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Home My WebLink AboutCOM 0122.023 2000-2002 Stephen K. Yamashtro Harry A Takahatihi Mavor ~T- Direcror y~ - _k• ' 'y °~...~-.-y . COUNTY Of ~H~41!!(ieEl`I DEPARTMENT OF FINANCE 25 Aupum Suaat, Itcan 118 • Hila Hawui %7204252 (808) %1-8234 • Fu (808)%I-8248 HAWAII COUNTY NONPROFIT GRANTS (FY 2001-02) HUMAN SERVICES NONPROFTf GRANTS REVIEW COMMITTEE FISCAL YEAR ENDING. June 30, 2002 DATE OF APPLICATION: 1 / 30 / O 1 GRANT APPLICATION FOR: Hilo Adult Day_ Center trr.R.~ nw? Legal Name ofOrganrzdion: Hawaii Island Adult Care, Inc. MatlingAddtess: 34 Rainbow Drive, Hilo, HI 96720 Facility/SiteAddresa: 34 Rainbow Drive, Hilo, HI 96720 Du~ector/SrteManager. Carolyn Cabreira OrgaauationPreatdmt: Dr. Tanya Johnson ContadPrsaon(GrantWritc): Paula Uusitalo Amouct of Request for County Fuuds: S 40.000 Total Annual Budget of Organization: S 702.605 Has the applicant applied for any other funds from the County of Hawari this fiscal year? ? Yes SotuedDepartment: ® No Ageucy/Program(s): ? Social Services ? Youth Programs ©Elderly Programs Check Categories: ? Cullum and ARS ? Education ? Other Briefly, deflue the program for which thndiaY is 6elut regaested: HIAC provides quality adult day services to the frail elders and disabled adults 18 veers and older 90~ of our narticioanta are 60 ynare and_o].der. 150+ individuals attend the Center duringthe course of one year. All the participants have some level of mental or physical disability/frailty, or have extenuating home/family conditions warrantir~ the need for daily care in a safe environment. _1_ ~.2.,2 ..Z..3 Comm. Ro:_~,+ I. (QUALIFYING STANDARDS FOR APPLICANTS An applicant must meet all of the following standards: ® Be chartered or otherwise authorised to do bminsa in the Suu for charitable purposd sad exempted from the federal income tax by the Iatemal Revenue Semce. Have a governing board whose members serve without compensation and have no conflict of mtert;st between then regular occupaaoas sad the sernces provuied. ® Have bylaws or policies which describe the meaner in which busmen rs conducted, including management, audit, focal pohaes and procedures, policres oa aepoaam, sad policrs oa maaagemmt of potwttal conflict of interest. ® Have at lent oae year's expeneace wuh the service or acunty for whuh the approprimon u sought or can otherwree demonsttau to the sawfaction of the County sufficrmt expertise to successfully earty out the sernce or scanty. ® Be licensed and accrediud m saordaace mth applicable tequuemmn of Federal, Stan end County laws. II. GRANT CONDITIONS The applicant agrees to comply with the following tarns and wndititms prior to receiving a gtattt award. A. Comply wath applicable Federal and State laws prohibiting diacrimrnaaea against say person on the beau of rice, color, national ongia, reh~oa, creed. amt, age, or bandicap• B Agin sot to use my pubbc foods for proposes of mtertunmmt a pe:gwatts. C. Comply with such other requummn u the Director of Finance may prsaibe oo insure adhetma by the nonprofit organtzaaon with Fedeol, Stan, and Cotmty Owe, and established standards for focal and program maoagernent D Allow the Director of Finmce, the comauttes of the council and they staffs, and the LegiaLtive Attdttor access to records, npoo, 9es, sad other related docummn is order that the program, oaoagemmt, and focal practices of the nonprofit orgaawaoa may be momtared and evahiated to wore the proper and effecnve expenditure of public funds. III. RECORDS AND REPORTS A. The applicant shall follow geaaally accepted sccmramg proeedinea and poetics and shall maintain boob, retwrds, dociimeau sad other evidence which mffinmtly and paaperly aceasrat for the atpenditure of County toads. The books, secasda and documents shall ba subject at all reaaooable Ames to inapeenoa, renews, or audits by the County aapmdfng sgmcy, the Director of Finance, and the I.egialanve Auditor, or by tbev reprsmtaava. B. The County upeodfng agency, Director of Finance, or County Council may requeu periodic wnaen repots on the oae of County funds. C. 7be nonprofit orgmiraaon aball submit a 5ml wnttm report to the I.e~slative Auditor vnthin sacty (60) days after June 30 of the fiscal ye.r. The report shall ixh?de m explaoatian of the public benefin derived from the awarding of the grmt, a listing of other funding soutcs and uootmb obtained dtiriag the grant pertod, and a wmplete ticcouatutg of all expmditiues aupposud by Camty of Hawni grmt funds {Per Chapter 2, Article 25, Sxtion 2-142(d), Hawan County Code, amended Auiuu, 1999}. -2: IV. (QUARTERLY ALLOCATION Undet no ctrattmsbnces shall grant funds 6e disbursed in a lump sum payment Grant funds unll be disbursed to Grantees only through a quarterly allocation process, The disbursement of grant funds can be formulated on an equal quarterly apporoottment base V, GRIEVANCE PROCEDURE The applicant will adopt and maintain a gnevance procedure to assure proper accounting for any concern and complamb about cis program or semces that may arise from m members, employed, cheats or from other member of the public. VI. DISCLOSURE OF INFORMATION All tnformadoti, dab or other ttterenal provided to the Cooety by virtue of this appUanati shall be subject to the Uniform information Ptaetrces Act (UlPA), Chapter 92F, Flawut Revised Sttuuta. All such material is deemed government record end shell be opm to the public avd may be provided to other public snd/or pavers funding winces. VII. CONTIIKiJED ELIGIBILITY Aay appliewt or reelpknt who withholds or omib any materW faeb or dalfbesatety misrapresenb each recd to the Comty of Hawaii shall: (1) Immediasely be disqualified from consideanon for Nonprofit Gtatit funding; OA (2) be m vtolanon of the corms of tbs Grant Apemeot of Canty finds in which ass a gent agreement can be termmaued by the County and the teeipiem or provider may be bable ro retmbttne all a a poreton of any funds recmved therein. VIII. ACKNOWLEDGEMENT Hawaii Island Adult Care,Inc. (Legal Name of Orgattiunon) hereby agrees to admrabtar the Hi 1 o Adult Day Ce n t e r (Program Title) m accordance with the regtrLdoeu, policies sod ptoeedura prescribed by the Hawaii Cotmty Finance Departmetit Dutnbtmoti of glint finds u Ilmited m grandee whteh tie m compliance wn6 County regulations, polietes dad peoeedutes. The Cowry tewrves the right to withhold grant distributions u any time the grantee u trot m compliance. It is the policy of the Cowry of Hawaii and for those who do btrsinees with the County to provide e4~ ~P~S'~ oPP~~ to all peaaons eegaedless of race. physical disabilities, color, religtaa, wc, age. or natiotbl ortgm L mandated by the Federal Civil Righb Acb, es amended, and any other federal a• state laws relating to equal entployeetem opportunities. IJC. AMENDMENTS TO TBB APPLICATION/EVALUATION The applicant aasura that it will atabmtt to the Human SaavicarNonprvfit Grob Review Committee (HSNPGRC) for poor review end approval a tvrrtren request anti jusdfit:ation fa any changes, addhiom. a dalettous to any portron(s) of the gent epphation a• a duly etteouted Great Agresmmt of Catmty Ftmds. 'iLe upplitnmt will cooPefEb and wist m any effort «ndaabkan by the HSNPGRC to evahrata, mapeet or otherwise momta the effectiveness, faw'bility, tmdlor cost e}Bcimey of mY rind all practtees, ptdieisa and proeedtues a activities purtniant to this application or a>ri grmt desigtiatian or allocation received as • tesalt of this appliaaon. -3- X. AUTHORITY AND CAPACITY OF APPLICANT "Ilte applicant cetttfies that a has the suffionty and capaetty to develop aad submu thu apphcanon, and to fully administer the program(s) pursuant to thu apphcanon UNSIGNED PROPOSALS WILL NOT BE ACCEPTED2 ~/3i Signature of Preaidend arson Date '^T ~ ~~ic...- 1 130 ~ o l Signanire of ve DirectorlMenaga Date -4= Hawau Island Adult Care, Inc County of Hawao Non-Pm~rt Grant FY 2001-02 PROGRAM/SERVICE DESCRIPTION A. Overview: 1) Describe the program for which the funding Is bsing requested. Hawau Island Adult Care, Inc. at the Hdo Adult Day Center, provides adult day acre for the frail elderly, physiarlly and mentally challenged adults who require supervised acre. The arnter opened its doors in 1978; today we are the largsat independent adult day a~ntar in the state, licensed for 105 parbapants. Average daily attendance is 80 frail elders and handicapped adults, ages 23 through 95 We servce a widespread geographical arsa~ from Warmea to Ita'u. Our full day servia~s provide acUwties including arts and crafts, entertainment, music, kareoke, excursions, games, celebration of all holidays and events, barbershop and beauty bar (personal hygiene) and exerase (group and individual). The Center provides limded medical acre such as dispensing medication by our on-srte nurse, partfapant acre plans, nutrl6onal counseling and implementation. The staff attend to the partidpants' daily personal needs on an individual basis The a~nter provides a safe daytime environment where partiapants' physia~l and mental health are observed and morntored A. 2) What unique or significant service will be provldsd9 Ths most important aspect of the day acre program is providing a safe, healthy, and soaally aches day time environment for frail elders and physta~Ny or mentally challenged adults who otharNnse would be pre-maturely institutlonalized into long tsnn care or could be left at home alone at nsk of injury. Frail elders are at nsk for falls and aaddsrtts. Dementia and Alzheimer's disease patleMs are inclined to wander away. These indlwduds auuwt bs left done. Ind'nndually, for participants at the Center, soaal actlvitlss are emphasized, providing much needed comparnonship in an oRen bnely world. Stroke victims are under suparviaed a~ro for exerasing and receive emotJOnal support in recovery. Day care dso providsa much needed respite for the aaregivers of these individuals giring the a~rsgivsrs a life again and deterring burnout. A. 3) What specific outcomes an to be achisved4 1) Plaang a trail ddsr of mentally/physiaitlly impaired adult m day sus costs 1840 -5800 monthly axnpared to bng•tertn care costing 58,000 minimum monthly and gsnsrely paid by Medicaid funds Thu funding request of 540,000 will assist 20 to 30 families with tuitlon co- share scholarships for their loved ones. This Nell allow families to romain together at horns and does not put a large burden on Mediaud funds 2) The Center outcomes include • 90% of partlapants attending the center remeirnng at home for at least six months. • 90% of partlapants whose soaalizatlonlnteractlon skills are maintained or improved. ¦ 90% of partlapants and aarsgivsrs who express aatlstadion with fhe progrem serna>t. ¦ 90% of partidparrts whose hygienstseR-care are mantained or improved. Hawan Island Adult Care, Inc 3) Personal outcomes for partiapants attending the center are that they continue to live as members of the community vinth dignity and rasped. Stroke victims and others living in isolation have the opportunity to return into the stream of society, after restorative exerase and mental recovery from depression A. 4) How will the proposed program empower participants/elNnts to become ssH-sufricisrrt and facilitate posklve social change? The malonty of Hilo Adult Day Centers participants remain self-suffiaent (as much as possible), and remain living independently with family until they pass on from this life or as long as possible. For participants debilitated by stroke the encouraging atmosphere and physical spaa3 for exercising at the Center provides the opportunity to return to self-sufficiency if at all possible Enjoyment of being involved in activities and the soaal'ization at the center creates seH-esteem and alleviates the depression most elders have at this time iri then lives The partiapants feel that they "bating" and have something positive to look forward, to each day. Caregivers are free to pursue their own lives while still providing overnight and weekend acre and support for their loved ones and the guilt of plating a family member in the nursing home is diverted The day aitre progrem a~eetes positive soaal change by preventing premature institutionalization and focusing on partiaparits remaining as a part of family and communrty life, hopefully to the end of their days B. ProblemlNeed: 1) What Is the problsm/nesd the proposed program is designed to meet? The problem/naed that the Hilo Adult Day Center addresses is daily "safe a;lre' for our frail elderly and disabled adults who need some type of assistance or supervision and cannot be left alone at home all day, often under doctors orders. Also, our progrem gives their pragivers much Headed respite to haw a life of their own and/or remain in the work Tons, thus preventing "caregiver bum-ouC. Caregiver burnout a3n essay Ised to institutionalizing their family member bea>tuse they a~n no longer do the often 24hour lob. Day a;tre allows the individuals needing care to have seK-worth and digrnly, and to rsma+n with families end loved ones as long es possible rather than being pre-maturely institutlonalaed into long term cars B. 2) Who are the target population and what era the specific needs? The mam target population consists of older adults with physical and /or mental impeinnents who require supervised day-dme care. Aa~ordinq to the County of Hawaii OTfica of Aging's 1990 Census Repoli them were 3,407 older adults in Eaat Hawan alone who could benefit from a day acre program. Naw almost a decade later, those aged 85 and older will be the nation's largest single populetwn. East Hawaii is no different, here, the 80-and-over aduk population is expelled to inaease 250% from 1990 to 2005 The secondary target population tiro the families who have slapped into the role of caregiver Their speafic need is to receive respite from anon-stop caregivinq job, those employed can continue doing so Taking acre of this need aids in detemnq burnout 2 Hawan Island Adult Care, Inc B. 3) What is the geographical area(s) to be served, facility and hours of operation? We serve East Hawau~ South Hdo, North Hilo and Hamakua (inducting Waimea), Puna and Ka'u distracts Hdo Adult Day Center currently operates at 34 Rainbow Dnve, in the old Hilo Memonal Hospdal, from Monday to Fnday, 7 00 AM to 4.30 PM C. CollaboratloNCoardinatlon: 1 } What specfflc measuros will be taken to collaborate%oordtnab wkh otMr community resoun;ss to achlew maximum program efTleNncy and cost efficttvensss? Hdo Adult Day Centers collaboration efforts indude: being an active member of the East Hawan case management's Interdisciplinary Tsam (IDT) which is sponsored by CMCP and inductee: Adult Protective Services, Alzhe~mers Assoaation, Catholic Chariities, County of Hawaii Coordinated Sernces, Hawaii State DepartrnsM of Human Services, Kaiser Pennanente, Legal Aid, Imerim Health Cars, Kokua Numes, Vfs Caro Csntsr of Hdo, Home Health, Nursing Home vnthout Walls, and the Senior Center Home Safety Monitoring Program. Ws also consult regularly with aoaal workers, doctors, mental health services for seniors on an indiwduel basis regarding partiapants; and refer famdiss to other assistancelaare they may need or as five needs erase Other direct collaborations for maximum effiaency and cost effectiveness are with: ¦ froordinatsd Services (Courrtv Elderly Actlvitlas Diviaionl. Hawaii County Economic Onoortundv Counal. County of Heiwaii Nutrition Program. and the tap services' County Share-ride program: provide transportation to the GIntK for a number Of our paAldpants • Hawaii Island Food Bank provides snacks for our participartts at a nominal fee. ¦ Hawaii Stall Dsoartrnent of Human Services: Provides for 20 poverty bwl partidpants to attend the center monthly. ¦ Kona Krafb: Cost sham on tuitan for three partiapants per month. ¦ Nursma Home w/o WaMs• provides for apht partidpanta per month. ¦ OOA Kuouna Can Program with Sernces for Seniors. provides for partidpants to attend the amter on a arse to case basis. ¦ Volunteer groups: R.S.V.P. volunteers who assist with partidpanta and in the kitchen; entertainment groups (e.g. Ths Silwr Steppers) weekly performances; Alu Like summer helpers framing program; Community Sernces, Teen Court, and the First to-Work Program vduntssrs help in assorted jobs, and mdividuala who come to help out in a vanety of ways. C. 2} How will tMw measures reduce or eliminate any existing duplication of services to your designate target group? The case management interdisdpAnary {IDT) team which meets monthly, idantfies dienta and matches them to the appropriate agsnq/prognun. One spsdfic purpose of the team is to eliminate duplication of seMas and we an an active member of this contingent. 3 Hawau Island Adult Care, Inc We are also the only qualified aduN day canter in East Hawau, Providing sernues to the target group with the assistance of grants and contracts from the State, county and pnvate foundations Indmduaily, each parUupant has a care plan developed by the Soual Sernuas Director, Day Center Drector and Health Sernces Coordinator, and/or a representative from any agency involved with this indmdual, which utilizes information and referral to fill any other needs/uare the parUapant may have, and back-ups the IDT system of serncas. D. Goals and Objectives: 1) What are tM major goals/benchmarka of the proposed programT 1) One major goal of our day care program is to reach as many as possible of the frerl elders and handicapped adults who can benefit from day care and be evadable as an alternative to long tern care insMuUonahzaUon Scholarship assistance towarcl tuition costs is the key to this goal Two thirds of our current participants are low income or at poverty level (under 39070 annual income) and would be unable to attend if not for outside assistance 2) Another progrem goal is to retain the pertiupants' independence level thus allowing them to be able to remain at home, and to maintain or return parUaparns to a physical mobility level which has been arroated by a stroke, surgery, or by isolationlnactivity poor to attending the center Retaining or returning to a healthy mental attitude and canng for one's personal self are part of the program goal for each individual participant. Giving respite to caregivers is included in this goal (their happiness is key to allowing these individuals to remain at home) D. 2) What specific objsctiwsJaction steps are planned for each goal? Goal #1 ¦ Keep referal and intake system effluent and streamlined to admit individuals as soon as day Darter services era roquired or requested. • Continue as an active member of the IDT progrem and working with the agenaes of East Hawaii. ¦ Attend health fairs and other community events, and be alive in community agendas and events as is possible. ¦ Continue to search out scholarship funds for parUapants who need supervised care but cannot afford it Finances should not be a problem when the care is needed, otherwise d institutionalized, the public (Medicaid) wUl carry a much larger burden of care. Goal #2 ¦ Initial interviews of disnt and family are used by Sodal Sernces Director, Day Center Director and Nurse for entry and to set up a client care plan. ¦ Close observation for first two weeks, assessment, care plan implementaUOn, staff umtinually take note of any status dtangas in partldpartta' health or sodal behavior ¦ Weekly staff meetings regarding diems aro held to keep all stall members abroast of all newfcurent participants and status changes. Close communication is kept with family. Commurnuation among slafi members is the key in canng for 1fie partidpanta' needs ¦ An annual surrey with speufic answers to goals, inducting satisfaction, mental state, hygiene and other goals will provide documentation of goals attained and information for improvement of the program. 4 Hawau Island Adult Care, Inc D. 3) What is the ttmsline (start and end dates) for each action step? Goal #1 - It is all ongomg processes, except the mtake pmcess Intake is set for a mawmum of five days to begin attending dey care after hawng all physraal health dearences, mternews completed, and ASAP for AduR Protective Services diems. Intake also includes a finanaal rewew if scholarship funds aro requested Goal iM2 -Initial Internees, observation and assessment is a two week process Staff meetings are held weekly; observations ongoing by all staff Partiapants a~n and do stay with us for years, end date is when they pass on to the new world, or are no longer physically a~pable of attending the Center. D. 4) What signiflcarrt cliarrti:errtered outcome(s) will fire program achieve? • Include in your answer how many paRlcipants/clierrts will: a) Attain at Nast one person program outeoma; or b) Show nraasurabla progress towards your program goals. If Hawaii Island Adult Care, Inc. receives the requested amount of 540,000, these funds well assist 20-30 addfional diems to attend day care for one year, and remam in their own homes, rethsr than being prematurely institutionalized. The outcomes aro defined in section A. 3 At least 90% dienta vnll remain living at home for at least sot months with the aid of day acre. Progress and improvements, and enjoyment at returning to the Center each day aro observed vnth ninety percent of the new partiapants. Notiaitable changes in new partiapants within the first weeks are the most evident. Some partiapanfs have experiena~d isolation proviousty and although little response is observed initlally, they begin to change, becoming soaable and interested in progrema and people Stroke victims are often very depressed when fret attending the day taro program They begin to improve physically and emotionally as they exerase and are among peers for encouregement. The majorrly of partidpants continue to attend tfie center until they are hospitalized or pass on to the next world. E. Service DNiverv: 1) What methodology will be used in the proposed program's delivery of sarviw(s)? Hilo AduR Day Centers enthusiastic, highly framed staff provide a ons-to-suc ratio in safe acre for frail elders and handiatpped aduRs as they always have, in the past 24 years. In the Alzheimers wing k is doser to a one-stafRto-four-partk~pants level of taro. A great vanety of daly activities are planned on a monthly schedule including exercising, arts and crafts, excursions, entertainment, karaoke and music, cskbratlona of holidays and events, a literecy program for younger adults, and a spsdaAzed program for AlzFreimers disease parUc:ipants. Trensportation to and from the day canter is provided by families, the amter, HCEOC, Coordinated Services, and the County's taw share-ride progrm 5 Hawan Island Adult Care, Inc F, val 'on: 1) What Process will be used to evaluab the program and service(s)? Program. Hawa+i Island Adult Care, Inc is licensed by the Department of Human Services and operates accord+ng to their regulations We submit detailed monthly and quarterly reports to State of Hawaii Department of Human Seances, Hawa+i Island United Way, Hevva++ Community Foundation, and all other granting agencies. We are evaluated and audited annually by the Department of Human Sernces for both the funding programs and for I+cens+ng ernces• Staff are assigned individual participants to monitor and manta+n these partiapants' individual progress reports which indude +nfomtation on personal hygiene, physical appearance, mental attitude, interaction with others, activity level, and other observations Data is collected from these reports and attendance records to evaluate current services An annual anonymous survey will provide documented information on the program for satisfactionlcare and activit+es, for program self-evaluation and improvement F. 2) How wilt this process measure ttro outcomes spacifled to Item D, (1~)? Individual partiGpant progress is noted in the Progress Reports updated monthly. Quarterly and semi-annual reports aro generated from these monthly notes. Attendance records and the survey Nell provide documentation for the outcome measurements. G. Program Fees: l) Does your organizstlon ehargs a membership fN for service participanb? No G. 2) Does tM proposed program charge participants a fee for service(s) provided by your organization? 1) Yes, please gee attached tuition fee schedule. Attachment ~1. 2) Our regwst for Z/0,000 is targeted to low income partidparrts to ~a~@ tuition teas. Parhdpartts' income dstemtinas their cosUshare. Through our scholarship grants program and/or through community agendas, our goal is that all individuals requesting to attend the center are able to do so regardless of their finanaal abilities to pay tees H. Viability: 1) VYhat is your Justlfkation or rationale for the sxpendHurs of public funds for fire proposed program9 Our justification for the expenditure of public funds for day cars tuition scholarships is the cost effectiveness of our d,arges, 6825 monthy per parson (fulttime attendance) as opposed to 38,1)()0+ of AAedicaxi funds for long tens care institutionalizatlon per person monthly. The nursing home Is often to onry other alternative. Statistics show that in Har+a?i, 8096 of all nursing home dients' costs are paid by the Department of Human Ssnricea AAedlcaid program. 6 Hawau Island Adult Care, Inc Although not dowmented, it is known that supennsed day time asre prevents hospitalization from falls and injunes, and a healthy mental state deters medical problems. Hawaii Courrty funds will give the elderly and handicapped, the opportunity to remain a part of our commundy and also save tremendously on hospitalization and long tens taro Msdia~id and Medicaro tax funds, e.g five pertiupants in day care who might otherwise have been institutionalized, yields a Media~id/Medicaro tax savings of 528,875+ per month Additionally, secunng the elderly the nght to a quality life, the opportunity to live independently and remain at home to the end of their lives should be a top societal pnorrty H. 2) What aro your financial and programmatic plans to sustain the proposed program beyond the upcoming fiscal year? 1) To provide continued community awareness of our program and to reach as many people as possible. 2) Continued Brent appliartions for the low income elderly, and continued research into the possibilky of Mediasid and Medicare funds paying for those requiring day care. 3) To continualy look for new ideas and variety to upgrade the progrem to make k the best vre a~n for our partiapants and their families. The increasing number of Alzheimars disease participants has prompted a completely separated program geared stnctly for their needs. QRGANIZATION/AGENCYlNFORMATION: A. $oard Of Directors: 1) Has the oryanizatlon's board of diroctors received formal training within the past two (2) itscal yearsT No. A formal framing session is planned for March of this year, faalitstsd by Helen Hsmmes of Hawaii Island United Way. New members are voted on the Board every January at the annual meeting. Board training wNl be planned for February or Maroh of each year, or in coniundion with Board treininga offered by Hawaii Island United Way or other community agsndsa. A. 2) What aro tM primary roles and rssporrsibilitles of your organi:atlon's Executive Director? ¦ Overell management and direction of Hawan Island AduR Care, Inc. and all duties aasigned by the Board of Directors • Implemenhfion of policles and evaluation of all programs of ttie orgarnzation. ¦ Coordinating and managing the process of intake, case management, and required reportirq to all agendas and foundations. • Responsible for the applications/reporbng to all granting agenaas and adminiatretron of the Persons-In-Need program. . 7 Hawarr Island Adult Care, Inc A. 3) What are the primary roles and responsibilities of your organization's board of directors? H I A C's bylaws state Powers and Functions The Board of Directors shall be the governing body of the corporation wrath the full power and authority to manage, oondud and control the business and affairs of the corporation All actions taken by the Board of Directors shall be deemed to be the acts of the corporation Please see the Bylaws in Supporting Documents which defines the roles of the executive officers B. Past garformance: 1) How effactlve has your organizatioNagency been in achieving program goals in the past two (2) flacal years? a) Quantitative data on numbers served Approwmataly 350 frail elderly and handiarlpped partiapants were enrolled in the Hilo Aduk Day Center dunng the past two years. b) Qualitative data shownng number and % of aarUaoants achieving measurable outwmes Based on the 350 partcipants served during the past two years: • 315 (90%) maintained or improved their socializationlnteraction skills. • 332 (95%) attended the center at least sa months consscutiwly, the majority of our clients are long term participants attending more than five years • C+ver 95% of participants and a>frsgiwrs have expressed satisfaction with services • 340 (98%) showed their hygiene/self was maintained or improved. Uwng sitwtion status: 165 (30%) lived independently. • 35 (10%) in pnvate a;Ire homes. • 210 (80%) lived with family, spouse, or hired a;trsgiver in their own homes. C. Financial: 1) Haw your oryanizatlon'a currant program operations rsmralnad the same as last yeah What maJor program or flnanelal changes will ba incumd next yah Yes, the program has remained the same except one change last year we applied to the Department of Education, Child and Adult Caro Food Program (USDA) for our lunch program at the a>tnter. It started in November and will have a small nagatnro impact on the day center budget. We put in a slight tuition rate increase begun January 1, this year, to offset the lunch progrem's additlonal costs, and irxxeases in afaf? medial insurance and gasoline for the vans No other maior program or finanaal changes are expelled or planned 8 Hawaa Island Adult Care, Inc C. 2) What is the status of all of your oryanizadon's major contracts or agrosments for the coming year (employment apnemsnts, office teases, primary grant rewnueisuppller, etc.) Our contacts and agreements are with Department of Human Servia~s -Nursing Home Without Walls, Serviajs for Senors, Adult Protective Services, May Templeton Hopper Foundation, and Office of Aging, Hawaii County are on an annual basis This year, is the renewal of the Department of Human Services contrect for the next four years, the final outcome of what the grant amount will be will not be known until the state Legislature allocates the funds in the late spnng. We have a ten year agreement with the County to lease our spaaa at 34 Rainbow Dnve for $1 00 a year, renewed on February 17, 1998 C. 3) How doss the proposed program fft Into your organization's long range financial plan? The adult day program is the morn fnancal entity of HWC and is the main focus of our organu.ation's efforts and planning. To keep the day center finanaally stable we need a regular attendanas of approwmatsly 80 diems. We live in a finanaally depressed area with a malonty of our target diets population being low-income. This proposal would meet the financial need (for diets and aMSr), as we rrorttinue to search for other types of income to assist these ekieriy m attending the center D. Monitoring: 1) During fire past two (2) fiscal years, what fnanclal and/or administrative monitoring has your orgardsadon reafved from any and all funding sources4 DeoartmeM of Human Servicsa• Lenore Kozohare. 933-8820 Laura Giddsns 588-5872 Hawax Island Unked Wav: Helen Hsmmes...... 935393 Adult Protechw Services: Norman Nishiki..... 933-8820 Nursing Home Without Walls: Jan Nakahare....... 933-8820 Services for Seniors: Debbie Ishado....... 935-1144 Cass Mart-acement Judy Akamine......... 974-8025 Hawaii Community Foundation: Steven Kaneahiro.... 888-731-3883 Prog?am OtTicer lor. May Templeton Hopper Foundation Afia~ M.G Soper Fund Teresa F. Hughes Fund Gwenfread Allen Fund Theodore Viers Fund Office of Aging. Hawaii CouMv. Dennis Shigsta...... 981-8800 9 Hawax Island Adult Care, !nc E. Alcohol. tobacco and dru4~res workolace oolicfas and indormation• 1) How does your organisation address alcohol, tobacco, and vtMr drug prevention information dissemination as part of your workplace and/or program envfronment7 All employees are issued the personnel polices, and the polices are reviewed Meth all new employees. Posters and bulletins are displayed for all employees on all pertinent matters HIAC's Personnel Polices state POLICY• HIAC is a drug and alcohol free workplace. PROCEDURES 1 To promote this goal, employees are required to report to work in appropnate mental and physical condit<on to perform their lobs in a sahsfadory manner 2 To maintain healthy and pleasant working condihona, smoking Mnll not be pennrtted wdtrin the buildings, or program offices in which HIAC conducts business. "No Smoking" signs will bs visible in all program and common areas 3 While on HIAC premises and while conducting business-related activiCes off HIAC premises, no employee may use, possess, distnbuts, salt, or be under the influence of alcohol or Olegal drugs Viola~on of this poliq may lead to diadplinary actlon, up to and including immediate tertnina6on of employment, and/or required partidpation in a substance abuse rehabrlitaton or Vestment program. Such violations may also have legal consequences. 10 NARRATIVE ATTACHMENT l~l Hawau Island Adult Care, inc. Fo= Question G. 2 pa e S Hilo Adult Day Cerrter ' Schedule Of Rabas Effective January 1, 2001 Idonlh ttiales Private Tuftlon tea, pM TudfoN/?eelst. Total Total Full Dav 1 Daypsrweek 3?A0.00 i1S.00 3255.00 2 Daya psrweek 3385.00 320.00 3405.00 3 Days par week 3550.00 330.00 3580.00 4 Wya PK wNk 3000.00 310.00 1840.00 Full Tims 3510.00 380.00 3890.00 ~OIL.QSY 1 WY PK~~ 3200.00 315.00 3213.00 2 Days per week 1340.00 320.00 3300.00 3 Wye perweek 3430.00 330.00 3480.00 4 Days Per week 3475.00 340.00 3615.00 S Oays P~~ 3500.00 360.00 3550.00 Holiday closures may be made up at the PeAldparne' ditoetlon "AsaWna - gehtarres wlth embu{etlon. hnteierdrtq, toflelhrp, andlor psrsonel care Other Foss Intake proceeetrq fee (one tkns only) 350.00 t3hampodBlow Dry (per shampoo) 37.00 Beth (per betlt) 315.00 tkfl HyOlene 113.00 Feedtnp 330.00 ttAsdiaal ellan Oral 320.00 Iryecffon .11A ar SC (per shot) 525.00 tipeclel t3ervioe Fee gee Peps 2 ZMnwd 4/27100 Pepe 1 Retet.~da Hilo Adult Day Center Spacial Service Fee Scfiedule One Ride Per Dry 7AM 11Week ?IWeek 3IVYesk 4Mfesk EV 0 A S 1 .00 i 21.00 i 20.00 S 37.00 S 47.00 s • 1 .ao s .oo s 36.ca s 45.ao a s7.oo C i 1 00 S 27.00 i 31{..00 i 40.00 5 63.00 D i 100 S 31. 44.00 87.00 S 00 ' E .00 i .00 S S 63.00 F S .00 S 37.00 I i .00 S 60.00 S 10.00 Tti,ro Rides Per Dry Zoos 1AMssk 2/1Nesk 3lWesk UWsek Evero D A 2.00 S 37.00 S .00 S .00 S 60.00 B i .00 S 48.00 i 68.00 i 66.00 3 110.00 C .00 S 40.00 S 00 .00 i 120.00 D ti 3.00 S 57.00 i S 100.00 S 141.00 i 00 : i S 1 .OD ; 162.00 i .00 S 60.00 S 101 S 133.00 i i .00 Per Trip zoos A = 3.28 8 3.75 4.00 0 4.60 E 00 ~ o ~ ~ o 0o au rn oo vNi ~ ~ rn oho n N N ~a {y ~ W p Tp O rO o L N O ~ ~ N S fO M r ~ i {y O Vl M ~ O~ ~O V1 E& ~ Y ~O 00 - M rf N N N ~ vMj a ~m~ ~ 0 G +r II Y! ~ LL G h $ ~ g g ~ b y Q ~y o~ vi v~ ,i Y C O ~ ~ a M rf N rf ~ ~ yC 3 ~ v ~ ~ W L O ^ h m 00 Z 8 ~ N 8 ao dJ ~ ~ O h M ~ ~ ~ ~ ~ O U V ~ t~+~ M N ~ ~ N ~ ~ 0 0 F U a W (7 h m ~ V J~ $ g $ c ~ g g a °R e~ M ~ n °i r 0 ~ c ~ ~ ~ ~ 'p ~ ~ ~ ~ w ~ w ~ ~ N ~ N ~ ~ a ~ ~ ~ C a o ~ ~ y ~ _ ~ ~ ~ ~ ~ s ~ C u _ ~ O ~ O 8 c ~ w ~ ~ ~ ~ ~ ~ ~ o " ~ ~ ~ ~ ~ ~ ~ E~ ~ ~ S ~ ~ ~ ~ ~ $ ~ ca ~ ~ ~ ~ 3 ~ ~ x ~ ~ c~a ~ W - F Z F Z F Z F ~ F ~ F 2~ F Z ~ O y ~ ~ N ~ ~ h ~O t~ Q Q ~ Z o o o C M 00 R ~ (V ~O O ~O ~D ~O O ~D n Q ~ d ~ v~ N vi vi v~ oo ~n Np N m m ~ a ~ - o A d } ~m~ ~ D 7 ~ (/J o g o 0 o r o o L~ ~O ~O ~O app a ~ h N N V1 h 00 V1 op0 N L O ~ ~ 00 R of ~ ~ ~p ~ t~ ~ O pig ~ ~ w d W m~ ~ a ~ ~°o r E 2 ~ g ~ $ g g r I~ ~9 w ~ W ~ ~ ~ ~ 00 ? 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E.otw v, co O Z~°'La a W'~=~~ ~~pp~~ ~~~pp~~~~pp ~7 aN--~ ~ti ~N 'st Nt0 r r ~ !9 g g g a C O L ~ O ~ O O ~ mom, OGDtpOfh Q D) U ~N ~ a ? C m ~ a~ 0 _ W _ O l0 ~ 10 !p W C ~ O F- C C H U ~ ~o CLL ~C ~~LL~ C E m ~ m~ ~ N m ~ ~a=y a~a~ Stephen K. Ysmashuo •~-'c;~ Hefty A Takalwhi Mayor ~ Director COUN'T'Y OF ~EYlti4l`I DEPARTMENT OF FINANCE 25 Aupum Strew, Room 1 I B • Hilo, Hewni %720.4252 (808) %I-8234 • Fu (808) %I-8248 HAWAII COUNTY NONPROFIT GRANTS (FY 2001-02) FINANCIAL QUESTIONNAIRE Please include as as attachment an explanation for all "NO" answers to questions #1 thni #I 1 below: Yes No © ? 1. Has the agency operated continuously for the past three (3) years? ® ? 2. Has the agency operated with a positive cash flow for the peat three {3) years? © ? 3. Does your Board of Directtxs approve a detailed cash flow budget before the begmaing of each 5sca1 yeaf? ® ? 4. i>o your Board meeting minutes show that quarterly financial statements are approved? © ? 5. v your egwty balance at least 20% of your Total Liability balance? ? 6. la yourTotal Cumeot Asset balance largo than your Total Current Liability balance? ® ? 7. Are bank reconciliations and accounting performed by someone other thaw the check signatory? ® ? 8. Are you fully insured for the agency's vehicle(s) and btuldmg(s)? ® ? 9. Is your Workers' Compensation at least 2% of payrollT ® ? 10. Are you ctirreot (non-delinquent) on all payroll and payroll tax payments? ® ? 11. Is the agency free of any pending litigation, liens or judgmems? ? ® 12. Within the past 12 months, has Ute agency applied for vendor or bank credit and was denied credit? If yea. please explain. As the grant applicant, I entify that rlis ogtnry)wr satLrjacrorily rapondd to each ojrhs above gaations and eaplainad as needed. I hu,eby eerrtjy that thin infointaafon v ttvs and comrct to the bat ojmy b+owlsdgs. Agency: Hawaii Island Adult Care. Inc. Phone: 961-3747 Prepared by: Paula Uuaitalo-Fiscal Officer ~ c_ ¢s' ~~°/d/ Pnoi Nesdl'uM yeeme Deo°~ ~ Certified by: Carolyn Cabreira ~;~pl PneiNem°otEsanmveDua~eor S~prtw uw JENNIFER L. GOSSERT CERTIFIED PUBLIC ACCOUNTANT An Accounting Corporation HAWAII ISLAND ADULT CARE, WC. FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30,1999 (WITH INDEPENDENT AUDITOR'S REPORT) HAWAII ISLAND ADULT CARE, INC. TABLE OF CONTENTS Independent Auditor's Report 1 Fuuncial Statements Statement of Financial Position 2 Statement of Activities 3 Statement of Functional Expenses 4 Statement of Cash F1ows 5 Notes to the Financial Statements 6 Ct:Rn~v pusuc ACCOUNTANT' Aa Aocouadai Coryoradon 688 IGaoole Stseer, Since 201 • Silo, I~ta+vaii %720 • Phone (808) 9693115 Fate (80819697463 IIQDEPENDENT AUDITOR'S REPORT The Board of Directors Hawaii Island Adult Care, Inc.: We have audited the accompanying statement of financial position of Hawau Island Adult Care, Inc., (a nonprofit orgaaiutioa) as of June 30, 1999, and the related statements of activities, functional expenses and cash flows for the year thin ended. These 5nancial statements are the ralponubility of the Orgarliratioa's management. Our respoaslbiiity is to express an opinion on thane financial statentents based oa our audit. We conducted our audit is accordance with geaaally accepted auditing standards. Those standards require that eve plan sad perform the audit to obtain reasonable asauance about whether the financial statements are free of material misstatement. Aa audit includes exA+_.:_++i~g, on a test basis, evidence supporting the amourrts and disclosures in the financial stateatetlts. An audit also includes assessing the accounting principles used sad the significant estimates made by mamgement, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for ow opinion. Our audit was perforsned for the purpose of forming an opinion on the basic 5nancial statements of Hawaii Inland Adult Care, Inc. taken as a whole. Ta our opinioq the financial statements referred to above presenc fairly, in all material respects, the financW position of Hawaii Island Adult Care, Inc. as of June 30, 1999, and tha changer is its net assets and its cash Sows for the year then ended in conformity with generally accepted accounting prinaples. January 18, 2000 1 HAWAII ISLAND ADULT CARE, INC. STATEMENT OF FINANCL4L POSITION June 30, 1999 AiStli i-~abilines and Net stet: Cyurent assets Current liabilities: Cash and cash equivalenu S 70,844 Account payabk S 14,456 Gimt aocomtt nxivabl4 na Atxnred payroll and related etallowaoce 64,923 liabilities 15,985 Unoooditiaoal promise to give 9,750 Rd'uadable advance 20,211 Prepaid otpeasa 8.279 Other iabillties 4.04 Total current liabilities 34-686 Total tatrreat assets 153.798 Total liabilities 34.686 Noneuereot assns: Net asters: Restricted endowment fund 33,900 Uotettrttxed 100,610 ~Y sad ~P~t. ~ 23.733 Temporarily restricted 22,233 y Permaamtiy restricted 33.900 Total noncurrent assns 37.633 Tool >~t asses 7as Total assets S 211 _a31 Total liabilities and na assns S 211.431 See aooompanying moa to 9naaeul statemmes. 2 HAWAII ISLAND ADULT CARE, INC. STATEMEM OF ACTIVITIES June 30,1999 Unresfziaod Temporarily Permanently Funs: Restricted Rettrreted ch.o8a is ner asses: Public Support and Reveatrec: Public Support: state of Hawaii Department of Human Services s 120,148 - - 120, lab Coumy a[Hawsii O16oe of Agog 2,313 - - 2,315 County of Hawaii Deparmuat aS Finaax 19,000 - - 19,000 Coutributiom: Hawaii Commuarty Fouadatioq May Templetaa Happy - 50,933 - 50,953 Hawaii Lriand Umted Way - 19,300 - 19,300 Private donatiorn 4,960 - 700 5,660 Equipment graaNt - 7,301 - 7,301 Grant mtnagmmt fx Pertonrin Need lVrnds 2,325 - - 2,325 Combined Federal Camparga 2,339 - - 2,339 Mcineray Farodanon - 20,000 - 20,000 Aloha Cate - 5,000 - 5,000 Mitcetlaneoas Gnau - 3,241 - 3,241 Revea»a: Client tuition aad feet 475,!)68 - - 475,068 Coarribroed !pace 24,000 - - 2a,ooo Renul income 8,142 - - 8,142 MiseelLneoas reveaue 147 - - 147 Special events 6,680 - - 6,680 Inwtytiacome 879 - 1,118 1,997 Net assets released from ratrictiaos: Satitfaaion of time restrrctioas Hawaii Island United Way 19,500 (19,500) - - RestricLOnt ssti~ed by Phu 74.210 R4.2I01 Total tevemu 759,713 12,485 1,818 774,016 Program tervran 638,820 - - 638,820 Supptnt services SS•892 85.892 Totai etcpartes n4.712 724.712 Ltaeate (decrease) is net artery 33,001 12,483 1,818 49,304 Net assets, begioamg of year 63"609 9.730 32.082 107.441 Netamts, cod of year j 10o.6jQ 33.900 1s6.74S See accompanying notes to 5tuocial statemeau. 3 HAWAII ISLAND ADULT CARE, INC. STATEMENT OF FUCTiONAL EXPENSES Year ended June 30, 1999 ProRam Admmtsnam'e Tool Sem°es ~8?GG>dL Salaries and related expeasea: Salaries S 332,042 33,494 407,536 Payroll taxes and employee beoe5ts 84.0 ~ 12.54_ 96.56 Other expenses: C7iem psopam expense 99,593 - 99,593 Ocespaory onas 36,607 - 36,607 O~ae eapeaae 12,127 1,238 13,363 ProQam soppiia 10,493 1,380 11,875 Insuraooa 9,555 1,829 11,384 Propam tranfporratim 6,243 - 6,243 Rapaira and msintenaace 10,346 303 10,831 PtafassiaoH Ew 3,262 8,308 11,370 Teival 1,071 47 1,118 SatTnamia; 1,806 759 2,565 Fseursians and events 930 1,373 2,323 FuodoisiaS expeofes - 1,207 1,207 Adverllsins and promotion 1.198 1.198 192,033 17,844 209,899 10.711 10.711 Total expenses S 638.820 85.892 724"712 See aotx>mpt?nyin~ Woos to 5naaeial stmts. 4 HAWAII ISLAND ADULT CARE,INC. STATII~NT OF CASK FLOWS Year ended June 30, 1999 Cash float from opesanng aeannes: Cash raoeiwd 4om temot: roaprems S 473,808 Sate o[Hawaii Department of Human Services 90,111 Cash received floor other grams 132,383 Private dmttioat gad other income received 20,629 Ineerrat reotived 1,997 Cash Paid to eaployees (503,364) Cash paid to supplier: (178.7931 Net cash Provided by opaatiag aaivines 34.371 Cash float $om iovetttng agivities: Cash:estncted for eadowment fund (1,818) Purchue of assort (12.9871 Net cash used by umstmg activities (14.8051 Net ingrate in cash gad cash agrrtvaleots 39,766 UmesniUed cash and ash apuvakats, be8innmi ~Y~ 31.078 Uaresvictod eaab and ash equivalents, end of year ~Q,~¢ Recondliation of change is sra assess to net cJth Fronded by opt7anag activities: Change is net ataas S 49,304 Adjusnoems W roconcile change in net autxs to net cash pmvrded by operating activities: Depredanoa and amortiation 10,711 Increase is grants rroervabk (30,037) Increase is client aocotrnts receivable (1,260) Dege~ae in prepud expeaaes 2.786 Ingote m aecoonu payable 3,084 Degease in aeguod payroll and related liabiLues (1,462) Lscrnse in other liabilities 1,234 Increase in retimdabk advance 20.211 Net cash provided by opeonng activities S 34.371 Theo were ro nonah firunciag or itrvating acnvitirs for the ynr ended Jooe 30.1999. Sa accompanying notes to flnaocial n.e~~_. 3 HAWAII ISLAND ADLJ!-T CARE, INC. NOTES TO FINANCIAL STATEMENTS June 30, 1999 1. StTI_~tM_ARY Op cIGNIFIC'A_rrr ACCOUN'I'L?~?G POLICIES ~DCIHI Hawau Island Adult Cate, Inc. (HIAC) was established on October 21, 1981 under the Taws of the State of Hawaii. HIAC was organized exclusively for the charitable purpose of providing Protective sad supportive care for flail, elderly and disabled adults on the Island of Hawaii. HIAC's Senior Hdpea program serve clients sad their fiuat7'ies is their homes and is the tommnnity. it operates a small ll~P Hsfe ~ Provide housing options for some of the elderly clients. HIAC mceives a substantial amount of its funding from client tuition sad fees and from State gretrts. The accompanying financial statements of Hawaii Island Adult Care, Inc. are presented in accordance with the staadatds of accouting and 5aancial reporting prescribed for not-for-profit organiutioas. In accordance with these staadsrda, the following accounting poGaes applicable to not-for-profit organisations are used by the organization. A r+++r~ A~'e~~a The organization reports its financial position and activities on the accrtrd basis of accounting in accordance with generally accepted accounting Principles and the AICPA industry audit guide"Not-For-Profit Organizations° Cash and Cash Epyi~ For purposes of the statements of cash Bows, HIAC considers all highly liquid investments that are available for current use with as initial maturity of three months or less to be cash equivalents. Promises to Give Contrtbutioos are recogoirsd when the donor makes a promise to give to HIAC that is, in substance, uaco~itional at the time of promise. Coatdbutiotu, grants and other sources of fimdiag received are recorded as uarewicted, temporan'ty restricted, or pertnurmtly remitted depending oa the existence ar nature of donor-imposed restrictions or stipulations. Corrtributioas that are restricted by the donor are reported as iaca'esses is unrestricted net assets only if the nestrittiona expire in the fiscal year in which the wntn'butiom are recogrrized. A1! other 6 HAWAII ISLAND ADULT CARE, INC. NOTES TO FIIdANC1AL STATF.1?~iNfS (Continued) hme 30, 1'999 donor-restricted contribution are reported >a increases in temporarily or pamarreatly restricted net wets dapendiag on the nature of the restriction. All unconditional promises to give am for a period of one yar or lest, th«dore HIAC hat not discoumed the value of the unconditional promisee to give. Pesrnanently restricted net assert are gigs and bequests that remain intact n s result of r+estrictione placed on the assert by the tetpecxive donor: or the Board of Director. HIAC hat eatablithed an mdoavnrem fund to segregate ip psmaoemly restricted ~t assets. The assert are held in invatmerrts with income 8rom such iavettmmtt to be used at the Boerd's disa~etioa Dutittg the year coded June 30, 1998, the Bond elected to add the income to the eadowmem fund. Of these pamanemly restricted net atseu held in the endowmem food, 57,398 era pemtnmtly restricted outside donor, and 526,502 have been designated as pamat>mtfy restriged by the Board ~Diractors of Hawaii Island Adult Care, lac. „ Although the current board's meat u to pamanmtly restrict these wets, the restrictian over the 526,502 of board designated asses could conceivably be reversed in the Srture. Temporarly rdtricted net aseets reflect donor stipulation placed on grants sad comnbutiom. such retbrictions maybe met in the tame year that the contributions are received or carried forward to subsequent flaal years. Therefore, FIIAC hat adopted the poticy of recording these contribution u temporarily restricted net attests that diher expire with the passage of time or aro flrlfiAed sad moved by action of the organiution purwam to the donor's wishes. Unrestricted net assets reprasem raaourcet over which the board of dindon has discretionary control. Whey a restriction expires, teaaporarity restricted eat assets are n~Jatsifled to unrestricted net aesett. HIAC has adopted the policy of rocading uara:triued gigs of long-lived assets as contributions inaaaeiag unrestricted net a:ew. ReSurdable Advance Hawaii Island Adult Care, Inc. records certain gram. revenue as a refundable advance umil it it expended for the purpose of the grant, at which time it u recognized ere rovarue. The bahurx in raflmdable advance at June 30, 1999 was 7 HAWAII ISLAND ADULT CARE, INC. NOTES TO FINANCIAL STATII~N}T5 (Coatimred) June 30, 1999 520,211 and represetus atnottots received under cataia grant agreenteats that wll be expanded in the naa fiscal year in aacordance with the gnat raquirameats. Donor-ComroLed Su~ort of Ldi~+ ++>>s Hawau Island Adult Care, Inc. durburaa pats-through Pesaonria Need monies to third party vendors oa behalf of ~igt'We iodividtrals within the qty at huge. These grants from private fi~ are awarded thcottgh the Hawau Community Foundation. The Tarots F. Hughes fitnd aisists individuals age SO and ova. The Crweafread Allen food assist eldaiy individual 62 years a olds. The Alice Soper Fund assists individuals age SO sad aver. The Theodore A Para Fund assists persons ova the age of SO yenta, who aro t+aidmts of East Hawaii with raourcea insufficient to meet their needs. With respect to these coturibtm'otu~, H1AC has ~ discretiowry contml ova the awarding of the assistance. HIAC saves ody as a conduit between the grantor sad third-party recipients re!'erred Snm other human sarvicp agenda. Any y unused fittxis at the and of the great period must ba returned tp tha grantor. In accordance with Statements of Financial Accounting Standards ttttmber 116, the otganiation has recorded thesedonor-designated gttum as other liabt'Go'a, and ao revenue or expense has bean recognized wept for an administrative fee alloatcd to HIAC by the donor fiord, tort to exceed SYe of the gent amount. Donated Facilities Hawaii Island Adak Carr, Inc. uses a portion of the old Hilo Hospital oa Rainbow Drive for Sl pa yar wader a lase from the Coumy of Hawaii. HlAC records t1u noon of space both as public support sad ocatpaacy axpansa at the estimated market value of SZ,000 pa month or 524,000 per year. The lease expirrs oa February 17, 2008. Donated property tad mste:ials are re~9ected as cotrtn'butions in the accomparryirtg Snaadal ataumaus at their estimated vahtes at date of receipt. A substatrtW auraba of volumears have donated their titer sad talema to help restore sad tnaiatain Hawaii Island Aduh Care, 1ac.'s fiunlitia sad to enrich the a HAWAII ISLAND ADULT CARE, INC. NOTES TO FINANCIAL STATEiv>EN'P5 (Coatimred) Juue 30, 1999 quality of its program services. However. rm amounts have boas reflected is the axamptnyiag Snaacid statameob for these dooatad services sitt+oe no objective base is available to measure the vahre a~f such services acct the recording of such donated services is not required under SFAS No. 116. T»x.Slaltalat The Corporation is dassi6ed u atax-exempt orgaoiation other thaw a pm~ato formdatioa under Section SOl(cx3) of the U.S. Tateraal Revenue Code acct is exempt Snm Federal sad State income taxes. Falimaatsa The preparation of fioanaal status is conformity with gmeraily accepted aaou~ principles require maoa~ to make aatimates sad atanzeptiom that aS6ct the reported amounts of assets sad 6abrlitiaa and disclosure of oorningmt asserts sad liabrl'tiea at the date of the Scandal and the reported amamts of revmres sad mrpmses during the reporting period. Actual reAdts could differ flora those eaa. 2. ACCOUNTS RECEIVABLE As of June 30, 1999, accounts receivable consisted of the following: Day are services receivable S 18,253 Sector Helpers services roceivable 17,819 State of Hawaii Department of Human Raaourcea 30,037 Other receivables 255 66,364 Allowance for doubt5rl accounts (1"4391 Net recavables 3. Unconditional promises to give consists of Hawaii Island United Wsy support which has been pledged on a aleadar year bags through December 31, 1999. 1a accordance with SFAS No. 116 thu pledge has been warded is the accompanying 0 HAWAII ISLAND ADULT CARE,INC. NOTES TO FINANCIAL ST'ATF.MENTS (Castimred) June 30, 1999 fmtacid statements presorted at iu Shc aoa-di~coumad Sce value since it w~ be received sa momhly WYmmts within a one yer period. 4. ~P~Y ~ equipment is stated at cost or at its doeted vahra Depredation is ~g ~ atnight-lips method over~the estimated usefirl li8e of the assn which may range $+om S to 15 years. As of June 30, 1999, peoperty and equipment coruisted of the following: Eq~Pm~ S 140,462 Vehicles 22,181 ~O~' ~ ~r'ov~s 13"71 g 176,361 Accumulated depreciation Net property and equipment S 23.733 5. r~ Nt~r~Ter PLro ?cF OF ~t^CE A_rv°J GRstv'TS ~r of Xa~«aii Depm»rwrrt of Hw»mr Resorr+cw - Hawaii ]shad Adult Care, Inc. is render oorrtracx with the Department of Human Service to pravids day are service fbr the 8rar~ ddariy and disabled lorv-income reddmu of Fiat Hawaii. Revemre $om this contract in Sscal year 1999 was 5120,148. Caorty of Hawmi -Hawaii Island Adult Cara Inc. is under contract with the County to maintain a small group home, Hale llaprrna, to provids residemtid service for the Bail eldaiy sad disabled bw-iaoome reidtats of East FLwau Revenue 5om this oantract is lisal year 1999 was 52,31 S. Funding under each purchase of service oomracts is subjax to the availsb~7ity of tFaads Rom loaf goveramamtal units and may bs mrbstantially reduced co short not>x by age ~ program requirements. Funding for thes programs is also oomrogeat upon satis6cxory paformaoce by Hawaii Island Cara Inc, in accardarrce with the teams of the coanads. in Taketa, IWata, Hara C8~ Associates Certlfled Public Accouataata HAWAII ISLAND ADULT CARE, INC. FINANCIAL STATEltAENTS FOR THE YEAR ENDED JUNE 30,1998 (WITFI INDEPENDENT AUDITOR'S REPORT) maple or contents Paces Independent Auditor's Report t Fkrenael Sfa6xnents Statement of Finendal Positlon 2 Statement of Adivitles 3 Statement of Functional Expenses 4 Statement of cash Fbws 5 Notes to the Financial Statements 6 - A TAKETA, IWATA, HARA & ASSOCIATES CEATIFlED PUBLIC ACCOUNTANTS 101 AUPUNt STREET, SUITE 739, HILO. H1967~J GREGG M. TAKETA, CPA P O. BOX 1759. HILO, Hl 96721 •t'=3 BRIAN M. IWATA, CPA PH (806) 935-~ JANET W. HARA, CPA FAX (808) 969.1,59 INDEPENDENT Al!DITOR'S REPORT The Board d Dlreetora Havvatl Island Adult Care, inc.: We haw audltsd the accompanyutg statement d flnanr5al position d tfalnaN Island Adult Cara, Ina, (a nonproAt oryanmWon) as d Juns 30, 1998. and tt+s rslalsd alatemsnb d ac>Yvitlss, hsiWonsl expanses and cash Vows far the year then ended. These financW slalsmerts are tlts raaponslbYKy d the Organimtlan's martagament. Our nteponatbYfy is to aogsass an opktion an these tktandaf slatemsnts based an our audlL We conducted our audit in somrdartos with gsnerely accepted audlting standards. Those standards require that we plan and pericnn ttrs audft to atrtaln reasanaWs assurance about whether the flnarteial statements are free d material mNsbtsrnent. An audit hrchidas examtnrtg, an a fast basis. evidence suPPo~n9 ~ and dhrioauree in ttrs ttnarxx:ial etaEerrlanfs. An audk also Ir>chrdaa asseasmg the accountlrlg prir7ClpNs used and tits aignHlant astlrr>sties made by management, as wall as evattrsttrtg the avsreY flnaneW atatamerrt prassntatlon. Ws balfsw that our audit provides s reasonable boas for our oplnton. Our audit was performed for the purpose d farrning an apinfon on the basK: financial sfatemsrtts of Flawali Island AdWt Cars, Inc. taken at a whole. In our opinion, the fhtendal statamenb rsferrod to above present fairy, in ati materiel respects, the flnartclal poaltlon d hlawatl Island Adult Care, Inc, es of June 30, 1998, and the dtartgaa In des net assets and tts caett flows for the yesr than ended in confarmly Meth generally accepted acoountlrtg Pw• Aprtl 30, 1999 1 NAWAl1 ISLAND ADULT CARE. INC. Statement of Rnancaal Position June 30, 1998 Assets i!sbliitlea and Nat Assets Current assets: Current I'iabflltlea: Cash and cash equivalents $ 31,078 Accounts payable $ 11,372 Client accounts receivable, net of Acausd payroll end related Ilabilitias 17,447 allowance 33,828 Other liabflitbs 2,800 Uncondiflonal promise to give 9,750 Pnspaid expanses 11,085 Total currant liabilities 31,819 Total current assets 85,521 Total liabiliflea 31,819 Noncurrent assets: Nat assets: Rastrfcted endowment fund 32,082 Unrestricted 85,809 Property and equipment, net 21,457 Temporarily restricted 9,750 Pennanentty restricted 32,082 Total noncurrent assets 53,539 Total net assets 107,441 Total assets $ 139,080 Total Ifabilities and net assets $ 139,060 See accompanying notes to flnanclal statements. 2 HAWAII ISLAND ADULT CARE. INC. Statement of Aehvrtles Year ended June 30, 7998 Unrostrlcted Temporary Psnnanenty Funds Restricted Rsatrirted Total Chanpss rn net assets: Public SuppoR and Revenues: Public Support State of Hewes DapartrnaM of Human Services S 120,148 - - 120,148 County of Hawaii pl'flee of Apirp 2,315 - - 2,315 Contrtbutlons: Newell Communuy Foundatlon, May Templeton Hopper - 48.858 48.856 Havrall Island Unftsd Way - 27,788 27,788 PAvab donations 8,198 - 1,625 9,823 EQWPmant pnnm 8,01)0 - 8,000 Grarrt manapemerrt fee Persons-in-Need Lunde 1,738 - - 1.738 Combined Federal Campapn 1,811 - - 1,811 Ravsnuae: plant tuftlon and fees 448.540 - - 448.540 ConMbuted space 2,4,000 - 24.000 Rsr>ml mmme 8,135 - - 8,135 Mleeellaneous revenue 5,316 - - 5,316 Spacial everrts 4,893 - - 4,893 Interest income 720 - 7,225 1,945 Net asssb rolaaead fmm rostrktbns: Satle(actlon of time roatrteeons Hawaii Island United Way 18.038 (18.038) - - Rssbiceone aatlslled by paymerMS 54,858 (54.858) - Total rovsnus 898,108 9,750 2,850 710,708 F_xpenus: tatvlGa 818.132 - - 818,132 Support eervwss 88,057 88,057 Total eurpanaq 704,189 - 704,189 Increase (deasaw) In net assets (8,081) 9,750 2,850 8,519 Nat asaete. baplnMnp of Year 97297 - 3,625 700,922 Net assets, beforo transfer of board designated funds 91,218 9,750 8,475 107,441 Tronshr to endowment fund (25,807) 25,607 Net assets. end of Year S 85.809 9,750 32,082 107.44 t ~ ~ i See accompanying notes tD tinandal stalaments. 3 HAWAII ISLAND ADULT CARE, INC. Statement of Funetlonal Expenses Year ended June 30, 1988 Program Adminlstratlvs Total Services Servkss eases Selanee and related expenses: Salarlss S 331,711 57,853 389,384 Payroll taxes and employee bsneflta 82,821 13,483 98,304 414,532 71,138 485.688 Other expenses: Giant program expense 89.184 - 89.184 Occupancy eosts 38,717 - 38.717 Of(Ice expense 11,380 1,072 12.452 Program suppNq 11,070 - 11,070 Insurance 9,171 1,829 11,000 Program transportatbn 10.544 - 10.544 Repairs end malntsnenee 10,484 - 10.484 Frofsesbnal fees 2,840 5,708 8.348 Tavel 1,714 3,802 5.518 Staff ftalnin9 3,831 1,318 4,947 Excurabns and evsrds 1,840 1,070 2,910 Fundraising expenses - 1,124 1,124 Advertlung and promotlon - 1,000 1,000 Bad dstrt expense 82 82 188,457 18,921 205,378 Depredation 13,143 - 13.143 Total expenses S 818,132 88.057 704 189 Sss aceompsnyirp rates to flnandal smtsnronts. 4 HAWAII ISLAND AOULT CARE. INC. statement a Cash Flows Year ended June 30. 1998 Cash Vows from operating actlnUea: Cash received from service rsdplsnts S 429.688 Stets of HawaN Departrt~rd a Human Ssrnces 140,173 Cash received from other grants 81,158 Private donatlons and otltar Income received 25.510 Intarestrecalwd 1,945 Cash geld to employees (483.189) Cash ~ ~ (185.421) Nat cash provided by operating aetlvitles 9.884 Cash flows from ~mastlnp actlvitlea: Cash rptrltxad far endowment fund (32.082) Purchaas a spats (12.825) Retlnxnsnta and delstlons a assets 12'084 Net cash used by investing actlviUas (32.8231 Nst Increase In each and eaah equivalents (22.959) Unroatrfeted cash and cash equivalents, beginning a year 54.037 Unroatrleted cash and cash squivalenta, end a year 5..... 3~~ Reconaliatlon of change in net assets t0 net nsh prortdad by operating actMhaa: S 8.519 Change In net aaaab Adjustments t0 raconcde chsnge m net assets to net cash provided by 13,143 Depncfatlon and anwrtlratlon (2.457) Gain ~ sale of ssseta 20,025 Detraaae in pronto nceFvabls IntYeateln dlantaceountarseeivabls (18.770) (9,750) Ina'eafe in unecndltlonal prortiasa to plus (1.125) Inasaas in prapald sxpanaaa (1,815) Deapss in accounts payaDls 1,294 Increase in aeauad payroll and elated Ilabditlsa Ittcraaaa in other tlabllitlaa 2.800 Nat cash provided b1l opsratlnp actlvitles Suoolamenfal dlsdasure a neh flow Intonnatlan: There were no norncaah flnandnp or Inveatlnp actlvttles for the year ended June 30, 1988. Sea accompanying notes to financial statements. 5 HAWAII ISLAND ADULT CARE, INC. Notes to Flnandal Statements June 30, 1998 (11 Summary of Sionrficant Accountlna Pdicias General tiawait Island Adult Cars, Inc. (HIAC) was satabUstted on October 21, 1981 under the Iaws of the State of Hawatl. HIAC was organixsd atcdruiwly for the rJtarMaltle purpose of P~d~9 Protectrve and supportive cars for iratl, elderly and disabled adults on the island of Harwari. H~AC's Senior Helpers program serves clients and flrsk ferttUiss In their stomas and in the oammuntly. It operates a small group home, HaN Kapuna, to provide houatng options for some of site elderly diems. HtAC receives a substantiM amount of its 9 from client tuition and tees and from Sfats grants. The accompanying flnendal ststemsrrtt of HarwaN Island Adult Caro, Inc. ere presented In accordance with the standards of aocatrttlng end tinarrcial reporting prescribed far not-for~rotlt organixationa. in accordance wrth these standards, Mss idlowr,g aceountlng pdkiss applkxbls to not-for-profit organrzatioms ors used by the arganlaalort. Acr~tai Basta The arganizatlon reports its flnandal poeitlon and actlvides on tlts aaxtral basis of accounting m accordance with gsnsraBy accepted sccounthtg pnndples end the AICPA Industry audR guide 'Not-for Profit Oryaniutions'. Cash and Cash Eaulvdanta For purposes of the atetsmants of cash floors, HIAC considers aN ttighy Iiqutd Irrvastments that are available for currant use with an initlal maturely of floss morrfha or less to bs cash equivalsnta. Promises to GNs Contrlbutfons are recognized when the donor makes a promise to t~ to HIAC that Is, in substance, unconditional et ttre tkne of prorrtbe. Contributions. grants and other sources d funding recsrved are recorded as unrestricted. tempararYy reebicted, or pernanently restricted dspsrrd„g on the sxratence a pf dpnpr.krt~aQ ree4idl0M pr Corrtributlora Cat ere reatrided try the donor ors reported as irxxessss kt unrestricted rtes assets only if the restriotlons expire fn the flscst year m which the ConMbuflons ors racognined. All Diller donor-raClrtsd ca+trbutfa+s are reported as ktcreases M Nmporariiy or permanently restricted rest assets depending on the nature of the roetrictlon. All uncondi8onal promises to give aro for a period of ores year or less, therotore HIA,C has not dlscquntsd the value of the unconditional promises to give. PernanantN Temporarily Restrktad and Unrestrletsd Nat AsseU Permanently rsstrk:ted rat assets are gifts and bequests that remain intact as a rosuit of rostndions placed on the assets by the rsspsctlvs donors ar the Board of Diredors. HIAC tea established an endowment fund to segregate its permanenBy restricted net assets. Ths assets are held in inveatmsnts with ncoma from such investments to be used at the Board's distxedon. For the year ended June 30,1998, the Board elected to add the income to the endowment fund. HAWAII ISLAND ADULT CARE, INC. Notes to Financial Statements. Continued Of these parmanenty restnctsd net assets held in the endowment fund, 58.475 are permanenty raatncted by outsrde donors, and 525,807 have bean designated as psrmanerrdy restricted by the Board of Dirocxors d Hawaii Island Adult Caro, Inc. Although the current boards intent ~s tc permanently rsstrid these assets. eta reatrkdion over the 525,807 d board desrgnated assets could concervebly bs reversed ~n the futuro. Temporenly resricted net assets rsfiect donor stipulations Placed on gnants and contribudons. Such roatrfctlons may he met in drs same year that the corrtribudons aro rscenred or carried forward to subsequent fiscal years. Therefore. H44C tea adopted the pdiry d recording these contritxrtlons as tsmporamly rsstricted net assets that slater expiro with the passage d tkna or are hdfllkd and removed by actions d the orgartizadort pursuant to the donor's wishes. Unrestricted rret assets reprosant resources over whldr the txrerd d dkaetors has dfscradonary control. When a rptrlcdon expfrss, tsmporarurlyy rsstrided net assets aro rsclassdled to unrestricted net assets. HIAC has adopted the poHry d recording unrestricted gala dlong-INed assets as oontribudona increasfnq unrostrkted net assets. Donor-Corttroaad Suooort d Indhriduala Hawaii Island Adult Caro. Inc. disburses pass-through Persons-in Need monies to thkd party vendors on behalf d aaglWe mdhriduels within the cortrmunity at IWe. These grants from Private funds are awarded through She Hawed Community Foundatlon. The Teresa F. Hughes fiord sssists all eligible adults. Ths C~wertfread ANan fund assists elderly indtviduais 82 yeare ar alder. Ths Alice Soper Fund assists individuals age 50 and over. Tiro Theodora A. Marra Fund esWta Parsons over the age of 50 ysara, who are residents d East Hawall vvdh resources insuff~iant m Waal they needs. With respect to these contrfbutlons, HIAC has no diaeredonary control war the awarding d the assistance. HIAC serves only as a conduR between the grantor and third-party reapianta referred from other human aarviaa agendss. My unused funds at the end d the grant period must be rotumed to the grantor. M accordance with Statements d Finandal Accot~r?tk?g Standards number 118, die organization tros recorded these donor-designated gronb as other Ilabditisa, and no revenue or expense bast been recognized except for an edmuttstradvs fee edocatsd to HIAC by the donor fund, not to exceed S% d the grant amount. Qonated Facditfes Havveli Island Adult Cars, ins uses a pordon d the old Hilo Hospital on Raurbow Drive for 51 per year under a lease from the Courtly d Hawed. HIAC rocords the contrlbutbn d specs both as public support and occupancy sxparae at tiro estimated market v~ue d 52,000 per month ar 524.000 par year. Ths lease exp(res on February 17, 2008. Donated Prooarty and Materials Donated property and materials aro reflected as contribudons in Ilia accompanying finanual statements at their ssdmated values at date d receipt. HAWA11 ISLAND ADULT CARE, INC. Notes to Financial Statements, Continued Donated Services A substantial number d volunteers have donated their time end talents to trNp restoro and maintain Hawati Island Adult Caro, Int.'s fadlitlss and to enrich the quality d its program serv~css. However, no amounts have been roflected in the aooompanying flnandal statsmsr?ts far these donated sernces since no objecWe base is avaYade to messuro the value d such aarvias and the recording d such donated servxxs is not roquirod under SFAS No. 118. Tex Status The Corporotbn is dassiflsd es atax-exempt arganizatlon other than a private foundation under Section 501(c)(3) d the U.S. Intemd Revenue Cods and Is exempt from Federal and State income faxes. The proparotlon d flnanciel statsmsrrts in confarrnity with generally accepted accounting prinuples roquves manpernent to make aetlmeees and assumptlons that atTeet the reported amounts d assets and Ilabilitles and dbdoeure d Cantktgent assets and IlabBitlss at tM dale d the Handal statements and the reported amounts d revenues and expenses during the roportktg period. Actuat results could differ from those astlmalss. (2) Accounts receivable As d Juns 30, 1998, account tecstvabls txxrsbtsd d the following: Day Care aervicss receivable S 17,788 Senxx Helpers services receivable 18,743 Other reesivabiss 555 35.087 Allowance for doubtful aecounta (1.439) Net recsfvables S 33.628 (3) Unconditlenal emmiw~~ fn niu. Unconditlonal promises to give consists d Hawaii Island United Way support which has been pledged on a calendar year beau through Decernbar 31, 11198. In accordance wltlt SFAS Nlo. 118 this pledge has been roeordsd in the aecornpenying flnandal atatsments presented at its full non-discounted face value alnce it wdl be received as monthly payments within a one year period. 8 HAWAII ISLAND ADULT CARE, INC. Notes to Firurndal Statematrh, Continued l41 Property and apu~pment Property and egwpment is stated at cost w at Iri donated value. Dspnxlegon rs computed wrng the strerght-hne method over the sdimated useful Ilfs of the asset whkh may range ftorr? 5 to 15 years. As of June 30, 1998, property and equipment consisted of the following: Equipment S 140,482 VehxYea 12,472 Property and Imprpvemenri 10.440 183.374 Accumulated depreciAtlon (141.9171 Net property end equipment i 21,457 (51 Govammenril Purrrhesa of Service Grenri State of HawaN Department o! Human Services -Hawaii Island Adult Cara, Inc. is under cpnVact vwth the Dapertrnent of Human Servieaa m provide day era service for the fray elderly and dbablsd low- Income reardsnri of East HawaY. ltwanue irorrr This aontr'act >n fiscal year 1898 was 5120.148. County of Hawap - Hawarl lalsnd Adult Cars, Ina Is under contract with the County to maintain a small group home, Hale Kapuna, to prowls residentlel services for the trod eldarty and dbabled low-income rssidenri of Fast Hawed. Revenue from this contract In flscel year 1998 nos 52.315. Funding under such purchase of service contracts b subject to the avetlsbYity of funds from local govsmmental units and may be substantlaly reduced on short notice by changes in program nsquvsmenri. Funding for these progrertra is abo contingent upon satlstactay performance by HeweN Island Adult Caro, ins. fn eccordanee wdh the terms of tt» contracts (81 Year 2lX)0 problem It is at least rsssonably posslbN that the potential consequences, which may et anY time arise as a reautt of problems essocfetsd with the Year-2000 corrvarsion, could rewit In a contngant Itabdity which existed an the date d the fglendal atatemenfs. Menagsrnent has made no estimates d these cosri, and the amount is not reflected In the flnandd etaDsment 9 Return of Organization Exempt From Income Tax ' OMeNO~= Form 990 Untler sectlpn 507(cl of the Internal Revenue Catle (except black loop benefit trust or ry ~ private lountlatlbn) or seatlon d947(a)(t) noneasmpt charttsble frost Tnh Form Is Open Depirtnerl>I Pe ~'eefu inlam,l Revenue Sanms Nofe The prgannabon may have to use a copy of this return 10 satisty state reporting roduirements to public Inapectlon A For the 7995 cslentlar year, OR tea year period beginning 7 1 , 7998 and en I 6 30 7g 9 9 g^^c^«e •r plew C Name of Drpanizahon ~1 D Employer ItlenlfllcHlon rromber `I°f'^a' maiRS I lv °°0'°" on°Na; ~iAWAII ISLAND ADULT CARE, INC. 99-0210974 (=1~;`~m s« Number and street {or P 0 box if mad rs not tleliveretl to street atltlress) I Raomisude E Talephdna number rr''te~`^°' Sp.nRC 34 RAINBOW DRIVE BOB 961-3747 L-Jnmm ^^Amen°e0 IneWC L~'nmm none ~irx City pr town, state or country. antl ZIPrO F Check ? d ezemptipn ~n 50~!"` µ~ILO, HI 96720 apD~tion is pending n0~ro 1 C Type of orgamnbon ~ Exempt under 501(c) (3 (insert number) OR ? seMion 4917(a)(1) nonexempt chantabk trust Note: Section 501 e 3 axem t o enrzetlona and 1647 a 7 nonsxem t chenteble truete MUST attseh a oom Isted Schedule A ortn 690 H(e) Is this a group return bled for afhliates~ Ves No I If either box in H is checked Yes' enter fourdipd group (b) It Yes; enter the number at athletes far which this exemption number (GEN) ? _ _ _ _ _ _ _ _ _ _ _ _ _ return is filed ? J Accounting methotl ~ Cash ®Accmal C 'e mo e+epenie ntum Nw en o nrserlpn Goven° 0 • mop Tulin Q yes NO Other a BDI ? K Check here ? if the organization's grass receipts are nonna5y ntlt more than 525,000 The organizatitln need not file a return wdh the IRS, but d d recervetl a Fonn 990 Packaoe in the mad, R should file a rotum wdhoul financial tlata Soma states retlulre a eomptete return Nofe Form 990-EZ ma be usetl b anizations w h rose re its les th n 100 000 and total a sets less than 250 000 at antl of ear Revenue Ex rues and Chan s In Not Assets or Fund Balances 1 Contnbutions, Pitts, grants, and simdu amounts recen+etl e DirectpuDlicsupport to 5,660. b Indirect public support ib 110, 859. c Govarnmentcontrtbutions(grants) to 141,463. d Totsl (add hoes to thrtlugh tc) (attach scheoule of contributors) (cashS 257,982. noncasht ) ttl 257,962. 2 Program service revenue mcluoinq gavammentlees and contracts (tram Part Vtt, hoe 93) 2 4 8 3 , 210 . 3 Membership dues antl assessmenls 3 4 Interest on savings and temporary cash investments t 1, 99 7 . 5 Dividends antl interest from securRles 5 5 a Gross rants 5s b Less rental expenses 5 e Net rental income or (loss) (subtract line 6b from line 6a) Be 7 Other investment income (descnbe ? 7 8 e Gross amount from sale of assets other A Becunties 5 Other than inventory Be 0 Less cost or other basis and Saks expenses c Gain or (loss) (attach scheoule) Bc tl Net pain or (loss) (combine line 8c, columns (A) and (B)) 5tl 6 Special events antl aCbvitiee (attach Schedule) e Gross revenue (nm inDlUtlinp S ~ of cpnlriDUtlonS reported on line 7a) ge 6 , 680 . h Less diroct expenses omer than Nntlrarsrnq expenses 96 c Net income or (toss) from specul events (subtraq one 9b from one 9a) SEE STATEMENT 1 9e 6 , 6 B 0 . 10 s Gross sales of Inventory, less returns and allowances toe b Less cost of goods sob tOb s Gross profit or (lass) from sales pf Inventory (attach scnedule) (subtract Tine 70b from tuu t0a) toe 11 Other evenue (horn Part VII, one 103) 11 14 7 12 Totel rnsnue add ones 7d Z 3 4 5 6c 7 Bd 9c 70c and 71 tz 750 , 016 . t9 Program services (from line 4t, column (5)) t3 614 , 82 0 . 14 Management and general (from line 44 column (C)) tt 84 , 6 85 . is 1,207. 15 Funtlraisinp (}Tom line 44, Column (O)) y, 15 Payments td emirates (attach scheoule) t 5 t 7 Totsl a: ernes ode Imes 76 ana 44 cotumn a t 7 7 0 , 712 . 75 Excess or (tlefictl) for Me year (suDirad Nne 171rom hoe 72) tg 4 9 , 30 4 . ~ 16 Net assets or funtl baances al bepinninp of year (from Ilne 73, column (A)) 76 10 7 , 4 41 . 20 Other changes in net assets or fund balances (amcn expknatlan) 20 0 21 Net assets or tune baances at end of ear combine tines 15. t 9, one 20 2t 15 6 , 7 4 5 . LHA For Pepsnrore Haeuctlon Aar Notice, tee Pepe 1 of the seperete InsVUdlons Form 990 (19981 uaa ~ 1 13350508 796386 HIAC •082 HAWAII ISLAND ADULT CARE, INC. HIAC`1 ^^'~c"te'a' HAFIAII ISLAND ADULT CARE I?QC. 99-0210974 Paget + P~ i~ tat@ment o Au organ•zatwns must complete coumn CAI Ca~umns ;d) rC) and (Ol are regwred for secuon SOtIC;(31 and Funetlotwl EX ens@S ia) or arizations and section 4947(a I,1) nonexempt cnarttable trusts but optional for others Do not include amounts reportetl on line ~ B Pro ram C M q j (0) Funtlraisinp 6b 86 9b, ,Ob or 16 of Part I ~ IAI Total { serves ( and nene dent 22 Grants antl allocations (attach schedule+ j I Cbll f r10nCbn { 22 I 23 Speafic assistance to intlivitluals (attach schetlWe) 1231 2a Benefits paid ttl D! fdr members (attach schedule) j 21 . ~ ~ 25 Compensation of dlficers duettors etc 25 . 0 0 0 . Q , 28 Othersalanesandwages '28 407,536. 352,042. 55,494. 27 Pension plan tontnbutlons 127 . ze Other employee benefits i 2e , 41, 510. 35 , 6 9 9 . 5 , 811. 2g Payroll taxes zg 55, 056. 48, 313. 6, 743. 30 Professionalfundraisingfees 3g 31 Accounting teas 3t I 32 Legal tees 32 33 Supplies 33 11, 875. 10, 495. 1, 380. 3a TeleDhone 31 35 Ptlstage and sh+pptnq 35 35 occupancy 35 12 , 607. 12 , 607 . 37 Equipmentrenf]landmantenance 37 10,851. 10,346. 505. 38 Pnnhng and publlcatlons 38 3q Travel 3g 7 , 3 61. 7 , 314. 4 7 . 40 Conferences convent+ons, antl maetmgs 40 2 , 5 6 5 . 1 , 80 6 . 7 59 . of Interest at 42 Oeprec(ahon, tlspletion, etc (attach schedule) a2 10 , 7 11 . 10 , 7 11 . 13 Other expanses(itemrze) j a CLIENT PROGRAM EXPENSE a3a 99,593. 99,593. bOFFICE EXPENSE asb 13,365. 12,127. 1,238. cINSURANCE a3c 11,384. 9,555. 1,829. dPROFESSIONAL FEES a3a 11,570. 3 262. 8,308. BOTHER aae 4 728. 950. 2 571.1 1,207. as tort anpaptw apeneb (ens nnb 22 Mrvuen ul OrPnrsetlone cpnquEne ceWmme IeF(DI ~M MeN rotvetp enb,a.,e as 700, 712. 614, 820. 84, 685. 1, 207 . Neportlnp DI Joint Coate - Dld you report rn column (8) (Program services) any joint costs tram a combined etlucatlonal campaign and fundraising sohcdatlon~ ? ~ Yes ®No If'Yes' enter (I) the aggregate amount of these lout costs S {it) the amount altdcated to Program servkes S ni the amount agocatad to Mana emsnt and sneral S ,and Iv the amount allocated to Funtlraisln 5 P Ilt Statement of Pro ram Service Accomplishments What is tba orpanlxatlon's primary exempt Durpose~ ? ELDERLY DAY CARE 6 IN-HOME CARE Pro rem Sarvlce N~ OIeN~Lflpne RX1trt pbC11W nIYI WTpf pYIpOM ecn4~enrnu n f! CW Ntl fD1CIN TN!'x 311b eN numDY of Cilbb ewvb Yb4epnf neYeG e0L` Diecuee ~apenaea p (A~awnip br edtkaal ens eePlNemenb Met N not n4burtll? ~Sepbon'A1lclfa) uM U) orenlLeone end ~W]pa,J nonueinpt enenbple Web moat talW enter Me amount pl pmb enp ptee • enp ~W)(eM1) ellpotlpM fo oMM) lrueb eul opeonN rot oMen1 a PROVIDE PROTECTIVE & SUPPORTIVE SUPPORT FOR FRAIL, ELDERLY 6t DISABLED ADUTS IN EAST HAWAII. INCLUDES ADULT DAY CARE, SUPPORT HELPERS FOR IN-HOME CARE, 6 A GROUP HOME FACILITY. GraMS and allocallone 141, 4 6 3 . 614 , 8 2 0 . b Grants and atlacat+ons C Grants and allDdabdns d Grants and allocatltlns • Other rd ram services a8ach schedule (Gents and allocations S t Tdgl of Praerem Smke Eapar•ee (should equal lu+e 4d column (B) Program servkes) ? 6 1 4 , 8 2 0 . exaa„ u-„ ee 2 13350508 796386 HIAC 082 HAWAII ISLAND ADULT CARE, INC. HIAC_1 corm?90,1?98'. HAWAII ISLAND ADULT CARE, INC, 99-0210974 Page3 PI art IY I Balance Sheets Note Where required attached schetlules antl amounts within the description column ehoultl De I (A) I (B) for en0-of-year amounts only Beginning of year End of veer I13 Casn-non-interest-bearing I I I6 i a6 Savings and temporary casn investments ~ 6 3 , 16 0 . ad 10 4 , 74 4 . la7a Accountsrecervahla ja7ai 64,925. ~ b Less allowancetordoubttulacccunts ~I7h 33,628.'a7c 64,925. ae a Pledges recervaole 43e 9 , 750. f b Less allowance fordoubttulaccounts tSh 9, 750. 4Be 9, 750. 19 Grants recervaole a9 SO Recervahles from othcers tllrectars, trustees and key employees (attach scnsdule) SO S1 a Other notes and loans recervable 51 e TTB b Less allowance for douodul accounts 31b S1c 62 Inventones for sale or use 32 39 Prepaid expenses antl deferred charges 11, 0 6 5 • S3 8 , 2 7 9 61 IfIVlSUTlente - 59durd/e5 (adaCh eChedllle) Sa SS a Investments • land, bwklings and egwpment bases SSa h Less accumulatetl depreciation (attach schedule) SSh S6c S6 Investments -other 56 S7 a Land, Dwldinps. and egmpment basis 37e 176 , 361 . h Less accumulatetldeprecution 37h 152,628. 21,457. 67e 23,733. 6E Other assets (tlescnba ? ) 63 S Totaf ettNe add lines 451hrou h 58 must a ual line 7a 139 , 0 60 . q 211, 4 31 . SO Accounts payable and accrued expenses 2 8 , 819. 60 30 , 4 41 . 61 Grants payable 61 62 Deferred revenue 82 SS Loans from ofhcero, duectors trustees, and key employees 03 J f!s a Taxaxempt bond lublldles Sae h Mortgages and older notes payabN bah 8S Olherliablldles(descnbe ?REFUNDABLE ADVANCE ) 2 800. OS 24,245. fie rot III Illtle adtl boas 60 throw h 65 31 619. ee 5 4 6 8 6 . OrpenlxetlOne that PollOer SFAS 117, check here ? and complete lines 67 through 69 and lines 73 and 74 e7 unrostncted 65, 609. 67 100, 610. q6 remponnyrestnMed 9,750. q3 22,235. ~ do Permanentyrastnded 32,082. 89 33,900. g OrgenlaetlOne that do not to11bM SFAS 117, check here ? ~ antl complete lines u 70 through 74 70 Capdat stock, trust pnnclpal, Or current funtls 70 ' 71 Paltl-In or capdal surplus, or land, bwldlnq, and egwpment funtl 71 72 Retainetl aaminps, endowment, accumulated income, or other funds 72 73 TOpI net eseett or Nod heleneae (add IIMe 67 through 69 GR goes 70 thrbugh 72, column (A) must equal Ilne 19 and column (S) must equal Bne 21) 10 7 , 4 41. T3 15 6 , 7 4 5 . Ta TOtel IhhllMlea and nM efesh I hod helkrlaH (ado 9Me O6 antl 73) 1 9 , ra 211 r 4 31 Form 990 is avaigbM for pu01k rnspechon antl, for some peopN, senree ae the pnmary or sob soume of Intormatron about a particular orpanmUOn How the pubkc perceives an organhation rn such cases may be detennlned by the infomudOn prosente0 on ds roNm Therefore, pleeq make sure the return is complete and accurate and July Oescnbes, m Part III, the orpanl2atlon's programs and accomplishments °,ia,°+rw 3 13350508 796386 HIAC 082 HAWAII ISLAND ADULT CARE, INC. HIAC_1 Form990~t9981 HAWAII ISLAND ADULT CAAE, INC. 99-0210974 Raoea I Part IV-A ' Reeonctltatton of Revenue per Audited ,Part IV-8 i Reconctllatlon of Expenses per Audttad Financial Statements with Revenue per Ftnanctal Statements Wlth Expenses per Return Retum a Total revenue gains, and other support a Total expenses and losses per perautllte0 finanaal statements ? a 774,016., autlited financial statements ?Ial 724,712. b Amounts includetl on line a but not on h Amounts included on line a but not on I ine 17 Farm 990 line t2. Form 990 I I I (t) Donated services I ~ (t) Net unrealiretl gains ~ I j antl use of facilities S 2 4, 0 0 0. 1 I4 on investments i I I j (2) Prior yearadlustments I I (2) oonatetl services I t i reported on hne 20 antl use of tacillties S 2 4, 0 0 0 Form 990 S (3) Recoveries of prior f (3) losses reportetl an I I year grants S I ~ line 20 Form 990 t I (q Other (specdyl I IeI Other (SPBCdy) I s s I, Add amounts on lines (1) through (1) ? h 2 4 , 0 0 0 . Add amounts an lines (t) through ? ~ h I 2 4 , 0 0 0 . t Una a minus hne D ? t 7 5 0, 016. a Une a minus tine b ? c I 7~ 0 0~ 712 . 0 Amounts Included on line 12, Form d Amounts included on line 17 Form I 990 but not on line a i 990 but not on line a (t) Investmentexpensas l ' (t) Investment expenses l not Included on not included on Ilne 6b, Form 990 i Ilne 6b Farm 990 S I (2) Other (speedy) (2) Other (specity) : : f Add amounts on Imes (1) antl (2) ? d I Adtl amounts on Imes (1) and (2) ? d e Tobl revenue per Ilne 12, Farm 990 a Total expenses per line 17, Farm 990 I (line c plus Ilne tl) ? e l 7 5 0 016 .I (lino t plus line d) ? I e l 7 0 0 , 712 . ~ List of Offlcere, Directors, Trustees, and Key Emplo ees (LIST each one even It not compensated I (A) Name and address I (sl Tltk and average hours ~C) Compensation (DI aoY~~GOMMb (E) Expense per week devoted to 11 not p I ,enter a.,~, a ashrnp account and osrtlon m ens r, otheraaowances I SEE STATEMENT 2 0. O.I 0. l I I I l I I a 7y Did any ollker, director trustee, or key employee reurve agprepate compensation of more than 5100,D00 from youro9_anrraeonravn'd an routed organizations of which more than S10 D00 was provided by the related organmtions~ If Yes' attach schedule ? I-1 Yea ' ^ : Na Form 990 1 1 3581 HAWAII ISLAND ADULT CARE, INC. 99-0210974 Pages Part VII Other Information _ Yes No 76 Ditl the organization engage in any activity not previously reported to the IRS If'Vee attach a tletalled tlescrlp6on of each atnviry r 7r 6 X 77 Were env changes made In the organlnng or governing tlocument5 Dut net reDOltetl to the IRS 7~X It'Y95 - attach a conformed copy of the changes ! j j 78 a DId the organization nave unrelated Duslness gross income of S7 000 or more during the year co~ ored by this returns ~ 1-8a-~--~ X- b If Yes; has It hletl a tax return on Form 990.7 tdr this year N /A 7gl p 79 Was there a liquidation, tllssoluhon terminahon or substanllal cdnlrachon during the years 7r 9 X If Yes attach a statement ~ i -r-- 60 a Is Me organization related (Diner than by assonallon wdh a statewide or nationwide orpanlnhon) tnrouph common membersnlp I I~ governing bodies trustees, officers etc to any other exempt or nonexempt orpan17ahon~ ~ BOa ~ X p If'Yes; enter the name df the organlxatlon ? and check whether It I5 exempt DR nonexempt 61 a Enter the amount of pohtlcal expenditures, tluect or mtluect, as tlascrlbed m the ~ instructions for line 81 81 a i 0 D Dld the organlutlon fde Form t 720•POL for this years 816 i X 82 a Did the orpanlzatlon receive donated services or the use of materuls,egwpment or facdlDes at no charge or at suostantlaly less than { feu rental values I gpa~ D If'Yes you may Intllcate the value of these dams here Do not lnclude this amount as revenue In PaR I or as an expense In PaR II (See Instmctlons for reporting In Part III) 826 2 4 , 0 0 0 . 89 a DId the orpanlnhon comply wdh the puDllc Inspection requlroments for returns antl exemption apDllcatlons~ 63a I X , D OW the organlutldn comply wdh the disclosure regwrements nWDnq to quid pro quo contnhutlans~ Bab X bet Dltl the orgamzahon solved any contnbuhons or gRts that wen not tax tletluctlbk~ flea ' X b Ii'Yes; did the orpanlxahon Include with every sdllcdatlon an express statement loaf such contrlbutlons or gdts were not i { tax deductlDle~ N/A eab' 86 501(c)(4), (5), or (6) organlza6ons - t Were substantially all tlues nondeduc6bb by members N/A 861 b OW the orpamsshon make Dory In-house lobbymp expentldures of t2 000 or less N / A BBD I If Yas' was answered to edher 85a or 85b, do not complete 85c through BSh below unless the organrsatlon received a waiver for proxy tax owed for the prior year e Dues, assessments, antl simllaramounts from members 86e N/A d Section t62(e) lohbyinq antl poldlcal expenditures 66d I N A e Aggregate nondetluctible amount of season 6033(e)(1)(A) dues notkes 86e N A t Taxable amount of lobbying and political expentldures (line BSd less 85e) 661 N A ~ I p Does the organization elea to pay the section 6033(e) px on Me amount in 851 N A BS I h If section 6033(e)(1 )(A) tlues notice were sent does the organization agree to atld Me amount In 051 to ds reasonaole esttmate of dues I a9oca61e to nandatluaible IoDDyinp and poldkal expenddures for the following tax yearn N/A 85h bb SOt(c)p)oryam:abons -Emer a InRlation fees and capdal contnhutions Included on line 12 BBa N/A ~ b Gross receipts, Included on Ilne 12, }or public use of club facilNes 68b : N A 87 501(c)(12) drganlrations -Enter t Gross Income Irom member or shareholders 871 N A b Gross Income from other sources (Do not net amounts due or paid to other sources against amounts due or receivetl from them) 87D N / A I 86 At any time tlunnp the year, tlId the orpanlzahon own a 50% or greater Interest in a taxable corporation or paRnershipv It Yes; complete Part IX 88 ~ X e9 t SOt(c)(3) organnatidns -Enter Amount of tax Imposed tlunnq the year under , season 4911? 0 . ,sectlon 4912 ? 0 • , secDOn 4955 ? 0 • j b 507(c)(3) antl 501(c)(4) orpaniutlans • Dld the organi7atlon engage in any sectlon 4958 excess DeneM transaction tlunnp the yen If Yss; attach a statement expBininp each transaclon 896 I X e Enter Amount of tax Impasetl do the organization managers or tllsquallfled persona dunnp the year antler sections 4912, 4955, and 4958 ? 0 d Enter Amount of tax in 89c, above reimbursed Dy the organrzation ? 0 90 t Llsl the states with which a copy of this eturn is flNd ? NONE b Number of employees employed In the pay penod Mat Inclutles March 12, 1998 906 ' 2 9 91 The booksaremcareof ?HAWAII ISLAND ADULT CARE, INC. 7ekpnoneno? (808)961-3747 ~ocatetlat? 34 RAINBOW DRIVE z1P+4 ?96720 9'11 Secion 49e7(a)(t) nonexempt chartable trusts tiling Form 9901n INu of Form t0et -Check hen ? and enter the amount of tax-exempt mlenst ncerved or tccmetl dunnq the tax ptr ? ~ 92 ~ N / A uda ~ 5 13350508 796386 HIAC 082 HAWAII ISLAND ADULT CARE, INC. HIAC_1 ~Orm 3yi~~19iB`~ HAWAII ISLAND ADULT CARE, INC. 99-0210974 Page4 Part VIII Analysis of Income-Producing Actlvlttes Enter gross amounts umess otnerwlse Unreutetl sus n?ss ~nwme P..~„_, sz -7 s13 i (E) Intl~catetl (0.) I (4) E(CI I (D) I Related oreaempt ~ 4uslness ~ Amount I ;o~~ I Amount ~ tunchdn income 93 Program service revenue L cotle _ I (a)DAY CENTER I ~ !T- ~ 363,364, (b)SENIOR HELPERS I ~ I I 111,704. (a)SMALL GROUP HOME I I 6,142. let i I (el L- I I (U MedlcarerMetllcald payments I I (q) Fees and contracts from government agencus ~I I 94 Membership dues ono assessments I 94 Interest on savings and temporary I cash Investments I I I I 1, 9 9 7. 96 Dividentlsandlnterest}romsecurrties I-I 9T Net rental Income or (loss) from real estate (a) debt-}Inanced property I (h)nottlebl•hnanced property 94 Net rental Income Or (1055) from personal property 99 Other investment income 100 Galn or (loss) from sales of assets other than inventory 107 Net Income or (loss) from special events 6, 680 . 102 Gross proM or (loss) from sales of Inventory I 103 Otnerrevenue a MISCELLANEOUS REVENUE 147. b I e 0 e 104 Subtotal (add columns (4), (D) and (E)) 0 • 0 . 4 9 2 , 0 3 4 . 104 TOTAL (add line 104, columns (4) (D), and (E)) ? 4 9 2 , 0 3 4 . Nate (line 105 plus bne 10, Part I should equal the amount on Ilne t 2, Part I ) P YIII alatlonship of Activities to ttaa Accomplishment of Exempt Purposes LMe Na ExDiein how each aclrvlty for wh>th Income n reported m coWmn (E) of Part VII coniributetl Importantty to Me aaomDNShment of ma orpamtatlon s ? exempt purposes (otber than by DrovlOlnp Nnds for such purposes) 93 L INCOME COLLECTED PROVIDE DIRECT SERVICES TO THE FRAIL ELDERLY AND ANDZCAPPED EITHER AT THE DAY CENTER, IN THEIR HOMES CHORE OR ERSONAL CARE , AND AT THE SMALL GROUP HOME OR CAREGIVER CLASSES. 95 INTEREST INCOME COLLECTED PRIMARILY FOR AN ENDOWMENT FOR A FUTURE HABITABLE PURPOSE. X IraforrnaUon Ragerdinp Taxable Subsldlsrias (Complete Ihle Pert it Ne'Yee' box on ?!s la sbsetse ) Name, address, and employer Identnc~atlon Percentage o1 Nature of business actrvlties Tohl Income End-ohyear number of carporetlon or partnership ownership Interest assets N A % eye °/a UIIOM {MM1114 Of pMIYlY I QCIY(I Nor I IIM~ urrlin~o P,~ r~WT mtludn0 CWTPNYine ~CX~CYIM Ntl fbtYlMnb tntl b M bYf Of my 41pW~Oprr ~r1U UMM it i~+YI mrwot MO comWrrl~ DrrclNaOn or pnpY+r (Olen mM oeian irr bO~O on Yi mbmrtien Pt wnien PniPw trr..ny Mn Pleete ~ I CAROLYN C~BRIERA, EXECUTIVE Sign , ~ _ c \ ~ ~ ' i , l _ 'DIRECTOR Hen Sgnatun of officer Date type or pnm name and tRle Preparer's ~ Date Pnp~m/. ssu Peid signature ~-r`~'`= ~~6 0 5 / 0 8 / 0 0 employee ? Preperere Frm'sname(oryours JENNIFER L. GOSSERT, CPA AAC EIN ? Userlnry ItseH-employed) '68B KINOOLE ST. , STE.201 and address HZLO, HI IZIP+4 ? 96720 aa3161 6 12nYe 13350508 796386 HIAC 082 HAWAII ISLAND ADULT CARE, INC. HIAC_1 SCHEDULE A Organization Exempt Under Section 501(c)(3) -"e ' 'S.5 s°. (Form 990) (Eacepl Prhrats Foundation) and Secllon 50f (e), 501(1), 501(k), 501(n),orSectfonept7(a)(1)NOnetamplCharrtaolaTrutt ~ ~ao.nmant ar me irarury Supplementary Information rremn a..,en~. senwe ? Mutt be completed by the above organlianont and attaphed to Ihelr Form p90 or 990EZ Name of the orgamutron Employer idemnlcauon number HAWAII ISLAND ADULT CARE, INC. 199 0210974 art 1 Compensatlon of the Fve Hiohest Paid Employees Other Than Officers, Directors, and Trustees (Sea Instmctlons Llst each one If mere are none, enter None'1 (a) Nama and atldress tlf each employee paid ~ (h) Title antl average hours r.i urtrh, ion, ~p (e) Expense more loan 550,000 ~ per week devotetl to ~ (cl Compensatlon ~„p„s account antl other _ p051[Ipn i I compmuuon I 3110wanCBe NONE ~ ~ i ~ I I I I I I Total number of other empltly9es pakl over 550,000 ? 0 Part ! Compensation of the Flve Hlt7hest Pafd Independent Contractors for Professional Services (See Instructions Llst each one (whether indlvlduals or firms) If them are none, enter None') (e) Name antl address of each Intlepentlsnt contractor paid moro than S50 000 (b) Type of service (e) Compensatlon NONE Total number of others recelvlnp over SS0,000 for prafisaronal servlcet ? 0 LHA For Pgerwork Reduetkn Act Nallce, see papa 1 dt tM Inetroetlant for Form p90 end Farm pii0-EZ Sehedule A (Form 9o0)19p! ea~tot u of-sb 7 13350508 796386 HIAC 082 HAWAII ISLAND ADULT CARE, INC. HIAC_1 ScnetluleA(Fcrm9901t998 HAWAII ISLAND ADULT CARE, INC. 99-0210974 Paget ! Part 1 ~ Statement About Actrvttles Yes No 1 During Me year has the organization attempted to influence national state or lucai legislation including any attempt to i,'ifluence pudlic opinion on a legislative matter or referentlum° ~1 X II'VB5' enter the total expenses paid or inCUrrBd in connection with the lobbying activitBS ? S I i Organizations that made an election under section 501(h) by filing Fortn 5768 must cdmolete Part VI-A Other organizations cnecking Yes' must complete Part VI•B ANO attach a statement giving a detailed description of ~ I ! lne lobbying actwRies I 2 During the year. has the oganizaticn, either tlirectly or intluectly, engaged in any of the following acts witfi any of its trustees tlirectors ~ i i ohicars, creators, key employees or memoers of then families or wRn any taxaola organization wdh which any such parson is - i aMliated as an officer, directtlr trustee, maloriry owner, or pnncipal beneficiary ) a Sale, exchange, or leasing of Droperty~ i 2a I ~ X D Lentllnp of mbney or other extension Of Cretlit~ I ' 126 ~ X ~ ~ ~ e famishing of goods, services or facilRies~ 12e X ~T- d Payment of compensatibn (or payment or reimbursement of expenses d more Than 51,000) j 2d ~ X -i e Transfer of any part of Rs income or assets 2e ~ I X If the answer to any question is Yes' attach a detliled statement explaining the transactions 3 Does the organization make gents for scholarships, fellowships, sfutlent loans, etc ~ 3~ _I I X_ a a Oo you have a section A03(6) annwty plan for your empltlyees7 ~4, ' X~ h Attach a statement ttl explain how the organization tletemtines that xMrvWUals or orpaniutions receiving proms or loans Irom it in II Nrtherance of Rs cnantable Drognms quality to nceive payments (Sea instmcGons I .peat 1y Reason for Non-Privets Foundatlon Status (Sae instrucrons ) The organization is not a prnate foundation because R a (Please chock ony ONE aDPllzable box) 6 ~ A church, convention of churches, or assxaGon of churches SecUOn 170(b)(1)(A)(i) 6 0 A school Section 170(D)(1)(A)(ii) (Also complete Part V, papa 0 ) 7 Q A hospdal or a cotlperative hospRal service organization Section 170(b)(1 )(A)(ui) S ~ A Federal, state, or Ibcal gavemmant or govemmental unR Section 170(b)(1)(A)(v) 9 0 A medical research organization operated in conpingion wdh a hospital Segion 170(b)(1)(A)(iil) Eller the hoapUal'a name, ally, and crate ? 10 ~ An organization operated for the beneM of a college or university ownetl or opentetl by a governmental unit Section 170(b)(1)(A)(iv) (Also complete the Support Sehetlule in Part IV-A ) 11 a ® An organization that normally receives a suDStlntial part of its support from a gdvernmentat unit or from the general public Section 170(bl(11(Al(vi) (Also complete the Support Seheaule in Part IV-A ) 116 ~ A community trust Sectibn 170(bl(1)(A)(vi) (Also compMte the Support 8ehedule in Part IV-A ) 12 ~ An organiution Mat norma9y receives (1) more than 3S 1(dYe of its support from contnbutions, membership tees, antl gross receipts from activities related to Rs charitable, etc , tuncGons - suDlect to certarr xceplions, antl (2) no more than 33 t/~Yo of its support from gross investment income antl unrelated business taxable income (less section 511 tax) from businesses acquiretl by the organization after June 30, 1975 See section 509(a)(2) (Also complete the Support Sehetlule in Part IV-A ) 13 0 An organw6on that is not controlled Dy any disqualified persons (other than fountlation managers) and supports organizations tlescnbe0 in (t 1 lines 5 Mrtlugn 72 a6ova ar (21 section 50t(cl(el (51 or (61 if Mev meet the test of sectitln 509(al(21 (See secbon 509(al(311 Provide Me fdUawuiq mtartnaGOn about Me supported organizatians (Sea instructions on page 4 ) (a) Name(s) of supported organization(s) (D) Lina number from above 1e An o amzaGon o anizad and orated to teat for ubkc sa Section 509 a 4 See instructions on pa e 4 ) azam u-av w 8 13350508 796386 HIAC 082 HAWAII ISLAND ADULT CARE, INC. HIAC_1 6cneduleA(Form 990)7998 HAWAII ISLAND ADULT CARE, INC. 99-0210974 Page3 Part IV-A SuppoA Schedule (Complete only IT you checked a box on Ilna 10, 11, or 12 above) Use ceeh method of aecountrnp Note You me use the worksheet rn the rnstruchons (or convertrn /tom the accrual to the cash method of eccounnn Calentlar year (dr Ilseal year batllnnma Inl V) 7997 I ID) 7996 (e) 7995 I (tl) 1994 le) total 1S Genf goon .nc cormbuUOna recwv.a - ;o~~e,nnuaauruauwprann Ss I lOB, 206. 224, 046. 294, 593.1 290, 498. 917, 343. 16 Memoershl feesreawed 3, 104. 3, 104, 17 Gross recatpis from admrsslons, merchandise sold or servx;es performed, dr turnishing of taclldles i I i In any achwty that Is not a busmess unrelated to the orpanlzahon's cnantabla etc purpose 568, 136. 488, 805. 410, 075. 366, 043.' 1, 833, 059. 18 Gross Income from Interest. drvldends, amounts recewed from payments on secunbes loans (sec- tion 512(a)(5)), rents, royaAies, and unrelatetl business taxa6b Income (less sechon 517 taxes) from Ouslnessas acgwred by the organlntlon attar June 30 1975 1, 9 4 5 . 3 , 32 8 . 3 , 3 5 9 . 3 , 510. 12 ,14 2 . 19 Net Income from unrelatetl busmess actrvdles not Included In Irne 16 3 , 5 0 0 . 3 , 5 0 0 . 2q Tu mrrv~ nvl~d br tM oiywnx~bon brNlll ma wm~r pw0 b it or wtPw+Mtl on ~b Mn.ll 21 The value of semces or tactlitles furnishetl to the organization by a governmental unit wdhout charge DO not 111CIUde the Value b} SBNlcee or faclldles penerolly tumishetl to the Publlc wdhout chalpe 22 ~InwInCORw rltltrcP~,CMtlub Dorol EE STATEME T 3 i .d~ pwn or (lost) horn w~ a1 taprtal 1, 4 31. 10 , 2 7 5 . 11, 7 0 6 . 23 Totalotlmasl5throuph22 678,287. 719,679. 709 458. 673,430. 2,780,854. 24 Line 23mtnusllne77 110,151. 230,874. 2 9,383. 307,387. 947,795. 26 Enters%otllne23 6,78 7,197. 7,095. 6,734. 20 Orpanl:atlona dsserlba0 In Ilnas 10 or 11 a Enter 2% of amount In column (e), Irne 24 ? 2 18, 9 5 6 . b Attach a list (which Is not open to DuDllc Inspection) showlnp the name o} and amount contdbuted by each person (other loan a governmental unA or publlcry suDPorted organizatlon)whose total glRS for 7991 through 1997 excwtletl the amount shown In une 26a Enter the sum of aq these excess amounts ? 206 0 e TotalsuDPOAtorsectlon509(a)(7)teriEnterhns24,cotumn(e) ? 20e 947,795. d Add Amounts from column(6)torhnes t0 12, 142. tq 3,500. 2z 11,706. 266 ? 2Etl 27,348. e Publlc support (line 26c menus line 26d total) ? 2Qa 92 0 , 4 4 7 . t Publis support persemage (Ilna 2Ea (numerator tllritletl line 2!e (denominatdr)) ? 21f 9 7.114 6 ^r, 27 Organ4allena tlaseri6etl on Ilna 12 a For amounts indudad In tines 75, tfi and 17 that were eceived from a'dlsquallAetl person' aWcn a hst to show the name of, and total amounts recewed In each year horn, each'disqualitb0 parson' Enter the sum of such amounts for each year N / A (1997) (1996) (1995) (1994) b For any amount Included In Irne 17 foal was receved from a nontlisquallhed person, attach a Ilst to show the name ot. and amount received for each year, that was moro than thelerperol (1?the amount on line 25 for the year or (2) SS 000 (include In Me Ilst organmtions descnbed In Imes 5 through 11, as well as Indrvitluals) ARer computing the 0lflerenca between the amount received and the larger amount decnDad In (7) or enter the sum of these dAferences (the excess amounts) for each year N/A (1997) (19961 (19951 (1994) C AOd Amounts from column (e) for Imes 16 16 t7 20 Z1 ? 27e N/A d Ada Llne 27a total and Irne 276 total ? 27tl N A e Publlc suppoA (hoe 27c, total menus Ilne 27d total) ? 27a N A t Total support for section 509(a)(2) test Enter amount on line 23, column (e) ? 271 N /A g Pu61k suppoA perantape pine 27e (numerator) dlvldM 6Y Ilne 47f, (denomimtor)) ? 27 N / A % h Inwatment Intone 70 column u Ilne 47Y denominato ? 271r N A 96 20 UnuwN Grants: Far an orpanraflon tlescr97ed M hoe 70,1 t, or 12, that recervetl any unusual grants during 7994 through 1997, atlach a Dst (which is not open t0 pu61rC Inspection) for each year showing the name of Me contributor. the date antl amount of Me gent. and s beef descnptlon of the nature of the grant Do not Include thaw grants m hoe 75 (Sw mstructlons) NONF atom y ra-oT w 13350508 796386 HIAC 082 HAWAII ISLAND ADULT CARE, INC. HIAC_1 scneduieAiFOrm990)ts98 HAWAII ISLAND ADULT CARE, INC. 99-0210974 Pagea Pl art V Pn~ate School Quesbonnarre (To be completed ONLY by schools that checked the box on Itne 6 in Part IV) N/A ~Yesi No 29 Does the arganlzation have a racally nondiscriminatory policy toward students by statement In Its charter Dylaws, other governing ~ , instrument, or in a resorution of Its governing bodyo ~ 29 30 Does the organization Include a statement of Its racially nondiscriminatory pollcy toward students in all Its brdcnures catalogues antl other written cammunx:ations with Ne public dealing with student admissions programs antl scholarships 90 37 Has the organisation puDlitixe0 Its raclally nondiscriminatory pollcy through newspaper or broadcast media dunnq the period of solicitation for students, or tluring the repistrallon period if It nos no solicitation program, In a way that makes the pollcy known to all parts or the Qeneral commundy It serves ~ 31 I I}'Yes' please describe it'NO' please explain (It you neetl more space, attach a separate statement ) 32 Does the organisation maintain the following a RecoMS Intlicating the racial composdion of the stutlent body, faculty, and administrative stafn 32a , b Records tlocumentinq loaf scholarships and other financial assispncs are awartled on a racially nondiscriminatory Dasis~ 32b ' C CDplee Of all CalalOQllBa, brbChuros, BnnoUflCemenfe, and Other Wntten CommunlCatlOne t0 the public dBaII11Q Wdh student admissions, Drograms, and scholarshipso 32c d Copiss of ail material used by the organisation or on es behad to solicit contnDUhons~ 320 If you answered'No'to any of the above please explain (If you neetl more space, attach a separate statement ) 33 Does the arganiratron tliscriminate Dy race In any way w0h respect to a Students' nghls or pnvileges~ 93a b Atlmissions poliCiaa~ 93b e Employment of faculty or administrative stain 33s ~ d Schotarohipsorotherfinancialassistance~ 33d i I e Educational potkieso 33e t Use of facil0les~ 331 , g ANletk programs 33 h OtherexlracurncuWractWOies~ 33h ~ M you answered'Ves' to any of fns aDOVe, Diease explain (lt you need more space, attaM a separate slafemanf ) 36 a Does the organiution receive any hnancial aid or assistance from a governmental agency Sea I I b Figs the organisation's nght to such axl ever been rovoketl or susDended~ 3eb ~ i It you ansvrored Yes to ertner 34a ar b, phase explain udng an attached statement 35 Does the organisation certrty that 0 has compiled wdh the applicable roguirements of sections 4 01 through 4 OS of Nev Proc 75-50, I 1975.2 C B 587 covennq racial nondiscnminatlon~ It No: attach an explanation 35 exact tx-ot ee 10 13350508 796386 HIAC 082 HAWAII ISLAND ADULT CARE, INC. HIAC_1 ScheduleAlFOrm 99011998 HAWAII ISLAND ADULT CARET INC. 99-0210974 PaoaS PaR VI-A Lobbying Expendttures by Electing Public Chanties l7d De completed ONLY by an ehgiDle organization that ttletl Form 5768) N / A Check here ? a ~ It tha organ+xat+on belongs to an att+liatatl group Check herB ? h r--- If Ou checka0 "a' above antl'Iimite0 control' rOVisldns a I Limas on Lobbytnp Expenditures (a) (h) TO De completetl for ALL (The lerm'expentlitures' means amounts paW or incurred) Affiliated group totals ekctinq organizations N A 36 Total lobbying expenditures to influence public Opinion (grassroots lobbying) 38 37 total lobbying expenditures to influence a legislative body (tlirect lobbying) 37 38 7dhl lObby+nq expenditures (add lines 36 an0 37) 38 39 Other exempt purpose expenditures 3q 10 Total exempt purpose expenditures lads lines 38 and 39) 40 41 Lobbying nontaxable amount Enter the amount from the following table If tha amount on Ilne 10 If • The lobbying nomaaahle amount b nor ww fl00 000 7t%of tM ~nnunt an NM b Q'R f100001)bYr nP+WMfI [QO [Qd f~bb btb plYf l!%O+bIb YPA~OYwfebb ttd Ovwf1000000 but not avwi1500 Ono f17l 000Pm t0%af T~uo.p ovwfl OpO ODO 41 Ovwft 700000 but not ovw a11000000 faal000 p1u~!%ofeM aor~ovw fl,lOO ODO . aw s+r o0o aoo s+ oco Oco l2 Grassroots nontaxable amount (enter 25% of line 41) 42 /3 Subtract line 42 from line 36 Enter-0- d line 42 is more than line 36 49 14 Subtract IInB 47 from line 38 Enter -0- if IInB 41 is mOrB than I+ne 38 4/ Caution I/ there rs an amount on s+ther Une 03 or line 44, you must fib Form 1720 /-Tear Avaraglnp Perlae Under Seetlon 601(h) (Some orpaniutions that made a section 601(h) electlOn do oat have to complete all of the five columns below See the instructions for Imes IS through 50 ) Labbylnp Eapend8urea Durlnp 4•YearAveraglnq Period N/A Calendaryeu(er (al Ihl (sl Idl (el fiscal year beglnnlnq In) ? 7998 1997 1996 7995 Total 48 Lobbying nontaxable amount 0 18 Lobbying testing amount 150% o} line 45 a 0 17 Total lobbymq ez andiNres 0 18 Grassroots nontaxable amount 0 Iq Grassrooh ceiling amount 750% of una 48 e 0 SO Grassrootslobbyinp e enddures 0 Part VI-B Lobbying AcUviiy by Nonelectlnp Public Charities (For ropartinp Doty by orpanwtions that did not complete Parl VI•A) N/A Ourtnp the year, did the arpaniratlon attempt to tn0uence national, state or total bpislation, including any attempt to Yea No Amount iMluance publ+c opinion on a lepislrirve matter or referendum, through Ne uss of a Volunteers h Paitl staN or management (include compensation in expenses reportetl on Imes c through h) e Media adveA+semants d Maalnps to members, bgislators, or the pubkc a Publications or published or broadcast sUlements 1 Grants to other organizations for lobbying purposes p Diroct contact with lepislatars, their stafh government oMculs, or a lepislathro hotly h Rallies, demonstrations, seminars, conventions speeches, letturof, or any other means I Total lobbymq expenddures (add Nnes c through h) ~ U •Yes' 1d any of the above, also attach a statement prvmq a detailed description of iha lobbying adrvitros °iais ue 11 13350508 796386 HIAC 082 HAWAII ISLAND ADULT CARE, INC. HIAC,1 ScnetluleA(FOrtn 99011998 HAWAII ISLAND ADULT CARE, INC. 99-0210974 Pagee Part VII Infortnatton ReparcJtnp Transfers To and Transactions and Relattonshtps With Noncharitabte _ _ Exempt Orpanlzattons 51 Did the reporting organiaaton tlractly or intllrectly engage in any of the following with any other organl:atlon tlescrrbetl in section Sot(c) of the Code (other than section 50t(c)(3) organizations) ar in section 527 relating to politlWl arganlxahons~ a Transfers from the reporting organization to a nonchantabla exempt ergamxatlon of I Yes No (I) Cash 517(IT X pq Other assets I +a q ' X b Other transactions (1) $a1Be OI a55e1510 a hpnCharnablB exempt Orgdnl2allpn ~b(I) I ~X~ (II) Purchases of assets from a noncharitable exempt organization b(lil ) I (III) Rental offacJitiesorequipment b(iIi)r X (Iv) Reimbursement a«anpements b(n)~~-X (v) Loans or loan guarantees blv)~ X (vl) Performance of servlces ar membership or Nntlraislnq solrcitatrons D(vl) ~ X e 5hannq of taalitles. eVulpment, mailing Ilsts, other assets, or paW employees c ~ X e If thB aheWBf to any D1 Me abOVe ie YBe; Complete ItIB ftlllpWing ephetll1lB Column (D) shouttl always IntlIC2IB the felt market value of the gootls, other assets or servrces given by the reporting organitatlon I} the organisation recervetl less than fair market value in any transaction or shahs arras ement, show in column (tl) Ne value of the tlotls other assets, or servlces recervetl N / A I+) Ib) I~) let Una no Amounl rmolvetl Name of nonchareable exempt organisation Descnp[ion of transfers, transactions, antl shannp arrangements 52 a Is Me organtratlon tlirectly or moirectty atfpatetl weh, or relatetl to, one or more tax-exempt organmtions tlescnbetl in section 507{c) of the Cade (otherthan section 507(c)(3)) or m section 527v ~ ~ Yse L~J No p ItYss; complete the followingschetlule N/A NI lbl lH Name of Orgamratlon Type Of Organl7atl0h DeeCflptl0n tlf mlatlOnemlp ~Oi ~w 12 13350508 796386 HIAC 082 HAWAII ISLAND ADULT CARE, INC. HIAC_1 HAWAII ISLAND ADULT CARE, INC. 99-0210974 FORM 990 SPECIAL EVENTS AND ACTIVITIES STATEMENT 1 GROSS CONTRIBUT. GROSS DIRECT NET DESCRIPTION OF EVENT RECEIPTS INCLUDED REVENUE EXPENSES INCOME SPECIAL FUNDRAISING EVENTS 6,680. 6,680. 6,680. TO FM 990, PART I, LN 9 6,680. 6,680. 6,680. FORM 990 PART V - LIST OF OFFICERS, DIRECTORS, STATEMENT 2 TRUSTEES AND KEY EMPLOYEES EMPLOYEE TITLE AND COMPEN- BEN PLAN EXPENSE NAME AND ADDRESS AVRG HRS/WK SATION CONTRIB ACCOUNT BOB CHOW PRESIDENT 857 UILANI STREET 1 0. 0. 0. HILO, HI 96720 BILL PEARMAN VICE PRESIDENT 701 HUEU PLACE 1 0. 0. 0. HILO, HI 96720 MAGGIE MALLEN SECRETARY 167 APOKE STREET 1 0. 0. 0. HILO, HI 96720 HAROLD LUSCOMB TREASURER 892 KOMOMALA DRIVE 1 D. 0. 0. HILO, HI 96720 CARL ROHNER DIRECTOR 1939 KILAUEA AVE. 1 0. 0. 0. HILO, HI 96720 KARYL FRANKS DIRECTOR P.O. BOX 986 1 0. 0. 0. HILO, HI 96720 DON BURCIAGA DIRECTOR 117 C. MALAMA PLACE 1 0. 0. 0. HILO, HI 96720 13 STATEMENT(S) 1, 2 :3350508 796386 HIAC 082 HAWAII ISLAND ADULT CARE, INC. HIAC_1 HAWAII ISLAND ADULT CARE, INC. 99-021097q BILL GREEN DIRECTOR 100 KAIULANI STREET 1 0. 0. 0. HILO, HI 96720 JAN HOUSER, MD DIRECTOR 1292 WAIANUENUE AVE. 1 0. 0. 0. HILO, HI 96720 DEREK KURISU DIRECTOR 50 E PUAINAKO AVE. 1 0. 0, 0. HILO, HI 96720 ROWENA LOO DIRECTOR P.O. BOX 517 1 0. 0. 0. HILO, HI 96720 TANYA JOHNSON DIRECTOR UNIV. OF HAWAII-HILO, DEPT. OF 1 SOCIOLOGY 0. 0. 0. HILO, HI 96720 GERALD LEE LOY DIRECTOR 38 KALAKAUA ST. 1 0. 0. 0. HILO, HI 96720 LESTER OSHIRO DIRECTOR P.O. HOX 4702 1 0. 0. 0, HILO, HI 96720 TOM ROBH DIRECTOR 2405 KALANIANAOLE ST., PH 17 1 0. 0. 0. HILO, HI 96720 DR. SHEHAH SADDY DIRECTOR 1190 WAIANUENUE AVE. 1 0. 0. 0. HILO, HI 96720 PEARL TANEMURA DIRECTOR 1080 LAULIMA STREET 1 0. 0. 0. HILO, HI 96720 JEAN NOBRIGA DIRECTOR 1039 LAULIMA STREET 1 0. 0. 0. HILO, HI 96720 NANCY YAMADA DIRECTOR 36 OLU STREET 1 0. 0. 0. HILO, HI 96720 IVAN YAMAMOTO DIRECTOR 1333 WAIANUENUE AVE. 1 0. 0. 0. HILO, HI 96720 14 STATEMENT(S) 2 13350508 796386 HIAC 082 HAWAII ISLAND ADULT CARE, INC. HIAC_1 HAWAII ISLAND ADULT CARE, INC. 99-0210974 EMMETT CAHILL ASSOCIATE MEMBER P.O. BOX 807 1 0. 0. 0. VOLCANO, HI 96785 STEVEN WOO, MD ASSOCIATE MEMBER 193 HALAI STREET 1 0. 0. 0. HILO, HI 96720 TOTALS INCLUDED ON FORM 990, PART V 0. 0. 0. SCHEDULE A OTHER INCOME STATEMENT 3 1997 1996 1995 1994 DESCRIPTION AMOUNT AMOUNT AMOUNT AMOUNT 1,431. 10,275. TOTAL TO SCHEDULE A, LINE 22 1,431. 10,275. 15 STATEMENT(S) 2, 3 13350508 796386 HIAC 082 HAWAII ISLAND ADULT CARE, INC. HIAC_1 HAWAII ISLAND ADULT CARE, INC Property and Equipment Property 8t Equipment Accumulated Deprec~at~on 6/30/98 6/30/99 6/30/98 6/30/99 Description Balance Additions Balance Balance Dep'n Balance Equipment 140,462 140,462 ]21,022 8,917 129,939 Vehicles 12,472 9,709 22,181 10,901 1,571 12,472 Property Improvements 10,440 3,278 13,718 9,994 223 10,217 163,374 12,987 176,361 141,917 10,711 152,628 terotSLal tcovea+se SosviCO EP1~~ iv):?ca - 8127 Inca.+r•nal 17eiva~ntte Survice~ P'~'t'"~~r r• BP/ED Disr_losurta Desl< Lo3A:LQeIes,GA 600538350 P v. 13ax ~s5o Loy Angelt~y, CA 90057 Perron to Contact. Felicia C. Mirailur IiAWAII I'uLAND ADULT t:A4ZC • Telephurre Number INC FKA HILO AUUL_T DAY CARE t>?18)t394-423? 34 RAINBOW DRIVE Refer Reply tu• HILO, HI 967~U 90-?67 Date: Fob iG, 1Et9U RC . 99-010'!74 HAWAII ISJLAND ADULT CARL ItQC Fi<A HILD ADULT DAY CARL l;entlemen: • Ttria is in responso to your request 'fur a Vetaarminataorr letter of the above-n+amt~tJ organiia•tiun. A reviaxw of our records intJicates that tiro alrovo-named arganiiation was rocogniced to be exempt from Federal income tax in July 1982, as err arg¢nizstian descr•ibcd in Internal Revenue Cude section SOltc)t3) I•t is further classified as an organ,.z¢tion th¢t is oat ¢ przvute foundation as tlefined in yectiun S09ta) of thaw code, becauyte it iF an or•Uani'zatlon described in section 170fLr)tl)lA)tvi). Tl~iy laatter verifies your ext:mpt statriy, anti the fact ttrat ttre arigirr¢1 determination latter isuued in July 19t3i? continuer to ba3 in ei fecL IF you are irr Haled of frrrttrer at;siot:,tnev, pl~~nt.ea Fa+~l free to contact me at thn above adtJrt+yu Wca apprnciatca your eooperataon in this regard 51ncQrelY, Disc] trsrtra+ A~..~.ls,t:tnt AGORD,. CERTIFICATE OF LIABILITY INSURANCE °"T"""IDD"" 01/24/2001 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Royal InSULance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTFICATE HOLDER. THIS CERTIFICATE DOER NOT AMEND, EXTEND OR 12 O P a u a h i S t. Suite 2 0 2 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Hilo, Hi 96720-3047 8 0 8- 9 3 4- 9 67 7 INSURERS AFFORDING COVERAGE "'u'"[D HAWAII ISLAND ADULT CARE INC. ~INSURERA ISLAND INSURANCE COMPANY 34 RAINBOW DRIVE INSURERS HILO, HI 96720 INSURFAC INSURER D 1 INSURER E COVERAGES ~ 'r THE POLICIES OF INSURANCE LISTED BELOW WIVE BEEN ISSUED TO THE INSURED NAMED ABOYE FOR THE POLICY PER NOTWRHSTANDING ANY REOUNtEMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICFt TiIS ER AMY EE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. CLUSq D CONDRIONS OF SUCH I POLICIES AGGREGATE LMRS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS TYr[or[IwRArc[ rouerrurra r tJ"Rf ORI[MLLIArUTY EACH OCCURRENCE f fAYMERCLLL GENERAL LWllm FIRE OAMAOE (Any onR Nnl f CWMS MADE ? OCCUR MED EXP (MY ant Aroonl f I PERSdNLI ADY INJURY S GENEIIAL AGGREILTE L GEN L AGGREGATE LIYR APPLIES PER pR000fR3 COYPR7P AGO [ POLICY P"6 lOC I AUTOMO[L[UAWTY COMSINEO SINGLE LIMB f I ANY AUTO (Eo RecpPnq AlL OWNED AUTOS BODILY INJURY X scHFDULEDAUTnb <P"P"'°"I [300 000 ' A HmEO AUro[ TO BE ASSIGNED 01/05/01 01/05/02 BODILY INJURY I NDN-avNeDAVros (PNMxgYKI f600 000 I PROPERTY OAWOE f DAIUD[llVl1Y AUTO ONLY-Fa ACCIDENT [ ~ ANY AUTO OTHER THAN fa ACC f AUTO ONLY AGO f I iRCEM WrRJTY EACH OCCURRENCE f I OCCUR ~CWM9 MADE AGGREGATE f I f DEDUCn[IE s RETENTgN f f I WORNG[COrMRMTgr AMD TORY UMRS ER drLOYQf UArRRY E L EACH ACCIDENT f I E L 01[FarE • EA EYPLGYEE f I E1018EME-POLICY lI1JfT i I OTN[R M(K[IIItDR Qf Dr[R111gRYLOCATGM[NO[CLIfRI[CWwOr[ ADDiO [Y OIDDR[lrO1TIV[LyL rRONrOM[ RE: LIABILITY APPLIES TO PROVIDING SOURCE OF FUNDING AND GRANTS FOR INSURED'S J OPERATIONS, INCLIIDING, THE PLACING AND FIINDING OF DHS CLIENTS AT THE FACILITY AT 34 RAINBOW DRIVE, HILO, HI 96720 CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED. CERTIFICATE HOLDER AppTpMAL VIwR®, [J[UR[II LRTR CANCELLATION fNOULD ANY a TN[ JIrDVf oocRf+m rourn ri e"rr~0 r[rDR[ TN[ orwAmR COUNTY OF HAWAII DAT[ TNQ[W, TN[ MMRIIr RWIIQI W[L oatMeelOttrwL 30 DAn WRfR[N OFFICE OF AGING NDT¢[mTN[nRTRCATLNaLDUIrArmTOTN¦LRrr,w7rAILUR[T000fo[IULL 101 AUPUN I STREET prof[ No D[LIWTJOR oR uwn G Arr Iwo uraN TN[ IR[uR[R. In AocRrf oR HILO, HI 96720 R[Ml[ ATN[l AUTX RV~[[MT~f /y_ i~ acoRD:e-B (TliT) ` ~9/end D CORPORATION lip ~ ACDRD. CERTIFICATE OF LIABILITY INSURANCE lz%z9 oo~kY' PROCUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION k>.lliam F. Jones Insurance A ency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE g 1 HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. 0. Box 1539 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Kailua-Kona, HI 96745 INSURERS AFFORDING COVERAGE INSURED - - - MSJRERA Northfield Insurance Compa_nv_____~ Hawaii Island Adult Care, Inc. INSURERS _ _ _ _ _ _ _ _ 34 Rainbow Drive wsuRERC _ _ _ 1 Hilo, HI 96720 INSURERD _ _ - _ I W SUPER E yl COVERAGES THE PO_'CiES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEPIOD INDICATED NOTWITHSTA+IOING `:r nECUIREIdENT, TERM GR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT IYITH RESPECT TO VdHICH TH4 C'cRTIFICATE MAV BE ISS„E:J OR F~RTAIPJ THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIIJ IS SUBJECT TO ALL THE 7ERh15 ExCLUSIONS AND CONDITIONS C= :UCH rC~ ~ ES AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS INSR - - _ - - POLICY EFFECTIVE POLICY EXPIRATION-_--- - - ~ - - - ' p TYPE OF INSURANCE POLICY NUMBER p r.rr I Y LIMITS I GEPcRAL LIABILITY EPGH CSC„RREI%CE 5 1'QQQ '70(~ ' A CC:q'cPC'C GENERALL'ABIIiY FIREC-r nvo~ei'e. ~ SQ,000 ':L<1+5 rAADE X OCCUR CP396771 Ol/Ol/Ol Ol/01/02 r1EC E%P.<~, one Deso~l _j,000 _ _ _ _ _ 'ER50 .ALn ADb Ir•JURV c 1 ~QQ ,'7QQ GENERAL %.GGPEGATE 1 09 QQQ I _ _ _ _ _ ~ _ _ a_ a " ]v'_-GGREGATE LIMIT APPLIES PEF PRODVCT$ COMP•OP AGG 5 Includ_~__ f Pn_ICY PROT LOC PUTDIAOBILE LIABILITY CON6'VEOSNGLE LIMIT - - I iEa ac:ar - 11II -.auto PL_CwNEO AUTOS WI~'IiT F JO'r05 11151Af^;I: A7~3c C}• EiC 80CI-/I\J..Rr IPer Je•sC~' - SCHEDULEOAUTOS SUf'JIUS L1f:G Cf OkUI _ -rlaE.-i PU-OS F 0 OOx 1539 / Kellua-r'ona HI 36'45 BOIL" INJ..Rr ,,,•,owNEDauros -'9 I`I;JFi~`:::E CONT'-_- ; c,,F'' HY rPeracooe• - A- • ' ic? 'ti%-'C-+ 'a t+;~- . =1~"_~ i.Y 71iE ~_----S ^-r OF ia4W qll Aili Iv ~~:T PRCPERTI CPNAGE C ?JEfT TD rPe•a.c.ce^ WRAGE LIABILITY = ' v ~ • r ~ vq , „ . - I AUTO DNL° EA ACCIDENT 5 - - IN_IjfER 13 FOLNJ INS'A:E":~ CLA;I,IS .:JUER - "'°AUTO T-S CiXJTRACT ARE fJOT '.C .ERA;, ANY OTHEF THA` EA ACC i GU=aA~TY FUN OF - AuTDOrly iAT a'I AGG ' EXCESS LIABILITY_ EACH OCCURRENCE OCC:/R CLAIMS MADE AGGREGA'E 5 CEDUCTIBLE PETENTION S E WORKERS COMPENSATION AND V+C STA U OTH TORY LI'11T5 ER EMPLOYERS LIABILT' E L EACH AGGIDENT _ E L DISEASE EA EMPLOYEE _ E L DISEASE DOLICY LIMIT 5 OTHER A Professional CP396771 O1/O1/O1 01/01/02 $1,000,000 Aggregate Liability $1,000,000 Each Occurrence OESCPIDTION OF OPERATIONSILOCATWNBNENICLESIEXCLUSIONS ADDED BY ENOORSEMENTISDECIAL PROVISIONS Re: Liability applies to providing source of funding and grants for insured's operation. Certificate holder is named as additional insured. CERTIFICATE HOLDER ADDITIONAL IN51N1ED, INBIMER LETTER CANCELLATION SHOULD ANY OF TH! ABOVE DESCROED POLICIES BE CANCELLED BEFORE THE E%PIRATION County Of Hawaii GATE T/EREDF THE I8BUINa II/SURlR RTLL ENDEAVOR TO MAIL 3Q._ DAYS WRITTEN I 1 NOTICE TO THE CERTIFICATE MOLDER IUYEO TO THE LEFT BUT FAILURE TO DO SO SHALL Department Of Finance ~E~P Np O~TIp~ ~f ~F 25 Aupuni Street I I ~Krr..Q~. ryr711Kfl1~~~.9' ~ KIND UPON THE INSURER ITS AGENTS OR Hilo, HI 96720 / . sr.E..+H.~FII AUTHORIEED R[PRESFNTATnV,ErrT~ 'r.Y'i'F"Y y J" Nary?ronl Cortroratlon PILING FFi :t0 PILQ IN OL'1`;,ICAT~ (Ca111noHlon ehFrp G.tO Prr ya:ro,~r7..,wi) i7ATi pP MAWAII DiPARTMlNT OP RlOULA70RY AOiNCrt:i Budn~w R~pbtntlen Dlvblon 1010 Rlohanir 9ernt r5 ~ M~Illna AJ~Inni P. O. Bow t0, Hondulu, Hwvall Oai10 _ ti VJ i ' In tha Matto of th• Incorporation c.~ I ' 1 I s : - ~n of I ~ ~k: H:LO ADULT I;AY CSR!? AiD '-11•!'!'1°H. I'j:. ~-r" -y f~i Gu Ci , r. PETITION FOR CHARTER OF INCORPORATION Tha undaNpwd, a m~b?Ity of whom an naldanta of the titate of Hawall, hanbY petitlan, urda the provialona of i M+etlon 41610 alld 41620, HatnaY RwWd Staweeb br a etrrtar of ittaorpontlwt, for thartlarlt+ea and tMlr aaaadataa. as • non•proflt wrpcatlon ut?'!er the nary of _ cl T IQ~Uf.T DO V G 4 RS 4 Tn C R~tmgR - rr,IG - arai In oarrnetlon harewlth da hereby Inoartioaa henln by nhrenp thanto the aooolnpetlylnp propwed chaRar of Ineorparadon wherein ae wt''f//orth varlaw Inattan nt111erad urdar Setxlnn 4/`1&20 ahxaaid. Oatai at ~4~U ,Hawoll, N4~day of _ ~n H~ , 18~. Si e) J IT71'FOX .rC..e ' Isipta aJ BETTY N AO itry t .sue . S7yltatlud ,rartoFlfawau 0. EDGAR STONE s couNTY oa Hawaii cc,,t,lttyl \ .~imrT?~ rrnx BETTY NAGAO ~Lar,d ED(IA R STONB b~ ~ a1rM attarrr ~ athr daooM and ay that they an !r pethlarrwe abtnla trrlted, drat they hive read the fexpoNN pedtlin and aehalled propoaad afarrter of IniirponNan red - •1•.. •w....rr.w irrrr nirarrtetefa thenln tat forth an tw to the boat of tMk knowladeN and In ~h~ M~n~r N ~h~ Inpra~oraYlon I r of I I HILO nnUI;r pAY CAI7& n1D CItirJ'I't•:ft, IiI~T, CHARTER OF INCDRPORATIQN TO ALL TO WHC~d THESE PRESENTS SHALL COME: I, s,5a unCardgnd Dirapr of Regulatory Agartdae of the Starry of Hawaii, nand Oreatlnq: WHEREAS, ,Ttltl?m_y F~~X BFTTY NnGAO , and EDGAR STONE , a marshy of whom are raJdazC of Cte Stir of H:wl:::, h:~a fl:a,: with rrN a, Dlra~or of Regulatory Agaatdat a variAed paNtlon to grant to than avd t:rar acw:iaa a ehtvtor of Inwrarrt:an m a ntnt:'oflt mrporatlon, In a,:aardana with the txorlalaru of Section 4ttf,:D, H.w:11 Ravl:al SLttuw:: ROVJ, THLAEFORE, KNOW YE, 71ut 1, the wld DYeetor, in the exarelae and aaaewdon of wary pawsr artd authority In anYwrl+a enabl4+g tna In thla bdulf, da hentay CoatR)tuta the aaW petitlonera and tltdr arrodara a a:orpxttl:.n urdar the lawn of the Stan of Hawaii for the pupora and In rite form Mreinafter set forth. I Tharstwotthaeorpustlanalvtllba: HILO ADULT DAY CARE AID CENTER, INC. U The lor:ailon of tlae pr)ndpel otfla;a of sh. eaarpor.tlon ahaU be In the C i tY of Hilo, County of Hawaii , State of Hawall, and the apeeMla addreae of In Inhlal oNlas shall be 34 Rainbow Drive, Hilo. liawaii 96720 S::ta of Hewail. , III The purpotw d the e:orParadon are: - •.....+or•tive and supportive care for the disabled Iv Th. rJur~tlon or ehta eorpor~tlon shall b. psrp.tuol. V Thy oltie~rs shill eons)st of (Till s Only) President-L'irectol• Vtce-Pre t:td~rlt Secretary-1'r•easurer VI Tlwe sFrll ba s bond of diroeton cortshtirp of not Im than~~ ttwnbvlst. Thy lollowirq persons sltaq y,t tha InIWI cars anG dlri~tors, and scull hold ofHp (or Uu Hrst yur a trrltll UwM suaasson s+n duly dared purswnt to tha byds.a da eorp~uatlon: Offln HaIA N~rn~ Haidota Address President-Director 'Judith Fox 281 Kipa Street de Director Hilo, Hawaii 96720 Vice-President William Carse 660 Kaumana Drive de Director Hilo, tiawali 96720 Secretary-Treasurer Betty Nagao 50 Aipuni Street &Director Hilo, Hawaii 96720 Director Edgar S}•one Volcano,lHawaii 96785 - vul 7ht eorpor:rion 4 orY,:r~:.:d for c: f I.l C 1 L4 b t Il G.rrpas.t only r.uf lr not crt,:n7iad fur profit, it will net lout tIW teoall, and Iq pat of let tttett, lnrvmt, w t.rn{na elu:t t:e ..:iir1ZJ::w'i tJ IL tn:nt:.:r7, tintetort, G OMbert, axe.pe ler atrvfoM evnu.uy n+dend m 11N aerpentiolL Upon diri.t,riirwl, iii e7 tba µ+.tc of'tht eorprnytl.~n a.'ter paynwtt of Is lute dabs eflatl bt traluferrad or dletrl6uted to :n crs;:ni:atla~ or crpenlss;ioru a ehtll •t tiu 4rrt qutitfy M en exempt elytnltatbn w orytnlutlerlt order Saotien W11c11.1 of the Internal R:n,an,ra C.: :a cf i43:. fAOt'.vlLtistaldln0 eny ether prevltlen et rhU Charter, thlt esrperttlen shall net, axatpt N an In:.:b:rnU.! dyraa, an~ap+ In :rly adivltla ar axarelta any povwri thn an not In funharartea of the pc;rpora,t of th4 c.+rWr:clon. IN WITh:E.'.~ >r//H.'RC9F, 1 haw Iwwnm wt my lord end tttl of tM Department of Repulrtory AWnelA at kcnoh,il,, :hls.~ 3 i?1 d:y of ~ % ( r~. A.~_ , , l OT O d Rayltiatuy A~.It::.a ey 9~5t~ forpontlen G Ay'~;ilr:.:ratar r ° ~ HAWAII ISLAND ADULT CARB, INC. ~ TELEPHONE (808) 961-3747 _ FAX (808) 961-3740 34 Rainbow Drive, Hilo, Hawaii 96720 BYLAWS OF HAWAII ISLAND ADULT CARE, INC. Revised December 17, 1997 ! Hilo Adult Day Care Center ¦ Senior Helpers ¦ Caregiver Coaaecrion ¦ Small Group Homes ' 'r~ ARTI .E I: NA This corporation is ]mown as Hawaii Island Adult Care, Inc. • gR i fCil•.1~1: LOCATION The location of the painapal office of the corporation is in Ailo, County and State of Hawaii, and the specific address of its initial office is 34 R9inbow Drive, Hilo, Aawaii 96720. The Corporation may maintain additional offices at such places as the Board of Directors chooses to designate. ARTICLE III: PURPOSES The corporation is organized exclusively for the charitable purpose of providing protective and supportive care for flail elderly and disabled adults on the Island of Hawaii. ARTICLE IV: BOARD OF DIRECTORS , 1• H4fiih~t. The Board of Directors shall consist of not more thaw twenty- one and not fewer than elevea members, provided that at any tune due to assignation or impricat rssi~nstion due to non-atter~danoe the Rf1191fl+' number Of members shall be allowed to conduct all business as necessary until such time as the minimum number of board members may be appointed. All members serve without compensation. ' 'K a: A11"members of the Board wade for a term of three years, asnewable for one term for a anaximttm of six years, b. One-third of the Board is elected each year, and the team of one-third of the Board expires each year. c, The Nominating Committee of the Board of Directors will prepare a slate of candida)es for officers and new board members to be presented w the Board' for election at the first ineeting of the calendar year. d. Removal. A member may be removed from the board by athree-fourths vote of board members voting an the issue at a properly convened meeting of tlu board. The member in question must asceive the written mson for removal ten (10) days before any meeting at which the matter is to be decided and must be afforded an opportunity to respond to the Board before any decision is taken. H I A C Bylaws I Rewsed December 17. 1997 e. Attendance; Three consecutive absences, unexplained or not excused by the President, shall be considered an itnplicit resignation from the board. The President shall so notify the member in question by letter. 2. Power and Functions. The Board of Directors shall be the governing body of the corporation, with the full power and authority to manage, conduct and control the business and affairs of the corporation. All actions taken by the Board of Directors shall be deemed to be the acts of the corporation, 3. s a. Regular meetings shall be held at least quarterly; a notice of such meetings stating date, time place and agenda shall be even to each member either orally or in writing az leazt seven days before the meeting. b. Special meetingi may be called by the President ar upon written request of two directors. The President ar Secrttary snail notify each member either orally or in writing of the purpose, agenda, date, time and place a~f the meeting az least seven days before the meeting, except in cogent circumstances. c. Written notix may be mailed ar faxed to the members address as recorded on the roster or delivered personally az their residence or place of business. d. Verbal notice tray be telephoned personally to the member or relayed via a reliable intnmaliaty. 4, Ouorum and Voting, Fifty percent of the existing directors shall constitute a quorum. Writtat proxies are permitted provided a quorum is present. No decision may be haastcted without a quorum, but those present may adjourn to a later date: A vote shall be determined by a simple majority of those present and voting. 5• ~r?mmilnpea. The Board may create and appoint such committees as required and shall define the authority and duties of such committees. Standing committees shall include, but not be limited to: 1) Personnel, 2) Nominating, 3) Fittana, 4) Planning, and ~ Bylaws. H 1 ~ C Bvlaws 2 Revised December 17. 1997 6 Associate !Members From time to time the Board may elect any number of individuals as associate members to serve to an ex-officio non-voting capacity Associate members present at Board meetings shall not considered when determining if a quorum is present ARTICLE V OFFICERS 1 OFFICERS The officers of these corporation aze a President, a Vice Prestdent, a Secretary, a Treasurer and a Prestdent ofEmentus 2 ELECTION All officers are elected by the Boazd at the first meettng of the calendar year Each officer shall take office for a term of one year In the election for any office, the person receiving a simple ma~onty vote of those present and voting shall be deemed elected 3 REMOVAL An officer may be removed from office by athree-fourths vote board members vottng on the issue The officer in question must receive the written reason for removal ten days before any meeting at which the matter is to be decided and must be afforded an opportunity to respond to the Board before any decision is taken Any resulting vacancy may be filled in at that same meettng in the manner provided in Article V section S An oflicer (or Board member) who willfully neglects to carry out the policies or actions duly voted upon an passed by the Board, or who farts to carry out the responsibilities as stated in the corporate bylaws, including attending meetings and participating in the functions of the Boazd, may be subject to removal to accordance with this article 4 RESIGNATION Any officer may resign at any time by giving a wntten notice to the Prestdent, or in the case of the President, to the Vice President Any such resignation shall take effect at the time specified in the notice, unless otherwise H f ~ C Bvlaws Re~•ised December l7, 1997 specified in the notice, acceptance of such resignation shall not be necessary to ' make it effective. 5. cancv. Any vacancy occurring in any office, rxcept the office of president, shall be filled by the Board of Directors at any general or special meeting of the Board. A person elected to fill a vacancy shall serve the unexpired term of the predecessor in office. 6. p~Si~Cpl. The President is the principal offices of the corporation and shall generally oversee its business and affairs.. In so doing the President: (a) is an ea-officio member of all oommittaes and prrsides over all meetings of the Board; (b) signs aII authorized contrarxs and other instruments unl~ directed otherwise by these bylaws, by the board, or by legal statute; (c) performs such other duties as direcud by the Board. 7. vice Pre is'dent. The Vice Prevdeat shall assist tt?e President. in doing so, the Vice President: (a) is as ex~fficio member of all committees; tb) assumes the powers and duties of the Ps~esidart is the absence air disability of the President; and, (c) performs such other dutiess as are properly required of the Vice President by the President air the Board of Directors. In case of a vacancy in the office of President, the Vice President shall become President and serve the unexpired term. 8. The Secretary: (a) is responsible for beeping minutes of the meetings of the Bond of Directors; (b) sees that all notices of meetings of the Board are given as required; (c) enstnres the proper mainte»ancx of the corporation records; (d) signs, with the President, all coartracts and other instrumgttts authorized m be executed, unless the signing and execution are expressly delegated by these bylaws ar by the Board of Directors, or~'are required by law, >o be performed by some other officer ar ageat of the corporation. Ia general, perfoam all other duties assigned by the President or Board a~f Directors. The Secretary's records shall be open at all times for inspection by any member of the Board of Directors. 9. Tr~y~. The Treasurer: (a) is responsible for overseeing the financial accounts of the corporation; (b) advises the board regarding financial matters; - ~ n ,...a ne..e...t,e. i -r i oo-t (c) serves as official chairman of the Finance Committee; (d) oversees the audit ' or review of the corporation's books; and (e) in general, peiforms all other duties assigned by the President or Board of Directors. The books and accounts shall be audited at least once every two years and submitted for a financial nview all other years by an auditor air auditors selected by the Board of Directors, ARTICLE VI: EXF.CCITNF nmF[-rnR 1. Agpointmmt. The Executive Director is appointed by the Board upon recommendation of the Personnel Committee. 2. pyl~y. The Executive Dirzctor shall carry out the policies and programs set by fire Board of Directors. 3. The Personnel Committee shall meet az least annually with the Director to evaluate the Director's perforntertce. 4. Corrective action- To be considered valid, any chazges of misconduct or malperfarmancx on the part of the Executive Director must be submitted in writing, along with pertinent documentation, to the President or flu Board. The President may then appoint a panel of three members to investigate the charges and to mport to the Board within thirty days. The President must concurrently present a Dopy of the charges and pertinent documentation to the Executive Director. • In any event, the Execudve Director must receive az least ten days notice of any Board meeting az which the changes are to be discussed and also have the opportunity to speak to the Board prior to any decision regarding the charges.' ARTICLE V[I: NON r YAB .rrv nF nmFrrnu c 1. F,g~yjpy~p. No director or officer of the corporation shall be liable for acu, default or neglect of any other director or officer, or for any loss sustained by the corporation, unless the same has resttlted from the director's or officer's • own willful misconduct, willful neglect or negligence. 2. IIIdG»>a1f7~. Every director and offiar shall be indemnified by the corporation against all reasonable costs, expenses, and liabilities ('including all legal fees) actually and necessarily inc~aszd by or imposed upon him/her in connection with or resulting from any claim, action, suit, proceeding, investigation, or inquiry of whatever nature in which the director may be iavolved as a party oz otherwise by reason of the director being or having been a director or afl7ar of the corporation, whether or not he/she continues to be such director or officer of the corporation at the time of the incurring or imposition of such costs, expenses, air liabilities. However, these shall be no indemnification in relation to matters as to which the director or officer shall be finally adjudged in aforesaid claim, action, suit, proceeding, investigation or inquiry to be liable for willful misconduct air willful negligence Wward the corporation is the perforrance of their duties as such director a¢ officer. As to whether or not a director air offiar was liable by mason of wr7lful misconduct or willful negligence toward the oarporatiat is the performance of their duties, in the absence of final adjudication of the acisterrce of such liability, the Board of Directors and each Director and officer may conclusively rely an an opinion of legal counsel selected by the Board of Directors. The foregoing right to indemnification shall be in additioat to and not in limitation of all other rights to which such person may be entitled as a matter of ]aw. ARTICLE V[II: ROBERT'S RULES OF ORDER Robert's Rules of Order, Revised (most current edition), shall govern the proceedings of all meetings of the corporation and its wnstituent parts, except as otherwise provided in these bylaws. ARTICLE IR: C=?>'I'S AND CONTRIBUTIONS The Board of Dinertors may accept on behalf of the corporation any contribution, gift, grant, bequest or device. H 1 A C Bylaws 6 Revised December 17. 1997 ARTIC .E Dim Ct'I'iON OF AcSS,-rc N Di5cO . 1'1'iON Should the corporation ever be dissolved, the assets of the corporation, if any, shall be distributed, following a vote of a simple majority (of those present and voting) of the Board of Director, to are oar more corporations that are exempt, oar have applied for exemption and ultimately receive exemption, from Federal income tax under section SOl (c) (3) of the Internal Revenue Code of 1954, or the corresponding provision of any future IInited States Internal Revenue Iaw, air a Federal air State Agency that provides similar services as provided is the corporation. Prefesrnce is such distribution shall be given to corporations whose purposes are similar to the purposes of this corporation. ARTiCL.F XI: NEPOTISM AND ('ONFL•iCT OF iNTIIt~cT 'Nepotism', far the purpose of this article, is favoritism shown to a relative (as in granting as appointive position) on the basis a~f relationship. 'Conflict of interest is the aeeidng of one's own individual gain at the expense or disadvantage of the corporation. No employee or member of the Board shall talcs nay official action directly affecting Hawaii Island Adult Care, Inc. involving any business or other undertal3ng in which that person has a financial interest air is engaged as legal counsel, advisor, consultant, represartative or other capacity. If the possibility of a conflict of interest should arise, whether by nepotism or otherwise, in the dealings of a Board ar staff member, such potential shall be made ]crown in writing m the Board of Directors. The Board shall nrle on all potential cases of conflict bf interest and/or nepotism at the first mating of the board possible following such notification, whether or not on the agenda. The partiapatron of stub person in the discussion or decision of the issue may be limited by the BoaN. ARTICLE Xii: At~r_E_NnMFN75 TO BYL-sic These bylaws may be anratded, repealed, or altered, is whole a~ in part, by a simple majority vote of the Direcmn present and voting at any general or special meetings of the Board of Directors, provided that a written notice to amend and copies of the proposed amendments(s) have been distributed to each director at least seven days ~ n , De...ru~ IlnrrmhPr 17 1997 before the meeting az which the proposed amendment or amendments are to be ' discussed and voted on. These bylaws shall be nwiewed annually by the By-laws committee, which shall make any recommendations for change to the President. ARTICLE XIII: NON PROFIT STATUS The corporation is not organized for pao5t. Notwithstanding any other provision of these articles, the corporation shall not carry on aay other activities not permitted to be e~rried on: (a) by a corporation exempt from federal income tax under section 501 (c) (3) of the Internal Revenue Code of 1954, or the corresponding provision of any future United States Internal Revenue Law, ar (b) by a corporation, oonttibutions to which are deductible under section 170 (c) (2) of the Internal Revenue Code of 1954, or the corresponding provision of any future United Stazes Internal Revenue Law. I hereby certify that these bylaws were duly adopted by the Board of Directors on October 11, 1995. Carl Rohner President H I A C Bvlaws 8 Rewsed December l7, 1997