2020-11-04T07:20:51-06:00 2019-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2019-01-01 480793267 Delta Dental of Kansas Inc DELT 3162641099 1619 N Waterfront Parkway Wichita KS 67206 Bryce Dougherty Current CFO/Treasurer 3162641099 2020-10-22 1 Kim Hunwardsen CPA P00484560 6122536500 2020-10-22 64.83.233.163 2020-10-22 13:56:17 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 818E7D27379BF4EE6921138ED2990C81DED2D31F 2019 2021-04-22 16:20:28Z Bryce Dougherty 1619 N Waterfront Parkway Wichita KS 67206 324243735 0 X www.deltadentalks.com X 1972 KS To make possible and facilitate a wider and more timely availability of oral health care. 10 7 142 0 0 0 0 0 309887359 303152334 2288188 2963417 0 0 312175547 306115751 1875818 2703358 0 0 11200675 11793739 0 0 0 290647135 285293770 303723628 299790867 8451919 6324884 80062941 91765906 8814841 10343647 71248100 81422259 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 271981377 294057975 Dental benefits (covered charges) provided to subscribers. Delta Dental served approximately 917,162 people this year. 9809645 9094359 The processing of dental benefit claims. 2703358 2703358 Grants paid out to 501(c)(3) organizations. 284494380 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 0 0 0 1 0 0 0 0 0 1 1 1 0 1 28962 0 1 142 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 7 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 Michael Herbert President and CEO 33.70 6.28 X 455423 0 64923 Michael Ellis Executive VP/CFO/Treasurer 36.80 3.21 X 318503 0 58167 Dean Newton - Managing Director & Executive VP 34.80 5.15 X 295898 0 63954 James Tuttle COO 28.10 11.87 X 249496 0 43022 Preddis Sullivan Dental Director and EVP 40.00 0.00 X 248502 0 12295 Robert Ebenkamp VP IT 39.70 0.29 X 220076 0 34406 Junetta Everett VP Professional Relations 40.00 0.00 X 213173 0 39017 Bryce Dougherty Controller 37.50 2.47 X 191931 0 39543 Kara Hunt VP HR 40.00 0.02 X 181912 0 29221 Nancy Umholtz Secretary 39.00 1.04 X 108733 0 23928 Dr Alan Marcotte - Chairperson (Jan-Jul)/Director (Aug-Dec) 1.46 0.41 X X 28122 0 0 Gary Yager - Vice Chairperson (Jan-Jul)/Chairperson (Aug-Dec) 1.30 0.40 X X 24202 0 0 Patrick Moriarty Director 1.50 0.00 X 23964 0 0 Shawn Naccarato Director 1.50 0.00 X 23853 0 0 Dr Brick Scheer Vice Chairperson (Aug-Dec) 1.50 0.10 X X 23687 0 0 Kimberly Borchers Director 1.46 0.00 X 23471 0 0 Angela McClure Director 1.46 0.00 X 23316 0 0 Lucynda Raben Director 1.50 0.00 X 23003 0 0 Ruth Teichman Director 1.42 0.00 X 22429 0 0 Nancy Zogleman Director 1.46 0.00 X 21430 0 0 2721124 0 408476 25 0 1 0 Jenkins & Leblanc PA 6810 Silverheel St Shawnee KS 66226 Dental Services 1948826 Wichita Endodontics LLC 3535 E Central Ave Wichita KS 67208 Dental Services 1719388 Wichita Family Dental Partnership 9339 E 21ST ST N Wichita KS 67206 Dental Services 1468561 Gage Center Dental Group PA 1271 SW Woodhull St Topeka KS 66604 Dental Services 1440575 Reusser & Reusser LLC 13121 E 21st St N Ste 107 Wichita KS 67230 Dental Services 1417498 536 Dental Services 524298 303145312 303145312 7022 7022 303152334 1408234 1408234 19683167 18127984 1555183 1555183 1555183 306115751 303152334 0 2963417 2703358 2703358 1931555 258277 1673278 7410083 3436993 3973090 1085027 530248 554779 758078 433840 324238 608996 260099 348897 113810 113810 131550 131550 48608 48608 185298 185298 5167605 140751 5026854 1076167 1076167 1394616 1335052 59564 24783 24783 247638 247638 507050 16435 490615 119381 30881 88500 401860 175136 226724 153249 153249 Claims 271981382 271981382 State Premium Tax 1300398 1300398 Clearing House Expense 449527 417678 31849 Equipment Rental & Main 391009 391009 1599839 1058060 541779 299790867 284494380 15296487 0 800 800 6775428 7774726 6196731 4809380 376731 387638 13063082 5881838 7239270 7181244 48226253 58254368 10574842 12619556 672886 738194 80062941 91765906 8177318 9524457 637523 819190 8814841 10343647 X 71248100 81422259 71248100 81422259 80062941 91765906 X 6324884 3220590 628685 X 0 1 X 1 0 1401415 1401415 7332320 2482957 4849363 4162878 3378648 784230 166469 20233 146236 7181244 Inv in Surency Life & Health 12619556 F 12619556 Unearned Premiums 819190 819190 X 130714234 3220590 859393 4079983 126634251 185298 179296202 179481500 306115751 120540075 -179296202 -179296202 299836277 185298 -230708 -45410 299790867 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, 2019 and 2018, 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 990 280,708. Earnings of C Corp 628,685. Reclass Advertising Expenses to Expenses on Form 990 -50,000. Part XI, Line 4b - Other Adjustments: ASC Claims Revenue Reported in Expenses on Financial Statement 179,296,202. Part XII, Line 2d - Other Adjustments: ASC Claims Revenue Reported in Expenses on Financial Statement -179,296,202. Part XII, Line 4b - Other Adjustments: Reclass Expense Reimbursement to Expenses on Form 990 -280,708. Reclass Advertising Expenses to Expenses on Form 990 50,000. 1 University of Kansas 1651 Naismith Drive Lawrence KS 66045 481124839 State of Kansas 36000 Gifts & Contributions Williams Fund; KU Health Systems Wichita Metro Chamber of Commerce 350 W Douglas Ave Wichita KS 67202 480477290 Sedgwick County 13892 Gifts & Contributions; Events/Sponsorships Chairman's Lunch; Honors Night; YP; Community Advancement; Diversity & Inclusion; Annual Dinner, extra tickets Kansas Insurance Educational Foundation 815 SW Topeka Boulevard Topeka KS 66612 480925186 501(c)(3) 10000 Gifts & Contributions Last year of 4-year donation, $10K/year from 2016-2019 Juvenile Diabetes Research Foundation (JDRF) 215 W Pershing Road Suite 300 Kansas City MO 64108 231907729 501(c)(3) 25000 Gifts & Contributions "Dream" Sponsorship March of Dimes KC 4400 College Boulevard Overland Park KS 66211 131846366 501(c)(3) 10000 Gifts & Contributions Annual Gift Emmaus House Inc - Garden City 802 N 5th St Garden City KS 67846 481197543 501(c)(3) 12000 Gifts & Contributions Year End Spending/Charitable Contributions Our Redeemer Lutheran Church - Hutchinson 407 E 12th Ave Hutchinson KS 67501 480680455 501(c)(3) 12000 Gifts & Contributions Year End Spending/Charitable Contributions Rose Brooks PO Box 320599 Kansas City MO 64132 510231573 501(c)(3) 35000 Gifts & Contributions Annual Gift Chamber of Commerce of Greater Kansas City 30 W Pershing Rd Suite 301 Kansas City MO 64108 440196840 501(c)(6) 25000 Gifts & Contributions Annual Gift KC Urban Neighborhood Initiative 2700 E 18th Street Suite 261 Kansas City MO 64127 454879810 501(c)(3) 10000 Gifts & Contributions Annual Gift Catholic Diocese of Wichita (The Lord's Diner - Wichita & Pittsburg) 520 N Broadway Wichita KS 67214 510214509 501(c)(3) 24000 Gifts & Contributions Year End Spending/Charitable Contributions Greater Wichita Partnership 501 E Douglas Wichita KS 67202 474134110 501(c)(3) 10000 Gifts & Contributions $10K/year from 2018-2022 Boys & Girls Club - Kansas City 4001 Blue Pkwy Suite 102 Kansas City MO 64130 436072065 501(c)(3) 25000 Gifts & Contributions Kids Night Out Sponsorship Starlight Theatre Association of Kansas City Inc 4600 Starlight Rd Kansas City MO 64132 440552079 501(c)(3) 5500 Gifts & Contributions Annual Gift Greater Wichita YMCA 402 N Market Wichita KS 67202 237128129 501(c)(3) 5200 Events/Sponsorships; Matching Gift Working Well Conference; Bowl-A-Thon; Matched Gift United Way of of the Plains 245 N Water St Wichita KS 67202 480547688 501(c)(3) 1140464 Gifts & Contributions; Events/Sponsorships; Charitable Giving Charitable Purpose funds; Breakfast Event; Luncheon Event; Loaned Executive Program; Street Banners; Yearly Gift; Staff Campaign Starkey Inc 4500 W Maple St Wichita KS 67209 480630180 501(c)(3) 26000 Gifts & Contributions; Events/Sponsorships "Saving Lifes" Capital Campaign; Golf Tournament Sponsorship Kansas Big Brothers Big Sisters Inc 310 E 2nd St N Wichita KS 67202 237056717 501(c)(3) 5075 Gifts & Contributions; Matching Gift Matched Gift Ronald McDonald House Charities - Wichita 1110 N Emporia Wichita KS 67214 480918101 501(c)(3) 15400 Gifts & Contributions; Events/Sponsorships Capital Campaign; Golf Tournament Sponsorship Botanica 701 Amidon St Wichita KS 67203 481007736 501(c)(3) 25000 Gifts & Contributions; Events/Sponsorships Nature Connects Sponsorship; Illuminations Sponsorship Sedgwick County Zoo 5555 W Zoo Boulevard Wichita KS 67212 486120530 Sedgwick County 107500 Gifts & Contributions; Events/Sponsorships Capital Campaign; Zoobilee Sponsorship Youth Entrepreneurs 4111 E 37th St N d101 Wichita KS 67220 481187886 501(c)(3) 10000 Events/Sponsorships Breakfast Series Air Capital Classic 9727 Shannon Woods 100 Wichita KS 67226 462001743 Sedgwick County 15000 Events/Sponsorships Sponsorship Mark Arts (formerly Wichita Center for Arts) 1307 N Rock Road Wichita KS 67206 480616251 501(c)(3) 10000 Events/Sponsorships Midnight at Mark Arts Wichita Festivals Inc (River Festival) 444 E William St Wichita KS 67202 480783840 501(c)(3) 7500 Events/Sponsorships Hot Air Balloon Sponsorship Big Brothers Big Sisters of Greater Kansas City 1709 Walnut St Kansas City MO 64108 436068464 501(c)(3) 7500 Events/Sponsorships Golf Tournament; Top Golf Event Envision 610 N Main St Wichita KS 67203 203874095 501(c)(3) 7500 Events/Sponsorships Golf Tournament; Gala GraceMed Health Clinic Inc 1122 N Topeka St Wichita KS 67214 481159633 501(c)(3) 7321 Events/Sponsorships; Toothbrush Kits Hotcakes for Hopecare; Say Grace 5K Race; Supplies for 10,080 toothbrush kits Hy-Vee Foundation Inc 5820 Westown Pkwy West Des Moines IA 50266 420942086 501(c)(3) 7000 Charitable Giving Kids Fit Sponsorship Exploration Place 300 N McLean Boulevard Wichita KS 67203 481000295 501(c)(3) 87468 Charitable Giving; Events/Sponsorships Annual Gift; Death by Chocolate Heartspring 8700 E 29th St N Wichita KS 67226 481232409 501(c)(3) 30500 Charitable Giving; Events/Sponsorships Annual Gift; Autism CARE Walk Oral Health Kansas 800 SW Jackson St Suite 1120 Topeka KS 66612 200337278 501(c)(3) 10000 Charitable Giving Yearly Conference United Way of Kansas City 801 W 47th St Suite 500 Kansas City MO 64112 440545812 501(c)(3) 500000 Charitable Giving Annual Gift Flint Hills Technical College 3301 W 18th Ave Emporia KS 66801 481156696 501(c)(3) 25000 Charitable Giving Dental Hygiene Program Scholarships Manhattan Area Technical College 3136 Dickens Ave Manhattan KS 66503 342064656 501(c)(3) 25000 Charitable Giving Dental Hygiene Program Scholarships Johnson County Community College 12345 College Blvd Overland Park KS 66210 480735009 501(c)(3) 50000 Charitable Giving Dental Hygiene Program Scholarships TeamSmile 2000 Swift St Kansas City MO 64116 753250075 501(c)(3) 32500 Charitable Giving Dental Treatment KS Society for Children with Challenges 100 N Main Suite 1002 Wichita KS 67202 480573804 501(c)(3) 20000 Charitable Giving Dental Treatment Children's Mercy 2401 Gilham Road Kansas City MO 64108 431564302 501(c)(3) 60000 Charitable Giving; Events/Sponsorships Dental Treatment - $50,000; Red Hot Night - $5,000; Big Slick - $5,000 Wichita State University 1845 Fairmount St Wichita KS 67260 481124839 501(c)(3) 58500 Charitable Giving; Gifts & Contributions; Events/Sponsorships Dental Hygiene Program Scholarships; College of Oral Health 50th Celebration; Economic Outlook Conference Healthe Kids Institute 2800 Rockcreek Pkwy Kansas City MO 64117 275105360 501(c)(3) 6161 Toothbrush Kits Supplies for 10,080 toothbrush kits Health Ministries Clinic Inc 720 Medical Center Dr Newton KS 67114 481091875 501(c)(3) 6234 Toothbrush Kits Supplies for 10,080 toothbrush kits United Methodist Mexican American Ministries - Genesis Family Health (Garde 310 E Walnut St Ste LL5 Garden City KS 67846 481049519 501(c)(3) 18260 Toothbrush Kits; Gifts & Contributions Supplies for 10,080 toothbrush kits; Year End Spending/Charitable Contributions Sedgwick County Health Department 1900 E 9th St Wichita KS 67214 486000798 Sedgwick County 6177 Toothbrush Kits Supplies for 10,080 toothbrush kits Johnson County Christmas Bureau 9503 Johnson Drive Merriam KS 66203 480884400 501(c)(3) 6268 Toothbrush Kits Supplies for 10,080 toothbrush kits 44 1 Part I, Line 2: Delta Dental of Kansas provided grants to public charities and governmental 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 Michael Herbert President and CEO 302462 0 136158 0 16803 0 50812 0 21033 0 527268 0 0 0 Michael Ellis Executive VP/CFO/Treasurer 246534 0 70204 0 1765 0 44057 0 15266 0 377826 0 0 0 Dean Newton - Managing Director & Executive VP 209723 0 76401 0 9774 0 49843 0 15567 0 361308 0 0 0 James Tuttle COO 193202 0 55186 0 1108 0 32933 0 11547 0 293976 0 0 0 Preddis Sullivan Dental Director and EVP 187007 0 59235 0 2260 0 0 0 14988 0 263490 0 0 0 Robert Ebenkamp VP IT 177877 0 40656 0 1543 0 29148 0 7280 0 256504 0 0 0 Junetta Everett VP Professional Relations 171181 0 39656 0 2336 0 28927 0 12899 0 254999 0 0 0 Bryce Dougherty Controller 155289 0 36324 0 318 0 25433 0 14861 0 232225 0 0 0 Kara Hunt VP HR 147987 0 33493 0 432 0 22877 0 7174 0 211963 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 245640 Payment of Dental Services 0 Raben DDS PA Board Member Dr. Raben > 35% owner 138297 Payment of Dental Services 0 Northrock Dental PA Board Member Dr. Scheer > 35% owner 106038 Payment of Dental Services 0 Form 990, Part VI, Section A, line 2 Michael Herbert, Michael Ellis, Nancy Umholtz, Dean Newton, James Tuttle, Dr. Alan Marcotte, Gary Yager, and Dr. Brick Sheer 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 628,685. Surency Life & Health Company 1619 N Waterfront Pkwy Wichita KS 67206 261969006 Insurance KS DDKS C 15038712 14909647 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 1127304 Cost Surency Life & Health Insurance Company N 280708 Cost