2016-08-04T12:37:29-05:00 2015-12-31 KPMG LLP 1918 Eighth Avenue Suite 2900 Seattle WA 98101 990 2015-01-01 910621480 Delta Dental of Washington % BRADLEY BERG DELT 2065221300 9706 4th Ave NE Seattle WA 98115 BRADLEY A BERG CFO & COO 2016-08-03 true SUE ROBISON P00560072 2069134000 2016-08-03 2015 2016-12-15 16:53:06Z Bradley A Berg 9706 4th Ave NE Seattle WA 98115 1175911531 false X www.deltadentalwa.com X 1954 WA SEE SCHEDULE O 11 6 411 59 0 51320 121448 1075513470 1140842247 18236329 5698486 663309 882837 1094464428 1147545018 4423574 6123545 978586624 1033807840 40132663 43531908 0 0 0 50963849 52975817 1074106710 1136439110 20357718 11105908 237972879 233609242 51398676 59767140 186574203 173842102 X SEE SCHEDULE O false true 1068371404 1140741658 SEE SCHEDULE O 3011395 SEE SCHEDULE O 1294421 1294421 SEE SCHEDULE O 5339271 4829124 100589 OTHER INCOME 5339271 4829124 100589 1078016491 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 49824 0 true 411 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 9706 4TH AVE NE SEATTLE WA 98115 X BECK GEORGE DOUGLAS CHAIR 11.0 4.0 X X 96732 0 0 BROWN COLLEEN DIRECTOR 4.0 3.0 X 64468 0 0 DWYER JAMES D PRESIDENT & CEO 36.0 4.0 X X 1321493 0 140633 FARRELL ANNE V DIRECTOR 7.0 3.0 X 67570 0 0 HARWELL JANIS L SECRETARY 8.0 3.0 X X 58379 0 0 LABBERTON WELLS K DIRECTOR 7.0 3.0 X 282007 0 0 LOHKAMP JOANNA LYN DIRECTOR 8.0 3.0 X 60689 0 0 PHIPPS GERALD S VICE CHAIR 10.0 4.0 X X 77762 0 0 RUTHERFORD EVE DIRECTOR 7.0 3.0 X 482307 0 0 SEELY JEFFREY THOMAS DIRECTOR 10.0 4.0 X 64484 0 0 TUNE JAMES F TREASURER 7.0 3.0 X X 58387 0 0 BERG BRADLEY A COO & CFO 36.0 4.0 X 657532 0 112525 MERLO KRISTIN N CHIEF MKTG, INFO & SALES OFF 40.0 0.0 X 627847 0 48817 GATES THOMAS A VP, PLANNING & CORP DEVEL 40.0 0.0 X 468335 0 88725 SMITH LAURA J WDS FDN, PRESIDENT & CEO 40.0 0.0 X 426676 0 27612 LO ERIC C VP, ACTUARIAL & UNDERWRITING 40.0 0.0 X 348943 0 38947 ALIABADI KAREN CHIEF HR STRATEGIST 40.0 0.0 X 266574 0 85494 BURSETT JOHN T SR VP, UNDERWRITING/ACTUARIAL 32.0 0.0 X 265665 0 39947 LAY LINDA T DIRECTOR, SALES ACCT. MGMT 40.0 0.0 X 247448 0 23764 SNYDER CINDY K VP, INNOVATIVE SERVICES 40.0 0.0 X 291053 0 111523 WHITNEY GARRETT DIR., IT ARCHITECTURE/INFRA 40.0 0.0 X 222255 0 29015 DOSCH KYLE P DENTAL DIRECTOR 40.0 0.0 X 217613 0 23473 ORENSTEIN JANE DIRECTOR, REG. & COMPLIANCE 40.0 0.0 X 216661 0 32592 CURHAN SUSAN SENIOR SALES EXECUTIVE 40.0 0.0 X 210640 0 36809 LILEY DARRYL DIRECTOR, IT OPERATIONS 40.0 0.0 X 205344 0 25506 7306864 0 865382 96 false true false DECARE SYSTEMS UNIT 1 CURRAHEEN ROAD CORK 0 EI SOFTWARE DEVELOPMENT 5142398 EMDEON BUSINESS SERVICES PO BOX 572490 MURRAY UT 84157 PRINTING/MAILING 3624343 ENCARA INC 4818 STARKET ROAD SW ROANOKE VA 24018 IND. PLAN TPA 2213343 GREENRUBINO INC 1938 FAIRVIEW AVE E 200 SEATTLE WA 98102 ADVERTISING AGENCY 2168144 AON CONSULTING INC PO BOX 905494 CHARLOTTE NC 28290 BROKER 1372544 83 8750 112698 121448 PROGRAM REVENUE 524114 1140741658 1140741658 SMILEMOBILE (MOBILE DENTIST OFFICE) 621990 100589 100589 1140842247 5207792 5207792 149001 149001 0 479396 479396 0 479396 479396 28605267 102939 28366513 238754 102939 341693 341693 0 0 0 OTHER INCOME 900099 403441 403441 403441 1147545018 1141245688 6177882 6123545 6123545 0 0 1033807840 1033807840 6358369 2755297 3603072 0 26399808 9362581 17037227 1632380 525208 1107172 6731470 2476963 4254507 2409881 1018274 1391607 0 14106 25079 -10973 332070 332070 72113 72113 0 471398 471398 6856503 3117591 3738912 5239910 3011395 2228515 5697055 3393751 2303304 5156715 38962 5117753 0 2011257 856261 1154996 1505840 545934 959906 0 759447 133702 625745 0 0 4474434 58020 4416414 279891 279891 COMMISSIONS 9310507 9310507 TAXES & SERVICE CHARGES 9431715 1263229 8168486 RESEARCH & DEVELOPMENT 250300 250300 DUES & SUBSCRIPTIONS 852417 72469 779948 260139 47770 212369 1136439110 1078016491 58422619 0 4100790 215485 3027927 2627084 0 0 21069920 28082760 0 0 0 0 0 0 0 0 2974435 3916372 67937854 48244152 16820018 19693702 188980209 176925744 275732 1263358 0 0 0 0 723848 884737 237972879 233609242 44126705 52572751 873466 125000 6398505 7069389 0 0 0 0 0 0 0 0 0 0 0 0 51398676 59767140 X 186574203 173842102 0 0 0 0 186574203 173842102 237972879 233609242 X 11105908 -6937007 -1002 -16900000 X false true X true false 122850 122850 122850 true COMMITTEE TO ELECT BARBARA BAILEY PO BOX 374 OAK HARBOR WA 98277 020556800 950 FRIENDS TO ELECT RANDI BECKER PO BOX 83 GRAHAM WA 98338 770708976 950 COMMITTEE TO ELECT DON BENTON PO BOX 5076 VANCOUVER WA 98686 510645142 950 FRIENDS OF ANDY BILLIG PO BOX 145 SPOKANE WA 99210 271127517 950 COMMITTEE TO ELECT BRIAN BLAKE PO BOX 1541 LONGVIEW WA 98632 870699800 950 FRIENDS OF BRADY WALKINSHAW 3518 FREMONT AVE NW 545 SEATTLE WA 98103 464272797 950 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. 1211191 1211191 11163206 8599153 2564053 1715345 816542 898803 12133820 9774378 2359442 41714292 29054079 12660213 19693702 true WASHINGTON EARLY LEARNING FUND 1218 THIRD AVENUE SEATTLE WA 98101 912041837 501(C)(3) 45000 YEARLY THRIVE BY FIVE FUNDING PENINSULA COMMUNITY HEALTH SERVICES - ADMINISTRATI 400 WARREN AVENUE SUITE 300 BREMERTON WA 98337 943079770 501(C)(3) 275000 NEW SIX CHAIR CLINIC IN PORT ORCHARD OLYMPIC EDUCATIONAL SERVICE DISTRICT (OESD) 114 105 NATIONAL AVE N BREMERTON WA 98312 910919927 501(C)(3) 21055 OLYMPIC KITSAP EARLY LEARNING COALITION AND ABCD PARTNERSHIP CHILDREN'S DENTAL HEALTH PROJECT 1020 19TH STREET NW STE 400 WASHINGTON DC 20036 061561317 501(C)(3) 25000 NATIONAL SEALANT WORK GROUP EDUCATIONAL SERVICE DISTRICT 123 3918 W COURT ST PASCO WA 99301 910948131 501(C)(3) 30000 SOUTHEAST EARLY LEARNING COALITION AND ABCD PARTNERSHIP - YEAR TWO VOLUNTEERS IN MEDICINE OF THE OLYMPICS CLINIC 819 GEORGIANA ST PORT ANGELES WA 98362 010590704 501(C)(3) 7371 FUND EQUIPMENT FOR NON-PROFIT CLINIC AMERICAN ACADEMY OF PEDIATRICS 141 NORTHWEST POINT BLVE ELK GROVE VILLAGE IL 60007 362275597 501(C)(3) 50000 NATIONAL FLUORIDATION CAMPAIGN WASHINGTON EARLY LEARNING FUND 1218 THIRD AVENUE SEATTLE WA 98101 912041837 501(C)(3) 20000 STATE HOME VISITING MATCH FUND TO EXPAND HOME VISITING PROGRAMS'S FOR WASHINGTON'S YOUNGEST CHILDREN JAMESTOWN SKLALLAM TRIBE 1033 OLD BLYN HIGHWAY SEQUIM WA 98382 910963298 GOVERNMENT 290282 EXPAND ACCESS TO DENTAL CARE FOR LOW INCOME ADULTS IN CLALLAM AND JEFFERSON COUNTIES COMMUNITY HEALTH ASSOCIATION OF SPOKANE 3919 N MAPLE SPOKANE WA 99205 911641797 501(c)(3) 125000 EXPAND ACCESS TO DENTAL CARE FOR LOW INCOME ADULTS IN CHILDREN IN CHENEY (NEW DENTAL CLINIC) NE WASHINGTON HEALTH PROGRAMS - ADMINISTRATION 509 EAST MAIN AVENUE CHEWELAH WA 99109 911053847 501(C)(3) 176937 EXPAND ACCESS TO DENTAL CARE FOR LOW INCOME PRIMARILY ADULTS (CLINIC EXPANSION IN LAKE SPOKANE) CHILDREN'S DENTAL HEALTH PROJECT 1020 19TH STREET NW STE 400 WASHINGTON DC 20036 061561317 501(C)(3) 16994 DEVELOP FLUORIDATION TOOLKIT CHARITABLE PARTNERSHIP FUND PO BOX 13276 PORTLAND OR 97213 931267966 501(C)(3) 26250 DEVELOPMENT COSTS OF FLUORIDEEXPOSED.ORG WEBSITE DENTAQUEST FOUNDATION 465 MEDFORD STREET BOSTON MA 02129 043265080 501(C)(3) 200000 NATIONAL INTERPROFESSIONAL INITIATIVE ON ORAL HEALTH FUNDING WASHINGTON ASSOCIATION OF COMMUNITY MIGRANT HEALTH 2120 STATE AVENUE NE SUITE 220 OLYMPIA WA 98506 911323282 501(C)(3) 56782 COMMUNITY HEALTH CENTER LEARNING SESSIONS 15 SCHEDULE 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 USE OF FUNDS. GRANTEE IS ALSO REQUIRED TO RETURN UNUSED FUNDING IF APPLICABLE. X X X X true true X X X X false true false false false false false false false DWYER JAMES D PRESIDENT & CEO 639415 0 670000 0 12078 0 118000 0 22633 0 1462126 0 0 0 LABBERTON WELLS K DIRECTOR 71806 0 0 0 210201 0 0 0 0 0 282007 0 0 0 RUTHERFORD EVE DIRECTOR 66723 0 0 0 415584 0 0 0 0 0 482307 0 0 0 BERG BRADLEY A COO & CFO 408593 0 238469 0 10470 0 85262 0 27263 0 770057 0 0 0 MERLO KRISTIN N CHIEF MKTG, INFO & SALES OFF 390099 0 229937 0 7811 0 18000 0 30817 0 676664 0 0 0 GATES THOMAS A VP, PLANNING & CORP DEVEL 291075 0 169678 0 7582 0 57960 0 30765 0 557060 0 0 0 SMITH LAURA J WDS FDN, PRESIDENT & CEO 272931 0 143877 0 9868 0 18000 0 9612 0 454288 0 0 0 LO ERIC C VP, ACTUARIAL & UNDERWRITING 227879 0 114625 0 6439 0 23791 0 15156 0 387890 0 0 0 ALIABADI KAREN CHIEF HR STRATEGIST 260000 0 0 0 6574 0 66947 0 18547 0 352068 0 0 0 BURSETT JOHN T SR VP, UNDERWRITING/ACTUARIAL 218079 0 51086 0 -3500 0 23915 0 16032 0 305612 0 0 0 LAY LINDA T DIRECTOR, SALES ACCT. MGMT 172119 0 74380 0 949 0 13770 0 9994 0 271212 0 0 0 SNYDER CINDY K VP, INNOVATIVE SERVICES 226317 0 58762 0 5974 0 89371 0 22152 0 402576 0 0 0 WHITNEY GARRETT DIR., IT ARCHITECTURE/INFRA 190914 0 35214 0 -3873 0 12414 0 16601 0 251270 0 0 0 DOSCH KYLE P DENTAL DIRECTOR 177000 0 40689 0 -76 0 14160 0 9313 0 241086 0 0 0 ORENSTEIN JANE DIRECTOR, REG. & COMPLIANCE 172212 0 43932 0 517 0 13777 0 18815 0 249253 0 0 0 CURHAN SUSAN SENIOR SALES EXECUTIVE 170089 0 44208 0 -3657 0 13607 0 23202 0 247449 0 0 0 LILEY DARRYL DIRECTOR, IT OPERATIONS 165233 0 40802 0 -691 0 1966 0 23540 0 230850 0 0 0 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 ALL KEY EMPLOYEES, INCLUDING PRESIDENT AND CEO, CFO/COO, VP UNDERWRITING/ACTUARIAL, CMO/CIO/CSO, VP PLANNING, AND CORPORATE DEVELOPMENT, CHIEF HUMAN RESOURCE STRATEGIST, AND VP INNOVATIVE SERVICES & PROVIDER RELATIONS COMPENSATION 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 2015 WERE AS FOLLOWS: BRADLEY BERG, CHIEF OPERATING AND FINANCIAL OFFICER, $67,262; THOMAS GATES, VP PLANNING AND CORPORATE DEVELOPMENT, $39,960; ERIC LO, VP UNDERWRITING/ACTUARIAL, $5,791; CINDY SNYDER, VP INNOVATION SERVICES AND PROVIDER RELATIONS, $73,371; KAREN ALIABADI, CHIEF HR STRATEGIST, $48,947. THE 457(B) PLAN HAD TOTAL ASSETS OF $511,770 AT DECEMBER 31, 2015. THE COMPANY ALSO MAKES A CONTRIBUTION TO A 457(F) NON-QUALIFIED SERP, A DEFINED CONTRIBUTION PLAN FOR THE PRESIDENT AND CEO DUE TO AGE RESTRICTIONS ASSOCIATED WITH THE 457(B) PLAN. THE COMPANY CONTRIBUTED $100,000 TO THE PLAN FOR 2015. THE 457(F) PLAN HAD TOTAL ASSETS OF $252,537 AT DECEMBER 31, 2015. 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 2015 - JAMES DWYER, BRADLEY BERG, KRISTIN MERLO, LAURA SMITH AND ERIC LO. THE PLAN HAD TOTAL ASSETS OF $992,000 AT DECEMBER 31, 2015. SCHEDULE J, PART I, LINE 5A FORM 990, PART VII, SECTION A INCLUDES SALES COMMISSION PAID TO TWO EMPLOYEES BASED ON NEW SUBSCRIBERS ACQUIRED. SCHEDULE J, PART I, LINE 6A THE BOARD OF DDWA APPROVED 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. SCHEDULE J, PART I, LINE 7 DDWA PAID COMMISSION TO INTERNAL SALES STAFF BASED ON THE NUMBER OF PRIMARY SUBSCRIBERS ACQUIRED BY THE COMPANY AS A RESULT OF NEW EMPLOYER GROUP SALES. 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 SEPTEMBER 21, 2015, DDWA DISTRIBUTED $16,900,000 IN CASH TO ITS SOLE MEMBER WASHINGTON DENTAL SERVICE ("WDS"). FORM 990, PART III, LINE 4A DDWA PROVIDES DENTAL INSURANCE FOR OVER 2,655,000 MEMBERS 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 NEARLY 4,400 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 2015, DDWA PROCESSED OVER 5,600,000 CLAIMS FOR SUBSCRIBERS AND THEIR DEPENDENTS. TO ENSURE PROVIDERS ARE SUBMITTED CLAIMS APPROPRIATELY, WE AUDITED OVER 33,000 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 SPONSORSHIPS AND DIRECT OUTREACH TO CUSTOMERS. IN 2015, 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) PROGRAM EXPANDS ACCESS TO DENTAL CARE FOR YOUNG CHILDREN IN WASHINGTON STATE BY PROVIDING DENTAL SERVICES, BOTH PREVENTATIVE AND RESTORATIVE - TO APPLE HEALTH-ENROLLED (MEDICAID) CHILDREN UP TO AGE SIX. STATEWIDE, THE UTILIZATION OF DENTAL SERVICES INCREASED FROM 21% TO 52% FROM 1997 TO 2015 AND OVER 1,100 PROVIDERS ARE BILLING FOR CARE. THE EARLY INTERVENTION IN MEDICAL SETTINGS PROGRAM IS TRAINING PEDIATRICIANS IN THE ADVANTAGES AND TECHNIQUES OF ORAL SCREENING, APPLYING FLUORIDATION AND REFERRING HIGH RISK PATIENTS FOR DENTAL CARE. SINCE 2002, TRAININGS HAVE REACHED 45% (>2,000) OF WASHINGTON PRACTICING PRIMARY CARE PHYSICIANS. 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. OVER 65,000 ORAL HEALTH CAREGIVER COURSES HAVE BEEN DELIVERED TO HOME HEALTH AIDES THAT CARE FOR OLDER ADULTS. FORM 990, PART III, 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 263,000 WASHINGTONIANS ARE RECEIVING THE HEALTH BENEFITS ASSOCIATED WITH FLUORIDATED WATER AS A RESULT OF THE FOUNDATIONS 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 PROVIDES 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 WILL PROVIDE 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, SECTION A, 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, SECTION A, 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) CONSISTING OF TEN TO FIFTEEN MEMBERS 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, SECTION A, 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, SECTION B, 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, SECTION B, 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 QUESTIONNAIRE, 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 CONFLICT OF INTEREST QUESTIONNAIRE. THE COMPLETED QUESTIONNAIRES THAT NOTE ANY CONFLICTS ARE REVIEWED BY THE BOARD AND ANY PERSONS WITH ACTUAL OR POTENTIAL CONFLICTS ARE INFORMED VIA WRITTEN COMMUNICATION. THE PROCEDURES FOR ADDRESSING ANY CONFLICT OF INTEREST INCLUDE, 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 DISCUSSION AND APPROVAL OF SUCH TRANSACTION; (4) ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED, COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED; (5) AND CONFLICTING ISSUES DURING THE COURSE OF A BOARD MEETING WHICH CANNOT BE RESOLVED ARE REFERRED TO THE GOVERNANCE COMMITTEE; AND (6) THE TRANSACTION OR ACTION MUST BE APPROVED BY A MAJORITY OF DISINTERESTED PERSONS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD APPOINTS THE HRCC, NONE OF WHOM MAY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY COMPENSATION ARRANGEMENTS, TO BE ACCOUNTABLE FOR SETTING A REASONABLE COMPENSATION PACKAGE FOR THE CEO AND ALSO REASONABLE TOTAL COMPENSATION RANGES FOR OTHER OFFICERS AND KEY EMPLOYEES (INCLUDING THE COO/CFO). THE HRCC DEVELOPS, 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, SECTION C, 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. BECK, GEORGE - $96,732 ------------------------------- DIRECTOR FEE - $87,882 CLINICAL REIMBURSEMENT - $8,850 LABBERTON, WELLS, K. $282,007 ------------------------------- DIRECTOR FEE - $71,806 CLINICAL REIMBURSEMENT - $210,201 PHIPPS, GERALD S. $77,762 ------------------------------- DIRECTOR FEE - $76,741 CLINICAL REIMBURSEMENT - $1,021 RUTHERFORD, EVE $482,308 ------------------------------- DIRECTOR FEE - $66,724 CLINICAL REIMBURSEMENT - $415,584 FORM 990, PART XI, LINE 9 DISTRIBUTION TO ITS SOLE MEMBER WDS: 16,900,000 WASHINGTON DENTAL SERVICE FOUNDATION 9706 4TH AVE NE SEATTLE WA 98115 910621480 EDUCATION WA 116000 1708000 DDWA WASHINGTON DENTAL SERVICE FUND 9706 4TH AVE NE SEATTLE WA 98115 911281990 EDUCATION WA 501(c)(3) 9 DDWA true WASHINGTON DENTAL SERVICE 9706 4TH AVE NE SEATTLE WA 98115 270937829 HOLDING CO. 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 16900000 CASH/INVESTMENT WASHINGTON DENTAL SERVICE o 763220 CASH WASHINGTON DENTAL SERVICE q 14400 SHARED SERVICES