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HomeMy WebLinkAboutCOM 0667.025 1998-2000 41 n-4 Pthtp) a • o• Stephen K. Yamashiro ° i1•; Harry A. Takahashi Mayor I� j -a ' • ' • Dvr:ror S. K. Schutte • �rF • OF M��*� D utu County of jataii DEPARTMENT OF FINANCE 25 Aupuni Street. Room 118 • Hilo. Hawaii 96720 -4252 1808) 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: 1 /28 / 2000 GRANT APPLICATION FOR: Caregivers Training Institute (Program Title) Legal Name of Organization: Hawaii Island Adult Care, Inc. Mailing Address: 34 Rainbow Drive, Hilo. HI 96720 Facility/Site Address: 34 Rainbow Drive. Hilo, HI 96720 Director /Site Manager: Carolyn Cabreira Phone: 961 -3747 Organization President: Robert "Steamy" Chow Phone: 961 -3747 Contact Person (Grant Writer) Paula Uusitalo Phone: 961 -3747 Amount of request for County funds: $ 5,000.00 Total annual budget of organization: $721,652.00 Has the applicant applied for any other funds from the County of Hawaii this fiscal year? 0 Yes Source /Department: N Agency /Program(s): (5 Social Services (..) Youth Programs id Elderly Programs Check Category (ies) 0 Culture and Arts (.5 Education (5 Other Comm. No, 6 6 7- 0 Z-G File No. AbM • Briefly, define the program for which funding is being requested: Ref. Tot F E DC Ref. Date FEB 2 3 2000 Caregivers Training Institute is: identifying caregivers needs; creating alliances and affiliations by utilizing all resources; providing workshops with hands -on training and information needs for persons taking on the role o caregiver or ier rai e •er •r men s family member. p y aca y c a enge• 1 •I. a QUALIFYING STAIIIIRDS 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. II. GRANT CONDITIONS The applicant agrees to comply with the following terms & conditions prior to receiving a grant award. A. Comply with applicable Federal and State laws prohibiting discrimination against any person on the basis of race, color, national origin, religion, creed, sex, age, or handicap. B. Agree not to use any public funds for purposes of entertainment or perquisites. C. Comply with such other requirements as the Director of Finance may prescribe to ensure adherence by the nonprofit organization with Federal, State, and County laws, and established standards for fiscal and program management. D. Allow the Director of Finance, the committees of the council and their staffs, and the Legislative Auditor access to records, reports, files, and other related documents in order that the program, management, and fiscal practices of the nonprofit organization may be monitored and evaluated to assure the proper and effective expenditure of public funds. 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 • IV. Q UARTERLY 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 govemment 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 Hawaii Island Adult Care, Inc. (Legal Name of Organization) hereby agrees to administer the Caregivers Training Institute (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 X. AUTHORITY AND CA/PITY 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! 1 /78 /2000 Signature of President/Chairper on Date . -� V 1 /28/7000 Signature of Exesutive Director/Manager Date • 4 0 Hawaii Island Adult Care, County of Hawaii Non - Profit Grant FY 2000 -01 PROGRAM /SERVICE DESCRIPTION A. Overview: 1) Describe the program for which the funding is being requested. Hawaii Island Adult Care, Inc. provides a community training program through our Caregiver Training Institute (CTI). This caregiver training provides professional counseling, support and education to individuals and families who have stepped into the role of caregiver for a frail elder or physically /mentally challenged adult. Many of those being cared for have Alzheimer's disease or some type of dementia. A. 2) What unique or significant service will be provided? Our CTI program provides quality hands -on training on caring for frail elderly and physically /mentally challenged adults. Classes offer training in basic home aide care, CPR, First Aid, Alzheimer's disease, averting burn -out, and information on many elderly subjects aiding the caregivers' role. Classes are offered at minimal cost or free and are well attended. The classes are offered as a service to the community to encourage, educate and support caregivers in their all- important role in taking care of their loved ones. Another crucial dimension is our Caregivers Support group, which started in 1990 and continues to meet at our center on the second Friday of each month at 9 am. This group provides comfort, education and "down to earth" advice on the relentless role and responsibilities of being a caregiver. It is facilitated by the Director of Social Services at Life Care Center and our Health Services Coordinator. A. 3) What specific outcomes are to be achieved? One hundred to 150 individuals will be able to attend workshops presented by health care professionals who instruct with hands -on experience in basic caregiver skills. They will leave the Caregiver Training Institute's sessions with new skills and knowledge on how to care and cope for their loved ones, elderly clients, and the handicapped. The caregivers also meet contacts in the community who can help them with their specific needs currently or at a later time. Through our resource fair and community health fairs we will also provide the community with written and verbal information on the various topics of caregiving. This past year we reached over 500 individuals at these events. Our CTI classes enable us to meet the challenge of providing adequate health and social support, as well as teaching skills and supplying information to East Hawaii caregivers. 1 • z Hawaii Island Adult Care, Inc. • A. 4) How will the proposed program empower participants /clients to become self - sufficient and facilitate positive social change? The alternative to affordable Caregiver Training Institute is institutionalized long -term care. Many frail elderly handicapped adults are prematurely placed into long -term care because their caregivers are ill equipped to properly care for their loved ones. When caregivers are provided with affordable quality training it makes it possible for families to remain together as long as possible. It also significantly decreases the cost associated with maintaining our increasingly elderly population. Compare the costs of living at home versus $6,000 - 8,000 per person per month, in a long -term care facility, usually paid for by Medicaid or Medicare funds. Living at home versus institutionalization retains dignity for the individual. This is an important positive social change needed in all communities. B. Problem /Need: 1) What is the problem /need the proposed program is designed to meet? The problem /need that our Caregivers Training Institute addresses is the unnecessary health problems, hospitalization, and/or premature long -term institutionalization of frail elders, Alzheimers disease victims and handicapped. These situations often occur due to the caregivers' frustration, lack of skills, and lack of a support system to give quality care. CTI training gives caregivers knowledge on preventive care and support at home. This lowers the risk factor for acute health episodes, provides a cost effective alternative to long term care and allows families to remain together. B. 2) Who are the target population and what are the specific needs? The primary target population are the families who have stepped into the role of caregiver. Adequate knowledge of the physical duties, and mental /emotional challenges of caregiving are necessary to provide a decent life for both the cared -for and care - provider. Quite often a family or spouse is instantly put in the position of caregiver because of stroke, broken bones, or with the development of Alzheimers' disease. It is a role that most people have never had to do before and therefore have no proper skills for this 24 hour job. The secondary target population are the older adults with physical and /or mental impairments who require supervision or care. The primary focus is maintaining their independence so they will be able to remain living at home rather than being institutionalized. The community of East Hawaii is home to a growing population of older adults. The expected population increase for those 60 and older is 250 %, from 1990 to 2005. Statewide, by the year 2010, the 60+ group is projected to grow to 299,500 or one in five persons (Office of Aging statistics). These older adults have greater health needs than the general population and many of them end up with their families stepping into the role of being their caretakers, in an effort to maintain their independence /dignity and avoid institutionalization. 2 Hawaii Island Adult Care, • • • B. 3) What is the geographical area(s) to be served, facility and hours of operation? The geographic area that we serve is East Hawaii: South Hilo, North Hilo and Hamakua, Puna and Ka'u districts. Our Caregiver Training Institute currently operates out of the Hilo Adult Day Center, located at 34 Rainbow Drive, in the old Hilo Hospital. Workshops are held at the center or at other locations in East Hawaii, for example, the Cooper Center in Volcano. 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? Hilo Adult Day Center currently collaborates /coordinates with other community resources to achieve maximum efficiency and cost effectiveness. We are an active member of the case management's Interdisciplinary Team (IDT) which includes: Adult Protective Services, Child Protective Services, Department of Human Services, Legal Aid, Coordinated Services, Interim Health Care, Kokua Nurses, Home Health, and Nursing Home without Walls. We also consult regularly with the Hawaii County Nutrition Program, Life Care Center, Veteran's Administration, Hilo Medical Center, social workers, doctors, and mental health services for seniors. Speakers and trainers come from these groups and from around the state. Medical equipment, medical supplies and pharmaceutical companies, independent private care home providers, and others all provide valuable information, supplies or equipment for the frail elderly and handicapped adults of our community. Participating in community health fairs, gives CTI and caregivers the opportunity to meet and get to know these resources. This year we will also work with Public acessTV to present mini sessions on caregiving on television. C. 2) How will these measures reduce or eliminate any existing duplication of services to your designate target group? Caregivers Training Institute is a collaborative effort from a large network of resources and it is the only program of its kind on this island. There is no duplication of services. 3 • Hawaii Island Adult Care, Inc. • D. Goals and Objectives: 1) What are the major goals /benchmarks of the proposed program? Caregiver Training Institute's major goal is to be an on -going program that provides training throughout the year. We are planning a minimum of 20 workshops in the new fiscal year. In this way more caregivers will be able to take advantage of the workshops; since being a caregiver is an on -going yearlong job. We will also be able to provide more workshops than during our prior 6 -week series style, and help more caregivers gain information and skills to assist them in making their role as caregivers much easier and meaningful. We will have workshops during the day, evenings and Saturdays. We will also hold some workshops in the rural areas. The Public Access TV mini sessions will also reach many people in the rural areas. We want to provide affordable training and preventive measures to as many current and future caregivers of the frail elderly and handicapped adults who can benefit from this program. The training and skills will enable caregivers to better care for their loved ones and alleviate some of the frustration that comes with the role. D. 2) What specific objectives /action steps are planned for each goal? 1) Organize the training series detailed outline: dates, times; speakers & trainers; staff; equipment; publications & print -outs; refreshments 2) Identification of caregivers from the case management team, Office of Aging and Services for Seniors for notification of classes. 3) Bulk mailing to elderly population and other caregivers D. 3) What is the timeline (start and end dates) for each action step? Planning and implementation will be on an on -going basis. D. 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 person program outcome; or b) Show measurable progress towards your program goals This request of $5,000 will allow 100 -150 caregivers to attend our institute. These numbers do not reflect the people attending health fairs or viewing mini sessions on Public Access TV. They will gain knowledge on preventive care and skills, and personal contacts to assist them in their life role. Contacts in the community can help the caregivers with their individual needs. All this aids them in caring for their family member(s) and gives support in allowing frail elders and others to remain in their own homes rather that being prematurely institutionalized. 4 Hawaii Island Adult Care, • • • HIAC's role in our community is elderly based with an adult day care center, an in -home care program (Senior Helpers) and as part of the Interdisciplinary/Case Management team involving all other agencies in the same field. These avenues give us contact with and knowledge of elders and caregiving families in our community. Past attendees still caring for their loved ones at home confirm the success of the program. They will personally acknowledge this fact. Feedback from attendees during the sessions is tremendously encouraging for us and for those who take on the challenge of caregiving. Very few people look forward to being prematurely institutionalized, and therefore the program is very successful per person, as these persons can continue to live at home with family or caregivers. E. Service Delivery: 1) What methodology will be used in the proposed program's delivery of service(s)? The same methodology will be used in the program's delivery of service that exists currently. Community professionals, qualified trainers and HIAC's nursing staff will conduct the same excellent training that they have for the past twelve years. F. Evaluation: 1) What process will be used to evaluate the program and service(s)? Each class participant completes and submits an evaluation and comment form after each class. The Caregivers Training Institute coordinator then compiles these forms into a report which is presented to the Interdisciplinary/Case Management Team for review, feed back, and the planning of the future CTI. Internally, the Managing Director and the senior staff review the report to improve the Caregiver Training Institute. F. 2) How will this process measure the outcomes specified in Item D, (1-4)? Many of our caregivers attending the sessions have some contact with our collaborating agencies and some of those receiving care attend the Center. All give us positive feed back. These direct links provide a thorough evaluation of whether or not needs are met and caregivers are able to continue caring for their loved ones at home, eliminating the need for institutionalization. G. Program Fees: 1) Does your organization charge a membership fee for service participants? No, we do not charge a membership fee for service. 5 , Hawaii Island Adult Care, Inc. • • G. 2) Does the proposed program charge participants a fee for service(s) provided by your organization? Our existing and proposed Caregivers Training Institute Program will offer workshops free of charge or for a nominal fee of $2.00 per session; except the CPR and First Aid, they will cost more. Please see narrative Attachment #1 Our request for $5,000 is targeted for any caregiver that is interested and scholarships will be available to anyone who cannot afford the nominal fees. H. Viability: 1) What is your justification or rationale for the expenditure of public funds for the proposed program? Our justification for the expenditure of public funds for our Caregivers Training Institute is that it will save tax dollars and also give dignity to our elders at the ending of their lives. The cost effectiveness of training caregivers to care for their loved ones in order for the frail elderly and others to remain in their homes and not be pre - maturely institutionalized at $6,000+ monthly of Medicare /Medicaid funds per individual. Teaching preventative health measures alleviates hospitalization costs, and for our elders to be able to remain at home makes for a socially conscientious community. H. 2) What are your financial and programmatic plans to sustain the proposed program beyond the upcoming fiscal year? Our plans to sustain our Caregivers Training Institute program beyond the upcoming fiscal year include: 1) Continued community awareness of this program and the social importance of caregivers and keeping the frail elderly at home. 2) Continued grant applications and support from businesses and families in our community. 3) Ongoing support group meetings once a month. 6 Hawaii Island Adult Care, 41 • 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, Hawaii Island Adult Care's Board of Directors received formal training on February 18, 1998. Hawaii Island United Way is offering formal board to directors training to all agency boards this month. Training for our entire board is also planned for later this year; date pending. Please see Narrative Attachment #2 A. 2) What are the primary roles and responsibilities of your organization's Executive Director? Please see Narrative Attachment #3 A. 3) What are the primary roles and responsibilities of your organization's board of directors? According to H.I.A.C's bylaws the primary roles and responsibilities of our Board of Directors are: Powers and Functions: The Board of Directors shall be the governing body of the corporation, with the full power and authority to manage, conduct and control the business and affairs of the corporation. All actions taken by the Board of Directors shall be deemed to be the acts of the corporation. Please see the Bylaws in supporting documents which defines the roles of the executive officers. B. Past performance: 1) How effective has your organization /agency been in achieving program goals in the past two (2) fiscal years? a) Quantitative data on numbers served: During the Caregivers Training Institute workshops held since July 1998, we trained 140 caregivers. This current year additional workshops are planned until June 30. Over 500 individuals turned out for our resource fair and the community health fairs in the last six months. Our monthly support group is attended by 5 to 10 persons per session. 7 • 0 Hawaii Island Adult Care, Inc. • b) Qualitative data showing number and % of participants achieving measurable outcomes. Approximately 100 -150 frail elderly and handicapped clients were cared for and able to remain independent and at home alone or with their loved ones rather than being institutionalized prematurely. C. Financial: 1) Have your organization's current program operations remained the same as last year? What major program or financial changes will be incurred next year? Current operations have remained the same as last year and no major program or financial changes are expected or planned. C. 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.? Our agreements with Department of Human Services, Nursing Home Without Walls, Services for Seniors Adult Protective Services, Office of Aging and private foundations are on going on an annual basis. We have a ten -year agreement with the County to lease our space at 34 Rainbow Drive for $1.00 a year. C. 3) How does the proposed program fit into your organization's long range financial plan? Our long -range financial plan is to provide quality care for our elderly community at an affordable cost. We live in a financially depressed area with a majority of our possible client population being low- income. This proposal will train caregivers, allowing frail elders and physically /mentally challenged to remain independent and at home and with quality care. 8 I ' • Hawaii Island Adult Care,. • 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? Adult Protective Services: Norman Nishiki 933 -8820 Nursing Home Without Walls: Jan Nakahara 933 -8820 Services for Seniors: Debbie Ishado 935 -1144 Case Management: Judy Akamine 974 -6025 Department of Human Services: Lenore Kozohara 933 -8820 Laura Giddens 586 -5672 Hawaii Island United Way: Helen Hemmes 935 -6393 Hawaii Community Foundation: Steven Kaneshiro 1- 888 - 731 -3863 Program Officer for: May Templeton Hopper Foundation Alice M.G Soper Fund Teresa Hughes Fund Gwenfread Allen Fund Theodore Vierra Fund Office of Aging, Hawaii County: Dennis Shigeta 961 -8600 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? All employees were issued the new revised personnel policies, and the policies are reviewed with all new employees. Posters and bulletins are displayed for all employees on all pertinent matters. HIAC's Personnel Policies state: POLICY: HIAC is a drug and alcohol free workplace. PROCEDURES: 1. To promote this goal, employees are required to report to work in appropriate mental and physical condition to perform their jobs in a satisfactory manner. • 2. To maintain healthy and pleasant working conditions, smoking will not be permitted within the buildings, or program offices in which HIAC conducts business. "No Smoking" signs will be visible in all program and common areas. 3. While on HIAC premises and while conducting business - related activities off HIAC premises, no employee may use, possess, distribute, sell, or be under the influence of alcohol or illegal drugs. Violation of this policy may lead to disciplinary action, up to and including immediate termination of employment, and /or required participation in a substance abuse rehabilitation or treatment program. Such violations may also have legal consequences. 9 • MIR ruil1VL' AllAl:ttm1 NT n ' Page -- Question G 2)0arging fees for service Hawaii Tribune - Herald, Sunday, July 18, 1999 -25 FB,]EE_ - sots Day care services I.; will be 4 available! �/ � 1 A r G 0 MEE* • Hawaii Island Adult Care, (MAC) will be presenting a Caregiver Training Workshop, Thursday, July 22nd from 8:00am • 11:OOam, at Hilo Adult Day Center, 34 Rainbow Drive. ::= The lasses will prepare caregivers on how to cope, understand and develop strategies on managing their frail disabled elderly loved one and cover basic hands i on nursing skills, with group discussion and an oppor- tunity to ask questions. Workshop facilitated by Maile Young, Health Service Coordinator. To register, call 961 -3747. 22— Hawaii Tribune - Herald, Sunday, July 18, 1999 Datebook caregiver training Hawaii Island Adult Care (HIAC) 4111 be presenting a caregiver train- iitg workshop Thursday, July 22, film 8 -11 a.m. at the Hilo Adult qay Center, 34 Rainbow Dr. The classes will prepare caregivers on hew to cope, understand and devel- op strategies on managing the frail, disabled elderly and cover basic hands-on nursing skills. Free day-cam services will be available. Workshop fad ilitated by Maile Young, Health Ser- vrce Coordinator, HIAC, 961 -3747. 1YA1(1(All VL Al1Al:t1M15N ifZ Page 7 -- Question A. Board training • Z ^.. • V Y A I I HIAC BOD -: of _. ORIENTATI mss' � .� j; ON 04 „. : , FEBRUARY 1 8th . Ballendorf HIAC is pleased to invite you to a special video Board Orientation from 5 to 7 pm on Wednesday, February 26th at Hilo Adult Day Center. Our speaker, Heidi M. Ballendorf, has had 17 years experience in the non -profit field and has been the President /Chief Professional Officer with Maui United Way since 1991. BOD members will have the opportunity to hear from Miss Ballendorf, an expert in the field about the latest information on: Funding, fund- raising, agency support and research information on non -profit organizations. The two hour meeting /workshop will also focus on: HAWAII ISLAND ADULT CARE *Description of agency purposes *Committees /staff assignments *Major programs *Long range plan *Funding Sources *Agency objectives *Expectations of BOD members *BOD Committee assignments *Board Manual /Bylaws *BOD Time (work hours per mo.) The presentation will concentrate on the development, strengths, accountability of BOD members in our community and endowment funding (which affects all activities and programs within our agency), and how to develop programs which will provide further growth for our agency. Miss Ballendorf, who has conducted many BOD orientations statewide, will also cover effectiveness, accomplishing objectives, expediting the goals of our agency, enhancing HIAC'S image and the commitment /importance of each BOD member in our community. REFRESHMENTS WILL BE SERVED THIS SPECIAL BOD ORIENTATION WILL BE PRECEDED BY A BRIEF BOD MEETING • • • •RATIVE ATTACHMENT #3 P.7 Organization /Agency Information: A. 2) Primary roles & responsibilities of Executive Director? Managing - Executive Director (Revised 16 June 99) Managing- Executive Director is responsible to the HIAC Board of Directors Qualifications for the job of Managing- Executive Director: A) A Bachelor's degree in Gerontology, Social Work, Human Development, or an equivalent experience acceptable to HIAC's Personal Committee, such as five years experience in direct supervision of those caring for the elderly, plus mentally and/or physically challenged adults. B) Knowledge of community and good working relationships with professional personnel and community agencies within the state. C) Have strong management qualities, creative, imagination, organizational and planning skills. D) A good overall knowledge and workings of a non - profit organization and grant writing. Job Summary: The Managing- Executive Director is responsible for: A) The overall management of Hawaiian Island Adult Care Inc. (HIAC) B) Establishing annual goals for H1AC. C) For the implementation of policies and the evaluation of all programs of the organization. ,.. D) Coordinating and managing the offices of the Health Service Coordinator, the Senior Helpers Coordinator, and the Center Program Director to oversee referrals, admissions, case management, reports as needed and prepare and submit the monthly client billing information to the accounting department. E) Will be responsible for the applications as well as administration for the PINS, DHS, and other grants with the assistance of the bookkeeper and staff as deemed necessary.. F)Other duties as assigned by the Board for the good of H1AC. I. General Responsibilities: Provides guidance and information leading to planning, programs., and policy adoption. Oversees the implementation of adopted plans, policies and programs. Serves as the staff associate to the designated standing committees of the Board. Works with the HIAC Board President to assist the board in being effective and provides any pertinent information to the President, as well as the Board, necessary to be meet this goal. Assures safekeeping of official documents. • For more information please see Job Description attached to Staff Information sheet with original application • • • . 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Schutte • `fi oirva• Deputy County of 3athaui 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 OUESTIONNAIRE Please include as an attachment an explanation for all "NO" answers to questions #1 thru 11 below: Yes No • O CS 1. Has the agency operated continuously for the past three (3) years? 0 0. 2. Has the agency operated with a positive cash flow for the past (3) years? O CS 3. Does your Board of Directors approve a detailed cash flow budget before the beginning of each fiscal year? 0 0 4. Do your Board meeting minutes show that quarterly financial statements are approved? O CS 5. Is your equity balance at least 20% of your Total Liability balance? 0 (5 6. Is your Total Current Asset balance larger than your Total Current Liability balance? O (5 7. Are bank reconciliationaand accounting performed by someone other than the check signatory? • O CS 8. Are you fully insured for the agency's vehicle(s) and building(s)? O 0 9. Is your Workers' Compensation at least 2% of payroll? 0 0 10. Are you current (not delinquent) on all payroll and payroll tax payments? 0 CS 11. Is the agency free of any pending litigation, liens or judgments? 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. 1 hereby certify that this information is true and correct to the best of my knowledge. Agency: Hawaii Island Adult Care, Inc. Phone: 961 -3747 Prepared by: Paula Uusitalo - Bookkeeper /Grtwtr C_ � £t' /1 7�Cca Print Name/Title Signature Date Certified by: Carolyn Cabreira ca,„,, c �. /37/or. Print Name of Executive Director Signature Date • • Hawaii Island Adult Care, Inc. County of Hawaii Non - Profit Grant FY 2000 -01 FINANCIAL QUESTIONNAIRE Attachment Explanation to NO answer: Question #2: Funding cuts for clients by the State Dept. of Human Services and intermittent low enrollment (stemming from the slow economy), caused a negative cash flow from FY 1995 to FY 1997. FY 1998 income matched expenses evenly. We were very pleased to finish FY 1999 in the black, and continue to do so this fiscal year. • • • • Taketa, Iwata, Hasa Cti Associates Certified Public Accountants e • • HAWAII ISLAND ADULT CARE, INC. FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 1998 (WITH INDEPENDENT AUDITOR'S REPORT) • • • Table of Contents Pages Independent Auditor's Report 1 Financial Statements Statement of Financial Position 2 Statement of Activities 3 Statement of Functional Expenses 4 Statement of Cash Flows 5 'Notes to the Financial Statements 6 - 9 • • TAKETA, IWATA, HARA & ASSOCIATES CERTIFIED PUBLIC ACCOUNTANTS 101 AUPUNI STREET, SUITE 139, HILO, HI 96723 P.O. BOX 1759, HILO, HI 96721 -1759 GREGG M. TAKETA, CPA BRIAN M. IWATA, CPA PH. (808) 935 -5431 JANET W. HARA, CPA FAX (808) 969 -1499 INDEPENDENT AUDITOR'S REPORT The Board of Directors Hawaii Island Adult Care, Inc.: We have audited the accompanying statement of financial position of Hawaii Island Adult Care, Inc., (a nonprofit organization) as of June 30, 1998, and the related statements of activities, functional expenses and cash flows for the year then ended. These financial statements are the responsibility of the Organization's management. Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with generally accepted auditing standards. Those standards require that we 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 the significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. Our audit was performed for the purpose of forming an opinion on the basic financial statements of Hawaii Island Adult Care, Inc. taken as a whole. In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of Hawaii Island Adult Care, Inc. as of June 30, 1998, and the changes in its net assets and its cash flows for the year then ended in conformity with generally accepted accounting principles. �i -cc & ,th., #4,-„_÷ 41J e Lz.P April 30, 1999 1 • • v HAWAII ISLAND ADULT CARE, INC. Statement of Financial Position June 30, 1998 Assets Liabilities and Net Assets Current assets: Current liabilities: Cash and cash equivalents $ 31,078 Accounts payable $ 11,372 Client accounts receivable, net of Accrued payroll and related liabilities 17,447 allowance 33,628 Other liabilities • 2,800 Unconditional promise to give 9,750 Prepaid expenses 11,065 Total current liabilities 31,619 Total current assets 85,521 Total liabilities 31,619 Noncurrent assets: Net assets: Restricted endowment fund 32,082 Unrestricted 65,609 Property and equipment, net 21,457 Temporarily restricted 9,750 Permanently restricted 32,082 Total noncurrent assets 53,539 Total net assets 107,441 Total assets $ 139,060 Total liabilities and net assets $ 139,060 See accompanying notes to financial statements. • 2 • • HAWAII ISLAND ADULT CARE, INC. Statement of Activities Year ended June 30, 1998 Unrestricted Temporarily Permanently Funds Restricted Restricted Total Changes in net assets: • Public Support and Revenues: Public Support: • State of Hawaii Department of Human Services $ 120,148 - - 120,148 County of Hawaii Office of Aging 2,315 - - 2,315 Contributions: Hawaii Community Foundation, May Templeton Hopper - 46,656 - 46,656 Hawaii Island United Way - 27,788 - 27,788 Private donations 8,198 - 1,625 9,823 Equipment grants - 8,000 - 8,000 Grant management fee Persons -in -Need funds 1,736 - - 1.738 Combined Federal Campaign 1,611 - - 1.611 Revenues: Client tuition and fees 448,540 - - 448,540 Contributed space 24,000 - - 24,000 Rental income 8,135 - - 8,135 Miscellaneous revenue 5,316 - - 5,316 Special events 4,693 - - 4,693 Interest income 720 - 1,225 1,945 Net assets released from restrictions: Satisfaction of time restrictions Hawaii Island United Way 18,038 (18,038) - - Restrictions satisfied by payments 54,656 (54,656) - - Total revenue 698,108 9,750 2,850 710,708 Expenses: Program services 616,132 - 616,132 Support services 88,057 - - 88,057 Total expenses 704,189 - - 704,189 Increase (decrease) in net assets (6,081) 9,750 2,850 6,519 Net assets, beginning of year 97,297 - 3,625 100,922 Net assets, before transfer of board designated funds 91,216 9,750 6,475 107,441 Transfer to endowment fund i (25,607) - 25,607 Net assets, end of year $ 65,609 9,750 32,082 107,441 See accompanying notes to financial statements. • • HAWAII ISLAND ADULT CARE, INC. Statement of Functional Expenses Year ended June 30, 1998 Program Administrative Total Services Services Expenses Salaries and related expenses: Salaries $ 331,711 57,653 389,364 Payroll taxes and employee benefits 82,821 13,483 96,304 414,532 71,136 485,668 Other expenses: Client program expense 89,184 - 89,184 Occupancy costs 36,717 - 36,717 Office expense 11,380 1,072 12,452 Program supplies 11,070 - 11,070 Insurance 9,171 1,829 11,000 Program transportation 10,544 - 10,544 Repairs and maintenance 10,484 - 10,484 Professional fees 2,640 5,708 8,348 Travel 1,714 3,802 5,516 Staff training 3,631 1,316 4,947 Excursions and events 1,840 1,070 2,910 Fundraising expenses - 1,124 1,124 Advertising and promotion - 1,000 1,000 Bad debt expense 82 - 82 188,457 16,921 205,378 Depreciation 13,143 - 13,143 Total expenses $ 616,132 88,057 704,189 See accompanying notes to financial statements. 4 • HAWAII ISLAND ADULT CARE, INC. • Statement of Cash Flows Year ended June 30, 1998 Cash flows from operating activities: Cash received from service recipients $ 429,688 State of Hawaii Department of Human Services 140,173 Cash received from other grants 81,158 Private donations and other income received 25,510 Interest received 1,945 Cash paid to employees (483,189) Cash paid to suppliers (185,421) Net cash provided by operating activities 9,864 Cash flows from investing activities: Cash restricted for endowment fund (32,082) Purchase of assets (12,825) Retirements and deletions of assets 12,084 Net cash used by investing activities (32.823) Net increase in cash and cash equivalents (22,959) Unrestricted cash and cash equivalents, beginning of year 54,037 Unrestricted cash and cash equivalents, end of year $ 31,078 Reconciliation of change in net assets to net cash provided by operating activities: Change in net assets $ 6,519 Adjustments to reconcile change in net assets to net cash provided by operating activities: Depreciation and amortization 13,143 Gain on sale of assets (2,457) Decrease in grants receivable 20,025 Increase in client accounts receivable (18,770) Increase in unconditional promises to give (9,750) Increase in prepaid expenses (1,125) Decrease in accounts payable (1,815) Increase in accrued payroll and related liabilities 1,294 Increase in other liabilities 2,800 Net cash provided by operating activities $ 9,864 Supplemental disclosure of cash flow information: There were no non-cash financing or investing activities for the year ended June 30, 1998. See accompanying notes to financial statements. 5 • • • c • HAWAII ISLAND ADULT CARE, INC. Notes to Financial Statements June 30, 1998 (1) Summary of Significant Accounting Policies General Hawaii Island Adult Care, Inc. (HIAC) was established on October 21, 1981 under the laws of the State of Hawaii. HIAC was organized exclusively for the charitable purpose of providing protective and supportive care for frail, elderly and disabled adults on the Island of Hawaii. HIAC's Senior Helpers program serves clients and their families in their homes and in the community. It operates a small group home, Hale Kapuna, to provide housing options for some of the elderly clients. HIAC receives a substantial amount of its funding from client tuition and fees and from State grants. The accompanying financial statements of Hawaii Island Adult Care, Inc. are presented in accordance with the standards of accounting and financial reporting prescribed for not - for - profit organizations. In accordance with these standards, the following accounting policies applicable to not - for - profit organizations are used by the organization. Accrual Basis The organization reports its financial position and activities on the accrual basis of accounting in accordance with generally accepted accounting principles and the AICPA industry audit guide "Not -for Profit Organizations ". Cash and Cash Equivalents For purposes of the statements of cash flows, HIAC considers all highly liquid investments that are available for current use with an initial maturity of three months or less to be cash equivalents. Promises to Give Contributions are recognized when the donor makes a promise to give to HIAC that is, in substance, unconditional at the time of promise. Contributions, grants and other sources of funding received are recorded as unrestricted, temporarily restricted, or permanently restricted depending on the existence or nature of donor - imposed restrictions or stipulations. Contributions that are restricted by the donor are reported as increases in unrestricted net assets only if the restrictions expire in the fiscal year in which the contributions are recognized. All other donor - restricted contributions are reported as increases in temporarily or permanently restricted net assets depending on the nature of the restriction. All unconditional promises to give are for a period of one year or less, therefore HIAC has not discounted the value of the unconditional promises to give. Permanently, Temporarily Restricted and Unrestricted Net Assets Permanently restricted net assets are gifts and bequests that remain intact as a result of restrictions placed on the assets by the respective donors or the Board of Directors. HIAC has established an endowment fund to segregate its permanently restricted net assets. The assets are held in investments with income from such investments to be used at the Board's discretion. For the year ended June 30, 1998, the Board elected to add the income to the endowment fund. C • • HAWAII ISLAND ADULT CARE, INC. Notes to Financial Statements, Continued Of these permanently restricted net assets held in the endowment fund, $6,475 are permanently restricted by outside donors, and $25,607 have been designated as permanently restricted by the Board of Directors of Hawaii Island Adult Care, Inc. Although the current board's intent is to permanently restrict these assets, the restriction over the $25,607 of board designated assets could conceivably be reversed in the future. Temporarily restricted net assets reflect donor stipulations placed on grants and contributions. Such restrictions may be met in the same year that the contributions are received or carried forward to subsequent fiscal years. Therefore, HIAC has adopted the policy of recording these contributions as temporarily restricted net assets that either expire with the passage of time or are fulfilled and removed by actions of the organization pursuant to the donor's wishes. Unrestricted net assets represent resources over which the board of directors has discretionary control. When a restriction expires, temporarily restricted net assets are reclassified to unrestricted net assets. HIAC has adopted the policy of recording unrestricted gifts of long -lived assets as contributions increasing unrestricted net assets. Donor - Controlled Support of Individuals Hawaii Island Adult Care, Inc. disburses pass - through Persons -in Need monies to third party vendors on behalf of eligible individuals within the community at large. These grants from private funds are awarded through the Hawaii Community Foundation. The Teresa F. Hughes fund assists all eligible adults. The Gwenfread Allen fund assists elderly individuals 62 years or older. The Alice Soper Fund assists individuals age 50 and over. The Theodore A. Vierra Fund assists persons over the age of 50 years, who are residents of East Hawaii with resources insufficient to meet their needs. With respect to these contributions, HIAC has no discretionary control over the awarding of the assistance. HIAC serves only as a conduit between the grantor and third -party recipients referred from other human services agencies. Any unused funds at the end of the grant period must be returned to the grantor. In accordance with Statements of Financial Accounting Standards number 116, the organization has recorded these donor - designated grants as other liabilities, and no revenue or expense has been recognized except for an administrative fee allocated to HIAC by the donor fund, not to exceed 5% of the grant amount. Donated Facilities Hawaii Island Adult Care, Inc. uses a portion of the old Hilo Hospital on Rainbow Drive for $1 per year under a lease from the County of Hawaii. HIAC records the contribution of space both as public support and occupancy expense at the estimated market value of $2,000 per month or $24,000 per year. The lease expires on February 17, 2008. Donated Property and Materials • Donated property and materials are reflected as contributions in the accompanying financial statements at their estimated values at date of receipt. 7 • • C HAWAII ISLAND ADULT CARE, INC. Notes to Financial Statements, Continued Donated Services A substantial number of volunteers have donated their time and talents to help restore and maintain Hawaii Island Adult Care, Inc.'s facilities and to enrich the quality of its program services. However, no amounts have been reflected in the accompanying financial statements for these donated services since no objective basis is available to measure the value of such services and the recording of such donated services is not required under SFAS No. 116. Tax Status The Corporation is classified as a tax - exempt organization other than a private foundation under Section 501(c)(3) of the U.S. Internal Revenue Code and is exempt from Federal and State income taxes. Estimates 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. (2) Accounts receivable As of June 30, 1998, accounts receivable consisted of the following: Day Care services receivable $ 17,769 Senior Helpers services receivable 16,743 Other receivables 555 35,067 Allowance for doubtful accounts (1,439) Net receivables $ 33,628 (3) Unconditional promises to give Unconditional promises to give consists of Hawaii Island United Way support which has been pledged on a calendar year basis through December 31, 1998. In accordance with SFAS No. 116 this pledge has been recorded in the accompanying financial statements presented at its full non - discounted face value since it will be received as monthly payments within a one year period. 8 • • HAWAII ISLAND ADULT CARE, INC. Notes to Financial Statements, Continued (4) Property and equipment Property and equipment is stated at cost or at its donated value. Depreciation is computed using the straight -line method over the estimated useful life of the asset which may range from 5 to 15 years. As of June 30, 1998, property and equipment consisted of the following: Equipment $ 140,462 Vehicles 12,472 Property and improvements 10,440 163,374 Accumulated depreciation (141,917) Net property and equipment $ 21,457 (5) Govemmental Purchase of Service Grants State of Hawaii Department of Human Services - Hawaii Island Adult Care, Inc. is under contract with the Department of Human Services to provide day care services for the frail elderly and disabled low- income residents of East Hawaii. Revenue from this contract in fi scal year 1998 was $120,148. County of Hawaii — Hawaii Island Adult Care, Inc. is under contract with the County to maintain a small group home, Hale Kapuna, to provide residential services for the frail elderly and disabled low- income residents of East Hawaii. Revenue from this contract in fiscal year 1998 was $2,315. Funding under such purchase of service contracts is subject to the availability of funds from local govemmental units and may be substantially reduced on short notice by changes in program requirements. Funding for these programs is also contingent upon satisfactory performance by Hawaii Island Adult Care, Inc. in accordance with the terms of the contracts (6) Year 2000 problem It is at least reasonably possible that the potential consequences, which may at any time arise as a result of problems associated with the Year -2000 conversion, could result in a contingent liability which existed on the date of the financial statements. Management has made no estimates of these costs, and the amount is not reflected in the financial statement. 9 Deloitte & Touche LLP HAWAII ISLAND ADULT CARE, INC. Financial Statements for the Years Ended June 30, 1997 and 1996 and Independent Auditors' Report DeloltteTouche Tohmatsu International • s Deloitte & Touche LLP /\ Suite 1200 Telephone: (808) 543 -0700 (� 1132 Bishop Street Facsimile: (808) 526 -0225 Honolulu, Hawaii 96813 -2870 INDEPENDENT AUDITORS' REPORT To the Board of Directors of the Hawaii Island Adult Care, Inc.: We have audited the accompanying balance sheets of Hawaii Island Adult Care, Inc. as of June 30, 1997 and 1996, and the related statements of activities, cash flows, and functional expenses for the years then ended. These financial statements are the responsibility of Hawaii Island Adult Care, Inc: s management. Our responsibility is to express an opinion on these financial statements based on our audits. We conducted our audits in accordance with generally accepted auditing standards. Those standards require that we 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. We believe that our audits provide a reasonable basis for our opinion. In our opinion, such financial statements present fairly, in all material respects, the financial position of Hawaii Island Adult Care, Inc. as of June 30, 1997 and 1996, and the results of its operation and its cash flows for the years then ended in conformity with generally accepted accounting principles. September 26, 1997 DeloitteTouche Tohmatsu International • y • • HAWAII ISLAND ADULT CARE, INC. BALANCE SHEETS JUNE 30, 1997 AND 1996 1997 1996 ASSETS CASH AND CASH EQUIVALENTS $ 54,037 $ 52,808 ACCOUNTS RECEIVABLE - Net (Note 3) 34,883 55,606 9,940 16,324 PREPAID EXPENSES 31,402 38,702 PROPERTY - Net (Note 4) $130,262 $16 TOTAL LIABILITIES AND NET ASSETS CURRENT LIABILITIES: 6,407 $ 1,404 Accounts payable $ 6,4 26,4 07 21,404 Accrued liabilities 29,340 22,977 Total current liabilities NET ASSETS: Unrestricted: Undesignated 7 711,690 115,763 ,697 ,76 Board- designated endowment funds 5 607 permanently restricted endowment funds (Note 5) 100,922 140,463 Total net assets $130,262 $16r TOTAL See notes to financial statements. -2 , • • . • HAWAII ISLAND ADULT CARE, INC. STATEMENTS OF ACTIVITIES YEARS ENDED JUNE 30,1997 AND 1996 1997 Permanently Unrestricted Restricted Total Unrestricted PUBLIC SUPPORT AND REVENUE: Client tuition and fees $ 387,757 $ 387,757 $ 470,609 Department of Human Services 120,148 120,148 120,148 Other grants and awards 110,689 110,689 107,410 Contributed space 24,000 24,000 24,000 Rental income 9,300 9,300 9,135 Private donations 10,125 $ 3,625 13,750 3,467 Special events - net 9,209 9,209 3,381 Interest 2,939 2,939 3,328 Miscellaneous revenue 1,920 1,920 3,718 Total public support and revenue 676,087 3,625 679,712 745,196 EXPENSES: 624,273 624,273 700,765 Program servi Fundraising and administration 94,980 94,980 95,402 Total expenses 719,253 719,253 796,167 INCREASE (DECREASE) IN NET ASSETS BEFORE CUMULATIVE EFFECT OF CHANGE IN ACCOUNTING PRINCIPLE (43,166) 3,625 (39,541) (50,971) CUMULATIVE EFFECT OF CHANGE IN 15,147 ACCOUNTING PRINCIPLE (Note 2) INCREASE (DECREASE) IN NET ASSETS (43,166) 3,625 (39,541) (35,824) NET ASSETS, BEGINNING OF YEAR 140,463 140,463 176,287 NET ASSETS, END OF YEAR $ 97,297 $ 3,625 $1$1 ®22 $ 140,463 See notes to financial statements. -3- e • • HAWAII ISLAND ADULT CARE, INC. STATEMENTS OF CASH FLOWS YEARS ENDED JUNE 30, 1997 AND 1996 1997 1996 OPERATING ACTIVITIES: $ (39,541) $ (35,824) Decrease in net assets Adjustments to reconcile decrease in net assets to net cash provided by (used in) operating activities: Permanently restricted endowment contributions (3,625) Depreciation 12,028 9,600 Cumulative effect of change in accounting principle (15,147) Change in: ) ,517 Accounts receivable 6,384 20,723 (1 1,517 Prepaid expenses ) 84 (7,39 ,3 3 Accounts payable 6 5 , 0 00 9,98 Accrued liabilities Net cash provided by (used in) operating activities 2,332 (40,902) FINANCING ACTIVITIES - Permanently restricted endowment 3,625 contributions INVESTING ACTIVITIES - Property additions (4,728) (24,976) INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS 1,229 (65,878) CASH AND CASH EQUIVALENTS, BEGINNING OF YEAR 52,808 118,686 CASH AND CASH EQUIVALENTS, END OF YEAR $ 54,037 $ 52,808 See notes to financial statements. -4- • • 9 • ON VI 1 M N N V1 t- V1 00 00 0 O r r CI Q .- +VOM00 N 00M .r.� 0 1I N0 NO ta v �� N ‘ f6 O� _ v1 DD V1 O 01 O 0 � � 00 O: O; iA 2 t 11 V1 .-+ -r . 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' G W y 0 .. 03 al? a 0 .'p 1 O 8 = N� e O .InFW¢ Q E. N • 0 • HAWAII ISLAND ADULT CARE, INC. NOTES TO FINANCIAL STATEMENTS YEARS ENDED JUNE 30,1997 AND 1996 1. ORGANIZATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Organization Hawaii Island Adult Care, Inc. (HIAC) was organized on October 21, 1981 under the laws of the State of Hawaii. HIAC provides day care services for the elderly in the Hilo area. In addition, it provides Alzheimer support counseling services for family members of those suffering from Alzheimer's disease and respite services for caretakers of the frail and vulnerable elderly. The Center also provides in -home chore and personal care services. Summary of Significant Accounting Policies Basis of Accounting - The financial statements are prepared on the accrual basis of accounting and in accordance with generally accepted accounting principles. HIAC classifies its net assets and its revenue, support and expenses based on the existence or absence of donor - imposed restrictions. Temporarily restricted net assets result from contributions whose use is limited by donor stipulations that either expire with the passage of time or can be fulfilled and removed by actions of the organization pursuant to those stipulations. There were no temporarily restricted net assets at June 30, 1997 and 1996. Permanently restricted net assets or endowment funds result from contributions whose use is limited by donor stipulations that do not expire; only income can be used currently. Unrestricted net assets represent resources over which the board of trustees has discretionary control. Income Taxes - HIAC is classified as a tax- exempt organization under Section 501(c)(3) of the 11 S. Internal Revenue Code. It is recognized to be exempt from both federal and state income taxes. Property and Depreciation - Property is stated at cost or at a value established by the Board of Directors at the date of gift. Depreciation is computed using the straight -line method over the estimated useful lives of the assets. Contributions - All contributions are considered available for unrestricted use unless specifically restricted by the donor. Donated Facilities - HIAC uses a portion of the old Hilo Hospital in consideration for $1 per year. HIAC records the contribution of space both as public support and expense at estimated market value of $24,000 per year. Donated Services - No amounts have been reflected in the accompanying financial 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 to HIAC. -6- • • a • Use of Estimates - 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 revenue and expenses during the reporting period. Actual results could differ from those estimates. 2. CHANGES IN ACCOUNTING PRINCIPLES Beginning in fiscal 1996, HIAC adopted Statements of Financial Accounting Standards (SFAS) No. 116, Accounting for Contributions Received and Made, and No. 117, Financial Statements of Not-for-Profit Organizations. SFAS No. 116 establishes accounting standards for contributions. Contributions received, including unconditional promises to give, are recognized as revenue in the period received at their fair values. Adoption of SFAS No. 116 had no significant effect on HIAC's financial statements. SFAS No. 117 establishes standards for general- purpose external financial statements provided by not- for- profit organizations. SFAS No. 117 also requires not - for - profit organizations to classify their net assets as unrestricted, temporarily restricted, and permanently restricted. The cumulative effect of adopting SFAS 117 at July 1, 1995 was the recognition of $15,147 as an increase in unrestricted net assets from formerly deferred grant revenue. 3. ACCOUNTS RECEIVABLE Accounts receivable as of June 30, 1997 and 1996 consisted of the following: 1997 1996 Grant - Department of Human Services $20,025 $20,025 Client tuition and fees 10,328 10,524 Senior helpers 5,461 14,208 Internal Revenue Service 8,348 Hawaii County Office of Aging Other 508 605 Allowance for doubtful accounts (1,439) (1,439) Total $34,883 555,606 4. PROPERTY As of June 30, 1997 and 1996, property consisted of the following: 1997 1996 Equipment $ 130,276 $ 125,548 Vehicles 21,917 26,211 Office improvements 10,440 10A40 Construction in progress 12,661 162,633 174,860 Less accumulated depreciation (131,231) (136,158) Total $® $$ 3® 7._ a • • 5. PERMANENTLY RESTRICTED NET ASSETS In fiscal 1997, HIAC received endowment contributions of $3,625. The earnings from such endowment may be used for operations. 6. CONTRACTS AND GRANTS Department of Human Services - HIAC is under contract with the Department of Human Services (DHS) to provide day care services to the elderly. Under this agreement, participants are required to be low income, frail, and disabled individuals living on the island of Hawaii. HIAC recognized revenue of $120,148 from this contract in both fiscal 1997 and 1996. Office of Aging - HIAC received funds from the County of Hawaii, Hilo Office of Aging (OOA), to provide elderly care and services. The OOA funds were contributed by HIAC for the purpose of establishing scholarships for the elderly requiring day care. The funds were received over a six month period beginning January 1997 and used toward the care of qualified individuals. HIAC recognized revenue of $20,000 from this program in fiscal 1997. Executive Office of Aging - HIAC received funds from the County of Hawaii, Office of Aging, to provide caregiver training and support services. This program is designed to train caregivers in the delivery of services to the elderly and disabled in their own homes, thus reducing the possibility of premature institutionalization. Services are to include personal care and homemaker services. HIAC recognized revenue of $9,000 under this agreement in fiscal 1996. County of Hawaii - HIAC also received funds from the County of Hawaii to maintain Hale Kupuna - small group homes. Under this contract, HIAC is to assist individuals by placing and/or maintaining them in small group home situations; provide information, counsel, and guidance assistance to individuals and agencies seeking information about the program; and provide basic support services and growth opportunities in order to enhance the continued function of small group home participants. HIAC recognized revenue of $2,316 and $6,068 from this contract in fiscal 1997 and 1996, respectively. '7. OPTION TO TERMINATE AGREEMENT Under the terms of the contracts with DHS, DHS has the option to terminate the contract at any time should the State's funding be substantially reduced due to changes in program requirements and should HIAC not satisfy its obligations under the agreements. DHS must give written notice of its intent to terminate this agreement no later than 30 calendar days prior to the effective date of termination. * * * * ** -8 Farm 990 • Retur r anization Exempt Fro .te Tax 15 Under sect of the Internal Revenue Code (exc black OMB No. 1545-0047 ck lung benefit 1697 trust or private foundation) or section 4947(a)(1) nonexempt charitable trust This Fonn Is Department of the Treasury .Open to Public Internal Revenue saws Note: The organization may have to a copy of this retum to satisfy state reporting requirements. Inspection A For the 1997 calendar year, OR tax year period beginning July 1 , 1997, and ending J11IIP 30 , t B Check if: P1.... C Name of organization D Employer identification number ❑ Change of address laesi or Ha ... s l an . '. - e • • : 9 1 • ❑ Initial return Pant et Number and street (or P.O. box if mail is not delivered to street address) Room/suite E Stab registration number . ❑Finalretum 5... 34 Rainbow Drive ❑ Amended retum endfic City or town, state or country, and ZIP+4 F Check ► ❑ it exemption application (required oleo y Ste ts reporting) o , HI 96720 is pending Hil Ste - O Type of organization El Exempt under section 501(c)( 3 ) • (Insert number) OR O. ❑ 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 retum filed for affiliates? . ❑ Yes ® No 1 If either box In H is checked 'Yes: enter four-digit group exemption number (GEN) • G�7 (b) If 'Yes: enter the number of affiliates for which this return Is filed: . le .1 Accounting method: ❑ Cash ] Accrual, (c) is this a separate retum filed by an organization covered by a group ruling? ❑ Yes El No ❑ Other (specify) • K Check here • ❑ if the organization's gross receipts ere normally not more than 925,000. The organization need not file a retum with the IRS; but If it received a Form 990 Package in the mail, It should file a retum without financial data. Some states require a complete return. Note: From? 990-¢ may be used by organizations with gross receipts less than $100,000 and total assets less than $250,000 at end of year. Part Revenue Ex • enses and Chan !es in Net Assets or Fund Balances See S•ecifc.Instructions on •a•e 11. 1 Contributions, gifts, grants, and similar amounts received: a Direct public support • la 96,320 • . b Indirect public support lb 1,611 c Government contributions (grants) 1c d Total (add lines la through lc) (attach schedule of contributors) • (cash $ • noncash $ ) 97,931 2 Program service revenue including govemment fees and contracts (from Part VII, line 93) 582,139 3 Membership dues and assessments . 4 Interest on savings and temporary cash investrnents • 1.945 5 Dividends and interest from securities 6a Gross rents 8a j • b Less: rental expenses •6b c Net rental income or (loss) (subtract line 6b from line 6a) 1 7' Other investment income (describe ► ) • 8a Gross amount from sale of assets other IN Securities (e) other cc than inventory 8a 0 • b Less: cost or other basis and sales expenses . c Gain or (loss) (attach schedule) . . 8c d Net gain or (loss) (combine line 8c, columns (A) and (B)) 8d 9 Special events and activities (attach schedule) . a Gross revenue (not including $ of contributions reported on line la) 9 a I b Less: direct expenses other than fundraising expenses 1 • c Net income or (loss) from special events (subtract line 9b from line 9a) 9c 4,693 . 10a Gross sales of inventory, less returns and allowances , 110a I j b Less: cost of goods sold 10b c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 100 from line 10a) 10c 11 Other revenue (from Part VII, line 103) 11 _ 12 Total revenue (add lines 1d, 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 11) 12 686 ; 708 13 - Program services (from line 44, column (B)) 13 592,132 1 14 Management and general (from line.44, column (C)) 14 86,933 8. 15 Fundraising (from line 44, column (D)) 15 1,124 . 0 18 Payments to affiliates (attach schedule) 16 17 Total expenses (add lines 16 and 44, column (A)) 17 680,189 • 18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 6 51 9 19 Net assets or fund balances at beginning of year (from line 73, column (A)).. 19 1 00 , 977 9 20 Other changes in net assets or fund balances (attach explanation) 20 z 21 Net assets or fund balances at end of ear combine lines 18, 19, and 20 21 10 441 For Paperwork Reduction Act Notice, see page 1 of the separate instructions. Cat. No 11292Y Form 990 (1997) 4 Form 990 (18137) Page 2 Part 11 . Statement of `' ..1 organs must complete column (!). Columns (B), (C), a.._ (0) wired for section 501(c)(3) and (4) organizations Functional Expenses and section 4941(a)(1) nonexempt charitable trusts but optional for others. (See Specific Instructions on page 15.) Do not include amounts reported on line j (8) Program (C) Management (o) Fundraising 66, 8b, 9b, 10b, or 16 of Part I. ,4 Total services and general 22 Grants and allocations (attach schedule) (cash $ nond $ ) 22 ■ 23 Specific assistance to individual s (attach schedule) 23 24 Benefits paid to or for members (attach schedule). 24 25 Compensation of officers, directors, etc. . 25 26 Other salaries and wages 26 189_ 164 131 , 71 1 S7,651 27 Pension plan contributions 2 . 28 Other employee benefits 28 t • : s 29 Payroll taxes 29 40.441. 34.779 5,662 30 Professional fundraising fees 30 31 Accounting fees 31 8.348 3.147 5,201 32 Legal fees 32 33 Supplies 33 14.319 14.027 292 34 Telephone 34 5.674 5.674 35 Postage and shipping 35 1.833 1.753 80 36 Occupancy 36 20.463 20.463 37 Equipment rental and maintenance ... 37 8,591 8 , 591 38 Printing and publications 38 418 357 61 39 Travel 39 3.141 976 2,16 5 40 Conferences, conventions, and meetings . . 40 2.375 738 1.637 41 Interest 41 958 938 20 42 Depreciation, depletion, etc. (attach schedule) 42 13,143 13 ,143 43 Other expenses (itemize): a 43a b Grant expenses 43b 89,184 89,184 c see Attachment B 43c 26,704 18,609 6,341 1,124 d . 43d e 430 , . 44 Total functional expenses (add lines 22 through 43) Oiganfrations completing commas (e)•(0), cany these rotate td ones 13.15. 44 680,189 592,132 86 , 9 3 3 1,124 Reporting of Joint Costs. —Did you report in column (B) (Program services) any joint costs from a combined educational campaign and fundraising solicitation? O. ❑ Yes TO No If "Yes," enter 0) the aggregate amount of these joint costs $ ; 00 the amount allocated to Program services $ , 011) the amount allocated to Management and general $ ; and Qv) the amount allocated to Fundraising $ Part Statement of Program Service Accomplishments (See Specific Instructions on page 18.) What is the organization's primary exempt purpose? ►• •elderly. . 4ay- ••cars•• &•- 1n-hom4.•-care Program S erv ice All organizations must describe their exempt purpose achievements In a clear and concise manner. State the number (Required for 501(c)(3) and of clients served, publications issued, etc. Discuss achievements that are not measurable. (Section 501(c)(3) and (4) (4) op., and 4947(a)(1) organizations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of grants and allocations to others.) ftumbut m ro na for a _Attnl.t..A.a.y._.Genter - aea.. Attachment. .0 511,014 (Grants and. allocations $ ) b .$enzox.. el.pera..Erngxam - see..Atitachiu.ent C 67,885 (Grants and allocations $ ) c Small GrQup HgmQe — gee Attachment G 13,233 (Grants and allocations $ ) d (Grants and allocations $ ) e Other program services (attach schedule) (Grants and allocations $ 1 f Total of Program Service Expenses (should equal line 44, column (B), Program services) • 592,1:2 Forth 990 (1997) r , - _ p Pege 3 Part Balance Sheets (See�ecific Instructions on t ; page 18.) Note: Where required, attached schedules and amounts within the description -. - - (A) (8l 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 . 54 0 37 48 Al 1 60 7 473 Accounts receivable . . . .. . . 47a 33.628 j b Less: allowance for doubtful accounts . 47b IL 912 47c 13,628 s//SSZ 48a Pledges receivable 48a 9 , 750 b Less: allowance for doubtful accounts . . 48b 48c 9.750 49 Grants receivable 20,025 49 50 Receivables from officers, directors, trustees, and key employees ' (attach schedule) 50 51a Other notes and loans receivable (attach S schedule) 51a j d b Less: allowance for doubtful accounts . , 51b _ 51c 52 Inventories for sale or use 52 53 . Prepaid expenses and deferred charges 9,866 53 11,065 54 Investments — securities (attach schedule) 54 55a Investments —land, buildings, and equipment: basis SSa b Less: accumulated depreciation (attach schedule) 55b 55c 56 Investments —other (attach schedule) • 56 57a Land, buildings, and equipment: basis . 57a 1 63 374 % b Less: accumulated depreciation (attach /// schedule) 57b (141,917) 31,402 57c 21,457 .58 Other assets (describe P. • ) 58 59 Total assets (add lines 45 through 58) (must equal line 74) . . . . 130,262 59 139,060 60 Accounts payable and accrued expenses 29,340 60 28,819 61 Grants payable 61 to 62 Deferred revenue 62 R 63 Loans from officers, directors, trustees, and key employees (attach :a . schedule) 63 3 64a Tax- exempt bond liabilities (attach schedule) 64a b Mortgages and other notes payable (attach schedule) 64b 65 Other liabilities (describe ► New gate funds & PIN g)r' ' 65 2.800 66 Total liabilities (add lines 60 through 65) 2 , 340 66 31,619 Organizations that follow SFAS 117, check here • ® and complete lines , 67 through 69 and lines 73 and 74. i 67 Unrestricted 9 7 99 7 67 6 5 609 .0 68 Temporarily restricted 68 Q,7_5.0 a 69 Permanently restricted 1 69 5 69 17 Organizations that do not follow SFAS 117, check here • ❑ and c ii complete lines 70 through 74. // a 70 Capital stock, trust principal, or current funds . . . . . . . 70 .8 71 Paid -in or capital surplus, or land, building, and equipment fund . . 71 I 72 Retained earnings, endowment, accumulated income, or other funds 72 ,,, 73 Total net assets or fund balances (add lines 67 through 69 OR lines Z 70 through 72; column (A) must equal line 19 and column (B) must equal line 21) 10 73 1 07.441 74 Total liabilities and net assets / fund balances (add lines 66 and 73) 130 , 262 74 139,060 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. . • • - - Form 990 (1997) - Page 4 Part IV - Reconciliation of Raven er Audited Part IV -B Reconci n of Expenses per Audited • Financial Statements with Revenue per Financial Statements with Expenses per Return (See Specific Instructions, page 20.) Return a Total revenue, gains, and other support / a Total expenses and losses per per audited financial statements. . ► a 710 708 audited financial statements ► a 704 189 b Amounts included on line a but not on jj b Amounts included on line a but not line 12, Form 990: �j on line 17, , Form 990: (1) Net unrealized gains / (1) Donated services on investments . $ and use of facilities $2 , 000 (2) Donated services 24,000 (2) Prior year adjustments and use of facilities $ reported on line 20, (3) Recoveries of prior Form 990 . . . $ year (4) Other grants (specify): $ (3) line 20, Form 90 on $ $ . (4) Other (specify): Add amounts on lines (1) through (4) • 24,000 $ Add amounts on lines (1) through (4)• 24,000 c Line minus line b. • . , . . • 686 708 c Une a minus line b • 680 189 d Amounts included on line 12, % d Amounts included on line 17, Form 990 but not on line 9 Form 980 but not on line a: (1) Investment expenses (1) Investment expenses not included on line not included on line 6b, (2) Other r (specify): $ (2) Other (specify): Add amounts on lines (1) and (2) • . Add amounts on lines (1) and (2) • e Total revenue per line 12, Form 990 a Total expenses per line 17, Form 990 680 189 Ike c plus line d) . . . . . • e 686, 708 pine c plus line d) 10. e ® List of Officers, Directors, Trustees, and Key Employees (List each one even if not compensated; see Specific Instructions on page 20.) W Name and address (a) Title end average hours per ( not paidCompensation ter empbyee benefit Wes & account an i and other week devoted to poskion deferred compenraton allowances See Attachment D • • 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 $10,000 was provided by the related organizations? ► ❑ Yes ® No If "Yes," attach schedule —see Specific Instructions on page 20. • Form 990 (1997) ,, E' Page 5 • Part VI Other Information (Sae...,ic Instructions on page 21.) Yes No 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 goveming documents but not reported to the IRS? . . '��/n'�/�/�f(( //(//((;; (�(((( /�(��((�� X If "Yes," attach a conformed copy of the changes. ttfl� / //. 78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return?. X II b If "Yes," has it filed a tax return on Form 990 -T for this year? 78b ' A 79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If "Yes," attach a statement 79 , X i 80a Is the organization related (other than by association with a statewide or nationwide organization) through common X membership, governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization? . . prp b If "Yes," enter the name of the organization • and check whether it is ❑ exempt OR ❑ nonexempt. saA 81a Enter the amount of political expenditures, direct or indirect, as described In the instructions for line 81 181a 1 X b Did the organization file Form 1120 -POL for this year? �© 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? b If "Yes," you may indicate the value of these items here. Do not include this amount j jj as revenue in Part I or as an expense in Part II. (See instructions for reporting in Part III.) 182b1 74 ,00O 83a Did the organization comply with the public inspection requirements for returns and exemption applications? b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? . . 83b a 84a Did the organization solicit any contributions or gifts that were not tax deductible? b If "Yes," did the organization include with every solicitation an express statement that such contributions mgr. /A ��� or gifts were not tax deductible? 85 501(c)(4), (5), or (6) organizations. — Were substantially all dues nondeductible by members? nit b Did the organization make only in =house lobbying expenditures of $2,000 or less? 85b fal If "Yes" was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization rrj 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) 85f AA/ g Does the organization elect to pay the section 6033(e) tax on the amount in 85f?. i , h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount in 85f to its reasonable . • estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year?. 86 501(c)(7) organizations. Enter. a Initiation fees and capital contributions included on j j% line 12 86b N/A 13 Gross receipts, included on line 12, for public use of club facilities 86b 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 N/A i sources against amounts due or received from them) 87b 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 j j j • 89a 501(c)'3) organizatiqy1Enter. Amount of tax imposed N ring the year under: N/A // section 4911 • ; section 4912 •_ / ; section 4955 • �f( �j (�( /� ((((�� 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 c Enter: Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 • d Enter: Amount of tax in 89c, above, reimbursed by the organization • 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, 1997 (See instructions.) . . 190b 1 29 91 The books are in care of • Telephone no. ►( Z Located at • ZIP + 4 • 92 Section 494 7(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041 — Check here • ❑ and enter the amount of tax -exam •t Interest received or accrued durin • the tax ear . . • 92 x . Farm 990 - Page 6 Part VII Analysis of Incomo -ProWg Activities (See Specific Instructions page 25.) Enter gross amounts unlesd otherwise Unrelated business income Excluded by section 512, 513, or 514 (E) Related or indicated. (A) - (8) (C) (D) exempt function 93 Program service revenue: Business code Amount Exclusion code Amount . income a Day Center 486,083 b Senior Helpers 85,426 o Small Group Homes 10,630 d e f Medicare/Medicaid payments . g Fees and contracts from government agencies 94 Membership dues and assessments , . . 95 Interest on savings and temporary cash investments 4,693 98 Dividends and Interest from securities . . . 97 Net rental income or (loss) from real estate: /�/ /��� / V � ������ ����������� 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 (loss) from sales of assets other than inventory • 101 Net income or (loss) from special events . . 4,693• 102 Gross profit or (loss) from sales of inventory , 103 Other revenue: a b • c d e 104 Subtotal (add columns (B), (D), and (E)) . ��a / A 105 T o t a l (add line 104, columns (B), (D), and (E)) . . . • 5 8 8 , 7 7 7 • Note: (Line 105 plus line ld, Part 1, should equal the amount on line 12, Part.L) - .. Part: VIII Relationship of Activities to the Accomplishment of Exempt Purposes (See Specific Instructions on page 26.) 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). 93 -a -c All income collected provide direct services to the frail_eldeily and handicaned either at our da center in their homes chore or •ers.nal care at the small •rou. home or care'iver classes 95 Intrast is haing saved /sailed * b uildin g an endow for the future of services - our exempt purpose • 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 ' Total End-of -year number of corporation or partnership ownership interest business activities Income assets % % Under penalties of perjury,) declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge Please and belief, it Is true, correct @nd complete. Declaration of preparer (other than officer) Is based on all information of which preparer has any knowledge.. Sign (see oral Instruction yonlpag 10 5 Here t o .b a ' f4 i c1q ' Carolyn Cabriera,Act.Ex Direct Signature of otf Date Type or print name and title. Paid Preparers signature Date Check if self- Preparers SSN • • Preparer's Fan's name (or employed • ❑ f Use Only yours if self-employed) EIN • and address ZIP + 4 • • SCHEDULE A Orga n Exempt Under Sectio l' )(3) OMB No. 1&5-0047 (Form 990) pt i -note Foundation) and Section 501(e) 501(W, 501(n), or Section 4947(a)(1) Nonexempt Charitable Trust 110y � ■ • Supplementary Information x Department Internal Revenue serv ry le Must be completed by the above organiza ached to their Form 990 or 990-EZ. Name of the organization Employer Identification number Hawaii Island Adult Care, Inc. 99 0210974 Part I Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and 7Fustees (See instructions on page 1. Ust each one. If there are none, enter "None. ") (a) Name and address of each employee paid more (b) Title and average hours (d) Contributions to (e) Expense than $50,000 per week devoted to position (c) Compensation e t ed co p tion aliowaannces er None • • Total • number of other employees paid over $50,000 4 Part II Compensation of the Five Highest Paid Independent Contractors for Professional Services (See instructions on page 1. Ust 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 (e) Compensation None • • Total number of others receiving over $50,000 for professional services For Paperwork Reduction Act Notice, see page 1 of the Instructions for Form 990 and Form 990 -EZ. Cat. No. 11285E Schedule A (Form 990) 1997 • 6 Schedule .@ (Form 990) 1997 - i .. • Page 2 Part III Statements About Activiti ss Yes No 1 During the year, has the organization attempted to influence national, state, or local legislation, including any X attempt to influence public opinion on a legislative matter or referendum? 1 If "Yes; enter the total expenses paid or incurred in connection with the lobbying activities ► $ Organizations that made an election under section 501(h) by filing Form 5788 must complete Part VI -A. Other organizations checking "Yes," must complete Pan 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: a Sale, exchange, or leasing of property? 2a X b 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 $1,000)? 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 rants for scholarships, fellowships, 3 X 9 9 p ps, student loans, etc ? 4 Attach a statement to explain how the organization determines that individuals or organizations receiving grants � j or loans from it in furtherance of its charitable programs qualify to receive payments. (See instructions on page 2.) Part IV 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). 8 ❑ A school. Section 170(b)(1)(A)(i). (Also complete Part V, page 4.) 7 ❑ A hospital or a cooperative hospital service organization. Section 170(b)(1)(A)(I). 8 ❑ A Federal; state, or local govemment 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)(ii). Enter the hospital's name, city, and state • 10 ❑ An organization operated for the benefit of a college or university owned or operated by a govemmental unit. Section 170(b)(1)(A)(iv) (Also complete the Support Schedule in Part IV -A.) 11a n 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 in Part IV -A.) 12 ❑ An organization that normally receives: (1) more than 33 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 33'h% 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 organizations. (See instructions on page 4.) (b) Line number (a) Name(s) of supported organization(s) from above 14 ❑ An organization organized and operated to test for public safety. Section 509(a)(4). (See instructions on page 4.) • Schedule A (Form 990) 1997 • ft•99 3 a Part :IV -A Support Schedule (L et,. only if you checked a box on line 10, 11, o Lia.- ash method of accounting. Note: You may use the worksheet in the instructions for converting from the accrual to the cash method of accounting. Calendar year (or fiscal year beginning in) . • (a) 1996 . (b) 1995 (c) 1994 (d) 1993 (e) Total 15 Gifts, grants, and contributions received. (Do not include unusual grants See line 28.) 228 354 224 046 294 593 290 498 1, 037.491 16 Membership fees received 3,104 3 ,104 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 445,318 488,805 410,075 366,043 1,710,241 18 Gross income . from interest, dividends, amounts received from payments on securities • loans (section 512(a)(5)), rents, royalties, and unrelated business taxable income Qess section 511 taxes) from businesses acquired 1 94 5 3 3 28 3 3 5 9 3,510 , 510 12,142 ,14 2 by the organization after June 30, 1975 . > > 19 Net income from unrelated business 6,170 activities not included in line 18 2,670 3 , 500 • 20 Tax revenues levied for the organization's benefit and either paid to it or expended on • its behalf 21 The value bi services or facilities fumished to the organization by a governmental unit • without charge. Do not include the value of services or facilities generally fumished to the public without charge. . . . . . . • • 22 Other income. Attach a schedule. Do not 1,431 10 , 2 7 5 11,706 include gain or (loss) from sale of capital assets 23 Total of lines 15 through 22 678,28T /19,679 /09,455 673,430 z,7&0,854 24 Una 23 minus line 17 232,969 230,874 299,383 307,387 1 070 613 25 Enter l %of line 23 . . . . . . 6.783 7,197 7.095 6.734 26 Organizations described in lines 10 or 11: a Enter 2% of amount in column (e), line 24 . . . . ■ 28e 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 1993 through . 26b 1996 exceeded the amount shown in Tine 26a. Enter the sum of all these excess amounts ► 4 c Total support for section 509(a)(1) test: Enter line 24, column (e) • ► 28c 1 070 613 • d Add: Amounts from column (e) for lines: 18 12.142 19 6.170 / // 22 11 . 706 26b — 0 — . . . . ► 26d 30.018 e Public support (line 26c minus line 26d total) , . ► 26e 1 , 040. 59 5 f Public support percentage (line 26e (numerator) divided by line 26c (denominator)) ■ 261 97 % 27 person," attach described list to show the name of, andrtotal amounts received In each year from each "disquarefed person." Enter t "disqualified um of such amounts for each year: (1996) (1995) (1994) (1993) 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) $5,000. (Include in the list organizations described in lines 5 through 11, as well as individuals.) After computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year. • (1996) • (1995). (1994) (1993) • c Add: Amounts from column (e) for lines: 15 16 • 10. 27c 17 . 20 21 0. 27 e d Add: Line 27a total and line 27b total . . • e Public support (line 27c total minus line 27d total) ► 27e I$ ����, A f Total support for section 509(a)(2) test: Enter amount on line 23, column (e) . . • 1 • 27a % g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) % h 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 1993 through 1996• 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.) Schseule (Form 990)1997 Page Private School Qt.-,4t10.3 (See instructions on page 4.) N/A 4 (To be completed ONLY by schools that checked the box on line in Part IV) Yes No 29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, • other goveming 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 Pj brochures, catalogues, and other written communications with the public dealing with student admissions, y!�% % / %, programs, and scholarships? Ar 31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during / i 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? If "Yes," please describe; if "No," please explain. (If you need more space, attach a separate statement.) j j 32 Does the organization maintain the following: a Records indicating the racial composition of the student body, faculty, and administrative staff? b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis? c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student admissions, programs, and scholarships? d Copies of all material used by the organization or on its behalf to solicit contributions? / / If you answered "No" to any of the above, please explain. (If you need more space, attach a separate statement ) / 33 Does the organization discriminate by race in any way with respect to: a Students' fights or privileges? b Admissions policies? c Employment of faculty or administrative staff? d Scholarships or other financial assistance? • e Educational policies? f Use of facilities? g Athletic programs? h Other extracurricular activities? j j If you answered "Yes" to any of the above, please explain. (If you need more space, attach a separate statement ) % Ai 34a Does the organization receive any financial aid or assistance from a govemmental agency? . . . . ... ®■ b Has the organization's right to such aid ever been revoked or suspended? If you answered "Yes" to either 34a 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, coverin• racial nondiscrimination? If "No," attach an explanation . . . Schedule A (Form 990) 1997 4Page 5 Part .VI -A Lobbying Expendi L., Electing Public Charities (See i tit..,a on page 6.) (To be completed (Irby an eligible organization that filed Form 5768) N/A Check here P. a ❑ if the organization belongs to an affiliated group. . Check here ► b ❑ if you checked "a" above•and "limited control" provisions apply. • Limits on Lobbying Expenditures • Affiliated group To be co totals for ALL electing (The term "expenditures" means amounts paid or incurred.) organizations 38 Total lobbying expenditures to influence public opinion (grassroots lobbying) . . 38 • 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37 38 Total lobbying expenditures (add lines 38 and 37) 38 39 Other exempt purpose expenditures 39 40 Total exempt purpose expenditures (add lines 38 and 39) • 40 41 Lobbying nontaxable amount. Enter the amount from the following table—j It 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 $1,500,000 . $175,000 plus 10% of the excess over $1600,000 Over $1,500,000 but not over $17,000,000 . $225,000 plus 5% of the excess over $1,500,000 Over $17,000,000 $1 000,000 • j 42 Grassroots nontaxable amount (enter 25% of line 41) 43 Subtract line 42 from line 36. Enter -0- if line 42 is more than line 36- . . ... . . 44 Subtract line 41 from line 38. Enter -0- if line 41 is more than line 38 Caution: if there is an amount on either line 43 or line 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) • • 1997 1996 1995 1994 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)) j A 50 Grassroots lobbying expenditures . . . . Part: :VI -B Lobbying Activity by Nonelecting Public Charities . N/A (For reporting only by organizations that did not complete Part VI -A) (See instructions on page 7.) During the year, did the organization attempt to influence national, state or local legislation, including any Yes No Amount attempt to influence public opinion on a legislative matter or referendum, through the,use of: a Volunteers b Paid staff or management (Include compensation in expenses reported on tines c through h.) c Media advertisements d Mailings to members, legislators, or the public e Publications, or published or broadcast statements t Grants to other organizations for lobbying purposes g Direct contact 'with legislators, their staffs, government officials, or a legislative body h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means . . . . � / / / / �� j 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. • Schedule ip (Form 990) 1997 - Page 6 Part VII Information Rega._.ng sfers To and Transactions and nela hips With Noncharitable Exempt Organizations N/A 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 of: _ Yes No (1) Cash 51a0) (If) Other assets a(ii) b Other transactions: (1) Sales of assets to a noncharitable exempt organization _ b(i) (11) Purchases of assets from a noncharitable exempt organization b(ii) (111) Rental of facilities or equipment b(iii) (lv) Reimbursement arrangements b(Iv) (v) Loans or loan guarantees b(v) (vi) Performance of services or membership or fundraising solicitations b(vi) 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: (e) (b) (c) (d) Line no. Amount Involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements • • • • • • 52a 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? ■ ❑ Yes ❑ No b If "Yes," complete the following schedule: le) • @) • ldi Name of organization Type of organization Description of relationship • • • • • y a ' cn 0 W 01 o) 0) 01 01 O 01 m m 2 co 2 3 _a a m O . z o m O A (omn 3 d ¢o O (00 co co co C c0 c = j -- 3 m co a m m 3 0 0 o N v 3 m as m 1 narnf 3 CD 7 d o rn m ( ( ( CO CO CO CO V C. m c N O a my -‘ - 0 0 CO 03 V CO (a 330 (0 Ao<a m mm a s a - mT O 3 O N co W C C c c c, a s g� ' CO C1 3 3 3 3 3 •� CD m - a m m mm mm m m 0 o C C O O a w K ..r. ti .a O� y (D m c N a 7 3_ � j > > � w C C< a C C C C a O m N N town . . S 7 C 7 7 7 7 7 p W O O< m m co co m m m N n N ry S 7 > a C . m co co 0 0 CO m 0 3,,,a ma y 0 a0 mm -, mmmm o a CO N . O• 3 . aaaaa . 0 , O (j a a c ID 0 ) j (o (0 ( C D CO CO (0 (O CO � 0) "4 N m W ( S Q. _, 7 c j CO W a CO (D (D t0 CD 0 O 0 •V O 0 0 y N N O -1 V V o) o1 a W Al w m CO m 0 ccD 0 (O O (o (0 (0 (O (D (O (0 CO v �( m (O 91 9.1 m a 2 O)c. cT 5t co ao V O) v t AA� m n D O m -1 m -L -< 0 S N O -+ co NO) 0 O ANO)as co • 0 (O Z 9 0) W c0 G) (O N N CT V - co co W N V O (0 CD A W O 01 c 0 � a -S c W CO CO CO ( A A A a .. V n a D A m a m v Z c m r _, f m (0 W N O) o) O — co 0 O A A A 0) ( CO CO CT N O (/) a 0) a V A O V CO O W O J m J —5 - 1 O) _, _, - N3 A -s _. —s co co O — c0 N W 0) 0) O a CO A N O) -, -t W C (0 W A W A� ) 00 A O 0) i V OO cO W IV V p" co A O cn N - O O-+ N W 0 COO C C a- vc � - 0 c 03 3 3 CO CO - N O) 0 CID 01 O (D CO cc - CU a. W V A N CO (T CO N O) (D .+ N U1 O V V C N) V CO 01 CO W _ V A N O A W A O m N) v 00000_a a 0 m m-a R W �a —S —S N W N CO 7 0 A N N V V 01001N A 0)cJ43N CO m 0 CO W W O O O W 01 O) W O 01 C 7 O) O (U W m .. N N NO) O) �p c 01 01 CO (01 10 CO W co U) CO CO N v� _ _ _ 1 _ _ w 3 (D (0 O �a O) O) -+ s —S V W CO CI n W ail • (D c 0 N O V 1 1 O CO V i O m O) 0) N V DO .m+ N V a CO N a O O a N Ut N CO CO O V CO - 3 a / • • • Hawaii Island Adult Care, Inc. 34 Rainbow Dr. Attachment B Hilo, 1-11 96720 Schedule EIN: #99-021097 Form 990 -1997 Page 2, Part II, line 43: Other Expenses Total Program Mgmnt Fundraising Advertising 1,000 1,000 Bad Debts 82 82 Bank fees, GE taxes, licenses 507 507 BOD Insurance 1,829 1,829 Membership Dues 1,238 619 619 Minor Equipment Purchases 1,893 1,893 Miscellaneous 1,124 1,124 Special program & staff events 2,910 1,840 1,070 Staff Program Support 4,947 3,631 1,316 Transportation Program 10,544 10,544 Total Other Expenses 26,074 18,609 6,341 1,124 • . • e . • lawaii Island Adult Care, Inc. 14 Rainbow Dr. Attachment C - -Lilo, HI 96720 =IN: #99- 0210974 Form 990 -1997 Page 2, Part I11, lines a - d HILO ADULT DAY CENTER: The Dav Center provides daily health and social services in a supervised setting to disabled adults 18 years and older. In F.Y. 1998, the center serviced 176 individuals. Average daily census equaled 60 patients. Many of these individuals would be in a nursing home if not for the center, the day program allows them to remain living at home. Publish quarterly newsletter for families and community at large. The State of Hawaii donates space for the program at an estimated value of $24,000 per year. SENIOR HELPERS: The Senior Helper program provides in -home personal care and homemaker services to homebound, disabled adults. The program also offers respite to family caregivers. In F.Y. 1998 Senior Helpers provided an average of 625 hours of in -home services per month with an average open caseload of 14 patients. "ALL GROUP HOME: The Small Group Home provides supportive group living and case management services to semi - disabled, low income adults 60 years and older. In F.Y. 1998 the group home housed four residents. • e • • Hawaii Island Adult Care, Inc. Attachment D 34 Rainbow Dr. Hilo, HI 96720 EIN: #99-0210974 Form 990 -1997 Page 4, Part V List of Officers, Directors, and Trustees (A) Name and Address (B) Title & (C) Compen- (D) Contribu- (E) Expense average hours sation (if not tions to account and per week paid, enter employee other devoted to zero). benefit plans allowance position Robert Kita President 0 0 0 391 Mohouli St. 1 Hr /week Hilo, HI 96720 Mele Spencer Vice -Pres. 0 0 0 P.O. Box 1373 1 Hr/week Hilo, HI 96721 Ivan Yamamoto Secretary 0 ' 0 0 Hale Anuenue Restorative 1 Hr /week • Care Center 1333 Waianuenue Ave., Hilo, HI 96720 Harold Luscomb Treasurer 0 0 0 892 Komomala Drive 1 Hr /week Hilo, HI 96720 Robert Chow 1/4 Hr./Week 0 0 0 857 Uilani St. Hilo, HI 96721 • Jan Houser, M.D. 1/4 Hr /week 0 0 0 Hilo Medical Associates 73 Puuhonu PI. Hilo, HI 96720 Derek Kurisu 1/4 Hr /week 0 0 0 50E Puainako Ave. Hilo, HI 96720 Rowena Loo 1/4 Hr./Week 0 0 0 PO Box 517 Hilo, HI 96721 • • e s List of Officers, Directors, and Trustees (A) Name and Address (B) Title & (C) Compen- (D) Contribu- (E) Expense average hours sation (if not tions to account and per week paid, enter employee other devoted to zero). benefit plans allowance position Maggie Mallen 1/4 Hr /week 0 0 0 167 Apoke St. Hilo, HI 96720 Lester Oshiro 1/4 Hr /week 0 0 0 77 Mohouli Street Hilo, HI 96720 Dr. William Pearman 1/4 Hr /week 0 0 0 701 Hueu Place Hilo, HI 96720 Tom Robb 1/4 Hr /week 2405 Kalanianaole St., PH 17 Hilo, HI 96720 Ann Tanouye 1/4 Hr./Week 0 0 0 Hilo Medical Center 1190 Waianuenue Ave., Hilo, HI 96720 Nancy Yamada 1/4 Hr /week 0 0 0 36 Olu St. Hilo, HI 96720 Rev. Phillip Zabell 1/4 Hr /week 0 0 0 1753 Uhaloa Rd. Hilo, HI 96720 Associate Members: Carl Rohner President 1939 Kilauea Ave. Emeritus Hilo, HI 96720 1/4 Hr /week Emmet Cahill 1/4 Hr /week 0 0 0 PO Box 807 Volcano, HI 96785 A. Stephen Woo, Jr. M.D. 1/4 Hr /week 0 0 0 193 Halai Street Hilo, HI 96720 b tomal Rovesme Santo r •. Farm:.; & Spacial Coonlin. !Staff 0 . vn ' :'. fl visiaa - 8127 P.O. Box 2320 Internal Revenue Service EP/ED Disclosure Desk Loa CA. 900 -' O Angeles, P.O. Box 2350 Los Angeles, CA•90053 Person to Contact: • • . .Felicia C. Miraflor HAWAII ISLAND ADULT CARE 'Telephone Number: INC FKA HILO ADULT DAY CARE (213)894 -4232 34 RAINBOW DRIVE Refer Reply to: HILO, 111 96720 ' 90 -267 Date: Feb 1.6, 1990 • RE: 98- 0210974 • HAWAII •ISLAND ADULT CARE • INC FICA HILO ADULT DAY CARE Gentlemen: This is in response to your request 'For a determination letter of the above -named organization. A review of our•recor indicates that the above -named organization was recognized to be exempt from Federal income tax in July 1982, as an organization described in Internal Revenue Code section 501(c)(3). It is further classified as an organization that is not a private foundation as defined in section 509(a) of the code, because it is an organization described in section 170(b)(1)(A)(vil. This letter verifies your exempt status, and the fact that the original determination letter issued in July 1982 -continues to be in effect. If you are in need of further assistance, please feel free to contact me at the above address. We appreciate your cooperation in this regard. Sincerely, Disclosure Assistant • ,•• ACORD Dia"laixtrrn 12/27/99 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION TRIAD INS AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 420 WAIAKAMILO RD #205 COMPANIES AFFORDING COVERAGE HONOLULU HI 96817 COMPANY A NAUTILUS INS CO INSURED COMPANY HAWAII ISLAND ADULT CARE INC 7 COMPANY L, 34 RAINBOW DR HILO HI 96720 COMPANY 1 A 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 POUCIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECT POLICY EXPIRATION TYPE OF INSURANCE POIJCY NUMBER IJMITS DATE (MM/DTY) DATE (MWDDNY) k GENERAL LIABILITY NC099702 1/01/00 1/01/01 GENERAL AGGREGATE $1,000,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $ EXCLUDED CLAIMS MADE I X I OCCUR PERSONAL & ADV INJURY $1,000,000 OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE B1, 000, 000 FIRE DAMAGE (Any One Be) 50,000 MED EXP (Any one person) $ 1,000 Au °m°Ba ummurf 'This ins Jrance c'enra ANY AUTO c farinee,--sp.e.thiC,Lra t hrit lIcenzed by fie Ste 01- Hawaii an is not st4.) COMBINED SINGLE LIMIT $ ALL OWNED AUTOS 1".••.„ r.ir axarrifInati.., If the insurer is • •ndc‘r Chi?, contract a not severe( by BODILY INJURY SCHEDULED AUTOS I1. . 1, • " , (P pinyon) HIRED AUTOS c of tha S,Qat a 0714w.i. • BODILY INJURY NON-OWNED AUTOS (Per accident) —1"1 e 1 Int AGENCY INC. Line Braer Licen :II I i7;37"t3) PROPERTY DAMAGE $ AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER 11-IA? AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM WC STATU- OM- WORKERS COMPENSATOR AND TORY LIMITS ER " EMPLOYERS UABILRY EL EACH ACCIDENT _ $ THE PROPRIETOR/ PARTNERS/EXECUTIVE INCL EL DISEASE-POUCY umrr _ — OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ OTHER DESCRIPTION OF OPEFIATONS/LOCATIONSNEHICLES/SPECIALIIEMS • CERT HOLDER IS NAMED AS ADD'L INSURED BUT ONLY AS THEIR INTEREST MAY APPEAR. SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE COUNTY OF HAWAII EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 3_0_. DAYS TIFI WINIT 7H, ICE70E CFICIRE t104DEFINME TO THE LEM; 25 AUPUNI STREET BUT FMUJRE 70 . ' SHALL IMPOSE NO OR LUU3ILrrY HILO, HI 96720 OF ANY K1ND THE R$IMPANY,...RSAGENTS ESEIMATRES. AUTHORIZED REP "" • ••• • v TRIAD INSURANCE AGENCY • B Non ProfIt Corporation FILING FFE S10 FILE IN DUj (Conn/onion charge 5.10 per ye sv- oiai.,1$) STATE OF HAWAII DEPARTMENT OF REGULATORY AGENCIES Business Registration Division 1010 Richards Street Mailing Address: P. O. Box 40, Honolulu, Hawaii 96310 f�J , 4J - In the Matter of the Incorporation i r� of HILO ADULT DAY CARE AID r LATER . [':j:. - " - � - r c✓ • . c: PETITION FOR CHARTER OF INCORPORATION The undersigned, a majority of whom are residents of the State of Hawaii, hereby petition, under the provisions of C ction 418.19 and 416-20, Hawaii Revised Statutes, for a charter of incorporation, for themselves and their aasociatas, as a ncn •profitcorpaation under the name of H I LO ,ADIfTT DAY CARR A T?? CFM FR. TMC and In connection herewith do hereby incorporate herein by reference thereto the accompanying proposed charter of incorporation wherein are set forth various matters required under Section 416.20 aforesaid. �,c}! / cats at ',ge alto , Hawaii, this ....2131 day of (v!!.laAtel , 1911. • (sir tore/ J / ITT.11 FOX y/ ,,' (Slgnae) BETTY NAGAO • • Signature) G. EDGAR STONE STATE OF HAWAII af, COUNTY OF HAWAII • (County) 1rmrT FnY w. BETTY NAGAO sand EDGAR STONE , being first duly swum on oath, depose and say that they are the patiainkii &&r6 r,,nsd, t,Fa: - :hay have re ad Ile foregoing netitlon and attached proposed charter of incorporation and know the contents thereof; and that the matter and sii temefs therein set forth are true to the best of their knowledge and belief. • /4 a c (si / ,DITW FOX Subscribed and sworn to before rue this .2l� day of gp,�.-at+./ / a r 19 II/ �/�// � BETTY RAOA0 1LG: (1r y .)et 4 �(� Md. N y Publi �?'�n`f Judicial Circuit State of Hawaii gnature) • My commission expires: 0,5/8,3_, G. EDGAR STO Rev: e I n the Matter of the Incor pore don . _ of • HILO ADULT DAY CAPE AID Ci {t4 1!•u). CHARTER OF INCORPORATION TO ALL TO WHOM THESE PRESENTS SHALL COME: 1, the undersigned Director of Regulatory Agencies of the State of Hawaii, send Greeting: WHEREAS, .111DImif Fig RFTTV NARAO and EDGAR STONE a majority of whom are reddents of the State . of Hawaii, hava fflcd with ma as Dlractor of Regulatory Agandas a verified petition to grant to than and their as:odatas a charter of Inrararatian w a nonprofit corporation, in accordance with the provisions of Section 416.20, Hawaii Ravlead Statutas, NOW, THCREFORE, KNOW YE, That I, the said Director, In the exercise and execution of every power and authority In anywise enabling ma 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 sat forth. The mama of the corperatlon shall be: HILO ADULT DAY CARE AID CENTER, INC. 11 The location of the principal of flea of the corporation shall be in the City Of HI1 O , C oun t.y Of Hawaii , State of Hawaii, and the specific address of its Initial office shall be 34 Rainbow Drive, Hilo, Hawaii 96720 *State of Hawaii. III The purposes of the corporation are: To provide protective and sbpportive care for the disabled elderly. • / Co ' IV The duration of the corporation shall be perpetual. ._ V The officers shall consist of a: ITIti .I Only) President - Director Vice - President Secretary - Treasurer V1 There shall be a board of directors consisting of not less than 1 member(s). The following persons shall ba the initial fficers and directors, and shall hold office for the first year or until their Suecesson are duly elected pursuant to tha by-laws f the corporation: Office Held Na_ a Residence Address i President- Director 'Judith Fox 281 Kipa Street Hilo, Hawaii 96720 • & Director Vice - President William Carse 660 Kaumana Drive & Director Hilo, Hawaii 96720 Secretary - Treasurer Betty Nagao 50 Aipuni Street &Director Hilo, Hawaii 96720 Director • Edgar Sfrone / P.O.Box 176 Volcano, Hawaii 96785 I I • / _ ...... VII I The corporation shall have all the pc :. rovided by law. , i -:-.-__ _ I. • .• • . VIII • The corporation is orbar ad for dill CS tabl • pa-pasts only and Is not orosntcad fa profit. It will not Issue any stook, and no part of Its risen, Imams, or aarn(rp chill is :: :11rILatw3 to Its merctars. drainers. w officers. except for unless actually rendered to the oorporeyon. Upon diaat4Jot, all 0 Oa ... of'tl the torso a lai a;tsr payment of Its just dabs dull be transf rrd or distributor] to an orgcniatton or orward:.:t:ons ea shall et t o tirna qualify as an exempt organization or organisations under Section Settcllti of tha Intornal Rsr.ancsa Calla of Iff Notwithstanding sny other provision of this Charter. this corporation shall not, axatpt to an in::�:.untlal ck, rao, aniar In any salsifies or exorcise any powers that are not In furthorancl of the outposts( of this wrpor:tlan. IN WITNESS yfrfCRCOF. I have hereunto it my hand end seal of the Department of Regul4tory Agendas. at 3Aft day of 1)( v-1..., — 1 • ne Uf Regulatory Aa.n::l $ • By Corporation & Boas ici A ,air �.:Jator • • • • • - I i4 � 4 I - I o + HAWAII ISLAND CULT CARE, INC. S a TELEPHONE: (808) 961 -3747 FAX: (808) 961-3740 • _ -± 34 Rainbow Drive, Hilo, Hawaii 96720 BYLAWS OF HAWAII ISLAND ADULT CARE, INC. I Revised December 17, 1997 is Hilo Adult Day Care Center • Senior Helpers • Careeiver Connection • Small Group Homes . ARTICLE I: NAME • This corporation is known as Hawaii Island Adult Care, Inc. • ARTICLE II: LOCATION The location of the principal office of the corporation is in Hilo, County and State of Hawaii, and the specific address of its initial office is 34 Rainbow Drive, Silo, Hawaii 96720. The Corporation may maintain additional offices at such places as the Board of Directors chooses to designate. ARTICLE III: PURPOSES The corporation is organized exclusively for the charitable purpose of providing protective and supportive are for frail elderly and disabled adults on the Island of • Hawaii. ARTICLE IV: BOARD ()F DIRECTORS 1. Board membership. The Board of Directors shall consist of not more than twenty- one and not fewer than eleven members, provided that at any time due to resignation or implicit resignation due to non - attendance the remaining number of members shall be allowed to conduct all business as necessary until such time as the minimum number of board members may be appointed. All members serve without compensation. • a ' All niemlicrs of -the ser4 for a term of three years, renewable for one term for a maximum of six years. • b. One -third of the Board is elected each year, and the term of one -third of the Board .expires each year. c. The Nominating Committee of the Board of Directors will prepare a slate of candidates for officers and new board members to be presented to the Board' for election at the first meeting of the calendar year. d. Removal. A member may be removed from the board by a three- fourths vote of board members voting on the issue at a properly convened meeting of the board. • The member in question must receive the written reason for removal ten (10) , days before any meeting at which the matter is to be decided and must be afforded an opportunity.to respond to the Board before any decision is taken. H.I.A.0 Bylaws 1 Revised December 17. 1997 • • u 2 e. Attendance: Three consecutive absences, unexplained or not excused by the President, shall be considered an implicit resignation from the board. The President shall so notify the member in question by letter. 2. Powers and Functions. The Board of Directors shall be the governing body of the corporation, with the full power and authority to manage, conduct and control the business and affairs of the corporation. All actions taken by the Board of Directors shall be deemed to be the acts of the corporation. 3. M tinc a. Regular meetings shall be held at least quarterly; a notice of such meetings stating date, time place and agenda shall be given to each member either orally or in writing at least seven days before the meeting. b. Special meetings may be called by the President or upon written request of two directors. The President or Secretary shall notify each member either orally or in writing of the purpose, agenda, date, time and place of the meeting at least seven days before the meeting, except in exigent circumstances. c. Written notice may be mailed or faxed to the members address as recorded on the roster or delivered personally at their residence or place of business. d. Verbal notice may be telephoned personally to the member or relayed via a reliable intermediary. • 4. Ouorum and Voting. Fifty percent of the existing directors shall constitute a quorum. Written proxies are permitted provided a quorum is present. No decision may be transacted without a quorum, but those present may adjourn to a later date. A vote shall be determined by a simple majority of those present and voting. 5. Committees. The Board may create and appoint such committees as required and shall define the authority and duties of such committees. Standing committees shall include, but not be limited to: 1) Personnel, 2) Nominating, 3) Finance, 4) Planning, and 5) Bylaws. HIA Bylaws 2 Revicerl December 17 1997 • • 6. Associate Members: From time to time the Board may elect any number of individuals as associate members to serve in an ex- officio non - voting capacity. Associate members present at Board meetings shall not considered when determining if a quorum is present. ARTICLE V: OFFICERS 1. OFFICERS: The officers of these corporation are a President, a Vice President, a Secretary, a Treasurer and a President of Emeritus. 2. ELECTION: All officers are elected by the Board at the first meeting of the calendar year. Each officer shall take office for a term of one year. In the election for any office, the person receiving a simple majority vote of those present and voting shall be deemed elected. 3. REMOVAL: An officer may be removed from office by a three - fourths vote board members voting on the issue. The officer in question must receive the written reason for removal ten days before any meeting at which the matter is to be decided and must be afforded an opportunity to respond to the Board before any decision is taken. Any resulting vacancy may be filled in at that same meeting in the manner provided in Article V section 5. An officer (or Board member) who willfully neglects to carry out the policies or actions duly voted upon an passed by the Board, or who fails to carry out the responsibilities as stated in the corporate bylaws, including attending meetings and participating in the functions of the Board, may be subject to removal in accordance with this article. 4. RESIGNATION: Any officer may resign at any time by giving a written notice to the President, or in the case of the President, to the Vice President. Any such resignation shall take effect at the time specified in the notice; unless otherwise • • H.I.A.0 Bylaws 3 Revised December 17, 1997 • • . specified in the notice, acceptance of such resignation shall not be necessary to make it effective. 5. Vacancy. Any vacancy occurring in any office, except the office of president, shall be filled by the Board of Directors at any general or special meeting of the Board. A person elected to fill a vacancy shall serve the unexpired term of the predecessor in office. 6. President. The President is the principal officer of the corporation and shall generally oversee its business and affairs. In so doing the President: (a) is an ex- officio member of all committees and presides over all meetings of the Board; (b) signs all authorized contracts and other instruments unless directed otherwise • by these bylaws, by the board, or by legal statute; (c) performs such other duties as directed by the Board. 7. Vice President. The Vice President shall assist the President. In doing so, the Vice President: (a) is an ex- officio member of all committees; (b) assumes the powers and duties of the President in the absence or disability of the President; and, (c) performs such other duties as are properly required of the Vice President by the President or the Board of Directors. In case of a vacancy in the office of President, the Vice President shall become President and serve the unexpired term. 8 . Simmgay.. The Secretary: (a) is responsible for keeping minutes of the meetings of the Board of Directors; (b) sees that all notices of meetings of the Board are given as required; (c) ensures the proper maintenance of the corporation records; (d) signs, with the President, all contracts and other instruments authorized to be executed, unless the signing and execution are expressly delegated by these bylaws or by the Board of Directors, or'` are required by law, to be performed by some other officer or agent of the corporation. In general, perform all other duties assigned by the President or Board of Directors. The Secretary's records shall be open at all times for inspection by any member of the Board of Directors. 9. Treasurer. The Treasurer. (a) is responsible for overseeing the financial accounts of the corporation; (b) advises the board regarding financial matters; HI AC Bylaws 4 RPVicPr4 ll•AAmhAr 1 1 nn'/ • • (c) serves as official chairman of the Finance Committee; (d) oversees the audit or review of the corporation's books; and (e) in general, performs all other duties assigned by the President or Board of Directors. The books and accounts shall be audited at least once every two years and submitted for a financial review all other years by an auditor or auditors selected by the Board of Directors, ARTICLE VI• EXEC UTIVE DIRECTO 1. Appointment. The Executive Director is appointed by the Board upon recommendation of the Personnel Committee. • 2. Duties. The Executive Director shall carry out the policies and programs set by the Board of Directors. 3. adagio. The Personnel Committee shall meet at least annually with the Director to evaluate the Director's performance. 4. Corrective action. To be considered valid, any charges of misconduct or malperformance on the part of the Executive Director must be submitted in writing, along with pertinent documentation, to the President or the Board. The President may then appoint a panel of three members to investigate the charges and to report to the Board within thirty days. The President must concurrently present a copy of the charges and pertinent documentation to the Executive Director. In any event, the Executive Director must receive at least ten days notice of any Board meeting at which the changes are to be discussed and also have the opportunity to speak to the Board prior to any decision regarding the charges.' ARTICLE VII: NON - LIABILITY OF DIRECTORS 1. Exculpation. No director or officer of the corporation shall be liable for acts, default or neglect of any other director or officer, or for any loss sustained by • • • the corporation, unless the same has resulted from the director's or officer's own willful misconduct, willful neglect or negligence. 2. indemnification. Every director and officer shall be indemnified by the corporation against all reasonable costs, expenses, and liabilities ('including all legal fees) actually and necessarily incurred by or imposed upon him/her in connection with or resulting from any claim, action, suit, proceeding, investigation, or inquiry of whatever nature in which the director may be involved as a party or otherwise by reason of the director being or having been a director or officer of the corporation, whether or not he/she continues to be such director or officer of the corporation at the time of the incurring or imposition of such costs, expenses, or liabilities. However, there shall be no indemnification in relation to matters as to which the director or officer shall be finally adjudged in aforesaid claim, action, suit, proceeding, investigation or inquiry to be liable for willful misconduct or willful negligence toward the corporation in the performance of their duties as such director or officer. As to whether or not a director or officer was liable by reason of willful misconduct or willful negligence toward the corporation in the performance of their duties, in the absence of final adjudication of the existence of such liability, the Board of Directors and each Director and officer may conclusively rely on an opinion of legal counsel selected by the Board of Directors. The foregoing right to indemnification shall be in addition to and not in limitation of all other rights to which such person may be entitled as a matter of law. ARTIC E Vnl' ROBERT'S RU ES n OVER Robert's Rules of Order, Revised (most current edition), shall govern the proceedings of all meetings of the corporation and its constituent parts, except as otherwise provided in these bylaws. A RTICLE IX: GIFTS ONE The Board of Directors may accept an behalf of the corporation any contribution, gift, grant, bequest or device. H.I.A.0 Bylaws 6 Revised December 17, 1997 • CLE X• DISTRTRT TION OF ASSFTC UPON DISSOLUTION Should the corporation ever be dissolved, the assets of the corporation, if any, shall be distributed, following a vote of a simple majority (of those present and voting) of the Board of Directors, to one or more corporations that are exempt, or have applied for exemption and ultimately receive exemption, from Federal income tax under section 501 (c) (3) of the Internal Revenue Code of 1954, or the corresponding provision of any future United States Internal Revenue Law, or a Federal or State Agency that provides similar services as provided in the corporation. Preference is such distribution shall be given to corporations whose purposes are similar to the purposes of this corporation. AND ONFf IC'r OF INTI'RFST "Nepotism ", for the purpose of this article, is favoritism shown to a relative (as in granting an appointive position) on the basis of relationship. "Conflict of interest" is the seeking of one's own individual gain at the expense or disadvantage of the corporation. No employee or member of the Board shall take any official action directly affecting Hawaii Island Adult Care, Inc. involving any business or other undertaking in which that person has a financial interest or is engaged as legal counsel, advisor, consultant, representative or other capacity. If the possibility of a conflict of interest should arise, whether by nepotism or otherwise, in the dealings of a Board or staff member, such potential shall be made known in writing to the Board of Directors. The Board shall rule on all potential cases of conflict of interest and/or nepotism at the first meeting of the board possible following such notification, whether or not on the agenda. The participation of such person in the discussion or decision of the issue may be limited by the Board. ARTICLE XII: AMENDMENTS TO BYLAWS These bylaws may be amended, repealed, or altered, in whole or in part, by a simple majority vote of the Directors present and voting at any general or special meetings of the Board of Directors, provided that a written notice to amend and copies of the proposed amendments(s) have been distributed to each director at least seven days H.1..a.0 Bylaws 7 Revised December 17. 1997 • • before the meeting at which the proposed amendment or amendments are to be discussed and voted on. These bylaws shall be reviewed annually by the By -laws committee, which shall make any recommendations for change to the President. ARTICLE XIII: NON PROfTT STATUS The corporation is not organized for profit. 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) (3) of the Internal Revenue Code of 1954, or the 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. I hereby certify that these bylaws were duly adopted by the Board of Directors on October 11, 1995. i Carl Rohner President • H.I.A.0 Bylaws 8 Revised December 17, 1997