2020-09-18T10:46:34-05:00 2019-12-31 381357951 PLANTE & MORAN PLLC 8181 E TUFTS AVE SUITE 600 DENVER CO 80237 990 2019-01-01 840568337 COLORADO DENTAL SERVICE INC COLO 8002330860 4582 S ULSTER STREET NO 800 DENVER CO 80237 GREGORY VOCHIS CPA CFO AND TREASURER 8002330860 2020-09-14 1 DORI J EGGETT P00645252 3037409400 2020-09-14 71.218.244.155 2020-09-14 14:10:42 MD P C6E4C47366026390A9CD5C2EB00C82EA640792D2 6C9B1A35775087DBDB8A6D25ECA509C7F6C27838 2019 2022-01-07 14:23:13Z DELTA DENTAL OF COLORADO HELEN WEISS DREXLER 4582 S ULSTER STREET NO 800 DENVER CO 80237 469534953 0 X WWW.DELTADENTALCO.COM X 1958 CO TO IMPROVE THE ORAL HEALTH OF THE COMMUNITIES WE SERVE. 15 11 253 0 68577 56833 0 0 446875292 464909728 3652615 4623521 6070 1704 450533977 469534953 7098833 6635410 387405578 403568026 19816373 20729890 0 0 0 33795150 31887487 448115934 462820813 2418043 6714140 129980594 143965290 37854441 39024496 92126153 104940794 X DELTA DENTAL OF COLORADO (DDCO) WAS FORMED AS A 501(C)(4) ORGANIZATION IN ORDER TO IMPROVE THE ORAL HEALTH OF THE COMMUNITIES IT SERVES. BECAUSE PEOPLE WITH DENTAL INSURANCE OVER TIME HAVE BETTER ORAL HEALTH OUTCOMES, DELTA DENTAL OF COLORADO DEVOTES ITSELF TO PROVIDING HIGH QUALITY AFFORDABLE DENTAL INSURANCE TO AS MANY COLORADANS AS POSSIBLE. UNFORTUNATELY, THERE ARE MANY PEOPLE FOR WHOM DENTAL INSURANCE IS NOT POSSIBLE. FOR THESE PEOPLE, DELTA DENTAL HAS A NUMBER OF DIFFERENT PROGRAMS ESTABLISHED TO PROVIDE THEM WITH ORAL HEALTH EDUCATION, DIRECT PATIENT DENTAL SERVICES, AND FREE DENTAL INSURANCE SO THAT GOOD ORAL HEALTH WILL ALSO BE ACHIEVABLE FOR THEM. 0 0 450376419 464909728 PROVISION OF RISK AND SELF-FUNDED PLANS TO SUBSCRIBERSDELTA DENTAL OF COLORADO DEVOTES ITSELF TO ITS MISSION OF IMPROVING THE ORAL HEALTH OF COLORADO'S PEOPLE. BECAUSE PEOPLE WITH DENTAL INSURANCE ARE OVER TWICE AS LIKELY TO VISIT A DENTIST REGULARLY, DELTA DENTAL OF COLORADO WORKS HARD TO MAKE DENTAL INSURANCE AS AFFORDABLE AND ACCESSIBLE AS POSSIBLE, AND TO THAT END, INSURES OVER 1,000,000 PEOPLE IN COLORADO AND 300,000 IN OTHER VARIOUS STATES. THE REVENUE GENERATED IS USED TO FUND THE COMMUNITY BENEFIT EFFORTS DESCRIBED IN LINE 4B. 7045000 6635410 COMMUNITY BENEFIT PROGRAMSAS A NONPROFIT, DELTA DENTAL OF COLORADO DEVOTES SIGNIFICANT RESOURCES TO FULFILLING OUR MISSION OF IMPROVING THE ORAL HEALTH OF THE COMMUNITIES WE SERVE. DELTA DENTAL OF COLORADO PROVIDES DENTAL BENEFITS AND ORAL HEALTH INFORMATION AND SERVICES TO AS MANY PEOPLE AS POSSIBLE. OVER THE PAST FIFTEEN YEARS, DELTA DENTAL OF COLORADO HAS DEVOTED A SUBSTANTIAL AMOUNT OF ITS ADJUSTED NET GAIN TO ITS COMMUNITY ENGAGEMENT PROGRAM, INCLUDING $1.4 MILLION IN 2019. THESE ACTIVITIES INCLUDE TABLES, DONATIONS, CORPORATE SPONSORSHIPS WITH MANY ORGANIZATIONS INCLUDING THE AMERICAN HEART ASSOCIATION AND MILE HIGH UNITED WAY. THE COMPANY ALSO SPONSORS LOCAL NONPROFIT ORGANIZATIONS AND COMMUNITY EVENTS AND DONATED OVER 206,000 ORAL HEALTH ITEMS REACHING MORE THAN 129,000 PEOPLE THROUGHOUT COLORADO. THROUGH THESE COMMUNITY BENEFIT EFFORTS, A PORTION OF THE FUNDING SUPPORT GOES TO DELTA DENTAL OF COLORADO FOUNDATION, WHICH RECEIVED $5.0 MILLION IN 2019 TO ADVANCE ORAL HEALTH EQUITY THROUGH GRANT MAKING. THE COMPANY SUPPORTS ENGAGEMENT IN THE COMMUNITY THROUGH IT'S VOLUNTEER PROGRAM WITH 111 OF ITS 200 EMPLOYEES CONTRIBUTING THEIR TIME IN 2019. 457421419 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 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 0 0 253 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X GREGORY VOCHIS CPA 7204894718 4582 S ULSTER STREET NO 800 DENVER CO 80237 HASSAN SALEM TRUSTEE 5.00 0.00 X 31292 0 0 JOHN PAUL HOPKINS TRUSTEE 5.00 0.00 X 41554 0 0 KELLY J BROUGH CHAIR 5.00 0.00 X X 57387 0 0 TAMANNA TIWARI MPH MDS BDS TRUSTEE 5.00 X 30500 0 0 MARK WEHRLE CPA RETIRED TRUSTEE 5.00 0.00 X 48677 0 0 ANDREA JEAN YOUNG TRUSTEE 5.00 X 32250 0 0 LEO TOKAR TRUSTEE 5.00 0.00 X 33334 0 0 MARY MARGARET NOONAN VICE CHAIR 3.00 2.00 X X 45367 0 0 RICHARD CALL DMD TRUSTEE 3.00 2.00 X 38160 0 0 KIM KRETSCH DDS TRUSTEE 3.00 2.00 X 41361 0 0 BRANDON OWEN DDS TRUSTEE 5.00 0.00 X 33806 0 0 WALT VOGL DDS SECRETARY 5.00 0.00 X X 34594 0 0 NED CALONGE MD MPH TRUSTEE 5.00 0.00 X 35500 0 0 ANN SOMERS DDS TRUSTEE 5.00 0.00 X 30405 0 0 ANN BLOCK TRUSTEE 5.00 0.00 X 37074 0 0 HELEN W DREXLER CEO/PRESIDENT 43.00 2.00 X 612357 0 45894 DAVID W GERBUS JD CHIEF ADMINISTRATIVE OFFICER & GENERAL COUNSEL 45.00 X 394933 0 40381 GREGORY C VOCHIS CPA CFO/TREASURER 45.00 X 391318 0 36135 ROBERT M THOMPSON VICE PRESIDENT SALES AND CLIENT/BROKER EXPERIENCE 45.00 X 332970 0 38598 KATHLEEN S JACOBY VICE PRESIDENT MARKETING AND MEMBER EXPERIENCE 45.00 X 318918 0 35276 BRIAN L STEELE DIRECTOR OF CLIENT SERVICES 45.00 X 227904 0 33022 DEVIN W FARRELL DIRECTOR, SALES STRATEGY AND PROVIDER RELATIONS 45.00 X 201601 0 19877 BRANDON L THALL DIRECTOR OF FP&A- FORMER 45.00 X 200814 0 13699 PAMELA PATTON CPA CONTROLLER - FORMER 45.00 X 197446 0 19449 BROOKE S BODART RDH MPA DIRECTOR OF BUSINESS PROGRAMS 45.00 X 187591 0 20333 3637113 0 302664 10 0 1 0 DDP OF VIRGINIA 4818 STARKEY RD SOUTHWEST ROANOKE VA 24014 IT SUPPORT & CLAIMS PROCESSING 3100614 WYSSTA SERVICES INC PO BOX 86 STEVENS POINT WI 54481 3RD PARTY INSURANCE PROCESSING 2315391 REVGEN PARTNERS INC 6300 S SYRACUSE WAY STE 760 CENTINNIAL CO 80111 BUSINESS VALIDATION AND TECHNOLOGY CONSU 1377753 ENCARA INC 4818 STARKEY RD SOUTHWEST ROANOKE VA 24014 MARKETING AND MANAGEMENT SERVICES 1058257 FISERV INC PO BOX 979 BROOKFIELD WI 53008 POSTAGE AND PRINTING 950000 55 SELF FUNDED PLAN PREMI 524114 249876450 249876450 RISK PLAN PREMIUMS 524114 199364404 199364404 ADMIN - SELF FUND PLAN 524298 15699160 15699160 DISCOUNT PLAN FEES 524114 256995 256995 RISK SHARING 524298 -287281 -287281 464909728 2716011 66873 2649138 1907510 0 1907510 1907510 1907510 VISION PREMIUMS 524298 1704 1704 1704 469534953 464909728 68577 4556648 6635410 6635410 403568026 403568026 4045427 3964518 80909 11523692 11293218 230474 1062781 1041525 21256 3099691 3037697 61994 998299 978333 19966 4613799 3691039 922760 353416 282733 70683 73546 73546 391211 391211 41501 29051 12450 2064604 2064604 741888 519322 222566 3127945 2502356 625589 1103661 882929 220732 308767 61753 247014 99431 19886 79545 1442566 793411 649155 COMMISSIONS 9053367 9053367 DATA PROCESSING (CLAIMS 5059724 5059724 POSTAGE AND MAILING 2014291 1611433 402858 FEES, LICENSES, & DUES 1026790 205358 821432 370980 125726 245254 462820813 457421419 5399394 0 7623670 797536 4136882 16118173 22507392 26558224 0 2000000 1163871 0 17074343 13525546 3294068 3548797 90236210 33573165 734388 47119615 284113 14249780 129980594 143965290 8369004 10450845 6440000 5000000 4267914 3866925 18777523 19706726 37854441 39024496 X 92126153 104940794 92126153 104940794 129980594 143965290 X 6714140 6061501 39000 X 0 1 X 1 0 2457482 2144021 313461 1509113 1072681 436432 13107748 10308844 2798904 3548797 BONDS 38903762 F OTHER INVESTED ASSETS 8215853 F 47119615 ACCRUED INTEREST 434322 RELATED PARTY RECEIVABLES 576978 PREPAID EXPENSES 1899634 INVESTMENT PROCEED RECEIVABLE 11338846 14249780 PROVISION FOR UNPAID CLAIMS 12731206 ACCRUED EMPLOYEE BENEFITS 1783044 ACCRUED RISK RESERVES 517041 OTHER ACCRUED LIABILITIES 4375684 DEFERRED RENT 299751 19706726 202461000 6061501 6061501 196399499 273135454 273135454 469534953 197034000 0 197034000 265786813 265786813 462820813 PART XI, LINE 4B - OTHER ADJUSTMENTS: COST REIMBURSEMENT RECLASS 265,575,610. GAAP TO STATUTORY ADJUSTMENT 7,559,844. PART XII, LINE 4B - OTHER ADJUSTMENTS: COST REIMBURSEMENT RECLASS 265,575,610. GAAP TO STATUTORY ADJUSTMENT 211,203. 1 CLINICA TEPEYAC 4725 HIGH STREET DENVER CO 80216 841285505 501C3 155000 FUNDING TO SUPPORT LOCAL HEALTH ORGANIZATION TO INCREASE ACCESS TO HEALTHCARE AMERICAN HEART ASSOCIATION 1280 S PARKER RD DENVER CO 80231 135613797 501C3 126200 SUPPORT LOCAL HEALTH ORGANIZATION COLORADO MISSION OF MERCY 712 9TH STREET PENROSE CO 81240 742374672 501C3 42000 FUNDING TO SUPPORT LOCAL ORGANIZATION'S OVERALL HEALTH EVENT NATIONAL FOUNDATION OF DENTISTRY FOR THE HANDICAPPED 1800 15TH STREET SUITE 100 DENVER CO 80202 846129064 501C3 27500 FUNDING TO SUPPORT NATIONAL DENTAL ORGANIZATION MILE HIGH UNITED WAY PO BOX 5547 DENVER CO 80217 840404235 501C3 23400 FUNDING TO SUPPORT NATIONAL ORGANIZATION AMERICAN DIABETES ASSOCIATION 2451 CRYSTAL DRIVE SUITE 900 ARLINGTON VA 22202 131623888 501C3 17500 SUPPORT LOCAL HEALTH ORGANIZATION UNIVERSITY OF CO FOUNDATION PO BOX 173364 DENVER CO 80217 846049811 501C3 15000 FUNDING TO SUPPORT HEALTH ORGANIZATION WOMENS FOUNDATION OF COLORADO 1901 E ASBURY AVE DENVER CO 80208 841039305 501C3 5000 FUNDING FOR LOCAL ORGANIZATION METRO CARING 1100 E 18TH AVE DENVER CO 80218 846116951 501C3 10500 SUPPORT LOCAL HEALTH ORGANIZATION NATIONAL KIDNEY FOUNDATION INC 500 TAYLOR ST COLUMBIA SC 29201 131673104 501C3 10500 FUNDING TO SUPPORT NATIONAL HEALTH ORGANIZATION CRAIG HOSPITAL FOUNDATION 3425 S CLARKSON ST ENGLEWOOD CO 80113 237352287 501C3 10250 FUNDING TO SUPPORT IMPROVED ACCESS TO OVERALL HEALTH FOR COLORADANS SPECIAL OLYMPICS COLORADO 12450 E ARAPAHOE RD STE C CENTENNIAL CO 80112 840713739 501C3 10000 FUNDING TO SUPPORT HEALTH ORGANIZATION A PRECIOUS CHILD INC 7051 W 118TH AVE BROOMFIELD CO 80020 263349334 501C3 10000 SPONSORSHIP FOR LOCAL ORGANIZATION BOYS AND GIRLS CLUBS IN COLORADO 2017 W 9TH AVE DENVER CO 80204 471955928 501C3 10000 FUNDING TO SUPPORT ORGANIZATION'S YOUTH EMPOWERMENT EFFORTS CIRCLE 128 S ULSTER STREET DENVER CO 80230 472199655 501C3 10000 FUNDING TO SUPPORT LOCAL ORGANIZATION COLORADO HEALTH INSTITUTE 303 E 17TH AVE SUITE 930 DENVER CO 80203 743082235 501C3 10000 FUNDING TO SUPPORT LOCAL HEALTH ORGANIZATION IN ITS EFFORT TO INCREASE ACCESS TO OVERALL COLORADO STATE UNIVERISTY FOUNDATION 410 UNIVERSITY SERVICES CENTER FORT COLLINS CO 80523 237098397 501C3 10000 FUNDING TO SUPPORT EDUCATION AND HUNGER RELIEF PROGRAM FLORENCE CRITTENTON SERVICES OF COLORADO 55 SOUTH ZUNI STREET DENVER CO 80223 840429686 501C3 10000 SUPPORT LOCAL ORGANIZATION FOOTHILLS ART CENTER 809 15TH ST GOLDEN CO 80401 840612999 501C3 10000 FUNDING TO SUPPORT LOCAL CULTURE AND HUMANITIES ORGANIZATION NATIONAL CIVIC LEAGUE OF COLORADO 190 EAST 9TH 200 DENVER CO 80203 841255845 501C3 10000 FUNDING TO SUPPORT NATIONAL ORGANIZATION THE DENVER POST COMMUNITY FOUNDATION 5990 WASHINGTON ST DENVER CO 80216 274328521 501C3 10000 FUNDING FOR LOCAL ORGANIZATION COLO WOMENS CHAMBER OF COMM 1350 17TH ST DENVER CO 80202 841145793 501C3 9800 FUNDING TO SUPPORT LOCAL ORGANIZATION AMERICAN LUNG ASSOCIATION 55 W WACKER DRIVE SUITE 1150 CHICAGO IL 60601 131632524 501C3 8650 SUPPORT LOCAL HEALTH ORGANIZATION GIRL SCOUTS OF COLORADO 3801 E FLORIDA AVE DENVER CO 80210 840410630 501C3 8500 FUNDING TO SUPPORT ORGANIZATION'S YOUTH EMPOWERMENT EFFORTS JUDI'S HOUSE 1741 GAYLORD STREET DENVER CO 80206 841600797 501C3 7750 SUPPORT LOCAL ORGANIZATION COLORADO DENTAL ASSOCIATION 8301 E PRENTICE AVE STE 400 GREENWOOD VILLAGE CO 80111 846031478 501C6 7500 SPONSORSHIP FOR ORAL HEALTH ORGANIZATION PROJECT WORTHMORE 1609 HAVANA ST AURORA CO 80010 450933835 501C3 7500 FUNDING FOR LOCAL ORGANIZATION TRAILHEAD INSTITUTE 1385 S COLORADO BLVD STE 622/A DENVER CO 80222 841267213 501C3 7500 FUNDING FOR LOCAL ORGANIZATION DENVER METRO CHAMBER COMMERCE 1445 MARKET ST 4TH FLOOR DENVER CO 80202 840186760 501C6 7050 SUPPORT LOCAL ORGANIZATION AMERICAN CANCER SOCIETY 2255 S ONEIDA ST DENVER CO 80224 131788491 501C3 7000 SUPPORT LOCAL HEALTH ORGANIZATION DENVER AREA COUNCIL BOY SCOUTS OF AMERICA 10455 WEST 6TH AVE SUITE 100 DENVER CO 80215 840404225 501C3 6500 SUPPORT LOCAL ORGANIZATION COLORADO NONPROFIT ASSOCIATION 789 SHERMAN ST STE 240 DENVER CO 80203 840942908 501C3 6000 SPONSORSHIP FOR HEALTH ORGANIZATION COLORADO SUCCEEDS 1390 LAWRENCE ST DENVER CO 80204 753221270 501C3 6000 FUNDING FOR LOCAL ORGANIZATION FOOD FOR THOUGHT DENVER 5288 COORS ST ARVADA CO 80002 812971428 501C3 5800 FUNDING FOR LOCAL ORGANIZATION'S EFFORTS TO INCREASE ACCESS TO HEALTHY FOOD OPTIONS MILE HIGH BEHAVIORAL HEALTHCARE PO BOX 919 AURORA CO 80040 840512896 501C3 5500 SUPPORT LOCAL HEALTH ORGANIZATION INSURANCE MANAGEMENT ASSOCIATES FOUNDATION PO BOX 2992 WICHITA KS 67201 237432160 501C3 5300 SUPPORT LOCAL DENTAL ORGANIZATION AORN FOUNDATION 2170 S PARKER RD STE 400 DENVER CO 80231 841193583 501C3 5000 DONATION TO LOCAL HEALTH ORGANIZATION BOYS & GIRLS CLUBS OF METRO DENVER 2017 W 9TH AVE DENVER CO 80204 840510404 501C3 5000 FUNDING TO SUPPORT ORGANIZATION'S YOUTH EMPOWERMENT EFFORTS CENTER FOR AFRICAN AMER HEALTH 3601 MARTIN LUTHER KING JR BLVD DENVER CO 80205 841477546 501C3 5000 SUPPORT LOCAL HEALTH ORGANIZATION COLORADO BLACK HEALTH COLLABORATIVE 17815 E POWERS DR CENTENNIAL CO 80015 270803976 501C3 5000 SUPPORT LOCAL HEALTH ORGANIZATION COLORADO CHILDRENS CAMPAIGN 1580 LINCOLN ST SUITE 420 DENVER CO 80203 742374672 501C3 5000 FUNDING TO SUPPORT LOCAL CHILDREN'S BENEFIT ORGANIZATION COMITIS CRISIS CENTER INC PO BOX 919 AURORA CO 80040 742348147 501C3 5000 FUNDING FOR LOCAL ORGANIZATION DENVER CENTER FOR PERF ARTS 1101 13TH ST DENVER CO 80204 840407760 501C3 5000 FUNDING TO SUPPORT LOCAL CULTURE AND HUMANITIES ORGANIZATION DENVER HEALTH FOUNDATION 601 BROADWAY SUITE 750 DENVER CO 80203 841085196 501C3 5000 FUNDING TO SUPPORT IMPROVED ACCESS TO OVERALL HEALTH FOR COLORADANS DENVER PUBLIC SCHOOLS 1860 LINCOLN ST DENVER CO 80203 846001099 501C3 5000 FUNDING FOR LOCAL SCHOOL ORGANIZATION DENVER PUBLIC SCHOOLS FOUNDATION 1860 LINCOLN ST DENVER CO 80203 846001099 501C3 5000 FUNDING FOR LOCAL SCHOOL ORGANIZATION DENVER SCHOLARSHIP FOUNDATION 789 SHERMAN ST DENVER CO 80203 205143175 501C3 5000 FUNDING FOR LOCAL ORGANIZATION GRAND VALLEY CATHOLIC OUTREACH 245 S 1ST GRAND JUNCTION CO 81501 200064007 501C3 5000 FUNDING TO LOCAL CHURCH ORGANIZATION HISPANIC CHAMBER OF COMMERCE 924 W COLFAX AVE SUITE 201 DENVER CO 80204 840845219 501C3 5000 FUNDING FOR LOCAL ORGANIZATION LIVE WELL COLORADO 1490 LAFAYETTE ST 404 DENVER CO 80218 262464764 501C3 5000 SUPPORT LOCAL HEALTH ORGANIZATION MENTAL HEALTH COLORADO 1120 LINCOLN ST SUITE 1606 DENVER CO 80203 840446365 501C3 5000 SUPPORT LOCAL HEALTH ORGANIZATION ORAL HEALTH COLORADO 4950 S YOSEMITE ST GREENWOOD VILLAGE CO 80111 900137772 501C3 5000 INCREASE TO ACCESS TO ORAL HEALTHCARE PARENT POSSIBLE 800 GRANT ST STE 200 DENVER CO 80203 841169805 501C3 5000 FUNDING FOR LOCAL ORGANIZATION ROCKY MOUNTAIN YOUTH MEDICAL AND NURSING CONSULTANTS INC 9197 GRANT STREET STE 100 THORNTON CO 80229 841321485 501C3 5000 FUNDING TO SUPPORT HEALTH ORGANIZATION TRANSPLANT FOUNDATION INC 600 17TH STREET STE 2515 SOUTH DENVER CO 80202 020744032 501C3 5000 FUNDING TO SUPPORT HEALTH ORGANIZATION WOMEN'S LEADERSHIP FOUNDATION PO BOX 3004 DENVER CO 80201 320248696 501C3 5000 FUNDING FOR LOCAL ORGANIZATION DELTA DENTAL OF COLORADO FOUNDATION 4582 S ULSTER STREET 800 DENVER CO 80237 841389431 501C3 5000000 SUPPORTED ORGANIZATION OF THE COMPANY 55 2 PART I, LINE 2: THE COMPANY HAS PROCEDURES TO ASCERTAIN THAT ALL GRANTS ARE MADE TO 501(C)(3) ORGANIZATIONS AND ARE PROPERLY APPROVED BY MANAGEMENT. ADDITIONALLY, THE ORGANIZATION REQUIRES PERIODIC REPORTS TO ASCERTAIN THAT SUBSTANTIAL GRANTS ARE USED FOR THEIR PROPER INTENDED PURPOSE. X X X X 1 0 0 1 0 1 0 0 0 HELEN W DREXLER CEO/PRESIDENT 442014 0 168021 0 2322 0 37000 0 8894 0 658251 0 0 0 DAVID W GERBUS JD CHIEF ADMINISTRATIVE OFFICER & GENER 282014 0 110192 0 2727 0 37102 0 3279 0 435314 0 0 0 GREGORY C VOCHIS CPA CFO/TREASURER 282600 0 108325 0 393 0 27171 0 8964 0 427453 0 0 0 ROBERT M THOMPSON VICE PRESIDENT SALES AND CLIENT/BROK 241644 0 89793 0 1533 0 34553 0 4045 0 371568 0 0 0 KATHLEEN S JACOBY VICE PRESIDENT MARKETING AND MEMBER 231561 0 85013 0 2344 0 31527 0 3749 0 354194 0 0 0 BRIAN L STEELE DIRECTOR OF CLIENT SERVICES 158409 0 68954 0 541 0 25647 0 7375 0 260926 0 0 0 DEVIN W FARRELL DIRECTOR, SALES STRATEGY AND PROVIDE 147673 0 53718 0 210 0 16352 0 3525 0 221478 0 0 0 BRANDON L THALL DIRECTOR OF FP&A- FORMER 170323 0 30313 0 178 0 12420 0 1279 0 214513 0 0 0 PAMELA PATTON CPA CONTROLLER - FORMER 168065 0 28939 0 442 0 11022 0 8427 0 216895 0 0 0 BROOKE S BODART RDH MPA DIRECTOR OF BUSINESS PROGRAMS 143761 0 43645 0 185 0 14639 0 5694 0 207924 0 0 0 PART I, LINE 4A PAMELA PATTON AND BRANDON THALL RECEIVED $33,462 & $31,922 OF SEVERANCE RESPECTIVELY. PART I, LINE 5: THE COMPANY HAS AN INCENTIVE COMPENSATION PLAN AND A SALES INCENTIVE PLAN WHICH PROVIDES AN ANNUAL BONUS FOR ALL ELIGIBLE EMPLOYEES IF THE COMPANY REACHES CERTAIN GOALS, INCLUDING A MINIMUM NET GAIN GOAL. ALL ACTIVE FULL-TIME EMPLOYEES ARE ELIGIBLE FOR ONE OF THE INCENTIVE PLANS. THE COMPANY ALSO HAS A LONG-TERM INCENTIVE PROGRAM FOR EXECUTIVES, WHICH IS BASED ON BOTH A MEMBERSHIP GROWTH AND RETURN ON REVENUE FACTOR. THE LONG-TERM INCENTIVE PROGRAM HAS THREE-YEAR TARGETS AND PAYOUTS, AND IN MARCH OF 2020 THE PLAN ENDING DECEMBER 31, 2019 WAS PAID. PART I, LINE 6: SEE NARRATIVE FOR LINE 5A ABOVE. ROCK VIEW DENTAL CARE WALT VOGL, DELTA DENTAL OF COLORADO TRUSTEE 230347 CLAIMS PAID FOR DENTAL SERVICES PROVIDED 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS WHO ARE DEFINED AS PARTICIPATING DENTISTS WHO ARE ENGAGED IN THE PRACTICE OF DENTISTRY IN THE STATE OF COLORADO. THE PARTICIPATING DENTISTS ARE THOSE THAT HAVE SIGNED A PARTICIPATING DENTIST AGREEMENT WITH THE ORGANIZATION AS PRESCRIBED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE ORGANIZATION HAVE THE AUTHORITY TO ELECT THE BOARD OF TRUSTEES AT THE ANNUAL MEETING OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN MATTERS OF THE ORGANIZATION ARE SUBJECT TO A VOTE OF THE MEMBERS. A QUORUM OF 15% OF MEMBERSHIP, OR 500 MEMBERS, WHICHEVER IS GREATER, IS REQUIRED. FORM 990, PART VI, SECTION B, LINE 11B WE ENGAGE AN INDEPENDENT CPA TAX PROFESSIONAL TO PREPARE OUR FORM 990, AND BOARD MEMBERS GENERALLY FEEL THIS IS THE APPROPRIATE FIDUCIARY PROCESS. THE AUDIT, INVESTMENT AND FINANCE COMMITTEE'S ROLE THEN IS TO EVALUATE THE FIRM HIRED TO PREPARE THE RETURN AND TO DETERMINE IT IS APPROPRIATELY FILED. WE HAVE TAKEN THOSE STEPS WITH OUR AUDIT, INVESTMENT, AND FINANCE COMMITTEE. THE BOARD OF TRUSTEES REVIEWS AND APPROVES FORM 990 PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C DDCO CONDUCTS AN ANNUAL COMPLIANCE TRAINING, WHICH IS MANDATORY FOR ALL EMPLOYEES TO ATTEND. THE CONFLICTS OF INTEREST POLICY IS DISCUSSED AT THIS TRAINING. ON AN ANNUAL BASIS, ALL EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT AND SUBMIT ANY POTENTIAL OR PERCEIVED CONFLICT OF INTEREST. RECEIPT OF ALL SIGNED AND COMPLETED FORMS ARE TRACKED IN AN EXCEL FILE; ORIGINAL FORMS ARE KEPT IN THE PERSONNEL FILE IN THE HUMAN RESOURCES OFFICE. ANY REPORTED POTENTIAL OR PERCEIVED CONFLICTS OF INTEREST ARE REVIEWED AND, IF NECESSARY, EMPLOYEES AND THEIR MANAGER ARE ADVISED TO REMOVE THEMSELVES FROM ANY SITUATION INVOLVING THE POTENTIAL CONFLICT. ADDITIONALLY, ALL NEW EMPLOYEES RECEIVE COMPLIANCE TRAINING AND ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT. EMPLOYEES ARE INSTRUCTED TO COMPLETE A NEW CONFLICT OF INTEREST STATEMENT DURING THE COURSE OF THE YEAR, SHOULD THEIR SITUATION CHANGE. THE CONFLICT OF INTEREST POLICY AND STATEMENT FORMS ARE POSTED ON THE COMPANY INTRANET. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION HAS A COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES THAT IS RESPONSIBLE FOR SETTING THE COMPENSATION OF THE PRESIDENT AND CEO. THE COMMITTEE ENGAGES THE SERVICES OF A THIRD PARTY TO PROVIDE RANGES OF COMPENSATION THAT ARE APPROPRIATE FOR THE DUTIES REQUIRED BY THE POSITION OF THE PRESIDENT, AS WELL AS THE POSITION OF THE VICE PRESIDENTS. THE CEO AND PRESIDENT OF THE CORPORATION IS RESPONSIBLE FOR THE COMPENSATION PROCESS OF THE REMAINING EXECUTIVES OF THE ORGANIZATION. THE ORGANIZATION ENGAGES A THIRD PARTY TO PROVIDE RANGES OF ACCEPTABLE INCREASES AND COMPENSATION LEVELS OF AVERAGE SALARIES BY SALARY GRADE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAINTAINS COPIES OF THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS THAT ARE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION HAS A STATEMENT ON ITS WEBSITE, WWW.DELTADENTALCO.COM, THAT INFORMS THE PUBLIC THAT THESE DOCUMENTS ARE AVAILABLE FOR PUBLIC INSPECTION AT ITS CORPORATE HEADQUARTERS. THE ORGANIZATION'S ANNUAL REPORT IS ALSO POSTED ON ITS WEBSITE, WHICH STATES THAT "COMPLETE AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR INSPECTION AT OUR CORPORATE OFFICES UPON REQUEST". DOCUMENTS ARE AVAILABLE FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990, PART XI, LINE 9: UNRECOGNIZED ACTUARIAL GAINS 39,000. DELTA DENTAL PLAN OF COLORADO FOUNDATION 4582 S ULSTER ST 800 DENVER CO 80237 841389431 DENTAL HEALTH AND EDUCATION CO 501(C)(3) LINE 12A, I DELTA DENTAL OF COLORADO 1 SPRINGROCK DENTAL INC 4582 S ULSTER ST 800 DENVER CO 80237 475247650 DELIVERING QUALITY ORAL HRALTHCARE TO UNDERSERVED PATIENTS CO 501(C)(3) LINE 10 DELTA DENTAL OF COLORADO 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 DELTA DENTAL PLAN OF COLORADO FOUNDATION B 5000000 FMV DELTA DENTAL PLAN OF COLORADO FOUNDATION O 373701 FMV DELTA DENTAL PLAN OF COLORADO FOUNDATION Q 697324 FMV SPRINGROCK DENTAL INC R 652515 FMV