efile Public Visual Render
ObjectId: 202421599349301127 - Submission: 2024-06-07
TIN: 99-0204777
Form
990
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
21
Open to Public Inspection
A
For the 2021 calendar year, or tax year beginning
10-01-2021
, and ending
09-30-2022
B
Check if applicable:
Address change
Name change
Initial return
Final return/terminated
Amended return
Application pending
C
Name of organization
Hawaii Youth Services Network
Doing business as
Number and street (or P.O. box if mail is not delivered to street address)
677 Ala Moana Blvd 904
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Honolulu
,
HI
96813
D Employer identification number
99-0204777
E Telephone number
(808) 489-9549
G
Gross receipts $
633,730
F
Name and address of principal officer:
677 Ala Moana Blvd 904
Honolulu
,
HI
96813
I
Tax-exempt status:
501(c)(3)
501(c)
(
)
(insert no.)
4947(a)(1)
or
527
J
Website:
https://www.hysn.org/
H(a)
Is this a group return for
subordinates?
Yes
No
H(b)
Are all subordinates
included?
Yes
No
If "No," attach a list. See instructions.
H(c)
Group exemption number
K
Form of organization:
Corporation
Trust
Association
Other
L
Year of formation:
1981
M
State of legal domicile:
HI
Part I
Summary
1
Briefly describe the organization’s mission or most significant activities:
Promoting the well being of youth and strengthening of families and communities by providing leadership, encouraging collaboration and creating partnerships.
2
Check this box
3
Number of voting members of the governing body (
Part VI
, line 1a)
........
3
11
4
Number of independent voting members of the governing body (
Part VI
, line 1b)
.....
4
11
5
Total number of individuals employed in calendar year 2021 (
Part V
, line 2a)
......
5
5
6
Total number of volunteers (estimate if necessary)
.............
6
50
7a
Total unrelated business revenue from
Part VIII
, column (C), line 12
........
7a
0
b
Net unrelated business taxable income from Form 990-T, Part I, line 11
.........
7b
Prior Year
Current Year
8
Contributions and grants (
Part VIII
, line 1h)
.........
1,267,259
630,946
9
Program service revenue (
Part VIII
, line 2g)
.........
1,500
1,219
10
Investment income (
Part VIII
, column (A), lines 3, 4, and 7d )
....
2,298
1,565
11
Other revenue (
Part VIII
, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)
5,329
0
12
Total revenue—add lines 8 through 11 (must equal
Part VIII
, column (A), line 12)
1,276,386
633,730
13
Grants and similar amounts paid (
Part IX
, column (A), lines 1–3 )
...
515,507
188,803
14
Benefits paid to or for members (
Part IX
, column (A), line 4)
.....
0
15
Salaries, other compensation, employee benefits (
Part IX
, column (A), lines 5–10)
380,544
309,705
16a
Professional fundraising fees (
Part IX
, column (A), line 11e)
.....
0
b
Total fundraising expenses (
Part IX
, column (D), line 25)
36,185
17
Other expenses (
Part IX
, column (A), lines 11a–11d, 11f–24e)
....
258,848
228,769
18
Total expenses. Add lines 13–17 (must equal
Part IX
, column (A), line 25)
1,154,899
727,277
19
Revenue less expenses. Subtract line 18 from line 12
.......
121,487
-93,547
Beginning of Current Year
End of Year
20
Total assets (
Part X
, line 16)
.............
976,145
636,781
21
Total liabilities (
Part X
, line 26)
.............
308,337
79,382
22
Net assets or fund balances. Subtract line 21 from line 20
.....
667,808
557,399
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
2024-06-07
Signature of officer
Date
Judith Clark
Executive Director
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
Check
if
self-employed
PTIN
P00846083
Firm's name
NATALIE J IWASA CPA INC
Firm's EIN
91-2183089
Firm's address
1331 LUNALILO HOME ROAD
HONOLULU
,
HI
96825
Phone no.
(808) 395-3233
May the IRS discuss this return with the preparer shown above? (see instructions)
..........
Yes
No
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form
990
(2021)
Page 2
Form 990 (2021)
Page
2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this
Part III
..............
1
Briefly describe the organization’s mission:
Promoting the well being of youth and strengthening of families and communities by providing leadership, encouraging collaboration and creating partnerships.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ?
.....................
Yes
No
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services?
...........................
Yes
No
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a
(Code:
) (Expenses $
176,513
including grants of $
97,456
) (Revenue $
)
Basic Center ProgramGoals: The Hawaii Basic Center Program will ensure safe, stable housing, and increase the social and emotional well-being, permanent connections, and connections to education and employment among RHY in Hawaii. HYSN will maintain a coordinated system of care statewide through a statewide coalition of youth-serving providers that will provide a safe environment for runaway and homeless youth (RHY), reunite youth with their families (as appropriate), strengthen family relationships, and help youth transition to safe and appropriate living arrangements.ObjectiveOutcome/Number servedYouth will obtain up to 21 days of emergency shelter. 10 of 10Youth will exit the BCP to safe, appropriate housing situations. 9 of 10Youth will be reunited with family when safe and appropriate. 8 of 10Youth admitted to shelter will participate in individual and/or group counseling. 7 of 10Families of youth admitted to shelter will be offered family counseling. 10 of 10Families of youth admitted to shelter will participate in family counseling. Website: 38,495 Email: 10 Instagram: 1,755In personVirtual: 949Total contacts: 41,209Youth will be linked to at least 1 system of care provider to assist with identified physical care, mental health, substance, abuse, personal safety, and/or sexual risk behaviors. 8 of 10Sheltered youth will report an increased sense of well-being upon exit. 7 of 10Staff will facilitate and assist youth in establishing and maintaining supportive permanent connectionswithfamily, school, peers, and community. 10 of 10 youth 100%RHY, youth at-risk of running away, and their families will access information relevant to their needs and issues through TeenLink Hawaii, a web-based information and outreach service,Website: 38,495 Email: 10 Instagram: 1,755 In person: 0/virtual: 949 Total contacts: 41,209By time of exit from shelter, youth can identify at least 1 person other than BCP staff that they can go to for advice or support. 8 of 10 youth 80%Sheltered youth that have not graduated from high school will be enrolled in school, an alternative education program, or GED program by end of shelter stay. 8 of 10Sheltered youth who are enrolled in school and capable of participating in educational opportunities will attend school or receive support in staying current with schoolwork during their shelter stay. 9 of 10Sheltered youth that have not graduated from high school will be enrolled in school, an alternative education program, or GED program by end of shelter stay. 8 of 10Sheltered youth who are enrolled in school and capable of participating in educational opportunities will attend school or receive support in staying current with schoolwork during their shelter stay. 9 of 10To coordinate and sustain partnerships, expand access to services, and facilitate identification/response to the needs of homeless youth HYSN will:.Maintain a statewide coalition of youth agencies and provide opportunities for networking and collaboration that include:Networking meetings and/or professional development trainingprograms 1 meeting 48 attendeesPublish a monthly e-newsletter 12 issues 2,186 subscribersShare information on youth resources, best practices, employment opportunities, and funding opportunities with youth service providers via e-mail.At least weekly. As of 9/30/2022, 2,184 recipients.Giving youth a voice in community needs assessment and planning through an annual Children and Youth Summit. 47 youth 20 youth in Summit leadership roles.
4b
(Code:
) (Expenses $
162,840
including grants of $
) (Revenue $
)
SCOPE OF WORK AND ACCOMPLISHMENTS FOR THE SPREP AND SRAE CONTRACTS WITH THE CNMI PUBLIC SCHOOL SYSTEMSConduct training of facilitators on the teen pregnancy prevention curricula in use in the CNMI (Making a Difference, Making Proud Choices, Be Proud Be Responsible). Planning for training completed. Actual training conducted November 2022.Assess professional development and training needs of PSS and community partner staff to build capacity in the CNMI to reduce unplanned pregnancy and sexually transmitted infections (STI) and increase sustainability of the PREP program. HYSN Director, CNMI Programs have worked with the PREP Director to identify training needs. Assess and respond to professional development,training and support needs of PSS staff and students related to COVID-19 issues.Based on identified needs, training is planned on trauma informed approaches with Tia Hartsock as a trainer.Provide training and technical assistance to PSS staff on teen pregnancy and STI prevention and related topics. Four PREP and SRAE staff attended a 2-day training on child sexual abuse prevention in June 2022. Met with PREP and SRAE staff to discuss implementation plan and update sexual harassment and bullying policy. Roll-out of SATC curriculum scheduled for 2nd semester of 2022-2023 school year. Director of CNMI Programs provided on site training and technical assistance during most of the contract period.The HYSN Executive Director provided technical assistance on budget revisions, no-cost extension of time, and reporting.Provide copies of any teen pregnancy and STI prevention print, video, and/or web-based materials designed for Asian and Pacific Islander youth that HYSN creates during the contract period. Provided access to brochures on disaster preparedness in multiple Pacific Island and Asian languages during the April June quarter.Work with PSS staff to promote community and parent support of teen pregnancy and STI prevention education. Provided support for HOPE training during this period.Work with PSS staff to design, develop, test, and distribute promotional materials related to the PREP and SRAE projects.HYSN created a PowerPoint demonstrating the positive outcomes of the teen pregnancy prevention program using the CY21 birthrate data.Work with PSS staff to disseminate outcomes achieved in the PREP and SRAE programs since inception including reduction in teen birth rate and sexual health risk factors and increases in protective factors that reduce risk of unplanned pregnancy and STIs. Includes, but is not limited to, conference and grantee meeting workshops and poster sessions; reports; and press releases. Updated presentations materials are available for use (see above).Provide information on best and promising practices in youth work, resources, data, training opportunities and more via the monthly HYSN electronic newsletter and e-mail broadcasts. E-newsletter is published monthly and received by 79 CNMI residents. Shared information on other resources with PREP Director and PREP Coordinator via e-mail.Assist PSS staff in educating government employees, elected officials, and community members about youth issues in the CNMI (including unplanned pregnancy and STIs), and efforts by the PSS to address youth needs and issues through the PREP and SRAE grants. Continuing to work with PREP staff to orient and educate new FYSB Project Officer, Cheri Thompson. Responded to request by FYSB staff for resources for a survivor of sex trafficking in the CNMI during the April to June quarter.Provide consultation and advice via phone, e-mail, and in-person as needed and appropriate. Ongoing throughout contract period.Provide training and technical assistance on federal grant writing, grants management, and sustainability. Provided technical assistance on budget revision and semi-annual reporting. Reviewed notice of funding availability to determine if the PSS was eligible to apply (It was not eligible). Provide information to federal staff about impact of any disasters or events affecting public school operations and specifically about the PREP and/or SRAE programs. Nothing that needed to be reported during this reporting period.In cooperation with PREP staff, ensure that all performance measure data required by the PREP program is collected and submitted. Ensure that data needed to measure progress toward objectives is collected, analyzed, and used in the quality improvement process. All data has been collected, reviewed, and submitted in a timely fashion.Assist in preparation of 6-month and end-of-year progress reports, and non-competitive continuation proposals. Assisted in preparation in of PREP performance reports.Participate in periodic conference calls with federal staff. Participated in scheduled calls with federal program staff.Send an HYSN representative to the 2022 teen pregnancy grantee meeting and/or topical training. The HYSN Executive Director attended the grantee meeting in June. She presented a poster titled, Pacific Islander Youth Reactions to the COVID Pandemic.Meet with PSS staff in Hawaii and/or CNMI at least twice per year. The Director, CNMI Programs has been in Saipan during most reporting period.Coordinate the data management and evaluation of the PREP Project.Maintain a computer-based data management system that:Enables students to take pre- and post-tests and student entry/exit surveys on computer.Transmits the student responses electronically to HYSN.Enables PSS and HYSN staff to report outcomes by individual class, school, or for the full CNMI.Maintains student confidentiality.Ongoing throughout contract period.Compile and analyze internal evaluation data including student demographic and attendance data, and pre-post-tests; training evaluations; and needs assessments. Ensure that data is submitted as required. Ongoing throughout contract period.Utilize vital statistics, Youth Risk Behavioral survey, and other data to track the impact of the PREP program on teen birth rates and sexual risk behavior Created PowerPoint using latest teen birth data.Provide training and technical assistance to increase the capacity of the PSS to conduct evaluation. Provided support for continuous quality improvement sessions.Seek opportunities to share lessons learned and successes in teen pregnancy/STI prevention and positive youth development with other professionals and colleagues through presentations at local, regional, national, and/or international conferences or articles published in professional journals. Conducted a poster session at the 2022 American Public Health Association about the impact of COVID on adolescents in the CNMI. Conduct a similar presentation at the Hawaii International Summit on Violence Abuse and Trauma in March 2022.Conducted a workshop on Impact of the COVID Pandemic on Pacific Islander Youth in August 2022.Assist PSS staff in needs assessment and planning for sustainability of PREP and SRAE programs and for new projects and program expansion. Ongoing throughout contract period. HYSN is prepared to offer training on sustainability and grant writing to PSS staff when conditions allow.Assist PSS staff in identification of potential funding sources, and preparation and submission of new funding applications.Nothing new during this reporting period.
4c
(Code:
) (Expenses $
127,931
including grants of $
) (Revenue $
)
Street Outreach ProgramGoal: The Hawaii Street Outreach Program will increase the personal safety, well-being, self-sufficiency and permanent connections with families, communities, schools and other positive networks among RHY in Hawaii by:Providing street-based services to runaway, homeless, and street youth who have been subjected to or are at risk of sexual abuse, prostitution, sexual exploitation, or severe forms of trafficking in persons.Establishing and maintaining approaches that identify and minimize sexual exploitation and human trafficking and providing services to youth who are victims or at risk of any type of sexual victimization and severe forms of trafficking.Coordinating and sustaining partnerships that strengthen the integration of comprehensive services to address the needs of the homeless youth population to increase protective factors and reduce risk factors that impact effective transition to adulthood. RHY will access street-based and/or drop-in center-based outreach.283 unduplicated youthRHY will reduce their risk of sexual exploitation, trafficking, abuse, assault, or substance use by establishing safety plans to reduce risks while on the streets. 145 RHY will reunite with families 19RHY will enter shelter or other safe, stable housing. 1RHY will receive information on prevention of and/or resources for sexual abuse/exploitation, trafficking, and/or substance abuse. 148To prevent illness or unplanned pregnancy and promote good health, youth will access primary or preventive health or mental health care services annually. 84 unduplicated youth (some served in both reporting periods)To ensure adequate nutrition and hygiene, RHY will obtain gateway services, such as providing food, clothing, hygiene, and other supplies to meet basic needs and build trust with outreach workers. 282 youth 1,145 unitsYouth will complete assessments for emergency and critical care needs to the extent that the youth will allow. 140To increase emotional and behavioral health and well-being, youth will access case management and follow-up services to address emotional and behavioral needs while establishing permanency plans. 19Youth will participate in educational services (such as attending school, participating in a GED program, applying for school admission). 27Youth will obtain full or part-time employment and/or participate in services designed to lead to employment (workforce readiness, job training). 36Youth will obtain access to public transportation by obtaining bus passes. 31+ 9 other homeless young adultsYouth will obtain legal identification. 26 87% of targetYouth will be linked with housing resources (e.g., rental assistance, transitional living, rapid re-housing).To coordinate and sustain partnerships, expand access to services, and facilitate identification/response to the needs of homeless youth HYSN will:Maintain a statewide coalition of youth agencies and provide opportunities for networking and collaboration that include:Networking meetings and/or professional development trainingprograms 1 meeting 48 attendeesPublish a monthly e-newsletter 12 issues 2,186 subscribersShare information on youth resources, best practices, employment opportunities, and funding opportunities with youth serviceproviders via e-mail.At least weekly.As of 9/30/2022, 2,184 recipients.Giving youth a voice in community needs assessment and planning through an annual Children and Youth Summit. 47 youth 20 youth in Summit leadership roles
4d
Other program services (Describe in Schedule O.)
(Expenses $
143,550
including grants of $
91,347
) (Revenue $
)
4e
Total program service expenses
610,834
Form
990
(2021)
Page 3
Form 990 (2021)
Page
3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)?
If "Yes," complete Schedule A
.....................
1
Yes
2
Is the organization required to complete
Schedule B, Schedule of Contributors
? See instructions.
...
2
Yes
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office?
If "Yes," complete Schedule C,
Part I
.............
3
No
4
Section 501(c)(3) organizations.
Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year?
If "Yes," complete Schedule C,
Part II
.........
4
Yes
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19?
If "Yes," complete Schedule C,
Part III
..
5
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts?
If "Yes," complete
Schedule D,
Part I
.........................
6
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures?
If "Yes," complete Schedule D,
Part II
....
7
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets?
If "Yes,"
complete Schedule D,
Part III
..............
8
No
9
Did the organization report an amount in
Part X
, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in
Part X
; or provide credit counseling, debt management, credit repair, or debt negotiation services?
If "Yes," complete Schedule D,
Part IV
..............
9
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments?
If "Yes," complete Schedule D,
Part V
......
10
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in
Part X
, line 10?
If "Yes," complete
Schedule D,
Part VI
.
...................
11a
Yes
b
Did the organization report an amount for investments—other securities in
Part X
, line 12 that is 5% or more of its total assets reported in
Part X
, line 16?
If "Yes," complete Schedule D,
Part VII
.......
11b
No
c
Did the organization report an amount for investments—program related in
Part X
, line 13 that is 5% or more of its total assets reported in
Part X
, line 16?
If "Yes," complete Schedule D,
Part VIII
.......
11c
No
d
Did the organization report an amount for other assets in
Part X
, line 15 that is 5% or more of its total assets reported in
Part X
, line 16?
If "Yes," complete Schedule D,
Part IX
............
11d
No
e
Did the organization report an amount for other liabilities in
Part X
, line 25?
If "Yes," complete Schedule D,
Part X
11e
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)?
If "Yes," complete Schedule D,
Part X
11f
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete
Schedule D, Parts XI and XII
......................
12a
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year?
If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional
12b
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)?
If "Yes," complete Schedule E
13
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?
.....
14a
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more?
If "Yes," complete Schedule F, Parts I and IV
.........
14b
No
15
Did the organization report on
Part IX
, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization?
If “Yes,” complete Schedule F, Parts II and IV
.....
15
No
16
Did the organization report on
Part IX
, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals?
If “Yes,” complete Schedule F, Parts III and IV
...
16
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on
Part IX
, column (A), lines 6 and 11e?
If "Yes," complete Schedule G,
Part I.
See instructions.
....
17
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on
Part VIII
, lines 1c and 8a?
If "Yes," complete Schedule G,
Part II
............
18
No
19
Did the organization report more than $15,000 of gross income from gaming activities on
Part VIII
, line 9a?
If "Yes," complete Schedule G,
Part III
...................
19
No
20a
Did the organization operate one or more hospital facilities?
If "Yes," complete Schedule H
....
20a
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on
Part IX
, column (A), line 1?
If “Yes,” complete Schedule I, Parts I and II
.....
21
Yes
Form
990
(2021)
Page 4
Form 990 (2021)
Page
4
Part IV
Checklist of Required Schedules
(continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on
Part IX
, column (A), line 2?
If “Yes,” complete Schedule I, Parts I and III
........
22
No
23
Did the organization answer "Yes" to
Part VII
, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees?
If "Yes," complete Schedule J
.......................
23
No
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002?
If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a
...............
24a
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?
...
24b
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
...............
24c
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?
...
24d
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations.
Did the organization engage in an excess benefit transaction with a disqualified person during the year?
If "Yes," complete Schedule L,
Part I
....
25a
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ?
If "Yes," complete Schedule L,
Part I
.......................
25b
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons?
If "Yes," complete Schedule L,
Part II
...........
26
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L,
Part III
.........................
27
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L,
Part IV
instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor?
If "Yes," complete Schedule L,
Part IV
......................
28a
No
b
A family member of any individual described in line 28a?
If "Yes," complete Schedule L,
Part IV
.....
28b
No
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b?
If "Yes," complete Schedule L,
Part IV
.....................
28c
No
29
Did the organization receive more than $25,000 in non-cash contributions?
If "Yes," complete Schedule M
..
29
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions?
If "Yes," complete Schedule M
.................
30
No
31
Did the organization liquidate, terminate, or dissolve and cease operations?
If "Yes," complete Schedule N,
Part I
31
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?
If "Yes," complete Schedule N,
Part II
........................
32
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3?
If "Yes," complete Schedule R,
Part I
............
33
No
34
Was the organization related to any tax-exempt or taxable entity?
If "Yes," complete Schedule R,
Part II
, III, or IV, and
Part V
, line 1
.........................
34
No
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)?
If "Yes," complete Schedule R,
Part V
, line 2
...
35b
36
Section 501(c)(3) organizations.
Did the organization make any transfers to an exempt non-charitable related organization?
If "Yes," complete Schedule R,
Part V
, line 2
.............
36
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes?
If "Yes," complete Schedule R,
Part VI
37
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for
Part VI
, lines 11b and 19?
Note.
All Form 990 filers are required to complete Schedule O.
............
38
Yes
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this
Part V
...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable
..
1a
4
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable
.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners?
..................
1c
No
Form
990
(2021)
Page 5
Form 990 (2021)
Page
5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
(continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return
..................
2a
5
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note.
If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. See instructions.
2b
No
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?
...
3a
No
b
If “Yes,” has it filed a Form 990-T for this year?
If “No” to line 3b, provide an explanation in Schedule O
...
3b
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?
..
4a
No
b
If "Yes," enter the name of the foreign country:
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?
..
5a
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T?
............
5c
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?
...
6a
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?
......................
6b
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?
....................
7a
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?
.....
7b
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?
.........................
7c
No
d
If "Yes," indicate the number of Forms 8282 filed during the year
....
7d
0
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
..
7f
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?
......................
7g
No
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?
..........................
7h
No
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?
........
8
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?
........
9a
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?
...
9b
10
Section 501(c)(7) organizations.
Enter:
a
Initiation fees and capital contributions included on
Part VIII
, line 12
...
10a
b
Gross receipts, included on Form 990,
Part VIII
, line 12, for public use of club facilities
10b
11
Section 501(c)(12) organizations.
Enter:
a
Gross income from members or shareholders
.........
11a
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.)
..........
11b
12a
Section 4947(a)(1) non-exempt charitable trusts.
Is the organization filing Form 990 in lieu of Form 1041?
12a
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
.........
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans
....
13b
c
Enter the amount of reserves on hand
............
13c
14a
Did the organization receive any payments for indoor tanning services during the tax year?
.....
14a
No
b
If "Yes," has it filed a Form 720 to report these payments?
If "No," provide an explanation in Schedule O
..
14b
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year?
....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income?
..
If "Yes," complete Form 4720, Schedule O.
16
No
17
Section 501(c)(21) organizations.
Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953?
..
If "Yes," complete Form 6069.
17
Form
990
(2021)
Page 6
Form 990 (2021)
Page
6
Part VI
Governance, Management, and Disclosure.
For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines
8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this
Part VI
..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
11
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
11
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee?
.................
2
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person?
.
3
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
.
4
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets?
.
5
No
6
Did the organization have members or stockholders?
................
6
Yes
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body?
....................
7a
Yes
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body?
...................
7b
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body?
.......................
8a
Yes
b
Each committee with authority to act on behalf of the governing body?
............
8b
No
9
Is there any officer, director, trustee, or key employee listed in
Part VII
, Section A, who cannot be reached at the organization’s mailing address?
If "Yes," provide the names and addresses in Schedule O
.......
9
No
Section B. Policies
(
This Section B requests information about policies not required by the Internal Revenue Code.
)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates?
............
10a
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
............................
11a
No
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990.
.....
12a
Did the organization have a written conflict of interest policy?
If "No," go to line 13
.......
12a
Yes
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts?
..........................
12b
Yes
c
Did the organization regularly and consistently monitor and enforce compliance with the policy?
If "Yes," describe on Schedule O how this was done
...................
12c
Yes
13
Did the organization have a written whistleblower policy?
...............
13
Yes
14
Did the organization have a written document retention and destruction policy?
.........
14
Yes
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official
...........
15a
Yes
b
Other officers or key employees of the organization
................
15b
No
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year?
......................
16a
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements?
............
16b
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filed
HI
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
Own website
Another's website
Upon request
Other (explain in Schedule O)
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
Regina Torres Jacobs
677 Ala Moana Blvd 904
Honolulu
,
HI
96813
(607) 287-7826
Form
990
(2021)
Page 7
Form 990 (2021)
Page
7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this
Part VII
..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a
Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
List all of the organization’s
current
officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.
List all of the organization’s
current
key employees, if any. See the instructions for definition of "key employee."
List the organization’s five
current
highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the
organization and any related organizations.
List all of the organization’s
former
officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.
List all of the organization’s
former directors or trustees
that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.
See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(F)
Estimated amount of other compensation from the organization and related organizations
(1)
Judith Clark
......................................................................
Executive Dir.
40.00
.................
0.00
X
116,845
0
0
(2)
Carole Gruskin
......................................................................
President
1.50
.................
0.00
X
X
0
0
0
(3)
Vonnell Ramos
......................................................................
Vice President
1.50
.................
0.00
X
X
0
0
0
(4)
Jefferson Gourley
......................................................................
Secretary
1.50
.................
0.00
X
X
0
0
0
(5)
Sione Ford Naeata
......................................................................
Treasurer
1.50
.................
0.00
X
X
0
0
0
(6)
Cheryl Johnson
......................................................................
Director
1.50
.................
0.00
X
0
0
0
(7)
Cyd Hoffeld
......................................................................
Director
1.50
.................
0.00
X
0
0
0
(8)
Nicole Hokoana
......................................................................
Director
1.50
.................
0.00
X
0
0
0
(9)
Richard Kim
......................................................................
Director
1.50
.................
0.00
X
0
0
0
(10)
Nicole Cowan
......................................................................
Director
1.50
.................
0.00
X
0
0
0
(11)
Greg Tjapkes
......................................................................
Director
1.50
.................
0.00
X
0
0
0
(12)
Jaque Kelley-Uyeoka
......................................................................
Director
1.50
.................
0.00
X
0
0
0
(13)
Joni Chun
......................................................................
Director
1.50
.................
0.00
X
0
0
0
(14)
Paul Tonnessen
......................................................................
Director
1.50
.................
0.00
X
0
0
0
Form
990
(2021)
Page 8
Form 990 (2021)
Page
8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
(continued)
(A)
Name and title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(F)
Estimated amount of other compensation from the organization and related organizations
1b
Sub-Total
................
c
Total from continuation sheets to
Part VII
, Section A
....
d
Total (add lines 1b and 1c)
...........
116,845
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization
1
Yes
No
3
Did the organization list any
former
officer, director or trustee, key employee, or highest compensated employee on line 1a?
If "Yes," complete Schedule J for such individual
..............
3
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000?
If "Yes," complete Schedule J for such
individual
...........................
4
No
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization?
If "Yes," complete Schedule J for such person
........
5
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization
0
Form
990
(2021)
Page 9
Form 990 (2021)
Page
9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this
Part VIII
.............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512 - 514
1a
Federated campaigns
..
1a
b
Membership dues
..
1b
c
Fundraising events
..
1c
d
Related organizations
1d
e
Government grants (contributions)
1e
617,275
f
All other contributions, gifts, grants, and similar amounts not included above
1f
13,671
g
Noncash contributions included in lines 1a - 1f:$
1g
3,285
h Total.
Add lines 1a-1f
.......
630,946
Business Code
2a
Training
611430
1,219
1,219
b
c
d
e
f
All other program service revenue.
g
Total.
Add lines 2a–2f
.....
1,219
3
Investment income (including dividends, interest, and other
similar amounts)
......
1,565
1,565
4
Income from investment of tax-exempt bond proceeds
0
5
Royalties
...........
0
(ii) Personal
(i) Real
6a
Gross rents
6a
b
Less: rental expenses
6b
c
Rental income or (loss)
6c
d
Net rental income or (loss)
.......
0
(ii) Other
(i) Securities
7a
Gross amount from sales of assets other than inventory
7a
b
Less: cost or other basis and sales expenses
7b
c
Gain or (loss)
7c
d
Net gain or (loss)
.........
0
8a
Gross income from fundraising events (not including $
of contributions reported on line 1c).
See
Part IV
, line 18
....
8a
b
Less: direct expenses
...
8b
c
Net income or (loss) from fundraising events
..
0
9a
Gross income from gaming activities.
See
Part IV
, line 19
...
9a
b
Less: direct expenses
...
9b
c
Net income or (loss) from gaming activities
..
0
10a
Gross sales of inventory, less
returns and allowances
..
10a
b
Less: cost of goods sold
..
10b
c
Net income or (loss) from sales of inventory
..
0
Business Code
Miscellaneous Revenue
11a
b
c
d
All other revenue
....
e
Total.
Add lines 11a–11d
......
0
12
Total revenue.
See instructions
.....
633,730
1,219
1,565
Form
990
(2021)
Page 10
Form 990 (2021)
Page
10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).
Check if Schedule O contains a response or note to any line in this
Part IX
..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of
Part VIII
.
(A)
Total expenses
(B)
Program service
expenses
(C)
Management and
general expenses
(D)
Fundraising
expenses
1
Grants and other assistance to domestic organizations and domestic governments. See
Part IV
, line 21
....
188,803
188,803
2
Grants and other assistance to domestic individuals. See
Part IV
, line 22
...........
0
3
Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See
Part IV
, lines 15 and 16.
.............
0
4
Benefits paid to or for members
.......
0
5
Compensation of current officers, directors, trustees, and key employees
...........
98,160
63,955
9,815
24,390
6
Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B)
.........
0
7
Other salaries and wages
........
161,072
143,543
15,196
2,333
8
Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions)
....
8,338
7,584
754
9
Other employee benefits
.......
19,238
16,869
1,821
548
10
Payroll taxes
...........
22,897
18,517
2,205
2,175
11
Fees for services (non-employees):
a
Management
......
0
b
Legal
.........
0
c
Accounting
...........
27,749
27,749
d
Lobbying
...........
0
e
Professional fundraising services.
See
Part IV
, line 17
0
f
Investment management fees
......
1,213
1,213
g
Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)
40,170
37,422
2,576
172
12
Advertising and promotion
....
375
300
75
13
Office expenses
.......
0
14
Information technology
......
0
15
Royalties
..
0
16
Occupancy
...........
41,649
30,157
5,746
5,746
17
Travel
............
45,917
45,903
7
7
18
Payments of travel or entertainment expenses for any federal, state, or local public officials
.
0
19
Conferences, conventions, and meetings
....
17,410
14,843
2,346
221
20
Interest
...........
169
169
21
Payments to affiliates
.......
0
22
Depreciation, depletion, and amortization
..
6,563
6,563
23
Insurance
...
4,983
2,388
2,595
24
Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a
Dues & subscriptions
10,339
10,150
189
b
Supplies
7,422
6,347
583
492
c
Parking
5,924
5,838
43
43
d
Training
5,657
5,657
e
All other expenses
13,229
12,558
613
58
25
Total functional expenses.
Add lines 1 through 24e
727,277
610,834
80,258
36,185
26
Joint costs.
Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation.
Check here
if following SOP 98-2 (ASC 958-720).
Form
990
(2021)
Page 11
Form 990 (2021)
Page
11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this
Part IX
..............
(A)
Beginning of year
(B)
End of year
1
Cash–non-interest-bearing
........
246,325
1
81,578
2
Savings and temporary cash investments
.........
41,170
2
140,692
3
Pledges and grants receivable, net
......
3
0
4
Accounts receivable, net
.............
459,651
4
187,972
5
Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons
.......
5
1,096
6
Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B)
...
6
0
7
Notes and loans receivable, net
...........
7
0
8
Inventories for sale or use
............
8
0
9
Prepaid expenses and deferred charges
......
11,085
9
7,738
10a
Land, buildings, and equipment: cost or other basis. Complete
Part VI
of Schedule D
10a
52,023
b
Less: accumulated depreciation
10b
41,039
12,078
10c
10,984
11
Investments—publicly traded securities
.
169,906
11
174,149
12
Investments—other securities. See
Part IV
, line 11
.....
12
0
13
Investments—program-related. See
Part IV
, line 11
..
13
0
14
Intangible assets
...............
32,968
14
29,608
15
Other assets. See
Part IV
, line 11
...........
2,962
15
2,964
16
Total assets.
Add lines 1 through 15 (must equal line 33)
...
976,145
16
636,781
17
Accounts payable and accrued expenses
.....
308,337
17
79,382
18
Grants payable
...
18
19
Deferred revenue
.........
19
20
Tax-exempt bond liabilities
.........
20
21
Escrow or custodial account liability.
Complete
Part IV
of Schedule D
21
22
Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons
.........
22
23
Secured mortgages and notes payable to unrelated third parties
..
23
24
Unsecured notes and loans payable to unrelated third parties
..
24
25
Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24).
Complete
Part X
of Schedule D
25
26
Total liabilities.
Add lines 17 through 25
..
308,337
26
79,382
Organizations that follow FASB ASC 958,
check here
and complete lines 27, 28, 32, and 33.
27
Net assets without donor restrictions
..........
666,007
27
492,797
28
Net assets with donor restrictions
...........
1,801
28
64,602
Organizations that do not follow FASB ASC 958,
check here
and complete lines 29 through 33.
29
Capital stock or trust principal, or current funds
.....
29
30
Paid-in or capital surplus, or land, building or equipment fund
...
30
31
Retained earnings, endowment, accumulated income, or other funds
31
32
Total net assets or fund balances
...........
667,808
32
557,399
33
Total liabilities and net assets/fund balances
........
976,145
33
636,781
Form
990
(2021)
Page 12
Form 990 (2021)
Page
12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this
Part XI
..............
1
Total revenue (must equal
Part VIII
, column (A), line 12)
............
1
633,730
2
Total expenses (must equal
Part IX
, column (A), line 25)
............
2
727,277
3
Revenue less expenses. Subtract line 2 from line 1
..............
3
-93,547
4
Net assets or fund balances at beginning of year (must equal
Part X
, line 32, column (A))
..
4
667,808
5
Net unrealized gains (losses) on investments
...............
5
-16,862
6
Donated services and use of facilities
.................
6
7
Investment expenses
.....................
7
8
Prior period adjustments
.....................
8
9
Other changes in net assets or fund balances (explain in Schedule O)
........
9
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal
Part X
, line 32, column (B))
10
557,399
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this
Part XII
.............
Yes
No
1
Accounting method used to prepare the Form 990:
Cash
Accrual
Other
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
Separate basis
Consolidated basis
Both consolidated and separate basis
b
Were the organization’s financial statements audited by an independent accountant?
2b
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
Separate basis
Consolidated basis
Both consolidated and separate basis
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight
of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
No
b
If "Yes," did the organization undergo the required audit or audits?
If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Form
990
(2021)
Form 990 (2021)
Additional Data
Software ID:
21013475
Software Version:
2021v4.1
Form 990, Special Condition Description:
Special Condition Description