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COM 0122.019 2000-2002
Stephen K Yamashuo _ ' • - Harry A Takahashi _ Mayor Drrector = _ c - 000NTY OF ~Hi41K~I`I _ • DEPARTMENT OF FINANCE 25 Aupum StraeR Room 118 • Hilo, Harm %720.4252 -r (808) %1.8234 • Fa: (BOB) %I-8248 ~ - HAWAII COUNTY NONPROFIT GRANTS (FY 2001-02) ~ - HUMAN SERVICES NONPROFIT GRANTS REVIEW COMMITTEE co FISCAL YEAR ENDING Iune 30, 2002 DATE OF APPLICATION• January 26 , 2001 GRANT APPLICATION FOR: Hamakua Health Center Van (haQna71W) Legal Name ofOrganuation: Hamakua Health Center, Inc. MatlmgAddrds: P. O. Box 509 Honokaa, Hawaii 96727 Factltty/StteAddras: 45-549 Plumeria Street Honokaa. Hawaii 96727 Duxtor/StteMaaaga: J.E. Potter Swartz OrgenuahonPtr~tdent: Patrick Linton Contact Person (Grant Wnter): J . E. Potter Swartz Amouut of Requert for County Fonda: E 35 , 342.28 Total Annual Budget of Organization: E 1, 620 , 553.00 Has the applicant applied for a~ other funds from the Cotmty of Hawaii this fiscal yeu7 ? Yd SotucdDepartmmt: ® No Ageocy/Prognm(s): ? Social Services ? Youth Programs ? Elderiy Programs ChtckCategones: ? CultureandArta ? Education ®Otlter Health Care Briefly, define the program for which }boding b bring rsgnated: Operational support for transportation used for access to medical and health tarn aPrvi rna fnr~o n th t zr' ro transnnrra}inn_ - Comm. No. ! 1 2 . ! 7 Q Ftile No. 8 U D -1 / ~ ~ . / i Ref. Tot Pnsraefed /fSE~G Na FFR 2 0 2001 -"-~"ilef. Date - - I. QUALIFYING STANDARDS FOR APPLICANTS An applrcant must meet all of the followtng standards: ? Be chartered or othetwtse authorized to do btrsmeas m the State for chentabk purposes cad exempted from the federN income rax by ttte Internal Revenue Service ? Have a govemtng board whose members serve wtthou[ compemation sad have no cotifltct of interest betwern then regular occupations and the acmes provrded. ? Have bylaws or pohcra whrc6 describe the tiiemc m which bttsroess u conducted, tncludrog managemem, audit, fiscal pohcid and procedures, policta on tiepotism, and pohaes on maoagemeot of potential confitct of interest. ? Have u least one year's expenerice with the semce or acnvtty for which the appropnadon u nought or can othrnnse demoosaate to the sansfietion of the County stifficitmt exptanae to attcceufitlly carry out the service or activity. ? Be licensed and accredited m accordance wtb apphuble regtitremmts of Fedaal, Stste sad Cotroty laws II. GRANT CONDITIONS The applicant agrees to wtnply with the following fatale sad condttioaa prior to receivu?g a grant award. A. Comply with applicable Federal sad State lams prohibitrag discnminadeo against say person on the bests of rice, color, national angm. rehgiao, creed, snt, age, or htuadicap. B Agri not to use say public foods for ptupaes of eoterhi®mt a pettptwta. C. Comply with strch other regniremmb ar the Director of Ftnaoce may ptesaibe to tinaura sdhaeace by the nonprofit trrgantraaan rnth Federal, State, cad Cottnty lawn, sad atablisbed standards far fiscal and Pmtl~ D Allow the Dueetor of Fiaaoce, the committees of the council sad their stafii, and the l.egislaove Attditor access to records, reporh, files, sad other related documeau m order that the propam, maoagemeat, and fiscal practices of the nonprofit orgaairanoa [tray be moaitaed sad evahtated ro aastrta the proper and effective expeaditiue of public fiends. III. RECORDS AND REPORTS A. The applicant shall hollow geoeiallY accepted aecawwg ptocedura and pnetica sad shall maintain boob. records. documrmu sad other evidence which suffict®tly clod psopariy aacwr8 fitr the expenditure of Cowry fitds. The boob, records and doeumitatt shall be subject in all maamabk times m itaspectwn. reviews, ar aiidita by the Cottaty ercpeadirtg agmiy, the Diiactor of Fioaoea, sad the I.eptlaava Atditor, or by then reprdantanva. B. The Cowry expending agency, Director of Fioaxe, or Cortaty Coiixil may ragiwt periodic wntteti repau on the we of Cowry Nods. C The ocoprofit orgtitnatitrn shall submit a final written capon m the Lepalaave Atrditor within sixty (60) days attar June 30 of the fiscal yeQ The npott shall ioehide m atp4aadon of the public 6eaafits derived from the awarding of the [;rant, a hstmg of other Nailing anises rind amoimL obtained during the grant period, snd a complete aecouotmg of all expeodrtures supported by Camry of Hawari gnot funds {per L'hapter 2, Mack 25, Section 2-142(d), Hawaii Cotmty Code, amended August, 1999}. -2: IV. f~UARTERLY ALLOCATION Under no cacumabaces shall gran[ fiiada be dubutsed m a lump sum payment. Grant funds wtp be disbursed to Gnn[ees only through a quuterly allocation process The dubunement of gnat fiuid9 cm be formulated on m equal quarterly appoRiotiment basis. V. GRIEVANCE PROCEDURE The apphcaat will adopt and mamtam a gnevmce procedure to assure proper accounting for my concern and complaints about iu program or services that may arse from iu member, esnployea, chenu or 6om other member of the public VI. DISCLOSURE OF INFORMATION All information, data or other metmal provided to the County by vvtue of thu apphcatioa shall be subject to the Uniform Liformatioa Practicer Act (UiPA), Chapter 92F, Hawau Revved Statutes. All each maters! >s deemed government record and shall be open to the public sad mry be ptmeded to other public aadlor pmaoe fiindmg sources VII. CONTINUED ELIGIBII.P17' Aay applkaat or reelp4nt who wlthhohU or omib say mabrW fact or dd~eratdy mYrepraenb soeh 6eb to the Comfy of HawW shall: (1) Lamediately be duquahCied fiom coaudtaatiaa for Naopnfit Groat firading; OR (2) be m vrohmon of the terms of the Gram Agrsemant of Cowry fiends m which use a goof agreemem cm be tetiainated by the County end the recipi®t or provider may be liabk to reimburse all a ¦ portinn of any fiends received therein VIII. ACKNOWLEDGEMENT Hamakua Health Center. Inc_ (Legal Name of Organtation) herebysgreestoadmiauterthe Hamakua Health Van (Program Titk) m accordance mth the regulatioaa, pohcia sad proceduta praaibed by die Hawes Cowry Finance Deparaaeat. Dumbuaon of grant fiends is hrnrted to grwtees which are in compltaace wtth County tegulatsoaa, policws and procedures. The Cowry taarvea tha right to withhold groat dutdbutiom at say time the grantee u not m comphaace. It u the polity of the Cowry of Hawur sad for those who do bwroeae with the Cowty to ptovtde aqua! employment opportumtia m all pasoas regardlaa of race, phynal ditabihtiee, wlor, rehgioa, sent. age, or national ongm u matidased by the Federal Cml Rtghb Acb, d amended, and say odrer fedora! or state laws reLting to equal employmem opportunities. II{. AMENDMENTS TO THE APPLICATION/EVALUATION The appht:aat aesnres that it will aubmrt t4 the Hmaaa Services NonproSt Gtanu Review Committaa (HSNPGRC) for poor renew and approval a wnttea mquat and lwtificauon far any cltarigee, add[tioaa, a dektroae to any portioa(e) of the grwt apphcanon or a duly eaeiuted Grwt Agreement of Cotmry Fwda. 7Le applicant will cooperate and aasut m any effort wdeReioso by the HSNPGRC ro evaluate, mapetx err otherwise moment the effectiveatsu, feuibility, eadlor coat efficirncy of my end all practices, policia and procedora m aetmna pursuant to thu apphcatioa a any gtwt deeigaetion or allocation received u a result of thu applicatwa - -3- X. AUTHORITY AND CAPACITY OF APPLICANT The apphcaat crattfiea that tt has the authanty and capacity to develop and submit thu apphcauon, and to fully administer the program(s) Pursuant to thu upphcanon. UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! P~~-.~ slag/o~ Signature of Ptwdent/ n Date P ! St of Executive Dttxtar atuger Date -4= Narrative A Overview I Describe the program for which funding is being requested Funding is requested for operation of the Health Center Van service. The van service provides transportation to health services, appointments, and health related classes at the Hamakua Health Center and to specialist and acute or long-term services in Hilo, Waimea and Kona as required The service is provided for all non-driving patients, which includes disabled persons, elderly persons without cars or those not licensed to drive The service is available to meet the needs of all the residents of the service arcs of the Health Center, primarily from Papaaloa to Kukuihaele, but also includes service for residents of North and South Kohala. Until now the van has been provided on an as needed basis, however a schedule for service is being developed which will expand access by increasing tnps with multiple nders 2 What unique service will be provided' The van is unique in its door-to~oor service and in its flexibility to meet multiple needs. Along with Health Service appointments at the Health Center, the van permits stops at pharmacies and stores if riders need these services. It ensures access to medications, which may be part of treatment. It permits patients to make and keep appointments necessary for their health care. Persons with chronic disabling conditions with frequent medical needs are provided a service coordinated with their medical needs. 3 What specific outcomes are to be achieved The specific outcomes to be achieved are: 1 Creating access to primary health services 2 Providing safe and accessible transportation to those in need 3 Allowing primary care providers to make medically necessary referrals for specialized care 4 Create access to specialized regional services and diagnostic equipment for residents located outside the vicinity of those services 4 How will the proposed program empower participants/clients to become self-sufficient and facilitate positive social change' Participants in the van program are able to make and keep medical appointmenu without relying on friends or family to deliver them for care This allows people with chronic conditions to remain at home longer and still receive needed health care For some people the van is the only way they can get health care In some families where the vehicle or dnvers are not available during the day without losing work, the van service ensures that those at home can get the care they need Persons who wish to keep their medical issues confident[al are able to obtain service without any need to disclose mfortnation to those who could provide them transportation B ProblemiNeed I What is the problem/need the proposed programs are designed to meet Persons who live m rural areas have difficulty making and keeping medical appointments if they do not have their own transportation In the Hamakua district many ret~rcd people Irve in the Camps, which are not served by regulaz transportation As they age, more of them do not dove themselves Those w[th disabilities and chronic ~Ilness they are likely to need more access to health care and less likely to be able to dove themselves Z What is the target population and what are the specific needs? The target population is the group of people without transportation, which has health care needs Specific groups include• The aged Persons with physical disabilities Persons with diminished mental capacity Persons with chronic illness Persons with low incomes Persons with limited access to private transportation The specific need shared by these groups addressed by this program is a need for medical care access In order to get medical care, people need to make appointments and meet them. Particularly in today's complex medical systems where referrals and insurance plans require timely completion of visits and diagnostic tests access to reliable transportation coordinated with appantment times is necessary. 3 What is the geographic area to be served and hours of operation The primary service area is Hamakua from Papaaloa to Kukuihaele and Waimea, about 80% of the service will be in that area Some of the services to which van clien[s will be transported are in Kona and Hilo North and South Kohala have populations, which need to access low cost sliding fee services, which are available at Hamakua Health Center. Van service to and from Waimea, Kawaihae and Waikoloa Village areas will constitute about l5%ofthe services Hours of operation of the service are• 8 OOam to 5 OOpm Monday through Fnday Because some services require early or late travel, services aze available by pre arrangement for other hours. C Collaboration/Coordination I What specific measures will be taken to collaborate/coordinate with other community resources to achieve maximum program efficiency and cost effectiveness The program serves the needs of individuals to access services provided by others, not Just the Health Center These services include many specialty physicians, diagnostic services of Hilo Medical Center and North Hawaii Community Hospital, classes of the Diabetes Center in Hdo, access to physical therapy and other services Other community services such as senior centers, transitional housing, and sheltered workshops have been informed of the vans availability while other programs such as Senior transportation are encouraged to continue including health care transportation as well as other servtces Establishment of a schedule for the van service will be coordinated with existing transportation services and will also be coordinated with schedules of diagnostic services and acute outpatient services to provide the best access for patients 2 How will these measures eliminate duplication of services to your designated target group The available transportation services are not adequate for the needs of the target group By scheduling van servtces at times when no other servtce is available, the service will not duplicate other servtces D Goals and Objectives I What are the maJor goals benchmarks of the program Goal I Enable persons with limned access to transportation to obtain medical services Benchmark Provide service to residents of each camp, or its vicinity weekly Benchmark Provtde transportation service for 100 client visits per month 2 3 What specific obJectiveslactton steps are planned for each goal? What is the timeline for each action step Action I Formulate schedule of servtce for geographic areas Begin development February 2001 Complete schedule April 2001 Revue schedule quarterly -July 2001, October 2001 and January 2002. Actton 2 Provtde information to agencies and locations through meetings and talks Develop schedule of meetings with Senior Centers, Camp meetings, Community Groups, and Schools. April 2001 -July 2001 ' Action 3 Develop brochures for use at business and other sites including Health Center and van programs information Distribute by Apri12001 Acton 4 Provide van services On call January 2001 - Apnl 2001 On schedule Apnl 2001. Action 5 Mamtam van, mechanical service Monthly maintenance starting January 2001 Action 6 Develop and maintain log of services Log trips and patients monthly Starting January 2001 and continuing monthly Acton 7 Evaluate Compare services to plan Revisit agencies and communities for additional outreach Adjust schedule Quarterly - April, July, and October 4 What significant client centered outcomes wdl the program ach~eve~ a. 20 clients will achieve improved control of diabetes through access provided to the Diabetic Education Program by the van. b 60 clients will improve their control of diabetes, hypertension, by regular access to follow up pnmary care c 20 chronically disabled clienu wdl receive care for acute rllttess, which they would not otherwise access d 30 pauents m need of diagnostic and specialty services will be able to access care through the van service. E Service Delivery I What methodology will be used in the proposed programs delivery of service? Persons in need of service will access the van by either a duet[ call to the Health Center or will be directed to the van service a the time an appointment or referral is made by Health Center staff When a client or patient needs transportation to a health service, an effort to schedule that service m coordination with van schedule will be made. Should the health service not fit with the vans schedule availability, the health service appointment will be arranged for un scheduled van time to allow a special tnp. The van will go to the home or a designated place convenient to the client(s) pick up the client(s) and bang them to the health service site Following the appointment for service the van wJl pick up the client and return them home or to a designated location of the client's choice. Clients who need to obtain medications or medical egmpment may be taken to pharmacies or other suppliers to fill those needs before returning home F Evaluation l What process will be used for to evaluate the program and servtce~ Statistical reports will be kept and evaluated quarterly Client satisfaction will be evaluated both anecdotally and through survey data Any incidents or problems will be assessed through regular on going quality assurance processes Z How will this process measure the outcomes specified rn D I-4~ Data collected will be compared with outcome goals Prognun adjustments will be made through increased emphasis on aspects, which may not be meeting outcomes anticipated Should the anticipated outcomes be~udged, in the evaluation, to require adjustment, they will also be subject to change G Program Fees l Dces your program charge a membership fee for service participants -Then: is no membership fee 2 Does the proposed program charge participants a fee for service? There will be no fees for van services Medical Service fees provided by the Health Center are variable depending upon insurance requirements. A sliding fee scale rs available for persons below 300% of the poverty level (attached). No one rs refused service due to inability to pay regardless of income The Health Center participates with a variety of outreach programs and assists patrents with access to programs, which cover medical costs The Health Center also participates rn the State Primary Care "POS" program which covers costs for medically indigent patrents H Viability I What rs the ~ustrfication or rationale for expenditure of public funds for the proposed program The persons who are rn need of transportation assistance, who arc served by this program have an ongoing need for medical care Our society recognizes a "right to medical care" through programs such as Medicare, Medicaid, Quest, State Primary Care and many other programs Access to care is viewed as coming above the ability to pay and as a desirable universal benefit Similarly, the access to care should not be arbitrarily terminated when age disability or financial circumstances limit mobility It is appropriate that efforts be made to ensure mobility and that these efforts receive public support 2 What are your financial and programmatic plans to sustain the proposed program beyond the up coming fiscal year? The Health Center as a provider of services to uninsured and low-income patients seeks ongoing support through a variety of Grants, contrrbutrons, contracts and programs Since the proposed service is a critical part of our mission to provide access to services, the Health Center will continue to seek funds for rts support and to the extent possible, keep the service m place Funding sought and received by the Health Center will, where possible, include transportation services as an aspect of our overall service 1 Budget Attached Organization A Board of Directors I Has the Board of Directors received formal training within the past two fiscal years Yes Training in aspects of Board Role was incorporated rn an over all agency assessment commissioned by the Board of Directors through Waves of Change, Tom Sherman, PhD November 1999 Further formal training was incorporated rn a Strategic Planning process conducted by Maya Yonttng-Domes February I I, 2000. A Board Training session rs scheduled for January 26, 2001 through the Hawau Primary Care Association to which we will be sending representatives a What plans do you have to provide formal trammg to Current Board Members With Bay Clinic, a Hilo based Community Health Center, we are exploring Board Training for our combined Boards Using services from the National Association of Community Health Centers. b When will next Board Training be completed? No firm schedule for a whole Board training is set c. How will you provide formal framing for new Board members and those who miss a scheduled traintng~ Currently, there is not a formal trammg program in place New board members meet with the Board President and may also attend one or more meetings before being voted into the Board Board trammg is reported rn reports to the Board and rs often discussed at Board _ meetings. which allows Board members who miss meetings or trammg to catch up with current issues 2 What are the pnmary roles and responsibtlities of your organtzattons Executive Dvector~ I Assist Board providing information, analysis, recommendations, and progress toward goals 2 Implement Program Activrt~es Policies 3 Supervise staff 4 Assist Board with Budget Development and provide financial reporting 5 Manage contracts and obligations. 6 Represent Health Center to outside agencies and programs. 3 What are the Primary responsibilities ofthe Board I Set policies for overall agency operation 2. Develop and oversee Budget and Fmanc~al Records including annual audit 3. Hire, direct and evaluate the Executive Director 4 Set mission/vision goals and strategic plans for agency. 5 Credential and accept medical staff providers. 6 Monitor Quality of Service and Rtsk management What are the responsibilrt~es of the Board Prcsident~ Presides over meetings Monitors progress and participations Meets wrth Executive Director Convenes task forces Appoints AdHoc committees What are the responsibilities of the Board Vice President Assist Prcs~dent with dunes Assume leadership to absence of the President Secretary/Treasurer Participates in Finance Committee Review and assures completion of the records of the Agency Certifies resolutions of the Board. B Past performance How effective has your organrzatron been rn achrevmg program goals during the past two fiscal years During the year ended September 2000, the Health Center served 14,381 vrsiu During the fiscal year ending December 1999, the Health Center met its budgeted goal of 13,300 visru When data rs available for December 2000 we antrcrpate exceeding the budgeted goal of l4, 500 visits a Quantrtatrve Data During the year ending September 1999, the Health Center served 13,292 vrsru. b Qualrtatrve date Outcomes of Health Care delivery vary dependrg upon "outcome measures" which may be defined to many ways All of our vrsru receive a diagnosis of the problem, which causes the patient to come rn, and a defined set of services including checking vital sings and performing indicated diagnostic tests. Depending upon the diagnosis, a plan of treatment is developed and canned out. Qualrtatrve measures related to the correctness and comprehensiveness of the care we provide, performed by outside agencies, are positive across the board. For the van, delivering the patient for diagnostic, treatment, education or screening services will be the measurable outcome and rt will occur for vrrivally 100% of those served C Financial Have your organr7ations current program operations remained the same as last year' No Our overall services have expanded. Services through the Tele-mad project (a rural health outreach grant) have expanded stgnrficantly with new staff and new web based record technology Immunrzatron services have expanded with participation rn Department of Health Projects Staff changes include a new nurse, a new van driver and a new financral/accountrng assistant ' New patient centered software rs being used staring January 1, 2001 We have completed our first year of participation rn Covering Kids. an outreach project - for the Children's Health Initiative Program (a FederaUState program) and are now participating in the Immigrant Health Initiative program to provide services to otherwise unserved immigrant populations We have also expanded case management within our nursing program through a grant from the Bureau of Primary Health Care Mayor changes for the coming year The Health Center has applied for a Public Health Service "330" Grant This grant will enable expansion to Dental Health Care, Pediatrics specialty care and Behavioral Health Care and permit consideration of expanding services to meet needs in Norch and South Kohala for community based health care 2 What is the Status of all of your organizations mayor contracts or agreements for the coming year State POS grant -current State Family Planning grant -current State Peds Immunization grant - cutrent State Adult Immunization grant State BCCCP grant -current pending approval State BCCCP Outreach -ended 10/2000 Medicare Rural Health Contract - current Bureau of Primary Health Care Case Management -ended 3/2000 Rural Health Outreach Grant -scheduled to end 8/31/01 anticipated extension through 3/30/02 Bureau of Primary Health Care 330 grant -pending Covering Ktds Grant Outreach -current Building Lease -month to month Waiting HHSC for multi year lease Physician and Nurse Contracts -year to year -current 3 How does the proposed program fit into your organizations long-range financial plan This project benefits the Health Center by contributing to its ability to provide accessible caze to its patients, all residents of Hamakua As retirees age, meeting that commitment will require the Health Center to ensure that more transportation and or portable services are available The Health Center sees transportation as the most cost effective approach at this time and in the foreseeable future The Health Center will continue to seek and identify resources to underwrite these costs D Monitoring During the past two fiscal years, what financial and or administrative monitoring has your organization received from any and all funding source Primary Care Family Planning Department of Health Phone. (808)733-9022 Family Health Services Division Maternal and Child Health Branch 741-A Sunset Avenue Honolulu, Hawaii Queens Health Plans Phone (808) 522-7500 Site Vint Evaluation Queens Health Plans Two Waterfront PIa7a, Suite 200 Honolulu, Hawau 96813 Aloha Care Phone: (808)973-1650 Medical Records Audn Aloha Care Quality Improvement 1357 Kap~olam Blvd , Swte 1250 Honolulu, Hawau %814 Rural Health Clm~c (Medicare) Phone: (808) 692-7420 Department of Health Hospital and Medical Fac~lrttes Branch Office Quality Assurance 601 Kamokda Blvd ,Room 395 Kapolei, Hawau 96707 Reports for Rural Health Outreach Grant Office of Grants Management Phone (301) 694-4254 Bureau of Pnmary Health Care Health Resources and Services Admtn 4350 East West Highway 1 I'" Floor Bethesda, MD 20814 Monte Parham E Alcohol, Tobacco and Drug Free Workplace Policies and Information I How does your orgamration address alcohol, tobacco and other drug prevention mfotmatton dissemination as part of your workplace and/or program envvonment? The workplace is alcohol, tobacco and drug free. No one ~s permitted to use these substances during work or to arrive at work under then influence Non-smokers may be given preference m hying Clients for Health Care are asked m the Health History if they use these items and are counseled rn treatment to refrain from or moderate use Records of thrs counseling are kept and noted in patient records Health Center staff members are active m the Lung Association, the Cancer Society and m the schools with health promotion classes and actrvitres The Health Center participates when possible with the East Hawan Tobacco Free Coalmon Stepden K Yamashuo _ Harry A Tskahiuht Mayor Dtrecror - _ - 000NTY OF IIi4`lI~i41`I DEPARTMENT OF FINANCE 23 Aupum Saaet, Roan 118 • Hilq H~wni %720252 (806) %1-8234 • Fu (806) %1-87A8 HAWAII COUNTY NONPROFIT GRANTS (FY 2001-02) FINANCIAL QUESTIONNAIRE Please mclude as as attachment an explanation for all "NO" aaawera to questions #1 thtu #11 below: Yes No ® ? 1. Has the agency operated continuously for the put three (3) years? ? © 2. Hera the agency operated with a positive cash flow for the put three (3) years? ® ? 3. Does your Board of Duectora approve a detailed cash flow budget before the begintung of each 5sca1 year'! ® ? 4. Do your Hoard meeting mimna show that quarterly financial statements att approved? ® ? 5. la your equity badurce at leaf 20% of your Tohl Liability balattceT ® ? 6. Is your Total Cturaot Aeaet baltrnce larger then your Total Current Liability balance? ® ? 7. Are bank reconctliuions sad accotmtteg performed by someone other than the checlt aigtutory? ® ? 8. Aro you fully insured for the agency's vehicle(s) a~ btrikling(a)7 ® ? 9. Ia yo»r Workers' Compeos:tion at least 2% of payroll? ® ? 10. Are you current (non•delirrquent) on all Payroll and payroll tax payments? ? ® 1 1. Is the agency &ne of any pendutg htigatioo, lien or jttdgmtmts7 ? ® 12. Within the put 12 months, hers the agency applied for vendor or beak credit and wu domed credit? If yea, Please expLia. As the gsant apphrant, I certify that the agency has sattrjactorily responded m each ojrhs above grterdonr and aprauted err needed !hereby certify that thin tnforntation tr erne and comeer to the belt ofnry know/ed~e Agency Hamakua Health Center, Inc. per: (808) 775-7204 J.E. Potter Swartz ~ Prepared by: Executive Director v 2~ C/ Pna N~mYt-nle S Doe Ceatifiadby: _ J.E. Potter Swartz C c Pnnt Nerve of FseeWw Duaeeor S~ COUNTY 0~ ii~41K~41I HUMAN SERVICES NONPROFIT GRANTS (FYZ001-02) Staff Iniormatlon Sheet Name ~O~ ~ P"` Podtlon Title ~ caps suQ n¦. rte. FieWo[Stod! w ~ Ann Mortensen x x Assistant Financial Lynette McDowell x x Data Entry John Bannister x x Van Driver Outreach MedicalRecords Velma Batin x x Beverly Hiraoka x x Cashier Roxanne Palva- h x x Rece tionist Florencio Tabancu a x x Eligibility/ Outreach B.S.M,Ed. Outreach( Marilyn Hagana Education x x Cvrn Kids Referral/ Anita Loo x x k Beverly Cypriano Assoc. D: x Director of Tracy Dacar " x x Nurse, L.P.N. Lorna Laikupu x x " Arlyn Anastasio x x " JoAnn LauKon x x " D.O. h r e x x Ph sician M.D. 1 x x " Tawn Keene x x " Catherine B.S.N.nurai g Nurse e d' ippnve x Donna Banal Ass istaY~ic an x x Physician AB819 . Claire Midallia A x x Assiatantative Liz Shouse x x C.F.O. J.E. Potter B.S.,M*Ed. Executive Communit x x Director Deve opment Z 1 ~ a N . ~ N ~ a ~ ~ a ~ a3 m p 2 o a ~ ~ m 1 m ~ m ~ m ~ z 1 ~ 1 i Z 1 ~ ~ ~ ~ ~ ~ ~ ~ ~ n~ ~ ~ s ~ y ; ti_ ~ ~ n w r~ n ~ o i2 a • Y ~ ~ ~ n N 3 N ~ < ^ IV 'a a O ~ M (~D Q O O tf Q 1 O O N N 01 Z ~ Z rt m 3 m? ~ ~0 Z E~ g ~ ~ ry d d ~ :T rNr ~ ~ N :1 ~j ~ a S ~ £ fMD N CI C K T d M M a r'h N C 8 K o a ~ N ~ x ~ 3 d IC N N • N • N • ~ • ~ • t~ • ~ • ~ G Q N O H r H J H m H A c O~ O W r .P ~ 'S W O A O O ~ S a ~ m ~ > H rr~~ ~ F .Y N W W t G V~ ttii N W (D f+ R 9 ~ ~p O Y O r J • C7 r ~ C] O 7 O ~o .a ~ N r n ~ ~ o r v o ~ ~ 3 ~ ~ ~ ~ o + ~ Vii ~ ~ n`a ~m w „g ~3p " ~ A r~ ~ $ el fN.. 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N V W N OI O J N O N - .1 d fi N O• J O~ 00 I N OD I W 1 ~ H IIp A N N p. O A N ~ J' LPL H N • ~ ~ 1C F-~ V A A • ~ O ~ ~ 1m1~~ ~ R ~ ~O UI UI O N y ~ W N W ~ N + D ~ 'P W N N N M n N In .1 5 m W p 1I N 'A In 'p o ~ O ~ Q A I ~ ~ ~ D s 2 4 „ - ~ ~ ~ oro _ s ~m J ~ W a ~ - ~ s~ ~ O I o O o O p 0 N O J Cf O UI p l N 1 y k O I O O 00 ~ N I OD O I O I ~ Z 0 O O O O O t N T O O O .O O O yy~~ N 1 p ' W ~ J . O N O~ D N O p. ~ O A O O N O N~ O ~ O 777 m O O O O O O E9 O O O ~ T 7 O • N 0 4 s 3 J X [ ~ p ~ ~ 19)i C ~ _ b~ ~ N DI r N ~ rt N O _ ~ O - O ~ ~ C ~ _ _ _ j 1-S a O J J J J 9 O ,,,I fT L W N O (O OD .I r 2 II y ` r n ~ ~a s y ~ pn c d ~ ~ ,*3i C c > ~ > 7y0 G 7~ z > ~ ~ y L7 ~ ~p per, r L=*1 ,'nl ~ O ~ O p ~ S < ~ 88 a c 2 3 R ~O m m~ ~ y c 3 ~ r ~ z a ~ ~ s a c0 h 7 0 ~ y y~ ~ C ~ ~ ~ ~ r z o z > 3 a n c z ~ e ~ z 3 x ~ a 0 w Y d Pl 2 d ~ y > v x W N m A W ID N ~ fD UI O N m O A O ~O ~O N T O N A ti a d ~ O O O+ OD W W O W W J O U1 N O~ O H J O A . W r O m m O O N UI J ~ H rt R ~1 O O~ A W O O ~ v O O O O~ F+ T !7 ~ 6 fD o N ~ O ~ G N N I A ~ ~ M W N O N a fD I W O D h4 Cl ~ QI ~ m~ w l o l m .aI ~ r ~ 70 N m c or o E~ ~W n x ~ r r~{ 3 O N 7 N r N ~ ~ a o O O ~O O ~ O O O O. O N O~ ~ V P .P O O O O UI O O O O O UI N O p Cs7 111 O O O O O O O O O VI is 00 ~ ~ ~ ~ OD O O O O O O O O `O ° o 0 0o m o ~ a r o o No r to I ~ ' p ; R 00 ~ O O O ~ V1N N~ ~ T O ~ ~ p y Z C p AI L ~ O I O I O I ~ 1 W ~ O~ O O I O C N ~ $ ~ I O O I l A o I o c 33 a u. c ° I ° ~ m o ~ y 0 o b~ r tr N r rt t b x o ~ < o a ~ o I o I ~ rn o I I o I o u+ o _ o o o I u' I ~ o I I o I o ul o O c r O s ~ ~ 1 a ~ ~ T Q c °v c m n r. ~ n n 2 u a N O O ~ ~ ; ; p ~ p 9 ~ O{ > ~ D O m T Y m Z t' Z ~ ~ m ~ 1 EO z m ~ ~ w Z ~ 2 ~ r ~ G ra m ~ ~ ~ ~ ~ a 3 X w ~ ~ x 9 ^y r c ym = i % CI Vl y a N N r ~ to ~ C O A N f7 3 C fD pip ~ m 4 OD N OD ~1 O N O O~ ~ ; 7 O~ Ui C1 N OD OD W ~ ; M r O+ to ~ cn A D fD ~ ~ .O H ~ O ~ ~ F1 N W O~ G ~ C O~ O b g < r W ~ 3 m eA[I O ~ ~ '~ll i 7 ~ n p 'i ~ ~p ~'i N A N ti ~ D N T N ~ N N A CO $ T r m W N y O r r O W = 2 v cNii ~ ~ ~ r ~ c ~ ~ m ~ g w aoo N ~ ~ ~ ~ c ~ ~ p O f+ .P H y W N „ .Tj ~ ~D OD W 01 Ui O~ W O~ ~ N O~ .P ~dj ~ y D o r v ? `o `y _ ~ 0 0 O 4 l/~ O ~ e T 3 W ~ O O a S ~ 3 O~ N RY ~p O~ N $ X r ° r ~O to C N ~ ~ ~o r o r d J J N ~ p. S o NO H ~ ro 0 o b~ 70 y N sg ~ W ~ ~ C U1 O~ N ~ W f., ~p N O~ N ~ d A F+ ~O T N N U1 ~p F+ ~O U1 J ~ ~O O N N O r J UI _ " OD O N ~ - ? o ~ y ~ ~ ~ ~ y ~ ~ ~ m a ~ a ~ c 3 ~ m ~ ~ ~ n d a a S a y a p= o e D P. R aa s e m m ~ ~ r r' 3 3 4 0 ~ = D N = ~ -n Fd ° ~ = m 2 w ~ ~ ~ ~ ~ I r n w m n 2 ~ ~ m m 2 rt ~ d m m C 7c N ~ (D Oo r r S r N v I 1 o O w S A N ~ I O O O O O y 5 r UI 1 N A 1 ~ r b OI I J O ~ O O O > ~ fT A O 1 ~ ^,J OI 1 O O O ~ 0 0 0 0 ~ n o o m 5 0 pC~ H y S7 ; a n a a~ ~ ~ ~ m g m $ o T A OI r N W 1 VI r O7 J N 'f• 1,71 I O• O J W D A ~O O Cl A m I O O U N m m - O A OI O N O O O m N O O ~p S W a a r J ~1 A rT N O m J O O ~ ~ ~ ~O O O ~ A O • - O O O O y O O _ - s- a O O `F• USSR Table 6 Pnvate Foundations Weinberg Foundation $131,676 00 Robert Wood Johnson $49,353 00 HAIIRAICUA HEALTH CENTER, INC. AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 1999 (With Comparative Totals for December 31, 1998) ~w~s~. ~iaid~avta% .A~.51ey~uc~uaww~ilra~rlras fLK/wGLY~,r,.GtiM~„r SIri6?7J .~..brW, .firww D~6J /Po~/J7l~!!)B ~ ~s s ~~e 1 i a ~t a~ ~a m ti o. z >0ss.~~.sa~ .Sow ~0s ,~(Qyraa, s`~~a 96768 .laze 80~.S7R 8978 .max 80~ 37R 8007 RID .PEND NT A ITOR'S FPORT To the Board of Directors Hamalcua Health Center, Inc. Honokaa, Hawaii 96727 We have audited the accompanying statement of financial position of Hamakua Health Center, Inc. (a Hawaii nonprofit corporation) as of December 31, 1999, aad the related statements of activity, functional expenses, changes in net assets and cash flows for the year then ended. These financial statements are the responsibility of the Health Center's management. Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit m accordance with grnerally accepted auditing staadands. Those standards roquire that we plan end perform the audit to obtain reasonable assurance about whether the financial statements are fiu of material misstatemrnt. Aa audit inchides examining, on a test basis, evidrnce supporting the amounts and disclosures in the fiuancial statements. An audit also includes assessing the accounting principles used and significant estimates made by managemrnt, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion, the financial statements refemd to above present fairly, m all material respects, the 5nancial position of Hamakua Health Center, Inc. as of December 31, 1999, and the changes in its net assets and its cash flows for the year thrn rnded in conformity with grnerally accepted accounting pnnciples. Makawao, Hawaii l Apn121, 2000 HAMARUA HF.U.TH CF1i7'ER. Ixc Statameat o[ PLoandal Podtlon December 31, 1999 (Wtth Comparaave Tools for December 31,1998) ASS87S 1434 1434 CURRENT ASSETS Cash: Checlung • Bank of Ffawau S 32,662 S 59,862 Savmp • Bank of Hawau 21,685 1,085 Money Muket Funda (Note 4) 49,323 50,798 Petty Cash and Cash Regtrter 350 350 Total Cash 104,020 112,095 Accountr Retetvabte - Grab and Rmb 50,631 44,423 Accouan Retetvabla -Parent BBltn~ (oat) (Noe 3) 254,139 115,579 Attounu Recnwble -Other 3,173 Total Axounb Accruable 305,370 163,175 Investmenn (Note 4) 1,280,701 1,403,216 Preprd Insurance 35,469 35,974 Other Prepaid Expenses 3,750 3,414 Tout Current Asutr 1,729,310 1,717,874 FOtED ASSETS (Note 3) Land 125,705 125,705 Budding 149,756 149,756 Fqutpmmt 388,343 306,460 Fumtahtttgs 140,699 140,699 Leasehold lmprovemmtr 10,716 10,716 815,219 733,336 Accumulated Depreaaaan (447,907) (407,437) Net Ft:ed Assen 367,312 325,899 TOTAL ASSETS S 2,096,622 S 2,043,773 The aecompanyfn6 noes and Auditors report are an mugrai pan of thex financfal snumenu Pace 2 HAMAKUA HEALTH CENTER, INC. Statement of Flnane.W Podtion December 31, 1999 (Wtth Ctunparanve Totals for December 31, 1998) I.IABII.I7T85 AND NET ASBBTS CURRENT LIABILITIES Atcounw Payable S 41,654 S 80,679 Pension Plan (No[e S) Accrued Pennon Lmbtltry 30,775 44,993 Innng[ble Pension Arse[ 0 (45,767) Net Pennon Plan 30,775 (774) Deferred Revenue 32,476 - Vaunon Payable 42,223 43,708 Lme of Credit Payable (Note 6) 428,389 465,000 Accrued Payroll and Tales 32,975 30,438 Total Cumtu Lubiltnet 611,492 619,051 NET ASSETS Uoresmcted Net Asses 1,482,423 1,424,722 Temporarily Restricted Net Atxrs 2,707 0 Permanently Reamtted Ner Assets 0 0 Total Net Assets 1,485,130 1,424,722 TOTAL LLIBILI77ES AND NET ASSETS S 2,0%,622 S 2,043,773 The aaompanymg notes end Aud~mr't report arc sn integral part of thex flnanclal sntemenn Page 3 HAMAKIJA HEALTH CENTER. INC Statement of Activity For the Year Ended December 31, 1999 (Wtth Comparative Torah for the Year Faded December 31,1998) 1999 Temporarily Permanently Unremicted Restntted Resmsed Total REVENUE Pauent Fees and Health Insurance Btllmgs S 665,215 S 665,215 S 753,172 Sate of Hawan Grant Funds 234,007 234,007 123,528 Federal Grant Funds 279,340 279,340 34,284 Investment and Interest Income 176,631 176,631 260,517 Ocher Grants 41551 S 99,005 140,556 12,500 Rennllncome 20,923 20,923 8,262 Counry of Hawau Grants 5,000 5,000 42,500 Othu Income and Contnbuaons 3,974 3,259 7,293 26,321 Net Auer Released from Resmrnona 99,557 (99,557) 0 0 Ton! Publtc Support and Unrestntted Revenue 1,526,198 2,707 0 1,528,905 1,261,084 EXPENSES Payroll and Related Expenses Wages 765,914 765,914 795,696 Payroll Taxes and Frmge Benefits 168,302 168,302 150,299 Pension Plan (Note 5) 31,549 31,549 36,261 965,765 0 0 965,765 982,256 Sernces: Contras and Other Servtces 101,536 101,536 13,267 Itunrance 46,609 46,609 40,106 Professional Setvtca 26,338 26,338 38,660 Travel and Related Costs 14,260 14,260 17,545 Adverttvng and Promotion 19,438 19,438 15,747 208,181 0 0 208,181 125,325 Factltry Costs. Ren[ (Note 8) 54,557 54,557 54,557 Deprecation 40,470 40,470 32,160 Mamcenance 32,316 32,316 31,177 Utilities 24,390 24,390 25,900 151,733 0 0 151,733 143,794 Othu Operating Ettpensn Supplies 52,235 52,235 55,116 Interest Ezperue 37,861 37,861 22,391 Telephone 21,363 21,363 15,956 Office Expense 18,807 18,807 18,129 Equipment and Vehicle Expertu 10,818 10,818 4,791 Mucepaneous Expenses 1,734 1,734 8,409 Bad Debt Ettpense 0 0 142,472 142,818 0 0 142,818 267,264 TotalExpenus 1,468,497 0 0 1,468,497 1,518,639 Change m Net Auets S 57,701 S 2,707 SO S 60,408 S (257.555) The accompanying nodes and Audlmrs report are an integral pas o[ these Cviancul sratemena Page 4 HAMAKUA HEALTH CENTER, [NC. S4ttammt d Fmetimd 8spmaea For the Year Ended De[tmber 31, 1999 Program Supptxtmg Sernw Sernces Tool Payroll and Related Expense[. Wages S 666,660 S 99,254 S 765,914 Payroll Taxes and Fnttge Benefits 146,492 21,810 168,302 Pension Plan (Nate 5) 27,461 4,088 31,549 840,613 125,152 %5,765 Faahty Cons: Rea[ (Nou 8) 52,920 1,637 54,557 Depreaaaon 39,756 1,214 40,470 Mam[enance 31,347 %9 32,316 Utilises 23,658 732 24,390 147,181 4,552 151,733 Sernces Contras and Other Serntes 93,539 7,997 101,536 [ttsttratta 45,211 1,398 46,609 Profauaaal Semen 8,349 17,989 26,338 Travd and Relaxed Can 8,397 5,863 14,260 Adverostag sad Promxaon 10,789 6,649 19,438 166,285 41,8% 208,181 Other Operating Expenses Supplies 45,445 6,790 52,235 Telephone 20,722 641 21,363 Office Espenta 16,362 2,445 18,807 Interest Expense 32,939 4,922 37,861 Equipment and Vehtele Expense 10,493 325 10,818 Miscellaneoa Expenses 0 1,734 1,734 125,%1 16,857 142,818 Total Expenses S 1,280,040 S 188,457 S 1,468,497 The accompenying now sad Auditor's report ere ae tnngnl part of these Bnsnelal sntelaena page 5 HAMAKUA HEU.TH GFM'FR, ING 9tatemaet o! l7sansea lA Net Assets For the Year Faded December 31, 1999 Temporaxtly Permanently Total Unrntncted Ramtted Resmc[ed Net Asseo Ne[ Assess, December 31, 1997 S 1,591,326 SO SO S 1,591,326 Excess Revenue Over (Under) Expenses (257,555) 0 0 (257,555) Pnor Penod Adlusunent (Note 11) 90,951 0 0 90,951 Net Assets, December 31, 1998 1,424,722 0 0 1,424,722 Excess Revenue Over (Under) E:penses 57,701 2,707 0 60,408 Net Assets, December 31, 1999 S 1,482,423 S 2,707 SO S 1,485,130 The accompanying now and Audrmrs report ue and integral part of these flnantsal statements Pate 6 t1ArfAxuA HFAL7H cENren, nvc ShtemDnt o~[ Csuh Fbwa For the Yeu Faded December 31, 1999 (With Compannve Tools for the Yeu Faded December 31, 1998) 1?44 142fl CASH FLOWS FQOM OlEtA1'QQG ACITVL'[18S Cash Received from Panetro aM Ins. Compames S 540,012 S 591,691 Cash Reenved from Gramon - Public and Pnvate 633,444 731,729 Cash Recnvedfrom Doaon and Orherlncome 82,592 123,948 ?nvea~ent Income Aecnved 184,423 198,711 Cash Pud to Employees and Vendors (1,457,274) (1,285,530) Net Cash Used by Opesatmg Atsntttl (Noce 30) (16,803) (139,451) CASH FLOWS USHD DY 1111VE87QYG ACITVI'1~S Purchase of Office and Program Equspmene (81,883) (25.523) Purchau of Vehtrle 0 (20,200) Net Cazh Used by Invgmg Acnvttus (81,883) (45,723) CASH PLOWS F1tOB! rDYANCING AC'lMTJS3 Net Purchase of lnvatmeaots (172,778) (161,690) Wtthdnwa! from Investment Portfolio 300,000 0 Proceeds from Bank Loam 85.000 440,000 Prmapal Payments on Beak Loam (121.611) (25,000) Nn Cash Fronded by Finantmg Acnnnes 90,611 253.310 Net Increase (Decease) m Cash for the Yeu (8,075) 68,136 CASH DAIANCB, DSGDYNWG OF YBAI 112,095 43,959 CASH EALANCB, ffivu or YEAI s 104,020 s 112,09s The sccompatrym; notes and Audnor's report ere an mtegnl part of these finanelal statements Page 7 Hamakua Health Curter, Inc. Notes m Finsndal Statements December 31, 1999 Note 1. NATURE OF ACTM'I'fES Hamakua Health Center, Inc. ('The Center) was iamrporated on October 29, 1964 as Hamakua Infirmary, a Hawaii nonprofit corporation. Oa April 27, 1993, amended articles of incorporation were filed changing the name to Hamakua Health Center, Inc. as well as reestablishing its purposes to provide comprehensive health care services. The Center provides medical facilities and serviar for the care and treatment of the residents of the Hamakua Coast. The Center formerly provided medical services almost exclusively tp employees of Hamakua Sugar Company, Inc. (Hamakua Sugar), and wan !mown as the Hamakua Medical Center, Inc. Hamakua Sugar filed Chapter 11 bani¢trptry on August 11, 1992 and continued to operate until March 1993 when it ceased its normal operatioru. Since that time, the Center has converted its primary revenue sources rA third parry medical insurance and granu. Hamakua Health Center, Inc. is exempt from Federal income taxes pursuant to internal Revenue Code section 501(c)(3), and exempt from State income taxes under Section 416-19 and 416-20 of the Hawaii Revised Statutes. Therefore, no provision for Federal or State income taxes is required. Note 2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of Acmundna -The Center follows standards of accounting and financial reporting for voluntary health and welfare organizations as described in the American Institute of Certified Public Accountants' "Industry Guide for Audits of Voluntary Health and Welfare Organvations." Accordingly the tlaantdal satemeats are prepared on the aarval basis of accounting. Under this method of accounting, revenuu is recorded when earned ratirer than when received and expenses are recorded when incurred Lather than when paid. Public Sunoort and Revenue -Grants and other rnntributions of cash and other assets are reposed as temporarily restricted support if they are received with donor stipulations that limit the use of the donated assets. Whm a donor restriction expires, that !s, when a stipulated time restriction ends or purpose restriction is accomplished, temporarily restricted net assets are reclassified to turrestrieted net assets and reported in the statement of activities as net assets released from restrictions. Invesmrents -Carrying amounts and fair values of investments are based on quoted market prices (see Note 4). Cash -For purposes of the statement of cash flows, Hamakua Health Center considers all cash and other highly liquid investments with initial maturities of three months or less to be cash equivalents. Page 8 _ Hamakua Health Center, Inc. Notes to the Financial Statements December 31, 1999 Noce 3. USE OF ESTIMATES The accompanying financial statements have been prepared in accordance with generally accepted accounting principles. The preparation of financial statements in accordance rwth generally accepted accounting prindples requites management to make estimates and assumptions that affect the reported amounts of assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the period. Actual results could differ from those estimates. Fixed Assets -Property and equipment was u~snsferred from the Hamakua Medical Center, Inc. in 1993 based on the book value at that time. There was ao physical Inventory done when this transfer took place, and no assessment was made of the fair market value of the land. The actual value of the land and other assets may differ matenally from the book value that was transferred from Hamakua Medical Center to Hamakua Health Center. Depreciation expense has been estimated each year based on these book values. Accounts Receivable -Accounts receivable -Patient Billings totaling 5254,739 represents management's estimate of actual collectablllty from insurance cazriers and individuals. The estimates are based on historical collection rates. Actual amounts collected may differ from these estimates. Noce 4. INVESTMENTS Investmenu as of December 31, 1999 are summarized as follows: Fair Unrealized X435 Market Value Gain/(Lossl Cash 5 49,323 5 49,323 5 - Mutual Funds 282,357 262,174 (20,183) Debt and Equity Securities 660.853 1.018.527 357.674 943.210 1.280.701 337.491 Total Invested ,i 992.533 1.330.024 S 337.491 Investment retain for the year was as follows: Dividends 5 28,046 Interest 1,977 Realized Losses (41,323) Unrealized Gains 200,430 Investment Fees (12.4991 Total S 176.631 • Page 9 Hamakua Health Center, Inc. Notes to the Financial Statements December 31, 1999 Noce 5 DEFINED BENEFIT PENSION PIAN Hamakua Health Center, inc. has a qualified noncontributory defined benefit retirement plan for substantially all full time bargaining and non-bargaining employees. The benefits are based on years of service and as employee's compensation. Contributions were formerly patd to Hamakua Sugaz Company, Inc. for a defined benefit pension plan for the Center and Hamakua Sugar employees. Contributions to this plan were suspended July 1993 following the Hamakua Sugar Company bankruptcy. As a result of a settlement agreement with the PBGC and the Trustee of Hamakua Sugar Company, Inc., the Center accepted sponsorship of certain amounts relating to the former plan. In 1997, both plans were combined to save rnsts. It is the Center's funding policy m contribuoe the required amount of minimum funding under ERISA regulations. Plan participants are not required to make contributions. Plan assets are invested pnmarily in mutual funds. The following table sets forth the plan's funded status and amounts recognized in the Cenre~s finanaal statements as of December 31, 1999: Fair value of plan assets S 501,703 Projetted benefit obligation 546.225 Funded status S (44.5221 Weighted-average assumptions: Discount rate 7.0% Expected return on plan assets 7.5% hate of compensation increase 4.5% Changes in pension accounting for the period: Net periodic peasion cost S 31,549 Employer rnntribution 0 Benefits paid 16,200 Amount included in other comprehensive income for the period 0 Amounts recognized in the statement of financial position consist of: Accrued pension liability S 30,775 Intangible asset 0 Net amount recognized S 30.775 Page 10 Hamakua Health Ceater, Iac. Notes to the Finandal Statements December 31, 1999 Note 6. LINE OF CREDIT PAYABLE As of December 31, 1999, the Center had a 5525,000 line of credit with Bank of Hawaii, secured by investment acrnunts at Padfie Century Trust (see Note 4). A loan requirement is that the fair market value of the iavestmertt account always be at least equal to the loan balance. Interest due is a floating rate of 1 percent above Bank of Hawaii's base rate and is payable monthly. N of December 31, 1999, 5428,389 of the line of credit had been drawn down and was outstanding. the loan expired on March 31, 2000 and was renewed until May 31, 2000. The loan is renewable annually by mutual agreement of the parries. Note 7. DONATED SERVICES Under SFAS No. 116, contributions of dornted services that create or enhance nonfinancial assets or that require specialized skills, are provided by individuals possessing those skills, and wouid typically need m be purchased if not provided by donation, an rnorded at thar fair values is the period received. Volunteer services provided to the Center do not meet tine ciitetia Cor tecognitlon under SFAS No. 116 and, thus, have not been recognized in the statement of activ[tiea. Nevertheless, many volunteers have donated signifinnt amounts of time to the Center. Note 8. COMMITMENTS AND CONTINGENCIES OoeratinQ Lease -The Center has a revocable permit from the Hawaii Health Systems Corporation, an agency attached ro the State Department of Health (the State), for the use of the land and building used by the medical clinic. This permit expired on June 30, 1999, and the Organiradon is currently on a month to month lase. Management is actively pursuing along-term lease of the land. The Center paid 554,557 on this rnntract in 1999. Government Grants - Hamakua Health Center received significant amounts of grant Funds from government agendes in 1999. 'These agendes perform audits of the non- profit Organization's mmpBance with grant provisions, and may request that the Center return funds if it is in nonrnmpllance. Management believes that the Center has complied in all matenal respects with grant requirements. Page 11 - tiamakua Health Center, Inc. Notes to the Financial Statements December 31, 1999 Noce 9. CONCENTRATIONS OF CREDIT RISK ;nvestments -The Hamakua Health Center has invested a significant amount of cash in debt and equity securities and mutual funds. The return on and appreciation or depreciation of these investments is subject to wladle market conditions. During the year ended December 31, 1999, the Center received approximately 1296 of its revenue from its investments. Significant reductions, if any, could have an adverse effect on the Organization. Labor Foree -All of the Center's non-management labor fore is subject to a wllective bargaining agreement. Note 10. RECONCILIATION OF EXCESS REVENUE OVER EXPENSES WITH NET CASH USED BY OPERATING ACTNITlES Excess Revenue Over Expenses S 60,408 Adjustmenu to Reconcile: Depreciation 40,470 Realized Investment Losses 41,323 Unrealized Investment Gains ( 46,030) increase in Aeoouats Receivable (142,195) Decrease in Prepaid Ezpenses 169 Decrease in Accounts Payable ( 36,025) Increase in Pension Payable 31,549 Increase in Accrued Expenses 1,052 Increase rn Deferred Revenue 32.476 Net Cash Used by Operating Activities S( 16.8031 Note 11. PR10R PERIOD ADJUSTMENT In accordance with FASB 87, the Center changed its method of recording its defined benefit pension plan. This resulted in recognizrng an intangible pension asset and other carrying amount changes related to years prior co 1998. The net adjustment is 590,951. Page I2 _ Hamakna Heailt>i Curter, Ina Notes to the Finaned Statements December 31,1999 Note 12. FINANCIAL. STATEMENT PRESENTATION The financial statements include certain prior year summarized comparative information in total but not by net asset class. Such information does not include suffident derail to constitute a ptrsentation is conformity with generally accepOed accotmting ptintsples. Accordingly, such information should be read in conjunction with the organization's finanaal statements for the year ended December 31, 1998, fmm which dre ~~m~+9tized information is derived. Note 13. FUNCTIONAL ALLOCATION OF E7iPENSES The rnsts of pmvidiag the various programs and activities have bem ~~~*mArized on a functional base in the statement of functioml e~enaes. Accordingly, certain costs have been alloated among the programs and supporting services benefited. Page 13 HAMAKUA HEALTH CENTER, INC. AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 1998 ~ov~n rJj.' ~adasans, .rr.~y~,.?~...... er.~. wnm? S .91~bb.a ~n.r lIfJJJ ' /~a~ssr~s ,Sd~~r~~,o~eclesbs~a`~arysovtzliasz .9a d..~oim 880f~9 34`/a!~ 9x788 .9~.e 8o~.s7.e~.~978,~ 8o~.s7.88Gi~7 IIdDEPENDEIVT AUDITOR'S REPORT To the Board of Directors Hamalma Health Center, Inc Honokae, Hawaii %727 We have audited the accompanying statement of financial position of Hamakua Health Center, Inc (a Hawaii nonprofit corporation) a, of December 31, 1998, and the related statements of activity, fitnctioml expenses, changes is net assets and cash Sows for the year then ended These Snancial statemenu are the responsibility of the Health Center's rrurtagemeat Our responsibility is to express an opinion on these financial statements based on our audit We conducted our audit in accordance with generally accepted auditing standards Those standards require that we plea and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts end disclosures in the financial statements An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statemenrt presentation. We believe that our audit provides a reasonable basis for our opinion In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of Hamalara Health Center, Inc as of December 31, 1998, and the changes m its net assets and its cruh flows for the year then ended in conformity with generally accepted accoutring principles. L Makawao, Hawaii ~ March 18, 1999 HAMAlCUA HEALTH CENTER, INC. Statement of Finandal Position December 31, 1998 ASSETS CURRENT ASSETS Cash: Checking - BOH 59,862 Savings - BOH 1,085 Money Market Funds (Note 4) 50,798 Petty Cash and Cash Register 350 Total Cash 112,095 Accounts Receivable -Grants 44,423 Accounts Receivable - Pstieat Billings (set) 115,579 Accouata Receivable -Other 3,173 Total Accounts Receivable 163,175 Investments (Note 4) 1,403,216 Prepaid Insurance 35,974 Other Prepaid Ettpensa 3,414 Total Current Assets 1,717,874 FIXED ASSETS (Note 2) Land 125,705 Building 149,756 Equipment 306,460 Furnishings 140,699 Leasehold Improvemeaa 10,716 733,336 Accumulated Depredation (407,437) Net Fized Assets 325,699 TOTAL ASSETS 52~3,77~3 i The accompanying notes and Auditor's report are an integral part of these fmanaal statements. Pegs 2 HAMAKUA HEALTH CENTER, INC. Statemeat of Pinamcial Position December 31, 1998 LIABILITIES AND NET ASSETS CURRENT LIABILITIES Accounts Payable 580,679 Pension Plan (Note 5) Accrued Pension Liability 44,993 Iatangtble Pension Asset 4( 5,767) Net Pension Plan (774) Vacation Payable 43,708 Line of Credit Payable (Note 6) 465,000 Accrued Payroll and Taxes 30,438 Total Cuaent Liabilities 619,051 NET ASSETS Unrestnaed Net Assets 1,424,722 Temporarily Restricted Net Assets 0 Permanently Restricted Net Assets 0 Total Net Assets 1,424,722 TOTAL LIABILITIES AND NET ASSETS 52,043,773 The accompanying notes and Auditor's report are an integral part of these financ~el statements Pege 3 HAMAKUA HEALTH CENTER, INC. Statement of Activity For the Year Ended December 31, 1998 Temporanly Permanently Unrestrcted Hestnctsd Restncted Total REVENUE Patient Fees & Health Insurance Billings 753,172 753,172 Investment and Interest Income 260,517 260,517 State of Hawaii Greau 157,812 157,812 County of Hawaii Groats 42,500 42,500 Other Income and Contributions 34,583 34,583 Other Granu 12,500 12,500 Net Asseu Released from Restrictions 55,000 (55,000) 0 1,261,084 0 0 1,261,084 Total Public Support and Unrestricted Revenue 1,261,084 0 0 1,261,084 EXPENSES Payroll and Related Expenses: Wages 795,696 795,696 Payroll Taxes and Fnnge Benefits 150,299 150,299 Pension Plaa (Note 5) 36,261 36,261 982,256 0 0 982,256 Facility Cosu: Rent (Note 8) 54,557 54,557 Utilities 41,856 41,856 Depreciation 32,160 32,160 Maintenance 31,177 31,177 159,750 0 0 159,750 Services: Insurance 40,106 40,106 Professional Services 38,660 38,660 Travel and Related Cosu 17,545 17,545 Advertising and Promotion 15,747 15,747 Contract and Other Services 13,267 13,267 125,325 0 0 125,325 Other Operating Expenses Bad Debt Ezpenee 142,472 142,472 Supplies 55,116 55,116 Office Expenses 22,920 22,920 Interest Ezpease 22,391 22,391 Miscellaneous Expenses 8,409 8,409 251,308 0 0 251,308 Total Expenses 1,518,639 0 0 1,518,639 Excess Revenue Over(Uader) Expenses (x257,555) SO SO (5257,555) The accompanying notes and Auditor's report ere an integral pert of these financial statements. Psge 4 HAMAKUA HEALTH CENTER, INC. Statement of Functional Expenses For the Year Ended December 31, 1998 Program Supporting Services Services Total EXPENSES CLASSIFICATIONS Payroll and Related Expenses: Wages 705,177 90,519 795,696 Payroll Taxes and Fringe Benefits 133,201 17,098 150,299 Pension Plaa (Note S) 32,137 4,124 36,261 870,515 111,741 982,256 Facility Costs: Rent (Note 8) 52,920 1,637 54,557 Utilities 40,600 1,256 41,856 Deprecration 31,195 965 32,160 Maintenance 30,242 935 31,177 154,957 4,793 159,750 Services: Insurance 38,903 1,203 40,106 Professional Services 14,044 24,616 38,660 Travel and Related Costs 5,549 11,996 17,545 Advertising and Promotion 12,238 3,509 15,747 Contract and Other Services 10,142 3,125 13,267 80,876 44,449 125,325 Other Operating Expenses Bad Debt Expense 142,472 0 142,472 Supplies 49,463 5,653 55,116 Office Expenses 22,232 688 22,920 Interest Expense 19,844 2,547 22,391 Miscellaneous E:pensd 8,409 0 8,409 242,420 8,888 251,308 Total Expenses 1,348,768 169,871 1,518,639 The eccompenymg notes and Auditor's report are en integral part of these financial statements Page 5 HAMAKUA HEALTH CENTER, INC. Statement of Changes in Net Assets For the Year Ended December 31, 1998 Temporarily Permanently Total Unrestricted Restricoed Restricted Net Asseu Net Assets, December 31, 1997 51,591,326 SO SO 51,591,326 Excess Revenue Over (Under) Expenses (257,555) 0 0 (257,555) Pnor Penod Adjustment (Note 11) 90,951 0 0 90,951 Net Asseu, December 31, 1998 57,424,722 SO SO 51,424,722 The eccompanymp notes And Auditor's report sre and inteprsl pert of these finanaal atetements. Pape 8 HAMAKIJA HEALTH CENTER, INC. Statemmt oP Cash Flows For the Year Ended December 31, 1998 CASH FLOWS FROM OPERATING ACTIVITIES Cash Received from Patients anti Ins. Companies 5591,691 Cash Received from Graaton -public and Private 231,729 Cash Received from Donors and Other lnrnme 123,948 Iavestmentlacome Received 198,711 Cash Paid to Employees and Vendors (1,285,530) Net Cash Used by Operating Activities (Note 9) (139,451) CASH FLOWS USED BY IIWESTING AGTTiITI'IES Purchase of Office and Computer Equipment (25,523) Purchase of Vehicle (20,200) Net Cash Used by Investing Activities (45,723) CASH FLOWS USED BY FINANCING ACTIVTTIES Purchase of Investments (Net of tnutee fees) (161,690) Proceeds from Bank Loans 440,000 Principal Payments on Bank Loam (25,000) Net Cash Provided by Firtancing AcGVida 253,310 Net Decrease in Cmh for the Year 68,136 CASH BALANCE, DECEMBER 31, 1997 43,959 CASH BALANCE. DECEMBER 31, 1998 5112,095 The accompenymg notes and Auditor's report ere an integral pert of these financial statements. Pepe 7 Hamalma Health Center, Ina. Notes to Financial Statemems December 31, 1998 Note 1 NATURE OF ACTIVI'1']ES Hamakua Health Center, Inc. (The Center) was incorporated on October 29, 1964 as Hamakua Infirmary, a Hawaii nonprofit corporation. On Apnl 27, 1993, amended articles of inwrporation were filed changing the name to Hamelara Heahh Center, Inc as well as reestablishing its purposes to provide comprehensive health care services The Center provides medical facilities and services for the care and treatmem of the residems of the Hamelma Coast. The Center formerly provided medical services almost exclusively to employees of Hamakua Sugar Company, Inc. (Hamakua Sugar), and was !mown as the Hamakua Medical Caner, Inc Hamalcua Sugar filed Chapter 11 baalwptry oa August 11, 1992 and continued to operate tmtil March 1993 when it ceased its normal operations. Since that time, the Center has converted its primary revenue sources to third party medical insurance and grants. Hamakua Health Center, Inc. in exempt from Federal income taxes pursuant to Internal Revenue Code section SOl(ex3), and exempt from State income taxes under Section 416- 19 and 416-20 of the Hawaii Revised Statrnq. Therefore, no provision for Federal or Staze income taxes is required. Note 2 SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of Accountina -The Caner follows standards of accounting and financial reporting for volumary health and welfare organizations as described in the American Institute of Certified Public Accouatmta' "Industry Guide for Audits of Voluntary Heahh and Welfare Organizations." Accordingly the financial statements are prepared on the accrual basis of accouming. Under this method of accoutrting, revenue is recorded when earned rather than when received and expenses are recorded when incurred rather than when pard Public Srlpoort and Revenue -Grants and other cotrtributioas of cash and other assets are reported as temporarily restricted support if they are received with donor stipulations that limit the use of the donated assets. When a donor ratriction expira, that is, when a stipulated time restriction ends or purpose restriction is accomplished, temporarily ratricted net assets are reclassified tv unrestricted net assets and reported is the statement of activities as net assets released from restrictions F Investments -Carrying amounts and fair values of investments are based on quoted ' market prices (see Note 4). 1 Page 8 Hamalrua Health Center, Inc, Nates to the Financial Statements December 31, 1998 Note 3 USE OF ESTIMATES The accompanying financial statemenm have been prepared in accordance with generally accepted accounting principles The preparation of financial statements in accordance with generally accepted accounting principles requires menagemert to make estimates and assumptions that affect the reported arttounts of assets and liabilities at the date of the financial statemerts and the reported amounts of revenue and expenses during the period Actual results could differ from those estimates. Fixed Assets -Property and equipment was transferred finm the Hamakua Medical Center, Inc in 1993 based on the book value at that time. There was' no physical inventory done when this transfer took place, and no assessment was made of the fair market value of the land. The ac4ral value of the land and other assets may differ materially from the book value that was transferred from Hanrelma Medical Center to Hamakua Health Certer Depreciation expense has bcen estimated each year based on these book values Accounts Receivable -Accounts receivable totaling 5142,472 were written off during the year due to managemert's assessment that they were not collectible. Actual amoums collected may differ from these estimates. Note 4 INVESTMENTS Investments as of December 31, 1998 aro summarized as follows: Fair Unrealized ~4St Market Value S~III Cash S 50,798 S 50,798 S - Mutual Funds 484,154 494,397 10,243 Debt and Equity Securities 625.005 908.819 283.814 1.109.159 1.403.216 294.057 Total Invested t 1.159.957 1.454.014 S 294"057 Investment return for the year was as follows: Dividends S 160,467 Interest 7,434 Realized Gains 30,810 Unrealized Gains 74,555 Bank Fees (12"7741 Total S 260.492 Page 9 Hamakua Halth Center, Ina, Notes to the Financial Statements December 31, 1998 Note 5 DEFIIVED BENEFIT PENSION PLAN Hamakua Health Center, Inc. has a qualified noncontributory defined benefit retirement plan for substantially all full time bargaining and non-bargaining employees The benefits are based on years of service and as employee's wmpensation Contributions were formerly paid to Hamakua Sugar Company, Inc. for a defined benefit pension plan for ffie Center and Hamahia Sugar employees. Contributions to this plan were suspended July 1993 following the Hamakua Sugar Company banlQirptcy As a result of a settlement agreement whh the PBGC and the Trustee of Hamekua Sugar Company, Inc., the Cemer accepted sponso»hip of certain amounts relating to the former plan in 1997, both plans were combined to save costs It is the Center's funding policy to contribute the required amount of minimum funding under ERISA regulations. PLm participants are not required to make contributions. Plan assets are invested primarily in mutual funds. The following table sets forth the plan's funded status and amounts recognized in the Center's financial statements as of December 31, 1998. Fair value of plan assets S 480,858 Projected benefit obligation 579.600 Funded status S (98.7421 Weighted-average assumptions. Discount rate 7 0% Expected return on plan assets 7.5% Rate of compensation increase 4 5% Changes in pension accotnrting for the period Net periodic pension cost $ 36,261 Employer contribution 0 Benefits paid 12,270 Amount included in other comprehensive income for the period (28,944) Amounts recognized in the statement of financial position consist of Accrued pension liability $ 44,993 Imangible asset 45.767 t Nec amount recognized S 774 Page 10 Hamakaa Health Cwter. Inc. Notes to the Financial Statemems December 31, 1998 Note 6 LINE OF CREDIT PAYABLE As of December 31, 1998, the Center had a S525,000 Gne of credit with Bank of Hawaii, secured by investment accounts at Pacific Century Trust (see Note 4) A loan requirement is that the fair market value of the iavestmem account always be equal to the loan balance Interest due is a floating rate of 1 percent above Bank of Hawaii's base rate and is payable momhly As of December 31, 1998, 5465,000 of the line of credit had been drawn down and was outstanding. The loan expires on March 31, 1999 and is renewable annually by mutual agreement of the parties. Note 7. DONATED SERVICES Under SFAS No. 116, contributioffi of donated services that create or enhance nonfinancial assets or that require specialized skills, are provided by individuals possessing those skills, end would typically need to be purchased if not provided by donatioq are recorded at their fair value in the period roceived. Volurtar services provided to the Center do not meet the criteria for recx>gaidon under SFAS No. 116 and, thus, have not been recognized in the statemmrt of activities. Nevertheless, many volunteers have donated significant amoums of time to the Center Note 8. CO)VIIviTI'IV~NTS AND CONTINGENCIES QperatinQ Lease -The Cemer has a revocable permit from the Hawaii Health Systems Corporatioq an agency attached to the State Department of Health (the Stated for the use of the Lad which the medical clinic is situated on. This permit expires June 30, 1999. IVlmagemerit is actively purating a long-term lease of the land, which should begin July 1, 1999 and last several yearo. The Center paid 554,557 on this contract in 1998. Goine Concern -During the year ended December 31, 1998, the Cemer incurred substantial losses and increased its debt by 5440,000. Management has formulated a pLn to deal with these adverse conditions by cutting costs and increasing funding sources. The most significant part of the pLn is to obtain a large Federal operating grant during 1999 in additioq the Center intends to use 5100,000 of the investment account to pay down the Line of Credit and, if necessary, spend 530,000 per month from the investment account to pay off the loan Page 1l Hamakua Health Center, Ina Notes to the Financial Statements December 31, 1998 Note 8 (corninued) Year 2000 Issues -The Cemer has begun to implemem efforts to bring all of the Cemer's computer applications into year 2000 readiness. Because of the unprecedented nature of the year 2000 issue, its effects and the success of related romediatioa efforts will not be fully determinable until the year 2000 sad thaeaRer. Thus management can sot provide assuranx that the Center is or will be year 2000 ready, that the Center's year 2000 remediation efforts will be succa+sful, or that the parties with which tbt Cemer does business will be year 2000 ready ~ ' Note 9 CONCENTRATIONS OF CRIDIT RISK The Hamalwa Health Center has iaveated a significant amouar of cash in debt and equity securities and mutual Sinda. The return on and appreciation or depreciation of these investments is subject to vohuile market conditions. During the year ended December 31, 1998, the Curter received approximately 21% of its revemte from its investments. Significam reductions, if any, could have an adverse effect on the Organiratioa. Note 10. RECONCILIATION OF EXCESS REVENUE OVER EXPENSES WITH NET CASH USED BY OPERATING ACTIVITIES Excess Revenue Under Expenses S( 257,555) Adjustaums to Reconcile: Prior Period Adjustmert (Note 11) 90',451 Depreciation 32,160 Increase in Allowaaa for Bad Debts 142,472 Unrealized Gains ( 74,555) Increaaein Accounts Receivable ( 62,952) Decrease in Prepaid Expenses 680 Incroaae in Accounts Payable 38,420 Decrease in Pemioa Payable ( 55,390) Increase in Accrued Expenses 6.318 Net Cash Used by Operating Activities S( 139-451) Note 11 PRIOR PERIOD ADJUSTI~NT In accordance with FASB 87, the Center changed its method of recording its defined benefit pension plan This resulted in recognizing as intangible pension asset and other carrying amount changes related to years prior to 1998. The net adjustment is 590,951 Page 12 t'l In 14. I•~' MN! l i~,~l RCIIIIR O~ O: J.lill%:•ilnil ~_Sr'ili~)( ilUdl I:: ('r1111C TeX ~ J~w u,„'. r •rr q.,n 501(x) al Ihw Inhro,1 rwv~nnw r;nrlw (wxrwl.l bla. N hnlp bwnc0l Irusl _ J or puvalc tomtda0on) or se~lfmt gM7(axq umtexengd r.hallabh Ws! Tlds fume is Open LMlrlrl~i~~ ail ~~I I',• Trei N, I„Ir,,,,11 •K,,. sT,..w Ilulw• 7)IC crgrmxatan nary have fo use a ccry 0l Uus refunt fo sohsyy sl,le relllYrfNq rerpnrerrteMs to Publir. Iltsyecllolt A for the 1799 ulcnJ+¦ epr, Or lea ar rlod he Innm 1999 and endil D Urw~k If C nsmsauer.upon D 4~~ rNln,b~ 1`I+w,n~ cl.v,y-wxurr.: Inslw.t )lamakua Health Center Inc. 99-01 p p1 ~tl Nurrhw L rtrtel 4n4a1 .elan a 1 pw (ar P O hoe d mul s na MwrM Y a4sN sEtlr) RpeINWyY E TrYLiM~ nwhr foal relun •p:Wlc P.0 Oox 509 808 775-720 MtWr• ~ M+,dN nlnrn aoa~ Lrq, Taan p col.Iny awr DP e / F Check ~ 11 eXe two :uY q;:l:°ylIX Honokaa HI 96727 eppltahon is pending G Type of orgaruxatton ? X F-xampl under sectwn 501(c) 3 ~(uwrl Lurnhar) ar ~ seclwn 4%7(a)(1) Lwnezempl clanWWe trLnt Nuts: Secllon 5pT(c~ ex oryardrsUom and I9M7(it(1)nanexsmpf chnitsbAe hush Must affseh a eompMfad Sdu'duM A (fain l9b~ H Is tMs a group retun (led to a8dtales7 Yes x No 1 If tdlw hm m H n dadlee Yn,' rAa lour aql group namphon rstmbsr (GF1n ~ (h) If Yp; erAr the nulnMr d dfdula fa afsdl the raWm a fibd ~ J Aecotalhrq rrtelltod Gsh X Accrual c b Ills a 7 reh rekan MM sn otvtnd a ruk t Yes X No OIMr t ~ K Check here ~ d bM oryarxzabon'a post recetpb era rtorrtWly not more Uten 525,1X10 Tha organt=ahan need not file a ralurn with Ute IRS, but d d retetved a Farm 990 pscksps m Ota rtwl, d sfnWd OM a rahan rrtOtout firtanctal dale. Soata slants reauba a complete slum. Note: Fain 990•EZ ma ba farad tktns tYM Ma tltan !OD 0~ and fatal ataats Mss than .000 of cod of ar Part I t"' ewnue sea and Ch a In Net Asaab tx and Balances see Imtructlons 1 Contrtlxdusts, ells, gaols, and stmdar anatrds recatved• a Dlract pudic support 1 ¦ 78 941 . b Indirect publK stlpperl 1 b c Gowrrvrlsrd cmtrtbtdtom (pants) 1 e 535 746. d Tohl (sdd hoes la tlsaugh tc) (athch acMmth of cdrdnbtaas) (cash S nateaah f 0) . L-ld Sant ld 614 687. 2 Program sarvlca ravenw tncltltltng govarmwtt has and tattracts (from Part VII, hoe 93) 2 706 231. 3 Msntherstup dues ant asseasttttrtts 3 4 Interest on savlrtgs and hrtTpaery cah utvattnents . . 4 1 977 . S Dlvldends and inters) Iran sectnttsa S 28 046 . 6a Cross rants 8a 20 923. b Lass• ranW aapartsas 8b 13 313 . c Net rents) Income or pons) (subtract Itrte 6b ham line 8a) 8c 7 610 . 7 Other Investment income (deurdts ~ 7 8a Cross arrant hom qN of aae4 o9w N) Securlha pq Other ~ Oprt Irtvanbry 859 870. 8a i b Las cost a other beat and alas t)tLpergaa 901 193. ab ¦ c Gana(brs)(s8arhtda8de) See. Lr$ Sklpi..... -41 323. ac i d Net gem a pLta) (tortldne Itrr Bc, tekans (/1) and ed -41 323 . 9 Spacul svsrtts and ar:Wtha (attach aelydtdy a Grose revenue (not trteltldbtg f of contrlbuboro reported on lute la) 9¦ b Lea, duact aapsrnas Deter Unrt Mdratatrtq ettpattsaa 9b e Nat Lrtcortte a pass) hen space) averds (sttlttraet lute 9b hom Ixla 9a) 9c l0e Cross salsa of Irnantay, tats rabms attd Nbwantas t0a b Leas cost of goads sold 10b c gems proFt a (bsa) flsm tale of ttlYrnpr (smelt sdadlb) (ttbtrai 9tts 1~ tlom Nta IOa) tOc 11 Other revenlN (lrom Part VII, Pula 103) 11 12 Total tt)YatTIN add hna 1d 2 3 4 S 8C 7 Bel 9C tOt and 11 1Z 1 317 228 . s 13 Program sarvtta (hen ItrN 44, coltam p3)) 13 1 278 695 . ~ 14 Martsgerttertt and general (hen Ilrts 44, coha)n (Ly) 11 178 843 . M 13 Ftndraalnq (hom IIrn 44, cdum (D)) . . . . . 15 0 . ~ 18 Payrttertb b af0ltata (s)hah scttedtla) 18 a 17 Total • sea add Imes 16 and a4 cohsTat 17 1 457 250 . a 18 Excess a (ds8'elp fa Ott year (sttbhact hrr 17 from hna 12) la -140 022 . i ~ 19 Net suers a hod Wlenca at bsptming d yaY (ham hoe 73, column (/1)) 19 1 424 722 . r i 20 Other rJwtpaa m rIN asssh a IIrM balartas (attach exphnaban) . . 20 200 430. a 21 Net assets a ltsd balances at end of ar combos hoes 18 19 and 20 21 1 485 130 eAA For Paperwork Reductlon Act tvotlea, sN sapwaM insbunlena. - Tee,wlot aYtass Form 990 (1999) n~~n_ 1~~''Z II :_n ;lua ilcal lh Ccntcr, Lle. 97-0115515 raae2 ••1 ~'•t'lcnt^nl ~•f~~n,utional Ex~COSlS All a env ahons rrarsl comtlcte cclwnn Colwtms L " rel~rrrcJ fur sc~lo•ri :.UI(c)(]) and (4) orpam~aborn arW sc~bar 4547(a)(I)rnunexempl chardabla husLtllwl oyho,~islM1laao6nrs Do n^f urlwk amawrts r^por tcd on Irne '6'x_ (1!) Program t4a11eger1leilt (.fr Rb, ?G, IOfr, or IF of Fart I (A) Tolsl sorvrces and gnwral FurWraisrnp Y ~ 22 Gr.mis ad allaatpra (allach sclydule) eW ; ~J~~or J1~ (cash S Tal i"r :k[.'-j non cash f ) 22 ~ , 23 SµaLc assulance to udmJUals pnxh xh) 23 ~ ~ 24 B¢nehls paid to a for memliera (allach xh) 24 25 Camprnaalaln of olhcen, drrectws, eb 25 63 000. 31 644 33 644. 0 26 Olher salaries and wages 26 700 149. 635 016. 65 133. 0. 27 Pensran plan tonbrbulrans 27 31 549. 27 461. 4 088. 0. 28 Olher employee benehls 28 100 997. 88 175 12 822. 0 29 Payroll saes 29 66 787. 58 318. 8 469. 0 30 Professrmal lundrarsmp fees 30 0. 0 0. 0. 31 Accounlrnq fees 31 0. 0. 0. 0 32 Legal tees 32 0. 0. 0. 0 33 supplies 33 52 235. 45 445. 6 790. 0. 34 Telephone 34 21 363. ZO 7Z2. 641. 0. 3S Postage and stappmp 3S 0. 0. 0. 0 . 36 Occuparxy 39 101 254. 97 941. 3 313. 0 31 Equrpmenl rsnW and mamlanancs 3)' 30 818. 30 493. 325. 0. 38 Printing and publrabons 3a 0. 0. 0. 0. 39 Travel 39 14 260. 8 397. S 863. 0. 4q tadaaau, mradrora, and mrmpa 40 0. 0. 0 . 0 . 41 tntatnt 41 37 861. 32 939. 4 922. 0. 42 pepec,aron daslebaq do (aaca sd~de) 42 40 470. 39 256. 1 214. 0 . b Insurance 43b 46 609. 45 211. 1 398. 0 cProfessional Services 49c 18 301. 8 349. 9 52. 0. aAdv_ertt_stn~enti Proaotion 43d 19 438. 10 789. 8 49. 0 e see oth.r ~ ensas stmi 43• 132 159. 118 539. 13 620. 0. tlrew a krs i • is 41 1 457 250. 1 278 695. 178 843. 0. tt.pa+tnq d Joint coos - Od you Hoar m coharn (wo0ram smvKee> any pnt costs from a combmad res x No eduwUonal campaign and haldrawrtp sohuhbont ~ ? ? It 'Yes,' enter Q) the agpropaM amarrt d Orase pmt tesa S ; 00 the amornt allocated to proQam semaa S , Ot0 ama+m Mlocaad la mrnpenrerd and ~N S ,and Oh the smoud allonad to hndrarsrn f art II ~ Statement of P ram Service /1e shments VNMt rs the orpanrrabon's granary exempt Durpaeal ? ~rer1M M~IU on ~arvicn te•rn~lenes_ef earty~ otstr_tet PnRal•~aErDa•ss All aganrxabam mp1urnst 6dosnsaenbs Urrr 1 Purpose adaevenrirrh In a tiler and rlor~ mann4r S Or nunber of a m,tglL.na G,enls served Du 4947 rsnaed. aku~s athaertwtls INt w nol taeeuaabla. (9edwr~5p1(c & (4) apen• w rrabarn 6 secben 494 a 1 none: bulls mrlel also anar tl~ anent d a al b oUrsrs aa.~. a Provided various health c~re_ser_vices to more than 13~000~atients in the com_muni_ty r_egar_d_lgss_of their ability tojiaY_________________ (C>rards and s9oabana S 0.) 1 278 695 . b romp srd alloeabans S ) c ttlrana aM a9oatlau S ) d • Olher ram ssrvrces aria and a9oeatraa S 1 Tdal d ran Servlca should I Irne 44 tohaar farvrcas ~ 1 278 695 BAA 7L~ras ravel - Form 990 (1999) Form 9:HI t9~f 41an~ak ua H"alth tenter, Inc. _ 99-0115515 Pape1 I'ar114 Ualancc Sl~ccls (see swh~xhuns) Nule: WiMrc rrNwred, aftac/red scNeduNs and amounts anflun the descnptlal (A) (D) column should be for and•ol year smounts oMy Begimmq of year End of year 40 Cash -non-into~est•beannq 60 212. a _ 33.012 46 Sav,ngs and temp«ary cash rnvestments • • 51 883. 4i 71 008 . 47a Accounts recenable 47a 254 739 b Less allowance 1« doubtful accounts 47b 118 752. 47c 254 739 40a Pledges recewable 49a b Less allowance for doubtful accounts 49b 4Bc 49 Grants recewable „ „ 44 423. 49 SO 631. ~ 50 Receivables hom ofRcers, directors, trrstees, and key employees s (attach sthedub) . . . 9 i 51 a Othn notes 8 loans rxawable (aNxh schedWe) 51 e s b Less allowance f« doWrihd accords 51 b 51 c S2 Invenlonae f« sal. « uaa . . ~ 9 Prepaid expanses and deterred charges 39 388. 9 39 219 S4 Investments - searibss (slfach sclbdWa) 1:5A Stott.. 1 403 216. 34 1 280 701 55a InvesMSnb -land, buddirps, 6 equpmant Wass b Less• xctanWabd deprxukon (sltach xhadula) $b Sc 36 Irwaafmams - other (attach scMdWe) 9 Sts Und, tkaldirgs, and equpment• buss 57a 815 219 . b Less acurraaalad dapreuabon (anach selydWa) 576 447 907. 325 899. 57c 367 312 . 50 Olhar assab (dss«~W ' ) 9 5f Total esseb add hoes 45 tiro I hra 74 2 043 773.9 2 096 622 . 60 Accents psyalda and atxrued erperMea 154 825. M 119 852 . ~ 67 Grants Payable h 62 Oalarrad rewnua . 9 32 476. ` fig Lonna ham officers, dirsU«s, tnateea, and kry engbyMS (atlarh schedule) ti3 ~ ti4a Tax-exemD4 land IlabddNS (atlseh schsdiN) !4a t i b tvlortgages and other nobs peyede (aWCh solrMde) . 465 000. ti4b 428 389 s 9 09~erludfdd~ss(dsaaiW? See floe 65 Stat -774.9 30 775. 69 Tetel 9abWtln add INree ti0 619 051. p 611 492 Oryanlatlone thel Iolisw SFA{ 117, tbaek hew • . ard.canpbb•Irrs 67 . Urough fig and bees 73 and 74 67 urveelncbd 1 424 722. 87 1 482 423. 9 Tsmp«srdy restricted 0 . p 2 707 . 69 PamwNnty restricted N R Orysnlratlane that do net lotlew SFA9117, check I~ae ? ~ and complete hoes tt 70 though 74. Y 70 CaP~bl stock, trust pnncipal, « wrrenl hrds 70 999 71 Pad•m or capbl surplus, «land, bukhrq, sod eplaprnrd had 71 72 Rebmsd eamrgs, andownrM, atwtkdsted mcame, or o9ter Ards 7Z 73 Total net aswb or fond belnrcee (add hna 67 fleotgh ti9 er hoes 70 Urouph 72, whim (A) must equal Isn 19 rrd eoknn must equM tku 21) 1 424 722. 7S 1 485 130 . 74 Tool Pabl9tbs and net aseetdNnd tnleneea add Nnee 66 and 2 043 773. 7t 2 096 622 . Form 990 ~s avadade for pudk irspxtan and, for some peopb, ttsrwe as tlM prlrtwy « sole tolaee of kdofrrls9ort about • pastleubr «gamsabon. Haw tlr WNic parcewes an orgardratlon m wd+cues mry ba debrminW by the iMormatlar pr~enbd an ~h rohrn Thant«e, please males sue tM rstun is complab end atxveb sod Ady drmba, m Part III, lha orgamrauon'e txoWSme and aaanpMlrnenb. BAA taaoim osoure rom 9'9 n9 Ila;l;,1)ua Ilcailh Center Inc. 99-0115515 Pa c4 ~P.rrt IV-A Rcconrili-ris,n of Revenue fi~reer Audited Part IV•U Recotlcillalion of Expenses per Audited F(IIaITCi:.I ~;alctTTents with Revclluo Rnancial Slatentenls wiUt Expenses prr RNurn (Sec Instructions) per RclutTt ¦ Tulsl rnrnus, guns, zN other supppl a 7da1 expp~enss~aa and losses per per zuditrd hrunsul sUlanrrih ? a 1 528 905. audrlad finan~al autemanb ? s 1 4G8 497 b Mnowrls included on hne a but p Amounts xxluderl on Ixxe • but nd nut on Irne 12, Form 990 an has 17, Form 990. (1) Nel unrealaed (1) Oenelad serv• gams on raa and use investments f 199 830. dtautibea S 1 024. Donaledserv• ~ Pdayartdpat• Kes and use nrllt rsppy~ on of facrhhes S 1 024. 4aa t0, Fain 990 . S app S ~ ~Fam~Om f (4 Other (speuy) (4) OIMr (apeuy): I1etMUr ~errente- Rental Expe_fes Ile_u~ Ey~.n_e.S 22 722 aet~bur~eaents S 22 722. Add smamts on hits! (1) Add amounb on hoes (1) urorgh N) ~ b 223 576. though (4) ? b 23 746. c line a minus Irna b ? e 1 305 329. a line • mows line b ? c 1 444 751. d Amounts xscludad on hne 12, d AmourMs kaludad on Lim 1J, Form 990 but ratan hne a: Fain 990 but not an tens c (1) InvasbMnt elf ~ ~ p) Im7sbnsnt Fain 99o S 12 499. 6b, Fam1~99101M. S 12 499. Omer (specty>• GO Ottrr (apacdy). ---_----f ---_----'S add arraunta an hoes p) and R) a 12 499. add amanb on imes p) and GO ? a 12 499 . • Trial rsvsnus par line 12, Farrn • Total upsretas par Iirta 17, Fam 99o ins c ten Ima • 1 317 828. 990 Ina c hr Iku • 1 457 250. art w List o lNticors t,,ctors T writ arw even d not aaa mstrucbans TdN arsl Itosn (h laf CordribtAlats to (q Exvanae W Name and address ~ pW~m acrd t ~atd al anm Patrick Linton PO Box 6783 Kamuela HI 9674 President 1 0. 0. 0. John Paltnkas PO Box 1009 Honokaa NI 9672 Vice Pre 1 0. 0. 0. Kure LundburB___________ PO Box 484 Paauilo HI 96776 Sec/Trees 1 0. 0. 0. David Horgan PO Box 474 Paauilo HI 96776 Meslber/Director 1 0. 0. 0. Ada lamme-Polio - PO Box 639 Honokaa HI 9672 Member/Director 1 0. 0. 0. _PhilliQ Villafuerte _ PO Box 172 Pa aaloa HI 9678 Member/Director 1 0. 0. 0. Fern Yamane PO Box 94 Ookala HI 96774 Member/Director 1 0. 0. 0. Takashl_ Domingo PO Box 1740 Honokaa NI 9672 Member/Director 1 0. 0. 0. Cynthia 7uan PO Box 63 Paauhau HI 96775 Member/Dl rector 1 0. 0. 0. See Llst d Offices Elc Statement 63 000. 2 595. 0. A Did airy officer. dxeda,lnssW, a key employee roeerva apprspab tan d more man =TO0,000 hom you organaalan and all related agsnlzatana, d wfaM mare man 10,000 sras provdsd by gsa related organrsabans7 ~ Q Ya ©feo Is 'Yes; atlsrh schedub -sea usstrucbona BAA ncFSasa ryayp - Fam 990 (1999) Ferrn970 19?~) Ilamakua Health Center, Inc. 99-0115515 PabeS Part VI Ulhcr InfonnaUon see ttrfic rnstruaxfns Yes No 76 Dxl the orparx:atxxr esgage m arty scanty rqt Pravrorry reported b Bw IR37 If Yaa; attach a dsledW dasurplron oleachacbvrly 76 X 77 Were arty changes made m the organrzrnp a 9overtxrW documents bLL not reported b Ux In57 77 X It'Yes,' apath a conformed copy of pr charrpaa fyy( 78a Did Ns argenrzabon haw urvalated busrnasa grow rncarrr of S1,Ob9 ar more dunrq tM year covered by Uaa raban7 78a X b It 'Yes; tqs rt Irkd a Wx raurn on Form 9B0•T for Ws yeas] - • • • • 786 79 Was there a Irqurdatron, drssolubon, temrnsbon, ar subslanWl carrtractgn dr?rng pr year] If 'Yes; attach ""fit a statement 79 X BOa Is the arpanaatron related (other Nan by assacrWn enN a aMlewrds ar rrborrwrde orpareratron) through tomnron ~ ~ `~+'i menrbarslxp, {pvarmnp bodras, Wstsas, officers, ale, b arty other saanpl a norraxarrrpt orgarxabon7 Boa X bllYes;enterprnamsdprorgarozebon? _ _____________________________.anddrdcwtrtlwdr~axamptor norrxartgt. 81 s Enter tM smourl d pobbtal axperMrbres, dryad or xdiracl, as dsaaaed N the irrtruaharr . ftt a 0. b Drd the orgamrabon file Form 112Q-?OL far Nn year] . . . BI b X B2 a Drd the arpanwbon recava donated servKas ar the w d msterpk, equpmanL or facrbYea al no trwgs a at ' subsrntra y tau ern fair renal valw7 . B2¦ X b If 'Yes,' you mey usd~ca4 the vNus d Ursa rEems hen. Do not rnGrds pia amount u rawnus m Part I a as an expanse m Part II. (Sea xrtrueborr for raportuq rn Part 111 J B2b 1 024 . t13a Drd the aparuzatron tamely wrN the publK rmpactlbn raglrlrMlrnb for ratuna and axenlppm applxaboro7 B3a X b Drd Iha arpanrzabbn comply wrN the diaclosua regraramsnM rNatrq b quid pro quo torMribWrnet . B36 X Ma Did pr arpararaban sdrut arty contrrbubar a tl~ prl wan not tax dadrebOM7 84a X b II'Yea; dd the orWmatron mchxle wdh wrory sdfelhbpt an eotpasa staternenl Nat weh corNrbtAwns ar gilb wen not lax deduchbM7 Btb 8S 50I(c)(4), (5), w (fQ orparwborr. a Were subsUralaly ep due nadedrspWa by rron~bera7 f15a b Dul pr arganraben rtrake only m•hotaa lob6yaq a~endlbrsa d i2A00 a Meat . 8S b It Yes' was arrrwred b efprr B5a a flab, de nal eenplaM fie though ~ below u>fess the oryartixatlon raterved a wawsr Ibr proxy tax orrsd fa pM Pmr ysr c Doss, ussasnrnls, and axnler amoutM from members . BSc d Sacbon 162(s) lohbyrng and po8bpl sxpsrxfiluaa BSd a ApprepaM rrondeducLbM arrant of Section G033(~)(1)(/t) Ors rtdreaa B5a f Taxade amorart d IObbyrnp and pdrtiesl expandltuaa Qkr BBd Mss 85a) R{I p Doss pr orpanuration ebct b pay tlr Satdon 8033(s) fax an pr ertrrad b fr5t7 87 h II Sactxn 6o33(p(1)N) dress nobcas wen sent, does tlr orWnirabon a0ne b add ttr ennead in B5f b rb nasarMs esbmaM d des a8ocabla b nadeductibM lobbyrrrp and poYfkal axperrdrbras fa tlt• fapowrrp fax year] fDh 06 5or(e)(n orpanvapar. EnYr: a InltWrart fees and eaprMl eattrmrlar ntelydad on Irrr 12 Bia b Cross recarpb, rnGuded on hM 12, far publre w d ehb faedilraa BBb fl7 50I(c)(I?) arpsrxraharr. Hinter: ¦ Crou arcarro tram rtrsnrbers a sfrralgldera fAs bGrou xfcbms from Dees saacas. (tb not rrl arrrouds due a gab b etlrr soucss aparrrt arrrrrds due ar raearvsd hom prm.) B7b B6 At any bona duraq pr , did pr agraaapon own . 50% ar 9reMer natal h . taxabM t anon or pYtrrnlap, a an erWty dlareprded u asparals hom pw arparirahan urdw Ropufaborr Saehbrs 301.7701.2 and 301.7701.37 If Yes; carrplsM Par11X M X Bea 501(r~J(,0 orpardsapOna. Enter. Mrrad of tax estpcaad an pr arpanrxabon dump tfr year under: Section 4911 ~ 0 . ; Section 4912 ? 0 . , Seeger 4955 ? 0 . b 501(c)(3) and 50I(e) 4) OrpYaritlarr. Dld era orgarrraUOn enpe9e n any Setpan 49tSB axcaa barrafil trsnsaebon durrq pr yar or d~rt become awes d an excsa bsrrfil trarrsactlon hom ¦ error year? If Yea; attach a stafsmem explarnrrrp oath trarracbon fi9b X c Enter Amoud d 4x rmposad on tln orpre=atrn rTWlapart or drgrrllfiad paraorr durrq 1M year udar Secbans 4912.4955. and 4958 . . . . ~ ~ . d Enler• Arrrorad d fax an Imo B9c, oboes, rsirMtased by pr orpMaiatlan . ~ 90aUsitMsgtawrNwfichacopydthisrehmrfiNd? N_one - b Nrarrbar d employees empbysd in pr PaY Pertod prt brchtdas Myth 12, 1999 (sa xrtncborr) . 90b 21 9t 7haboobararnarod~ Elizabeth Shouse__________ reNpfanenurrber? (808_775_7204______ weoran? PO Box 509 Nonokaa HI_ z1?+4? 96727-0509 ___~____L_____________________________ ___-______y 92 Sschon 49q(a)(q n'arxsmpf afrltfabN (rtrb MJrrp Farm 99G h Ysu d Fanw 7PI7 -Cheek hers . . ~ IUI and enter pr ertaurM d tax•sxampl rnteral received or accrued dump tlr lu war 92 9Ap Form 990 (1999) sea~orm rtmw F~~m9~0(199'>)llamakrra health Center, Inc. 99-0115515 Pace6 F'ari VII Anal sis of Income-Prodttcin AellvHles ee rnstructrons Ursrelaled brarneas rncoms Excluded secban 51 513 a 514 Enter gross amounts unless la) (e) (p) Related(w exertgt ollrerwrss udreated Busnrgs ryes AmouX cbaron code Nroua hetcbon uKOrtro g3 Program sarvKe revenue aHedlcal Services 675 750. b Program Fees 30 481. c d • f MedrearelMedreard payments q Fe i mrtrada from gtrermant egemr 94 Mambarstap doss and assaatrtrards 9S ledrat an tempt L Wnportry onh rmmrst 14 1 977 . 96 Dndends 6 myerast from sanrnsa 14 28 046. 97 fMt mfr nrwnN a (loo) from rW effete ,Lr f a debt•financed properly b not dsbl-financed property 16 37 86I'. 98 Nd mfr imanm a 0ost) from Pn pop 99 OdMr rmestment elCerrU t00 Gay+yr (lossY aarea of assets 18 -41 323. otfter Than r tilt tlr umns a (lots) from speed erenh 102 cwpremvmlw.mx.ra.rwe~ 103 g111er ravens: a b c d 104 15rhbW (tad mlurer (51(Dl rr (4) 1. 6 105 1'eld (edd lam 104, colurru W, (D), and t17) ~ 32.792 Neu: aM 105 XrM f Pert ! should eM anwtt ofr ae f2 Ptrf f on of a to mlalt Pu metnc0am. LJne Na forty p~ aAMty for wMdr mCynm k nppYd In eekam (q d Pan VII eorMnbuud rntportaMy b 0m aeeemplrsfrnsnt ~ of 11M erpert¢aUOn~e elcar4( PtaPdsM (o0mr ifIY11M proebbq hello fa wch pupolea). 93a atient ees an tit art r i ors nts rovi a or t e continuation o me ice services to t e Hama ua Coast Cotamunit re ar ess o t e atients' ai it to a. 93 Um re a rant rovi es vocations trainin or nurses. Parttct ants a so are c ar a ees or some o t e c asses o ere . arC Iniamatlon R and Ws a EMitlas w maoueban. N/A W • t>•) f~7 0» OrJ Noma, addreu, and FJN d ~f~, d Ndue of actrvrtlet partrMnlep, Or dtareperded entity awrsAlp (daml -0f•Yea ~ aaseri X x Please n~r.`o8~w~ a u~r~ie` en m.e~r'a"~ii.`.°i r°m~`• `~a"~..C'° w.r, a. He9rc ~ If lg a~-ci~ ~ epWeaOmpr Dem typeavrM Nerve rre 7eM Paid Pnprpre a.ar i Meerere aw: Prw Pro- °ipni0" ~ 1~- ~cJ 07/17/00 'w- ~ 575-72-2863 Pamrs r~e~ - John D. Carbonaro CP A P. C. Use cw~..~~ ? 1043 Hakawao Ave. 11205 EIN 99-0303190 Only .,,ener.. Hakawao HI ZIP~4 ~ 96768 pJAA raraoros ryamp Form 990 (1999) a.grYnn~la~.'..~"~"~.""".~ 1999 sctlcriulc A Organization Exempt Under (Pone 990) Section 501(cx~ ms w~~ .py nawrsr ~n W.~ K. xwpt Prlveb Foundetlen) end Sectlen 90101, 901 901(1c), 507(n~ or Seceoa +xl) iw.car one+anpt ChM1+bN Trust Supplwtwntry In - (Soe +op+roM In+trucW+~i Musl IN com kted the abevo o enlatbns and Ntached la lhetr Ferro 9e0 of 9!0•EZ Wnw d r¦ pOeuoNa tteerrr< N+Yaeon Muba Hamakua Nealth Center Inc. 99-0115515 Part I • • Compensation of the flue Highest Paid Employees Other Than Olflcers, Directors, and Trustees (Sea xtsUUChans lul aarh ors If thxe era tterM, enter Tlone.~ Name and address of each a) Thus ~ week+0e (c) Compatsaaon rod) OatOat ~ (e) Expartsa e^W~~+_ P_+~~ a aaant antl other i50 dwotad t0 D~~n eNonances TaWn I Keeney1 MD____________ PO Box 1348 Honokaa HI 96727 Doctor 40 110 059. Anthony R GiasollfL MD________ • PO Box 433 Paautlo HI 96776 Doctor 40 104 863. Christoy_her D Brace PO Box 1756 Honokaa HI 96727 Doctor 40 104 091. Catherine A Marquette PO Box 265 Pe eekeo HI 96783 Nurse Practitioner37 59 512. Tom rxanasr d oBsr empbyoes pad over s50 000 ? N n art' Compensatlarl of the Flue Highest Pald Independent Corttratfdors /oF Services (Se+ tnstruthors. list each one lydsOSr kidivldusb a funs). It 1)we w Hate, sntr'Hsrte.9 Narts and address of each Irdsperrdsnl oattracbr peal mac Bun X0,1)00 Qy Type of sertncs (e) Carrtpersatan None rout rtunUer of o0rn recenut0 over 250,000 tar servrees Non BM Fu Paperwork Rdeetlon Aet Notla, eee tlro Matrrretlans for Foam !i0 and Form ti10•f~ &Itedtle A (Form 990) 1999 1tEI1Wa1 OrMn!' SclreduleA loon 7;0 t937 Hamakua Health Centel Int. 99-0115515 Pa e2 Part III Statcmcnts About ActlviUt:e res No 1 Dung the Year, has 0s orgarnzabon attempted to udluents nahorsi, sbte. or teal IepisbUon, mcludmp any attempt to influents public opman on a lepislabva matter ar rsferendum7 1 X If'Yes.' solar the Wfal expanses pad or incurred m comecbon vnlh 8s lobbymp acWiUes ~ S - ~ .y+~ Orgamzatans that made en slecbon under sacban 501(h) by flhrq Farm 5768 must complete Pert VI•A Other oroanwbons checwrq'Yes; must complete Part VI.B and albch a sfakrrant pomp a dstaded dssuipbon of the lobbying atUwUes E 2 Dump Us year, has the orparnzatan, e~Cier dnecdy or irdinc0y, ~osaad m ary of the ldlownq acb wdh arty of its Irusteat, dneclas, affKers. creators, key amplIopyy~~, a memWrs a(tlbx famiUea, or wdh arty taxabh aganw6on wgUi whx:h arty such person is affllulsd ss an ofKcer, director, VrsYe, mslary owner, or pnnnpal txtnefiaary. a Sala, ezchanga, or leasnq of properlyi 2a X b Larding of money a other exlersan of uadd7 2b X c Fumishrrp of goods, services, o< fauhUes7 2c X d Payment of comparsatan (or prymeM or retrtrbrrssnard of axpasw d more 8ren (1,000)7 See Pt V, Fm 99U 2d X e T)arafer of arty part of ib mtome ar asssbT 2e X If the arawsr to sty grasUon rs'Ya; atbrh a daWled sbbrtary er~lanwq the barnacUOns. E Does ds arpanwtan make pranb for aclalarsNps, fa8owslipt, sadarrt lots, sal 3 X 4a Do you have • section ~03(b) amuy plan far year amploisasl •a b Attach • stabrnard b expWn horn Its ar debrmrss 1tW rdrwdub or organtabors recarvsq qmb ar tors from d in h+dannca of ib Urn am to nrr»rva msbuebons. Put N Ratwtt for Non•Prlvate Fouttdatlon Shd1s (sw wbucoona.) The arpara:amn rs not a prnW faudatron bseatsa d b (plaaw clack any one appla:abts box). S A rdsrch, torrvardron of churcfas, ar sssatratan d ctsactMt Sadton 170(b)(1)(/U(). 6 A school. 3ecban 170(b)(1)N)C~)• Ww eoelpNte Part V, papa 4.) 7 A tnspiW ar a cooparafrva hotpbl twice argarYZatlon. 9ecbon 170(b)(1)(/1)(u). 8 A federal. stab, ar bcal povemmant ar pwsmaMal ant See0an 17o(b)(1)N)b)• 9 A medx;al research orpannudron operaMd m toryux0an anlh a Faspdal. 9aebar 170(b)(1)(/t)(u). Enlsr the hoapNars name. any, and slate 10 ~ M orpanraUan opsrabd tar the bsraflt d a eollapa or unrvarsrly owned or operated by a pwarraranW and. SeeUan 170(b)(1)(A)(rv) Wso comple0s 8s Support ScMdrde m Parl N•A.) 11 a Q M orparszabon That norrruly recawa a subsbrrtlal part d rb support from a goverrxranbl rod Or hoar Us gararal public Sedan 170(b)(1)(/1)(vq (Also tampbb the fappsrl Scladrde m Part IV•A.) 11 b 0 A wmmumy WsL secban 171>(b)(1)(A)h). peso Compkb 17s Support schadd. m Part IV •A ) 12 ®M organuabat )hat nonrsly reesrrn: (n1) mete than !11)!% of rb support from eonlntxfiors, rnar~bsrsfap fees, and mss receipts ham actmws related b ib clanbbN, ak fuMlars - to urbm axc~Uorq, and (2) fa manthan 3L1/!% M ib support ham grors irnasUrant IrlCallla and ialrelaled btsirass fwbN income (less secUan 511 bx) from bulneaas aequrW by the orgaruzabon anti Jut 30, 1975. See saefan S09(~)(2). Wso corrrplete the Support SeMduM m Part N•AJ 13 ? M or bon that is rat corr6olled by airy dsQuliRed parlors (attar den Poisrdaban rrwrapers) and srgparts arpanwUors descn'bsd m• (1) boss 5 tfrouph 12 above, or (Z> sactlan 5g1(c)(4), (5), or (6), d tlsy meal Ur teal of seeban 509(a)(Z). (Sae sacUan 509(x) Provxfa the fol mfamNan about the supported orparszstars (Sae usbucbats ) (a) Narrs(s) d supported arpanwflan(s) N) Los rxmbar from above 11 (1 M oraanwUon aaanaed and oaanted to lest for oublk sa(elr. Section 509(x)(4) (Sea mslrueUOrs ) gM ry~yss Schedule A (Form 990) 1999 Sclr_'cI~AeA am 990 1999 Hamakua Health Center Inc. 99-0115515 Pa e3 Part IV•A Support SchtldulC (ConplakorYeyy d you chocked a bore an bne to, t 1, a lt) Via torah maMOdo/acoawnrlrrg. NoN: You may uw 0re w0rksrrear in the eashafiors fa cvN.rWp nom Yre accnrN ro tls torah matlr0d d aaanhrg Calendar year (or 6sal yw (a) (b) (c) be91mrh9 h) 1996 1947 1446 1995 ToeWl 15 dfla, Aran~yyppannpd~ conhbutana ruparar°N°drl ~an4 3N 1M~e 28 355 677. 190 426. 219 T42 . 322 565. 1 088 410 16 Merretersh fNS `starved 17 prow roapa Iram ednaaawm. wadWdrM sad ar wYMM Psrfaaa4 a faaaMq d 1a0hhw m aM acewry YOI n ed a hlaa110 Yaelebd ED ea 'a 591 691. 871 028. 898 023. 2 176 710. 4 537 452 16 Grw aimae has mino~tw, iaMrbWMs, asaab raanrN hen 11tf Al seoieiYea Mrr (Sedkn SIB XX mll, releNaa, aM sadrM 6ursNt teetle roes Dar Se:YSn „1 tam) bear taanau~ seprd bf b ar~? inYanellrhaw 1915. 198 711. 262 028, 33 815. 74 609. 569 163. 19 tlt aiaaa !tors uselsae lsesnaaa ada~a~ nor ndudM h Yea u t0 Taa revNnsa NwaO for the arparrralfon's barndll and aiew ord ro rl ar a~ardad on ds bahdf 21 The value d eervkp a facYdip hanlelad to tit or0ar~r~~po~rrnen4l erctuda fs vahar d aerriep a ~ir1Na (lerlM furrlh0ad 10 ZZ Ofnr hcoma.Apadr• selydllls. 0o rq1 axhda 0~ aas~asu) horn sW d 468. 33 . 0. 501. z3 TaW d hop 15 ZZ 1 146 079. 1 32 950. 1 151 613. 2 573 884. 6 195 526. tt the rmrslawl7 54 3 8. 4 2 53 590. 397 174. 1 658 074. 2! Emr1%dNna2'{ 11 461. 1 40. 1 516. 2 T3 . t9 Oryandtlana dsacribad ea Unee 10 ar 11: a EMar Z% d trout h aAam (a), luw t4 . t9a b Atlxh a hat (wlich s nol openb public aspettlan) fs rome d end arrant catnbuted by each perms (otter than a Oerermnnau unt a pubhrJy at~a~ arparraMlan) whose Eohl alts fa 19951hragh 199! eaeeeded tiw retreat shown n Yoe 26a. EnMr sun d sil tlwe ezeesa artaunb ? 26b e ToW support for Seebon f09W(1) !eel: F1Yar Yoe tt, alum (y t6c d Add: Arrwues hom wham (s) fa bras: ti tf ZZ =fb ~ ttld e Publre support (Ihe 26c rtsnua Noe 26d bW) . ~ tfe 1 ~ubfc the dNlded Wrstie den' ~ to % a orf.raaM.as a.olb.d.a l1p 1L a Fa annaaMS irchrded n IYss 15, 16, and 17 fat wen `eased ham a 'diagrahOW person; a6aeh a IM 4 show tM nems d, and tom amouMS reserved h each year hen, sach'dhquYYlad penes.' Eller trs sun d such artrorrds fa each yet: 049°) 09g')------------ 09~------------ r94ts'------------- bFa ary amour nehded h leis 17 Usl wp recsrved hom a rratlsgWYlad.penon, attach a IM to show tlr rams d, and amount `served l0r sash yssr, frM was more then ttr tort ter d (1) 6r amoral an boa 25 for Ys yet a (A 15,000. (Irelude in tlr Int a d the lar0ardsecrbsd In~(lja(Z), ertr ~ auin dtlrse)Nllenrk(1tM acepa err'a`ta) tora~rYr~ maned (1998) (1997)--^^-^-^---- (1~^^^------^-^ (1~----^-------- cAdd. Amoures nom column (s) fa Ilnss: tf 1.088.410. 1f , 17 4, 537, 452. m zt 27e 5 625 862. d Add: Lou 27a 1041 and Iw 27b ro41 . ~ Z7d • PublK support Oma 27c to41 mss hoe 27d loW) 27e 5 625 862 . I To41 >a4P0rt ter seetlan 509(a)(Z) tpt: Etter amaad an hrs 23, cnlrarrr (e) . ? t71 6 195 526 . f ruWk wPPOrt f one 27s (manwalo0 dlvldad by Rrra 271(deaorrinalsr'p 27 90 . S l % h Irrreatesnt Intent 1 colwm • diviNd fns 271 27h 9.19 % ?b IlmtswlCrsn4: Fa an orfanaahon dsearbed h Iha 10,11, a i2 tlW received ay ursawl pranty du..xq 1995 ~qq~ 1998, atlaeh ¦ hsl ((whch is not opM~ 4 publk napeetlen) fa each year alrosdn0 the rwrr d tls cortrrtaACr, Yr dab and amount of the pram, sod a boor! descnptan of IM nature of tM pnxil_ Do rgt Irxbda tlrae ¢anla u+ hoe 1!. (!es m_atructlorn.) r!lAOrol ,yam orm ) 19 Sctxvhdnn drm9~p 1999 Hamakua Nealth Center Inc. 99-0115515 Pa e4 Part V••~ Privali Sr.hool Qutlstltlnnain (See rntructlorls.) (Te b compMlad Olry by xhoeb that cllaclyd Me bout as W i to Vert M N /A Yaa No 29 Does the apanmtlon have a rxlaly nax>,sammnatory pollry toward aLdarlb dJ sbterrlsnl in ds chartr, bylaws, olhar povrnlnp elstrumsnl, a m a raWutan of lb povarrynp bedyt 29 ' 4 30 Doe ls1ootgqh~~exxaspanliabon Include a sbtemaM of lb rxlally naid~avmwflory policy toward studxds m all ib bracfarss, cam scholaisMxps7W cortrrllrncaaors rnM ~ P~~ deahng , shdrd admissaro, proprann, ~ 31 Has the organlxaben Pubhcaed its rxiilly rpndiscnrtnnatory polrcy graph or broadcast media dumq gls Prlad of sollcdalan for swdama, a duoq 8la repstratan parald 1 d has ro labbon program, m a way That maNes the polty Wloart b all parts of the ganrsl camaaay d satvas7 31 If 'Yes: please dasad~e, d'No; please explain. (h you need more a11xh a separate stabmrllJ 32 Does Ms apanlxabon msrdam 0M lellowxp. a Records xldlcabnp Me racW axrpoalbon of the studard body, fatuly, and adrrurwstrabvs sbM7 32a 6 Rxords doamarArq that sctnbrshps and OCMr tlrMfClal awatance era awarded on a ratuly rlorldlscrmermlory basis] . . . . . 32b c Copes of ag catabgtrs, troctxrea, amancamenb, and oMr wrilbn corrrraaru'.atiors b 8r publK daalbrp 32c wdh shdant admasrons. Progralna. and acholarslYpst . . dCoples of all rtrbrlal used by the argarurabon a on lb behalf b solrnt crntrlbWOro7 32d If you answered Tb' to any of gls above, pNne axpbin t1f you rlaad more spas, atbdl a seprab abbmam.) 33 Does the apatwatlar dnumunaM by raa n any wary wWr rasped to: a Shldanls' rlphb or ptmMpss] . . . . . 33a b Mrraaslons polKles7 . . 33b c EmDloymanl of toady or admmrdrabvs staR7 33e d Scfx>farsfrps or oMr fironcwl asasWxaT . 33d a Eduatlonsl pdxasai . . 33e / Ilse of fxllltrost . 331 q Alhlabc pregramai . . 33 h OUrr extracurrladr xtmbes7 33h If you answered Yaa' b arty of Bra above, phew aaplah. (If you rMad mat space. atbdr • separate shesrnerM.) 34¦ Deea the aganWbon receive any finrlclal old Or aasuWx:e from a pownerlsrlbl agarlcy7 . . . . . 34a b Figs the orparorabon's npM b such aai err been revekad ar srlsperudadi 34b If you answred Yes' to aditr 3/a ar b, phew explain ualnp an a8adwd sbbmrd. 35 Does the aparrutabon certdv Mat d has compiled rnth the appFeabM rapWramenb of axtlans 4 01 thrauph 405 of Rev Prx 75.50 1975.2 C B 587 coven rxul norxlmernrwutlon7 If 'NO' atbch sn ex larrben. 33 BAA TQl~or l>/auT c (orm ) 1 sclkduleA orm990 t999 Hamakua Health Center Inc. 99-0115515 Pa es Part VI•A Lobbying Expcnditurcs by petting Pubiic Charitles see mslrucuorr< ) fro bs canplelad Ordy by an ebgibla agarasabon Ural BMd Fare 5768) N/A Click here ~ a d tM or9amratron Gktrrpa b en al8kabd group. Check here ? b d ctstckad'a' above and 1imrlad cerrbW' Limns on Lobbying Expenditures To be cbompleted A}hl a~ oup for a8 elecbrrp (The lerm'espsrkdtra' mqm amwds paid a mnared) a srn:auons 36 Total bbbymq esparki41as b mfhrencs public oprrsarr (prasxa)h Idrbprq) 38 37 Total labbyerp espertdibrns b ut8usna a la9is4We body (doad lobbrrrr~ 37 3e Total lobbym9 espardibraa (add Inca 36 and 37) 3t 39 OIMr asampt purpara esparkduas 3g 10 ToW assmpl pupas experktbaa (add Inca 38 and 39) . 40 4t Lobbyoq rnntaxabls amant. Enlar Vie amara from the fdlaa+rq laNa - - II the amount on Bm 101e - 71re Ieblyine naeutrabN a~sattt la - Not ova f50V,000 PO% d Uta amaad on lira 40 . . ow SSU4oGO as rot over sl,aaooo9 i1t1g09D plln 1s% a Ili ts. oar tso4ool ' pw iI,p00,00D but net aver fi,l04~ f175,~ ru IIl% d ar as oar f1,8}~p1 11 Ortr St,509,00o but net avr f17,009,9~ ttt5,l~ rut S%d tla atewsru tI,9A,891 O+a (17,000,000 f1,t100,000 42 Gruxoob rtarWaWs amoud (ardor 75% of Una 41) 42 43 SWNnct Ina 42 from Iota 36. Fsta -0- d hrr 42 b mon than biro 36 43 M SWrtract Ins 41 from lino 3& Enbr -0- d biro 41 is man Uwr 9rN 38 M Cautlon: M drara rs an amevrt on aHMr IMe 43 a• a,. mug ala Fam 4TI0. 4 -Yev Averaging Period Under Section 501(h) (Soma aryxrxabau that made • aaotlon 1(10 elactlen do riot haw m corrgkN au at the tiva coharata below 9aa er astruetlars for live 48 Urorrph 50.) Lobbylno ~atrihrrM Crlrhra 1 •Yaar AwraBine Period CaMndar year W (b) (e) W N1 ((a Bsca~l year 1999 1998 1997 1996 ToW baaMninq In) 4S Lobbyetp nadaouWe amoun 16 Lebbtsp nrorR 1 d hte t 47 7oW bbbyur9 as 4{ Grastroob mn• tasabN amount q fYataetY Houk lif%dlbr a 78 Craaxoob bhbyrq nq P ffor~rapatnp m~iy~agarYraBrt did eanvlP •A) (Sae irotruauar.) Orroq Ili yaat, did the argarrratbn atMrpt b allNlarrea national. atala a local Ipnlatron, utt:llydnt0 ary anempt b nfirartn public apwort an a Ia0rs4bva rrr0ar ar nlNardun, throtgh Br wa of. Yss Ne AmouM a YokaMears X b Pak stall a maYgtpemerd Orxfuda companaa8ort m sttpsrres rapaMd on Mrbs a throtrph h.) . X c Medta ~ . . . . . . . X ~ d Madotps b msmWrs, la9rslators. or the pW>Ite X • Publiabons, « pWtbahsd a broadcaatslabentanb . X 1 Grans b oew apara:aboro far lobbrm9 PraDosas X e Ouect tontaU vnih laphtalaa, that staffs, powrenaM of8r:lals, ar a laphlabva body . . X h RWras, damaratratlon, samkwa, eanrattbarrt, spaatdtaa, laebras, a any otttr means X l Total iobbynq axpat~ttuas (add Imes c through h) . . . If'Yes' to airy of the above also attach a a4tement uiwrra a dstaded dasuioVon of Vie lobbyuq acWrbes BAA tyapn SctakWa A (Form 990) 1999 SctrduteA orm990 t999 Hamakua Nealth Center Inc 99-0115515 Pa es art VU Itt(ormaiiot? Regarcliny Transfers To and Transactions and Relationships YVNfi Noncharitab{e Exempt Orysniiations (sae erauettons) 51 Did Ule reparbu orgarnrabon dreclly a utllrocty ergege rn any of tlr following ~Ih ary ofnar orparvzabon dssuibed in section 501(c) of the Code Nan sactren 501(e)(9) orgarsxsbors) or m saclron527, rNalrnq b polrbW aganrzetrars7 a Trarrtars from Ua raporbng aganmtron b a nonttanlabh exempt orgenasban af• Yes No (q Cash 51s X ppONrr assets s X b Other Vansacuons (pSales or exchanges of assay vnih a noncfrarrtable exempt agerraWn b X (ll)PUChasas of asseb hen a noncfrntable exempt agoxratan b X (q~Rental of facrlrUas, equipment, or ouw assets b I X (H)ltarmbrrsemenl arrurpanrnts . . b X (v)Loans or Ian WararNees b v X (vpPerfamartce of sources a rtrrrrbershp a tundrarsrnq sdrubbar . . . . b v1 X e Shenrq of fauhtrss, equpnrnt, mokrq Inls, otlw nwb, or pard errpbyea e X d If Ur~ rop~ywer to ary d qr above rs'Yea: IM fW sdrdW Colurm (b) slwuW ehrays slww Iha fw market value of the L other , or sources ~r I1.~ on fscgnaa Nss tlwr fan mvkel value m a ansicbon a d the a asw a servrees recawad. Un(a iro. ArrrouN~rwWved rlorr W norretrnfalda)enrrrpl orgosrabon DsealOtlon d bsmferti end tlrnnp smrrpenarb 52a Is dr aganwbon drecdy a rMractly alfilr4d wdll, or related b, error rnors taz~szempt ageruxaborts dasarhW m sacbon 501(c) of Na Coda (Olho iM asetfon 5O1(e)(3)) a m section 527T . r Q Yn ®NO b If'Yes' Nte N1e fol schedule; Name of (erpenrzataxr Type Of %r~p nratrm Desenpbon (~ralabanshp BAA Tasorss rymef Schedule A (Form 990) 1999 ' 4562 DepreclationandAmorttution °"a ""60"' Form pnrJudinq In(omlatloet on LJsted Properly) 1999 i~ w ''awvo (99> ? Atlun w "'les°aceeriu?` wasn. s7 Namr(p Fxnm a Rrhxn ewx~ r AdlMer b Ya1dr lha race, Wdra Marrt~ rf.,rr Hamakua Health Center Int. F rr 990 a e 2 99-0115515 Part I~' Electlon to Expense Certain Tangible P~er,~ (Sactlon 179) (Nab: If you helve any 'listed proPUb'.' aar4Mb V Mbre you corrrWeU Part 1) 1 Maximum dolor 6mrbtian If m ardarpnas cone bufraes, fee urYrrctlora 1 S 19 000 . 2 Tool cost of Satlran 179 properly pbced m servrce. See irotructiera 2 3 Ttxeslxdd cost of Saban 179 properly belays reductron rn IYrxbherr 3 5200 000 4 Reduciran m lumbbon Subtract kne 3 from One 2. If zero or less, erlbr •0• 4 ! Dollar lirtfbtbn for bx year. Subtract hoe 4 ham Ens 1 If zero of bus, enter -0•. If owned fihrrp se ara sea rrutructroru ! 6 a d Car w f E4ere eon 7 Lined properly Flrbr anrorad ham lux 27 7 B Total eNcted coat of Section 179 properly. Add amanb rn wham (c), lots 6 and 7 t 9 Tsmabve deducbon Enter ttr tnalNr d Ilya S ar Iln 8 9 10 Car7awr of drsellowsd deduction ham 1998. See rrabu:llars 10 11 BrRUnfi rrrcarra hmbaon. Enter Oa smeller d btaaaea urcona (not lees Ilan zero) or Ilya ! (see uutrs) 11 12 Secban 119 exparue dsductlorr. Add leas 9 and 10, brt do not cyst rtrore Oan bra i l 12 13 of disaYowed b 2000. Add IMp 9 and 10 lees On 12 t3 Neb: UD not yea Part 11 or Pan N16ebw kr IUled preperb' (eubrnO6Nert careeir otlw NIYeNs, ClNufar teNpharNS, cM4N oarrloufars, or praparry aced Ibr wderbMrmenf neereaekrc w rnuwnwr0. kaeeefl rw Parr V br aflad praperp% .arty IIAACRS De~ndatlon for Asseh Placed In SNYIp Only Dluirq Your 1999 Tax Yaar (Oe Nat hrrh L4fd NepeAyl Seclbn A - tierarel Awet AecwM actlon U If you ara maver0 ifa eNeban rerdM Sectlon lfr'a(0(4) b group cry aafeb pbced in tefvrce duxq Ore tax ysv rMa one ar more larval octet aocorrrb~ Lack OYf box. SSen~ rsbue0onf . ~ n Bectlea ~ - Oerreral M eatruelroro tU ~)erw a+ (gwsarrr.crr. (p crrraaear ar a~ao.~ ~ ~pabMMVrrew Iwwi~r ewW teaw~iYan Yice mar tla3• r 2 320.3 Mt1 S/L 474. b! 9 32 NM 5/L 1 289. c7• 67 146.7 MM 5/L 0. d 10• r e 1!• 120- 2!• r 25 rs S!L h Rafrdentlal renal 27.5 rs MM S/ L a<~ 27.5 rs MM 5/L I Nauaardsnhelnal 39 rs MM S/L aaperh MM S/l 1fee0ea C - AMraetha uahrrsOonf 16 a qaa lib S! L b12• er 12 rs 5/L ce0• 40 rs MM S/L P Other on NN 6relede llebd irotrucboro t7 ('IDS and ADS daduetlon tar ewla plead ht service n tax yeas begmrnp Oefara 1999 t7 38 OT . 18 Ihop.ny caged b Secban 168(0(1) eMctbn 18 19 ACRS and atlw 19 ~ Summa uutructlons Za Lnbd prapaly. Entw arrant ham lea Z6 20 ZI Tobl Add dsdrryroru an bra 12, lugs 1! and 16 h colrarn ,and Iwas 17 Urough 20. Fsbr twe aril on Ua appropnab bras of you reban. Parbtaftrlps and 8 aorporatlom -foe uaMchorn 21 40 470 . 22 For assets shown above end plead m service dump Oa current yw, cyder Ua ran of Ors boas attrrbdaMa b Ssctlon 263A coeb 22 or a u on , eee n f. roman rartuee orm Form 4862 1999 Hamakua Health Center Inc. 99-0115515 Pa ez Pant V Listed Property - Automobiles, Certain Other Vehicles, Cellular Telephones, Certain Computers, and Property Used for Entertalnrnerff, Rer:reatlon, or Amusement colrrvrs (sjY (c~o/Secharr~~ ~ of Mr sfardard rtalea0a nM~ lease expense. corr~ste on/Y23a, 136. Q and Secalon C !r Seetfen A - nNatlon end Olher brkrmeeert See rne6ucOgo for INMts Ar aukr+wdNs 73 a Do u ler rrdmn b m Ue buruen/imabneM ur dsinel7 Yes Ne 23b If Y ' b th endexe wntlnf Yes No (a) (b) (dI U) ((1 (W (h) O) r,9. a aowm aw ow r+.ca eia""'r cae ar err tr a.rwnu+ w~..r rreew o.p.o.eon erne whM Mp nYrn[e u1M~ K CeM WY P.ereti Oeee CanMihan Ore,~4an ~r79 24 Pr wed rtwre Oro 50% m a hfep bwarss w sae uwtruchons 2S Pr used 50% a less m a wlfied busnrss w sN netnicborr M 26 Add amnnb m caharrl (h). Enter the total hers and on line 20, Pepe 1 . 26 . 27 Add amounts m column i Enter the roVl here end pt Ime 7 1 D sectlon ! - Nlarereen en UN of WMdN Csngdrm e+s eafan far wANss andbye esY arapM?, Pebr/. d ayr bsse aer 7f eer,'erndNrdprsea ll yw prwsdr0 Nhcln myaursalom)Nat fasfanseerfM ssssbse+w S1sb'M Cm arYyrawfa eerelwr m mapM1ep fAtr tsbsn Aram nbelrs W (cI (dD (y ~ TeW nsla dtwen drmn0 ee ~ VeFYcle I VehlcN 2 VsNeN 3 Vehch 4 Vehcla S Vetxcle 6 (Ds rot mdude oxerserq mMs - w imhraeom) 29 ToW ammuhe rMb ddwe durbq iM yesr 30 ToW oOrr Darsonal (rgncommWrq) mks driven 31 ToW rrxlas driven dunnq the year. Add boas 2B Orouph 30 YN Ns YN Ne Yea No Yea Ne Yee No Yes Ne 32 Was the vatecle evadable far peraorMl w dump oM•duy tqust 33 Was the valecle used pnmeny by a more Oro 5% owner ar ra4ted person? 34 Is anoOrr vetecls avadebN far sonal use? Seetlen C - Crwetlana ler Glpleyere YYlle lhwlde VehldN for UN by Thep Enpbyeee Arrswsr RrN 9uesflarr fo deMnnrne d you mNt an eumspean fa aerrpfea'p Sectlan B Ax velYCNs used by errtploy+es wfa are not more than S% oa?rrs a related parsons. 3S 0o you mmmem a vmOan policy statameM tlrt prolibb aM persarrt w d velscles, meludr canrrsNrq, Yes No by your employees? . ~ 36 Do you mnntam a wntUn pdxy sLbrrrrd lhat prdtlbb perwnel w of vehides, axtspl correntfirq, by your ampbyees7 See ubtrucbana far vehcMa used by corporap aflkere, dtadas, ar 1 % ar more aearrs , 37 Do you treat aN use of veMClea by emDbiees es Deteonet w) . 39 Do you provxls maa Orn Mve vehicles b you arrpbyees, abtam urforrnebon hom your employes abed Or w of Or vebclea, and retain Or ndorrrraon recarvedt 39 DO you oral tlr raqueemardb tanaMNrq quNrfied etAOrnablle demanstreOon w7 SM metructrgb . NeN: if your arsswer to 35, 3ti, 37, 38, or 39 fs Yes,' you rred not cargMY Bastion B fa Or rn`ved vefdcNs. ~ r , r• Parh,Y4 Amorllation ' (d W (a) (e) (A oexae6m a mw ar ~ wwwrmre inn on kr Osrarre. 10 Amorhreban of costs that rns d 1999 bx Y: 11 Amartrzatwn Of cosb Ihal balers 1999 Il e2 To W. ErMe+ tyre and on'Olfrr DedutOons' or'OOrr ' IMr M return 62 namsu iorsrns orm 4 (199 ) Fornt 990 Schedule of Contributors Donating;5,000 or 1999 Line ld More in Monsy, Securilfes, or Other Property Statement (Not Open For Putilw tnspedlon.) ? Attach b return Name as Shown on Return Employer Idenhflca6an Number Namakua Health Center, Inc. 99-0115515 Page Number 1 Contributor's Name and Address Dsscriptlon Date Amount Received Received State of Hawaii Dept. of Health Cash Grants P 0. Box 3378 Honolulu HI 96801 Various 158,316 State of Hawaii Deat. of Human Sv stash Grants P 0. Box 339 Honolulu HI 96809-0339 Various 113.469. County of Hawaii [ash Grant 25 Auouni Street. Room 116 Htlo NI 46720-4252 Various 5.000. Federal Dept. of Health 8 Huron Servi dsash Grants 4350 East-Nest Hishway, 11th Flr. Bethesda ND 20814 Various 260,700. Hawaii State Primary Care Assoclatto Cash Grants 345 Queen Street. aK702 Honolulu HI 96813-4718 Various 19.261. The Harry a Jeanette wernbera Foundation. In Cash Grant 3660 Waralae Avenue. Suite 400 Honolulu HI 96816-3260 Various 80,000. Pacific Century Trust Cash Grant P 0. Box 3170 Honolulu HI 96802 Various 5.580. noxozr aae oans~ Forrn 990 Schedule of Gains and Losses from 1999 unc ES(A) and 8(B) Sale of Assets Other than Inventory Stalcment ~ Attach b roksn Name F~nploysr Identficahon fAmbar Hamakua Healtfi Center, Inc. 99-01155]5 Part 1, une 8, Column (A) SeCUr1U05 Public Securities Gross Descnpbon Sales Pncs Basis Publicly Traded Securities 859.870. Cost 901 193 Sell Ex s Bests 901 193. Nonpublic Securities Cost, other bases or Date Acquirod Dafe SoW Cross FMV when donated Descnphon and hMihod and b Whom Sabs Puce (State which on top) 7oW Securities 859.870. 901, 193. Win or (Loss) fran Sah of SeeuriWs -41, 323 . Part I, une e, Column (B) Other Assets Clete Acqused Dab Sob Gross Cost, otter bans or Chser~ptwn and Method and b Whom Sales Pnee Flr{V when donated Cost Deorsciation eases Donsbon FINV Cost Deoroclatan BasK Donebon FMV Cost Daorenabon Bssn OonebonFMV Cost - - - - - - - Dsorecmbon Bash Donation FMV Total Other As'sds Gain ar Mss) from SaN of Otlrer Asaeb +eEwmo~scn i~~ ~ - Flarnakua hleallh Canter, Inc. 99-0115515 1 Form 990, Page 2, Part II, Line 43 Other Expenses Stmt (A) (8) (C) (D) Total Program Management Ftaxiratsmg Other expenses (itemize) services and eneral contract and other Service 100.512. 92,515. 7.997. 0. Office Expenses 29.913. 26.024. 3.889. 0 Miscellaneous Expense 1.734. 0. 1,734. 0. Total 1~ 3~ 159. 1.18, 539. 13, 620. Form 990, Page 3, Part IV, Ltne 54 Investments • Set:uritles StaNmertt Degfnninq End of Line 54 - Investrnants • Securities: of Yea Year Debt and Eautty Securities at fair market value 908,819. 1.018.527. Mutual Funds at fair market value 494,397. 262.174. Total 1.403,216. 1.280,701. Form 990, Page 3, Part IV, Ltrte 66 Other LiabllMfa Statamant 8aginnlnp Endo( Lino fi5.Othar Liabllitlas: of Yea Yaar Accrued Pension Liability 44,993. 30,775. Intangible Pension Asset -45,767. Total -774. 30, 775. Form 990, Page 4, Part V uat of Officara, Ek. stabmant (A) N) Name and address T'iW and Comparts..a.bt,o~n Confnbuttoro Expense avsraps ttous per (If not pNdr t0 employee BCCnlrit week devoted enta-0•) bertefit plans and other to ptxsdton and deferred allowances compensation Lois Keb PO Dox 962 Nonokaa. NI 967 7leeber/Dtrector 1 0. 0. 0. Carol Kalaau PO eox 53! Nonokaa. NI 967 7Ne6er/Dtrector 1 0. 0. 0. Glenn Oshlro PO boa 302~tlonokaa. Ml 96 r/Dtrector 1 0. 0. 0. Quincie Martlnes PO aox 2U Laeseheehee, xI 9Q aheber/Dtrector 1 0. 0. 0. Clarence Souza PO box 343 Paeutlo, HI 967 9feeberrDtrector 1 d . 0. 0 Hamakua Health Center, Ine. 99.0115515 2 Form 990, Page 4, Part V Conllnued l.lst of OtOcsrs, Ete. Statement (A) (8) N) (4 Name and address Title and Conlpsmafron Contnbubom F~pense average hours per (N not paid, to employee account week devoted ardar-0~) txtrlefit plans and other to posdlon and dsterted allowances compsnsatron Bernie Centeto ~0 Do: 1126 Nonek~a. MI 96 a9sber/Director 1 0. 0. 0. Jane Sherwood ro eox If~9 Kawla. N1 96 Arab~r/Dlr~ctor 1 0. 0. 0. J.E. Potter Swartz ?0 !ex SD! Monekaa. M1 96 lxec Dl rector 40 63.000. 2.595. ~ 0. Total 63,000. ~2y59~ Hamakua Health Center,lnc. 99.0115515 3 Supporting Statement of: Form 990 p 1/Line 20 Dasaiption Amount Unrealized Gains on Securities 200.430. Total 200, 430. SupporUny Statement of: form 990 p 3/Line 60, colunn (A) Desuiptlon Amount Accounts Pavable 80,679. Vacation Pavable 43.708 Accrued Payroll and Tazes 30,438. Total 154, 825 . SuppoMnq Statement of: Form 990 p 3/line 64b, colunn (A) Desctiptlon Amount line of Credit Pavable 465.000. Total 465.000. Form ' Applicatlon for Extension of Time to Flie a. „y.,,., ,w..,~.letw Certain Excise, Income, InMrlnatlon, and Other Returns ~~lt°" ~""M:.:.'":: • Rae. etwale a~aaaen Nr.ech tetwn. Pleas ty0a a n"~ atelre..t/.wr.e eirr.r crfpiealt ar~M Heat kua Health Center Inc. 99-0115515 see cery try M.ne.. srer, w Mae a smr rwwra tr r 0 bit nuuCr, a err • ~ erMtwM r re.t mete Ise dw daN p , 0. Box 509 m for fduq yov ch. re.n s rer Oda. aYr. rr ~ cer a hnrt~ Asra sr rrruarr. retYn SN tmvut6oe Honokaa HI 96727 Notr. CorPa+aM urcorrre tar iehrn 6tea mart tter farm 7MMAO regr,ast en exfenabn aI mme N tma. Parltwafrloa, l~71r/GY, and coats mwr tae fanrrfT.lrb tw.ar an axWalan armor. r Ima form ?016, raae, ar rat 1 I repast an exbraan d Ups ultll Aug 15 _ _ _ _ _ , 2Q00 , to fiN (deck oMy orty: Fam 7061'a5(D) Farm 990•T (Se 101(x) a 40~(a) trop Farm 117Ad0 (Sa 4961 lane) Form 8612 Form 706•GS(1) Form 990•T (trtat aaw tltan aborr) Farts 3620•A Form 8613 X corm 990 a 990•FS Farts 1 W I (eslata) (aN ea#1retNns) iam 4770 Ftxma776 Fam 990•BL Form 1041 d Form 5727 Farm 8804 Fam 990•PF Fenn 1042 Form 6064 Farts 8fA1 If tlts arpanaabarl doe rot lrve an ofila a plaaa d brsirres n site llNlsd StsW, allerk tle box ~ ? 2a FacNartla?year 199 ,aotharWtywtxlpirwq__ _ andsndrrp_ b If tlla tax year a Yar Ise plan 12 nnlltlts, ehedt raaeorc ~YdmY feban U F4W rNrn ~Gr4a h aaeoratUrq grad Ye No 3 Has an elMlsran d IYrM b fiN bean W~rWr parrsd for tli /rx yeart 4 StsYaddrlslrylesltMtlasdaaae .The finalpytal_sudtt for the year has not,ret____________ been cotapleted__Therefore,, additlonal_tita$ is_regktgsted to_ti~~ a ~oaplete_atid__ - accurate return Sa if Urs form a far Farm 706di5(D), 706-Q9(~, 990.81.. 990•Pf, 91aT,1a41(etr , 1012,112G1mJ, 472D. ti069, 8612.6813.8773.8104, a 1M31, erdM UM tertiatlra tax. lass arty aadb. 9efa bxituellots . •S b If Urfs Aorm a for Form 9!0•PF, 990•T, 1041 (eWS), 1012, a 8801, MMSr n ' asbnlaMd tax oamanta rttade. lrtdlba aly Rte yw orarpaymrR alswad a 1.E1j Q • • • • S e salaaee dw. Stbtracl 9na Sb from Nne Ss. Irle4rda yw payrfwr rrMt 1Ms r rrllt aatlpatt if requlnd. Sae xTSfruebau 7 may. Q.' ~ . f S1g11itUr8 lql~ Vti11 ~ utw wNrw d aahn'. I ate... eM 1 ttewetatrw er roe. Mdq eraneat,ae rtlrMr d iie 6til d ai ~e+rta~. rr rr4 s r w.. encl. tl a•nYlrO. ale ewt 1 tw aavM b Prere ti lea. 7 ~ Ti ~ CPA DeY ~ DS~DI~DD FIN and . TM straw baNer wAMAse w sal N and aY ra0lre Iha Maly M - Te a osra8lals~ by t4 p - - _ we Have approved ya. wplaaw~ogqnon. aiw..aaa, tlr. tam w ya. rbm. ~l w ~ a~yotr ~ blMtrdkgprlot axwle'ISi)~This qi a ~a rto~ ~y~taan°~a m a a v~W laaat~ ~t M ~ ~ ottwwle requrw m w made an ay tllnaly IYad raYrn. P1wN •tladt pas krm to yar rabsn. Ws Nave Net approved you appbeaYon. AMr carrrdsrar0 the raeora sUfad m item 4, rra eamot pant you regwst tar an externwn of time to fiN. We an not granhrp Cr 10-0ry pan pwlod. Wa cannot aonsdar yar appUeaban becalae d we filed afNr the due GN d the rebrn far whKfl an extansron was raglesled. OtMr~_---'---------------------~-_-______---__--_-_-_~---_--------- M or.er rrw II yxl aaa a t~ d fhb bra Y a rabnad M n sddrso air tllw 1al wen s4aa drrs snYr tla eaNr b rrra Ne oqy rtalN a ssnr. CXTENSION APPROVED PINN John D. Carbonaro PA A P.C. TyW rw.ea, Star. rr Mrs s sl.r Knar (w ?a. tla ararer. a ae~ • mt arwws b rrral rrrW Pr«iae 1043 Ha laao Ave. m205 C+M Torn a /err Oleer, aw, ar 7Jf Cart fa a fawel neerw, sw Mitetxllae• Hakawao HI 96768 ICHAR~CRF ~~LVt~ t1IJ1 Fa Peperwerk Redactlort Act fNtla, see se0anle Inetruetlens. g~Tn' nriorot nllsrN ~~it .n yr °n..bC d~.~Gl~_ .a~~ ; a ~~y9 INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY DISTRICT DIRECTOR P. O. HOX 2508 CINCINNATI, OH 45201 Employer Identification Number• Date: AUG DA )699 99-0115515 DLN: 17053205717049 HAMAKUA HEALTH CENTER INC Contact Peraoa: PO HOX 509 THOMAS 8 O'HRIHN ZD# 31187 HONOXAA, HI 96727-0509 Contact Telephone Number. (877) 829-5500 Ouz Letter Dated: August 1993 Addaadum Applies: No Dear Applicant. _ This modifies our letter of the above date in which we stated that you would be treated as an organization chat is not a private foundation until the expiration of your advance ruling period. Your exempt status under section 501 (a) of the Internal Revenue Code as an organization described in section 501(c)(3) is still is effect. eased on the information you submitted, wa have determined that you are not a private foundation within the meaning of section 509(a) of the Code because you are an organization of the type described in section 509(a)(2). Grantors and contributors may rely on this determination unless the Internal Revenue Service publishes notice to the contrary. Rowever, if you lose your section 509(a)(2) statue, a grantor or contributor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act, or the substantial or material change on the past of the organization that resulted 1a your lose of such statue, or if he or she acquired knowledge that the Internal Revenue Service had given notice that you would no longer be classified ae a section 509(a)(2) organization. If we have indicated in the heading of thle letter that an addendum applies, the addendum enclosed ie an integral part of this letter. 9ecauee this letter could help resolve any questions about your private foundation statue, please keep it in your permanent records. If you have any questions, please contact the person whose name and telephone number are shown above. Sincerely yours, f ~ ~ ~d1o+a:C Districe~ctor Letter 7050 (DO/CG) ~ I .1 I I CERTIFICATE OF INSURANCE leauad ey Truck Insurenoa E:changa, Loa Anga1N, CA Namur Namakua Haalttl CaMar Insured Addrwa P. O. Boa SOq Honokaa.HSwan 9!797 117,4399 um r Thls aaRlnaaa or vanfloatlon of Iraurana 19 not an Inwntnv pdby ¦Id dew Iqt amend, aalond, or akar the aovaraga afforded by tllo Polby nfarnd to above. NebldThalaltdiq .Ity fagldranlMt; e91m a aondltlon a any epnhaet or olhor deoumaa 7dtll rwpaat b rrhleh thla oaAMaala ar wAIMMIen d Nlallrallan nutr M Naaad a may palMrl, Nq Inaurana afladad by tM PNby la wbJaot to all the tarma, wtluNan, aad earldNMlrla aauoh poNoy. lauaod hw s fpngla IJmR as Indkailad balew. •JINOLE IJMIT {i mll0on t9aeh OOOYrrallw • COIIIpradlwlalva HaYlltww ProNaalonM UabiMly, Oallarai Ll9gYNy, OoMly lelury 8 PfopaAy Oanlga LlabMty • CIWm Made •fAadlllad OoOUrranq Q •000Yrranea Ff1 DESCRIPTION OF OPERAT10NiNlHICLESftIPEC1AL ITEMIIRIMARKf: Erhfana a HaNrlesn aanaral and Prohaalollal UahlMty aoraraga nlwnq to Orallt witb County of HawaN for Patlant Ed9aaNan and Outrawll flMrlaa9 Program• Nogea a uwNlaNOn a the eowragrr automatkiaMy 7alminaha eorMga. Mgr eanwllatlon tMe wrtllloata baoeme¦ vaW ano without afhd A bnskdown a1 the IYIIIb ~ a Pnrldad tlpen daaeand. Effactlva Oatobar 1, 1999 Cplltlnuwa untlt aaneafad DaI. p{aw Loe AngNas, CA Other County a HasaU IntonK 9{ Aupunl'traM. Roaan 116 Hllo. Reveal! 99720 January 27, 7999 ~ DATE TYPED Autllori:ad w FARMERS INSURANCE GROUP OF COMPANIES NIiC :III ? i Hm,~H_H; , a - ~ - 'N ~ ~i;~ Underlying Iosunnce (Item 6) I i 6a. Controlling Underlym` Imunoce K Company Truck Imunnee E:ehanQe ' Policy Number 1174-4323 b 'i„ I I ' Policy Period From: October 1, 2000 To: October 1, 2001 , i Limits of Insurance Each Oocarrenee 51,000,000 A~reSate (where appllnbk) SN/A I i I r, Company , Polley Number Poley Period From: To: Limib of Imunnce Eseh Oeenrrenn S I A~repte (when appUnble) S ~ I 66.Other Underlying Insanoce Company Polley Number ~ ~ Polley Period From: To: Limib of Imunnee Each Ocearrsnce S ~ A~repte (when applicabk) S i 6dorxwtn#W,rd w,d rhapo(kpoltr,napNo~(1##7J fidwx~rnr Nrn,brr £ndorlurntdlNa?dalr Authonranon ' ' /n fYlrnear WhrnoJ, tlr eowparry Wuing rha pdny hee canted thu Pd~'ro be r/gned by ra authorised oglerrs, I ar the aurhariud of/lcerr ojd# Coelpany i aaarnry-~n-jact, bur tha po/iry.rhol(nu br Wand luJm dto rignrdby ~ a duly mrthwaedrrpre.#ataNwr ojN# caepany ~'M I ~ . ~ AluAoArsd ReprefentaaMe ~ f ~ Date /swtd October 24, 2000 i I i Page 1 oj1 ~ I t~ - ~ _ - MlW ~ECOCC2 , a~ s' ® , I I Farmers Insurance Group of Companies ~ 4680 Wlishirn Boulevard ' Los Anfdes, CA 90010 i'urJ; Iosuiube Exchrye • Fomen fnnuaam Cenq~yof Wahluaeor • Torun Frmms IsiaaoeCompmy ~ i OCCURRENCE HEALTHCARE PROFESSIONAL r.rsnrr.rTV EXCESS INSURANCE POLICY DECLARATIONS PAGE ' This policy is issaed solely by the Company dalpated blow ~ NOTICE: This policy is issued on ea ~~r+±*r*•+ct: basis. ' ~ Please consult the policy terms for details. ~ ` Near/lpr~AAldLrs.tdQrao(/fra,/): /miedg`aerravrnrmr~.prwdkrreredov.boidw ~ Haoakua Health Center, Inc. orHei rAe roil: i P.O. fibs 109 Tccor Fsrasns Irrnarnr Corpr~ ~ I.thaa 3tr'cet I . Hotokaa, Hatrafi 96727 I .ljtarNa:90.0.7.002-103 O~erfredrrdereAe/awsef. Ta:as i I Asatr Sur Oklaaha PoUryNrwbo: r174~313/El ' Polley Period (Item 2) From: October 1, 2000 To: October 1, 2001 12:01 A.1N. standard tlme at the address of the Iasored o stated above. ~ ' Annual Premium (Item 3): 510,357 Llmib o[ imannee (Item 4): All Coverages 54,000,000 Per Occumuce Total Underlying Limib of Imunace (Items) i a Each Occurrence 51,000,000 b. Aggregab (where appltpble) SN/A Page 1 oj2 -•sd~ ~ - - - - - NSW `E%OCC3 J^ t7 ~ „ STATE OF HAWAII DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS Business Registration Division Honolulu In the Matter of the Incorporation ) of ) HAMAKUA HEALTH CENTER, INC. ) nrrtFivDED A_ND REeTn~D ARTTCL•E~ OF INCORPOR_nTTON (Sections 415B-38 and 40, Hawaii' Revised Statutes) CASE & LYNCH Peter R. Kubota (5070-0) 460 Kilauea Avenue Hilo, HI 96720 Attorneys for Hamakua Health Center, Inc. STATE OF HAWAII DEPARTMENT OF CONIlKERCE AND CONSUMER AFFAIRS Business Registration Division Honolulu In the Matter of the Incorporation ) of ) HAMAKUA HEALTH CENTER, INC. ) AMENDED AND RESTATED ARTICLES OF INCORPORATION The undersigned, desiring to amend the Charter of Incorporation issued on October 30,r 1964, of the Hamakua Infirmary, now known as the Hamakua Health Center, Inc., heresy amend and restate the Charter of Incorporation in its entirety by ezecutinq and adopting the following Amended and Restated Articles of Incorporation: ARTICLE I CORPORATE NAME The name of the corporation shall be: HAI+lAKUA HEALTH CENTER, INC. ARTICL'c II CORPORATE LOC?.TION The address of the corporation's office is: Post Office Hoz 509, Honokaa, HI 96727. ARTICLE III DURATION The period of the corporation's duration is perpetual. ARTICLE IV CORPORATE PURPOSES Section 1. Subject to the limitations of Section 2, the corporation is organized exclusively for the following purposes: (a) The provision of comprehensive health care services to the Hamakua community, which has historically been underserved by health professionals. The corporation will provide comprehensive medical care and health education to all persons in the community, regardless of their ability to pay for services. (b) The transaction of any or all lawful activities for which nonprofit corporations may be incorporated under Chapter 415H, Hawaii Revised Statutes. Section 2. The corporation shall be operated ezclusively for charitable, religious, scientific, literary and educational purposes within the siaaniaq of section 501(c)(3) of the Internal Revenue Code of 1986, as aaiandad (the "Code") and the regulations thereunder, as amended. Such activities shall be conducted in accordance with section 501(c)(3) and the regulations thereunder as they now azist or as they may hereafter be amended. ARTICLE V CORPORATE POWEIi~S Section 1. The corporation shall have all powers, rights, privileges and immunities, and shall be subject to all of the liabilities conferred or imposed by law upon corporations of .this nature, and shall be subject to and have all the benefits of all general lava with respect to corporations. Section 2. The corporation shall have, in addition to the general powers conferred upon it under the statutes of the State of Hawaii, the following powers subject to the limitations described in Article VI: 1. To indemnify any person who was or is a party or is threatened to be made a party to any proceeding (other than an actioa by or in the right of the corporation) if that person is or was a director, officer, employes or other agent of the corporation, or is or was serving at the request of the corporation as a director, officer, employee or agent o£ another foreign or domestic corporation, partnership, joint venture, trust or other enterprise, or was a director, officer, employes or agent of a foreign or domestic corporation which was a predecessor corporation of the corporation or of another enterprise at the request of the predecessor corporation, against ezpenses (including attorneys' fees), judgments, fines, settlements and other amounts actually and reasonably incurred in connection with the proceeding if the person acted in good faith and in a manner the person reasonably believed to be in or not opposed to the best interests of the corporation, and, :~~,,r with respect to any criminal proceeding, had no reasonable cause to believe the conduct of the person was unlawful. The termination of any proceeding by judgment, order, settlement, conviction, or upon a plea of polo coatendere or its equivalent, shall not o£ itself, create a presumption that the person did not act ~n good faith and in a manner which the person reasonably believed to be in or not opposed to the best interests of the corporation, or that the parson had reasonable cause to believe that the person's conduct wan unlawful; 2. To indemnify any person who wan or is a party or is threatened to be made a party to any threatened, pending, or completed action by or in the right of the corporation to procure a judgment in its favor because that person is or was a director, officer, employee or other agent of the corporation, or is or was aervinq at the request of the corporation as a director, officer, employee, or agent of another foreign or domestic corporation, partnership, joint venture, trust, or other enterprise, or was a director, officer, employee or agent of a foreign or domestic corporation which wan a predecessor corporation of the corporation or of another enterprise at the request of the predecessor corporation, against ezpenses (including attorneys' fees)' actually and reasonably incurred by the person in connection with the defense or settlement of the action if the person acted in good faith and in a manner the person reasonably believed to be in or not opposed to the best interests of the corporation; ezcept that no indemnification shall be made in respect of any claim, issue, or matter as to which the person shall have been adjudged to be liable for negligence or misconduct in the performance of the person's duty to the corporation unless and only to the eztent that the court in which the action or suit was brought shall determine upon application that, despite the adjudication of liability but in view of all circumstances of the case, the person is fairly and reasonably entitled to indemnity for such eapenses as the court deems proper. ARTICLE VI LIMITATIONS Section 1. The corporation is not organized for profit and it will not issue any stock. No part of the net earnings of the corporation shall inure to the benefit of, or be distributable to its directors, officers, members, or other private persons, ezcept that the corporation shall be authorized and empowered to pay reasonable compensation for services actually rendered to the corporation. _s _ :r• No part of the activities of the corporation shall be the carrying on of propaganda, or otherwise attempting to influence legislation, ezcapt that members of the Corporation's Board of Directors and personnel of the corporation may testify or make other appropriate communication where formally requested to do so by a legislative body or a committee or a member thereof, in matters concerniaq legislation relating to the public purposes of the corporation or public appropriations to programs and activities of the corporation, and the corporation shall not participate in, or intervene in (including the publiahiag or distribution of statements) any political campaign on behalf of any candidate for public office. Notwithstanding any other provision of these articles, the corporation shall not carry oa any activities whatsoever not permitted to be carried on (a) by a corporation ezempt from federal income taz under section 501(c)(3) of the Code, or (b) by a corporation, contributions to which era deductible under section 170(c)(2) of the Code. Section 2. If the corporation is for any one or mare tazable pears determined to be a private foundation as 8efined in section 509(a) of the Code, than:.-(a) the corporation will distribute its income each_taz pear at such time and in such manner as not to become subject to the taz oa undistributed income imposed by section 4942 of the Code; (b) the corporation will eat engage in any act of self-dealing as defined in section 4941(d) of the Code; (c) the corporation will not retain any ezcess business holdings as defined is section 4943(c) of the Code; (d) the corporation will not make any investments in such manner as to subject it to taz under section 4944 of the Code; and (e) the corporation will not make any tazable ezpenditures as defined in section 4945(d) of the Code. ARTICLE VII MEMBERS The corporation shall have at least 9 members, and not more than 25 members, all of whom shall be members of the Board of Directors. Tha members of the corporation shall be determined from time to time as follows: (a) Members seryir~sA by ~h.. corporation; At least 51~ of the members shall be active users of the services provided by the corporation. These members shall reside in the area serviced by the corporation, and shall be reasonably representative of the individuals served by said corporation on such factors as ethnicity, race and sea. Further, these members shall be representative as to age and economic status of the recipients of the corporation's services. -5- d ~v (b) Non-ic Members; The remaining members shall be comprised of persons who live sad/or work in the community served by the corporation. No more than one-half of the Non-User members may be health professionals. ARTICLE VIII DIRECTORS All members of the corporation will serve on the Board of Directors. If any person shall for any reason cease to be a member, said person shall sutamstically cease to be a Director; and likewise if a person ceases to be a Director, said person shall automatically cease to be a member. The management of the business and affairs of the corporation sad the control and distribution of its property shall be vested in the Hoard of Directors. At least one director must be a resident of the State of Hawaii. The Hoard of Directors shall have full power to control and direct the business affairs of the corporation, subject however to any limitations contained herein or in the Bylaws of the corporation or by statute. The directors of the corporation and their residence addresses, are as follows: ~IIlB Residence Address David `lor2an PO Box 474, Paauilo. HI 96776 George A. [ihite PO Box 136 Paauilo, HI 96776 Francis S. 'lorgan PO Box 250, Paauilo, HI 96776 Fritzv Hoffman PO Box 310, Honokaa, HI 96727 ARTICLE IX OFFICERS The officers of the corporation shall consist of a president, vice-president, secretary, treasurer and such other officers as the Board of Directors deems necessary, with such qualifications, duties and powers as are provided for in the Bylaws. The officers are appointed on an annual basis by vote of a majority of the Hoard of Directors. Any two or more yy offices may be held by the same person, provided that the corporation shall have at least two Persons as officers. The officers and their residence addresaea era as follows: Office g~R Residence Address President MJRG,1bT, Mr. David P.O.Box 474 Paauilo, Hawaii %776 Vice-President M7RG?,N, Francis S. P.O.Box 250 Paauilo, Hawaii 96776 Secretary WHITE, George A. P.0. Box 136 Paauilo, Hawaii 96776 Treasurer WHITE, George A. P.O.Box 136, Paauilo, Hawaii 96776 A&TICLE % ADOPTION ARD A1~ND1~L1T OF BYLAWS The power to altar, amend, or repeal the Bylaws of the corporation ar adopt new Bylaws shall be vested in the Board of Directors. r ARTICLE XI DISSOLUTION Upon the dissolution of the corporation or the winding up of its affairs, the aaaets of the corporation shall be distributed for one or more azampt purposes within the meaning of Section 501(c)(3) of the Internal Rsvsnue Code (or the corresponding section of any future taz coda), ar shall be distributed to the federal government, or to a state or local government, for a public purpose. Any such assets not so disposed of shall be disposed by the Senior Judge of the Circuit Court of the Third Judicial Circuit, ezclusively for such purposes or to such organization or organizations, as said Court shall determine, which are organized and operated ezclusively for such purposes. ARTICLE XII A1!~NDMErIT The Articles of Incorporation set forth herein shall be subject to amendment from time to time as provided by law, ezcept that no amendment shall be made which would chaage the objects and purposes of this corporation to include objects and purposes which would not be ezclusively charitable, religious, educational, scientific or literary, or which would permit net earnings of the corporation to inure to the benefit of any member, donor or private individual, or which would permit any transaction or activity not permitted to be conducted or . carried on by an organization ezempt under section 501(c)(3) of the Code. We certify under the penalties of Section 415H-158, Hawaii Revised Statutes, that we have read the foregoing statements and that the same are tsue and correct. Witness our hands this 27th day of Aoril , 1993. David F. Morgan ~~~Z• 9~~"-e?,,~-L (Name of Member/Director) (Signature'7o~f Memb /Director) George A, white (Name of Member/Director) ( igaature of Memb r/Director) r Leila Hoffman (Name of Member/Director) natur f er/Director) (Name of Member/Director) (Signature of Member/Director) 0383iC BYLAWS I M~ShiR Section I. ~rcatmi The members of the corporation shall consist of all members of the Board of Directors dected or appointed as provided in these Bylaws. Section 2 Members of the Corporation: Membership Organization The members of the wtporation shall consist only of the members of the Board of Directors, and upon ceaaiag to be membms of the Board of Directors, such persons shall cease to be members of the corporation. II Board of Directors The Board of Directors shall consist of" (a) Size of Board. The Board of Directors shall consist of such number not less than (9) ruse members. (b) Members serviced by the corporation: At least 51% of the members shall be active users of the serviaa provided by the corporation These members shall reside in the area serviced by the corporation, and shall be reasonably representative of the individuals served by said corporation as such fitctass as etlnmcity, race sad sac. Further, these members shall reasonably be representative as to age and economic status of the recipierrta of the wrporatioa's services. (c) Non-User Members: The rernairung members shall be comprised of persons who live and/or work in the community served by the corporation. No more than ono-half of the Non-User members maybe health professionals. (d) F-xchrded Members: Paid staff of corporanon, imncediate family members of paid staff, contracted vendors, and service providers. Section 1 Election At least 30 days prior to the annual meeting, the Board President shall appoim a nominating wmmittee of at least 3 or more directors. The purpose of the notinating committee is to present qualified individuals to the Board as nominees for election and to present a slate of officer for election at the annual meeting. At each annual meeting the Board of Directors shall elect by a two-thiMs(2/3) affirmative vote dirxtors to replace those whose terms expire at that meeting or additional directors, if the number of directors shall be increased The Board shall be consulted as to criteria used by the nominating committee in securing qualified candidates prior to the committee firraliartg its rewtnaterrdariom. Section 2. Term, etc The term of the members of the Board o('Directors shall be for a period of three (3) years and until a wccesaor shall bs dccted as herein provided. Ia the event that the rarmber of the members of the Board of Directors shall be changed, such chmge shall be made in such mariner that the terms of appro~dmatety one-third (113) of the total number wnstituting the Board of Directors shall expire each year. Aay trusaber of the Board of Directors maybe removed from office upon the a53rarative vote of not leas than ?J3 of the full Board of Directors. No Director may serve for more than 3 consecutive 3 year terms, or more than 9 consecutive years. Director will be allowed to serve up to 3 successive 3 year terms After at least a one year absence from the Board, former Directors may be eligible for nomination to serve on the Board . Section 3 Vacancies Should a vaCanry acwr in the Board of Directors for any reason. the Pt~sidant may select a nominating committee. The remaining s of the Board of Directors may, by a two-thirds (Z3) aSrmative vote, elect a successor to 511 the vacancy to serve for the unexpired term so vacated. Section 4 Quorum and Affumttive Voting (a) Quonun - At the start of a Board of Directors meeting a majority of the Board of Directors or seven (7) whichever is less who are physically or electronically present by a method of communication which permits each Director to ooote~orat>eouslY communicate with every other Director shall conantute a quorum. Directors trust be present for the duration of the meeting (b) Affirmative Voting - Once a quonun is established as affamative vote by a majority of the Directors presettt shall be suffiderrt to approve a motion psrsented for action unless otherwise prescribed by the Board in such cases where it is deser'miaed that vote by the full Board is warranted. In such cases where vote by the full board is directed, the vote may be taken by the Seaetary using either mail or dectrotnc means provided, however, that an affirmative vote by not less than 75'iG ofthe Dirocxors shall be required to approve a motion so long as the full Boatel has been reasonably ttotifled. Section 5. ComBict of Merest Each member of the Board of Directors sball complete a Conflict of Iaerest Statetneat no less than on an anraral basin. A new Director shall be roquirod to complata a Conflict of Imerest Statement within thirty (30) days of bxomimg a Board member. From time to time as isauea are brought before the Board for cwnsiderstioq should nay Director feel that he/she has a cottflict of itueteat it is inammbettt upon said Director to declare such conflict before the rant of tpe Board and shall be preciuded tom voting. It shall be up to the duir ~ the presidimQ o®oer and the reef of the Directors ptesertt to determine whether or mot said Dir«xor shad be tirrt6et ptechtded floor participating in the discussions on the matter. It shall be within the right of arty Director present to excux the Director in cotrflict form the room of any dad all fiuther disatstions. Shaild a Diraxor be farad to be in violation of the conflict of interest policy a~~~~ such director shall be sttbject to immediate disariasal from the Board upon a two thirds (?/3) vote to that affect by the Hill Board. Section 6 Powers of the Board of Directors All of the powers of and authority of the corporation shall be vested in and be ezercrxd by the Board of Dirxtors, arcoept u limited by Lw, the Charter or the Bylaws, and in 6utheraace and trot is 1®tation of said getteral powers, the Board of Daecton shall have the power to acquire and dispose of property, to appoirrt o~cets, sgaas or the Exeattive Director of the corporation as in its judgmem the beR infants of the owpotaAion may require amd to corder upon and to delegate to them by power of sttonxy or otberwix such power amd authority as it shall detettniae; to flx the saWies or compettsation of any and all of the agems and Executive Director of the corporation amd in its discretion requite sewtity of any of thorn for the 8tiddtil perfotmamce of arty of their duties; to approve the budget on as artnud basis and nay revisions; to make policaes, Hiles and regulatioro not irtconaistait with law or the Charts or Bylaws for the operation of the medical center, to thate such standing and ad hoc committees (ittcluding an executive committee or committees) of the Board of Dirocton dad to designate as members of such committees such persons as it shall detertmae and to confer upon such cotrmtittees nult powers and authority as may by resolutions be set forth for the carrying on or drercising of the powers of the corporation; to remove or suspend arty oiflcer and getterally to do any and every lawful act necessary or proper to carry into effect powers, purpoxa artd objectives of the corporation Section 7 IndemmScatioa Each person who is or was a Board of Director or Officer of the Corporation, sad each person who is or was a D'gector or OlEoar of the Corporation who ai tfre request of the Corporation is serving or has served as m officer, director, partner, joint veotuter or trustce of soother corporation, partnership, joint vagdue or trust or other eaterprfse shall be iadegmi&d by the Corpotation, and entitled to advmoegrmt of ezpeasa of litigation, to the iWleat extort pe?mitted user Hawaii Revised Stattrea, 415B-6 egamat thox expenses (including attorneys' fen), judgments, 9na agd amounts paid in aettlemmt which aro allowed to be paid, rambuned err advanced by the Corporation agd which are actually and rtaaonabty incurred in comeGian with nay action, aril or praoadiggs, Pen~B or thrrateaed, whether civil. criminal, .dmfoistrarive err iavratigdive, in which arch person rosy be involved by reuon of his being or having been a Director err Offiar of this Corporation or of arch other egtarpfae. Such iadeao@flation shaD be made only in accordance with Hawaii Revised Statutes 41 SB-G and arbject to the caoditiam thereof As a condition of a~ arch right of indamm6cation, the Corporation may requiro that it be pvmitted to partiapate is the defense of nay such action or proceedings through legal counsel designated by the Corporation sad a< the espease of the Corporation The Corporation Horst purcFrase sad maintain iawtance on behalf of arty arch persona whether or not the Corporstion would have the power to iadermify arch Oars and Directors against say liability under Hawaii Revised Statutes 415B~. ff nay expmam or other amounts are paid by way of utdemaiScation other than by court order or by m insurance carrier, the Corporation shell so irdorm the directors. lII Officers Section 1. Principal Officers The principal officers of the oorporstion shall be a President, a Yce Preaideat, a Secretary and a Trwrrrer, who shall be grdnbas in good standing of the Board of Directors upon preservation by the Nominating committee shall be alactad by tfm Board of Dirorxora at tfre annual greeting, to serve for one year agd until their succeaaors are appointed, subject to removal at say time by fire Board of Directors. The offices of the Secretary and Treasura msy be hdd by the same person. Section 2 President The Presidettt shall be the general executive officer of the corporation end have general supervision over its business and affairs and see to the proper observance sad ettforoetnettt of the Charts and Bylaws of the corporation and the policies, rotes sad mgutations, actions and orders of the Board of Directors. The Praidau shall call such meetings of the Board of Directors as are herein provided for and such other meetings as aro required to carry otrt the business of the corporation. The President shall be an ex~cio member of all standing and ad hoc committees. Secdon 3. Vice President During the absence or disability of the lrtesidem, the Vice President, shall have a!1 the powers of the President. Section 4 Secretary The Secretary shall give the notices of all meetitgs and shall keep the tnimtta of such meetings. The Secretary shall keep the mernbedup roll of the corporation. The Secretary shall perform all other duties assigned by the Board of Directors. Section 5 Treasurer The Treasurer shall assure that the funds and property of the corporation are appropriately safeguarded and managed and shall assure that appropriate records, books and reports of all Enancial traasaetiom are prepared and maintained. Section 6 Assistant Tttaa~rrer/Assistant Secretary The Board may appoint an Assistant Secretary and as Assiata~ Tt+eawrer in order to assist the Secretary and Treasurer in carrying out their respective duties and mpcrosibilitia. The Assista~ Secretary sad Assistant Trewuer are tat netxssarity required to be members of the Board. N Committees -Standing and Ad hoc Section I. Comatittee Formation The Board of Directors, by a~rmadve vote may designate one or more standing or ad hoc committees, each of which shall consist of two or more directors, but the designation of such committees and the dekgmon thereto of authority shall tat operate to relieve the Board of Directors or any individual director, of a~ t~sporatibility impwed on it or him or her by law The Board empowers the President to appauat the members of committees and committee chairs subject to ratifiation of the Board for both Standing and Ad hoc committees. Ranoval of a committee hair requires a two thirds (?J3) vote of the full Board. Section II Quorum A quorum for a comarittee shad be at least 5Ry-one percent (51%) of the members who are present At the start of a committee meeting members who aro physically or electronically present by a method of cotmarniation which permits each Dnector to contemporaneously cottunutricate with every other Director dull constitute a quontm. Section lII• AffirataCive Voting Once a quorum is established as at5rntative vote by a majority of the committee members present shall be sufficient to approve a motion presented for action. Section N Committee Duties and powers The duties and responsibility of each committee shall be established in writing and approved by the Board and may be modified from time to time. All committee actions are subject to review and approval by the Board. V Execution of Instruments Section 1. Props Officers Except as otherwise provided by law, aU clteck.~, notes, bonds, deeds, leases, contracts and other doarmeats or insWmenta shall be signed, exewted and delivered by the Prdidem or Via President, sad by the Tteawnr or the Secretary, and provided further that the Board of Directors may fiom time to time by resolution authorize ebecks, agreements, certiScates and doarmeata of a~ nattue to be signed, executed aad delivered by such oi$cers, agents or emplayea of the corporation, or any one of them, in such manner as may be detettnined by the Board of Directors. VI Meetings Section 1. Meetings The Board of Directors shall meet on a regular basis, but no leu frequently than quarterly Speaal meetings may be called upon the request of the President, one of the Vice Presidgtts, or three members of the Board of Directors. Section 2. Notice of Meetings The Secretary shall give written notice of each mating of the Bond of Diroctors by mailing or delivering the same not less flan three (3) days nor more than fifty (SO) days before the meeting unless otherwise pracnbed by the Board, The 8tihtr+e of the Secretary to give such notice or the Hoer-recppt of such noticx by any Diroctor ahdl not invalidate the proceedings of any meeting of the Board of Directors at which a quorum of the Directors is Present. Section 3 Anmial Mating Unless otherwise direcxed by the Board of Directors, the aamral meeting of the mernbas of the Corporation dull be the regular meeting of the Board held in Jaouuy of each year. VII Ameridmeata These Bylaws may be alterod, amended or repealed at any ~ messing « any special meetirtg called for the purpose by s two-thirda(2/3) vae of an the mmibcs of the corporation prprat ~ the meeting. provided that the written notice a~ the meeting shall elate that one of the purposes of the meeting is the considantion a~f the amendment of the Bylaws. witness our hands thin 26th day of 1997. Tnhn Palinlraa (Name of MembedDirector) (S' ofM,,//em,^,ba/Diroctor) Carol Kalaau f~.s~.? (Name Of Mernber/Director) (Sr Of Mernher/DIrECtOr) i.nia Koh Fem. (Name of Member/Dir+ector) i of M ber/Director) Ada Pulin-Lamme Name of MenibedDirector) (Signature o /Director) HMtAKIIA HEALTH CLNTIA IIfDIIHQ 11~V 1011(.11.4 AIfD 1!'ItOCIDIIRL9 1t1HlTH4\D DATIi LMlLOYIIRNT 0>< RELATIVL4 A!!'!b'YlID '1B '1 C.odlkt dlsle+at O111CTNL GAeraeoe x-~.r trge d POLICY Ii1iC recogmzp that the encpbymeot of rdatives within the EIalth Center may ante problems which need to be addnased. It ahw csoopuzes that selection of sod ramtion of its bat employee might baoome a problem if a 5tmd policy apinrt ampioygeat of tdated mdividusis ware punaud. .r In oNer W promote in decision coaldctg, an asasting employee may not make the refection or the hiring detasiou !br s reisted appiic~. The reporting c+eLtionship for enher may not ioc4cde the other, in order to avoid a~ apparancx of oon8ict of interest in supervision. Should air questions of 8ranas elite, it must be brought to the attention of the F.~oeprtive Dilator, ar to the Madla! D if it iuvdva the F~taartive Director. The F~oeaative Diraxor may resolve the isace. The Medial Director may ra6er the isnre to the Board of Directors for nsohrtioa if ha a she feels it nsoasary. Employees shall not conduct FII;C lactinees wRh a Iav?ms awned by a ralttive or wiiu3t will imrre to the benefit of a n'ladve without ptia approval of the FgiC F.ioautive Director. Employees crust deal with contractors, supplieca, patients and athx petsorn doing business with IDiC m the bat lateral of HIiC and without 9tvor ar prafesmce based upon pr~rsonal cocuideration. This policy is intended to apply to Childredpsraats, scblicr$s, spwsa or spousal equiwlems or other dosely bonded persona. HAMAYDA HEALTH ClN1ZA lI1DIX NQ tfZV - FOLICIESAND PYOCiDURF,t 11TZtT' 8iM DATTi )1LVRWtiD 1tA1Ti CONFLICT' OF II~11'iRL41' AFFHpM1~DA'1's ~ R!!H 1tiA1! X-lie! POLICY IdEiC expects its peemanent employees to devote rhea $dl attention and best e~'ort to their job with IdT3C. HIiC hu m desire to iDtetflste with outside iaaatesn a activities which dnrly do not affect job per6otautt~ce or in atry way ootf8ict with HIiCs bat intetet PROCEDURE Outside emproymau ar activity, which iorJude both pad std unpaid work or service, may be acceptable if it: woes not adversely affect the empbyeet per6ottoatioe is bidder rn®uLr job with I~IC -is not performed for a competitor or is competition with HIiC ar soy ai'its opetatiom ar service. does not reflect to the duxxedit of l~i:C. It u the nespoanbility a~f the employee to distatas airy Saute outside employment ar activity which may tepreseen a poomnial ootdGct of iatateat with their Srptetviaor or the Fxetattive Director. Any amplayee violating ~ PAY ~Y ~ to ~P~Y action or discharge. Employees shall be asked to sign a Coact of Itrtetdt Statement admowledgog then awareness of this policy. This statement steal! be kept in the employee's penooual Bk. HAMAKUA IIEes.re c~xTEis nrDrx xa nsv POLICIIS AND PROCEDUHiS DLlY' HLAD DA1Z 1tiYRWED DA1! CONFLICT OF INTEREST At?!lOVLDDATE ~d ACKNOWLEDGMENT XFIt ATi__„ ty X-Rd d The undersigned has read sad understands the Con9id of Tataest Polity of Hamalma Health Curter Thry further agree to limit their outside activities and ittwlvemwt to those winch would not imrolve oon9icts with their oomiuted job performance, a in the best interest of Harnahis Heakh Gaoler. To the extatt such a corl8ict may arise, the tmdaaigned agteas to dearly dnclose the nature and esiem of sudt COa~ict and subsequent dtangea is it sad to either laminate their interest in co~icting activity or.their work with or teapomibt~ity to the Heahh Carta if such oDn9ict is judged by the F~oecar+ivs Director or the l3oand of Dtrectots to jeoparditt the imereata ofthe Heahh CerrZer. Signature Date Ptim n~aR~i TAX CLEARANC! Ap'LJCATION vy~ 2¢ w,waTrraalw~rat~ntar 1. ARLJOtafRO0~011Y~T101t (PllAfiRt~RQ~I~CL~A111.1~ 11»m'gRARi>a11TtiQtNANAQ f~~e w.r ~ ~,y Hamakua Health Center, Inc. ~ o / lob IIAVAQR~l6~ P. o. 13ox 509 ¢At'lt4CASlE 1f 1!~` 1l~~ Honokaa, Hawaii 96727 Alf Tt~NMr Hamekua Health Center, Inc. IF ~ ~ APAPu~ z rARnonrlcATtoll~llwwtnl w?wA! cielo+u pppeE to a 3 0 0 1 3 0 3 5 OCT 1 82000 per I~ntaA~ nflorefl D• 9 9 0 1 1 5 5 1 De zn.7c ct Taxation soma ra.cunnr • s. Al~lmwr Is Aplh (CMCR ear 01R ftR7oq A VED ? ppMppATRl1 ? a IxRfpIATRll1 6r1 TAx tttI~TGRrAMQATICN o tNtINIGUAI o t~Artrtiww a srAn o Tarr oCt 2 0 2000 v uMQTt~ tlMKl~Y COti~AN1/ o utint0l~A~r.rrr PAt~.r,. 4. TtR TAR dJAl1ANORi ti t~011ata~ MOIb ~ - ® CfrY, OOUHrY, OR QTATC OOV61MiNf OOIRlIACr W tMYYAY • ? uaJ011 L~IOfNr • Alf ? telAL MATH LJOl1>tr ? tp111Nt.R0111J~0[ ? rti4~ W1R ? f'NMICIAL CLORIl10 ? t t~AYlttttNr ? t~Ol{~L - ? HAWANiTATfit1Y1DOi0Y ? rlD11111LCdRRAOT ? lGN ;C;;~'--_rtl~_'.:si :.~ztf ? atIR00H111A1.T ? OTMfe ;`Y ~ , 'pMf~ONY. /lA1Mp/d1I1/M~/W~7~1/1'A~IMAR . »z~ J.E. Potter Swarta Executive Director PRI NAM 1*INT TI77.R 001'MW O/10~4 O~IUd I~MMr. NI~M~Ir (Cdr ACPI~b~I \L(- ~[Q~~/,]~~ 008 t 773-A133ext21 X08) 7759 04 >a as= -T~ nalaNe RAx (v(oWO+ AT1'ORItiY. M ¦+~I,lw by wrn!!rr dtr tt,.~. ool~oln. atato.a orrnl P.Itar, «tllswaw csd. . a.s„+r 9~rMe~,dlt~ FMm~1, ~ Ilr tea lbnn~ ~ymlr~t M MMI~ wl !IY ~CreRPrtMMa~~lalsrOn M t~~iOdiM d naad+M !M>•fiq~/Wbr. UINI~DMILIC~IIDINIMILLIAr~t~~lM~bu1 rLR/1NT1IrRplFlffiCNMa? ~ Tlet#ONrIAQipOw~WT~A/RJCATtONrRC01O~T1~CSRRIC~TtUIONAPFlIOYAL 6~sYuatlelr b Ms ~p10tAto11 M HM~ R~ d~~of M TRttbCWAlw u#w11YibmYeen on p~y~ d IAY ~ or r egrnd t~ it rplM~ tr.a ~ dlq ZO'd EO~ST 00. Li ~~0 bOVti-SLL-gOg:xej b31N3J Hllli3i FXl~kili HAMAKUA HEALTH CENTER P.O. Oox 509 A Honokaa Hawaii 96727 CORPORATE RESOLUTION I, J E Potter Swartz, Executive Director of Hamakua Health Center, a Hawaii corporation, hereinafter referred to as the "Corporation", do hereby certify that tltc following is a full, true and correct copy of a resolution duly adopted by the Board of Directors of the Corporation at its meeting drily called and held at the ot'fice of ilia Corporation, P O. Box 509, Honokaa, Hawaii on the 21", of November, 1995 which a quorum was present and acting throughout, and that said resolution has not been modified, amended or rescinded and continues in full force and effect "RESOLVED that any individual at the time holding the pasttion of President, Vice President, Finance Committee Chairman, and executive Director are hereby authorized to execute on behalf of the Corporation any bid, proposal or contract for the sale or rental of the products of the Corporation or for services to be performed by the Corporation, and to execute artd bond requited by any such bid, proposal or contract with the United States Government or the State of Hawaii or the City and County of Honolulu, or any County yr Municipal Govcrninent of said State, or any department or subdivision of any of them." IN WITNESS WHERE OF, 31° day of May, 2000. sv~' J Pvtter Swartz, Executive Dir for On this ~-3l S~ dap of 2000, before personally appeared -Ss ~~~f'rc.r w.Y-}~ , t!6 me known to be the person described in and who executed the for'egaing instrument, and acknowledged that he executed the same as his free act and deed. State of Hawaii ) County of ) S.S. Lynn Kawakami My commission expires: -L._2-~~1 Tel. (808) 775-7204 O Fax: (808) 775-9404 Explanation of Cash Flow Hamakua Health Center operates in a complex system of reimbursement which is dictated by insuresa, state psymont programs, faded payment programs and grant programs. As s provider of Quest services and in light of its mission to provide service regardless of the patients ability to pay or payment soum, the Health Center ucepts reimbutsemeat from an array of payment programs which is las than the actual cost of services provided to itt patients. During the test year, defieietu:ies in reimbtuawtent required the Health Center to spend a portion of its t+eserves. The dscisiaa to do so, rather than borrow for the operational ab+ortfall, was reached by the Board after comideration of costs of borrowing again7[ anticipated investment revenue. The health Center will be beas6ted in the ca®ing year by new Federal law requiring Medicaid payments to meet 100l~L of ooap for Medicaid patients. Alen new systems to improve the Health Caster billing and eollectioaa and data analysis capacity are now beinf implemented. (3ranta for operational support and service development are also being aoug!>t to close these gaps experienced between revenues and expense. ZA'd I£.6 T0, 6 9a~ DOb6-SLL-SOg:xej