2015-08-07T12:24:16-05:00 2014-12-31 KPMG LLP 1918 EIGHTH AVENUE SUITE 2900 SEATTLE WA 98101 990 2014-01-01 910621480 Delta Dental of Washington % BRADLEY BERG DELT 2065221300 9706 4th Ave NE Suite Seattle WA 98115 BRADLEY A BERG CFO & COO 2065221300 2015-08-07 true SUE ROBISON P00560072 2069134000 2014 2016-02-25 16:41:14Z Bradley A Berg 9706 4th Ave NE Seattle WA 98115 1183658273 false X www.deltadentalwa.com X 1954 WA SEE SCHEDULE O 11 6 409 32 0 18932 51320 1012247971 1075513470 10233517 18236329 630289 663309 1023130709 1094464428 2817976 4423574 921250711 978586624 38427111 40132663 0 0 0 44387862 50963849 1006883660 1074106710 16247049 20357718 264323604 237972879 48592063 51398676 215731541 186574203 X SEE SCHEDULE O false true 1010309506 4423574 1075417980 SEE SCHEDULE O 2828390 SEE SCHEDULE O 2235426 SEE SCHEDULE O 3008179 95490 1018381501 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 false false true 47566 0 true 409 true false false false false false false X 11 6 false false false false false 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 DWYER JAMES D PRESIDENT & CEO 36.0 4.0 X X 1222192 0 178513 BECK GEORGE DOUGLAS VICE CHAIR 11.0 4.0 X X 87012 0 0 BRANCH DAVID W DIRECTOR 7.0 3.5 X 135252 0 0 LABBERTON WELLS K DIRECTOR 7.0 3.0 X 275933 0 0 DINEEN PATRICK JOSEPH TREASURER 7.0 3.0 X 58899 0 0 HARWELL JANIS L DIRECTOR 7.0 3.0 X 58899 0 0 FARRELL ANNE V DIRECTOR 7.0 3.0 X 41594 0 0 SEELY JEFFERY THOMAS DIRECTOR 7.0 3.0 X 54833 0 0 PHIPPS GERALD S DIRECTOR 11.0 4.0 X 62479 0 0 TUNE JAMES F SECRETARY 5.0 1.0 X X 53833 0 0 LOHKAMP JOANNA L CHAIR 9.0 3.0 X X 89305 0 0 BERG BRADLEY A COO & CFO 36.0 4.0 X 578688 0 147228 MERLO KRISTIN N CHIEF MKTG, INFO & SALES OFF 40.0 0.0 X 498521 0 124166 GATES THOMAS A VP, PLANNING & CORP DEVEL 40.0 0.0 X 399705 0 100618 LO ERIC C VP, ACTUARIAL & UNDERWRITING 40.0 0.0 X 266864 0 63500 SNYDER CINDY K VP, INNOV. SVCS & PROVIDER REL 40.0 0.0 X 201885 0 43554 SMITH LAURA J WDS FDN, PRESIDENT & CEO 40.0 0.0 X 342757 0 65814 BURSETT JOHN T SR VP, UNDERWRITING/ACTUARIAL 40.0 0.0 X 233523 0 53901 LAY LINDA T DIRECTOR, SALES ACCT. MGMT 40.0 0.0 X 297591 0 46386 SCHOBER DEBRA F SENIOR SALES EXECUTIVE 40.0 0.0 X 262096 0 33672 CURHAN SUSAN L DIRECTOR MKTG, PRODUCTION MGMT 40.0 0.0 X 198451 0 56765 INGE RONALD E FMR VP, DENTAL DIRECTOR & PR 40.0 0.0 X 546569 0 52823 WEBBER SUSAN S FORMER CHIEF HR OFFICER 40.0 0.0 X 393474 0 54921 CHITTOOR VENKATARAMAN FORMER CIO 40.0 0.0 X 297858 0 21918 6658213 0 1043779 99 true true false DECARE SYSTEMS UNIT 1 CURRAHEEN ROAD CORK 0 IC SOFTWARE DEVELOPMENT 3777417 EMDEON BUSINESS SERVICES PO BOX 57249 MURRAY UT 84157 PRINTING/MAILING 3762920 GREENRUBINO INC 1938 FAIRVIEW AVE E 200 SEATTLE WA 98102 ADVERTISING AGENCY 2170344 PRESIDIO NETWORKED SOLUTIONS 7601 ORA GLEN DR 100 GREENBELT MD 20770 NTWK INFRASTRUCTURE 1959269 ENCARA INC 4818 STARKEY ROAD SW ROANOKE VA 24018 IND. PLANNED TPA 1649734 95 11875 39445 51320 PROGRAM REVENUE 524114 1075417980 1075417980 SMILEMOBILE (MOBILE DENTIST OFFICE) 621990 95490 95490 1075513470 5936070 5936070 213668 213668 0 531473 531473 0 531473 531473 98445008 2835428 85769342 3424503 12675666 -589075 12086591 12086591 0 0 0 OTHER INCOME 900099 131836 131836 131836 1094464428 1075645306 18767802 4423574 4423574 0 0 978586624 978586624 6539279 2877887 3661392 0 24094158 8865483 15228675 1429866 480282 949584 5781985 2232310 3549675 2287375 989612 1297763 0 316193 29596 286597 260437 260437 72475 72475 0 560153 560153 7248299 2135383 5112916 4854237 2828390 2025847 4804038 3101487 1702551 4781737 485861 4295876 0 1987008 829305 1157703 1614930 529716 1085214 0 848766 181006 667760 34 34 0 4395554 41941 4353613 233891 233891 COMMISSIONS 8381757 8381757 TAXES & SERVICE CHARGES 8563806 1136158 7427648 RESEARCH & DEVELOPMENT 343350 343350 DUES & SUBSCRIPTIONS 822197 81176 741021 874987 91478 783509 1074106710 1018381501 55725209 0 -12060969 4100790 42521769 3027927 0 0 12989640 21069952 0 0 0 0 100000 0 0 0 2672736 2974435 61107611 44287593 16097749 16820018 200641797 188980177 341970 275732 0 0 0 0 1018912 723848 264323604 237972879 44602557 44126705 255482 873466 3734024 6398505 0 0 0 0 0 0 0 0 0 0 0 0 48592063 51398676 X 215731541 186574203 0 0 0 0 215731541 186574203 264323604 237972879 X 20357718 -8228052 3006 -41290010 X false true X true false 132000 0 132000 132000 true COMMITTEE TO ELECT DAWN MORRELL 2106 MANORWOOD DR SE PUYALLUP WA 98374 010679962 1000 COMMITTEE TO ELECT KAREN KEISER PO BOX 13290 DES MOINES WA 98189 911947669 1000 FRIENDS OF MELANIE STAMBAUGH PO BOX 73267 PUYALLUP WA 98373 710896890 1000 COMMITTEE TO ELECT SUSAN FAGEN PO BOX 1471 PULLMAN WA 99163 264513295 1900 BRUCE CHANDLER CAMPAIGN PO BOX 1108 ZILLAH WA 98953 912066326 1000 FRIENDS OF BOB FERGUSON PO BOX 2405 SEATTLE WA 98111 010699595 1000 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 11028250 8318852 2709398 1220722 731019 489703 11411234 8888348 2522886 36236214 26349374 9886840 16820018 true UNION GOSPEL MISSION - YAKIMA BOX 565 YAKIMA WA 98907 237050061 501(c)(3) 100000 EXPAND THE YAKIMA CLINIC WACMHC 2120 STATE ST NE 220 OLYMPIA WA 98506 911323282 501(c)(3) 51782 FUNDING FOR THE COMMUNITY HEALTH CENTER DIRECTORS DENTAL LEARNING NETWORK. WASHINGTON EARLY LEARNING FUND 1218 THIRD AVE 800 SEATTLE WA 98101 912041837 501(c)(3) 45000 YEARLY THRIVE BY FIVE FUNDING DENTAQUEST FOUNDATION 465 MEDFORD ST BOSTON MA 02129 043265080 501(c)(3) 150000 NATIONAL COMMITTEE FOR QUALITY ASSURANCE FAMILY HEALTH CENTERS PO BOX 1340 OKANOGAN WA 98840 911275011 501(c)(3) 300000 NEW CLINIC IN BREWSTER NEIGHBORCARE HEALTH 1537 WESTERN AVE SEATTLE WA 98101 910893287 501(c)(3) 300000 EXPAND ACCESS BY PURCHASING EQUIPMENT FOR NEW NORTH END MERIDIAN DENTAL CLINIC AMERICAN ACADEMY OF PEDIATRICS 141 NORTHWEST POINT BLVD ELK GROVE IL 60007 362275597 501(c)(3) 50000 NATIONAL FLUORIDATION CAMPAIGN MEDICAL TERMS INTERNATIONAL 9680 153RD AVE NW REDMOND WA 98052 930878944 501(c)(3) 180000 MAINTAIN ACCESS BY PURCHASING EQUIPMENT FOR NEW NORTH END MERIDIAN DENTAL CLINIC. DENTAQUEST FOUNDATION 465 MEDFORD ST BOSTON MA 02129 043265080 501(c)(3) 200000 ENGAGEMENT OF PRIMARY CARE PHYSICIANS IN DELIVERY OF ORAL HEALTH SERVICES. PUGET SOUND CHRISTIAN CLINIC 2150 NORTH 122ND STREET SEATTLE WA 98133 331052418 501(c)(3) 150000 EQUIPMENT FOR LYNWOOD CLINIC INTERFAITH COMMUNITY HEALTH CENTER 220 UNITY STREET BELLINGHAM WA 98225 911202013 501(c)(3) 300000 RENOVATE AN OFFICIAL SUITE INTO A 12 OPERATORY DENTAL CLINIC INTERNATIONAL COMMUNITY HEALTH SERVICES 720 8TH AVE S 2ND FLOOR SEATTLE WA 98104 910947084 501(c)(3) 150000 ICHS REQUESTED AN ADDITIONAL $150,000 FOR THE NEW 10 CHAIR DENTAL CLINIC WITHIN THEIR SHORELINE CLINIC WHICH OPENED IN SEPTEMBER 2014 COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY 2722 COLBY EVERETT WA 98201 911255170 501(c)(3) 99317 EXPAND THE LYNNWOOD CLINIC VOLUNTEERS IN MEDICINE OF THE OLYMPICS CLINIC 819 GEORGIANA ST PORT ANGELES WA 98362 010590704 501(c)(3) 54500 THIRD YEAR ABCD PROGRAM IN CLALLAM/JEFFERSON COUNTIES NATIONAL NETWORK FOR ORAL HEALTH ACCESS 181 E 56TH AVE STE 501 DENVER CO 80216 841186592 501(c)(3) 25000 UNDERWRITING COSTS OF THE NOHLI PARTICIPANTS DEPARTMENT OF SOCIAL AND HEALTH SERVICES PO BOX 45842 OLYMPIA WA 98504 916001088 WA STATE 16000 FLUORIDATION TRANING GRANTS TO WATER SYSTEMS EDUCATIONAL SERVICES DISTRICT 123 33 SOUTH 2ND AVE YAKIMA WA 98902 910919927 WA STATE 30000 SOUTHEAST EARLY LEARNING COALITION AND ABCD PARTNERSHIP - YEAR ONE EDUCATIONAL SERVICE DISTRICT 114 105 NATIONAL AVE N BREMERTON WA 98312 753214740 WA STATE 30000 EARLY LEARNING COALITION AND ABCD PARTNERSHIP WASHINGTON STATE DEPARTMENT OF EARLY LEARNING PO BOX 40970 TACOMA WA 98504 753214740 WA STATE 10000 ONLINE TRAINING FOR CHILD CARE PROVIDERS DEPARTMENT OF HEALTH PO BOX 40709 OLYMPIA WA 98504 911444603 WA STATE 34327 2015 WASHINGTON STATE SMILE SURVEY WASHINGTON STATE EARLY LEARNING FUND 1218 THIRD AVE 800 SEATTLE WA 98101 911444603 WA STATE 20000 STATE HOME VISITING MATCH FUND TO EXPAND HOME VISITING PROGRAM'S FOR WASHINGTON'S YOUNGEST CHILDREN 21 0 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 X true true false true false false false false false DWYER JAMES D PRESIDENT & CEO 620536 0 565000 0 36656 0 158000 0 20513 0 1400705 0 0 0 BERG BRADLEY A COO & CFO 368550 0 200794 0 9344 0 125262 0 21966 0 725916 0 0 0 INGE RONALD E FMR VP, DENTAL DIRECTOR & PR 345959 0 191845 0 8765 0 43495 0 9328 0 599392 0 0 0 MERLO KRISTIN N CHIEF MKTG, INFO & SALES OFF 354418 0 135648 0 8455 0 96474 0 27692 0 622687 0 0 0 WEBBER SUSAN S FORMER CHIEF HR OFFICER 99741 0 121439 0 172294 0 49319 0 5602 0 448395 0 64825 0 GATES THOMAS A VP, PLANNING & CORP DEVEL 261712 0 131539 0 6454 0 74960 0 25658 0 500323 0 0 0 SMITH LAURA J WDS FDN, PRESIDENT & CEO 221916 0 106636 0 14205 0 58000 0 7814 0 408571 0 0 0 CHITTOOR VENKATARAMAN FORMER CIO 35014 0 130503 0 132341 0 19923 0 1995 0 319776 0 0 0 LO ERIC C VP, ACTUARIAL & UNDERWRITING 176117 0 82487 0 8260 0 54935 0 8565 0 330364 0 0 0 SNYDER CINDY K VP, INNOV. SVCS & PROVIDER REL 169032 0 33594 0 -741 0 27045 0 16509 0 245439 0 0 0 BURSETT JOHN T SR VP, UNDERWRITING/ACTUARIAL 194464 0 40559 0 -1500 0 38893 0 15008 0 287424 0 0 0 LAY LINDA T DIRECTOR, SALES ACCT. MGMT 167769 0 132141 0 -2319 0 30922 0 15464 0 343977 0 0 0 SCHOBER DEBRA F SENIOR SALES EXECUTIVE 95406 0 169617 0 -2927 0 17173 0 16499 0 295768 0 0 0 CURHAN SUSAN L DIRECTOR MKTG, PRODUCTION MGMT 164865 0 35757 0 -2171 0 36189 0 20576 0 255216 0 0 0 DOSCH KYLE P DENTAL DIRECTOR 161912 0 32445 0 -498 0 30453 0 10201 0 234513 0 0 0 LABBERTON WELLS K DIRECTOR 64201 0 0 0 211732 0 0 0 0 0 275933 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 INCENTIVE AWARDS AND AN EXECUTIVE AUTO STIPEND PAID TO CERTAIN EMPLOYEES. BOARD MEMBERS RECEIVE A GROSS-UP PAYMENT 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 2014 WERE AS FOLLOWS: BRADLEY BERG, CHIEF OPERATING AND FINANCIAL OFFICER, $67,262; KRISTIN MERLO, CHIEF MARKETING, INFORMATION AND SALES OFFICER, $43,974; THOMAS GATES, VP PLANNING AND CORPORATE DEVELOPMENT, $39,960; SUSAN WEBBER, FORMER CHIEF HUMAN RESOURCES OFFICER, $31,477; ERIC LO, VP UNDERWRITING/ACTUARIAL, $5,791. THE 457(B) PLAN HAD TOTAL ASSETS OF $635,015 AT DECEMBER 31, 2014. 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 2014. THE 457(F) PLAN HAD TOTAL ASSETS OF $154,425 AT DECEMBER 31, 2014. 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 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. SCHEDULE J, PART I, LINE 4A FORM 990, PART VII, SECTION A INCLUDES SEVERANCE PAID TO TWO FORMER EMPLOYEES. SUSAN WEBBER AND VENKATARAMAN CHITTOOR WERE PAID $169,110 AND $131,250, RESPECTIVELY. SCHEDULE J, PART I, LINE 5A FORM 990, PART VII, SECTION A INCLUDES SALES COMMISSION PAID TO TWO EMPLOYEES BASED ON NEW SUBSCRIBERS ACQUIRED. 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 JULY 16, 2014, DELTA DENTAL OF WASHINGTON (DDWA) DISTRIBUTED $18,800,000 IN CASH TO ITS SOLE MEMBER WASHINGTON DENTAL SERVICE (WDS). ON JULY 23, 2014, THE DDWA BOARD OF DIRECTORS APPROVED, SUBJECT TO OFFICE OF THE INSURANCE COMMISSIONER (OIC) REVIEW, AN EXTRAORDINARY DISTRIBUTION OF DDWA'S SUBSIDIARIES, WDS HOLDINGS LLC, THE INSTITUTE OF ORAL HEALTH, AND AN INVESTMENT C3 JIAN FROM DDWA TO WDS THAT WAS VALUED AT APPROXIMATELY $22,630,000. ON AUGUST 6, 2014, THE OIC APPROVED THE DISTRIBUTION REQUEST. ON SEPTEMBER 4, 2014, DDWA MADE THE DISTRIBUTION TO WDS VALUED AT $22,490,000. FORM 990, PART III, LINE 4A DDWA PROVIDES DENTAL INSURANCE FOR OVER 2,492,000 MEMBERS 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 OVER 4,300 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 2014, DDWA PROCESSED OVER 5,400,000 CLAIMS FOR MEMBERS AND THEIR DEPENDENTS. TO ENSURE PROVIDERS ARE SUBMITTING CLAIMS APPROPRIATELY, WE AUDITED OVER 30,000 INDIVIDUAL CLAIMS, THE RESULTS OF WHICH INCLUDE THE 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 BENEFITS OF ORAL HEALTH THROUGH MARKETING EFFORTS IN PRINT, DIRECT MAIL, TV, RADIO, ONLINE MEDIA AND EVENT SPONSORSHIPS. IN 2014, THE MARKETING AND ADVERTISING CAMPAIGN CONTINUED TO REACH OUT TO NEW AUDIENCES VIA PROMOTIONAL SPONSORSHIPS IN AN ATTEMPT TO PROMOTE THE BENEFITS OF GOOD ORAL HEALTH IN A MORE DIRECT AND INTERACTIVE WAY. 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 THEIR WORK SPECIFICALLY ON YOUNG 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 - MEDICAID-ENROLLED CHILDREN UP TO AGE SIX. IN COUNTIES WITH ABCD, THE UTILIZATION OF DENTAL SERVICES INCREASED FROM 20% TO 51% FROM 1997 TO 2014. 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. 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 III, LINE 4D 1. DDWA IS ENGAGED IN EFFORTS TO PROMOTE EVIDENCED BASED DENTAL CARE THROUGH THE INSTITUTE OF ORAL HEALTH (IOH), A NON-PROFIT WHOLLY OWNED SUBSIDIARY OF DDWA THROUGH SEPTEMBER 4, 2014 WHEN THE IOH WAS DISTRIBUTED TO DDWA'S PARENT COMPANY WASHINGTON DENTAL SERVICE. THE PURPOSE OF THE IOH IS TO EDUCATE DENTAL PROVIDERS THROUGHOUT THE COUNTRY ON THE LATEST RESEARCH RELATED TO ORAL HEALTH, AND CORRELATIONS BETWEEN ORAL HEALTH AND OVERALL HEALTH. THE IOH CONDUCTS AN ANNUAL CONFERENCE NATIONALLY THAT HAS ATTRACTED HUNDREDS OF PROVIDERS. 2. 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. 3. 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. 4. 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 INCLUDEING, BUT NOT LIMITED TO, RACE, COLOR, RELIGION, CREED, AGE, SEX, SEXUAL ORIENTATION OR NATIONAL ORIGIN. 5. 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. 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 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 MEMBERS. 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, EACH COVERED PERSON IS REQUIRED TO SIGN A STATEMENT AFFIRMING THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE CONFLICTS 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. 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 REASONABLE COMPENSATION PACKAGES FOR EACH OFFICER AND KEY EMPLOYEE (INCLUDING THE CEO AND CFO/COO). 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 XI, LINE 9 DISTRIBUTION TO ITS SOLE MEMBER WASHINGTON DENTAL SERVICE: 41,290,010 FORM 990, PART VII, SECTION A, LINE 1A THE FOLLOWING DIRECTORS ALSO RECEIVED CLINICAL REIMBURSEMENTS ADDITIONAL TO THEIR DIRECTOR'S FEES REPORTED IN COLUMN D - REPORTABLE COMPENSATION FROM THE ORGANIZATION. BRANCH, DAVID W. - $135,252 --------------------------- DIRECTOR FEE - $62,983 CLINICAL REIMBURSEMENT - $72,269 LABBERTON, WELLS, K. - $275,933 ------------------------------- DIRECTOR FEE - $64,201 CLINICAL REIMBURSEMENT - $211,732 WASHINGTON DENTAL SERVICE FUND 9706 4TH AVE NE SEATTLE WA 98115 911281990 EDUCATION WA 501(c)(3) 9 DDWA true WASHINGTON DENTAL SERVICE FOUNDATION 9706 4TH AVE NE SEATTLE WA 98115 910621480 EDUCATION WA 501(c)(4) 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 41290010 CASH/INVESTMENT WASHINGTON DENTAL SERVICE O 131613 CASH WASHINGTON DENTAL SERVICE Q 14400 SHARED SERVICES