DEC II 3 ZOI7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0MB 1545-0047
Form 990 0
Return of Organization Exempt From Income Tax 2016
Under section 501(c), 527. or 4941(a)(1) of the Intemal Revenue Code (except private foundations)
Do not enter social security numbers on this form as it rna be made public. Open to Public
mgwm? Ir Information about Form 990 and Its Instructions is at m. Irs. gov/form990. Inspection
A For the 2018 calendar year. or tax year beginning . 2016. and ending .
3 Check If applicable 6 Name GRASSROOT INSTITUTE OF HAWAI I INC 0 Wm'mm numb"
Dru-renames 99?0354937
Number and street (or 0 box It mail is not delivered to street address) Roomlsune Telephone number
1050 BISHOP ST 508 (808) 591-9193
City or tawn. state or pmvu'ice. enmity. and ZIP ori'oreiun postal code
HONOLULU HI 96813 9033me 619, 477. 7
Nameandaddressofpimapalo?icer Hill ls I I: gm,

WILLIAM AKINA 1050 BISHOP ST #508 HONOLULU HI 968 1 3 
I Tax-exempt status 1x15011313) 15011:) 1 )4 (insert no.) 1 ?ame) or I 1521
Website: H(c) Group exemptm number 
Formoromanization TXICorporatienIJEJst I I Association I Other' WYearotformation 2001 mmdlegeldomrcile HI
[Part I jSummary
1 E?s?z sash: 1112019953593) 9551910: mosses-3'3 geese; 5E9. EQQCBILOE 
0 



E, 
3 2 Check this box if the organization discontinued its operations or disposed of more than 25% of its net assets.
?5 3 Number of voting members of the governing body (Part VI, line 1a) 3 7
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 2016 (Part V. line 2a) 5 0
IE 6 Total number of volunteers (estimate if necessary) a 0
Ta Total unrelated business revenue from Part column (C), line 12 7a ?1 4 61 
Net unrelated business taxable income from Form 990-T. line 34 7b 0 
Prior Year Current Year
a 8 Contributions and grants (Part line 1h) 439, 251 507, 370 .
9 Program service revenue (Part line 29Investment income (Part column (A), lines Other revenue (Part column (A). lines 5. 6d. 8c. 9c, 10c, and 11e) 
12 Total revenue add lines 8 through 11 (must equal Part column (A). line 12Grants and similar amounts paid (Part IX. column (A), lines 1-3) 
14 Bene?ts paid to or for members (Part IX, column (A), line 4) 
15 Salaries, other compensation, employee bene?ts (Part IX. column (A), lines 5-1018a Professional fundraising fees (Part IX. column (A). line 11e) 8 I 000 .
g. Total fundraising expenses (Part ix column (D) line 33?. I
17 Otherexpenses (Part or column (A) lines 11a-11d 111-2491;; i0 . . 19M10- 199, 724,
18 Total expenses Add lines 13-17 (must equal Part IX co?umnm) line 25) . . 470, 188 511, 013 
19 Revenue less expenses. Subtract line 18from line 12 .2. II .2037Beginning of Current Year Elld of Year
55 20 Total assets (Part X, line 16Total liabilities (Part x, line 26Net assets or fund balances. Subtract line 21 from line [Signature BTock?
Underpenaiumotperjury 
?rem 
I II Di
Sign swarm Date 
Here WILLIAM AKINA PRESIDENT
I A
sergnabire I cm Ed PTIN
Paid GERALD USHIJIMA 1 
Preparer Fm'arame GERALD Y. USHIJIMA - .
Use Only Fm'saddress 1110 UNIVERSITY AVE STE 508 99?0230347
HONOLULU HI 96826?1508 Mm (808) 949-5588
May the IRS discuss this return with the preparer shown above? (see instructions) Yee No
BAA For Paperwork Reduction Act Notice. see the separate instructiona TEEA0101 11116116 Form 990 (2016)

3



Form 990 (2016) GRASSROOT INSTITUTE OF HAWAII, INC 99-0354 937 Pagez
Statement of Program Service Accomplishments
Check If Schedule 0 contains a response or note to any lune Part Ill 
1 Brie?y describe the organlzatlon?s 
PUBLIC POLICY RESEARCH AND EDUCATION






 

2 the organization undertake any program serVIces during the year were not listed on the pnor

Form 990 'Yes.? describe these new servuces on Schedule 0
3 the organization cease conducting, or make changes 1n how It conducts. any program servrces? Yes No

lf 'Yes.? describe these changes on Schedule 0

4 Describe the organization's program servnce accomplishments for each of Its three largest program servrces. as measured by expenses
Section 501(c)(3) and 501(c)(4) organizations are requrred to report the amount of grants and allocations to others. the total expenses,
and revenue. If any, for each program servuce reported

 

4a(Code )(Expenses 2,835, 0_ )(Revenue 0.)
TRANSPARENCY PROGRAM - MULTIFACETED EFFORTES TO SHED LIGHT ON










 

4b(Code )(Expenses 83,808, 0, )(Revenue 0.)
AKAKA BILL EDUCATION - PUBLIC EDUCATION REGARDING THE MOVEMENT TO






 

4c(Code )(Expenses 8,700. 0. )(Revenue 15,000.)
JONES ACT REFORM- RESEARCH INTO EFFECTS OF THE 1920 JONES ACT ON THE



EQBEEC: BED: i031: QIITE ELISE: IPIUE: EITIOI AND GUAM .











 

4d Other program servroes (Descnbe an Schedule 0 

 

 

(Expenses 3 18 2 7 1 Including grants of 0 (Revenue 7 I 8 33 
4 Total program servrce expenses 4 1 3 61 4 
BAA 11I16I16 Form 990 (2016)

Form 990 (2015) GRASSROOT INSTITUTE OF HAWAII, INC 99-0354 937 Page3
Checklist of Required Schedules
Yes No
1 ls the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? lf ?Yes, complete
Schedule A 1 
2 ls the organization reqwred to complete Schedule 8, Schedule of Contributors (see instructions)? 2 
3 Did the organization engage in direct or indirect political campaign on behalf of or in opposrtion to candidates
for public of?ce? If 'Yes, complete Schedule C, Part I. 3 
4 Section 501(c)(3) organizations. Did the organization en a in lobbying activmes, or have a section 501(h) election
In effect during he tax year? If ?Yes, comple Schedule art ll . . 4 
5 Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues,
assessments, or amOunts as defined in Revenue Procedure 98-19? ll 'Yes,?complete Schedule C, Part 5 
5 Did the organization maintain any donor adVised funds or any funds or accOunts for which donors have the right
to provrde advrce on the distribution or investment of amounts in such funds or accounts? If ?Yes, complete Schedule D,
Part . . . . 6 
7 Did the organization receive or hold a conservation easement, including easements to preserve open space, the
enwronment, historic land areas, or historic structures? If 'Yes,? complete Schedule D, Part ll 7 
3 Did 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 X, or provrde credit counseling, debt management, credit repair, or debt negotiation
sewices'7 lf ?Yes,?complete Schedule D, Part IV . . . 
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 followrng questions is ?Yes?, then complete Schedule D, Parts Vi, Vll, IX, gt,? .
orX as applicable E- ?u 
a Did the organization report an amount for land, bmldings, and equ1pment in Part X, line 107 If 'Yes,'complete Schedule
D, Part 11 a 
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 Vll. . . . . 11 
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 167 If ?Yes, complete Schedule D, Part 11 
:1 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 0, Part lX 11d 
Did the organization report an amount for other liabilities in Part X, line 25'? ll ?Yes,?complete Schedule D, PartX 11 
Did the organization's separate or consolidated ?nanCial statements for the tax year include a footnote that addresses
the organization's liability for uncertain tax posmons under FIN 48 (ASC 740)? If ?Yes, complete Schedule D, Part 11f 
12a Did the organization obtain separate, independent audited ?nanCial statements for the tax year'Plf ?Yes, complete
Schedule D, Parts 123 
Was the organization included in consolidated independent audited ?nanCial statements for the tax year? If 'Yes, and
if the organization answered ?No? to line 12a. then completing Schedule D, Parts XI and lS optional 12b 
13 ls the organization a school described in section 170(b)(1)(A)(ii)9 If 'Yes, complete Schedule 13 
14a Did the organization maintain an of?ce, employees, or agents out5ide of the United States? 14a 
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraismg,
business, investment. and program sewice 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 
15 Did the organization re art on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any
foreign organization? I ?Yes,'complete Schedule F, Parts ll and 15 
16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assustance to
or for foreign individuals? If ?Yes,? complete Schedule F, Parts Ill and iv 15 
17 Did the organization report a total of more than $15,000 of expenses for professronal fundraismg servrces on Part IX,
column (A), lines 6 and 11e? ll 'Yes,? complete Schedule G, Part I (see instructions) 17 
13 Did the organization report more than 515,000 total of fundraising event gross income and contributions on Part 
lines to and 83" If ?Yes,'complete Schedule G, Part ll 13 
19 Did the organization report more than $15,000 of gross income from gaming activrties on Part line ?Yes,?
complete Schedule G, Part 19 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BAA TEEA0103 11l16ltB

 

Form 990 (2016)

Form 990 (2016) GRASSROOT INSTITUTE OF HAWAII, INC 99?0354937 Page4
"gaging-l Checklist of Required Schedules (continued)

 

20a Did the organization operate one or more hospital faculties? If ?Yes, complete Schedule 

If 'Yes? to line 20a, did the organization attach a copy of its audited ?nanCIal statements to this return? 

21

22

23

Did the organization report more than 000 of grants or other assistance to any domestic organization or
domestic government on Part IX column (A) line 1? If ','Yes complete Schedule 1, Parts I and ll 

Did the organization report more than $5,000 of grants or other asSIStance to or for domestic ll?llelduaIS on Part IX,
column (A), line 2? If ?Yes,?complele Schedule l, Parts land Ill 

Did the organization answer "Yes to Part VII, Section A line 3 4 or 5 about compensation of the organization' 5 current
and former of?cers, directors, trustees key employees and highest compensated employees? If 'Yes,? complete
Schedule 

243 Did the organization have a tax-exempt bond issue With an outstanding prinmpal amount of more than $100 000 as of

25

26

27

28

the last day of the year that was Issued after December 31 2002? If 'Yes,? answer lines 24b through 24d and
complete Schedule If ?No, ?90 to line 25a 

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 bonds? 

Did the organization act as an 'on behalf of' issuer for bonds outstanding at any time during the year? 

a Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess bene?t
transaction With a disqualified person during the year? lf 'Yes, complete Schedule Partl 

Is the organization aware that it engaged in an excess benefit transaction With a disqualified person in a prior year, and
tgat the transaction has not been reported on any of the organization's prior Forms 990 or 990- lf 'Yes,? complete
chedule L, Partl 

Did the organization report any amount on Part line 5 6, or 22 for receivables from or payables to any current or
former of?cers, directors, trustees, key employees highest compensated employees or disqualified persons?
lf ?Yes, ?complete Schedule L, Part ll 

Did the organization provide 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? If Yes,? complete Schedule L, Part 

Was the organization a party to a busmess transaction With one of the followmg parties (see Schedule L, Part IV
instructions for applicable ?ling thresholds, conditions, and exceptions?519 ?I'llcurrent or former of?cer, director, trustee, or key employee? If ?Yes, complete Schedule L, Part lV . . 28a 
bA family member of a current or former officer, director, trustee, or key employee? If ?Ye,?s complete
Schedule L, Part IV . . . 28b 
An entity of which a current or former officer, director trustee, or key employee (or a family member thereof) was an
of?cer director, trustee, or direct or indirect owner? If Yes,? complete Schedule Part IV 28c 
29 Did the organization receive more than $25,000 in non-cash contributions? If 'Yes,? complete Schedule 29 
30 Did the organization receive contributions of art, historical treasures, or other similar assets, or quali?ed conservation
contributions? If 'Yes,? complete Schedule 30 
31 Did the organization liqmdate, terminate, or dissolve and cease operations? If 'Yes,? complete Schedule N, Part 31 
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 
33 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 R, Partl 33 
34 Was the organization related to any tax-exempt or taxable entity? If 'Yes, complete Schedule R, Part ll, or IV,
and Part V, line 1 34 
353 Did the organization have a controlled entity Within the meaning of section 512(b)(13)? 35a 
If 'Yes' to line 353, did the organization receive any payment from or engage in any transaction With a controlled
entity Within the meaning of section ll 'Y,es' 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 
37 Did the organization conduct more than 5% ol its actiwties 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 
38 Did the organization complete Schedule 0 and provrde explanations in Schedule 0 for Part VI, lines 11b and 19?
Note. All Form 990 ?lers are reqUired to comp. 'ete Schedule 0 38 
BAA Form 990 (2016)

TEEA0104 1 "15116

 

 

 

 

 

 

 

 

 

 

 

Form 990 (2016) GRASSROOT INSTITUTE, OF HAWAII, INC 99?0354 937 Page 5
[951%le 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
1 a Enter the number reported in Box 3 of Form 1096 Enter if not applicable 1 a I
Enter the number of Forms included in line 1a Enter -0- if not applicable 1 0
Did the organization comply With backup Withholding rules for reportable payments to vendors and reportable gaming I - _l
(gambling) Winnings to prize Winners? . . 1 
2 a Enter the number of employees reported on Form Transmittal of Wage and Tax State-
ments. ?led for the calendar year ending With or Within the year covered by this return 2 a 0 
If at least one is reported on line 2a, did the organization ?le all reqUired federal employment tax returns? - 2 in 
Note. If the sum of lines 13 and 2a is greater than 250, you may be reqUIred to e-file (see instructions) 
3 3 Did the organization have unrelated business gross income of $1,000 or more during the year?7. . 3am 
ll 'Yes. has it ?led a Form 990T for this year? If ?No' to line 3b, prowde an explanation in Schedule 0. 3 

 

4 a At any time during the calendar year did the organization have an interest in or 3 Signature or other authority over a
nanCIaI account in a foreign country (such as a bank account securities account, or other finanCial account)?. . . . . . . 4 a 

If 'Yes.? enter the name of the foreign country .. 
See instructions for filing reqUirements for 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? 5 a 
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? 5 
If 'Yes,? to line Sa or 5b. did the organization file Form 8886-Does the organization have annual gross receipts that are normally greater than $100, 000, and did the organization
solicn any contributions that were not tax dedi. tible as charitable contributions? 6 a 

 

if ?Yes,? did the organization include With every soliCitation an express statement that such contributions or gifts were
not tax deductible? . . . 6 

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 a. . . - . 
serwces prowded to the payor7 7 a 
it ?Yes,? did the organization notify the donor of the value of the goods or serVices provrded'? . . . 7 
Did the organization sell, exchange, or othenivise dispose of tangible personal property for which it was requrred to ?le
Form 8282'Yes,? indicate the number of Forms 8282 ?led during the year 7 H..- 4 . -- 
9 Did the organization receive any funds, directly or indirectly, to pay premiums on a personal bene?t contract? 7 
Did the organization during the year pay premiums, directly or indirectly, on a personal benefit contract? . . 7f 
If the organization received a contribution of qualif? ed intellectual property did the organizationi ?le Form 8899
as reqUired'7 . . . 7 
if the organization received a contribution of cars. boats, airplanes or other vehicles did the organization file a
Form 1098-0? 7 
3 Sponsoring organizations maintaining donor advised funds. Did a donor adVised fund maintained by the sponsoring - L.. 
organization have excess busmess holdings at any time during the year'7. . . 8
9 Sponsoring organizations maintaining donor advised funds. - 
a Did the sponsoring organization make any taxable distributions under section 4966'? 93
Did the sponsoring organization make a distribution to a donor, donor adwsor, or related person? 9 
10 Section 501(c)(7) organizations. Enter 
a Initiation fees and capital contributions included on Part line 12 10a 
Gross receipts, included on Form 990, Part line 12, for public use of club laCilities 10 
11 Section 501(c)(12) organizations. Enter
a Gross income from members or shareholders 11 a
Gross income from other sources (Do not net amounts due or paid to other sources
against amounts due or received from them 11 
12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization ?ling Form 990 in lieu of Form 10417 123
If 'Yes,? enter the amount of tax-exempt interest received or accrued during the year L1 2 bL 
13 Section 501(c)(29) quali?ed nonpro?t health in5urance issuers. 
a Is the organization licensed to issue quali?ed health plans in more than one state? . . . . 13a

 

Note. See the instructions for additional information the organization must report on Schedule 0
Enter the amount of reserves the organization is required to maintain by the states In

 

 

 

 

 

 

 

 

which the organization is licensed to issue qualit? ed 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? 14a 
If 'Yes,? has it ?led a Form 720 to report these payments? If 'No,'provide an explanation in Schedule 0 14b

 

BAA TEEA0105 Form 990 (2016)

Form990(2015) GRASSROOT INSTITUTE OF HAWAII, INC 99- 0354937

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

Page 6

Check if Schedule 0 contains a response or note to any line in this Part VI . . . . 

Section A. GoverningBody and Management

 

1 a Enter the number of voting members of the governing body at the end of the tax year 1 a 7

 

 

if there are maternal 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 0

Enter the number of voting members included in line 1a. above, who are independent . . . . 1 6

 

 

 

2 Did any officer. director. trustee, or key employee have a family relationship or a busrness relationship With any other
of?cer, director. trustee. or key employee? . . 

3 Did the organization delegate control over management duties customarily performed by or under the direct supervISion
of of?cers. directors. or trustees. or key employees to a management company or other person? 

4 Did the organization make any signi?cant changes to its governing documents
Since the prior Form 990 was filed? 
5 Did the organization become aware during the year of a Significant diverSion of the organization?s assets'> 
6 Did the organization have members or stockholders? 
7a Did the organization have members, stockholders, or other persons who had the power to elect or appomt one or more
members of the governing bodyAre any governance deci5ions of the organization reserved to (or subject to approval by) members,
stockholders, or persons other than the governing body? 

8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by
the followmg

a The governing body? . . . . .
Each committee With authority to act on behalt of the governing body? 

9 Is there any of?cer, director. trustee, or key employee listed in Part VII. Section A. who cannot be reached at the
organization?s mailing address? If ?Yes, provrde the names and addresses in Schedule Section B. Policies _(This Section rgquests information about golicres not requrred by the Internal Revenue Code 

 

10a Did the organization have local chapters. branches. or af?liates? . 

If 'Yes.? did the organization have written and procedures governing the actiwties of such chapters. af?liates. and branches to ensure their
operations are With the organization's exempt purposes? 

11 2 Has the organization prowded a complete copy of this Form 990 to all members of its governing body before filing the form? 
Describe in Schedule 0 the process. if any. used by the organization to rewew this Form 990
123 Did the organization have a written con?ict of interest policy? If ?No, ?90 to line 13 

Were of?cers. directors or trustees. and key employees requned to disclose annually interests that could give rise
to con?icts? 

Did the organization regularly and monitor and enforce compliance the policy? If 'Yes,? describe in
Schedule 0 how this was done 

13 Did the organization have a written whistleblower policy? . . . 
14 Did the organization have a written document retention and destruction policy? 

15 Did the process for determming compensation of the followmg persons include a reVIew and approval by independent
persons. comparability data. and contemporaneous substantiation of the deliberation and demsmn?l

a The organization's CEO. Executive Director, or top management of?CIat 
Other of?cers or key employees of the organization 
If 'Yes' to line 15a or 15b. describe the process in Schedule 0 (see instructions)
16; Did the organization invest in, contribute assets to. or participate in a jomt venture or Similar arrangement with a
taxable entity during the year? 

If 'Yes,? did the organization follow a written policy or procedure requrring the organization to evaluate its
participation in iomt venture arrangements under applicable federal tax law. and take steps to safeguard the
organization' 5 exemjt status respect to such arrangements? 

Yes

No

 

10a

 

10b

 

11a

 

"1?35

 

12b

 

12c

 

13

 

14

 

15$?

 

15b

 

163

 

 

m.

 

 

 

Section C. Disclosure
17 List the states With which a copy of this Form 990 is reqUired to be ?led 5 Hawaii



18 Section 6104 reqmres an organization to make its Forms 1023 (or 1024 if applicable). 990, and 990- (Section 501(c)(3)s only) available

for public inspection Indicate how you made these available Check all that apply
Own websne Another?s web5ite Upon request [1 Other (explain in Schedule 0)

19 Describe in Schedule 0 whether (and if so, how) the organization made its governing documents. con?ict of interest policy, and ?nancial 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 355 MERCHANT ST #3377 HONOLULU HI 96801 (808)

BAA TEEA0106 11115115

591-9193
Form 990 (2016)

Form 990 (2015) GRASSROOT INSTITUTE. OF HAWAII, INC 99?0354937 P3987
llia' Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and
- Independent Contractors
Check If Schedule 0 contains a response or note to any lrne rn Part VII . 

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1 a Complete this table for all persons requrred to be lrsted Report compensatron for the calendar year or the
organrzatron's tax year

0 all of the organrzatron?s current offrcers, d-rectors. trustees (whether or organrzatrons). regardless of amount of
compensatron Enter -0- 1n columns (D), (E), and (F) if no compensatron was pard

0 all of the organrzatron?s current key employees, If any See Instructions for of 'key employee 

the organrzatron's ?ve current hrghest compensated employees (other than an of?cer, drrector, trustee. or key employee)
who received reportable compensatron (Box 5 of Form and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organrzatron and any related organrzatrons

0 all of the organization's former of?cers, key employees, and hrghest compensated employees who received more than $100,000
of reportable compensatron from the organrzatron and any related organrzatrons

all of the organrzatron's former directors or trustees that received. In the capacrty as a former drrector or trustee of the
organrzatron, more than $10,000 of reportable compensatron from the organrzatron and any related organrzatrons

persons In the followrng order trustees or drrectors, trustees, of?cers, key employees, hrghest compensated
employees. and former such persons

Check box If nerther the organrzatron nor any related organrzatron compensated any current of?cer, drrector, or trustee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(C)
(A) (B) (D) (E) (F)
Name and Trtle Average )5 both an officer and a Reportable Reportable Estrmated
hours drrectorltruslse) compensatron from compensatron from amount of other
w??eeorganrzatron
haurs for 3 a g: 92 (ED) 3 3 and related
g. organrzatrons
a I: a
dotted g; a
lrne) 
CL
(.1). BLCEEBP. 9 599214315 12 0_._59
CHAIRMAN 0. 0. 0.
?11.1414 EEK I5. .145 9.99
110,096. 0. 0.
9-539
TREASURER 0. 0. 0.
JEL (ELLE Q. 
DIRECTOR 0. 0. 0.
J9- 3013} [i 1213.13.33 0_-_09
DIRECTOR 0. O. 0.
J9- 30.131331: 1? ZLNES. 0_-_09
DIRECTOR 0. O. 0.
MARE 0_-_09
DIRECTOR 0. O. 0.
J2) 
J2) 
11?) - 
(11) 

?13) 
(14) 

 

 

 

 

 

 

 

 

 

 

 

BAA TEEA0107 11116116 Form 990 (2016)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 990 GRASSROOT INSTITUTE OF HAWAII, INC 99?0354937 Pages
fa??iyllg Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(B) (C)
i
(A) Ageraga (do not chegifln'w?gre thg?it?Name and title vegek :fr'cgpaesg comggiegg?nefrom 
ts, a" grassroots, massacres? ?mitt?
hours 9- F, ?4 3' 3 organization
for and related
related 0 .0 co organizations
organize a a- 
E1 9

dotted Eng?? 9.00.. (33
line) (D g.
O.
119 
(16) 
(17) 
(1 E) 

129? 
17-1) 
123) 1 
(23)


122i 
1bSub-total 110,096. 0_ 0_
Total from continuation sheets to Part VII, Section A 
dTotal(addlines1band 1c) 110,093 0_ 0.
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 of?cer, director, or trustee, key employee. or highest compensated employee 
on line 1a? lf 'Yes,'complete Schedule for such 3 
4 For any listed on line 13. is the sum of reportable compensation and other compensation from i
the organization and related organizations greater than $150000? If 'Yes. complete Schedule for 
such indiwdual 4 
5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or indiwdual 
for servrces rendered to the organization? If 'Yes. complete Schedule for such person 5 

 

 

 

 

Section B. Independent Contractors

1 Complete this table for your five highest compensated independent contractors that received more than 3100.000 of
compensation from the organization Report compensation for the calendar year ending with or Within the organization's tax year

 

(A)
Name and busrness address

(B)
Description of servrces

(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
BAA



11I16I15

 

Form 990 (2016)

Form 990 (2019)

GRASSROOT INSTITUTE OF HAWAII,

of Revenue

INC

99-0354937

 

 

 


Total revenue

(Bl
Related or
exempt
function
revenue

(C)

Unrelated
busmess
revenue

Revenue
excluded from tax
under sections
512-514

 

Contributions. Gifts. Grants
and Other Similar Amounts

 

1a
1b
1c
1d
1e

 

Membership dues 
Fundralsmg events 
Related organizations 
Government grants (contnbutlons) . .

 

 

 

 

All other contributions, Pitts, grants. and
amounts not "it: uded above. . 1 

Noncash contnbulions Included In llnesta-lt 5
Total. Add lines 1a-1f

 

 

501.370.
103, 628 .



 

5071 370.

 

Program Service Revenue

Busmess Code

NA

 

28 EVENTS

9. 940.

9, 940'.?

 



 

 

 

 

 

All other program servnce revenue . .

 

Total. Add lines 2a-2f 

9,940.

 

Other Revenue

3 Investment Income (Including Interest and
other Similar amounts) 

48.

48.

 

4 Income from Investment of tax-exempt bond proceeds . . Ir

 

5 Royaltles 

 

(0 Real Personal

 

6a Gross rents
Less rental expenses
Rental Income or (loss). .
Net rental Income or (loss) 

 

 

 

 

 

(I) Securities I Other

7 a Gross amount from sales of

assets other than Inventory 1 02 1 1 9 .


 

Less cost or other basts
and sales expenses . . . 103! 628 

Gain or (loss) 1 i0 9 . 
Net gain or (loss) -

 

 

 



-1, 509.

 

8 a Gross Income from fundralsmg events
(not Including. 
of contributions reported on line 1c)
See Part IV, line 18 a
Less direct expenses 
Net Income or (loss) from fundrausrng events -

 

 

9 a Gross Income from gaming 
See Part IV. lune 19 a

in Less. direct expenses b: 
Net income or (loss) from gaming 

 

 

 

10a Gross sales of Inventory, less returns
and allowances

Less cost of goods sold bI
Net Income or (loss) from sales of Invenmry ..

 

 

 

Miscellaneous Revenue Business Code

 

 

 

 

 

All other revenue 

 

Total. Add lInes 11a-11d 

 

 

 



12 Total revenue. See Instructions 

515, 849.

 

9, 940.

 

-l,46l.

0

 

BAA

TEEAD109

11l16l16

 

Form 990 (2016)

Form 990 (2016)

GRASSROOT INSTITUTE OF HAWAII,

IPa??er? ll 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 Part IX 

INC

99-0354 937

Page 10

 

Do not include amounts reported on lines
6bPart 

(A)
Total expenses

(3)

Program servrce
expenses

(C)
Management and
general expenses

(D)
Fundralsmg
expenses

 

1 Grants and other to domestic
organizations and domestic governments
See Part IV. Irne 21 

2 Grants and other to domestic
See Part IV, lrne 22 

3 Grants and other to foreign
organizations. foreign governments. and for-
eign See Part IV, lines 15 and 16

4 Benefits paid to or for members 

5 Compensatron of current of?cers. drrectors.
trustees. and key employees 

6 Compensatron not included above. to
drsqualr?ed persons (as de?ned under
section 4958(l)(1)) and persons described
In 4958(c)(3)(B) 

7 Other salaries and wages 

8 Pensron plan accruals and contributions
(Include section 401(k) and 403(b)
employer 

9 Other employee bene?ts . . .
10 Payroll taxes 
11 Fees for servrces (non-employees)

a Management 
Legal 


Lobbying .
Prolessronal servrces See Part IV. lrne 17
Investment management fees 

 

 

 

 

110. 096.

904396.

20. 000.

 

 

171.725.

164?67.

6. 858.

 

 

21.473.

20._397 .

1.076.

 

 

 

 

1,717.

1. 000.

717.

 

4.850.

 

8.000.

41850.

8. 000.

 

 

9 Other (If lrne amount exceeds 10% of line 25. column

(A) amounl. list llne expenses on Schedule 0) . .
Advertising and promotIOn 

Of?ce expenses 
Infonnatlon technology 

Royalties 
Occupancy 
Travel 

Payments of travel or entertainment

expenses for any federal, state. or local

public of?cnals 
Conferences. conventions. and meetings . . .

Interest 
Payments to af?liates 
Deprecratron. depletion. and amortrzatron.

Insurance 

Other expenses. Itemlze expenses not

covered above (List miscellaneous expenses

in Ilne 24a. If line 24a amount exceeds 10%

of lune 25. column (A) amount. IlSt line 24e
expenses on Schedule 0 

3 PRINTING

All other expenses 

Total functional expenses. Add lines 1 through 24e. .

58.014.

40. 098.

17.916.

 

15.159.

14.668.

491.

 

2.065.

351.

1.714.

 

5.467.

3.803.

1.658.

0000

 

 

34.151.

25. 000.

7. 902.

1.249.

 

28. 678.

14.510.

12. 423.

1.745.

 

 

 

5. 327 .

.

5.327.

 

 

778.

0

778 .

 

8.134.

5. 000.

3. 134 .

 

 

6. 737.

3.884-

I. 680

1. 173-

 

2.312.

1.712.

600

 

20. 80'3-

2043373-

382-

 

3. 919-

3.000-

919-

 

1. 611.

0 .

773.

838.

 

511.018.

413. 615.

84.016.

13, 387 .

 

26

Joint costs. Complete this line only If
the orgamzatron reported In column (B)

lornt costs from a combined educational
campargn and fundrarsmg sollcnatlon

Check here It followrng

SOP 98-2 (ASC 958-720) 

 

 

 

 

 

BAA

TEEA0110 11I16l16

 

Form 990 (2016)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 990 (2016) GRASSROOT INSTITUTE OF HAWAII. INC 99?0354 937 Page11
[Pajt?ainii?t?l 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 SaVings and temporary cash investments Pledges and grants receivable. net 3
4 Accounts receivableLoans and other receivables from current and former of?cers. directors, 5
trustees ke em lo ees. and highest compensated employees Complete . I - a
PartllofSc eduei?.? 5
5 Loans and other receivables from other disquali?ed persons (as defined under 
section 4958(f)(1)). persons described in section 4958(c)(3)(B). and contributing 
employers and sponsoring organizations section 501(c)(9) voluntary employees' a -- 
bene?Ciary organizations (see instructions) Complete Part II of Schedule 5
2 7 Notes and loans receivable. net 7
3 Inventories for sale Prepaid expenses and deferred charges . 9
10a Land, bUIldings. and eqUIpment cost or other basis 
Complete Part VI of Schedule 103 4 I 54 1 . 
bLess accumulated deprecration . . . . 10b 3.066. 1, 903, 1, 475_
11 investments publicly traded securities 11
12 Investments other securities See Part IV. line 11 12
13 investments - program-related See Part IV. line 11 . 13
14 Intangible assets 14
15 Other assets See Part lV. line 11 15
16 Total assets. Add lines 1 through 15 (must equal line 34Accounts payable and accrued expenses Grants payable 13
19 Deferred revenue 1 I 000. 19 3 I 093.
20 Tax-exempt bond liabilities 20
.3 21 Escrow or custodial account liability Complete Part IV of Schedule 21
22 Loans and other payables to current and former officers. directors. trustees. 5'
'5 key employees. highest compensated employees. and disquali?ed persons W- n. I I.
Complete Part II of Schedule . . . 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 of Schedule . . . 25
26 Total liabilities. Add lines 17 through Organizations that follow SFAS 117 (ASC 958). check here Hand complete 5
8 lines 27 through 29, and lines 33 and 34. mmwm?m?uhm ?g
27 Unrestricted net assets 27
El 28 Temporarily restricted net assets 23
1, 29 Permanently restricted net assets 29
5 Organizations that do not follow SFAS 117 (ASC 958). check here i
?g and complete lines 30 through 34. 
30 Capital stock or trust principal. or current funds 30 
3 31 Paid-in or capital surplus. or land. burlding. or equipment fund 31
2 32 Retained earnings. endowment. accumulated income. or other funds Total net assets or fund balances 10 I 696Total liabilities and net assets/fund balances BAA Form 990 (2016)

TEEAO111 ??6116

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 990 (2015) GRASSROOT INSTITUTE OF HAWAII, INC 99?0354 937 Page 12
52a Reconciliation of Net Assets
Check If Schedule 0 contaIns a response or note to any Me In thIs Part XI 
1 Total revenue (must equal Part column (ATotal expenses (must equal Part IX, column (ARevenue less expenses Subtract Me 2 from Net assets or fund balances at begInnIng of year (must equal Part X, Me 33, column 4 10 I 696 .
5 Net unrealized gaIns (losses) on Investments . 5
6 Donated servrces and use of . . . 6
7 Investment expenses . . . 7
3 PrIor perIod adjustments 3
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 We 33,
column 10 15' 527.
lt?ad?ll? ?lFinancial Statements and Reporting
Check If Schedule 0 contaIns a response or note to any Me In thIs Part XII . El
Yes No
1 Accountan method used to prepare the Form 990 'Cash DAccrual  : Other ?23; 
4 I
If the organIzalIon changed Its method of accountmg from a prIor year or checked 'Other,? epraIn ,9 I,
In Schedule 0 I
2a Were the organIzatIon?s ?nanCIal statements compIIed or reVIewed by an Independent accountant? . . 2 a 
If 'Yes,? check a box below to IndIcate whether the Manual statements for the year were compIIed or revnewed on a 
se arate baSlS, consoIIdated baSlS, or both I
Separate baSlS DConsoIIdated DBoth consolldated and separate baSlS 
Were the organIzatIon's ?nanCIal statements audIted by an Independent accountant? 2 
If ?Yes,? check a box below to IndIcate whetheI lhe ?nanCIal statements for the year were audIted on a separate '1 ., 3: I
consolldated or both .
Separate DConsolIdated basIs DBoth consolIdated and separate basIs n? 
If ?Yes' to lIne 2a or 2b, does the organIzatIon have a commIttee that assumes for overSIght of the audIt,
reVIew, or comleatIon of Its ?nanCIal statements and selectIon of an Independent accountantthe organIzatIon changed eIther Its overSIght process or selectIon process durIng the tax year, explaIn 3" ix 5 3
In Schedule 0 Tm}
3 a As a result of a federal award, was the organlzatlon reqUIred to undergo an audIt or audIts as set forth In the SIngle
AudIt Act and OMB CIrcular 3 a 
If 'Yes,? dId the organIzatIon undergo the reqUIred audIt or audIts7 If the organIzatIon dId not undergo the reqUIred audIt
or audIts, explaIn why In Schedule 0 and descrIbe any steps taken to undergo such audIts 3 

 

 

 

 

BAA

TEEA01 12 11I15115

 

Form 990 (2016)

SCHEDULE A
(Form-990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ.

Information about Schedule A (Form 990 or 990-EZ) and its instructions is
at 

 

OMB No 1545-0047

2016

Open to Public
Inspection

 

Name of the organization

Employer identi?cation 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

?40! 01 

(0m

1



11
12





Enter the number of supported organizations

A church, convention of churches, or assomation of churches described in section 

A school described in section (Attach Schedule (Form 990 or 990-EZ) 

A hospital or a cooperative hospital serwce organization described in section 

A medical research organization operated In conjunction With a hospital described in section Enter the hospital?s
name. City, and state

An organization operated for the benefit of a college or univerSity owned or operated by a governmental unit described 
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 
An agricultural research organization described in section 170(b)(1)(A)(ix) operated in conjunction 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


An organization that normally receives (1) more than of its support from contributions, membership fees. and gross receipts

from activrties related to its exempt functions?subject to certain exceptions, and (2) no more than 33-18% of its support from gross
investment income and unrelated busmess taxable income (less section 511 tax) from busmesses achIred by the organization after
June 30, 1975 See section 509(a)(2). (Complete Part 

An organization organized and operated excluswely to test for public safety See section 509(a)(4).

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

Type I. A supporting organization operated, superVised, or controlled by its supported organization(s). typically by giVing the supported

organization(s) the power to regularly appornt or elect a majority of the directors or trustees of the supporting organization You must
complete Part IV, Sections A and B.

Type II. A supporting organization supewised or controlled in connection With its supported organization(s), by haying control or

management of the supporting organization vested in the same persons that control or manage the supponed 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 requwement (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



Prowde the followmg information about the supported organization(s)

 

Name of supported organization

(ii) EIN Type of organization
(described on lines 1-10

above (see instructions?

Amount of monetary
support (see instructions)

(iv) Is the
organization listed
in your governing
dowment?

(vi) Amount of other
support (see instructions)

 

Yes No

 

(A)

 

(EL

 

(C)

 

(D)

 

(E)

 

Total

 

 

 

 

 

 

BAA For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

 

Schedule A (Form 990 or 990-EZ) 2016
TEEAD401 oerzaiis

 

 GRASSROOT INSTITUTE OF HAWAII, INC 99?0354937 Page2

IEaittizllitlSupport Schedule for Organizations Described in Sections 170(b)(1l(A)(iv) and 170(b)(1)(A)(vi)

(Complete only if you checked the box on line 5. 7, or 8 of Part I or if the organization failed to qualify under Part Ill If the
organization fails to qualify under the tests listed below, please complete Part 

Section A. Public Support

mm? 2012 2013 2014 2015 2016 Total
1 Gills, grants. conlnbulions, and

membership fees received not
include any 'unusual granls' . . .

2 Tax revenues levred for the
organization?s bene?t and
either paid to or expended
on its behalf 

3 The value of servrces or
facrlities furnished by a
governmental unit to the
organization wrthout charge. . .

4 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
shown on line 11, column . .

 

 

 

 

 

 

 

5 Public support. Subtract line5 .1 .
from line4 . .4:

Section B. Total Support

 

 

Calendar year (or ?scal year
beginning in) . 2012 lb) 2013 2014 2015 2015 Total

7 Amounts from line 4 

 

 

8 Gross income from interest,
payments received
on securities loans. rents.
royalties and income from
similar sources 

9 Net income from unrelated
busrness activ1ties. whether or
not the busrness is regularly
carried on 

10 Other income Do not include
gain or loss from the sale of
capital assets (Explain ll"l

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part VI 
11 Total support. Add lines 7
through 10 
12 Gross receipts from related activ1ties, etc (see instructionsFirst ?ve years. If the Form 990 is for the organization's ?rst, second, third, fourth, or ?fth tax year as a section 501(c)(3)
organization, check this box and stop here 
Section C. Computation of Public Support Percentage
14 Public support percentage for 2016 (line 6. column divided by line 11, column 14 
15 Public support percentage from 2015 Schedule A. Part II, line 14 15 

 

 

 

16a 33-1l3% support test-2016. If the organization did not check the box on line 13. and line 14 lS 33-13% or more. check this box
and stop here. The organization qualifies as a publicly supported organization 

33-1l3% support test-2015. If the organization did not check a box on line 13 or 163, and line 15 IS 33-1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization . . 

17a 10%-facts-and-circumstances test-2016. If the organization did not check a box on line 13, 163, or 16b, and line 14 IS 10%
or more, and if the or anization meets the ?facts-and-crrcumstances? test, check this box and stop here. Explain in Part VI how
the organization mee the ?facts-and-crrcumstances? test The organization qualifies as a publicly supported organization 

test-2015. if the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10%
or more. and If the organization meets the 'facts-and-crrcumstanoes' test, check this box and stop here. Explain in Part VI how the

 

organization meets the 'facts?and?crrcumstances' test The organization quali?es as a publicly supported organization Iv
18 Private foundation. If the organization did not check a box on line 13, 163, 16b, 17a, or 17b, check this box and see instructions 
BAA Schedule A (Form 990 or 990-EZ) 2016

0908116

 

Schedule A (Form 990 or 990-E2) 2016 GRASSROOT INSTITUTE OF HAWAII INC
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 it the organization
fails to _qualify under the tests listed below, please complete Part ll 1

Section A. Public Support

Calendar year (or fiscal year beginning in) 

99?0354937 Page3

 

2012 2013

1

at



Gifts, grants. contributions.

and membership fees

received (Do not include

any 'unusual grants 
Gross receipts from 
merchandise sold or servrces
performed, or faCIlities

furnished in any actiwty that is
related to the organization's
tax-exempt purpose

Gross receipts from actiwties
that are not an unrelated trade

or busmess under section 513 .

Tax revenues lewed for the
organization's bene?t and

either paid to or expended on

Its behalf 
The value of sewices or
facdities furnished by a
governmental unit to the
organization wrthout charge. . .
Total. Add lines 1 through 5 . .
Amounts included on lines 1,

2, and 3 received from
disquali?ed persons 

Amounts included on lines 2
and 3 received from other than
disquali?ed persons that
exceed the greater of $5,000 or
1% of the amount on line 13

for the year 

Add lines 7a and 7b

Public support. (Subtract line
7c from line 6 

2014

2015

2016

Total

 

151L988 .

304,597 .

36CL 762.

439.251.



1.763.968.

 

12L124 .

154 302.

17.264.

23.891.

9. 940.

78. 521.

 

 

 

 

164, 112.

319,899.

378J26.

463.142.

517. 310.

1.842. 489.

 

33. 340.

66. 468.

70. 652.

68. 635.

1154663.

354. 758.

 

17.510.

49.386.

179.370.

214035.

114000.

278.301.

 

60.850.

250L022 .

633. 059.

 



we
5

31 




7&4 
3..

??3.Hit. a. .

115,854?an;
?6w . 

. . eat.63,

89.670.

'31}

126.663.

a. .24? . .3
3., ., .2562
A a 
. y. I.
5a; 4.3 303 3?9"

1.209.430.

 

Section B. Total Support

 

Calendar year (or ?scal year beginning in) 'r

9

Amounts from line 6 

1th Gross income from interest. dwidends.

11

12

13

14

payments received on securities loans.
rents. royalties and income from
Similar sources 
Unrelated busrness taxable
income (less section 511

taxes) from busmesses

acqurred after June 30, 1975 . .

Add lines 10a and 10b 

Net Income from unrelated busmess
actiinties not included in line 10b.
whether or not the busrness is

regularly carried on 

Other income Do not include
gain or loss from the sale of
capital assets (Explain in

Part VI 

Total support. (Add lines 9,
10c, 11, and 12)



2012

2013

2014

2015

2016

Total

 

164, 112.

319, 899.

378,026.

463, 142.

517, 310.

1,842, 489.

 

1.929.

42.

--1, 461.

513.

 

 

1.929.

42.

?1.461.

513.

 

 

 

 

164, 115.

 

319. 899.

 

37%. 955.

 

463, 184 .

 

515, 849.

First five years. If the Form 990 is for the organization's ?rst, second, third, faurth, or fifth tax year as a section 501(c)(3)

organization. check this box and stop here 

Section C. Commitation of Public Support Percentage

 

1,_843,002.

 

 

 

 

 

 

 

 

15 Public support percentage for 2016 (line 8, column diVided by line 13, column 15 65 62 
15 Public support percentage from 2015 Schedule A, Part line 15. 16 62 . 4 9 
Section D. Computation of Investment Income Percentage
17 Investment income percentage for 2016 (line 10c, column dwided by line 13, column 17 0 . 03 
18 Investment income percentage from 2015 Schedule A, Part line 33-15% support tests?2016. if the organizat-on did not check the box On line 14, and line 15 is more than 33-16%, and line 17
is not more than 33-11396, check this box and stop here. The organization quali?es as a publicly supported organization u-
support tests?2015. If the organization did not check a box on line 14 or line 193, and line 16 is more than 33-18%, and
line 18 is not more than check this box and stop here. The organization qualr?es as a publicly supported organization I-
20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .. 
BAA oerzeris

 

Schedule A (Form 990 or 990-52) 2015'

 GRASSROOT INSTITUTE OF HAWAII, INC 99?0354937 Page4

?air-Elly] Supporting Organizations
(Complete only if you checked 3 box in line 12 on Part I If you checked 12a of Part I, complete Sections
A and If you checked 12b of Part I, complete Sections A and If you checked 12c of Part I, complete
Sections A, D, and If you checked 12d of Part I, complete Sections A and D, and complete Part 

Section A. All Supporting Organizations

 

Yes No

1 Are all of the organization?s supported organizations listed by name in the organization's governing documents? 1
If 'No, describe in Part VI how the supported organizations are deSignated lf desrgnated by class or purpose, descnbe ms s?
the desrgnation If historic and continuing relationship, explain 

 

 

2 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) 2

 

33 Did the organization have a supported organization described in section 501(c)(4), (5), or (6)7 If ?Yes, answer - -- 
and (0) below 3a

 

Did the organization con?rm that each supported organization quali?ed under section 501(c)(4), (5), or (6) and

I
satis?ed the public support tests under section If 'Yes,?describe in Part VI when and how the organization 7 mm 5
made the deterrnination 3b

 

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) - "m 
purposes? lf 'Yes, explain in Part VI what controls the organization put in place to ensure such use 36

 

4a Was any supported organization not organized in the United States (?foreign supported organization)? If 'Yes'and - 
if you checked 12a or 12b in Part I, answer and below 43

 

I

Did the organization have ultimate control and discretion in decrding whether to make grants to the foreign supported 
organization? If 'Yes, describe in Part VI how .he organization had such control and discretior despite being controlled -. - - 

or superwsed by or in connection With its supported organizations 4b

 

Did the organization support any foreign supported organization that does not have an IRS determination under . 3
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 exclusrvely for section 170(c)(2)(B) purposes 4c

0

 

5a Did the organization add, substitute, or remove any supported organizations during the tax year? If 'Yes, answer ?i 
and below (if applicable) Also, provrde detail in Part VI, including the names and EN numbers of the supported 1 
organizations added, substituted, or removed, (ii) the reasons for each such action, the authority under the

organization's organizmg document authorizmg such action, and (iv) how the action was accomplished (Such as by "w 
amendment to the document) 5a

 

Type I or Type II only. Was any added or substituted supported organization part of a class already desrgnated in the 
organization?s organizmg document? 5b

 

Substitutions only. Was the substitution the result of an event beyond the organization's control? 5c

 

6 Did the organization provrde support (whether In the form of grants or the provrsron of servrces or facrlities) to
anyone other than its supported organizations, (ii) indiViduaIs that are part of the charitable class bene?ted by one
or more of its supported organizations. or other supporting organizations that also support or bene?t one or more of "w -- 
the ?ling organization's supported organizations? If 'Yes,? provrde detail in Part VI. 3

 

7 Did the organization provrde a grant, loan, compensation, or other Similar payment to a substantial contributor 
(de?ned in section a family member of a substantial contributor, or a 35% controlled entity - *4
regard to a substantial contributor? If 'Yes,? complete Part I of Schedule I. (Form 990 or 990-EZ) 7

 

8 Did the organization make a loan to a disquali?ed person (as de?ned in section 4958) not described in line 79 If 'Yes,? a - 1
complete Part I of Schedule (Form 990 or 990-EZ) 3

 

9a Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons

as de?ned in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or 
If 'Yes, provide detail in Part VI 9a

 

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, provrde detail in Part 9b

 

Did a disqualified person (as de?ned in line 9a) have an ownership interest in, or derive any personal bene?t from, 
assets in which the supporting organization also had an interest? If ?Yes, 'provrde detail in Part VI 9c

 

10a Was the organization subject to the excess busrness 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 103

 

I: Did the organization have any excess busrness holdings in the tax year? (Use Schedule C, Form 4720, to determrne 
whether the organization had excess busrness holdings.) 1th

 

 

 

 

BAA TEEA040-4 census Schedule A (Form 990 or 990-EZ) 2016

ScheduleAtForm 990 or 990-E2) 2016 GRASSROOT INSTITUTE OF HAWAII, INC 99~0354937 Page 5
lt??tw?l Supporting Organizations (continuedL

 

 

11 Has the organization accepted a gift or contribution from any of the followrng persons'7 i

a A person who directly or indirectly controls, either alone or together With persons described in and below, the 
governing body of a supported organization? 11a

 

A family member of a person described in above? 11 

 

 

A 35% controlled entity of a person described In or above? If 'Yes? to a, b, or c, provrde detail in Part VI. 11c
Section B. Type I Supporting Organizations

 

 

Yes No

 

1 Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appornt
or elect at least a maiority of the organization?s directors or trustees at all times during the tax year7lf ?No,?descnbe in
Part VI how the supported organizationfs) effectively operated, supervrsed, or controlled the organization's actiwtres
If the organization had more than one supported organization, describe how the powers to appornt and/or remove
directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, mm 
applied to such powers during the tax year 1

 

2 Did the organization operate for the bene?t of any supported organization other than the supported organization(s) 1'
that operated supervrsed, or controlled the supporting organization? If 'Yes,? explain in Part VI how prowding such 

benefit camed out the purposes of the supported organization(s) that Operated superwsed, or controlled the - - 
supporting organization 2

Section C. Type II Supporting Organizations

 

 

 

 

1 Were a majority of the organization's directors ul' trustees during the tax year also a majority of the directors or trustees .
of each of the organization's supported organization(s)7 lf ?No,?describe in Part how control or management of the - - ?w

supporting organization was vested in the same persons that controlled or managed the supported organization(s) 1

Section D. All Type Supporting Organizations

 

 

Yes No

 

1 Did the organization prOVide to each of Its supported organizations. by the last day of the ?fth month of the . 
organization?s tax year, a written notice describing the type and amount of support provrded during the prior tax . e? ?1
year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and capies of the 
organization?s governing documents in effect on the date of notification, to the extent not prewously proxiided'? 1

 

2 Were any of the organization's of?cers, directors, or trustees either appomted 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 v- 4? at
the organization maintarned a close and continuous working relationship With the supported organrzatron(s) 2

 

3 By reason of the relationship described in (2), did the organization?s supported organizations have 3 Signi?cant i:
vorce in the organization?s investment policres and in directing the use of the organization's income or assets at 
all times during the tax year? If ?Yes,?descnbe in Part the role the organization's supported organizations played a" 1? 
in this regard 3

. Section E. Type Functionally Integrated Supporting Organizations

 

 

 

1 Check the box next to the method that the organization used to satisfy the Integral Part Test during the year(see instructions).
a The organization satis?ed the Test Complete line 2 below
The organization rs the parent of each of its supported organizations Complete line 3 below

(2 The organization supported a governmental entity Describe in Part Vl how you supported a government entity (see instructions)

 

2 Activrties Test Answer and below. yes No

 

a Did substantially all of the organization?s activities during the tax year directly funher the exempt purposes of the
supported organizationts) to which the organization was responsive? 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 constituted
substantially all of its actiwties 23

 

Did the described in constitute actiVities that, but for the organization's involvement, one or more of
the organization?s supported organization(s) would have been engaged in? If 'Yes,? explain in Part the reasons for
the organization?s pasrtion that its supported organization(s) would have engaged in these actiwtres but for the - - 
organization?s involvement 2b

 

3 Parent of Supported Organizations Answer and below. 5

a Did the organization have the power to regularly appomt or elect a majorrty of the officers, directors, or trustees of
each of the supported organizations? Provrde details in Part VI. 3a

 

Did the organization exercrse a substantial degree of direction over the pohcres, programs and actniities of each of its 
supported organizations? If 'Yes,? describe in Part the role played by the organization in this regard 3b

 

 

 

 

BAA TEEA0405 0923/15 Schedule A (Form 990 or 990-EZ) 2016

Schedule A (Form 990 or 990-EZ) 2016

 

GRASSROOT INSTITUTE OF HAWAII,
{335$va Type Non-Functionally Integrated 509(a)(3) Supporting Organizations

INC

99-0354937 Pages

1 Check here if the organization satis?ed 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 

 

Section A Adjusted Net Income

(A) Prior Year

(B) Current Year
(optional)

 

Net short-term capital gain

 

Recoveries of prior-year distributions

 

Other gross income (see instructions)

 

Add lines 1 through 3

 

DepreCiation and depletion

(hth-l

 



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)

at

 

7

Other expenses (see instructions)

 

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 instructions for short
tax year or assets held for part of year)

 

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 1c)

1d

 

 

Discount claimed for blockage or other
factors (explain in detail in Part VI)

13. a




 

indebtedness applicable to non-exempt-use assets

 



Subtract line 2 from line 1d



 

5

Cash deemed held for exempt use Enter 1-112% of line 3 (for greater amount,
see instructions)

 

Net value of non-exempt?use assets (subtract line 4 from line 3)

 

Multiply line 5 by 035

 

Recoveries of prior-year distributions

 



Minimum Asset Amount (add line 7 to line 6)

 

ova-40501.5:

 

Section Distributable Amount

Current Year

 

Adjusted net income for prior year (from Section A, line 8, Column A)

 

Enter 85% of line 1

 

Minimum asset amount for prior year (from Section B, line 8. Column A)

 

Enter greater of line 2 or line 3

 

Income tax imposed in prior year



 





Distributable Amount. Subtract line 5 from line 4, unless subJect to emergency
temporary reduction (see instructions)

 

6

 

 

Check here if the current year is the organization's first as a non-functionally integrated Type supporting organization

(see instructions)

BAA

09128116

Schedule A (Form 990 or 990-EZ) 2016

 

Schedule A (Form 990 or 990-EZ) 2016

GRASSROOT INSTITUTE OF HAWAII,

INC

99-0354937

[ParttV I Type Non-Functionally Integrated 509(a)(3) Supporting Organizations jcontinued)
Section Distributions
Amounts paid to supported organizations to accomplish exempt purposes

1
2

murmur-bu

10

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 achIre exempt-use assets

Quali?ed set-asrde amounts (prior IRS approval requrred)
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 (provide details

in Part VI) See instructions
Distributable amount for 2016 from Section C. line 6
Line 8 amount diVided by Line 9 amount

Page 7

Current Year

 

Section Distribution Allocations (see instructions)


Excess
Distributions

(ii)
Underdistributions
Pre-2016


Distributable
Amount for 2016

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 Distributable amount for 2016 from Section C, line 6
2 Underdistributions, if any. for years prior to 2016 (reasonable
cause reqwred explain in Part VI) See 
3 Excess distributions carryover, if any. to 2016?
a it 1? magma;
3? 1 . if
From 2013 *t
From 2014 
eFrom2015 ?i 
Total of lines 3a through .. -- 
9 Applied to underdistributions of prior years mm .1
Applied to 2016 distributable amount - - 
i Carryoverfrom 2011 not applied (see instructions) .
Remainder Subtract lines 39. 3h, and Bi from 3f
4 Distributions for 2016 from Section D,
line 7 
a Applied to underdistributions of prior years 
Applied to 2016 distributable amount
Remainder Subtract lines 4a and 4b from 4
5 Remaining underdistributions for years prior to 2016, If any 
Subtract lines 39 and 4a from line 2 For result greater than 
zero, explain in Part VI See instructions 1
6 Remaining underdistributions for 2016 Subtract lines 3h and 4b
from line 1 For result greaterthan zero. explain in Part VI See
instructions
Excess distributions carryover to 2017. Add lines 3] and 4c
Breakdown of line 7
a i
Excess from 2013 . . . .
Excess from 2014
Excess from 2015 . . .
9 Excess from 2016 . . .
BAA

TEEAD407

09f28116

Schedule A (Form 990 or 990-EZ) 2016

 

ScheduleA(Fonn 990 or 990-EZ) 2016 GRASSROOT INSTITUTE OF HAWAII, INC 99-0354937 Page8
[Part VI ,plemental information. Provide the ex lanations required by Part ll, line 10; Part ll, line 173 or 17b Part ill, line 12, Part lV,
. Sec Ion A, lines 11a, 11b, and NC, Part IV, Section B, lines 1 and 2; Part lV, Section C, line 1;
Part IV, Section D, lines 2 and 3, Part IV, Section E, lines 1c, 2a, 2b, 33, 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 

 

BAA TEEAD403 oerzane Schedule A (Form 990 or 990-EZ) 2016

 

 

 

 

 

 

 

 

 

 

 

 

. . OMB 154543047
SCHEDULE Supplemental Financial Statements 
(Form 990) Complete if the organization answered ?Yes' on Form 990, 201 6
Part IV. line 
.. Information about Schedule (Form 990) and its instructions is at Inspection i
Name of the organization Employer identi?cation number
GRASSROOT INSTITUTE OF HA. INC 99?0354937
IPartfl - [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 adv15ed funds Funds and other accounts

1 Total number at end of year 

2 Aggregate value of contnbutions 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 advrsed funds

are the organization?s property, subject to the organization's exclusive legal control? DYes No

6 Did 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 advrsor, or for any other purpose conferring
impemtissmle private bene?t? . DYes No

[Pait?llrirl Conservation Easements.
Complete if the organization answered 'Yes' on Form 990, Part lV, line 7
1 Purpose(s) of conservation easements held by the organization (check all that apply)
Preservation of land for public use (e recreation or education) Preservation of a historically important land area
Protection of natural habitat BPreservation of a certi?ed historic structure
Preservation of open space

2 Complete tines 2a through 2d if the organization held a quali?ed 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 . . . . . . . . 2 a
Total acreage restricted by conservation easements 2 
Number of conservation easements on a certi?ed historic structure included in 2 
(I Number of conservation easements included in achired after 8/1 7706, and not on a historic
structure listed in the National Register 2 
3 Number of conservation easements modi?ed. transferred. released, extingu1shed, or terminated by the organization during the
tax year 

4 Number of states where property subject to conservation easement is located 

5 Does the organization have a written poliCy regarding the periodic monitoring, inspection, handling of Violations,

and enforcement of the conservation easements it holds? . No
6 Staff 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 enforcmg conservation easements during the year

8 Does each conservation easement reported on line 2(d) above satisfy the requrrements of section 
and section DYes 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 organization's ?nanCial statements that describes the organization's accounting for
conservation easements.

[Paart Organizations Maintaining Collections of Art, Historical Treasures, Or Other Similar Assets.
Complete if the organization answered 'Yes? on Form 990, Part IV, line 8.

 

1 a If the organization elected, as permitted under SFAS 116 (A80 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 researcn in furtherance of public service. provrde,
in Part the text of the footnote to its ?nanCIal statements that describes these items

If the organization elected, as perrnitted under SFAS 116 (A80 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 funherance of public sewice, provide the
followmg amounts relating to these items

Revenue included on Form 990, Part line 1 I- 
(ii) Assets included In 990, Part 

2 If the organization received or held works of art. historical treasures, or other srmilar assets for ?nancral gain. provrde the followrng
amounts reqmred to be reported under SFAS 116 (A80 958) relating to these items

a Revenue included on Form 990, Part line 1 
Assets included in Form 990, Part 
BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990. TEEA3301 08115116 Schedule 0 (Form 990) 2016

Schedule 990) 2016 GRASSROOT INSTITUTE OF HAWAII, INC 99?0354 937 Page2
Or anizations MaintainingCollections of Art, Historical Treasures, or Other Similar Assetchontinued)

3 Usmg the organization's achIsmon, accession, and other records, check any of the followmg that are a Signi?cant use of Its collection
items (check all that apply)

a Public Loan or exchange programs
Scholarly research Other
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 organization sohcrt or receive donations of art, historical treasures, or other Similar assets
to be sold to raise funds rather than to be maintained as part of the organization's collection? Yes No

Baht Escrow and Custodial Arrangements. Complete If the organization answered 'Yes? on Form 990, Part IV,
line 9, or reported an amount on Form 990, Part X, line 21

 

 

1 a Is the organization an agent, trustee, custodian or other Intermediary for contributions or other assets not included
on Form 990, Part x7 Yes No

If 'Yes,? explain the arrangement in Part and complete the followmg table

 

 

 

 

 

 

 

 

Amount
Beginning balance . . . . . 1 
Additions during the year . . 1 
Distributions during the year . 1 
Ending balance 1 
2 3 Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? [1 Yes 7 No
If 'Yes,? explain the arrangement in Part Check here if the explanation has been provrded on Part . . . 

 

{Ha?tVEigLEndowment Funds. Complete if the organization answered 'Yes' on Form 990, Part IV, line 10
Current year Priorlear quyears back Three years back Fowears back

 

 

1 3 Beginning of year balance . . .
Contributions 

 

 

Net investment earnings, gains,
and losses 

Grants or scholarships 

Other expenditures for faculties
and programs 

Administrative expenses .

9 End of year balance 
2 Prowde the estimated percentage of the current year and balance (line 19, column held as

a Board deSignated or quaSi-endowment 

Permanent endowment ?5

Temporarily restricted endowment 

The percentages on lines 2a, 2b, and 2c should equal 100%

 

 

 

 

 

 

 

 

 

 

3 a Are there endowment funds not in the possessron of the organization that are held and administered for the

 

 

 

 

 

organization by Yes No
unrelated organizatiOns 3ati)
(ii) related organizations 3am)

If 'Yes' on line 3am), are the related organizations listed as reqmred on Schedule 3b

 

 

 

4 Describe in Part the intended uses of the organization?s endowment funds
ja'?thjl] Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 113. See Form 990, Part X, line 10.

 

 

 

 

 

 

 

 

 

 

 

 

Description Of Cost or other Cost or other to) Accumulated Book value
(investment) baSlS (otheg depreciation
1 a Land . 5.5; mileage

BUIIdings 

Leasehold improvements 

quurpment 4'541_ L066. 1:475-

Other 
Total. Add lines ?Ia through 1e (Column (dLmust equal Form 990, Part X, column (BBAA Schedule (Form 990) 2016

TEEA3302 08115116

SchedUIeDtForm 990) 2016 GRASSROOT INSTITUTE OF HAWAII, INC 99?0354 937 Page3
Investments Other Securities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b See Form 990. Part X. line 12
of secunty or category (including name at security) (13) 300k value Method of valuation Cost or end-ol?year market value
(1) FinanCIal derivatives 
(2) Closely-held eqwty interests 
(3) Other

 

 

 

 

 



 



 



 



 



 



 



 



 



 

 

.7 Investments Program Related.
Complete if the organization answered 'Yes' on Form 990. Part IV. line 110 See Form 990, Part X, line 13

Description of investment Book value Method of valuation Cost or end-of-year market value

 

 

 

(1)
(2)
(3L

EL
(EL
EL
(3)
(EL
(10)
Total lCo/umn must equal Farm 990, ParlX, column (3)/me l3) . 

[Par?tltx?szil Other Assets.
Complete if the oLganization answered ?Yes' on Form 990, Part IV, line 11d See Form 990. Part X, line 15

Description Book value

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)
(2)
(3)
(4)
(5)
(6)
(1L
(8)
(9)
(10)
Total. (Column must equal Form 990, Part X, column (B) line 15) iv
.I Other Liabilities.
Complete if the orqanization answered 'Yes? on Form 990. Part IV, line He or See Form 990, Part X. line 25
Description of liability Book value
(1) Federal income taxes
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
Total (Column must equal Form 990, Part X, column (3) line 25) . . . I-
2. Liability for uncertain tax postions In Part prowde the lead of the footnote to the organization's ?nanual statements that reports the organization's liability Ior uncertain
tax posmons under FIN 43 (ASC 740) Check here if the text of the Iootnote has been pmwded in Part 

BAA TEEA3303 08115116 Schedule (Form 990) 2016

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ScheduleDIForm 990) 2016 GRASSROOT INSTITUTE OF HAWAII, INC 99-0354937 P3994
31$le 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 ?nanCIaI statements 1

2 Amounts included on Me 1 but not on Form 990, Part Me 12 it 
a Net unrealized gains (losses) on investments . . . 2a ?33; 1
Donated serVIces and use of faCIlities. 2 I
Recoveries of prior year grants . . . . 2c ?33:
Other (Describe In Part . . 2 {5
9 Add lines 2a through SubtractlineZefromline1 3

4 Amounts Included on Form 990, Part line 12, but not on line 1 ,3 i
a Investment expenses not included on Form 996, Part line To. . . 4a - :1
bOther(DescrIbe In Part . . . . . 4b :14
Add lines 4a and 4b 4 

5 Total revenue Add IInes 3 and 4c. (Thrs must equal Form 990, Part I, Ime 12 5

 

 

 

{Hamill Reconciliation of Expenses per Audited Financial Statements With Expenses per Return.
Complete If the organIzatIon answered ?Yes? on Form 990. Part IV. IIne 12a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 Total expenses and losses per audIted fmancral statementsAmounts Included on line 1 but not on Form 990. Part IX. line 25 a. .1 
a Donated serwces and use of facilities . 2 a 
bPrioryearadIustments . . . . . . . . . . . . . 2b 
Other losses 2 
Other (Describe In Part . . . . 2 
Add lines 2a through 2d . . 2e

3 Subtract line 2e from line Amounts Included on Form 990, Part IX, Me 25. but not on line 1 ,5
a Investment expenses not Included on Form 990, Part IIne 7b 4 a :3 . .4
bOther(Describe in Part . . . . . . . 4b gig:
cAddIInes4aand4b 4c

5 Total expenses Add lines 3 and 4c. (This must equal Form 990 Part! Ime 18 5

 

[git-33min S?plemental Information.

Prowde the descriptions requured for Part II, lines 3. 5, and 9. Part lines 1a and 4. Part IV, IInes 1b and 2b, Part V.
line 4. Part X. line 2, Part XI, lines 2d and 4b, and Part XII, lines 2d and 4b Also complete this part to prowde any addItional information

 

BAA Schedule (Form 990) 2016

TEEA3304 0811516

 

SCHEDULE 
(Form 990)

Attach to Form 990.
Department of the Treasury
Internal Revenue Semce

Noncash Contributions

Complete if the organizations answered 'Yes? on Form 990, Part IV, lines 29 or 30.

Information about Schedule (Form 990) and its instructions is at 

 

OMB No 1545-0047

2016

- Open to Public i
i


Inspection

 

Name at the organization

GRASSROOT INSTITUTE OF HAWAII.
L953: Types of Property

INC

 

Employer identification number

99-0354937

 




N-Art Works of art
Art - Historical treasures 
Art Fractional interests 

Books and publications 
Clothing and household goods 
Cars and other vehicles
Boats and planes 
Intellectual property 
Securities - Publicly traded 
Securities -- Closely held stock 
Securities Partnership, LLC, or trust interests. .
Securities Miscellaneous 

Quali?ed conservation contribution 
Historic structures

Quali?ed conservation contribution Other. . . .
Real estate ReSIdential 

Real estate CommerCIal 
Real estate Other
Collectibles 
Food inventory 
Drugs and medical supplies
TaXIdermy 
Historical artifacts
SCienti?c speCimens 
Archeological artifacts 

Other" 


Other? -





Other 

Other" 

(3)
Check if
applicable


Number of
contributions or
items contributed

C)


Noncash contribution
amounts reported

on Form 990.

Part line ?ig




Method of determining
noncash contribution amounts

 

 

 

 

 

 

 

 

 

1031 628 .

PUBLICLY TRADED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

29

30a

31

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

If 'Yes,? describe the arrangement in Pan II

Does the organization have a gift acceptance policy that requrres the rewew of any nonstandard contributions? 31

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? 

32a Does the organization hire or use third parties or related organizations to sohcnt, process, or sell

33

noncash contributions? 

If 'Yes,? describe in Part II

If the organization didn?t report an amount in column for a type of property for which column is checked,

describe in Part It

 

 

 

Yes

No

 

30a

 

 

323

 

 

 

 




 

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990.

TEEA4601

08124I16

 

Schedule (Form 990) (2016)

SCHEDULE 0 Supplemental Information to Form 990 or 990- E2 15450047

(Form 990 or 990-EZ)

InIemaI Revenue Semce at gov/form990.

Name of the organization
GRASSROOT INSTITUTE OF HAWAII, INC
Pt VI, Lane 19 UPON REQUEST

Complete to provide information for responses to specific questions on 201 6
Form 990 or 990- E2 or to provide any additional information.

- Attach to Form 990 or 990- E2. 1
Department of the Twas,? Ir Information about Schedule 0 (Form 990 or 990-EZ) and its instructions is l??ope" {to 

 

Inspectjom, 
Employer IdentIficatIon number

99-0354 937

 

Pt XII, Llne 2C LINE ZB SHOULD SAY NO SO THIS IS NOT APPLICABLE

Pt VI, Llne 11b EXECUTIVE OFFICER

 

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

 

TEEM901

08116116

Schedule 0 (Form 990 or 990-EZ) (2016)