Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 1,587,850 | 1,587,850 | ||||
| 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 | 1,587,850 | 1,587,850 | ||||
| 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) .. | 168,552 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 1,419,298 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 1,587,850 | 1,587,850 | ||||
| 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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | 1,587,850 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 on 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 2 | 'ELEPAIO SOCIAL SERVICES ("ESS") IS A NOT-FOR-PROFIT CORPORATION AND WAS FORMED IN NOVEMBER 2020 TO PROVIDE COMMUNITIES WITH COORDINATED, CULTURALLY PROFICIENT SOCIAL SERVICES IN A MANNER THAT PROMOTES COMMUNITY SELF-DIRECTION AND SELF-SUFFICIENCY, WITH A GOAL OF ESTABLISHING HEALTH AND ECONOMIC EQUITY. ESS ALSO SUPPORTS THE MISSION OF ITS PARENT CORPORATION, WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED (DBA WAIANAE COAST COMPREHENSIVE HEALTH CENTER) ("WCCHC"), A NOTFORPROFIT CORPORATION, THROUGH THE DELIVERY OF COMMUNITY WELLNESS AND RELATED HUMAN SERVICES. |
| FORM 990, PART III, LINE 4A CONTINUED: | COMMUNITY FOOD DISTRIBUTIONS: LARGE SCALE, DRIVE-THRU FOOD DISTRIBUTIONS BEGAN AT THE START OF THE PANDEMIC AND WERE HELD MONTHLY FOR THE FIRST COUPLE OF YEARS, PROVIDING 1,500-2,000 HOUSEHOLDS WITH 100+ POUNDS OF FOOD. AS COVID HAS TAPERED OFF AND RESOURCES SCARCE, WE HAVE HAD TO DECREASE THE NUMBER OF FOOD DISTRIBUTIONS FROM MONTHLY TO QUARTERLY, FOCUSING ON THE MONTHS WHEN KEIKI ARE OUT OF SCHOOL. IN 2022, 4,355 HOUSEHOLDS WERE SERVED AT 4 COMMUNITY FOOD DISTRIBUTIONS. A TOTAL OF 591,586 POUNDS OF FOOD (OF WHICH 269,913 POUNDS WAS LOCAL PRODUCE) WAS DISTRIBUTED TO COMMUNITY. PRODUCE PRESCRIPTIONS: IN 2018, THE STATE'S FIRST KEIKI PRODUCE PRESCRIPTION PROGRAM WAS LAUNCHED TO CONNECT GOOD FOOD TO POSITIVE HEALTH OUTCOMES IN THE HEALTH CENTER'S PATIENTS. THE PROGRAM HAS SINCE EXPANDED TO ADULTS WITH CHRONIC DISEASES RELATED TO NUTRITION, PREGNANT/NEW MOMS AND SOON TEENS. HEALTH CENTER PROVIDERS ARE ABLE TO REFER THEIR PATIENTS TO THE PROGRAM WHERE THEY ARE ENROLLED WITH `ELEPAIO SOCIAL SERVICES AND ISSUED $60/MONTH FOR THE PURCHASE OF FRESH LOCAL PRODUCE AND POI AT THE FARMER'S MARKET OR THROUGH ITS PARTNER, FARM LINK HAWAII FOR ONLINE ORDERING AND FREE DELIVERY. CLINICAL HEALTH MEASUREMENTS THAT INCLUDE BLOOD PRESSURE, WEIGHT AND A1C ARE COLLECTED EVERY 3 MONTHS TO CONNECT GOOD FOOD TO POSITIVE HEALTH OUTCOMES IN THE PATIENT'S MEDICAL RECORD. FOOD SUBSCRIPTIONS: AT THE ONSET OF THE PANDEMIC, LARGE SCALE COMMUNITY DRIVE THRU FOOD DISTRIBUTIONS WERE HELD MONTHLY, CONTINUING FOR SEVERAL YEARS UNTIL GOVERNMENT RESOURCES DRIED UP. IN AN ATTEMPT TO GIVE AUTONOMY BACK TO COMMUNITY, TO BE ABLE TO CHOOSE THE FRESH FOODS THAT THEY LIKE TO EAT AND ARE CULTURALLY RELEVANT TO THEM, THE FOOD SUBSCRIPTION PILOT PROGRAM WAS CREATED. HEAD OF HOUSEHOLDS THAT FALL UNDER THE ALICE (ASSET LIMITED, INCOME CONTRAINED, EMPLOYED) CATEGORY, REPORT AS FOOD INSECURE AND ARE PATIENTS OF WCCHC ARE ELIGIBLE TO RECEIVE $250 IN FOOD VOUCHERS/MONTH FOR 6 MONTHS TO PURCHASE FRESH LOCAL PRODUCE, PROTEINS, POI AND HONEY DIRECTLY FROM THE FOOD PRODUCERS AT THE MAKEKE FARMERS MARKETS. ONLINE ORDERING AND FREE DELIVERY IS ALSO AVAILABLE FOR PARTICIPANTS WITH TRANSPORTATION AND OTHER BARRIERS TO GETTING TO THE MARKET. OVER A TWO-YEAR PERIOD, A TOTAL OF 303 ALICE HOUSEHOLDS WILL BE ENROLLED AND THE HEALTH-RELATED QUALITY OF LIFE FOR HEAD OF HOUSEHOLD WILL BE MEASURED. EMERGENCY PREPAREDNESS PLANNING/RESPONSE: STRENGTHENING COMMUNITY FOOD SYSTEMS AND DECREASING FOOD INSECURITY IS A PRIORITY GIVEN THE GEOGRAPHIC ISOLATION AND THE NUMBER OF SMALL FARMERS IN THE AREA. THE COMMUNITIES IT SERVES ARE NESTLED BETWEEN THE WAIANAE MOUNTAIN RANGE TO THE EAST AND THE PACIFIC OCEAN TO THE WEST. IT IS ONE OF THE MOST ISOLATED REGIONS ON THE ISLAND OF OAHU, WITH ONLY ONE ROAD IN AND OUT A CHALLENGE OF SIGNIFICANT CONCERN IN TIMES OF NATURAL DISASTER. THE `ELEPAIO SOCIAL SERVICES TEAM HAS DEVELOPED A PLAN THAT FOCUSES ON EMERGENCY COMMUNITY FOOD ACCESS, SUPPLY DISTRIBUTION AND COMMUNICATION FOR OUR MOST VULNERABLE COMMUNITY MEMBERS TO ENSURE SAFETY AND WELL BEING IN TIMES OF NATURAL DISASTER. FURTHER EFFORTS HAVE BEGUN TO ORGANIZE A BROADER COMMUNITY RESPONSE TO CREATE A COMMUNITY RESILIENCY HUB WITH OTHER PARTNERING AGENCIES AND VOLUNTEERS TO ALLOW FARTHER REACH. COMMUNITY EVENTS/WORKSHOPS: A VARIETY OF COMMUNITY EVENTS THAT SUPPORT EDUCATION AROUND CULTURE, NUTRITION, AGRICULTURE, SUSTAINABILITY, AND OVERALL HEALTH ARE DEVELOPED THROUGHOUT THE YEAR, AS COVID RESTRICTIONS ALLOW. |
| FORM 990, PART V, LINE 13A | 'ELEPAIO RECEIVED A VEHICLE THAT IS USED TO FULFILL ITS EXEMPT PURPOSE FROM WAIANAE DISTRICT COMPREHENSIVE HEALTH & HOSPITAL BOARD, INC., (EIN 99-0148164,) AND WILL BE FILING FORM 1098-C THIS YEAR. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE CORPORATION IS WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INC., A HAWAII NONPROFIT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER OF THE ORGANIZATION, WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INC. SHALL ELECT THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE DIRECTORS OF THE CORPORATION SHALL BE ELECTED BY THE MEMBER AT THE ANNUAL MEETING OF THE MEMBER OR AT A SPECIAL MEETING OF THE MEMBER HELD FOR THAT PURPOSE. THE SOLE MEMBER OF THE CORPORATION SHALL BE THE WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED, A HAWAII NONPROFIT CORPORATION (THE "MEMBER"). |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ACCOUNTING DEPARTMENT OF WAIANAE COAST COMPREHENSIVE HEALTH CENTER IS RESPONSIBLE FOR THE TIMELY PREPARATION OF THE FORM 990. THE COMPLETED FORM 990, AND, IF APPLICABLE, FORM 990-T AND RELATED STATE FORMS ARE PROVIDED TO THE 'ELEPAIO SOCIAL SERVICES BOARD OF DIRECTORS IN ADVANCE OF THE FILING DEADLINE. AFTER ALL QUESTIONS AND CONCERNS OF THE BOARD HAVE BEEN ADDRESSED AND CHANGES INCORPORATED INTO THE FORM 990, AS APPLICABLE, ALL MEMBERS OF THE BOARD OF DIRECTORS ARE INVITED TO REVIEW THE COMPLETED FORM 990 BEFORE SUBMITTAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANY MEMBER OF THE BOARD IS REQUIRED TO RECUSE THEMSELVES FROM MAKING ANY DECISION RELATING TO 'ELEPAIO BUSINESS WHEN THEY ARE AWARE OF CIRCUMSTANCES THAT MIGHT REASONABLY CAUSE THEIR IMPARTIALITY TO BE QUESTIONED. USING THE WAIANAE COAST COMPREHENSIVE HEALTH CENTER'S CONFLICT OF INTEREST POLICY, 'ELEPAIO SOCIAL SERVICES DETERMINES ON WHETHER A CONFLICT OF INTEREST EXISTS BY 1) REVIEWING ANNUAL DISCLOSURE FORMS COMPLETED BY BOARD MEMBERS AND NON-BOARD MEMBERS WHO SIT ON A BOARD COMMITTEE; AND 2) CONDUCTING A DISCUSSION AND HOLDING A VOTE BY BOARD MEMBERS WHEN A BOARD MEMBER/OTHER MEMBER DISCLOSES A CONFLICT DURING A BOARD AND OR BOARD COMMITTEE MEETING. CONFLICTS OF INTEREST ARE REVIEWED AT THE FOLLOWING LEVELS: 1) AN ANNUAL STATEMENT IS COMPLETED BY BOARD MEMBERS AND/OR NON-BOARD MEMBERS WHO SIT ON A BOARD COMMITTEE. 2) DISCLOSURE IS MADE AT A BOARD AND/OR BOARD COMMITTEE MEETING. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE HUMAN RESOURCES DEPARTMENT OF WAIANAE COAST COMPREHENSIVE HEALTH CENTER UTILIZES NUMEROUS HEALTH CARE-RELATED RESOURCES AND/OR CONTRACTS FOR SERVICES TO CONDUCT PAY STUDIES ON EMPLOYEE AND KEY MANAGEMENT POSITIONS. THE VISIONLINK ADVISORY GROUP CONDUCTS A REVIEW OF KEY EMPLOYEE COMPENSATION INTENDED TO SATISFY THE SAFE HARBOR FOR ORANIZATION MANAGERS DESCRIBED IN TREASURY REGULATION SECTION 53.4958-1 AND REBUTTABLE PRESUMPTION STANDARD DESCRIBED IN TREASURY REGULATION SECTION 53.4958.6. THIS PROCESS WAS LAST COMPLETED ON JULY 2021. THE EXECUTIVE DIRECTOR'S (ED) COMPENSATION IS DETERMINED BY THE WAIANAE COAST COMPREHENSIVE HEALTH CENTER PRESIDENT AND CEO. THE WAIANAE COAST COMPREHENSIVE HEALTH CENTER UTILIZES NUMEROUS HEALTH CARE-RELATED RESOURCES AND/OR CONTRACTS FOR SERVICES TO CONDUCT PAY STUDIES ON EMPLOYEE AND KEY MANAGEMENT POSITIONS. THE HEALTH CENTER STARTED PARTICIPATING IN 2004. 'ELEPAIO SOCIAL SERVICES UTILIZES THE HEALTH CENTERS ANNUAL REVIEWS TO DETERMINE IF ANY ADJUSTMENTS NEED TO BE MADE TO ITS PAY SCALE UTILIZING CURRENT COMPENSATION SURVEYS. THIS PROCESS WAS LAST REVIEWED MARCH 2021. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS, ALTHOUGH NOT PUBLICIZED, IS MADE AVAILABLE UPON REQUEST. |
| Software ID: | |
| Software Version: |