2019-11-01T07:09:28-05:00 2018-12-31 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2018-01-01 480793267 Delta Dental of Kansas Inc DELT 3162641099 1619 N Waterfront Parkway Wichita KS 67206 Michael Ellis Executive VP & CFO 3162641099 2019-10-31 1 Deb Nelson CPA P01264758 7012398500 2019-10-31 216.147.181.45 2019-10-31 13:34:28 CD P 66CC91E6B7F11C4783FFFA5645E675327CB67316 66CC91E6B7F11C4783FFFA5645E675327CB67316 2018 2020-01-14 16:20:31Z Michael Ellis 1619 N Waterfront Parkway Wichita KS 67206 323866167 0 X www.deltadentalks.com X 1972 KS To make possible and facilitate a wider and more timely availability of oral health care. 10 7 141 0 0 0 0 0 303515482 309887359 1819880 2288188 0 0 305335362 312175547 1221911 1875818 0 0 11576495 11200675 0 0 0 287487812 290647135 300286218 303723628 5049144 8451919 74038776 80062941 7778216 8814841 66260560 71248100 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 276297045 299250807 Dental benefits (covered charges) provided to subscribers. Delta Dental served approximately 918,547 people this year. 9903815 10636552 The processing of dental benefit claims. 1875818 1875818 Grants paid out to 501(c)(3) organizations. 288076678 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 28830 0 1 141 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 Michael Ellis 3162641099 1619 N Waterfront Parkway Wichita KS 67206 Dr Alan Marcotte Chairperson 1.90 0.20 X X 22219 0 0 Gary Yager Vice Chair 1.50 0.00 X X 12093 0 0 Shawn Naccarato Director (Jun-Dec) 0.80 0.00 X 5530 0 0 Dr Patrick Moriarty Director 1.20 0.00 X 10908 0 0 Ruth Teichman Director 1.40 0.00 X 11590 0 0 Dr Brick Scheer Director 1.70 0.00 X 11353 0 0 Angela McClure Director 1.50 0.00 X 11408 0 0 Nancy Zogleman Director 1.60 0.00 X 10826 0 0 Dr Lucynda Raben Director 1.80 0.00 X 13928 0 0 Kimberly Borchers Director 1.30 0.00 X 10856 0 0 Mark Philips Director (Jan-May) 0.60 0.10 X 5861 0 0 Michael Herbert President and CEO 34.30 5.70 X 451973 0 63469 Michael Ellis Executive VP/CFO/Treasurer 37.80 2.20 X 301809 0 55236 Nancy Umholtz Secretary 39.20 0.80 X 110536 0 20962 Dean Newton - Managing Director & Executive 35.60 4.40 X 295546 0 62737 James Tuttle Chief Operating Officer 35.00 5.00 X 246546 0 15521 Bryce Dougherty Controller 38.10 1.90 X 183409 0 37791 Robert Ebenkamp VP Information Technology 39.80 0.30 X 211562 0 33412 Kara Hunt VP Human Resources 39.90 0.10 X 174511 0 28442 Junetta Everett VP Professional Relations 40.00 0.00 X 206522 0 37814 Natalie Daney VP Client Service 39.60 0.40 X 167650 0 24873 2476636 0 380257 22 0 1 0 Jenkins & Leblanc PA 6810 Silverheel St Shawnee KS 66226 Dental Services 1942406 Wichita Family Dental Partnership 9339 E 21ST ST N Wichita KS 67206 Dental Services 1487632 Gage Center Dental Group PA 1271 SW Woodhull St Topeka KS 66604 Dental Services 1431986 Wichita Endodontics LLC 3535 E Central Ave Wichita KS 67208 Dental Services 1390571 Martin and Frankenberry DDS PA 3101 N Cypress St Wichita KS 67226 Dental Services 1375601 539 Dental Services 524298 309873143 309873143 14216 14216 309887359 1367007 1367007 12611801 11690620 921181 921181 921181 312175547 309887359 0 2288188 1875818 1875818 1754102 244070 1510032 7032808 3233699 3799109 994970 536355 458615 818231 306199 512032 600564 269663 330901 54406 54406 95800 95800 49147 49147 183576 183576 5093824 129136 4964688 924941 924941 1626527 1413360 213167 169267 152296 16971 273360 273360 460760 16379 444381 101068 22844 78224 447568 214833 232735 137161 137161 Claims 276746797 276746797 State Premium Taxes 1277167 1277167 Clearing House Expense 432968 408674 24294 Equipment Rental and Ma 312345 312345 2260453 917043 1343410 303723628 288076678 15646950 0 800 800 5833195 6775428 5380630 6196731 331911 376731 12659868 5420598 7362722 7239270 45434046 48226253 9239675 10574842 455797 672886 74038776 80062941 7057109 8177318 721107 637523 7778216 8814841 X 66260560 71248100 66260560 71248100 74038776 80062941 X 8451919 -2891511 -572868 X 0 1 X 1 0 1401415 1401415 7332320 2294948 5037372 163400 7626 155774 3762733 3118024 644709 7239270 Inv in Surency Life & Health 10574842 F 10574842 Unearned Premiums 637523 637523 X 308760211 -2891511 -340249 -3231760 311991971 183576 183576 312175547 303772616 0 303772616 183576 -232564 -48988 303723628 Part X, Line 2: Delta Dental of Kansas, Inc. is tax exempt under Section 50l(c)(4) of the Internal Revenue Code and a similar provision of state law. 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, 2018 and 2017, the unrecognized tax benefits accrual was zero. The Company will recognize future accrued interest and penalities related to unrecognized tax benefits in income tax expense if incurred. Part XI, Line 2d - Other Adjustments: Reclass Expense Reimbursement to Expenses on Form 990 232,564. Earnings of C Corp -572,813. Part XII, Line 4b - Other Adjustments: Reclass Expense Reimbursement to Expenses on Form 990 -232,564. 1 University of Kansas 1651 Naismith Drive Lawrence KS 66045 481124839 State of Kansas 25000 Williams Fund Donation Wichita Center for Arts 1307 N Rock Road Wichita KS 67206 480616251 501(c)(3) 25000 Year 3 of 3 Year Commitment of $75,000 Wichita Metro Chamber of Commerce 350 W Douglas Ave Wichita KS 67202 480477290 Sedgwick County 11852 Centennial - $4,000; Ambassador - $1,000; YP - $1,600; Community Advancement - $3,600; Membership - $1,652 Kansas Insurance Educational Foundation 815 SW Topeka Boulevard Topeka KS 66612 480925186 501(c)(3) 10000 Year 3 of 4 Year Commitment of $40,000 United Way of KC 801 W 47th St Suite 500 Kansas City MO 64112 440545812 501(c)(3) 43500 Yearly Support - $10,000; Community Liasion Program - $8,500; Centennial Celebration - $25,000 Juvenile Diabetes Research Foundation (JDRF) 215 W Pershing Road Suite 300 Kansas City MO 64108 231907729 501(c)(3) 25000 Yearly Support March of Dimes KC 4400 College Boulevard Overland Park KS 66211 131846366 501(c)(3) 10000 Yearly Support Rose Brooks PO Box 320599 Kansas City MO 64132 510231573 501(c)(3) 10000 Yearly Support KC Urban Neighborhood Initiative 2700 E 18th Street Suite 261 Kansas City MO 64127 454879810 501(c)(3) 10000 Yearly Support Boys and Girls Club of South Central Kansas 2400 N Oppurtunity Drive Wichita KS 67219 481071303 501(c)(3) 7500 2018 Gift Rise Up for Youth PO Box 1256 Wichita KS 67201 471381305 501(c)(3) 25000 2018 Gift YMCA 402 N Market Wichita KS 67202 237128129 501(c)(3) 75000 Healthy Eating Program Greater Wichita Partnership 501 E Douglas Wichita KS 67202 474134110 501(c)(3) 10000 Year 1 of 4 Year Commitment of $40,000 United Way of of the Plains 245 N Water St Wichita KS 67202 480547688 501(c)(3) 243597 Yearly Support - $25,000; Loaned Executive Program - $8,500; Dental Treatment - $590,000 Ronald McDonald House Charities - Wichita 1110 N Emporia Wichita KS 67214 480918101 501(c)(3) 15000 Capital Campaign - $10,000; Golf Tournament - $5,000 American Heart Association - Kansas 1861 N Rock Road Suite 380 Wichita KS 67206 135613797 501(c)(3) 35000 Rethink Your Drink - $25,000; Heart Walk -$10,000 Botanica 701 Amidon St Wichita KS 67203 481007736 501(c)(3) 25000 Carousel - 2nd year of 2 year Commitment $30,000; Illuminations - $10,000 Youth Entrepreneurs 4111 E 37th St N d101 Wichita KS 67220 481187886 501(c)(3) 15000 Biz Bang Event Sponsor Air Capital Classic 9727 Shannon Woods 100 Wichita KS 67226 462001743 Sedgwick County 15000 Ambassador Sponsor Big Brothers Big Sisters of Greater Kansas City 1709 Walnut St Kansas City MO 64108 436068464 501(c)(3) 17000 Golf Tournment - $12,000; Rise! A Rooftop Crawl - $5,000 Sedgwick County Zoo 5555 W Zoo Boulevard Wichita KS 67212 486120530 Sedgwick County 8040 Zoobilee - $7,500; Extra Tickets - $540 Wichita Business Journal 121 N Mead Suite 100 Wichita KS 67202 593089188 Sedgwick County 5192 Best in Business Exploration Place 300 N McLean Boulevard Wichita KS 67203 481000295 501(c)(3) 24330 Your Big Mouth: Oral Health Education Programs for Rural Kansas Preschools Heartspring 8700 E 29th St N Wichita KS 67226 481232409 501(c)(3) 70172 Capital Campaign - $15,000; Healthy Smiles for Children with Special Needs Program - $55,172 Oral Health Kansas 800 SW Jackson St Suite 1120 Topeka KS 66612 200337278 501(c)(3) 20000 2018 Oral Health Kansas Conference; 2019 Oral Health Kansas Conference Kansas Food Bank 1919 E Douglas Ave Wichita KS 67211 480959213 501(c)(3) 550000 Matching Program (Backpacks for Kids Summer)- $50,000; Healthy Foods Program - $500,000 KanSmile Foundation 1861 N Webb Road Wichita KS 67206 384047498 501(c)(3) 5900 Naso-Alveolar Molding Training Special Olympics Kansas 5280 Foxridge Drive Mission KS 66202 480890981 501(c)(3) 15000 Athlete Dental Outreach Wichita State University 1845 Fairmount St Wichita KS 67260 481124839 501(c)(3) 50000 Dental Hygiene Program Scholarships Flint Hills Technical College 3301 W 18th Ave Emporia KS 66801 481156696 501(c)(3) 25000 Dental Hygiene Program Scholarships Manhattan Area Technical College 3136 Dickens Ave Manhattan KS 66503 342064656 501(c)(3) 25000 Dental Hygiene Program Scholarships TeamSmile 2000 Swift St Kansas City MO 64116 753250075 501(c)(3) 32500 Dental Treatment Head and Neck Cancer Living Foundation 6240 W 135th St Suite 200 Overland Park KS 66223 464214254 501(c)(3) 64331 Dental Treatment - Committed $250,000 Children's Mercy 2401 Gilham Road Kansas City MO 64108 431564302 501(c)(3) 55000 Dental Treatment - $50,000; Red Hot Night - $5,000 Genesis Family Health 310 E Walnut St Ste LL5 Garden City KS 67846 481049519 501(c)(3) 5162 Supplies for 10,080 toothbrush kits Sedgwick County Health Department 1900 E 9th St Wichita KS 67214 486000798 Sedgwick County 6177 Supplies for 10,080 toothbrush kits First United Methodist Church-Wesley House 411 E 12th Pittsburg KS 66762 480559096 501(c)(3) 6263 Supplies for 10,080 toothbrush kits Johnson County Christmas Bureau 9503 Johnson Drive Merriam KS 66203 480884400 501(c)(3) 7200 Supplies for 12,000 toothbrush kits 38 0 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 295236 0 140381 0 16356 0 49737 0 20573 0 522283 0 0 0 Michael Ellis Executive VP/CFO/Treasurer 239162 0 61009 0 1638 0 41887 0 14441 0 358137 0 0 0 Dean Newton - Managing Director & Executive 204481 0 81215 0 9850 0 49005 0 15100 0 359651 0 0 0 James Tuttle Chief Operating Officer 188907 0 56522 0 1117 0 5804 0 11054 0 263404 0 0 0 Bryce Dougherty Controller 151591 0 31548 0 270 0 24059 0 14394 0 221862 0 0 0 Robert Ebenkamp VP Information Technology 173531 0 36535 0 1496 0 28332 0 7010 0 246904 0 0 0 Kara Hunt VP Human Resources 144362 0 29628 0 521 0 22289 0 6934 0 203734 0 0 0 Junetta Everett VP Professional Relations 167908 0 36247 0 2367 0 28097 0 12412 0 247031 0 0 0 Natalie Daney VP Client Service 118227 0 49086 0 337 0 23236 0 2355 0 193241 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 (revenues, administration costs, income from operations, etc). Patrick O Moriarty DDS Chartered Board Member Dr. Moriarty > 35% owner 204255 Payment of Dental Services 0 Raben DDS PA Board Member Dr. Raben > 35% owner 136950 Payment of Dental Services 0 Northrock Dental PA Board Member Dr. Scheer > 35% owner 113834 Payment of Dental Services 0 Form 990, Part VI, Section A, line 2 Nancy Zogelman, Nancy Umholtz, Michael Herbert, Michael Ellis, Dean Newton, Dr. Alan Marcotte, and Mark Phillips 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: Earnings from C Corp Subsidiary -572,813. Other changes in net assets due to rounding -55. Surency Life & Health Company 1619 N Waterfront Pkwy Wichita KS 67206 261969006 Insurance KS DDKS C -314999 12808390 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 864150 cost Surency Life & Health Insurance Company N 232564 cost