Schedule L
(Form 990)
(Rev. January 2025)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
Attach to Form 990 or Form 990-EZ.
Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
Open to Public Inspection
Name of the organization
ARIZONA DENTAL INSURANCE SERVICE INC
 
Employer identification number

86-0274899
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... $
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ $
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e) Original principal amount (f) Balance due (g) In default? (h) Approved by board or committee? (i) Written agreement?
To From Yes No Yes No Yes No
Total ............... $  
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990) (Rev. 1-2025)
Schedule L (Form 990) (Rev. 1-2025)
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) BRUCE A SPIGNER DDS PC
  		Board Member 137,145 CONTRACTED PROVIDER PAYMENTS WERE MADE TO BOARD MEMBER BRUCE SPIGNER CONSISTENT WITH REGULAR COMPANY REIMBURSEMENT RATES.   No
(2) RICHARD B HIGGS DDS PC
  		Board Member 221,431 CONTRACTED PROVIDER PAYMENTS WERE MADE TO BOARD MEMBER RICHARD B HIGGS CONSISTENT WITH REGULAR COMPANY REIMBURSEMENT RATES.   No
(3) WARREN AND HAGERMAN DENTAL PLLC
  		MICHAEL A. WARREN OWNS MORE THAN 35% OF WARREN & HAGERMAN DENTAL 357,492 CONTRACTED PROVIDER PAYMENTS WERE MADE TO WARREN AND HAGERMAN DENTAL PLLC CONSISTENT WITH REGULAR COMPANY REIMBURSEMENT RATES. BOARD MEMBER MICHAEL A. WARREN OWNS MORE THAN 35% OF WARREN & HAGERMAN DENTAL.   No
(4) TANGERINE DENTAL GROUP LLP
  		Shaharyar Ashraf OWNS MORE THAN 35% OF TANGERINE DENTAL GROUP LLP 160,335 CONTRACTED PROVIDER PAYMENTS WERE MADE TO ASHRAF AND TANGERINE DENTAL GROUP LLP CONSISTENT WITH REGULAR COMPANY REIMBURSEMENT RATES. BOARD MEMBER SHAHARYAR ASHRAF OWNS MORE THAN 35% OF TANGERINE DENTAL GROUP LLP.   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990) (Rev. 1-2025)


Additional Data


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