TIN:
SCHEDULE O
(Form 990)
Department of the Treasury
Internal Revenue Service
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Inspection
Name of the organization
HAWAII DENTAL SERVICE
Employer identification number
99-0107971
99-0107971
| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: | HAWAII DENTAL SERVICE OPERATES 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. 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. FURTHERMORE, HAWAII DENTAL SERVICE MAKES DONATIONS TO PUBLIC CHARITIES OR PRIVATE ENTERPRISES IN CONNECTION WITH ITS OVERALL PURPOSE IN THE PUBLIC OR COMMUNITY INTEREST. |
| 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| FORM 990, PART VI, SECTION A, LINE 7B | APPROVAL OF DECISIONS: BYLAWS AND ARTICLES OF INCORPORATION MAY BE ALTERED OR REPEALED, OR NEW BYLAWS AND ARTICLES OF INCORPORATION MAY BE ADOPTED IN LIEU THEREOF, BY ADOPTION OF A RESOLUTION BY THE BOARD OF DIRECTORS SETTING FORTH THE PROPOSED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 THE WHISTLEBLOWER PROGRAM. 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 APPERANCE OF A CONFLICT OF INTEREST. IN THE CURRENT YEAR, SOME POTENTIAL CONFLICTS OF INTEREST WERE DISCOVERED. THESE POTENTIAL CONFLICTS INVOLVED CONTRIBUTIONS MADE TO OUTSIDE ORGANIZATIONS WITH WHOM OFFICERS HAD SOME AFFILIATION. THESE CONTRIBUTIONS WERE RETROACTIVELY APPROVED BY AN EXECUTIVE COMMITTEE OF THE BOARD. THE ORGANIZATION CLARIFIED ITS POLICIES, AND EDUCATED THE DIRECTORS, OFFICERS, AND KEY EMPLOYEES ABOUT THE IMPORTANCE OF THESE POLICIES IN LIGHT OF THESE ACTIONS. |
| 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 RESOURCES 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/CEO AND EXECUTIVES ANNUALLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | TAX RETURNS AND OTHER REQUIRED DOCUMENTS ARE AVAILABLE UPON REQUEST. |
| PART VI, SECTION A, QUESTION 4 | IN 2018, HDS AMENDED AND RESTATED THEIR ARTICLES OF INCORPORATION, CLARIFYING AND BROADENING THEIR MISSION. THE ACTIVITIES HAVE NOT CHANGED SIGNIFICANTLY, HOWEVER, THEY WERE NOT SPECIFICALLY ENUMERATED IN THE 2018 RETURN, AS SUCH HDS WANTED TO ENUMERATE THEM BELOW: THE OBJECTS AND PURPOSES FOR WHICH THE CORPORATION IS ORGANIZED ARE AS FOLLOWS: (A) 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 AND TO INDIGENT PERSONS AND TO PROMOTE AND ADVANCE RESEARCH, STUDY AND LEARNING IN THE FIELD OF DENTISTRY, ORAL HYGIENE AND RELATED SCIENCES; (B) TO ESTABLISH, CONDUCT, MAINTAIN, SPONSOR AND PROMOTE STUDIES OF COMMUNITY DENTAL NEEDS, STATISTICAL STUDIES OF THE DENTAL REQUIREMENTS OF THE POPULATION AND TO INVESTIGATE AND CONDUCT PROGRAMS FOR PROVIDING DENTAL CARE OVER A BROAD AREA AND TO MAKE AVAILABLE FULL DENTAL CARE FOR MEMBERS OF THE PUBLIC; (C) TO ESTABLISH, CONDUCT, OPERATE, MAINTAIN, SPONSOR AND PROMOTE A PROGRAM FOR RECRUITMENT OF DENTISTS IN ORDER TO MAKE DENTAL SERVICES MORE AVAILABLE; GENERALLY TO DO ALL THINGS NECESSARY TO RENDER DENTAL SERVICE MORE AVAILABLE; (D) TO ENTER INTO CONTRACTS, AGREEMENTS, UNDERTAKINGS AND PROGRAMS TO PROVIDE DENTAL CARE TO INDIVIDUALS, GROUPS, AND MEMBERS OF THE PUBLIC AND GENERALLY TO DO ALL THINGS NECESSARY TO RENDER DENTAL SERVICE MORE AVAILABLE; (E) TO ESTABLISH, CONDUCT, OPERATE, MAINTAIN, SPONSOR AND PROMOTE DENTAL CLINICS, LABORATORIES AND RELATED FACILITIES TO PROVIDE MORE ADEQUATE AND COMPLETE DENTAL COVERAGE TO FULFILL AND MEET THE NEEDS FOR PROPER AND COMPLETE DENTAL SERVICES AND CARE WHERE SUCH NEED IS FOUND TO EXIST; (F) TO PURCHASE, OR OTHERWISE ACQUIRE, OWN, OPERATE, MANAGE, CONDUCT, DEVELOP, IMPROVE, SELL, ASSIGN, TRANSFER, CONVEY, LEASE, SUBLEASE, PLEDGE AND OTHERWISE ALIENATE AND DISPOSE OF, AND TO MORTGAGE OR OTHERWISE ENCUMBER REAL OR PERSONAL PROPERTY, INCLUDING BUSINESSES AND RENTAL PROPERTIES, WHEREVER SITUATED WHEN NECESSARY OR USEFUL IN CARRYING OUT THE PURPOSES AND OBJECTIVES OF THE CORPORATION; (G) TO RECEIVE CONTRIBUTIONS IN MONEY OR PROPERTY FROM INDIVIDUAL PERSONS OR CORPORATIONS TO BE USED FOR THE PURPOSES OF THE CORPORATION; (H) TO CONDUCT AND OPERATE ITS BUSINESS AND AFFAIRS SO AS TO BE SELF-SUSTAINING BUT THE CORPORATION SHALL BE PRIVILEGED TO FURNISH DENTAL SERVICES TO NEEDY AND DESERVING INDIVIDUALS ON A CHARITABLE BASIS; (I) TO MAKE DONATIONS OF PROPERTY OR MONEY TO MUNICIPALITIES OR PUBLIC CHARITIES, OR TO PRIVATE ENTERPRISES OR PURPOSES SO FAR AS IT MAY DEEM NECESSARY OR HELPFUL IN CONNECTION WITH THE ACCOMPLISHMENT OF THE PURPOSES HEREIN STATED OR IN THE PUBLIC OR COMMUNITY INTEREST; (J) TO NEGOTIATE AND ENTER INTO CONTRACTS WITH INSTITUTIONS, EMPLOYING UNITS, GROUPS OF EMPLOYERS AND EMPLOYEES, ASSOCIATIONS, FRATERNAL AND LABOR, GOVERNMENTAL AGENCIES, INSURANCE COMPANIES, AND OTHER GROUPS AND INDIVIDUALS FOR THE RENDITION OF DENTAL SERVICES BY DENTAL LICENTIATES; (K) TO FORM PANELS OR GROUPS OF MEMBERS IN VARIOUS PARTS OF THE STATE OF HAWAII AND TO NEGOTIATE AND CONTRACT WITH THE MEMBERS OF SUCH PANELS AND GROUPS FOR THE PERFORMANCE BY THEM OF DENTAL SERVICES UPON UNIFORM SCHEDULES FOR PAYMENT ESTABLISHED BY THE BOARD OF DIRECTORS OF THE CORPORATION TO PATIENTS FOR WHOM THE CORPORATION IS OBLIGATED TO FURNISH DENTAL SERVICES PURSUANT TO POLICIES OR CONTRACTS OF THE CORPORATION; (L) TO ACQUIRE OR BUILD DENTAL OFFICES AND EQUIP THE SAME FOR THE PERFORMANCE OF DENTAL SERVICES BY DENTAL LICENTIATES IN SUCH PLACES IN THE STATE OF HAWAII AS THE BOARD OF DIRECTORS MAY DEEM NEEDFUL OR REQUIRED TO CARRY OUT THE PURPOSES FOR WHICH THE CORPORATION IS FORMED; (M) TO ENTER INTO CONTRACTS OR COOPERATIVE ARRANGEMENTS WITH HOSPITALS, DIAGNOSTIC AND TREATMENT CENTERS, REHABILITATION CENTERS AND ANY OTHER INSTITUTION OR CLINIC AS A PART OF WHICH DENTAL SERVICES MAY BE RENDERED TO SUPPLY THE SERVICES OF DENTAL LICENTIATES ON A PATIENT-DENTIST BASIS, TO CONSTRUCT OR SUPPLY FACILITIES FOR THE PERFORMANCES OF DENTAL SERVICES IN CONJUNCTION THEREWITH, AND TO CONTRACT FOR OR ARRANGE WITH SUCH INSTITUTION OR CLINIC FOR JOINT DISCHARGE OF COMMON EXPENSES AND COSTS IN CONJUNCTION THEREWITH; (N) TO DO AND TRANSACT ANY AND EVERY KIND OF BUSINESS WHICH IS PERMITTED UNDER THE LAWS OF THE STATE OF HAWAII FOR NON-PROFIT CORPORATIONS AS ARE NOW IN FORCE OR AS HEREAFTER AMENDED; AND 2. TO OPERATE EXCLUSIVELY FOR SUCH PURPOSES AS ARE PERMITTED BY APPLICABLE LAW AND REGULATIONS FOR ORGANIZATIONS DESCRIBED IN SECTION 50L(C)(4) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED (HEREINAFTER REFERRED TO AS THE "CODE"), OR CORRESPONDING SECTION OF ANY FUTURE FEDERAL TAX CODE. |
| FORM 990, PART XI, LINE 9: | CHANGE IN ACCRUED POSTRETIREMENT LIABILITIES 6,801,546. GAIN ON DISSOLUTION OF LINKDDS 221,368. LIQUIDATION OF LINKDDS -15,370. ROUNDING 6. |
| FORM 990, PART XII, LINE 2C: | NO CHANGE FROM PRIOR YEAR. |
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021
Additional Data
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