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
National Kidney Foundation of Hawaii Inc
Employer identification number
99-0266733
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.") ....
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
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.
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..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
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
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
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.") .
1,135,859
615,385
1,110,973
324,880
900,196
4,087,293
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......
1,240,715
1,541,975
1,340,768
1,385,995
1,215,919
6,725,372
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.
2,376,574
2,157,360
2,451,741
1,710,875
2,116,115
10,812,665
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.)
10,812,665
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...
2,376,574
2,157,360
2,451,741
1,710,875
2,116,115
10,812,665
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
30,556
42,367
47,063
104,067
180,145
404,198
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
30,556
42,367
47,063
104,067
180,145
404,198
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.)..
2,407,130
2,199,727
2,498,804
1,814,942
2,296,260
11,216,863
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
96.400 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.420 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
3.600 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.580 %
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:
13000199
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
National Kidney Foundation of Hawaii Inc
Employer identification number
99-0266733
Return Reference
Explanation
PART I, LINE 1
THE MISSION STATEMENT OF THE NATIONAL KIDNEY FOUNDATION OF HAWAII(NKFH) IS TO PREVENT KIDNEY AND URINARY TRACT DISEASE, IMPROVE THE HEALTH AND WELL-BEING OF INDIVIDUALS & FAMILIES AFFECTED BY THESE DISEASES AND INCREASE THE AVAILABILITY OF
PART I, LINE 1 CONTINUED
ALL ORGANS FOR TRANSPLANTATION. SOME OF THE MOST SIGNIFICANT ACTIVITIES THIS YEAR INCLUDE: (1) WORLD KIDNEY DAY WAS RECOGNIZED IN A MAJOR CAMPAIGN AT ALA MOANA SHOPPING CENTER & COMPREHENSIVE SCREENING PROGRAM
PART I, LINE 1 CONTINUED
AT THE ALA MOANA HOTEL. SIMILAR AWARENESS EVENTS WERE HELD IN MAUI, HAWAII ISLAND AND THROUGHOUT THE STATE. PUBLIC RELATIONS ACTIVITIES INCLUDED TV, RADIO AND PRINT INTERVIEWS AND APPEARANCES.
PART I, LINE 1 CONTINUD
(2) LOCAL SCREENINGS WERE ENHANCED WHEN A NATIONAL PROGRAM ENDED. K-USA (KIDNEY URINE SCREENINGS & ANALYSIS) IS A NEW SCREENING FOR PROTEIN (EARLY INDICATOR) DEVELOPED FOR WIDE- SPREAD REACH. K-USA & COMPREHENSIVE KEDS (KIDNEY EARLY
PART I, LINE 1 CONTINUED
DETECTION SCREENING) ARE HELD ALL YEAR THROUGHOUT THE STATE. (3) PROGRAM EVALUATION REPORTS CONTINUE TO BE SHOWCASED AT PROFESSIONAL CONFERENCES. NEW FINDINGS ARE BEING ANALYZED FOR JOURNAL PUBLICATION.
PART I, LINE 1 CONTINUED
(4) EARLY EDUCATION PROGRAMS ARE DELIVERED THROUGHOUT THE STATE IN ORDER TO PREVENT OR SLOW THE PROGRESSION OF KIDNEY DISEASE, LIKE KIWI (KIDNEY INTERACTIVE WORKSHOP & INFO), COOKING CLASSES AND CKD SUPPORT GROUPS.
PART I, LINE 1 CONTINUED
(5) PATIENT SERVICES CONTINUE TO BE PROVIDED TO ALL KIDNEY PATIENTS INCLUDING PEER MENTORING WHERE PATIENTS ARE MATCHED FOR GUIDANCE;P COOKING PROGRAMS FOR KIDNEY PATIENTS FACING STRICT DIETARY RESTRICTIONS; ASSISTANCE FUNDS; MEDICAL
PART I, LINE 1 CONTINUED
IDENTIFICATION JEWELRY; AND PATIENT HANDBOOKS (6) YOUTH OUTREACH HAS EXPANDED IN PROGRAM CONTENT AND MORE WIDESPREAD IN DELIVERY. A KIDNEY CAMP IS UNDER DEVELOPMENT. (7) PROFESSIONAL WORKSHOPS AND CONFERENCES ARE HELD ANNUALLY
PART I, LINE 1 CONTINUED
TO PROVIDE CURRENT KIDNEY INFO AND MANAGEMENT SUPPORT TO HEALTHCARE PROVIDERS. (8) GROUPS FORMED BY NKFH SUCH AS THE HAWAII ORGAN TRANSPLANT SUPPORT GROUP, HAWAII DONOR FAMILY COUNCIL,
PART I, LINE 1 CONTINUED
HAWAII LIVING DONOR COUNCIL, HAWAII COALITION ON DONATION AND TRANSPLANT ASSOCIATES OF HAWAII HELP TO RAISE AWARENESS ABOUT THE IMPORTANCE OF ORGAN DONATION. NKFH ADVOCACY IS IN PLACE FOR THOSE AFFECTED BY KIDNEY DISEASE, ISSUES RELATED
PART I, LINE 1 CONTINUED
TO ORGAN DONATION AND OTHER COMMUNITY HEALTH MATTERS. (9) BEYOND DIRECT SERVICES, NKFH HAS CREATED AN INNOVATION DIVISION THAT CAPITALIZES ON CURRENT HEALTHCARE TRENDS. THIS ENDEAVOR IS AN EXTENSION OF OUR EFFORT TO CREATE SUSTAINABLE
PART I, LINE 1 CONTINUED
SYSTEMIC IMPACT TO IMPROVE THE HEALTH OF OUR COMMUNITY. NKFH IS TAKING ON PROJECTS THAT MATERIALIZE CONCEPTS & STRATEGIES TO IMPROVE HEALTH OUTCOMES, CONTROL COSTS AND IMPACT QUALITY OF LIFE. CURRENT ACTIVITIES INCLUDE:
PART I, LINE 1 CONTINUED
(A) PARTICIPATING IN THE DEVELOPMENT AND CONTRIBUTION TO THE EXECUTION OF THE STATE OF HAWAII HEALTHCARE INNOVATION PLAN; (B) TRANSFORMING PHYSICAN OFFICES, COMMUNITY HEALTH CENTERS, AND OTHER HEALTHCARE PROVIDERS INTO PATIENT-CENTERED MEDICAL
PART I, LINE 1 CONTINUED
HOMES; AND (C) CREATING A CKD REGISTRY FOR EARLY IDENTIFICATION AND MANAGEMENT OF KIDNEY DISEASE (AND EVENTUALLY OTHER CHRONIC DISEASES).
PART I, LINE 1 CONTINUED
THESE INNOVATIONS REINFORCE OUR ABILITY TO ACCOMPLISH OUR MISSION ACROSS ALL STAGES OF CHRONIC DISEASE, ACROSS THE ENTIRE STATE, EVEN IN REMOTE AREAS WHERE DISPARATE/ DISADVANTAGED HAVE LIMITED ACCESS TO CARE.
PART III, LINE 4D
OTHER PROGRAMS INCLUDE RESEARCH AND COMMUNITY SERVICES. MOST OF THE RESEARCH PROGRAMS ARE COORDINATED AND FUNDED DIRECTLY BY OUR NATIONAL OFFICE. PARTIAL SUPPORT OF THIS FUNDING IS PROVIDED BY THE AFFILIATES, INCLUDING THE NKFH. THE NKFH HAS
PART III, LINE 4D CONTINUED
A LOCAL PROGRAM EVALUATION AND RESEARCH GROUP MADE UP OF UNIVERSITY PROFESSORS, GRADUATE STUDENTS, AND COMMUNITY RESEARCHERS CALLED THE SEARCH TEAM (SYSTEMIC EVALUATION AND RESEARCH FOR CHRONIC KIDNEY DISEASE) WHICH HAS HELPED WITH
PART III, LINE 4D CONTINUED
PROGRAM QUALITY AND OUTCOME ANALYSIS. THE NKFH OFFERS A VARIETY OF VOLUNTEER OPPORTUNITIES TO PROFESSIONALS AND THE GENERAL COMMUNITY TO GET INVOVLED WITH THE NKFH.
PART VI, SECTION B, LINE 11
THE RESOURCE COMMITTEE REVIEWS THE FORM 990 AND PRESENTS IT TO THE BOARD OF DIRECTORS FOR APPROVAL BEFORE IT IS SIGNED AND FILED. ALL MEMBERS OF THE BOARD RECEIVE A COPY OF THE FORM 990.
PART VI, SECTION B, LINE 12C
THE CONFLICT OF INTEREST POLICY IS MONITORED AND UPDATED ANNUALLY, REQUIRING ALL DIRECTORS AND KEY EMPLOYEES TO REVIEW THE POLICY, IDENTIFY ANY CONFLICTS THAT MAY EXIST AND SIGN AN ACKNOWLEDGEMENT FORM.
PART VI, SECTION B, LINE 15B
THE ORGANIZATION DEVELOPED A TEMPLATE FOR ALL POSITIONS OUTLINING THE MINIMUM, MIDPOINT AND MAXIMUM COMPENSATION LEVELS FOR EACH POSITION BASED ON MARKET RESEARCH OF COMPETITIVE LEVELS OF COMPENSATION FOR SIMILAR POSITIONS,
PART VI, SECTION B, LINE 15B CONTINUED
CONDUCTED BY A TASK COMMITTEE FROM THE BOARD, WHICH IS UPDATED PERIODICALLY. COMPENSATION AMOUNTS ARE WITHIN THESE PARAMETERS AND ARE DOCUMENTED IN PERSONNEL FILES AND APPROVED BY IMMEDIATE SUPERVISORS. CEO COMPENSATION IS
PART VI, SECTION B, LINE 15B CONTINUED
REVIEWED AND APPROVED BY THE BOARD AND IS DOCUMENTED IN PERSONNEL FILE AND MINUTES.
PART VI, SECTION C, LINE 19
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. FINANCIAL STATEMENTS ARE AVAILABLE VIA THE ANNUAL FORM 990 VIA THE INTERNET AT WWW.GUIDESTAR.ORG WEBSITE AS WELL AS IN
PART VI, SECTION C, LINE 19 CONTINUED
THE OFFICE
SCHEDULE L, PART IV
THE NKFH HAS CONTRACTED WITH KIDNEY FRIENDS HAWAII, A 501C(3) NON-PROFIT ORGANIZATION, TO PERFORM CERTAIN ADMIN SUPPORT SERVICES FOR THE KIDNEY CARS CAMPAIGN FOR WHICH IT WAS PAID $78,000 DURING FISCAL YEAR ENDED 6/30/14. THE NKFH
SCHEDULE L, PART IV CONTINUED
ALSO RECEIVED GIFTS FROM THE KIDNEY FRIENDS TOTALLING $78,000. KIDNEY FRIENDS ALSO RENTED SOME OFFICE SPACE ON OAHU AND MAUI FROM NKFH FOR WHICH IT PAID NKFH $43,836 DURING FISCAL YEAR ENDED 6/30/14.
SCHEDULE L, PART IV CONTINUED
KIDNEY FRIENDS MISSION IS TO RAISE FUNDS TO SUPPORT CHARITABLE ORGANIZATIONS IN HAWAII WHO SUPPORT KIDNEY DISEASE AND ORGAN DONATION AWARENESS. GLEN HAYASHIDA IS THE CEO OF NKFH AND ALSO SERVES AS A DIRECTOR FOR KIDNEY FRIENDS
SCHEDULE L, PART IV CONTINUED
LINDA KATAGIRI IS A DIRECTOR AND OFFICER OF NKFH AND ALSO SERVES AS A DIRECTOR FOR KIDNEY FRIENDS. THE NKFH WORKS WITH KOLOHE INDUSTRIES DBA KOLOHE MOTORS TO PERFORM CERTAIN AUCTION SERVICES FOR THE KIDNEY CARS
SCHEUDLE L, PART IV CONTINUED
CAMPAIGN. DURING FISCAL YEAR ENDED 6/30/14, NKFH PAID KOLOHE MOTORS $238,438 IN COMMISSIONS. SHAUN PINARD IS THE OWNER OF KOLOHE INDUSTRIES AND IS THE SON OF A KEY EMPLOYEE OF NKFH, DIANA BENNINGFIELD.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.