2023-12-04T10:47:33-06:00 2022-12-31 135565207 KPMG LLP 401 UNION STREET SUITE 2800 SEATTLE WA 98101 990 2022-01-01 910621480 DELTA DENTAL OF WASHINGTON DELT 2065221300 400 FAIRVIEW AVE N SUITE 800 SEATTLE WA 98109 RYAN BARTLETT VICE PRESIDENT OF FINANCE & CFO 2065221300 2023-12-04 1 RYAN BARTLETT 999009999 0 JAMES R LANCASTER P00742579 2069134000 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z RYAN BARTLETT 400 FAIRVIEW AVE N SUITE SEATTLE WA 98109 1801870818 0 X WWW.DELTADENTALWA.COM X 1954 WA DDWA WILL REVOLUTIONIZE THE ORAL HEALTH INDUSTRY AND IMPROVE OVERALL HEALTH. 11 6 570 77 0 0 21695 671483 1617648578 1688122627 12420481 9084626 240167 255592 1630330921 1698134328 4947592 6347657 1476312672 1529658909 60663511 65657286 0 0 0 69467008 70254686 1611390783 1671918538 18940138 26215790 260648362 256611926 73217260 93918845 187431102 162693081 X SEE SCHEDULE ODDWA WILL REVOLUTIONIZE THE ORAL HEALTH INDUSTRY AND IMPROVE OVERALL HEALTH. THIS INCLUDES, BUT IS NOT LIMITED TO, THE FOLLOWING: TO SECURE DENTAL SERVICE FOR EMPLOYER GROUPS, INDIVIDUALS AND THEIR FAMILIES; PROVIDE INNOVATIVE PRODUCTS AND SERVICES; TO ENCOURAGE, FOSTER AND FINANCE PROFESSIONAL AND SCIENTIFIC STUDY AND RESEARCH IN THE GENERAL FIELD OF ORAL HEALTH; AND TO EDUCATE THE PUBLIC CONCERNING THE NEED FOR AND ADVANTAGE OF ADEQUATE DENTAL TREATMENT. 0 0 1576440690 1688063858 SEE SCHEDULE ODDWA PROVIDES DENTAL INSURANCE FOR OVER 3,916,000 PRIMARY SUBSCRIBERS AND THEIR DEPENDENTS THROUGHOUT THE STATE OF WASHINGTON AND ACROSS THE NATION. WORKING COLLECTIVELY WITH PRODUCERS AND BENEFIT MANAGERS, WE OFFER STANDARD INSURANCE BENEFITS, AS WELL AS HIGHLY CUSTOMIZED PLANS TO MEET THE NEEDS OF INDIVIDUALS AND THEIR FAMILIES. WE HAVE CONTRACTED WITH NEARLY 4,800 DENTISTS, CREATING A NETWORK OF PROVIDERS SERVING PATIENTS ACROSS THE STATE. AS A MEMBER OF THE DELTA DENTAL PLANS ASSOCIATION, A NATIONAL ASSOCIATION SUPPORTING DELTA INSURERS NATION-WIDE, OUR MEMBERS ARE ABLE TO ACCESS DELTA CONTRACTED PROVIDERS IN EVERY STATE. IN 2022, DDWA PROCESSED OVER 7,608,000 CLAIMS FOR SUBSCRIBERS AND THEIR DEPENDENTS. TO ENSURE PROVIDERS ARE SUBMITTED CLAIMS APPROPRIATELY, WE AUDITED OVER 43,000 INDIVIDUAL CLAIMS, THE RESULTS OF WHICH INCLUDE EDUCATION OF DENTAL OFFICE STAFF ON THE USE OF CDT CODES, INVOICING PROCEDURES AND REDUCING COMMON ERRORS. 2901946 SEE SCHEDULE ODELTA DENTAL OF WASHINGTON PROMOTES THE VALUE OF DENTAL BENEFITS AND IMPORTANCE OF ORAL HEALTH THROUGH MARKETING EFFORTS IN MEDIA ADVERTISING, PUBLIC RELATIONS, EVENT SPONSORSHIPS AND DIRECT OUTREACH TO CUSTOMERS. MARKET RESEARCH FINDINGS SHOW THESE ACTIVITIES IMPROVE OUR ABILITY TO REACH AND ENCOURAGE AUDIENCES TO EMBRACE GOOD ORAL HEALTH AND MAKE WISE USE OF DENTAL BENEFITS. 2739837 2739837 0 SEE SCHEDULE ODENTAL DISEASE IS THE SINGLE MOST COMMON CHRONIC DISEASE OF EARLY CHILDHOOD - FIVE TIMES MORE COMMON THAN ASTHMA. NEARLY ONE IN FIVE ADULTS, NATIONALLY, HAS UNTREATED DENTAL CAVITIES. THE ARCORA FOUNDATION (THE FOUNDATION), A WHOLLY OWNED SUBSIDIARY OF DDWA, SUPPORTED ALMOST EXCLUSIVELY BY DDWA, FOCUSES MUCH OF THEIR WORK ON COMMUNITIES EXPERIENCING ORAL HEALTH DISPARITIES, INCLUDING CHILDREN AND SENIORS, AND WORKS CLOSELY WITH PARTNER ORGANIZATIONS TO DEVELOP AND IMPLEMENT INNOVATIVE PROGRAMS THAT IMPROVE ORAL HEALTH. THE ACCESS TO BABY AND CHILD DENTISTRY (ABCD) SYSTEM OF CARE EXPANDS ACCESS TO DENTAL CARE FOR YOUNG MEDICAID INSURED CHILDREN UNDER SIX IN WASHINGTON STATE BY PROVIDING DENTAL SERVICES, BOTH PREVENTATIVE AND RESTORATIVE. IN COUNTIES WITH ABCD, THE UTILIZATION OF DENTAL SERVICES INCREASED FROM 21% TO 51% FROM 1997 TO 2021. THE EARLY INTERVENTION IN MEDICAL SETTINGS PROGRAMS, MOUTHMATTERS, TRAINS PEDIATRIC MEDICAL PROVIDERS IN THE ADVANTAGES AND TECHNIQUES OF EARLY INTERVENTION AND PREVENTION THROUGH ORAL SCREENING AND EDUCATION, APPLYING FLUORIDATION AND REFERRING HIGH RISK PATIENTS FOR DENTAL CARE. 4211796 3607820 314361 1. WATER FLUORIDATION IS THE MOST IMPORTANT STEP A COMMUNITY CAN TAKE TO IMPROVE THE ORAL HEALTH OF ALL RESIDENTS. THE FOUNDATION PROMOTES LEGISLATION TO ENCOURAGE FLUORIDATION, PROVIDES ASSISTANCE TO GROUPS WHO ARE COMMITTED TO BRINGING THE BENEFITS OF FLUORIDE TO THEIR COMMUNITIES AND HELPS PREVENT ROLLBACKS IN EXISTING FLUORIDATED COMMUNITIES. SINCE 2001, OVER 680,000 WASHINGTONIANS RECEIVE THE HEALTH BENEFITS ASSOCIATED WITH FLUORIDATED WATER AS A RESULT OF THE FOUNDATION'S WORK.2. ASSISTING THE WORK OF THE FOUNDATION ARE DDWA EMPLOYEES VOLUNTEERING THEIR TIME. DDWA ENABLES ALL EMPLOYEES TO ENGAGE WITH THE PUBLIC REGARDING ORAL HEALTH THROUGH THE USE OF TWO VOLUNTEER DAYS PER YEAR. THE SMILEMOBILE PROGRAM OFFERS VOLUNTEER OPPORTUNITIES IN ASSISTING WITH PATIENT RECRUITMENT AND REGISTRATION WHILE IN A COMMUNITY. THE MOBILE DENTAL VAN STAFFED WITH DENTAL PROFESSIONALS, TRAVELS THE STATE OF WA PROVIDING PREVENTIVE, RESTORATIVE AND EMERGENT DENTAL CARE TO CHILDREN, YOUTH AND PREGNANT/POSTPARTUM PEOPLE WITH A FOCUS ON BLACK, INDIGENOUS, PEOPLE OF COLOR IN UNDERSERVED AREAS OF THE STATE. SINCE 1995, THE PROGRAM HAS EXAMINED OVER 48,000 PATIENTS.3. DDWA MATCHES DONATIONS MADE BY EMPLOYEES TO NON-PROFIT ORGANIZATIONS WITH OFFICIAL IRS 501(C)(3) STATUS, ALTHOUGH THE FOLLOWING ORGANIZATIONS/EVENTS ARE NOT ELIGIBLE FOR MATCHING: CHURCHES, POLITICAL CAMPAIGNS/ORGANIZATIONS, CAPITAL FUNDING, FRATERNAL/LABOR ORGANIZATIONS, TRIPS/TOURS, MASS MAILINGS, ORGANIZATIONS/GROUPS THAT DISCRIMINATE FOR ANY REASON INCLUDING, BUT NOT LIMITED TO, RACE, COLOR, RELIGION, CREED, AGE, SEX, SEXUAL ORIENTATION OR NATIONAL ORIGIN.4. IN 2018, DDWA SUPPORTED THE SEATTLE CHILDREN'S HOSPITAL TO EQUIP AND OPERATIONALIZE THE NEW ODESSA BROWN CHILDREN'S CLINIC (OBCC) DENTAL CLINIC. IN 2022, AND WITH THE OPENING OF OBCC, THE FINAL $2.5M PAYMENT WAS MADE. OBCC HUB WILL BE AN INNOVATIVE, FORWARD THINKING PROJECT THAT WILL TEST AND PROMOTE NEW HEALTH DELIVERY STRATEGIES IN WASHINGTON STATE. DDWA ALSO PROVIDED $275K TO UW SCHOOL OF DENTISTRY TO COVER THE WASHINGTON STATE DEPARTMENT OF ORAL HEALTH DENTAL EXAMS FOR ITS GRADUATING CLASS. 4211796 3607820 314361 1586294269 0 1 1 0 0 0 0 0 0 1 0 0 1 1 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 1 1 0 0 1 74147 0 1 570 1 0 0 0 0 0 0 1 0 X 11 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X RYAN BARTLETT 2065221300 400 FAIRVIEW AVE N SUITE 800 SEATTLE WA 98109 X MITCHKE MARK PRESIDENT & CHIEF EXECUTIVE OFFICER 36.00 4.00 X X 3620219 0 431827 LABBERTON WELLS K CHAIR - BRD. & DDS FEES 11.00 4.00 X X 389984 0 0 SEELY JEFFREY T SECRETARY 12.00 4.00 X X 161337 0 0 BROWN COLLEEN BIRDNOW TREASURER 9.00 3.00 X X 154640 0 0 RUTHERFORD EVE M VICE CHAIR - BRD. & DDS FEES 15.00 5.00 X X 913003 0 0 HAKES KATHERINE DIRECTOR - BRD. & DDS FEES 12.00 4.00 X 803174 0 0 FARRELL ANNE V DIRECTOR 8.00 2.00 X 133334 0 0 NELSON CAROL K DIRECTOR 11.00 3.00 X 127225 0 0 WHITE MARVIN DIRECTOR 7.00 2.00 X 122946 0 0 ARMSTRONG SCOTT DIRECTOR 10.00 3.00 X 133334 0 0 PICKEL CHRISTOPHER DIRECTOR - BRD. & DDS FEES 11.00 3.00 X 558672 0 0 BARTLETT RYAN VP, CHIEF FINANCIAL OFFICER 40.00 0.00 X 406605 0 51974 BERG BRADLEY SVP & CHIEF ADMIN OFFICER 36.00 4.00 X 1823578 0 209566 ALIABADI KAREN CHIEF HR STRATEGIST 40.00 0.00 X 817940 0 120319 WHITNEY GARRETT SENIOR VP, CHIEF INFORMATION OFFICER 40.00 0.00 X 706168 0 121198 SNYDER CINDY SENIOR VP, CHIEF OPERATING OFFICER 40.00 0.00 X 666993 0 102485 ROBINSON HERBERT SENIOR VP, CHIEF REVENUE OFFICER 40.00 0.00 X 609869 0 53658 CHEUNG STEPHEN VP, MARKETING 40.00 0.00 X 309813 0 51522 LO ERIC VP, ACTUARIAL & UNDERWRITING 40.00 0.00 X 512903 0 98599 ABDELLATIF VANETTA PRES/CEO ARCORA FDN 39.50 0.50 X 464531 0 74015 ROGERS TIFFANY HEAD OF DISTRIBUTION & STRATEGY 40.00 0.00 X 425543 0 25695 SCHOBER DEBRA SR SALE & STRGY EX LGGRP 40.00 0.00 X 328259 0 34426 LAY LINDA VP OF SALES, THRU 04/2022 40.00 0.00 X 522712 0 10264 DAYTON THEMBA SALES MANAGER, THRU 03/2022 40.00 0.00 X 343732 0 37029 JAHRMAN CHRIS DIR OF OPER & PNT EXP, THRU 03/2022 40.00 0.00 X 292672 0 28519 TUNE JAMES F FORMER DIRECTOR 0.00 0.00 X 11797 0 0 15360983 0 1451096 144 1 1 0 8 WEST UNIT 1 CURRAHEEN ROAD CORK EI SOFTWARE DEVELOPMENT 7857069 WYSSTA SERVICES INC PO BOX 86 STEVENS POINT WI 54481 INDIVIDUAL PLAN TPA 7811756 REDCARD SYSTEMS LLC 744 OFFICE PARKWAY ST LOUIS MO 63141 PRINTING/MAIL SVCS 3383179 ENCARA INC 4818 STARKEY ROAD SW ROANOKE VA 24018 INDIV PLAN ACQUISITION MKTG 2828892 SLALOM LLC PO BOX 101416 PASADENA CA 91189 CONSULTING 2015344 99 17115 654368 671483 PREMIUM REVENUE 524114 1688063858 1688063858 SMILEMOBILE 621990 58769 58769 1688122627 5410306 5410306 198522 198522 107212288 103582516 153974 3629772 -153974 3475798 3475798 255592 255592 255592 1698134328 1688378219 0 9084626 6347657 6347657 1529658909 1529658909 15745666 4437932 11307734 34849910 15531773 19318137 2558579 959914 1598665 8664034 3833962 4830072 3839097 1576935 2262162 211711 9436 202275 426625 426625 72721 72721 471009 471009 5127083 2616834 2510249 8760895 2901946 5858949 5764154 3422546 2341608 9120809 56855 9063954 3913716 102308 3811408 1012019 355783 656236 563651 148196 415455 19020 19020 5707574 36167 5671407 455348 455348 TAXES & SERVICE CHARGES 15187024 2562907 12624117 COMMISSIONS 11533715 11533715 DUES & SUBSCRIPTIONS 1781048 120584 1660464 RESEARCH & DEVELOPMENT 16637 2829 13808 109927 4360 105567 1671918538 1586294269 85624269 0 2345020 11452470 2371933 2056393 31893597 27619683 7199137 5973516 78641591 52977627 26878430 25663964 187737103 162329374 1113506 962177 1109636 20554349 260648362 256611926 63094547 59188598 560600 1173513 9562113 8969238 0 24587496 73217260 93918845 X 187431102 162693081 187431102 162693081 260648362 256611926 X 26215790 -35153811 -15800000 X 0 1 X 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 230000 230000 230000 1 AMY WALEN FOR STATE HOUSE PO BOX 853 REDMOND WA 98073 824989832 1000 0 APRIL FOR WASHINGTON 3911 W 27TH AVE STE 101 PMB 101 KENNEWICK WA 99337 874046423 1000 0 BRUCE CHANDLER CAMPAIGN PO BOX 1108 ZILLAH WA 98953 912066326 1000 0 BRYAN SANDLIN CAMPAIGN COMMITTEE PO BOX 1770 ZILLAH WA 98953 881283663 1000 0 CAMPAIGN TO ELECT PAUL HARRIS 237 CHKALOV DRIVE VANCOUVER WA 98684 272531536 1000 0 CAROLYN ESLICK CAMPAIGN PO BOX 776 SULTAN WA 98294 830700073 500 0 CASCADE PAC - MAINSTREAM REPUBLICANS PO BOX 98006 DES MOINES WA 98198 821114119 5000 0 CITIZENS FOR FRANK CHOPP 4209 SUNNYSIDE AVE NORTH SEATTLE WA 98103 320020852 1000 0 CITIZENS FOR JUNE ROBINSON 616 WETMORE EVERETT WA 98201 455346884 1000 0 CITIZENS FOR STEVE BERGQUIST PO BOX 2050 RENTON WA 98059 454489263 1000 0 CITIZENS TO ELECT MIKE STEELE PO BOX 1072 CHELAN WA 98816 812608262 1000 0 CITIZENS TO ELECT STEVE CONWAY PO BOX 112020 TACOMA WA 98411 010735404 1000 0 CLAIRE FOR SENATE 31811 PACIFIC HIGHWAY S SUITE B FEDERAL WAY WA 98003 824403196 500 0 COMMITTEE TO ELECT DREW C MACEWEN PO BOX 651 UNION WA 98592 364732450 1000 0 COMMITTEE TO 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COMMITTEE TO ELECT SKYLER RUDE PO BOX 502 WALLA WALLA WA 99362 812502739 1000 0 COMMITTEE TO ELECT STEPHANIE MCCLINTOCK 10013 NE HAZEL DELL AVE 276 VANCOUVER WA 98685 462908931 1000 0 COMMITTEE TO ELECT TOM DENT 601 S PIONEER WAY SUITE F PMB 396 MOSES LAKE WA 98837 464970913 1000 0 COMMITTEE TO RE-ELECT ED ORCUTT PO BOX 1280 KALAMA WA 98625 900038949 1000 0 DENNY HECK FOR LT GOVERNOR PO BOX 235 OLYMPIA WA 98507 850575085 1000 0 ELECT JAMILA TAYLOR PO BOX 3996 FEDERAL WAY WA 98063 833917287 500 0 ELECT JESSE SALOMON PO BOX 77295 SEATTLE WA 98177 823939741 1000 0 ELECT LAUREN DAVIS PO BOX 9100 SEATTLE WA 98109 824710355 1000 0 ELECT MONICA STONIER PO BOX 61762 VANCOUVER WA 98666 271504430 1000 0 ENTERPRISE WASHINGTON 1603 116TH AVE NE SUITE 120 BELLEVUE WA 98004 680670355 20000 0 FRIENDS TO ELECT KRISTINE REEVES 1815 SW CAMPUS DRIVE 26332 FEDERAL WAY WA 98093 812277473 1000 0 FRIENDS FOR CINDY RYU PO BOX 33548 SHORELINE WA 98133 202771557 1000 0 FRIENDS OF ALEX YBARRA PO BOX 175 QUINCY WA 98848 834576849 1000 0 FRIENDS OF ANDREW BARKIS PO BOX 8728 LACEY WA 98509 811755579 1000 0 FRIENDS OF APRIL BERG PO BOX 14893 MILL CREEK WA 98082 850659766 1000 0 FRIENDS OF BETH DOGLIO 120 STATE AVE NE 200 OLYMPIA WA 98501 475314796 1000 0 FRIENDS OF BILL BOYCE PO BOX 6513 KENT WA 98064 873615791 2000 0 FRIENDS OF CARMEN GOERS PO BOX 235 AUBURN WA 98071 870815008 1000 0 FRIENDS OF CHRIS CORRY 2010 WEST HOB HILL SUITE 1 YAKIMA WA 98902 825239321 1000 0 FRIENDS OF CHRIS REYKDAL 855 TROSPER ROIAD SUITE 108-117 TUMWATER WA 98512 271751460 1000 0 FRIENDS OF DAN BRONOSKE PO BOX 64998 TACOMA WA 98464 845074803 1000 0 FRIENDS OF DREW STOKESBARY PO BOX 92 AUBURN WA 98071 465287065 1000 0 FRIENDS OF ELECT LARRY SPRINGER 10536 NE 122ND STREET KIRKLAND WA 98034 830382872 1000 0 FRIENDS OF GREG GILDAY PO BOX 1472 STANWOOD WA 98292 844900200 1000 0 FRIENDS OF HILARY FRANZ 401 2ND AVENUE SOUTH 303 SEATTLE WA 98104 812324084 1000 0 FRIENDS OF JAVIER VALDEZ PO BOX 25873 SEATTLE WA 98165 873098939 1000 0 FRIENDS OF JESSICA BATEMAN 120 STATE AVENUE 1462 OLYMPIA WA 98501 822228368 1000 0 FRIENDS OF JOE FITZGIBBON PO BOX 66235 BURIEN WA 98166 272265718 1000 0 FRIENDS OF JULIA REED 401 2ND AVENUE SOUTH 303 SEATTLE WA 98104 874736382 1000 0 FRIENDS OF KAREN KEISER PO BOX 13290 DES MOINES WA 98198 911947669 1000 0 FRIENDS OF KELLY CHAMBERS 1002 N MERIDIAN SUITE 100 PMB 207 PUYALLUP WA 98371 825044633 1000 0 FRIENDS OF LAURIE JINKINS PO BOX 2032 TACOMA WA 98401 272214467 1000 0 FRIENDS OF LILLIAN ORTIZ-SELF PO BOX 581 MUKILTEO WA 98275 463819721 500 0 FRIENDS OF MANKA DHINGRA 17221 NE 115TH CT REDMOND WA 98052 815223744 1000 0 FRIENDS OF MARCUS RICCELLI PO BOX 1325 SPOKANE WA 99210 455222828 1000 0 FRIENDS OF MARI LEAVITT PO BOX 65195 TACOMA WA 98466 812668177 1000 0 FRIENDS OF NICOLE MACRI PO BOX 9100 SEATTLE WA 98109 811159785 1000 0 FRIENDS OF NOEL FRAME PO BOX 99143 SEATTLE WA 98139 454760606 1000 0 FRIENDS OF PATTY KUDERER PO BOX 23037 SEATTLE WA 98102 475315866 1000 0 FRIENDS OF PHIL FORTUNATO PO BOX 2201 AUBURN WA 98071 821366387 1000 0 FRIENDS OF ROGER GOODMAN 218 MAIN STREET PMB 763 KIRKLAND WA 98033 830458254 500 0 FRIENDS OF SANTOS PO BOX 78606 SEATTLE WA 98178 911913482 1000 0 FRIENDS OF SHARLETT MENA PO BOX 7437 TACOMA WA 98417 874010260 1000 0 FRIENDS OF SPENCER HUTCHINS PO BOX 1117 GIG HARBOR WA 98335 861762782 1000 0 FRIENDS OF STEVE HOBBS 3309 114TH DRIVE NE LAKE STEVENS WA 98258 204733784 4000 0 FRIENDS OF STROM PETERSON PO BOX 12066 SEATTLE WA 98102 471385570 500 0 FRIENDS OF TANA SENN PO BOX 771 MERCER ISLAND WA 98040 463757260 1000 0 FRIENDS OF TINA ORWALL 17837 FIRST AVE S PMB 299 NORMANDY PARK WA 98148 453602805 1000 0 FRIENDS OF VANDANA SLATTER 11900 NE 1ST STREET SUITE 300 BELLEVUE WA 98005 461880322 1000 0 FRIENDS TO ELECT GREG CHENEY PO BOX 981 BRUSH PRAIRIE WA 98606 881915527 1000 0 GERRY POLLET FOR STATE REPRESENTATIVE 7750 17TH AVE NE SEATTLE WA 98115 800147715 1000 0 GRIFFEY 4 STATE HOUSE PO BOX 83 ALLYN WA 98524 272697662 500 0 HACKNEY FOR THE 11TH PO BOX 12066 SEATTLE WA 98102 844680106 1000 0 HARRY TRUMAN FUND PO BOX 9100 SEATTLE WA 98109 911769570 20000 0 HOUSE DEMOCRATIC CAMPAIGN COMMITTEE 4130 1ST AVE S SUITE D SEATTLE WA 98134 916178946 1000 0 HOUSE REPUBLICAN ORGANIZATIONAL COMMITTEE PO BOX 7222 OLYMPIA WA 985077222 916177625 1000 0 JACKSON LEGACY PAC 2937 54TH AVE SW A TUMWATER WA 98512 812080103 10000 0 JEFF HOLY FOR SENATE PO BOX 40285 SPOKANE WA 99220 824751774 1000 0 KEVIN WATER FOR STATE HOUSE 401 MAPLE WAY STEVENSON WA 98648 874162054 1000 0 MARKO FOR SENATE 401 2ND AVENUE SOUTH 303 SEATTLE WA 98104 260696977 1000 0 MICHELLE DOWNEY CALDIER FOR STATE REP PO BOX 1710 PORT ORCHARD WA 98366 464305309 1000 0 MIKE CHAPMAN FOR STATE REPRESENTATIVE 1321 SOUTH LAUREL STREET PORT ANGELES WA 98362 811993695 1000 0 MY-LIHN THAI 11900 NE 1ST STREET 300 BELLEVUE WA 98005 824927031 1000 0 NIKKO TORRES FOR STATE SENATE 5100 IVY ROAD PASCO WA 99301 882385130 1000 0 PEOPLE FOR JOE NGUYEN PO BOX 23037 SEATTLE WA 98102 825037835 1000 0 PEOPLE FOR JOE SCHMICK PO BOX 620 COLFAX WA 99111 450582705 1000 0 PEOPLE FOR MIA PO BOX 297 SEAHURST WA 98062 463326224 1000 0 PEOPLE FOR PEDERSEN 815 FIRST AVENUE 111 SEATTLE WA 98104 203979617 1000 0 PEOPLE FOR REBECCA SALDANA PO BOX 20776 SEATTLE WA 98102 814617205 500 0 PEOPLE FOR TARRA SIMMONS PO BOX 774 TRACYTON WA 98393 843381309 1000 0 PEOPLE FOR TIMM ORMSBY PO BOX 2177 SPOKANE WA 992102177 550876251 1000 0 PEOPLE FOR YASMIN PO BOX 12066 SEATTLE WA 98102 873173541 1000 0 REAGAN FUND PO BOX 904 OLYMPIA WA 98507 911716818 20000 0 REPUBLICAN STATE LEADERSHIP COMMITTEE 1201 F STREET NW SUITE 675 WASHINGTON DC 20004 050532524 10000 0 SENATE REPUBLICAN CAMPAIGN COMMITTEE PO BOX 11025 OLYMPIA WA 98508 910987396 1000 0 SHELLY FOR STATE PO BOX 37 ADDY WA 99101 680674661 1000 0 SIMONFORSENATE PO BOX 114 FERNDALE WA 98248 880925691 2000 0 STEPHANIE FOR WA PO BOX 5802 PASCO WA 99302 881416754 1000 0 SUZANNE SCHMIDT FOR STATE REPRESENTATIVE 9116 E SPRAGUE AVE 470 SPOKANE VALLEY WA 99206 874316868 1000 0 THARINGER FOR STATE REPRESENTATIVE PO BOX 834 SEQUIM WA 98382 272555702 1000 0 THE KENNEDY FUND 401 2ND AVENUE SOUTH 303 SEATTLE WA 98104 462745811 20000 0 THE LEADERSHIP COUNCIL PO BOX 11025 OLYMPIA WA 98508 911714860 20000 0 VOTE ALICIA RULE PO BOX 9100 SEATTLE WA 98109 825493030 1000 0 VOTE DEBRA LEKANOFF 10789 N BEACH ROAD BOW WA 98232 825166939 1000 0 VOTE LIZ BERRY PO BOX 9100 SEATTLE WA 98109 844023836 1500 0 WASHINGTON SENATE DEMOCRATIC CAMPAIGN 4130 1ST AVE S SUITE D SEATTLE WA 98134 462614068 1000 0 PART I-A, LINE 1: DDWA PROVIDES DIRECT CAMPAIGN CONTRIBUTIONS TO CANDIDATES FOR WASHINGTON STATE ELECTED EXECUTIVE OFFICE, LEGISLATIVE OFFICE, AND POLITICAL ORGANIZATIONS IN ORDER TO PROMOTE AN ENVIRONMENT FOR IMPROVED ORAL HEALTHAND OVERALL HEALTH CARE POLICY, AS WELL AS TO SUPPORT OUR OVERALL MISSION OF IMPROVING HEALTH IN OUR STATE. DDWA ALSO PROVIDES LIMITED DIRECT SUPPORT FOR LOCAL LEVEL CANDIDATES OR INITIATIVES THAT PROMOTE A POSITIVE BUSINESS CLIMATE IN WASHINGTON STATE. ALL CONTRIBUTIONS ARE CONDUCTED IN ACCORDANCE WITH FEDERAL AND STATE LAWS AND REPORTING REQUIREMENTS. 351239 351239 6816578 354527 6462051 12809795 5649776 7160019 5867440 4458503 1408937 52796539 42514821 10281718 25663964 RIGHT-OF-USE ASSETS 19917661 INTEREST RECEIVABLE 636688 20554349 LEASE LIABILITY 24587496 24587496 1 SEATTLE CHILDRENS 4800 SAND POINT WAY NE SEATTLE WA 98105 910564748 501(C)(3) 2500000 0 FUNDING FOR DENTAL SUPPORT SKAGIT VALLEY COLLEGE 2405 E COLLEGE WAY MOUNT VERNON WA 98273 910822539 501(C)(3) 896988 0 FINANCIAL SUPPORT FOR DENTAL THERAPY PROGRAM UW SCHOOL OF DENTISTRY BOX 357137 SEATTLE WA 981957137 943079432 501(C)(3) 275000 0 UNDERWRITE WREB FEES COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY 8609 EVERGREEN WAY EVERETT WA 982082619 911255170 501(C)(3) 250000 0 FUNDING FOR DENTAL SUPPORT COMMUNITY HEALTH CARE 101 EAST 26TH ST TACOMA WA 98421 911349657 501(C)(3) 250000 0 FUNDING FOR DENTAL SUPPORT SOCIETY OF TEACHERS OF FAMILY MEDICINE 11400 TOMAHAWK CREEK PARK LEAWOOD KS 66211 510187107 501(C)(3) 205920 0 FUNDING OF ORAL HEALTH EDUCATION BETTER HEALTH TOGETHER 1023 W RIVERSIDE STE 101 SPOKANE WA 99201 900997482 501(C)(3) 180103 0 LEAD PARTNER FUNDING FOR SPOKANE LIN CITY OF SPOKANE W 808 SPOKANE FALLS BLVD SPOKANE WA 992013336 916001280 LOCAL GOVERNMENT 147941 0 FUNDING FOR FLUORIDATION CAPITAL SUPPORT AMERICAN HEART ASSOCIATION 710 2ND AVE SUITE 900 SEATTLE WA 98104 135613797 501(C)(3) 129244 0 GENERAL FUNDING SUPPORT NORTH SOUND 1204 RAILROAD AVE SUITE 200 BELLINGHAM WA 98225 814680689 501(C)(3) 123920 0 LEAD PARTNER FUNDING FOR N. SOUND LIN LIFELONG HEALTH FOR ALL 210 SOUTH LUCILE STREET SEATTLE WA 98108 912011386 501(C)(3) 100000 0 FUNDING FOR DENTAL SUPPORT UNITED WAY OF KING COUNTY 720 SECOND AVENUE SEATTLE WA 98104 910715071 501(C)(3) 97270 0 ANNUAL GIVING CAMPAIGN FRONTIER BEHAVIORAL HEALTH 107 SOUTH DIVISION STREET SPOKANE WA 99202 910853801 501(C)(3) 70441 0 FUNDING FOR DENTAL SUPPORT ASIA PACIFIC CULTURAL CENTER 4851 S TACOMA WAY TACOMA WA 98409 911854410 501(C)(3) 60000 0 FUNDING FOR DENTAL SUPPORT SECOND HARVEST FOOD BANK 1234 E FRONT AVE SPOKANE WA 992022148 237173826 501(C)(3) 57862 0 ANNUAL GIVING CAMPAIGN FOOD LIFELINE 815 SOUTH 96TH SEATTLE WA 98108 911090450 501(C)(3) 57568 0 ANNUAL GIVING CAMPAIGN UNITED WAY OF SPOKANE COUNTY 920 N WASHINGTON ST 100 SPOKANE WA 99201 910606058 501(C)(3) 57500 0 ANNUAL GIVING CAMPAIGN UNIVERSITY OF ST THOMAS 2115 SUMMIT AVENUE SAINT PAUL MN 55105 410693970 501(C)(3) 50000 0 DONATION/GIFT FOR THE RACIAL JUSTICE INITIATIVE AMERICAN ACADEMY OF PEDIATRICS 345 PARK BLVD ITASCA IL 60143 362275597 501(C)(3) 50000 0 DENTAL HEALTH GRANT UNITY CARE NW 1616 CORNWALL AVENUE BELLINGHAM WA 98225 911202013 501(C)(3) 50000 0 FUNDING FOR DENTAL SUPPORT PUBLIC HEALTH FOUNDATION ENTERPRISES INC 13300 CROSSROADS PARKWAY NORTH SUITE 450 CITY OF INDUSTRY CA 91746 952557063 501(C)(3) 50000 0 FUNDING FOR DENTAL SUPPORT WASHINGTON ASSOCIATION FOR COMMUNITY HEALTH 101 CAPITOL WAY N SUITE 200 OLYMPIA WA 98501 911323282 501(C)(3) 42759 0 FUNDING FOR DENTAL SUPPORT CHINESE INFORAMTION AND SERVICE CENTER 611 S LANE ST SEATTLE WA 98104 237438529 501(C)(3) 40000 0 FUNDING FOR DENTAL SUPPORT LOWER ELWHA KLALLAM TRIBE 243511 HWY 101 WEST PORT ANGELES WA 98363 910838085 40000 0 FUNDING FOR DENTAL SUPPORT RECOVERY CAFE 2022 BOREN AVE SEATTLE WA 98121 912158547 501(C)(3) 40000 0 FUNDING FOR DENTAL SUPPORT PACIFIC ISLANDER COMMUNITY ASSOCIATION OF WA 33710 9TH AVE S STE 1 FEDERAL WAY WA 98003 842470123 501(C)(3) 39500 0 FUNDING FOR DENTAL SUPPORT COMMUNITY HEALTH PARTNERS PO BOX 2853 LONGVIEW WA 98632 912016542 501(C)(3) 35000 0 FUNDING FOR DENTAL SUPPORT PACIFIC ISLANDER HEALTH BOARD OF WASHINGTON 6519 EAST SIDE DR NE TACOMA WA 98422 862588152 501(C)(3) 35000 0 FUNDING FOR DENTAL SUPPORT UNIVERSITY OF SOUTH CAROLINA 1600 HAMPTON ST SUITE 613 COLUMBIA SC 29208 576001153 501(C)(3) 34000 0 FUNDING FOR DENTAL SUPPORT MEDICAL TEAMS INTERNATIONAL 9680 153RD AVENUE NW REDMOND WA 98052 930878944 501(C)(3) 31200 0 FUNDING FOR DENTAL SUPPORT ARTS FUND PO BOX 19780 SEATTLE WA 98109 910839644 501(C)(3) 25000 0 GENERAL FUNDING SUPPORT ALIMENTANDO AL PUEBLO 15003 14TH AVE SW BURIEN WA 98166 863983808 501(C)(3) 25000 0 FUNDING FOR DENTAL SUPPORT COMMUNITY HEALTH WORKERS COALITION 24315 89TH PL W EDMONDS WA 98026 832266657 501(C)(3) 25000 0 FUNDING FOR DENTAL SUPPORT EAST AFRICAN COMMUNITY SERVICES 7050 32ND AVE SOUTH SEATTLE WA 98118 912138852 501(C)(3) 25000 0 FUNDING FOR DENTAL SUPPORT ANGELS FOR ANGELS 12704 8TH AVE SW BURIEN WA 98146 275180670 501(C)(3) 25000 0 FUNDING FOR DENTAL SUPPORT THE TUBMAN CENTER FOR HEALTH AND FREEDOM 3518 S EDMONDS STREET SEATTLE WA 98118 851543325 501(C)(3) 25000 0 FUNDING FOR DENTAL SUPPORT UTOPIA MEDIA & ENTERTAINMENT LLC 20823 14TH PL W LYNNWOOD WA 98036 272196011 501(C)(3) 25000 0 FUNDING FOR DENTAL SUPPORT LATINO COMMUNITY FUND OF WASHINGTON STATE PO BOX 30669 SEATTLE WA 98103 205987399 501(C)(3) 20000 0 FUNDING FOR DENTAL SUPPORT TRI-CITIES LULAC COUNCIL #47014 PO BOX 3381 PASCO WA 99302 522072106 501(C)(3) 20000 0 FUNDING FOR DENTAL SUPPORT REFUGEE & IMMIGRANT SERVICES NORTHWEST 2000 TOWER STREET M/S 41 EVERETT WA 98201 911167743 501(C)(3) 20000 0 FUNDING FOR DENTAL SUPPORT WOW - TRICITIES 745 THE PARKWAY RICHLAND WA 99352 851726598 501(C)(3) 20000 0 FUNDING FOR DENTAL SUPPORT CHARITABLE PARTNERSHIP FUND PO BOX 13276 PORTLAND OR 97213 931267966 501(C)(3) 16000 0 COMMUNITY FLUORIDATION LUMMI NATION 2592 KWINA ROAD BELLINGHAM WA 98226 911836621 501(C)(3) 15000 0 FUNDING FOR DENTAL SUPPORT LINDQUIST CLINIC FOR CHILDREN 130 131ST ST SOUTH TACOMA WA 98444 910615378 501(C)(3) 12000 0 FUNDING FOR DENTAL SUPPORT UW SCHOOL OF DENTISTRY CO DNCARE FUND ON BEHALF O 1959 NE PACIFIC ST SEATTLE WA 98195 943079432 501(C)(3) 10588 0 FUNDING FOR DENTAL SUPPORT YOUTH AND FAMILY LINK 907 DOUGLAS ST LONGVIEW WA 98632 910726260 501(C)(3) 10000 0 FUNDING FOR DENTAL SUPPORT 44 2 PART I, LINE 2: THE GRANTEE IS REQUIRED TO SIGN A GRANT AGREEMENT STATING THAT THEY WILL USE THE FUNDS ONLY FOR PURPOSES OUTLINED IN THE GRANT AGREEMENT AND APPLICATION. THE GRANTEE IS REQUIRED TO FILE REPORTS ON REGULAR INTERVALS OUTLINING THE USE OF FUNDS. GRANTEE IS ALSO REQUIRED TO RETURN UNUSED FUNDING IF APPLICABLE. X X 1 1 X X X X 1 1 0 0 0 0 0 0 0 MITCHKE MARK PRESIDENT & CHIEF EXECUTIVE OFFICER 1159346 0 2451000 0 9873 0 394705 0 37122 0 4052046 0 0 0 BERG BRADLEY SVP & CHIEF ADMIN OFFICER 805565 0 571282 0 446731 0 178786 0 30780 0 2033144 0 486876 0 ALIABADI KAREN CHIEF HR STRATEGIST 468742 0 340503 0 8695 0 98838 0 21481 0 938259 0 0 0 RUTHERFORD EVE M VICE CHAIR - BRD. & DDS FEES 167689 0 0 0 745314 0 0 0 0 0 913003 0 0 0 WHITNEY GARRETT SENIOR VP, CHIEF INFORMATION OFFICER 413323 0 286800 0 6045 0 84022 0 37176 0 827366 0 0 0 HAKES KATHERINE DIRECTOR - BRD. & DDS FEES 134861 0 0 0 668313 0 0 0 0 0 803174 0 0 0 SNYDER CINDY SENIOR VP, CHIEF OPERATING OFFICER 386166 0 271717 0 9110 0 79805 0 22680 0 769478 0 0 0 ROBINSON HERBERT SENIOR VP, CHIEF REVENUE OFFICER 330923 0 273388 0 5558 0 19066 0 34592 0 663527 0 0 0 LO ERIC VP, ACTUARIAL & UNDERWRITING 312680 0 198473 0 1750 0 64894 0 33705 0 611502 0 0 0 PICKEL CHRISTOPHER DIRECTOR - BRD. & DDS FEES 127225 0 0 0 431447 0 0 0 0 0 558672 0 0 0 ABDELLATIF VANETTA PRES/CEO ARCORA FDN 329600 0 127933 0 6998 0 53636 0 20379 0 538546 0 0 0 LAY LINDA VP OF SALES, THRU 04/2022 127037 0 392384 0 3291 0 7623 0 2641 0 532976 0 0 0 BARTLETT RYAN VP, CHIEF FINANCIAL OFFICER 286635 0 119970 0 0 0 20500 0 31474 0 458579 0 0 0 ROGERS TIFFANY HEAD OF DISTRIBUTION & STRATEGY 129462 0 296081 0 0 0 10357 0 15338 0 451238 0 0 0 LABBERTON WELLS K CHAIR - BRD. & DDS FEES 186225 0 0 0 203759 0 0 0 0 0 389984 0 0 0 DAYTON THEMBA SALES MANAGER, THRU 03/2022 48954 0 107019 0 187759 0 2757 0 34272 0 380761 0 0 0 SCHOBER DEBRA SR SALE & STRGY EX LGGRP 133131 0 195006 0 122 0 10651 0 23775 0 362685 0 0 0 CHEUNG STEPHEN VP, MARKETING 250594 0 59219 0 0 0 20048 0 31474 0 361335 0 0 0 JAHRMAN CHRIS DIR OF OPER & PNT EXP, THRU 03/2022 102042 0 38642 0 151988 0 5437 0 23082 0 321191 0 0 0 SEELY JEFFREY T SECRETARY 161337 0 0 0 0 0 0 0 0 0 161337 0 0 0 BROWN COLLEEN BIRDNOW TREASURER 154640 0 0 0 0 0 0 0 0 0 154640 0 0 0 TUNE JAMES F FORMER DIRECTOR 11797 0 0 0 0 0 0 0 0 0 11797 0 0 0 PART I, LINE 1A ANY FIRST CLASS TRAVEL IS SUBJECT TO THE APPROVAL OF THE CEO, CAO OR CFO. DDWA PROVIDES A WELLNESS PROGRAM WHICH REIMBURSES APPROVED EXPENSES FOR ALL EMPLOYEES WORKING 30 HOURS OR MORE A WEEK, WITH A MAXIMUM PAYABLE OF $480 PER YEAR FOR HEALTH CLUB MEMBERSHIPS, AEROBIC OR GENERAL EXERCISE CLASSES, WEIGHT LOSS PROGRAMS, STRESS MANAGEMENT AND MASSAGE THERAPY. THESE REIMBURSEMENTS ARE TREATED AS TAXABLE INCOME. DDWA GROSSES UP BOARD MEMBER FEES TO COVER B&O TAXES ASSESSED ON DIRECTOR FEES PAID TO THE BOARD. PART I, LINE 3 THE HUMAN RESOURCES AND COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS ENGAGES IN AN INDEPENDENT EXTERNAL CONSULTANT TO EVALUATE THE COMPENSATION OF ALL KEY EMPLOYEES, INCLUDING THE PRESIDENT AND CEO, CFO, CHIEF MISSION OFFICER AND VP, CORPORATE DEVELOPMENT OF WASHINGTON DENTAL SERVICE, IN COMPARISON TO THE PRACTICE OF SIMILAR EMPLOYERS IN THE MARKETPLACE. THE PROCESS IS CONDUCTED ON AN ANNUAL BASIS. PART I, LINES 4A-B THEMBA DAYTON ($188,000) AND CHRIS JAHRMAN ($153,367) RECEIVED SEVERANCE PAYMENTS DURING THE YEAR. THE COMPANY MAKES CONTRIBUTIONS TO A NONQUALIFIED PERFORMANCE BASED COMPENSATION PLAN, AS DETERMINED BY THE BOARD OF DIRECTORS, WHICH IS SUBJECT TO CODE SECTION 457(B). PLAN PARTICIPANTS ARE BOARD-APPROVED EXECUTIVE LEADERSHIP WHO RECEIVE AN ANNUAL CONTRIBUTION BASED ON A PERCENTAGE OF THE PRIOR YEAR EARNINGS LESS THE COMPANY MATCHING CONTRIBUTION TO THE 401(K) PLAN. COMPANY CONTRIBUTIONS ARE DIRECTED BY EACH PARTICIPANT, BUT VESTING OF THE BENEFIT IS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE AS REQUIRED BY CODE SECTION 409(A). CONTRIBUTIONS MADE IN 2022 WERE AS FOLLOWS: MARK MITCHKE, PRESIDENT & CHIEF EXECUTIVE OFFICER, $374,205; BRADLEY BERG, SENIOR VP AND CHIEF ADMINISTRATOR OFFICER, $158,286; KAREN ALIABADI, SENIOR VP AND CHIEF HUMAN RESOURCE STRATEGIST, $78,338; GARRETT WHITNEY, SENIOR VP AND CHIEF INFORMATION OFFICER, $63,522; CINDY SNYDER, SENIOR VP AND CHIEF OPERATING OFFICER, $59,305; ERIC LO, VP OF ACTUARIAL & UNDERWRITING, $44,570; VANETTA ABDELLATIF, PRES/CEO ARCORA FDN, $33,136. THE 457(B) PLAN HAD TOTAL ASSETS OF $1,707,303 AT DECEMBER 31, 2022. IN ADDITION, THERE IS ANOTHER 457(B) NONQUALIFIED SERP DEFERRED COMPENSATION PLAN FOR SENIOR MANAGEMENT THAT THE COMPANY DOES NOT MAKE ANY CONTRIBUTIONS TO. EACH OF THE FOLLOWING PARTICIPANTS CONTRIBUTED $20,500 TO THE PLAN DURING 2022 - MARK MITCHKE, BRADLEY BERG, GARRETT WHITNEY, STEPHEN CHEUNG AND ERIC LO. THE PLAN HAD TOTAL ASSETS OF $1,147,210 AT DECEMBER 31, 2022. PART I, LINE 6A: THE BOARD OF DDWA ANNUALLY APPROVES A COMPANY-WIDE BONUS MATRIX BASED ON FOUR METRICS, ONE OF WHICH WAS BASED ON THE OPERATING PROFIT MARGIN OR THE FISCAL YEAR. THE OTHER METRICS ARE ADMINISTRATIVE COST, NEW GROUP SALES, AND GROUP CUSTOMER PERSISTENCY (RETENTION). FORM 990, PART VI, SECTION A, LINE 6 DDWA'S MEMBER DENTISTS ARE CONSIDERED MEMBERS OF THE COMPANY'S PARENT COMPANY, WASHINGTON DENTAL SERVICE (WDS). MEMBER DENTISTS ELECT THE DENTAL MEMBERS OF THE WDS BOARD OF DIRECTORS, IN ACCORDANCE WITH THE WDS BYLAWS. WDS DIRECTORS ALSO CURRENTLY SERVE AS DIRECTORS ON THE DDWA BOARD. FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNANCE & NOMINATING COMMITTEE (GNC) OF THE BOARD OF DIRECTORS SOLICITS ADVICE ON CANDIDATES AND SUBMITS NOMINEES TO THE WDS/DDWA BOARD FOR CONSIDERATION AND APPROVAL TO BE VOTED UPON. THE ENTIRE MEMBERSHIP ELECTS AND RE-ELECTS MEMBER DIRECTORS, WHO COMPRISE A MINORITY OF THE BOARD. THE INCUMBENT INDEPENDENT DIRECTORS NOMINATE AND ELECT OR RE-ELECT INDEPENDENT DIRECTORS. A MEMBER ADVISORY PANEL (MAP) CONSISTS OF TEN TO FIFTEEN MEMBERS THAT ARE SELECTED BY THE WDS BOARD FROM NOMINEES BY THE GNC. THE MAP PROVIDES CONSULTATION TO THE COMPANY, INCLUDING THE GNC AND BOARD, ON A VARIETY OF MATTERS. FORM 990, PART VI, SECTION A, LINE 7B SEE ABOVE FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS COMPLETED BY KPMG. THE FORM 990 AND SUPPORTING DOCUMENTATION IS REVIEWED AND APPROVED BY THE DIRECTOR OF FINANCE AND THE CFO/CAO. ELECTRONIC COPIES OF THE RETURN ARE PROVIDED FOR REVIEW TO ALL BOARD MEMBERS PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE INVESTMENT AND AUDIT COMMITTEE OF THE BOARD IS CHARGED WITH MONITORING PROPOSED OR ON-GOING TRANSACTIONS FOR CONFLICTS OF INTEREST AND ADDRESSING ANY POTENTIAL OR ACTUAL CONFLICTS. PURSUANT TO THE CONFLICT OF INTEREST POLICY, AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE, AIMED AT DETERMINING ANY FAMILY AND BUSINESS RELATIONSHIPS AND TRANSACTIONS, OR OTHER TRANSACTIONS THAT MAY POSE A POTENTIAL CONFLICT, IS DISTRIBUTED TO ALL COVERED PERSONS (I.E. BOARD MEMBERS,OFFICERS AND EXECUTIVE LEADERSHIP OR KEY EMPLOYEES). COVERED PERSONS ARE REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICTS AT THE TIME WHEN SUCH CONFLICTS ARISE. WHEN SOMEONE BECOMES A COVERED PERSON AND ANNUALLY THEREAFTER, THEY ARE REQUIRED TO EXPLICITLY ACKNOWLEDGE A STATEMENT AFFIRMING THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (2) HAS READ THE POLICY AND UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE POLICY, INCLUDING COMPLETING THE CONFLICTS OF INTEREST QUESTIONNAIRE IF ANY CONFLICTS EXIST. THE COMPLETED QUESTIONNAIRES THAT NOTE ANY CONFLICTS ARE REVIEWED BY THE BOARD AND ANY PERSONS WITH ACTUAL OR POTENTIAL CONFLICTS ARE INFORMED OF ANY ACTION VIA WRITTEN COMMUNICATION. THE PROCEDURES FOR ADDRESSING ANY CONFLICT OF INTEREST INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: (1) THE CONFLICTING INTEREST IS FULLY DISCLOSED TO THE BOARD;(2) THE INTERESTED PERSON RESPONDS TO FACTUAL QUESTIONS RELATED TO THE SUBSTANCE OF THE TRANSACTION OR ARRANGEMENT BEING CONSIDERED, AFTER WHICH HE/SHE SHALL LEAVE THE MEETING; (3) THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OR DISAPPROVAL OF SUCH TRANSACTION; (4) ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED AND COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED IF DEEMED APPROPRIATE; (5) CONFLICTING ISSUES DURING THE COURSE OF A BOARD MEETING WHICH CANNOT BE RESOLVED ARE REFERRED TO THE GOVERNANCE AND NOMINATING COMMITTEE; AND (6) THE TRANSACTION OR ACTION MUST BE APPROVED BY A MAJORITY OF DISINTERESTED PERSONS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD APPOINTS A HUMAN RESOURCES AND COMPENSATION COMMITTEE OF THE BOARD (THE HRCC), NONE OF WHOM MAY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY COMPENSATION ARRANGEMENTS, TO BE ACCOUNTABLE FOR SETTING REASONABLE COMPENSATION PACKAGES FOR THE CEO. THE HRCC DEVELOPED, CONSISTENT WITH THE ORGANIZATION'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA FOR OFFICERS AND KEY EMPLOYEES. THE HRCC ALSO HIRES A QUALIFIED INDEPENDENT COMPENSATION AND BENEFITS SPECIALIST (INDEPENDENT EXPERT) TO REVIEW, ANALYZE AND PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFIT PACKAGES OF OFFICERS AND KEY EMPLOYEES. APPROPRIATE COMPARABILITY DATA IS OBTAINED FROM THE INDEPENDENT EXPERT, I.E., TOTAL ECONOMIC BENEFITS PAID BY SIMILAR SITUATED ORGANIZATIONS (BOTH TAXABLE AND TAX-EXEMPT) FOR SIMILAR JOB RESPONSIBILITIES. THE HRCC'S WRITTEN RECORDS INCLUDE THE (1) TERMS OF THE ARRANGEMENTS WITH THE OFFICERS AND KEY EMPLOYEES (INCLUDING THE DATE THE ARRANGEMENT WAS APPROVED); (2) A LIST OF MEMBERS PRESENT DURING THE DISCUSSION ON ANY ARRANGEMENTS; AND (3) A DESCRIPTION OF THE COMPARABLE DATA RELIED UPON BY THE HRCC. KEY DELIBERATIONS OF THE HRCC ARE ALSO DOCUMENTED IN MINUTES WHICH ARE APPROVED AT THE NEXT HRCC MEETING. THE MOST RECENT COMPENSATION REVIEW WAS COMPLETED IN 2022 FOR DIRECTORS AND SMT, AND INCLUDED THE PRESIDENT/CHIEF EXECUTIVE OFFICER, CHAIR, VICE CHAIR, SECRETARY, TREASURER, OTHER C-LEVEL EXECUTIVES AND OTHER VICE PRESIDENT ROLES. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS AND DISCLOSURES ARE FILED QUARTERLY AND ANNUALLY WITH THE WASHINGTON STATE OFFICE OF THE INSURANCE COMMISSIONER (OIC) AS A MATTER OF PUBLIC RECORD. ALL DOCUMENTS SO FILED ARE AVAILABLE TO THE PUBLIC ON THE OIC WEBSITE. AMENDMENTS TO BYLAWS ARE FILED WITH THE WASHINGTON SECRETARY OF STATE'S OFFICE FROM TIME-TO-TIME AS THEY ARE APPROVED BY THE GOVERNING BODY. GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1A THE FOLLOWING DIRECTORS ALSO RECEIVED CLINICAL REIMBURSEMENTS IN ADDITION TO THEIR DIRECTOR'S FEES, THE TOTAL OF WHICH IS REPORTED IN COLUMN D - REPORTABLE COMPENSATION FROM THE ORGANIZATION. LABBERTON, WELLS, K. - $389,984 DIRECTOR FEE AND BENEFITS - $186,225 CLINICAL REIMBURSEMENT - $203,759 RUTHERFORD, EVE, M. - $913,003 DIRECTOR FEE AND BENEFITS - $167,689 CLINICAL REIMBURSEMENT - $745,314 HAKES, KATHERINE - $803,174 DIRECTOR FEE AND BENEFITS - $134,861 CLINICAL REIMBURSEMENT - $668,313 PICKEL, CHRISTOPHER - $558,672 DIRECTOR FEE AND BENEFITS - $127,225 CLINICAL REIMBURSEMENT - $431,447 FORM 990, PART XI, LINE 9: DISTRIBUTION TO WASHINGTON DENTAL SERVICES -15,800,000. ARCORA FOUNDATION 400 FAIRVIEW AVE N SEATTLE WA 98109 910621480 EDUCATION WA 639000 2954000 DDWA WASHINGTON DENTAL SERVICE FUND 400 FAIRVIEW AVE N SEATTLE WA 98109 911281990 ORAL HEALTH EDUCATION WA 501(C)(3) LINE 10 ARCORA 1 WASHINGTON DENTAL SERVICE 400 FAIRVIEW AVE N SEATTLE WA 98109 270937829 HOLDING CO WA 501(C)(4) N/A 0 SPRINGROCK VENTURES II LP 2001 6TH AVE SUITE 3400 SEATTLE WA 98101 851520667 INVEST ORAL HEALTH DE SRMC 0 0 SPRINGROCK MANAGEMENT COMPANY (SRMC) 2001 6TH AVE SUITE 3400 SEATTLE WA 98101 851502581 MGMT/GP IN SRV II WA WDS C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 WASHINGTON DENTAL SERVICE R 15800000 CASH WASHINGTON DENTAL SERVICE O 4379421 BOOK WASHINGTON DENTAL SERVICE Q 74800 BOOK SPRINGROCK MANAGEMENT COMPANY O 621642 BOOK SPRINGROCK MANAGEMENT COMPANY Q 20000 BOOK