2015-09-01T21:05:13-05:00 2014-12-31 205325889 ACCUITY LLP 999 BISHOP STREET STE 1900 HONOLULU HI 96813 990 2014-01-01 990246999 HAWAII DENTAL SERVICE FOUNDATION HAWA 8085211431 700 BISHOP STREET NO 700 HONOLULU HI 96813 MARK YAMAKAWA VICE PRESIDENT 8085211431 2015-08-28 0 KIM AT JONES P00940140 8085313400 2014 2016-02-25 16:41:14Z JOHN KOTAKE 700 BISHOP STREET SUITE 700 HONOLULU HI 96816 7396902 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) 5 5 0 0 0 0 2000000 4000000 0 0 3634285 712576 0 0 5634285 4712576 413186 503624 0 0 0 0 0 0 0 98368 37539 511554 541163 5122731 4171413 18385783 22690783 279 0 18385504 22690783 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 503624 503624 DURING 2014, HDSF DISTRIBUTED $503,624 TO 9 ORGANIZATIONS WHO HAVEPROGRAMS IN PLACE TO SUPPORT ORAL HEALTH INITIATIVES IN HAWAII.SEE SCHEDULE I FOR ADDITIONAL DETAILS. 503624 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 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 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 GARRETT B K OKA CHAIR (TERMED 5/8/14) 1.00 1.00 X 0 0 0 SUSAN LI VICE CHAIR 1.00 1.00 X 0 0 0 JOHN KOTAKE CHAIR 1.00 1.00 X 0 0 0 PAUL CHANG TRUSTEE 1.00 1.00 X 0 0 0 CASEY TAMASHIRO PRESIDENT 1.00 1.00 X X 0 0 0 CHARLES SUGIYAMA TRUSTEE 1.00 1.00 X 0 0 0 CHERYL TAKITANI-SMITH TREASURER 1.00 40.00 X 0 240198 78214 MARK H YAMAKAWA VICE PRESIDENT (AS OF 12/2014) 1.00 40.00 X 0 43750 1584 PENNY SHIROMA SECRETARY (TERMED 5/2014) 1.00 40.00 X 0 61342 20867 FAYE KURREN VICE PRESIDENT (RETIRED 2014) 1.00 40.00 X 0 2237483 121156 KATHY FAY SECRETARY (AS OF 5/2014) 1.00 40.00 X 0 240031 122095 0 2822804 343916 0 0 1 0 0 4000000 4000000 410544 410544 2986358 2684326 302032 302032 302032 4712576 0 0 712576 503624 503624 5968 5968 31549 31549 MISCELLANEOUS 22 22 541163 503624 37539 0 2066606 223042 16311317 22455878 7860 11863 18385783 22690783 279 0 279 0 X 18385504 22690783 18385504 22690783 18385783 22690783 4171413 133866 0 X 0 1 X 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 UNIVERSITY OF HAWAII FOUNDATION 2444 DOLE ST BACHMAN HALL 105 HONOLULU HI 96822 990085260 501(C)(3) 49519 PURCHASE DENTAL EQUIPMENT (MAUI COLLEGE) ALOHA MEDICAL MISSION 810 N VINEYARD BLVD HONOLULU HI 96817 990234811 501(C)(3) 48484 DENTAL CLINIC SERVING UNINSURED AND UNDERSERVED. HAWAII PRIMARY CARE ASSOCIATION 735 BISHOP STREET SUITE 230 HONOLULU HI 96813 990268275 501(C)(3) 137501 FUNDING FOR HAWAII SMILES PROJECT HAWAII PUBLIC HEALTH ASSOCIATION 7192 KALANIANAOLE HWY A143A PMB 226 HONOLULU HI 96825 990175490 501(C)(3) 16400 FAMILY ORAL HEALTH EDUCATION KE OLA MAMO INC 1505 DILLINGHAM BLVD RM 205 HONOLULU HI 96817 990288045 501(C)(3) 50000 FUNDING FOR DENTAL SERVICES TO ELIGIBLE, UNINSURED ADULT NATIVE HAWAIIANS KEIKI O KA'AINA 1050 BISHOP STREET 436 HONOLULU HI 96813 990327534 501(C)(3) 11000 FUNDING FOR HAWAII KEIKI SMILES PROJECT KOKUA KALIHI VALLEY 2239 N SCHOOL STREET HONOLULU HI 96819 990149797 501(C)(3) 140000 PURCHASE DENTAL EQUIPMENT LIFE FOUNDATION 677 ALA MOANA BLVD SUITE 226 HONOLULU HI 96813 990230542 501(C)(3) 30000 FUNDING FOR DENTAL SERVICES TO UNINSURED PATIENTS SHRINERS HOSPITAL FOR CHILDREN - HONOLULU 1310 PUNAHOU STREET HONOLULU HI 96826 362193608 501(C)(3) 20720 PURCHASE DENTAL EQUIPMENT 9 0 FORM 990, SCHEDULE I DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS FORM 990, SCHEDULE I THERE IS A FORMAL PROCESS FOR APPLICANTS TO REQUEST GRANTS FROM THE FOUNDATION. APPLICANTS NEED TO SUBMIT PURPOSE AND BUDGET FOR GRANTS AND PROOF OF EXEMPT STATUS. AT THE END OF THE YEAR, APPLICANTS WHO RECEIVED GRANTS ARE REQUESTED TO SUBMIT A REPORT OF HOW THE GRANT WAS SPENT. REQUESTS FOR GRANTS ARE REVIEWED BY THE VICE PRESIDENT AND SUBMITTED TO BOARD OF TRUSTEES FOR APPROVAL. 0 1 0 0 0 0 0 0 0 CHERYL TAKITANI-SMITH TREASURER 0 180198 0 60000 0 0 0 65575 0 12639 0 318412 0 0 FAYE KURREN VICE PRESIDENT (RETIRED 2014) 0 424360 0 392752 0 1420371 0 113138 0 8018 0 2358639 0 0 KATHY FAY SECRETARY (AS OF 5/2014) 0 180031 0 60000 0 0 0 112540 0 9555 0 362126 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 CONSULANT 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 AND CEO. 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, 2014 AND 2013. 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 FORM 990, PART VI, LINE 6 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 FORM 990, PART VI, LINE 7A 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 11 DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, LINE 11B 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 FORM 990, PART VI, LINE 12C 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 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 FORM 990, PART VI, LINE 15A & 15B 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 AND CEO ANNUALLY. 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 0 0 1 0 0 0