2021-11-10T15:04:51-06:00 2020-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2020-01-01 480793267 Delta Dental of Kansas Inc DELT 3162641099 1619 N Waterfront Parkway Wichita KS 67206 Bryce Dougherty CFO 3162641099 2021-11-09 1 Bryce Dougherty 999009999 Kim Hunwardsen CPA P00484560 6122536500 2021-11-03 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Bryce Dougherty 1619 N Waterfront Parkway Wichita KS 67206 290746407 0 X www.deltadentalks.com X 1972 KS To make possible and facilitate a wider and more timely availability of oral health care. 10 6 144 0 0 0 0 0 303152334 273331585 2963417 2266112 0 0 306115751 275597697 2703358 1653195 0 0 11793739 12883200 0 0 0 285293770 262447523 299790867 276983918 6324884 -1386221 91765906 94720952 10343647 10745903 81422259 83975049 X To make possible and facilitate a wider and more timely availability of dental care, thereby advancing the public health and the science and art of dentistry in the state of Kansas, by establishing, maintaining, and operating a non-profit prepayment dental service plan or plans in the state of Kansas. 0 0 247984789 265131825 Dental benefits (covered charges) provided to subscribers. Delta Dental served approximately 915,796 people this year. 10329909 8199760 The processing of dental benefit claims. 1653195 1653195 Grants paid out to 501(c)(3) organizations. 259967893 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 26353 0 1 144 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 6 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X Bryce Dougherty 3162641099 1619 N Waterfront Parkway Wichita KS 67206 Dean Newton President and CEO (Apr-Dec) 38.60 1.40 X 360414 0 53943 Michael Ellis Executive VP CFO/Treas(Jan-Jun)/Controller(Jul-Dec) 37.60 2.40 X 269790 0 58788 James Tuttle COO 38.40 1.60 X 251874 0 45441 Natalie Daney Chief Sales Officer (Apr-Dec) 39.70 0.30 X 234400 0 30328 Preddis Sullivan Dental Director and EVP 40.00 0.00 X 245199 0 18145 Robert Ebenkamp VP IT 39.90 0.10 X 220711 0 35916 Junetta Everett VP Professional Relations 40.00 0.00 X 213171 0 41149 Jennifer Bauer Feb-Mar Interim President and CEO 39.20 0.80 X 217134 0 36065 Bryce Dougherty Controller (Jan-Jun)/CFO/Treas (Jul-Dec) 37.60 2.40 X 205102 0 42753 Michael Herbert President and CEO (Jan) 39.50 0.50 X 199350 0 48449 Sarah Patterson Chief Innovation & Marketing Officer 38.10 1.90 X 187078 0 22595 Kara Hunt VP HR 40.00 0.00 X 181254 0 25025 Stephen Peppes Vice President of Sales 34.00 6.00 X 162194 0 39350 Nancy Umholtz Secretary 39.20 0.80 X 108285 0 25928 Dr Brick Scheer Vice Chairperson 3.00 0.40 X X 33537 0 0 Gary Yager Chairperson 2.60 0.20 X X 32239 0 0 Shawn Naccarato Director 3.00 0.00 X 30303 0 0 Lucynda Raben Director 2.90 0.00 X 28718 0 0 Angela McClure Director 2.70 0.00 X 28303 0 0 Patrick Moriarty Director 2.70 0.00 X 27303 0 0 Kimberly Borchers Director 2.60 0.00 X 27037 0 0 Ruth Teichman Director 2.60 0.00 X 27037 0 0 Nancy Zogleman Director 2.60 0.00 X 26718 0 0 Dr Alan Marcotte Director (Jan-Aug) 2.50 0.00 X 22916 0 0 Nick Troilo Director (Aug-Dec) 0.50 0.00 X 6906 0 0 3346973 0 523875 27 0 1 0 Jenkins & Leblanc PA 6810 Silverheel St Shawnee KS 66226 Dental Services 1607629 Wichita Endodontics LLC 3535 E Central Ave Wichita KS 67208 Dental Services 1542493 Frankenberry and Johson DDS 3101 N Cypress St Wichita KS 67226 Dental Services 1371390 Gage Center Dental Group PA 1271 SW Woodhull St Topeka KS 66604 Dental Services 1327449 Wichita Family Dental Partnership 9339 E 21ST ST N Wichita KS 67206 Dental Services 1188458 520 Dental Services 524298 265555533 265555533 Administrative Services Plan 524298 7769708 7769708 6344 6344 273331585 1635513 1635513 15779309 15147557 1153 631752 -1153 630599 630599 275597697 273331585 0 2266112 1653195 1653195 2700293 2700293 7561271 3971312 3589959 1153623 634493 519130 817546 532591 284955 650467 283003 367464 288307 288307 200051 200051 48000 48000 180534 180534 5258400 239436 5018964 967891 967891 1555219 1218616 336603 43164 43164 262535 262535 249734 2760 246974 76432 21786 54646 465208 223300 241908 305470 305470 Claims 245312309 245312309 COVID Relief Payments 3059781 3059781 State Premium Tax 1041053 1041053 Clearing House Expense 394359 363130 31229 2739076 1411128 1327948 276983918 259967893 17016025 0 800 800 7774726 2104342 4809380 7736980 387638 426787 13225337 6339239 7181244 6886098 58254368 62796388 12619556 14048304 738194 721253 91765906 94720952 9524457 9884377 819190 861526 10343647 10745903 X 81422259 83975049 81422259 83975049 91765906 94720952 X -1386221 2510465 -203 1428749 X 0 1 X 1 0 1401415 1401415 7332320 2670965 4661355 241246 39174 202072 4250356 3629100 621256 6886098 Inv in Surency Life & Health 14048304 F 14048304 Unearned Premiums 861526 861526 X 116597435 2510465 -161331346 -158820881 275418316 180534 -1153 179381 275597697 114044442 1153 1153 114043289 180534 162760095 162940629 276983918 Part X, Line 2: The company evaluates its tax positions that have been taken or are expected to be taken on income tax returns to determine if an accrual is necessary for uncertain tax positions. As of December 31, 2020 and 2019, the unrecognized tax benefits accrual was zero. The company will recognize future accrued interest and penalties related to unrecognized tax benefits in income tax expense if incurred. Part XI, Line 2d - Other Adjustments: Reclass Expense Reimbursement to Expenses on Form 990 397,199. Earnings of C Corp 1,428,749. Reclass COVID Relief Payments to Expenses on Form 990 -3,059,781. ASC Claims Expenses Reported in Expenses on Form 990 -160,097,513. Part XI, Line 4b - Other Adjustments: Loss on Sale of Assets -1,153. Part XII, Line 2d - Other Adjustments: Loss on Sale of Assets 1,153. Part XII, Line 4b - Other Adjustments: Reclass Expense Reimbursement from Revenue on Financials -397,199. Reclass COVID Relief Payments from Revenue on Financials 3,059,781. ASC Claims Expenses Reported in Revenue on Financials 160,097,513. 1 United Way of Greater Kansas City Inc 801 W 47th St Suite 500 Kansas City MO 64112 440545812 501C3 500000 Partnerships Rose Brooks Center Inc PO Box 320599 Kansas City MO 64132 510231573 501C3 250000 Partnerships Children's Mercy Hospital 2401 Gilham Rd Kansas City MO 64108 440605373 501C3 160000 Partnerships; Events & Sponsorships (Big Slick) HNC Living Foundation 8100 Newton St Suite 100 Overland Park KS 66204 464214254 501C3 100000 Partnerships Heartspring Inc 8700 E 29th St N Wichita KS 67226 480561969 501C3 52500 Partnerships; Events & Sponsorships (Autism Care Walk) TeamSmile Inc 2000 Swift Ave Kansas City MO 64116 753250075 501C3 32500 Partnerships Oral Health Kansas Inc 712 S Kansas Ave Suite 414 AB Topeka KS 66603 200337278 501C3 10000 Parnerships Healthy Kids Institute 2800 Rockcreek Pkwy Kansas City MO 64117 275105360 501C3 12480 Fair Market Value Supplies for 20,160 kits Toothbrush Kits United Methodist Western Kansas Mexican-American Ministries Inc(Genesis F 712 St John St Garden City KS 67846 481049519 501C3 6260 Fair Market Value Supplies for 10,080 kits Toothbrush Kits GraceMed Health Clinic Inc 1150 N Broadway St Wichita KS 67214 481159633 501C3 1000 6177 Fair Market Value Supplies for 10,080 kits Toothbrush Kits; Events & Sponsorships (Say Grace Race) Kansas Athletics Incorporated 1651 Naismith Dr Lawrence KS 66045 486033929 501C3 31000 Gifts & Contributions (KU Williams Fund) Wichita Regional Chamber of Commerce Inc 350 W Douglas Ave Wichita KS 67202 480477290 501C3 45586 Gifts & Contributions; Events & Sponsorships (G&C: YP 2020-2021, Community Advancement 2020-2021, Diversity & Inclusion 2020-2021, Membership 2020; E&S: Annual Meeting 2020-2021, Chairman's Lunch 2020-2021, Honors Night 2020-2021, Journey Unseen 2020) Youth Entrepreuners Inc 4111 E 37th St N D101 Wichita KS 67220 481187886 501C3 10000 Gifts & Contributions (Youth Entrepreuners) Greater Wichita Partnership Inc 505 E Douglas Ave Wichita KS 67202 474134110 501C3 10000 Gifts & Contributions (Greater Wichita Partnership) United Way of the Plains 245 N Water St Wichita KS 67202 480547688 501C3 35000 Gifts & Contributions (Loaned Executive Program, Yearly Gift) Starlight Theatre Association of Kansas City Inc 4600 Starlight Rd Kansas City KS 64132 440552079 501C3 5500 Gifts & Contributions (Starlight Theatre KC) Kansas Insurance & Financial Services Education Foundation 815 SW Topeka Blvd Topeka KS 66612 480925186 501C3 10000 Gifts & Contributions (KS Insurance Dept. - Education) Kansas Chamber of Commerce & Industry Education Foundation Inc 835 SW Topeka Blvd Topeka KS 66612 237339573 501C3 10000 Gifts & Contributions (KS Chamber of Commerce) Chamber of Commerce of Greater Kansas City 30 W Pershing Rd Suite 301 Kansas City MO 64108 440196840 501C6 25000 Gifts & Contributions (KC Chamber of Commerce) Air Capital Charities Inc (Wichita Open) 9727 Shannon Woods Suite 100 Wichita KS 67226 462001743 501C3 15000 Events & Sponsorships (Wichita Open Ambassador Sponsorship) Ronald McDonald House Charities of Wichita Inc 551 N Hillside St Suite 102 Wichita KS 67214 480918101 501C3 5400 Events & Sponsorships (Annual Golf Tournament Sponsorship) Sedgwick County Zoological Society Inc 5555 W Zoo Blvd Wichita KS 67212 486120530 501C3 7500 Events & Sponsorships (Zoobilee Sponsorship) Botanica Inc 701 Amidon St Wichita KS 67203 481007736 501C3 10000 Events & Sponsorships (Illuminations Sponsorship) Wichita Business Journal 121 N Mead St Suite 100 Wichita KS 67202 999999999 7500 Events & Sponsorships (Award Sponsorships) 22 2 Part I, Line 2: Delta Dental of Kansas provided grants to public charities, governmental organizations, and other organizations to further the purpose of the organization. For each organization that receives a grant, Delta Dental of Kansas requires acceptance of the grant, the grant reporting requirements and the due date for reporting via a signed agreement letter. The Grant Reporting Package requires completion of a Narrative Report addressing the details of the project, Project Budget Summary Form (including submission of invoices if appropriate), Acknowledgement Plan and any additional Components as indicated in the agreement letter. X 1 1 X X X X X 0 0 0 1 1 1 1 0 0 Dean Newton President and CEO (Apr-Dec) 294004 0 56353 0 10057 0 52288 0 3878 0 416580 0 0 0 Michael Ellis Executive VP CFO/Treas(Jan-Jun)/Controller(Jul-De 208824 0 60175 0 791 0 43882 0 16155 0 329827 0 0 0 James Tuttle COO 203944 0 46793 0 1137 0 33865 0 13181 0 298920 0 0 0 Natalie Daney Chief Sales Officer (Apr-Dec) 171731 0 62175 0 494 0 28673 0 2758 0 265831 0 0 0 Preddis Sullivan Dental Director and EVP 204930 0 36926 0 3343 0 3239 0 18514 0 266952 0 0 0 Robert Ebenkamp VP IT 182229 0 36050 0 2432 0 29802 0 9115 0 259628 0 0 0 Junetta Everett VP Professional Relations 174774 0 33779 0 4618 0 29573 0 16756 0 259500 0 0 0 Jennifer Bauer Feb-Mar Interim President and CEO 192717 0 24417 0 0 0 21159 0 15743 0 254036 0 0 0 Bryce Dougherty Controller (Jan-Jun)/CFO/Treas (Jul-Dec) 173787 0 30873 0 442 0 26445 0 17242 0 248789 0 0 0 Michael Herbert President and CEO (Jan) 76218 0 115122 0 8010 0 44372 0 5713 0 249435 0 0 0 Sarah Patterson Chief Innovation & Marketing Officer 161150 0 25554 0 374 0 20939 0 2521 0 210538 0 0 0 Kara Hunt VP HR 152211 0 28598 0 445 0 23369 0 2584 0 207207 0 0 0 Stephen Peppes Vice President of Sales 121982 0 40026 0 186 0 29238 0 10934 0 202366 0 0 0 Part I, Line 1a Delta Dental of Kansas did pay for the companion travel for board of directors and leadership team members when they attended out of town business meetings. The companion travel amount was treated as taxable compensation and is included in the board of directors' 1099-MISC and the leadership team members' W-2. Part I, Line 5 Total revenues for both Delta Dental and the wholly owned subsidiary, Surency Life & Health Insurance Company, are a determining factor in the management bonus payout. Part I, Line 6 Management bonuses are not determined solely on net earnings, but on metrics that would factor into net earnings (revenue, administration costs, income from operations, etc). Patrick O Moriarty DDS Chartered Board Member Dr. Moriarty > 35% owner 4913 Cash COVID Relief Funds Raben DDS Board Member Dr. Moriarty > 35% owner 2766 Cash COVID Relief Funds Northrock Dental Board Member Dr. Moriarty > 35% owner 2121 Cash COVID Relief Funds Rose Hill General Cosmetic Dentistry Board Member Dr. Troilo > 35% owner 8059 Cash COVID Relief Funds Patrick O Moriarty DDS Chartered Board Member Dr. Moriarty > 35% owner 192261 Payment of Dental Services 0 Raben DDS PA Board Member Dr. Raben > 35% owner 125564 Payment of Dental Services 0 Northrock Dental PA Board Member Dr. Scheer > 35% owner 103757 Payment of Dental Services 0 Rose Hill General Cosmetic Dentistry Board Member Dr. Troilo > 35% owner 358435 Payment of Dental Service 0 Form 990, Part VI, Section A, line 2 Michael Herbert, Michael Ellis, Nancy Umholtz, Dean Newton, James Tuttle, Gary Yager, Bryce Dougherty, Jennifer Bauer, Natalie Daney, Dr. Brick Sheer, and Sarah Patterson have a business relationship with each other. They all serve as either officers or directors of Surency Life & Health Insurance Company, a related for-profit company. The officers and directors do not have stock ownership interest in the related for-profit company. Form 990, Part VI, Section A, line 6 The organization has members. The membership of Delta Dental of Kansas is comprised of the dentists who have current participating agreements with Delta Dental of Kansas. Each member is entitled, at every meeting of members, to one vote per person, but no member shall be entitled to vote by proxy. Form 990, Part VI, Section A, line 7a The board of directors are comprised of ten (10) members. Four (4) are elected by the membership and are among the corporation's participating dentists. Two (2) are appointed by the governor of the state of Kansas, and four (4) are appointed by the commissioner of insurance of the state of Kansas. Form 990, Part VI, Section A, line 7b Any proposed changes to the by-laws are subject to member approval. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing board. Form 990, Part VI, Section B, line 11b An independent accounting firm prepares the Form 990. The 990 is then reviewed by the organization's accounting personnel. Any questions or comments are addressed and any necessary changes are made. The Form 990 with all related schedules is then provided to the entire governing body for review prior to filing. Form 990, Part VI, Section B, line 12c The chairperson of the board and the governance committee monitor and enforce our conflict of interest policy. Each director, officer, and key employee of Delta Dental of Kansas annually files a statement regarding conflicts of interest which exist, or which might be expected to exist, within the upcoming year. The statement discloses as fully as possible the nature of potential conflicts and the nature of the director's, officer's, or key employee's interest in the potential transaction. All statements are reviewed by the president and chairperson and may be circulated to members of the board of directors. Each director, officer, and key employee agree to answer any questions about potential conflicts they may have. If a conflict is identified, voting may be restricted. Form 990, Part VI, Section B, line 15 The Delta Dental of Kansas process for determining compensation for the CEO, officers, and key employees does include an annual review by independent persons, comparability date, and contemporaneous substantiation of the deliberation and decision. Delta Dental of Kansas has contracted with a consulting group to provide compensation studies for our positions. The consultant uses published market data sources to identify the relevant duties and responsibilities provided. Market data is used as appropriate for each position, from local, regional, and national markets. They provide a complete report that documents the findings of the market review process for our positions and their recommendation regarding the grade level of placement of the position. Delta Dental of Kansas also has a compensation committee, comprised of selected board members. One of the purposes of the committee is to review, report, and make recommendations to the board regarding compensation of all officers and executive team employees. The committee is responsible to meet with the President/Chief Executive Officer annually to review his/her performance and employment contract, make recommendations to the board regarding the President/Chief Executive Officer's annual compensation and benefits package and to review the President/Chief Executive Officer's recommendations as to salary adjustments and incentive payments for officers, executives, and senior management. Form 990, Part VI, Section C, line 19 Delta Dental of Kansas annual report is available to the public through our website, www.deltadentalks.com. Our governing documents and conflict of interest policy are available to the public upon request. Form 990, Part XI, line 9: Equity Earnings of Subsidiary 1,428,749. Surency Life & Health Company 1619 N Waterfront Pkwy Wichita KS 67206 261969006 Insurance KS DDKS C 15000517 16282185 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 Surency Life & Health Insurance Company O 993815 Cost Surency Life & Health Insurance Company N 397199 Cost