chapter 42f, hawaii revised statutes d ii) · community. the program intends to serve families in...

THE THIRTIETH LEGISLATURE APPLICATION FOR GRANTS

CHAPTER 42F, HAWAII REVISED STATUTES

Type of Grant Request:

D Operating Ii) Capital

Legal Name of Requesting Organization or Individual: Oba:

Living Way Church, Inc.

Amount of State Funds Requested: $_s_so_,o_o_o _____ _

Brief Description of Request (Please attach word document to back of page if extra space is needed):

PLANS, LAND ACQUISITION, DESIGN, CONSTRUCTION FOR CULTURAL, EDUCATIONAL AND COMMUNITY RESOURCE CENTER.

Amount of Other Funds Available:

State: $ ____________________ _

Federal : $ ____________________ _

County: $ ____________________ _

Private/Other: $ ____________________ _

New Service (Presently Does Not Exist): D Type of Business Entity:

l•l so1 (C)(3) Non Profit Corporation

D Other Non Profit

D Other

Total amount of State Grants Received in the Past 5 Fiscal Years:

$-0-

Unrestricted Assets:

$-0-

Existing Service (Presently in Operation): l•I

Mailing Address:

2005 Mokuhau Road

City: State:

Wailuku HI

Zip:

96793

Contact Person for Matters Involving this Application

Name: Title: Gregory Dela Cruz Pastor

Email: Phone: [email protected] (808)344-3679

State Tax ID#

~ Signature Name and Title

Gregory Dela Cruz, Pastor

Applicant: LIVING WAY CHURCH

Application for Grants

If any item is not applicable to the request, the applicant should enter "not applicable".

I. Certification - Please attach immediately after cover page

1. Certificate of Good Standing (If the Applicant is an Organization)

tf the applicant is an organization, the applicant shall submit one (1) copy of a certificate of good standing from the Director of Commerce and Consumer Affairs that is dated no earlier than December 1, 2018. -

2. Declaration Statement

The applicant shall submit a declaration statement affirming its compliance with Section 42F-103, Hawaii Revised Statutes. ( .. ;rJ\)

3. Public Purpose

The applicant shall specify whether the grant will be used for a public purpose pursuant to Section 42F-102, Hawaii Revised Statutes. C/r~J

n. Background and Summary

This section shall clearly and concisely summarize and highlight the contents of the request in such a way as to provide the State Legislature with a broad understanding of the request. Please include the following:

1. A brief description of the applicant1s background;

living Way Church Maui was established in 2004 intentionally in the area known as Happy Valley, Wailuku, Maui. Living Way Church Maui addresses the spiritual, cultural and historical needs of this distressed community. The Happy Valley Community is officially designated as a slum area, riddled with blight. This area is 1n the middle of f1Ve Hawaiian Homestead sites, more than 20 low income apartment buildings and three public housing projects. intergenerational families double and triple up to stay together and keep sheltered. Happy Valley is a densely populated, urban and rural area, and forgotten.

The Church remains committed to sharing the Gospel of Jesus Christ and the building up of His Church. We strive to accomplish this mission through our commitment to cultivate strong healthy families who have a sense of places a sense of purpose, and who know whom they are.

Rev 12/18/18 1 Application for Grants


Living Way Church provides a vast array of programs that benefit the Happy Valley Community including but not limited to family and cultural strengthening through classes. groups and mentoring; food distribution to families in need; jail reintegration mentoring; accountability referrals; and guidance to substance abuse referrals.

2. The goals and objectives related to the request;

Living Way Church has been given an opportunity to expand its outreach into the community by purchasing a six acre parcel in Kahakuloa, Maui, a ten minute distance from home base 399 N. Market St., Happy Valley. This parcel wm lead to the creation of nwahi Pana", a sacred place steeped in spiritual, cognitive, and cultural experiences as well as educational, Hawaiian history, and artistic development Participants, especially the community of Native Hawaiians, will arrive at a place in their lives where all can live peaceably in safety, practice healthy lifestyles, by accessing resources and preparing to succeed and enjoy learning Native Hawaiian culture and the arts.

Future projects at this site will include gardens producing food crops of significant value to the Hawaiian community; mentoring entrepreneurial developmen~ such as a poi kitchen where taro is ground and prepared into poi and/or for sale to support local farmers; a one-stop shop where families may receive assistance to various agencies and ministries without judgment; on the job training in food preparation, farming, heavy equipment operation and maintenance, and building maintenance.

3. The public purpose and need to be served; All projects and programs of living Way Church are open and available to the general public.

4. Describe the target population to be served; and It has been our experience that over the fifteen years Living Way Church has served the Happy Valley Community, 70% of the families that have sought benefits from the services we provide have been from the Native Hawaiian Community. The program intends to serve families in the low-income to moderate income brackets, the minority, people who work in low wage jobs, have large families and/or live on a fixed income of retirement or disability payments.

5. Describe the geographic coverage. This project will serve the entire Island of Maui.

m. Service Summary and Outcomes

The Service Summary shall include a detailed discussion of the applicant's approach to the request. The applicant shall clearly and concisely specify the results, outcomes, and measures of effectiveness from this request The applicant shall:

Rev 12/18118 2 Application for Grants

Applicant LIVING WAY CHURCH

1. Describe the scope of work, tasks and responsibilities;

Upon the award of grant funds1 payoff the property in full which will allow us to direct resources to create the "Wahi Pana".

2. Provide a projected annual timeline for accomplishing the resu1ts or outcomes of the service; SIXTY DAYS FROM RELEASE OF GRANT FUNDS

3. Describe its quality assurance and evaluation plans for the request. Specify how the applicant plans to monitor, evaluate, and improve their results; and NOT APPLICABLE

4. list the measure(s) of effectiveness that will be reported to the State agency through which grant funds are appropriated (the expending agency}. The measure{s} will provide a standard and objective way for the State to assess the program's achievement or accomplishment. Please note that if the level of appropriation differs from the amount included in this application that the measure(s) of effectiveness wm need to be updated and transmitted to the expending agency.

IV. Financial

Budget

1. The applicant shall submit a budget utilizing the enclosed budget forms as applicable, to detail the cost of the request

a. Budget request by source of funds (i:!ir·k) b. Personnel salaries and wages (;.-1::i:) c. Equipment and motor vehicles (i)nr<) d. Capital project details C..ini,:) e. Government contracts, grants, and grants in aid (1..Jrl!';)

2. The applicant shall provide its anticipated quarterly funding requests for the fiscal year 2020 .

.. Quarter 1 Quarter 2 Quarter 3 jQuarter4 Total Grant

550,000 I 550,000

3. The applicant shall provide a listing of all other sources of funding that they are seeking for fiscal year 2020. NOT APPLICABLE

4. The applicant shall provide a listing of all state and federal tax credits it has been granted within the prior three years. Additionally. the applicant shall provide a listing of all state and federal tax credits they have applied for or anticipate applying for pertaining to any capital project, if applicable. NOT APPLICABLE



5. The applicant shall provide a listing of all federal, state, and county government contracts, grants, and grants in aid it has been granted within the prior three years and will be receiving for fiscal year 2020 for program funding. NOT APPLICABLE

6. The applicant shall provide the balance of its unrestricted current assets as of December 31, 2018. SEE ATTACHED.

V. Experience and Capability

1. Necessary Skills and Experience - NOT APPLICABLE ··

The applicant shall demonstrate that it has the necessary skills, abilities, knowledge of, and experience relating to the request. State your experience and appropriateness for providing the service proposed in this application. The applicant shall also provide a listing of verifiable experience of related projects or contracts for the most recent three years that are pertinent to the request.

2. Facilities - NOT APPLICABLE

The applicant.shalt provide a description of Its facilities and demonstrate its adequacy in relation to the request. lf facilities are not presently available, describe plans to secure facilities.

Vt Personnel: Project Organization and Staffing

1. Proposed Staffing, Staff Qualifications, Supervision and Training - NOT APPLICABLE· GRANT Will BE USED TO PAY OFF PROPERTY,

The applicant shall describe the proposed staffing pattern and proposed service capacity appropriate for the viability of the request. The applicant shall provide the qualifications and experience of personnel for the request and shall describe its ability to supervise, train and provide administrative direction relative to the request.

2. Organization Chart - NOT APPLICABLE

The applicant shall illustrate the position of each staff and line of responsibility/supervision. If the request is part of a large, multi-purpose organization, include an organization chart that illustrates the placement of this request.

3. Compensation


DECLARATION STATEMENT OF APPLICANTS FOR GRANTS PURSUANT TO

CHAPTER 42F, HAWAI'I REVISED STATUTES

The undersigned authorized representative of the applicant certifies the following:

l) The applicant meets and will comply with all of the following standards for the award of grants pursuant to Section 42F-103, Hawai'i Revised Statutes:

a) ls licensed or accredited. in accordance with federal, state, or county statutes. rules.. or ordinances, to conduct the activities or provide the services for which a grant is awarded:

b) Complies with all applicable federal and state lav,,s prohibiting discl'imination against any person on the basis of race, color, national origin, religion., creed, sex, age., sexual orientation, or disability;

c) Agrees not to use state funds for entertainment or lobbying activities; and

d) Allows the state agency to which fonds for the grant were appropriated for expenditure, legislative committees and their staff. and the auditor full access to their records. reports, files, and other related documents and information for purposes of monitoring, measuring the effectiveness, and ensuring the proper expenditure of the grant.

2) If the applicant is an organization, the applicant meets the following requirements pursuant to Section 42f-103. Hawai'i Revised Statutes:

a) Ts incorporated under the laws of the State; and

b) Has bylaws or policies that describe the manner in which the activities or services for which a grant is awarded shall be conducted or provided.

3) Jf the applicant is a non-profit organization, it meets the following requirements pursuant to Section 42Fl 03. Hawai'i Revised Statutes:

a) Is detennined and designated to be a non-profit organi:zation by the [ntemal Revenue Service: and

b) Has a governing board whose members have no material conflict of interest and serve without compensation.

Pursuant to Section 42f-103, Hawai'i Revised Statutes, for grants used for the acquisition of land, when the organization discontinues the activities or services on the Jand acquired for which the grant was awarded and disposes of the land in fee simple or by lease, the organization shall negotiate with the expending agency for a lump sum or installment repayment to the State of the amount ofthe grant used for the acquisition of the land.

Further, the undersigned authori;red representative certifies that this statement is true and correct to the best of the applicant's knowledge.

Oregon: Dela Cruz (Typed Name)

Rev 1212/16

.--'-f-t /.;..=1 &II-).... 11-1---- ... _ ··-(Date)

Pastor (Title)

5 Application for Grants

Applicant LIVING WAY CHURCH

The applicant shall provide an annual salary range paid by the applicant to the three highest paid officers, directors, or employees of the organization by position title, not employee name.

VU. Other

1. litigationa NOT APPLICABLE.

The applicant shall disclose any pending litigation to which they are a party, including the disclosure of any outstanding judgement. If applicable, please explain.

2. licensure or Accreditation - NOT APPLICABLE.

The applicant shall specify any special qualifications, including but not limited to licensure or accreditation that the applicant possesses relevant to this request.

3. Private Educational Institutions - NOT APLICABLE.

The applicant shall specify whether the grant will be used to support or benefit a sectarian or non-sectarian private educational institution. Please see !·\:~tlc!e X. S·~cfa:i;". i ,< fr,:::. ;.::::.t,::o;~ r· . ....,,·,·:;;Fr: •-ri,"n for the relevance of this question '...(...., ~,... -.. :;} ~ ...... _.._ ...... ~.'.!,~ .. ~~..? • .:,...."':::.:~--cf..!~ ..

4. future Sustainability Plan

The applicant shall provide a plan for sustaining after fiscal year 2019-20 the activity funded by the grant if the grant of this app\ication is:

( a) Received by the applicant for fiscal year 2019-20, but

(b) Not received by the applicant thereafter.

If grant funds are not awarded, we wm continue to apply for grants and conduct future fundraising events.


BUDGET REQUEST BY SOURCE OF FUNDS Period: July 1, 2019 to June 30, 2020


BUDGET Total State Total Federal Total County CATEGORIES Funds Requested Funds Requested Funds Requested

(a) (b) (c)

A. PERSONNEL COST 1. Salaries 2. Payroll Taxes & Assessments

3. Fringe Benefits

TOTAL PERSONNEL COST

B. OTHER CURRENT EXPENSES

1. Airfare, Inter-Island 2. Insurance 3. Lease/Rental of Equipment 4. Lease/Rental of Space

5. Staff Training

6. Supplies

7. Telecommunication

8. Utilities

9 10 11 12 13

14 15

16 17 18 19 20

TOTAL OTHER CURRENT EXPENSES

C. EQUIPMENT PURCHASES

D. MOTOR VEHICLE PURCHASES

E. CAPITAL 550,000

TOTAL (A+B+C+D+E} 550,000

Budget Prepared By:

SOURCES OF FUNDING (a) Total State Funds Requested 550,000 Gregory Dela Cruz, Pastor

(b) Total Federal Funds Requested Name~ typ_!!r print)

(c) Total County Funds Requestec .,,(A,?) (d) Total Private/Other Funds Requested Signature OT"Authorized Official


TOTAL BUDGET 550,000 Name and Title (Please type or print)

6

Total Private/Other Funds Requested

(d)

65,000 20,000

10,000

95,000

7,000 20,000

15,000 300,000 20,000 10,000

20,000

13,000

405,000

25,000

25,000

550,000

(808) 344-3679

Phone

o,J,a/t, I Date


BUDGET JUSTIFICATION· PERSONNEL SALARIES AND WAGES Period: July 1, 2019 to June 30. 2020


!POSITION TITLE FULL TBME ANNUAL SALARY EQUIVALENT A

NOT APPLICABLE

-

---·

TOTAL:!

JUSTIFICATION/COMMENTS:

7

f)/oOF TIME ALLOCATED TO

GRANT REQUEST B

.

"


BUDGET JUSTIFICATION • PERSONNEL SALARIES ANO WAGES Period: July 1, 2019 to June 30, 2020

TOTAL STATE FUNDS REQUESTED

(Ax B)

L- -$ -$ -$ . $ -$ -$ -

~- -$ -$ -

$ -$ -

$ -$ -


BUDGET JUSTIFICATION .. EQUIPMENT AND MOTOR VEHICLES Period: July 1, 2019 to June 30, 2020


DESCRIPTION NO.OF COST PER TOTAL TOT.AL EQUIPMENT ITEMS ITEM COST !BUDGETED -

$ -NOT APPLICABLE $ -

$ -$ --$ ~

TOTAL:


DESCRIPTION NO.OF COST PER TOTAL TOT.Al. OF MOTOR VEHICLE VEHICLES VEHUCLE COST BUDGETED

$ -NOT APPLICABLE $ -

$ -$ -$ -

TOTAL:




TOTAL PROJECT COST

PLANS

LAND ACQUISITION

DESIGN

CONSTRUCTION

EQUIPMENT

TOTAL:

JUSTBFICATION/COIVIMENTS:

BUDGET JUSTIFICATION - CAPITAL PROJECT DETAILS Period: July 1, 2019 to June 30, 2020

FUNDING AMOUNT REQUESTED

OTHER SOURCES ALL SOURCES OF FUNDS STATE FUNDS OF FUNDS

RECEIVED IN PRIOR YEARS REQUESTED REQUESTED FY: 2017-2018 FY: 2018-2019 FY:2019-2020 IFY:2019-2020

50000

500000

550,000

9

FUNDING REQUIRED IN SUCCEEDING YEARS

FY:2020-2021 FY:2021-2022


GOVERNMENT CONTRACTS, GRANTS, AND I OR GRANTS IN AID

Applicant:LIVING WAY CHURCH

CONTRACT DESCRIPTION

1 ·2 . NOT APPLICABLf __ _

3 4 5 6 7 8 9 10 11 12 13 14;

' 15 i 1s·i ·· ·

I

17 i

18 19 20;

~1 I

22 i ... I 23: 24 · 25 26 27 28 29 30

I .... I

EFFECTIVE DATES

10

AGENCY

;

Contracts Total:

GOVERNMENT i

ENTITY ' (U.S. / State I Haw I

Hon I Kau I MS!!!L_:

I

; ... ~-· ~ ..


Department of Commerce and Consumer Affairs

CERTIFICATE OF GOOD STANDING

I, the undersigned Director of Commerce and Consumer Affairs of the State of Hawaii, do hereby certify that

LIVING WAY CHURCH MAUI, INC.

was incorporated under the laws of Hawaii on 07/12/2010; that it is an existing nonprofit corporation; and that, as far as the records of this Department reveal, has complied with all of the provisions of the Hawaii Nonprofit Corporations Act, regulating domestic nonprofit corporations.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of the Department of Commerce and Consumer Affairs, at Honolulu, Hawaii.

Dated: January 16, 2019

Director of Commerce and Consumer Affairs

To check the authenticity of this certificate, please visit: http:/ /hbe. ehawaii. gov I documents I authenticate. html Authentication Code: 314585-COGS_PDF-229880D2

· Business Start Date: 11/20/2005 STATE OF HAWAII

· DEPARTMENT OF TAXATION LICENSE tSSVEO FOR THE PRIVILEGE OF ENGAGING IN BUSINESS AND OTHER ACTIVITIES UPON THE CONomoN THAT THE UOENSEE SHALL PAY THE TAXES ACCRUING TO.THE STATE OF HAWAII UNDER '.fBE.-PROVfSIONS OF CHAPrER ~7. HRS, AS AMENDED. LICENSEE'S .ACTIVITIE:S ARE·t.1sTEO ON THE APPLICATION ON FILE WITH THE OIRECTOR OF TAXATION. . . : .

. GENERAL EXCISE TAX.LICENSE "HAWAIITAX1DNOMBER:W29936297~01 TM1$ U~IS N.01' TflAN$A:RABLE. . ,: . · : . TO SE DISPLAVEO OON$Pl~UOUSLY AT1'HE ·. , .. -uYINO WAY CHURCH MAUI . ~:SUED, ~=~ll<C

· twtt~O:FTAXATlON

..


CHAPTER42F, HAWAII REVISED STATUTES

Type of Grant Request

D Operating [II Capital

Legai Name of Requesting Organization or Individual: Oba:


Amount of State Funds Requested: $550,000 ~~-~----~ Brief Description of Request (Please attach word document to back of page if extra space is needed):

PLANS, LAND ACQUISITION, DESIGN, CONSTRUCTION FOR CULTURAL. EDUCATIONAL AND COMMUNITY RESOURCE CENTER.


State: $ ~----~~~~~~

Federal: $ __________ _

Counfy: $ __________ _

Private/Other: $ __________ _

New Service (Presently Does Not Exist): 0 Type of Business Entity:


D Other Non Profit

Oother


$-0-


$-0-

Existing Service (Presently in Operation): liJ Mailing Address:

2005 Mokuhau Road

City: State:

Wailuku HI

Zip:

96793


Name: Gregory Dela Cruz

Email: [email protected]

Federal Tax 10#:

47-1~

... Authorized Signature

Title: Pastor

Phone: (808)344-3679

State Tax ID# WZ.q13t,:J.q-=f-01


Name and Title Date Signed

To: State Capitol

From: Inez Okamura

Date 1/19/20

RE: GIA Grant

I submitted my grant application 1/18/20 and later discovered that some pages were

inadvertently omitted. I am writing to notify you of this and will mail the completed application

in full immediately.

Thank you for this opportunity to apply for the grant in our effort to serve the people of Maui.

~ Inez Okamura

Living Way Church Maui



ff any item is not applicable to the request, the applicant should enter "not applicable". I I. Certification - Please attach immediately after cover page

1. Certificate of Good Standing (If the Applicant is an Organization)

If the applicant is an organization, the applicant shall submit one (1) copy of a certificate of good standing from the Director of Commerce and Consumer Affairs that is dated no earlier than December 1, 2018.


The applicant shall submit a declaration statement affirming its compliance with Section 42F-103, Hawaii Revised Statutes. (link)

3. Public Purpose

The applicant shall specify whether the grant will be used for a public purpose pursuant to Section 42F-102, Hawaii Revised Statutes. (Link)

II. Background and Summary


1. A brief description of the applicant's background;

Living Way Church Maui was established in 2004 intentionally in the area known as Happy Valley, Wailuku, Maui. Living Way Church Maui addresses the spiritual, cultural and historical needs of this distressed community. The Happy Valley Community is officially designated as a slum area, riddled with blight. This area is in the middle of five Hawaiian Homestead sites, more than 20 low income apartment buildings and three public housing projects. Intergenerational families double and triple up to stay together and keep sheltered. Happy Valley is a densely populated, urban and rural area, and forgotten.

The Church remains committed to sharing the Gospel of Jesus Christ and the building up of His Church. We strive to accomplish this mission through our commitment to cultivate strong healthy families who have a sense of place, a sense of purpose, and who know whom they are.






was incorporated under,1the laws of Hawaii on 07/12/2010; that it is an existing nonprofit corporation; and that, as far as the records of this Department reveal, has complied with all of the provisions of the Hawaii Nonprofit Corporations Act, regulating domestic nonprofit corporations.


Dated: October 02, 2018

Director of Commerce and Consumer Affatrs

To check the authenticity of this certificate, please visit: http: I /hbe. ehawaii. gov I documents/ authenticate. html Authentication Code: 314585-COGS_PDF-229880D2

Business Start Date: 11/20/2005 STATE OF HAWAII

DEPARTMENT OF TAXATION

FORMG-44A (REV. 2001)

LICENSE ISSUED FOR THE PRIVILEGE OF ENGAGING IN BUSINESS AND OTHER ACTIVITIES UPON THE CONDITION THAT THE LICENSEE SHALL PAY THE TAXES ACCRUING TO THE STATE OF HAWAII UNDER THE PROVISIONS OF CHAPTER 237, HRS, AS AMENDED. LICENSEE'S ACTIVITIES ARE LISTED ON THE APPLICATION ON FILE WITH THE DIRECTOR OF TAXATION.

GENERAL EXCISE TAX LICENSE THIS LICENSE IS NOT TRANSFERABLE. TO BE DISPLAYED CONSPICUOUSLY AT THE PLACE OF BUSINESS FOR WHICH ISSUED.

94J41, Kurt Kawafuchi, DlRECTOROF TAXATION

HAW All TAX ID NUMBER: W29936297-01

LIVING WAY CHURCH MAUI LIVING WAY CHURCH MAUL INC. 2005 MOKUBAU RD STE 101 W AILUKU HI 96793-1118

INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201

Date: HAR O 9 zats

LIVING WAY CHURCH MAUI INC 2005 MOKUHAU RD WAILUKU, HI 96793

Dear Applicant:

DEPARTMENT OF THE TREASURY

Employer Identification Number: 47-1043756

DLN: 17053002369035

Contact Person: SIRIJUN MAYI ID# 31449

Contact Telephone Number: (877) 829-5500

Accounting Period Ending: December 31

Public Charity Status: "· ·"'.l:'iO{b,( li"CA')--C-,,- --· Form 990 Required:

No Effective Date of Exemption:

July 12, 2010 Contribution Deductibility:

Yes · Addendum Applies:

No

-- ...... -_ ...

We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are .exempt from Federal income tax under section 50l(c)(3) of the Internal.Revenue Code. Contributions to you are deductible under section 170 of the Code ... You are also qualified to receive tax deductible bequests, devises. transfers or gi~s under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records.

Organizations exempt under section 501(c)(3) of the -Code are further classified as either public·charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this

----1-et--Ft-er • - - c ·, ----·-. __ ..,.,.,,......_,,._.c--•=c~- '• ,~-----""'"""·--··:"" C,_ "

For important information about your responsibilities as a tax-exempt organization, .go to WNw. irs.gov/charities .. Enter "4221-PC" in the search bar to view Publication 4221-PC. Compliance Guide for 501(c)(3) Public Charities. which describes your recordkeeping, reporting, and disclosure requirements.

Sincerely,

fa,; . ..; £~-~J Director. Exempt.Organizations

. Letter 947


CHAPTER 42F, HA WAI'I REVISED STATUTES

The undersigned authorized representative oftbe applicant certifies the following:

1) The applicant meets and wi1I comply with all of the following standards for the award of grants pursuant to Sectfon 42F-103, Hawai'i Revised Statutes:

a) Is licensed or accredited. in accordance with federal_ state, or county statutes, rules... or ordinances, to conduct the activities or provide the services for which a grant is awarded:

b) Complies \\ith all applicable federal and state laws prohibiting discrimination against any person on the basis of race, color, national origin, religion, creed, sex, age, sexual orientation, or disability;

c} Agrees not to use state funds for entertainment or lobbying activities; and

d) Allows the state agency to which funds for the grant were appropriated for expenditure, legislative committees and their staff. and the auditor full access to their records, reports, files, and other reiated documents and information for purposes of monitoring, measuring the effectiveness, and ensuring the proper expenditure of the grant.

2) If-the applicant is an organization, the applicant meets the following requirements pursuant to Section 42F-103. Hawai'i Revised Statutes:

a) !s incorporated under the laws of the State: and


3) If the applicant is a non-profit organization, it meets the foHowing requirements pursuant to Section 42Fl03. Hawai'i Revised Statutes:

a) ls detennined and designated to be a non-profit organization by the Internal Revenue Service: and

b) Has a governing board whose members have no material connict of interest and serve without compensation.

Pursuant to Section 42F-103, Hawai'i Revised Statutes, for grants used for the acquisition of land, when the organization discontinues the activities or services on the land acquired for which the grant was awarded and disposes of the land in fee simple or by lease, the organization shall negotiate with the expending agency for a lump sum or installment repayment to the State of the amount ofihe grant used for the acquisition of the land.

Further, the undersigned authorized representative certifies that this statement is true and correct to the best of the applicant1s knowledge.

-~t /,_,_I&'-'-/ .......... f df ________ _ {Date)

Gregon: Dela Cruz Pastor (Typed Name_) (Title)



CHAPTER 42F, HAWAI'I REVISED STATUTES

The undersigned authotized representative of the applicant certifies the following:

l) The applicant meets and v,,m comply with an of the foHowing standards for the award of grants pursuani to Section 42F-103, Hawai'i Revised Statutes:

a) ls licensed or accredited, in accordance with federal, state, or county statutes, rules, or ordinances, to conduct the activities or provide the services for which a grant is awarded;

b) Complies with all applicable federal and state laws prohibiting discrimination against any person on the basis of race, col01", national origin, religion, creed, sex, age, sexual orientation, or disability;

c) Agrees not to use state funds for entertainment or lobbying activities; and

d) Allows the state agency to which funds for the grant were appropriated for expenditure, legislative committees and their staff. and the auditor full access to their records, reports, files, and other related documents and information for purposes of monitoring, measuring the effectiveness, and ensuring the proper expenditure of the grant.

2) If the applicant is an organization, the applicant meets the following requirements pursuant to Section 42F-103, Hawai'i Revised Statutes:

a) [s incorporated under the laws of the State; and


3) If the applicant is a non-profit organization, it meets the following requirements pursuant to Section 42Fl 03, Hawai'i Revised Statutes:

a) Is detennined and designated to be a non-profit organization by the Internal Revenue Service: and

b) Has a governing board whose members have no material conflict of interest and serve ,vithout compensation.

Pursuant to Section 42F-103, Hawai'i Revised Statutes, for grants used for the acquisition of land, when the organization discontinues the activities or services on the land acquired for which the grant was awarded and disposes of the 1and in fee simple or by lease, the organization shall negotiate with the expending agency for a lump sum or installment repayment to the State of the amount of the grant used for the acquisition of the land.

Further, the undersigned authorized representative certifies that this statement is true and correct to the best of the applicant's knowledge.

Gregonr Dela Cruz Pastor (Typed Name) (Title)



Living Way Church provides a vast array of programs that benefit the Happy Valley Community including but not limited to family and cultural strengthening through classes, groups and mentoring; food distribution to families in need; jail reintegration mentoring; accountability referrals; and guidance to substance abuse referrals.

2. The goals and objectives related to the request;

living Way Church has been given an opportunity to expand its outreach into the community by purchasing a six acre paircel in Kahakuloa, Maui, a ten minute distance from home base 399 N. Market St., Happy Valley. This parcel wm lead to the creation of "Wahi Pana", a sacred place steeped in spiritual, cognitive, and cultural experiences as well as educational, Hawaiian history, and artistic development. Participants, especially the community of Native Hawaiians, wm arrive at a place in their lives where all can live peaceably in safety, practice healthy lifestyles, by accessing resources and preparing to succeed and enjoy learning Native Hawaiian culture and the arts.

Future projects at this site will include gardens producing food crops of significant value to the Hawaiian community; mentoring entrepreneurial development, such as a poi kitchen where taro is ground and prepared into poi and/or for sale to support local farmers; a one-stop shop where families may

. receive assistance to various agencies and ministries without judgment; on the job training in food preparation, farming, heavy equipment operation and maintenance, and building maintenance.

3. The public purpose and need to be served; All projects and programs of Living Way Church are open and available to the general public.

4. Describe the target population to be served; and It has been our experience that over the fifteen years Living Way Church has served the Happy Valley Community, 70% of the families that have sought benefits from the services we provide have been from the Native Hawaiian Community. The program intends to serve families in the low-income to moderate income brackets, the minority, people who work in low wage jobs, have large families and/or live on a fixed income of retirement or disability payments.

5. Describe the geographic coverage. This project will serve the entire Island of Maui.

m. Service Summary and Outcomes

The Service Summary shall include a detailed discussion of the applicant's approach to the request. The applicant shall clearly and concisely specify the results, outcomes, and measures of effectiveness from this request. The applicant shall:


I

/

,/·-. ..

.133.3 oa I = JI,?Ni I :nv JS ---------~:----~·----· :--"'"••••• .. HJ;/ON 3i1HJ.

·.-1; ~-:·. i

·._\-~. ..... •\

\ ', i

..

I. ,-1••' _,..-· _ ....... _.,,.

-~

·ii·

\

I I

,:,D

< ~ 'l':

r-< < r=.:

E-::r ~

~~ ~ --.; ~ .._,,.,

z ~

i' < C r-.

z '"-i

ii': ..... '.::) -_;

~ ,Y:, ::,:::: < i3:: > ......

,-. < ~ :.::::'.'. c:::i -'I: ~ ..,...

:::, ~ JJ c:,

...--.. >;:P ~-__.. . 1-,-L._"""\

c..._-.,.) \ '\ <. I .

~~ "' ..-:::-<

\ '

" ~

< ?;:

::: --..._ ::;:

:::; ;:; ~

::: 72 <

k:: i-

~ ;-'l.

... ..._~::::, ---' ~-.


1. Describe the scope of work, tasks and responsibilities;

Upon the award of grant funds, payoff the property in full which wm allow us to direct resources to create the 0 Wahi Pana".

2. Provide a projected annual timeline for accomplishing the results or outcomes of the service; SIXTY DAYS FROM RELEASE OF GRANT FUNDS

3. Describe its quality assurance and evaluation plans for the request. Specify how the applicant plans to monitor, evaluate, and improve their results; and NOT APPUCABLE

4. List the measure(s) of effectiveness that will be reported to the State agency through which grant funds are appropriated (the expending agency). The measure(s) will provide a standard and objective way for the State to assess the program's achievement or accomplishment. Please note that if the level of appropriation differs from the amount included in this application that the measure(s) of effectiveness will need to be updated and transmitted to the expending agency.

IV. Financial

Budget

1. The applicant shall submit a budget utilizing the enclosed budget forms as applicable, to detail the cost of the request.

a. Budget request by source of funds (i..ir;k) b. Personnel salaries and wages {U::i-:) c. Equipment and motor vehicles (1-:iDU d. Capital project details (__l..)ni1:)

e. Government contracts, grants, and grants in aid G-.lcl,;)

2. The applicant shat! provide its anticipated quarterly funding requests for the fiscal year 2020.

-· Quarter 1 Quarter 2 Quarter 3 !Quarter 4 I Total Grant

550,000 1 !550,000

3. The applicant shall provide a listing of all other sources of funding that they are seeking for fiscal year 2020. NOT APPUCABLE

4. The applicant shall provide a listing of all state and federal tax credits it has been granted within the prior three years. Additionally, the applicant shall provide a listing of all state and federal tax credits they have applied for or anticipate applying for pertaining to any capital project, if applicable. NOT APPLICABLE




6. The applicant shall provide the balance of its unrestricted current assets as of December 31, 2018. SEE ATIACHED.


1. Necessary Skills and Experience - NOT APPLICABLE

The applicant shall demonstrate that it has the necessary skills, abilities, knowledge of, and experience relating to the request. State your experience and appropriateness for providing the service proposed in this application. The applicant shall also provide a listing of verifiable experience of related projects or contracts for the most recent three years that are pertinent to the request.

2. Facilities - NOT APPLICABLE

The applicant shalfrprovide a description of its facilities and demonstrate its adequacy in relation to the request. If facilities are not presently available, describe plans to secure facilities.

VI. Personnel: Proiect Organization and Staffing

1. Proposed Staffing, Staff Qualifications, Supervision and Training - NOT APPLICABLE - GRANT Will BE USED TO PAY OFF PROPERTY,

The applicant shall describe the proposed staffing pattern and proposed service capacity appropriate for the viability of the request. The applicant shall provide the qualifications and experience of personnel for the request and shall describe its ability to supervise, train and provide administrative direction relative to the request.

2. Organization Chart - NOT APPLICABLE


3. Compensation




VII. Other

1. litigation- NOT APPLICABLE.


2. Licensure or Accreditation - NOT APPLICABLE.


3. Private Educational Institutions - NOT APUCABLE.

The applicant shall specify whether the grant will be used to support or benefit a sectarian or non-sectarian private educational institution. Please see Article X. Section i, of the State Constitution for the relevance of this question.

4. Future Sustainability Plan

The applicant shall provide a plan for sustaining after fiscal year 2019-20 the activity funded by the grant if the grant of this application is:

(a) Received by the applicant for fiscal year 2019-20, but


If grant funds are not awarded, we will continue to apply for grants and conduct future fundraising events.




6. The applicant shall provide the balance of its unrestricted current assets as of December 31, 2018. SEE ATTACHED.


1. Necessary Skills and Experience a NOT APPLICABLE ··

The applicant shall demonstrate that it has the necessary skills, abilities, knowledge of, and experience re\ating to the request. State your experience and appropriateness for providing the service proposed in this application. The applicant shall also provide a listing of verifiable experience of related projects or contracts for the most recent three years that are pertinent to the request.

2. Faemties - NOT APPLICABLE

The applicant shall provide a description of its facilities and demonstrate its adequacy in relation to the request. If facilities are not presently available, describe plans to secure facilities.

Vt Personnel: Project Organization and Staffing

1. Proposed Staffing, Staff Qualifications, Supervision and Training - NOT APPLICABLE O GRANT Will BE USED TO PAY OFF PROPERTY,

The applicant shalt describe the proposed staffing pattern and proposed service capacity appropriate for the viability of the request. The applicant shall provide the qualifications and experience of personnel for the request and shall describe its ability to supervise, train and provide administrative direction relative to the request.

2. Organization Chart a NOT APPLICABLE


3. Compensation




VU. Other

1. litigation~ NOT APPLICABLE.


2. Licensure or Accreditation ~ NOT APPLICABLE.


3. Private Educational Institutions ~ NOT APUCABLE.

The applicant shall specify whether the grant will be used to support or benefit a sectarian or non-sectarian private educational institution. Please see ,bfride )(_Section -1 .. of.the, State Constitution for the relevance of this question.

4. Future Sustainability Plan

The applicant shall provide a plan for sustaining after fiscal year 2019-20 the activity funded by the grant if the grant of this application is:

(a) Received by the applicant for fiscal year 2019-20, but


If grant funds are not awarded, we wm continue to apply for grants and conduct future fundraising events.


BUDGET REQUEST BY SOURCE OF FUNDS Period: July 1, 2019 to June 30, 2020


BUDGET Total State Total Federal Total County

CATEGORIES Funds Requested Funds Requested Funds Requested (a) (b) (c)

A. PERSONNEL COST

1. Salaries

2. Payroll Taxes & Assessments

3. Fringe Benefits

TOTAL PERSONNEL COST

B. OTHER CURRENT EXPENSES .

1 . Airfare, Inter -Island

2. Insurance

3. Lease/Rental of Equipment

4. Lease/Rental of Space

5. Staff Training

6. Supplies

7. Telecommunication

8. Utilities

9 10

11

12

13

14

15

16

17

18

19

20

TOTAL OTHER CURRENT EXPENSES

C. EQUIPMENT PURCHASES

D. MOTOR VEHICLE PURCHASES

E. CAPITAL 550,000

TOTAL (A+B+C+D+E) 550,000

Budget Prepared By:

SOURCES OF FUNDING (a) Total State Funds Requested 550,000 Gregory Dela Cruz, Pastor

(b} Total Federal ·Funds Requested Name <1)3.se type or print) - ~

(c) Total County Funds Requestec '-. I 7»r - _, I

(d) Total Private/Other Funds Requested Signafilre drJl.uthorized Official


TOTAL BUDGET 550,000 Name and Title (Please type or print)

6

Total Private/Other

Funds Requested (d)

65,000

20,000

10,000

95,000

7,000

20,000

15,000

300,000

20,000

10,000

20,000

13,000

405,000

25,000

25,000

550,000

(808) 344-3679

Phone

OlftR /1q I DE!te


BUDGET JUSTIFICATION - PERSONNEL SALARIES AND WAGES Period: July 1, 2019 to June 30, 2020

Applicant: LIVING WAY CHURCH.

POSITION TITLE

NOT APPLICABLE

TOTAL:


FULL TIME EQUIVALENT

7

ANNUAL SALARY A

%0FTIME ALLOCATED TO

GRANT REQUEST B


BUDGET JUSTIFICATION - PERSONNEL SALARIES ANO WAGES Period: July 1, 2019 to June 30, 2020

TOTAL STATE FUNDS REQUESTED

(Ax B)

$ -$ -$ -

$ -$ -

$ -$ -

$ -

$ -$ -$ -

$ -$ -$ -


BUDGET JUSTIFICATION - EQUIPMENT AND MOTOR VEHICLES Period: July 1, 2019 to June 30, 2020


DESCRIPTION NO.OF COST PER TOTAL EQUIPMENT ITEMS ITEM COST

$ NOT APPLICABLE $

$

$

$

TOTAL:


DESCRIPTION NO.OF COST PER TOTAL OF MOTOR VEHICLE VEHICLES VEHICLE COST

$

NOT APPLICABLE $

$

$

$

TOTAL:


8

TOTAL BUDGETED

----

-

TOTAL BUDGETED

----

-



TOTAL PROJECT COST

PLANS

LAND ACQUISITION

DESIGN

CONSTRUCTION

EQUIPMENT

TOTAL:


BUDGET JUSTIFICATION - CAPITAL PROJECT DETAILS Period: July 1, 2019 to June 30, 2020

FUNDING AMOUNT REQUESTED

OTHER SOURCES ALL SOURCES OF FUNDS STATE FUNDS OF FUNDS

RECEIVED IN PRIOR YEARS REQUESTED REQUESTED

FY: 2017-2018 FY: 2018-2019 FY:2019-2020 FY:2019-2020

50000

500000

550,000

9

FUNDING REQUIRED IN SUCCEEDING YEARS

FY:2020-2021 FY :2021-2022


GOVERNMENT CONTRACTS, GRANTS, AND I OR GRANTS IN AID

Applicant:LIVING WAY CHURCH

CONTRACT DESCRIPTION

1 2 NOT APPLICABLE 3 4

---···· --······-·-----··-·

7 8 9

10 11 12·,

13 14 15

_. _____ ·---·-·--·-·· 16 17 18 19 20 21 22 23 24 25 26

I --··-------- •.. ,..~ . ····-·-· ··-··-·--·---·--···

-'--·--------··--27 2a·1-- ·-2s t··- ---~ 30 i"

EFFECTIVE DATES

·· I~----

-+----·-·-

··-··· -I -

10

AGENCY

/--

Contracts Total:

GOVERNMENT ENTITY

(U.S. / State I Haw I · Hon I Kau I Mau) ·

r····.=--~•···--, . -----···

-1- ·- --------·-;

·-----+

---f---1 I ··-----·

i

i

I ···- .. - ··--·-···--·-···--!



CHAPTER42F, HAWAH REVISED STATUTES

Type of Grant Request:

D Operating [II Capital

Legai Name of Requesting Organization or Individual: Oba:


Amount of State Funds Requested: $ 550,ooo -------~-Brief Description of Request (Please attach word document to back of page if extra space is needed):

PLANS, LAND ACQUISITION, DESIGN, CONSTRUCTION FOR CULTURAL, EDUCATIONAL AND COMMUNITY RESOURCE CENTER.


State: $ __________ _

Federal: $ __________ _

County: $ __________ _

Private/Other: $. __________ _

New Service (Presently Does Not Exist): 0 Type of Business Entity:


0 Other Non Profit

Oother


$-0-


$-0-

Existing Service (Presently in Operation): [ii

Mailing Address:

2005 Mokuhau Road

City: State:

Wailuku HI

Zip:

96793


Name: Gregory Dela Cruz

Email: [email protected]

Federal Tax ID#: 47:1:& Authorized Signature

Title: Pastor

Phone: (808)344-3679


Name and Title Date Signed



If any item is not applicable to the request, the applicant should enter "not applicable". I I. Certification - Please attach immediately after cover page

1. Certificate of Good Standing (If the Applicant is an Organization}

If the applicant is an organization, the applicant shall submit one (1) copy of a certificate of good standing from the Director of Commerce and Consumer Affairs that is dated no earlier than December 1, 2018.


The applicant shall submit a declaration statement affirming its compliance with Section 42F-103, Hawaii Revised Statutes. (Link)

3. Public Purpose

The applicant shall specify whether the grant will be used for a public purpose pursuant to Section 42F-102, Hawaii Revised Statutes. (Lio_~)

II. Background and Summary


1. A brief description of the applicant's background;

Living Way Church Maui was established in 2004 intentionally in the area known as Happy Valley, Wailuku, Maui. Living Way Church Maui addresses the spiritual, cultural and historical needs of this distressed community. The Happy Valley Community is officially designated as a slum area, riddled with blight. This area is in the middle of five Hawaiian Homestead sites, more than 20 low income apartment buildings and three public housing projects. Intergenerational families double and triple up to stay together and keep sheltered. Happy Valley is a densely populated, urban and rural area, and forgotten.

The Church remains committed to sharing the Gospel of Jesus Christ and the building up of His Church. We strive to accomplish this mission through our commitment to cultivate strong healthy families who have a sense of place, a sense of purpose, and who know whom they are.






was incorporated under the laws of Hawaii on 07/12/2010; that it is an existing nonprofit corporation; and that, as far as the records of this Department reveal, has complied with all of the provisions of the Hawaii Nonprofit Corporations Act, regulating domestic nonprofit corporations.


Dated: October 02, 2018

Director of Commerce and Consumer Affatrs

To check the authenticity of this certificate, please visit: http: I /hbe. ehawaii. gov I documents I authenticate. html Authentication Code: 314585-COGS_PDF-229880D2

Business Start Date: 11/20/2005 STATE OF HAWAII

DEPARTMENT OF TAXATION

FORMG-44A (REV. 2001)

LICENSE ISSUED FOR THE PRIVILEGE OF ENGAGING IN BUSINESS AND OTHER ACTIVITIES UPON THE CONDITION THAT THE LICENSEE SHALL PAY THE TAXES ACCRUING TO THE STATE OF HAWAII UNDER THE PROVISIONS OF CHAPTER 237, HRS, AS AMENDED. LICENSEE'S ACTIVITIES ARE LISTED ON THE APPLICATION ON FILE WITH THE DIRECTOR OF TAXATION.

GENERAL EXCISE TAX LICENSE THIS LICENSE IS NOT TRANSFERABLE. TO BE DISPLAYED CONSPICUOUSLY AT THE

PtA?}Z)::;;H.ISffiJffi Kurt Kawafuchi, DlRECTOR OF.TAXATION

HAWAil TAX ID NUMBER: W29936297-0l

LIVING WAY CHURCH MAUI LIVING WAY CHURCH MAUI, INC. 2005 MOKUHAU RD STE 101 WAILUKU HI %793-1118

INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201

Date: HM o 9 2015

LIVING WAY CHURCH MAUI INC 2005 MOKUHAU RD WAILUKU, HI 96793

Dear Applicant:

DEPARTMENT OF THE TREASURY

Employer Identification Number: 47-1043756

DLN: 17053002369035

Contact Person: SIRIJUN MAYI ID# 31449

Contact Telephone Number: (877) 829-5500

Accounting Period Ending: December 31

Public Charity Status: - -"1:iO{b;( 11(AJ(rr------·-.-----...,.--,---·0"

Form 990 Required: No

Effective Date of Exemption: July 12. 2010

Contribution Deductibility: Yes ·

Addendum Applies: No

We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are .exempt from Federal income tax under section 50l(c)(3) of the Internal.Revenue Code. Contributions to you are deductible under section 170 of the Code .. You are also qualified to receive tax deductible bequests, devises. transfers or gi~s under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status. you should keep it in your permanent records.

Organizations exempt under section 501(c)(3) of the ·Code are further classified as either public·charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this

---le-t-+-tei-"' O •------------•·-·-·· ... ' -- •·, . -~-·-•-•= ,_ WO -- WC-<---...;··c·- ·,.. ·-•

For important information about your responsibilities as a tax-exempt organization •. go to IIMW.irs.gov/charities ... Enter "4221-PC" in the search bar to view Publication 4221-PC. Compliance Guide for 501(c)(3) Public Charities. which describes your recordkeeping, reporting, and disclosure requirements.

Sincerely.

7-,,:.,v A7~ Director. Exempt.Organizations

Letter 947

chapter 42f, hawaii revised statutes d ii) · community. the program intends to serve families in...

Documents