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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.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
Hawai'i Pacific Health
 
Employer identification number
99-0246363
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) GREAT ALOHA RUN
418 KUWILI ST STE 102
HONOLULU,HI96817 		99-0314751 501 (C) (3) 180,000       GENERAL SUPPORT
(2) BIKESHARE HAWAI'I
914 ALA MOANA BLVD
HONOLULU,HI96814 		46-4561541 501 (C) (3) 90,000       GENERAL SUPPORT
(3) University of Hawaii
1334 Lower Campus Road
HONOLULU,HI96822 		99-6000354 Government 66,565       GENERAL SUPPORT
(4) AMERICAN HEART ASSN
677 ALA NOANA BLVD
HONOLULU,HI96813 		13-5613797 501 (C) (3) 55,000       GENERAL SUPPORT
(5) HAWAI'I EXECUTIVE COLLABORATIVE
827 FORT ST MALL 2ND FL
HONOLULU,HI96813 		84-4041099 501 (C) (3) 50,000       GENERAL SUPPORT
(6) HEALTHCARE ASSOCIATION OF HAWAI'I
707 RICHARDS ST PH2
HONOLULU,HI96813 		99-0105817 501 (C) (3) 35,000       GENERAL SUPPORT
(7) UH FOUNDATION
2444 DOLE ST 105
HONOLULU,HI96822 		99-0085260 501 (C) (3) 31,667       GENERAL SUPPORT
(8) HAWAI'I COMMUNITY FOUNDATION
827 FORT STREET MALL
HONOLULU,HI96813 		99-0261283 501 (C) (3) 30,000       GENERAL SUPPORT
(9) DIAMOND HEAD THEATRE
520 MAKAPUU AVE
HONOLULU,HI96813 		99-0073495 501 (C) (3) 19,000       GENERAL SUPPORT
(10) HAWAI'I PUBLIC HEALTH INSTITUTE
850 RICHARDS ST 201
HONOLULU,HI96813 		68-0637054 501 (C) (3) 18,000       GENERAL SUPPORT
(11) AMERICAN RED CROSS
4155 DIMOND HEAD ROAD
HONOLULU,HI96816 		53-0196605 501 (C) (3) 17,500       GENERAL SUPPORT
(12) SHIDLER COLLEGE OF BUSINESS
2404 MAILE WAY STE A303F
HONOLULU,HI96822 		99-0339302 501 (C) (3) 15,000       GENERAL SUPPORT
(13) HAWAIIAN HUMANE SOCIETY
2700 WAIALAE AVE
HONOLULU,HI96826 		99-0073490 501 (C) (3) 15,000       GENERAL SUPPORT
(14) AFTER SCHOOL ALL START
4747 KILAUEA AVE
HONOLULU,HI96816 		27-4604870 501 (C) (3) 15,000       GENERAL SUPPORT
(15) ARTHRITIS FOUNDATION
1355 PEACHTREE ST NE STE 600
ATLANTA,GA30309 		58-1341679 501 (C) (3) 15,000       GENERAL SUPPORT
(16) HONOLULU MUSEUM OF ART
900 SOUTH BERETANIA ST
HONOLULU,HI96814 		99-0079713 501 (C) (3) 15,000       GENERAL SUPPORT
(17) MAKE A WISH HAWAI'I
223 SKING ST STE 100
HONOLULU,HI96813 		99-0220777 501 (C) (3) 15,000       GENERAL SUPPORT
(18) MARCH OF DIMES
1580 MAKLOA ST 1200
HONOLULU,HI96814 		13-1846366 501 (C) (3) 14,500       GENERAL SUPPORT
(19) HOUSING HAWAII'S FUTURE
1008 LUNAAI PL
KAILUA,HI96734 		87-3388003 501 (C) (3) 12,500       GENERAL SUPPORT
(20) GIFT FOUNDATION OF HAWAI'I
1288 ALA MOANA BLVD 201
HONOLULU,HI96814 		30-0266316 501 (C) (3) 10,000       GENERAL SUPPORT
(21) GIRL SCOUTS OF HAWAI'I
410 ATKINSON DR STE 2E1 BOX 3
HONOLULU,HI96814 		99-0073488 501 (C) (3) 10,000       GENERAL SUPPORT
(22) BOYS AND GIRLS CLUB OF HAWAI'I
1000 BISHOP ST STE 505
HONOLULU,HI96813 		99-6005407 501 (C) (3) 6,000       GENERAL SUPPORT
(23) WAIKIKI COMMUNITY CENTER
310 PAOAKALANI AVE
HONOLULU,HI96815 		99-0179392 501 (C) (3) 5,500       GENERAL SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Graphic Arrow
23
3
Enter total number of other organizations listed in the line 1 table ........................ . Graphic Arrow
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021
Page 2

Schedule I (Form 990) 2021
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)
(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
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. THE HAWAI'I PACIFIC HEALTH ('HPH') DONATIONS COMMITTEE REVIEWS AND APPROVES DONATIONS TO 501(C)(3) ORGANIZATIONS ON AN ANNUAL BASIS. NO FURTHER MONITORING IS NECESSARY FOR DONATIONS MADE TO 501(C)(3) ORGANIZATIONS.
Schedule I (Form 990) 2021



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