2025-11-13T17:22:27-06:00 2024-12-31 421539623 KMH LLP 1003 BISHOP STREET SUITE 2400 HONOLULU HI 96813 990 2024-01-01 990073521 PALOLO CHINESE HOME PALO 8087372555 2459 10TH AVENUE HONOLULU HI 96816 DARLENE NAKAYAMA CHIEF EXECUTIVE OFFICER 8087372555 2025-11-13 1 1 DANIELLE A HARANO P01258470 8085262255 2025-10-23 2024 2025-03-06 01:10:19Z DARLENE NAKAYAMA 2459 10TH AVENUE HONOLULU HI 96816 21610999 0 X WWW.PALOLOHOME.ORG X 1920 HI TO EDUCATE, SUPPORT AND CARE FOR SENIORS AND THEIR FAMILIES BY PROVIDING A CONTINUUM OF QUALITY CARE. 15 14 219 30 0 0 2890519 550570 17880324 20299260 110895 284250 222001 165278 21103739 21299358 0 0 0 0 10736468 11264837 0 0 103277 9919760 10779691 20656228 22044528 447511 -745170 31600065 31067299 7656473 7663133 23943592 23404166 X TO EDUCATE, SUPPORT, AND CARE FOR SENIORS AND THEIR FAMILIES BY PROVIDING A CONTINUUM OF QUALITY CARE IN A CULTURALLY SENSITIVE FAMILY SETTING. 0 0 16576956 17241443 ICF/SNF - PALOLO CHINESE HOME IS LICENSED AS AN ICF/SNF UNIT AND PROVIDES 113 NURSING HOME BEDS TO ELDERLY RESIDENTS, REGARDLESS OF RACE. 601628 1526606 ADULT RESIDENTIAL HOME - PALOLO CHINESE HOME IS LICENSED AS AN ADULT RESIDENTIAL CARE HOME TYPE II FACILITY (EARCH II) THAT HOUSES 18 ELDERLY RESIDENTS, REGARDLESS OF RACE. 1308199 479445 ADULT DAY CARE - PALOLO CHINESE HOME IS LICENSED AS AN ADULT DAY CARE CENTER FOR 40 ELDERLY PARTICIPANTS, REGARDLESS OF RACE. 1113312 1051766 OTHER PROGRAM SERVICES INCLUDE COMMUNITY OUTREACH PROGRAMS SUCH AS MEALS HOME DELIVERY, HOME CLEANING, COMPANIONSHIP, PERSONAL CARE AND CATERING. 1113312 1051766 19600095 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 34 0 219 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 15 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 HI X JUSTIN LEE 8085425260 2459 10TH AVENUE HONOLULU HI 96816 PATRICIA BLANCHETTE MD MPH SECRETARY & MEDICAL DIRECT 4.00 X X 36000 0 0 ELVIRA LO PRESIDENT 2.00 X X 0 0 0 ISOO OSHIMACPA TREASURER 2.00 X X 0 0 0 SANDRA SOUZA VICE PRESIDENT 2.00 X X 0 0 0 ERIC WATANABE ASSISTANT TREASURER 2.00 X X 0 0 0 FRANCES GOO DIRECTOR 2.00 X 0 0 0 GLADYS LEE DIRECTOR 2.00 X 0 0 0 JEFFREY SCHMIDT ESQ DIRECTOR 2.00 X 0 0 0 GORDON AU DIRECTOR 2.00 X 0 0 0 LAWRENCE TSEU DDS DIRECTOR 2.00 X 0 0 0 ANDREW FONG MD DIRECTOR 2.00 X 0 0 0 REGINALD YEE ESQ DIRECTOR 2.00 X 0 0 0 KIN MING CHING OD DIRECTOR 2.00 X 0 0 0 RODNEY UCHIDA DIRECTOR 2.00 X 0 0 0 DARLENE NAKAYAMA CEO 40.00 X 244251 0 27382 AGNES DELOS REYES REGISTERED NURSE 40.00 X 128908 0 13851 JAMIE SUZUKI REGISTERED NURSE 40.00 X 146713 0 11246 JUAN GONZALEZ DIRECTOR OF NURSING 40.00 X 132854 0 14047 RACHAEL YOUNG DIRECTOR OF HR 40.00 X 119118 0 12823 EVA HIDALGO HOMECARE AIDE 103.00 X 122220 0 7104 930064 0 86453 12 0 1 0 KAHU MALAMA NURSES INC 1357 KAPIOLANI BOULEVARD SUITE 915 HONOLULU HI 96814 STAFFING 1537610 GENESIS ELDERCARE REHABILITATIONLLC PO BOX 821322 PHILADELPHIA PA 191821322 THERAPY 523933 PRIME TIME HEALTHCARE LLC 15380 WEIR STREET OMAHA NE 68137 STAFFING 315680 TRAVEL CARE HAWAII LLC 1050 QUEEN STREET HONOLULU HI 96814 STAFFING 289660 PROLINK STAFFING 4600 MONTGOMERY ROAD SUITE 300 CINCINNATI OH 45212 STAFFING 268192 11 10241 540329 550570 ICF/SNF UNIT AND NURSING HOME 623000 17241443 17241443 ADULT RESIDENTIAL CARE HOME 623000 1526606 1526606 OTHER - COMM. OUTREACH, ETC. 624200 1051766 1051766 ADULT DAY CARE CENTER 621400 479445 479445 20299260 221282 221282 89724 22954 66770 66770 66770 295558 35007 261390 6207 34168 28800 62968 62968 78360 21090 57270 57270 CHANGE IN VALUE OF PERM TRUST 900099 20852 20852 MISCELLANEOUS REVENUE 900099 20386 20386 41238 21299358 20299260 0 449528 X 280251 36000 195401 48850 8878184 8120834 756018 1332 198634 166380 31809 445 1223279 1064552 158727 684489 612317 72172 39090 39090 103304 103304 24957 19522 5435 4520961 4116248 377416 27297 114289 114289 115663 15483 96864 3316 347023 159142 187881 550796 528559 20355 1882 30180 18613 11567 6697 1610 5087 166339 166339 852948 753248 94812 4888 218416 198593 16114 3709 NURSING & DIETARY SUPPL 1704194 1704194 0 0 TAXES & LICENSES 1228824 1227928 896 0 REPAIRS & MAINTENANCE 315348 311940 1746 1662 MISCELLANEOUS EXPENSE 247504 204957 38086 4461 193158 193158 22044528 19600095 2341156 103277 498529 583851 3305897 3026848 14000 214000 3046387 2750825 122455 96233 94836 168680 37060839 15667538 21981524 21393301 2222301 2498573 310136 330988 4000 4000 31600065 31067299 2206622 2558595 0 -3290 500 500 5449351 5107328 7656473 7663133 X 23098012 22243244 845580 1160922 23943592 23404166 31600065 31067299 X -745170 205749 -5 X 0 1 X 1 0 X 788531 3171734 342562 2890519 550570 7743916 788531 3171734 342562 2890519 550570 7743916 120077 7623839 145480 152173 145890 204135 311006 958684 2791 18674 34816 169973 98746 325000 9027600 90355555 0.84450 0.86040 X SCHEDULE A, PART II, LINE 10, EXPLANATION FOR OTHER INCOME: OTHER INCOME SPECIAL FUNDRAISING EVENT PROCEEDS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 792143 298300 51413 34371 1107485 761101 25301 93991 88250 792143 521322 222652 96790 79663 761101 439074 120100 54648 92500 521322 393294 19550 34130 7900 439074 0.00000 1.00000 0.00000 0 0 395050 395050 28931521 10743994 18187527 1911553 1911553 5487587 4923544 564043 335128 335128 21393301 X 21331036 205749 44044 249793 21081243 24957 193158 218115 21299358 21870462 44049 44049 21826413 24957 193158 218115 22044528 PART IV, LINE 2B: THE ORGANIZATION HOLDS SECURITY DEPOSITS FOR TWO COMPANIES LEASING SPACE. THE TENANT'S SECURITY DEPOSIT IS REFUNDED UPON TERMINATION OF THE LEASE, LESS ANY REPAIRS AND MAINTENANCE. PART V, LINE 4: EARNINGS FROM THE ENDOWMENT FUNDS ARE USED TO SUPPLEMENT THE OPERATIONS OF THE HOME'S PROGRAMS IN ACCORDANCE WITH THE HOME'S MISSION STATEMENT. PART X, LINE 2: THE HOME IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND COMPARABLE STATE LAW. ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR FEDERAL INCOME TAX IN THE ACCOMPANYING FINANCIAL STATEMENTS. MANAGEMENT EVALUATED THE HOME'S TAX POSITIONS AND CONCLUDED THAT THE HOME HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. THE HOME'S 2021 THROUGH 2023 FEDERAL TAX RETURNS REMAIN OPEN TO EXAMINATION BY THE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 21,090. RENTAL EXPENSES 22,954. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 193,158. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 21,090. RENTAL EXPENSES 22,954. ROUNDING ADJUSTMENT 5. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 193,158. GOLF TOURNAMENT 78360 78360 4415 7632 8247 797 78360 78360 4415 7632 8247 797 21091 57269 X 1 1 X X X X 0 0 0 0 0 0 0 0 0 DARLENE NAKAYAMA CEO 244251 0 0 0 0 0 18970 0 8412 0 271633 0 0 0 JAMIE SUZUKI REGISTERED NURSE 146713 0 0 0 0 0 11246 0 0 0 157959 0 0 0 PART I, LINE 1B THE ORGANIZATION PROVIDES GROSS-UP PAYMENTS FOR THE ANNIVERSARY AWARDS AND EMPLOYEE OF THE YEAR AWARDS GIVEN TO EMPLOYEES, WHICH MAY INCLUDE EMPLOYEES LISTED IN FORM 990, PART VII, SECTION A. THESE GROSS-UP PAYMENTS ARE INCLUDED IN TAXABLE COMPENSATION. FORM 990, PART VI, SECTION A, LINE 1A PATRICIA BLANCHETTE, MD IS A DIRECTOR AND IS ALSO THE MEDICAL DIRECTOR FOR PALOLO CHINESE HOME. SHE IS COMPENSATED FOR HER WORK AS MEDICAL DIRECTOR BUT HER POSITION ON THE BOARD IS VOLUNTARY. SHE RECUSES HERSELF DURING BOARD MEETINGS ON ISSUES THAT MAY CAUSE A POTENTIAL CONFLICT OF INTEREST (ONLY WHEN IT RELATES TO HER DUTIES AS MEDICAL DIRECTOR). FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPRISED OF THE CHIEF EXECUTIVE OFFICER, THE OFFICERS OF THE BOARD, THE IMMEDIATE PAST PRESIDENT, AND ONE OTHER DIRECTOR ELECTED BY THE BOARD OF DIRECTORS. ALL ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE ARE SUBJECT TO RATIFICATION BY THE BOARD OF DIRECTORS. A MAJORITY OF THE MEMBERS OF THE EXECUTIVE COMMITTEE CONSTITUES A QUORUM TO TRANSACT BUSINESS, AND THE MAJORITY APPROVAL OF SUCH QUORUM ON ANY MATTER IS DEEMED VALID AND BINDING. FORM 990, PART VI, SECTION B, LINE 11B THE DIRECTOR OF FINANCE AND BUSINESS OPERATIONS REVIEWED THE FORM 990. THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWED THE FORM 990 AND UPON APPROVAL MADE A RECOMMENDATION TO THE BOARD OF DIRECTORS FOR FINAL APPROVAL. THE BOARD OF DIRECTORS REVIEWED AND APPROVED THE FORM 990 BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C PALOLO CHINESE HOME HAS A WRITTEN CONFLICT OF INTEREST POLICY THAT WAS CREATED BY AND FOR DIRECTORS AND OFFICERS OF THE ORGANIZATION. IF IT IS UNCLEAR WHETHER A CONFLICT EXISTS, THE DETERMINATION IS MADE BY THE OFFICERS AND BOARD OF DIRECTORS. IF A CONFLICT EXISTS, THE DIRECTOR OR OFFICER ABSTAINS FROM VOTING ON THE MATTER. THE BOARD OF DIRECTORS HAS THE AUTHORITY TO REMOVE A BOARD MEMBER WHO KNOWINGLY AND INTENTIONALLY DOES NOT DISCLOSE A CONFLICT OF INTEREST. ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE REQUIRED TO BE COMPLETED AND SIGNED BY ALL DIRECTORS AND OFFICERS. FORM 990, PART VI, SECTION B, LINE 15 PALOLO CHINESE HOME REVIEWS ANNUAL COMPENSATION ADJUSTMENTS AT THE EXECUTIVE BOARD MEETING BY DISCUSSING APPROPRIATE COMPENSATION AMOUNTS IN LIGHT OF MARKET COMPARABLES. RECOMMENDATIONS ARE MADE TO THE BOARD OF DIRECTORS, WHO HAVE FINAL APPROVAL, AS WELL AS APPROVAL OVER ANY ADDITIONAL OR EXTRAORDINARY COMPENSATION. THIS PROCESS WAS LAST COMPLETED IN 2020. FORM 990, PART VI, SECTION C, LINE 19 PALOLO CHINESE HOME'S ORGANIZING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. PALOLO CHINESE HOME PUBLISHES AN ANNUAL REPORT CONTAINING FINANCIAL INFORMATION. THE ANNUAL REPORT IS AVAILABLE ON PALOLO CHINESE HOME'S WEBSITE. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES AND CONTRACT LABOR: PROGRAM SERVICE EXPENSES 4,116,248. MANAGEMENT AND GENERAL EXPENSES 377,416. FUNDRAISING EXPENSES 27,297. TOTAL EXPENSES 4,520,961. FORM 990, PART XI, LINE 9: ROUNDING ADJUSTMENT -5. PCH MANAGEMENT LLC 2459 10TH AVENUE HONOLULU HI 96816 461019166 MANAGEMENT & CONSULTING HI 0 0 PALOLO CHINESE HOME PCH LANDHOLDING LLC 2459 10TH AVENUE HONOLULU HI 96816 462398671 REAL ESTATE HOLDING HI 0 0 PALOLO CHINESE HOME