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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2017
Open to Public
Inspection
Name of the organization
KAHALA SENIOR LIVING COMMUNITY INC
 
Employer identification number
99-0290103
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) ALZHEIMER'S ASSOCIATION
1050 ALA MOANA BLVD 2610
HONOLULU,HI96814 		99-0212360 501(C)(3) 47,097       TO SUPPORT EDUCATION AND AWARENESS
(2) CATHOLIC CHARITIES HAWAII
1822 KEEAUMOKU STREET
HONOLULU,HI96822 		99-0073547 501(C)(3) 48,065       SENIOR HOUSING ASSISTANCE
(3) HAWAII MEALS ON WHEELS
PO BOX 61194
HONOLULU,HI96839 		99-0198132 501(C)(3) 51,445 82,541 FAIR MARKET VALUE FOOD HOT MEALS FOR COMMUNITY SENIORS
(4) HELPING HANDS HAWAII
2100 N NIMITZ HIGHWAY
HONOLULU,HI96819 		23-7365077 501(C)(3)   7,050 FAIR MARKET VALUE REFRIGERATORS, STOVES, MICROWAVES, WASHER/DRYER HELP INDIVIDUALS AND FAMILIES STABILIZE THEIR LIVING CONDITION TO WORK TOWARDS SELF-SUFFICIENCY
(5) KAPIOLANI COMMUNITY COLLEGE
4303 DIAMOND HEAD ROAD
HONOLULU,HI96816 		99-6000354 501(C)(3) 7,209       OCCUPATIONAL THERAPIST TRAINING
(6) KOKUA KALIHI VALLEY
2239 N SCHOOL ST
HONOLULU,HI96819 		99-0149797 501(C)(3) 27,680 16,602 FAIR MARKET VALUE RESOURCE BOOKLET SENIOR HEALTH / PROGRAM ASSISTANCE
(7) PALAMA SETTLEMENT
810 N VINEYARD BLVD
HONOLULU,HI96817 		99-0074140 501(C)(3)   14,942 FAIR MARKET VALUE GIFT BAGS PROVIDE HOUSEHOLD TOILETRIES AND CANNED GOODS TO HOMEBOUND SENIORS
(8) PROJECT DANA
2720 NAKOOKOO ST
HONOLULU,HI96826 		99-0143990 501(C)(3) 37,885       SUPPORT SENIOR PROGRAMS
(9) SAINT MARY STAR OF THE SEA SCHOOL
4469 MALIA STREET
HONOLULU,HI96821 		99-0078514 501(C)(3) 11,407       SPONSOR THE EAST HONOLULU FOOD FESTIVAL
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
9
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2017
Page 2

Schedule I (Form 990) 2017
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) SCHOLARSHIP PROGRAM 14 38,775      
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
PART I, LINE 2: EACH GRANT TO AN UNRELATED ORGANIZATION IS APPROVED AND INCLUDED IN THE BUDGET; ALL EXPENDITURES ARE PRESENTED TO THE BOARD OF DIRECTORS. THE HAWAII COMMUNITY FOUNDATION MONITORS THE USE OF SCHOLARSHIP FUNDS ON BEHALF OF KAHALA SENIOR LIVING COMMUNITY.
Schedule I (Form 990) 2017



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