2025-08-25T17:09:36-05:00 2024-12-31 205325889 ACCUITY LLP 999 BISHOP STREET STE 2300 HONOLULU HI 96813 990 2024-01-01 990107971 HAWAII DENTAL SERVICE HAWA 8085211431 900 FORT STREET MALL SUITE 1900 HONOLULU HI 96813 DIANE SL PALOMA PRESIDENT/CEO 8085211431 2025-08-25 1 0 JOAN FUJITA P00235894 8085313400 2024 2025-03-06 01:10:19Z DIANE SL PALOMA 900 FORT STREET MALL SUITE 1900 HONOLULU HI 96813 369380362 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 8 160 0 4059 2753 0 0 248098694 258234249 13493680 16959491 2059129 59596 263651503 275253336 2219146 1988639 205491811 212600641 14815826 16131152 0 0 0 14447683 16442609 236974466 247163041 26677037 28090295 400402813 448191415 34290492 30617383 366112321 417574032 SEE SCHEDULE O. 0 0 231646151 1988639 252990108 HAWAII DENTAL SERVICE (HDS) OFFERS AND ADMINISTERS DENTAL CARE PROGRAMS TO ABOUT 644,000 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 2024, 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 $1.9 MILLION IN GRANTS TO OTHER CHARITABLE ORGANIZATIONS. 2775141 3631290 MANAGING THE DENTAL BENEFITS OF ELIGIBLE BENEFICIARIES COVERED BY THE STATE OF HAWAII MED-QUEST PROGRAM. 1612851 PROGRAM-RELATED INVESTMENTS. HDS INVESTS IN CERTAIN PROGRAM-RELATED INVESTMENTS WITH OTHER DELTA DENTAL COMPANIES TO PROVIDE DENTAL CARE TO INDIVIDUALS, GROUPS AND MEMBERS OF THE PUBLIC AND GENERALLY TO DO ALL THINGS NECESSARY TO RENDER DENTAL SERVICES MORE AVAILABLE. FMG HAS CONTRACTS WITH COMMUNITY CARE NETWORK (CCN), FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE (FEDVIP), AND VETERAN AFFAIRS DENTAL INSURANCE PROGRAM (VADIP). 234421292 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 1 1 1 0 0 0 0 0 0 1 1 1 0 1 4037 0 1 160 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 8 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 MASON A SAVAGE DDS DIRECTOR 1.00 1.00 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 SHAKIL AHMED DIRECTOR 1.00 X 0 0 0 MARTIN OISHI DDS DIRECTOR 1.00 X 0 0 0 DAVID K TODANI DIRECTOR (TILL 06/24) 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 DIRECTOR 1.00 1.00 X 0 0 0 COLBERT SETO CIO TILL 1124 ASSISTANT SECRETARY (TILL 11/24) 40.00 1.00 X 322294 0 88459 ELAINE FUJIWARA CCO EFF 0624 ASSISTANT SECRETARY (TILL 06/24) 40.00 1.00 X 291312 0 114948 T KIMO BLAISDELL CHAIR 1.00 X 0 0 0 DIANE SL PALOMA PHD PRESIDENT & CEO 40.00 2.00 X 553563 0 70288 MINNA-MARI LEHTI COO ALL YEAR SEC. (TILL 06/24), VP (EFF 06/24) 40.00 1.00 X 368994 0 135297 QUIN OGAWA TREASURER & CFO 40.00 2.00 X 326479 0 64050 EMMIT A KANE VICE CHAIR 1.00 1.00 X 0 0 0 CHAD YANO DIRECTOR OF INFO SYSTEMS 40.00 X 186083 0 50875 CLESSON PANG DIRECTOR OF UNDERWRITING 40.00 X 211250 0 82456 JOEY LEE DIRECTOR OF SALES 40.00 X 151329 0 43698 JAN IGA DIRECTOR OF HR 40.00 X 171206 0 47920 ROQUE ARANADOR DIRECTOR OF INFORMATION TECHNOLOGY 40.00 X 197183 0 86364 IOANA GEBAUER DIRECTOR OF PROFESSIONAL RELATIONS 40.00 X 147957 0 40373 TRACIE MUKAI DIRECTOR - PROJECT MANAGEMENT OFFICE 40.00 X 147359 0 50895 JUNKO KAWABATA APPLICATION SUPPORT MANAGER 40.00 X 141395 0 39994 PATTI GARRETT FORMER ASSISTANT SECRETARY 40.00 1.00 X 220129 0 49220 CARA NUMASAKI FORMER INTERIM CFO/ TREAS 40.00 2.00 X 169041 0 52524 3605574 0 1017361 17 1 1 0 COMMUNITY CASE MANAGEMENT CORPORATION 91-1360 KARAYAN STREET EWA BEACH HI 96706 CARE COORDINATION 1141166 COMPASS CONSULTING GROUP INC 200 GALLERIA PARKWAY SE STE 1950 ATLANTA GA 30339 BROKER 354063 LOVELYTICS DATA LLC 4201 WILSON BLVD SUITE 110-372 ARLINGTON VA 222031859 DATA ANALYSTIC CONSULTING SERVICES 316413 ACCUITY LLP 999 BISHOP STREET SUITE 2300 HONOLULU HI 96813 AUDIT AND TAX PREPARATION 269529 HIGH TECH HUI LLC 1050 QUEEN STREET SUITE 100 HONOLULU HI 96814 SYSTEM CONSULTING SERVICES 234329 11 SUBSCRIPTIONS EARNED 621300 256621398 256621398 FMG DENTAL INSURANCE CONTRACTS 621300 1612851 1612851 258234249 16426271 16426271 8299 8299 0 94651947 94118727 533220 533220 533220 MISC. OTHER INCOME 621300 55537 55537 PROFESSIONAL SERVICES 621300 4059 4059 59596 275253336 274716057 4059 533220 1988639 1988639 212600641 212600641 2626437 1549461 1076976 9718376 6623367 3095009 1190692 702032 488660 1667749 983305 684444 927898 547089 380809 261273 261273 21989 21989 754088 754088 2815345 1647581 1167764 481549 481549 409134 368356 40778 1895707 1275170 620537 1112844 745605 367239 266454 201 266253 143795 143795 4002858 2721304 1281554 846197 680690 165507 BROKER COMMISSIONS 1355179 1355179 DUES 559856 559856 PRINTING 344662 75533 269129 BUSINESS DEVELOPMENT 327360 327360 844319 557139 287180 247163041 234421292 12741749 0 60668324 49270204 14557679 14340843 6300168 6275704 23804491 13307377 14235479 10497114 297820835 355614859 6820328 12192691 400402813 448191415 12324479 13570364 3938347 4679201 18027666 12367818 34290492 30617383 X 366112321 417574032 366112321 417574032 400402813 448191415 X 28090295 18413953 4957463 X 0 1 X 1 0 1185290 438637 746653 2862163 1983465 878698 19757038 10885275 8871763 10497114 REFUNDABLE GROUP SUBSCRIPTIONS 6192232 LEASE OBLIGATION 6175586 12367818 256063945 18413953 1677343 20091296 235972649 832718 38447969 39280687 275253336 209382354 1500000 1500000 207882354 832718 38447969 39280687 247163041 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 - $177,343 GRANT TO HDSF - $1,500,000 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) 37800 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) 15050 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION & WALK TO END ALZHEIMER'S SPONSORSHIP AMERICAN HEART ASSOCIATION PO BOX 4002030 DES MOINES IA 50340 135613797 501(C)(3) 15253 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION & HEART WALK SPONSORSHIP AMERICAN LUNG ASSOCIATION 1050 QUEEN STREET SUITE 100 HONOLULU HI 96814 131632524 501(C)(3) 7000 0 OUTSTANDING MOTHER AWARDS AND PROGRAM SUPPORT BOYS AND GIRLS CLUB OF HAWAII 1000 BISHOP STREET SUITE 505 HONOLULU HI 96813 996005407 501(C)(3) 6050 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION & 28TH ANNUAL WALK IN THE COUNTRY DINNER SPONSORSHIP CENTER FOR TOMORROW'S LEADERS - HAWAII 874 DILLINGHAM BLVD BLDG 72A ROOM 116 HONOLULU HI 96817 463490591 501(C)(3) 50000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION FAMILY HUI HAWAII PO BOX 22596 HONOLULU HI 96813 464318561 501(C)(3) 10000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION GIRL SCOUTS OF HAWAII 410 ATKINSON DRIVE SUITE 2E1 BOX 3 HONOLULU HI 96814 990073488 501(C)(3) 6500 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION & 2024 WOMEN OF DISTINCTION TABLE SPONSORSHIP HAWAII DENTAL ASSOCIATION FOUNDATION 1345 S BERETANIA ST SUITE 301 HONOLULU HI 96814 813947506 501(C)(3) 20000 0 GIVE KIDS A SMILE GALA SPONSORSHIP HAWAII DENTAL SERVICE FOUNDATION 900 FORT STREET MALL SUITE 1900 HONOLULU HI 96813 990246999 501(C)(4) 1500000 0 SUPPORT ORGANIZATION MISSION HAWAII HIGH SCHOOL ATHLETIC ASSOCIATION PO BOX 11419 HONOLULU HI 96828 990330769 501(C)(3) 10000 0 2024-2025 GIRLS FLAG FOOTBALL SPONSORSHIP HELPING HANDS HAWAII 2100 N NIMITZ HIGHWAY HONOLULU HI 96819 237365077 501(C)(3) 15100 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION & 50TH ANNIVERSARY PAINA SPONSORSHIP HONOLULU COMMUNITY ACTION PROGRAM 1132 BISHOP STREET SUITE 100 HONOLULU HI 96813 990140622 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) 5200 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION & SIGNATURE CHEFS FEEDING MOTHERHOOD SPONSORSHIP PARTNERS IN DEVELOPMENT FOUNDATION 2040 BACHELOT STREET HONOLULU HI 96817 943271325 501(C)(3) 5050 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION AND ULU HANA PEWA AWARDS - KOKUA SPONSOR RESIDENTIAL YOUTH SERVICES & EMPOWERMENT 42-470 KALANIANAOLE HIGHWAY KAILUA HI 96734 812102826 501(C)(3) 50000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION RISEHI FOUNDATION 105B N KAINALU DRIVE KAILUA HI 96734 822170434 501(C)(3) 10000 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION RONALD MCDONALD HOUSE CHARITIES OF HAWAII 1970 JUDD HILLSIDE ROAD HONOLULU HI 96822 990222124 501(C)(3) 16200 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION & HOPE AND HEROES 2024 GALA SPONSORSHIP 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) 5100 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) 12900 0 SUPPORT FOR COMMUNITY SERVICES PROVIDED BY THE NON-PROFIT ORGANIZATION AND VARIOUS SPONSORSHIPS 20 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 X 1 1 X X X X X 0 0 0 0 0 0 0 1 0 DIANE SL PALOMA PHD PRESIDENT & CEO 366312 0 181913 0 5338 0 42715 0 27573 0 623851 0 0 0 MINNA-MARI LEHTI COO ALL YEAR SEC. (TILL 06/24), VP (EFF 06/24) 271800 0 97194 0 0 0 128012 0 7285 0 504291 0 0 0 COLBERT SETO CIO TILL 1124 ASSISTANT SECRETARY (TILL 11/24) 237401 0 84893 0 0 0 66360 0 22099 0 410753 0 0 0 ELAINE FUJIWARA CCO EFF 0624 ASSISTANT SECRETARY (TILL 06/24) 227294 0 64018 0 0 0 100699 0 14249 0 406260 0 0 0 QUIN OGAWA TREASURER & CFO 240484 0 85995 0 0 0 56700 0 7350 0 390529 0 0 0 CLESSON PANG DIRECTOR OF UNDERWRITING 182609 0 28141 0 500 0 70774 0 11682 0 293706 0 0 0 ROQUE ARANADOR DIRECTOR OF INFORMATION TECHNOLOGY 170853 0 26330 0 0 0 80849 0 5515 0 283547 0 0 0 PATTI GARRETT FORMER ASSISTANT SECRETARY 190735 0 29394 0 0 0 43322 0 5898 0 269349 0 0 0 CHAD YANO DIRECTOR OF INFO SYSTEMS 161403 0 24680 0 0 0 29518 0 21357 0 236958 0 0 0 CARA NUMASAKI FORMER INTERIM CFO/ TREAS 146771 0 22270 0 0 0 39166 0 13358 0 221565 0 0 0 JAN IGA DIRECTOR OF HR 148499 0 22707 0 0 0 27630 0 20290 0 219126 0 0 0 TRACIE MUKAI DIRECTOR - PROJECT MANAGEMENT OFFICE 128722 0 18137 0 500 0 29400 0 21495 0 198254 0 0 0 JOEY LEE DIRECTOR OF SALES 133905 0 17424 0 0 0 22442 0 21256 0 195027 0 0 0 IOANA GEBAUER DIRECTOR OF PROFESSIONAL RELATIONS 131033 0 16924 0 0 0 27814 0 12559 0 188330 0 0 0 JUNKO KAWABATA APPLICATION SUPPORT MANAGER 128582 0 12813 0 0 0 30672 0 9322 0 181389 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 6 FIRST CLASS TRAVEL IS AVAILABLE TO THE PRESIDENT/CEO AND BOARD CHAIR PERSON FOR TRAVEL OF 3,000 MILES OR MORE. 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. DR MATTHEW OISHI FAMILY MEMBER OF DIRECTOR 1455 GRANT MARTIN OISHI DIRECTOR SEE NOTE 2 0 MASON A SAVAGE DIRECTOR 338664 SEE NOTE 2 0 ALLISON TRAN DIRECTOR 287147 SEE NOTE 2 0 RCUH NOTE 3 900148 SEE NOTE 3 0 NONA TAMANAHA DIRECTOR 3105900 SEE NOTE 1 0 KERIANN ERNST DIRECTOR 5613966 SEE NOTE 1 0 EMMIT KANE DIRECTOR 1605333 SEE NOTE 1 0 KEVIN HASEYAMA DIRECTOR 1739861 SEE NOTE 1 0 EMI ENO ORIKASA DIRECTOR 182544 SEE NOTE 2 0 JOSEPH CHA DIRECTOR 217685 SEE NOTE 2 0 KAIMANA GOO - RAHTZ DIRECTOR 178052 SEE NOTE 2 0 JAN BOIVIN DIRECTOR 5613966 SEE NOTE 1 0 BRANDON YOKOTA FAMILY MEMBER OF DIRECTOR 323309 SEE NOTE 2 0 PARENTS AND CHILDREN TOGETHER NOTE 1 128536 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 -PREMIUMS ARE RECEIVED FROM VARIOUS ORGANIZATIONS IN WHICH OFFICERS AND DIRECTORS OF HDS SERVE AS BOARD MEMBERS. (E) PURPOSE OF ASSISTANCE SMILEFUND GRANT FROM HAWAII DENTAL SERVICE FOUNDATION (HDSF) TO THE UNIVERSITY OF HAWAII FOUNDATION (UHF). THIS GRANT FROM HDSF TO UHF WAS APPROVED TO PAY FOR THE REGISTRATION FEES FOR DR. MATTHEW OISHI TO ATTEND THE PACIFIC REGION INDIGENOUS DOCTORS CONGRESS AND PRESENT HIS ORAL HEALTH RESEARCH FINDINGS TO MEDICAL COLLEAGUES. THE GRANT WAS AWARDED ON AN OBJECTIVE, NONDISCRIMINARY BASIS BASED ON PRE-ESTABLISHED CRITERIA. DR. MATTHEW OISHI IS THE ORAL HEALTH DIRECTOR AT THE JOHN A. BURNS SCHOOL OF MEDICINE AT THE UNIVERSITY OF HAWAII AND IS THE SON OF DR. MARTIN OISHI WHO IS A HAWAII DENTAL SERVICE (HDS) BOARD MEMBER. HDSF IS A CONTROLLED ENTITY OF HDS (EIN: 99-0107971). DR. MARTIN OISHI IS NOT ON THE BOARD OF HDSF, NOR WAS THE GRANT DIRECTLY TO DR. MATTHEW OISHI. THE GRANT WAS AWARDED AT THE DISCRETION OF THE HDSF DIRECTOR, AND DUE TO THE SIZE OF THE GRANT, THE GRANT DID NOT REQUIRE BOARD APPROVAL. 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. ALL EMPLOYEES, BOARD OF DIRECTORS, 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 15 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 4,957,460. ROUNDING 3. 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 54491 2012273 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 8299 COST HAWAII DENTAL SERVICE FOUNDATION B 1500000 COST HAWAII DENTAL SERVICE FOUNDATION O 338780 COST HAWAII DENTAL SERVICE FOUNDATION Q 510492 COST HAWAII CLIENT SERVICES Q 7516 COST