HomeMy WebLinkAboutCOM 0667.035 1998-2000Stephen K. Yamashiro
Mayor
GRANT APPLICATION FOR:
Legal Name of Organization:
Mailing Address:
Facility /Site Address:
Director /Site Manager:
Organization President:
Contact Person (Grant Writer)
Total annual budget of organization:
County of 3amaii
DEPARTNIENT OF FINANCE
25 Aupunt Street, Room 118 • Hilo, Hawaa 96720 -4252
(808) 961-8234 • Fax (808) 961 -8248
HAWAII COUNTY NONPROFIT GRANTS (FY 2000 -01)
HUMAN SERVICES NONPROFIT GRANTS REVIEW COMMITTEE (HSNPGRC)
FISCAL YEAR ENDING:June 30, 2001 DATE OF APPLICATION: January 28 , 2000
(Program Tille)
Kona Adult Day Center, Inc.
Amount of request for County funds: $ 20,000 -
Kona Adult Day Center, Inc.
P.O. Box 1160. Kealakekua HT 96750
81 -989 Halekii St., Kealakekua, HI 96750
Ken Ono, Executive Director
Estela Halverson
Ken Ono
$ 325,722
Has the applicant applied for any other funds from the County of Hawaii this fiscal year?
0 Yes Source /Department: fiNo
Agency /Program(s): 0 Social Services 0 Youth Programs O Elderly Programs
Check Category (ies) (.5 Culture and Arts V Education Other / f I 7
6
Comm.
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FS /7E 2 1 CA9E-6 /ve/e_ File No. ADM
Briefly define the program for which funding is being requested:
Phone: 322 -7977
Phone: 322 -7977
Phone: 322 -7977
IT to 5ranreJ ODr lw
Harry A. Takahashi
Director
S. K. Schutte
Deputy
Ref. To: Se
Ref. Date FEB 2 3 2000
Day Care and Day Health encompasses unique services ranging from social and recreational
therapy to medical care, therapy and maintenance at the highest level of functioning.
The Day Health component is undergoing major expansion this year and will meet the needs
of a growing population of people needing health services while continuing to remain at home.
Kona Adult Day Care and Day Health program is the only Day Care and Day Health program on
Hawaii's west side. 1
I. QUALIFYING STANDARDS FOR APPLICANTS
III. • .
• •
An applicant must meet all of the following standards:
Be chartered or otherwise authorized to do business in the State for charitable purposes and
exempted from the Federal income tax by the Internal revenue Service.
Have a governing board whose members serve without compensation and have no conflict of
interest between their regular occupations and the services provided.
)0 Have bylaws or policies which describe the manner in which business is conducted, including
management, audit, fiscal policies and procedures, policies on nepotism, and policies on
management of potential conflict of interest.
Have at least one year's experience with the service or activity for which the appropriation is
sought or can otherwise demonstrate to the satisfaction of the County sufficient expertise to
successfully carry out the service or activity.
Be licensed and accredited in accordance with applicable requirements of Federal, State and
County laws.
II. GRANT CONDITIONS
The applicant agrees to comply with the following terms & conditions prior to receiving a grant award.
A. Comply with applicable Federal and State laws prohibiting discrimination against any person on
the basis of race, color, national origin, religion, creed, sex, age, or handicap.
B. Agree not to use any public funds for purposes of entertainment or perquisites.
C. Comply with such other requirements as the Director of Finance may prescribe to ensure adherence
by the nonprofit organization with Federal, State, and County laws, and established standards for
fiscal and program management.
D. Allow the Director of Finance, the committees of the council and their staffs, and the Legislative
Auditor access to records, reports, files, and other related documents in order that the program,
management, and fiscal practices of the nonprofit organization may be monitored and evaluated to
assure the proper and effective expenditure of public funds.
RECORDS AND REPORTS
A. The applicant shall follow generally accepted accounting procedures and practices and shall
Maintain books, records, documents, and other evidence, which sufficiently and properly account
for the expenditure of County funds. The books, records and documents shall be subject at all
reasonable times to inspection, reviews, or audits by the County expending agency, the Director of
Finance, and the Legislative Auditor, or by their representatives.
B. The County expending agency, Director of Finance, or County Council may request periodic
written reports on the use of County funds.
C. The nonprofit organization shall submit a final written report to the Legislative Auditor within
sixty (60) days after June 30 of the fiscal year. The report shall include an explanation of the
public benefits derived from the awarding of the grant and a listing of other funding sources and
amounts obtained during the award period.
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IV. OUARTERLY ALLOCATION
V. GRIEVANCE PROCEDURE
VI. DISCLOSURE OF INFORMATION
VII. CONTINUED ELIGIBILITY
VIII. ACKNOWLEDGMENT
IX.
(Legal Name of Organization)
• •
All information, data, or any other material provided to the County by virtue of this application shall be
subject to the Uniform Information Practices Act (UIPA), ch. 92F, Hawaii Revised Statutes. All such
material is deemed government record and shall be open to the public and may be provided to other public
and/or private funding sources.
Under no circumstances shall grant funds be disbursed in a lump sum payment. Grant funds will be
disbursed to Grantees only through a quarterly allocation process. The disbursement of grant funds can be
formulated on an equal quarterly apportionment basis.
The applicant will adopt and maintain a grievance procedure to assure proper accounting for any concerns
and complaints about its programs or services that may arise from its members, employees, clients or from
other members of the public.
Any applicant or recipient who withholds or omits any material facts or deliberately misrepresents
such facts to the County of Hawaii shall: I) Immediately be disqualified from consideration for Nonprofit
Grant funding; OR 2) be in violation of the terms of the Grant Agreement of County funds in which case a
grant agreement can be terminated by the County and the recipient or provider may be liable to reimburse all
or a portion of any funds received therein.
Kona Adult Day Center, In.c
Adult Day Care /Health
hereby agrees to administer the
(Program Title)
in accordance with the regulations, policies and procedures prescribed by the Hawaii County Finance
Department. Distribution of grant funds is limited to grantees, which are in compliance with County
regulations, policies and procedures. The County reserves the right to withhold grant distributions at any
time the grantee is not in compliance. It is the policy of the County of Hawaii and for those who do business
with the County to provide equal employment opportunities to all persons regardless of race, physical
disabilities, color, religion, sex, age, or national origin as mandated by the Federal Civil Rights Acts, as
amended, and any other federal or state laws relating to equal employment opportunities.
AMENDMENTS TO THE APPLICATION/EVALUATION
The applicant assures that it will submit to the HSNPGRC for prior review and approval, a written request
and justification for any changes, additions, or deletions to any portion(s) of the grant application or a duly
executed Grant Agreement of County Funds. The applicant will cooperate and assist in any effort
undertaken by the HSNPGRC to evaluate, inspect or otherwise monitor the effectiveness, feasibility, and/or
cost efficiency of any and all practices, policies and procedures or activities pursuant to this application or
any grant designation or allocation received as a result of this application.
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• •
Y. AUTHORITY AND CAPACITY OF APPLICANT
The applicant certifies that it has the authority and capacity to develop and submit this application, and to
fully administer the program(s) pursuant to this application.
UNSIGNED PROPOSALS WILL NOT BE ACCEPTED!
Signatuje .f PresidendChai . so' Date
Signa
// , t/t.,
re o Executive Director/Manager
4
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Date
F
NARRATIVE QUESTIONS
• •
Kona Adult Day Center, Inc.
Hawaii County Human Services Nonprofit Grants
FY 2000 — 2001
A. Overview
1. Describe the program for which funding is being requested.
Funding is being requested for Adult Day Health services which is described as supportive services
provided in a protective setting for part of a day by an organized program for elderly and disabled adults.
The basic objective of the program is two -fold: 1) provide an enrichment program for clients through the
socio - medical model adult day health program and 2) provide respite from continuous caregiving for
primary caregivers and their families. Kona Adult Day Center (KADC) is a community- based,
freestanding adult day center, conceived in 1986 and implemented in December 1988, to provide an
alternative for caregivers that would enable an impaired family member to remain in the home as long as
appropriate. Thus far, the need for respite is greatest among caregivers of persons with Alzheimer's
disease or related dementia.
Until Kona Adult Day Center opened, there were no community -based adult day services for residents of
West Hawaii/Kona. KADC is still the only adult day program in West Hawaii. The community has
benefited tremendously by having this long term care alternative available to those in need. The Center
provides supervision, protective care, socialization and health monitoring for its participants.
The impact of KADC within the community is very positive. Health and social services providers within
the long term care network have interfaced with the program, with referrals flowing back and forth between
various providers on a routine basis. Physicians who utilize adult day services for their patients have
looked upon the program as a necessary health intervention which meets the social, wellness, and
functional maintenance needs of their patients. Local physicians agree that their patient load of those aged
60+ is increasing rapidly and that the number of patients diagnosed with Alzheimer's disease and related
dementia is intensifying.
Needless to say, after eleven years of operation, KADC has made a niche for itself in the community and
within the long -term care continuum. The Kona Adult Day Center program is recognized statewide by
providers of adult day services as a model of adult day health service provision.
Kona Adult Day Center was originally licensed through the Department of Human Services as an adult day
care facility. "Day care" is defined as a social model of care, while "day health" is a medical model of
adult care. In 1995, after rigorously adapting to State of Hawaii's strict requirements for adult day
licensing, KADC was surveyed by the Department of Health and proudly received its adult day health
license. The Center is the only freestanding, nonprofit adult day health program in the State of Hawaii.
All other day health programs are affiliated with a hospital.
2) What unique or significant service will be provided?
At a minimum, KADC's adult day health services shall include the following activities:
• Development and continual monitoring of individual service plans which are consistent with
medical reports of the adult's health condition and activity limitations.
• Provision of leadership, assistance and supervision by staff in the individual's participation in
all appropriate program activities.
• Provision of leisure, recreational and socialization activities that provides interaction between
staff and participants and among participants.
13. Problem /Need
• •
• Provision of individual or group physical conditioning exercises and simple calisthenics,
constructive games or crafts that maximize the individual's physical and mental capabilities,
and help to strengthen and improve limb and motor coordination.
• Provision of reminders, encouragement and assistance by staff to enable the individual to
maintain or to improve personal hygiene, selfcare, and attention to health care needs,
including the provision of staff supervision of self - administered oral and non -oral
medications.
• Provision of counseling by staff to individual and to the individual's family caregivers, if any,
to assist in simple decision - making and problemsolving, to resolve adjustment problems, to
build upon available family support, and to increase awareness on the part of the individual
and/or family caregiver of appropriate social services and health/medical care resources in the
community, including the provision of referral services to secure needed services.
3) What specific outcomes are to be achieved?
• Participant's hygiene /selfcare will be maintained or improved.
• Participant's socialization/interaction skills will be maintained or improved.
• Participants and families will express satisfaction with KADC services.
• Participants will be maintained at home and within the community for 6 months with adult
day health care services.
4) How will the proposed program empower participants /clients to become self - sufficient and facilitate
positive social change?
KADC participants will empower to become more self - sufficient by constant encouragement and
reinforcement of independent care by Center staff. Participant's personal hygiene, socialization skills and
general well being will be' improved through attendance of the adult day health program. Positive social
change occurs when caregivers are relieved of the burden of full -time caregiving, allowing them to
continue with job, family matters and personal goals with the knowledge that their loved ones are cared for
in a safe, secure and encouraging environment.
1) What is the problem/need that the proposed program is designed to meet?
Adults who attend KADC cannot be adequately cared for in the home setting but are not yet ready for
nursing home placements. KADC is dedicated to providing a health, social and recreational program that
enables impaired adults to experience feelings of belonging, friendship, accomplishment and independence
in a caring and secure social environment. KADC is an essential link in the continuum of long term care
within the West Hawaii community.
2) Who is the target population and what are the specific needs?
KADC provides services to the impaired adults, 18 years or older, who meet the eligibility requirements for
adult day care /day health services. These persons include the frail, vulnerable elderly, and other adults who
require protective and/or supervised care in a safe environment. In specific terms, these include the
following persons: those with Alzheimer's disease or related dementia disorders, those with physical
disabilities, such as stroke or Parkinson's disease, those with mental retardation or other stable chronic
Mental conditions, and those requiring socialization and stimulation in order to remain functional and active
members of their home and community.
3) What is the geographic area to be served facility and hours of operation?
The geographic areas served by KADC include North and South Kona, specifically north to the Kona
Palisades area and south to Kealia. The 6,000 square foot facility is located in Kealakekua, across from
the Kealakekua post office on Halekii Street. The center is open Monday through Friday from 7:30 a.m. to
5:00 p.m., excluding holidays.
C. Collaboration /Coordination
1) What specific measures will be taken to collaborate /coordinate with other commtnity resources to
achieve maximum program efficiency and cost effectiveness?
KADC coordinates services for older adults through participation in the "Interdisciplinary Team ".
Coordinated through the Department of Health Case Management Coordination project, the
Interdisciplinary Team meets once per month in the KADC conference room to confidentially discuss "at
risk" adults. The Team has many clients in common and works to efficiently and cost effectively improve
their lives through coordination of community services. Members of the Team include Public Health
Nursing, Services for Seniors, Coordinated Services for the Elderly, West Home Health Services, Winn's
Claims, Legal Aid Society Hawaii, Care Resources Hawaii, Veterans Administration, Hospice of Kona,
Center for Independent Living, and Kona Adult Day Center. The Team representatives assist clients, and
when appropriate their families, with issues of health, social, recreational, financial, adaptive medial
equipment, legal and transportation.
In August 1998, the KADC Board took the opportunity with the resignation of the Executive Director to
reassess KADC's management and clinical structure with the goal of strengthening both elements at a
reduced financial cost. KADC entered into an agreement in September 1998 with Kona Health Services to
provide an Executive Director (Ken Ono), all clinical nursing services, and a Medical Director, at a savings
of approximately $1,100 per month. Robin Seto, M.D., a board certified internist and board certified
gerontologist is the Medical Director.
2) How will these measures reduce or eliminate any existing duplication of services to your designated
target group?
Through the Interdisciplinary Team's collaborative efforts, each client's needs are identified and processed
on an individual basis. The Team's case management eliminates any duplication of services or funding.
D) Goals and Oblectives:
1) What are the major goals/benchmarks of the proposed program?
The Kona Adult Day Center has established the following program goals and objectives:
** Program Goals for the Individual:
a) The client will be able to associate with a place and a group corresponding to his or her
own sense of identity.
b) The client's maximum level of independence will be assessed and maintained through
individual program planning.
c) Mentally and physically impaired adults will be maintained at their highest level of
functioning, thus preventing or delaying further deterioration.
d) Health monitoring as well as protective and supportive care for the frail and disabled
adults will be included in care planning and services.
e) The participant's knowledge of and access to elderly services available in the community
will facilitated.
f) Premature or inappropriate institutionalization in a nursing home or a hospital will be
prevented.
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• •
g) Socializing, peer interaction, and continued relationships with the community will be
ensured.
h) Isolation and prejudice often associated will frail and disabled adults will be reduced.
** Program Goals for Families and Other Caregivers:
a) Families that desire to keep elderly members in the home will be given relief from full -
time care of an impaired older adult.
b) Family members will be enabled to continue productive careers instead of being
homebound with an elderly, disabled spouse, parent or other family member.
c) Families and other caregivers will be assured that elders dependent upon them are being
cared for appropriately during the day.
** Program Goals for the West Hawaii Community:
a) An integral component of the community service network and of the long -term care
continuum will be made available to the West Hawaii community.
b) The medical community and other resources statewide will be provided a liaison in the
area of geriatrics, especially Alzheimer's disease and other related disorders.
2) What specific objectives/ action steps are planned for each goal?
During initial assessment of each participant, an individual plan of care is developed. This plan of care,
approved by the client's personal physician is shared with the participant's family and is updated on a six -
month basis. The individual plan of care clearly defines the goals planned for the participant. Each
individual plan of care will specify how the objectives are to be carried out, who will oversee each
objective and will record the results of each step.
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3) What is the timeline (start and end dates) for each action step?
a) Intake and Assessment: The program director and the nursing coordinator receive referrals from
various sources (hospital discharge planner, physicians, home health care agencies, Nursing Home
Without Walls, Public Health Nursing/Case Management Coordination Project, families, Department
of Human Services caseworker, Coordinated Services for the Elderly, and others).
b) The intake and assessment processes include ascertaining pertinent information for social and medical
assessments, baseline survey for caregiver burden, physician history and physical, determination of
appropriateness for day health services, and home, hospital, or office visit with the client and family.
c) Assessment needs result with the formulation of a plan of care prior to enrollment. The care plan will
include the need to coordinate other agency /community services to meet the identified needs of the
client.
d) Nursing coordinator must receive TB clearance and history and physical report from client's physician
prior to client enrollment.
e) After completion of intake paperwork by client, family, physician and appropriate resources, client is
admitted to KADC.
f) Respite/ Vacation: A client's position may remain open during a period not to exceed ten successive
days for vacation, or if the caregiver in need of respite should arrange care for the client at another
location.
g) Discharge: Discharge is based on the broad goals of the client, family, or referral source and in most
cases, will be included in the individual's care plan. When discharge is anticipated or eminent, the
nursing coordinator and case manager will implement the discharge plan. Discharges are frequently
influenced by a change in the status of the client, in the social/home support system, or in the primary
caregiver's ability to continue to provide for the needs of the client. Discharge procedures include, at a
minimum: a discharge summary including recommendations for continued care; referrals to
community service agencies, care homes, institutions, and the like; and, a follow -up call or letter by the
KADC program director on the client's status one month or sooner after discharge.
F. Evaluation:
4) What significant client- centered outcome(s) will the program achieve?
a) 90% of the participant's hygiene /self care will be maintained or improved;
b) 90% of the participant's socialization/interaction skills will be maintained or improved;
c) 90% of the participant's families will express satisfaction with Kona Adult Day Center services;
d) 90% of the participant's will be maintained at home for a minimum of 6 months with adult day health
services.
E. Service Delivery:
1) What methodology will be used in the proposed program's delivery of service(s)?
Individualized Plan of Care: KADC develops an individualized plan of care for all of its clients. The care
plan summarizes findings from: a) Physician History and Physical, b) Nursing Assessment, c) Social
Assessment, d) Recreational Assessment, e) other summaries and referral information. The care plan is
developed through a case management approach involving the nursing coordinator, the activities director,
the program director, other staff members and the participant's family when appropriate. Goal setting and
development of objectives form the cornerstone of the care plan development. Services provided within
the adult day health center determined to significant in achieving goals and objectives are identified in the
care plan, These services often include exercise, attention to toileting routine, assistance with eating, and
the like. In addition, clients are evaluated for their functional acuity level which help staff identify clients
that require more care and supervision. An applicable goal for all clients is to maintain the highest
functional level possible and to prevent premature deterioration.
KADC has implemented dual programming, i.e., programming activities that benefit two distinct types of
clients: those with cognitive impairments - -- Alzheimer's disease or other related disorders and those with
physical impairments. The care plan is tailored for these two broad types of clients, thereby making the
experience at KADC more meaningful or appropriate for each client.
Individualized Discharge Plan: KADC develops an individualized discharge plan, as all clients enrolled at
the Center will be discharged. The reasons for eventual discharge may be identified at the beginning of
enrollment, especially if enrollment is for a specified length of time. In all cases, discharge is based on the
broad goals of the client, family, or referral source and in most cases, will be included in the individual's
care plan. When discharge is anticipated or eminent, the nursing coordinator and the program director will
implement the discharge plan. Discharge procedures include at a minimum: a) a discharge summary
including recommendations for continued care, b) referrals to community service agencies, care homes,
institutions, and the like, and c) a follow -up call or letter from KADC program director or nursing
coordinator on the client's status one month or sooner after discharge.
1) What process will be used to evaluate the program and service(s)?
Program effectiveness is measured through annual surveys, one specific to caregivers and one specific to
referral sources. These surveys describe strengths and weaknesses of the program and assist KADC staff
and Board of Directors in preparing future short and long -range goals.
The KADC adult day health program is licensed through the Department of Health and undergoes an
extensive annual site visit to include facility, program/record keeping, operational, administrative and
fiscal review. Quarterly and annual evaluation reports are required by most KADC funding sources,
including Department of Human Services, Hawaii Island United Way, Hawaii County, and May Templeton
Hopper Foundation.
The Standards and Guidelines for Adult Dav Services developed by the National Institute on Adult Day
Services, a branch of the National Council on Aging, provides important benchmarks which Kona Adult
Day Center has elected to follow.
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•
H. Viability:
• •
2) How will this process measure the outcomes specified in Item D, (1-4)?
The surveys, site visits and quarterly /annual reports will provide KADC staff, administration and Board of
Directors with information to ensure the quality of its program.
G. Program Fees:
1) Does your organization charge a membership fee for service participants?
There are no "membership" fees for KADC participants.
2) Does the proposed program charge participants a fee for service(s) provided by your
organization?
a). A participant fee rate sheet is attached.
b). Describe how you will ensure that all interested participants
the entire fee.
11 be included despite an inability to pay
Financial access may include use of available funding sources through the Department of Health, the
Department of Human Services, scholarship through the May Templeton Hopper Foundation, scholarship
through the Theresa Hughes Foundation, partial or full tuition payment through Services for Seniors, the
Salvation Army, The Alzheimer's Association, and most importantly through the KADC Tuition
Assistance corporate donation, used as scholarship money for low- income eligible participants. The TAF
is overseen by a committee comprised of four members of the KADC Board of Directors and funds
approximately $48,000.00 in scholarship money annually.
As proven by the number of applicants in the recent year, more scholarship money is needed. This need is
reflected in the attached budget.
1) What is your justification or rationale for the expenditure of public funds for the proposed
program?
Public dollars are saved. By meeting the physical, medical and social needs of older adults,
especially those with Alzheimer's disease, Kona Adult Day Center can help prevent acute care
costs and nursing home placement. Day health services are a cost - effective, providing care for a
frail and dependent age group and providing support and respite for caregivers who can continue
with their lives and their jobs, as well.
As life expectancy increases, the likelihood of acquiring disability or Alzheimer's disease /related
dementias increases significantly. The need for KADC's specialized program will undoubtedly
continue.
2) What are your financial and programmatic plans to sustain the proposed program beyond the
upcoming fiscal year?
KADC Board of Directors and Executive Director will continue to monitor the program finances and
quality of service, ensuring that the program will be sustained through the upcoming fiscal year and
beyond.
I. Budget
Please see attached Budget forms.
Organizational/Agency Information
A. Board of Directors:
• •
1) Has the organization's Board of Directors received formal training within the past two (2)
fiscal years?
Please see attached certification of training from Help for Non - Profits in October 1997.
2) What are the primary roles and responsibilities of your organization's Executive Director?
a) Serve as Chief Operations Executive of the organization;
b) Serve as Professional Advisor to the Board;
c) Recommend appropriate policies for consideration;
d) Implement effectively all policies adopted by the Board;
e) Inform the Board fully and accurately regarding the program;
0 Interpret the needs of the program and present professional recommendations on all problems and
issues considered by the Board;
g) Develop a budget (in conjunction with the finance committee) and keep the Board up -to -date on
budget;
h) Recruit the best personnel and develop a competent staff and supervise it;
i) Devote time to improving staff;
j) Assist the Board in developing and conducting community information programs;
k) Assist the committees of the Board to achieve their objectives, the Executive Director is an ex officio
member of the following committees: finance, fund development, and marketing.
3) What are the primary roles and responsibilities of your organization's Board of Directors?
a) Set policy, evaluate overall program and set strategic directions for the center.
b) Counsel and advise — giving the benefit of its judgement, expertise and familiarity with the local
setting;
c) Consult with the Executive Director on all matters which the Board is considering;
d) Delegate responsibility for all executive functions;
e) Refrain from handling administrative details;
f) Make all the staff responsible to the Executive Director;
g) Share all communication with the Executive Director;
h) Provide support to the Executive Director and staff in carrying out their professional duties;
i) Support the Executive Director in all decisions and actions consistent with policies of the Board and
the standards of the organization;
j) Hold the Executive Director accountable for the supervision of the organization;
k) Evaluate the work of the Executive Director. Set Standards of Performance for Executive Director.
I) Actively take part in the Board committees to assure that the committees achieve their objectives.
Clarify role of executive officers vs. general membership.
President:
a) Presides at all meeting of the corporation and the board of directors;
b) Chairs the Executive Committee;
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c) Assures that all policies established by the board of directors and provision of the organization's by-
laws are carried out;
d) Assures that the treasurer, secretary, committee chairs, executive d and other officers perform
their duties and provide timely reports are determined necessary;
e) Signs such documents as authorized by the board and/or required by the office;
f) Chairs the annual performance review of the executive director;
Vice - President:
a) Assumes the duties of the president in his/her absence or inability to act;
b) Provides oversight and support for a designated committee or group of committees as appointed by the
president;
c) Chairs major committees and/or activities as appointed by the president;
d) Assumes other duties and responsibilities as appointed by the president and/or as authorized by the
board.
Secretary:
a) Assures the accurate and timely preparation of the minutes of all meeting of the corporation and board
of directors and signs them;
b) Assures the timely distribution of minutes of board meetings to all members of the board of directors;
c) Assures the timely and proper notification about meetings of the board of directors to the respective
members;
d) Maintains a record of attendance at meetings of the board of directors;
e) Assures the safekeeping of the official records and documents of the organization, except those
covered under the responsibilities of the treasurer;
Treasurer:
a) Assures the proper receipt and custody of all monies received by the organization in accordance with
sound and generally accepted business practices;
b) Assures the timely deposit of all payroll withholding as required by law and in accordance with sound
and generally accepted business practices and assures the board that such practices are occurring;
c) Provides and attests to the accuracy of a financial report to the board of directors at each meeting,
clearly reflecting the financial position of the organization including all current and long -term
indebtedness, cash position and other such details as are feasible and required;
d) Assures that the organization's financial records are externally audited on an annual basis consistent
with acceptable standards of accounting;
e) Serves as chair of the finance committee.
B. Past Performance
1) How effective has your organization/agency been in achieving program goals in the past two
fiscal years? Include the following information:
a) Quantitative data on numbers served; and
b) Qualitative data showing number and % of participants achieving measurable outcomes.
Please see attached information sheet titled "Past Performance ".
C. Financial:
1) Have your organization's current program operations remained the same as last year? What
major program or financial changes will be incurred next year?
At KADC we have three levels of participant care: (1) the group with Alzheimer' disease whose functional
level is low, (2) the group with physical disabilities whose functional level is limited in range of activity"
but whose cognitive level is high, and (3) the group of physically fit and cognitively aware who need
• •
socialization and stimulating recreational activities. Over the past year our level of participant care and
function has changed. Group one and two have increased while group three has decreased. This increase
in our lower limited functional group require individualized attention and increased staffing. our supply
and equipment needs have changed resulting in higher cost. We plan to continue community outings. The
increase in group two will require more specialized transportation.
It is our goal to provide quality health and activity program for each of these three groups.
2) What is the status of all of your organization's major contracts or agreements for the coming
year (employment agreements, office leases, primary grants revenue /supplier, etc.)?
State Department of Human Services, P.O.S.: contract effective through June 30, 1999
Nursing Home Without Walls: effective through June 30, 1999
County of Hawaii: effective through June 30,1999
Services for Seniors' effective while funding available
Hawaii Island United Way: funding through December 31.1999
May Templeton Hopper: funding through December 31, 1999
Tuition Assistance Fund: Commitments equaling $24,000 from January — December 1999
Rental agreement with The Queen Emma Foundation: agreement on a year -to -year basis w/ each party able
to give one -year notice to quit.
Agreement with Kona Health Services, Inc. to provide administrative, clinical nursing, and medical director
services, effective September 1, 1998 for three years.
2) How does the proposed program fit into your organization's long range financial plan?
The development of the adult day health program is essential to achieving sufficient volume and mix of
clients to enable the Center to be self - sufficient on a long term basis.
D. Monitoring:
1) During the past two (2) fiscal years, what financial and/or administrative monitoring has your
organization received from any and all funding sources?
Please see attached list titled "Monitoring ".
E. Alcohol, Tobacco, and Drug -Free Workplace policies and Information:
1) How does your organization address alcohol, tobacco, and other drug prevention information
dissemination as part of your workplace and/or program environment?
Kona Adult Day Center Personnel Policies address the issue of alcohol, tobacco and drugs in the following
manner:
Policy 606.6 Smoking: To maintain health and pleasant working condition, smoking will not be permitted
within the buildings or program offices in which Kona Adult Day Center conducts business. "No
Smoking" signs will be visible in all program and common areas.
Policy 613.2 Drug Free Work Place: It is impossible for any staff member to efficiently perform the
responsibilities of his or her position while under the influence of alcohol and drugs. Staff members are
prohibited from working while under the influence of alcohol and/or drugs. The possession of such
substances on the premises is strictly forbidden. Either offence necessitates termination.
9
•
• •
Kona Adult Day Center, Inc.
Financial and Administrative Monitoring
1. State of Hawaii
Department of Health
Hospital and Medical Facilities Branch
Sharon K. Matsubara, B.S.N., R.N., Surveyor
1-270 Queen Emma Street, Suite 1100
Honolulu, HI 96801
Telephone: (808) 586 -4090
Fax: (808) 586-4747
2. State of Hawaii
Department of Human Services
Purchase of Service
Gail Ninomoto, Program Specialist
810 Richards Street, Room 400
Honolulu, HI 96813
Telephone: (808) 586 -5669
Fax: (808) 586-5700
3. Hawaii Island United Way
Helen Hemmes, President and CPO
P.O. Box 745
Hilo, HI 96721
Telephone: (808) 935 -6393
4. County of Hawaii
Dept of Finance
Harry Takahashi, Director
25 Aupuni St. Rm. 118
Hilo 96720
Telephone: (808) 961-8234
Fax: (808) 961 -8248
10
Kona Adult Day Center, Inc.
Past Performance
Kona Adult Day Center has been very effective in achieving program goals in the past two
years. Listed under Programs /Service Description, D. Goals and Objectives the narrative itemizes:
the goals of the program(individual, family, and community); the objectives /action steps planned
for each goal; the timeline for each action step; and, the client centered outcomes to be achieved.
KADC has realized their goals, objectives, and client centered outcomes.
Quantitative Data: New admissions form 1/1/99 through 12/31/99 totaled 39 participants, an
Average oft per month. Because of the frail nature of the participants, it is not unusual for there
to be an average of two discharges per month as well. The average enrollment for that twelve
month period was 39. The average daily attendance was 25.
Qualitative Data: Program achievements can be found under #4) What significant client centered
outcome(s) will the program achieve?
a) 90% of the participant's hygiene /selfcare will be maintained or improved;
b) 90% of the participant's socialization/interaction skills will be maintained;
c) 90% of the participant's families will express satisfaction with Kona Adult Day Center;
d) 90% of the participants will be maintained at home for a minimum of 6 months with adult day
health services.
11
•
4
• •
Kona Adult Day Center, Inc.
FEES
Note: KADC has established the following rates according to the general level of care required.
Please see the attached sheet for a description of Levels I, II and III.
Special Hourly Rate: $10.00/hour
Daily Rate: (hours are 7:30 am to 5:00 pm)
Level I $45 /day
Level II $50 /day
(Level III — rates may vary subject to assessment of care needs by RN)
Full -time monthly rate: (five days per week, excluding holidays *)
Level I
Level II
(Level III — rates may vary subject to assessment of care needs by RN)
$725.00 /month
$775.00 /month
Holiday care rate (hours are 7:30 am to 4:00 pm) $50.00 /day
Intake and Trial Day Fees:
One -time fee for pre - enrollment appointments and processing $40.00
Trial day fee
(The "trial day" fee is applied toward the regular intake
fee of $40.00 when the participant enrolls in the program)
Additional Services:
Lunch (provided by the County Nutrition program) $.75 /day
Bathing $20.00/bath
Feeding $35.00 /month
Active Therapy $65.00 /month
Transportation by KADC Van:
One Way $5.00
Round Trip $10.00
Note: Some individuals who meet income and other criteria may qualify for short term or long term tuition
assistance. Contact Program Director for more information.
(Effective 9/1/96; Form revised 6/10/98)
$30.00
POSITION TITLE'::' : • ' :
PRECEDING: FISCAL YEA R'•`.: ' ; -':.
=:
FISCAL; YEAR 2000 -01; ;_i', ;r
I tem
#
..n? Eniployee`'!:;'s- ; ;.
a ,.., ,
{L ast Naine;First)?'r ;:: ; ;,
:.
• k -ss': "'` 4'+
',Status,;
; :land
',Sala
Total Agency
Budget
FY 99 -00
Total Program Budget
FY 99 -00
Total Agency
Budget
FY 2000 -01
Total Program
Budget
FY 2000 -01
:.. Giant Request Only-° •
,Pr` ...d`;, ' ' ,r.
x e '•'
-,, -Enditures."
1-
Tide: Program Director
3P' > {:
FT
- --
FT
- --
Name: Tiqui, R
r.,;;? -;;
22,045
- --
22,582
2,258
�'
Title: Activities Coord
i'•rr• ^:'.
FT
- --
FT
- --
Name: Tavares, D
.x,$fi °'�;'
18,847
19,874
1,987
3.
Title: Secretary/Bookkeeper
s'`'`
FT
- --
FT
Name:
Gesford, Gail
.r?
19,757
FT
- --
- --
19 , 282
FT
- --
- --
- --
- --
4'
Title: Activities Asst.
P "'•
Name: Gouveia, M
.,;•,.$!,
15,372
- --
16,227
- --
2,434
Title: Health Assistant
' 'f;P;;wv
FT
- --
FT
- --
- --
5
Name: Lorenzo, P
$''S'`
15,372
- --
14,997
- --
2,250
6.
Title:
Health Asst.
:, P
PT
- --
- --
.
Name: Sween, A
$::
5,166
- --
7,498
- --
3,352
7
Title: Health Asst.
PT
- --
PT
Name: Llanes, S
' '$.'`.
14,924
- --
14,997
- --
0
TOTAL.POSITION ;COUNT
` ;. P,, •y a
:* [FOTAL`SALARIE$ `.
.. - ,• ' ;
(to 'be,'reflected'tn ., Talile 4):
"' -' $: ,:'
Continued on ner
t page
AGENCY /ORGANIZATION: Kona Adult Day Center, Inc.
INSTRUCTIONS:
PROJECT NAME
BUDGET TABLE I
DETAILS OF PERSONNEL SERVICES
All admin strative and Direct Program Salaries must be included. (Please exclude non - program positions
2. a) P= Indicate if whether employee is - F/T =Full Time Employed (30 -40 hours per week)
NT= Part-Time Employed (20 or less hours per week)
b) Salaries
ON TITLE _ r ;'" ;: 7
POSITION
. FISCAL =;.; ';;
L YEAR 2000 -01'
FISCAL
Item
#
4 ' , ,,'., r . mployeer;':j';ti { i,;
:. , (L asf , N a tne,Eirst) Y:::'•: : '<
'' +;;; i ,_ yg ° :.^ ; e5.. *,✓
.iStatus {i
_';,&!?d..
I„kSal
Total Agency
Budget
FY 99 -00
total Piogyyi�Dudget
Total [iud�cl Agency
6
FY 2000 -01
Total Pt g ram
g
FY 2000 -01
Grant Request Only
1..
•Expenditures
8 •
Title: Health Asst.
r',=g;
FT
PT
0
Name: Foster, 14
$ • ;..:
14,924
9,921
0
9.
Tit Health Asst.
'= :S[�`
PT
PT
1
Name: Toyama, B
<<$::
2,066
2,066
0
Title:
Name:
Title:
Name:
Title:
Nd
Name:
Title:
Name:
Title:
Name:
T9T4I,'OSJTION CO UNT
9
9
.4 91,41- ,S0A�2IEsx; . # >a :2%
,,( fobs; i*t ed'• �tir'4bfe`
y .,
>;:;;,i;;"
127,968
127,444
12,281
iMcTPI ICTI(INS - I All administrative and Direct Proeram Salaries must be included. (Please exclude non - program positions)
AGENCY /ORGANIZATION:
2.
a)
Kona Adult Day Center, Inc.
b) Salaries
PROJECT NAME
BUDGET TABLE I
DETAILS OF PERSONNEL SERVICES
P= Indicate if whether employee is - F /'F =Full Time Employed (30 -40 hours per week)
NT Employed (20 or less Hours per week)
DESCRIPTION
PRECEDING FISCAL YEAR
FISCAL YEAR2000 -01
Item
#
Employee Benefits%Payroll Taxes _
Total Agency Budget
FY 99 -00
Total Program Budget
FY 99 -00
Total Agency Budget
FY 2000 -01
Total Program Budget
FY 2000 -01
Grant Request Only
Projected
• Expenditures
2.
EMPLOYEE BENEFITS
(TOTAL)
17,429
19,560
1,369
Health Insurance
15,206
17,017
1,191
Dental Insurance
2,223
2, 543
178
*
Other Benefits (Specify)
0
0
0
3.
PAYROLLTAXES(TOTAL)
13,436
18,156
1,452
FICA 5 %
6,398
8,533
683
SUI(Unemploymentlns.) 3 %
3,839
5,188
415
Workers' Compensation 2 %
2,559
3,450
276
TDI (Disability) .5 %
640
865
78
TOTAL ' "
(ta be'refle%tedin:Table4). _ ,'"
30 865
37,716
3,000
AGENCY /ORGANIZATION: Kona Adult Day Center, Inc.
TABLE 2
EMPLOYEE BENEFITS /PAYROLL TAXES
PROJECT NAME:
UST itemize as attachment(s). Applicable only to the ` Grant Request Only Protected Expenditures' column.
. DESCRIPTION ` ' '
PRECEDING FISCAL YEAR
FISCAL YEAR 2000 -01
Item
#
Expenses .
Total Agency Budget
FY 99 - 00
Total Program Budget
FY 99 -00
Total Agency Budget
FY 2000 -01
Total Program Budget
FY 2000 -01
Grant Request Only
Projected
Expenditures
1.
PROFESSIONAL FEES (TOTAL)
85,162
83,387
0
Legal
4,000
2,000
Accounting/Bookkeeping
4,750
4,475
Audit Fees
3,500
4 , 000
*
Administrative Fees 7 %
25,000
35,000
III
*
Other Nursing Contract
47,912
37,912
_
2.
SUPPLIES (TOTAL)
4,430
5,000
641
Office
825
900
0
Program
2,575
3,100
641
Consumable
1,030
1,000
0
3.
TELEPHONE
4,080
3,940
198
4.
POSTAGE & FREIGHT
927
840
80
5.
OCCUPANCY (TOTAL)
35,672
22,415
0
Rent
7,650
9,900
1
Utilities
11,588
8,375
Janitorial
11,742
11,400
*
Repairs and Maintenance
3,000
3,000
6.
EQUIPMENT (TOTAL)
0
0
0
*
Purchase
*
Rental
*
Repairs and Maintenance
AGENCY /ORGANIZATION: Kona Adult Day Center, Inc.
TABLE 3
DETAILS OF OTHER CURRENT EXPENSES
PROJECT NAME:
* = MUST itemize as attachment(s). Applicable only to the "Grant Request Only Projected Expenditure" column.
D .
:.•.:' .;..:,,..DESCR4PTION?;!;:.',. ". � •. -._
;' ; ; .:° ".r: PRECEDING FISCAL YEAR" ':;',,,;';r.;
-' _. .. _
,..FISCAL'.YEAR2000 O L:.
;....
'new
:: Or.'l'"
. i i , l � ' , i . . :'' - Ai „ " /"'
, EX enses. . %� : �` """ ' `' `” ' ` ' ' "' °
Y ;` � " ') " „' # t . '^�'Y` ` :`?
Total Agency Budget
FY 99 - 00
Total 1'rogram Budget
FY 99 - 00
Total Agency Budget
FY 2000 - 01
Total Program Budget
FY 2000 - 0I
,'' Grant Request Only '
Projected Expenditures
7.
INSURANCE(TOTAL)
r t "`'
6,468
-
„ -r"
6,498
..
.,.....
0
General Liabilit
1,460
�,`
1,416
”
Fire
1,720
::, P
? ?; :1 J''�.; `. '.'
1,668
Auto
2 000 ,
:.` °,:
7 .„ >...
�•.. ;c };
2,164
,
.. ,.. ..
NDOA (Board Insurance)
1,288
.�'.wr ":�
1,250
8.
PRINTING
(''" , ::i ` ^'
1,440
, . , ....
•
1,740
,
..
400
9
PUBLICATION & SUBSCRIPTIONS
750
: "'ji ;';
700
,
250
10.
TRAVEL(TOTAL)
., ' f:p::..it$
60O
; ''S?:t .`,_ ";gti
a, ...
180
u, C. .l �::. ....
...
150
Air Fare
400
%:.,.''•'i } `. }'.
s::'.:" : '�'.
110
110
Per Diem
0
;i ^
.: t.q
70
.
;
40
Auto Rental
200
")' k!�'+
; "v',
0
r
0
;•
11.
AUTO MILEAGE REIMBURSEMENT
'. "tW'�` i'''"
35O
_ , .,
350
12.
AUTO GASOLINE PURCHASES
6,600 600
.' s %: * %" t' "»
:,a;;.�.
000
6,000
'
13.
MEMBERSHIP DUES
.'r... { ;
0
`it "` ,.
... .., .,
0
"i'i� =` �,. 'a
. �.'
0
• 14.
STAFF TRAINING
ti. t;i�.:' Y
750
.. . t _ ..-
. .- .,. 1
500
-. ,
..
300
•1 5.
OTHER
Fundraising Expense
;< .
1,500
4,050
0
Security — Bldg Alarm
,i..l
800
.. �,
_': <:
Ili..
696
'.y'd. ,j irvi �. �. .;..,.
0
'',TO
r e 0 ecl e d.in Table S):e` " -y. •
AGENCY /ORGANIZATION: Kona Adult Day Center, Inc.
PROJECT NAME:
TABLE 3 (Continued)
DETAILS OF OTHER CURRENT EXPENSES (OPERATING COSTS)
* = MUST itemize as attachment(s). Applicable only to the "Grant Request Only Projected Expenditure" column.
DESCRIPTION
PRECEDING FISCAI, YEAR
FISCAL YEAR 2000 _ 2001
Rein
1)
Expenses It ; 1
it „1.1 (, ;3
tntat Agency nndgct ,
FY 99 -00 t
total ['ingrain Mudge
l'Y 99 -00
to nI Agency Budget
I ' Y 00 -01
Tow ['ingrain Budget
t Y 00 -01
Grant Request Only
Projected Expcn4ituim
15.
Other (Continued)
,
r
Therapy Consultant
500:
- - --
3,000
- - --
1,250
Activity Consultant
100
- - -- _
X 500
- - --
0
Personnel Requitment
50
- - --
50
- - --
0
Community Education
1,100
- - --
1,500
- - --
900
Misc
3,968
- - --
1,000
- - --
300
'I O PAL
(to be reflected in Table 5)
78,150
--
AGENCY /ORGANIZA'T'ION:
Kona Adult Day Center, Inc.
I'Itu1EC'I' IJrl�lli:
I A111.1i 3 (Continued)
DETAILS or OTHER CURRENT EXPENSES (OPERATING COSTS)
+ = M th
UST Remi as aliacluuenl(s). Appl cable only to e "( ,t_ini Repics t Only 19IJCCic c d I.xpcndum cuhnun
•
^...., "..;:.. - '• s . ostpons +- <,.� . ;• �, ::, -: `
�:. }; Vi t:;: :; . � ?.i� ?::,. •� y .,�. ,,µ , ;:5= ,.,a� >;' ?�: „�y,,;,
$ �, Ft y r r °• ,„ . > • . •,+ S r • r , , x t,
. PRECpDINCFISCAE?Y
E AR'
;:FIS
CAli YEAR' 2000'
Total Agency Budget
FY 99 -00
Total Program Budget
FY 99 -00
Total Agency Budget
FY 2000 -01
Total Program Budget
FY 2000 -01
- Gran[ Request
(Table 1) TOTAL POSITION COUNT (P)
9
9
(Table 3) TOTAL OF OTI1ER CURRENT EXPENSES
155,579
(Table 1) TOTAL SALARIES ($)
127,968
127,444
:. . , ... . ''TOTAI;'BUDGET.'' -T' • . "'� :..
314,412
(Table 2) EMPLOYEE BENEFITS /PAYROLL TAXES
30,865
37,716
O :
.:TOTALPERSONNE6COST5 _ -�
158,833
165,160
OTAENUMBER Of POSITIONS .;b'
9
9
y'h.b l• 1 �'.': n : p. `::.'; a.,:. ^ '...: e
• .:.• _. ,.. :,.. ...:
pense .,-
NO
... ,' - :.. ..
. • �p,, ;�,� , .: .,. _,. , .
•`..{'.
... ,: .. •PRECEDING�FISCAli:YEAR ; ; , .. : , :.
..... . ,
; i py •: .: _
;. �: } :�; : �,, : ;c' �.: s � . %FI
• °: LYE; 000 =01 ,„:`�
:: ^ ,:. .
;,:Grant Request Only .'
. ...,
Total Agency Budget
FY 99 -00
Total Program Budget
FY 99 -00
'total Agency Budget
FY 2000 -01
Total Program Budget
FY 2000 -01
(Table 4) TOTAL PERSONNEL SERVICES
158,833
165,160
15,281 '
(Table 3) TOTAL OF OTI1ER CURRENT EXPENSES
155,579
460,562
4,719
:. . , ... . ''TOTAI;'BUDGET.'' -T' • . "'� :..
314,412
325,722
20,000
AGENCY /ORGANIZATION: Kona Adult Day Center, Inc.
PROJECT NAME:
TABLE 4
SUMMARY OF PERSONNEL REQUIREMENTS
Personnel Requirements: Salary ($) and Number of Positions (P)
TABLE 5
SUMMARY OF EXPENSES
Total Budget Summary of Personnel Services and Other Current Expenses
•
Revenue Sources `?, :
' PRECEDING' FISCAL %YEAR 1999- 00` = = ; ' F ';
`FISCAL YEAR'2000 -01
Total Agency Amount
Total Program Amount
Amount Requested
Amount Projected
County of Hawaii
14,325
20,000
State of Hawaii
0
0
•
Federal Funds
0
0
.. ',tY�` ,t.'a�, +•4=
.';- .:•..;.....
Private Foundations*
19,700
30,000
United Way Funds
15,000
15,000
Admissions
0
"
'
0
Donations
18,800
:.
;. ,,
20,000
Fundraising
13,700
16,000
Pay Phone
0
,; ' '<'
0
Vending Machines
0
A °
-
0
Service/ProgramFees
15,050
.., ..,- .
17,000
Third-party reimbursement(s)
50,000
55,000
Tuition
134,700
i° ;..'- ' s;.£,. :: i : ..;;. :
.145,000
Others (Please list)
Interest income
500
500
_TOTAL REVENUES. --
281,775
65,000
253,500
AGENCY /ORGANIZATION: Kona Adult Day Center, Inc.
- I'lease list funding source on a separate sheet and indicate the amo int requested
TABLE 6
Summary of Income
PROJECT NAME: •
Kona Adult Day Center, Inc.
•
Table 6 Summary of Income Supplement
Private Foundations
Fiscal Year 1999 -2000
May Templeton Hopper $15,550
Hawaii Community Foundation 2,500
Misc. 1,650
Total: $19,700
Fiscal Year 2000 -2001:
May Templeton Hopper $15,550
Hawaii Community Foundation 5,000
Atherton Foundation 3,500
Misc. 5,950
Total: $30,000
Name
Degree
&
Field of Study
Admin.
Staff
Staff of
Grant
Program
Othe
r
stare
Full
Time
Part
Time
Position Title
Kenneth T. Ono*
Bachelors -Bus
M- Health Adm
Adm
✓
`�
Executive Director
Rowena Tiqui
High School
"
we
Program Director
Delta Ono, R.N.*
Diploma
Reg. Nurse
Nursing Coordinator
Doris Tavares
High Schoo
v.
Activity Coordinator
Marvaleen Gouveia
High School
`�
✓
Activity Assistant
Gail Gesford
High School
`''
Secretary /Bookkeeper
Health Assistant
Stephanie Llanes
Nurse Assistant
IV
A--
Marilyn Foster
Nurse Assistant
ve
ve
Health Assistant
Bert Toyama
Bachelors -
Engineering
Health Assistant
Aileen Rabang
Nurse Assistant
Health Assistant
*Under contract and emp_oyed
,
through KONA HEALTH SERVICES
e
Staff Information Sheet
COUNTY OF HAWAII
HUMAN SERVICES NONPROFIT GRANTS (FY 2000 -01)
v
Nursing Coordinator
1
Nursing Assistants
ICoua Achill Day Cenlcr
Organ!zational Chart
Board of Directors
Execullke Director
Program DlrccLir
J
Office Manager
t
Activity Coordinator
1
Activity Assistants
•
STAFF NAME
GESFORD, GAIL
GOUVEIA, MARAVLEEN
LLANES, STEPHANIE
ONO R.N., DELTA
ONO, KEN
RABANG, EILEEN
TAVARES, DORIS
TIQUI, ROWENA
TOYAMA, BERT
KONA ADULT DAY CENTER, INC.
P.O. BOX 1360, KEALAKEKUA, HAWAII 96750
(808)322 -7977; FAX (808)322 -0614
PERSONNEL LIST
JOB DESCRIPTION
SECRETARY/BOOKKEEPER FULL TIME
ACTIVITY ASSISTANT FULL TIME
HEALTH ASSISTANT ON CALL
NURSING COORDINATOR PART TIME
EXECUTIVE DIRECTOR PART TIME
HEALTH ASSISTANT PART TIME
ACTIVITY DIRECTOR FULL TIME
PROGRAM DIRECTOR FULL TIME
HEALTH ASSISTANT ON CALL
Revised 1/12/00
FULL TIME;
PART TIME; OR
ON CALL
Name
Natsuko Aoki
Retired Nurse
Joined BOD 9/98
Mike Asam 75 -369 Hoene Street
H.C.F.C.U. Kailua -Kona, Hawaii 96740
9 years on BOD; 7 years as president
N. Pat Ryan
Keahou Rehab
Joined BOD 8/98
Kaoru Uyeda
Department of Health
9 years on BOD
• Kona Adult Day Center, Inc •
P.O. Box 618
Kealakekua, Hawaii 96750
Board of Directors
Residence Business Telephone
Estela Halverson 78 -7206 Puuloa Road B: 0
President Kailua -Kona, Hawaii 96740 H: 324 -1541
Educator F: 324 -1541 call first
3 years on BOD; President as of 9/98 ;Marketing Committee
Barbara Kossow 73 -4354 Malalo Place Bank of Hawaii B: 322 -9377
Vice - President Kailua -Kona, Hawaii 96740 P.O. Box 8 H: 325 -5203
Bank of Hawaii Kealakekua, Hawaii 96750 F: 322 -9465
3 years on BOD; VP as of 9/98; Fund Development
Ken Apilado .: P.O. Box 892 Bank of Hawaii B: 326 -3945
Treasurer Kealakekua, Hawaii 96750 75 -5595 Palani Road H: 322 -9757
Bank of Hawaii Kailua -Kona, Hawaii 96740 F: 326 -3919
9 years of BOD; 9th year as Treasurer; Chairperson of Finance Committee
H.C.F.C.U.
P.O. Box 747
Kealakekua, Hawaii 96750
Catherine Hamilton 72 -1039 Mamalahoa Highway Clark Realty Corp.
Clark Realty Corp. Kailua -Kona, Hawaii 96740
4 years on BOD; Tution Assistance Committee; Fundraising Committee
Marjorie Mulhail 78 -7253 Puupele Road
Retired Business Kailua -Kona, Hawaii 96740
9 years on BOD; 9 years as VP; Chairperson of Fundraising Committee
75 -1038 Mamalahoa Highway
Holualoa, Hawaii 96725
82 -1034 Hookipa Place
Captain Cook, Hawaii 96704
3i- 9-6
Reginald Morimoto 78 -6852 Walua Road First Hawaiian Bank B
Secretary Kailua -Kona, Hawaii 96740 P.O. Box 618 H: 322 -2051
First Hawaiian Bank Kealakekua, Hawaii 96750 F. 322 -3150
9 years of BOD; 7th year as Secretary
8: 0
H: 323 -2030
F: 0
B: 322 -0980 X127
H. 0
F: 322 -0890
8: 326 -9774
H: 325 -3424
F: 329 -3336
B 0
H. 322 -9255
F: 0
Edwin Ueda P.O. Box 539 B: 0
Businessman Kealakekua, Hawaii 96750 H: 323 -2848
6 years on BOD; Tuition Assistance Committee F: 0
B: 0
H: 323 -3336
F. 0
•
B: 0
H: 329 -3521
F: 329 -3521 call first
The Kona Adult Day Center Board of Directors meets on the fourth Thursday of each month at 4:00 p m. in the conference room at the Center.
SECTION 3 03 of the KADC By -Laws states that a director "shall hold office until the next annual meeting and thereafter
until their succossors are duly appointed and qualified ".
Revised' 4/99
•
February 2d00
March 2000
April 2000
May 2000
June 2000
July 2000
August 2000
September 2000
October 2000
November 2000
December 2000
Kona Adult Day Center, Inc.
P.O. Box 1360
Kealakekua, HI 96750
322 -7977
Board of Directors Meeting Schedule
January 2000 Thursday, January 20, 2000
4:00 p.m.
Thursday, February 24, 2000
4:00 p.m.
Thursday, March 23, 2000
4:00 p.m.
• Thursday, April 27, 2000
4:00 p.m.
Thursday, May 25, 2000
4:00 p.m.
Thursday, June 22, 2000
4:00 p.m.
Thursday, July 27, 2000
4:00 p.m.
Thursday, August 24, 2000
4:00 p.m.
Thursday, September 28, 2000
4:00 p.m.
Thursday, October 26, 2000
4:00 p.m.
Thursday, November 16, 2000
4:00 p.m.
Thursday, December 28, 2000
4:00 p.m.
• •
1. Major Responsibilites
A. Program Administration
1, Fiscal Management
KONA ADULT DAY CENTER
POSITION DESCRIPTION
FOR
EXECUTIVE DIRECTOR
a. Coordinates with the board to ensure financial stability and
sound fiscal management for the adult day center.
b. Prepares budget and consults with the treasurer, finance committee, and
accountant.
c. Oversees program accounting procedures to ensure that the accounting
system complies with all legal and funding requirements.
d. Responsible for overseeing the preparation of regular, detailed
financial reports to the board.
e. Implements fiscal control practices to achieve financial accountability
and maximum efficiency in the use of program resources, including
but not limited to the following:
1) Establish written procedures for purchase of supplies and equipment.
2) Require written authorization for those who handle funds or sign
checks.
3) Authorizes and monitors expenditures on an ongoing basis to ensure that
they remain within budgeted limits.
2. Payroll and Employee Benefits
1. Oversees proper, efficient, and timely execution of payroll.
2. Provides payroll service with accurate and timely information related to
employee status.
3. Oversees proper and smooth provision of employee benefits.
3. Personnel Management
0
a. Assists the personnel committee of the board in the developing of personnel
policies and job descriptions and to design the total staff structure for
the program.
b. Provides linkage between the board of directors and staff.
c. Recruits, interviews, and selects staff members. •
d. Conducts regular staff meetings.
e. Oversees staff supervision.
f. Conducts periodic review and, evaluation of staff job performance.
g. Manages employee grievances according to established personnel
policies
h. Oversees staff development and training.
i. Discharges employees when necessary.
page 2
Executive Director
Position Description
B. Program Development
11. Other Responsibilities
• •
1. Public Relations and Community Education
a. Builds public and community support for the Center.
b. Speaks to community groups.
c. Participates in community workshops, seminars, and training.
d.: Participates with interagency organizations, case management teams,
and the like.
e. Oversees publication and distribution of quarterly newsletters.
2. Fund - raising and Grant writing
a. Administrates fund - raising campaigns In coordination with the
board of directors.
b. Oversees donor stewardship program.
c. Oversees office procedures governing the recording, depositing,
accounting and authorized expenditure of fund raising monies.
d. Grant writing for operational or capital funds.
e. Writes to foundations and philanthropies to obtain funding support
for needy clients.
f. Adm inistrates special tuition funds, e.g. Kupuna Villas Assistance
Fund.
C. Facility Management
1. Oversees the fulfillment of certification and licensure requirements.
2. Maintains adequate client census levels.
3. Provides guidance and procedures to manage problems arising from
the day to day operation of the program and services.
4. Provides inforamtion requested by funding bodies, public officials,
service agencies, and others who are in need of such information.
• 5. Oversees adequate management of the center office to ensure proper
office practices are instituted and maintained.
A. Liason to the Board of Directors
I. Functions as an ex officio to the board of directors.
2. Accounts to the board for all actions and decisions.
3. Assists, when needed, the preparation of agendas for board meetings;
oversees the mailing of kagendas and other materials to the board
members.
4. Attends board meetings.
5. Provides and interprets information required by the board for
, policy formulation and for planning and development.
6. Presents regular reports to the board related to all phases of program
operation.
page 3
Executive Director
Position Description
C. Other duties, as directed by the Board of Directors.
111 Qualifications:
A. Experience, training and education
B. Skills and knowledge
C. Other Requirements
1. Valid driver's license to the State of Hawaii.
2. Availability to travel off island as needed.
IY. Supervision
• •
7. Makes recommendations to the board about the program regarding
changes in direction, plans for future growth and expansion, etc.
8. Provides linkage between board and staff.
9. Provides assistance with developement of program gods.
10. Provides information and makes recommendations about the
facility, including condition, safety, need for renovations, repairs,
need for addtional space, etc.
1 1. Provides information, makes recommendations, and offers assistance
when needed to special committees of the board.
1. Experience in health, human or social services.
2. Bachelors degree from an accredited college or university, or
substantial evidence In work history of an ability to carryout
the duties and responsibilities of the position.
3. One year of administrative experience in health, human or social services.
4. Experience in the adequate supervision of others.
1. Understanding and acceptance of the precepts of adult day care.
2. Familiarity with the needs of the population to be served and
dedication to the philosophy of service.
3. Ability to organize, plan, and implement ideas and services.
4. Ability to exercise sound judgement and decision making.
5. Ability to develop and manage budgets and fiscal planning.
6. Ability to communicate with staff and an ability to oversee conflict
resolution.
The executive director Is directly accountable to the board of directors and receives
direction, supervision, and guidance from this body.
•
• •xhibit B
KENNETH T. ONO
P.O. Box 275
Captain Cook, HI 96704
Ph: 328 -8740
EDUCATION
1965 - 68 Hilo High School
1968 - 72 Bachelor of Business Administration (BBA) - Univ. of Hawaii
1974 - 76 Master of Health Administration (MHA) - Duke University
1974 Administrative Intern, Veterans Administration Hospital - Durham,
North Carolina
1976 - 77 Administrative Resident, St. Joseph's Hospital - Lewiston, Idaho
EMPLOYMENT
1996 - Present Owner /President - West Home Health Services, Inc. .
Captain Cook, Island of Hawaii
Provide skilled nursing, physical therapy, occupational therapy, medical social
services, and other services to patients in their home. Medicare and Medicaid
certified Agency with accreditation with commendation by the Joint Commission on
Accreditation on Healthcare Organizations. Chair of the Kona - Kohala Chamber of
Commerce.
1 993 - 1 996 President and Chief Executive Officer - Wilcox Health System
and its subsidiaries. Kauai, Hawaii
The Health System is the parent company of Wilcox Memorial Hospital, G.N.
Wilcox Health Center Properties, Wilcox Hospital Foundation, G.N. Wilcox Health
Services, and Wilcox Medical Clinic. Wilcox is the major healthcare provider on the
Island of Kauai with revenues of $72 million per year, a labor force of 750
employees, and 85 medical staff members. Within first year, turned system around
from money - losing for the previous six years to money- making vertically integrated
operation.
Expanded services such as school health clinic, physician medical group
ownership, federal rural funding for economic development, new emergency
department, insurance managed care risk contracting, and islandwide health
planning with the community. Significant interaction with government officials and
legislators and received $2 million from the 1995 Legislature and Governor.
• •
1988 - 1993 President, The Queen's Medical Center -West Hawaii, Kailua -Kona
Island of Hawaii
Responsible for the coordination and implementation of a number of major
initiatives involving facilities, program development, and liaison activities among
physicians, hospitals, insurance carriers, and government officials on the Big Island.
Activities included the SHPDA Big Island Plan, West Hawaii Regional Medical
Center, and North Hawaii Community Hospital. Also served as Executive Director
of Kona - Kohala Healthcare, a joint venture between The Queen's Health Systems
and local physicians from 1988 -1990.
1986 - 1988 Executive Director, South Bay Family Medical Group - Redondo
Beach, California
Chief Executive Officer of 11- physician primary care medical group. Group
grew from four to eleven physicians in two years. Responsible for PPO and HMO
risk contracting, physician compensation plan, ancillary services growth, and office
building development.
1981 - 1986 American Medical International (AMI) - Los Angeles, CA
Executive Director /Chief Executive Officer AMI South Bay
Hospital - Redondo Beach, California
CEO of first district hospital in California to be leased (30 years) to an
investor owned company. Responsible for transition to AMI financial, personnel,
and other operational systems. Negotiated with unions. Established new fifteen
member hospital board of directors composed of equal representation from the
community, medical staff and AMI.
Grew 203 -bed hospital from a $28 million to a $48 million per year operation
in 2 '/ years. Developed three satellite physician offices occupied by active
hospital medical staff members. Established two medivans to transport patients
from home to physician office and hospital funded by hospital auxiliary, foundation
and hospital district. Implemented fully integrated flexible labor staffing which
reduced labor expense per unit of service by thirty percent.
Selected 1985 Young Man of the Year by the Redondo Beach Chamber of
Commerce.
•
American Medical International (con't.)
1972 - 1981 Various other positions
• •
Operations Assistant, AMI Pacific Southwest Region - Brea, CA
As Assistant Regional Director for Operations, responsible for operational
consultant support services for 12 hospital region with annual revenues of $250
million.. Worked very closely with each hospital CEO in areas of staffing, equipment
selection, personnel and wage administration, major construction, materials
management, and planning.
Directed activities of regional office specialists in nursing, labor management,
laboratory, radiology, medical records, quality assurance, purchasing, pharmacy,
food service and plant operations.
Developed CON's for $53 million, $36 million, $20 million, and $12 million
hospital projects.
Responsible for operational transition for newly acquired 99 -bed and 203 -bed
hospitals to AMI systems, policies, and procedures.
Served as Interim Hospital CEO as required.
Associate Administrator, AMI Community Hospital of Santa Cruz,
Santa Cruz, CA
PRESENT PROFESSIONAL AND COMMUNITY ACTIVITIES
PERSONAL
• •
Board Member, Hawaii Supreme Court Disciplinary Board
Member, State Emergency Medical Services Commission
Chair, Kona - Kohala Chamber of Commerce
Immediate Past President and current Board Member, American Cancer
Society, West Hawaii Unit
PAST ACTIVITIES
Board of Trustees, Healthcare Association of Hawaii
Treasurer, Chairman of Finance Committee, and Board Member, North
Hawaii Community Hospital
Board Member, Hawaii Community Federal Credit Union
Club Service Director and Treasurer, Kona Rotary Club
Board Member, Kona Adult Day Care Center
Secretary, County of HI Emergency Medical Services Commission
Member, University of Hawaii Chancellor's Advisory Committee for UH -West
Hawaii
President, Community Organization for Educational Development
Member, Ke Ola o Hawaii Health Services Committee, University of Hawaii
School of Medicine
Vice - Chair, State Health Planning and Development Agency Big Island
Planning Committee
Chair, SHPDA Garden Island Planning Committee
Honorary Chair - March of Dimes, Kauai Walk -A -Thon
Board Member, Kauai Chamber of Commerce
Board and Executive Committee Member, American Cancer Society, Pacific
Division
Married - wife registered nurse; two daughters
Excellent health. Hobbies include fishing, camping,
horseback riding, sports and social activities.
4
it 193
Kona Adult Day Center, Inc.
Program Director
Major Responsibilities:
I. Personnel
a. Assists executive director in conducting and evaluating performance of activity
coordinator and nursing coordinator. Assists each coordinator in conducting and
evaluating performance of their respective staff. Evaluation is given three months
after employment date and annually thereafter.
b. Assists in developing orientation and training programs for staff.
c. Assists in developing, coordinating, implementing, and evaluating staff training
programs and opportunities for professional growth and development.
d. Recruit, train, orient volunteers and assist with their placement in various
manpower needs of the program.
e. Develops and implements recognition program for volunteers as well as staff.
f. Develops good working relationships with all community programs.
g. Coordinate, execute and evaluate effectiveness of empioytnent arrangements of
agencies working with KADC, such as Alu Like, State Employment Service, etc.
II. Community Relations
a. Assists in making presentations to various community organizations.
b. Plans staff participation in workshops and training sessions for professionals,
paraprofessionals, caretakers and staff.
c. Develops, coordinates, and evaluates procedures, forms, policies for client
intake, referral, assessment, careplanning and discharges.
d. Networks with referral sources in the comrflnnity and provides information
about center services. for
e. Makes regular contact with community agetwies, hospital social worker,
physician offices in order to obtain referrals.
f. Assists or participants in community education sessions.
• •
Kona Adult Day Center, Inc.
Program Director
Page 2
11I. Program
a. Plans, coordinates, implements and evaluates safety procedures with staff.
b. Develops proper procedures for storing medicine medical supplies and for
proper maintenance of medical equipment.
c. Develops, coordinates, and evaluates procedures, forms, policies for client
intake, referral, assessment, care - planning, and discharges.
d. Develops, coordinates, and evaluates procedures to ensure family input in care
planning.
e. Develops, evaluates support/educational programs for family members.
f. Acts as a liaison with community agencies and programs.
g. Coordinate and evaluate nutrition component of programs.
h. Develops, implements, evaluates health program.
i. Develops, implements, evaluates activities program.
1V.. Participant Care Coordination
a. Intake and Assessment
1. Receives referrals from family and community agencies /physicians and
screens referrals for appropriateness of day care services.
2. Conducts intake and social/financial assessments.
3. Conducts home or hospital visits if appropriate.
4. Schedules appointments with families, agencies, physicians, in order to
complete intake and assessment.
• 5. Reviews center policies and procedures and all applicable information
with the family /caregiver prior to enrollment.
6. Coordinates enrollment and attendance days with nursing coordinator.
7. Determines need for resource coordination and referral.
8, Processes Department of Human Services applications.
9. Processes Tuition Assistance Fund applications when indicated.
•
Kona Adult Day Center, Inc.
Program Director
Page 3 '
b. Care Planning and Evaluation
1. Participates with activity and nursing/health staff in the planning and
evaluation of individual care plans.
2. Participates on community multidisciplinary teams to coordinate
community resources for client and family.
3. Assists family /caregiver in planning long term care goals, including
financial planning
4. Coordinates and conducts discharge planning and follow -up
c. Counseling and support
1. Provides family /caregiver support and education in order to maintain
integrity of social support system.
2. Facilitates KADC Caregiver Support Group and attends support groups
within the community when indicated.
3. Identifies caregiver and family educational and training needs and plans
training sessions.
4. Refers families for counseling when indicated.
V. Supervision
This position receives direct supervision and direction from the executive director. This
position follows all applicable policies, guidelines, and procedures established under
KADC.
VI. Qualification Requirements for this Position
1. Education, Training, and Experience
a. Graduate from an accredited college /university
b. Prior work experience with the elderly
c. Experience in the supervision of others
d. Knowledge of community and good working relationship with professional
personnel and community agencies
e. Management capability
Kona Adult Day Center, Inc.
Program Director
Page 4,
Qualifications (continued)
• •
f. Demonstration of organizational and planning skills
g. Knowledge and experience in working with cognitively and physical impaired
elderly /adults and ability to incoporate this knowledge into the planning of the
program.
h, Ability to exercise good judgement and tact in dealing with client, caregiver, and
the public;to provide leadership and gain acceptance and cooperation of others;
empathize with, understand and influence individuals toward program goats and
objectives.
2. Other Requirements
a. Possess valid Hawaii State driver's license.
b. Availability to travel off island as needed.
•
ROWENA L. TIQUI
78 -131 Ehukai Street #B
Kailua -Kona HI 96740
(808) 322-6133
RESUME
EXPERIENCE:
Current Caretaker
Oversee the operation of a small estate in Keauhou, Kona. Includes the main house, guest
house and maids quarters. Supervise a yardman and housekeeper.
2/97 - 6/97 Caregiver
Took care of ninety -two year old Gretchen Giacontetti until she passed away on June
23, 1997. Her care included, planning and preparing her meals, feeding, changing,
bathing and transporting her to and from doctor appointments.
1995 - 1997 Hale Koa Hotel
Front Desk Cashier
Checked guests in/out (i.e. Verified eligibility {must be military). Complete proper forms.
Explain hotel policies /procedures, directions. restaurant. spa and pool hours . Accept pay-
ments, cash, check, charge cards. Handle phone inquiries. Create reservations. Priority.
customer service.
1989 to 1994 University of Hawaii Federal Credit Union
1993 - 1994 Member Sen Representative
Did all credit union transactions out in the field of membership (i.e. Community
Colleges, UH School of Medicine- Queens Hospital and other affiliates of the
University of Hawaii system), except for cash. For security reasons we were not
allowed to handle cash transactions. Opened new accounts. accepted deposits. took
loan applications, closed loans. etc.(Also did presentations to eligible groups to
inform them of our benefits)
1989 - 1993 Administrative Assistant to the Chief Executive Officer
Handled calls correspondence, inquiries and related communique's with the
CEO. Scheduled meetings and appointments with members of the Board of Directors.
managers. vendors. employees. etc. Made travel arrangements and hotel accommodations
to seminars, workshops and other out of town meetings for CEO, Managers and Board of
Directors. This position also required a lot of interaction with people in all phases of the
financial industry. It was very important for me to be aware of changes and the newest
technologies happening within the financial industry.
1977 to 1988 First Federal Savings and Loan Association of Hawaii
1977 - 1979 Teller
1979 - 1980 Senior Teller
1981 - 1988 Operations Supervisor
/Supervised 20 jellerr clerks. receptionists and assistant operations supervisors
inclusive. Responsible for the daily operations and handling of all cash and check
transactions; new accounts: certificate renewals; ATM transactions and balancing;
staff scheduling; and continuous education of the above, staff. Maintaining a
harmonious and efficient team was the biggest challenge of this position, especially
so because of the varying ages. sexes, races, personalities and religions.
Continue Resume
Page 2
• •
1968 to 1976 Teller with American Security Bank (aka. First Interstate; a.k.a. First Hawaiian Bank)
Handled all cash and check transactions: sold travelers checks, money orders, drafts,
and cashier's checks. Responsible for balancing all transactions at days end.
EDUCATION: Waipahu High School, Waipahu, Hawaii.
Educational Courses offered through:
American Institute of Banking (AIB - banks)
Institute of Financial Education (IFE - savings and loans)
Hawaii Credit Union League (HCUL - credit unions) _
(Note: Courses too numerous to list. available upon request)
Dale Canegie Institute
NOTE: ,otary Public for 16 years)Current Commission expires April 22. 1998.
PERSONAL: Enjoy reading and listening to mellow music. specifically `oldies' of the '50 and
'60's. I have a collection of approximately 500 original movie videos I enjoy watching.
I also collect Coca -Cola memorabilia from all over the world.
O
• •
Kona Adult Day Center, Inc.
Position Description
Secretary /Bookkeeper
071399
Location of this position
This position operates out of the Kona Adult Day Center, located on Halekii Street,
Kealakekua, Hawaii and whose mailing address is P.O. Box 1360 Kealakekua, HI
96750.
Major Responsibilities
A. Maintains efficient and organized office operations, including:
1. Maintain accurate filing information systems for client medical record and other
confidential documentation.
2. Maintain visit logs, time sheets, and statistical reports.
3, Maintains efficient filing system for office operations, personnel files,
correspondence, forms and the like.
4. Maintains the Center's gerontology reference library system for use by clients'
families, community agencies, and professionals. _
5. Maintain inventory system and orders supplies as necessary.
6. Answers telephone, records messages, and relays messages.
7. Maintain current telephone register of staff, consultants, volunteers, clients and
their families /caregivers.
8. Oversees the repair and maintenance of office equipment, renews maintenance
contracts.
B. Maintains accurate record of monetary transactions and fiscal information, including:
1. Prepares, sends out, and record receipt of monies from monthly client billing
. statements. Answers inquiries from clients, families, and payors.
2. Documents all fiscal /billing information pertinent to Center operations and
maintains this system for efficient retrieval of information.
3. Makes bank deposits when necessary.
4. Maintains accurate records of all donations, in -kind donations, and annual giving
pledges and of all expenses related to KADC fundraising activities.
5. Maintains accounts payable system and prepares checks for payment for
Executive Director signature.
6. Collects and prepares semimonthly pay period staff payroll information for
transmission to KADC accountant. Maintains employee vacation, sick leave,
workers compensation and other records.
7. Assist KADC accountant in the routine transmittal and receipt of KADC fiscal
information relating to billing, accounts payable and the like.
C. Performs clerical duties as directed by the Executive Director including:
1. Preparation, photocopying, distributing, mailing the minutes of various board and
administrative meetings.
2. Preparation and mailing of KADC newsletter.
3. Preparation of financial reports, statistical reports, and the like.
4. Preparation of Center manuals, updating of manual material according to need
and as directed by the Executive Director.
5. Recording minutes of KADC staff meetings.
6. Preparation of correspondence, purchase orders for DHS reimbursements, client
intake /assessment /evaluation reports, monthly activity calendars, and the like.
D. Other responsibilities
1. Assist in the greeting of clients in the morning.
2. Oversee clerical functions of the Center.
3. Other responsibilities as assigned and directed.
Qualifications
A. High school diploma and certificate demonstrating secretarial training or
equivalent experience.
B. Typing skill of 60 words per minute, knowledge in the use of office equipment
and machines, including computer experience.
C. Sensitivity to the needs and concerns of the elderly, especially the frail elderly,
and their families.
D. Good organizational skills.
E. Flexibility and ability of accept direction.
F. Ability to function as a member of a team.
G. Current Hawaii's driver's license and clean driving abstract.
Supervision
This position reports to and receives direct line supervision from the KADC
Executive Director.
• •
07/39
Date
GAIL GAFORD •
P.O. BOX 861
Na'alehu, HI 96772 (808)929 -9695
•
nBJECTIVE: Desire long -term employment
ATTRIBUTES: *18 years experience in the accounting field
*Excellent organizational and managerial skills
*Quick study, able to accommodate all areas within a company
EDUCATION: WAPATO SENIOR HIGH SCHOOL. Graduated 1972.
Studied numerous accounting /clerical courses.
YAKIMA VALLEY COMMUNITY COLLEGE. 1973 -74,
Studied numerous accounting /clerical courses.
EXPERIENCE: NA'ALEHU FRUIT STAND
Na'alehu, HI 96772
December'.1994 to present
KITCHEN: Responsible for packaging baked goods, cooking orders,
stocking, backup and pumping propane.
KONA RANCH HOUSE, INC.
75 -5653 0ioii St., Kaiiva -Kona, HI 96740
September 1987 to February-1992.
ADMINISTRATIVE ASSISTANT: 'Responsible for all accounting facets
of a 120 seat restaurant: accounts payahie, accounts receivable, hank
deposits, sales computation (liquor & food) P.C., labor costs, payroll (for
65 people), timely employment reports to state, Liquor inventory control.,
change orders, meal count and all office procedures includinc correspondence.
Also worked the hostess /cashier position, supervising waits, bus help and
,sts (approximately 10 people)-
RICK SAUVE BAIL BONDS, INC.
215 S. 24th Ave, Yakima, WA 98902
September 1974 to May 1987
OFFICE MANAGER (sole office personnel ): Responsible for
securing collateral to hail people out of jail (i.e. mortgaces, cars, guns,
jewelry, co- signers, etc.). Return people to jail when necessary. Worked
with the court system, County Auditor's office, title companies, sheriff's
office and the police department. Handled accounts payable, accounts
receivable, hank deposits, correspondence and occasionally full charge
responsibilities of this nationwide, 24 -hour, 7 -day a week business.
MACHINES PROFICIENT WITH: Computer programs: Lotus 123 Spread-
sheet, Quicken, Quickhooks Pro, Voikswriter, Windows; 10 -Key, Type 60 -80 wpm.
REFERENCES: Anne & Bill Brye, Owners /Operators
Kona Ranch House, Inc. (808)329 -7061
Rick Sauve, Owner /Operator
Rick Sauve Bail. Bonds, Inc. (509)575 - 5333
Stephen K. Yamashiro
Mayor
County of 3athaii
DEPARTMENT OF FINANCE
25 Aupum Street, Room 118 • Hiio, Hawaii 96720-4252
(808) 961-8234 • Fax (808)961 -8248
HAWAII COUNTY NONPROFIT GRANTS (FY 2000 -01)
FINANCIAL QUESTIONNAIRE
Please include as an attachment an explanation for all "NO" answers to questions #1 thru 11 below:
Yes
I
0
(5
No
2.
3.
4.
5.
6.
7.
8.
9.
10.
I1.
12.
As the grant applicant, 1 cert that the agency has satisfactorily responded to each of the above questions and explained as
needed. 1 hereby cert5 that this inforntatton is true and correct to the best of my knowledge.
Agency: Kona Adult Day Center, Inc. Phone 32 _ - 797
sadl / 0/ ( 9-€3
lidag Atilt
Prepared by: Gail Gesford /Secretary /Bookkeeper
Print Name/Title
Certified by: Kenneth T. Ono
Has the agency operated continuously for the past three (3) years?
Has the agency operated with a positive cash flow for the past (3) years?
Does your Board of Directors approve a detailed cash flow budget before the beginning of
each fiscal year?
Do your Board meeting minutes show that quarterly financial statements are approved?
Is your equity balance at least 20% of your Total Liability balance?
Is your Total Current Asset balance larger than your Total Current Liability balance?
Are bank reconciliations and accounting performed by someone other than the check signatory?
Are you fully insured for the agency's vehicle(s) and building(s)?
Is your Workers' Compensation at least 2% of payroll?
Are you current (not delinquent) on all payroll and payroll tax payments?
Is the agency free of any pending litigation, liens or judgments?
Within the past 12 months, has the agency applied for vendor or bank credit and was
denied credit? If yes, please explain.
Print Name of Executive Director
Date
gnature Date
Harry A. Takahashi
Director
S. K. Schutte
Deputy