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)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 202,402 | 584,157 | 326,186 | 324,932 | 511,767 | 1,949,444 |
| 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 | 202,402 | 584,157 | 326,186 | 324,932 | 511,767 | 1,949,444 |
| 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) .. | 152,259 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 1,797,185 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 202,402 | 584,157 | 326,186 | 324,932 | 511,767 | 1,949,444 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 1 | 1 | ||||
| 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 | 1,951,817 | |||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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 2023 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-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, 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 2023. 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 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| 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 PROFESSIONAL EDUCATION FOR STUDENTS, 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 | 1)COMMUNITY DEVELOPMENT BLOCK GRANT - KALENA PARK "IMPROVEMENT INITIATIVE" UNDER THE GUIDANCE OF GET FIT KAUAI DIRECTOR,THE PROJECT WAS EXECUTED ON TIME AND WITHIN BUDGET DUE TO HER LEADERSHIP FOR MAINTAINING A CLEAR VISION TO ACHIEVE THE GOAL THROUGH TEAM MOTIVATION AND FOCUS, AS WELL AS DETAILED MANAGEMENT FOR DELIVERY COORDINATION, SAFETY STANDARDS COMPLIANCE, AND THE ABILITY TO APPROPRIATELY ADDRESS THE UNFORESEEN CHALLENGES. THE PROJECT ENTAILED SITE PREPARATION; DISMANTLING, REMOVAL AND DISPOSAL OF THE OLD PLAYGROUND EQUIPMENT; CONSTRUCTION/INSTALLATION OF THE NEW PLAYGROUND EQUIPMENT; REMOVAL OF THE OLD (PERIMETER) FENCE AND REPLACEMENT WITH THE INSTALLATION OF CEMENT BALLS; AND INSTALLATION OF CEMENT WHEEL STOPS IN THE PARKING LOT. THE PREVIOUSLY DILAPIDATED PLAYGROUND WAS TRANSFORMED INTO A LIVELY PLAY AREA WITH VIBRANT NEW EQUIPMENT AND COLORFUL CEMENT BALLS MARKING THE PERIMETER OF THE PARK. THE PROJECT BEGAN ON APRIL 23, 2024 WITH THE CONTRACTORS FROM EXERPLAY AND PACIFIC PLAYSCAPES, INC., AND CONCLUDED WITH THE OPENING DAY CELEBRATION ON MAY 9, 2024, BEGINNING WITH A BLESSING BY CULTURAL PRACTITIONER SEAN CHUN, A MESSAGE BY THE MAYOR AND CHEERS FROM COUNCIL MEMBERS AND OTHER COMMUNITY ATTENDEES. SPECIAL RECOGNITION WAS GIVEN TO THE BOYS AND GIRLS CLUB, WILCOX ELEMENTARY SCHOOL, AND KAUAI CARES. THE SPACE QUICKLY BECAME A CENTER OF ACTIVITY WITH CHILDREN EXPLORING AND ENJOYING THE NEW FEATURES. A POSITIVE RECEPTION CAME FROM FAMILIES WHO GATHERED TO CELEBRATE THE NEW PLAYGROUND. UNDER THE CDBG GUIDELINES, A TOTAL OF 1,980 PERSONS (UNDUPLICATED) WERE ASSISTED WITH THIS FUNDING AWARD. |
| FORM 990, PAGE 2, PART III, LINE 4B | NA LEI WILI AHEC PROVIDES THE COMMUNITY OF STUDENTS IN GRADES K-20 WITH HEALTH EDUCATION RESOURCES, AWARENESS, EXPOSURE, AND EXPLORATION ACTIVITIES; HEALTH CAREERS RESOURCES AND TRAINING OPPORTUNITIES; AND RURAL ROTATION EXPERIENCES FOR STRENGTHENING THE PIPELINE OF HEALTH PROFESSIONALS ON THE ISLAND. COLLABORATIVE PARTNERSHIPS INCLUDE K-12 SCHOOLS, KAUAI COMMUNITY COLLEGE, SEVERAL NURSE-AIDE TRAINING PROGRAMS, JOHN A BURNS SCHOOL OF MEDICINE (JABSOM), AND PRIVATE-SECTOR VENDORS AND COMMUNITY GROUPS AND ORGANIZATIONS. ANNUAL TEEN HEALTH CAMPS AND PERIODIC WORKSHOPS LED BY JABSOM MEDICAL STUDENTS AND OTHER HEALTH PROFESSIONALS, PROVIDE SKILLS-BUILDING IN CASTING, SUTURING, VITAL SIGN ASSESSMENT, INFECTIOUS DISEASE/HAND-WASHING, PROBLEM-BASED LEARNING, VENIPUNCTURE, AND VIRTUAL REALITY CAREER EXPLORATION (EMT/RN/SURGTECH), MENTAL HEALTH AWARENESS, INJURY PREVENTION IN SPORTS AND PHYSICAL FITNESS, FORENSICS EXPLORATION, MOBILE CLINIC VISIT. HIGH SCHOOL STUDENTS ALSO PARTICIPATED IN THE HOSA STATE AND INTERNATIONAL CONFERENCES AND COMPETITIONS (TOTAL 150 HIGH SCHOOL STUDENTS IN 6 ACTIVITIES - BY 1 AHEC DIRECTOR, PLUS 5 PRE-HEALTH CAREER CORPS TRAINERS PAID WITH OTHER FUNDING; STATE CONFERENCE ATTENDANCE/COMPETITION TRAVEL COSTS FOR 80 HIGH SCHOOL STUDENTS & 2 HOSA ADVISORS & 2 CHAPERONES FOR 12,370; 12 AHEC SCHOLARS COMPLETED CLINICAL ROTATIONS/YEAR-LONG TRAINING IN RURAL AREAS: DPT (7); MD-GY4 (1); MD-GY3 (1); D-APRN (1); MD RESIDENT-1 (PEDS); MD RESIDENT-1 (OPHTH) AND ALL RECEIVED 500 STIPENDS EACH, 6,000); TOTAL COSTS 18,370. |
| FORM 990, PAGE 2, PART III, LINE 4C | THE HAWAI'I HEALTH WORKFORCE SUMMIT (HELD 9/9/23) IS A FREE ONE-DAY CONFERENCE OPEN TO ALL HEALTHCARE PROFESSIONALS IN AND ASSOCIATED WITH HAWAI'I. THE 2023 ANNUAL EVENT, HOSTED BY THE HAWAII/PACIFIC BASIN AHEC CENTER, WAS HELD AT THE HILTON HAWAIIAN VILLAGE HOTEL CORAL BALLROOM WITH A TOTAL OF 607 REGISTERED PARTICIPANTS, INCLUDING PHYSICIANS, PHYSICIAN ASSISTANTS, APRNS, COMMUNITY HEALTH WORKERS, MEDICAL DIRECTORS, OFFICE MANAGERS, ALLIED HEALTH PROFESSIONALS, PHYSICIAN RECRUITERS, AS WELL AS OTHER HEALTH PROFESSIONALS, AND THE INDUSTRY SPONSORS AND EXHIBITORS. TRACK-TOPICS INCLUDED GERIATRICS, RURAL HEALTH, BEHAVIORAL HEALTH, AND HEALTHCARE PROVIDER HAPPINESS. CME CREDITS WERE AWARDED BY THE HAWAII MEDICAL BOARD. ATTENDEES GOT CONNECTED TO THOSE IN THE INDUSTRY (SPONSORS, EXHIBITORS, OTHER ATTENDEES), MET THE NEXT GENERATION OF HEALTHCARE PROFESSIONALS DURING THE HIGH SCHOOL AND UNDERGRADUATE POSTER COMPETITIONS, AND STAYED TO ENJOY PRIZE DRAWINGS MADE POSSIBLE BY THE GENEROUS INDUSTRY AND COMMUNITY PARTNERS. OTHER ATTENDEES INCLUDE 33 VOLUNTEERS (STUDENTS IN THE PRE-HEALTH CAREER CORPS); 12 AHEC STAFF - PAID FROM OTHER FUNDING. |
| FORM 990, PAGE 6, PART VI, LINE 11B | ALL BOARD MEMBERS WILL INDIVIDUALLY REVIEW THE FINAL DRAFT AND APPROVE THE RETURN 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 6/22/2001 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 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 MAY BE HIGHER OR LOWER THAN PEER GROUP TARGET PERCENTILES. THE PROCESS IS DOCUMENTED IN THE BOARD MINUTES AND IN THE INDIVIDUAL'S PERSONNEL FILE. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONSULTING & CONTRACTED SVCS 256,067 0 0 |
| Software ID: | |
| Software Version: |