2021-11-13T14:14:02-06:00 2020-12-31 420714325 RSM US LLP 210 PARK AVE SUITE 1725 OKLAHOMA CITY OK 73102 990 2020-01-01 237322578 DELTA DENTAL PLAN OF OKLAHOMA DELT 4056072100 PO BOX 54709 OKLAHOMA CITY OK 731541709 ASHLEY ALBRIGHT CHIEF FINANCIAL OFFICER 4056072100 2021-11-13 1 ASHLEY ALBRIGHT 999009999 LAUREN NOWAKOWSKI P01796934 4052397961 2021-11-13 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z ASHLEY ALBRIGHT PO BOX 54709 OKLAHOMA CITY OK 731541709 264512760 0 X DELTADENTALOK.ORG X 1973 OK PROVIDE DENTAL BENEFITS 18 8 126 0 0 0 0 0 248017630 236918373 1360441 2359399 -620363 183542 248757708 239461314 2312556 8193093 0 0 11283044 12997902 0 0 0 231775474 209650642 245371074 230841637 3386634 8619677 81882714 90645723 17600430 17613506 64282284 73032217 X OUR MISSION IS TO BE OKLAHOMA'S FOREMOST DEVELOPER, MARKETER, AND ADMINISTRATOR OF QUALITY DENTAL BENEFIT PROGRAMS WHICH ASSURE HIGHEST STANDARDS OF SERVICE, STABILITY, EFFICIENCY, FAIRNESS AND PROFESSIONALISM, SUPPORTING AND ENCOURAGING QUALITY DENTAL CARE FOR THE CITIZENS WE SERVE. IN FULFILLING THIS MISSION, WE WILL MAINTAIN FINANCIAL STABILITY THAT ALLOWS FOR THE GROWTH, COMPETITIVENESS AND THE FLEXIBILITY TO RESPOND TO CHANGING CONDITIONS. FINALLY, TO BE MINDFUL OF THE NEEDS OF CONSTITUENCIES WE SERVE-PATIENTS, PURCHASERS AND DENTISTS. 0 0 194990771 237030074 GROUP PREPAID DENTAL CARE PROGRAM PROCESSING AND PAYMENT OF CLAIMS. 8193093 8193093 CONTRIBUTIONS TO A CHARITABLE FOUNDATION WHICH PROVIDES DENTAL HEALTH EDUCATION. 203183864 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 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 0 1 1 1 0 1 692 0 1 126 1 0 0 0 0 0 0 0 0 X 18 8 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OK X ASHLEY ALBRIGHT 4056072100 16 NW 63RD ST OKLAHOMA CITY OK 73116 X GEAN ATKINSON SECRETARY 1.00 3.00 X X 4302 0 0 DR MICHAEL MCLEOD DIRECTOR 1.00 3.00 X 26049 0 0 DR DEBORAH CORWIN DIRECTOR 1.00 3.00 X 13238 0 0 DR MICHAEL HOWL DIRECTOR 1.00 0.00 X 82763 0 0 DR TOMMY MAYHUE DIRECTOR 1.00 3.00 X 113685 0 0 SANDY BJORNSON DIRECTOR 1.00 0.00 X 10134 0 0 DR L COLIN FOSTER DIRECTOR 1.00 3.00 X 3246 0 0 DR W ROGER WEBB DIRECTOR 1.00 3.00 X 3246 0 0 DR G KEN RAINS DIRECTOR 1.00 0.00 X 101728 0 0 BRAD C HOGAN DIRECTOR 1.00 0.00 X 5964 0 0 WILLIAM C MABREY IV DIRECTOR 1.00 0.00 X 7020 0 0 MARY WHITSON DIRECTOR 1.00 3.00 X 4830 0 0 MICHAEL MCCULLOUGH TREASURER 1.00 0.00 X X 7626 0 0 DANNY RAMSEY CHAIRMAN OF THE BOARD 1.00 0.00 X X 12930 0 0 JEFFREY HILST DIRECTOR 1.00 0.00 X 5964 0 0 ROSS PARKER ALLEN DIRECTOR 1.00 3.00 X 60220 0 0 CHRISTOPHER MINNIGH DIRECTOR 1.00 0.00 X 72657 0 0 MATTHEW GRAY DIRECTOR 1.00 0.00 X 92618 0 0 JOHN GLADDEN PRESIDENT AND CEO 40.00 1.00 X 998455 0 58815 TANIA FOSS CHIEF OPERATING OFFICER 40.00 1.00 X 320918 0 95393 DAVID JONES CHIEF INFO. AND SECURITY OFFICER 40.00 0.00 X 290416 0 100773 LOUIS TURBEVILLE CFO - ENDED JAN 2020 40.00 1.00 X 106910 0 137298 LAN MILLER VP OF SALES 40.00 0.00 X 203772 0 104675 ASHLEY ALBRIGHT CHIEF FINANCIAL OFFICER 40.00 1.00 X 251888 0 81845 SAM DECH VP OF IT 40.00 0.00 X 160167 0 59062 MARTHA TUMELSON DIR. OF HUMAN RESOURCE 40.00 0.00 X 157410 0 32392 JAMES WILLIAMS DIR. OF APPLICATION DEVELOPMENT 40.00 0.00 X 137237 0 39548 DEEYA FOREMAN DIR. OF CUSTOMER SERVICE 40.00 0.00 X 112120 0 25594 CASSANDRA DAVIS MANAGER OF FINANCE 40.00 1.00 X 115571 0 24896 AMANDA BRAY DIR., MARKETING AND COMMUNICATION 40.00 0.00 X 110062 0 20551 CHRISTINA SHORT DIR., ASSURANCE SERVICES 40.00 0.00 X 100910 0 25618 3694056 0 806460 15 0 1 0 PLUS CONSULTING LLC 505 WASHINGTON AVENUE CARNEGIE PA 15106 CONSULTING SERVICES 805316 RED CARD SYSTEMS LLC 744 OFFICE PARKWAY SAINT LOUIS MO 63179 PRINTING AND MAILING SERVICES 561973 THE OKLAHOMA MEDIA COMPANY PO BOX 120687 DALLAS TX 75312 PRINTING AND MAILING SERVICES 511447 PEAK MEDIA LLC 6016 NW 154TH ST EDMOND OK 73013 ADVERTISING SERVICES 479638 THYSSENKRUPP ELEVATOR CORPORATION PO BOX 3796 CAROL STREAM IL 60132 ELEVATOR REPAIR SERVICES 228972 10 DENTAL BENEFIT COVERAGE 900099 236785735 236785735 PATIENT DIRECT MEMBER FEES 900099 99578 99578 DELTA U 900099 26816 26816 DELTA USA 900099 6244 6244 236918373 1261421 1261421 554892 483051 71841 71841 71841 25666373 24568395 1097978 1097978 1097978 OTHER INCOME 900099 111701 111701 111701 239461314 237030074 0 2431240 8193093 8193093 3788409 416311 3372098 6156572 431885 5724687 911347 114170 797177 1486469 252600 1233869 655105 60110 594995 128941 128941 1252602 1252602 130927 130927 9323246 50892 9272354 1054199 1054199 1061706 295845 765861 701132 479856 221276 164469 164469 76990 76990 196758 353 196405 368875 368875 875627 160000 715627 164041 164041 NET CLAIMS PAID 192679055 192679055 OFFICE FACILITY 1006169 1000 1005169 BANK FEES 338218 338218 TAXES, LICENSES, FEES 54102 54102 73585 48694 24891 230841637 203183864 27657773 0 6096862 9499850 10672887 10404125 942197 919829 23293036 11612644 11228928 11680392 50676840 56036527 2240000 2080000 25000 25000 81882714 90645723 11122072 10020029 740000 510000 3533015 4826096 2205343 2257381 17600430 17613506 X 64282284 73032217 64282284 73032217 81882714 90645723 8619677 130256 0 X 0 1 X 1 0 1733869 1733869 12119564 4388950 7730614 9439603 7223694 2215909 11680392 RESERVE & DEPOSITS 428010 SUPPLEMENTAL RETIREMENT PLAN 1829371 2257381 X PART X, LINE 2: WITH THE EXCEPTION OF DELTA DENTAL PRACTICE (DPS), DELTA DENTAL PLAN OF OKLAHOMA (THE PLAN) IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE AND SECTION 501(C)(3) FOR THE RELATED FOUNDATION, AND ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. NET INCOME GENERATED BY DPS WILL BE TAXABLE WHEN IT OCCURS. SINCE INCEPTION, DPS'S OPERATIONS HAVE BEEN MINIMAL AND NO TAX IS REFLECTED IN THE ACCOMPANYING FINANCIAL STATEMENTS. 1 DELTA DENTAL OF OKLAHOMA FOUNDATION PO BOX 54709 OKLAHOMA CITY OK 73116 274417052 501C3 5891845 GENERAL SUPPORT OKC DENTAL HEALTH ASSOCIATES PC 1308 N KELLY AVE EDMOND OK 73003 731547094 51104 GENERAL SUPPORT DENTAL PROFESSIONALS OF OKLAHOMA PC 1732 24TH AVE NW STE C-107 NORMAN OK 73069 273382885 42088 GENERAL SUPPORT EDMOND PEDIATRIC & TEEN DENTISTRY 101 S SAINTS BLVD STE 212 EDMOND OK 73034 452802814 18624 GENERAL SUPPORT FOX BROERMANN PEDIATRIC DENTISTRY OF TULSA 6585 S YALE AVE STE 510 TULSA OK 74136 271690582 12536 GENERAL SUPPORT CRAIG & STREIGHT ORTHODONTICS PLLC 706 24TH AVE NW NORMAN OK 73069 463130306 12040 GENERAL SUPPORT GLENN A ASHMORE DDS INC 2828 NW 30TH ST OKLAHOMA CITY OK 73112 731048272 11176 GENERAL SUPPORT MLK DENTISTRY INC 2930 S PITTSBURG AVE TULSA OK 74114 823828790 10992 GENERAL SUPPORT JAMES F OWENS DDS MS PC 10507 E 91ST ST STE 410 TULSA OK 74133 731534829 10176 GENERAL SUPPORT CORNERSTONE FAMILY DENTISTRY 1325 S SANGRE RD STILLWATER OK 74074 832798951 9792 GENERAL SUPPORT DENTAL DESIGN STUDIO LLC 561 MERCHANT DR NORMAN OK 73069 274159162 9440 GENERAL SUPPORT ADA SMILE PLACE PLLC 1801 ARLINGTON ST ADA OK 74820 471480816 9360 GENERAL SUPPORT BRENT W MOODY DDS PC 4320 MCAULEY BLVD OKLAHOMA CITY OK 73120 731564231 9328 GENERAL SUPPORT EDMOND FAMILY DENTAL DESIGNS PLLC PO BOX 1459 EDMOND OK 73083 432083958 8624 GENERAL SUPPORT ORAL & MAXILLOFACIAL ASSOCIATES LLC 3601 NW 138TH ST STE 100 OKLAHOMA CITY OK 73134 201080270 8616 GENERAL SUPPORT STILLWATER DENTAL ASSOCIATES PC 1439 S WESTERN RD STILLWATER OK 74074 841678968 8456 GENERAL SUPPORT ORTHODONTIC ASSOCIATES PC 10914 HEFNER POINTE DR STE 300 OKLAHOMA CITY OK 73120 731464375 8288 GENERAL SUPPORT JENNIFER M LAUVETZ ENMEIER 816 S PINE ST STILLWATER OK 74074 731515120 7888 GENERAL SUPPORT ADA FAMILY DENTISTRY INC 116 E 14TH ST ADA OK 74820 263525854 7536 GENERAL SUPPORT HEATH BRYAN COLEMAN DDS OF OKLAHOMA II PLLC 4440 NW EXPRESSWAY STE A OKLAHOMA CITY OK 73116 842320244 7456 GENERAL SUPPORT HEALTHY SMILES FAMILY DENTISTRY PLLP 1326 E 43RD CT STE 100 TULSA OK 74105 731554427 7264 GENERAL SUPPORT DENTAL DEPOT OF NORMAN PLLC 2828 NW 30TH ST OKLAHOMA CITY OK 73112 454027420 7256 GENERAL SUPPORT DENTAL GROUP PC PO BOX 649 PRYOR OK 74362 731282834 7232 GENERAL SUPPORT STEVE H TRUONG DDS PLLC 16 NE 2ND ST STE B OKLAHOMA CITY OK 73104 462590326 7224 GENERAL SUPPORT CONTEMPORARY FAMILY DENTISTRY PC 1117 NW 32ND ST NEWCASTLE OK 73065 141981193 7120 GENERAL SUPPORT DENTAL DEPOT OF MIDWEST CITY LLC 2828 NW 30TH ST OKLAHOMA CITY OK 73112 202225597 7104 GENERAL SUPPORT DENTAL DEPOT WESTMINSTER VILLAGE LLC 2828 NW 30TH ST OKLAHOMA CITY OK 73112 731580678 7008 GENERAL SUPPORT MT LINCOLN PLLC 2828 NW 30TH ST OKLAHOMA CITY OK 73112 261919038 7008 GENERAL SUPPORT PHILLIP R PARKER DDS MS MS PC 1521 36TH AVE NW NORMAN OK 73072 731533267 6776 GENERAL SUPPORT JEFFREY J AHLERT DDS PLLC 14600 E 88TH PL N OWASSO OK 74055 731533841 6760 GENERAL SUPPORT DENTAL DEPOT OF 145TH & N PENN PLLC 2828 NW 30TH ST OKLAHOMA CITY OK 73112 462205300 6752 GENERAL SUPPORT WM J BLUM DDS PC 700 24TH AVE SW NORMAN OK 73069 731508613 6696 GENERAL SUPPORT CORNERSTONE DENTAL PLLC 1601 AIRPORT DR SHAWNEE OK 74804 262716991 6608 GENERAL SUPPORT HALLEYS FAMILY DENTAL CARE PLLC 806 S PINE ST STILLWATER OK 74074 640954564 6608 GENERAL SUPPORT JOHN F CARLETTI DDS CORP 2808 E 101ST ST TULSA OK 74137 730968397 6544 GENERAL SUPPORT SMILE GALAXY PEDIATRIC DENTISTRY PC PO BOX 892290 OKLAHOMA CITY OK 73189 680582635 6544 GENERAL SUPPORT ROGER POTTS DENTAL GROUP PC 1101 SE TECH CENTER DR STE 195 VANCOUVER WA 98683 731576907 6504 GENERAL SUPPORT ALLEN AND HANSEN DENTISTRY PARTNERSHIP 2401 NW 23RD ST STE 23 OKLAHOMA CITY OK 73107 205338088 6352 GENERAL SUPPORT ALEXANDER D WILLIAMS DDS PLLC PO BOX 3189 SYRACUSE NY 13220 811965799 6296 GENERAL SUPPORT AARON COHENOUR DDS PLLC 2200 NW 122ND ST OKLAHOMA CITY OK 73120 462407557 6280 GENERAL SUPPORT HEFNER - ROCKWELL DENTAL DEPOT PLLC 2828 NW 30TH ST OKLAHOMA CITY OK 73112 208697466 6272 GENERAL SUPPORT WEATHERFORD DENTAL CARE PLLC 1325 N WASHINGTON ST WEATHERFORD OK 73096 455482591 6264 GENERAL SUPPORT PEDIATRIC DENTAL CARE PLLC 1300 CROP CIR YUKON OK 73099 842097996 6144 GENERAL SUPPORT ORTHODONTICS EXCLUSIVELY PLLC PO BOX 30070 SALT LAKE CITY UT 84130 261634631 6120 GENERAL SUPPORT DANA M ROSS 3902 S 113TH WEST AVE SAND SPRINGS OK 74063 208731293 6008 GENERAL SUPPORT MICHAEL M CHENG DDS PC 100 W 15TH ST EDMOND OK 73013 204085434 5848 GENERAL SUPPORT STORTS FAMILY DENTISTRY JTL PLLC 1220 MERRICK DR ARDMORE OK 73401 844064788 5776 GENERAL SUPPORT JASON D WALKER DDS PC 804 S PINE ST STILLWATER OK 74074 208954340 5632 GENERAL SUPPORT EASTERN OKLAHOMA ORAL & MAXILLOFACIAL SURGERY 4716 W URBANA ST STE 100 BROKEN ARROW OK 74012 462460850 5560 GENERAL SUPPORT EDMOND DENTAL ASSOCIATES PLLC PO BOX 7326 EDMOND OK 73083 271475853 5368 GENERAL SUPPORT RAJESH M PATEL DDS INC 10130 S MEMORIAL DR TULSA OK 74133 731443861 5328 GENERAL SUPPORT KRISTEN CAMPBELL DDS PLLC 420 24TH AVE SW NORMAN OK 73069 822698076 5288 GENERAL SUPPORT PARKSIDE DENTISTRY PLLC 924 ROBTRICE CT EDMOND OK 73034 810940547 5216 GENERAL SUPPORT PERFECT SMILES FAMILY DENTISTRY 500 N EASTERN AVE MOORE OK 73160 753011416 5208 GENERAL SUPPORT GREEN COUNTRY DENTAL ARTS OF CATOOSA PC 2036 S MILLER LN STE B CATOOSA OK 74015 455252259 5184 GENERAL SUPPORT OKC-OMS HOLDINGS PLLC PO BOX 108811 OKLAHOMA CITY OK 73101 464189630 5136 GENERAL SUPPORT SCD DENTAL PC PO BOX 3189 SYRACUSE NY 13220 461382617 5064 GENERAL SUPPORT 1 58 PART I, LINE 2: THE ORGANIZATION MONITORS TO ENSURE THAT THE CHARITABLE PURPOSES ARE SATISFIED AND REQUIRES SUPPORTING DOCUMENTATION FROM THE RECEIPIENT ORGANIZATION TO CONFIRM USE. FORM 990, SCHEDULE I, PART II: IN RESPONSE TO THE COVID-19 PANDEMIC, IN NOVEMBER 2020, DELTA DENTAL PLAN OF OKLAHOMA (DDOK) ISSUED A CREDIT TO OUR CURRENT FULLY INSURED CLIENTS, CURRENT INDIVIDUAL CLIENTS AND MOST SELF-FUNDED CLIENTS. DDOK ALSO ISSUED A PANDEMIC RELIEF COMPENSATION TO DDOK PARTICIPATING PROVIDERS. X X 1 1 0 0 0 0 0 0 0 JOHN GLADDEN PRESIDENT AND CEO 900701 0 87117 0 10637 0 37150 0 21665 0 1057270 0 0 0 TANIA FOSS CHIEF OPERATING OFFICER 282226 0 37365 0 1327 0 74067 0 21326 0 416311 0 0 0 DAVID JONES CHIEF INFO. AND SECURITY OFFICER 251269 0 37800 0 1347 0 72304 0 28469 0 391189 0 0 0 ASHLEY ALBRIGHT CHIEF FINANCIAL OFFICER 234083 0 17360 0 445 0 54038 0 27807 0 333733 0 0 0 LAN MILLER VP OF SALES 180203 0 23025 0 544 0 75251 0 29424 0 308447 0 0 0 LOUIS TURBEVILLE CFO - ENDED JAN 2020 37898 0 0 0 69012 0 136079 0 1219 0 244208 0 0 0 SAM DECH VP OF IT 143195 0 16673 0 299 0 35672 0 23390 0 219229 0 0 0 MARTHA TUMELSON DIR. OF HUMAN RESOURCE 141988 0 13546 0 1876 0 19384 0 13008 0 189802 0 0 0 JAMES WILLIAMS DIR. OF APPLICATION DEVELOPMENT 124747 0 12239 0 251 0 17247 0 22301 0 176785 0 0 0 PART I, LINES 4A-B LOUIS TURBEVILLE RECEIVED SEVERANCE PAYMENT OF $68,821. THE ORGANIZATION PROVIDES A SUPPLEMENTAL RETIREMENT PLAN FOR CERTAIN EXECUTIVES. THE FOLLOWING INDIVIDUALS PARTICIPATE IN THE PLAN: JOHN GLADDEN TANIA FOSS DAVID JONES LAN MILLER ASHLEY ALBRIGHT SAMUEL DECH FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUALS HAVE A BUSINESS RELATIONSHIP BY VIRTUE OF THEIR POSITIONS AS OFFICERS OF DELTA DENTAL OF OKLAHOMA DENTAL PRACTICE SUPPORT: JOHN GLADDEN AND ASHLEY ALBRIGHT. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE CORPORATION SHALL BE EVERY PARTICIPATING DENTIST AND ANY OTHER PROVIDER OF HEALTH SERVICES THAT HAS BEEN ELECTED TO MEMBERSHIP, IF ANY, WHO ARE UNDER CONTRACT WITH THE CORPORATION. A DIRECTOR SERVING AS A PUBLIC DIRECTOR SHALL BE CONSIDERED A MEMBER OF THE CORPORATION AND, THEREFORE, PERMITTED TO VOTE. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS ARE ELECTED BY THE MEMBERSHIP (OUR PARTICIPATING DENTISTS). EVERY YEAR, ONE-THIRD IS VOTED UPON BY THE MEMBERSHIP EITHER IN PERSON, BY MAIL BALLOT OR BY PROXY AND EACH ARE ELECTED TO A THREE YEAR TERM. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD WILL BE EMAILED A COPY OF THE FORM 990 PRIOR TO FILING THE RETURN FOR DISCUSSION AND COMMENT. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY HAVING MEMBERS ANNUALLY SIGN AN AGREEMENT AND DISCLOSING ANY BUSINESS RELATIONSHIPS WHICH CONFLICT THEIR DUTIES OF DELTA DENTAL PLAN OF OKLAHOMA. FORM 990, PART VI, SECTION B, LINE 15 DDOK HIRED AND RETAINS THE HAY GROUP AS A CONSULTANT. THEY EVALUATE THE JOB DESCRIPTION AND COMPARE IT TO MARKET ANALYSIS DATA TO DETERMINE COMPENSATION LEVELS. THIS ANALYSIS IS PRESENTED TO THE FINANCE AND AUDIT COMMITTEE FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION LISTS THE GOVERNING DOCUMENTS THROUGH THE DEPARTMENT OF INSURANCE. THE DOCUMENTS ARE ALSO AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A: REPORTABLE COMPENSATION PAID TO THE ORGANIZATION'S DIRECTORS REFLECTED ON PART VII, SECTION A INCLUDES COMPENSATION FOR DENTAL SERVICES IN ADDITION TO COMPENSATION FOR SERVICES IN THE CAPACITY AS A DIRECTOR OF THE ORGANIZATION. DELTA DENTAL OF OKLAHOMA FOUNDATION PO BOX 54709 OKLAHOMA CITY OK 73154 274417052 DENTAL HEALTH AND EDUCATION OK 501(C)(3) LINE 10 DELTA DENTAL PLAN OF OKLAHOMA 1 DELTA DENTAL PLAN OF OKLAHOMA POLITICAL ACTION COMMITTEE PO BOX 54709 OKLAHOMA CITY OK 73154 815050812 POLITICAL SUPPORT OK 527 DELTA DENTAL PLAN OF OKLAHOMA 1 DELTA DENTAL OF OK DENTAL PRACTICE SUPPORT INC PO BOX 54709 OKLAHOMA CITY OK 73154 461958347 SUPPORT SERVICES OK DELTA DENTAL PLAN OF OKLAHOMA C 332725 25948 1.00000 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DELTA DENTAL OF OKLAHOMA FOUNDATION B 5891845 FMV