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 990107971 HAWAII DENTAL SERVICE HAWA 8085211431 900 FORT STREET MALL SUITE 1900 HONOLULU HI 968133705 DIANE SL PALOMA PRESIDENT/CEO 8085211431 2024-02-13 1 DIANE SL PALOMA 999009999 1 X RACHEL C ANTAL P01263071 8085313400 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z X DIANE SL PALOMA 900 FORT STREET MALL SUITE 1900 HONOLULU HI 968133705 352199250 0 X WWW.HAWAIIDENTALSERVICE.COM X 1962 HI PROMOTE BETTERMENT OF MEDICAL & DENTAL HEALTH OF THE PUBLIC FOR THE GENERAL WELFARE OF THE COMMUNITY 15 10 160 10 3385 2146 0 0 240591065 243490397 13279546 6892080 1609034 2002618 255479645 252385095 4701838 3187021 201330186 202348257 14383828 13520418 0 0 0 11408272 12611943 231824124 231667639 23655521 20717456 358953785 357056921 39749580 43579579 319204205 313477342 X SEE SCHEDULE O. 0 0 217743763 3187021 240584197 HAWAII DENTAL SERVICE (HDS) OFFERS AND ADMINISTERS DENTAL CARE PROGRAMS TO ABOUT 693,000 INDIVIDUALS THROUGHOUT THE STATE OF HAWAII. AS A MEMBER OF THE DELTA DENTAL PLANS ASSOCIATION, A NATIONAL ASSOCIATION SUPPORTING DELTAS NATION-WIDE, HDS SUBSCRIBERS ARE ABLE TO ACCESS DELTA CONTRACTED PROVIDERS IN EVERY STATE. IN 2022, HDS PROCESSED OVER 1.2 MILLION CLAIMS FOR SUBSCRIBERS AND THEIR DEPENDENTS. TO ENSURE PROVIDERS ARE SUBMITTING CLAIMS APPROPRIATELY, HDS CONTINUALLY AUDITS CLAIMS TO REDUCE COMMON ERRORS. IN ADDITION, HDS AWARDED $3.1 MILLION IN GRANTS TO OTHER CHARITABLE ORGANIZATIONS. 1818479 0 2906200 MANAGING THE DENTAL BENEFITS OF ELIGIBLE BENEFICIARIES COVERED BY THE STATE OF HAWAII MED-QUEST PROGRAM. 219562242 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 1 1 1 0 1 4125 0 160 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X QUIN OGAWA 8085211431 900 FORT STREET MALL SUITE 1900 HONOLULU HI 968133705 SHAKIL AHMED DIRECTOR 1.00 X 0 0 0 CHARLES R SUGIYAMA DDS VICE CHAIR 1.00 1.00 X X 0 0 0 TYLER KIMURA DIRECTOR 1.00 X 0 0 0 DAVID K TODANI DIRECTOR 1.00 1.00 X 0 0 0 MARTIN OISHI DDS DIRECTOR 1.00 X 0 0 0 MASON A SAVAGE DDS CHAIR 1.00 1.00 X X 0 0 0 EMI ENO ORIKASA DDS PRESIDENT 1.00 1.00 X X 0 0 0 ALLISON P TRAN DDS DIRECTOR 1.00 1.00 X 0 0 0 JOHN R BLACK DDS DIRECTOR 1.00 X 0 0 0 KEVIN S HASEYAMA DIRECTOR 1.00 X 0 0 0 KERIANN ERNST DIRECTOR 1.00 1.00 X 0 0 0 EMMIT A KANE VICE CHAIR 1.00 1.00 X X 0 0 0 T KIMO BLAISDELL VICE CHAIR 1.00 X X 0 0 0 NELSON KM LAU DIRECTOR 1.00 X 0 0 0 NONA TAMANAHA DIRECTOR 1.00 X 0 0 0 KAIMANA GOO-RAHTZ DMD DIRECTOR (EFFECTIVE 7/1/22) 1.00 1.00 X 0 0 0 CHERYL TAKITANI-SMITH TREASURER & CFO (THROUGH 1/15/22) 40.00 2.00 X 150899 0 102223 THOMAS DELANEY ASSIST. SEC. & CIO (THROUGH 4/1/22) 40.00 1.00 X 180120 0 77099 CARA NUMASAKI INTERIM CFO/TREASURER (1/15/22-6/22/22) 40.00 2.00 X 169092 0 48287 MINNA-MARI LEHTI SECRETARY & COO 40.00 1.00 X 346817 0 108277 DIANE SL PALOMA PHD PRESIDENT & CEO 40.00 2.00 X 334323 0 42579 PATTI GARRETT ASSISTANT SECRETARY(6/22/22-9/14/22) 40.00 X 212234 0 49522 QUIN OGAWA TREASURER & CFO (EFFECTIVE 6/22/22) 40.00 2.00 X 132959 0 3842 COLBERT SETO ASSISTANT SECRETARY (EFFECTIVE 9/14/22) 40.00 X 82865 0 7453 GWYN HIRASA DIRECTOR OF DENTAL OPERATIONS 40.00 X 172162 0 74003 CHAD YANO DIRECTOR OF INFORMATION SYSTEMS 40.00 X 178122 0 49871 ELAINE FUJIWARA DIRECTOR OF SALES 40.00 X 205619 0 73361 CLESSON PANG DIRECTOR OF UNDERWRITING 40.00 X 202775 0 63968 JAN IGA DIRECTOR OF HUMAN RESOURCES 40.00 X 164758 0 29951 ROQUE ARANADOR DIRECTOR OF INFORMATION TECHNOLOGY 40.00 X 190044 0 84491 MICHAEL OROZCO DIRECTOR OF MARKETING 40.00 X 160904 0 31136 CHRISTINE FEJERAN DIRECTOR OF GOVERNMENT PROGRAMS 40.00 X 150800 0 23368 RYAN KADOOKA INFORMATION TECHNOLOGY MANAGER 40.00 X 139899 0 42797 MARK H YAMAKAWA PRESIDENT & CEO (UNTIL 11/22/21) 40.00 2.00 X 536260 0 5495 3710652 0 917723 29 1 1 0 CONCORD USA LLC 509 2ND AVENUE SOUTH HOPKINS MN 55343 SYSTEM CONSULTING SERVICES 1910967 TRANSEO SOLUTIONS LLC 111 HEKILI STREET SUITE A229 KAILUA HI 96734 SYSTEM CONSULTING SERVICES 1223900 COMMUNITY CASE MANAGEMENT CORPORATION 91-1360 KARAYAN STREET EWA BEACH HI 96706 CARE COORDINATION 913500 HIGH TECH HUI LLC 1050 QUEEN STREET SUITE 100 HONOLULU HI 96814 PROJECT MANAGEMENT 561138 COMPASS CONSULTING GROUP INC 4348 SOUTH- POINT BLVD 201 JACKSONVILLE FL 32216 BROKER 293658 11 SUBSCRIPTIONS EARNED 621300 243490397 243490397 243490397 8723383 8723383 11744 11744 0 97971108 99802411 -1831303 -1831303 -1831303 FMG DENTAL INSUR. CONTRACTS (NET) 621300 1973558 1973558 MISC. OTHER INCOME 621300 25675 25675 PROFESSIONAL SERVICES 621300 3385 3385 2002618 252385095 245489630 3385 6892080 3187021 3187021 202348257 202348257 2904245 1245523 1658722 7065441 3993971 3071470 1533360 747360 786000 1144863 558006 586857 872509 425261 447248 189533 189533 282718 282718 71989 71989 577947 577947 1979488 1034582 944906 152106 152106 308045 269008 39037 1202484 745262 457222 1110336 683967 426369 95281 128 95153 78911 78911 2728512 1724264 1004248 460950 331261 129689 BROKER COMMISSIONS 1382223 1382223 ORAL HEALTH 515540 515540 DUES 467773 467773 BUSINESS DEVELOPMENT 234293 2913 231380 773814 367695 406119 231667639 219562242 12105397 0 27394423 42912053 13768693 13160866 4522734 5634538 20616896 6355620 12814705 14261276 293719005 273780143 6734225 0 7308045 358953785 357056921 12144047 13069619 4598515 4443777 23007018 26066183 39749580 43579579 X 319204205 313477342 319204205 313477342 358953785 357056921 X 20717456 -33451869 7007550 X X 0 1 X 1 0 1096245 216340 879905 3415138 1758451 1656687 16105513 4380829 11724684 14261276 REFUNDABLE GROUP SUBSCRIPTIONS 15106505 ACCRUED PENSION LIABILITY 3161989 LEASE OBLIGATION 7797689 26066183 183678024 -33451869 -71630 -33523499 217201523 607140 34576432 35183572 252385095 196484067 0 196484067 607140 34576432 35183572 231667639 FORM 990, PART IV, LINE 12B THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF HAWAII DENTAL SERVICE, HAWAII DENTAL SERVICE FOUNDATION, AND HAWAII CLIENT SERVICES CORPORATION. THE HDS AUDIT COMMITTEE, WHICH CONSISTS OF BOARD MEMBERS, SELECTS THE AUDITORS AND REVIEWS THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D - OTHER ADJUSTMENTS GAIN ON DISSOLUTION OF LINKDDS - 221,368 LIQUIDATION OF LINKDDS - (15,370) EQUITY INVESTMENT IN CORPORATE SUBSIDIARY - (277,628) SCHEDULE D, PART XI, LINE 4B - OTHER ADJUSTMENTS IN ACCORDANCE WITH GAAP, AUDITED FINANCIALS DO NOT INCLUDE SELF-INSURED PREMIUMS AND RELATED CLAIM PAYMENTS. SCHEDULE D, PART XII, LINE 4B - OTHER ADJUSTMENTS IN ACCORDANCE WITH GAAP, AUDITED FINANCIALS DO NOT INCLUDE SELF-INSURED PREMIUMS AND RELATED CLAIM PAYMENTS. 1 ALOHA COUNCIL - BOY SCOUTS OF AMERICA 42 PUIWA ROAD HONOLULU HI 96817 990073482 501(C)(3) 5500 0 PROGRAM SUPPORT ALOHA UNITED WAY 200 NORTH VINEYARD BLVD SUITE 700 HONOLULU HI 96817 990073494 501(C)(3) 10000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION DOMESTIC VIOLENCE ACTION CENTER PO BOX 3198 HONOLULU HI 96801 990290389 501(C)(3) 56000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION & DVAC ANNUAL GALA FIVE MOUNTAINS HAWAII INC(KIPUKA O KE OLA) PO BOX 818 KAMUELA HI 96743 990330168 501(C)(3) 50000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION HAWAII ACADEMY OF SCIENCE 1776 UNIVERSITY AVENUE UA4-4 HONOLULU HI 96822 996006863 501(C)(3) 140000 0 PROVIDE SUPPORT FOR THE HAWAII STATE SCIENCE AND ENGINEERING FAIR (HSSEF), AND FOR SEED MONEY, SUPPORT PROGRAM COSTS, AND ORAL HEALTH PROJECTS HAWAII DENTAL SERVICE FOUNDATION 900 FORT STREET MALL SUITE 1900 HONOLULU HI 96813 990246999 501(C)(4) 1800000 0 SUPPORT ORGANIZATION MISSION HAWAII EXECUTIVE COLLABORATIVE 827 BISHOP STREET 2ND FLOOR HONOLULU HI 96813 844041099 501(C)(3) 7500 0 KALO TO THE WORLD SPONSORSHIP HAWAII VA FOUNDATION (OUR KUPUNA) 111 HEKILI STREET 102 KAILUA HI 96734 471288647 501(C)(3) 50000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION IOLANI SCHOOL 563 KAMOKU STREET HONOLULU HI 96826 996006863 501(C)(3) 400000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION JHCS PTSO (CAMPBELL HS - STEAM PROGRAM) 91-980 NORTH ROAD EWA BEACH HI 96706 237128503 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION KIDS HURT TOO HAWAII THE KUKUI CENTER 245 N KUKUI STREET 102 HONOLULU HI 96817 990353665 501(C)(3) 50000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION KUMANO I KE ALA O MAKAWELI PO BOX 181 WAIMEA HI 96796 473180959 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION LALAKEA FOUNDATION 2106 KAIWIKI ROAD HILO HI 96720 943272419 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION LANAKILA PACIFIC FOUNDATION 1809 BACHELOT ST HONOLULU HI 96817 990321768 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION LEGACY OF LIFE 405 N KUAKINI ST SUITE 810 HONOLULU HI 96817 990257883 501(C)(3) 50000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION LUNALILO HOME 501 KEKAULUOHI STREET HONOLULU HI 96825 990075244 501(C)(3) 20000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION MA KA HANA KA IKE BUILDING PROGRAM P O BOX 968 HANA HI 96713 020556883 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION MANA MAOLI (HAKU COLLECTIVE) 1903 PALOLO AVENUE ROOM C3 HONOLULU HI 96816 311783481 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION MARCH OF DIMES (MARCH FOR BABIES OAHU) 1550 CRYSTAL DR SUITE 1300 ARLINGTON VA 22202 131846366 501(C)(3) 12500 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION MAUNALANI FOUNDATION 5113 MAUNALANI CIRCLE HONOLULU HI 96816 990075234 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION MAUNALUA FISHPOND HERITAGE CENTER PO BOX 240204 HONOLULU HI 96824 261349087 501(C)(3) 50000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION MOLOKAI GENERAL HOSPITAL PAUL G STEVENS MD OUTPATIENT CLINIC PO BOX 408 KAUNAKAKAI HI 96748 990251372 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION OAHU ECONOMIC DEVELOPMENT BOARD 735 BISHOP ST SUITE 424 HONOLULU HI 96813 990229787 501(C)(3) 50000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION OHANA PACIFIC FOUNDATION 45-181 WAIKALUA RD KANEOHE HI 96744 134335629 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION OLELO COMMUNITY TELEVISION 1122 MAPUNAPUNA ST HONOLULU HI 96819 990275429 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION PARENTS AND CHILDREN TOGETHER 1485 LINAPUNI STREET SUITE 105 HONOLULU HI 96819 990119678 501(C)(3) 6000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION PARTNERS IN DEVELOPMENT FOUNDATION 2040 BACHELOT STREET HONOLULU HI 96817 943271325 501(C)(3) 10000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION SUSANNAH WESLEY COMMUNITY CENTER 1117 KAILI ST HONOLULU HI 96819 990073528 501(C)(3) 50000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION THE SALVATION ARMY 2950 MANOA ROAD HONOLULU HI 96822 941156347 501(C)(3) 25156 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION YMCA OF HONOLULU 1441 PALI HIGHWAY HONOLULU HI 96813 990073533 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION 37 1 PART I, LINE 2: THE PURPOSE OF THE GRANTS AWARDED BY HAWAII DENTAL SERVICE (HDS) ARE REVIEWED AND APPROVED BY THE HDS CEO AND ANOTHER EXECUTIVE. OTHER DONATIONS ARE CONTRIBUTED TO VARIOUS PUBLIC CHARITABLE ORGANIZATIONS TO SUPPORT THE EXEMPT FUNCTIONS OF THE ORGANIZATIONS AND ARE NOT MONITORED. HOWEVER, IF THE CEO AND/OR EXECUTIVE HAVE A POTENTIAL CONFLICT OF INTEREST, HE OR SHE WILL RECUSE THEMSELVES FROM THE SELECTION PROCESS, AND/OR BOARD OF DIRECTOR WILL MAKE THE DECISION ON THE GRANTS. X X 1 1 X X X X X 0 0 0 0 0 0 0 1 0 MARK H YAMAKAWA PRESIDENT & CEO (UNTIL 11/22/21) 283260 0 253000 0 0 0 4561 0 934 0 541755 0 0 0 MINNA-MARI LEHTI SECRETARY & COO 251192 0 94749 0 876 0 99951 0 8326 0 455094 0 0 0 DIANE SL PALOMA PHD PRESIDENT & CEO 330000 0 0 0 4323 0 24348 0 18231 0 376902 0 0 0 ELAINE FUJIWARA DIRECTOR OF SALES 172647 0 32461 0 511 0 59933 0 13428 0 278980 0 0 0 ROQUE ARANADOR DIRECTOR OF INFORMATION TECHNOLOGY 160676 0 29368 0 0 0 77372 0 7119 0 274535 0 0 0 CLESSON PANG DIRECTOR OF UNDERWRITING 171732 0 31043 0 0 0 54892 0 9076 0 266743 0 0 0 PATTI GARRETT ASSISTANT SECRETARY(6/22/22-9/14/22) 179374 0 32860 0 0 0 31769 0 17753 0 261756 0 0 0 THOMAS DELANEY ASSIST. SEC. & CIO (THROUGH 4/1/22) 95136 0 84984 0 0 0 72968 0 4131 0 257219 0 0 0 CHERYL TAKITANI-SMITH TREASURER & CFO (THROUGH 1/15/22) 51335 0 99564 0 0 0 100937 0 1286 0 253122 0 0 0 GWYN HIRASA DIRECTOR OF DENTAL OPERATIONS 146934 0 25228 0 0 0 61116 0 12887 0 246165 0 0 0 CHAD YANO DIRECTOR OF INFORMATION SYSTEMS 150580 0 27542 0 0 0 29164 0 20707 0 227993 0 0 0 CARA NUMASAKI INTERIM CFO/TREASURER (1/15/22-6/22/ 135875 0 33217 0 0 0 34894 0 13393 0 217379 0 0 0 JAN IGA DIRECTOR OF HUMAN RESOURCES 138542 0 26216 0 0 0 22862 0 7089 0 194709 0 0 0 MICHAEL OROZCO DIRECTOR OF MARKETING 136443 0 24461 0 0 0 18129 0 13007 0 192040 0 0 0 RYAN KADOOKA INFORMATION TECHNOLOGY MANAGER 124640 0 15259 0 0 0 32546 0 10251 0 182696 0 0 0 CHRISTINE FEJERAN DIRECTOR OF GOVERNMENT PROGRAMS 125646 0 25154 0 0 0 11455 0 11913 0 174168 0 0 0 PART I, LINE 1A SUPPLEMENTAL COMPENSATION INFORMATION: HDS HOLDS A CORPORATE MEMBERSHIP IN A SOCIAL CLUB IN WHICH THE CLUB REQUIREMENTS DICTATE THAT AN INDIVIDUAL BE IDENTIFIED TO AUTHORIZE TRANSACTIONS. AS SUCH, HDS'S CEO HAS BEEN DESIGNATED AS THE AUTHORIZED INDIVIDUAL. ONLY BUSINESS TRANSACTIONS ARE ALLOWED AND SUBSTANTIATED BY PROPER DOCUMENTATION. DISCRETIONARY SPENDING ACCOUNT: ONLY BUSINESS RELATED TRANSACTIONS ARE ALLOWED AND SUBSTANTIATED BY PROPER DOCUMENTATION. PART I, LINE 7 NON-FIXED PAYMENTS: HDS HAS AN INCENTIVE PLAN DETAILING THE INCENTIVE CALCULATION WHEN THE COMPANY ACHIEVES CERTAIN PERFORMANCE STANDARDS AND STRATEGIC GOALS. THE INCENTIVE AMOUNT VARIES EACH YEAR DEPENDING ON ACHIEVEMENT OF STRATEGIC GOALS. INCENTIVE AMOUNTS FOR OFFICERS ARE APPROVED BY THE BOARD OF DIRECTORS COMPENSATION COMMITTEE WHICH IS DOCUMENTED IN MINUTES. INCENTIVE AMOUNTS FOR MANAGEMENT AND STAFF ARE APPROVED BY OFFICERS AND THE BOARD OF DIRECTORS THROUGH THE ANNUAL BUDGETING PROCESS. MARTIN OISHI DIRECTOR 151281 SEE NOTE 2 0 MASON A SAVAGE DIRECTOR 290287 SEE NOTE 2 0 CHARLES R SUGIYAMA DIRECTOR 354266 SEE NOTE 2 0 IOLANI SCHOOL NOTE 3 276530 SEE NOTE 4 0 UNIVERSITY HEALTH ALLIANCE NOTE 3 5583072 SEE NOTE 4 0 HAWAII PACIFIC HEALTH NOTE 3 6063730 SEE NOTE 4 0 ALLISON TRAN DIRECTOR 291904 SEE NOTE 2 0 HAWAII STATE FCU NOTE 3 243100 SEE NOTE 4 0 RESEARCH CORPORATION OF THE UNIVERSITY OF HAWAII NOTE 3 858228 SEE NOTE 4 0 NONA TAMANAHA DIRECTOR 4212290 SEE NOTE 1 0 SUZY P HOLLINGER DIRECTOR (THROUGH 6/16/2021) 1581684 SEE NOTE 1 0 KAIMANA GOO-RAHTZ DIRECTOR 186203 SEE NOTE 2 0 PATSY NANBU DIRECTOR (THROUGH 6/16/2021) 2822956 SEE NOTE 1 0 KERIANN ERNST DIRECTOR 1804402 SEE NOTE 1 0 SCHEDULE L, PART IV: NOTE 1 - PREMIUMS FOR DENTAL PLAN - EMPLOYER GROUP PURCHASES AN HDS DENTAL PLAN BUT THE DIRECTOR DOES NOT INFLUENCE DECISION MAKING IN PURCHASING THE DENTAL PLAN FROM HDS.NOTE 2 - DENTIST PARTICIPATING IN HDS PROVIDER NETWORK OFFERING DENTAL SERVICES TO HDS SUBSCRIBERS.NOTE 3 - MARK YAMAKAWA IS THE CEO THROUGH 11/22/21, AND DIANE PALOMA IS THE CEO AS OF 11/22/21, OF HDS. PREMIUMS ARE RECEIVED FROM VARIOUS ORGANIZATIONS ON WHICH MARK OR DIANE SERVES AS BOARD MEMBER. NOTE 4 - DENTAL PREMIUM PAYMENTS TO HDS FROM VARIOUS ORGANIZATIONS IN WHICH MARK YAMAKAWA OR DIANE PALOMA IS A BOARD MEMBER. FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: HAWAII DENTAL SERVICE OPERATES TO PROMOTE AND ENCOURAGE THE BETTERMENT OF THE GENERAL MEDICAL AND DENTAL HEALTH OF THE PUBLIC FOR THE COMMON GOOD AND GENERAL WELFARE OF THE COMMUNITY. ITS GOAL IS TO INNOVATE AND CONDUCT PROGRAMS FOR DENTAL CARE AND TO MAKE AVAILABLE, ON A BROAD SCALE, THE BENEFITS OF THE SCIENCE OF DENTISTRY TO MEMBERS OF THE PUBLIC. DENTAL COVERAGE IS AVAILABLE TO THE GENERAL PUBLIC AS HAWAII DENTAL SERVICE MAINTAINS AN ENROLLMENT POLICY THAT IS OPEN TO INDIVIDUALS AND FAMILIES, AS WELL AS SMALL AND LARGE GROUPS. FURTHERMORE, HAWAII DENTAL SERVICE MAKES DONATIONS TO PUBLIC CHARITIES OR PRIVATE ENTERPRISES IN CONNECTION WITH ITS OVERALL PURPOSE IN THE PUBLIC OR COMMUNITY INTEREST. FORM 990, PART VI, SECTION A, LINE 6 DESCRIPTION OF ORGANIZATION'S MEMBERS: MEMBERSHIP IS SOLELY AVAILABLE TO DENTISTS WHO HAVE BEEN DULY LICENSED TO PRACTICE IN THE STATE OF HAWAII AND WHO MEET ANY ADDITIONAL REQUIREMENTS CONSISTENT WITH APPLICABLE LAW ESTABLISHED BY THE BOARD OF DIRECTORS FROM TIME TO TIME. APPLICATION IS MADE IN WRITING AND APPROVED BY THE BOARD OF DIRECTORS. MEMBERS MAY AT ANY TIME BY A MEETING DULY CALLED FOR SUCH PURPOSE DEPOSE OR REMOVE FROM OFFICE ANY DENTIST DIRECTOR, WITH OR WITHOUT CAUSE, EXCEPT AS SUCH REMOVAL WOULD BE CONTRARY TO LAW. FORM 990, PART VI, SECTION A, LINE 7A ELECT BOARD MEMBERS A MAJORITY OF THE MEMBERS OF THE BOARD OF DIRECTORS SHALL BE COMPRISED OF NON-DENTIST REPRESENTATIVES FROM THE GENERAL PUBLIC AND THE REMAINING MEMBERS SHALL BE MEMBER DENTISTS. MEMBER DENTISTS AND PUBLIC DIRECTORS RESPECTIVELY ELECT DENTISTS AND PUBLIC DIRECTORS TO THE BOARD OF DIRECTORS FOR A THREE YEAR TERM. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL OF DECISIONS: BYLAWS AND ARTICLES OF INCORPORATION MAY BE ALTERED OR REPEALED, OR NEW BYLAWS AND ARTICLES OF INCORPORATION MAY BE ADOPTED IN LIEU THEREOF, BY ADOPTION OF A RESOLUTION BY THE BOARD OF DIRECTORS SETTING FORTH THE PROPOSED AMENDMENT AND DIRECTING THAT IT BE SUBMITTED TO A VOTE AT THE ANNUAL OR SPECIAL MEETING OF THE MEMBERS. THE PROPOSED AMENDMENT SHALL BE ADOPTED UPON RECEIVING AT LEAST TWO-THIRDS OF THE VOTES WHICH MEMBERS PRESENT IN PERSON AT THE MEETING ARE ENTITLED TO CAST. THE BYLAWS MAY ALSO BE AMENDED BY AFFIRMATIVE VOTE OF THE DIRECTORS THEN IN OFFICE, WITHOUT FURTHER ACTION BY THE MEMBERS, FOR THE PURPOSE OF CURING AMBIGUITIES, CORRECTING OR SUPPLEMENTING DEFECTIVE OR INCONSISTENT PROVISIONS, OR ENABLING THE CORPORATION TO COMPLY WITH APPLICABLE LAWS AND REGULATIONS. FORM 990, PART VI, SECTION B, LINE 11B APPROVED COPY OF FORM 990: THE RETURN IS THOROUGHLY REVIEWED BY THE CONTROLLER PRIOR TO FINAL REVIEW WITH THE CHIEF FINANCIAL OFFICER AND PRESIDENT. A COPY OF FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C WRITTEN CONFLICT OF INTEREST POLICY: THE HDS COMPLIANCE PROGRAM CONTAINS THE HDS CONFLICTS OF INTEREST POLICY. EMPLOYEES (DIRECTORS, KEY EMPLOYEES AND OFFICERS) OF HDS ARE REQUIRED TO COMPLETE THE CONFLICTS OF INTEREST DISCLOSURE STATEMENT AND CERTIFICATION TO DISCLOSE ANY ARRANGEMENTS WHICH MAY CONSTITUTE AN ACTUAL CONFLICT OF INTEREST OR GIVE RISE TO THE APPEARANCE OF A CONFLICT OF INTEREST ANNUALLY. THE HDS COMPLIANCE DEPARTMENT REVIEWS THE ANNUAL CONFLICTS OF INTEREST DISCLOSURE STATEMENT AND CERTIFICATIONS AND REPORTS POTENTIAL CONFLICTS OF INTERESTS TO THE HDS BOARD OF DIRECTORS. ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST MAY ALSO BE RAISED BY ANY OTHER MEMBER OF THE BOARD OF DIRECTORS OR THROUGH THE WHISTLEBLOWER PROGRAM. IN ADDITION, THE ORGANIZATION PROVIDES ANNUAL FIDUCIARY TRAINING TO ITS DIRECTORS AND OFFICERS AND REVIEWS SCENARIOS WHICH MAY GIVE RISE TO A CONFLICT OF INTEREST. AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS, BUT AFTER SUCH PRESENTATION, THE INTERESTED PERSON SHALL RECUSE THEMSELVES FROM THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE ARRANGEMENT INVOLVING THE CONFLICT OF INTEREST OR THE APPERANCE OF A CONFLICT OF INTEREST. IN THE CURRENT YEAR, SOME POTENTIAL CONFLICTS OF INTEREST WERE DISCOVERED. THESE POTENTIAL CONFLICTS INVOLVED CONTRIBUTIONS MADE TO OUTSIDE ORGANIZATIONS WITH WHOM OFFICERS HAD SOME AFFILIATION. THESE CONTRIBUTIONS WERE RETROACTIVELY APPROVED BY AN EXECUTIVE COMMITTEE OF THE BOARD. THE ORGANIZATION CLARIFIED ITS POLICIES, AND EDUCATED THE DIRECTORS, OFFICERS, AND KEY EMPLOYEES ABOUT THE IMPORTANCE OF THESE POLICIES IN LIGHT OF THESE ACTIONS. FORM 990, PART VI, SECTION B, LINE 15 PROCESS FOR DETERMINING COMPENSATION: COMPENSATION FOR THE CEO AND OFFICERS ARE DETERMINED BASED ON ADVICE FROM AN INDEPENDENT COMPENSATION CONSULTANT WHO USES DELTA DENTAL PLANS ASSOCIATION AND HAWAII EMPLOYERS COUNCIL COMPENSATION SURVEY INFORMATION FOR COMPARABLE POSITIONS. OFFICER COMPENSATION IS APPROVED BY THE BOD COMPENSATION COMMITTEE. AMOUNTS ARE DOCUMENTED IN MINUTES AND HUMAN RESOURCES DEPARTMENT RECONCILES THE PAYMENT AT END OF EACH YEAR. COMPENSATION FOR MANAGEMENT AND STAFF POSITIONS ARE EVALUATED AND DETERMINED BASED ON HAWAII EMPLOYERS COUNCIL SURVEYS AND APPROVED BY THE PRESIDENT/CEO AND EXECUTIVES ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 TAX RETURNS AND OTHER REQUIRED DOCUMENTS ARE AVAILABLE UPON REQUEST. PART VI, SECTION A, QUESTION 4 IN 2018, HDS AMENDED AND RESTATED THEIR ARTICLES OF INCORPORATION, CLARIFYING AND BROADENING THEIR MISSION. THE ACTIVITIES HAVE NOT CHANGED SIGNIFICANTLY, HOWEVER, THEY WERE NOT SPECIFICALLY ENUMERATED IN THE 2018 RETURN, AS SUCH HDS WANTED TO ENUMERATE THEM BELOW: THE OBJECTS AND PURPOSES FOR WHICH THE CORPORATION IS ORGANIZED ARE AS FOLLOWS: (A) TO INNOVATE AND CONDUCT PROGRAMS FOR DENTAL CARE AND TO MAKE AVAILABLE ON A BROAD SCALE THE BENEFITS OF THE SCIENCE OF DENTISTRY TO MEMBERS OF THE PUBLIC AND TO INDIGENT PERSONS AND TO PROMOTE AND ADVANCE RESEARCH, STUDY AND LEARNING IN THE FIELD OF DENTISTRY, ORAL HYGIENE AND RELATED SCIENCES; (B) TO ESTABLISH, CONDUCT, MAINTAIN, SPONSOR AND PROMOTE STUDIES OF COMMUNITY DENTAL NEEDS, STATISTICAL STUDIES OF THE DENTAL REQUIREMENTS OF THE POPULATION AND TO INVESTIGATE AND CONDUCT PROGRAMS FOR PROVIDING DENTAL CARE OVER A BROAD AREA AND TO MAKE AVAILABLE FULL DENTAL CARE FOR MEMBERS OF THE PUBLIC; (C) TO ESTABLISH, CONDUCT, OPERATE, MAINTAIN, SPONSOR AND PROMOTE A PROGRAM FOR RECRUITMENT OF DENTISTS IN ORDER TO MAKE DENTAL SERVICES MORE AVAILABLE; GENERALLY TO DO ALL THINGS NECESSARY TO RENDER DENTAL SERVICE MORE AVAILABLE; (D) TO ENTER INTO CONTRACTS, AGREEMENTS, UNDERTAKINGS AND PROGRAMS TO PROVIDE DENTAL CARE TO INDIVIDUALS, GROUPS, AND MEMBERS OF THE PUBLIC AND GENERALLY TO DO ALL THINGS NECESSARY TO RENDER DENTAL SERVICE MORE AVAILABLE; (E) TO ESTABLISH, CONDUCT, OPERATE, MAINTAIN, SPONSOR AND PROMOTE DENTAL CLINICS, LABORATORIES AND RELATED FACILITIES TO PROVIDE MORE ADEQUATE AND COMPLETE DENTAL COVERAGE TO FULFILL AND MEET THE NEEDS FOR PROPER AND COMPLETE DENTAL SERVICES AND CARE WHERE SUCH NEED IS FOUND TO EXIST; (F) TO PURCHASE, OR OTHERWISE ACQUIRE, OWN, OPERATE, MANAGE, CONDUCT, DEVELOP, IMPROVE, SELL, ASSIGN, TRANSFER, CONVEY, LEASE, SUBLEASE, PLEDGE AND OTHERWISE ALIENATE AND DISPOSE OF, AND TO MORTGAGE OR OTHERWISE ENCUMBER REAL OR PERSONAL PROPERTY, INCLUDING BUSINESSES AND RENTAL PROPERTIES, WHEREVER SITUATED WHEN NECESSARY OR USEFUL IN CARRYING OUT THE PURPOSES AND OBJECTIVES OF THE CORPORATION; (G) TO RECEIVE CONTRIBUTIONS IN MONEY OR PROPERTY FROM INDIVIDUAL PERSONS OR CORPORATIONS TO BE USED FOR THE PURPOSES OF THE CORPORATION; (H) TO CONDUCT AND OPERATE ITS BUSINESS AND AFFAIRS SO AS TO BE SELF-SUSTAINING BUT THE CORPORATION SHALL BE PRIVILEGED TO FURNISH DENTAL SERVICES TO NEEDY AND DESERVING INDIVIDUALS ON A CHARITABLE BASIS; (I) TO MAKE DONATIONS OF PROPERTY OR MONEY TO MUNICIPALITIES OR PUBLIC CHARITIES, OR TO PRIVATE ENTERPRISES OR PURPOSES SO FAR AS IT MAY DEEM NECESSARY OR HELPFUL IN CONNECTION WITH THE ACCOMPLISHMENT OF THE PURPOSES HEREIN STATED OR IN THE PUBLIC OR COMMUNITY INTEREST; (J) TO NEGOTIATE AND ENTER INTO CONTRACTS WITH INSTITUTIONS, EMPLOYING UNITS, GROUPS OF EMPLOYERS AND EMPLOYEES, ASSOCIATIONS, FRATERNAL AND LABOR, GOVERNMENTAL AGENCIES, INSURANCE COMPANIES, AND OTHER GROUPS AND INDIVIDUALS FOR THE RENDITION OF DENTAL SERVICES BY DENTAL LICENTIATES; (K) TO FORM PANELS OR GROUPS OF MEMBERS IN VARIOUS PARTS OF THE STATE OF HAWAII AND TO NEGOTIATE AND CONTRACT WITH THE MEMBERS OF SUCH PANELS AND GROUPS FOR THE PERFORMANCE BY THEM OF DENTAL SERVICES UPON UNIFORM SCHEDULES FOR PAYMENT ESTABLISHED BY THE BOARD OF DIRECTORS OF THE CORPORATION TO PATIENTS FOR WHOM THE CORPORATION IS OBLIGATED TO FURNISH DENTAL SERVICES PURSUANT TO POLICIES OR CONTRACTS OF THE CORPORATION; (L) TO ACQUIRE OR BUILD DENTAL OFFICES AND EQUIP THE SAME FOR THE PERFORMANCE OF DENTAL SERVICES BY DENTAL LICENTIATES IN SUCH PLACES IN THE STATE OF HAWAII AS THE BOARD OF DIRECTORS MAY DEEM NEEDFUL OR REQUIRED TO CARRY OUT THE PURPOSES FOR WHICH THE CORPORATION IS FORMED; (M) TO ENTER INTO CONTRACTS OR COOPERATIVE ARRANGEMENTS WITH HOSPITALS, DIAGNOSTIC AND TREATMENT CENTERS, REHABILITATION CENTERS AND ANY OTHER INSTITUTION OR CLINIC AS A PART OF WHICH DENTAL SERVICES MAY BE RENDERED TO SUPPLY THE SERVICES OF DENTAL LICENTIATES ON A PATIENT-DENTIST BASIS, TO CONSTRUCT OR SUPPLY FACILITIES FOR THE PERFORMANCES OF DENTAL SERVICES IN CONJUNCTION THEREWITH, AND TO CONTRACT FOR OR ARRANGE WITH SUCH INSTITUTION OR CLINIC FOR JOINT DISCHARGE OF COMMON EXPENSES AND COSTS IN CONJUNCTION THEREWITH; (N) TO DO AND TRANSACT ANY AND EVERY KIND OF BUSINESS WHICH IS PERMITTED UNDER THE LAWS OF THE STATE OF HAWAII FOR NON-PROFIT CORPORATIONS AS ARE NOW IN FORCE OR AS HEREAFTER AMENDED; AND 2. TO OPERATE EXCLUSIVELY FOR SUCH PURPOSES AS ARE PERMITTED BY APPLICABLE LAW AND REGULATIONS FOR ORGANIZATIONS DESCRIBED IN SECTION 50L(C)(4) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED (HEREINAFTER REFERRED TO AS THE "CODE"), OR CORRESPONDING SECTION OF ANY FUTURE FEDERAL TAX CODE. FORM 990, PART XI, LINE 9: CHANGE IN ACCRUED POSTRETIREMENT LIABILITIES 6,801,546. GAIN ON DISSOLUTION OF LINKDDS 221,368. LIQUIDATION OF LINKDDS -15,370. ROUNDING 6. FORM 990, PART XII, LINE 2C: NO CHANGE FROM PRIOR 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 FOUNDATION 900 FORT STREET MALL SUITE 1900 HONOLULU HI 968133705 990246999 ORAL HEALTH SUPPORT HI 501(C)(4) N/A N/A 1 HAWAII CLIENT SERVICES CORPORATION 900 FORT STREET MALL SUITE 1900 HONOLULU HI 968133705 452740308 ADMIN SERVICES HI HAWAII DENTAL SERVICE C 1654339 1.00000 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 HAWAII DENTAL SERVICE FOUNDATION A 11413 COST HAWAII DENTAL SERVICE FOUNDATION B 1800000 COST HAWAII DENTAL SERVICE FOUNDATION O 365299 COST HAWAII DENTAL SERVICE FOUNDATION Q 1022346 COST