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) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 25,000 | 35,700 | 60,700 | |||
| 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 | 25,000 | 35,700 | 60,700 | |||
| 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. | 60,700 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 25,000 | 35,700 | 60,700 | |||
| 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 | 60,700 | |||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 2024 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-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2024, 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 2024. 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 2025. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| 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 | PALLIATIVE CARE IS A WIN-WIN-WIN-WIN. EXPANDING ACCESS TO PALLIATIVE CARE BENEFITS ALL PARTS OF THE HEALTHCARE SYSTEM. PEOPLE LIVING WITH SERIOUS ILLNESS ARE BETTER ABLE TO MANAGE PHYSICAL AND EMOTIONAL SYMPTOMS AND HAVE PEACE OF MIND THAT THEIR CARE IS CONSISTENT WITH WHAT MATTERS MOST. FAMILIES AND CAREGIVERS FEEL SUPPORTED AND BETTER EQUIPPED TO HELP THEIR LOVED ONES. CLINICIANS EXPERIENCE GREATER PROFESSIONAL SATISFACTION AND LESS BURNOUT. HEALTH SYSTEMS BENEFIT FROM BETTER QUALITY CARE AT A GREATER VALUE AND AN EXPERT, STABLE AND RESILIENT CLINICIAN WORKFORCE |
| FORM 990, PAGE 2, PART III, LINE 4A | HUI POHALA WAS AWARDED 3.6 MILLION FROM THE STATE OF HAWAI`I DEPARTMENT OF HUMAN SERVICES MED-QUEST DIVISION TO EXPAND PALLIATIVE CARE IN THE COMMUNITY. HONOLULU, HAWAII WHEN SOMEONE LEARNS THAT THEY HAVE A SERIOUS ILLNESS, IT CAN BE DEVASTATING. IT IS EVEN MORE DISTRESSING IF FINDING ACCESS TO APPROPRIATE CARE IS AN ISSUE. EVEN MEDICAL PROFESSIONALS MAY FACE CHALLENGES IN IDENTIFYING AND REFERRING PATIENTS TO SPECIALISTS WHO CAN ALLEVIATE THE SEVERITY OF THEIR SYMPTOMS. HUI POHALA WAS AWARDED 3.6 MILLION FROM THE STATE OF HAWAII DEPARTMENT OF HUMAN SERVICES (DHS), MED-QUEST DIVISION, WHICH WILL PROVIDE HUI POHALA WITH THE TOOLS AND RESOURCES TO TACKLE THOSE CHALLENGES AND MAKE PALLIATIVE CARE MORE ACCESSIBLE FOR VULNERABLE POPULATIONS. THE GRANT IS COMPOSED OF BOTH STATE, AND FEDERAL AMERICAN RESCUE PLAN ACT FUNDS. WE ARE PLEASED TO ANNOUNCE OUR COMMITMENT TO EXPANDING TRAINING RESOURCES AND EQUIPPING A WIDER AUDIENCE WITH ESSENTIAL TOOLS AIMED AT ENHANCING COMPREHENSION AND IMPLEMENTATION OF PALLIATIVE CARE, SAID JUDY MOHR PETERSON, MED-QUEST ADMINISTRATOR. WITH A LONGSTANDING DEDICATION TO THIS FIELD, WE LOOK FORWARD TO COLLABORATING WITH HUI POHALA IN ADVANCING THIS CRITICAL INITIATIVE. WE ARE SO GRATEFUL THAT DHS/MED-QUEST HAS GIVEN US THIS OPPORTUNITY TO LEAD THIS GAME-CHANGING INITIATIVE, SAID RAE SEITZ, MD, CHIEF EXECUTIVE OFFICER OF HUI POHALA, WHO HAS DECADES OF EXPERIENCE SERVING IN BOTH PROVIDER AND PAYER (HEALTH INSURANCE) ROLES WITH HMSA AND KAISER PERMANENTE HAWAII. PALLIATIVE CARE HELPS PATIENTS BETTER COPE WITH A SERIOUS ILLNESS AND GREATLY IMPROVES THEIR QUALITY OF LIFE AND HEALTH OUTCOMES, DR. SEITZ SAID. PALLIATIVE CARE CURRENTLY IS UNDER-UTILIZED AND NOT WELL UNDERSTOOD. HUI POHALA WANTS TO CHANGE THIS BY EQUIPPING PHYSICIANS AND OTHER HEALTHCARE PROFESSIONALS SO PATIENTS AND FAMILY CAREGIVERS CAN EASILY ACCESS PALLIATIVE CARE. HUI POHALA WILL BE WORKING ON A NUMBER OF INITIATIVES TO IMPROVE ACCESS TO HIGH-QUALITY PALLIATIVE CARE OUTSIDE OF HOSPITALS AND DOCUMENT THE EFFECTIVENESS OF THIS CARE WITH QUALITY METRICS SO PEOPLE WITH SERIOUS ILLNESSES CAN REMAIN IN THEIR HOMES AND COMMUNITIES SAFELY AND APPROPRIATELY. THESE INITIATIVES INCLUDE DEVELOPING RESOURCES FOR PATIENTS AND THEIR FAMILIES TO MANAGE CARE AT HOME AND TRAINING TO UPSKILL HEALTHCARE PROVIDERS, PARTICULARLY IN RURAL OR UNDERSERVED COMMUNITIES WHERE IT IS DIFFICULT TO ACCESS TIMELY, APPROPRIATE CARE. TRAINING, TOOLS, AND RESOURCES WILL BE MADE AVAILABLE AT NO COST TO ORGANIZATIONS AND INDIVIDUALS CARING FOR THOSE WITH SERIOUS ILLNESSES. HUI POHALA IS SUPPORTING THE DEVELOPMENT OF PILOT PROGRAMS TO RECRUIT AND RETAIN NURSES FOR HOME AND COMMUNITY-BASED PALLIATIVE CARE AND WILL LEAD THE CREATION OF A CENTRALIZED RESOURCE HUB FOR INFORMATION, TRAINING, AND RESOURCES REGARDING PALLIATIVE CARE THAT WILL BE AVAILABLE TO PROVIDERS, HEALTHCARE PROFESSIONALS, PATIENTS, AND CAREGIVERS IN HAWAII AND THE PACIFIC ISLANDS. HUI POHALA IS CONTINUING TO DEEPEN THE COMMUNITYS UNDERSTANDING OF THE PERSISTENT GAPS AND CHALLENGES THAT PREVENT HEALTHCARE PROFESSIONALS AND CAREGIVERS FROM PROVIDING THE BEST CARE POSSIBLE THROUGHOUT THE STATE AND ACTIVATING RECOMMENDATIONS WITH THE HIGHEST VALUE. CLINICIANS AND OTHERS ON THE FRONTLINES OF PATIENT CARE READILY SEE THE WEAK LINKS IN OUR HEALTHCARE SYSTEM. WERE EXCITED TO WORK ON MULTIPLE SOLUTIONS TO FILL THE GAPS, DR. SEITZ SAID. IN ADDITION TO PROVIDING TRAINING FOR DOCTORS, NURSE PRACTITIONERS, REGISTERED NURSES, AND OTHERS, WERE THINKING OUTSIDE THE BOX AND BELIEVE COMMUNITY HEALTH WORKERS, HEALTHCARE NAVIGATORS, EMERGENCY MEDICAL TECHNICIANS, GOVERNMENT AGENCIES, HOME HEALTH AGENCIES, FEDERALLY QUALIFIED HEALTH CENTERS, AND OTHERS ARE KEY TO REACHING MORE HAWAII FAMILIES AND MAKING PALLIATIVE CARE MORE ACCESSIBLE. |
| FORM 990, PAGE 6, PART VI, LINE 11B | COPIES OF THE RETURN WERE REVIEWED AND APPROVED BY THE BOARD PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE BOARD WILL ASK THE PERSON THAT THEY SUSPECT FAILED TO DISCLOSE THE CONFLICT OF INTEREST TO EXPLAIN ALLEGED FAILURE TO DISCLOSE. THEN THEY WILL INVESTIGATE. THE BOARD WILL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION IF THE PERSON FAILED TO DISCLOSE CONFLICT OF INTEREST. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | SUB-CONTRACTOR 1,680,531 1,212 0 OTHER FEES 2,925 0 0 TOTAL 1,683,456 1,212 0 |
| Software ID: | |
| Software Version: |