2019-11-06T15:56:20-06:00 2018-12-31 205325889 ACCUITY LLP 999 BISHOP STREET STE 1900 HONOLULU HI 96813 990 2018-01-01 990246999 HAWAII DENTAL SERVICE FOUNDATION HAWA 8085211431 700 BISHOP STREET NO 700 HONOLULU HI 96813 MARK H YAMAKAWA VICE PRESIDENT 8085211431 2019-10-23 0 KIM AT JONES P00940140 8085313400 72.253.96.98 2019-10-23 16:46:04 HS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 C000E71B0E810C0CCC3D21634A5B677F6E7EE192 2018 2020-03-31 21:24:44Z MASON SAVAGE 700 BISHOP ST STE 700 HONOLULU HI 96813 13766638 0 X N/A X 1986 HI TO PROMOTE THE WELFARE OF THE COMMUNITY AND CONTRIBUTE TO THE CHARITABLE AND HEALTH ISSUES OF THE COMMUNITY. (SEE SCHEDULE O) 6 6 0 0 0 0 4288883 3163242 0 0 1397816 2907096 0 0 5686699 6070338 663278 2464051 0 0 88257 210982 0 0 0 156085 206387 907620 2881420 4779079 3188918 46977719 43596298 26956 32033 46950763 43564265 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 2597732 2464051 DURING 2018, HDSF DISTRIBUTED $2,464,051 TO 14 ORGANIZATIONS WHO HAVEPROGRAMS IN PLACE TO SUPPORT ORAL HEALTH INITIATIVES IN HAWAII AND CALIFORNIA.SEE SCHEDULE I FOR ADDITIONAL DETAILS. 2597732 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X CHERYL TAKITANI-SMITH 8085211431 700 BISHOP STREET SUITE 700 HONOLULU HI 96813 PAUL CHANG TRUSTEE 1.00 1.00 X 0 0 0 CASEY TAMASHIRO PRESIDENT (TERMED 5/2018) 1.00 1.00 X X 0 0 0 CHARLES SUGIYAMA VICE CHAIR 1.00 1.00 X 0 0 0 MASON A SAVAGE CHAIR 1.00 1.00 X 0 0 0 SHAKIL AHMED TRUSTEE 1.00 1.00 X 0 0 0 DAVID K TODANI TRUSTEE 1.00 1.00 X 0 0 0 EMI ENO ORIKASA DDS PRESIDENT (EFF 5/2018) 1.00 1.00 X X 0 0 0 CHERYL TAKITANI-SMITH TREASURER 1.00 41.00 X 0 274489 112249 MARK H YAMAKAWA VICE PRESIDENT 1.00 41.00 X 0 517332 312678 THOMAS DELANEY SECRETARY 1.00 41.00 X 0 226184 91445 0 1018005 516372 0 0 1 0 0 3163242 3163242 1401699 1401699 9201697 7696300 1505397 1505397 1505397 6070338 0 0 2907096 2464051 2464051 210982 210982 6545 6545 48292 48292 11 11 286 286 6471 6471 3500 3500 4378 4378 705 705 ORAL HEALTH OUTREACH 133681 133681 MISCELLANEOUS 2518 2518 2881420 2597732 283688 0 421364 391258 46529516 43200413 26839 4627 46977719 43596298 26956 32033 26956 32033 X 46950763 43564265 46950763 43564265 46977719 43596298 3188918 -6575416 0 X 0 1 X 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 ALOHA MEDICAL MISSION 810 N VINEYARD BLVD HONOLULU HI 96817 990234811 501(C)(3) 265000 DENTAL CLINIC SERVING UNINSURED AND UNDERSERVED. CENTER FOR INDEPENDENT DOCUMENTARY INC 1300 SOLDIERS FIELD RD SUITE 4 BOSTON MA 02135 042738458 501 (C) (3) 10000 EDUCATIONAL DOCUMENTARY ON HEALTH ISSUES DENTAL LIFELINE NETWORK 1800 15TH STREET SUITE 100 DENVER CO 80202 846129064 501 (C) (3) 18700 FUND PROGRAM FOR VOLUNTEER DENTISTS AND LABS TO PROVIDE ORAL CARE TO VULNERABLE POPULATION HAMAKUA HEALTH CENTER INC 45-549 PLUMERIA STREET HONOKAA HI 96727 990115515 501 (C) (3) 15000 TOOTH BUS PROVIDING ORAL HEALTH SERVICES HAWAII COMMUNITY FOUNDATION 1164 BISHOP ST STE 800 HONOLULU HI 96813 990261283 501 (C) (3) 1000000 ENDOWMENT FOR COMMUNITY SCHOLARSHIP FUND. HAWAII PRIMARY CARE ASSOCIATION 735 BISHOP STREET SUITE 230 HONOLULU HI 96813 990268275 501 (C) (3) -10827 REFUND FOR UNUSED GRANT AWARDED IN PRIOR YEAR. HUI MALAMA OLA NA OIWI 1438 KILAUEA AVE HILO HI 96720 990286468 501 (C) (3) 59406 PROMOTE PREVENTIVE ORAL HEALTH EDUCATION FOR SENIORS IN HAWAII COUNTY. HUI NO KE OLA PONO 95 MAHALANI STREET ROOM 21 WAILUKU HI 96793 990287193 501(C)(3) 223067 INCREASE ACCESS TO ORAL CARE FOR CHILDREN ON MAUI & VIRTUAL DENTAL HOME PROJECT. KALIHI-PALAMA HEALTH CENTER 915 N KING STREET HONOLULU HI 96817 990161221 501 (C) (3) 250000 ORAL CARE TO PREGNANT WOMEN, WIC CLIENTS AND CHILDREN. KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES 2239 NORTH SCHOOL STREET HONOLULU HI 96819 990149797 501(C)(3) 110060 EXPAND ACCESS TO ORAL CARE FOR DISADVANTAGED COMMUNITY. QUEEN'S MEDICAL CENTER 1301 PUNCHBOWL STREET HONOLULU HI 96813 990073523 501 (C) (3) 80000 PURCHASE EQUIPMENT THAT WILL IMPROVE QUALITY OF ORAL CARE. UNIVERSITY OF HAWAII FOUNDATION 2444 DOLE STREET BACHMAN 105 HONOLULU HI 96822 990085260 501(C)(3) 75000 OUTREACH TO UNDERSERVED POPULATION IN MAUI. WAIMANALO HEALTH CENTER 41-1374 KALANIANAOLE HIGHWAY WAIMANALO HI 96795 990273205 501 (C) (3) 34756 IMPROVE QUALITY OF CARE FOR DISADVANTAGED COMMUNITY WEST HAWAII COMMUNITY HEALTH CENTER 75-5751 KUAKINI HIGHWAY SUITE 203 KAILUA KONA HI 96740 200495394 501 (C) (3) 333889 DENTAL CLINIC SERVING UNINSURED AND UNDERSERVED & VIRTUAL DENTAL HOME PROJECT 14 FORM 990, SCHEDULE I DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS THERE IS A FORMAL PROCESS FOR APPLICANTS TO REQUEST GRANTS FROM THE FOUNDATION. APPLICANTS NEED TO SUBMIT PURPOSE AND PROPOSED BUDGET FOR GRANTS AND PROOF OF 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 HDS FOUNDATION AND VICE PRESIDENT AND SUBMITTED TO THE BOARD OF TRUSTEES FOR APPROVAL. 0 1 0 0 0 0 0 0 0 CHERYL TAKITANI-SMITH TREASURER 0 218050 0 56018 0 421 0 96614 0 15635 0 386738 0 0 MARK H YAMAKAWA VICE PRESIDENT 0 385551 0 126062 0 5719 0 302697 0 9981 0 830010 0 0 THOMAS DELANEY SECRETARY 0 194674 0 31510 0 0 0 79358 0 12087 0 317629 0 0 PART I, LINE 3 THE FOUNDATION DOES NOT PAY COMPENSATION TO ITS TRUSTEES 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. PART I, LINE 4B MARK H. YAMAKAWA PARTICIPATED IN A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN WHICH ACCRUED BENEFITS OF $226,000 IN 2018 WHICH IS INCLUDED IN THE RETIREMENT AND OTHER DEFERRED COMPENSATION EXPENSE AMOUNT REPORTED FOR HIM IN SCHEDULE J, PART II, LINE (2), COLUMN (C). 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 SERVICES CORPORATION, YEARS ENDED DECEMBER 31, 2018 AND 2017. 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 TRUSTEES 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 TRUSTEES TO SERVE ON THE HAWAII DENTAL SERVICE FOUNDATION BOARD OF TRUSTEES 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 TRUSTEES 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, TRUSTEES ARE PROVIDED WITH THE CONFLICTS OF INTEREST POLICY AND ARE REQUIRED TO SUBMIT A CONFLICTS OF INTEREST DISCLOSURE STATEMENT AND CERTIFICATION ANNUALLY. TRUSTEES 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 TRUSTEES 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 CONSULANT 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. HAWAII DENTAL SERVICE 700 BISHOP STREET SUITE 700 HONOLULU HI 96813 990107971 DENTAL PLAN PROVIDER HI 501(C)(4) N/A N/A 0 HAWAII CLIENT SERVICES CORPORATION 700 BISHOP STREET SUITE 710 HONOLULU HI 96813 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