2024-04-17T21:58:21-05:00 2023-06-30 261659234 CW ASSOCIATES CPAS 700 BISHOP STREET SUITE 1040 HONOLULU HI 96813 990 2022-07-01 990149797 KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES KOKU 8087919400 2239 NORTH SCHOOL STREET HONOLULU HI 96819 DAVID DERAUF CHIEF EXECUTIVE OFFICER 8087919400 2024-04-17 1 DAVID DERAUF 999009999 0 RODNEY M HARANO P00389596 8085311040 2024-04-17 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DAVID DERAUF 2239 NORTH SCHOOL STREET HONOLULU HI 96819 25762283 0 X WWW.KKV.NET X 1972 HI KOKUA KALIHI VALLEY AND AFFILIATE (THE "CENTER") WERE INCORPORATED IN THE STATE OF HAWAII IN MAY 1972 TO PROMOTE HEALTH AND TO PROVIDE COMPREHENSIVE FAMILY SERVICES IN THE KALIHI VALLEY COMMUNITY IN THE CITY & COUNTY OF HONOLULU, HAWAII. THE CENTER IS A FEDERALLY-QUALIFIED HEALTH CENTER THAT PROVIDES A BROAD RANGE OF HEALTH AND SOCIAL SERVICES TO A LARGELY MEDICALLY-UNDERSERVED IMMIGRANT POPULATION. 12 12 306 780 0 0 13956128 13074325 11223129 9523463 8342 265621 10345 2068845 25197944 24932254 0 0 0 0 15571578 17075982 0 0 0 5899055 5960144 21470633 23036126 3727311 1896128 24586907 26538790 1909267 2057498 22677640 24481292 TOGETHER WE WORK TO ADVANCE HEALTH, TO INSPIRE HEALING, TO FOSTER RECONCILIATION, AND TO CELEBRATE ABUNDANCE IN THE AHUPUA'A OF KALIHI THROUGH STRONG RELATIONSHIPS THAT HONOR CULTURE AND PLACE. 0 0 18019540 11592308 SERVICES PERFORMED TO PROVIDE ACCESS TO MEDICAL, BEHAVIORAL HEALTH, DENTAL, PHARMACY AND SOCIAL SERVICES IN THE KALIHI VALLEY COMMUNITY. 18019540 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 84 0 306 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 HI X CHAN HOU LEI CHIEF FINANCIAL OFFIC 8087919400 2239 NORTH SCHOOL STREET HONOLULU HI 96819 SANDRA HARVEY PRESIDENT 1.00 X X 0 0 0 THOMAS KUSATSU VICE PRESIDENT/TREASURER 1.00 X X 0 0 0 VANESSA DACUMOS SECRETARY 1.00 X X 0 0 0 PUA AUYONG DIRECTOR 1.00 X 0 0 0 EDWARD KEMPER DIRECTOR 1.00 X 0 0 0 BRYANT DE VENECIA DIRECTOR 1.00 X 0 0 0 KAREN FOX DIRECTOR 1.00 X 0 0 0 RICKEY MURASHIGE DIRECTOR 1.00 X 0 0 0 DAVID NAKAMOTO DIRECTOR 1.00 X 0 0 0 PAULINA ROBERT DIRECTOR 1.00 X 0 0 0 FAITH KAHALE SAITO DIRECTOR 1.00 X 0 0 0 BEVERLY KILLION DIRECTOR 1.00 X 0 0 0 DAVID DERAUF CHIEF EXECUTIVE OFFICER 40.00 X 265464 0 57968 CHAN HOU LEI CHIEF FINANCIAL OFFICER 40.00 X 131126 0 26179 YUET MUI KONG CHIEF OPERATIONG OFFICER 40.00 X 97708 0 16375 LAURA DEVILBISS CLINICAL DIRECTOR 40.00 X 236583 0 27550 MELISSA MCKINNEY PHYSICIAN 40.00 X 183445 0 29811 MYA HLA PSYCHIATRIST DIR OF BH 40.00 X 170425 0 42125 ANGELICA AGAPITO PHYSICIAN 40.00 X 161299 0 29373 JASON HIRAMOTO DENTAL CO-DIRECTOR 40.00 X 153267 0 21003 KRISELLE GINES PHYSICIAN 40.00 X 156577 0 15042 1555894 0 265426 8 0 1 0 E-MDS PO BOX 679493 DALLAS TX 75267 MEDICAL BILLING 364712 VPLS DEPT LA 25225 PASADENA CA 91185 INFORMATION TECH SUPPORT 275243 CVS PHARMACY ONE CVS DRIVE WOONSOCKET RI 02895 PHARMACY DISPENSING FEE 241001 TIMES PHARMACY 1620 NORTH SCHOOL STREET HONOLULU HI 96817 PHARMACY DISPENSING FEE 185825 4 9042473 4031852 100000 13074325 MEDICAID 624110 6126063 6126063 PRIVATE INSURANCE 624110 1275557 1275557 PHARMACY 624110 1182181 1182181 MEDICARE 624110 604708 604708 CAPITATION FEES 624110 334854 334854 100 100 9523463 265621 265621 2783660 830029 1953631 1953631 OTHER INCOME 624110 115214 115214 115214 24932254 11592308 0 265621 863084 281955 581129 11186301 9685983 1500318 775080 632073 143007 3104140 2635985 468155 1147377 929386 217991 5542 5542 47039 47039 2004352 1329274 675078 2090236 1883622 206614 301319 34937 266382 84949 74519 10430 748255 149132 599123 71454 71454 REPAIRS AND MAINTENANCE 195524 88114 107410 MISCELLANEOUS 111806 53728 58078 DONATED SUPPLIES 101350 101100 250 TRAINING 58742 40764 17978 139576 98968 40608 23036126 18019540 5016586 0 2402536 2421490 9348482 11657293 1235867 1135359 1913715 1943825 10990 37023 1643 1270 24783483 15479709 9673674 9303774 0 38756 24586907 26538790 1909267 2018742 0 38756 1909267 2057498 X 17844933 20047902 4832707 4433390 22677640 24481292 24586907 26538790 X 1896128 -92476 X 0 1 X 1 1 1 X 8372631 8989833 14619464 13956128 13074325 59012381 8372631 8989833 14619464 13956128 13074325 59012381 59012381 100910 71578 35943 8342 265621 482394 27910 34980 60730 115214 238834 59733609 51248911 0.98790 0.99160 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME AND FEES - 2018 AMOUNT: $ 27,910. 2019 AMOUNT: $ 34,980. 2021 AMOUNT: $ 60,730. 2022 AMOUNT: $ 115,214. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2288000 2288000 12694242 8393098 4301144 1345998 958956 387042 3203372 2459378 743994 5251871 3668277 1583594 9303774 OPERATING LEASE LIABILITIES 38756 38756 X 26464274 302672 1229348 1532020 24932254 0 24932254 24262830 395149 831555 1226704 23036126 0 23036126 PART X, LINE 2: U.S. GAAP REQUIRES UNCERTAIN TAX POSITIONS TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS IF THEY ARE MORE LIKELY THAN NOT TO FAIL UPON REGULATORY EXAMINATION. MANAGEMENT HAS EVALUATED KKV AND AFFILIATE'S TAX POSITIONS AS OF JUNE 30, 2023 AND 2022 AND FOR THE YEARS THEN ENDED, AND DETERMINED THAT KKV AND AFFILIATE HAD NO UNCERTAIN TAX POSITIONS REQUIRED TO BE REPORTED IN ACCORDANCE WITH U.S. GAAP. KKV AND AFFILIATE ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS IN PROGRESS FOR ANY OPEN TAX PERIODS. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE FROM KALIHI VALLEY COMMUNITY FOUNDATION (REPORTED SEPARATELY) 5,000. COST OF GOODS SOLD 830,029. (INCREASE) DECREASE IN NET ASSETS WITH DONOR RESTRICTIONS 394,319. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 830,030. EXPENSES FROM KALIHI VALLEY COMMUNITY FOUNDATION (REPORTED SEPARATELY) 1,525. PART XI, LINE 2B - DONATED SERVICES AND USE OF FACILITIES CONTRIBUTED MEDICAL SERVICES: $266,185 CONTRIBUTED RENT: $36,487 PART XII, LINE 2A - DONATED SERVICES AND USE OF FACILITIES CONTRIBUTED MEDICAL SERVICES: $266,185 CONTRIBUTED RENT: $36,487 CONTRIBUTED RENT RELATED TO CAPITALIZED LEASEHOLD INTEREST: $92,477 X X X 0 0 0 0 0 0 0 0 0 DAVID DERAUF CHIEF EXECUTIVE OFFICER 254362 0 11000 0 102 0 22556 0 35412 0 323432 0 0 0 LAURA DEVILBISS CLINICAL DIRECTOR 235481 0 1000 0 102 0 20101 0 7449 0 264133 0 0 0 MELISSA MCKINNEY PHYSICIAN 182344 0 1000 0 101 0 15584 0 14227 0 213256 0 0 0 MYA HLA PSYCHIATRIST DIR OF BH 169323 0 1000 0 102 0 14478 0 27647 0 212550 0 0 0 ANGELICA AGAPITO PHYSICIAN 160196 0 1000 0 103 0 5718 0 23655 0 190672 0 0 0 JASON HIRAMOTO DENTAL CO-DIRECTOR 152157 0 1000 0 110 0 13018 0 7985 0 174270 0 0 0 KRISELLE GINES PHYSICIAN 155469 0 1000 0 108 0 0 0 15042 0 171619 0 0 0 CHAN HOU LEI CHIEF FINANCIAL OFFICER 125018 0 6000 0 108 0 11137 0 15042 0 157305 0 0 0 X FOOD CREDITS 1 100000 COST 0 0 0 0 PART I, COLUMN (B): THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C A COPY OF THIS POLICY IS GIVEN TO ALL BOARD MEMBERS UPON COMMENCEMENT OF SUCH PERSON'S RELATIONSHIP WITH THE ORGANIZATION. EACH BOARD MEMBER SIGNS AND DATES THE POLICY AT THE BEGINNING OF HER/HIS TERM OF SERVICE OR EMPLOYMENT AND EACH YEAR THEREAFTER. FAILURE TO SIGN DOES NOT NULLIFY THE POLICY. THE POLICY AND DISCLOSURE FORM MUST BE FILED ANNUALLY BY ALL SPECIFIED PARTIES. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S SALARY IS DETERMINED BY THE BOARD OF DIRECTORS. ALL OTHER STAFF COMPENSATION IS DETERMINED BY THE SALARY COMMITTEE AND APPROVED BY THE CEO. THE BOARD OF DIRECTORS APPROVES THE STAFF SALARY SCALE. COMPARABLE DATA IS OBTAINED FROM HAWAII PRIMARY CARE ASSOCIATION AND HAWAII ALLIANCE OF NONPROFIT ORGANIZATIONS (HANO). THIS PROCESS IS DOCUMENTED IN THE SALARY COMMITTEE MINUTES AND HR RECORDS. THIS WAS LAST UNDERTAKEN IN MAY 2023. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CAPITALIZED LEASEHOLD INTEREST - NET CHANGE -92,476. KALIHI VALLEY COMMUNITY FOUNDATION 2239 NORTH SCHOOL STREET HONOLULU HI 96819 990329894 PROVIDE FINANCIAL SUPPORT TO CENTER HI 501(C)(3) LINE 7 KOKUA KALIHI VALLEY COMP FAMILY SVCS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0