporate franchise; (q) To have and exercise all powers necessary or convenient to effect any or all of the purposes !or which the corporation is organized. ARTICLB I9 The corporation is organized !or the purposes set lorth in Article III only and is not organized !or prolit, it will not isaue any stock and no part o! its assets, income or earnings shall be distributed to its members, directors or oLPicars, except that the corporation shall be authorized and empowered to pay reasonable compensation !or services actually rendered to the corporation and to make payments and distributions in furtherance o! the purposes sat lorth in Article III. ARTICLE O Upon dissolution of the corporation, assets o! the corporation shall ba distributed !or one or more exempt purposes within the seaninq o! Section Sol(c)(3) o! the internal Revenue Code, or corresponding Lutura sections, to an exempt organization or organizations under Section 501(c)(3) of the Internal Revenue coda, or corresponding luture sections, or to a state or local govarnaant !or a public purposd. 5 ARTICLE VI There shall be no corporate stock. The corporation shall ba a membership corporation. Membership shall be determined, governed and regulated in accordance with the By-Laws of the corporation. ARTICLE VII The corporation shall have a Board of Directors of at least live but not more than eighteen members. The members o! the Board o! Directors shall be elected or appointed at such times, in such manner and for such terms as may be prescribed by the By-Laws. Tha By-Laws may provide !or the removal of directors and the filling of vacancies and may contain provisions that the remaining members o! the Board of Directors (although less than a majority thereof) may fill vacancies in the Board of Directors, including temporary vacancies caused by the illness of any director or the absence of any director from the State o! Hawaii. A director must be a member o! the corporation. The Board of Directors shall have full power to control and direct the business and affairs o! the corporation and to provide !or any and every lawful act, whether in the ordinary course o! business o! the corporation or otherwise, including specifically, but without limitation to the generality o! the foregoing, the power to provide !or the purchase by the corporation of such property as the purposes of the corporation shall require, without limit as to amount, the power to provide for the incurring by the corporation of debts, without limit as to amount, the issuance of notes and other evidences of such debts, the power to provide for the mortgage, pledge and/or hypothecation of all or any part o! the assets o! the corporation, including after-acquired assets, as security for any debt or debts o! the corporation, the power to create such committees (including an executive committee or committees) and to designate as members o! such committees such persons as it shall determine, and to confer upon such committees, such powers and authorities as may by resolution ba sat forth for the purpose o! carrying on or exercising any of the powers o! the corporation, and the power to remove or suspend any officer. ARTICLE VIII The ofticers of the corporation shall ba a President, one or more Vice presidents, a Trensurer, a Secretary, and such other o!licsrs and subordinate oflicera as may ba provided !or in the By- laws. Tha otlicers shall be appointed at such tiaas, in ouch manner and for such terms as may ba prescribed by the By-Lave. An officer or subordinate officer must ba a member of the corporation. 6 The persons who are the first officers and directors o! the corporation, together with their residence and/or mailing addresses ara as follows: Names Office Address Michael J. Mataukawa President/Director 75-5722 Kuakini Hwy. suite 206 Kailua-Kona, HI 96740 Marjorie Mulhall Vice President 78-7253 Puupala Places Kailua-Kona, HI 96740 Kenneth Apilado Treasurer/Director P.O. Sox 892 Kealakekua, HI 96750 Kathleen M. Miahina Secretary P.O. Box 740 Captain Cook, HI 96704 Michael E. Asam Director 75-369 Hoene Street Kailua-Kona, HI 96740 Susan Entz Director 77-6425 Kuakini Hwy. Kailua-Kona, HI 96740 Jana Kunitomo Director P.O. Box 234 Kealakekua, HI 96750 Sharon Matsuyama Director P.O. Box 817 Captain Cook, HI 96704 Reginald T. Morimoto Director 78-6852 Walua Road Kailua-Kona, HI 96740 Kenneth Ono Director P.O. Box 275 Captain Cook, HI 96704 Susumu Oshima Director P.O. Box 48 Kealakekua, HI 96750 Alfred Rabara, Sr. Director P.O. Box 764 Kealakekua, HI 96750 Gerald Scott Director P.O. Box 273 Kailua-Kona, HI 96745 Dr. Robin Seto Director P.O. Box 2029 Kealakekua, HI 96750 7 Rev. Leon Sterling Director P.O. Box 902 Kailua-Kona, HI 96745 Lewis Sterry Director 76-796 Io Street Kailua-Kona, HZ 96740 Howard Tatsuno Director P.O. Box 533 Kealakekua, HI 96750 Frank Thompson Director P.O. Box 4 Kealakekua, HI 96750 Kaoru Uyeda Director P.O. Box 735 Kealakekua, HI 96750 l1RTICLE IZ No contract or other transaction between the corporation and one or more o! its directors, or between the corporation and any corporation, firm or association in which one or more of its director are directors or are financially interested, shall be either void or voidable by reason o! the fact that such director or directors are present at the meeting of the Board o! Directors, or committee thereof, which authorizes or approves such contract or transaction, or that his or her or their votes are counted !or such purpose it (a) the fact of such common directorship or financial interest be disclosed or known to the Board o! Directors or committee, and the Board of Directors or committee authorize, approve or ratify such contract or transaction in good faith by a vote sufficient for such purpose, without counting the vote or votes o! such director or directors; or (b) the fact of such common directorship or financial interest be disclosed or known to the shareholders and/or members and they approve or ratify such contract or transaction in good Paith by the affirmative vote or written consent o! two-thirds o! the shareholders and/or members entitled to vote; ar (c) if it be affirmatively shown that the contract or transaction ba just and reasonable as to the corporation at the time it was authorized or approved. Such common or interested directors may ba counted in determining the presence o! a quorum at such meeting. 7UtTICLE I The corporation shall have succession by its corporate name in perpetuity and shall have all the powers herein enumerated or implied haretrom and the powers now provided (or which may be hereafter provided) by law !or incorporated companies. 8 11RTICLB ZI Service o! legal process may be made upon the corporation in the manner provided by law. ]1RTICLB ZII No officer, director or member of the corporation shall be liable for the obligations of the corporation. 71RTICLB ZIII No substantial part o! the activities of the corporation shall be the carrying on o! propaganda, or otherwise attempting to intluenca legislation, and the corporation shall not participate in, or intervene itt (including the publishing or distribution of statements) any political campaign on behalf of any candidate for public ottice. Notwithstanding any other provision, the corporation shall not carry on any other activities not permitted to be carried on (1) by a corporation exempt Prom federal income tax under Section 501(c)(3) o! the Internal Revenue Code, or corresponding section o! any future federal tax code, or (2) by a corporation, contributions to which are deductible under Section 170(c)(2) o! the Internal Revenue Code, or corresponding section of any luture laderal tax code. We certify under the penalties of Sections 415H-10 and 415H-158, Hawaii Revised Statutes, that we have read the above statements and that the same are true and correct. IN WITNESS WHEREOF, the parties have hereunto set their hands this 11th day of Seytember 1989. 9 HY-LAWs OF 1CONA ADIILT DAY CENTER, INC. ARTICLE I Among the scientific, charitable and educational purposes of this corporation are: 1. The corporation shall basically provide the services of a day care and respite center to patients in the community including those suffering from Alzheimer's disease and related demential and their families. The primary service provided by the corporation will be a day health care program which will seek to make a positive impact on the quality of life for participants as well as provide for respite for families and caregivers to allow them to maintain their family member at home for as long as feasibly possible. 2. The corporation will provide a highly- interactive program including supervision and monitoring, behavior management, sensory stimulation and reality orientation and recreation, including the use of creative therapy to encourage reminiscence and recollection. The staff will actively work with participants, emphasizing a staff intensive approach to handling the special needs and problems of patients. The staff will provide comprehensive and ongoing care coordination for participating patients and their families. 1 3. It is intended that the corporation will be an integral component of an innovative continuum of care being established for patients in the Island and State of Hawaii. The system of care may include but not limited to community based as well as institutional based programs including diagnostic services; home based and institutional based respite care; residential care; personal, legal and financial counselling; information, research and referral; support groups and specialized nursing home care. The corporation may also serve as a focal point for caregiver in professional training and education, as well as research concerning service delivery and management of patients. The corporation is intended to include an important mix of community, university, hospital, religious and government institutions. ARTICLE II MEMBERSHIP SECTION 2.01. MEM8ER8. The membership of this organization shall consist of those persons who were participants of the Kona Day Care Center program which was operated by Hawaii Island Adult Care, inc., a Hawaii nonprofit corporation, as of 19_ 2 Susan Entz Kenneth Apilado Ann Brye Dr. Kevin Kunz Howard Tatsuno Kaoru Uyeda Kathleen Mishina Sharon Matsuyama Gerald Scott Jane Kunitomo Kenneth ono Michael Matsukawa Frank Thompson Dr. Robin Seto Marjorie Mulhall Michael Asam Reginald Morimoto Alfred Rabara, Sr. Lewis Sterry Rev. Leon Sterling Susumu Oshima The members of the corporation hereafter shall be limited to those individuals who are admitted to membership by a majority vote of the Board of Directors of this corporation. SECTION 2.02. ELIGIBILITY. Membership shall be open to all persons over the age of la years who can demonstrate a sincere willingness and ability to be a full participant in the activity of the corporation regardless of citizenship, residence, race, religion, sex, creed or occupation. SECTION 2.03. VOTING RIGHTS. Only members in good standing shall be entitled to vote. SECTION 2.0~. 71NNQ11L DQEB. There shall be no fees or dues for membership. SECTION 2.05. TERNIN]1TION OB lIEMBERBEIP. Any member may terminate his membership upon submission of a writing to such effect to the Board of Directors. Termination shall be effective upon receipt. The Board of Directors may, upon two-thirds (2/3) vote of the entire Board, terminate the membership of any person if, after notice to such person, the 3 Board of Directors find good cause therefor. "Good cause~~ includes one's failure to attend any three (3) consecutive meetings of the membership (regular, annual or special meetings) without excuse. SECTION 2.06. ANNUAL MEETING. The annual meeting of the corporation, upon notice as hereinafter provided, shall be held during the first three months of the corporation's fiscal year, at a date and time determined by the Board of Directors, at which meeting the members shall elect a Board of Directors, consider reports of the affairs of the corporation, and transact such other business as may properly be brought before the meeting. SECTION 2.07. SPECIAL MEETING. Special meetings of the corporation, for any purpose or purposes whatsoever, may be called at any time by the President, or by any two or more members of the Board of Directors, or upon the written request of not less than one-fifth (1/5) of the members of the corporation, and shall be called by any officer directed to do so by the Board of Directors. SECTION 2.08. PLACB 01 MEETING. Meetings of the members shall be held at the principal office of the corporation in the State o! Hawaii, or elsewhere as may be designated for members' meetings from time to time by the Board of Directors, in which case such meetings may be held, upon notice thereof as hereinafter provided, at such other 4 place or places as the Board of Directors shall have determined, and as shall be stated in such notice. SECTION 2.09. NOTICE OF HEETINGB. Written notice of each meeting of the members, whether annual or special, shall be given in writing at least 14 days of a meeting, or in emergencies, within a reasonable time, to members entitled to vote by the Secretary or the Assistant Secretary or, if there be no such officer, or in case of his neglect or refusal, by any director or officer. Such notices shall be mailed to the member's address appearing on the books of the corporation not less than ten days before such meeting. Any notice of a members' meeting sent by mail shall be deemed to be delivered when deposited in the United States mail, first class, with postage thereon prepaid, addressed to the member as aforesaid. Notice of members' meetings shall specify the place, the day and the hour of meeting and, in case of a special meeting, the general nature of the business to be transacted. When a meeting is adjourned for any reason, notice of the adjourned meeting shall be given as in case of an original meeting. SECTION 4.10. QIIORIIM. The presence in person or through representation by proxy of members entitled to exercise a majority of the voting power of the corporation shall be required and shall constitute a quorum at all meetings of the members for the transaction o! business except as otherwise provided by law, by the Articles of Incorporation, or by these By-Laws. Every decision of a 5 majority of such quorum shall be valid as a corporate act, except in those specific instances in which a larger vote is required by law, by the Articles of Incorporation or by these By-Laws. If, however, such majority shall not be present or represented at any meeting of the members, the members entitled to vote thereat, present in person or by proxy, shall have power to adjourn the meeting from time to time, until such requisite percentage of voting shares shall be present. At such adjourned meeting at which the requisite percentage of voting shares shall be represented, any business may be transacted which might have been transacted at the original meeting. SECTION 2.11. PR07CIE8. Every member entitled to vote, or to execute consents, may do so, either in person or by written proxy. Proxies which are delivered by electronic means (facsimile copy, telegraph, etc.) shall be presumed valid if the Secretary determines that the signature appears to be that of the member and confirms the proxy with the member by telephone. ARTICLE III DIRECTORS SECTION 3.01. N[JlS88R OY DIRECTORS. The authorized number of corporate directors shall be the number elected initially and at each annual members' meeting or meetings. 6 BECTION 3.02. PONERB OF DZRECTORB. Subject to the limitation of law, or the Articles of Incorporation and of the By-Laws as to action to be authorized or approved by the members, all corporate powers shall be exercised by or under authority of, and the business and affairs of this corporation shall be controlled by, a Board of Directors. 9BCTZON 3.03. ELECTION AND TENURB OF OFFICE. The directors shall be elected by ballot at the annual meeting of the members by not less than fifty-one percent (51$) of the total members of the corporation or a majority of the members present, whichever is less, and shall hold office until the next annual meeting and thereafter until their successors are duly elected or appointed and qualified; subject, however, pursuant to Section 3.05, to removal by the members or the Board of Directors for good cause. "Good cause" includes one's failure to attend any three (3) regular consecutive meetings of the Board ofDirectors without excuse. The Directors' term of office shall begin immediately after election. SECTION 3.0~. YACANCIEB. Vacancies in the Board of Directors may be filled by a majority of the remaining directors, though less than a quorum, or by a sole remaining director, and each director so elected shall hold office until his successor is elected at a regular meeting of members or at a special meeting called for that purpose. The members may at any time elect a director to fill any vacancy not filled by 7 the directors, and may elect the additional directors at the meeting at which an amendment of the By-Laws is voted authorizing an increase in the number of directors. A vacancy or vacancies shall be deemed to exist in case of the death, resignation or removal of any director, or if the members shall increase the authorized number of directors but shall fail at the meeting at which such increase is authorized, or at an adjournment thereof, to elect the additional director so provided for, or in case the members fail at any time to elect the full number of authorized directors. if the Board of Directors accepts the resignation of a director tendered to take effect at a future time, the board, or the members, shall have power to elect a successor to take office when the resignation shall become effective. No reduction of the number of directors shall have the effect of removing any director prior to the expiration of his term of office. SECTION 3.05. REIiOVAL OF DIRECTORS. Any individual director may be removed from office by a vote of two-thirds (2/3) of the total members or a vote of two-thirds (2/3) of the entire Board of Directors for good cause. "Good cause" includes one's failure to attend any three (3) regular consecutive meetings without excuse. 8 SECTION 3.06. ANNIIAL HOAAD OF DIRECTORS' NEETINGB. The annual meeting of the Board of Directors shall be held on the same day as the annual members' meeting, immediately following the members' meeting. SECTION 3.07. SPECIAL NEETING6. Special meetings of the Board of Directors for any purpose or purposes shall be called at any time by the President or if he is absent or unable or refuses to act, by any Vice President, or by any director. SECTION 3.08. PLACE OF MEETINGS. Meetings of the Board of Directors shall be held at the principal office of the corporation in the State of Hawaii, or such other place as designated for meetings of the Board of Directors from time to time by resolution of the Board or written consent of all of the members of the Board. SECTION 3.09. NOTICS OF MEETINGS. Written notice of the time and place of each meeting of the Board of Directors, whether annual or special, shall be delivered personally to the directors or sent to each director by letter or by telegram, charges prepaid, or electronic means, addressed to him at his address as it is shown upon the records of the corporation, or if it is not shown on such records or is not readily ascertainable, at the place in which the meetings of the directors are regularly held. In case such notice is mailed or telegraphed or sent electronically, it shall be deposited in the United States mail, first class, 9 postage prepaid, or delivered to the telegraph company office in the locale in which the principal office of the corporation is located or sent electronically at least five days prior to the time of the holding of the meeting and shall be deemed to be delivered to the Director thereupon. In case such notice is delivered as above provided, it shall be so delivered at least four hours prior to the time of the holding of the meeting. Such mailing, telegraphing or delivery as above provided shall be due legal and personal notice to such director. When a meeting is adjourned for any reason, notice of the adjourned meeting shall be given as in case of an original meeting. SECTION 3.10. CONSENT TO DIRECTORS• 2SEETINGS OR DIRECTORB• ACTIONS. The transactions of any meeting of the directors, however called and noticed and wherever held, shall be valid as though had at a meeting duly held after regular call and notice if a quorum be present and if either before or after the meeting, all of the directors not present sign a written waiver of notice, or a consent to the holding of such meeting, or an approval of the minutes thereof. All such waivers, consents or approvals shall be filed with the corporate records or made a part of the minutes of the meeting. Any action which may be taken at a meeting of the directors may be taken without a meeting if authori2ed by a writing signed by all of the directors and filed with the Secretary of the corporation. 10 Directors' actions which are authorized under this section include, but is not limited to, polling of individual directors concerning proposed action, provided that each director, whether voting in the affirmative, negative or abstention, shall execute a written waiver of notice of meeting, or a consent to the holding of a meeting by such polling, waiving debate, or approval of the minute of such polling. SECTION 3.11. NEETIN6 SY CONFERENCE TELEFHONB OA ELECTRONIC MEANS. Members of the Board of Directors of the corporation, or any committee designated by such Board, may participate in a meeting of such Board or committee by means of conference telephone or similar communications equipment whereby all persons participating in the meeting can hear each other, and participation in a meeting in such manner shall constitute presence in person at such meeting. SECTION 3.12. QIIOROM AND VOTE. Twenty-five percent (253) of the directors (present either in person or by means of a conference telephone) shall be necessary to constitute a quorum for the transaction of business, and the action of a majority of the directors present at any meeting at which there is a quorum, when duly assembled, is valid as a corporate act; provided that a minority of the directors, in the absence of a quorum, may adjourn from time to time, but may not transact any business; provided, further, that any 11 action taken by a quorum consisting of less than fifty-one percent (514) of the directors shall be subject to the notification provisions set forth below: A. Upon adjournment of the meeting at which less than fifty-one percent (514) of the directors were present, the minutes or summary of the action taken shall be given or circulated to all of the directors by writing or in person or by telephone message. B. Upon receipt of such notice of the minutes or summary oP the action taken, the directors who were not present shall have two (2) days in which to object to the action taken. Any objection shall be specific and shall be in writing. C. The mere fact that an objection was made does not affect the finality of any action. SECTION 3.13. COMPENSATION OF DIRECTORS AND COMMITTEE MSMHERS. Directors and members of all committees shall not receive any stated salary or other compensation for their services as such but, by resolution of the Board, expenses of attendance, if any, may be allowed for attendance at each regular or special meeting of the Board or committee. ARTICLE IV gFFlcaRs SECTION 4.01. DESIGNATION. The officers shall be a President, one or more Vice Presidents, a Secretary, a 12 Treasurer, and such other officers as may be designated in these Hy-Laws. SECTION 4.02. ELECTION. The officers shall be elected by the Board of Directors at their first regular meeting of the fiscal year, and at such other times as the directors may from time to time determine. SECTION 4.03. CONIIENBATION. The officers of the corporation shall not be entitled to compensation or a stated salary, except that reasonable expenses related to their office may, by resolution of the Board of Directors, be allowed. SECTION 4.04. REMOVAL AND RE8Il3NATION. Any officer may be removed for cause by a majority of the directors at any regular or special meeting of the Board, or, except in case of any officer chosen by the Board of Directors, by any officer upon whom such power of removal may be conferred by the Board of Directors. Any officer may resign at any time by giving written notice to the Board of Directors or to the President, or to the Secretary of the corporation. Any such resignation shall take effect at the date of the receipt of such notice or at any later time specified therein; and unless otherwise specified therein, the acceptance of such resignation shall not be necessary to make it effective. 13 SECTION 4.05. VACANCIES. A vacancy in any office because of death, resignation, removal, disqualification or other cause shall be Pilled in the manner prescribed in the By-Laws for regular appointments to such office. SECTION 4.06. PRESIDENT. The President shall be the chief executive officer of the corporation and shall, subject to the control of the Board of Directors, have general supervision, direction and control of the business and affairs of the corporation. He shall preside at all meetings of the stockholders and of the Board of Directors. He shall be ex- officio a member of all the standing committees, including the executive committee, if any, and shall have the general powers and duties of management usually vested in the office of President of a corporation, and shall have such other powers and duties as may be prescribed by the Board of Directors or the By-Laws. SECTION 4.07. VICE PRESIDENTS. The Vice Presidents shall at the discretion of the Board of Directors, in the absence or disability of the President, perform the duties and exercise the powers of the President, and shall perform such other duties as the Board of Directors shall prescribe. SECTION 4.08. 88CRETAAY. The Secretary shall keep, or cause to be kept, a book of minutes, at the principal office or such other place as the Board of Directors may order, of all meetings of directors and members, with the time and place of holding, whether regular or special, and if 14 special, how authorized, the notice thereof given, the names of those present at directors' meetings, the number of shares of stock present or represented at members' meetings and the proceedings thereof. The Secretary shall keep, or cause to be kept, at the principal office of the corporation, a register, showing the names of the members and their addresses. The Secretary shall give, or cause to be given, notice of all the meetings of the members and of the Board of Directors required by the By-Laws or by law to be given; he shall have such other powers and perform such other duties as may be prescribed by the Board of Directors or by the By-Laws. SECTION x.09. TREA8ORER. The Treasurer shall receive and keep all the funds of the corporation, and pay them out only on the check of the corporation, signed in the manner authorized by the Board of Directors. BECTION 4.10. A88ISTANT9. Any Assistant Secretary or Assistant Treasurer, respectively, may exercise any of the powers of Secretary or Treasurer as directed by the Board of Directors and shall perform such other duties as the Board of Directors may direct. BECTION 4.11. BIIBOADINATE OFFICERS. The Board o! Directors may from time to time appoint such subordinate officers, employees or agents as the business of the corporation may require, fix their tenure of office and allow them suitable compensation. 15 SECTION 4.12. EZECIITIVE AND OTEER CONIiITTEEB. The Board of Directors may appoint an executive committee, and such other committees as may be necessary from time to time, consisting of such number of its members and with such powers as it may designate, consistent with the Articles of Incorporation and By-Laws and the laws of the State of Hawaii. Such committees shall hold office at the pleasure of the Board. ARTICLE V CORFORATE RECORDS AND REPORTS SECTION 5.01. RECORDS. The corporation shall maintain adequate and correct accounts, books and records of its business and properties. All of such books, records and accounts shall be kept at its principal place of business in the State of Hawaii, as fixed by the Board of Directors from time to time. SECTION 5.02. INSPECTION OF SOO1C8 AND RECORDS. A membership book shall be kept by the Secretary and shall be open to all reasonable times for the inspection of the members. The original or a copy of these By-Laws, as amended or otherwise altered to date, certified by the Secretary, shall be open to inspection by the members of the corporation. 16 BECTION 5.03. BIGNING OF CHEC1~8. All checks, drafts or other orders for payment of money, notes or other evidences of indebtedness, issued in the name of or payable to the corporation, shall be signed or endorsed by such person or persons and in such manner as shall be determined from time to time by resolution of the Board of Directors. SECTION 5.0~. ESECIITION OF CONTRACTS. The Board of Directors, except as otherwise provided in the By-Laws, may authori2e any officer or officers, agent or agents, to enter into any contract or execute any instrument in the name of and on behalf of the corporation. Such authority may be general or confined to specific instances. Unless so authorized by the Board of Directors, no officer, agent or employee shall have any power or authority to bind the corporation by any contract or engagement, or to pledge its credit, or to render it liable for any purpose or to any amount. SECTION 5.05. ANNIIAL ERSIHITB. The Board of Directors shall cause an annual exhibit to be filed with the Director of the Department of Commerce and Consumer Affairs as provided by Chapter 415B, Hawaii Revised Statutes, as amended. ARTICLE VI INDE1QiI1ICATION OF DIRECTORS AND OFFICSRB Any person who, by reason of the fact he is or was a director or officer of the corporation, or is or was serving 17 at the request of the corporation as a director or officer of another corporation, partnership, joint venture, trust or other enterprise, is or was a party, or is threatened to be made a party, to any threatened, pending or completed action, suit or proceeding, whether civil, criminal, administrative, or investigative, shall be indemnified by the corporation, provided he acted in good faith and in a manner he reasonably believed to be in or not opposed to the best interests of the corporation, and, with respect to any criminal action or proceeding, had no reasonable cause to believe his conduct was unlawful. Such indemnification shall be provided against expenses, including attorneys' fees, judgment, fines and amounts paid in settlement actually and reasonably incurred by him in connection with such action, suit or proceeding; provided, however, that with respect to an action or suit by or in the right of the corporation, such indemnification shall be only against expenses, including attorneys' fees, and in such cases no indemnification shall be made in respect of any claim, issue or matter as to which such person shall have been adjudged to be liable for negligence or misconduct in the performance of his duty to the corporation, unless, and only to the extent that, the court in which the action or suit was brought determines, upon application, that despite the adjudication of liability and in view of all the circumstances o! the case, the person is fairly and reasonably entitled to indemnity for such expenses as the court shall deem proper. 18 To the extent that a director or officer of the corporation has been successful on the merits or otherwise in defense of any such action, suit, or proceeding or in defense of any claim, issue or matter therein, he shall be indemnified against expenses, including attorneys' fees, actually and reasonably incurred by him in connection with the action, suit, or proceeding. Any other indemnification hereunder, unless ordered by a court, shall be made by the corporation only as authorized in the specific case upon a determination that indemnification of the director or officer is proper in the circumstances because he has met the applicable standard of conduct set forth herein. The determination shall be made by the Board of Directors by a majority vote of a quorum consisting of directors who were not parties to the action, suit, or proceeding, or if such a quorum is not obtainable, or even if obtainable if a quorum of disinterested directors so directs, by independent legal counsel in a written opinion, or by the members. The termination of any action, suit, or proceeding by judgment, order, settlement, conviction, or upon a plea of nolo contenders or its equivalent, shall not, of itself, create a presumption that the person did not act in good laith and in a manner which he reasonably believed to be in or not opposed to the best interests of the corporation, or, with respect to any criminal action or proceeding, that he had reasonable cause to believe that his conduct was unlawful. Expenses, including attorneys' fees, incurred in defending a 19 civil or criminal action, suit or proceeding may be paid by the corporation, in advance of the final disposition of the action, suit, or proceeding as authorized by the Board of Directors in the specific case, upon receipt of an undertaking by or on behalf of the director or officer to repay such amount unless it shall ultimately be determined that he is entitled to be indemnified by the corporation as authorized herein. The indemnification provided hereunder shall not be deemed exclusive of any other rights to which those seeking indemnification may be entitled under any applicable statute as amended from time to time, any By-Laws, agreement, vote of stockholders or disinterested directors or otherwise, both as to action in their official capacity and as to action in another capacity while holding such office, and shall continue as to a person who has ceased to be a director or officer and shall inure to the benefit of the heirs, executors and administrators of such person. The corporation may purchase and maintain insurance on behalf of any person who is or was a director or officer of the corporation, or is or was serving at the request of the corporation as a director or officer of another corporation, partnership, joint venture, trust or other enterprise against any liability asserted against him and incurred by him in any such capacity, or arising out of his status as such, whether or not the corporation would have the power to indemnify him against such liability under the provisions herein. 20 ARTICLE VII ANEND![ENTS TO EY-LAWB The By-Laws of the corporation may from time to time be repealed, amended or altered, or new By-Laws may be adopted, subject to repeal or change by action of the members, by a 753 vote of the members of the corporation entitled to vote at a meeting duly noticed and called therefor, upon the prior recommendation of the Board of Directors. ARTICLE VIII DI88OLUTION The corporation may be dissolved upon the vote of 753 oP the members of the corporation entitled to vote. ADOPTION OF BY-LAWB The undersigned, on this 19th day of September 1989, does hereby attest that the foregoing provisions were adopted as the By-Laws of said Corporation pursuant to a meeting of the Board of Directors. 071289/390.doc 21 Kona Adult Day Center Personnel Policies 4.13.6 Emolovment of Relatives 1 General Statement: KADC will accept and consider apphcahons for employment from relatives, close family members as well as close personal rclahons of employees or volunteers as long as such employment does not present a conflict of mterest or problems of safety, secunty, supervision, or morale Definition of Relatives• For the proposes of this policy, the definition of relatives, close family members mcludes parenu, grandpattms, children, spotues, brothers, sisters, in-laws, as well as close personal relations such as significant others, domestic partners, gvlfnend/boy~tend relanonships, etc 3 Prohibitions We generally will not hue or transfer such persons mto positions whereby they doectly supervise or are supervised by another close family member or close personal relation Further, such relatives or relahoas generally wtll not be placed in positions whett they work with or have access to sensitive mfoimation regardmg a close family member or close personal relation or there rs an actual or apparent conflict of interest 4 Coveraee This polity applies to all cate¢ones of employment at KADC ,ccepted by Board of Directors January 28, 1999