Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
NA LEI WILI AREA HEALTH EDUCATION CENTER
Employer identification number
99-0337948
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% 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). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
185,282
422,038
490,135
118,567
170,692
1,386,714
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
185,282
422,038
490,135
118,567
170,692
1,386,714
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
1,386,714
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
185,282
422,038
490,135
118,567
170,692
1,386,714
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
76
76
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
200
200
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
45
280
3,348
3,673
11
Total support (Add lines 7 through 10).
1,390,663
12
Gross receipts from related activities, etc. (see instructions)
..................
12
1,265
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
99.720 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
98.780 %
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
NA LEI WILI AREA HEALTH EDUCATION CENTER
Employer identification number
99-0337948
Return Reference
Explanation
FORM 990 - ORGANIZATION'S MISSION
TO BENEFIT THE PEOPLE OF THE ISLANDS OF OAHU AND KAUAI CONSISTENT WITH THE FEDERAL AREA HEALTH EDUCATION CENTER SYSTEM PROGRAM GUIDE, THROUGH PROGRAMS THAT SUPPORT BETTER HEALTH CARE SERVICES BY THE ADVANCEMENT OF HEALTH CARE PROGESSIONAL EDUCATION FOR STUDENTS, THAT PROMOTE DEVELOPMENT OF HEALTH PROFESSIONS THAT PROMOTE THE DEVELOPMENT OF HEALTH PROFESSIONS EDUCATION WHICH EMPHASIZES PRIMARY CARE TO UNDERSERVED POPULATIONS, THAT FOSTER COOPERATION AMONG HEALTH PROFESSIONALS EDUCATIONAL INSTITUTIONS AND COMMUNITIES, THAT CREATE OPPORTUNITIES FOR BUILDING PARTNERSHIPS BETWEEN ACADEMIC INSTITUTIONS AND COMMUNITIES, THAT ENABLE PARTICIPATING HEALTH CARE PROVIDERS AND COMMUNITIES TO CREATE AND IMPLEMENT MULTI-PROFESSIONAL AND COMMUNITY-BASED APPROACHES TO THE HEALTH CARE NEEDS OF UNDERSERVED COMMUNITIES, THAT FACILITATE TRAINING FOR THOSE INVOLVED IN HEALTH CARE, THAT EMPHASIZES CULTURAL COMPETENCE AND RESPONSIVENESS TO COMMUNITY DEFINED HEALTH CARE INTIATIVES, AND THAT PROVIDE FOR EVALUATION OF THE EFFECTIVENESS OF HEALTH EDUCATION.
FORM 990, PAGE 2, PART III, LINE 4A
STUDENTS FROM THE KUHIO PARK TERRACE AREA AND ATTENDING FARRINGTON HIGH SCHOOL ON OAHU ALONG WITH ELDERLY FAMILY MEMBERS RESIDING IN THE KALIHI VALLEY (ELDERLY) HOUSING PARTICIPATED IN THE YEAR LONG PROGRAM FOR LEARNING CARE-GIVING SKILLS AND PRACTICING THE SKILLS WITH THEIR ELDERLY FAMILY MEMBERS. THE PROGRAM EMPHASIZES EDUCATION AND TRAINING IN TAKING AND RECORDING ACCURATE VITAL SIGNS, READING MEDICATION LABELS AND ASSISTING WITH ADMINISTERING OF DAILY MEDICATIONS, RECORDING EVENTS IN A DAILY CHART, COMMUNICATING WITH THE TEAM OF MEDICAL CARE PROVIDERS, AND CPR TRAINING AND CERTIFICATION. GOOH SHA: SUMMER HEALTH ADVENTURE (GRADES 6-12): TWENTY-SEVEN NATIVE HAWAIIAN STUDENTS FROM THE EAST AND WEST SIDES OF THE ISLAND PARTICIPATED IN TWO SEPARATE EVENTS FOR LEARNING MORE ABOUT HEALTH CAREERS AND NATIVE HAWAIIAN CULTURAL HEALTH PRACTICES. STUDENTS VISITED A FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER, RURAL STATE HOSPITAL, PACIFIC MISSILE RANGE FACILITY CRASH AND FIRE RESCUE, MAHAULEPU HISTORIC AREA, AND A LOCAL JUNIOR COLLEGE NURSING PROGRAM. BESIDES LEARNING ABOUT THE VARIOUS HEALTH CAREERS, STUDENTS GAINED A BETTER UNDERSTANDING OF PATHOPHYSIOLOGY RELATING TO DISEASES AFFECTING THE NATIVE HAWAIIAN POPULATION, EARNED CPR/FIRST AID CERTIFICATION, HARVESTED HERBS AND MADE TRADITIONAL HAWAIIAN BEVERAGES AND MEDICINES, ACQUIRED MASSAGE TECHNIQUES, AND USED TEAMWORK SKILLS FOR MENTORING ALONGSIDE THE NURSING STUDENTS TO SANITIZE AND PREP AN AREA FOR SURGICAL PROCEDURES. PROFESSIONALS INCLUDED COMMUNITY OUTREACH WORKERS, FAMILY PRACTITIONER, NURSE PRACTITIONER, LICENSED CLINICAL SOCIAL WORKERS, NUTRITIONIST, OPTOMETRISTS, PHARMACIST, FIRE FIGHTERS, KAUAI COMMUNITY COLLEGE NURSING STUDENTS AND INSTRUCTORS, AND NATIVE HAWAIIAN CULTURAL PRACTITIONERS. GOOH SHB: SUMMER HEALTH BLAST - PATCH FITNESS (K-5): PARTNERSHIP WITH THE COUNTY OF KAUAI- KEKAHA SUMMER FUN PROGRAM FOR PROVIDING SERVICES OVER A 6 -WEEK PERIOD BETWEEN JUNE AND JULY TO 56 STUDENTS IN PHYSICAL FITNESS, HEALTH AND NUTRITION AWARENESS AND EDUCATION, AND HEALTH CAREERS EXPOSURE TO SPORTS MEDICINE, PHYSICAL THERAPY, CHIROPRACTIC, AND KINESIOLOGY. ADDITIONALLY, 515 STUDENTS AT KALAHEO ELEMENTARY SCHOOL EXPERIENCED THE PATCH FITNESS PROGRAM REGULARLY THROUGH THE YEAR-LONG PHYSICAL EDUCATION CLASSES.
FORM 990, PAGE 2, PART III, LINE 4B
BRINGING IN-SERVICE TRAINING WITH CEU'S TO 25CIVILIAN PROFESSIONALS WORKING WITH CLIENTS IN BEHAVIORAL HEALTH AND AT VARIOUS COMMUNITY SERVICE ORGANIZATIONS AND HEALTH CARE FACILITIES.
FORM 990, PAGE 2, PART III, LINE 4C
FAMILY PRACTITIONER) AT A FQCHC, AND ONE 4TH YEAR MEDICAL STUDENT ON ROTATION IN RURAL CLINICS. THE PROGRAM IS DESIGNED TO PROVIDE THE HEALTH PROFESSIONALS AND THEIR FAMILIES WITH A SUPPORT NETWORK GEARED TO THEIR INTERESTS TO KEEP THEM HAPPY AND CONNECTED TO THE COMMUNITY WHILE THE HEALTH PROFESSIONAL SPOUSES ARE ENGAGED IN RURAL COMMUNITY WORK. DOMESTIC VIOLENCE; PARTNERED WITH KDHO AND VARIOUS GOVERNMENT AND SERVICE ORGANIZATIONS FOR BRINGING A WORKSHOP ON INFANT DEATH INVESTIGATIONS AND TRAINING TO 31 POLICE OFFICERS, ATTORNEYS, AND SOCIAL SERVICE WORKERS. ATTENDEES LEARNED HOW TO IMPROVE THEIR INVESTIGATION AND INTERVIEWING SKILLS FOR BETTER OUTCOMES. KAUAI COMMUNITY HEALTH NEEDS ASSESSMENT: PROVIDED COORDINATION OF PROJECTS AND FISCAL SUPPORT FOR THE YEAR-LONG ACTIVITIES OF DEVELOPING LOGIC MODEL PLANS FOR IMPLEMENTATION WITHIN THE NEXT 2-5 YEARS IN THE AREAS OF COMMUNITY DESIGN/BUILT ENVIRONMENT, EDUCATION/LIFE-LONG LEARNING, HEALTH AND WELLNESS, HOUSING, AND WELLNESS.
FORM 990, PAGE 6, PART VI, LINE 11B
ALL BOARD MEMBERS WILL INDIVIDUALLY REVIEW THE FINAL DRAFT AND APPROVE IT BEFORE IT IS FILED.
FORM 990, PAGE 6, PART VI, LINE 12C
SINCE THE ADOPTION OF THE CONFLICT OF INTEREST AND ETHICS POLICY AND PROCEDURE ON 6/22/2012, THE BOARD OF DIRECTORS COMPLETES THE SELF- DISCLOSURE FORM AT ITS QUARTERLY AND ANNUAL MEETINGS. THE FORMS ARE COLLECTED AND REVIEWED BY THE PRESIDENT OR PRESIDING MEMBER PRIOR TO THE START OF THE MEETING. BOARD MEMBERS IN CONFLICT ARE RECUSED FROM DISCUSSION AND VOTING, AND THE FORMS ARE ATTACHED TO THE MINUTES.
FORM 990, PAGE 6, PART VI, LINE 15A
IN DETERMINING SALARY ADJUSTMENTS FOR THE EXECUTIVE DIRECTOR, THE BOARD OF DIRECTORS USES THE EXECUTIVE DIRECTOR'S CURRENT LEVEL OF COMPENSATION AS THE STARTING POINT. THE BOARD BASES ANY ADJUSTMENT TO THE COMPENSATION LEVEL PRIMARILY ON COMPARISONS TO PEER ORGANIZATIONS AND THEIR SIMILARLY- POSITIONED EXECUTIVES ALONG WITH THE EXECUTIVE DIRECTOR'S PERFORMANCE. THE BOARD HAS DISCRETION TO SET COMPENSATION AT LEVELS THAT MY BE HIGHER OR LOWER THAN PEER GROUP TARGET PERCENTILES. THE PROCESS IS DOCUMENTED IN THE BOARD MINUTES AND IN THE INDIVIDUAL'S PERSONNEL FILE. THIS IS A NEW PROCESS AS OF 2012 AND HAS NOT BEEN USED YET.
FORM 990, PAGE 6, PART VI, LINE 19
NO DOCUMENTS WERE REQUESTED BY THE PUBLIC.
FORM 990, PART IX, LINE 11G
52,240 0 0
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.