DELTA DENTAL PLAN OF WYOMING: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- DELTA DENTAL PLAN OF WYOMING (EIN 83-0209667)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-10-09
- IRS object ID
- 201832829349300248
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-10-09T17:56:15-05:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 830331229 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGEE HEARNE & PAIZ LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1088 | AddressLine1Txt |
| City | CHEYENNE | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82003 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 830209667 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA DENTAL PLAN OF WYOMING | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DELT | BusinessNameControlTxt |
| Phone | 3076323313 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6234 YELLOWSTONE RD | AddressLine1Txt |
| City | CHEYENNE | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82009 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KERRY HALL | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 3076323313 | PhoneNum |
| Signature | 2018-09-24 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMBER NUSE | PreparerPersonNm |
| PTIN | P01208432 | PTIN |
| Phone | 3076342151 | PhoneNum |
| Preparation | 2018-09-24 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 69.144.123.34 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-09-24 | IPDt |
| IP Tm | 15:44:07 | IPTm |
| IP Timezone | MD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 6C2FFC085B97510C19FB7E6EE6534D2EF22340D9 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2018-06-14 16:35:46Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA DENTAL OF WYOMING | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KERRY HALL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6234 YELLOWSTONE RD | AddressLine1Txt |
| City | CHEYENNE | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82009 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $40,129,790 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1968 | FormationYr |
| Legal Domicile State | WY | LegalDomicileStateCd |
| Activity Or Mission | DELTA DENTAL IS DEDICATED TO IMPROVING ORAL HEALTH THROUGH OUR DENTAL BENEFIT PROGRAMS, ADVOCACY AND COMMUNITY SUPPORT. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 19 | TotalEmployeeCnt |
| Total Volunteers | 7 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $35,681,770 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $37,973,146 | CYProgramServiceRevenueAmt |
| PY Investment Income | $418,028 | PYInvestmentIncomeAmt |
| CY Investment Income | $747,332 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $36,099,798 | PYTotalRevenueAmt |
| CY Total Revenue | $38,720,478 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $250,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $520,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,198,416 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,168,149 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $33,833,742 | PYOtherExpensesAmt |
| CY Other Expenses | $36,270,214 | CYOtherExpensesAmt |
| PY Total Expenses | $35,282,158 | PYTotalExpensesAmt |
| CY Total Expenses | $37,958,363 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $817,640 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $762,115 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,821,602 | TotalAssetsBOYAmt |
| Total Assets EOY | $17,605,625 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,169,864 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,765,679 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,651,738 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,839,946 | NetAssetsOrFundBalancesEOYAmt |
| Mission | DELTA DENTAL IS DEDICATED TO IMPROVING ORAL HEALTH THROUGH OUR DENTAL BENEFIT PROGRAMS, ADVOCACY AND COMMUNITY SUPPORT. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $36,570,954 | ExpenseAmt |
| Grant | $520,000 | GrantAmt |
| Revenue | $37,973,146 | RevenueAmt |
| Desc | PROVIDE PROCESSING OF DENTAL PLANS, PAYMENTS AND CLAIMS FOR PURCHASERS, SUBSCRIBERS AND PARTICIPATING DENTISTS WITH THE GOAL OF MAKING AFFORDABLE DENTAL CARE AVAILABLE TO ALL WYOMING CITIZENS. | Desc |
| Total Program Service Expenses | $36,570,954 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 1476 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 19 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KERRY HALL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3076323313 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6234 YELLOWSTONE RD | AddressLine1Txt |
| City | CHEYENNE | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82009 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| DR ROBERT TYRRELL | ||||||
| CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $5,563 | $0 | $0 |
| DR BRAD KINCHELOE | ||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $2,510 | $0 | $0 |
| BOB PALMER | ||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $2,410 | $0 | $0 |
| DR SCOTT HOUFEK | ||||||
| VICE CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $2,399 | $0 | $0 |
| RITA MEYER | ||||||
| DIRECTOR | 1.00 | Yes (X) | $2,510 | $0 | $0 | |
| JIM LINTON | ||||||
| DIRECTOR | 1.00 | Yes (X) | $2,288 | $0 | $1,440 | |
| JACKIE FREEZE | ||||||
| DIRECTOR | 1.00 | Yes (X) | $2,633 | $0 | $0 | |
| MARY BURMAN | ||||||
| DIRECTOR | 1.00 | Yes (X) | $840 | $0 | $0 | |
| ROD CHISHOLM | ||||||
| DIRECTOR | 1.00 | Yes (X) | $1,690 | $0 | $0 | |
| DR BRUCE HOLWELL | ||||||
| DIRECTOR | 1.00 | Yes (X) | $850 | $0 | $0 | |
| DR DAN MORRISON | ||||||
| DIRECTOR | 1.00 | Yes (X) | $880 | $0 | $0 | |
| DR RYNE PAULSON | ||||||
| DIRECTOR | 1.00 | Yes (X) | $890 | $0 | $0 | |
| DR AARON TAFF | ||||||
| DIRECTOR | 1.00 | Yes (X) | $940 | $0 | $0 | |
| PATRICIA GUZMAN | ||||||
| VICE PRESIDENT | 50.00 | Yes (X) | $137,434 | $0 | $39,516 | |
| KERRY HALL | ||||||
| PRESIDENT/CEO | 50.00 | Yes (X) | $244,492 | $0 | $127,094 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $408,329 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $168,050 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA DENTAL OF SOUTH DAKOTA | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 N EUCLID AVE | AddressLine1Txt |
| City | PIERRE | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57501 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | CLAIMS PROCESSING & SUPPLIES | ServicesDesc |
| Compensation | $652,729 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DENTAL PREMIUMS & ADMIN | Desc |
| Business | 524114 | BusinessCd |
| Total Revenue Column | $37,973,146 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $37,973,146 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $37,973,146 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $430,625 | TotalRevenueColumnAmt |
| Exclusion | $430,625 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,693,173 | SecuritiesAmt |
| Other | $32,846 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,369,897 | SecuritiesAmt |
| Other | $39,415 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $323,276 | SecuritiesAmt |
| Other | -$6,569 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $316,707 | TotalRevenueColumnAmt |
| Exclusion | $316,707 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $38,720,478 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $37,973,146 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $747,332 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $520,000 | TotalAmt |
| Program Services | $520,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $408,329 | TotalAmt |
| Program Services | $218,456 | ProgramServicesAmt |
| Management And General | $189,873 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $449,166 | TotalAmt |
| Program Services | $242,550 | ProgramServicesAmt |
| Management And General | $206,616 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,296 | TotalAmt |
| Program Services | $80,620 | ProgramServicesAmt |
| Management And General | $68,676 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,587 | TotalAmt |
| Program Services | $56,477 | ProgramServicesAmt |
| Management And General | $48,110 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,771 | TotalAmt |
| Program Services | $30,656 | ProgramServicesAmt |
| Management And General | $26,115 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,912 | TotalAmt |
| Program Services | $1,782 | ProgramServicesAmt |
| Management And General | $7,130 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,045 | TotalAmt |
| Program Services | $9,209 | ProgramServicesAmt |
| Management And General | $36,836 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,714 | TotalAmt |
| Management And General | $49,714 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,937 | TotalAmt |
| Program Services | $22,867 | ProgramServicesAmt |
| Management And General | $160,070 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,130 | TotalAmt |
| Program Services | $62,543 | ProgramServicesAmt |
| Management And General | $56,587 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,398 | TotalAmt |
| Program Services | $25,677 | ProgramServicesAmt |
| Management And General | $43,721 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,066 | TotalAmt |
| Program Services | $14,554 | ProgramServicesAmt |
| Management And General | $36,512 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,857 | TotalAmt |
| Program Services | $18,199 | ProgramServicesAmt |
| Management And General | $45,658 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,830 | TotalAmt |
| Program Services | $11,936 | ProgramServicesAmt |
| Management And General | $19,894 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,936 | TotalAmt |
| Program Services | $7,101 | ProgramServicesAmt |
| Management And General | $11,835 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DENTAL CLAIMS PAID | $33,973,757 | $33,973,757 | |
| COMMISSIONS | $541,316 | $541,316 | |
| COMPUTER - CLAIMS | $450,923 | $408,085 | $42,838 |
| DUES | $228,529 | $79,985 | $148,544 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $433,864 | TotalAmt |
| Program Services | $245,184 | ProgramServicesAmt |
| Management And General | $188,680 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,958,363 | TotalAmt |
| Program Services | $36,570,954 | ProgramServicesAmt |
| Management And General | $1,387,409 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,107,308 | BOYAmt |
| EOY | $2,080,898 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $809,188 | BOYAmt |
| EOY | $1,074,740 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,902,474 | BOYAmt |
| EOY | $2,935,183 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,223 | BOYAmt |
| EOY | $43,865 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $260,031 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $182,247 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,892 | BOYAmt |
| EOY | $77,784 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,072,054 | BOYAmt |
| EOY | $9,440,463 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,831,002 | BOYAmt |
| EOY | $1,919,189 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,461 | BOYAmt |
| EOY | $33,503 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,821,602 | BOYAmt |
| EOY | $17,605,625 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,808,357 | BOYAmt |
| EOY | $2,446,278 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $353,596 | BOYAmt |
| EOY | $370,556 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,007,911 | BOYAmt |
| EOY | $1,948,845 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,169,864 | BOYAmt |
| EOY | $4,765,679 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,651,738 | BOYAmt |
| EOY | $12,839,946 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,651,738 | BOYAmt |
| EOY | $12,839,946 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,821,602 | BOYAmt |
| EOY | $17,605,625 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $762,115 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $426,093 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,000 | OtherCostOrOtherBasisAmt |
| Book Value | $10,000 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $59,168 | OtherCostOrOtherBasisAmt |
| Depreciation | $53,508 | DepreciationAmt |
| Book Value | $5,660 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $116,754 | OtherCostOrOtherBasisAmt |
| Depreciation | $66,573 | DepreciationAmt |
| Book Value | $50,181 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $74,109 | OtherCostOrOtherBasisAmt |
| Depreciation | $62,166 | DepreciationAmt |
| Book Value | $11,943 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $77,784 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| INVESTMENT IN LIFE INSURANCE CONTRACT | $1,819,053 | F |
| CERTIFICATE OF DEPOSIT | $100,136 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $1,919,189 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED COMPENSATION PAYABLE | $928,102 |
| MEMBER REPURCHASE PLAN PAYABLE | $1,020,743 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,948,845 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $37,973,145 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $37,973,145 | RevenueSubtotalAmt |
| Other Revenues Not Included | $747,333 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $747,333 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $38,720,478 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $37,886,340 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $37,886,340 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $72,023 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $72,023 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $37,958,363 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | MANAGEMENT EVALUATED THE COMPANY'S TAX POSITIONS AND CONCLUDED THAT THE COMPANY HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS. WITH FEW EXCEPTIONS, THE COMPANY IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL TAX AUTHORITIES EXCEPT FOR THE LAST THREE YEARS FILED. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | INVESTMENT INCOME 430,626. GAIN ON SALE OF INVESTMENTS 323,276. LOSS ON SALE OF EQUIPMENT -6,569. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | NET AMORTIZATION OF PREMIUMS AND DISCOUNTS 28,879. INVESTMENT MANAGEMENT FEES 49,713. LOSS ON SALE OF EQUIPMENT -6,569. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WYOMING DELTA DENTAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6234 YELLOWSTONE ROAD | AddressLine1Txt |
| City | CHEYENNE | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82009 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 300799719 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $520,000 | CashGrantAmt |
| Valuation Method Used | CASH | ValuationMethodUsedDesc |
| Purpose Of Grant | GENERAL | PurposeOfGrantTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PATRICIA GUZMAN | ||||||||||||||
| VICE PRESIDENT | $122,810 | $0 | $13,000 | $0 | $1,624 | $0 | $13,472 | $0 | $26,044 | $0 | $176,950 | $0 | $0 | $0 |
| KERRY HALL | ||||||||||||||
| PRESIDENT/CEO | $221,144 | $0 | $20,000 | $0 | $3,348 | $0 | $96,644 | $0 | $30,450 | $0 | $371,586 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | DELTA DENTAL OF WYOMING HAS ADOPTED A COMPENSATION POLICY PURSUANT TO WHICH IT FOLLOWS THE PROCESS OUTLINED IN TREASURY REGULATION SECTION 53.4958-6 TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS AS TO THE COMPENSATION OF ITS CEO. THIS PROCESS INCLUDES REVIEW AND APPROVAL OF THE COMPENSATION ARRANGEMENT BY A COMPENSATION COMMITTEE COMPOSED ENTIRELY OF PERSONS WITH NO CONFLICT OF INTEREST (AS DEFINED IN REGULATIONS SECTION 53-4958-6(C)(1)(III)), RELIANCE ON COMPARABILITY DATA COMPILED BY AN INDEPENDENT COMPENSATION CONSULTANT AND CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT. THIS PROCESS IS UNDERTAKEN ANNUALLY WITH RESPECT TO THE CEO AND ALL OTHER DISQUALIFIED PERSONS. IT WAS CONDUCTED ON MAY 5, 2017. DELTA DENTAL PAID COUNTRY CLUB DUES FOR KERRY HALL. THIS IS INCLUDED AS PART OF EMPLOYMENT CONTRACT AND WAS INCLUDED IN W-2 WAGES. |
| PART I, LINE 4B | KERRY HALL PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN ACCRUING $74,389 IN 2017. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| DR DANIEL MORRISON | |||
| BOARD MEMBER | $370,609 | DENTIST WHO PARTICIPATES IN THE ORGANIZATION'S PROVIDER NETWORK AND RECEIVES REIMBURSEMENT FOR PATIENT CLAIMS FROM THE ORGANIZATION. | 0 |
| DR AARON TAFF | |||
| BOARD MEMBER | $127,916 | DENTIST WHO PARTICIPATES IN THE ORGANIZATION'S PROVIDER NETWORK AND RECEIVES REIMBURSEMENT FOR PATIENT CLAIMS FROM THE ORGANIZATION. | 0 |
| DR BRAD KINCHELOE | |||
| BOARD MEMBER | $522,160 | DENTIST WHO PARTICIPATES IN THE ORGANIZATION'S PROVIDER NETWORK AND RECEIVES REIMBURSEMENT FOR PATIENT CLAIMS FROM THE ORGANIZATION | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERS ARE COMPRISED OF DENTISTS WHO HAVE CONTRACTS WITH DELTA DENTAL OF WYOMING. |
| FORM 990, PART VI, SECTION A, LINE 7A | STATE IS DIVIDED INTO SIX REGIONS WHERE DENTISTS ELECT PARTICIPATING MEMBERS TO THE GOVERNING BODY. SEVEN AT LARGE DIRECTORS (TWO MEMBERS AND FIVE AT LARGE INDIVIDUALS) ARE ALSO ELECTED BY THE MEMBERSHIP. |
| FORM 990, PART VI, SECTION A, LINE 7B | AMENDMENTS TO THE ORGANIZATION'S ARTICLES OF INCORPORATION AND BYLAWS MAY BE INITIATED BY THE BOARD OF DIRECTORS BUT REQUIRE APPROVAL OF THE MEMBERS TO BE EFFECTIVE. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION FOLLOWS A POLICY THAT IS DESIGNED TO ENSURE APPROPRIATE OVERSIGHT AND REVIEW OF THE FORM 990. AN INTERNAL WORKING GROUP INCLUDING THE ORGANIZATION'S CEO, DIRECTOR OF ACCOUNTING, OUTSIDE TAX PREPARER, LEGAL COUNSEL AND OTHERS HELP COMPILE AN INITIAL DRAFT OF FORM 990. ONCE A COMPLETE DRAFT IS DEVELOPED AND REVIEWED BY THE WORKING GROUP, THE DRAFT (WITH ALL ATTACHMENTS) IS SUBMITTED TO THE ORGANIZATION'S BOARD OF DIRECTORS FOR REVIEW AND QUESTIONS. THE BOARD COMPLETED ITS REVIEW AT THE OCTOBER 2018 BOARD MEETING, PRIOR TO THE FILING OF FORM 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION'S WRITTEN CONFLICT OF INTEREST POLICY COVERS ANY DIRECTOR OR OFFICER. IT REQUIRES DISCLOSURE OF ALL MATERIAL FACTS REGARDING ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST ON AN ONGOING BASIS. THE BOARD DETERMINES, BY A MAJORITY OF ITS DISINTERESTED BOARD MEMBERS, WHETHER A CONFLICT OF INTEREST EXISTS. THE BOARD DETERMINES, BY A MAJORITY OF ITS DISINTERESTED PARTIES, WHETHER THE ORGANIZATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION UNDER THE CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT AND, IF NOT, WHETHER IT IS IN THE ORGANIZATION'S BEST INTERESTS TO GO FORWARD WITH THE TRANSACTION. EACH PERSON SUBJECT TO THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM AND HAS A CONTINUING DUTY TO UPDATE SUCH STATEMENT. CONFLICT OF INTEREST DISCLOSURE FORMS ARE REVIEWED ANNUALLY. |
| FORM 990, PART VI, SECTION B, LINE 15A | DELTA DENTAL OF WYOMING HAS ADOPTED A COMPENSATION POLICY PURSUANT TO WHICH IT FOLLOWS THE PROCESS OUTLINED IN TREASURY REGULATION SECTION 53.4958-6 TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS AS TO THE COMPENSATION OF ITS CEO. THIS PROCESS INCLUDES REVIEW AND APPROVAL OF THE COMPENSATION ARRANGEMENT BY A COMPENSATION COMMITTEE COMPOSED ENTIRELY OF PERSONS WITH NO CONFLICT OF INTEREST (AS DEFINED IN REGULATIONS SECTION 53-4958-6(C)(1)(III)), RELIANCE ON COMPARABILITY DATA COMPILED BY AN INDEPENDENT COMPENSATION CONSULTANT AND CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT. THIS PROCESS IS UNDERTAKEN ANNUALLY WITH RESPECT TO THE CEO AND ALL OTHER DISQUALIFIED PERSONS. IT WAS CONDUCTED ON MAY 5, 2017. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FINANCIAL STATEMENTS ARE PROVIDED ANNUALLY TO ALL PARTICIPATING MEMBERS. |
| PART XII, LINE 2C: | DELTA DENTAL HAS A COMMITTEE THAT OVERSEES THE AUDIT |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WYOMING DELTA DENTAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6234 YELLOWSTONE ROAD | AddressLine1Txt |
| City | CHEYENNE | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82009 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 300799719 | EIN |
| Primary Activities | PUBLIC CHARITY | PrimaryActivitiesTxt |
| Legal Domicile State | WY | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WYOMING DELTA DENTAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | B | TransactionTypeTxt |
| Involved | $520,000 | InvolvedAmt |
| Method Of Amount Determination | CASH | MethodOfAmountDeterminationTxt |
Comments