2017-08-09T16:46:59-05:00 2016-12-31 KPMG LLP 1918 Eighth Avenue Suite 2900 Seattle WA 98101 990 2016-01-01 910621480 Delta Dental of Washington % BRADLEY BERG DELT 2065221300 400 Fairview Ave N Suite 800 Seattle WA 98109 BRADLEY A BERG CFO & COO 2065521300 2017-07-21 true SUE ROBISON P00560072 2069134000 2017-07-20 167.68.102.5 91023620172215000001 2017-08-09 P 3AC9F63EF25020CF8126B786BC09F228788F687D 3AC9F63EF25020CF8126B786BC09F228788F687D 2016 2021-01-29 14:40:06Z X BRADLEY A BERG 400 Fairview Ave N Suite 800 Seattle WA 98109 1283378216 false X www.deltadentalwa.com X 1954 WA SEE SCHEDULE O 11 6 431 69 0 121448 15231 1140842247 1214541837 5698486 21033745 882837 579853 1147545018 1236170666 6123545 2091085 1033807840 1095470209 43531908 47849193 0 0 0 52975817 60636802 1136439110 1206047289 11105908 30123377 233609242 248365385 59767140 55420460 173842102 192944925 X SEE SCHEDULE O false true 1134360963 1214441463 See Schedule O 2821958 See Schedule O 1830880 1830880 See Schedule O 753329 260205 100374 SMILEMOBILE REVENUE 753329 260205 100374 1139767130 false false true false false false false false false true false false false false false false true false false false false false false false false false true false true false false false false false false false false false false false false true true true true false true 52338 0 true 431 true false false false false false false X 11 6 false false false false true true true true true false false true true true true true true true true true true WA X BRADLEY BERG 2065221300 400 FAIRVIEW AVE N SUITE 800 SEATTLE WA 98109 X BECK G DOUGLAS CHAIR 11.0 4.0 X X 154573 0 0 BROWN COLLEEN B DIRECTOR 4.0 3.0 X 129193 0 0 DWYER JAMES D PRESIDENT & CEO 36.0 4.0 X X 2088436 0 142140 FARRELL ANNE V DIRECTOR 8.0 3.0 X 108885 0 0 HARWELL JANIS L SECRETARY 8.0 3.0 X X 118049 0 0 LABBERTON WELLS K DIRECTOR 9.0 4.0 X 344598 0 0 LOHKAMP JOANNA L DIRECTOR 8.0 3.0 X 118131 0 0 PHIPPS GERALD S VICE CHAIR 12.0 5.0 X X 152042 0 0 RUTHERFORD EVE M DIRECTOR 7.0 3.0 X 595966 0 0 SEELY JEFFREY T DIRECTOR 12.0 5.0 X 129207 0 0 TUNE JAMES F TREASURER 6.0 3.0 X X 125129 0 0 BERG BRADLEY COO & CFO 36.0 4.0 X 724661 0 130469 ALIABADI KAREN CHIEF HR STRATEGIST 40.0 0.0 X 443603 0 95327 BURSETT JOHN SR VP, UNDERWRITING/ACTUARIAL 32.0 0.0 X 246321 0 41821 GATES THOMAS VP, PLANNING & CORP DEVEL 40.0 0.0 X 679702 0 107737 LO ERIC VP, ACTUARIAL & UNDERWRITING 40.0 0.0 X 390474 0 55285 LOWRY-OAKES DIANE PRESIDENT & CEO FOUNDATION 40.0 0.0 X 223259 0 93330 MERLO KRISTIN CHIEF MKTG, INFO & SALES OFF 40.0 0.0 X 715785 0 51116 SNYDER CINDY VP, INNOVATIVE SERVICES 40.0 0.0 X 339523 0 128115 CURHAN SUSAN DIRECTOR, MKTG & PRODUCT MGMT 40.0 0.0 X 269979 0 15819 DOSCH KYLE DENTAL DIRECTOR 40.0 0.0 X 223037 0 24610 JAHRMAN CHRISTOPHER DIRECTOR, OPS & PATIENT EXPERI 40.0 0.0 X 223246 0 30225 LAY LINDA DIRECTOR, SALES ACCT. MGMT 40.0 0.0 X 320815 0 24263 SCHOBER DEBRA SENIOR SALES EXECUTIVE 40.0 0.0 X 424301 0 28609 9288915 0 968866 111 false true false DECARE SYSTEMS UNIT 1 CURRAHEEN ROAD CORK 0 EI SOFTWARE DEVELOPMENT 5600620 CHANGE HEALTHCARE OPERATIONS LLC PO BOX 572490 MURRAY UT 84157 PRINTING/MAILING 3607294 ENCARA INC 4818 STARKEY ROAD SW ROANOKE VA 24018 INDIVIDUAL PLAN TPA 2870782 TIG PO BOX 85244 SAN DIEGO CA 92186 COMPUTER VENDOR 2638576 WEST MONROE PARTNERS LLC 222 WEST ADAMS ST FL 11 CHICAGO IL 60606 CONSULTING 1759117 88 3150 12081 15231 PROGRAM REVENUE 524114 1214441463 1214441463 SMILEMOBILE (MOBILE DENTIST OFFICE) 621990 100374 100374 1214541837 4967668 4967668 165184 165184 0 505596 505596 0 505596 505596 47788880 15319563 47207550 581330 15319563 15900893 15900893 0 0 0 0 0 0 0 0 0 OTHER INCOME 900099 74257 74257 74257 1236170666 1214616094 21539341 2086085 2086085 5000 5000 0 1095470209 1095470209 8674992 3281652 5393340 0 27747667 10116730 17630937 1759741 525963 1233778 7031735 2455688 4576047 2635058 977555 1657503 0 394471 50629 343842 293159 293159 72401 72401 0 400027 400027 6727027 3303322 3423705 4995487 2821957 2173530 6007575 3380520 2627055 5523349 34878 5488471 0 2089158 890171 1198987 1642916 492239 1150677 0 968748 122385 846363 0 0 5361440 106833 5254607 335447 335447 COMMISSIONS 12089192 12089192 TAXES & SERVICE CHARGES 11988722 1394116 10594606 RESEARCH & DEVELOPMENT 187990 187990 DUES & SUBSCRIPTIONS 986131 56316 929815 573562 33289 540273 1206047289 1139767130 66280159 0 215485 23377578 2627084 2847707 0 0 28082760 20123062 0 0 0 0 0 0 0 0 3916372 5751003 59959780 41458332 19693702 18501448 176925744 175274728 1263358 1633128 0 0 0 0 884737 856731 233609242 248365385 52572751 50283870 125000 77500 7069389 5059090 0 0 0 0 0 0 0 0 0 0 0 0 59767140 55420460 X 173842102 192944925 0 0 0 0 173842102 192944925 233609242 248365385 X 30123377 4579446 -15600000 X false true X true false 137200 137200 137200 true FRIENDS OF ANDREW BARKIS PO BOX 8728 LACEY WA 98509 811755579 1000 ANNETTE CLEVELAND FOR STATE SENATE 6400 NE HIGHWAY 99 VANCOUVER WA 98665 454514627 2000 COMMITTEE TO ELECT BARBARA BAILEY PO BOX 374 OAK HARBOR WA 98277 020556800 1050 FRIENDS TO ELECT RANDI BECKER PO BOX 83 GRAHAM WA 98338 770708976 1050 FRIENDS OF BETH BETH DOGLIO PO BOX 222 OLYMPIA WA 98507 475314796 500 FRIENDS OF ANDY BILLIG PO BOX 145 SPOKANE WA 99210 271127517 1050 Form Sch C Part I-A Line 1 DDWA PROVIDES DIRECT CAMPAIGN CONTRIBUTIONS TO CANDIDATES FOR WASHINGTON STATE ELECTED EXECUTIVE OFFICE, LEGISLATIVE OFFICE, AND POLITICAL ORGANIZATIONS IN ORDER TO PROMOTE AN ENVIRONMENT FOR IMPROVED ORAL HEALTH AND OVERALL HEALTH CARE POLICY, AS WELL AS TO SUPPORT OUR OVERALL MISSION OF IMPROVING ORAL HEALTH IN OUR STATE. DDWA ALSO PROVIDES LIMITED, DIRECT SUPPORT FOR LOCAL LEVEL CANDIDATES OR INITIATIVES THAT PROMOTE A POSITIVE BUSINESS CLIMATE IN WASHINGTON STATE. ALL CONTRIBUTIONS ARE CONDUCTED IN ACCORDANCE WITH FEDERAL AND STATE LAWS AND REPORTING REQUIREMENTS. 0 0 0 0 0 499043 388269 110774 9856153 8300858 1555295 49604584 32769205 16835379 18501448 true Choice Regional Health Network 1217 4th Ave E Ste 200 Olympia WA 98506 911704039 501(C)(3) 15000 Prenatal Pilot South Park Senior Citizens 8201 10th Ave S STE 4 Seattle WA 98108 911317638 501(C)(3) 10000 Dental hygiene grant Volunteers in Medicine of the Olympics PO Box 639 Port Angeles WA 98362 010590704 501(C)(3) 282635 Fund equipment for non-profit clinic Washington Association of Community Migrant Health 2120 State Avenue NE Suite 220 Olympia WA 98506 911323282 501(C)(3) 53764 Community Health Center Learning Session Washington State Department of Health PO Box 47880 Olympia WA 98507 911444603 WA DOH 16595 Water engineer grants Washington Early Learning Fund 1111 3rd Avenue STE 210 Seattle WA 98101 204829769 501(C)(3) 65000 State Home Visiting Match Fund to expand Health Point 955 Powell Ave SW Renton WA 98057 910884412 501(C)(3) 225000 Expansion of Dental Clinic Charitable Partnership Fund PO Box 13276 Portland OR 97213 931267966 501(C)(3) 13125 New dental clinic in Tukwila Puyallup Tribal Health Authority 2209 E 32nd ST Tacoma WA 98404 911116355 501(C)(3) 225000 Expansion of Dental Clinic Better Health Together 1023 W Riverside STE 101 Spokane WA 99201 900997482 501(C)(3) 35000 Accountable Community Health Partnership American Academy of Pediatrics 141 Northwest Point Boule Elk Grove IL 60007 362275597 501(C)(3) 50000 National Fluoridation Campaign Swinomish Indian Tribal Community 11404 Moorage Way La Conner WA 98257 910434170 501(C)(3) 385000 Expansion of Tribal Clinic The Point Gamble S'Klallam Tribe 31912 Little Boston Rd NE Kingston WA 98346 910875163 501(C)(3) 62500 Expansion of Tribal Clinic Country Doctor Community Clinic 500 19th Avenue E Seattle WA 98112 237100868 501(C)(3) 300000 New Dental Clinic Peninsula Community Health Services PO Box 960 Bremerton WA 98337 943079770 501(C)(3) 180000 New Dental Clinic in Belfair Project Access Northwest 1111 Harvard Ave Seattle WA 98122 204377921 501(C)(3) 15000 King County Dental Care Coordination Northwest Regional Primary Care Association 200 W Thomas St STE 330 Seattle WA 98119 911252785 501(C)(3) 10500 NACHC Oral Health Sealant Collaborative 17 Form Sch I Part I Line 2 THE GRANTEE IS REQUIRED TO SIGN A GRANT AGREEMENT STATING THAT THEY WILL USE THE FUNDS ONLY FOR PURPOSES OUTLINED IN THE GRANT AGREEMENT AND APPLICATION. THE GRANTEE IS REQUIRED TO FILE REPORTS ON REGULAR INTERVALS OUTLINING THE USE OF FUNDS. GRANTEE IS ALSO REQUIRED TO RETURN UNUSED FUNDING IF APPLICABLE. X X X X true true X X X X true true false false false false false false false BECK G DOUGLAS CHAIR 154573 154573 DWYER JAMES D PRESIDENT & CEO 794462 1280000 13974 118000 24140 2230576 LABBERTON WELLS K DIRECTOR 131375 213223 344598 PHIPPS GERALD S VICE CHAIR 147620 4422 152042 RUTHERFORD EVE M DIRECTOR 120533 475433 595966 BERG BRADLEY COO & CFO 475852 239692 9117 101272 29197 855130 ALIABADI KAREN CHIEF HR STRATEGIST 272550 166161 4892 75532 19795 538930 BURSETT JOHN SR VP, UNDERWRITING/ACTUARIAL 202344 48337 -4360 24281 17540 288142 GATES THOMAS VP, PLANNING & CORP DEVEL 302241 393798 -16337 74674 33063 787439 LO ERIC VP, ACTUARIAL & UNDERWRITING 252645 135635 2194 28937 26348 445759 LOWRY-OAKES DIANE PRESIDENT & CEO FOUNDATION 187928 33027 2304 61332 31998 316589 MERLO KRISTIN CHIEF MKTG, INFO & SALES OFF 410077 293553 12155 18000 33116 766901 SNYDER CINDY VP, INNOVATIVE SERVICES 209653 118742 11128 104110 24005 467638 CURHAN SUSAN DIRECTOR, MKTG & PRODUCT MGMT 85973 43219 140787 5189 10630 285798 DOSCH KYLE DENTAL DIRECTOR 182126 40937 -26 14570 10040 247647 JAHRMAN CHRISTOPHER DIRECTOR, OPS & PATIENT EXPERI 179875 44960 -1589 14372 15853 253471 LAY LINDA DIRECTOR, SALES ACCT. MGMT 178070 141501 1244 14246 10017 345078 SCHOBER DEBRA SENIOR SALES EXECUTIVE 101194 325200 -2093 8096 20513 452910 SCHEDULE J, PART I, LINE 1A DDWA OCCASIONALLY PAYS FOR SPOUSAL TRAVEL FOR THE CEO, WHICH IS TREATED AS TAXABLE INCOME. ANY FIRST CLASS TRAVEL IS SUBJECT TO THE APPROVAL OF THE CEO. DDWA PROVIDES A WELLNESS PROGRAM WHICH REIMBURSES 50% OF APPROVED EXPENSES FOR ALL EMPLOYEES WORKING 30 HOURS OR MORE A WEEK, WITH A MAXIMUM PAYABLE OF $40/ MONTH, OR $480 PER YEAR, AND 25% OF APPROVED EXPENSES FOR PART-TIME EMPLOYEES WORKING 20 TO 30 HOURS A WEEK WITH A MAXIMUM PAYMENT OF $20/ MONTH, OR $240 PER YEAR FOR HEALTH CLUB MEMBERSHIPS, AEROBIC OR GENERAL EXERCISE CLASSES, WEIGHT LOSS PROGRAMS, STRESS MANAGEMENT AND MASSAGE THERAPY. THESE REIMBURSEMENTS ARE TREATED AS TAXABLE INCOME. ADDITIONALLY, HEALTH OR LUNCHEON CLUB DUES ARE PAID IN FULL FOR SENIOR MANAGEMENT WHICH IS INCLUDED IN TAXABLE INCOME. DDWA GROSSES UP AN EXECUTIVE AUTO STIPEND PAID TO CERTAIN EMPLOYEES. DDWA GROSSES UP BOARD MEMBER FEES TO COVER B&O TAXES ASSESSED ON DIRECTOR FEES PAID TO THE BOARD. SCHEDULE J, PART I, LINE 3 THE HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO EVALUATE THE COMPENSATION OF ALL KEY EMPLOYEES, INCLUDING PRESIDENT AND CEO, COO/CFO, VP UNDERWRITING/ACTUARIAL, CMO/CIO/CSO, VP PLANNING, AND CORPORATE DEVELOPMENT, CHIEF HUMAN RESOURCE STRATEGIST, AND VP INNOVATIVE SERVICES & PROVIDER RELATIONS, IN COMPARISON TO THE PRACTICE OF SIMILAR EMPLOYERS IN THE MARKETPLACE. THE PROCESS IS CONDUCTED ON AN ANNUAL BASIS. SCHEDULE J, PART I, LINE 4B THE COMPANY MAKES CONTRIBUTIONS TO A NON-QUALIFIED, SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP), AS DETERMINED BY THE BOARD OF DIRECTORS, WHICH IS SUBJECT TO CODE SECTION 457(B). PLAN PARTICIPANTS ARE "KEY EMPLOYEES" WHO RECEIVE AN ANNUAL CONTRIBUTION BASED ON THEIR AGE, EARNINGS AND PROJECTED 401(K) INVESTMENT RETURNS. THE INVESTMENT OF THE COMPANY CONTRIBUTIONS IS DIRECTED BY EACH PARTICIPANT, BUT VESTING OF THE BENEFIT IS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE AS REQUIRED BY CODE SECTION 409(A). CONTRIBUTIONS MADE IN 2016 WERE AS FOLLOWS: BRADLEY BERG, CHIEF OPERATING AND FINANCIAL OFFICER, $83,272; THOMAS GATES, VP PLANNING AND CORPORATE DEVELOPMENT, $56,674; ERIC LO, VP UNDERWRITING/ACTUARIAL, $10,937; CINDY SNYDER, VP INNOVATION SERVICES AND PROVIDER RELATIONS, $87,338; KAREN ALIABADI, CHIEF HR STRATEGIST, $57,532; DIANE LOWRY-OAKES, PRESIDENT & CEO of WDS Foundation, $46,298. THE 457(B) PLAN HAD TOTAL ASSETS OF $644,644 AT DECEMBER 31, 2016. THE COMPANY ALSO MAKES A CONTRIBUTION TO A 457(F) NON-QUALIFIED SERP, A DEFINED CONTRIBUTION PLAN FOR THE Companys PRESIDENT AND CEO DUE TO AGE RESTRICTIONS ASSOCIATED WITH THE 457(B) PLAN. THE COMPANY CONTRIBUTED $100,000 TO THE PLAN FOR 2016. THE 457(F) PLAN HAD TOTAL ASSETS OF $386,858 AT DECEMBER 31, 2016. IN ADDITION, THERE IS ANOTHER 457(B) NONQUALIFIED SERP DEFERRED COMPENSATION PLAN FOR SENIOR MANAGEMENT THAT THE COMPANY DOES NOT MAKE ANY CONTRIBUTIONS TO. EACH OF THE FOLLOWING PARTICIPANTS CONTRIBUTED $18,000 TO THE PLAN DURING 2016 - JAMES DWYER, BRADLEY BERG, KRISTIN MERLO, ERIC LO, AND DIANE LOWRY-OAKES. THE PLAN HAD TOTAL ASSETS OF $627,397 AT DECEMBER 31, 2016. SCHEDULE J, PART I, LINE 6A THE BOARD OF DDWA ANNUALLY APPROVES A COMPANY-WIDE BONUS MATRIX BASED ON SEVEN METRICS, ONE OF WHICH WAS BASED ON THE OPERATING PROFIT MARGIN FOR THE FISCAL YEAR. THE OTHER METRICS WERE ADMINISTRATIVE COST, NEW SALES FOR SMALL AND LARGE CUSTOMERS, CUSTOMER PERSISTENCY, NETWORK GROWTH AND OPERATIONAL PERFORMANCE. Form 990 Part III, LINE 1 DDWA WILL REVOLUTIONIZE THE ORAL HEALTH INDUSTRY AND IMPROVE OVERALL HEALTH. THIS INCLUDES, BUT IS NOT LIMITED TO, THE FOLLOWING: TO SECURE DENTAL SERVICE FOR EMPLOYER GROUPS, INDIVIDUALS AND THEIR FAMILIES; PROVIDE INNOVATIVE PRODUCTS AND SERVICES; TO ENCOURAGE, FOSTER AND FINANCE PROFESSIONAL AND SCIENTIFIC STUDY AND RESEARCH IN THE GENERAL FIELD OF ORAL HEALTH; AND TO EDUCATE THE PUBLIC CONCERNING THE NEED FOR AND ADVANTAGE OF ADEQUATE DENTAL TREATMENT. Form 990 Part III, LINE 3 ON OCTOBER 17, 2016, DDWA DISTRIBUTED $15,600,000 IN CASH TO ITS SOLE MEMBER WASHINGTON DENTAL SERVICE. Form 990 PART III, LINE 4A DDWA provides dental insurance for over 2,886,000 primary subscribers and their dependents throughout the state of Washington and across the nation. Working collectively with producers and benefit managers, we offer standard insurance benefits, as well as highly customized plans to meet the needs of individuals and their families. We have contracted with approximately 4,500 dentists, creating a network of providers serving patients across the state. As a member of the Delta Dental Plans Association, a national association supporting Delta insurers nation-wide, our members are able to access Delta contracted providers in every state. In 2016, DDWA processed over 5,800,000 claims for subscribers and their dependents. To ensure providers are submitting claims appropriately, we audited over 37,000 individual claims, the results of which include education of dental office staff on the use of CDT codes, invoicing procedures and reducing common errors. FORM 990, PART III, LINE 4B DDWA PROMOTES THE VALUE OF DENTAL BENEFITS AND IMPORTANCE OF ORAL HEALTH THROUGH MARKETING EFFORTS IN MEDIA ADVERTISING, PUBLIC RELATIONS, EVENT SPONSORSHIP AND DIRECT OUTREACH TO CUSTOMERS. IN 2016, WE MADE SIGNIFICANT REFINEMENTS TO OUR PROMOTIONAL TACTICS AND MESSAGES. MARKET RESEARCH CONFIRMED THAT THESE CHANGES IMPROVED OUR ABILITY TO REACH AND ENCOURAGE AUDIENCES TO EMBRACE GOOD ORAL HEALTH AND MAKE WISE USE OF DENTAL BENEFITS. FORM 990 PART III, LINE 4C Dental decay is the single most common chronic disease of early childhood - five times more common than asthma. Nearly one in five adults, nationally, has untreated dental cavities. The Washington Dental Service Foundation (the Foundation), a wholly owned subsidiary of DDWA, supported almost exclusively by DDWA, focuses much of their work specifically on children and seniors, and works closely with partner organizations to develop and implement innovative programs. The Access to Baby and Child Dentistry (ABCD) programs expand access to dental care for young children in Washington State by providing dental services, both preventative and restorative - to Medicaid-enrolled children up to age six. In counties with ABCD, the utilization of dental services increased from 21% to 52% from 1997 to 2016. The Early Intervention in Medical Settings programs is training pediatricians in the advantages and techniques of oral screening, applying fluoridation and referring high risk patients for dental care. The Foundation is engaging health professionals, including pharmacists and home health aides, to take preventative steps with seniors before oral health problems affect their overall health. Form 990 Part VI, LINE 4D 1. WATER FLUORIDATION IS THE MOST IMPORTANT STEP A COMMUNITY CAN TAKE TO IMPROVE THE ORAL HEALTH OF ALL RESIDENTS. THE FOUNDATION PROMOTES LEGISLATION TO ENCOURAGE FLUORIDATION AND PROVIDES ASSISTANCE TO GROUPS WHO ARE COMMITTED TO BRINGING THE BENEFITS OF FLUORIDE TO THEIR COMMUNITIES. SINCE 2001, AN ADDITIONAL 287,000 WASHINGTONIANS ARE RECEIVING THE HEALTH BENEFITS ASSOCIATED WITH FLUORIDATED WATER AS A RESULT OF THE FOUNDATION'S WORK. 2. ASSISTING THE WORK OF THE FOUNDATION ARE DDWA EMPLOYEES VOLUNTEERING THEIR TIME. DDWA ENABLES ALL EMPLOYEES TO ENGAGE WITH THE PUBLIC REGARDING ORAL HEALTH THROUGH THE USE OF TWO VOLUNTEER DAYS PER YEAR. VOLUNTEER TIME IS SPENT WORKING ON THE SMILEMOBILE, A MOBILE DENTAL FACILITY TRAVELING TO UNDERSERVED AREAS OF THE STATE. MORE THAN 20,000 LOW-INCOME AND AT-RISK-CHILDREN STATE-WIDE RECEIVED DENTAL SERVICES IN THE LAST 10 YEARS THROUGH THE FOUNDATION OPERATED SMILEMOBILE. VOLUNTEER TIME IS ALSO SPENT HANDING OUT FLYERS PROMOTING ORAL HEALTH TO WASHINGTON CITIZENS AT FAIRS, THE ZOO, PARADES, AND EVENTS ACROSS THE STATE. 3. DDWA MATCHES DONATIONS MADE BY EMPLOYEES TO NON-PROFIT ORGANIZATIONS WITH OFFICIAL IRS 501(C)(3) STATUS, ALTHOUGH THE FOLLOWING ORGANIZATIONS/EVENTS ARE NOT ELIGIBLE FOR MATCHING: CHURCHES, POLITICAL CAMPAIGNS/ORGANIZATIONS, CAPITAL FUNDING, FRATERNAL/LABOR ORGANIZATIONS, TRIPS/TOURS, MASS MAILINGS, ORGANIZATIONS/GROUPS THAT DISCRIMINATE FOR ANY REASON INCLUDING, BUT NOT LIMITED TO RACE, COLOR, RELIGION, CREED, AGE, SEX, SEXUAL ORIENTATION OR NATIONAL ORIGIN. 4. DDWA SUPPORTED THE UNIVERSITY OF WASHINGTON'S SCHOOL OF DENTISTRY BY CREATING THE DDWA DENTIST OF THE FUTURE FUND. THIS FUND PROVIDED TRAINING FOR DENTAL STUDENTS AND PRACTICING DENTISTS EMPHASIZING EVIDENCE BASED INSTRUCTION, INTER-PROFESSIONAL EDUCATION, RISK ASSESSMENT AND BEHAVIORAL CHANGES AND MORE FULLY INCORPORATING ORAL HEALTH INTO OVERALL HEALTH IN PATIENT MANAGEMENT. DDWA ALSO SUPPORTED ESTABLISHING A 20 CHAIR DENTAL TEACHING CENTER AT THE PACIFIC TOWER COMMUNITY HEALTH AND INNOVATION CENTER. THE CENTER PROVIDES DENTAL CARE FOR A LOW INCOME, HIGHLY DIVERSE POPULATION, INCLUDING UNDERSERVED ADULTS WHO ARE MEDICAID INSURED OR UNINSURED AND WILL WORK WITH REFERRING ORGANIZATIONS TO ADDRESS BARRIERS TO CARE. Form 990 Part VI, LINE 6 DDWA'S MEMBER DENTISTS ARE CONSIDERED MEMBERS OF THE COMPANY'S PARENT COMPANY, WDS. MEMBER DENTISTS ELECT THE DENTAL MEMBERS OF THE WDS BOARD OF DIRECTORS. WDS DIRECTORS ALSO SERVE AS DIRECTORS ON THE DDWA BOARD. Form 990 Part VI, LINE 7A THE GOVERNANCE & NOMINATING COMMITTEE (GNC) OF THE BOARD OF DIRECTORS SOLICITS ADVICE ON CANDIDATES AND SUBMITS NOMINEES TO THE BOARD FOR CONSIDERATION AND APPROVAL TO BE VOTED UPON. THE ENTIRE MEMBERSHIP ELECTS AND RE-ELECTS MEMBER DIRECTORS, WHO COMPRISE A MINORITY OF THE BOARD. THE INCUMBENT INDEPENDENT DIRECTORS NOMINATE AND ELECT OR RE-ELECT INDEPENDENT DIRECTORS. A MEMBER ADVISORY PANEL (MAP) CONSISTS OF TEN TO FIFTEEN MEMBERS THAT ARE SELECTED BY THE BOARD FROM NOMINEES BY THE GNC. THE MAP PROVIDES CONSULTATION TO THE COMPANY, INCLUDING THE GNC AND BOARD, ON A VARIETY OF MATTERS. Form 990 Part VI, LINE 7B RECOMMENDED CHANGES TO THE WDS CORPORATE BY-LAWS BY THE WDS BOARD ARE SUBJECT TO APPROVAL BY THE WDS MEMBER DENTISTS. FORM 990, PART VI, LINE 11B THE 990 IS COMPLETED BY KPMG. THE FORM 990 AND SUPPORTING DOCUMENTATION IS REVIEWED AND APPROVED BY THE ACCOUNTING SUPERVISOR, DIRECTOR OF FINANCE AND THE CFO/COO. ELECTRONIC COPIES OF THE RETURN ARE PROVIDED FOR REVIEW TO ALL BOARD MEMBERS PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, LINE 12C THE Investment and AUDIT COMMITTEE OF THE BOARD IS CHARGED WITH MONITORING PROPOSED OR ON-GOING TRANSACTIONS FOR CONFLICTS OF INTEREST AND ADDRESSING ANY POTENTIAL OR ACTUAL CONFLICTS. PURSUANT TO THE CONFLICT OF INTEREST POLICY, AN ANNUAL CONFLICT OF INTEREST QUESTIONNARIE, AIMED AT DETERMINING ANY FAMILY AND BUSINESS RELATIONSHIPS AND TRANSACTIONS, OR OTHER TRANSACTIONS THAT MAY POSE A POTENTIAL CONFLICT, IS DISTRIBUTED TO ALL COVERED PERSONS (I.E. BOARD MEMBERS, OFFICERS AND EXECUTIVE LEADERSHIP OR KEY EMPLOYEES). COVERED PERSONS ARE REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICTS AT THE TIME WHEN SUCH CONFLICTS ARISE. WHEN SOMEONE BECOMES A COVERED PERSON AND annually THEREAFTER, THEY ARE REQUIRED TO EXPLICITLY ACKNOWLEDGE A STATEMENT AFFIRMING THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (2) HAS READ THE POLICY AND UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE POLICY, INCLUDING COMPLETING THE CONFLICTS OF INTEREST QUESTIONNAIRE IF ANY CONFLICTS EXIST. THE COMPLETED QUESTIONNAIRES THAT NOTE ANY CONFLICTS ARE REVIEWED BY THE BOARD AND ANY PERSONS WITH ACTUAL OR POTENTIAL CONFLICTS ARE INFORMED of any action VIA WRITTEN COMMUNICATION. THE PROCEDURES FOR ADDRESSING ANY CONFLICT OF INTEREST INCLUDES, BUT ARE NOT LIMITED TO, THE FOLLOWING: (1) THE CONFLICTING INTEREST IS FULLY DISCLOSED TO THE BOARD; (2) THE INTERESTED PERSON RESPONDS TO FACTUAL QUESTIONS RELATED TO THE SUBSTANCE OF THE TRANSACTION OR ARRANGEMENT BEING CONSIDERED, AFTER WHICH HE/SHE SHALL LEAVE THE MEETING; (3) THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSSION AND APPROVAL OF SUCH TRANSACTION; (4) ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED, COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED if deemed appropriate; (5) AND CONFLICTING ISSUES DURING THE COURSE OF A BOARD MEETING WHICH CANNOT BE RESOLVED ARE REFERRED TO THE GOVERNANCE AND NOMINATING COMMITTEE; AND (6) THE TRANSACTION OR ACTION MUST BE APPROVED BY A MAJORITY OF DISINTERESTED PERSONS. FORM 990, PART VI, LINE 15 THE BOARD APPOINTS A HUMAN RESOURCES AND COMPENSATION COMMITTEE OF THE BOARD (THE HRCC), NONE OF WHOM MAY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY COMPENSATION ARRANGEMENTS, TO BE ACCOUNTABLE FOR SETTING REASONABLE COMPENSATION PACKAGES FOR THE CEO. IN 2016, THE HRCC DEVELOPED, CONSISTENT WITH THE ORGANIZATION'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA FOR OFFICERS AND KEY EMPLOYEES. THE HRCC ALSO HIRES A QUALIFIED INDEPENDENT COMPENSATION AND BENEFITS SPECIALIST (INDEPENDENT EXPERT) TO REVIEW, ANALYZE AND PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFIT PACKAGES OF OFFICERS AND KEY EMPLOYEES. APPROPRIATE COMPARABILITY DATA IS OBTAINED FROM THE INDEPENDENT EXPERTS, I.E., TOTAL ECONOMIC BENEFITS PAID BY SIMILAR SITUATED ORGANIZATIONS (BOTH TAXABLE AND TAX-EXEMPT) FOR SIMILAR JOB RESPONSIBILITIES. THE HRCC'S WRITTEN RECORDS INCLUDE THE (1) TERMS OF THE ARRANGEMENTS WITH THE OFFICERS AND KEY EMPLOYEES (INCLUDING THE DATE THE ARRANGEMENT WAS APPROVED); (2) A LIST OF MEMBERS PRESENT DURING THE DISCUSSION ON ANY ARRANGEMENTS; AND (3) A DESCRIPTION OF THE COMPARABLE DATA RELIED UPON BY THE HRCC. KEY DELIBERATIONS OF THE HRCC ARE ALSO DOCUMENTED IN MINUTES WHICH ARE APPROVED AT THE NEXT HRCC MEETING. FORM 990, PART VI, LINE 19 FINANCIAL STATEMENTS AND DISCLOSURES ARE FILED QUARTERLY AND ANNUALLY WITH THE WASHINGTON STATE OFFICE OF THE INSURANCE COMMISSIONER (OIC) AS A MATTER OF PUBLIC RECORD. ALL DOCUMENTS SO FILED ARE AVAILABLE TO THE PUBLIC ON THE OIC WEBSITE. AMENDMENTS TO BYLAWS ARE FILED WITH THE WASHINGTON SECRETARY OF STATE'S OFFICE FROM TIME-TO-TIME AS THEY ARE APPROVED BY THE GOVERNING BODY. GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1A THE FOLLOWING DIRECTORS ALSO RECEIVED CLINICAL REIMBURSEMENTS ADDITIONAL TO THEIR DIRECTORS FEES REPORTED IN COLUMN D REPORTABLE COMPENSATION FROM THE ORGANIZATION. LABBERTON, WELLS, K. $344,598 ------------------------------- DIRECTOR FEE - $131,375 CLINICAL REIMBURSEMENT - $213,223 PHIPPS, GERALD S. $152,042 ------------------------------- DIRECTOR FEE - $147,620 CLINICAL REIMBURSEMENT - $4,422 RUTHERFORD, EVE M. $595,966 ------------------------------- DIRECTOR FEE - $120,533 CLINICAL REIMBURSEMENT - $475,433 FORM 990, PART XI, LINE 9 DISTRIBUTION TO ITS SOLE MEMBER WDS: $15,600,000 WASHINGTON DENTAL SERVICE FOUNDATION 400 FAIRVIEW AVE N SUITE 800 SEATTLE WA 98109 910621480 EDUCATION WA 109000 2066000 DDWA WASHINGTON DENTAL SERVICE FUND 400 FAIRVIEW AVE N SUITE 800 SEATTLE WA 98109 911281990 EDUCATION WA 501(c)(3) 9 DDWA true WASHINGTON DENTAL SERVICE 400 FAIRVIEW AVE N SUITE 800 SEATTLE WA 98109 270937829 HOLDING CO. WA 501(c)(4) NA true false false false false false false false false false false false false false false true false true true false WASHINGTON DENTAL SERVICE r 15600000 CASH/INVESTMENT WASHINGTON DENTAL SERVICE o 959467 CASH WASHINGTON DENTAL SERVICE q 14400 SHARED SERVICES