all? BIUZ 0 WW CIBNNVOS m. 990 0 Department of the Treasury Internal Revenue ServIce 29493371207219- 8. 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 for Instructions and the latest information. UMU N0 lb4b-UU4/ Open to Public Inspection A For the 2017 calendar year, or tax year beginning 2017, and ending 20 3 Check If applicable 6 Name of organIzatIon GRAS SROOT I NSTITUTE OF HAWAI I I NC 0 Emp'Over Identification number Address change busmess Name change Number and street (or 0 box If mail Is not delivered to street address) Room/smte Telephone number InItIaIreturn 1050 BISHOP ST 508 (808)591?9193 Final return/termlnated City or town, state or provmce, country, and ZIP or foreign postal code Amended return HONOLULU, HI 96813 Gross recelpts$ 684 904. Application pending Name and address 0f officer H(a) Is this a group return Iorsubordrnates'ID Yes No WILLIAM AKI NA, 1 050 BISHOP ST #50 8, HONOLULU, HI th) Are all subordlnates Included? El Yes No L- Tax-exempt status WebSIte: PForm of organization Corporation Trust LXI 501(c)(3) Cl 501(c) A Assoc1ation Other Summary )4 (insert no) D4947(a)(1) 0? I Year of formation If attach a list (see instructions) H(c) Group exemption number 2 0 0 ll State of legal domICIle I 1 BrIefIy describe the organizatIon's or most signi?cant actIVItIes ?913.14 ?9391, gang 3 2 2 Check this box If the organization discontInued its operations or disposed of more than 25% of Its net assets. 8 3 Number of voting members of the body (Part VI, line 1a) . 3 7 '3 4 Number of Independent voting members of the governing body (Part VI, line 1b) 4 6 5 Total number of IndIVIduals employed In calendar year 2017 (Part V, line 2a) 5 0 6 Total number of volunteers (estImate If necessaryTotal unrelated busmess revenue from Part column (C), Me 12 7a 0 . Net unrelated busmess taxable Income from Form 990Prior Year Current Year a, 8 ContrIbutions and grants (Part line 1h) . 507 370. 67 g, 723. 9 Program sen/Ice revenue (Part line 29Investment Income (Part column (A), lines Other revenue (Part column (A), ?ms 5, 6d, 8c, 90, 10c, and 11e) . 12 Total revenue?add ?ms 8 through 11 (must equal Part column (AGrants and amounts paid (Part IX, column (A), lines 1? . 14 Benefits paid to or for members (Part IX, column (A), line 4) 3 15 Salaries, other compensation, employee bene?ts (Part IX, column (A), lines 5?1016a Professional fundraIsmg fees (Part IX, column (A), line He) . 8 000 Total fundraIsmg expenses (Part IX, column (D), line 25) 2,915 I 17 Other expenses (Part IX, column (A), IInes 11a?11d, 11f-24eTotal expenses. Add lines 13?17 (must equal Part IX, column (A), line 25Revenue less expenses. Subtract line 18 from We 12 . . 4 831. 83 007 . 3% Beginning of Current Year End of Year 3% 20 Total assets (PartX line16) 54,073. 109, 513. g; 21 Total (Part 2532 Net assets or fund balances. Subtract km 21 from 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 oVeparer/her than officer) IS based on all Information of which preparer has any knowledge Walsh Me. I II /02 I 8 Sign Signature of officer Date I Here WILLIAM AKINA, PRESIDENT Type or print name and title ?1 1 Paid Print/Type preparer?s name Pre A'SSIgnature te Check If PTIN Preparer GERALD USHIJIMA self-employed P01356124 Use Only Firm's name GERALD Y. USHIJIMA CPA r?rrKe EIN 99?0230347 Flrm's address 1110 UNIVERSITY AVE STE 508, HONOLULU, HI 96826-1508 Phone no (808) 94 9?5588 May the IRS discuss this return with the preparer shown above? (see instructI n5) r-nr-u "on. Yes No For Paperwork Reduction Act Notice, see the separate instructions. BAA . .0 Form 990 (2017) to 03 8 NOV 192018 3 [Lb an new?! I IT r/ Form 990 (2017) Page 2 Statement of Program Service Accomplishments Part . . . . . . . . . . . . . El 1 Briefly describe the organization's missmn: 2 Did the organization undertake any Significant program servnces during the year were not listed on the If "Yes," describe these new serVIces on Schedule 0. 3 Did the organization cease conducting, or make Significant changes In how It conducts, any program If "Yes,? describe these changes on Schedule 0. 4 Describe the organization's program serVIce for each of Its three largest program serVIces, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are requnred to report the amount of grants and allocations to others, the total expenses, and revenue, If any, for each program serwce reported. 4a (Code. (Expenses 13 grants of 0 (Revenue 0 4b (Code (Expenses Including grants of (Revenue 4c (Code: (Expenses Includlng grants of (Revenue 4d Other program sen/Ices (Describe in Schedule 0.) (Expenses Including grants of (Revenue 4e Total program servnce expenses 37 1 I 825 REV 12105117 PRO Form 990 (2017) Form 990 (2017) Page 3 Che'cklist 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 ScheduleAthe organization reqUIred to complete Schedule 8, Schedule of Contributors (see instructions)? . . . 2 3 Did the organization engage In direct or Indirect political campaign actIVItIes on behalf of or In opposmon to candidates for public office? If "Yes," complete Schedule Partl . . . . . . . . . 3 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 llthe 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 Revenue Procedure 98-19? If "Yes," complete Schedule C, 5 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, Partl . . . . . . . . . . . . . 5 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 ll . . . 7 8 the organization maintain collections of works of art, historical treasures, or other Similar assets? If ?Yes, complete Schedule D, Part . . . . . . . . . . . . . . . . . . . . . . . . . 3 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 or prowde credit counseling, debt management, credit repair, or debt negotiation serVIces? If ?Yes,? ?complete Schedule D, Parth . . . . . 10 Did the organization, directly or through a related organization, hold assets In temporarily restricted endowments, permanent endowments, or quasi? ?endowments? lf "Yes, complete Schedule D, Part . . 10 11 If the organization?s answer to any of the followmg questions is ?Yes,? then complete Schedule D, Parts Vl, . VII, IX, or as applicable. all}, All?; fee..- 3 Did the organization report an amount for land, and eqUIpment In Part X, line 10? If ?Yes, 7 complete Schedule D, Part 11a 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 0 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 line 16? If "Yes, complete Schedule D, Part . . . . . 11c 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 11d Did the organization report an amount for other liabilities in Part X, line 25? If ?Yes, complete Schedule D, Part 11e 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 posmons under FIN 48 (A80 740)? ll ?Yes, complete Schedule D, Part 11f 12 a Did the organization obtain separate, Independent audited finanCIaI statements for the tax year? If "Yes," complete Schedule D, Parts XI and . . 123 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 [5 optional 12b 13 Is the organization a school described in section If ?Yes, complete Schedule . . . . 13 14 a Did the organization maintain an office, employees, or agents outSIde of the United States? . . 143 Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraismg, busmess, Investment, and program serVIce actIVItIes outSIde the United States, or aggregate foreign Investments valued at $100,000 or more? lf ?Yes, complete Schedule F, Parts land lV. . . . 14b 15 Did the organization report on Part IX, column (A), line 3, more than 000 of grants or other aSSIstance to or for any foreign organization? If "Yes, complete Schedule F, Parts the organization report on Part IX, column (A), line 3, more than 000 of aggregate grants or other aSSIstance to or for foreign IndIVIduals? If "Yes, complete Schedule F, Parts Ill and IVDid the organization report a total of more than $15,000 of expenses for professmnal fundraising serVIces on Part IX, column (A), lines 6 and 11e? If "Yes, complete Schedule G, Part! (see InstructionsDid the organization report more than $15, 000 total of fundraismg event gross Income and contributions on Part lines 10 and 8a? If "Yes, complete Schedule G, Part Did the organization report more than $15, 000 of gross income from gaming actIVIties on Part line 9a? If "Yes, complete Schedule G, Part Ill . . . . . . . . . . . . . . . . . . . . 19 Form 990 (2017) REV 12105117 PRO Form 990 (2017) Part IV Checklist of Required Schedules (continuedPage 4 Did the organization operate one or more hoSpitaI facilities? If ?Yes, complete Schedule If ?Yes" to line 20a, did the organization attach a copy of Its audited finanCIaI statements to this return? Did the organization report more than $5,000 of grants or other to any domestic organization or domestic government on Part IX, column (A). line 1? lf ?Yes,? complete Schedule I, Parts land ll . 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? lf ?Yes, complete Schedule I, Parts land Ill 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 . 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. lf go to line 258 . Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? . Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bondsDid the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? . 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! 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 If?Yes,?completeScheduleL, PartlDid the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payabies to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part Did the organization prowde a grant or other aSSistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? it "Yes, complete Schedule L, Part . Was the organization a party to a busmess transaction With one of the foliowmg parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions). A current or former officer, director, trustee, or key employee? If ?Yes, complete Schedule L, Part IV A family member of a current or former officer, director, trustee, or key employee? If ?Yes," complete ScheduleL,Parth An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If ?Yes, complete Schedule L, Part IV Did the organization receive more than $25,000 in non-cash contributions? If ?Yes, complete Schedule Did the organization receive contributions of art, historical treasures, or other Similar assets, or qualified conservation contributions? If "Yes,? 'complete Schedule . . . . . Did the organization liqUIdate, terminate, or dissolve and cease operations? If "Yes, complete Schedule N, Partl . Did the organization sell, exchange, dispose of, or transfer more than 25% of Its net assets? lf "Yes, complete Schedule N, Part ll Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301. 7701 -2 and 301.7701 If "Yes, complete Schedule Fl, Partl Was the organization related to any tax- -exempt or taxable entity? If ?Yes, complete Schedule H, Part II, oer,andParti/,line1 Did the organization have a controlled entity Within the meaning of section 512(b)(13)? . 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 Fl, Part V, line 2. Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes,? complete Schedule H, Part V, line 2 . . . . . 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 VIDid the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines 11b and 19? Note. All Form 990 filers are reqwred to complete Schedule REV 12l05l17 PRO Form 990 (2017) Form 990 (2017) Statements Regarding Other IRS Filings and Tax Compliance Check if Schedule 0 contains a response or note to any line in this Part . Yes No 1a Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable . . . . 1a 0 E: - {Lift SEE Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable . . . . 1b 0 3.5+ $52? Did the organization comply With backup Withholding rules for reportable payments to vendors and Egg: its?? reportable gaming (gambling) Winnings to prize Winners? . 1c 2a Enter the number of employees reported on Form W- 3, Transmittal of Wage and Tax gig raga Statements, filed for the calendar year ending With or Within the year covered by this return 2a 0 $31 {"53 it If at least one is reported on line 2a, did the organization file all reqwred federal employment tax returns? 2b Note. If the sum of lines 1a and 2a is greater than 250, you may be reqUIred to e-file (see instructions) ?g 2.3.35; 3a Did the organization have unrelated busmess gross income of $1,000 or more during the year? . 3a If "Yes," has it filed a Form 990-T for this year? If "No" to line 3b, prowde an explanation in Schedule 0 . 3b 4a At any time during the calendar year, did the organization have an interest in, or a Signature or other authority over, a finanCiaI account in a foreign country (such as a bank account, securities account, or other financial account)? . . . 4a If "Yes,? enter the name of the foreign country. :2 J: Egg ?3 See Instructions for filing reqwrements for Form 114, Report of Foreign Bank and Financial Accounts 4 4' mg at: at; 22th.: 5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? . 5a Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? Sb If "Yes" to line 53 or 5b, did the organization file Form . 5c 6a Does the organization have annual gross receipts that are normally greater than $1 00, 000, and did the organization so i0it any contributions that were not tax deductible as charitable contributions?. 6a If ?Yes, did the organization include With every an express statement that such contributions or gifts were not tax deductible? 6b 7 Organizations that may receive deductible contributions under section 170(c). 3% 3 Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods E33251 and serwces prowded to the payor"Yes, did the organization notify the donor of the value of the goods or serwces provided? . . 7b Did the organization sell exchange, or othenivise dispose of tangible personal property for which it was reqUIredtofileForm8282?Yes," indicate the number of Forms 8282 filed during the year . . . I 7d I 3% 5?19}. Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? 7e Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . 7f If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as reqUIred? 79 If the organization received a contribution of cars, boats. airplanes, or other vehicles, did the organization file a Form 1098-0? 7h 8 Sponsoring organizations maintaining donor advised funds. Did a donor adwsed fund maintained by the 3353,: 131': 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 Did the Sponsoring organization make a distribution to a donor, donor adwsor, or related person? 9b 10 Section 501(c)(7) organizations. Enter. a Initiation fees and capital contributions included on Part line 12 . . . . . 10a fir: Gross receipts, included on Form 990, Part line 12, for public use of club faculties . 10b r?f; 11 Section 501(c)(12) organizations. Enter. Egg AW i. a Gross income from members or shareholders . . . 11a pal-?21 .i L: Gross income from other sources (Do not net amounts due or paid to other sources "3453": be?? . against amounts due or received from them11b $.52 5% - - 12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041? 123 If ?Yes,? enter the amount of tax- -exempt interest received or accrued during the year. . 12b ?g 3" 13 Section 501 qualified nonprofit health insurance issuers. 1.163 1335': ?a Is the organization licensed to issue qualified health plans in more than one state? . 13a Note. See the instructions for additional information the organization must report on Schedule 0. .1 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 Enter the amount of reserves on hand . . . . . . . . . . . . 13c 14a Did the organization receive any payments for indoor tanning services during the tax year? . . . . If ?Yes,? has it filed a Form 720 to report these payments? If ?prowde an _xplanation in Schedule REV 12105? 7 PRO Form 990 (2017) Form 990 (2017) Page 6 Governance, Management, and Disclosure For each ?Yes? response to lines 2 through 7b below, and for a ?No" response to line 8a, 8b, or 10b below, describe the Circumstances, processes, or changes in Schedule 0. See instructions. Check if Schedule 0 contains a response or note to any line In this Part 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 7 If there are material differences In voting rights among members of the governing body, or . i if the governing body delegated broad authority to an executive committee or Similar committee, explain in Schedule 0. Enter the number of voting members included in line 1a, above, who are independent . 1b 6 2 Did any officer, director, trustee or key employee have a family relationship or a busmess relationship With any other officer, director, trustee, or key employee? . . 3 Did the organization delegate control over management duties customarily performed by or under the direct supeNi5ion of officers, directors, or trustees, or key employees to a management company or other person? 4 Did the organization make any Significant changes to its governing documents Since the prior Form 990 was filed? 5 Did the organization become aware during the year of a Significant diver3ion of the organization?s assets? . 6 7 0)th Did the organization have members or stockholders? a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing bodyAre any governance deCIsions of the organization reserved to (or sub)ect to approval by) members, stockholders, or persons other than the governing bodyDid the organization contemporaneously document the meetings held or written actions undertaken during the year by the followmg a The governing bodyEach committee With authority to act on behalf of the governing body? . . Sb 9 Is there any officer director, trustee, or key employee listed in Part VII Section A, who cannot be reached at the organization' 3 mailing address? if "Yes,? p?rovrde the names and addresses in Schedule 0. . . . . 9 Section B. Policies (T his Section 8 requests information about poIICies not requrred by the Internal Revenue Code.) Yes No 10a Did the organization have local chapters, branches, or affiliates? . . . 10a If ?Yes, did the organization have written poIICIes and procedures governing the actiVities of such chapters, affiliates, and branches to ensure their operations are consistent With the organization' 5 exempt purposes? 10b 11a Has the organization prowded a complete copy of this Form 990 to all members of its governing body before filing the form? 11a Describe in Schedule 0 the process, if any, used by the organization to reView this Form 990. - - 12a Did the organization have a written conflict of interest policy? it go to line 13 . . . . 12a Were officers, directors, or trustees. and key employees requued to disclose annually interests that could give rise to conflicts? 12b Did the organization regularly and con3istently monitor and enforce compliance With the policy? If "Yes," describe in Schedule 0 how this was done . . . . . . . . . . . . 12c 13 Did the organization have a written Whistleblower policyDid the organization have a written document retention and destruction policy? . . . 14 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 deCI5ion? - a The organization's CEO, Executive Director, or top management official . . . . . . . . . . . . 15a Other officers or key employees of the organization . . . . . . . . . . . 15b If ?Yes" to line 15a or 15b, describe the process in Schedule (see instructions). - . 16a Did the organization invest in, contribute assets to, or partICIpate in a pint venture or Similar arrangement With a taxable entity during the year"Yes," did the organization follow a written policy or procedure requmng the organization to evaluate its partICipation in mint venture arrangements under applicable federal tax law, and take steps to safeguard the organization?s exempt status With respect to such arrangements71-66- Section C. Disclosure 17 List the states With which a copy of this Form 990 is requwed to be filed hr; 18 Section 6104 reqUIres an organization to make its Forms 1023 (or 1024 if available for public inspection. Indicate how you made these available. Check all that apply. El Own website Another?s web5ite Upon request Other (explain in Schedule 0) 19 Describe in Schedule 0 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: WILLIAM AKINA, 1050 BISHOP ST 508, HONOLULU, HI 96813 (808)591?9193 REV 12105l17 PRO Form 990 (2017) Form 990 (2017) Page 7 Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Check if Schedule 0 contains a response or note to any line in this Part VII . . . . . . . . . . . . Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 13 Complete this table for all persons requrred to be listed. Report compensation for the calendar year ending With or within the organization's tax year. 0 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. 0 List all of the organization's current key employees, if any. See instructions for definition of ?key employee." 0 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 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations. List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations. 0 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. List persons in the followmg order: indiwdual trustees or directors, institutional trustees; officers; key employees; highest compensated employees; and former such persons. Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee. (CI Posmon (A) (8) (do not check more than one (D) (E) (F) Name and Title Average boxI unless person IS both an Reportable Reportable Estlmated hours per of?ce,- and a director/trustee) compensation compensation from amount of week (list any 0 7: _n from related other hours for a; a 3 35 the organizations compensation related 3 a 8 :33 3 organization from the organizations Sig 8' 3 organization below dotted 9 g. i g? and related line) organizations 3 a. D. CHAIR 0 . O. 0 . 118,736. 0. 24,761. (3IEDKEMP050 TREASURER 0. 0. 0. DIRECTOR, VICE CHAIR 0. 0. 0. DIRECTOR 0. 0. 0. DI RECTOR 0 . 0 . 0 . DIRECTOR 0. 0. 0 . -19.) 1.1.9) .119) .1114.) REV 12105117 PRO Form 990 (2017) Form 990 (2017) Page 8 Part VII Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) . (Cl Posmon (A) (8) (do not check more than one ID) (E) In Name and title Average box, unless person .3 both an Reportable Reportable Estimated hours per of?cer and a director/trustee) compensation compensation from amount of week (list any 0 7: I 11 from related other hours for ac: (3. 3 35 the organizations compensation related 3 a 3 cu Big r3b organization from the organizations 8. 133 organization below dotted - a and related line) a ?g organizations a an. a 2's D. .115.) .119) 1 .116) 153.9.) 1.2.1.1 i 1.23.) 1.2.9.) .123) 1.2.5.1 1b Sub-total. . . . 118,736. 0. 24,761. Total from continuation sheets to Part VII Section A . . . . . Totalladdlines1band1c). 118 736.0. 24,761. 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 for such indiwdual 4 For any indiwdual listed on line 1a, is the sum of reportable compensation and other compensation from the east}. 3337 organization and related organizations greater than $150,000? If "Yes," complete Schedule for such 3:1? 35?3?? indiwdual 5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual 351 5 for sewices rendered to the organization? If ?Yes," complete Schedule for such person 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 yeah Name and busmess address (3) Description of sewices 10) 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 a legatkh?tw ?ww'v :3 1i; W??f - Ewe:- ,?Wr Fri; Alf? REV 12l05117 PRO Form 990 (2017) Form 990 (2017) Page 9 Part Statement of Revenue CheckifScheduleOcontainsa ornotetoan lineinthis PartVIllIt; (A) (B) (C) Total revenue Related or Unrelated Revenue exempt business excluded from tax J. function revenue under sections as? 4 revenue 512-514 Federated campaigns . . . 1a Membership dues . . . 1b Fundraismg events . . . . 16 Related organizations . . 1d Government grants (contributions) 1e All other contributions, gifts, grants. and amounts not included above 1f 67 6 7 2 3 Noncash contributions included in lines 1a-1f Total.AddIine51a?1f676,723. Busmess Code EVENTS 6 151. I . I . s. and Other Similar Amounts ?3 "d . 93" Contributions, Gifts, Grants All other program service revenue . Total.Addlines 2a?2fInvestment income (including dwidends, interest, and other Similar amountsIncome from investment of tax-exempt bond proceeds Royalties . . . . . . . . . . .0) Fteal A (ii) Personal Program Service Revenue Gross rents Less. rental expenses Rental income or (loss) Net rental income Gross sales of (I) Securities Other assets other than invuritmy Less cost or other bass and sales expenses Gain or (loss) . Net gain or (loss) Gross income from fundraismg events (not including of contributions reportedon-li-neut-c). See Part IV, line 18 . . . . a 33: expenses . . . Net income or (loss) from fundraismg events . Gross income from gaming actiwties. See Part IV, line Less. direct expenses . . . . Net income or (loss) from gaming activities . - Gross sales of inventory, less returns and allowances . . . a Less: cost of goods sold . . . Net income or (loss) from sales of inventory . . Miscellaneous Revenue Busmess Code Other Revenue All other revenue . . . - Total. Add lines 11aTotal revenue. See instructionsREV 1ziosi17 PRO . - Form (2017) a. Form 990 (2017) page 10 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 0 contains a response or note to any line In this Part IX . . . Do not include amounts reported on lines 6bPart vm. 3 WP 3.3111219311121222 1 Grants and other to domestic organizations T'i??mwmlit?w 3515511133?" :31? and domestic governments. See Part IV, line 21 F253 1111-13-12:; 2 Grants and other aSSistance to domestic 27273;,? 1= but? indIVIduals. See Part IV, llne 22 E??hs?Sm 3:32 191191;?ng 3 Grants and other assmtance to foreign ?nw??wi organizations, foreign governments, and foreign Fat-15v. ~r 4w indiwdua'is. See Part IV lines 15 and 16 . - 3. (311:1 . 53::?21331; r3313} 4 Benefits paid to or for members Ewwf?t??f 11.513.? 1.21;.st 551139.. ??emsi?l 5 Compensation of current officers, directors, trustees and keyemployees 118,736. 97,771. 20,965. 0. 6 Compensation not included above, to disqualified persons (as defined under section 4958010)) and persons described in section 4958(c)(3)(B) 7 Othersalariesand wages . 151,148. 135,800. 15L348. 0. 8 Pen3ion plan accruals and contributions (include section 401(k) and 403(b) employer contributions) 9 Other employee benefits . 13, 7'92. 10, 300. 3, 492. 0. 10 Payroll taxes. 11 Fees for serwces (non- employees): a Management Legal Accounting 300 . 0 . 300 . . Lobbying Professional fundraising services. See Part IV, iine 17 Investment management fees 9 Other (If line 119 amount exceeds 10% of line 25. column (A)amount, 161,018. 83,146. 77,872. 0_ 12 Advertising and promotion Officeexpenses 1,355. 0. 1,355. 0. 14 Information technology 10, 742. O. 10, 742. 0. 15 Royalties . 16 Occupancy 33,091. 0. 32,297. 794. 17 Travel . . 31,396. 15,470. 15,511. 415. 18 Payments of travel or entertainment expenses for any federal, state. or local public offICials 19 Conferences, conventions, and meetings 20 Interest . . Payments to affiliates . . 22 DepreCIation, depletion, and amortization 23 InsuranceOther 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 24a expenses on Schedule 0.) a 2.3.1.111 1.1113 '315133119215 . 2 6 6 7 0 . All other expenses 6, 131. 3, 744 23. 25 Total functional expenses. Add lines 1 through 24s Joint costs. Complete this line only if the organization reported in column (B) iornt costs from a combined educational campaign and fundraismg solicitation. Check here if followrng SOP 98-2 (ASC 958-720) . . REV 12l05l17 PRO Form 990 (2017) Form 990 (2017)- Page 11 Part Balance Sheet Check if Schedule 0 contains a response or note to any line in this Part . . (A) (B) Beginning of year End of year 1 Cash?non-interest-bearing . 12 738 . 1 9O 018. . 2 SaVings and temporary cash investments . 3 6 4 05 . 2 13, 555. 3 Pledges and grants receivable, net 3 4 Accounts receivable net . 3, 4 55. 4 3 500. 5 Loans and other receivables from current and former officers directors, Egg 414? trustees, key employees, "#4813 *1 mm??f?i?q? and highest compensated employees. Complete Part II of ScheduleL . . . as?? 6 Loans and other receivables from other disqualified persons (as defined under section ?g - . ??534:st 4058(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and g5; 41:24-44:12: ?it'd? sponsoring organizations of section 501 voluntary employees'- benefitiary - 3 organizations (see instructions). Complete Part II of Schedule . a 7 Notes and loans receivable net . . . . .. 8 Inventories for sale or use 9 Prepaid expenses and deferred charges 10a Land, bwldings, and eqUIpment: cost or other baSlS. Complete Part VI of Schedule 10a 4 I 5 4 1. Less: accumulated depreciation 10b 3 528 . 11 Investments?publicly traded securities . 12 Investments?other securities. See Part IV, line 11 13 lnvestments? ?program-related. See Part IV, line 11 . 14 Intangible assets . . 15 Other assets. See Part IV line 11 . 16 Total assets. Add lines 1 through 15 (must equal line 34). 54 073. 16 109, 513. 17 Accounts payable and accrued expenses . Grants payable . 19 Deferred revenue . 20 Tax- -exempt bond liabilities . 21 Escrow or custodial account liability. Complete Part IV of Schedule D. 22 Loans and other payables to current and former officers, directors. trustees. key employees, highest compensated employees, and 4 1'9; disqualified persons. Complete Part II of Schedule '3 23 Secured mortgages and notes payable to unrelated third parties 24 Unsecured notes and loans payable to unrelated third parties 25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part of Schedule . . . . . . . 25 26 Total liabilities. Add lines 17 through 25 38, 54 8 26 10, 981. Organizations that follow SFAS 117 (A50 958), check here and 53.5335" fig; #32313?? "245% 3 complete lines 27 through 29, and lines Unrestricted net assets . 27 28 Temporarily restricted net assets . 23 'g 29 Permanently restricted net assets. 29 3 Organizations that do not follow SFAS 117 (A80 958), check here I and :1 E?g?hg?gp 31,3 5 complete lines 30 through 34. :15; ?e g; 30 Capital stock or trust prinCipal, or current funds . . 30 31 Paid- -in or capital surplus, or land, budding. or eqUipment fund 31 32 Retained earnings, endowment, accumulated income, or other funds . Total net assets or fund balances . . 15, 525. 33 98, 532 . 34 Total liabilities and net assets/fund balances . REV 12105? 7 PRO Form 990 (2017) Form 990 (2017) Part XI Reconciliation of Net Assets Page 1 2 Check If Schedule 0 contains a response or note to any line in this Part XI . . . . 1 Total revenue (must equal Part Vlli, column (A), line 12Total expenses (must equal Part IX, column(A line 25) 2 601, 897. 3 Revenue less expenses. Subtract line 2 from line Net assets or fund balances at beginning of year (must equal Part X, line 33 column Net unrealized gains (losses) on investments 5 6 Donated sewices and use of faCIlIties 6 7 anestment expenses . 7 8 Prior period adjustments. . . 8 9 Other changes In net assets or fund balances (explain in Schedule 0) . . 9 10 Net assets or fund balances at end of year Combine lines 3 through 9 (must equal Part X, line 33, column . 10 98 532 . Financial Statements and Reporting Check if Schedule 0 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 i If the organization changed Its method of accounting from a prior year or checked "Other," explain In Schedule 0. 2a Were the organization's finanCIal statements compiled or reviewed by an Independent accountant? . 2a If "Yes," check a box below to indicate whether the financial statements for the year were compiled or rewewed on a separate baSis, consolidated ba3is, or both: Separate ba3is [3 Consolidated El Both consolidated and separate it" Were the organization' 5 finanCIaI statements audited by an Independent accountant? . 2b If ?Yes, check a box below to indicate whether the finanCIal statements for the year were audited on a separate ba3is, consolidated baSlS, or both. Separate El Consolidated baSlS Both consolidated and separate If ?Yes" to line 2a or 2b, does the organization have a committee that assumes for overSIght of the audit. renew, or compilation of its finanCIal statements and selection of an Independent accountant? 2c If the organization changed either Its over5ight process or selection process during the tax year, explain In Schedule 0. 33 As a result of a federal award, was the organization reqUIred to undergo an audit or audits as set forth In A the Single Audit Act and OMB Circular A- 133?. . 3a If "Yes. did the organization undergo the reqUIred audit or audits? If the organization did not undergo the reqwred audit or audits explain why in Schedule 0 and describe any steps taken to undergo such audits. 3b REV 12105?? PRO Form 990 (2017) 43 OMB No 1545-0047 SCHEDULE A. Public Charity Status and Public Support (Form 990.0r 990-EZ) Complete if the organization is a section 501(c)(3) organization or a section nonexempt charitable trust. Department of the Treasury Attach to Form 990 or Form 990-52. Open to Public Internal Revenue Seniice Go to for instructions and the latest information. Inspection Name of the organization Employer identification number GRASSROOT INSTITUTE OF HAWAII, INC 99-0354937 Reason for Public Charity Status (All organizations must complete this part.) See instructions. The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.) 1 A church, convention of churches, or assomation of churches described in section 2 A school described in section (Attach Schedule (Form 990 or 0 3 A hospital or a cooperative hOSpital semce organization described in section 4 A medical research organization operated in conjunction With a hospital described in section Enter the hospital's name, City, and state. 5 [3 An organization operated for th??o'??ii?i'ii'oi section (Complete Part II.) A federal, state, or local government or governmental unit described in section An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section (Complete Part II.) A community trust described in section (Complete Part II.) 9 An agricultural research organization described in section 170(b)(1)(A)(ix) operated in comunction With a land?grant college or univerSity or a non-Iand-grant college of agriculture (see instructions). Enter the name, City, and state of the college or universny 10 An org aniza'fio?'t??af Tt?s' 's'ii?o?isorri?r'o'i? receipts from actiwties related to its exempt functions?subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated busmess taxable income (less section 511 tax) from busmesses acqwred by the organization after June 30, 1975. See section 509(a)(2). (Complete Part Ill.) 11 An organization organized and operated excluswely to test for public safety. See section 509(a)(4). 12 An organization organized and operated excluswely for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 129. a Type I. A supporting organization operated, supemised, or controlled by its supported organization(s), typically by giVing the supported organization(s) the power to regularly appomt or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B. Cl Type II. A supporting organization supervised or controlled in connection With its supported organization(s), by haVing control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV. Sections A and C. Type functionally integrated. A supporting organization operated in connection With, and functionally integrated With, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E. Type non-functionally integrated. A supporting organization operated in connection With its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution reqUIrement and an attentiveness reqUirement (see instructions). You must complete Part IV, Sections A and D, and Part V. Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type functionally integrated, or Type non-functionally integrated supporting organization. Enter the number of supported organizations . . . . . . . . Prowde the followmg information about the supported organization(s). \Im on -n Name of supported organization (ii) EIN Type of organization (N) Is the organization Amount of monetary (vi) Amount of (described on lines 1?10 ?8th your governing support (see other support (see above (see instructions? document? instructions) instructions) Yes No (A) (B) (C) (D) (E) Total ?*ir For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ. BAA Schedule A (Form 990 2017 REV 11/13/17 PRO 0 Schedule A (Form 990 or ago-'52) 2017 Page 2 - Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part or if the organization failed to qualify under Part If the organization fails to qualify under the tests listed below, please complete Part Section A. Public Support Calendar year (or fiscal year beginning in) 2013 2014 2015 2016 2017 Total 1 Gifts, grants, contributions, and membership fees received. (Do not include any ?unusual grants") 2 Tax revenues lewed for the organization?s benefit and either paid to or expended on Its behalf 3 The value of sewices or facilities furnished by a governmental unit to the organization Without charge . Total. Add lines 1 through 3 . 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 . . . 7 31;; 5:31,? ii 6 Public support. Subtract line5from line4 M?wm Wl?m? %E?i?em Section B. Total Support Calendar year (or fiscal year beginning in) 2013 2014 M29415 2016 2017 Total 7 . . . . 8 Gross income from interest, diVidends, payments received on securities loans, rents. royalties, and income from Similar sources . . . .. . . 9 Net income from unrelated busmess actIVIties, whether or not the busmess is regularly carried Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) . . . 11 Total support Add lines7through 10 seam 12 Gross receipts from related activmes, etc/(see instructionsFirst five years. If the Form 990 is for the organization' 3 first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, checkthisboxandstog?ere . . . . . . . . . . . . . . . . . . . . . . . . Section C. Computation of Public Support Percentage 14 Public support percentage for 2017?line 6, column dwided by line 11. column . . . . 14 15 Public support percentage from 2016 ScheduleA Part II line 14 . . . 15 16a 331/3% support test?2017. the organization did not check the box on line 13, and line 14 is 335% or more, check this box and stop here. The organization qualifies as a publicly supported organization . . . . . . . . 33?ia% support test? ?201?6. If the organization did not check a box on line 13 or 16a, and line 15 IS 331/a% or more, check this box and step here. The organization qualifies as a publicly supported organization . . . . . . . . . . . 17a 10%-facts- and- circumstances test- 2017. if the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts- and- circumstances" test check this box and stop here. Explain in Part VI how the organization meets the ?facts-and- Circumstances" test The organization qualifies as a publicly supported DD 10%-facts-and-circumstances test?2016. If the organization did not check a box on line 13, 16a, 16b, or 17a. and line 15 is 10% or ore, and if the organization meets the "facts-and-crrcumstances" test, check this box and stop here. Explain in Part VI how the organization meets the ?facts?and-CIrcumstances" test. The organization qualifies as a publicly. supported organization . . . . . . . . . . . . . . [j 18 Private foungation. If the organization did not check a box on line 13,16a, 16b 17a, or 17b, check this box and see Schedule A (Form 990 or 990-EZ) 2017 REV PRO Schedule A (Form 990 or 990-EZ) 2017 Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.) Section A. Public Support Page 3 Calendar year (or fiscal year beginning in) 2013 2014 2015 2016 2017 Total 1 Gifts, grants, contributions, and membership fees recewed- (Do not Include 304, 597. 360, 762. 439, 251. 507, 370. 676, 723. 2, 288, 703. 2 Gross receipts from merchandise sold or serwces performed, or facmties furnished in any actiwty that is related to the 15,302. 17,264. 23,891. 9,940. 8,151. 74,548. 3 Gross receipts from actiwties 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 semces or faculties furnished by a governmental unit to the organization Without charge . 6 Total. Add lines 1 through 5. 319, 899. 378, 026. 463, 142. 517, 310. 684, 874. 2, 363, 251. 7a Amounts included on lines 1, 2, and 3 recelved from dlsqual'fied persons 66, 468. 70,652. 68, 635. 115, 663. 149, 854. 471, 272. Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% ofthe amount on line 13fortheyear 49, 386. 179, 370. 21,035. 11,000. 106, 568. 367, 359. Addlines7aand7b 115,854. 250,022. 89,670. 126,663. 256,422. 838,631. 8 Public support. (Subtract line 7c from lineBH1,524,620. Section B. Total Support Calendar year (or fiscal year beginning in) 2013 2014 2015 2016 2017 Total 9 . . . 319,899. 378,026. 463,142. 517,310. 684,874. 2,363,251. 10a Gross income from interest, diVidends, payments received on securities loans, rents, royalties, and income from Similar sources . Unrelated business taxable income (less section 511 taxes) from busmesses achired after June 30,1975 . Addlines10aand10b 1,929. 42. ?1,461. 30. 540. 11 Net income from unrelated busmess actIVities not included in line 10b, whether or not the busmess 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) 319, 899. 379 955 463,184. 515, 849 684, 904. 2,363,791. 14 First five years. If the Form 990 is for the organization' 5 first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here . El Section C. Computation of Public Support Percentage 15 Public support percentage for 2017 (line 8, column dIVIded by line 13, column (Public support percentage from 2016 Schedule A, Part line Section D. Computation of Investment Income Percentage 17 Investment income percentage for 2017 (line 10c, column diVided by line 13, column . . . 17 0, 02 18 Investment income percentage from 2016 Schedule A, Part line 17 . . . 18 0.03 19a 33?73?/o support tests?2017. If the organization did not check the box on line 14, and line 15 is more than 33173%, and line 17 is not more than 334%, check this box and stop here. The organization qualifies as a publicly supported organization 331.13% support tests?2016. If the organization did not check a box on line 14 or line 19a. and line 16 is more than 331/3%, and line 18 is not more than 331/3%, check this box and stop here. The organization qualifies as a publicly supported organization [j 20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions El REV 11113I17 PRO Schedule A (Form 990 or QQO-EZ) 2017 Schedule A (Form 990 or QQO-EZ) 2017 Supporting Organizations (Complete only if you checked a box in line 12 on Part I. If you checked 12a of Part complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.) Section A. All Supporting Organizations Page the organization's supported organizations listed by name In the organization's governing documents? if describe in Part VI how the supported organizations are des:gnated lf desrgnated by class or purpose, describe the desrgnation. if historic and continuing relationship, explain. Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or If "Yes,? explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2). Did the organization have a supported organization described in section 501(c)(4), (5), or it ?Yes," answer and (0) below. Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? if "Yes," describe in Part VI when and how the organization made the determination. Did the organization ensure that all support to such organizations was used excluswely for section 170(c)(2)(B) purposes? If "Yes, explain in Part VI what controls the organization put in place to ensure such use. Was any supported organization not organized in the United States (?foreign supported organization")? If "Yes, and if you checked 12a or 12b in Part l, answer and below. Did the organization have ultimate control and discretion in deCIding whether to make grants to the foreign supported organization? if ?Yes," describe in Part VI how the organization had such control and discretion despite being controlled or supervrsed by or in connection With its supported organizations. Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or If "Yes,? explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used excluswely for section 170(c)(2)(B) purposes. Did the organization add, substitute, or remove any supported organizations during the tax year? If "Yes," answer and below (if applicable). Also, prowde detail in Part VI, including the names and numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action, the authority under the organization?s organizmg document authoriZing such action; and (iv) how. the action was accomplished (such as by amendment to the organiZing document). Type I or Type II only. Was any added or substituted supported organization part of a class already de5ignated in the organization's organizmg document? Substitutions only. Was the substitution the result of an event beyond the organization?s control? Did the organization prowde support (whether in the form of grants or the prOVlSlon of serwces or facilities) to anyone other than its supported organizations, (ii) indiwduals that are part of the charitable class benefited by one or more of its supported organizations, or other supporting organizations that also support or benefit one or more of the filing organization's supported organizations? lf "Yes, provide detail in Part VI. Did the organization provide a grant, loan, compensation, or other Similar payment to a substantial contributor (defined in section a family member of a substantial contributor, or a 35% controlled entity With regard to a substantial contributor? it ?Yes, complete Part of Schedule (Form 990 or QQO-EZ). Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If "Yes, complete Part I of Schedule (Form 990 or 990-EZ). Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or if "Yes, prowde detail in Part Vi. Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If ?Yes, prowde detail in Part VI. Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If "Yes, prowde detail in Part VI. Was the organization subject to the excess busmess holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type non-functionally integrated supporting organizations)? if ?Yes, answer 10b below. Did the organization have any excess busmess holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess busmess holdings.) . ?it Hi- ?11. Cd . . ev- it? E7133 faint?? i ice: .1). l5 I i555?) Schedule A (Form 990 or 990452) 2017 REV 11I13I17 PRO 43. Schedule A (Form 990 or 990-EZ) 2017 Part IV Su'pporting Organizations (continued) 11 a Page 5 Has the organization accepted a gift or contribution from any of the followmg persons? A person who directly or indirectly controls, either alone or together with persons described in and (0) below, the governing body of a supported organization? A family member of a person described in above? A 35% controlled entity of a person described In or above? If ?Yes" to a, b, or c, provide detail in Part VI. Yes No 11a 11b 11c Section B. Type I Supporting Organizations Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization?s directors or trustees at all times during the tax year? it "No, describe in Part VI how the supported organization(s) effectively operated, superwsed, or controlled the organization ?5 actiwties. If the organization had more than one supported organization, describe how the powers to appOint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year. Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, superVised, or controlled the supporting organization? If "Yes, explain in Part VI how prowding such benefit carried out the purposes of the supported organization(s) that operated, superwsed, or controlled the supporting organization. Yes No Section C. Type II Supporting Organizations 1 Were a majority of the organization?s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization's supported organization(s)? If "No, describe in Part VI how control 0i management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s). Yes No Section D. All Type Supporting Organizations 1 Did the organization prowde to each of its supported organizations, by the last day of the fifth month of the organization's tax year. a written notice describing the type and amount of support prowded during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and copies of the organization's governing documents in effect on the date of notification, to the extent not prewously prowded? Were any of the organization's officers, directors, or trustees either appOInted or elected by the supported organization(s) or (ii) sewing on the governing body of a supported organization? if "No, explain in Part VI how the organization maintained a close and continuous working relationship With the supported organization(s) By reason of the relationship described in (2), did the organization's supported organizations have a Significant veice in the organization's investment polimes and in directing the use of the organization's income or assets at all times during the tax year? If ?Yes, describe in Part the role the organization ?5 supported organizations played in this regard. Yes No Section E. Type Functionally Integrated Supporting Organizations Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions). 1 a 2 a El The organization satisfied the ActiVities Test. Complete line 2 below. The organization is the parent of each of its supported organizations. Complete line 3 below The eiganization supported a governmental entity Describe in Part VI how you supported a government entity (see instructions). Actiwties Test. Answer and below. Did substantially all of the organization's actiwties during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responswe? If ?Yes,? then in Part VI identify those supported organizations and explain how these actiwties directly furthered their exempt purposes, how the organization was responsrve to those supported organizations, and how the organization determined that these actiwties constituted substantially all of its actiwties. Did the activities described in constitute activmes that, but for the organization?s involvement, one or more of the organization's Supported organization(s) would have been engaged in? it "Yes, explain in Part the reasons for the organization?s position that its supported organization(s) would have engaged in these activities but for the organization '5 involvement. Parent of Supported Organizations. Answer and below. Did the organization have the power to regularly appomt or elect a majority of the officers, directors, or trustees of each of the supported organizations? Prowde details in Part VI. Did the organization exercrse a substantial degree of direction over the pOIiCleS, programs, and activities of each of its supported organizations? If ?Yes, describe in Part the role played by the organization in this regardREV 11l13l1'r' PRO Schedule A (Form 990 or 990-EZ) 2017 Schedule A (Form 990 or 990-EZ) 2017 Page 6 Ty'pe Non-Functionally Integrated 509(a)(3) Supporting Organizations 1 Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20. 1970 (explain in Part VI) See instructions. All other Type non-functionally integrated supporting organizations must complete Sections A through E. Section A - Adjusted Net Income (A) Prior Year (B) Current Year (optional) 1 Net short-term capital gain 2 Recoveries of prior-year distributions 3 Other gross income (see instructions) 4 Add lines 1 through 3. 5 DepreCIation and depletion 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) Ch 7 Other expenses (see instructions) NI 8 Adjusted Net Income (subtract lines 5. 6, and 7 from line 4). Section - Minimum Asset Amount (A) Prior Year (B) Current Year (optional) 1 Aggregate fair market value of all non-exempt-use assets (see 3.1% 3?53; instructions for short tax year or assets held for part of year) ?3133" ?5.23: cf? a Average value of securities 1a Average cash balances 1b Fair market value of other non-exempt?use assets 1c Total (add lines 1a, 1b, and 10) 1d Discount claimed for blockage or other Wetiw W. factors (explain in detail in Part VI). We 1.5}an 2 AchiSition indebtedness applicable to non-exempt-use assets 3 Subtract line 2 from line 1d. 3 4 Cash deemed held for exempt use. Enter 1-1/2% 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 .035. 6 7 Recoveries of prior-year distributions 7 8 Minimum Asset Amount (add line 7 to line 6) 8 Section - Distributable Amount 1?35"; Current Year 21? amnesia 1 Adjusted net income for prior year (from Section A, line 8, Column A) 1 2 Enter 85% of line 1. 2 ?W?i?i'm 53*5f?r?Z?J ?tiff: 3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3 54sz ?is? n? 4 Enter greater of line 2 or line 3. 4 am? &?mim?w? 5 Income tax imposed in prior year 5 5H- c?y?w?i? ?will 6 Distributable Amount. Subtract line 5 from line 4, unless subject to 5?5: ?it-g emergency temporary reduction (see instructions). 5 7 El Check here if the current year is the organization?s first as a non-functionally integrated Type supporting organization (see instructions). REV 11l13l17 PRO Schedule A (Form 990 or 990-EZ) 2017 Schedule A (Form 990 or 990-EZ) 2017 Type Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued) Section - Distributions 1 2 acumen-boo ?0 Amounts paid to supported organizations to accomplish exempt purposes Amounts paid to perform actiwty that directly furthers exempt purposes of supported organizations, in excess of income from activity Administrative expenses paid to accomplish exempt purposes of supported organizations Amounts paid to acquire exempt-use assets Qualified set-aside amounts (prior IRS approval reqUired) Other distributions (describe in Part VI). See instructions. Total annual distributions. Add lines 1 through 6. Distributions to attentive supported organizations to which the organization is reSponswe (prowde details in Part VI). See instructions. Distributable amount for 2017 from Section C, line 6 Line 8 amount divided by line 9 amount Page 7 Current Year Section - Distribution Allocations (see instructions) (ii) Underdistributions Pre-2017 Excess Distributions Distributable Amount for 2017 Distributable amount for 2017 from Section C, line 6 Underdistributions, if any, for years prior to 2017 (reasonable cause reqwred?explain in Part VI). See instructions. Excess distiibutions if any. to i? 2013 I'I'Cii'i'i Pm i-rom 2015 From WM 6 Total of lines 3a through Applied to underdistributions of prior years Applied to 20 I7 distributable amount Carryover from 2012 not applied (see instructions.) Remainder. Subtract lines 39, 3h, and Si from 3f. Distributions for 20 I 7 from Section L), line i? 3 Applied to underdistributions of prior years 0' Applied to 2017 distributable amount Remainder Subtract lines 4a and 4b from 4. Remaining underdistributions for years prior to 2017, if any. Subtract lines 39 and 4a from line 2. For result greater than zero, explain in Part VI. See instructions. Remaining underdistributions tor 2017. Subtract lines 3h and -?Ib trom line 1. I or result greater than zero, explain in Part VI. See instructions. Excess distributions carryover to 2018. Add lines 3] and 4c. Breakdown of 7 Excess trom 201.3 Lr-zcess 2014 . Excess. from 20 I . trorn 2016 . 09.0593 Excessfrom 2017 . . . Schedule A (Form 990 or 990-EZ) 2017 REV 11/13/17 PRO Schedule A (Form 990 or 990-52) 2017 Page 8 Supplemental Information. Prowde the explanations required by Part II, line 10; Part II, line 17a or 17b; Part Ill, line 12; Part IV, Section A, lines 9a, 9b, 90, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 10, 2a, 2b, 3a, and 3b; Part V, line 1; Part V, Section B, line 1e; Part V, Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions.) REV 11I13117 PRO Schedule A (Form 990 or 990-EZ) 2017 OMB No 1545-0047 SCHEDULE Supplemental Financial Statements (Form 990) . . Complete if the organization answered "Yes? on Form 990. Part IV. line 6, 7, 8. 9, 10,113, 11b,11c, 11d, 11e,11f,12a. or 12b. Department of the Treasury Attach to Farm 990. Open to PUbllC lntemal Revenue SerVice Go to for instructions and the latest information. Inspection Name of the organization Employer Identification number GRASSROOT INSTITUTE OF HAWAII, INC 99-0354 937 Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered ?Yes" on Form 990, Part IV, line 6. Donor adVised funds Funds and other accounts 1 Total number at end of year. 2 Aggregate value of contributions to (during year) 3 Aggregate value of grants from (during year) 4 Aggregate value at end of year. 5 Did the organization inform all donors and donor adVIsors in writing that the assets held In donor adVIsed funds are the organlzation' 3 property, subject to the organization? sexclusive legal controlDid the organization inform all grantees, donors, and donor adVisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor. or for any other purpose conferring private benefitConservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7. 1 Purpose(s) of conservation easements held by the organization (check all that apply). Preservation of land for public use recreation or education) Preservation of a historically important land area Protection of natural habitat Preservation of a certified historic structure Preservation of open space 2 Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year. Held at the End of the Tax Year a Total number of conservation easements . . . . . . . . . . . . . . . . . 2a Total acreage restricted by conservation easementsNumber of conservation easements on a certified historic structure included In . . . 2c Number of conservation easements included in acquired after 7/25/06, and not on a historic structure listed in the National Register . . . . . . . . 2d 3 Number of conservation easements modified, transferred, released, or terminated by the organization during the tax year 5 Does the organization have a written policy regarding the periodic monitoring, inspection, handling of Violations, and enforcement of the conservation easements it holdsStaff and volunteer hours devoted to monitoring, inspecting, handling of Violations, and enforcmg conservation easements during the year 7 Amount of expenses incurred in monitoring, Inspecting, handling of Violations, and conservation easements during the year 8 easement reported on line 2(d) above satisfy the reqUirements of section and section . . . . . . . . . . . . . . . . . . . . . . . . . . Yes CI No 9 In Part describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and include, If applicable, the text of the footnote to the organizatlon's financral statements that describes the organization's accounting for conservation easements. Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. Complete if the organization answered "Yes? on Form 990, Part IV, line 8. 1a If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other Similar assets held for public exhibition, education, or research in furtherance of public servrce, provnde, in Part the text of the footnote to its finanCial statements that describes these items. If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other Similar assets held for public exhibition, education, or research in furtherance of public serVice, prowde the followmg amounts relating to these itemS' Revenue included on Form 990, Part ine1 . . . . . . . . . . . . . . . . (ii) Assets included in Form 990, Part . . . . . . . 2 If the organization received or held works of art, historical treasures, or other similar assets for finanCIal gain, provide the foIIowmg amounts reqwred to be reported under SFAS 116 (ASC 958) relating to these items: a Revenue included on Form 990, Part line Assets included in Form 990, Part . . . . . . . . . . . . . . . . . . . . . For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule (Form 990) 2017 BAA REV11I13117 PRO Schedule (Form 990) 2017 Page 2 Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (contmued) Usmg the organIzatIon' achISItIon, acceSSIon, and other records. check any of the followmg that are a signIficant use of its collectIon Items (check all that apply): a PubIIc ethbItion Scholarly research PreservatIon for future generatIons 4 Prowde a descrIptIon of the organIzatIon's collectIons and explaIn how they further the organization's exempt purpose In Part 5 During the year, dId the orgamzation solicit or receive donations of art. hIstorIcaI treasures, or other SImIlar assets to be sold to raIse funds rather than to be maintaIned as part of the organIzatIon's collectIon? Escrow and Custodial Arrangements. Complete If the organization answered ?Yes" on Form 990, Part IV, Me 9, or reported an amount on Form 990, Part X, km 21. 1a Is the organIzatIon an agent trustee, custodIan or other IntermedIary for contributions or other assets not Included on Form 990, Part . . . . . . . . . . . . If "Yes explain the arrangement In Part and complete the followmg table. Loan or exchange programs Other Yes No Yes No nt 0 BegInnIng balance . 16 AddItIons durIng the year 1d DIstrIbutIons durIng the year 1e EndIng balance . 1f 2a the organIzatIon Include an amount on Form 990, Part X, line 21, for escrow or custodIal account IIabIlIty? Yes [3 No If ?Yes," explaIn the arrangement In Part Check here If the explanatIon has been provrded on Part . Endowment Funds. Complete If the organIzatIon answered ?Yes" on Form 990, Part IV, Me 10. Current year PrIor year Two years back (d1 Three years back Four years back 1a BegInnIng of year balance ContrIbutIons Net Investment gems, and losses . Grants or scholarshIps . Other expendItures for and programs . AdmInIstratIve expenses . 9 End of year balance . 2 Prowde the estrmated percentage of the current year end balance ?me 19, column held as. a Board deSIgnated or quaSI- -endowment Permanent endowment Temporarily restrIcted endowment The percentages on IInes 2a, 2b, and 20 should equal 100%. 3a Are there endowment funds not In the posseSSIon of the organIzatIon that are held and admInIstered for the organIzatIon by: unrelated organIzatIons . (ii) related organIzatIons . . If ?Yes" on Me 3a(n), are the related orgamzations listed as reqmred on Schedule . 4 DescrIbe In Part the Intended uses of the organIzatIon' endowment funds. Part VI Land, Buildings, and Equipment. Complete if the organizatlon answered ?Yes" on Form 990, Part IV, Ine 11a. See Form 990, Part X, line 10. DescrIptIon of property Cost or other basIs Cost or other Accumulated Book value (Investment) (other) depreCIatIon 1a in? . . . Leasehold Improvements EqUIpment 4,541. 3,528. 1,013. Other Total. Add lInes 1athrough 1e. (Column must equal Form 990, PartX, column (8), [me 10c?) . . . l, 013. REV 11l13l17 PRO Schedule (Form 990) 2017 Schedule (Form 990) 2017 anestments?Other Securities. Page 3 Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12. Description of security or category (including name of security) Book value Method of valuation Cost or end-of-year market value (1) FlnanCial derivatives . (2) Closely?held eqwty interests . Total. (Column must equal Form 990, Part X, col (8) line 12 tax, 3?5 Part Investments?Program Related. Complete?lf the organization answered ?Yes" on Form 990, Part IV, line 110. See Form 990, Part X, line 13. Description of investment Book value Method 01 valuation Cost or end-of?year market value ((8) l9) Total. (Column mustequal Form 990, Part X, col (B) line 13 Part IX Other Assets. Complete if the organization answered ?Yes" on Form 990, Part IV, Ime 11d. See Form 990, Part X, Ime 15. Description Book value (1 (2) (3) (4) (5) l6) (7) (SI (9) Total. (Column must equal Form 990, Part X, col. (B) line 15.) Other Liabilities. Complete if the organization answered ?Yes" on Form 990, Part IV, line He or 11f. See Form 990, Part X, line 25. 1. Descriptron of liability Book value gm?aijja?uq .5 (1) Federal income taxes 51.11:? (2) an?? (3) (5)2513; (6) .3. It; :4 (7) ?r'r'i?ii tag; f3 4 ?r (P (8) an?; tr :13; (9) - - . Total. (caimn must equal Form 990, PailX, col (B) line 25.) ng?aw ?35:31 2. Liability for uncertain tax posntlons. In Part provide the text of the footnote to the organnzatnon' flnanCIal statements that reports the organization's liability for uncertain tax posmons under FIN 48 (A80 740). Check here If the text of the footnote has been prowded in Part [j Schedule (Form 990) 2017 I a' aSnag-- Schedule (Form 990) 2017 Page 4 Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered ?Yes" on Form 990, Part IV, line 12a. 1 Total revenue, gains, and other support per audited fInanCIal statements . Amounts Included on line 1 but not on Form 990, Part Me 12: Net unreaIIzed gaIns (losses) on Investments Donated sewices and use of RecoverIes of mar year grants . Other (Describe in Part . Add lines 2a through 2d . 3 Subtract lIne 2e from We 1 . 4 Amounts included on Form 990, Part line 12, but not on Met a Investment expenses not Included on Form 990, Part lIne 7b Other (DescrIbe In Part . Add lines Total revenue Add knee 3 and 4c. (ths must equal Form 990, PartI, Ime 12) Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete If the organization answered "Yes" on Form 990, Part IV, lIne 12a. 1 Total expenses and losses per audited finanCIal statements 2 Amounts Included on line 1 but not on Form 990, Part IX, Me 25: Donated sewices and use of facilIties Prior year adjustments Other losses Other (DescrIbe In Part Add lines 2a through 2d . 3 Subtract line 2e from line 1 . . 4 Amounts Included on Form 990, Part IX, line 25, but not on line 1: a Investment expenses not Included on Form 990, Part line 7b Other (Describe In Part . Add lines 4a and 4b 5 Total expenses. Add lInes 3 and 4c. (T his must equal Form 990, Far?, Ime 18.). Part Supplemental Information. Prowde the descriptIons reqUIred for Part II, lines 3, 5, and 9, Part IInes 1a and 4; Part IV, IInes 1b and 2b, Part V, Me 4, Part X, IIne 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to prowde any addItIonal Information. BAA REV 11/1311? PRO Schedule (Form 990) 2017 SCHEDULE Noncash Contributions (Form 990) . Complete if the organizations answered ?Yes" on Form 990, Part IV, lines 29 or 30. Department of the Treasury .A?aCh to Form 990' Open to PUb'id Internal Revenue Sewice GO to for the latest information. Inspection Name of the organization Employer identification number GRASSROOT INSTITUTE OF HAWAII, INC 99-0354 937 Types of Property (bl id) Check if Number of contributions or 2:12:15; gigging: Method of determining applicable Items contributed Form 990 3: ?ne 1 noncash contribution amounts Art?Works of art Art?Historical treasures . Art?Fractional interests . Books and publications 545' Lani 1' :4 n. Clothing and household . .9 goods . . . . . . . . . 4? ?i 0145de b; 1' Cars and other vehicles Boats and planes Intellectual property . Securities?Publicly traded . . 1 149, 854. PUBLICLY TRADED STOCK Securities?Closely held stock . Securities?Partnership, LLC, or trust interests domain-4m d?L 12 Securities? Miscellaneous 13 Qualified conservation contribution Historic structures . . 14 Qualified conservation contribution ?Other 15 Real estate ReSidential . 16 Real estate? CommerCIal 17 Real estate?Other . 18 Collectibles 19 Food inventory . . 20 Drugs and medical supplies . 21 TaXIdermy . 22 Historical artifacts . 23 Solentific speCImens 24 Archeological artifacts 25 Other> 26 Other 27 Other> 28 Other 29 Number of Forms 8283 received by the organization during the tax year for contributions for which the organization completed Form 8283, Part IV, Donee Acknowledgement . . . . . 29 Yes No 303 During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't reqUIred to be used for exempt purposes for the entire holding period?Yes," describe the arrangement in Part II. 31 Does the organization have a gift acceptance policy that reqwres the reVIew of any nonstandard 32a Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash contributions?Yes," describe in Part II. - 33 If the organization didn't report an amount in column for a type of property for which column is checked, describe in Part II. For Paperwork Reduction Act Notice, see the Instructions for Form 990. BAA Schedule (Form 990) 2017 REV 11/1311? PRO SCHEDULE 0 Supplemental Information to Form 990 or 990-EZ (Form 990 or 990-EZ) Complete to provide information for responses to specific questions on . Form 990 or 990-EZ or to provide any additional information. Depanmem of the Treasury Attach to Form 990 or QQO-EZ. Open to Public Internal Revenue Serwce Go to for the latest Information. Inspection Name of the organization Employer identification number GRASSROOT INSTITUTE OF HAWAII, INC 99?0354937 Pt VI, Llne 19: UPON REQUEST Pt XII, Llne 2c: LINE ZB SHOULD SAY NO SO THIS IS NOT APPLICABLE For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. BAA Schedule 0 (Form 990 or 990-EZ) (2017) REV 07I25118 PRO