2014-11-04T14:12:16-06:00 2013-12-31 205325889 ACCUITY LLP 999 BISHOP STREET STE 1900 HONOLULU HI 96813 990 2013-01-01 990107971 HAWAII DENTAL SERVICE HAWA 8085211431 700 BISHOP STREET NO 700 HONOLULU HI 96813 FAYE KURREN CEO & PRESIDENT 8085211431 2014-10-31 1 KIM AT JONES P00940140 8085313400 2013 2015-11-30 17:44:51Z FAYE W KURREN 700 BISHOP STREET SUITE 700 HONOLULU HI 96813 314144164 0 X WWW.HAWAIIDENTALSERVICE.COM X 1962 HI PROMOTE AND ENCOURAGE THE BETTERMENT OF THE GENERAL MEDICAL AND DENTAL HEALTH OF THE PUBLIC (CONTINUED) FOR THE COMMON GOOD AND GENERAL WELFARE OF THE COMMUNITY. 15 5 103 0 0 0 0 0 183236375 191703878 4079635 15491940 17092 0 187333102 207195818 2068508 2089976 158461708 163129532 10082412 9222984 0 0 0 4766869 7056401 175379497 181498893 11953605 25696925 155904958 176648172 23776689 22508722 132128269 154139450 X SEE SCHEDULE O. 0 0 172009690 2089976 188014293 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. SEE SCHEDULE O - FORM 990, PART III, LINE 4A FOR PROGRAM SERVICE ACCOMPLISHMENTS. 2729518 0 3689585 MANAGING THE DENTAL BENEFITS OF ELIGIBLE BENEFICIARIES COVERED BY THE STATE OF HAWAII MEDICAID PROGRAM. 174739208 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 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 3092 0 1 103 1 1 1 0 0 0 0 0 0 0 0 0 X 15 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X CHERYL TAKITANI-SMITH 8085211431 700 BISHOP STREET SUITE 700 HONOLULU HI 96813 T KIMO BLAISDELL CHAIR 1.00 X 0 0 0 JOHN BLACK DIRECTOR 1.00 X 0 0 0 PAUL CHANG DIRECTOR 1.00 1.00 X 0 0 0 NORMAN S CHUN TREASURER 1.00 X 0 0 0 SUZY HOLLINGER DIRECTOR 1.00 X 0 0 0 JOHN I KOTAKE DIRECTOR 1.00 1.00 X 0 0 0 KIM JAMES LAWLER DIRECTOR 1.00 X 0 0 0 SUSAN A LI SECRETARY 1.00 2.00 X 0 0 0 GARY K NAKATA TERM 092013 DIRECTOR 1.00 X 0 0 0 PATSY NANBU DIRECTOR 1.00 X 0 0 0 GARRETT B K OKA DIRECTOR 1.00 1.00 X 0 0 0 MICHAEL J O'MALLEY VICE CHAIR 1.00 1.00 X 0 0 0 CASEY Z TAMASHIRO DIRECTOR 1.00 1.00 X 0 0 0 TRAVIS UMEMOTO DIRECTOR 1.00 X 0 0 0 JON YOSHINO ASST TREASURER/SECRETARY 1.00 X 0 0 0 DAVID K TODANI DIRECTOR 1.00 X 0 0 0 FAYE W KURREN PRESIDENT & CEO 40.00 1.00 X 618609 0 189654 KATHY FAY VP - OPERATIONS 40.00 X 234648 0 148648 CHERYL TAKITANI-SMITH VP - FINANCIAL AFFAIRS 40.00 1.00 X 232875 0 96761 TOM DELANEY DIRECTOR OF INFORMATION SY 40.00 X 161119 0 44700 ROBERT SHERMAN DENTAL DIRECTOR 40.00 X 163495 0 44229 JIM JOHNSON DIR. OF CLAIMS & CUSTOMER 40.00 X 136864 0 48972 ROQUE ARANADOR MANAGER OF INFORMATION SYS 40.00 X 126810 0 35094 MINNA MARI LEHTI DIRECTOR OF COMPLIANCE 40.00 X 119716 0 17597 1794136 0 625655 8 0 1 0 DENTAQUEST 465 MEDFORD STREET BOSTON MA 02129 CLAIM PROCESSING 1190462 COMMUNITY CASE MANAGEMENT 91-1360 KARAYAN STREET EWA BEACH HI 96706 CARE COORDINATION 875000 STRATEGIC COMMUNICATIONS PO BOX 283137 HONOLULU HI 968283137 ADVERTISING 461489 BENEFIT PLAN SOLUTIONS INC 680 IWILEI ROAD 528 HONOLULU HI 96817 BROKER 212009 ERNST & YOUNG LLP 55 MERCHANT STREET 1900 HONOLULU HI 96813 ACCOUNTING SERVICE 140449 8 RISK SUBSCRIPTIONS EARNED 621300 159436305 159436305 ASC SUBSCRIPTIONS EARNED 621300 17601792 17601792 MEDICAL PARTNERS (WHOLESALE) 621300 14642660 14642660 MEMBERSHIP DUES 621300 900 900 22221 22221 191703878 2697692 2697692 6000 6000 0 119736594 106942346 12794248 12794248 12794248 207195818 191703878 0 15491940 2089976 2089976 163129532 163129532 1866987 1866987 5195600 3371266 1824334 958186 641173 317013 710130 326802 383328 492081 226455 265626 312436 199931 112505 169142 77839 91303 18848 18848 551068 551068 2328070 2196240 131830 443322 443322 393833 366549 27284 214078 133961 80117 524618 310049 214569 82444 3600 78844 54906 8355 46551 93704 59291 34413 222436 162522 59914 BROKER COMMISSIONS 965472 965472 DUES & SUBSCRIPTIONS 283137 244166 38971 ALL OTHER EXPENSES 184702 85594 99108 PRINTING 132764 81369 51395 81421 59066 22355 181498893 174739208 6759685 0 43706220 58867389 8692280 8838685 2438365 3087764 4930668 4681511 219556 249157 100848537 105605177 155904958 176648172 8352796 7146151 0 0 2472565 2946649 0 0 0 0 0 0 0 0 0 0 12951328 12415922 23776689 22508722 X 132128269 154139450 0 0 0 0 132128269 154139450 155904958 176648172 X 25696925 -7534873 -868030 4717159 X 0 1 X 1 0 1363581 1336589 26992 2672868 2471581 201287 894219 873341 20878 249157 CLAIMS PAYABLE TO DENTISTS 7535000 REFUNDABLE GROUP SUBSCRIPTIONS 4880922 12415922 1 HAWAII DENTAL SERVICE FOUNDATION 700 BISHOP ST STE 700 HONOLULU HI 96813 990246999 501(C)(4) 2000000 SUPPORT ORGANIZATION PROGRAMS ALOHA UNITED WAY 200 N VINEYARD BLVD HONOLULU HI 96817 990073494 501(C)(3) 11000 GENERAL SUPPORT AMERICAN RED CROSS HI CHAPTER 4155 DIAMOND HEAD ROAD HONOLULU HI 96816 990073477 501(C)(3) 5000 GENERAL SUPPORT AMERICAN HEART ASSOCIATION PO BOX 4002030 DES MOINES IA 50340 135613797 501(C)(3) 5000 GENERAL SUPPORT MARCH OF DIMES 1580 MAKALOA STREET SUITE 1200 HONOLULU HI 96814 131846366 501(C)(3) 11000 GENERAL SUPPORT 4 1 FROM 990, SCHEDULE I DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS: THE PURPOSE OF THE GRANTS AWARDED BY HAWAII DENTAL SERVICE (HDS) ARE REVIEWED AND APPROVED BY HDS CEO EXCEPT FOR GRANTS TO HDS FOUNDATION, WHICH ARE APPROVED BY THE HDS BOARD OF DIRECTORS. HDS FOUNDATION CHAIR REPORTS ON THE USE OF GRANTS TO HDS BOARD OF DIRECTORS. OTHER GRANTS ARE AWARDED TO VARIOUS PUBLIC CHARITABLE ORGANIZATIONS TO SUPPORT THE EXEMPT FUNCTIONS OF THE ORGANIZATIONS AND ARE NOT MONITORED. X X X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 FAYE W KURREN PRESIDENT & CEO 411500 0 158140 0 48969 0 180996 0 8658 0 808263 0 0 0 KATHY FAY VP - OPERATIONS 174648 0 60000 0 0 0 139490 0 9158 0 383296 0 0 0 CHERYL TAKITANI-SMITH VP - FINANCIAL AFFAIRS 174875 0 58000 0 0 0 81791 0 14970 0 329636 0 0 0 TOM DELANEY DIRECTOR OF INFORMATION SY 145119 0 16000 0 0 0 35782 0 8918 0 205819 0 0 0 ROBERT SHERMAN DENTAL DIRECTOR 152895 0 10600 0 0 0 38292 0 5937 0 207724 0 0 0 JIM JOHNSON DIR. OF CLAIMS & CUSTOMER 124421 0 12443 0 0 0 34861 0 14111 0 185836 0 0 0 ROQUE ARANADOR MANAGER OF INFORMATION SYS 117840 0 8970 0 0 0 29523 0 5571 0 161904 0 0 0 SCHEDULE J, 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. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: CEO RECEIVES GROSS UP PAYMENTS FOR LIFE INSURANCE PREMIUMS OVER $50,000, AN AUTO ALLOWANCE, AND PARKING OVER INTERNAL REVENUE SERVICE LIMITS. THE PAYMENTS TO THE INDIVIDUALS ABOVE ARE INCLUDED IN THEIR W-2S AS COMPENSATION. SCHEDULE J, 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 PERFORMANCE AND ACHIEVEMENT OF STRATEGIC GOALS. INCENTIVE AMOUNTS FOR OFFICERS AND CERTAIN DIRECTORS WITH REPORTABLE COMPENSATION EXCEEDING $150,000 ARE APPROVED BY THE BOARD OF DIRECTORS COMPENSATION COMMITTEE WHICH IS DOCUMENTED IN MINUTES. INCENTIVE AMOUNTS FOR MANAGEMENT AND STAFF ARE APPROVED BY OFFICERS. SUSAN LI DIRECTOR 2967953 SEE NOTE A 0 PATSY NANBU DIRECTOR 2967953 SEE NOTE A 0 PAUL CHANG DIRECTOR 2449825 SEE NOTE C 0 DAVID TODANI DIRECTOR 802980 SEE NOTE A 0 NORMAN CHUN DIRECTOR 426029 SEE NOTE B 0 JOHN KOTAKE DIRECTOR 340362 SEE NOTE B 0 CASEY TAMASHIRO DIRECTOR 277511 SEE NOTE B 0 JOHN BLACK DIRECTOR 184581 SEE NOTE B 0 KIM LAWLER DIRECTOR 184545 SEE NOTE B 0 GARRET OKA DIRECTOR 169568 SEE NOTE B 0 SCHEDULE L, PART IV NOTE A - 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 B - DENTIST PARTICIPATING IN HDS NETWORK OFFERING DENTAL SERVICES TO HDS SUBSCRIBERS.NOTE C - PREMIUMS FOR DENTAL PLAN. FORM 990, PART III, LINE 1 HAWAII DENTAL SERVICE OPERATES FOR THE PROMOTION OF THE COMMON GOOD AND GENERAL WELFARE OF THE PEOPLE. 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. IN ADDITION, HAWAII DENTAL SERVICE PROVIDES FUNDING TO HAWAII DENTAL SERVICE FOUNDATION THAT GRANTS TO ORGANIZATIONS THAT HAVE PROGRAMS IN PLACE TO SUPPORT ORAL HEALTH INITIATIVES IN THE COMMUNITY. FORM 990, PART III, LINE 4A, DESCRIPTION OF PROGRAM SERVICE: HAWAII DENTAL SERVICE (HDS) OFFERS AND ADMINISTERS DENTAL CARE PROGRAMS TO SUBSCRIBER GROUPS AND INDIVIDUALS THROUGHOUT THE STATE OF HAWAII. THE TERMS OF THE AGREEMENTS GENERALLY PROVIDE THAT THE SUBSCRIBER GROUPS OR INDIVIDUALS PAY HDS A STIPULATED AMOUNT, INCLUDING AN ADMINISTRATIVE FEE, WHICH IS USED TO PAY FOR DENTAL BENEFITS AND EXPENSES OF ADMINISTERING THE DENTAL SERVICE CONTRACTS. IN ADDITION, HDS FUNDED $2,000,000 TO HDS FOUNDATION IN 2013 TO SUPPORT ORAL HEALTH INITIATIVES IN THE COMMUNITY. FORM 990, PART IV, LINE 12B, AUDITED FINANCIAL STATEMENTS: THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF HAWAII DENTAL SERVICE, HAWAII DENTAL SERVICE FOUNDATION, AND HAWAII CLIENT SERVICES CORPORATION. THE AUDIT COMMITTEE, 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 ORGANIZATION'S MEMBERS: MEMBERSHIP IN THE CORPORATION IS COMPRISED OF DENTIST AND PUBLIC MEMBERS. DENTIST MEMBERSHIP IS AVAILABLE TO ALL DENTISTS AND DENTAL SURGEONS WHO HAVE BEEN DULY LICENSED TO PRACTICE IN THE STATE OF HAWAII BY THE BOARD OF DENTAL EXAMINERS OF THE STATE OF HAWAII. APPLICATION IS MADE IN WRITING AND APPROVED BY THE BOARD OF DIRECTORS. CERTAIN ORGANIZATIONS (COMPANIES, ORGANIZATIONS, OR ENTITIES CONTRACTING WITH HDS FOR DENTAL BENEFITS FOR AT LEAST 2 CONSECUTIVE YEARS WITH MORE THAN 100 OR MORE ELIGIBLE SUBSCRIBERS AT THE TIME OF SUCH DESIGNATION) ARE INVITED TO BECOME PUBLIC MEMBERS AND APPROVED BY THE BOARD OF DIRECTORS. BOTH MEMBERSHIPS OF THE CORPORATION MAY AT ANY TIME DEPOSE OR REMOVE FROM OFFICE ANY 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: DENTISTS AND PUBLIC MEMBERS RESPECTIVELY ELECT DENTISTS AND PUBLIC DIRECTORS TO THE BOARD OF DIRECTORS FOR A THREE YEAR TERM. DUE TO STAGGERED TERMS 1/3 OF DIRECTORS ARE ELECTED ANNUALLY. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL OF DECISIONS: AMENDMENTS TO THE BYLAWS REQUIRE APPROVAL OF NOT LESS THAN A MAJORITY OF EACH CLASS OF MEMBERSHIP. FORM 990, PART VI, SECTION B, LINE 11 APPROVED COPY OF FORM 990: THE RETURN IS THOROUGHLY REVIEWED BY THE CONTROLLER PRIOR TO FINAL REVIEW WITH THE VP-FINANCIAL AFFAIRS AND PRESIDENT. A COPY OF FORM 990 IS PROVIDED TO BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C WRITTEN CONFLICT OF INTEREST POLICY: PURSUANT TO THE HDS CONFLICTS OF INTEREST POLICY, EMPLOYEES AND DIRECTORS OF HDS ARE PROVIDED WITH THE CONFLICTS OF INTEREST POLICY AND ARE REQUIRED TO SUBMIT A CONFLICTS OF INTEREST DISCLOSURE STATEMENT ANNUALLY. COMPLIANCE DEPARTMENT REVIEWS THE ANNUAL CONFLICTS OF INTEREST DISCLOSURE STATEMENTS AND REPORTS POTENTIAL CONFLICTS OF INTERESTS TO THE HDS BOARD OF DIRECTORS. THE BOARD OF DIRECTORS ARE NOT ALLOWED TO PARTICIPATE IN DELIBERATIONS OR VOTE ON ISSUES/TRANSACTIONS WHICH THEY HAVE A CONFLICT OF INTEREST IN. 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 RESOURCE 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 AND CEO ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 PUBLIC DISCLOSURE OF ORGANIZATION GOVERNING DOCUMENTS: TAX RETURNS AND OTHER REQUIRED DISCLOSURES ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN ACCRUED POSTRETIREMENT LIABILITIES 4,717,159. HAWAII DENTAL SERVICE FOUNDATION 700 BISHOP STREET SUITE 700 HONOLULU HI 96813 990246999 SUPPORT COMM. HI 501(C)(4) N/A N/A 1 HAWAII CLIENT SERVICES CORPORATION 700 BISHOP STREET SUITE 710 HONOLULU HI 96813 452740308 ADMIN SERVICES HI HI DENTAL SCVS C 166728 893985 1.00000 1 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 HAWAII DENTAL SERVICE FOUNDATION B 2000000 CASH HAWAII CLIENT SERVICES CORPORATION O 154469 CASH HAWAII CLIENT SERVICES CORPORATION A 6000 CASH HAWAII DENTAL SERVICE Q 152651 CASH