OMB 1545-0047
Form 99 0 0
Return of Organization Exempt From Income Tax 2 O1 5
Under section 501(c), 527. or 4947(a)(1) of the lntemal Revenue Code (except private foundations) 
Do not enter social security numbers on this form as it may be made public. Open<to Public 
Information about Form 990 and its instructions is at . Ihissiiection
A For the 2015 calendar year. or tax year beginning . 2015. and ending .
Check It appi-cabie Name Of organization GRASSROOT INST I TUTE OF HAWAI I INC Identi?es? number
Address change Domg busmess Name change Number and street (or 0 box if mail is not delivered to street address) Room/swte Telephone number
Initialretum 335 MERCHANT ST 3377 (808) 591?9193

Final reluml'lermmaled

 

 

City or town. state or provmce. country. and ZIP or foreign postal code

 

 

 

 

 

 

 

Amendedreturn Honolulu HI 96801 Grossreceipts 5 463, 184 .
Application pending Name and address of principal of?cer H(a) Is this a group return for subordinates? Yes No
WILLIAM AKINA 335 MERCHANT ST #3377 HONOLULU HI 9 6 8 1 9533'! Elm No
i -Tax-exempl slalus 501 I I 501(c) (insert no) I4947(a)(1) or I  527 
Website: A We) Group exemption number 
Form of organization IXICorporation I I Trust I I Association I I Other I Year of formation 2 1 1M State of legal domicde I

 

I ParI?l 1 Summary

 

 

 

 

 

 

 

 

 

   

 

 

 

 

 

 

 

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 Bl'e?! (lescr'be 9539101 T?LStf'Qni?Ea?t Elli-1149 3914113! ANP. EDUCAT ION

8 . 

2 Check an; box Ef the organization discontinued its operations or disposed of more than 
?5 3 Number of voting members of the governing body (Part VI. line 13) 3 6
4 Number of independent voting members of the governing body (Part VI, line 1b) 4 5
3% 5 Total number of indIVIduals employed in calendar year 2015 (Part V. line 23) 5
6 Total number of volunteers (estimate if necessary) 5 
7a Total unrelated busmess revenue from Part column (C). line 12 7a 4 2 .
Net unrelated business taxable income from Form 990-T. line 12% 7b 0 .
I RECEIVED Prior Year Current Year
8 Contributions and grants (Part line 1h) or.) 360 I 762 . 439; 251 
2 9 Program seNice revenue (Part line 29Investment income (Part column (A). lines Other revenue (Part column (A). lines 5, 6d. 8c. 90. 10c. O)
12 Total revenue add lines 8 through 11 (must equal Palell. @ml?tmGrants and similar amounts paid (Part IX, column (A), lines 1-3 . ?7 U. I 
14 Bene?ts paid to or for members (Part IX, column (A). line 4) 
a: 15 Salanes, other compensation. employee bene?ts (Part IX. column (A). lines 5?1016a Professwnal fundraismg fees (Part IX, column (A), line 11e) 
Total fundraismg expenses (Part IX. column (D). line 25) 1 5 I 32 8 22$? I If; ,0 
17 Other expenses (Part IX. column (A), lines 11a?11d. 111-24e) 139I 773 1 96p 010 .
18 Total expenses Add lines 13-17 (must equal Part IX. column (A), line 25Revenue less expenses Subtract line 18 from line Beginning of Current Year End of Year
g? 20 Total assets (PartX. line16) 24I 456. 31I 459.
5: 21 Total liabilities (Part X, line 26201% 22 Net assets or fund balances. Subtract line 21 from line @[Rart Iii: ISanature Block
czmUnder penalties ol pequry. I declare that I have examined this return. i accompanying schedules and statements. and to the best of my knowledge and belief. it is true. correct. and
Ncomplete Declaration of pre?parr ther thin of?cer)?is baseWon of which preparer has any knowledge I. In .
so N?l?j law I I?/??Ille
P4 Sign Signature of of?cer Date I I
Here WILLIAM AKINA
:3 Type or name and title - I
Print/Type preparers name Prepar signature Date Check BI if PTIN
8 Paid GERALD USHIJIMA, CPA - self-employed P01356124
2 Preparer Finn's name GERALD . USHIJIMA CPA 
Use rum-s address 1 1 10 UNIVERSITY AVE STE 508 99?0230347
HONOLULU HI 96826-1508 Phoneno (808) 949-5588
May the IRS discuss this return with the preparer shown above? (see instructions) IXI Yes I I No

 

BAA For Paperwork Reduction Act Notice, see the separate instructions.

TEEAO101 10112115 Form 990 (2015) [20

525

 

Form 990 (2015) GRASSROOT INSTITUTE OF HAWAII, INC 99-0354 937 Page2
[ml Statement of Program Service Accomplishments
Check If Schedule 0 contains a response or note to any line In Part 
1 Bne?y descnbe the organization?s missuon:
PUBLIC POLICY RESEARCH AND EDUCATION

 



 

2 Did the organization undertake any program servuces dunng the year Were not listed on the pnor

Form 990 or 990-527 Yes No
If 'Yes,? describe these new servnces on Schedule 0.
3 Old the organization cease conducting. or make sugnl?cant changes In how It conducts, any program servnces" Yes No

If 'Yes,? describe these changes on Schedule 0

4 Describe the organizatlon's program servrce for each of Its three largest program servnces, as measured by expenses
Section 501(c)(3) and 501(c)(4) organlzatlons are reqmred to report the amount of grants and allocations to others, the total expenses,
and revenue, If any. for each program serVIce reported

 

4a(Code )(Expenses 31,716, Including grantsof 0_ )(Revenue 11 776.)
TRANSPARENCY PROGRAM MULTIFACETED EFFORTES TO SHED LIGHT ON










 

4b(Code )(Expenses 85,640, Including grantsof 0, )(Revenue 3,500_)
AKAKA BILL EDUCATION - PUBLIC EDUCATION REGARDING THE MOVEMENT TO



 

4c(Code' )(Expenses 2,927, Including grantsof 0_ )(Revenue 5 
ACT RESEARCH INTO EFFECTS OF THE 1920 JONES ACT ON THE






 

4 Other program serVIces. (Descnbe 1n Schedule 0.) 
(Expenses 2 60 55 1 Including grants of 0 (Revenue 82 7 57 
4 Total program servuce expenses BAA TEEAO102 10/12/15 Form 990 (2015)

 

 

 

Form990t2015) GRASSROOT INSTITUTE OF HAWAII, INC 99?0354937 Page3

 

 

 

 

. Yes No
1 Is the organization descnbed in section 501 or 4947(a)(1) (other than a private foundation)? If ?Yes, complete
Schedule A 1 
2 Is the organization reqUIred to complete Schedule B, Schedule of Contributors (see Instructions)? 2 

 

3 Did the organization engage In direct or Indirect political campaign actiVIties on behalf of or in opposition to candidates
for public of?ce? If ?Yes, complete Schedule C, Part I 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 II 4 

 

5 Is the organization a section 501(c)(4), 501(c)(5). or 501(c)(6) organization that receives membership dues.
assessments. or Similar amounts as de?ned In Revenue Procedure 98-19? If ?Yes,'complete Schedule C, Part 5 

 

6 Did the organization maintain any donor advrsed funds or any Similar funds or accounts for which donors have the right
to prOVlde adVIce on the distribution or investment of amounts in such funds or accounts? If ?Yes.?complete Schedule D, 
Part I 6

 

7 Did the organization receive or hold a conservation easement, including easements to preserve open space. the
envrronment. historic land areas. or historic structures? If ?Yes, complete Schedule D, Part II 7 

 

8 Did the organization maintain collections of works of art, historical treasures. or other Similar assets? If ?Yes,?
complete Schedule D, Part 8 

 

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 prowde credit counseling, debt management, credit repair. or debt negotiation

 

 

serwces? If 'Yes, complete Schedule D, Part IV 9 
10 Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments,
permanent endowments, or quasi?endowments? If ?Yes,'complete Schedule D, Part 10 

  
 

 

 

I re
11 If the organization's answer to any of the followmg questions Is ?Yes'. then complete Schedule D, Parts VI, VII. IX. g? .. g?ttj;
or as applicable at}: Wig?

 

a Did the organization report an amount for land, bUIldings and eqUIpment in Part X. line 10? If ?Yes,'complete Schedule

 

 

 

 

 

 

 

 

 

D, Part VI 11 a 
Did the organization report an amount for investments - other secunties 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 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 16? If 'Yes,?complete Schedule D, Part 11 
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported
in Part X, line 16? If ?Yes,?complete Schedule D, Part IX 11d 
Did the organization report an amount for other liabilities in Part X, line 25? If ?Yes, complete Schedule D, Part 11 
Did the organization' 5 separate or consolidated ?nanCIal statements for the tax year Include a footnote that addresses
the organization' liability for uncertain tax posmons under FIN 48 (A80 740)?7 If ?Yes,? complete Schedule D, Part 11 
123 Did the organization obtain separate. Independent audited nanCIal statements for the tax year? If ?Yes,? complete
Schedule D, Parts XI, and XII 12a 
Was the organization included in consolidated. Independent audited ?nanCIal statements for the tax year? If ?Yes, and
If the organization answered ?No' to Ime 123, then completing Schedule D, Parts XI and XII :5 optional 12 
13 Is the organization a school described in section If ?Yes,?complete Schedule 13 
14a Did the organization maintain an of?ce. employees. or agents outSIde of the United States? 14a 

 

Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraismg,
busmess. 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 report on Part IX, column (A). line 3. more than $5.000 of grants or other aSSIStance to or for any
foreign organization? If ?Yes,?complete Schedule F, Parts Did the organization report on Part IX. column (A). line 3, more than $5,000 of aggregate grants or other assastance to
or for foreign indIVIduaIs? If 'Yes,?complete Schedule F, Parts Ill and IV 16 

 

17 Did the organization report a total of more than $15.000 of expenses for professmnal fundraismg servrces on Part IX.
column (A). lines 6 and 11e? If ?Yes,'complete Schedule G, Part I (see instructions) 17 

 

18 Did the organization report more than 515.000 total of fundraismg event gross income and contnbutions on Part 
lines to and 8a? If 'Yes, complete Schedule G, Part II 18 

 

19 Did the organization report more than $15,000 of gross income from gaming actiVIties on Part line 9a? If ?Yes,?
complete Schedule G, Part 19 

 

 

 

 

 

8AA 10/12/15 Form 990 (2015)

 

F0rm_990 (2015) GRASSROOT INSTITUTE OF HAWAII, INC 99?0354 937 Page4
LPa??EI?Checklist of Required Schedules (continued)

 

 

 

. Yes No
20a Did the organization operate one or more hospital faCIlltleS? If 'Yes?, complete Schedule 20a 
If ?Yes? to line 20a, did the organization attach a copy of Its audited ?nanCIaI statements to this return? 20b

 

21 Did the organization report more than $5,000 of grants or other ass:stance to any domestic organization or
domestic government on Part IX, column (A), line 1? If ?Yes,?complete Schedule I, Parts I and II 21 

 

22 Did the organization report more than $5,000 of grants or other a55istance to or for domestic indIVIduals on Part IX,
column (A), line 2? If ?Yes,?complete Schedule I, Parts I and Ill 22 

 

23 Did the organization answer 'Yes? to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current
and former of?cers, directors, trustees, key employees, and highest compensated employees? If ?Yes, complete 
Schedule . 23

24a Did the organization have a tax-exempt bond issue With an outstanding pnncupal amount of more than $100,000 as of
the last day of the year. that was issued after December 31, 2002? If 'Yes,'answerlines 24b through 24d and

 

 

 

 

complete Schedule If ?No, ?90 to line 25a 24a 
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? 24b
Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease

any tax?exempt bonds? 24c
Did the organization act as an 'on behalf of' issuer for bonds outstanding at any time during the year? 24d

 

25a Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess bene?t
transaction With a disquali?ed person during the year? If ?Yes, complete Schedule L, Partl 253 

 

Is the organization aware that it engaged in an excess bene?t transaction With a disquali?ed 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, complete
Schedule L, Part I 25!) 

 

26 Did the or anization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or
former icers, directors, trustees. key employees, highest compensated employees, or disquali?ed persons?
If 'Yes?, complete Schedule L, Part II 26 

27 Did the organization provude a grant or other assmtance to an of?cer, 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 27
I 23 Was the organization a party to a busmess transaction With one of the foIIowmg parties (see Schedule L, Part IV 
instructions for applicable filing thresholds, conditions, and exceptions). Is??i
a A current or former of?cer, director, tnistee, or key employee? If 'Yes,'complete Schedule L, Part IV 233
A family member of a current or former of?cer, director, trustee, or key employee? If ?Yes, complete
Schedule L, Part IV 28b 
An entity of which a current or former of?cer, 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 L, Part IV 23? 
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 quwdate, termmate, or dissolve and cease operations? If 'Yes,?complete Schedule N, Partl 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 301.7701-3? If 'Yes,?complete Schedule R, Part I 33 
34 Was the organization related to any tax-exempt or taxable entity? If ?Yes,?complete Schedule R, Part II, or IV,
and Part V, line 1 34 
35a Did the organization have a controlled entity Within the meaning of section 512(b)(13)? 353 
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)? lf 'Yes,?complete Schedule R, Part V, line 2 35b 
36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-chantable related
organization? If ?Yes, complete Schedule R, Part V, line 2 36 
37 Did the organization conduct more than 5% of 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 
33 Did the organization complete Schedule 0 and prOVIde explanations in Schedule 0 for Part VI, lines 11b and 19?
Note. All Form 990 ?lers are reqwred to complete Schedule 0 38 
BAA Form 990 (2015)

TEEAO104 10/12115

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 990(2015) GRASSROOT INSTITUTE OF HAWAII, INC 99-0354 937 Page5
 _Eai:t_V_l 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 3 a
Enter the number of Forms W-ZG included in line ta Enter if not applicable 1 . .2: 
Did the organization comply With backup Withholding rules for reportable payments to vendors and reportable gaming *4 9
(gambling) Winnings to prize Winners? 1 
2 3 Enter the number of employees reported on Form Transmittal of Wage and Tax State? .: n.9, 3;
ments, ?led for the calendar year ending With or Within the year covered by this return 2 a 
If at least one IS reported on line 2a, did the organization ?le all requn?ed federal employment tax returns? 2 
Note. If the sum of lines 18 and 2a is greater than 250, you may be requrred to e-?le (see instructions) 39* 
3 a Did the organization have unrelated busrness gross income of $1.000 or more during the year? 3 a 
If 'Yes' has it ?led a Form 990-T for this year? If 'No? to line 3b, provrde an explanation in Schedule 0 3 
4a At any time during the calendar year, did the organization have an interest in, or 3 Signature or other authority over, a
?nancral account in a foreign country (such as a bank account, securities account, or other ?nancial account)? 4a 
If ?Yes,' enter the name of the foreign country w. .
See instructions for ?ling requrrements for Form 114, Report of Foreign Bank and Financral Accounts (FBAR) 3% a m: ?w is??
5 3 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? 5 
If 'Yes,? to line 5a or 5b. did the organization ?le Form 8886-1?? 5c
6 a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization
sohcrt any contributions that were not tax deductible as charitable contributions? 6 a 
If 'Yes,? did the organization include With every an express statement that such contributions or gifts were
not tax deductible? . . . 6 
7 Organizations that may receive deductible contributions under section 170(c). it? :1 
a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and .. mm
servrces prowded to the payor? 7 a
If 'Yes,? did the organization notify the donor of the value of the goods or servrces provrded? . . . . 7 
Did the organization sell, exchange, or othenivise dispose of tangible personal property for which it was requrred to ?le
.Form 8282? 7 
(1 If ?Yes,? indicate the number of Forms 8282 ?led during the year 7 dl 2., is ?gr gag;
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 bene?t contract? 7f 
If the organization received a contribution of quali?ed intellectual property, did the organization ?le Form 8899
as requrred? 7 
If the organization received a contribution of cars, boats. airplanes, or other vehicles, did the organization ?le a
Form 1098-0? 7 
8 Sponsoring organizations maintaining donor advised funds. Did a donor advrsed fund maintained by the sponsoring . m; :2 *1
organization have excess busmess holdings at any time during the year? 8
9 Sponsoring organizations maintaining donor advised funds. :twi @333 . 
a Did the sponsoring organization make any taxable distributions under section 4966? 9 a
Did the sponsoring organization make a distribution-to a donor, donor advrsor. or related person? 9 
10 Section 501(c)(7) organizations. Enter: 
a Initiation fees and capital contributions included on Part line 12 10a :5 
Gross receipts, included on Form 990, Part line 12, for public use of club facrlities 10b 5 g, a . 
11 Section 501(c)(12) organizations. Enter a V33: 3 :1
a Gross income from members or shareholders 11 a of. r.
Gross income from other sources (Do not net amounts due or paid to other sources 1 
against amounts due or received from them 11 3" 
12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization ?ling Form 990 in lieu of Form 1041? 12 a
If 'Yes,? enter the amount of tax-exempt interest received or accrued during the year I 12 bl 
13 Section 501(c)(29) quali?ed nonpro?t health insurance 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 requrred to maintain by the states in 
which the organization is licensed to issue quali?ed health plans . . . 13 
Enter the amount of reserves on hand 13 .
14a Did the organization receive any payments for indoor tanning servrces during the tax year? 143 
If 'Yes,? has it ?led a Form 720 to report these payments? If 'No,'prowde an explanation in Schedule 0 14b

 

 

 

 

8AA TEEA0105 10/12/15

Form 990 (2015)

 

Form 990 (2015) GRASSROOT INSTITUTE OF HAWAII, INC 99-0354 937 Pages
IPart Vliz?iyil 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 VI 

Section A. Governing?ody and Management

 

 

 

1 a Enter the number of voting members of the governing body at the end of the tax year 1 a
if there are material differences In voting rights among members
of the governing body, or if the governing body delegated broad
authority to an executive committee or committee, explain In Schedule 0.

Enter the number of voting members included In line 13, above, who are independent 1 
2 Did any of?cer, director, trustee, or key employee have a family relationship or a busmess 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? 3 
4 Did the organization make any Signi?cant changes to its governing documents
Since the prior Form 990 was ?led? 4 
5 Did the organization become aware during the year of a Signi?cant dwersnon of the organization's assets? 5 
6 Did the organization have members or stockholders? 6 
7 3 Did the organization have members, stockholders, or other persons who had the power to elect or appomt one or more
members of the governing body? 7 a 
Are any govemance deCI5ions of the organization reserved to (or subject to approval by) members,
stockholders, or persons other than the governing body? 7 
8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by 
the followmg .
a The governing body? 8 a 
Each committee With authority to act on behalf of the governing body? 8 
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, ?prowde the names and addresses in Schedule 0 9 
Section B. Policies (This Section requests information about policies not required by the Internal Revenue Code.)
Yes No
10 a Did the organization have local chapters, branches,?or af?liates? 1 0 a 
If 'Yes.? did the organization have written polities and procedures governing the activmes of such chapters. affiliates. and branches to ensure their
operations are consistent the organization's exempt purposes? 1 0 
11 a Has the organization prowded a complete copy of this Form 990 to all members of its governing body before filing the form? 11 a 
Describe in Schedule 0 the process, if any, used by the organization to reVIew this Form 990. mtg?? :ngj
12 3 Did the organization have a written con?ict of interest policy? If 'No,?go to line 13 12 a 
Were of?cers, directors, or trustees, and key employees requned to disclose annually interests that could give rise
to con?icts? 1 2 
Did the organization regularly and con5istently monitor and enforce compliance With the policy? If 'Yes,'descnbe in
Schedule 0 how this was done 1 2 
13 Did the organization have a wntten whistleblower policy? 13
14 Did the organization have a written document retention and destruction policy? 14 
15 Did the process for determining compensation of the followmg persons include a reVIew and approval by independent i, 5
persons. comparability data, and contemporaneous substantiation of the deliberation and VJ ?t 
a The organization?s CEO, Executive Director, or top management 15a 
Other of?cers or key employees of the organization 15 
If ?Yes? to line 15a or 15b, describe the process in Schedule 0 (see instructions) ?as; i2;
16a Did the organization invest in, contribute assets to, or partICIpate in a pint venture or Similar arrangement With a mix? a: 1::ng
taxable entity dunng the year? 
If 'Yes,? did the organization follow a written policy or procedure requmng the organization to evaluate Its g, if]:
partICIpation in iomt venture arrangements under applicable federal tax law, and take steps to safeguard the if 
organization's exempt status With respect to such arrangements? 
Section C. Disclosure
17 List the states with which a copy of this Form 990 Is-reqUired to be ?led ?13313; 5; 
18 Section 6104 reqwres an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501 only) available
for public inspection Indicate how you made these available Check all that apply.
Own webSIte El Another?s websne Upon request Other (explain in Schedule 0)
1 9 Describe in Schedule 0 whether (and it 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) 591-9193

 

BAA TEEA0106 10112115 Form 990 (2015)

 

 

 

Form 990(2015) GRASSROOT INSTITUTE OF HAWAII, INC 99-0354937 Page?
Compensation of Of?cers, 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
1 a Complete this table for all persons requ1red 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 organizatlon's current key employees, if any. See Instructions for de?nition of 'key employee 
0 List the organization's ?ve current highest compensated employees (other than an of?cer, 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
0 List all of the organization?s former of?cers, 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 organizatlon'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 indiVIdual trustees or directors. institutional tmstees, of?cers, key employees, highest compensated
employees, and former such persons

Check this box if neither the organization nor any related organization compensated any current of?cer, director, or trustee

(C)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A (B) (D) (E) (F)
Name and Title Average is both an of?cer and a Reportable Reportable Estimated
director/trustee) compensation from compensation from amount of other
#23 2 9; 3 2.1 
('35t any 9- 2 a :r 3 organization
hours for a a ,2 3 a) and related
olrglaart?ifzi- 3 3 organizations
tions 2 3
below 511 P.
clotted 
me) (D 
(.1). 3131451313. 9 '2 9 ?_59
CHAIRMAN 0 0. 0
?1?.le $7394. 15 $5915 _4 9 0
101,923. 0. 0.
JEL E11 :59
TREASURER 0. 0. 0.
ELLE Dis 
DIRECTOR 0. 0. 0.
I (9- 30.3} [2991313 9 -_09
0. 0. o.
BQBEBT. 9 -_09
DIRECTOR 0. 0. o. 0

J2) 
J3) 
L19) 
L11) 
L13) - 

(14)

 

 

 

 

 

 

 

 

 

 

 

BAA TEEA0107 10/12/15 Form 990 (2015)

 

 

me99000?0 GRASSROOT INSTITUTE OF HAWAII, INC

99-0354 937

Page 8

??aw?rtiylijISection A. Of?cers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(B) (C)

(A) Arverage t(,do notlchegks #331; thtz?iguone (D) (E) (F)
ours ox. un ess person is an rtabl rtabl 
Name and title veg" Of?cer and a director/trustee) compi?gationefrom 
(us. any 9. e. 2: s. 2.1 message, character?s? 
hours 9. '31 a 3 organIZation
for 9 c- 1,0, and related
same as g? 8 
- tions ?3 
below 54. 0 a)
dotted CD 9- 3
line) to $3 
8 .
XE) 
115).
(17)
(18)

(20)
(21)


(24)
BEL
1bSub-total 101,923, 0.
Total from continuation sheets to Part VII, Section A 
dTotal (addlines 1b and1c) 101,923_ . 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

 

3 Did the organization list any former of?cer, director, or tmstee, key employee, or highest compensated employee

on line 1a? If ?Yes, complete Schedule for such 

Yes No

 

 

 

 

 

 

 

 

 

 

 

 

4 For any individual listed on line 1a, IS the sum of reportable compensation and other compensation from 
the organization and related organizations greater than $150,000? If 'Yes'complete Schedule for - 
such individual 4 
5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or indIVIdual ?31) 3? 3
for sewices rendered to the organization? If ?Yes, complete Schedule for such person 5 
Section B. Indep_endent Contractors
1 Complete this table for your ?ve highest compensated independent contractors that received more than $100,000 of
compensation from the organization Report compensation for the calendar year ending With or Within the organization's tax year
(A) (B) (C)
Name and busrness address of serVices 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 TEEAO108 10/12/15

 


A 
A, I
?u?l 
c- . 
. ,wzwx 
?.lrwsu I

9 ?1 .154


Aw him-V1,, 

hit/??4

Form 990 (2015)

 

 

Form

990 (2015) GRASSROOT INSTITUTE OF HAWAII, INC
IPart Statement of Revenue

Check If Schedule 0 contains a response or note to any lIne In Part 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total revenue Related or Unrelated Revenue
7 a exempt busmess excluded from tax
11> functlon revenue under sectlons
revenue 512-514
3 . 
,2 1a Federated campaigns Membership dues 1b 6 k? a 1,
15$ Fundralsmg events 1 gz ii :5 g? 
Related orgamzatlons . . . . . 1d . 
?1 ?snag 5? It: A
Government grants (contnbullonsAll other contnbullons, gifts, grantsamounts not Included above . . Noncash contnbullons Included In l1nes 1a-1f .g a 1, $2
8 hTotal.Addlines1a-1f . . .. 4391251. a a a 
Busmoss Code 23,891. 23,891 All other program servuce revenue
I a 5w Ar' .. 
Total. Add lInes 2a-2f . 23, 891 . 3230? - . 53? .11? . gags/$331]
3 Investment Income (Including d1v1dends, Interest and
other amountsIncome from Investment of tax-exempt bond proceeds . . 
5 Royaltles. . . . .
(I) Real (II) Personal 6&2 ga? it?: $413: sagas?? rig/:5
'63 Gross rents g9 gss?gs. gt, 33Less: rental expenses Rental 1ncome or (loss). . 35 x? ?s rigs; ?9 301%
Net rental 1ncome or (loss) 
was 912's? so 
7a Gross amount from sales of (?gamma g? ?39% 3mg; ff" g; $5 3
assets other than inventory ~39 qA Eggs 1; mi
1 2? 2 331%?
Less cost or other ?1 a; a} I
and sales expenses . . 3% 2 1,51,;
1: Galn or (loss) itNet galn or (loss) 
:1 .1 w: 212M 
83 Gross Income from fundralsmg events 1 A: 1* 
(not Includlng. ?g as?: f? 
of contnbutlons reported on lune 1cSee Part IV, llne Less. dlrect expenses as g: '33 .1
5 Net Income or (loss) from fundralsmg events . 
9a Gross Income from gamlng 1? f; 3? ?31" g? 
See Part IV. lIne Less dlrect expenses 9, g? ,3 (E
1: Net Income or (loss) from gaming 
103 Gross sales of Inventory. less returns 2 3?
and allowances a a 1
Less cost of goods sold 
Net Income or (loss) from sales of Inventory 
M1scellaneous Revenue Buslness Code i
1 1 a 


All other revenue 
Total. Add Imes 11a-11d I
12 Total revenue. See Instructions BAA TEEAO109 10/12/15 Form 990 (2015)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 990 (2015) GRASSROOT INSTITUTE OF HAWAII, INC 99?0354 937 Page 10
[Part 1 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 not include amounts reported on lines Total expenses Pro
gram servrce Management and FundraISin

6b? Bb' and 10b of Part expenses general expenses expensesg

1 Grants and other aSSistance to domestic .. g; if: I) 1; 
organizations and domestic governments. a ?v ?f a 
See Part IV, line Grants and other aSSistance to domestic 3 g; is . t.
indIVIduals See Part IV. line 22 3., 13a 

3 Grants and other a55istance to foreign . {3 ?31" 53% .. g; a. .3 
organizations. foreign governments, and for- >5 (at .5 3; g,
eign indiVIduals See Part IV, lines Bene?ts paid to or for members 21;, . A

5 Compensation of current of?cers, directors,
trustees. and keyemployees 101,923. 91,823. 10,100 0,

6 Compensation not included above. to
disquali?ed persons (as de?ned under
section 4958(f)(1)) and persons descnbed
in section 4958(c)(3)(B) 

7 Othersalariesandwages 152,184. 137,825. 12.294. 2,065.

3 Pen5ion plan accruals and contributions
(include section 401 and 403(b)
employer contributions) 

9 Otheremployeebene?ts 20,071? 18,000. 2,071. O.

10 Payroll taxes 
11 Fees for sewices (non-employees)
a Management 
bLegaI 1,311. 933. 378. 0.
cAccounting 1,466. 366. 1,100_ 0.
Lobbying 
Prolessmnal fundraismg services See Part lV, line 17 . Eff I. 33.1% :?mggm .. j?fggl
Investment management fees 
9 Other (If line amount exceeds 10% of line 25, column
. . 62,332. 46,032. 10,300. 6,000.
12 Advertismg and promotion Of?ceexpenses 2,773, 930. 12343. 500.
14 Information technology 4, 524, 1, 889. 2, 635. 0.
15 Royalties 
16 Occupancy 35,353. 25,000_ 10,353? 0.
17 Travel 29,451. 25,255_ 4'135_ 61
18 Payments of travel or entertainment 
expenses for any federal, state, or local
public of?CIals 
19 Conferences. conventions, and meetings . . . Interest 2,691. 0. 2,691. 0.
21 Payments to af?liates 
22 DepreCIation, depletion, and amortization . . . Insurance 7,034. 3.034. 4,000. 0,
24 Other expenses Itemize expenses not 3 1? ?3 -. f. .Igcovered above (List miscellaneous expenses ., ?3 ?3 :13line 24e lf line 24e amount exceeds 10line 25, column (A) amount, list ltne 24e expenses on Schedule 0 1 
1.24.7 800 17- 430A
44 331 766- 1.246 2.319
25.917- 24.128 377 1.412
4.267 2.900 1.0114. 363
eAllotherexpenses 9,597. 54. 7,973. 1,570.
25 Totalfunctionalexpenses . 470, 188. 380,830. 74, 030. 15,328.

26 Joint costs. Complete this line only if

BAA

the organization reported in column (B)

10int costs from a combined educational
campaign and fundraismg solicitation.

Check here if followmg

SOP 98-2 (A80 958-720) 

 

 

 

 

10 10/12l15

 

Form 990 (2015)

 

 

 

Form 990(2015) GRASSROOT INSTITUTE OF HAWAII, INC 99?0354 937 page?
[Part ?ill 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 Savungs and temporary cash Investments 2 6 I 0 3O 
3 Pledges and grants receivable, net 3
4 Accounts receivableLoans and other receivables from current and former of?cers, directorstrustees ke em Io ees. and highest compensated employees. Complete 3" 33% i 3?
Part II of Sc edu?e 5
6 Loans and other receivables from other disquali?ed persons (as de?ned under his i a .32" 39:13: $551 . it? it
section 4958(f)(1)), persons described In section 4958(c)(3)(B), and contnbuting . ,6 i :11? if? i e, (i 
employers and sponsoring organizations of section 501(c)(9) voluntary employees a
bene?CIary organizations (see Instructions). Complete Part II of Schedule 6
.9 7 Notes and loans receivableInventories for sale or use 3
'9 Prepaid expenses and deferred charges 9
103 Land. bUIldIngs, and eqUIpment. cost or other gij": g? .j 92g
Complete Part VI of Schedule 103 4154 1 '59 gs" I ?i :2 1.th ?1111?1? 111111sz
Less accumulated depreCIation 10b 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 IV, line 11 15
16 Total assets. Add lines 1 15 (must equal line 34Accounts payable and accmed expenses Grants payable 13
19 Deferred revenue Tax-exempt bond liabilities 20
3 21 Escrow or custodial account liability Complete Part IV of Schedule i 21
22 Loans and other payables to current and former of?cers, directors, trustees, {$59313 ?:be 7V 2* {g
.9 key employees, highest compensated employees, and disquali?ed persons. Lea: mm m??m?wa? 2 a ?is Assam?.- -2 fast.?
3 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 25 
in Organizations that follow SFAS 117 (A80 958), check here Hand complete
8 lines 27 through 29, and lines 33 and 34. 
5 27 net assets 
23 Temporarily net assets 
'0 29 Permanently restricted net assets 
Organizations that do not follow SFAS 117 (A80 958), check here 
and complete lines 30 through 34.
30 Capital stock or trust pnnCIpal, or current funds 
3 31 Paid-in or capital surplus. or land, bUIlding. or eqUIpment fund 31
2 32 Retained earnings, endowment. accumulated Income, or other funds Total net assets or fund balances Total liabilities and net assets/fund balances . BAA Form 990 (2015)

TEEA0111 10/12/15

 

 

Form 990 (2015) GRASSROOT INSTITUTE OF HAWAII INC 99?0354 937 Page 12
IPart Reconciliation of Net Assets

C-heck If Schedule 0 contalns 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 line Net assets or fund balances at beglnnIng of year (must equal Part X, km 33, column Net unreallzed gaIns (losses) on Investments 5
6 Donated serVIces and use of faCIlIties 6
7 Investment expenses 7
8 Pnor penod 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 ?ms 3 through 9 (must equal Part X, We 33.
column 1o 10? 696. 
IPaI?t-?Xll??l Financial Statements and Reporting
Check If Schedule 0 contalns a response or note to any Me In thIs Part XII 
1 AccountIng method used to prepare the Form 990: .Cash EIAccrual DOther
If the organlzatlon changed Its method of from 3 mm year or checked ?Other,? explaIn
In Schedule 0.
2 a Were the organIzatIon's ?nancial statements complied or reVIewed by an Independent accountant? 
If 'Yes,? check a box below to IndIcate whether the ?nanCIal statements for the year were compiled or reVIewed on a
se arate baSIs, consolIdated baSIs. or both:
[j Separate baSlS DConsolIdated DBoth consolIdated and separate 
1-, Were the organIzatIon's ?nanCIal statements audited by an Independent accountant? 
If 'Yes,? check a box below to IndIcate whether the ?nanCIal statements for the year were audited on a separate
baSlS. consolidated baSIs. or both
Separate baSlS DConsolIdated DBoth consolIdated and separate basis
If 'Yes? to ?ne 2a or 2b, does the organizatlon have a that assumes responSIbIlIty for oversught of the audIt,
reVIew, or comleatIon of Its ?nancIal statements and selectIon of an Independent accountant? 2 
If the organlzatlon changed eIther Its process or selection process dunng the tax year, explaIn Wage 
Schedule result of a federal award. was the organIzatIon required to undergo an audIt or audIts as set forth In the SIngle
AudIt Act and OMB CIrcular 3 a 
If ?Yes.? dId the organIzatIon undergo the reqUIred audit or audIts? If the organization dId not undergo the reqmred audIt
or audIts, explaIn why In Schedule 0 and descnbe any steps taken to undergo such audits 3 
BAA Form 990 (2015) 

TEEA01 12 10/20/15

 

 

OMB No 15450047

2015

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.

SCHEDULE A
(Form 990 or SQO-EZ)

 

Attach to Form 990 or Form 990-EZOpen to?i?pubiict'

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

Department of the Treasury at irs gov lform990 
. . 

Internal Revenue Semce

 

 

 

Name of the organization Employer Identification number
GRASSROOT INSTITUTE OF HAWAII, INC 99-0354937
[Part I IReason 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 11. check only one box 
1 A church, convention of churches. or assocration of churches descnbed in section 
A school described in section (Attach Schedule (Form 990 or 990-EZ) 
A hospital or a cooperative hospital seNice organization described in section 
A medical research organization operated in conjunction With a hospital described in section Enter the hospital's
name, crty, and state. 

An organization operated for the bene?t of a college or univerSIty owned or operated by a governmental unit described in section
(Complete Part II.)

A federal, state. or local government or governmental unit described in section 

7 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 

 



8 A community trust described in section (Complete Part II 

9 An organization that normally receives (1) more than 33-1/3% of its support from contributions. membership fees, and gross receipts
from activmes related to its exempt functions subject to certain exceptions, and (2) no more than 33-1/3% 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 

10 An organization organized and operated excluswely to test for public safety See section 509(a)(4).
11 An organization organized and operated excluswely for the bene?t 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 11a through 11d that describes the type of supporting organization and complete lines 11e. 11f, and 119

a Type I. A supporting organization operated, supewised. or controlled by its supported organization(s). typically by givmg the supported
organization(s) the power to regularly appomt or elect a maionty of the directors or trustees of the supporting organization You must
complete Part IV, Sections A and B.

Type II. A supporting organization supervused 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 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.



0

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 requnrement and an attentiveness reqmrement (see
instructions) You must complete Part IV. Sections A and D, and Part V.

Check this box if the organization received a written detennination from the IRS that it is a Type I, Type II. Type functionally

integrated, or Type Ill non-functionally integrated supporting organization.
Enter the number of supported organizations
9 Prowde the followmg information about the supported organization(s)

 

 

 

 

 

 

 

 

 

(I) Name of supported (it) EIN (N) Is the Amount a! monetary (vl) Amount of oIJ'ier
organization organization listed support (see instructions) support (see 
in your governing
above (see instructions? document?it;
1 4?32,? 6 ii I I?ll,? It t; 
Total .1 a)

 

 

 

 

 

 

 

BAA For Paperwork Reduction Act Noti

ce, see the Instructions for Form 990 or 990-EZ.

TEEAO401 10/12/15

Schedule A (Form 990 or 2015

ScheduleAtForm 990 or 990-E2) 2015 GRASSROOT INSTITUTE OF HAWAII, INC 99?0354 937 Page2

 *Part=*ll ISupport 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 I or if the organization failed to qualify under Part If the
organization fails to qualify under the tests listed below, please complete Part Ill 

 

Section A. Public Support

 

Calendar year (or ?scal year
beginning in) 2011 2012 2013 2014 2015 Total
1 Gifts. grants, contributions. and
membership fees received Do not
include any 'unusual grants 

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

3 The value of seNices or
furnished by a
governmental unit to the
organization Without 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 . .

 

 

 

 

 

 

 

 

6 Public support. Subtract line 5
from line 4 

 

 

 

 

Section B. Total Support

Calendar year (or ?scal year
beginning in) 2011 2012 2013 2014 2015 Total

 

 

7 Amounts from line 4 

 

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

9 Net income from unrelated
busmess actiwties, whether or
not the busmess IS regularly -
carried on 

10 Other income. Do not Include
gain or loss from the sale of
capital assets (Explain In
Part VI 

 

 

 

.


 
   


w?
a.

gem
a%
wig?


11 Total support. Add lines 7 . Ll; {Iii ,v :gt? 
through 10 a. . assw?ss as 
12 Gross receipts from related activmes, 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 2015 (line 6. column diVided by line 11. column 14 
15 Public support percentage from 2014 Schedule A, Part II, line 14 15 

 

 

 

 

 

 

163 support test 2015. If the organization did not check the box on line 13, and line 14 is 33-1/3% or more, check this box
and stop here. The organization quali?es as a publicly supported organization 

33-1l3% support test 2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33?1/3% or more, check this box
and stop here. The organization quali?es as a publicly supported organization 

178 10%-facts-and-circumstances test - 2015. lfthe 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-crrcumstances' test, check this box and stop here. Explain in Part VI how
the organization meets the 'facts-and?CIrcumstances' test The organization quali?es as a publicly supported organization 

10%-facts-and-circumstances test 2014. If the organization did not check a box on line 13, 168, 16b, or 17a, and line 15 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-cwcumstances? test The organization quali?es as a publicly supported organization 
18 Private foundation. If the organization did not check a box on line 13. 16a, 16b, 173. or 17b, check this box and see instruotions 
BAA Schedule A (Form 990 or 990-EZ) 2015

TEEA0402 10112115

 

 

Schedule A (Form 990 or 990-E2) 2015 GRASSROOT INSTITUTE OF HAWAI I INC 99?0354 937 Page 3
tlSupport Schedule for Organizations Described in Section 509(a)(2)

only If you checked the box on line 9 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
Calendar year (or ?scal year beginning in) 2011 2012 2013 2014 2015 Total
1 Gifts, grants, contributions
and membership fees
received. (Do not include
any?unusualgrants) 173,852. 151,988. 304,597. 360,762. 439,251. 1,430,450.
2 Gross receipts from admis?
3ions, merchandise sold or
servrces performed, or faCIlitIes
furnished In any actIVIty that is
related to the organization's
tax-exemptpurpose 16,256. 12,124. 15,302. 17,264. 23,891. 84,837.
3 Gross receipts from actIVIties

that are not an unrelated trade
1 or busmess under section 513 .

4 Tax revenues leVIed for the
organlzation's bene?t and
either paid to or expended on
Its behalf 
5 The value of sewices or
furnished by a
governmental unit to the
organization Without charge. . 

6 Total.AddlInes1through5 -- 190,108. 164,112. 319,899. 378,026. 463,142. 1,515,287.

7 a Amounts Included on lines 1,
2, and 3 received from
dIsquaII?edpersons 42,283. 33,340. 66,468. 70,652. 68,635. 281,378.

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
fortheyear 18,500. 17,510. 49,386. 179,370. 21,035. 285,801.

cAddlines7aand7b - - -- 60,783. 50,850. 115,854. 250,022. 89,670. 567,179.

8 Public support. (Subtract line 2% 2&8 23; g; 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7cfromline6). . 948,108.
Section B. Total Support
Calendar year (or ?scal year beginning in) 2011 2012 2013 2014 2015 
1 9 190,108. 164,112. 319,899. 378,026. 463,142. 1,515,287.

 

10 a Gross Income from Interest, leldendS,
payments received on securitles loans,
rents, royalties and income from

I Similarsources 34. 3_ 11929_ 42. 2,008.

Unrelated business taxable
income (less section 511
taxes) from busmesses
achIred after June 30, 1975 . .

cAddlines10aand10b . . . . 34. 3. 1,929. 42. 2,008.
11 Net Income from unrelated busmess
actiwtles not Included In line 10b,
whether or not the busmess IS
regularly camed 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,
100.11.80d12-) 190,142. 164,115. 319,899. 379,955. 463,184. 1,517,295.
14 First ?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
15 Public support percentage for 2015 (line 8, column diVided by line 13, column 15 62 4 9 
16 Public support percentage from 2014 Schedule A. Part line 15 16 64 7 5 
Section D. Computation of Investment Income Percentage
17 Investment income percentage for 2015 (line 100, column lelde by line 13, column 17 0 . 1 3 
18 Investment Income percentage from 2014 Schedule A, Part line 17 18 0 1 3 
193 support tests 2015. If the organization did not check the box on line 14, and line 15 is more than and line 17
is not more than check this box and stop here. The organization quali?es as a publicly supported organization 
support tests 2014. If the organization did not check a box on line 14 or line 19a, and line 16 Is more than and
line 18 is not more than 33-1l3%, check this box and stop here. The organization quali?es as a publicly supported organization 
20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see Instructions 

 

BAA memos 10/12/15 Schedule A (Form 990 or 990-EZ) 201?s 

 

ScheduleMForm 990 or 990-E2) 2015 GRASSROOT INSTITUTE OF HAWAII, INC 99-0354 937 Page4
Part Supporting Organizations
(Complete only if you checked a box in line 11 on Part I. If you checked 11a of Part I, complete Sections
A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 110 of Part I, complete
Sections A, D, and E. if you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes No
1 Are all of the organization's supported organizations listed by name in the organizations governing documents? 1 7 i" i
If 'No, describe in Part VI how the supported organizations are desrgnated If de8ignated by class or purpose, descnbe 
the desrgnation If historic and contrnumg relationship, explain 1
2 Did the organization have any supported organization that does not have an IRS detemirnation of status under section 3: 331353"? 2%
509(a)(1) or If ?Yes,? explain in Part VI how the organization determined that the supported organization was *5 
descnbed in section 509(a)(1) or (2) 2

3 a Did the organization have a supported organization descnbed in section 501(c)(4), (5), or (6)9 If 'Yes,?answer I
and (0) below 3a
we?" 32>? 5 rs 
Did the organization con?rm that each supported organization quali?ed under section 501(c)(4), (5), or (6) and ig?ivasf?t gs 
satis?ed the public support tests under section 509(a)(2)? If 'Yes, 'descnbe In Part VI when and how the organization 
_made the determination 3b
3.23:; sun?s? 
Did the organization ensure that all support to such organizations was used exclusrvely for section 170(c)(2)(B) 5?3 LU Wt.
purposes? If 'Yes, explain in Part VI what controls the organization put in place to ensure such use 3?

 

 

4 a Was any supported organization not organized in the United States (?foreign supported organization)? If ?Yes' and
if you checked 11a or 11b in Part I, answer and (0) below 

 

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 the organization had such control and discretion despite being controlled

 

 

 

 

or supervrsed by or in connection its supported organizations 4b
use i 
Did the organization support any foreign supported organization that does not have an deterrnination under Em E: t3 5:
sections 501(c)(3) and 509(a)(1) or (2)9 If ?Yes, 'explain in Part VI what controls the organization used to ensure that ~31 .2322. 5332,1432
all support to the foreign supported organization was used exclusrvely for section 170(c)(2)(B) purposes 4c

 

5 a Did the organization add. substitute, or remove any supported organizations during the tax year? If ?Yes, answer 
and (0) below (if applicable) Also, provrde detail in Part VI, including the names and EIN numbers of the supported
organizations added, substituted, or removed, (ii) the reasons for each such action, the authority under the
organization?s organizmg document such action, and (iv) how the action was accomplished (such as by
amendment to the document) 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Substitutions only. Was the substitution the result of an event beyond the organization?s control? 5c
As 3l
6 Did the organization provrde support (whether in the form of grants or the provrsion of sewices or facrlities) to $0111? 
anyone other than its supported organizations, (ii) indIVIduals that are part of the chantable class bene?ted more of its supported organizations, or other supporting organizations that also support or bene?t one or more of 1
the ?ling organization's supported organizations? If ?Yes, 'provrde detail in Part VI 6
g??axgi}! 4
7 Did the organization provrde a grant, loan, compensation, or other srmilar payment to a substantial contributor its? (I
(de?ned in section a family member of a substantial contributor, or a 35% controlled entity With .41, a New-
regard to a substantial contributor? If ?Yes, complete Part I of Schedule (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 descnbed in line 7? If ?Yes,? st- ?331
complete Part I of Schedule (Form 990 or 8
9 a Was the organization controlled directly or indirectly at any time during the tax year by one or more disquali?ed persons lint?; ?33?3?
as de?ned in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or ?t "3 
If ?Yes, 'provrde detail in Part VI 93
Did one or more disquali?ed persons (as de?ned in line 9a) hold a controlling interest in any entity in which the 
supporting organization had an interest? If Yes/provrde detail in Part VI 9b
A 
Did a disquali?ed person (as de?ned in line 9a) have an ownership interest in, or derive any personal bene?t from, 1: I
assets in which the supporting organizatron also had an interest? If ?Yes,?provrde detail in Part VI So
103 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,? i -- -

 

answer 10b below . . 103

I) Did the organization, have any excess busrness holdings in the tax year? (Use Schedule C, Form 4720, to determine If 
whether the organization had excess busrness holdings.) 10b

BAA TEEA0404 10112/15 Schedule A (Form 990 or 990-EZ) 2015

 

 

 

 

 

 

 

Schedulg? (Form 990 or 990-E2) 2015 GRASSROOT INSTITUTE OF HAWAII INC 99?0354 937 Page 5
En Supporting Organizations (continued)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

. I Yes No
11 Has the organization accepted a gift or contribution from any of the followmg persons? 3 i
a 'Aperson who directly or Indirectly controls, either alone or together With persons described in and below, the 51", I?l?i?ih' i? 
governing body of a supported organization? 11a
A family member of a person described in above? 11b
A 35% controlled entity of a person descnbed In or above? If 'Yes' to a, b, or c, prowde 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 appomt ?is? 
or elect at least a maionty of the organlzation?s directors or trustees at all times during the tax year? If ?No, describe in ,5 3%
Part VI how the supported organization(s) effectively operated, supervrsed, or controlled the organization?s actiwties 2; Egva?, g;
If the organization had more than one supported organization, describe how the powers to appomt and/or remove 1% 
directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, 
applied to such powers during the tax year 1
. ?3533?, j? a 3s
2 Did the organization operate for the bene?t of any supported organization other than the supported organization(s) 3% I 
that operated, superwsed, or controlled the supporting organization? If 'Yes,'explain in Part VI how provrding such 23.3? ?3
bene?t carried out the purposes of the supported organization(s) that operated, supervrsed, or controlled the - *v - 
. supporting organization 2
Section C. Type II Supporting Organizations
Yes No
i ff?. w? git, -
1 Were a majority of the organizatIon?s directors or trustees during the tax year also a majority of the directors or trustees 39;: 9% Egan!
of each of the organization?s supported organization(s)? If ?No, describe in Part VI how control or management of the 
supporting organization was vested in the same persons that controlled or managed the suggorted organization(s) 1

 

 

Section D. All Type Supporting Organizations

 

1 Did the organization prowde to each of its supported organizations, by the last day of the ?fth month of the
organization?s tax year, a written notice descnbing the type and amount of support prowded dunng the pnor tax
year, (ii) a copy of the Form 990 that was most recently ?led as of the date of noti?cation. and copies of the
organization's governing documents in effect on the date of noti?cation, to the extent not preVIously prowded'7 

 

2 Were any of the organization?s of?cers. directors, or trustees either appomted or elected by the supported
organization(s) or (ii) servmg 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) 

 

 

3 By reason of the relationship described in (2). did the organization?s supported organizations have a Signi?cant
vouce in the organization?s Investment poliCIes and in directing the use of the organization?s income or assets at
all times during the tax year? If ?Yes, describe in Part VI the role the organization?s supported organizations played

in this regard 
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 organizatlon satis?ed the ActIVIties Test Complete line 2 below

The organization Is the parent of each of Its supported organizations. Complete line 3 below

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

 

 

 

 

 

 

 

 

 

 

2 ActIVIties Test. Answer and below. Yes No
its? $33:

a Did substantially all of the organization's actIVIties during the tax year directly further the exempt purposes of the 5: 2g; $15k1? 3; 
supported organization(s) to which the organization was responswe?7 If ?Yes, then in Part VI identify those supported me, 
Organizations and explain how these actiwties directly furthered their exempt purposes, how the organization was 1 33.1. E, t, 5,1,
responsrve to those supported organizations, and how the organization determined that these actiwties constituted 
substantially all of its activrties 2a

t, 3?

Did the actIVIties described in constitute actiwties that, but for the organization's involvement. one or more of 3 3% if A 
the organization's supported organization(s) would have been engaged in? If ?Yes,'explain in Part VI the reasons for Alt/.131? 
the organization's posrtion that its supported organization(s) would have engaged in these actiwties but for the 
organization?s involvement 2b

3 Parent of Supported OrganizatIons. Answer and below. 533:;

a Did the organization have the power to regularly appomt or elect a majority of the o?icers, directors, or trustees of 3?

each of the supported organizations? Prowde details in Part VI 3a

 

nv',,3
2?s 

 

the organization exerCIse a substantial degree of direction over the poIICIes, programs. and actIVIties of each of its
I supported organizations? If ?Yes, describe in Part VI the role played by the organization in this regard 3b

BAA . TEEA0405 10/12/15 Schedule A (Form 990 or 990-EZ) 2015

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

 

 

 

 

 

 

 

 

 

 

Schedule A (Form 990 or 990-E2) 2015 GRASSROOT INSTITUTE OF HAWAI I INC 9 9?0 354 937 Page a
Part IType Non-Functionally Integrated 509(a)(3) Supporting Organizations
1 Check here if the organization satisfied the Integral Part Test as a qualifying trust on November 20, 1970 See instructions. All
other Type non-functionally integrated supporting organizations must complete Sections A through E.
Section A Adjusted Net Income (A) Prior Year 
1 Net short-term capital gain 1
2 Recoveries of prior-year distributions 2
3 Other gross income (see instructions) 3
4 Add lines 1 through 3 4
5 Deprecnation and depletion 5
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) 6
7 Other expenses (see instructions) 7
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8
Section Minimum Asset Amount (A) Pnor Year 
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short Xi? a I mg 
tax year or assets held for part of year) pigAverage value of secunties 1 a -
Average cash balances 1 
Fair market value of other non-exempt-use assets 1 
Total (add lines 13, 1b. and 1c) 1 
Discount claimed for blockage or other
factors (explain in detail in Part VI):
2 AchIsmon indebtedness applicable to non-exempt-use assets 2
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 pnor?year distributions 7
8 Minimum Asset Amount (add line 7 to line 6) 8 
. ?33
Section Distributable Amount 1 83: Current Year
1 Adjusted net income for prior year (from Section A. line 8, Column A) 1 
2 Enter 85% of line 1 2 i?
3 Minimum asset amount for prior year (from Section B. line 6. Column A) 3
4 Enter greater of line 2 or line 3 4 
5 Income tax imposed in prior year 5 'f 
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency 
temporary reduction (see 6 
7 Check here if the current year is the organization's ?rst as a non-functionally?integrated Type supporting organization
(see instructions).
BAA Schedule A (Form 990 or 990-EZ) 2015

TEEA0406 

 

 

Schedule A (Form 990 or 990-52) 2015 GRASSROOT INSTITUTE OF HAWAI [Part IType Ill Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)
Section Distributions

1 Amounts paid to supported organizations to accomplish exempt purposes 

Page 7
Current Year

2 Amounts paid to perform actwity that directly furthers exempt purposes of supported organizations.
in excess of income from actiwty 

3 Administrative expenses paid to accomplish exempt purposes of supported organizations 
4 Amounts paid to acqmre exempt-use assets 
5 Quali?ed set-aSide amounts (prior IRS approval requrred) 
6 Other distributions (descnbe in Part VI) See instructions 
7
8

 

Total annual distributions. Add lines 1 through 6 -. 

Distributions to attentive supported organizations to.which the organization is responsrve (provrde details
in Part VI). See instructions 

Distributable amount for 2015 from Section C. line 6 

 

 

 

 

10 Line 8 amount diVided by Line 9 amount 
. . . "l . . 
Section Distribution Allocations (see instructions) Underdistributions Distributable
Distributions Pre-201 5 Amount for 201 5

Distributable amount for 2015 from Section C, line 6 f?fj?; 

2 Underdistnbutions. if any. for years prior to 2015 (reasonable a 
cause reqmred see instructions) 33%? 2? . 



 

 

3 Excess distnbutions carryover. if any, to 2015.

 

 

 

 

 

 

 

 

 

 

 

 

Applied to underdistnbutlons of prior years 

 

 

From 2013 . 

From 2014 

Total of lines 3a through 
9



Applied to 2015 distributable amount 
Carryover from 2010 not applied (see instructions) 
Remainder. Subtract lines 39, 3h, and Si from St 

4 Distributions for 2015 from Section D.
lane 7 .

3 Applied to underdistnbutions of prior years 

Applied to 2015 distnbutable amount 
Remainder Subtract lines 4a and 4b from 4 

 

 

 

 

 

he

 

 

 

 

 

 

 

5 Remaining underdistributions for years prior to 2015, if any.
Subtract lines 39 and 4a from line 2 (if amount greater than
zero. see instructions) 

 

6 Remaining underdistributions for 2015. Subtract lines 3h and 4b
from line 1 (if amount greater than zero, see instructions) 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7 Excess distributions carryover to 2016. Add lines Breakdown of line 7 3; u. 3? ?t fig?
6 Excess from 2013 
Excess from 2014 
Excess from 2015 3
BAA Schedule A (Form 990 or 990-EZ) 2015

TEEA0407 10112l15

 

 

Schedule A

l-l

 

(Form 990 or 990-E2) 2015 GRASSROOT INSTITUTE OF HAWAII. INC 99?0354 937 Pages
Su plemental Information. Provide the ex lanations required by Part ll, line 10; Part II, line 17a or 17b;Par1 Ill, line 12, Part IV,
Sec ion A, lines 1,113, 11b, and 11c, Part IV, Section B, Iinesl and 2, Part IV, Section C, line 1,

Part IV, Section D, lines 2 and 3, Part IV, Section E, lines 1c, 2a. 2b, Ba and 3b, Part V, line 1, Part V, Section B, line le, 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

TEEA0403 10/12/15 Schedule A (Form 990 or 2015

Schedule (Form 990) 2015

GRASSROOT INSTITUTE OF HAWAII,

INC

99-0354 937

Page 2

Organizations Maintaining Collections of Art, Historical Treasures, or 0ther_Similar Assets (continued)

3 Usmg the organization's achIsmon, accessmn, and other records, check any of the followmg that are a Signi?cant use of Its collection

Items (check all that apply)
a Public exhibition
Scholarly research
. Preservation for future generations

Other

 

cl Loan or exchange programs

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 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? 

rid

line 9, or reported an amount on Form 990, Part X, line 21.

Yes

EINO

?s?m Escrow and Custodial Arrangements. Complete if the organization answered 'Yes? on Form 990, Part IV,

 

1 a 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

DNO

 

 

 

 

 

 

 

 

Amount
6 Beginning balance 1 
Additions during the year . 1 
Distributions dunng the year 1 
Ending balance . . 1f
2 3 Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? Yes

If 'Yes,? explain the arrangement in Part Check here if the explanation has been prowded on Part 

Hm

 

IPaifteVi?l Endowment Funds. Complete if the organization answered ?Yes? on Form 990, Part IV, line 10.

 

Current year

Prior year

Two years back

Three years back

Four years back

 

1 a 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 PrOVide the estimated percentage of the current year end balance (line 19, column held as.

a Board deSignated or quaSi-endowment 
Permanent endowment 
Temporarily restricted endowment 








?o

The percentages on lines 2a. 2b, and 20 should equal 100%.

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

organization by:
unrelated organizations

(ii) related organizations 
If 'Yes? on line 3a(ii), are the related organizations listed as reqUIred on Schedule R9 

4 Describe in Part the intended uses of the organization?s endowment funds
Land, Buildings, and Equipment.
Complete if the organization answered ?Yes? on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

 

Yes No

 

3a(i)
3a(ii)
3b

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Description Of DFOPGITY Cost or other Cost or other Accumulated Book value
(investment) ba5is (other) de -reCIation
1 a Land 
BUIldings 
Leasehold improvements 
quUIpment 4,541. 2,638. 1,903.
Other 
Total. Add lines 1a through 1e. (Column must equal Form 990, Part X, column (B), line 10c) 1 . 90 3 
BAA Schedule (Form 990) 2015

TEEA3302

10112115

 

SCHEDULE 0
(Form 990 or 990-EZ)

Department of the Treasury
internal Revenue Semca

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to speci?c questions on
Form 990 or 990-EZ or to provide any additional information.

Information about Schedule 0 (Form 990 or 990-EZ) and its instructions is

Attach to Form 990 or 990-EZ.

at 

OMB No 1545-0047

2015

iw??f?3ww??m
ggen 
?inspection 

's
w. "it 


 

 

2-

i

 

(i

 

Name of the organlzatlon

GRASSROOT INSTITUTE OF HAWAII, INC

Pt VI, Llne 19
Pt XII, Line 2c

UPON REQUEST
LINE 28 SHOULD SAY NO SO THIS IS NOT APPLICABLE

 

 

Employer number

99-0354 937

 

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or TEEA4901

Schedule 0 (Form 990 or 990-52) (2015)