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HomeMy WebLinkAboutCOM 0667.031 1998-2000 t/18 Scaok\ad Ypvre- L. — 4 HOSPICE of HILO 3s CELEBRATING LIFE, DAY BY DAY F � C } F fl4k Ad4 y &tee 9' BOARD OF DIRECTORS OFFICERS January 31, 2000 President Gory N. Hagerman, Est rue Prrident 'Mud L Hammes. Ph 1) Secretor Hawaii County Council Ronny 1rcnrurer c/o Office of Legislative Audit John F. Rnney County of Hawaii 25 Aupuni Street MEMBERS Hilo, HI 96720 Catherine 0. Campo i nha Sarah E. Cope, RN Sidney M Fuke Dear Council Members: Cora May Jensen, RN Jamie Mnana Kawauchi Wes Kimura With this letter Hospice of Hilo respectfully submits its application for FY 2000 -01 Gerald T. Nagata funding support from the County of Hawaii Human Services Nonprofits Grants Gladys YS " " " "'ura program. Our $15,000 request is targeted to two principal areas: Carol L. Winegarden, RN A. Stephen Woo, Jr. . AID F_recutire Director (1) Staff development Brenda lenRN, RSN (2) Outlier Expenses (i.e. cost - overruns in those cases where Alice e Ada, ereDirector , MD ' J extraordinary medical needs outpace our Medicare or other insurance ADVISORY COUNCIL reimbursements). Shigekn 1 (:hang • Gr old L &Mien° These are areas in which a moderate investment by the County will yield large Tony Hanley dividends to the community. We look forward to the opportunity to meet with the Jan L. Houser, MD members of the Council to further clarify our request and to provide any additional Allan K. nawa information that might be useful in your deliberations. Thank you very much for Diane K. Kieffer, RN, RSN your consideration. Peter K. Kubota, Est James T. Limbetn, MD Sincerely, Warren ean Lee, RE Bobby Jean Lelthead4odd Esq. rum Rohm' Morris, NID C' "" "a $1fP1seo Brenda Ho, RN, MS Lenrnard 5. Tanaka Executive Director Stephen K. Yamahho, Est Terence T Ynshinka, Est Encl: FY 2000 -01 Grant Application Comm. No, 66 7 . 03r File No. I AtM United Well Ref. To: S g b C - 1011 WAIANUENUE AVENUE, HILO, 1-11 96720 Ref. Date FLCC H B 2 3 2000 TELEPHONE: (808) 969 -1733 • FACSIMILE: (808) 969 - #863 E -mail: hospice @hialoha.net www.web- factor.com /hospice/ &n rr\ No, rob 7. 03/ • •ICE OF HILO SUPPORTING DOCUMENTS CHECKLIST In summary of the rules and regulations to seek a grant of County funds, please submit the following documents or items in the order listed below: X One (1) ORIGINAL grant application - completed, with appropriate signatures affixed, and dated. 2. X Five (5) copies, double- sided, of the completed grant application. 3. Attach to the ORIGINAL grant application only, the following: X Organization /agency flow chart X List of current Board of Directors and Officers to include: C. Dates of expiration of terms of office C. Addresses and phone numbers of board numbers Regular meeting schedule of Board of Directors X Using Staff Information Sheet, list names of all agency staff. For all administrative staff involved in the program for which the funding is being requested, include: C. Job description C. Resume 4. Attach to the ORIGINAL grant application and copies, ONE (1) of each of the following: X FINANCIAL QUESTIONNAIRE - Must be completed and signed by organization's comptroller, accountant or bookkeeper and signed by the Executive Director. X ANNUAL FINANCIAL STATEMENTS - Agency's past two (2) years' annual financial statements: 1. Prepared by a qualified accountant and approved/signed by the Executive Director; OR 2. Prepared and signed by a Certified Public Accountant (CPA). X CURRENT AUDIT - All nonprofit organizations must have an audit prepared by an independent CPA at least every three (3) years. X IRS FORM 990 - Most current document for fiscal /calendar year. X INTERNAL REVENUE SERVICE (IRS) LETTER - Verifying agency's tax - exempt status for nonprofit organizations. X LIABILITY INSURANCE CERTIFICATE - Current and valid, to include the County of Hawaii as additional insured with a general liability of $1 million and $50,000 for each occurrence. X ARTICLES OF INCORPORATION - Signed and dated. X BY -LAWS - Must contain specific clauses regarding nepotism and conflict of interest. By -laws must be signed and dated. • • GRANT APPLICATION • • The following pages appear disorderly; however, they are a true reflection of the original on file in the Office of the County Clerk. • • Stephen K. Yamashiro alt}% ,,C' ;c '': • Harry A. Takahashi Ma or y `! �f. fi/i . Director s S. K. Schuttc Deputy County of Jatoaii DEPARTMENT OF FINANCE 25 Aupuni Street. Room 118 • Hilo. Hawaii 967204252 (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 31, 2000 GRANT APPLICATION FOR: Hospice (Program Title) Legal Name of Organization: Hospice of Hilo Mailing Address: 1011 Waianuenue Avenue, Hilo, HI 96720 Facility/Site Address: 1011 Waianuenue Avenue, Hilo, HI 96720 Director /Site Manager: Brenda Ho. RN. MS Phone: 969-1733 Organization President: Gary Hagerman, Esq. Phone: 775 -0993 Contact Person (Grant Writer) Ron Hart Phone: 969 - 1733 Amount of request for County funds: $ 15,000 Total annual budget of organization: $ 1,140 , 500 (FY 2000 -01) Has the applicant applied for any other funds from the County of Hawaii this fiscal year? 0 Yes Source/Department: None No Agency /Program(s): 0 Social Services 0 Youth Programs 0 Elderly Programs Check Catcgory (ies) 0 Culture and Arts 0 Education Other(Health) Briefly, define the program for which funding is being requested: Hospice is a program of compassionate, palliative, in -home care for the dying, provided at no cost to patient or family. An Interdisciplinary team of physician, 24 -hour on -call RNs, Certified Nurse Aides, Medical Social Worker, Spiritual & Bereavement Councilor and specially trained volunteers provide care. Medications, medical equipment, and medical supplies provided. Client in -put to Plan of Care ensures patient control, autonomy and dignity. 1 I V. QUARTERLY ALLOCATION 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. V. GRIEVANCE PROCEDURE 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. VI. DISCLOSURE OF INFORMATION 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. VII. CONTINUED ELIGIBILITY Any applicant or recipient who withholds or omits any material facts or deliberately misrepresents such facts to the County of Hawaii shall: 1) 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. VIII. ACKNOWLEDGMENT HOSPICE OF HILO (Legal Name of Organization) hereby agrees to administer the Hospice (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. IX. 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. 3 QUALIFYING STANDARDS FOR APPLICANTS 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. • 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. IL 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. III. 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. 2 X. 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! f � /-24-2000 Signature o Preside er on Date A trundr`- 4 , - 2 ( 4 - Zoo Signature of Executive Director /Manager Date 4 I • • NARRATIVE ANSWERS 4 Hospice of Hilo. • • County of Hawaii Grant Application FY 2000 -2001 I. PROGRAM / SERVICE DESCRIPTION A. Overview: 1) Describe the program for which funding is being requested. Hospice of Hilo provides a single program of integrated services called hospice. Funding is being requested to enhance selected components of this overall program. Hospice is a comprehensive system of care that provides palliative and supportive health services to terminally ill patients. The program also provides an array of social, psychological and spiritual care and logistical support services to both the terminally ill patient and members of the patient's family. The program of care is directed by our Medical Director who is a physician. Care is provided by an Interdisciplinary Team consisting of the physician, registered nurse case- managers, certified nurse aides, medical social worker, spiritual and bereavement counselor, therapists (physical, occupational, speech and dietary), volunteer coordinator, and specially trained volunteers. Hospice care is typically provided in the patient's own home. Nurses are on call 24 hours a day. In addition to the services of the Interdisciplinary Team, hospice patients are also provided medications and treatments for pain and symptom management, medical equipment and supplies, short- stay hospitalization for respite and acute care needs, and lab services as outlined by their insurance coverage. We are requesting County of Hawaii funding to enhance our program in two areas: a) Staff Development. The competency of our staff is the key to our success. Even small investments in staff development pay exponentially large dividends. In order to remain current, responsive and competitive we need to constantly upgrade the proficiency of our staff to meet higher standards of care and adapt to new methods of doing business. b) Outlier Expenses (Patient expenses exceeding the reimbursement rate). Hospice of Hilo receives a fixed per diem reimbursement established by The Health Care Finance Administration (Medicare). When actual patient expenses exceed the per diem, the excess costs are borne by the agency. In many cases the cost of providing care to patients with extraordinary medical needs exceeds the reimbursement rate. We are seeking funding to partially offset these losses and decrease the impact on other cost centers. 2) What unique or significant service will be provided? The hospice program of care is unique in three ways. First, it includes both the patient and the entire household as primary clients. Second it is comprehensive, focusing not only on medical issues but on the needs of the whole person: body, mind, and spirit. Hospice addresses the medical and nursing needs of the patient as well as the overall physical, social, psychological, spiritual and logistical needs of both patient and family. Third, hospice is client - centered care as distinct from the typical medical model of physician- centered care. The wishes, values and beliefs of the patient and family are carefully considered and integrated as integral components of the Plan of Care. - 3) What specific outcomes are to be achieved? Patient outcomes include: a) Optimized physical health through pain management, symptom control, nutritional counseling, and speech, physical and occupational therapy as needed. b) Enhanced psychological / emotional health through increased capacity to (1) control of their own situation, (2) remain in the familiar environment of their own home, (3) be less of a burden on their family, (4) be less isolated and more mobile, (5) have access to psychological, bereavement and spiritual counseling, and (6) have a sense of living and dying with dignity. c) Reduced likelihood of suicide due to unbearable pain, or feelings of worthlessness, helplessness, or hopelessness. d) Reduced likelihood of overtreatment 1 • s • Hospice of Hilo. County of Hawaii Grant Application FY 2000 -2001 Family outcomes include: a) Reduced physical stress due to having hospice assistance in caring for the patient. b) Reduced levels of fear and psychological distress due to (1) having input to the plan of care, (2) receiving explicit patient care instruction that lets them know what to expect and how to cope, (3) having more quality time to spend with their loved one, (4) receiving spiritual counseling, and (5) receiving guidance on end -of -life issues such as advance directives and living wills, funeral plans, death certificates, etc. c) Reduced expenditures required for medical and nursing care vs. hospitalization. d) Strengthening of the family unit as members are guided through the stages of the dying process (denial, anger, bargaining, acceptance), and are helped to develop more open communications, resolve conflicts and to reconcile broken relationships. e) Reduced potential for abuse of family members due to reduction in stress levels. f) Less protracted and disabling grieving process. Community outcomes include: a) Lower overall public costs associated with medical, hospital, and mental health services. b) Lower absenteeism and higher worker productivity from employees who receive support in, and respite from, caring for a dying family member. c) Lower levels of mental stress in the community due to (1) the availability of community -wide grief counseling and (2) grief support training offered to teachers, counselors, social workers, nurses and other health/mental health professionals. d) An enhanced sense of community and civic responsibility as the citizenry collaborates in taking care of their own. e) Improved understanding of end -of -life issues and the importance of planning for same. 4) How will the proposed program empower participants /clients to become self- sufficient and facilitate positive social change? The Hospice program empowers participants in the following ways: a) Hospice is a client- centered program of care that affirms the principle of patient self - determination and autonomy. Hospice empowers the patient by ensuring that the plan of care is specifically tailored to reflect her/his wishes and values, and those of the family. b) Hospice teaches family members the skills needed for effective patient care in the home, then supports this regimen of care with regular home visits by a registered nurses and by a 24 -hour a day on -call nursing service as needed. This empowers the family to remain in control of their own situation. c) Remaining at home as distinct from being institutionalized is perhaps the single most important way in which patients are empowered. d) Patients are empowered through the management of their pain and symptoms. e) Hospice provides supportive social services, volunteer support services, psychological counseling, spiritual care and bereavement support services, all of which help the patient and family members cope with their ever -changing situation. Hospice empowers it clients by helping them to maintain their equilibrium during a very challenging period, and to utilize their own personal capabilities as much as possible. 0 Patients are empowered and their self- sufficiency is enhanced as a result of the increased mobility permitted by the wheelchairs, walkers, and portable oxygen bottles made available through the Hospice program. Mobility outside the home is increased by transportation services provided by volunteers. 2 9 � • • Hospice of Hilo. County of Hawaii Grant Application FY 2000 -2001 Hospice facilitates positive social change by: a) Educating the local community and allied professionals through a monthly lecture series about grief and bereavement, advance directives, preparations for a death in the family, funeral planning, wills, long -term care planning and other end -of -life issues help to people do deal with these issues more effectively. b) Offering or co- sponsoring periodic trainings for other health and mental health professionals (such as the local chapter of the Hawaii Nurses Association and the Hilo Medical Society) through a series of public education seminars on end -of -life options and issues. c) Working as an active member of the state -wide coalition (including the State of Hawaii Executive Office on Aging, University of Hawaii Center on Aging, Saint Francis International Center on Healthcare Ethics and the Hawaiian Islands Hospice Organization) called Kokua Mau (Continuous Care) that is working improve end -of -life care through public and professional education and through advocacy for changes in public attitudes and policies related to death and dying, palliative care, and home care of the dying. d) Working to make the dying process a healthy process. Although we cannot change the fact that people die, hospice can help people to function better in their daily living. Even negative aspect such as depression, emotional instability and psychosomatic diseases are ameliorated by hospice interventions. This has consequences for employees' sick leave. e) Providing internship opportunities for Master of Social Work students and BSN nursing students at the University of Hawaii at Hilo and the Johns Hopkins School of Medicine. B. Problem / Need: 1) What is the problem /need the proposed program is designed to meet? Patient needs include the need to: a) Accept a change in the focus of medical care from curative to palliative (comfort) care. b) Control pain and other symptoms. c) Maintain physical health for as long as possible d) Remain as self - sufficient and autonomous for as long as possible e) Maintain a positive mental attitude f) Settle personal affairs g) Find spiritual comfort h) Avoid isolation; enjoy a sense of inclusion and belonging Family needs include the need for: a) Guidance and instruction in caring for the dying person b) Information about, and referral to, other sources of support in the community. c) Assistance in feeding, bathing, moving and comforting the patient d) Respite from the rigors of providing care to the patient e) Emotional and spiritual support in dealing with the impact of loss, and bereavement support following the death. f) Guidance in handling practical issues before and after the death (e.g. advance directives, wills, funeral arrangements, death certificates, social security, financial management), Community needs include the need for: a) Compassionate, client- centered, home -based end -of -life care. Today, over 70% of our people still die in a hospital. Governor Ben Cayetano has noted that "...it is critically important to individuals to control every moment of their lives up to the final days." As the Governor's Blue Ribbon Panel on Living and Dying with Dignity noted in their June 1998 report, "We told the governor 'dying has not been managed as well as it could be. The evidence of overtreatment is compelling.' We made a strong unanimous recommendation for hospice care where overtreatment is replaced by palliative care aimed at preserving comfort and dignity for dying patients" 3 • 6 Hospice of Hilo. County of Hawaii Grant Application FY 2000 -2001 2) Who are the target population and what are the specific needs? The target population includes: a) Any person who is diagnosed by a licensed physician as having a terminal illness and a prognosis of 6 months or Tess to live, who is no longer seeking curative treatment for the illness, and who resides within our service area. b) The families of such patients c) Members of the community -at -large who are grieving the death of a loved one d) Members of the community -at -large who am interested in leaming about death and dying, the Hospice program, and/or end -of -life issues e) Allied professionals interested in improving their skills in dealing with dying and/or grieving patients. The needs of the patients, family members and the community -at -large are detailed in Section B(1) above. 3) What is the geographic area(s) to be served, facility and hours of operation? a) Our service area includes that portion of the Island of Hawaii between Laupahoehoe Point and South Point Road, an area of 2,184 square miles. b) Our facility is located at 1011 Waianuenue Avenue in Hilo. Office hours are 8:00 a.m. to 4 :30 p.m. Monday through Friday. Our nursing staff is available 24 hours a day, every day. C. Collaboration / Coordination: 1) What specific measures will be taken to collaborate/coordinate with other community resources to achieve maximum program efficiency and cost effectiveness? To assure that the needs of our clients are met in the most efficient and cost effective manner, Hospice staff are actively involved in coordinating services with other community -based programs including: County of Hawaii Office of Aging, Coordinated Services for the Elderly, Services for Seniors, Senior Helpers, Big Island AIDS Project, Case Management Coordinated Services, Hawaii Island Adult Care, American Cancer Society, County of Hawaii Nutrition Program, Home Health Services, Legal Aid and DHS Adult Protective Services. Our contractual arrangements with Kokua Nurses for the provision of Certified Nurse Aide services, and with Hilo Medical Center for provision of in -house hospice services, ensure maximum program efficiency and cost- effectiveness. As a member of the Hawaii Islands Hospice Organization (HIHO), an alliance of all the hospice programs in the State of Hawaii, we are exploring the feasibility of sharing staff, data management systems and other resources required for compliance with Medicare regulations. 2) How will these measures reduce or eliminate any existing duplication of services to your designate target group? No other agency in East Hawaii is specifically designed and operated to provide comprehensive hospice care for the terminally ill and their families. Although we coordinate with allied community organizations to ensure a continuum of care for our designate target group, there is no duplication of services as such. D. Goals and Objectives: 1) What are the major goals/benchmarks of the proposed program? 2) What specific objectives /action steps are planned for each goal? 3) What is the timeline (start and end dates) for each action step? 4 • • • Hospice of Hilo. "' "'" County of Hawaii Grant Application FY 2000 -2001 Goal #1: Establish an inpatient hospice care facility Objectives: a. Complete an assessment of the need for in patient beds. [Start: March 2000. End: April 2000] b. Complete an analysis of the financial feasibility of establishing and operating an in- patient hospice care facility. [Start: March 2000. End: May 2000] c. Obtain the necessary license to operate an in patient hospice facility. [Start: April 2000. End: June 2000 d. Complete arrangements for the lease of the facility. [Start: May 2000. End: September 2000] Goal #2: Co- sponsor the eight annual Hospice Foundation ofAmerica National Bereavement Teleconference at UHH. Objectives: a. Apply to be a Teleconference Site Coordinator [Start: November 2000 End: December 2000] b. Prepare and disseminate publicity to local professionals [Start: February 2001 End: April 20011 c. Moderate the teleconference and follow - up panel [Start /End: April 2001] Goal #3: Continue to educate the public on end -of -life issue through our monthly Public Lecture Series. Objectives: a. Finalize the List of topics to be addressed in the series [Start: December 1999. End. December 2000] b. Recruit keynote speakers [Start: December 2000. End: February 2001] c. Prepare publicity [Start: June 2000. End: June 2001] d. Videotape lecture series for broadcast on Na Leo pubic access TV [Start: July 2000. End: June 2001] Goal #4: Continue the development of our Major Gifts program to ensure the long -term financial stability/viability of the agency. Objectives: a. Apply to the Hawaii Community Foundation for third (and final) year funding for development of our Planned Giving Program. [Start: July 2000. End: October 2000] b. Finalize a program for recognition of major donors [Start: July 2000. End: October 2000] Goal #5: Continue to improve the professional competency of staff Objective: a) Obtain funding and send Executive Director to the National Hospice Organization Senior Management and Leadership 2001 Conference. [Start /End: Nov. 12 - 16, 2000] 4) What significant client- centered outcome(s) will the program achieve? Include in your answer how many participants /clients will: (a) Attain at least one personal program outcome; or (b) Show measurable progress towards your program goals. a) 90% of client families reporting will evaluate the hospice program as "good -to- excellent" in terms of helping their terminally i11 patient to adjust to the changes occurring in his/her life. 5 • Hospice of Hilo. County of Hawaii Grant Application FY 2000 -2001 b) 90% of client families reporting will evaluate the hospice program as "good -to- excellent" in terms of helping them to adjust to the changes occurring in their lives related to the patient's dying process. c) 90% of client families reporting will evaluate the hospice program as "good -to- excellent" in terms of bringing their patient's pain to a comfortable level. d) 90% of client families reporting will evaluate the hospice program as "good -to- excellent" in terms of increasing their confidence to safely care for their loved one. E. Service Delivery: 1) What methodology will be used in the proposed program's delivery of service(s)? The methodology utilized in the hospice program is inherent in the hospice model of comprehensive care. The principal components of this model are: a) Assessment/Screening. An assessment of the patient's medical condition, psychosocial status, family support system, financial, legal, nutritional, spiritual and other needs is conducted by the RN Casemananger and the Medical Social Worker. The assessment also evaluates the array of support needed by family members to effectively cope with their situation. b) Plan of Care. Under the direction of the Hospice Medical Director and/or the patient's personal physician, a client- centered, palliative Plan of Care is developed based on the initial assessment and on input from the patient and family regarding their wishes and values. The Plan of Care is updated continuously as the condition of the patient and/or family changes. c) Case Management. Our staff of specially trained RN Casemanagers, in conjunction with the patient's Primary Caregiver, implement the Plan of Care in the patient's home, carefully monitoring the patient's condition and providing constant liaison with the physician(s). Nurses make scheduled visits to the home and are accessible 24 hours a day as needed. Certified Nurse Aides provide assistance with the patient's personal care. Therapists (physical, speech, art, occupational and dietary) are scheduled as needed. d) Social Work/Counseling. Our licensed Medical Social Worker provides social work services and counseling services to patient and family as needed. e) Volunteer Support Services. A corps of specially trained volunteers, under the direction of our Coordinator of Volunteers, provides an array of supportive services to the patient and family including personal care, companionship, transportation, respite care, housekeeping, etc. f) Spiritual Care. Within the hospice model, spiritual care is not necessarily regarded as synonymous with religious or pastoral care. Many people regard themselves as spiritual even though they are not affiliated with any religious organization or have any particular religious training or doctrinal beliefs. The aim of spiritual care within hospice is to facilitate the expression of the client's spiritual beliefs; to support the client's exploration of meaning in their life and beyond; to encourage participation in meaningful rituals; and to assist the client to come to a point of reconciliation, completion and peace with herself/himself, with others and with God or Ultimate Reality as they perceive It. g) Bereavement Counseling. A Master's level counselor, assisted by specially trained volunteers, provides grief counseling services to hospice family members for up to one year after the patient's death. Counseling is also offered to members of the community -at -large who are grieving the loss of a loved one. Counseling can consist of individual one - on-one sessions and/or support group meetings. h) Interdisciplinary Coordination. The members of the Interdisciplinary Team meet weekly to review cases, update the plan of care as needed, and coordinate interventions among the staff. 6 • • C • Hospice of Hilo. V � County of Hawaii Grant Application FY 2000 -2001 F. Evaluation: 1) What process will be used to evaluate the program and service(s)? a) Following the death of each patient, the attending physician completes a Discharge Summary that includes an evaluation of the hospice services rendered. b) Following the death of each patient, each hospice family is asked to complete a Family Evaluation of Hospice Program Outcomes form (See attachment) c) Following the death the Interdisciplinary Team (IDT) of hospice clinical staff assess their own results by completing the IDT Evaluation ofHospice Program Outcomes form (See attachment). d) A standing staff Committee on Quality Assurance continually monitors program quality standards. e) The Hawaii Department of Health Medicare Certification Officer conducts periodic on -site inspections. f) The Agency Participation and Allocation Committee of Hawaii Island United Way evaluates the program annually. HIUW member agencies are now required to identify specific program outcomes and measurable outcome indicators. g) Quarterly benchmark reviews will be conducted by the Management Team to monitor progress on program goals and to formulate corrective action plans as needed. 2) How will this process measure the outcomes specified in Item D, (1 -4)? Quarterly benchmark reviews will measure whether the stated program objectives detailed in Items D(1 :3) are met. Data from the Family Evaluation of Hospice Program Outcomes form and from the IDT Evaluation of Hospice Program Outcomes form will be compiled on an ongoing basis. At the end of the year all of these data will be summarized to measure the client outcomes identified in Item D(4) G. Program Fees: 1) Does your organization charge a membership fee for service participants? No. Hospice of Hilo has no membership fees. 2) Does the proposed program charge participants a fee for service(s) provided by your organization? No. Hospice of Hilo's services are provided at no cost to the patient or family. Our principal sources of revenue are Medicare and private medical insurance. No patient is denied admission or core services even if not covered by such insurance programs. H. Viability: 1) What is your justification or rationale for the expenditure of public funds for the proposed program? a) In their June, 1998 Final Report, the Govemor's Blue Ribbon Panel on Living & Dying With Dignity recommended "that Hospice care be made more available and offered more expediently to the dying." The Panel sought "support to change policies, both administrative and legislative, to facilitate good palliative care." The program of Hospice of Hilo is congruent with the Panel's recommendations and policy objectives. b) Although historically death has been seen largely as a private matter in our society, we are coming to recognize that how people die has profound public significance. Every death affects the whole. As a civil society we can reasonably expect that our terminally ill citizens be afforded the opportunity to meet death in a dignified and peaceful 7 • Hospice of Hilo. County of Hawaii Grant Application FY 2000 -2001 manner. No one should be denied the right to a good death, regardless of his or her status or ability to pay. c) The bonds of community are strengthened through public and private initiatives that ensure the possibility of dignified death to all. The public has an interest in strengthening the bonds of community. d) Families are strengthened through hospice programs that support and empower them in the process of caring for a dying member. The public has an interest in strengthening families. e) Medical costs are significantly reduced when dying people are provided hospice care at home. The public has an interest in reducing such costs. f) Working families are able to continue working when they have hospice help in caring for a dying member. The public has an interest in maintaining the productivity and earning power of its citizens. g) The emotional health of families is safeguarded when hospice and grief support are provided. The public has an interest in maintaining the mental health of its citizenry. 2) What are your financial and programmatic plans to sustain the proposed program beyond the upcoming fiscal year? Financial plans to sustain the program include: a) Reimbursement for services from private health insurance programs, Medicare and Medicaid. b) Hawaii Island United Way annual allocation c) County of Hawaii Non - Profit Grant d) Combined Federal Campaign annual allocation e) Fundraising events including (1) annual Friendship Mailing, (2) Light Up A Life, (3) Homes For the Holidays, (4) Charity Walk f) Donations and Memorials g) An on -going cost - review and cost - containment program. h) Solicitation of in -kind goods and services i) Continued development and implementation of a Planned Giving, Major Gifts and Endowment program. Programmatic plans to sustain the program include: a) Expand our patient census through a marketing program targeted to physicians, nurses and the general public. b) Maintain a strong volunteer base through an on -going program of recruitment, training and development. c) Improve the professional competence of our staff through external training courses and in -house in- service training seminars. d) Expand our community outreach in the areas of public education, bereavement counseling and professional education. I. Budget: 1) Complete the attached Budget tables [See Budget Tables] 2) Provide appropriate attachments, as indicated. [See Budget Attachments] 8 Hospice of Hilo. . . County of Hawaii Grant Application FY 2000 -2001 II. ORGANIZATION / AGENCY INFORMATION A. Board of Directors 1) Has the organization's Board of Directors received formal training within the past two (2) fiscal years? Yes, the Board of Directors participated in the following formal trainings (See Narrative Attachments for specifics): a) Next Steps In Strategic Planning, by Brenda Ho, Executive Director, October 20, 1998. b) Planned Giving, by Ron Hart, Director of Development, July 21, 1998. c) Orientation and Overview the Hospice Philosophy, Program and Environmental Factors, February 27, 1999. d) Strategic Planning Retreat, including review and prioritization of organizational goals, educational components on planned giving and endowments, April 24, 1999. e) Long Range Financial Forecast conducted by CPA Ann Fukuhara, August 24, 1999. 2) What are the primary roles and responsibilities of your organization's Executive Director? a) Overall Management and Administration including: (1) formulation of goals, objectives and procedures, (2) compliance with laws and licensing certification, (3) Quality Assurance, (4) program development. b) Financial Management including (1) develop annual budget, (2) oversee collection of receivables and disbursement of funds, (3) oversee audit process. c) Personnel Administration d) Conununity Relations/ Community Education e) Fund Development 3) What are the primary roles and responsibilities of your organization's Board of Directors? (Clarify role of executive officers vs. general membership) a) Executive Officers: The Executive Committee of the Board oversees the operation of the board, sets the agenda for board meetings, makes interim decisions as necessary, as serves as a resource to staff in key planning strategies. b) General Membership: The board as a whole is responsible for (1) oversight of agency, (2) setting goals and policies for the agency, (c) appointment and evaluation of Executive Director, (d) mid- and long -range planning, (e) representing the agency in the community. B. Past Performance: 1) How effective has your organization /agency been in achieving program goals in the past two (2) fiscal years? Include the following information: a) Quantitative data on numbers served. 1998 1999 Hospice Patients Served 167 175 Household Members Served 334 428 Hospice Volunteers Trained 45 41 Community (non- hospice program) Grief Clients Served No Data 138 Allied Professionals Trained No Data Community Education provided on End -of -Life Issues No Data 461 9 . • Hospice of Hilo. County of Hawaii Grant Application FY 2000 -2001 b) Qualitative data showing number and % of participants achieving measurable outcomes: • 1998 1999 Number / Percent Number / Percent Satisfactory Pain Control 74/77 96.1% 62/64 96.9% Control of Other Symptoms 76/78 97.4% 64/66 97.0% Management of Stress /Anxiety 73/77 94.8% -- -- Confidence to safely care for patient -- -- 70/72 97.2% Supported Patient's Quality of Life 77/78 98.7% 67/69 97.1% C. Financial: 1) Have your organization's current program operations remained the same as last year? What major program or financial changes will occur next year? In terms of the types of patient services provided, our program operations remained the essentially the same as the previous year. In 1999 we expanded our efforts in the area of public and professional education on end -of -life issues. In 1999 the number of clients served increased by 5% over the previous year (from 167 in 1998 to 175 in 1999). However the Average Length of Stay (ALOS) and thus the total number of patient -days decreased by 7 % (from 9,987 patient -days in 1998 to 9,261 patient days in 1999). This reflects the fact that patients are being referred to the hospice program later in their disease process, which in turn means that their acuity levels are higher, which in turn results in a substantially higher cost of providing care for many patients. We do not anticipate any major program or financial changes in the coming year. 2) What is the status of all of your organization's major contracts or agreements for the coming year (employment agreements, office leases, primary grant revenue/supplier, etc.)? a) The majority of patient care contracts are automatically renewed from year to year. b) The biennial contract with Hilo Medical Center to provide hospice in- patient acute care and hospice in- patient respite care was renewed in October 1998. 3) How does the proposed program fit into your organization's long range financial plan? The comprehensive hospice program described in this application is the sole program administered by Hospice of Hilo. This is the only program for which funding is being proposed. Our organization's long range financial plan is essentially a plan to maintain and expand this program. See Item H.2 above for a more detailed discussion of our long -range financial plan. 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 list all monitoring sources, contract names and phone numbers. a) Hawaii Island United Way, Helen Hemmes, CPO. Phone 935 -6393. b) Dept. of Health Medicare Certification, Gerald Chung. Phone 586 -4090. 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? As stipulated in the Employee Handbook, smoking is prohibited on the premises of Hospice of Hilo except in designated areas. Staff and volunteers are also prohibited from smoking in patients' homes or while transporting patients. It is forbidden to introduce, possess, use, or report for duty under the influence of any intoxicating liquors and/or illegal drugs. EAP services are available for assessment and referral for drug and alcohol problems. 10 • • ® v NARRATIVE ATTACHMENTS • Item I F (It 1) b • • Hospice of Hilo • FAMILY EVALUTION OF HOSPICE PROGRAM Name of Patient (please print) Name of Person completing this form 1. How did you learn about our hospice program? Physician Nurse Social Worker Friend Minister Hospital Staff Family Member Other (please explain) Please rate Hospice of Hilo's performance in the following areas: Not Excellent Good Average Fair Poor Applicable 2. How well did we explain and help you understand what to expect as the patient's condition changed? 5 4 3 2 1 NA 1 How well did we support your feelings and beliefs? 5 4 3 2 1 NA 4. How well did we help the patient adjust to the changes in their life after admission to hospice? 5 4 3 2 I NA 5. How well did we help you and your family adjust to the changes in your lives after admission to hospice? 5 4 3 2 1 NA 6. How well did we manage the patient's pain? 5 4 3 2 1 NA 7. How well did we manage the patient's other symptoms? 5 4 3 2 1 NA 8. How well did we increase your and your family's confidence to safely care for your loved one? 5 4 3 2 1 NA 9. How well did we assist the patient with their spiritual coneems? 5 4 3 2 1 NA 10. How well did we assist you and your family with your spiritual concerns? 5 4 3 2 I NA 11. How well did we respond if you contacted the evening or week -end on -call service? 5 4 3 2 1 NA 12. How well did we support the patient's quality of life? 5 .4 3 2 1 NA 13. If applicable, how well did we support the family at the time of the patient's death? 5 4 3 2 1 NA 14. If applicable, how well have we supported you and your family since the death? 5 4 3 2 1 NA 15. Were you satisfied with our services? Yes No If not, please explain 16. Based on the care your family received would you recommend hospice services to others? Yes No For Staff Use: Year Quarter 03/31/99 s 0 . • • Please rate the following. Your honest evaluation will help us improve our services. Not Excellent Good Average Fair Poor Applicable 17. Registered Nurse Casemanagcr 5 4 3 2 1 NA 18. On -Call Nurse(s) 5 4 3 2 1 NA 19. Medical Social Worker 5 4 3 2 1 NA 20. Certified Nurse's Aide 5 4 3 2 1 NA 21. Spiritual Counselor 5 4 3 2 1 NA 22. Bereavement Coordinator 5 4 3 2 1 NA 23. Coordinator of Volunteers 5 4 3 2 1 NA 24. Volunteers 5 4 3 2 1 NA 25. Therapist (Dietary, Physical, etc) 5 4 3 2 1 NA 26. Pharmacy 5 4 3 2 1 NA 27. Durable Medical Equipment 5 4 3 2 1 NA 28. Medical Supplies 5 4 3 2 1 NA 29. If there was one thing hospice could do better, what would it be? 30. Additional comments /suggestions about care, staff or services: 31. Would you and/or the patient have benefited from an earlier enrollment in the hospice program? . Yes No If yes, what was the reason for not enrolling sooner? 32. May we share your comments with others? Yes _No If yes, may we use your name? Yes No 33. Today's Date Thank you. ® EMBI, Inc. 03/31/99 Item IOF (1) et 1 fospicc of Hilo INTERDISCIPLII0tY TEAM EVALUATION OF PEID)RMANCE OUTCOMES 1. Patient Number Date Please rate Hospice of Hilo's performance in the following areas: Not Excellent Good Average Fair Poor Applicable 2. How well did we explain and help the family understand what to expect as the patient's condition changed? 5 4 3 2 1 NA 3. How well did we support the family's feelings and beliefs? 5 4 3 2 1 NA 4. How well did we help the.patient adjust to the changes in their life after admission to hospice? 5 4 3 2 1 NA 5. How well did we help the family adjust to the changes in their lives after admission to hospice? 5 4 3 2 1 NA 6. How well did we manage the patient's pain? 5 4 3 2 1 NA 7. How well did we manage the patient's other symptoms? 5 4 3 2 1 NA 8. How well did we increase the family's confidence to safely care for their Loved one? 5 4 3 2 1 NA 9. How well did we assist the patient with their spiritual concerns? 5 4 3 2 1 NA 10. How well did we assist the family with their spiritual concerns? 5 4 3 2 1 NA 11. How well die we respond after office hours? 5 4 3 2 1 NA • 12. How well did we support the patient's quality of life? 5 4 3 2 1 NA 13. How well did we support the family at the time of the death? 5 4 3 2 1 NA 14. How well have we supported the family since the death? 5 4 3 2 1 NA 15. Was the family satisfied with our services? Yes No If not, please explain 16. Please evaluate how well the family performed in providing patient care: Not Excellent Good Average Fair Poor Applicable 5 4 3 2 1 NA Additional comments /suggestions about care, staff or services: Date of Discharge: ® EMBI, Inc. 03/31/99 Year Quarter 1 • • Item IIA(1) a NEXT STEPS IN STRATEGIC PLANNING Presented by Brenda Ho, Executive Director October 20, 1998 Board Members Present: Gerald Nagata John Moran Ronny de Jong Cora -May Jensen Catherine Campainha Gary Hagerman Kathy Takehiro Rev. Tom Taylor Sarah Cope Dr. A. Stephen Woo, Jr. • • NEXT STEPS IN STRATEGIC PLANNING 1) Develop a Volunteer /Staff Committee planning grid: In order to assign all board and staff to appropriate committees. This will also help you to evaluate your Board and Committee needs and target individuals in the community to meet those needs. Maureen to develop one based on NHO example (Holly will send) by September 2) Develop a Revision to the Indigent Care Policy: To be prepared if there are not enough funds for the indigent needs. To be proactive before all cash reserve is lost. To be developed by type of program with priorities. Misae with Cora May, Judy - (Due Jan. 1) 3) Rewrite Vision /Mission Statements to include the priorities listed in questions 15 - 18 (above): Larry, Sarah, Ronny C., Catherine, Susan P. (Sept. Bd. Mtg.) 4) Define services: Define each individual program and prioritize them for your agency. If funding is lower/higher than expected, you will know which programs it will affect. Develop a system of cost accounting and quality assurance for your individual programs to evaluate their effectiveness and efficiency. 1. Hospice 2. Risk Management (see steps below) - December 2Sth 3. Grief / bereavement 4. Referral / Resource Center 5. Cost based budgeting and staffing 6. Comm. Education - Hospice - Grief - Communication - Speakers Bureau 5) Stabilizing /Risk Management Plan Fiscal Diversity Plan Develop programs that will help diversify the funding coming into Hospice of Hilo. 1. Planned giving 2. Memorials Education staff: 3. Increased insurance coverage 4. Accessing outside community resources 5. Endowment 1 • • 6. Capital campaign Brenda - rough draft to Finance Committee in September Executive Transition Plan Develop a plan to assure a safe transition in key leadership Etsuko -First draft in September, final in January Operational Risk Management Plan: Personnel Committee - January 1 - Flex staffing plan for growth - Identify staff needs (downsizing) Brenda - Identify Business system needs - On - going Bd. update Evaluate insurance coverage: Finance committee with the addition of Gary - Brenda to bring to August meeting. Contracting Development Plan: Develop a plan for the proper legal oversight of contracting. Evaluate legal counsel availability - John, Gerald, Brenda (due Jan 1) 6) Plan for partnering: Identify all of the opportunities for potential partnership, the pros/cons of each and prioritize the opportunities (October to full Board) Then develop a plan for approach. 1. SNFs / Home Care 2. Home Health 3. Hospitals 4. Palliative Care Units 5. Other hospices Brenda, Gerald, Dr. Alice Adee, Sarah, John, Gary, Outside help? 2 • Overview of the 1997 Strategic Plan Purpose: To identify the role and function of HOH, determine our top priorities and to develop a plan of action to meet these priorities. 1 Outcomes: Copied on Overhead Short Term Projects /Goals 1 #1. Adoption of the EMBI Policy and Procedure Manual 1 #2. Use of Building B 1 #3. State Licensure 1 #4. Role of the Advisory Board 1 #5. Thrift Store in the Puna area 1 #6. Contingency Plan for y2k continuation 1 #7. Upgrade the agencies benefit package and salaries. 1 #8. Assuming a leadership role in the community about death and dying. 3 Q • • Long Term Projects /Goals 1 #1. Hospice of Kona /Expansion /Island- wide hospice care 1 #2. Hospice Units within existing facilities 1 #3. Residential Homes 1 #4. Operational Endowment 1 #5. Indigent Care continuation 1 #6. Marketing Plan to Physicians, pis and families of terminally HI, churches, medical students, insurers, businesses, etc. 1 #7. JACHO accreditation. 1 #8. Planned Giving /charitable gift annuity. Role of the Planning Committee 1 The following roles and responsibilities of long range planning committees were extracted from various resource materials within our agency. 1 See overhead. 4 • • Update from last BOD Mtg. 1 Issue: difficulties of being on the planning committee. 1 Problem: lack of knowledge about areas that the committee needs to plan for and a lack of consensus from the board as to prioritization of the target areas. 1 Action: "To present target areas that need to be addressed and then provide the committee ideas to brainstorm ". Recommendation: 1 Listen to the presentation. Having each member take notes on each area /target. 1 Each member will evaluate the item on the following: 1 1. Overall feelings /concerns. 1 2. Priority (short/long /delete /revise). 1 3. Should this area be assigned to the Planning committee or other (s), and what would you expect from them. Presentation Agenda 1 Revisit the 1997 Strategic Plan. (See overhead copy of 1997 plan) 1 Potential Short term projects /goals. (less than one year) 1 Potential Long term projects /goals. (more than 1 year -less than 5 years) 1 Review of role of Planning Committee. (See overhead copy) 1 Discussion /Brainstorming 5 • • Item IIA(1)b Planned Giving A Presentation to the Board of Directors of Hospice of Hilo By Ron Hart Present: Gerald Nagata, Pres. Sidney Fuke July 21, 1988 Ronny de Jong, Secy Dr. A Stephen Woo. Jack Roney, Treas. David Hammes, Ph.D Sarah Cope Kathy Takehiro Cora -May Jensen Catherine Campainha Brenda Ho, Exec. Dir. 1. Review of our current Development Program a. Capital Campaign b. Donations and Memorials c. Annual Friendship Mailing d. Light Up A Life e. Hospice of Hilo Homes for the Holidays f. Hawaii Island United Way g. Combined Federal Campaign h. Hawaii County Nonprofit Grant i. Office on Aging Grant j. Hotel Charity Walk k. Other 2. What is Planned Giving? a. Planned Giving is often also called Deferred Giving. Essentially it means a program to encourage and assist people to include Hospice of Hilo in their estate planning. b. Planned Gifts are usually gifts from a donor's estate -- from his or her capital assets, usually given at the time of the donor' s death. c. Planned Gifts typically are gifts to a charitable organization's endowment fund as distinct from gifts that are given directly for operational purposes. d. Planned Gifts usually require a legal document, such as a will, a trust document, a life insurance policy, etc. e. Examples of various planned giving instruments are shown in the blue folder which was included with the materials mailed to you in preparation for this meeting. (Review each gifting vehicle) 1) Wills / Bequests 2) Gift Annuities 3) Charitable Remainder Trusts 4) Life Insurance 5) Retained Life Estate 6) Charitable Lead Trusts 1 • • 3. Why would making a Planned Gift to Hospice of Hilo make sense to a prospective donor? a. In many instances it would be in their own financial interest and the financial interest of their heirs, to do so. There are provisions in the tax code which encourage charitable giving. b. Planned Giving is a way for a prospective donor to endow his or her charitable intent for the future, a way of touching the lives of people in need long after they donor himself or herself has passed from the scene. To make a Planned Gift is to purchase a piece of eternity. 4. Why do we need a Planned Giving Program? We live in an uncertain world. Our funding sources are variable and, in not altogether predictable. At certain times our income may lag behind expenses. From time to time we may well be — almost certainly will be —be confronted with unanticipated costs. We need to be able to expand our programs in response to new or expanded needs. We need to be prepared for contingencies. We need to be able to continue to attract, train and retain the highest caliber staff. In short, we need to provide for the long -term stability and viability of the agency. We need a means of ensuring that the work of the agency endures and flourishes into the 21st century. A Planned Giving Program is one of the most effective ways to do that. 5. When k the time to initiate a planned Giving Program? a. I would like to suggest to you that the time is now. We have just finished the active phase of the capital campaign. Our visibility is high, our image is good. We have attracted many new friends and supporters to the agency. They now have a vested interest in our mission. b. Planned Giving in America. In 1997 Americans gave $143 billion to charities, up 7% from 1996. Of that total approximately 10% was in the form of Planned Gifts. Planned gifts increased 18% from 1996. An accelerated rate. Some professionals estimate that by the year 2000 fully one -half of all charitable gifts will be made through some type of PG arrangement. c. Since the postwar period the American economy has been growing at an unprecedented rate. Many Americans, through savings and wise investments, have accumulated substantial wealth. It is estimated that between 1990 and 2015, they will leave between $7 -10 Trillion dollars to their heirs, the government, and to charities. Whether Hospice of Hilo receives a fair share of that bounty depends upon how well we plan and prepare today. 6. What are the steps involved? #I. Make a Commitment. As an agency we need to commit to a planned giving program not simply as a stated goal, but as a declaration of intent. We need to embrace the planned giving program with a sense of sustained determination. I think of Shigeko Chang, who 13 years ago, stated her intention what Hospice of Hilo would have a 2 f � • • permanent home of its own. She knew that it would be a long process, with nothing concrete to show for many years. At the time it was not altogether clear how this idea was going to come into fruition, but she made a commitment, she declared her intention, and she did not let obstacles dissuade her. That is the kind of resolve that we are going to need for success in the Planned Giving program. We need to set our minds and our wills to the task —no pun intended. It has been pointed out by those who have been down this road before, that unless we are willing to make the Tong -term commitment required to bring the program to fruition, it would probably be better not to undertake it. Starting off the program with the idea that we could drop it in a couple of years if it didn't pay off is not the mind -set we need to adopt. #2. Develop a Marketing Plan The purpose of our marketing efforts will be to build donor awareness and acceptance of the notion of planned giving. Building awareness and acceptance is a long -term proposition. It will take many months, and like any successful marketing or advertising campaign, it must be done with consistency over time, not just now and then. In developing our market plan we will need to: a. Establish criteria by which we will categorize prospective donors into various markets, (i.e. primary secondary, tertiary). b. Decide what kind(s) of informational vehicles we will use with each market group, (e.g. generic newsletters, specialized brochures, estate planning seminars, etc.) and we also need to decide the content of these informational vehicles and the frequency with which we will provide them. These decisions will, in part, be driven by the budgetary resources available to us. c. Adopt a client-centered philosophy. The focus of the program should be on providing a service to the donor. If our primary emphasis is solely on inducing a donor to give, then the program will most likely fail. Instead we need our program to be donor - centered, and donor - friendly. We need to take the time to understand each prospective donor's interests, his or her financial situation and estate planning needs. We need to provide them with accurate information about the benefits that would accrue to them through various planned giving modalities. And we need to help them select the modality that is most suitable to their personal goals and objectives. Jack Roney has noted that estate planning is an involved process. People who have already developed an estate plan may not be open to revising it to accommodate Hospice of Hilo. The point of this observation is that we need to begin early to position in the minds of prospective donors the idea of a planned gift to Hospice of Hilo, and educating them about the financial benefits that could accrue to them if they did so. The Planned Giving program is, in essence, an educational program. 0 ' . • #3 Recruit Key Board Members Preliminarily we need two Board members, preferably from the Finance Committee, who are willing to take responsibility for being the point persons on the Board for the PG program. This would entail: a. Educating themselves, with the help of staff, about the general area of planned giving. b. Helping to educate their fellow board members about planned giving. c. Helping to select a consultant for the initial developmental phase of the program. d. Keeping the issue of PG in front of the board, ensuring that it is regularly included on the Board agenda and alive in the minds of the members of the board. e. Helping to recruit the Planned Giving Advisory Council. f. Serving as members of the Planned Giving Advisory Council, attending its quarterly meetings, and acting as the liaison between the Council and the Board of Directors. #4. Identify Core Donors We need to develop a mailing list. This may be the most difficult step because it means carefully applying our marketing criteria to each person in the agency's donor and volunteer constituency. This is tedious and painstaking, but in the long run, I have been told, it is better to do it right in the beginning than to try to fix it later. #5. Prepare the Budget a. It is better to start out small and grow than to start out big and fail b. The most expensive portion of the planned giving budget is staff time. It is not cost effective to have staff create newsletters and brochures. There are several large professional companies that specialize in producing such educational materials. c. Fewer dollars will be budgeted to cultivate our secondary and tertiary markets than for our primary markets. d. For the first year of the program we have received a capacity building grant of $9,750 grant from the Hawaii Community Foundation. If we perform well this year there is a good chance we can secure an additional $5,000 for the second year. . 4 • • 0 In the following years we may need to approach a bank or corporation to underwrite the operational expense of the program until it can become self - sustaining. e. In the long term we need to consider making the Planned Giving program a distinct budget item in the agency's annual budget. 116. Integrate PG into the overall fund development program. When I suggest that we add PG to the mix of our other existing fund development activities, I do not mean to imply that we simply add it as a component that stands alone as a distinct and separate adjunct to what we are already doing. I mean integrating Planned Giving into the overall Development program, weaving Planned Giving into every other fund development activities, piggy backing on them as it were, and malting it an integral part of the overall program. 7. Planned Givinv is a Iona -term developmental process. We will not see the fruits of our labors for several years. For the first four or five we should expect that the program will be all expense, and very little retum. In the early phase of the program we will be like Johnny Appleseed, cultivating the ground and sewing the seeds. . It will require constancy in our efforts to cultivate, and to position the idea of planned giving in general. Like any advertising campaign, constancy is the key. In the first phase, then, we will be engaged primarily in an educational process, providing specialized brochures and newsletters prepared by professionals. Offering seminars on estate planning, perhaps in conjunction with other agencies. 8. What will the orpanizational format of the PG Program look like? a. It will be under the ultimate control and direction of the Board b. It will be staffed by the Director of Development and by the Executive Director c. Eventually we would like to see the creation of a board level Development Committee that would oversee the entire development program of the agency, including the Planned Giving Program. d. The Planned Giving program should entail the creation of a permanent endowment fund. This would be distinct from the endowment fund for maintenance of the new facility. e. The Planned Giving Program will require the naming of a Planned Giving Advisory Council. This would be composed of professionals such as an attorney, a trust officer, a CPA, a marketing person, an estate planner, a real estate broker, a major donor, etc. We envision two members of the Board also sitting on this Advisory Council to provide liaison between the Council and the Board. O • • The purpose of the Advisory Council is to build credibility to the program, to provide technical assistance, to build bridges to the respective professions represented on the council, to open doors for us. Neither Hospice of Hilo, nor its Advisory Council is going to become estate planners or legal consultants per se. If a prospective donor is inclined to make a planned gift, he or she will consult with their own attorneys to structure a gift from their estate. Our role is basically that of providing information about the benefits of estate planning and about the various gifting vehicles available. 9. What is required of the Board? a. We would expect Board members to become conversant with the basic concepts of planned giving, and to act as an information resource within their professional and person circles as the opportunity arises. This is not to suggest that Board members should actively solicit their friends and colleagues. Such solicitations should be made only after a prospective donor has been carefully cultivated over time, and after we have some reason to believe that they might be open to an overture. On the other hand, once we have determined that a prospective donor is receptive, board members will need to participate in the solicitation process. b. We would like, ideally, for every Board member eventually to make a planned gift to Hospice of Hilo. 6 • • ITEM II A (1) c Hospice of Hilo 1999 New Board and Advisory Council Training Date: February 27, 1999 Time: 8 AM to 12 Noon Present Board Members: Gary Hagerman, David Hammes, Ronny de Jong, Jack Roney, Gerald Nagata, Sarah Cope, Cora -May Jensen, Sidney Fuke, Jamie Kawauchi, Catherine Campainha, Stephen Woo, Wes Kimura, Gladys Sonomura, Carol Winegarden Advisory Council: Shigeko Chang, Jan Houser, Diana Kiefer, Boby Jean Leithead -Todd, Robert Morris, Cynthia Sorenson, and Stephen Yamashiro Staff: Brenda Ho, Ron Hart, Misae Akiona. Agenda • Welcome to Hospice of Hilo - Introductions • Faces of Hospice: 15 minute video • Operational Overview including Finances: Brenda Ho • Board Structure and Goals: Gary Hagerman • Development: Ron Hart • Questions and Answers Page 1 • • • Item II A (1) d Hospice of Hilo Strategic Priorities 1999 Date: April 24, 1999 Time: 8 AM to 12 Noon Present Board Members: Gary Hagerman, David Hammes, Ronny de Jong, Jack Roney, Gerald Nagata, Cora -May Jensen, Catherine Campainha, Stephen Woo, Wes Kimura, Gladys Sonomura, Carol Winegarden Staff Brenda Ho, Ron Hart, Misae Akiona. Absent: Sarah Cope, Sidney Fuke, Jamie Kawauchi • List of identified Board Committee Activities Deadline Committee Activities July 1, 1999 By Laws Adoption of the EMBI P and P Manual July I, 1999 By Laws Role of the Advisory Board July 1, 1999 Planning Use of Building B Sept, 1, 1999 HR/Finance Upgrade the agencies benefit package & salaries • Ongoing Objectives 1. State Licensure 2. Contingency Plan for y2k 3. Planned Giving/Major Gift Program • Prioritized Objectives 1. Hospice of Kona/Expansion/Island -wide hospice care 2. Residential Homes 2. Operational Endowment 3. Indigent Care 4. Hospice Units within existing facilities 5. Assuming a leadership role in the community about death & dying. 6. Marketing Plan 6. Thrift Store in the Puna area 7. JCAHO accreditation. Developed & Adopted April 24, 1999 Page 1 of 1 • • • Item IIA(I)e Ann Fukuhara, CPA 714 Kanoelehua Avenue Hilo, HI August 24, 1999 Board Training: Long -Range Financial Forecast and Due Diligence Study Regarding the Proposed Merger of Hospice of Hilo and Hospice of Kona Board Members in attendance: Gary Hagerman, Sidney Fuke, Dr. A Stephen Woo, Jr., Jack Roney, Cora -May Jensen, Ardeth Weed Staff in Attendance: Brenda Ho, Ron Hart, Ellen Schumann AGENDA Purpose: To examine the issues related to a possible merger, not to recommend for or against this outcome. To give the board information and tools with which to assess the prospective merger, including management issues and financial issues. When for - profit organizations decide to merge they analyze various aspects of the entity they want to acquire. The Boston Consulting Matrix is one means for analyzing the entity to be acquired: 1. Future Growth and Profitability Considerations with respect to HOK a. Can it provide market share? Can it be profitable? b. Does it possess the necessary technological know -how? c. Is the entity price competitive? d. What are the operations costs? e. What is its productivity? f. At what point in the life cycle is the entity? (e.g. emerging, mature, or declining). g. Will it provide a balanced portfolio? 2. Management Considerations a. Synergy b. Corporate Culture c. Comparative Market Positions 1 4 � • • Item II A (1) e 3. Financial Considerations a. How profitable is the entity to be acquired b. What is its growth potential? c. Cost/benefit ratio: Costs: Audit fees Costs of reorganization Due diligence Costs of change in title & benefits Change of name costs (Signage, letterhead, brochure) Accounting system costs Cash infusion costs Opportunity costs Cost of new location Additional Mileage Overtime Personnel review costs Tracking, monitoring expenses Legal fees Regulatory costs (including Medicare, change of ownership, etc.) Staff orientation, development and education Computer network hardware and software Computer technical support. Benefits: Kona growth potential Advisory Board (a wide array of specialists) Market position. HOH will have better ability to raise funds Improved access to leadership at HIUW and County 4. Strategic Implications a. Population projections indicate Kona will increase substantially. People are coming from other states. b. Technological know -how. Sharing professional talent. c. Costs involved in the merger: d. 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V .�,4 F Y `_ o o A x 47 s C) o A ° E CC v¢ 0 s s s o s o o s e. s o 0 0 o 0 0 c ° 0 0 0 o s . 0 o o o s 4-I ,r, M M O O 0 O -4 O 10 co ';114-i r r- O\ 0 .-} n M u, M 0 'O O ` ���, .� d ry O M M .o u F a a h Z > e .. a N 0 O *• .• a E F c N V y co 0 V ? }' y .�'.' at Z ",' ` i.6 p is rn W N •H u r• W' ¢ g� � t-'. :� ° 0 C Co L „ 7 al q > c 0 C7 a� 3 ° ° s A E v v N a : c y i `"' ?.a. u.. t = 0 as c u} c u P. 0 r4 N a) ca ¢� y �. x u. u 3 ° 1 U � s r- ° ,_ c o c o m °' d p '° F - 9 BUDGET ATTACHMENTS P Q Hospice of Hilo. • • County of Hawaii Grant Application FY 2000 -2001 Budget Attachment A STAFF DEVELOMENT FY 2000 -01 Grant Request Financial Table No. Budget Item Projected Expenditure . 1. National Hospice Organization, Senior Management and Leadership 2000 Conference (Executive Director) Table 3, Item 10 Per Diem ($35 /day x 6 days) $ 210 Table 3, Item 10 Air Fare 700 Table 3, Item 10 Ground Transportation 70 Table 3, Item 15 Registration 500 Table 3, Item 15 Hotel Accommodations 520 TOTAL $2,000 STAFF DEVELOPMENT GRAND TOTAL $2,000 Summary of Staff Development Budget Items: Table 3, Item 10 (Page Total) $ 980 Table 3, Item 15 (Page Total) $1,020 TOTAL $2,000 R B • • Ilospice of Hilo. County of Hawaii Grant Application FY 2000 -2001 Budget Attachment B OUTLIER EXPENSES FY 2000 -01 Grant Request Financial Table No. Budget Item Projected Expenditure . Table 2, Item 2 Medications $ 9,000 Table 2, Item 2 Durable Medical Equipment $ 2,000 Table 2, Item 2 Patient Services $ 500 Table 2, Item 2 Patient Supplies $ 500 TOTAL $13,000 • • Hospice of Hilo. County of Hawaii Grant Application FY 2000 -2001 Budget Attachment C REQUEST SUMMARY 1. Staff Development 2,000 2. Outlier Costs 13,000 TOTAL REQUEST S15,000 • • FINANCIAL QUESTIONNAIRE • G • aIY Of • O J Stephen K. Yamashiro £s '. _Wit S Harry A. Takahashi Mayor ' * .� / : • Director it : - - • g - . / S. K. Schutte • OF et Deputy m y (County of jabuaii DEPARTMENT OF FINANCE 25 Aupuni Street, Room 118 • Hilo, 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 No ESX 1. Has the agency operated continuously for the past three (3) years? (851 (S 2. Has the agency operated with a positive cash flow for the past (3) years? ( (S 3. Does your Board of Directors approve a detailed cash flow budget before the beginning of each fiscal year? accepted and (A 0 4. Do your Board meeting minutes show tha ''rc i; s c. financial statements arez d? filed for (C (.S 5. Is your equity balance at least.20% of your Total Liability balance? audit. Qi 6. Is your Total Current Asset balance larger than your Total Current Liability balance? a (5 7. Are bank reconciliations and accounting performed by someone other than the check signatory? • (1 (S 8. Are you fully insured for the agency's vehicle(s) and building(s)? ( (5 9. Is your Workers' Compensation at least 2% of payroll? ( (S 10. Are you current (not delinquent) on all payroll and payroll tax payments? (( (.S 1 1. Is the agency free of any pending litigation, liens or judgments? (S a 12. Within the past 12 months, has the agency applied for vendor or bank credit and was denied credit? If yes, please explain. As the grant applicant, 1 certify that the agency has satisfactorily responded to each of the above questions and explained as needed. / hereby certify that this information is true and correct to the best of my knowledge, Agency: Hospice of Hilo Phone: 969 -1733 Prepared by: Monica Burnett, Full Charge Bookkeeper wok) eia 1.02& -c9OW Print Name/Title i at tu� ur rep e ������ f Date Certified by: Brenda Ho, RN MS ga """'„" � t ty /L(o —Loon Print Name of Executive Director Signature Date • • CURRENT AUDIT (1997) WITH ANNUAL FINANCIAL STATEMENTS FOR 1996 AND 1997 • • HOSPICE OF HILO FINANCIAL STATEMENTS FOR THE YEARS ENDED DECMEBER 31, 1998 AND 1997, AND INDEPENDENT AUDITOR'S REPORT Alex J. Sm • • CERTIFIED PUBLIC ACCOUNTANT INDEPENDENT AUDITOR'S REPORT The Board of Directors Hospice of Hilo I have audited the accompanying statements of financial position of Hospice of Hilo (a not- for -profit organization) as of December 31, 1998 and 1997, and the related statements of activities, cash flows, and functional expenses for the years then ended. These financial statements are the responsibility of Hospice of Hilo's management. My responsibility is to express an opinion on these financial statements based on my audits. I conducted my audits in accordance with generally accepted auditing standards. Those standards require that I plan 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 and 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 statement presentation. I believe that my audits provide a reasonable basis for my opinion. In my opinion, the financial statements referred to above present fairly, in all material respects, the financial position of Hospice of Hilo as of Decmeber 31, 1998 and 1997, and the changes in net assets and its cash flows for the year then ended in conformity with generally accepted accounting principles. AtA/t c PA March 26, 1999 04111, - 2439 FERDINAND AVENUE, HONOLULU, HAWAII 96822 (877) 257-6484 FAX: (808) 951 -9527 HILO - 495 HAIHAI STREET, HILO, HAWAII 96720 • HOSPICE OF HILO • Statements of Financial Position December 31, 1998 and 1997 Assets 1998 1997 Current assets Cash and cash equivalents (Note 1) $ 235,524 $ 369,883 Accounts receivable, net (Note 3) 245,993 126,268 Grant receivable (Note 4) 787 1,188 Promises to give (Note 1) 5,621 - Prepaid expenses 8,063 3,756 Total current assets 495,988 501,095 Noncurrent assets Restricted cash and cash equivalents (Note 1) 9,508 124,163 Restricted grant receivable (Note 4) 15,000 - Restricted promises to give, net (Note 1 & 5) 277,458 359,658 Restricted security deposit (Note 1) 1,460 - Buildings and equipment, net (Notes 1 & 6) 1,910,341 196,250 Total noncurrent assets 2,213,767 680,071 Total assets $ 2,709,755 $ 1,181,166 Liabilities and Net Assets Current liabilities Accounts payable $ 39,685 $ 64,106 Accrued payroll and related liabilities 33,904 24,142 Advances (Note 7) 80,000 - Total current liabilities 153,589 88,248 Long -term debt (Note 8) 185,000 - Total liabilities 338,589 88,248 Net assets Unrestricted Board designated 20,835 293,844 Undesignated 2,340,823 315,253 2,361,658 609,097 Temporarily restricted (Notes 1 & 9) 9,508 483,821 Total net assets 2,371,166 - 1,092,918 Total liabilities and net assets $ 2,709,755 $ 1,181,166 The accompanying notes are an integral part of these financial statements. 2 • . HOSPICE OF HILO • Statements of Activities Years Ended December 31, 1998 and 1997 Changes in Unrestricted Net Assets: 1998 1997 Revenues, contributions, and other support: Revenues: Patient service revenue (Note 1) $ 1,104,537 $ 912,813 Fees from govemmental agencies 11,456 7,129 1,115,993 919,942 Contributions: - Donations 61,174 39,108 Hawaii Island United Way 24,683 14,569 Combined Federal Campaign 6,790 3,920 Beanie baby contribution 6,500 Other contributions 252 235 99,399 57,832 Other support Interest income 10,900 18,560 Fundraising 39,214 9,339 Other income 3,248 2,450 53,362 30,349 Net assets released from restrictions (Note 9): Expenditures under building campaign 1,675,379 244,438 Expenditures under restricted grant 242 - Total unrestricted revenues, contributions, and other support 2,944,375 1,252,561 Expenses: Program services 973,545 826,255 Supporting services: Management and general 149,588 144,542 Fundraising 68,681 75,603 Total expenses 1,191,814 1,046,400 Increase in uniestricted net assets 1,752,561 206,161 Changes in Temporarily Restricted Net Assets (Note 9): Contributions restricted for building campaign, net 1,191,558 580,848 Restricted grant 9,750 - Net assets released from restrictions (1,675,621) (244,438) Increaca (decrease) in temporarily restricted net assets (474,313) 336,410 Change in net assets 1,278,248 542,571 Net assets, beginning of year 1,092,918 550,347 Net assets, end of year $ 2,371,166 $ 1,092,918 The accompanying notes are an integral part of these financial statements. 3 • HOSPICE OF HILO • Statements of Cash Flows Years Ended December 31, 1998 and 1997 1998 1997 Cash flows from operating activities: Cash received from service recipients and govemmental fees $ 1,076,669 $ 924,788 Cash received from contributors 85,088 57,832 Cash received from restricted grant 9,750 - Interest and other income received 59,862 30,349 Cash paid to employees (582,732) (493,300) Cash paid to suppliers (599,470) (553,182) Net cash used by operating activities 49,167 (33,513) Cash flows from investing activities: Purchase of capital additions (1,741,939) (173,326) Change in resbicted cash and cash equivalents 114,655 (124,163) Proceeds from sale of investments - 274,154 Net cash used by investing activities (1,627,284) (23,335) Cash flows from financing activities: Proceeds from capital campaign 1,258,758 343,195 Proceeds from long -term debt 300,000 - Payments on long -term debt (115,000) - Net cash provided by financing activities 1,443,758 343,195 Net change in cash and cash equivalents (134,359) 286,347 Cash and cash equivalents, beginning of year 369,883 83,536 Cash and cash equivalents, end of year $ 235,524 $ 369,883 Reconciliation of change in net assets to net cash provided (used) by operating activities: Change in net assets $ 1,278,248 $ 542,571 Adjustments to reconcile change in net assets to net cash provided (used) by operating activities: Increase in restricted net assets (1,191,558) (580,848) Depreciation 27,848 2,667 Decrease (increase) in accounts receivable (119,725) 7,346 Decrease in grant receivable 401 - Increase in promises to give (5,621) - Decrease (increase) in prepaid expenses (4,307) 1,339 Increase in restricted security deposit (1,460) - Decrease in accounts payable (24,421) (12,886) Increase in accrued payroll and related liabilities 9,762 6,298 Increase in advances 80,000 - Net cash provided (used) by operating activities $ 49,167 $ (33,513) The accompanying notes are an integral part of these financial statements. 4 P 0 . • HOSPICE OF HILO • Statement of Functional Expenses Year Ended December 31, 1998 (With comparative totals for the year ended December 31, 1997) Program Services Supporting Services Health Management Total Expenses Care and General Fundraising 1998 1997 Expenses: Salaries and wages $ 396,017 $ 95,029 $ 17,871 $ 508,917 $ 438,648 Patient supplies and services 407,634 - - 407,634 363,520 Payroll taxes and benefits 66,536 13,718 3,323 83,577 60,950 Building campaign expenses - - 46,139 46,139 71,112 Depreciation 22,278 5,570 - 27,848 2,667 Mileage reimbursement 21,307 415 296 22,018 16,932 Rent 15,644 3,504 348 19,496 21,325 Professional fees 429 13,570 - 13,999 13,240 Telephone 6,421 5,425 - 11,846 11,965 Repairs and maintenance 7,011 1,064 213 8,288 3,234 Office supplies and expenses 2,642 4,465 32 7,139 6,353 Printing 5,629 593 5 6,227 1,160 Interest expense 4,017 565 112 4,694 - Insurance 3,339 421 77 3,837 12,599 Utilities 3,062 766 - 3,828 - Postage 2,648 935 - 3,583 2,249 Dues and subscriptions 2,214 1,030 - 3,244 2,852 Volunteer training 1,880 - - 1,880 1,161 Taxes, license and fees 1,532 340 - 1,872 - Bad debt expense - 1,368 - 1,368 6,409 Meetings and conferences 775 181 23 979 6,014 Public education 888 62 - 950 3,604 • Other 1,642 567 242 2,451 406 $ 973,545 $ 149,588 $ 68,681 $ 1,191,814 $1,046,400 The accompanying notes are an integral part of these financial statements. 5 • HOSPICE OF HILO Notes to Financial Statemenn Years ended December 31,1998 and 1997 NATURE OF OPERATIONS Hospice of Hilo (Hospice) is a private, not - for - profit organization which began providing services in 1983. Hospice provides medical, nursing, counseling and other supportive services necessary for individuals with life - limiting illnesses and their families. Hospice is certified by the Department of Health as a qualified Medicare Hospice Program. Hospice is governed by a Board of Directors, with fourteen (14) and fifteen (15) members as of December 31, 1998 and 1997, respectively. The maximum number of Directors is fifteen (15) with three (3) year term limits on the elected Directors. The Executive Director is appointed by and is responsible to the Board of Directors for the day -to-day management of Hospice. NOTE 1. SIGNIFICANT ACCOUNTING POLICIES The financial statements of Hospice have been prepared on the accrual basis of accounting in accordance with the AICPA Audit and Accounting Guide, "Not -for- Profit Organizations." The significant accounting policies followed are described below to enhance the usefulness of the financial statements to the reader. Cash and cash equivalents Cash and cash equivalents include cash held in checking accounts, and in money market accounts managed by an investment management firm. Management believes Hospice is not exposed to any significant credit risk on cash and cash equivalents. Restricted cash and cash equivalents Restricted cash and cash equivalents represents the remaining funds limited by donor restrictions for a grant in 1998, and the building campaign in 1997, and are held in checking accounts, and in money market accounts managed by an investment management firm. Promises to give Unconditional promises to give that are expected to be collected within one year are recorded at net realizable value. (See also NOTE 5). Due to materiality, unconditional promises to give that are expected to be collected in future years are also recorded at the net realizable value rather than the present value of their estimated future cash flows. Conditional promises to give are not included as support until the conditions are substantially met. Unrestricted promises to give represents pledges from donor designated funds through Hawaii Island United Way, Inc., and the Combined Federal Campaign. 6 r HOSPICE OF HILO Ilk otes to Financial Statements, Co ued Years ended December 31, 1998 and 1997 NOTE 1. SIGNIFICANT ACCOUNTING POLICIES, Continued Restricted security deposit The restricted security deposit represents a security deposit on the land lease (See NOTE 10), held in a joint certificate of deposit between the Department of Land and Natural Resources, and Hospice. The certificate cannot be accessed without authorization from both parties, and interest earned on the certificate is paid to Hospice. Buildings and equipment Buildings and equipment are carried at cost, or at fair market value at the time of donation. Maintenance and repairs are charged to expense, and betterments are capitalized. Depreciation is provided over the estimated useful lives of three (3) to forty (40) years on a straight -line basis. (See details at NOTE 6). If donors stipulate how long contributions of buildings and equipment are to be maintained, the contributions are recorded as restricted support. In the absence of such stipulations, contributions of buildings and equipment are recorded as unrestricted support. Temporarily restricted net assets Temporarily restricted net assets are those whose use by Hospice has been Limited by donors to a specific time period or purpose. Patient services revenue Patient services revenue is reported at the estimated net realizable amounts from patients, third -party payors, and others for services rendered, including estimated retroactive adjustments under reimbursement agreements with third -party payors. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered and adjusted in subsequent periods as final settlements are determined. Contributions Contributions received and unconditional promises to give are measured at their fair values and are reported as an increase in net assets. Hospice reports support of cash and other assets as restricted support if they are received with donor stipulations that limit the use of the donated assets, or if they are designated as support for future periods. When a donor restriction expires, that is, when a stipulated time restriction ends or purpose restriction is accomplished, temporarily restricted net assets are reclassified to unrestricted net assets and reported in the statement of activity as net assets released from restrictions_ Advertising costs Advertising costs are expensed as incurred. 7 HOSPICE OF HILO Illotes to Financial Statements, Co ued Years ended December 31, 1998 and 1997 • NOTE 1. SIGNIFICANT ACCOUNTING POLICIES, Continued Income taxes No provision has been made for federal or state income taxes because Hospice has obtained tax exempt status under Internal Revenue Code Section 501 (c)(3) and applicable provisions of the Hawaii Revised Statutes. Donated services No amounts have been reflected in the statements for donated services inasmuch as no objective basis is available to measure the value of such services; however, a substantial number. of volunteers have donated their time in program and support activities. NOTE 2. USE OF ESTIMATES IN PREPARATION OF FINANCIAL STATEMENTS The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. NOTE 3. ACCOUNTS RECEIVABLE Accounts receivable represents fees owed by patients and third party health insurance plans for services provided. A summary of accounts receivable as of December 31, 1998 and 1997, follows: 1998 1997 Medicare receivable $ 110,062 $ 48,805 Medicaid receivable (See also NOTE 7) 95,478 41,273 HMSA 26,795 8,899 Other commercial insurance receivable 16,158 28,423 1996 receivable - 1,368 248,493 128,768 Less allowance for uncollectible receivables 2,500 - 2,500 Patient accounts receivable, net $ 245,993 $ 126,268 NOTE 4. GRANTS RECEIVABLE Unrestricted grants receivable represents amounts due for services provided under a contract with the County of Hawaii Office of Aging. Restricted grant receivable represents the final payment due under CDBG program funds through the County of Hawaii Office of Housing and Community Development. 8 HOSPICE OF HILO • Ilkotes to Financial Statements, Co ued Years ended December 31,1998 and 1997 NOTE 5. RESTRIL 1 hD PROMISES TO GIVE Restricted promises to give represent pledges restricted by donors for the building campaign as of December 31, 1998 and 1997. Management has taken a conservative approach and set up a provision of 20% of the pledges as uncollectible. A recovery on bad debt will be recognized in the future if Less than 20% of pledges are ultimately found to be uncollectible. At December 31, 1998, restricted promises to give and the expected timing of receipts were as follows: To be received in less than one year $ 154,013 To be received in one to five years 192,445 346,458 Less allowance for uncollectible pledges 69,000 $ 277,458 NOTE 6. BUILDINGS AND EQUIPMENT A summary of the Hospice's investment in buildings and equipment as of December 31,1998 and 1997, is set forth hereunder: Estimated Useful Lives 1998 1997 Building 40 years $ 1,776,168 $ - Furniture and fixtures 10 years 116,559 - Machinery and equipment 7 -3 years 44,960 21,671 Leasehold improvements 15 years 6,941 6,941 Computer software 5 years 5,543 - 1,950,171 28,612 Less accumulated depreciation 39,830 20,405 1,910,341 8,207 Construction in progress - building - 188,043 $ 1,910,341 $ 196,250 NOTE 7. ADVANCES Advances represent an advance from Medicaid for payments due to Hospice. Subsequent to year-end, Medicaid also paid many of the receivables covered by the advance. Therefore, the Medicaid advance will be applied to future Medicaid billings, paid back, or a combination of the two. 9 . HOSPICE OF HILO otes to Financial Statements, Co ued Years ended December 31, 1998 and 1997 NOTE 8. LONG-TERM DEBT Set forth hereunder is a summary of Hospice's long -term debt as of December 31, 1998: Bank of Hawaii, revolving line of credit up to $300,000, interest at 8.25% at December 31, 1998 (floating rate based on Hawaii base rate plus 0.50%), interest payable monthly, matures June 30, 2002, collateralized by security interest in capital campaign pledges, buildings and equipment, accounts receivable, and BOH deposit accounts. $ 185,000 Principal payments under the line of credit are due the month following a pledgor's payment in full under the pledgor's capital campaign pledge, and in full by June 30, 2002. NOTE 9. TEMPORARILY RESTRIC. ED NET ASSETS Hospice's temporarily restricted net assets relate to the building campaign and a restricted grant. Earnings on building campaign contributions are not restricted, unless specifically so restricted by the donor. Net assets are released from donor restrictions by incurring expenses satisfying the restricted purposes or by occurrence of other events specified by donors. Activities related to temporarily restricted net assets for the years ended December 31, 1998 and 1997, are as follows: 1998 1997 Temporarily Irbil icted net assets, beginning of year $ 483,821 $ 147,411 Contributions restricted by donors for the building Campaign (pledges and direct donations) 1,170,558 639,848 Provision for uncollectible pledges 21,000 (59,000) 1,191,558 580,848 Grant restricted by donor for Planned Giving 9,750 - 1,685,129 728,259 Less temporarily restricted net assets released for: Construction in progress - building 1,629,240 173,326 Building campaign expenses 46,139 71,112 Planned giving expenses 242 - 1,675,621 244,438 Temporarily restricted net assets, end of year $ 9,508 $ 483,821 10 • • HOSPICE OF HILO otes to Financial Statements, C ued Years ended December 31, 1998 and 1997 NOTE 10. OPERATING LEASES Hospice entered into a month - to-month lease for office space as of June 1, 1997, as a transition to the new building. Rent under the new lease was $1,250 for June 1997, and $2,000 per month thereafter. Previously, Hospice leased office space on a month - to-month basis from the State of Hawaii at $210 per month. Hospice also entered into a lease for approximately two (2) acres as the site for the new building, with the State of Hawaii, Department of Land and Natural Resources (DLNR), under General Lease No. 5 -5513. The term of the lease is 65 years, beginning on October 1, 1997,and ending September 30, 2062 Minimum annual rent under the Iease is initially $730, with the annual rent being reopened and redetermined every 10 years under the lease. According to an independent appraisal obtained by DLNR, the annual rent for the new building site represents 25% of the its fair market value rent. Also, management believes that the market value of renting the previous office space was $700 per month Accordingly, in 1998 and 1997, Hospice recorded additional rent expense of $2,190 and $2,998, respectively, offset by contribution support of an equal amount. Hospice also rents its office copier at $313 per month under an agreement from March 1996 through March, 1999. Management has determined that treatment of the copier agreement as an operating lease rather than capital lease does not have a material effect on the financial statements. Rental expense under the above leases for the year ended December 31,1998 and 1997 was $19,496 and $21,325, respectively. Future minimum lease payments under the above DLNR and copier leases for the next five (5) years, as of December 31,1998, are as follows: 1999 $ 1,356 2000 730 2001 730 2002 730 2003 730 $ 4,276 11 HOSPICE OF HILO el ites to Financial Statements, Coiled Years ended December 31,1998 and 1997 NOTE 11. FUNCTIONAL CLASSIFICATION OF EXPENSES The costs of providing the various programs and supporting services have been summarized on a functional basis in the statement of functional expenses. Accordingly, certain costs have been allocated among the programs and supporting services benefited. NOTE 12. RECLASSIFICATIONS Certain reclassifications have been made to the 1997 financial statements to conform to the 1998 presentation. 12 • • • IRS FORM 990 Ceram No 6(07 dZo - a. Form 990 C r .. •• ' •an t a pt F m ome Tax pvi s { '69 1 • ) a •f the Int Revenue Code (except black lung benefit tttSSS • trust or private forme a ion) or section 4947(a)(1) nonexempt charitable trust This Form Is Department of the Treasury Open to Public Internal Revenue Service Note: The organization may have to use a copy of this return to satisfy state reporting requirements. Inspection A For the 1998 calendar year, OR tax year period beginning , 1998, and ending , 19 B Check if: please C Name of organization ' D Employer identification number ❑ change or address use IRS HOSPICE OF HILO I 99- 0218512 abet or ❑ Initial return print or Number and street (or P.O. box if mail is not delivered to street address) Room/suite E Telephone number O Final return Vi 1011 WAIANUENUE AVE. I (808) 969 -1733 9 Amended 'alum speclnc City or town, stale or country, and Z1P+4 (required also for Instruc- F Check). 0 if exemption application Slate reporting) do s. HILO, HI 96720 is pending G Type of organization — jr. ® Exempt under section 501(c) ( 3 ) . 4 (insert number) OR O. U section 4947(a)(1) nonexempt charitable trust Note: Section 501(c)(3) exempt organizations and 4947(a)(1) nonexempt charitable trusts MUST attach a completed Schedule A (Form 990). H(a) Is this a group return filed for affiliates? D Yes IN No 1 If either box in H is checked 'Yes,' enter four-digit group exemption number (GEN) (b) If 'Yes' enter the number of affiliates for which Ihis return is filed: l► J Accounting method: 0 Cash © Accrual (c) Is this a separate return filed by an organization covered by a group ruling? ... ❑ Yes © No ❑ Other (specify) 11. K Check here ► ❑ if the organization's gross receipts are normally nol more than $25,000. The organization need not file a return with the IRS; but if il received a Form 990 Package in the mail, it should file a return without financial data. Some states require a complete return. Note: Form r. P::art 1 1 i 990 may be used by organizations with gross receipts less than $100,000 and total assets less than $250,000 at end of yea I. Revenue, Expenses, and Changes in Net Assets or Fund Balances (See Specific Instructions on page 13.) 1 Contributions, gifts, grants, and similar amounts received: a Direct public support la 1, 268, 982 • b Indirect public support 1b 31,725 c Government contributions (grants) lc 11,4 56 d Total (add lines la through 1c) (attach schedule of contributors) (cash$ 1,306,085 noncash$ 6,078 ) SEE STMT 1 ' 1d 1,312,163 2 Program service revenue including government fees and contracts (from Part VII, line 93) 2 1,104,537 3 Membership dues and assessments 3 4 Interest on savings and temporary cash investments 4 10, 900 5 Dividends and interest from securities 5 6a Gross rents 16a b Less: rental expenses 6b1 c Net rental income or (loss) (subtract line 6b from line 6a) 6a c 7 Other investment income (describe► ) 7 O 8a Gross amount from sale of assets other (A) securities (8) Other tY than inventory 8a b Less cost or other basis and sales expenses . 8b ME c Gain or (loss) (attach schedule) 8c d Net gain or (loss) (combine line 8c, columns (A) and (8) 8d 9 Special events and activities (attach schedule) SEE STMT 2 a Gross revenue (not including $ of contributions reported on line 1a) 19a I 39,, 214 b Less: direct expenses other than fundraising expenses l 9b I c Net income or (loss) from special events (subtract line 9b from line 9a) 9c 39,214. 10a Gross sales of inventory, less returns and allowances I10a b Less: cost of goads sold 10b ! _ c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b fr m line 10a) i 10c 11 Other revenue (from Part VII, line 103) 11 - 3,248 12 Total revenue (add lines 1d, 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 11) 12 2,470,062 13 Program services (from line 44, column (8)) 13 973, 545 f cg • 14 Management and general (from line 44, column (C)) 14 14 9, 588 $ 15 Fundraising (from line 44, column (D)) 15 68, 681 w 16 Payments to affiliates (attach schedule) • 16 17 Total expenses (add lines 16 and 44, column (A)) • 17 1,191,814 ii 18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 1, 27 8, 24 8 a 19 Net assets or fund balances at beginning of year (from line 73 column (A)) 19 1,092,918 , 20 Other changes in net assets or fund balances (attach explanation) 20 z 21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) i 21 2,371,166 For Paperwork Reduction Act Notice, see page 1 of the separate instructions. ISA r Form 990 (1998) STFFEDI923F1 - I • ' • ~ Form 990 (1998) 7 '-.> / I =ti it :part Il : Statement of All organizations must complete column (A). Columns (8). (C). an. 1) are required for section 501(c)(3)an• 4 ati• Functional Expenses and section 4947(a)(1) nonexempt charitable trusts but optional for others. (Sec Specific lnstru9ion{ g ) Do not include amounts reported on line (A) Total (8) Program (C) Management (D) Fundraising 6b, 8b, 9b, 106, or 16 of Par( I. services and general 22 Grants and allocations (attach schedule) (cash $ noncash $ ) 22 23 Specific assistance to individuals (attach schedule) 23 24 Benefits paid to or for members (attach schedule) 24 _ " . 25 Compensation of officers, directors, etc 25 56, 892 , 56, 892 26 Other salaries and wages 26 452,026 396,1017 38, 137 17, 871 27 Pension plan contributions 27 i 28 Other employee benefits 28 36,763 29,1721 5,457 1,585 29 Payroll taxes 29 46, 814 36,'815 8,261 1,738 30 Professional fundraising fees 30 12, 591 31 Accounting fees 31 13, 999 429 13, 570 32 Legal fees 32 33 Supplies 33 20, 327 20, 327 34 Telephone 34 11,846, 6,421 5,425 35 Postage and shipping 35 3, 583 2, 648 935 36 Occupancy 36 19,228 15,382 3,846 37 Equipment rental and maintenance 37 89, 792 87,743 1,488 561 38 Printing and publications 38 7, 177 6, 517 655 5 39 Travel 39 1,085 821 264 40 Conferences, conventions, and meetings 40 979 775 181 23 41 Interest 41 4,694 4,017 565 112 42 Depreciation, depletion, etc. (attach schedule) . 42 27,848 22,278 5,570 43 Other expenses (itemize): aSTMT 3 43a 398, 762 343, 634 8,342 34, 195 b 43b c 43c d 43d e 43e 44 Total functional expenses (add lines 22 through 43) organizations completing columns (B) -(D), carry these totes fo /inn l3./5 44 1,191,815 973,545 149,588_ 68, 681 Reporting of Joint Costs. — Did you report in column (B) (Program services) any joint costs from a combined educational campaign and fundraising solicitation? ► ❑ Yes IN No If 'Yes, enter (i) the aggregate amount of these joint costs $ ; (ii) the amount allocated to Program services $ (iii) the amount allocated to Management and general $ ; and (iv) the amount allocated to Fundraising $ IOW Statement of Program Service Accomplishments (See Specific Instructions on page 20.) What is the organization's primary exempt purpose? ► SEE STATEMENT 4 Program Service M organizations mud describe their exempt purpose achievements in a dear and concise manner. State the number of clients served, publications 01 J for a a)(3) issued, etc. Discuss achievements that are not measurable. (Section 501(c)(3) and (4) organizations and 4947(a)(1) nonexempt charitable trusts a947( end 1 ags., sae eosts must also enter the amount of grants and allocations to others.) '‘i. apeo n u) aMea4 .) a THE_TERMINALLX_LLL FEU ASSISTED _IN_ JaVING7•_IN CaMF4at DJGNITX_ AND_ THE.IA. JAMILI£.S_. _WERE_PAQVJDED_WITH RESPITE. _CARE. _ SOUNSE.LINS_ AND _EROflDNBL _suyrDRT (Grants and allocations $ i ) 973, 545 b 1 1 (Grants and allocations $ ) c (Grants and allocations $ ) d (Grants and allocations $ - ) e Other program services (attach schedule) (Grants and allocations $ j ) f Total of Program Service Expenses (should equal line 44, column (B), Program services) ■ 97 3, 54 5 STF FED1923F.2 ■ Form 990 (1998) F tip, r Part IV I Balance Sheets (See Specific Instructions on page 20.) Note: Where required, attached schedules and amounts within the description (A) (B) column should be for end -of -year amounts only Beginning of year End of year 45 Cash — non - interest - bearing .. _ • 45 46 Savings and temporary cash investments 999,096 46 295,032 47a Accounts receivable 47a 298,993 b Less: allowance for doubtful accounts 47b 2, 500 1 126, 268 47c 295,993 48a Pledges receivable 48a 352,079 b Less: allowance for doubtful accounts 48b 69, 000 359, 658 48c 283, 079 49 Grants receivable 1,188 49 15,787 50 Receivables from officers, directors, trustees, and key employees (attach schedule) 50 51a Other notes and loans receivable (attach schedule) I 513 N w b Less: allowance for doubtful accounts 51b 510 N rn 52 Inventories for sale or use 52 Q 53 Prepaid expenses and deferred charges 3, 756 53 8, 063 54 Investments — securities (attach schedule) 54 553 Investments — land, buildings, and equipment basis 553 b Less: accumulated depreciation (attach schedule) 55b 55c 56 Investments — other (attach schedule) 56 57a Land, buildings, and equipment basis 57a 1,950,171 b Less: accumulated depreciation (attach schedule) SE.E. STMT 5 57b 39,830 196,250 57c 1,910,341 58 Other assets (describe ii. SECURITY DEPOSIT ) 58 1,460 59 Total assets (add lines 45 through 58) (must equal line 74) 1,181,166 59 2,709,755 60 Accounts payable and accrued expenses 88,248 60 73,589 61 Grants payable 61 62 Deferred revenue 62 v 63 Loans from officers, directors, trustees, and key employees (attach get schedule) 63 W 64a Tax - exempt bond liabilities (attach schedule) 64a n b Mortgages and other notes payable (attach schedule) 64b 185, 000 65 Other liabilities (describe ► MEDICAID ADVANCE ) 65 80,000 66 Total liabilities (add lines 60 through 65) ' ` , 88,248 66 338,589 Organizations that follow SFAS 117, check here ► Q and complete lines x 67 through 69 and lines 73 and 74. $ 67 Unrestricted • 1609, 097 67 2,361,658 ` m 68 Temporarily restricted 1983, 821 68 9,508 To 69 Permanently restricted ja . 69 c Organizations that do not follow SFAS 117, check here ► ❑ and /. 1i complete lines 70 through 74. a 70 Capital stock, trust principal, or current funds 70 ▪ 71 Paid - in or capital surplus, or land, building, and equipment fund 71 SD • 72 Retained earnings, endowment, accumulated income, or other funds .. 72 4 73 Total net assets or fund balances (add lines 67 through 69 OR lines ru 70 through 72; column (A) must equal line 19 and column (8) must '` equal line 21) 1,i092,918 73 2,371,166 74 Total liabilities and net assets / fund balances (add lines 66 and 73) 1,181,166 74 _ 2,709,755 Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization. How the public perceives an organization in such cases may be determined by the information presented on its return. Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments. 1 SIFFED1923F.3 • Form 990 (1998) r /a ■i✓Y Part IV -A ; Reconciliation of Revenue per Audited Part IV -B ! Reco iliation of Expen ^ •e Mr : ' 1 f Financial Statements with Revenue per Financial Statements with pe • r ( f Return (See Specific Instructions, page 22.) Return a Total revenue, gains, and other support per a Total expenses and losses per audited financial statements ► a 2,470,062 audited financial statements .... 0.. a 1,191,814 . . b Amounts included on line a but not b Amounts included on line a but not on line 12, Form 990: on line 17, Form 99 . • (1) Net unrealized gains (1) Donated services on investments.... $ and use of facilities 1 $ (2) Donated services (2) Prior year adjustments and use of facilities $ reported on line 20, (3) Recoveries of prior Form 990 I $ year grants $ (3) Losses reported on (4) Other (specify): line 20, Form 990 .1 3 (4) Other (specify): $ Add amounts on lines (1) through (4)0. b $ Add amounts on lines (1) through (4)► b c Linea minus line b ► c 2,470,062 c Linea minus line b ■ c 1,191,814 d Amounts included on line 12, d Amounts included on line 17, Form 990 but not on line a: .................._......................_ Form 990 but not on line a: (1) Investment expenses : (1) Investment expenses not included on line not included on line 6b, Form 990 $ 6b, Form 990 ....' $ (2) Other (specify): (2) Other (specify): � ?: $ $ Add amounts on lines (1) and (2) ► d Add amounts on lines (1) and (2) ► d e Total revenue per line 12, Form 990 e Total expenses per line 17, Form 990 (line c plus line d) ■ e 2,470,062 (line c plus line d) ► e 1,191,814 l Part V l List of Officers, Directors, Trustees, and Key Employees (List each one even if not compensated; see Specific Instructions on page 22.) . (8) Title and average hours per (C) Compensation (D) Contributions to (E) Expense . (A) Name and address week devoted to position (If not paid, employee benefit plans & account and other enter - deferred compensation allowances SEE STATEMENT 7 i i • • 75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than 310,000 was provided by the related organizations? i ► [] Yes © No If "Yes," attach schedule — see Specific Instructions on page 22. i I STF FED1923FA • Form , 990 (1998) • � /�/ (part VI I Other Information (See Specific Instructions on page 23.) � C / No U 76 Did the organization engage in any activity not previously reported to the IRS? If 'Yes; attach a detailed description of each activity .... 76 X 77 Were any changes made in the organizing or governing documents but not reported to the IRS? 77 X If 'Yes,' attach a conformed copy of the changes. _ 78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return? 78a X b 11 •Yes," has it filed a tax return on Form 990 - for this year? 1 78b 79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If "Yes; attach astatement 79 X 80a Is the organization related (other than by association with a statewide or nationwide organization) through common membership, governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization? I 80a X b If 'Yes,' enter the name of the organization • and check whether it is ❑ exempt 012 ❑ nonexempt. 81a En the hen for amount of political 81 expenditures, direct or indirect, as described in the 8'1 a I NONE ............................... b Did the organization file Form 1120 -POL for this year? i 81b X 82a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fair rental value? 82a X b If 'Yes," you may indicate the value of these items here. Do not include this amount as revenue in Part I or as an expense in Part II. (See instructions for reporting in Part III.) 1 NOT VALUED 83a Did the organization comply with the public inspection requirements for returns and exemption applications? .. 83a X b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? 83b X 84a Did the organization solicit any contributions or gifts that were not tax deductible? .. 84a X b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or .. gifts were not tax deductible? 84b 85 501(c)(4), (5), or (6) organizations. — a Were substantially all dues nondeductible by members? 85a b Did the organization make only in -house lobbying expenditures of $2,000 or less? 85b . .............................. If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the prior year. c Dues, assessments, and similar amounts from members 85c N/A d Section 162(e) lobbying and political expenditures 85d N/A e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85e N/A f Taxable amount of lobbying and political expenditures (line 85d less 85e) 851 0 ::::::::::::::::::i ::::,.,i g Does the organization elect to pay the section 6033(e) tax on the amount in 85f? ... 85g h If section 6n11(e)(1)(A) dues notices were sent, does the organization agree to add the amount in 851 to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax yeah 85h 86 501(c)(7) organizations. — Enter. a Initiation fees and capital contributions included on line 12 86a N/A b Gross receipts, included on line 12, for public use of club facilities 86b N/A 87 501(c)(12) organizations. — Enter. a Gross income from members or shareholders - 87a N/A b Gross income from other sources. (Do not net amounts due or paid to other' j - sources against amounts due or received from them.) 87b N/A 88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership? If 'Yes,' complete Part IX - I 88 X 89a 501(c)(3) organizations. — Enter: Amount of tax imposed on the organization during the[ year under: section 4911 ► NONE ; section 4912 ► NONE _3 ; section 4955 • NONE b 501(c)(3) and 501(c)(4) organizations. — Did the organization engage in/any section 4958 excess benefit transaction during the year? If "Yes,' attach a statement explaining each transaction i - 89b X c Enter: Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 I • NONE d Enter: Amount of tax in 89c, above, reimbursed by the organization I • N/A 90a List the states with which a copy of this return is filed • b Number of employees employed in the pay period that includes March 12, 1998 (See instructions.) 190b 14 91 The books are in care of► MONICA BURNETT Telephone no. 0. ( 808) 96'9 -1 /33 Located at► 101 WAIANUENUE AVE., HILO, HI ZIP t 4► 96720 92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041 — Check here • ❑ and enter the amount of tax - exempt interest received or accrued during the tax year ! ► 192 STF FED1923F.5 1 • Form 990 (1998) r P b 1 Part VII : ' Analysis of Income -Pro• ucing Activities (See Specific Instructio on page 27) W C? `�J 1 I Enter gross amounts unless otherwise Unrelated business income Excluded by section 512. 513. or 514 (E) indicated. (A) (B) (C) (0) Related or 93 Program service revenue: Business code Amount Exclusion code Amoun exemp lion a COMMERCIAL INS. REIMB, 162,869 b c d e f Medicare/Medicaid payments 941, 668 g Fees and contracts from govemment agencies 94 Membership dues and assessments 95 Interest on savings and temporary cash investments 14 10, 900 96 Dividends and interest from securities 97 Net rental income or (loss) from real estate: a debt - financed property b not debt - financed property 98 Net rental income or (loss) from personal property .. 99 Other investment income 100 Gain or Coss) from sales of assets other than inventory 01 39, 214 101 Net income or (loss) from special events .. 102 Gross profit or (loss) from sales of inventory 103 Other revenue: a 3, 248 b _ c d e 104 Subtotal (add columns (B), (D), and (E)) ,._.<;;: ::: 50,114 1, 107, 785 105 Total (add line 104, columns (9), (D) and (E)) ► 1,157,899 Note: (Line 105 plus line 1d, Part 1, should equal the amount on line 12, Part l.) PartVIU. Relationship of Activities to the Accomplishment of Exempt Purposes (See Specific Instructions on page 28.) Line No. Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization's exempt purposes (other than by providing funds for such purposes). 93AREIMBURSEMENTS RECEIVED FROM COMMERCIAL INSURANCE ORGANIZATIONS FOR THE SERVICES PROVIDED TO PATIENTS. 93F REIMBURSEMENTS RECEIVED FROM MEDICARE /MEDICAID FOR THE SERVICES PROVIDED TO PATIENTS. 103A REIMBURSEMENTS FOR MATERIAL AND OTHER COSTS-.FOR EDUCATIONAL SEMINARS. Part IX ; Information Regarding Taxable Subsidiaries (Complete this Part if the "Yes" box on line 88 is checked.) Name, address, and employer identification Percentage of Nature of I Total End-of -year number of corporation or partnership ownership interest Jgusiness activities income - assets % 1 Under penalties of perjury, I declare that I have e rn, including accompanying schedules and statements, and to the best of my knowledge Please and beli.. it is tye, correct, and plot- ®. pr et (other than officer) Is based on all information of which preparer has any knowledge. (See Sign caner ��ru ` nll,;. ;°.: : /dd ' 4`f ' lib in Q *:a 1 .� f . r (: Here a ?nature of officer 1SV• ppp aaa���'aaa' Type or print name d t' e. U Date Check if Preparers 5511 Paid Preparers • setf- Preparer's cignatare d►© 11) employe 563 -65 -4684 Use Only Firm's name (or ALE J. I , CFA EIN • and address + 4 y self 2439 FERDINAND AVE., HONOLULU HI ZIP • 96822 and ad STF FEO1923F.6 • SCHEDULEA Orgalltion Exempt Under Sectiol J l(c)(3) .w y (Form 990) (Except Private Foundation) and Section 501(e), 601(0 1(k), (, 501(n), or Section 4947(a)(1) Nonexempt Charitable Trust Supplementary Information 1998 Department of the Treasury See separate instructions. Interne/ Revenue SeMAce ► Must be completed by the above organizations and attached to their Form 990 or 990 - EZ. Name of the organization Employer Identification number HOSPICE OF HILO 99- 0218512 part I1 Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See instructions on page 1. List each one. If there are none, enter `None ?) N ame and address of each employee paid m ore (b) T db e average hours (tl) C benefit plans (e) Expense (e ) ( ) 0 (e) Cwnpensetion employee deferred Mne pan s account and other Than $50,000 per week devoted to position deferred peiw0ai allowances MISAE AKIONA CLINICAL DIR. PO BOX 1673 HILO, HI 96720 FT 55,206 0 0 SHANNON LIBAO RN CASE MNGR. 25 -3352 PAKELEKIA ST. HILO, HI 96720 FT 58,438 0 0 Total number of other employees paid over $50,000 ► NONE .. .. ... rpoOtil Compensation of the Five Highest Paid Independent Contractors for Professional Services (See instructions on page 1. List each one (whether individuals or firms). If there are none, enter `None.") (a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation KOKUA NURSES 1210 AUAHI ST., SUITE 223 HONOLULU, HI 96825 NURSING SERVICES 123,430 • / e Total number of others receiving over $50,000 for _< professional services ► NONE For Paperwork Reduction Act Notice, see page 1 of the Instructions for Form 990 and Fonn 990 -EZ. Schedule A (Form 990) 1998 IS" STFFEO19S5F.1 • b • Schedule A (Form 990) 1998 Part III.I Statements About Activities No 1 During the year, has the organization attempted to influence national, state, or local legislation. including any attempt to influence public opinion on a legislative matter or referendum? 1 X ............................ ............................ ............................. ............................... ......... .................... If - Yes - enter the total expenses paid or incurred in connection with the lobbying activities ■ $ N/A • Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI -A. Other organizations checking "Yes; must complete Part VI -B AND attach a statement giving a detailed description of the lobbying activities. 2 During the year has the organization, either directly or indirectly, engaged in any of the following acts with any of its trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such :# person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary: nnimnimo a Sale, exchange, or leasing of property? 2a X h Lending of money or other extension of credit? 2b X c Furnishing of goods, services, or facilities? , 2c X d Payment of compensation (or payment or reimbursement of expenses if more than 81,000)? FORM 9 9 0 r FART V 2d X e Transfer of any part of its income or assets? 2e X If the answer to any question is 'Yes,' attach a detailed statement explaining the transactions. 3 Does the organization make grants for scholarships, fellowships, student loans, etc.? 3 X 4a Do you have a section 403(b) annuity plan for your employees? 4a X b Attach a statement to explain how the organization determines that individuals or organizations receiving grants or loans from it in furtherance of its charitable programs qualify to receive payments. (See instructions on page 2.) [Naii.N1 Reason for Non - Private Foundation Status (See instructions on pages 2 through 4.) The organization is not a private foundation because it is: (Please check only ONE applicable box.) 5 A church, convention of churches, or association of churches. Section 170(b)(1)(A)(i). 6 fl A school. Section 170(b)(1)(A)(ii). (Also complete Part V, page 4.) 7 fl A hospital or a cooperative hospital service organization. Section 170(b)(1)(A)(iii). • 8 fl A Federal, state, or local government or governmental unit. Section 170(b)(1)(A)(v). 9 A medical research organization operated in conjunction with a hospital. Section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state ► 10 D An organization operated for the benefit of a college or university owned or operated by a governmental unit. Section 170 (b)( 1 )(A)(w). (Also complete the Support Schedule in Part IV-A.) 11a ® An organization that normally receives a substantial part of its support from a governmental unit or from the general public. Section 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV -A.) 11b ❑ A community trust. Section 170(b)(1)(A)(vi). (Also complete the Support Schedule imPart IV -A.) 12 ❑ An organization that normally receives: (1) more than 3343% of its support from contributions, membership fees, and gross receipts from activities related to its charitable, etc., functions— subject to certain exceptions, and (2) no more than 3343% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Also complete the Support Schedule In Part IV -A.) 13 ❑ An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in: (1) lines 5 through 12 above; or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2). (See section 509(a)(3).) - Provide the following information about the supported organiizations. (See instructions on page 4.) - (a) Name(s) of supported organization(s) (b) Line number from above 14 ❑ An organization organized and operated to test for public safety. Section 509(a)(4). (See instructions on page 4.) STF FED1955F.2 Schedule A (Form 990) 1998 • °' Part (V.A 1 Support Schedule (Complete only if you checked a box on line 10, 1. 12. ) Use cash ',,' /`(hood . 8 g. Note: You may use the worksheet in the instructions for converting from the accrual to the casrP eth, I�a•�ting. • Calendar year (or fiscal year beginning in) ► (a) 1997 (b) 1996 (c) 1995 (d) 1994 (e) Total 15 Gifts, grants, and contributions received. (Do not include • unusual grants. See line 28.) 901,027 192,480 56, 906 81,969 682, 377 16 Membership fees received 17 Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is not a business unrelated to the organization's charitable, etc., purpose 924,788 839, 592 _, 165, 414 566,755 3,996,549 18 Gross income from interest, dividends, amounts received from payments on securities loans (section 512(a)(5)), rents, royalties, and unrelated business taxable income (less section 511 taxes) from businesses acquired by the organization after June 30, 1975 27,899 25, 556 14, 492 14,482 82, 429 19 Net income from unrelated business activities not included in line 18 20 Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf 21 The value of services or facilities furnished to the organization by a governmental unit without charge. Do not include the value of services or facilities generally furnished to the public without charge 22 Other income. Attach a schedule. Do not include gain or (loss) from sale of capital assets 2,450 1,577 2,271 1,159 7,457 23 Total of lines 15 through 22 ', 356, 164_, 009,2051_, 239,083 664,360 4,268,812 24 Line 23 minus line 17 431,376 169, 613 73, 669 97, 605 772,263 25 Enter l %of fine 23 13, 562 10, 092 12, 391 6, 644 26 Organizations described on lines 10 or 11: a Enter 2% of amount in column (e), line 24 • 26a 15,445 ............ ............................... ............ ............................... b Attach a list (which is not open to public inspection) showing the name of and amount contributed by each person (other than a govemmental unit or publicly supported organization) whose total gifts for 1994 through 1997 exceeded the amount shown in line 26a. Enter the sum of all these excess amounts ► 26b c Total support for section 509(a)(1) test Enter line 24, column (e) ► 26c 772,263 d Add: Amounts from column (e) for lines: 18 82,429 19 22 7,457 266 ■ 26d 89,886 e Public support (line 26c minus line 26d total) ► 26e 682,377 f Public support percentage (line 26e (numerator) divided by line 26c (denominator)) • 261 88.36% 27 Organizations described on line 12: a For amounts included in lines 15, 16, and 17 thatwereteceived from a'disqualiified person," attach a list to show the name of, and total amounts received in each year from, each 'disqualified person:' Enter the et= of such amounts for each year: (1997) (1996) (1995) (1994) b For any amount included in line 17 that was received from a nondisqualified person, attach a list to show the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000. (Include In the list organizations described in lines 5 through 11, as well as individuals.) After computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year: (1997) (1996) (1995) (1994) • c Add: Amounts from column (e) for lines: 15 16 17 20 21 ► 27c d Add: Line 27a total ... and line 27b total .... �. 27d e Public support (line 27c total minus line 27d total) • 27e 1 Total support for section 509(a)(2) test Enter amount on line 23, column (e) ► 1 271 I $ . g Public support percentage (line 27e (numerator) divided by line 27( (denominator)) ►- 27g • Investment income percentage (line 18, column (e) (numerator) divided by line 271 (denominator)) ► 27h 28 Unusual Grants: For an organization described in line 10, 11, or 12 that received any unusual grants during 1994 through 1997, attach a list (which is not open to public inspection) for each year showing the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant. Do not include these grants in line 15. (See instructions on page 4.) STF FED1955F.3 Schedule A (Form 990) 1998 • .— /_' ', .PalitAti Private School Questionnaire (See instructions on page 4.) (To be completed ONLY by schools that checked the box on line 6 in Part IV) N• y • ' r,E • Yes No 29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing Instrument, or In a resolution of its governing body? 29 .............................. 30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues, Ja and other written communications with the public dealing with student admissions, programs, and scholarships? 30 ......... ........ ................... 31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general community it serves? 31 .............................. If 'Yes," please describe; if "No; please explain. (If you need more space, attach a separate statement.) 32 Does the organization maintain the following: a Records indicating the racial composition of the student body, faculty, and administrative staff? 32a b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis? 321, c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student admissions, programs, and scholarships? 32c d Copies of all material used by the organization or on its behalf to solicit contributions? 32d If you answered 'we to any of the above, please explain. (If you need more space, attach a separate statement.) _,..,..... _ '.._... 33 Does the organization discriminate by race in any way with respect to: a Students' rights or privileges? 33a b Admissions policies? 33b c Employment of faculty or administrative staff? 33c d Scholarships or other financial assistance? 33d e Educational policies? 33e f Use of facilities? 33f g Athletic programs? 1 33g • h Other extracurricular activities? • 33h If you answered "Yes' to any of the above, please explain. (If you need more space, ath a separate statement.) 34a Does the organization receive any financial aid or assistance from a governmental agency? 34a b Has the organization's right to such aid ever been revoked or suspended? 34b .............................. ............................... .............................. If you answered Nes' to either 348 or b, please explain using an attached statement. 35 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05 of Rev. Proc. 75-50, 1975 -2 C.B. 587, covering racial nondiscrimination? 11 'No; attach an explanation 35 STFFEDIOSSF.4 Schedule A (Form 990) 1998 A A � / '' 5 9 Part VI A Lobbying Expenditu - by Electing Public Charities (See inst - ons on page 6. - L (To be completed ONLY by an eligible organization that filed Form 5768) _ 1 Check here I. a ❑ if the organization belongs to an affiliated group. Check here ► b ❑ if you checked "a" above and - limited control" provisions apply • (a) (b) Limits on Lobbying Expenditures Affiliated group To be completed totals for ALL electing (The term "expenditures" means amounts paid or incurred.) organizations 36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37 38 Total lobbying expenditures (add lines 36 and 37) 39 39 Other exempt purpose expenditures • 39 40 Total exempt purpose expenditures (add lines 38 and 39) 40 41 Lobbying nontaxable amount. Enter the amount from the following table — .: # 11 the amount on line 40 is — The lobbying nontaxable amount is — Not over $500,000 20% of the amount on line 40 Over $500,000 but not over $1 ,000,000 $100,000 plus 15% of the excess over $500,000` Over $1,000,000 but not over $1500,000 $175,000 plus 10% of the excess over 31,000,000 41 Over 31,500,000 but not over 317,000,000 3225,000 plus 5% of the excess over $1500,000 Over 317,000,000 31,000,000 . 42 Grassroots nontaxable amount (enter 25% of line 41) 42 43 Subtract line 42 from line 36. Enter -0- if line 42 is more than line 36 43 44 Subtract line 41 from line 38. Enter -0- if line 41 is more than fine 38 44 Caution: If there is an amount on eifherkne 43 or fine 44, you must file Form 4720. 4 -Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 45 through 50 on page 7.) Lobbying Expenditures During 4 -Year Averaging Period Calendar year (or (a) (b) (c) (d) (e) fiscal year beginning in) I. 1998 1997 1996 1995 Total 45 Lobbying nontaxable amount 46 Lobbying ceiling amount (150% of line 45(e)) ..... 47 Total lobbying expenditures 48 Grassroots nontaxable amount • 49 Grassroots ceiling amount (150% of line 48(e)) 50 Grassroots lobbying expenditures [Oft:yrojEl Lobbying Activity by Nonelecting Public Charities • (For reporting only by organizations that did not complete Part VI -A) (See instructions on page 8.) During the year, did the organization attempt to influence national, state or local legislation, inc)yding any attempt to influence Yes No Amount public opinion on a legislative matter or referendum, through the use of: r a Volunteers X b Paid staff or management (Include compensation in expenses reported on lines c through h.) ){ c Media advertisements X d Mailings to members, legislators, or the public X e Publications, or published or broadcast statements X f Grants to other organizations for lobbying purposes X g Direct contact with legislators, their staffs, govemment officials, or a legislative body X h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means X i Total lobbying expenditures (add lines c through h) If 'Yes to any of the above, also attach a statement giving a detailed description of the lobbying activities. STFFED1955F.5 • • Schedule A (Form 990) 1998 ■ ` OW Part VII? Information Regarding Transfers To and Transactions and Rela ionships With N a We Exempt Organizations 51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting organization to a noncharitable exempt organization o1: Yes No (i) Cash 51 a(i) X (11) Other assets a(ii) X • b Other transactions: (i) Sales of assets to a noncharitable exempt organization b(i) X (ii) Purchases of assets from a noncharitable exempt organization b(ii) X (iii) Rental of facilities or equipment b(iii) X (iv) Reimbursement arrangements -. b(iv) X (v) Loans or loan guarantees b(v) X (vi) Performance of services or membership or fundraising solicitations b(vi) X c Sharing of facilities, equipment, mailing lists, other assets, or paid employees c )( d If the answer to any of the above is "Yes,' complete the following schedule. Column (b) should always show the fair market value of the goods, other assets, or services given by the reporting organization. If the organization received less than fair market value in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received: (a) (b) (c) (d) Line no. Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements 62 a Is the organization directly or indirectly affiliated with, or related to, one or more tax -exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? p 0 Yes © No b If 'Yes,' complete the following schedule: (a) (b) .. (c) Name of organization Type of organization i 1 Description of relationship • 7- STF FED1955F8 • HOSPICE OF HILO C11 m Form 990 Schedule of Contributors _ Statement 1 Direct Indirect Govemment Date Public Public Contributions Name and Address Received Support Support (Grants) Total Harry & Jeanette Weinberg Foundation 3660 Waialae Ave., Suite 400 Honolulu, HI 96816 4/20/98 663,000 663,000 Mclnemy Foundation PO Box 3170 Honolulu, HI 96802 9/28/98 25,000 25,000 Hawaiian Electric Industries Charitable Foundation PO Box 730 Honolulu, 1-41 96808 2/3/98 10,000 10,000 Cooke Foundation, Limited 900 Fort Street Mall Pioneer Plaza, Suite 1300 Honolulu, HI 96813 6/18/98 10,000 10,000 Edwin & Cynthia Sorenson 878 Komomala Drive Hilo, HI 96720 9/16/98 10,000 10,000 Dr. A. Stephen Woo, Jr. 193 Hailai Street Hilo, HI 96720 9/10/98 9,500 9,500 Hawaii Radiologic Associates 670 Ponahawai St., Suite 110 Hilo, HI 96720 11/23/98 7,000 7,000 Kurisu Foundation • 1001 Bishop St., #2325 Honolulu, HI 96 1/7/98 5,000 5,000 • Realty Investment PO Box 747 Hilo, HI 96721 2/26/98 5,000 9 - 5,000 GTE Hawaiian Tel / PO Box 4249 Hilo, HI 96720 4/9/98 5,000 5,000 First Hawaiian Bank PO Box 3200 Honolulu, HI 96813 6/10/98 5,000 5,000 HOSPICE OF HILO • • ! ra C Form 990 Schedule of Contributors Statement 1 Direct Indirect Govemment Date Public Public Contributions Name and Address Received Support Support (Grants) Total Hawaii Emergency Physicians Associated, Inc. 1190 Waianuenue Ave. Hilo, HI 96720 7/6/98 5,000 5,000 Andrew P. Wilson 101 Aupuni St., #124 Hilo, HI 96720 7/8/98 5,000 5,000 Wataru Kawamoto PO Box 128 Mt. View, HI 96771 7/23/98 5,000 5,000 Tom Moyer 6668 G Kaumana Drive Hilo, HI 96720 Various 5,000 5,000 Hawaii Island United Way 29 Shipman Street, #102 Hilo, HI 96720 Various 24,683 24,683 Hawaii Pacific Area Combined Federal Campaign PO Box 1096 Honolulu, HI 96808 Various 6,790 6,790 County of Hawaii Office of Aging 101 Aupuni St., # 342 Hilo, HI 96720 Various 11,456 11,456 Other Building Campaign Contributions less than $5,000 Various 427,058 427,058 Other Contributions c $5,000 Various 67,424 252 67,676 Total to Form 990, Part I, line la - d 1,268,982 / 31,725 11,456 1,312,163 • r HOSPICE OF HILO • • sc+�'.e1 p Form 990 Schedule of Special Events and Activities Statement 2 Gross Contribution Gross Direct Net Description Receipts Included Revenue Expenses Income Friendship Drive 19,310 19,310 19,310 Light Up A Life 10,606 10,606 10,606 Home for the Holidays 9,298 9,298 9,298 Total to Form 990, Part I, line 9a - c 39,214 39,214 39,214 Form 990 Schedule of Other Expenses Statement 3 (A) (B) (C) (D) Program Management Description Total Services and General Fundraising Contracted Services 128,426 128,426 Patient Acute Care 49,946 49,946 Patient Medications 103,317 103,317 Patient Services 20,982 20,982 Patient Short Stay 7,228 7,228 Mileage Reimbursement 22,018 21,307 415 296 Bad Debts Expense 1,368 1,368 Building Campagn Expense 46,139 33,548 Dues and Subscriptions 3,244 2,214 1,030 Insurance 3,837 3,339 421 77 Office Expenses 7,139 2,642 4,465 32 Volunteer Training 1,880 1,880 Taxes, License and Fees 1,872 1,532 340 Miscellaneous 1,366 821 303 242 Total to Form 990, Part II, line 43a 398,762 343,634 8,342 34,195 Form 990 Statement of Organization's Primary Exempt Ptfrpose Statement 4 Explanation Hospice of Hilo's primary exempt purpose is to provide medical, nursing, couseling and other supportive services necessary for individuals with life- limiting illnesses and their families. HOSPICE OF HILO • • •9 -0 18512 C 0 ° Form 990 Schedule of Land, Buildings, and Equipment Statement 5 Date Placed Cost Accumulated Net Book Asset Description in Service Basis Depreciation Value Building 8/1/98 1,776,168 18,502 1,757,666 Funiture and Fixtures Various 116,559 4,774 111,785 Machinery and Equipment Various 44,960 15,152 29,808 Leasehold Improvements Various 6,941 1,080 5,861 Comuter Software Various 5,543 322 5,221 Total to Form 990, Part IV, line 57a - b 1,950,171 39,830 1,910,341 Form 990 Schedule of Depreciation Statement 6 Estimated Basis for Current Year Asset Description Method Useful Life Depreciation Depreciation Building SLMM 40 1,776,168 18,502 Fumiture and Fixtures SLMM 10 116,559 4,774 Machinery and Equipment SLMM 7 - 5 44,960 4,250 Leasehold Improvements SLMM 15 6,941 Computer Software SLMM 5 5,543 322 Total to Form 990, Part H, line 42 1,950,171 27,848 / HOSPICE OF HILO • • 99- 0218512 Form 990 List of Officers, Directors, Trustees and Key Employess Statement 7 Title and Contribution Expense Acct. Time Devoted to Employee and Other Name and Address to Position Compensation Benefit Plan Allowances Gary Hagerman, Esq. President NONE NONE NONE PO Box 609 Part-Time Honokaa, HI 96727 David L. Hammes, Ph.D. Vice- President NONE NONE NONE 155 Alohalani Dr. Part-Time Hilo, 1-11 96720 John F. Roney Treasurer NONE NONE NONE 401 Wainaku Ave. Part-Time Hilo, H1 96720 Ronny de Jong Secretary NONE NONE NONE PO Box 40 Part-Time Pepeekeo, HI 96783 Gerald T. Nagata Director NONE NONE NONE 1190 Waianuenue Ave. Part-Time Hilo, HI 96720 Sarah E. Cope Director NONE NONE NONE 276 Lahi St. Part-Time Hilo, HI 96721 Cora -May Jensen Director NONE NONE NONE 145 Honolii P1. Part-Time Hilo, HI 96720 Catherine D. Campainha Director NONE NONE NONE 135 Hoaloha St. Part-Time Hilo, HI 96720 A. Stephen Woo, Jr. M.D. Director NONE NONE NONE 193 Halai St. Part-Time Hilo, HI 96720 Sidney M. Fuke Director NONE NONE NONE 100 Pauahi St., Suite 212 Part-Time Hilo, HI 96720 ii HOSPICE OF HILO • • C / %= /�I- 1 p 1 ptgs Form 990 List of Officers, Directors, Trustees and Key Employess Statement 7 u Title and Contribution Expense Acct. Time Devoted to Employee and Other Name and Address to Position Compensation Benefit Plan Allowances Wes Kimura Director NONE NONE NONE 21 Kapaa St. Part-Time Hilo, HI 96720 Brenda Ho Executive 56,892 NONE NONE 17 -604 Paahana St. Director Keaau, HI 96749 Full -Time • a, t • INTERNAL REVENUE (IRS) LETTER Internal Revenue O ce i l epartment of the irepsu .mil is g 198x' OMB Clearance Number: 1545 -0056 Date: MAY 31, 1985 Employer Identification Number: 99- 0218512 HAWAII PATIENT ENRICHMENT INC Contact Person: 440 WEST LANIKAULA STREET HOWARD, RANDY LEE HILO, HI 967200000 Contact Telephone Number: 213 - 688 -4170 Our Letter Dated: March 17, 1983 Dear Applicant: This modifies our letter of the above date in which we stated that you would be treated as an organization which is not a private foundation until the expiration of your advance ruling period. Based on the information you submitted, we have determined that you are not a private foundation within the meaning of section 509(a) of the Internal Revenue Code, because you are an organization of the type described in section 509(a)(1) and 170(b)(1)(A)(vi). Your exempt status under section 501(c)(3) of the code is still in effect. Grantors and contributors may rely on this determination until the Internal Revenue Service publishes a notice to the contrary. However, a grantor or a contributor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act that resulted in your loss of section 509(a)(1) and 170(b)(1)(A)(vi) status, or acquired knowledge that the Internal Revenue Service had given notice that you would be removed from classification as a section 509(a)(1) and • 170(b)(1)(A)(vi) organization. Because this letter could help resolve any questions about your private foundation status, please keep it in your permanent records. If you have any questions, please contact the person whose name and telephone number are shown above. Sincerely yours, (A.- ,v a �:. TT lr : >. ::. L i IhLGTTR Letter 1050(CG) Internal Revenue Se ice Department the Treasury District Director - Person to Contact: > Ron Hart Entity Control Unit Director of Development and Telephone Number: Public Relations (209) 452 -4010 101 Aupuni St., PH 1014 B Refer Reply to: Hilo, HI 96720 Name Change Verification Date: May 22, 1998 re: Employer ID. #: 99- 0218512 fka: Hawaii Patient Enrichment, Inc. -Dear Ron Hart: This letter will serve as your ackowledgement of your organizations name change with the Internal Revenue Service. On or about March 1986, Hawaii Patient Enrichment, Inc. FEIN: 99- 0218512 became known as Hospice of Hilo. The FEIN was retained and is currently valid. Further verification was required to meet your funding needs as Letter 147C, attached, did not specify acknowledged name change. This letter is being sent to you per telephone verification with the Fresno Service Center Entity Control Unit on May 8, 1998. I hope that this information provided is sufficient. Please visit our office in The Hilo Lagoon Center, Suite 229 -B during normal walk -in office hours if we may be of further assistance. Sine : rely, de�1 Mine Taxpa er Service /Office Collection Representative • • J LIABILITY INSURANCE CERTIFICATE INCLUDING AUTOMOBILE INSURNCE CERIIFlC,A1L 01 INSURANCE DATE: 07/21/99 THIS CERTIFICATE IS ISSUED AS A MA OF INFORMATION COMPA FFORDINC COVERAGE 0 ONLY AND CONFERS NO RIGHTS UPO ., CERTIFICATE COMPA Lcgion Insurance Company HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR COMPANY ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PRODUCER INSURED NHO Insurance Agency, Inc. Hospice of Hilo P.O. Box 988 1011 Waianuenue Avenue St. Helena, CA 94574 Hilo, 111 96720 Coverages THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO EFFECTIVE EXPIRATION LTR TYPE OF INSURANCE POLICY II DATE DATE LIMITS A GENERAL LIABILITY PLS- 000428 08/01/99 08/01/00 BI &PD COMBINED X COMP. FORM-Claims Made SINGLE LIMITS OCC 51.000.000. PREMISES/OPERATIONS BI & PD COMBINED CONTRACTUAL -LIMITED SINGLE LIMITS AGG 53,000,000. B. F. PROPERTY DAMAGE PERSONAL IN) AGG SL000,000. A AUTO LIABILITY PL5 08/01/99 08/01/00 BI &PD COMBINED SINGLE LIMIT OCC 51,000.000. X HIRED AUTOS X NON -OWNED AUTOS EXCESS LIABILITY UMBRELLA FORM EA. OCCURRENCE S OTHER THAN AGGREGATE S A OTHER X MEDICAL PROF. PLS -000428 08/01/99 08/01/00 BI & it COMBINED LIABILITY - CLAIMS MADE SINGLE LIMIT OCC $1.000.000. BI & PD COMBINED SINGLE LIMIT AGG 53,000,000. DESCRIPTION OF OPERATIONS HOSPICE/ HOME HEALTH CERTIFICATE HOLDER County of Hawaii Finance Department 25 Aupuni St. 1411o, HI 96720 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED ABOVE, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NC) OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENT, OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE: �� • • J ARTICLES OF INCORPORATION • • STATE OF HAWAII DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS Business Registration Division 1010 Richards Street Mailing Address: P. O. Box 40, Honolulu, HI 96810 C In the Matter of the Amendment of ) the Charter of Incorporation of ) ) 3 Ca Cn r HAWAII PATIENT ENRICHMENT, INC. ) ) CD CERTIFICATE OF AMENDMENT The President and Secretary, respectively, of HAWAII PATIENT ENRICHMENT, INC., a Hawaii non - profit corporation, do hereby certify that at a special meeting of the members of said corporation duly called and held at 1190 Waianuenue Avenue, Hilo, Hawaii 96720, on the 12th day of March, 1986, for the purpose of changing the name of the said corporation, it was voted by not less than two- thirds of the members present at the meeting to amend the Charter of Incorporation of said corporation by deleting the name 'HAWAII PATIENT ENRICHMENT, INC.' wherever it appears in the Charter of Incorporation, and inserting in lieu thereof the name 'HOSPICE OF HILO'. IN WITNESS �WHEREOF, the undersigned have hereunto set their hands this (�,f / r day of n( CA / , 1986. /4( eo •• ice Held: ' esident 4ic face H ld: Secre ry -1- III III a , STATE OF HAWAII ) SS: COUNTY OF HAWAII ) S• K. JUDITH and MARILYN,SERFASS, being first duly sworn on oath, depose and say, that they are the President and Secretary, respectively, of HAWAII PATIENT ENRICHMENT, INC.; that as such officers they are duly authorized to sign the foregoing Certificate of Amendment; and that they have read the said Certificate, know the contents thereof, and that the same is true. resident Secre.a y Subscribed and sworn to before me this („l,l'^ day of yl.CCt,-},C -( J , 1986. k: N r Public, State of Hawaii. My commission expires: I O ( (cf ('gg I hereby the foregoing amendment this /4 day of , 1986. Directo of Come e and Consumer Affairs By ��t /ca `fi ti .ctinq Corporation an. Secur ties ;• inistrator 1 -2- STATE OF HAWAII DEPARNT OF REGULATORY AGENC. In the Matter of the Incorporation ) of ) HAWAII PATIENT ENRICHMENT, INC. ) ) CHARTER OF INCORPORATION TO ALL,TO WHOM THESE PRESENTS SHALL COME: I, the undersigned Director of Regulatory Agencies of the State of Hawaii, send Greeting: WHEREAS, SUSUMU YAMANE, DEWITT H. SMITH and MIMI WARSH a majority of whom are residents of the State of Hawaii, have filed with me as Director of Regulatory Agencies a verified petition to grant to them and their associates a charter of incorporation as a non - profit corporation, in accordance with the provisions of Section 416 -20, Hawaii Revised Statutes; NOW, THEREFORE, KNOW YE, That I, the said Director, in the exercise and of every power and authority in anywise enabling me in this behalf, do hereby constitute the said petitioners and their associates a corporation under the laws of the State of Hawaii for the purposes and in the form hereinafter set forth. I ! The name of the corporation shall be: ,HAWAII PATIENT ENRICHMENT, INC. II The location of the principal office of the corporation shall be Hilo, County and State of Hawaii, and the specific .ddress of its initial office shall he Hilo Hospital, 1190 Waianuenue Avenue. Ill The pur�s foi. which the corpor�n is organize are: 1. To provide social, educational, psychological, health and recreational facilities and services to the terminally ill, 2. To mitigate the pain suffered by terminally ill patients through the administration of various drug combinations, 3. To provide psychological and physical support to the families and relatives of terminally ill patients, . 4. To provide and maintain a dignified and peaceful environment for the terminally ill, 5. - To carry on any other lawful activities whatsoever which are consistent with the provisions of the corporation's Charter of Incorporation which may seem to the corporation capable of being carried on in connection with the foregoing purposes and powers, and which are calculated directly or indirectly to promote the interests of the corporation and . the community. -. IV The duration of the corporation shall be perpetual. V There shall be . a Board of Directors consisting of not less than three nor more than twenty -five directors and the initial Board of Directors shall consist of three directors. i The following persons shall be the initial officers and directors, and shall hold office for the first year or until their successors are duly elected pursuant to the By -Laws of the corporation: Office Held Name Residence Address President- Director SUSUMU YAMANE 440 Lanikaula Street Kilo, Hawaii 96720 Office held Name Residence Addr ss Vice President GEORGE BRACHER W 70 Ponahawai Street, @110 Hilo, Hawaii 96720 Secretary SHIGEKO CHANG 1190 Waianuenue Avenue Hilo, Hawaii 96720 Treasurer JOHN MARRACK 26 Waianuenue Avenue Hilo, Hawaii 96720 Director DEWITT H. SMITH 101 Waikahe Road Hilo, Hawaii 96720 Director MIMI WARSH P. O. Box 1919 Hilo, Hawaii 96720 IV In the furtherance of the foregoing purposes, the corporation shall have and exercise any and all powers, rights, privileges and immunities which are now or may hereinafter be secured by the laws of the State of Hawaii. VII The corporation is organized exclusively for charitable, educational, and /or scientific purposes, including, for such purposes, the making of distributions, to organizations that qualify as exempt organizations under Section 501(c) of the Internal Revenue Code of 1954 (or the corresponding provision of any future United States Internal Revenue Law). VIII No part of the net earnings of the corporation shall inure to the benefit of, or be distributable to, its members, directors, officers, or other private persons, except that the corporation shall be authorized and empowered to pay reasonable compensation for services rendered and to make payments and distributions in furtherance of the purposes set forth in Article Third hereof. No substantial part of the activities of the corporation shall be the carrying on of propaganda, or Otherwise attempting to influence legislation, j and the corporation shall not participate in or intervene in (including theib]ishiny or distributio f stateinen ts) any political campaign on behalf of any candidate for public office. Notwithstanding any other provision of these articles, the corporation shall not carry on any other activities not permitted to be carried on (a) by a corporation exempt from Federal income tax under Section 501(c) of the Internal Revenue Code of 1954 (or corresponding provision of any future United States Internal Revenue Law) or . (b) by a corporation, contributions to which are deductible under Section 170(c)(2) of the Internal Revenue Code of 1954 (or the corresponding provision of any future United States Internal Revenue Law). IX Upon the dissolution of the corporation, the Board of Directors shall, after paying or making provision for the payment of all of the liabilities of the corporation, dispose of all of the assets of the corporation exclusively for the. purposes of the corporation in such manner, or to such organization or organizations organized and operated exclusively for charitable, educational, religious, or scientific purposes as shall at the time qualify as an exempt organization or organizations under Section 501(c) of the Internal Revenue Code of 1954 (or the corresponding provision of any future United States Internal Revenue Law), as the Board of Directors shall i determine. Any such assets not so disposed of shall be disposed of by the District Court of the county in which the principal office of the corporation is then located, exclusively for such purposes or to such organization or organizations, as said Court shall determine, which are organized and operated exclusively for such purposes. -- -4- _— X This Chfber may be amended by th•ote of not less than two- thirds of the members of the corporation, in writing or at a meeting duly called and held for that purpose. XI The corporation is not organized for profit, it will not issue any stock, and no part of its assets, income, or earnings shall be distributed to its members, directors, or officers. IN WITNESS WHEREOF, I have hereunto 'set my hand and seal of the Department of Regulatory Agencies, at Honolulu, Hawaii, this ibFf, day of • , 1980. I DIRECTOR OF REGULATORY AGENCIES By E ' , P. Corporation & Securities A.&; istrator -5- • • C BY -LAWS • • sr CERTIFICATION BY PRESIDENT OF HOSPICE OF HILO I HEREBY CERTIFY that I am the duly elected, qualified and acting President of the above -named corporation and that the attached By -laws were duly adopted by said corporation on Zcy 2-/ /fl? and are currently effective. Date: ‘--Any -i i /993 President , T • • b BY LAWS OF HOSPICE OF HILO A NON - PROFIT CORPORATION ARTICLE I SECTION 1. NAME. The name of this Corporation shall be the Hospice of Hilo, hereinafter referred to as Hospice. SECTION 2. PURPOSE. The purposes, goals and objectives of Hospice shall be as specifically set forth in its Charter of Incorporation. SECTION 3. NON PROFIT CHARACTER. Hospice shall be a non - profit Corporation, and any net income or earnings which may be derived from its operations, in pursuance of the purposes of Hospice shall not be distributed to any member, director or office, or any private individual, but shall be used to promote the purposes of Hospice. ARTICLE II SECTION 1. PRINCIPAL OFFICE. The principal office of Hospice shall be maintained at 1011 Waianuenue Avenue, Hilo, Hawaii, or at such other place in the City of Hilo, State of Hawaii, as the Board of Directors may determine. Hospice may have other offices within the State of Hawaii as the Board of Directors shall determine. Revised /Adopted July 1998 1 of 12 • • w ARTICLE III Board of Directors SECTION 1. GENERAL POWERS. The directors shall oversee the general management and control of the business and affairs of the Corporation and shall exercise all the powers that may be exercised or performed by the Corporation, under the laws statutes of the State of Hawaii, the Articles of Incorporation and the By -Laws. SECTION 2. NUMBER AND TERM. There shall be a Board of Directors of the Corporation to consist of fifteen (15) members. SECTION 3. REGULAR MEETINGS. A regular meeting of the Board of Directors shall be held monthly without other notice than these By -Laws, at such date and time as the Board shall determine. The place for the monthly meeting of the Board of Directors shall be the Board Room of Hospice of Hilo, unless otherwise determined by the Executive Committee of the Board of Directors. SECTION 4. SPECIAL MEETINGS. Special meetings of the Board of Directors shall be called by or at the request of the President or any two Directors. Any special meeting shall be held in the board Room of Hospice of Hilo. SECTION 5. NOTICE. Notice shall be given of any special meeting of the Board of Directors at least two days previous thereto by written notice delivered personally or sent by mail, telegram or facsimile to each director at his or her address as shown by the records of the Corporation. If mailed, such notice shall be deemed to be delivered when deposited in the United States mail in a sealed envelope so addressed, with postage thereon prepaid. If notice is given by telegram, such notice shall be deemed to be Revised /Adopted July 1998 2 of 12 i • • • w delivered when the telegram is delivered to the telegraph company. If notice is given by facsimile such notice shall be deemed to be delivered when the facsimile transmission is successfully completed. Any director may waive notice of any meeting. The attendance of a director at any meeting shall constitute a waiver of notice Of such meeting, except where a director attends a meeting for the express purpose of objecting to the transaction of any business because the meeting is not lawfully called or convened. Neither the business to be transacted at, nor the purpose of, any regular or special meeting of the Board need be specified in the notice or waiver of notice of such meeting, unless specifically required by law or by these By -Laws. SECTION 6. QUORUM. A majority of the Board of Directors shall constitute a quorum for the transaction of business at any meeting of the Board, except as provided differently in these By -Laws. SECTION 7. MANNER OF ACTING. The act of a majority of the Directors present at a meeting at which a quorum is present shall be the act of the Board of Directors, except where otherwise provided by law or by these By -Laws. SECTION 8. VACANCIES. A vacancy on the Board of Directors occurs when there are less than fifteen (15) members. SECTION 9. TERMS. A. LENGTH. A term consists of a period of three (3) consecutive years. B. COMMENCEMENT OF TERM. A term commences on January 1s` following the member's election to the Board. Revised /Adopted July 1998 3 of 12 • • C. MAXIMUM TERMS. A member may serve no more than two (2) consecutive terms. A person is eligible for re- election to the board of Directors one (1) year after the completion of two (2) consecutive terms. SECTION 10. COMPENSATION. Directors shall receive no compensation for their services, provided that nothing herein contained shall be construed to preclude any director from serving the Corporation in any other capacity and receiving compensation therefore. SECTION 11. REMOVAL OF DIRECTORS. A. Any Director may be removed from the Board with or without cause, by a vote of three quarters (75 %) of the Directors present at a meting at which the quorum is composed of at least three quarters (75 %) of the complete Board of Directors. B. Any Board member who fails to attend three consecutive Board meetings and is no excused from attendance by the Secretary shall be automatically dropped from the Board of Directors. C. Any board member who does not attend on -half (50 %) of the regularly scheduled board meetings in each calendar year shall be automatically dropped from the Board of Directors. Excused absences do not count as attendance. D. A board member can be exempted from the provisions of paragraphs B or C by the affirmative vote of three quarters (75 %) of the members of the Board of Directors. A quorum at a meeting of the Board of Directors :cannot exempt a Board member from the provisions of paragraphs A or B unless said quorum is composed of at least three quarters (75 %) of the complete Board of Directors. Revised /Adopted July 1998 4 of 12 • • ARTICLE IV Officers SECTION 1. OFFICERS. The officers of the Corporation shall be a President, a vice President, a treasurer, a secretary and such other officers as may, be elected in accordance with the provisions of this Article. The Board of Directors may elect or appoint such other officers, including one or more assistant secretaries and one or more assistant treasurers, as it shall deem desirable, such officers to have the authority and perform the duties prescribed, from time to time, by the Board of Directors. Any two or more offices may be held by the same person, except that the same person may not hold the offices of President and secretary. SECTION 2. ELECTION AND TERM OF OFFICE. The officers of the Corporation shall be elected at the monthly Board of Directors meeting held in December. If the election of officers shall not be held at such meeting, such election shall be held as soon thereafter as may be convenient. Vacancies may be filled or new offices created and filled at any meeting of the Board of Directors. Each officer shall hold office until a successor shall have been duly elected. SECTION 3. REMOVAL. Any officer or agent elected or appointed by the Board of Directors may be removed by the Board with or without cause by a vote of three quarters (75 %) of the Directors present at a meeting at which the quorum is composed of at least three quarters (75 %) of the complete Board of Directors. SECTION 4. VACANCIES. A vacancy in any office because of the death, resignation, removal, disqualification or otherwise, may be filled by the Board of Directors. Revised /Adopted July 1998 5 of 12 ■ • • + SECTION 5. PRESIDENT. The President shall be the principal executive officer of the Corporation and shall, in general, supervise and control all of the business and affairs of the Corporation. The President shall preside at all meetings of the members and of the Board of Directors. He or she shall have full charge of the business office of the Corporation. The President may sign with the secretary or any other proper officer of the Corporation authorized by the Board of Directors, any deeds, contracts, or other instruments which the Board of Directors have authorized to be executed, except in cases where the signing and execution thereof shall be expressly delegated by statute to some other officer or agent of the Corporation; and in general, shall perform all duties incident to the office of President and such other duties as may be prescribed by the Board of Directors form time to time. SECTION 6. VICE PRESIDENT. In the absence of the President or in the event of his inability or refusal to act, the Vice President shall perform the duties of the President, and when so acting, shall have all the powers of and be subject to all the restrictions upon the President. The Vice President shall perform other duties as from time to time may be assigned by the President or by the Board of Directors. SECTION 7. TREASURER. The Treasurer shall have charge and custody of and be responsible for all funds and securities of the Corporation; and receive and give receipts for moneys due and payable to the Corporation from any source, whatsoever, and deposit all such moneys in the name of the Corporation in such banks, trust companies or other depositaries as shall be selected by the Board of Directors; prepare periodic financial statements of the Corporation's fiscal affairs and operations; and in general, perform all Revised /Adopted July 1998 6 of 12 • • + the duties incident to the office of treasurer and such other duties as from time to time may be assigned to the Treasurer by the President or by the Board of Directors. ARTICLE 8. SECRETARY. The Secretary shall keep the minutes of the meetings of the members and of the Board of Directors in one or more books provided for that purpose; see that all notices are duly given in accordance with the provisions of these By- Laws or as required by law; be custodian of the corporate records and keep a register of the post office address of each member which shall be furnished to the secretary by such member; and in general, perform all duties incident to the office of Secretary and such other duties as from time to time may be assigned to the secretary by the President or by the Board of Directors. SECTION 9. ASSISTANT TREASURERS AND ASSISTANT SECRETARIES. If required by the Board of Directors, the assistant treasurers and assistant secretaries, in general, shall perform such duties as shall be assigned to them by the Treasurer or the Secretary or by the President or the Board of Directors. SECTION 10. DELEGATION OF DUTIES. Upon request by any officer of the Corporation, the Board of Directors may delegate some or all of the duties and responsibilities of the officer to another officer or to an employee or agent of the Corporation for such time and subject to such terms and conditions, if any, as may be imposed by the Board of Directors. Revised /Adopted July 1998 7 of 12 • ARTICLE V Committees SECTION 1. COMMITTEES OF DIRECTORS. The Board of Directors may designate one or more committees, each of which shall include one or more, directors, to exercise the powers and functions prescribed by the Board of Directors; but the designation of such committees and the delegation thereto of the authority shall not operate to relieve the Board of Directors, or any individual director, of any responsibility imposed upon it or him by law. SECTION 2. STANDING COMMITTEES. The standing committees shall be (1) Executive, (2) Finance, (3) Nominating, (4) Human Resources, (5) Community Relations and Public Education, (6) Planning and (7) By -Laws. These committees shall have such duties and responsibilities as shall be established by the board. The chairpersons of all such committees shall be appointed by the President with the approval of the Board. The chairperson, in consultation with the President, shall select the committee members. The chairperson and members shall serve until the expiration of the fiscal year or until their successors are appointed. SECTION 3. OTHER COMMITTEES. The Board of Directors may create such other standing or special committees as it deems necessary to carry on the business and purposes of the Corporation. The President of the Corporation shall appoint the members thereof. Any member of a standing or special committee may be removed by the person or persons authorized to appoint such member or by the Board of Directors whenever, in their judgment, the best interests of the Corporation shall be served by such removal. Revised /Adopted July 1998 8 of 12 SECTION 4. TERM OF OFFICE. Each member of a standing committee shall continue as such until his successor is appointed, unless the committee shall be sooner terminated, or unless such member be removed from such committee, or unless such member shall cease to qualify as a member thereof. Every member of other committees shall continue upon such terms as are prescribed by the Board of Directors. ARTICLE VI Advisory Council There shall be an Advisory Council of fifteen (15) members. Members of the Advisory Council shall be chosen from various fields related to the purpose of Hospice, including financial support. Members of the Advisory Council shall be proposed to the Board of Directors by the Nominating Committee and voted upon at Board meetings at which at least three fourths (75 %) of the Board members are present. Members of the Board of Directors are encouraged to submit names for people to be on the Advisory Coundl to the Nominating Committee. The term of members of the Advisory Coundl shall be one (1) year from the date of their appointment by the Board of Directors. ARTICLE VII Contracts, Checks, Deposits and Funds SECTION 1. CONTRACTS. The Board of Directors may authorize any officer or officers, agent or agents of the Corporation, in addition to the officers so authorized by these By -Laws, to enter into any contract or execute and deliver any instrument in the Revised /Adopted July 1998 9 of 12 . . name of and on behalf of the Corporation. Such authority may be general or confined to specific instances. SECTION 2. CHECK, DRAFTS, ETC. All checks, drafts or other orders for payment of money, notes or other evidences of indebtedness issued in the name of the Corporation, shall be signed by such officer or officers, agent or agents of the Corporation and in such manner as shall from time to time be determined by resolution by the Board of Directors. SECTION 3. DEPOSITS. All funds of the Corporation shall be deposited from time to time to the credit of the Corporation in such banks, trust companies or other depositaries as the Board of Directors may select. SECTION 4. FINANCES AND AUDIT. Accounting procedures shall conform to generally accepted accounting practices and procedures. The books of the Corporation may be audited after the end of the fiscal year by a certified public accountant appointed by the Board of Directors. The auditor's report shall be filed with the records of the Corporation. A summary of the report shall be presented for action as soon as possible. The Executive Director shall be authorized to contract for services and materials within the provisions of the budget adopted by the Board of Directors. All funds received by the Corporation shall be deposited to the credit of the Corporation in depositories approved by the Board of Directors. No officer or employee shall obligate the Corporation beyond the limits of items in the approved budget without specific authority from the Board. Revised /Adopted July 1998 10 of 12 • • ARTICLE VIII Books and Records The Corporation shall keep correct and complete books and records of account and shall also keep minutes of the proceedings of its members, Board of Directors and committees having any of the authority of the Board of Directors. ARTICLE IX Fiscal Year The fiscal year of the Corporation shall begin on the first day of January and end on the last day of December in each year. ARTICLE XIV Waiver of Notice Whenever any notice whatsoever is required to be given under the provisions of the laws of the State of Hawaii or under the provisions of the Articles of Incorporation or By- Laws of the Corporation, a waiver thereof in writing signed by the persons or persons entitled to such notice, whether before or after the time stated therein shall be deemed equivalent to the giving of such notice. ARTICLE XV Nepotism No two or more members of a family or kin of the first and second degrees shall be Revised /Adopted July 1998 11 of 12 • • employed or under contract by the Corporation unless specifically permitted in writing by the Board of Directors. ARTICLE XI Conflict of Interest Members of the Board of Directors shall not engage in any activity, practice or act which conflicts with the interests of Hospice of Hilo. It a matter arises in which a member of the Board has, or appears to have, a conflict on interest the member shall promptly disclose it to the Board of Directors. During a meeting of the Board, the Chair shall rule on whether the Member shall be excused or shall be allowed to partidpate in the issue at hand. ARTICLE XIII Amendment to By -Laws These By -Laws may be altered, amended or repealed and new By -Laws may be adopted by a majority of the Board of Directors at a meeting of the Board of Directors at which at least three quarters (75 %) of the members of the Board are present. Changes to the By -Laws shall be proposed to the Board of Directors by the By -Laws Committee and shall be submitted in writing to each Board member no less than two (2) weeks before the Board Meeting at which such changes are to be voted upon. Revised /Adopted July 1998 12 of 12