2020-11-11T08:16:46-06:00 2019-12-31 341851358 CBIZ MHM LLC 530 HOWELL ROAD SUITE 209 GREENVILLE SC 29615 990 2019-01-01 941461312 DELTA DENTAL OF CALIFORNIA DELT 4159728300 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 ALICIA F WEBER CFO 4159748577 2020-11-02 1 KELLIE A LANFORD P00538614 8642412001 2020-11-02 162.231.92.163 2020-11-11 08:07:10 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 457EDB2BE6E124B7C9E7654176383C617BDC297E 2019 2021-04-22 16:20:28Z ALICIA F WEBER 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 5216016875 0 X WWW.DELTADENTALINS.COM X 1954 CA TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS, SERVICE, TECHNOLOGY AND PROFESSIONAL SUPPORT. 10 8 2250 0 400000 -400112 0 0 5419394176 5134632601 49734609 27708887 -4218479 25487299 5464910306 5187828787 12929477 14555566 4674049803 4402945492 293527117 330754164 0 0 0 312646261 260483327 5293152658 5008738549 171757648 179090238 2710139914 2483531581 1240231072 771561142 1469908842 1711970439 TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS, SERVICE, TECHNOLOGY AND PROFESSIONAL SUPPORT. 0 0 4895725915 5187428787 THE ORGANIZATION PROVIDED DENTAL BENEFIT COVERAGE FOR 23,692,000 BENEFICIARIES IN 2019, PRIMARILY THROUGH CONTRACTS WITH INDEPENDENT DENTISTS. INCLUDED WERE PUBLICLY SPONSORED DENTAL BENEFIT PROGRAMS ADMINISTERED BY THE ORGANIZATION, AS WELL AS 1,055,000 ENROLLED IN THE FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM (FEDVIP).THE ORGANIZATION PAID MORE THAN $4.4 BILLION FOR DENTAL CARE DURING 2019. 14555566 14555566 THE ORGANIZATION MADE GRANTS DURING 2019 TO FOSTER IMPROVED ACCESS TO DENTAL HEALTH CARE TREATMENT, TO SUPPORT PROFESSIONAL DENTAL EDUCATION, AND TO PROVIDE ORAL HEALTH INSTRUCTION FOR PATIENTS. 4910281481 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 1 0 1 114987 0 1 2250 1 1 1 0 0 0 0 0 1 0 X 10 8 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X ALICIA F WEBER CFO 4159748577 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 X BARTH ANTHONY S FORMER PRESIDENT/CEO 0.00 X 15472045 0 33055 MARTINEZ BELINDA EXE. VICE PRES/CAO 40.00 10.00 X 4469890 0 -1535831 HANKINSON MICHAEL G EXE. VICE PRES./CLO 40.00 10.00 X 1753369 0 49178 WEBER ALICIA F EXE. 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VICE PRES. 0.00 X 299998 0 0 POLYAKOVA YANA VICE PRES. 40.00 10.00 X 253901 0 44504 RADINE GARY D FORMER PRESIDENT/CEO 0.00 X 207930 0 89790 BERGERT GLEN F SECOND VICE CHAIR 5.00 2.00 X 268000 29185 0 MCCANN STEVEN F DIRECTOR 5.00 X 289655 0 0 TURNER CHAD VICE PRES. 40.00 10.00 X 235632 0 53636 O'TOOLE TERRY A TREASURER 5.00 X 268000 0 0 FERGUSON KENZIE KERRAN VICE PRES. 40.00 10.00 X 189690 0 32502 GONELLA ROY A FIRST VICE CHAIR 5.00 X 218788 0 0 KAPLAN GREGORY D DDS DIRECTOR 5.00 X 206607 0 0 FARNSWORTH R KENT DDS SECRETARY 5.00 X 194788 0 0 REID ANDREW J IMMEDIATE PAST CHAIR 5.00 X 192788 0 0 SCHROEDER KURT VICE PRES. 40.00 10.00 X 150402 0 30185 YODOWITZ HEIDI DIRECTOR 5.00 X 165200 0 0 PICKERING STEPHEN R DDS DIRECTOR 5.00 X 101788 0 0 DORSEY EDITH VICE PRES. 10.00 40.00 X 0 85595 12306 CASTRO MICHAEL J PRESIDENT/CEO 40.00 10.00 X 3176790 0 -3615328 53419845 4051511 -2674328 913 1 1 0 ELEVATED RESOURCES INC 3990 WESTERLY PL STE 270 NEWPORT BEACH CA 92660 CONSULTING SERVICES 23252139 CATALYST360 LLC 11000 OPTUM CIRCLE EDEN PRAIRIE MN 55344 CONSULTING SERVICES 7341439 DELOITTE CONSULTING LLP 555 MISSION STREET SAN FRANCISCO CA 94105 CONSULTING SERVICES 3975045 DEWPOINT INC 300 SOUTH WASHINGTON SQ STE 200 LANSING MI 48933 CONSULTING SERVICES 3737411 CBIZ CMF LLC 325 CHESTNUT STREET STE 410 PHILADELPHIA PA 19106 CONSULTING SERVICES 2052661 86 PROFESSIONAL SERVICES 524114 4645431093 4645431093 FEES & CONTRACTS FROM GOVERNMENT 524114 489201508 489201508 5134632601 27447385 27447385 28449590 28188088 261502 261502 261502 INCOME/LOSS FROM SUBSIDIARIES 524298 46493867 46093867 400000 OTHER REVENUE 524298 1755907 1755907 MISC EXPENSES 524298 -762475 -762475 -22000000 -22000000 25487299 5187828787 5187428787 400000 0 14555566 14555566 4402945492 4402945492 37947800 37947800 244760659 212086553 32674106 -3927452 -5369732 1442280 39160115 35908438 3251677 12813042 11621363 1191679 4115617 4115617 1541992 583864 958128 723786 723786 7726432 7726432 23606815 23294807 312008 37682355 37018310 664045 15497246 15492822 4424 19387306 17451860 1935446 6751515 4995095 1756420 1925023 1239847 685176 1422793 1422793 22926925 22176452 750473 1850405 1683071 167334 BROKER FEES 53134444 53134444 CONSULTANT FEES 30522163 23269470 7252693 OUTSIDE SERVICES 24154922 23384233 770689 ALL OTHER EXPENSES 7513588 820898 6692690 5008738549 4910281481 98457068 0 435577187 -52460877 254019678 411527071 316904338 299284593 175750000 105750000 35517402 42513239 300518997 164069710 145135507 136449287 926961611 865494167 388975102 645430166 31299089 29543935 2710139914 2483531581 483975895 514453719 42066317 44785297 714188860 212322126 1240231072 771561142 X 0 0 0 0 1469908842 1711970439 1469908842 1711970439 2710139914 2483531581 X 179090238 49640309 13331050 X 0 1 X 1 0 52592778 10981632 41611146 50554664 30818491 19736173 197371555 122269587 75101968 136449287 INVESTMENT - OTHER SECURITIES 645430166 F 645430166 ACCRUED RETIREMENT BENEFITS 41662527 DEFERRED COMPENSATION PLANS 29417285 GROUP PREFUNDING DEPOSITS 12937679 REFUNDABLE GROUP BALANCES 128304635 212322126 X 2725043598 49640308 49640308 2675403290 2512425497 2512425497 5187828787 2495912940 0 2495912940 2512825609 2512825609 5008738549 PART X, LINE 2: THE COMPANY IS A TAX-EXEMPT ORGANIZATION ORGANIZED UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE AND, AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE FINANCIAL STATEMENTS. CURRENT ACCOUNTING GUIDANCE CLARIFIES HOW UNCERTAINTIES IN TAX POSITIONS ARE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. POSITIONS INCLUDE THOSE WITH RESPECT TO THE COMPANY'S TAX EXEMPT STATUS AND WITH RESPECT TO INCOME TAXES ON UNRELATED BUSINESS INCOME. THE COMPANY HAS DETERMINED THAT SUCH TAX POSITIONS DO NOT RESULT IN UNCERTAINTIES REQUIRING RECOGNITION. PART XI, LINE 4B - OTHER ADJUSTMENTS: ADMINISTRATIVE SERVICE CONTRACTS CLAIM REIMBURSEMENT REVENUE INVESTMENT EXPENSES UNRELATED BUSINESS INCOME PART XII, LINE 4B - OTHER ADJUSTMENTS: CLAIMS INCURRED FOR ADMINISTRATIVE SERVICE CONTRACTS INVESTMENT EXPENSES UNRELATED BUSINESS EXPENSE CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENT IN DELTA REINSURANCE CORPORATION REINSURANCE 126650 0 0 0 0 0 0 126650 0 126650 0 0 1 0 0 0 PART III ACCOUNTING METHOD: PART 1, LINE 3(E): THE ORGANIZATION'S INVESTMENT IN DELTA REINSURANCE CORPORATION IS $126,650. 1 AARP FOUNDATION 601 E STREET NW WASHINGTON DC 20049 942312368 7500 2019 CELEBRATION OF SVC MEAL PACK PIONEER SPONSORSHIP ALAMEDA COUNTY COMMUNITY FOOD BANK 7900 EDGWATER DR OAKLAND CA 94621 942960297 501(C)(3) 15000 SAVOR THE SEASON EVENT SPONSORSHIP AMERICAN ONLINE GIVING FOUNDATION INC 2454 N MCMULLER BOOTH RD SUITE 431 CLEARWATER FL 33759 810739440 501(C)(3) 83929 DDC MATCHING GIFTS AMERICAN RED CROSS INC 1663 MARKET ST SAN FRANCISCO CA 94103 530196605 501(C)(3) 15000 2020 RED CROSS GALA BAY AREA COUNCIL 353 SACRAMENTO ST 10TH FLR SAN FRANCISCO CA 94111 237325853 501(C)(4) 10000 ANNUAL DINNER GOLD LEVEL SPONSOR BLUE STAR FAMILIES INC 515 VERBENA CT ENCINITAS CA 92024 800369895 501(C)(3) 12000 2019 CONTRIBUTION CALIFORNIA ACADEMY OF GENERAL DENTISTRY PO BOX 22417 SACRAMENTO CA 95822 942557207 501(C)(3) 20000 2019 CAGD FALL MEETING DDC SPONSORSHIP CALIFORNIA ASSOCIATION OF DENTAL PLANS 12700 PARK CENTRAL DR STE 400 DALLAS TX 75251 330385553 501(C)(6) 10700 2019 CONFERENCE & HILL DAY SPONSORSHIP CALIFORNIA STATE UNIV DOMINGUEZ HILLS PHILANTHROPIC FOUNDATION 1000 E VICTORIA ST STE 425 CARSON CA 907470001 473097839 501(C)(3) 5000 INAUGURATION GALA & BENEFIT HONORING DR THOMAS A PARHAM CHOC FOUNDATION 1201 WEST LA VELA AVE ORANGE CA 92868 956097416 501(C)(3) 10000 CHOC GLASS SLIPPER GUILD GALA CORPORATION OF THE FINE ARTS MUSEUMS 50 HAGIWARA TEA GARDEN DR SAN FRANCISCO CA 94118 943045948 501(C)(3) 5000 BUSINESS COUNCIL MEMBERSHIP RENEWAL OCT19 CSAC - EIA 75 IRON POINT CR STE 200 FOLSOM CA 95630 263287958 5000 2019 CSAC EIA HEALTHCARE SYMPOSIUM SPONSORSHIP DISABLED AMERICAN VETERANS 3725 ALEXANDRIA PIKE COLD SPRING KY 41076 310263158 501(C)(4) 7500 2019 NATIONAL DISABLED VETERANS WINTER CLINIC DELTA DENTAL COMMUNITY CARE FOUNDATION 560 MISSION STREET SUITE 1300 SAN FRANCISCO CA 94105 371570764 501(C)(3) 14000000 ENTERPRISE CONTRIBUTION TO DDCCF DESERT AIDS PROJECT 1695 N SUNRISE WAY PALM SPRINGS CA 92262 330068583 501(C)(3) 5000 25TH ANNUAL STEVE CHASE AWARD- BENEFACTOR SPONSORSHIP ENTERPRISE FOUNDATION 1887 MONTEREY RD STE 2105 SAN JOSE CA 95112 261670171 501(C)(3) 15000 GLAM19 HENRY M JACKSON FOUNDATION FOR THE ADVANCEMENT OF MILITARY MEDICINE 6720 A ROCKLEDGE DR STE 100 BETHESDA MD 20817 521317896 501(C)(3) 5000 2019 CONTRIBUTION JAMES R HOFFA MEMORIAL SCHOLARSHIP FUND INC 4600 EAST WEST HIGHWAY SUITE 300 BETHESDA MD 20814 522206826 501(C)(3) 10000 20TH ANNIVERSARY - PATRON SPONSORSHIP LA CLINICA DE LA RAZA INC 450 FRUITVALE AVE OAKLAND CA 946232210 941744108 501(C)(3) 10450 DONATION TO LA CLINICA DE LA RAZA LAPS FOR LEXI INC 12926 OLIVINE WAY SILVER SPRING MD 20904 462160960 501(C)(3) 5000 CONTRIBUTION LOVEALL FOUNDATION FOR CHILDREN 4120 DOUGLAS BLVD 306 GRANITE BAY CA 95746 680435070 501(C)(3) 6000 CHARITY GOLF TOURNAMENT MOAA MILITARY FAMILY INITIATIVE 201 N WASHINGTON ST ALEXANDRIA VA 22301 464219250 501(C)(3) 5000 CONTRIBUTION NATIONAL ASSOCIATION OF DENTAL PLANS 12700 PARK CENTRAL DR SUITE 400 DALLAS TX 75251 752801959 501(C)(6) 10000 CONVERGE 2019 SPONSORSHIP NATIONAL DENTAL ASSOCIATION 6411 IVY LANE STE 703 GREENBELT MD 20770 540315311 501(C)(3) 25000 106TH ANNUAL CONVENTION NATIONAL MILITARY FAMILY ASSOCIATION 3601 EISENHOWER AVE STE 425 ALEXANDRIA VA 22304 520899384 501(C)(3) 10000 PLEDGE TO OPERATION PURPLE CAMPS & SPONSORSHIP FOR 50TH ANNIVERSARY GALA RICHMONDERMET FOUNDATION 942 DIVISADERO 201 SAN FRANCISCO CA 94115 943232222 501(C)(3) 25000 YEAR-LONG CORPORATE SPONSORSHIP SACRAMENTO DISTRICT DENTAL FOUNDATION 2035 HURLEY WAY STE 200 SACRAMENTO CA 95825 237067087 501(C)(3) 5000 DISTRICT DENTAL SOCIETY & FOUNDATION GALA SPONSORSHIP SACRAMENTO FOOD BANK & FAMILY SERVICES DBA RUN TO FEED THE HUNGRY 3333 3RD AVE SACRAMENTO CA 95817 943315566 501(C)(3) 9500 2019 RUN FOR THE HUNGRY SAN FRANCISCO MUSEUM OF MODERN ART 151 THIRD STREET SAN FRANCISCO CA 941033159 941156300 501(C)(3) 5000 CORPORATE SPONSORSHIP SF MARIN FOOD BANK 900 PENNSYLVANIA AVE SAN FRANCISCO CA 94107 943041517 501(C)(3) 15000 ONE BIG TABLE EVENT SPONSORSHIP ST JOHNS WELL CHILD AND FAMILY CENTER INC 808 WEST 58TH ST LOS ANGELES CA 900373632 954067758 501(C)(3) 5000 ST. JOHN'S WELL CHILD & FAMILY CENTER 2019 GALA TRAGEDY ASSISTANCE PROGRAM FOR SURVIVORS PO BOX CC MCLEAN VA 22101 920152268 501(C)(3) 5000 CONTRIBUTION TRIUMPH CANCER FOUNDATION 947 ENTERPRISE DR LOFT B SACRAMENTO CA 931032331 453968833 501(C)(3) 21250 TRIUMPH UNCORKED FUNDRAISER UNIVERSITY OF FLORIDA - CONTINUING DENTAL EDUCATION PO BOX 100417 GAINESVILLE FL 326100417 590974739 501(C)(3) 10000 CONTINUING EDUCATION SPONSORSHIP UNIVERSITY OF THE PACIFIC 155 5TH STREET SAN FRANCISCO CA 94103 941156266 501(C)(3) 10000 CONTINUING EDUCATION SPONSORSHIP USC SCHOOL OF DENTISTRY 925 WEST 34TH STREET ROOM 212 LOS ANGELES CA 900890641 951642394 501(C)(3) 15000 DELTA DENTAL LECTURE SPONSORSHIP Z DENTAL DENTAL ELITE 3280 N COLORADO ST CHANDLER AZ 85225 320031941 7147 DENTAL KITS MISCELLANEOUS ITEMS LESS THAN 5000 109590 MISCELLANEOUS CONTRIBUTIONS 30 7 PART I, LINE 2: THE ORGANIZATION AWARDS GRANTS AND PROVIDES OTHER ASSISTANCE THROUGH CONTRIBUTIONS AND/OR SPONSORSHIPS FOR PROGRAMS THAT FOSTER DENTAL HEALTH AND EDUCATION, AS WELL AS COMMUNITY SUPPORT. THROUGH THESE GRANTS, CONTRIBUTIONS AND SPONSORSHIPS, THE ORGANIZATION HELPS FINANCE HEALTH, EDUCATION, AND RESEARCH PROJECTS IN DENTISTRY, HEALTH AND HUMAN SERVICES, AND CIVIC AND/OR COMMUNITY ACTIVITIES. INDIVIDUAL GRANTS, CONTRIBUTIONS AND/OR SPONSORSHIPS WILL GENERALLY NOT EXCEED $100,000 WITH EXCEPTION OF THE CONTRIBUTION MADE TO THE DELTA DENTAL COMMUNITY CARE FOUNDATION. GRANTS WILL BE LIMITED TO ONE-YEAR PROJECTS, SUBJECT TO RENEWAL. EXCEPT IN SPECIAL CASES, AN ORGANIZATION/ENTITY WILL NOT BE ELIGIBLE FOR MORE THAN ONE GRANT DURING ANY YEAR. X X X X 1 1 X X X X 1 1 0 1 0 1 0 1 0 BARTH ANTHONY S FORMER PRESIDENT/CEO 0 0 0 0 15472045 0 33055 0 0 0 15505100 0 0 0 MARTINEZ BELINDA EXE. VICE PRES/CAO 174903 0 1995954 0 2299033 0 -1542951 0 7120 0 2934059 0 370768 0 HANKINSON MICHAEL G EXE. VICE PRES./CLO 499077 0 1196450 0 57842 0 29400 0 19778 0 1802547 0 0 0 WEBER ALICIA F EXE. VICE PRES/CFO 540515 0 1002420 0 59761 0 31930 0 25105 0 1659731 0 0 0 JACKSON KEVIN L EXE. VICE PRES/CGO 499554 0 982622 0 25512 0 33422 0 31839 0 1572949 0 0 0 GAREN KIRSTEN E EXE. VICE PRES/CIO 489754 0 858480 0 24288 0 29400 0 31839 0 1433761 0 0 0 BUDD ROBERT P GRP. VICE PRES. 73477 0 650652 0 606158 0 57784 0 7302 0 1395373 0 0 0 CHAVARRIA SARAH EXE. VICE PRES/CPO 519538 0 799042 0 14383 0 29400 0 27407 0 1389770 0 0 0 RUIZ JOSEPH F GRP .VICE PRES. 356272 0 490681 0 18843 0 29400 0 19328 0 914524 0 0 0 NAVID MOHAMMADREZA GRP .VICE PRES. 365400 0 465944 0 10455 0 26700 0 18795 0 887294 0 0 0 LEIBOWITZ THOMAS J GRP .VICE PRES. 334525 0 454143 0 16203 0 29321 0 17670 0 851862 0 0 0 GILBERT LEROY R JR EXE. VICE PRES/COO 367308 0 350000 0 11428 0 29400 0 15402 0 773538 0 0 0 VERNA TONY VICE PRES. 199168 0 241123 0 317660 0 8400 0 7084 0 773435 0 0 0 HOFFMAN EVA C VICE PRES. 307458 0 337633 0 7979 0 29754 0 26256 0 709080 0 0 0 FULLERTON MELISSA VICE PRES. 0 265080 0 374025 0 5448 0 28669 0 28536 0 701758 0 0 ROBINSON KAREN L VICE PRES. 28270 0 291001 0 361466 0 7178 0 981 0 688896 0 0 0 NASR JAMAL L VICE PRES. 288032 0 318212 0 26975 0 35332 0 19328 0 687879 0 0 0 CROLEY DANIEL W VICE PRES. 295926 0 313950 0 9534 0 30509 0 29211 0 679130 0 0 0 TITCOMBE DOMINIC VICE PRES. 340260 0 270500 0 9848 0 29400 0 28751 0 678759 0 0 0 FEGLEY ANDREA M VICE PRES. 300628 0 330433 0 2002 0 28645 0 15526 0 677234 0 0 0 FOSTER JEANNE M VICE PRES. 0 274437 0 308214 0 33342 0 29400 0 22879 0 668272 0 0 ALBUM JEFFREY M VICE PRES. 285731 0 298903 0 9765 0 35868 0 26256 0 656523 0 0 0 SHEETZ MARTY A VICE PRES. 281668 0 313391 0 7349 0 29400 0 21676 0 653484 0 0 0 HOLM BRIAN VICE PRES. 277073 0 252812 0 54277 0 31684 0 23157 0 639003 0 0 0 YAMAMOTO JOHN M DDS VICE PRES. 272325 0 285359 0 10931 0 29687 0 31426 0 629728 0 0 0 NAKAHARA EARL VICE PRES. 289675 0 266436 0 13251 0 29400 0 26256 0 625018 0 0 0 BALTIS THOMAS VICE PRES. 299865 0 281211 0 618 0 29400 0 9753 0 620847 0 0 0 HARLIN CASEY J VICE PRES. 267624 0 275897 0 6209 0 29218 0 26256 0 605204 0 0 0 SANCHEZ WALTER VICE PRES. 260150 0 263861 0 12816 0 28665 0 31426 0 596918 0 0 0 MANOWSKI MIKE VICE PRES. 309759 0 235000 0 6394 0 29400 0 15526 0 596079 0 0 0 SWAMINATHAN SHANMUGA S VICE PRES. 274779 0 259329 0 5184 0 29088 0 26256 0 594636 0 0 0 RODZINKA BARBARA A VICE PRES. 0 248043 0 267713 0 12931 0 29400 0 20874 0 578961 0 0 YOUNG ANDY VICE PRES. 288206 0 207667 0 11520 0 29400 0 31426 0 568219 0 0 0 GRABOS MEGAN VICE PRES. 93912 0 176914 0 286902 0 6903 0 2944 0 567575 0 0 0 SHERMAN BRIAN VICE PRES. 290499 0 193348 0 10854 0 29400 0 24655 0 548756 0 0 0 GRAYBILL RICHARD C VICE PRES. 0 234551 0 258883 0 14037 0 29400 0 9584 0 546455 0 0 PARKER EARL JR VICE PRES. 0 241476 0 215381 0 4559 0 29400 0 18850 0 509666 0 0 LAYNE VALERIE DIRECTOR 224692 0 149083 0 19659 0 51104 0 26166 0 470704 0 0 0 MANER MICHAEL VICE PRES. 0 227202 0 183235 0 7344 0 29964 0 21001 0 468746 0 0 MAHFOUZ MIRIAM DIRECTOR 263362 0 141978 0 -1024 0 29400 0 29121 0 462837 0 0 0 GEE MELISSA DIRECTOR & CORPORATE COUNSEL - MANAG 248500 0 167541 0 330 0 29957 0 7638 0 453966 0 0 0 MCCARTY KRISTINA VICE PRES. 26575 0 160434 0 261660 0 2266 0 1219 0 452154 0 0 0 THOLIA ASHISH DIRECTOR 289406 0 129103 0 758 0 29400 0 3270 0 451937 0 0 0 CEMBROLA MIKE VICE PRES. 0 241189 0 144714 0 10421 0 29400 0 20144 0 445868 0 0 LOMAX CHAD DIRECTOR 231263 0 148616 0 10189 0 29400 0 19238 0 438706 0 0 0 GHALY KHALED VICE PRES. 0 152969 0 194876 0 16661 0 8400 0 16450 0 389356 0 0 SBRAGIA RICHARD VICE PRES. 274039 0 0 0 6752 0 28199 0 20621 0 329611 0 0 0 FRANZOI LYNN L CHAIR 328788 0 0 0 0 0 0 0 0 0 328788 0 0 0 DOERING RICK R FORMER SR. VICE PRES. 0 0 299998 0 0 0 0 0 0 0 299998 0 0 0 POLYAKOVA YANA VICE PRES. 216711 0 35000 0 2190 0 20934 0 23570 0 298405 0 0 0 RADINE GARY D FORMER PRESIDENT/CEO 196154 0 0 0 11776 0 89790 0 0 0 297720 0 0 0 BERGERT GLEN F SECOND VICE CHAIR 268000 29185 0 0 0 0 0 0 0 0 268000 29185 0 0 MCCANN STEVEN F DIRECTOR 289655 0 0 0 0 0 0 0 0 0 289655 0 0 0 TURNER CHAD VICE PRES. 191499 0 33867 0 10266 0 22279 0 31357 0 289268 0 0 0 O'TOOLE TERRY A TREASURER 268000 0 0 0 0 0 0 0 0 0 268000 0 0 0 FERGUSON KENZIE KERRAN VICE PRES. 186154 0 0 0 3536 0 18406 0 14096 0 222192 0 0 0 GONELLA ROY A FIRST VICE CHAIR 218788 0 0 0 0 0 0 0 0 0 218788 0 0 0 KAPLAN GREGORY D DDS DIRECTOR 206607 0 0 0 0 0 0 0 0 0 206607 0 0 0 FARNSWORTH R KENT DDS SECRETARY 194788 0 0 0 0 0 0 0 0 0 194788 0 0 0 REID ANDREW J IMMEDIATE PAST CHAIR 192788 0 0 0 0 0 0 0 0 0 192788 0 0 0 SCHROEDER KURT VICE PRES. 145000 0 0 0 5402 0 14472 0 15713 0 180587 0 0 0 YODOWITZ HEIDI DIRECTOR 165200 0 0 0 0 0 0 0 0 0 165200 0 0 0 CASTRO MICHAEL J PRESIDENT/CEO 1004492 0 2126814 0 45484 0 -3647204 0 31876 0 -438538 0 0 0 PART I, LINE 1A FIRST CLASS BUSINESS TRAVEL IS REIMBURSED TO THE CEO, EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, AND GROUP VICE PRESIDENTS. FIRST CLASS BUSINESS TRAVEL IS NOT TREATED AS TAXABLE COMPENSATION. REIMBURSEMENT FOR COMPANY APPROVED RELOCATION COSTS ARE "GROSSED UP" TO COVER ANY PERSONAL TAX LIABILITY THAT WOULD BE INCURRED BY THE EMPLOYEE FOR THE EXPENSE. FOUR OFFICERS AND ONE HIGHEST COMPENSATED EMPLOYEE RECEIVED THIS BENEFIT IN 2019. THE TOTAL AMOUNT REIMBURSED IS INCLUDED IN TAXABLE COMPENSATION. ALL EMPLOYEES WHO WORK AT LEAST 30 HOURS PER WEEK AND HAVE COMPLETED AT LEAST 30 DAYS OF SERVICE ARE OFFERED A FITNESS REIMBURSEMENT PLAN THAT ENCOURAGES OUR EMPLOYEES TO BE HEALTHY AND ACTIVE BY PROVIDING THE ACCESS THEY NEED TO HELP THEM ACHIEVE THEIR FITNESS GOALS. THE PLAN INCLUDES A REIMBURSEMENT, UP TO $540 PER CALENDAR YEAR, FOR INDIVIDUAL MEMBERSHIP FEES AT A FITNESS CENTER/STUDIO, HEALTH CLUB, OR SWIM AND TENNIS CLUB. IN ADDITION, THE PRESIDENT AND EXECUTIVE VICE PRESIDENTS MAY BE REIMBURSED FOR ONE SOCIAL CLUB UPON THE APPROVAL BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. ONE FORMER SENIOR EXECUTIVE RECEIVED THE SOCIAL CLUB BENEFIT FOR TWO MONTHS AND FIFTEEN EXECUTIVES RECEIVED THE FITNESS REIMBURSEMENT BENEFIT IN 2019. BOTH THE HEALTH AND SOCIAL CLUB REIMBURSEMENTS ARE INCLUDED IN TAXABLE COMPENSATION. FINANCIAL AND TAX PLANNING EXPENSES ARE REIMBURSED TO EMPLOYEES AT THE DIRECTOR OR ABOVE LEVELS OF MANAGEMENT. A COMPANY POLICY OUTLINES THE MAXIMUM REIMBURSEMENT ALLOWED FOR EACH MANAGEMENT LEVEL. FIFTEEN EXECUTIVES RECEIVED REIMBURSEMENTS IN 2019. THESE REIMBURSEMENTS ARE INCLUDED IN THE TAXABLE COMPENSATION OF THE REIMBURSED EMPLOYEES. PART I, LINE 4A: DURING 2019, THE FORMER PRESIDENT/CEO, ANTHONY S. BARTH, RECEIVED A PAYMENT IN SETTLEMENT OF POTENTIAL LITIGATION AS A RESULT OF HIS TERMINATION FROM THE ORGANIZATION. ADDITIONALLY, SIX EXECUTIVES, BELINDA MARTINEZ, ROBERT P. BUDD, TONY VERNA, KAREN L. ROBINSON, MEGAN GRABOS, AND KRISTINA MCCARTY RECEIVED A SEVERANCE PAYMENT UPON SEPARATION FROM THE ORGANIZATION. THESE PAYMENTS ARE INCLUDED ON SCHEDULE J AND REPORTED IN PART II, COLUMN(B)(III). PART I, LINE 4B: THE ORGANIZATION PROVIDES A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN TO CERTAIN OF ITS SENIOR EXECUTIVES AS SELECTED BY THE BOARD OF DIRECTORS. THE SUPPLEMENTAL RETIREMENT BENEFIT IS BASED ON EACH EXECUTIVE'S COMPENSATION AND YEARS OF SERVICE TO THE ENTERPRISE. THE BENEFIT IS SUBJECT TO THE RISK OF FORFEITURE IF REQUIRED YEARS OF SERVICE ARE NOT MET. ANNUAL DEFERRED COMPENSATION RELATED TO THIS PLAN IS REPORTED IN SCHEDULE J, PART II, COLUMN (C) FOR EACH PARTICIPANT AND REFLECTS THE CURRENT YEAR INCREASE OR DECREASE IN THE RELATED ORGANIZATION'S PENSION BENEFIT OBLIGATION ("PBO"), CALCULATED PURSUANT TO GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. THE PBO INCREASE OR DECREASE INCLUDES CHANGES IN ACTUARIAL ASSUMPTIONS (E.G., APPLICABLE DISCOUNT RATE), AS WELL AS CHANGES IN COMPENSATION AND YEARS OF SERVICE. IN 2019, MICHAEL J. CASTRO AND BELINDA MARTINEZ PARTICIPATED IN THE PLAN. IT SHOULD BE NOTED THAT DURING 2018, ANTHONY S. BARTH WAS TERMINATED AS PRESIDENT AND CEO. AS A RESULT OF THE TERMINATION, THE PBO WAS REDUCED FOR THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN THAT RELATED TO MR. BARTH AND WAS REFLECTED ON THE 2018 RETURN SCHEDULE J, PART II, COLUMN (C) IN THE AMOUNT OF $30,985,150; HOWEVER, AN ACCRUAL WAS REFLECTED IN THE 2018 FINANCIAL STATEMENTS FOR POTENTIAL SETTLEMENT EXPENSE IN CONTEMPLATION OF POTENTIAL LITIGATION WITH MR. BARTH. A FINAL SETTLEMENT PAYMENT WAS MADE TO MR. BARTH IN MARCH 2019 WHICH WAS APPLIED AGAINST THE 2018 ACCRUAL. THIS PAYMENT IS REPORTED IN SCHEDULE J, PART II, COLUMN (B)(III). FURTHERMORE, ON MAY 1, 2019, BENEFIT ACCRUALS UNDER THE PLAN CEASED AND THE PLAN WAS FROZEN. SUBSEQUENTLY ON FEBRUARY 6, 2020, THE PLAN WAS IRREVOCABLY TERMINATED AND ALL REMAINING PLAN BENEFITS WILL BE PAID IN A LUMP SUM ON OR AFTER FEBRUARY 7, 2021. PART I, LINES 5A AND 6A: DELTA DENTAL OF CALIFORNIA MAINTAINS A LONG-TERM INCENTIVE PLAN (LTIP) FOR ELIGIBLE EMPLOYEES OF THE ORGANIZATION, LINKING COMPENSATION TO THE COMPANY'S PERFORMANCE. USING SUCCESS METRICS SUCH AS REVENUES, NET GAIN AS A PERCENTAGE OF REVENUES, AND OTHERS, ALLOWS THE COMPANY TO ACCURATELY MEASURE ITS GROWTH, INFORM ON PROGRESS OF ITS BUSINESS TRANSFORMATION, AND EMPOWER CONTINUED SUCCESS. THE LTIP IS UNFUNDED AND ALL PAYMENTS FROM THE LTIP ARE DERIVED FROM THE GAINS OF THE COMPANY. AS SUCH, THERE IS NO GUARANTEE OF INCENTIVE PAYMENTS UNDER THE LTIP. THE CEO MAKES RECOMMENDATIONS TO THE COMPENSATION COMMITTEE FOR ITS REVIEW AND APPROVAL REGARDING THE PERFORMANCE OBJECTIVES, BOTH FINANCIAL AND NON-FINANCIAL, UPON WHICH PAYMENT OF AWARDS ARE BASED AND THE TIME PERIOD DURING WHICH PERFORMANCE SHALL BE MEASURED. EACH LTIP PLAN SPANS THREE YEARS, OVERLAPPING WITH CURRENT PLANS. PART I, LINE 7: THE PRESIDENT OF THE ORGANIZATION, WITH BOARD OF DIRECTORS APPROVAL, MAY GRANT AN ANNUAL BONUS TO ALL MANAGEMENT EMPLOYEES. THESE AMOUNTS ARE INCLUDED IN TAXABLE COMPENSATION. PART II, ROW (II): SOME OF THE ORGANIZATION'S OFFICERS ARE PAID BY A RELATED ORGANIZATION. ACCORDINGLY, THEIR COMPENSATION IS REPORTED ON ROW (II). PART II, ROW (I), COLUMN C: THE AMOUNTS FOR TWO EXECUTIVES, MICHAEL J. CASTRO AND BELINDA MARTINEZ, REFLECT NEGATIVE VALUES DUE TO A DECREASE IN THE ACTUARIAL VALUE OF THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AS OF DECEMBER 31, 2019. THE DECREASE IN ACTUARIAL VALUE OF THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN WAS A RESULT OF THE PLAN FREEZE WHICH OCCURRED ON MAY 1, 2019. PART II, ROW (I), COLUMN F: MONTHLY INSTALLMENTS WERE RECEIVED BY ONE OF THE ORGANIZATION'S EXECUTIVE VICE PRESIDENTS, BELINDA MARTINEZ, IN 2019, PURSUANT TO THE TERMS OF THE ORGANIZATION'S SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THIS PLAN WAS DESIGNED FOR THE LONG-TERM RETENTION OF SENIOR EXECUTIVES (E.G., THE EXECUTIVE VICE PRESIDENT HAD BEEN WITH THE ORGANIZATION FOR MORE THAN 30 YEARS) AND IS BASED ON A PERCENTAGE OF HER AVERAGE ANNUAL COMPENSATION RECEIVED FOR THE THREE YEARS PRIOR TO AGE 65 OR RETIREMENT, WHICHEVER COMES FIRST, AND ON HER LIFE EXPECTANCY AS DETERMINED PURSUANT TO THE INTERNAL REVENUE CODE. THE EXECUTIVE VICE PRESIDENT'S ANNUAL COMPENSATION, UPON WHICH THE PENSION BENEFIT PAYMENT IS BASED, HAS BEEN ESTABLISHED IN ACCORDANCE WITH THE PROCESS OUTLINED IN TREASURY REGULATION SECTION 53.4958-6 FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS. THIS PROCESS INVOLVES REVIEW AND APPROVAL OF COMPENSATION BY THE ORGANIZATION'S BOARD OF DIRECTORS, RELIANCE ON COMPARABILITY DATA PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTANT, AND CONTEMPORANEOUS DOCUMENTATION OF DELIBERATIONS AND DECISIONS REGARDING COMPENSATION. THE PAYMENTS SHOWN IN SCHEDULE J, PART II, ROW I, COLUMN (B)(III) (AND CARRIED TO FORM 990, PART VII, SECTION A, COLUMN (E)) WERE THEREFORE TRIGGERED IN 2019 WHEN THE EXECUTIVE VICE PRESIDENT SEPARATED FROM THE ORGANIZATION. SEE RELATED NOTE ABOVE FOR SCHEDULE J, PART I, LINE 4B, WHICH DESCRIBES THE ORGANIZATION'S SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. STEPHEN R PICKERING DDS PARTICIPATING PROVIDER 177026 DENTAL CLAIM PAYMENTS 0 BRENT KAPLAN FAMILY MEMBER OF A CURRENT DIRECTOR 267920 CONSULTING FEES 0 GREGORY D KAPLAN DDS PARTICIPATING PROVIDER 676618 DENTAL CLAIMS PAYMENTS 0 FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS OF THE ORGANIZATION WERE AMENDED IN 2019 TO ELIMINATE THE DIRECTOR TERM LIMIT OF TWO CONSECUTIVE THREE-YEAR TERMS, AS WELL AS CORRESPONDING PROVISIONS MAKING OFFICER TERMS ACCRETIVE TO DIRECTOR TERMS, AND TO IMPLEMENT ANNUAL DIRECTOR TERMS. ADDITIONAL AMENDMENTS ESTABLISHED A MANDATORY RETIREMENT AGE OF 75 YEARS FOR DIRECTORS; ELIMINATED THE LIMIT OF THREE CONSECUTIVE TERMS OF OFFICE FOR ALL OFFICERS; ESTABLISHED A MINIMUM THREE-YEAR TERM FOR THE CHAIR OF THE BOARD; AND ELIMINATED THE REQUIREMENT FOR THE SECRETARY AND TREASURER TO BE BOARD MEMBERS, THEREBY ALLOWING FOR THE APPOINTMENT OF THE CHIEF LEGAL OFFICER AND CHIEF FINANCIAL OFFICER, RESPECTIVELY, TO FILL THOSE POSITIONS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S BYLAWS NAME TWO CLASSES OF "MEMBERS," "CORPORATE MEMBERS AND "DENTIST MEMBERS." ALL CORPORATE MEMBERS ARE ALSO DIRECTORS OF THE ORGANIZATION AND SO ARE NOT "MEMBERS" AS DEFINED IN THE INSTRUCTIONS TO FORM 990, PART VI, QUESTION 6. HOWEVER, THE ORGANIZATION'S DIRECTORS ARE ELECTED BY ITS PARENT HOLDING COMPANY BOARD OF DIRECTORS, TWO OF WHOM ARE NOT ALSO DIRECTORS OF THE ORGANIZATION AND THUS MAY BE CONSIDERED "MEMBERS" PURSUANT TO THE INSTRUCTIONS. THE DENTIST MEMBERS HAVE A RIGHT TO VOTE UPON PROPOSED CHANGES TO THE PROPORTION OF THE DENTISTS SERVING AS DIRECTORS AND CORPORATE MEMBERS, AND SO MAY BE CONSIDERED "MEMBERS" UNDER THE INSTRUCTION. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S DIRECTORS ARE ELECTED BY THE PARENT HOLDING COMPANY BOARD OF DIRECTORS, WHICH INCLUDES TWO PERSONS WHO ARE NOT ALSO DIRECTORS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE DENTIST MEMBERS HAVE A RIGHT TO VOTE ONLY UPON PROPOSED CHANGES TO THE BYLAWS PROVISIONS THAT SPECIFY THE PROPORTION OF DENTISTS AND LAY PERSONS SERVING AS DIRECTORS AND CORPORATE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S CFO AND LEGAL COUNSEL OVERSEE THE COMPLETION OF THE FORM 990, AND, PRIOR TO FILING, REVIEW IT WITH THE PRESIDENT/CEO AND WITH THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY, AND BETWEEN ANNUAL STATEMENTS IS REQUIRED TO DISCLOSE ANY NEW POSITION OR RELATIONSHIP FORMED THAT POTENTIALLY RAISES A CONFLICT OF INTEREST. LEGAL COUNSEL REVIEWS THESE DISCLOSURES AND REPORTS THE INFORMATION TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PAID TO THE CEO AND EXECUTIVE VICE PRESIDENTS IS APPROVED BY THE COMPENSATION COMMITTEE OF THE PARENT HOLDING COMPANY OF THE ORGANIZATION, WHICH ALSO SERVES AS THE COMPENSATION COMMITTEE FOR THE ORGANIZATION. THE COMPENSATION COMMITTEE APPROVES COMPENSATION FOR THE ENSUING YEAR AFTER REVIEWING COMPARABILITY DATA PRESENTED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT, AN ASSESSMENT OF EACH OFFICER'S PERFORMANCE OVER THE PRECEDING YEAR, AND THE ORGANIZATION'S PROGRAM ACCOMPLISHMENTS FOR THE PRIOR YEAR. COMPENSATION PAID TO DIRECTORS IS ALSO APPROVED BY THE COMPENSATION COMMITTEE AFTER REVIEWING COMPARABILITY DATA IN A BENCHMARKING STUDY PREPARED AND PRESENTED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT RETAINED BY THE BOARD OF DIRECTORS. THESE PROCESSES WERE FOLLOWED FOR 2019 COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION ANNUALLY INCLUDES MAJOR PORTIONS OF ITS FINANCIAL STATEMENT IN A PUBLISHED ANNUAL REPORT THAT IS MADE AVAILABLE TO PERSONS OR ENTITIES KNOWN TO HAVE AN INTEREST IN THE ORGANIZATION, AND IS AVAILABLE TO THE LARGER PUBLIC UPON REQUEST. STATUTORY FINANCIAL STATEMENTS FOR SUBSIDIARY COMPANIES ARE INCLUDED IN QUARTERLY AND ANNUAL RETURNS TO STATE DEPARTMENTS OF INSURANCE REGULATING THE ORGANIZATION WHICH RETURNS ARE AVAILABLE TO THE PUBLIC. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990, PART VII; SCHEDULE J; SCHEDULE R THE ORGANIZATION, REGULATED BY THE CALIFORNIA DEPARTMENT OF MANAGED HEALTH CARE, IS A MEMBER OF THE DELTA DENTAL OF CALIFORNIA ENTERPRISE COMPANIES, WHICH INCLUDE DELTA DENTAL OF CALIFORNIA, DELTA DENTAL OF PENNSYLVANIA AND AFFILIATED COMPANIES OPERATING IN 15 STATES, THE DISTRICT OF COLUMBIA, PUERTO RICO AND THE U.S. VIRGIN ISLANDS. THE ENTERPRISE COMPANIES COMPRISE ONE OF THE NATION'S LARGEST DENTAL BENEFITS DELIVERY SYSTEMS COVERING 36.1 MILLION ENROLLEES AND PROCESSING 40.8 MILLION CLAIMS. TOTAL REVENUE FOR THE ENTERPRISE IS APPROXIMATELY $8.9 BILLION IN 2019. THE ORGANIZATION REPRESENTS APPROXIMATELY 58% OF TOTAL ENTERPRISE REVENUES. FORM 990, PART XI, LINE 9: PENSION LIABILITY AND POST-RETIREMENT ADJUSTMENTS 12,930,938. NET LOSS FROM SUBSIDIARIES 400,112. 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