2024-03-05T17:21:58-06:00 2022-12-31 205325889 ACCUITY LLP 999 BISHOP STREET STE 1900 HONOLULU HI 96813 990 2022-01-01 990246999 HAWAII DENTAL SERVICE FOUNDATION HAWA 8085211431 900 FORT STREET MALL SUITE 1900 HONOLULU HI 968133705 DIANE SL PALOMA PHD VICE PRESIDENT 8085211431 2024-02-22 1 DIANE SL PALOMA PHD 999009999 1 X RACHEL C ANTAL P01263071 8085313400 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z X MASON SAVAGE 900 FORT STREET MALL SUITE 1900 HONOLULU HI 968133705 16663470 0 X N/A X 1986 HI TO PROMOTE THE GENERAL WELFARE OF THE COMMUNITY AND ADVANCE HEALTH AND ORAL HYGIENE 7 7 0 0 0 0 0 1800000 0 0 4798801 2851230 0 0 4798801 4651230 1701995 1320991 0 0 287573 369408 0 0 0 187997 197176 2177565 1887575 2621236 2763655 64165492 52984817 42921 47464 64122571 52937353 X TO PROMOTE AND ENCOURAGE THE BETTERMENT OF THE GENERAL HEALTH AND WELFARE OF THE PEOPLE OF THE COMMUNITY AND ADVANCE RESEARCH, EDUCATION, STUDY AND LEARNING IN THE HEALTH AREAS SUCH AS DENTISTRY, ORAL HYGIENE AND RELATED SERVICE. (SEE SCHEDULE O). 0 0 1718343 1320991 DURING 2022, HDSF DISTRIBUTED $1,320,991 TO 12 ORGANIZATIONS WHO HAVE PROGRAMS IN PLACE TO SUPPORT ORAL HEALTH INITIATIVES IN HAWAII. SEE SCHEDULE I FOR ADDITIONAL DETAILS. 1718343 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 3 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X QUIN OGAWA 8085211431 900 FORT STREET MALL SUITE 1900 HONOLULU HI 968133705 MASON A SAVAGE DDS CHAIR 1.00 1.00 X 0 0 0 CHARLES R SUGIYAMA DDS VICE CHAIR 1.00 1.00 X 0 0 0 KERIANN ERNST DIRECTOR 1.00 1.00 X 0 0 0 DAVID K TODANI DIRECTOR 1.00 1.00 X 0 0 0 ALLISON P TRAN DDS DIRECTOR 1.00 1.00 X 0 0 0 EMI ENO ORIKASA DDS PRESIDENT 1.00 1.00 X X 0 0 0 KAIMANA GOO-RAHTZ DMD DIRECTOR (EFFECTIVE 7/1/22) 1.00 1.00 X 0 0 0 SHERELEE SANEISHI-KIM SECRETARY 34.00 6.00 X 0 143440 77899 CHERYL TAKITANI-SMITH TREASURER (UNTIL 1/15/22) 1.00 41.00 X 0 150899 102223 DIANE SL PALOMA PHD VICE PRESIDENT 1.00 41.00 X 0 334323 42579 CARA NUMASAKI INTERIM TREASURER (1/15/22-6/22/22) 1.00 41.00 X 0 169092 48287 QUIN OGAWA TREASURER (EFFECTIVE 6/22/22) 1.00 41.00 X 0 132959 3842 MARK YAMAKAWA VICE PRESIDENT (UNTIL 11/22/21) 1.00 41.00 X 0 536260 5495 0 1466973 280325 0 1 1 0 0 1800000 1800000 828614 828614 14034856 12012240 2022616 2022616 2022616 4651230 0 0 2851230 1320991 1320991 368908 345699 23209 500 500 7749 7749 61127 61127 32664 32664 1805 1805 28862 28862 10288 10288 11744 11744 3083 3083 ORAL HEALTH 38282 38282 MISCELLANEOUS 902 902 MEALS AND ENTERTAINMENT 670 670 1887575 1718343 169232 0 529985 1923054 63634735 51060649 772 1114 64165492 52984817 42921 47464 42921 47464 X 64122571 52937353 64122571 52937353 64165492 52984817 X 2763655 -13969659 20786 X X 0 1 X 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 HAWAII CHILDREN'S ACTION NETWORK 850 RICHARDS STREET SUITE 201 HONOLULU HI 96813 943257650 501(C)(3) 15000 0 FUNDING FOR OUTREACH AND EDUCATION TO INCREASE DENTAL VISITS DURING COVID-19 AMERICAN HEART ASSOCIATION INC 7272 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)(3) 164920 0 FUNDING TO ADDRESS HYPERTENSION, PROVIDE RESOURCES AND REFERRALS TO PATIENTS WHO NEED FURTHER ASSISTANCE, AND MEET PEOPLE WHERE THEY ARE. FRIENDS OF THE FUTURE 64-1032 MAMALAHOA HIGHWAY 311 KAMUELA HI 96743 990296604 501(C)(3) 20786 0 FUNDING TO LEVERAGE TWO-WAY PREVENTIVE TEXT MESSAGING PLATFORM TO PROMOTE EARLY ORAL HEALTH AND COORDINATE CARE FOR FAMILIES IN NEED OF TREATMENT. TARGET PREGNANT WOMEN AND INFANTS/TODDLERS AND THEIR FAMILIES. MOLOKAI OHANA HEALTH CARE INC 30 OKI PLACE KAUNAKAKAI HI 96748 510437659 501(C)(3) 149988 0 FUNDING TO PROVIDE ENHANCED ACCESS TO DENTAL CARE, EDUCATION, AND SPECIALTY ORAL CARE TO THE UNDERSERVED RESIDENTS ON THE ISLAND OF MOLOKAI. NATIONAL FOUNDATION OF DENTISTRY FOR THE HANDICAPPED 1800 15TH ST STE 100 DENVER CO 80202 900292578 501(C)(3) 20000 0 FUNDING TO ASSIST OLDER ADULTS, PEOPLE LIVING WITH DISABILITIES AND THOSE WHO ARE MEDICALLY FRAGILE BY LINKING THEM WITH VOLUNTEER DENTISTS WILLING TO PROVIDE DESPERATELY-NEEDED DENTAL TREATMENT FOR FREE UNIVERSITY OF HAWAII FOUNDATION - AREA HEALTH EDUCATION CENTER (AHEC) LOAN PO BOX 11270 HONOLULU HI 96828 990085260 501(C)(3) 300000 0 FUNDING TO THE UNIVERSITY OF HAWAII FOR THE HAWAII INNOVATIVE LOAN REPAYMENT PROGRAM FOR DENTISTS AND DENTAL HYGIENISTS WHICH IS ADMINISTERED BY AHEC. UNIVERSITY OF HAWAII FOUNDATION - HAWAII KEIKI PO BOX 11270 HONOLULU HI 96828 990085260 501(C)(3) 133447 0 FUNDING FOR HAWAII KEIKI - HDS DENTAL SEALANT PROGRAM WAIMANALO HEALTH CENTER 41-1347 KALANIANAOLE HWY WAIMANALO HI 96795 990273205 501(C)(3) 500000 0 FUNDING TO SUPPORT NEW DENTAL EXPANSION CLINICS. FORM 990, SCHEDULE I THERE IS A FORMAL PROCESS FOR APPLICANTS TO REQUEST GRANTS OF $5,000 OR MORE FROM THE FOUNDATION. APPLICANTS NEED TO SUBMIT GRANT PURPOSE, PROPOSED BUDGET FOR GRANTS, AND PROOF OF TAX-EXEMPT STATUS. AT THE END OF THE YEAR, APPLICANTS WHO RECEIVED GRANTS ARE REQUIRED TO SUBMIT A REPORT OF HOW THE GRANT WAS SPENT. REQUESTS FOR GRANTS ARE REVIEWED BY THE DIRECTOR OF THE HDS FOUNDATION AND VICE PRESIDENT AND SUBMITTED TO THE BOARD OF DIRECTORS FOR APPROVAL. EFFECTIVE SEPTEMBER 2021, THE BOARD OF DIRECTORS APPROVED A SECOND WAY FOR NON-PROFIT ORGANIZATIONS TO RECEIVE GRANTS LESS THAN $5,000. THE SMILE FUND GRANTS CAN BE REQUESTED AT ANY TIME DURING THE YEAR AND DOES NOT REQUIRE BOARD APPROVAL. THE HDS FOUNDATION DIRECTOR HAS THE DISCRETION TO FUND THE NON-PROFIT OR NOT DEPENDING ON EVALUATION OF THE ORGANIZATION'S GRANT APPLICATION. 0 0 0 0 0 0 0 0 0 MARK YAMAKAWA VICE PRESIDENT (UNTIL 11/22/21) 0 283260 0 253000 0 0 0 4561 0 934 0 541755 0 0 DIANE SL PALOMA PHD VICE PRESIDENT 0 330000 0 0 0 4323 0 24348 0 18231 0 376902 0 0 CHERYL TAKITANI-SMITH TREASURER (UNTIL 1/15/22) 0 51335 0 99564 0 0 0 100937 0 1286 0 253122 0 0 SHERELEE SANEISHI-KIM SECRETARY 0 121150 0 22290 0 0 0 64637 0 13262 0 221339 0 0 CARA NUMASAKI INTERIM TREASURER (1/15/22-6/22/22) 0 135875 0 33217 0 0 0 34894 0 13393 0 217379 0 0 PART I, LINE 3 THE FOUNDATION DOES NOT PAY COMPENSATION TO ITS DIRECTORS OR OFFICERS. COMPENSATION FOR OFFICERS REPORTED IS FOR A RELATED ORGANIZATION, HAWAII DENTAL SERVICE (HDS). HDS CEO AND OFFICER COMPENSATION IS DETERMINED BASED ON ADVICE FROM AN INDEPENDENT COMPENSATION CONSULTANT WHICH IS PRESENTED TO AND APPROVED BY HDS BOARD OF DIRECTORS COMPENSATION COMMITTEE AND DOCUMENTED IN THE MINUTES. PERIODICALLY AN INDEPENDENT CONSULTANT IS HIRED TO REVIEW THE COMPENSATION FOR MANAGEMENT AND STAFF POSITIONS. COMPENSATION FOR THESE POSITIONS ARE APPROVED ANNUALLY BY THE PRESIDENT/CEO AND EXECUTIVES. FORM 990, PART I & PART III, LINE 1 ORGANIZATION'S MISSION STATEMENT THE OVERALL EXEMPT PURPOSE OF HAWAII DENTAL SERVICE FOUNDATION, AS A VEHICLE FOR HAWAII DENTAL SERVICE, IS TO PROMOTE THE WELFARE OF THE COMMUNITY AND TO CONTRIBUTE TO THE CHARITABLE AND HEALTH ISSUES OF THE COMMUNITY. TO PROMOTE AND ENCOURAGE THE BETTERMENT OF THE GENERAL HEALTH, INCLUDING BUT NOT LIMITED TO MEDICAL AND DENTAL HEALTH, OF THE PUBLIC FOR THE COMMON GOOD AND GENERAL WELFARE OF THE PEOPLE OF THE COMMUNITY. TO PROMOTE AND ADVANCE RESEARCH, EDUCATION, STUDY AND LEARNING IN THE HEALTH AREAS SUCH AS THE FIELD OF DENTISTRY, ORAL HYGIENE AND RELATED SCIENCES. TO ESTABLISH, CONDUCT, MAINTAIN, SPONSOR AND PROMOTE STUDIES OF COMMUNITY HEALTH, SUCH AS MEDICAL AND DENTAL NEEDS, STATISTICAL STUDIES OF GENERAL HEALTH, SUCH AS MEDICAL AND DENTAL, REQUIREMENTS OF THE POPULOUS AND TO INVESTIGATE AND CONDUCT PROGRAMS PROVIDING GENERAL HEALTH, SUCH AS MEDICAL AND DENTAL CARE OVER A BROAD AREA. FORM 990, PART IV, LINE 12B AUDITED FINANCIAL STATEMENTS FOR THE ORGANIZATION ARE INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF HAWAII DENTAL SERVICE, HAWAII DENTAL SERVICE FOUNDATION, AND HAWAII CLIENT SERVICE CORPORATION, FOR THE YEAR ENDED DECEMBER 31, 2022. THE AUDIT COMMITTEE OF HAWAII DENTAL SERVICE, WHICH CONSISTS OF BOARD MEMBERS, SELECTS THE AUDITORS AND REVIEWS THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. FORM 990, PART VI, SECTION A, LINE 6 DESCRIPTION OF MEMBERS MEMBERS OR DIRECTORS OF THE HAWAII DENTAL SERVICE FOUNDATION ARE: -LIMITED TO INDIVIDUALS WHO SERVE AS DIRECTORS OF HAWAII DENTAL SERVICE -ALSO THE GOVERNING BODY OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A DESCRIBE CLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL & TYPE OF VOTING RIGHTS THE HDS FOUNDATION MEMBERSHIP, WHICH IS COMPRISED OF THE MEMBERS OF THE HAWAII DENTAL SERVICE BOARD OF DIRECTORS, ANNUALLY SETS THE NUMBER (CANNOT BE LESS THAN THREE) AND ELECTS THE DIRECTORS TO SERVE ON THE HAWAII DENTAL SERVICE FOUNDATION BOARD OF DIRECTORS FOR THE ENSUING YEAR. FORM 990, PART VI, SECTION B, LINE 11B DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE RETURN IS THOROUGHLY REVIEWED BY THE CONTROLLER OF HAWAII DENTAL SERVICE PRIOR TO FINAL REVIEW WITH THE TREASURER AND VICE PRESIDENT OF HDS FOUNDATION. A COPY OF THE FORM 990 IS PROVIDED TO THE DIRECTORS FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST PURSUANT TO THE HAWAII DENTAL SERVICE COMPANIES CONFLICTS OF INTEREST POLICY, DIRECTORS ARE PROVIDED WITH THE CONFLICTS OF INTEREST POLICY AND ARE REQUIRED TO SUBMIT A CONFLICTS OF INTEREST DISCLOSURE STATEMENT AND CERTIFICATION ANNUALLY. DIRECTORS ARE NOT ALLOWED TO PARTICIPATE IN DELIBERATIONS OR VOTE ON ISSUES/TRANSACTIONS WHICH THEY HAVE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 PROCESS FOR DETERMINING COMPENSATION THE FOUNDATION DOES NOT PAY COMPENSATION TO ITS DIRECTORS OR OFFICERS. COMPENSATION FOR OFFICERS REPORTED IS FOR A RELATED ORGANIZATION, HAWAII DENTAL SERVICE (HDS). HDS CEO AND OFFICER COMPENSATION IS DETERMINED BASED ON ADVICE FROM AN INDEPENDENT COMPENSATION CONSULTANT WHICH IS PRESENTED TO AND APPROVED BY HDS BOARD OF DIRECTOR'S COMPENSATION COMMITTEE AND DOCUMENTED IN THE MINUTES. COMPENSATION FOR MANAGEMENT AND STAFF POSITIONS ARE EVALUATED AND DETERMINED BASED ON EMPLOYERS COUNCIL SURVEYS AND APPROVED BY THE PRESIDENT/CEO AND EXECUTIVES ANNUALLY. FORM 990, PART VI, SECTION C, LINE 18 RETURNS ARE AVAILABLE ON OTHER WEBSITES SUCH AS GUIDESTAR. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF REQUIRED DOCUMENTS: TAX RETURNS AND OTHER REQUIRED DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: NEST FOR FAMILIES - A PROGRAM OF MULTIPLIER - RETURN OF UNUSED GRANT MONEY GIVEN IN 2021 20,786. FORM 990, PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR. FORM 990, PART VII, LINE 13 IN NOVEMBER OF 2021 MARK YAMAKAWA STEPPED DOWN AS PRESIDENT AND CEO OF HDS (VICE PRESIDENT OF HDSF). IN 2022 HE REMAINED ON AS A FULL-TIME EMPLOYEE TO AID THE TRANSITION OF DIANE S.L. PALOMA AS THE INCOMING PRESIDENT AND CEO OF HDS (VICE PRESIDENT OF HDSF) UNTIL HIS RETIREMENT IN FEBRUARY, 2022. THEREAFTER, HE SERVED AS AN INDEPENDENT CONTRACTOR THROUGH JUNE 30, 2022. HE HAS BEEN MARKED AS FORMER OFFICER IN THE CURRENT YEAR AS HE WAS NOT AN OFFICER OR PRESIDENT OF HDS OR HDSF AT ANY TIME DURING THE 2022 CALENDAR YEAR. AMENDED - SCHEDULE J, PART II, COLUMN C: UPON SUBSEQUENT REVIEW OF THE RETURN IT WAS NOTED THAT THE ACTUARIAL INCREASE IN THE DEFINED BENEFIT PLAN WAS INADVERTENTLY NOT INCLUDED IN THE DEFERRED COMPENSATION REPORTED IN PART VII AND SCHEDULE J. THE COMPANY IS AMENDING THE RETURN TO PROPERLY REFLECT THOSE AMOUNTS AND HAS ADDED EXTRA SAFEGUARDS TO THEIR TAX REVIEW PROCESS TO ENSURE THAT THE AMOUNT IS PROPERLY REPORTED IN THE FUTURE. HAWAII DENTAL SERVICE 900 FORT STREET MALL SUITE 1900 HONOLULU HI 968133705 990107971 DENTAL PLAN PROVIDER HI 501(C)(4) N/A N/A 0 HAWAII CLIENT SERVICES CORPORATION 900 FORT STREET MALL SUITE 1900 HONOLULU HI 968133705 452740308 ADMIN SERVICES HI HAWAII DENTAL SERVICE C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 HAWAII DENTAL SERVICE O 365299 CASH HAWAII DENTAL SERVICE P 1022346 CASH HAWAII DENTAL SERVICE C 1800000 CASH