2024-11-01T15:04:21-05:00 2023-12-31 205325889 ACCUITY LLP 999 BISHOP STREET STE 2300 HONOLULU HI 96813 990 2023-01-01 990107971 HAWAII DENTAL SERVICE HAWA 8085211431 900 FORT STREET MALL SUITE 1900 HONOLULU HI 968133705 DIANE SL PALOMA PRESIDENT/CEO 8085211431 2024-10-23 1 0 RACHEL C ANTAL P01263071 8085313400 2023 2024-10-15 13:58:12Z DIANE SL PALOMA 900 FORT STREET MALL SUITE 1900 HONOLULU HI 968133705 361123627 0 X WWW.HAWAIIDENTALSERVICE.COM X 1962 HI PROMOTE BETTERMENT OF MEDICAL & DENTAL HEALTH OF THE PUBLIC FOR THE GENERAL WELFARE OF THE COMMUNITY 14 9 159 0 4179 2861 0 0 243490397 248098694 6892080 13493680 2002618 2059129 252385095 263651503 3187021 2219146 202348257 205491811 13520418 14815826 0 0 0 12611943 14447683 231667639 236974466 20717456 26677037 357056921 400402813 43579579 34290492 313477342 366112321 SEE SCHEDULE O. 0 0 222678439 2219146 246632442 HAWAII DENTAL SERVICE (HDS) OFFERS AND ADMINISTERS DENTAL CARE PROGRAMS TO ABOUT 645,000 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 2023, HDS PROCESSED OVER 1.2 MILLION CLAIMS FOR SUBSCRIBERS AND THEIR DEPENDENTS. TO ENSURE PROVIDERS ARE SUBMITTING CLAIMS APPROPRIATELY, HDS CONTINUALLY AUDITS CLAIMS. IN ADDITION, HDS AWARDED OVER $2 MILLION IN GRANTS TO OTHER CHARITABLE ORGANIZATIONS. 2618489 3521202 MANAGING THE DENTAL BENEFITS OF ELIGIBLE BENEFICIARIES COVERED BY THE STATE OF HAWAII MED-QUEST PROGRAM. 225296928 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 0 1 0 0 0 0 0 1 1 1 0 1 4096 0 1 159 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 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 X 0 0 0 T KIMO BLAISDELL CHAIR 1.00 X X 0 0 0 NONA TAMANAHA DIRECTOR 1.00 X 0 0 0 NELSON KM LAU DIRECTOR 1.00 X 0 0 0 KERIANN ERNST DIRECTOR 1.00 1.00 X 0 0 0 KEVIN S HASEYAMA DIRECTOR 1.00 X 0 0 0 GARRETT BK OKA DDS DIRECTOR 1.00 X 0 0 0 SHAKIL AHMED DIRECTOR 1.00 X 0 0 0 MARTIN OISHI DDS DIRECTOR 1.00 X 0 0 0 DAVID K TODANI DIRECTOR 1.00 1.00 X 0 0 0 TYLER KIMURA DIRECTOR 1.00 X 0 0 0 ALLISON P TRAN DDS DIRECTOR 1.00 1.00 X 0 0 0 KAIMANA GOO-RAHTZ DMD DIRECTOR 1.00 1.00 X 0 0 0 EMI ENO ORIKASA DDS PRESIDENT 1.00 1.00 X X 0 0 0 CHARLES R SUGIYAMA DDS VICE CHAIR 1.00 1.00 X X 0 0 0 EMMIT A KANE VICE CHAIR 1.00 1.00 X X 0 0 0 COLBERT SETO ASSISTANT SECRETARY & CIO 40.00 X 262274 0 78709 DIANE SL PALOMA PHD PRESIDENT & CEO 40.00 2.00 X 538363 0 64512 MINNA-MARI LEHTI SECRETARY & COO 40.00 1.00 X 363442 0 130787 QUIN OGAWA TREASURER & CFO 40.00 2.00 X 285853 0 64343 ELAINE FUJIWARA CCO 40.00 X 233331 0 82455 CHAD YANO DIRECTOR OF INFORMATION SY 40.00 X 182675 0 50669 GWYN HIRASA DIRECTOR OF OPERATIONS 40.00 X 178252 0 83968 CLESSON PANG DIRECTOR OF UNDERWRITING 40.00 X 208300 0 73486 RYAN KADOOKA DATABASE ADMIN 40.00 40.00 X 138995 0 41303 CHRISTIE FEJERAN DIRECTOR OF GOVERNMENT PROGRAMS 40.00 40.00 X 157687 0 19791 JAN IGA DIRECTOR OF HR 40.00 X 168070 0 31995 ROQUE ARANADOR DIRECTOR OF INFORMATION TECHNOLOGY 40.00 X 194889 0 87097 MICHAEL OROZCO DIRECTOR OF MARKETING 40.00 X 185576 0 29898 PATTI GARRETT FORMER ASSISTANT SECRETARY 40.00 X 217568 0 40928 CARA NUMASAKI FORMER INTERIM CFO/ TREASURER 40.00 2.00 X 164835 0 49131 3480110 0 929072 15 1 1 0 COMMUNITY CASE MANAGEMENT CORPORATION 91-1360 KARAYAN STREET EWA BEACH HI 96706 CARE COORDINATION 1091000 HIGH TECH HUI LLC 1050 QUEEN STREET SUITE 100 HONOLULU HI 96814 PROJECT MANAGEMENT 484219 NEURAFLASH LLC 70 HILLTOP ROAD SUITE 3020 RAMSEY NJ 07446 SYSTEM CONSULTING SERVICES 392738 ACCUITY LLP 999 BISHOP STREET SUITE 2300 HONOLULU HI 96813 AUDIT AND TAX PREPARATION 345131 COMPASS CONSULTING GROUP INC 4348 SOUTH- POINT BLVD 201 JACKSONVILLE FL 32216 BROKER 309566 11 SUBSCRIPTIONS EARNED 621300 248098694 248098694 248098694 14184934 14184934 9013 9013 0 96771857 97463111 -691254 -691254 -691254 FMG DENTAL INSUR. CONTRACTS (NET) 621300 2023213 2023213 MISC. OTHER INCOME 621300 31737 31737 PROFESSIONAL SERVICES 621300 4179 4179 2059129 263651503 250153644 4179 13493680 2219146 2219146 205491811 205491811 2252488 1481854 770634 8932174 5544241 3387933 996887 543204 453683 1608981 876734 732247 1025296 558684 466612 360901 360901 21989 21989 678598 678598 2500791 1349973 1150818 72115 72115 260315 231584 28731 1439861 947611 492250 1100458 720800 379658 162045 1097 160948 120773 120773 3289594 2195864 1093730 911484 746034 165450 BROKER COMMISSIONS 1303431 1303431 ORAL HEALTH 594490 594490 DUES 529356 529356 BUSINESS DEVELOPMENT 254928 434 254494 846554 489936 356618 236974466 225296928 11677538 0 42912053 60668324 13160866 14557679 5634538 6300168 23774827 9539348 14261276 14235479 273780143 297820835 7308045 6820328 357056921 400402813 13069619 12324479 4443777 3938347 26066183 18027666 43579579 34290492 X 313477342 366112321 313477342 366112321 357056921 400402813 X 26677037 23792660 2165282 X 0 1 X 1 0 1185290 325934 859356 3765163 2065088 1700075 18824374 7148326 11676048 14235479 REFUNDABLE GROUP SUBSCRIPTIONS 10033457 ACCRUED PENSION LIABILITY 993594 LEASE OBLIGATION 7000615 18027666 251534887 23792660 675077 24467737 227067150 743469 35840884 36584353 263651503 200887113 497000 497000 200390113 743469 35840884 36584353 236974466 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 EQUITY INVESTMENT IN CORPORATE SUBSIDIARY - $178,077 GRANT TO HDSF - $497,000 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 UNITED WAY 200 NORTH VINEYARD BLVD SUITE 700 HONOLULU HI 96817 990073494 501(C)(3) 16925 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION ALS FOUNDATION OF HAWAII 244 AKIOHALA STREET KAILUA HI 96734 821080849 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION ALZHEIMER'S ASSOCIATION 677 ALA MOANA BOULEVARD SUITE 301 HONOLULU HI 96813 133039601 501(C)(3) 6000 0 PROGRAM SUPPORT AMERICAN HEART ASSOCIATION PO BOX 4002030 DES MOINES IA 50340 135613797 501(C)(3) 17437 0 PROGRAM SUPPORT AMERICAN RED CROSS - HAWAII CHAPTER 431 18TH STREET NW WASHINGTON DC 20006 530196605 501(C)(3) 180000 0 SUPPORT FOR COMMUNITY SERVICES FOR MAUI RELIEF EFFORTS PROVIDED BY THE NON-PROFIT ORGANIZATION CHILD & FAMILY SERVICES 91-1841 FT WEAVER ROAD EWA BEACH HI 96706 990073483 501(C)(3) 10000 0 FALL GALA SPONSORSHIP COUNCIL FOR NATIVE HAWAIIAN ADVANCEMENT 91-1270 KINOIKI STREET HONOLULU HI 96707 910313383 501(C)(3) 30000 0 22ND ANNUAL NATIVE HAWAIIAN CONVENTION - MAUI KOKUA SPONSORSHIP DOMESTIC VIOLENCE ACTION CENTER PO BOX 3198 HONOLULU HI 96801 990290389 501(C)(3) 10000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION & DVAC ANNUAL GALA FIGHTSTORY INC 94-530 UKEE STREET WAIPAHU HI 96797 923211645 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION HAWAII CHAMBER OF COMMERCE FOUNDATION RELIEF ACCOUNT 733 BISHOP STREET SUITE 1200 HONOLULU HI 96813 990266760 501(C)(3) 150000 0 SUPPORT FOR COMMUNITY SERVICES FOR MAUI RELIEF EFFORTS PROVIDED BY THE NON-PROFIT ORGANIZATION HAWAII COMMUNITY FOUNDATION 827 FORT STREET MALL HONOLULU HI 96813 990261283 501(C)(3) 150250 0 SUPPORT FOR COMMUNITY SERVICES FOR MAUI RELIEF EFFORTS PROVIDED BY THE NON-PROFIT ORGANIZATION HAWAII DENTAL ASSOCIATION FOUNDATION 1345 S BERETANIA ST SUITE 301 HONOLULU HI 96814 813947506 501(C)(3) 110000 0 SUPPORT FOR COMMUNITY SERVICES FOR MAUI RELIEF EFFORTS PROVIDED BY THE NON-PROFIT ORGANIZATION AND GIVE KIDS A SMILE GALA SPONSORSHIP HAWAII DENTAL SERVICE FOUNDATION 900 FORT STREET MALL SUITE 1900 HONOLULU HI 96813 990246999 501(C)(4) 497000 0 SUPPORT ORGANIZATION MISSION HAWAII FOODBANK INC 2611 KILIHAU STREET HONOLULU HI 96819 990220699 501(C)(3) 25980 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION HAWAII PUBLIC TELEVISION FOUNDATION (PBS HAWAII) 315 SAND ISLAND ACCESS ROAD HONOLULU HI 96819 990334518 501(C)(3) 7000 0 SESAME STREET SPONSORSHIP I OLA LAHUI INC 1441 KAPIOLANI BLVD SUITE 1802 HONOLULU HI 96814 208924382 501(C)(3) 25000 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 KAPIOLANI HEALTH FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990246364 501(C)(3) 25250 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 AND HEALING YOUNG HEARTS GALA SPONSORSHIP 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 MAKE LEMONADE PROJECT 3028 POLOHILANI PLACE HONOLULU HI 96817 862284195 501(C)(3) 50000 0 THE ROYAL ORDER BALL - PUOLO SPONSORSHIP MAUI FOOD BANK INC 760 KOLU STREET WAILUKU HI 96793 990315110 501(C)(3) 150000 0 SUPPORT FOR COMMUNITY SERVICES FOR MAUI RELIEF EFFORTS PROVIDED BY THE NON-PROFIT ORGANIZATION MAUI UNITED WAY INC 95 MAHALANI STREET 24 WAILUKU HI 96793 990086524 501(C)(3) 150000 0 SUPPORT FOR COMMUNITY SERVICES FOR MAUI RELIEF EFFORTS PROVIDED BY THE NON-PROFIT ORGANIZATION MOILIILI HONGWANJI MISSION 902 UNIVERSITY AVENUE HONOLULU HI 96826 990143990 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION'S PROJECT DANA PAPA OLA LOKAHI 894 QUEEN STREET HONOLULU HI 96813 990273765 501(C)(3) 10000 0 AHA HOOLOKAHI: 2023 NATIVE HAWAIIAN HEALTH & WELLNESS SUMMIT PARENTS AND CHILDREN TOGETHER 1485 LINAPUNI STREET SUITE 105 HONOLULU HI 96819 990119678 501(C)(3) 9000 0 PACT KEIKI DAY 2023 - SCHOOL SPONSORSHIP AND A NEW HOPE: MAY THE FORCE BE WITH US EVENT SPONSORSHIP SHIDLER ALUMNI ASSOCIATION 2404 MAILE WAY ROOM C-202 HONOLULU HI 96822 990339302 501(C)(3) 12500 0 EXECUTIVE VINEYARDS EVENT - PLATINUM SPONSORSHIP AND HALL OF HONOR AWARDS SPONSORSHIP SHRINERS HOSPITAL FOR CHILDREN 1310 PUNAHOU STREET HONOLULU HI 96826 264807090 501(C)(3) 25100 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) 50200 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION THE SALVATION ARMY 2950 MANOA ROAD HONOLULU HI 96822 941156347 501(C)(3) 155000 0 SUPPORT FOR COMMUNITY SERVICES FOR MAUI RELIEF EFFORTS PROVIDED BY THE NON-PROFIT ORGANIZATION AND BRING JOY HOLIDAY SPONSORSHIP UNIVERSITY OF HAWAII FOUNDATION 1314 SOUTH KING STREET SUITE B HONOLULU HI 96814 990085260 501(C)(3) 7500 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION, 13TH ANNUAL A'O A KOA UH WARRIOR VOLLEYBALL FUNDRAISER SPONSORSHIP, AND SHIDLER DAY SPONSORSHIP UNITED CEREBRAL PALSY 414 KUWILI STREET SUITE 105 HONOLULU HI 96817 990092154 501(C)(3) 50000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION YWCA OF OAHU 1040 RICHARDS STREET HONOLULU HI 96813 990073534 501(C)(3) 25000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION'S BELLA PROJECT 32 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 AFTER AWARDED. 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 DIANE SL PALOMA PHD PRESIDENT & CEO 343063 0 189750 0 5550 0 37211 0 27301 0 602875 0 0 0 MINNA-MARI LEHTI SECRETARY & COO 262061 0 101381 0 0 0 123351 0 7436 0 494229 0 0 0 QUIN OGAWA TREASURER & CFO 232337 0 53516 0 0 0 56842 0 7501 0 350196 0 0 0 COLBERT SETO ASSISTANT SECRETARY & CIO 228921 0 33353 0 0 0 56676 0 22033 0 340983 0 0 0 ELAINE FUJIWARA CCO 203461 0 29870 0 0 0 68591 0 13864 0 315786 0 0 0 ROQUE ARANADOR DIRECTOR OF INFORMATION TECHNOLOGY 167172 0 27717 0 0 0 80668 0 6429 0 281986 0 0 0 CLESSON PANG DIRECTOR OF UNDERWRITING 178676 0 29624 0 0 0 64274 0 9212 0 281786 0 0 0 GWYN HIRASA DIRECTOR OF OPERATIONS 152906 0 25346 0 0 0 71356 0 12612 0 262220 0 0 0 PATTI GARRETT FORMER ASSISTANT SECRETARY 186626 0 30942 0 0 0 37362 0 3566 0 258496 0 0 0 CHAD YANO DIRECTOR OF INFORMATION SY 156700 0 25975 0 0 0 29756 0 20913 0 233344 0 0 0 MICHAEL OROZCO DIRECTOR OF MARKETING 162040 0 23536 0 0 0 16235 0 13663 0 215474 0 0 0 CARA NUMASAKI FORMER INTERIM CFO/ TREASURER 141397 0 23438 0 0 0 35957 0 13174 0 213966 0 0 0 JAN IGA DIRECTOR OF HR 144172 0 23898 0 0 0 25576 0 6419 0 200065 0 0 0 RYAN KADOOKA DATABASE ADMIN 124661 0 14334 0 0 0 30934 0 10369 0 180298 0 0 0 CHRISTIE FEJERAN DIRECTOR OF GOVERNMENT PROGRAMS 136013 0 21674 0 0 0 7991 0 11800 0 177478 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 TO BE PAID BY HDS AND MUST BE 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 138997 SEE NOTE 2 0 MASON A SAVAGE DIRECTOR 191988 SEE NOTE 2 0 CHARLES R SUGIYAMA DIRECTOR 338903 SEE NOTE 2 0 ALLISON TRAN DIRECTOR 307473 SEE NOTE 2 0 RCUH NOTE 3 855590 SEE NOTE 3 0 NONA TAMANAHA DIRECTOR 2972850 SEE NOTE 1 0 KERIANN ERNST DIRECTOR 5568975 SEE NOTE 1 0 EMMIT KANE DIRECTOR 1625315 SEE NOTE 1 0 KEVIN HASEYAMA DIRECTOR 1719501 SEE NOTE 1 0 EMI ENO ORIKASA DIRECTOR 134003 SEE NOTE 2 0 GARRETT BK OKA SEE NOTE 4 264059 SEE NOTE 2 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 - PREMIUMS ARE RECEIVED FROM VARIOUS ORGANIZATIONS IN WHICH DIANE PALOMA, PRESIDENT/CEO OF HDS, SERVES AS A BOARD MEMBER.NOTE 4 - DR. GARRETT B.K. OKA WAS A BOARD MEMBER EFFECTIVE JULY 2023 AND RESIGNED IN OCTOBER 2023. 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 NORMAL REPORTING PROCESSES AT HDS. 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 APPEARANCE OF A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A PROCESS FOR DETERMINING COMPENSATION: COMPENSATION FOR THE CEO AND OFFICERS ARE BASED ON ADVICE FROM AN EXTERNAL COMPENSATION CONSULTANT USING RELEVANT MARKET DATA FOR COMPARABLE POSITIONS. OFFICERS COMPENSATION IS APPROVED BY THE BOARD'S COMPENSATION COMMITTEE AND DOCUMENTED IN MINUTES. COMPENSATION ADJUSTMENTS ARE PROCESSED WITH THE COMPANY WIDE INCREASES ANNUALLY. COMPENSATION FOR NON-OFFICER ROLES ARE ADJUSTED BASED ON RELEVANT MARKET DATA AND APPROVED BY THE OFFICERS OF HDS. FORM 990, PART VI, SECTION C, LINE 19 TAX RETURNS AND OTHER REQUIRED DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN ACCRUED POSTRETIREMENT LIABILITIES 2,165,282. 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 2026556 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 9013 COST HAWAII DENTAL SERVICE FOUNDATION B 497000 COST HAWAII DENTAL SERVICE FOUNDATION O 351123 COST HAWAII DENTAL SERVICE FOUNDATION Q 542630 COST HAWAII CLIENT SERVICES Q 5262 COST