2014-07-30T19:25:25-07:00 2013-12-31 990 2013-01-01 910621480 Delta Dental of Washington DELT 2065221300 9706 4th Ave NE Seattle WA 98115 Bradley A Berg CFO & COO 2065282340 2014-07-31 2013 2015-11-30 17:44:51Z Bradley A Berg 9706 4th Ave NE Seattle WA 98115 1084477896 0 X www.deltadentalwa.com X 1954 WA Delta Dental of Washington (DDWA) will revolutionize the oral health industry and improve overall health. 12 7 392 0 0 0 29355 18932 960572322 1012247971 5545830 10233517 787412 630289 966934919 1023130709 1855929 2817976 872239309 921250711 36217291 38427111 0 0 0 36673445 44387862 946985974 1006883660 19948945 16247049 256524052 264323604 50215555 48592063 206308497 215731541 DDWA will revolutionize the oral health industry and improve overall health. This includes, but is not limited to, the following: to secure dental services 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. 0 0 951353955 0 1011850565 DDWA provides dental insurance for over 2,365,000 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 over 4,000 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 2013, DDWA processed over 5,175,000 claims for subscribers and their dependents. To ensure providers are submitting claims appropriately, we audited nearly 42,000 individual claims, the results of which include education of dental office staff on the use of CDT codes, invoicing procedures and reducing common errors. 2432266 1009014 0 DDWA promotes the benefits of oral health through marketing efforts in print, direct mail, TV, radio, online media and event sponsorships. In 2013, 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. 1699434 1699434 0 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 - to Medicaid-enrolled children up to age six. In counties with ABCD, the utilization of dental services increased from 21% to 51% from 1997 to 2013. 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. 530924 0 0 DDWA is engaged in efforts to promote evidenced based dental care through the Institute for Oral Health (IOH), a non-profit wholly owned subsidiary of DDWA. 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. 132000 109528 0 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, the Foundation's work in local communities has increased access to fluoridated water to more than 208,000 Washington residents. 515931 0 105546 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 Smile Mobile, a mobile dental facility traveling to underserved areas of the state. The Smile Mobile has delivered dental care to more than 30,000 children state-wide. Volunteer time is also spent handing out flyers promoting oral health to Washington citizens at fairs, the zoo, parades, and events across the state. 160542 0 0 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. 826000 0 0 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. 2165397 109528 105546 957651052 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 45299 0 1 392 1 0 0 0 0 0 0 X 12 7 0 0 1 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WA X Bradley Berg 2065221300 9706 4th Avenue NE Seattle WA 981152157 X Dr G Douglas Beck Board of Directors - Vice Chair 10 0.5 X X 67428 0 0 Dr David W Branch Board of Directors 10 0.5 X 59324 0 0 Dr David W Branch - Dental Claims Clinical reimbursement 0 0 X 258894 0 0 Mr Patrick J Dineen Board of Directors - Treasurer 7 0 X X 48880 0 0 Ms Janis L Harwell Board of Directors 7.0 0 X 53880 0 0 Ms Anne Farrell Board of Directors 5 0 X 0 0 0 Ms Joanna L Lohkamp Board of Directors - Chair 12.0 0.5 X X 80708 0 0 Dr Jack E Neal Board of Directors - Secretary 6.0 0 X X 44808 0 0 Dr Gerald Phipps Board of Directors / Board of Trustees 15 0.5 X 60396 0 0 Mr Allen W Puckett Board of Directors 5.0 0 X 46808 0 0 Ms Kristin Stred Board of Directors 5.0 0 X 53880 0 0 Mr James F Tune Board of Directors 8.0 0 X 47808 0 0 W Kurt Labberton - Dental Claims Clinical reimbursement 0 0 X 214364 0 0 James Daniel Dwyer President & Chief Executive Officer 40 0 X X X 1163101 0 78109 Ronald Edward Inge VP, Dental Director & Prof. Relations 40 0 X 1089971 0 129454 Bradley Alan Berg Chief Operating & Financial Officer 40 0 X 549273 0 143224 Venkataraman Chittoor Chief Information Officer 40 0 X 447790 0 134601 Kristin Nielsen Merlo Chief Marketing Officer, VP Sales 40 0 X 427845 0 125632 Thomas Andrew Gates VP, Planning & Corp. Development 40 0 X 424321 0 102084 Susan Siclari Webber Chief Human Resources Officer 40 0 X 400314 0 103270 Eric Che-Teh Lo VP Actuarial & Underwriting 40 0 X 278816 0 63277 Laura Jean Smith WDS Foundation, President & CEO 40 0 X 320349 0 60526 John Theodore Bursett Senior VP, Underwriting/Actuarial 32 0 X 295932 0 53519 James Christopher Darnell Director of Sales 40 0 X 240476 0 53782 Linda Jo Lay Director - Account Management 40 0 X 230166 0 46598 Susan Lisa Curhan Director Marketing & Product Mgmt. 40 0 X 208130 0 51954 7113662 0 1146030 82 0 1 0 Emdeon Business Services PO BOX 572490 Murray UT 841572490 Printing/mailing services 3262031 GreenRubino Inc 1938 Fairview Ave E Seattle WA 98102 Advertising agency 2930933 DeCare Systems Unit 1 Curraheen Rd Cork Ireland EI Software Development 2572626 Presidio Networked Solutions 7601 Ora Glen Drive Ste 100 Greenbelt MD 20770 Network Infrastructure 1558562 Aon Consulting Inc PO Box 905494 Charlotte NC 282905494 Insurance broker 1350638 73 0 0 0 11700 0 7232 0 18932 Premium Revenue 524114 1011850565 1011850565 0 0 Smilemobile (Mobile Dentist Office) 621990 105456 105456 0 0 Other Program Service Revenue 900099 291950 291950 0 0 0 0 0 0 1012247971 6213677 6213677 0 0 288026 288026 0 0 0 0 0 0 630289 0 0 0 630289 0 630289 0 0 630289 65079001 0 60200900 1146287 4878101 -1146287 3731814 3731814 0 0 0 0 0 0 0 0 1023130709 1022481488 0 630289 2817976 2817976 0 0 0 0 921250711 921250711 6759466 3156609 3602857 0 0 0 0 0 22861499 8047480 14814019 0 1438915 491618 947297 5117411 2009316 3108095 2249820 946900 1302920 0 0 0 0 712355 26718 685637 0 289232 0 289232 73255 73255 0 0 0 0 636914 0 636914 0 7158580 2355614 4802966 0 4462809 2432266 2030543 0 5214245 3095342 2118903 0 2736854 263149 2473705 0 0 0 0 0 1800733 777944 1022789 0 1456270 504708 951562 0 0 0 0 0 818474 253564 564910 0 0 0 0 0 0 0 0 0 4246207 38053 4208154 0 230117 0 230117 0 Commissions 7819528 7819528 0 0 Taxes & service charges 5296312 1135445 4160867 0 Research & development 233742 0 233742 0 Dues & subscriptions 684539 77888 606651 0 517696 76968 440728 0 1006883660 957651052 49232608 0 -12598875 -12060969 39572792 42521769 16841663 12989640 70000 100000 2154361 2672736 57384135 41286386 14481144 16097749 192392677 200641797 585523 341970 3024767 1018912 256524052 264323604 45790243 44602557 270338 255482 4154974 3734024 50215555 48592063 X 206308497 215731541 0 0 0 0 206308497 215731541 256524052 264323604 X 16247049 -4671818 0 0 0 -2152187 X 0 1 X 1 0 124850 0 0 124850 124850 1 Friends of Derek Stanford PO Box 2041 Bothell WA 98041 272317624 900 0 Committee to Elect JT Wilcox PO Box 747 McKenna WA 98558 270758934 900 0 Friends of Marcus Riccelli PO Box 1325 Spokane WA 99210 455222828 900 0 People for Timm Ormsby PO Box 2177 Spokane WA 99210 550876251 900 0 Citizens for Chad Magendanz PO Box 1362 Issaquah WA 98027 611679658 500 0 Friends for Jay Rodne PO Box 2848 Issaquah WA 98027 201125805 900 0 Committee to Elect Kevin Parker PO Box 198 Spokane WA 99210 260348064 900 0 Citizens for Michael Baumgartner PO Box 48237 Spokane WA 99228 271747900 900 0 Committee to Elect Joel Kretz 1014 Toroda Creek Rd Wauconda WA 98859 272630585 900 0 Shelly for State 127 N Wynne St Colville WA 99114 680674661 900 0 Friends of John Smith PO Box 183 Colville WA 98114 461660411 1700 0 Committee to Elect Larry Haler 1860 McMurray Ave Richland WA 99354 201624033 900 0 Friends of Sharon Brown 4309 W 27th Place Ste 103 Kennewick WA 99338 462639382 1700 0 Friends of Susan Fagan PO Box 1471 Pullman WA 99163 264513295 900 0 People for Joe Schmick PO Box 620 Colfax WA 99111 450582705 900 0 People for Zack Hudgins 4512 South 136th St Tukwila WA 98168 810555017 900 0 Committee to Elect Cary Condotta PO Box 3001 Wenatchee WA 98807 710896890 900 0 Committee to RE-Elect Janea Holmquist PO Box 429 Moses Lake WA 98837 800435914 900 0 Norm Johnson for State Representative 55 west Washington Ave Ste 33 Yakima WA 98903 800190629 900 0 Committee to RE-Elect Charles Ross PO Box 996 Naches WA 98937 263352534 900 0 Bruce Chandler Campaign PO Box 1108 Zillah WA 98953 912066326 900 0 Committee to Elect James Honeyford PO BOx 844 Sunnyside WA 98944 911561953 900 0 Committee to Elect Terry Nealey PO Box 7 Dayton WA 99328 262195116 900 0 Campaign to Elect Paul Harris 1916 SE 130th Ave Vancouver WA 98683 272531536 900 0 Friends to Elect Liz Pike PO Box 662 Camas WA 98607 454280048 900 0 Committee to Elect Brandon Vick PO Box 1434 Battle Ground WA 98604 271915545 900 0 Committee to Elect Brian Blake PO Box 1541 Longview WA 98632 870699800 900 0 Committee to Re-Elect Ed Orcutt PO Box 1280 Kalama WA 98625 900038949 900 0 Samuel Hunt for State Representative PO Box 2573 Olympia WA 98507 900642727 900 0 Friends of Chris Reykdal 855 Trosper Rd Ste 108-177 Tumwater WA 98512 271751460 900 0 Committee to Elect Drew Hansen PO Box 2140 Poulsbo WA 98370 453489418 900 0 Committee to Elect Kevin Van De Wege 10 Sable Court Sequim WA 98382 200522366 900 0 Tharinger for State Representative PO Box 834 Sequim WA 98382 272555702 900 0 Committee to Elect Dawn Morrell 2106 Manorwood Dr SE Puyallup WA 98374 010679962 900 0 Friends of Hans Zeiger PO Box 73303 Puyallup WA 98373 270422184 500 0 Citizens to Elect Larry Seaquist PO Box 821 Gif Harbor WA 98335 204220154 900 0 Jan Angel for State Senate 5184 Granada Place SE Port Orchard WA 98367 461415980 1700 0 Friends of Laurie Jinkins PO Box 2032 Tacoma WA 98401 272214467 900 0 Committee to Elect Tamara Green 10316 93rd St SW Tacoma WA 98498 602632403 900 0 Friends of Steve O'Ban PO Box 65335 University Place WA 98464 271992105 900 0 Voters for Dick Muri PO Box 1581 Tacoma WA 98401 911975610 900 0 Friends of David Sawyer 1002 South 94th St Tacoma WA 98444 453660584 500 0 Citizens to Elect Steve Conway PO Box 112020 Tacoma WA 98411 010735404 900 0 Steve Kirby Campaign 9415 Tacoma Ave So Tacoma WA 98444 711000906 900 0 Committee to Elect Linda Kochmar 30333 1st Ave So Federal Way WA 98023 911826508 900 0 Citizens for Christopher Hurst 62504 Indian Summer Way E Enumclaw WA 98022 010841227 900 0 Committee to Elect Cathy Dahlquist 1348 Florence St Enumclaw WA 98022 272819445 900 0 Citizens for Pam Roach PO Box 682 Auburn WA 98071 263590667 900 0 Citizens for Ruth Kagi 19553 35th NE Lake Forest Park WA 98155 911914967 900 0 Firends for Cindy Ryu PO Box 33548 Seattle WA 98133 202771557 900 0 Friends of Karen Keiser PO Box 13290 Des Moines WA 98198 911947669 900 0 Committee to Elect Eileen Cody 6714 38th Ave SW Seattle WA 98126 911646573 900 0 Friends of Joe Fitzgibbon PO Box 66591 Burien WA 98166 272265718 900 0 Friends of Sharon Nelson 7318 SW 258th Pl Vashon WA 98070 261377785 900 0 Committee To Re-Elect Kathy Haigh 87 E Walker Park Rd Shelton WA 98584 299527931 900 0 Timothy Sheldon PO Box G Hoodsport WA 98548 203465831 900 0 Committee To Elect Drew C MacEwen PO Box 651 Union WA 98592 364732450 900 0 Friends of Reuven Carlyle PO Box 9100 Seattle WA 98109 261852908 900 0 Friends of Gael PO Box 9100 Seattle WA 98109 371666948 500 0 Jeanne Kohl-Welles 2212 Queen Anne Ave S PMB 256 Seattle WA 98109 911559456 900 0 Friends to Elect Eric Pettigrew PO Box 28660 Seattle WA 98118 534801080 900 0 Friends of Santos PO Box 78606 Seattle WA 98178 911913482 900 0 Friends for Dan Kristiansen PO Box 2007 Snohomish WA 98291 912064816 900 0 Kristine Lytton Campaign 10074 Commercial Ave PMB 349 Anacortes WA 98221 272056758 900 0 Judy Clibborn for State Representative PO Box 808 Mercer Island WA 98040 010649609 900 0 Citizens for Vincent Buys PO Box 25 Lynden WA 98264 271476576 900 0 Citizens to Elect Jason Overstreet PO Box 1203 Blaine WA 98231 272221211 500 0 Committee to Elect Doug Ericksen PO Box 748 Ferndale WA 98248 820553277 900 0 Citizens for Frank Chopp 1000 Aurora Ave N Ste 100 Seattle WA 98109 320020852 900 0 People for Pedersen 815 First Ave Ste 111 Seattle WA 98104 203979617 900 0 Committee to Elect Steve Hobbs 3309 114th Drive NE Lake Stevens WA 98258 204733784 1800 0 Committee to Elect Larry Springer 700 20th Ave W Kirkland WA 98033 830382872 900 0 Friends of Roger Goodman 218 Main St PMB 763 Kirkland WA 98033 830458254 900 0 Citizens for Andy Hill 23515 NE Novelty Hill Rd Ste B211 1 Kirkland WA 98053 272057163 1800 0 Gerry Pollet for State Representative 7750 17th Ave NE Seattle WA 98115 800147715 900 0 Re-Elect Pat Sullivan Campaign 26513 168th Pl SE Covington WA 98042 043679431 900 0 Hargrove for House PO Box 7341 Covington WA 98042 261973735 500 0 Friends of Joe Fain PO Box 7809 Covington WA 98042 271654871 1800 0 Friends of Ross Hunter PO Box 4204 Bellevue WA 98009 043645222 900 0 Friends of Cyrus 929 109th Ave NE Bellevue WA 98004 900791775 900 0 Rodney Tom for State Senate PO Box 594 Medina WA 98039 571234123 1800 0 Committee to Elect Jim Moeller 1701 Broadway Ste 328 Vancouver WA 98663 450476516 900 0 House Democratic Campaign Committee 1000 Aurora Ave N Ste 100 Seattle WA 98109 916178946 900 0 The Kennedy Fund 3518 Fremont Ave NW Ste 545 Seattle WA 98103 462745811 5000 0 Senate Democratic Campaign Committee PO Box 45042 Seattle WA 98145 916163985 900 0 Harry Truman Fund PO Box 9100 Seattle WA 98109 911769570 5000 0 Citizens to Re-Elect Brad Owen Lt Governor PO Box 1426 Seattle WA 98584 760843646 500 0 People for Randy Dorn 2607 Mayes Rd SE Lacey WA 98503 611561950 500 0 WA St Democrats PO Box 4027 Seattle WA 98194 911135732 2500 0 Jay Inslee for Washington PO Box 21067 Seattle WA 98111 452533952 1000 0 Friends of Bob Ferguson PO Box 2405 Seattle WA 98111 010699595 500 0 House Republican Organizational Committee PO Box 7222 Olympia WA 98507 916177625 900 0 The Leadership Council PO Box 11025 Olympia WA 98508 911714860 10000 0 Reagan Fund PO Box 904 Olympia WA 98507 911716818 10000 0 Senate Republican Campaign Committee PO Box 11025 Olympia WA 98508 910987396 900 0 WA St Republicans 11811 NE 1st St Ste A306 Bellevue WA 98005 910486656 2500 0 Troy Kelley 2521 Fremont St Tacoma WA 98406 203888484 1000 0 Friends of Courtney Gregoire 603 Stewart St Ste 819 Seattle WA 98101 462279223 2300 0 Friends of Stephanie Bowman PO Box 23011 Seattle WA 98102 462755282 1800 0 Ed Murray for Mayor 3518 Fremont Avenue N Seattle WA 98103 461489838 1400 0 Michael Wolfe for Port 2518 S Brandon Ct Seattle WA 98108 462029973 250 0 Friends of Dow Constantine 603 Stewart Street Suite 819 Seattle WA 98101 264389886 900 0 Citizens to Re-Elect Dave Somers PO Box 1082 Snohomish WA 98290 912115935 500 0 Citizens for John Creighton 6619 132nd Ave NE PMB 18 Kirkland WA 98033 462047173 1800 0 Committee to Elect Matt Manweller 110 W 6th Avenue PMB 392 Ellensburg WA 98926 454883829 900 0 Committee to Elect Dave Taylor 1661 Beane Road Moxee WA 98936 264761911 900 0 Committee to Elect Mary Helen Roberts Return of 2010 contribution - no EIN available 3924 149th Pl SW Lynnwood WA 98087 123456789 -500 0 Maureen Walsh Return of 2011 contribution - no EIN available PO Box 461 Walla Walla WA 99362 123456789 -800 0 Schedule 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 1211191 1211191 0 11022176 8049947 2972229 0 1191527 656303 535224 0 9766165 8679589 1086576 0 34193076 23900547 10292529 16097749 1 Rural Resources Community Action 956 South Main Street Ste A Colville WA 99114 910793447 501c3 32196 Third Year ABCD Program Volunteers in Medicine of the Olympics Clinic (VIMO) 909 Georgiana Port Angeles WA 98362 010590704 501c3 55000 Second Year ABCD Program in Clallam/Jefferson Counties DentaQuest Foundation 465 Medford Street Boston MA 02129 043265080 501c3 100000 Engagement of primary care physicians in delivery of oral health services Empire Health Foundation 111 North Post Street Ste 301 Spokane WA 99201 263375286 501c3 38000 Better Health Tomorrow ER Diversion Project Empire Health Foundation 111 North Post Street Ste 301 Spokane WA 99201 263375286 501c3 12000 Oral Health Leadership Coordinator position Washington Early Learning Fund 1218 Third Avenue Seattle WA 98101 912041837 501c3 45000 Yearly Thrive by Five funding Washington Early Learning Fund 1218 Third Avenue Seattle WA 98101 912041837 501c3 20000 State Home Visiting Match Fund to expand home visiting programs for Washington's young children HealthPoint 955 Powell Ave SW Renton WA 98057 910884412 501c3 300000 Dental equipment for Midway Clinic International Community Health Services 720 8th Ave S 2nd floor Seattle WA 98104 910947084 501c3 120000 Equipment InterID dental clinic NE Washington Health Programs 509 East Main Avenue Chewelah WA 99109 911053847 501c3 377888 Equipment upgrade for Colville Clinic NE Washington Health Programs 509 East Main Avenue Chewelah WA 99109 911053847 501c3 206112 Equipment upgrade for three clinics Smile Partners 8112 Grand Ave NE Bainbridge Island WA 98110 200381039 501c3 12500 Portable dental equipment for mobile program SonBridge Dental Clinic 1200 SE 12th St College Place WA 99324 202958334 501c3 81500 Capital expenses and start-up costs Empire Health Foundation 111 North Post Street Ste 301 Spokane WA 99201 263375286 501c3 5250 Oral health project consultant Healthy Kids Healthy Portland PAC 2419 NE Sandy Blvd Portland OR 97232 461743058 20000 Additional fluoridation support for Portland Healthy Kids Healthy Portland PAC 2419 NE Sandy Blvd Portland OR 97232 461743058 50000 Fluoridation support for Portland PEW Charitable Trust 901 E Street NW 10th Floor Washington DC 20004 562307147 501c3 50000 Campaign for Dental Health Washington Association of Community & Migrant Health Centers (WACMHC) 510 Plum Street SE Ste 101 Olympia WA 98501 911323282 501c3 89341 Funding for the Community Health Center Directors Collaborative Whatcom Alliance for Healthcare Access 800 East Chestnut Street Ste 2 Bellingham WA 98225 810677295 501c3 164175 Dental/Medical collaboration referral services Whatcom Alliance for Healthcare Access 800 East Chestnut Street Ste 2 Bellingham WA 98225 810677295 501c3 30000 Engaging a health care delivery system in Whatcom County for the purpose of establishing a dental/medical collaboration project. 14 1 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 1 1 X X X X X 0 1 0 0 0 0 0 0 0 James Daniel Dwyer President & Chief Executive Officer 603086 0 545000 0 15015 0 73630 0 21979 0 1258710 0 0 0 Ronald Edward Inge VP, Dental Director & Prof. Relations 360245 0 255557 0 474169 0 108101 0 21353 0 1219425 0 500323 0 Bradley Alan Berg Chief Operating & Financial Officer 340875 0 197038 0 11360 0 119762 0 23462 0 692497 0 0 0 Venkataraman Chittoor Chief Information Officer 262212 0 182427 0 3151 0 108213 0 26388 0 582391 0 0 0 Kristin Nielsen Merlo Chief Marketing Officer, VP Sales 250045 0 169904 0 7896 0 96474 0 29158 0 553477 0 0 0 Thomas Andrew Gates VP, Planning & Corp. Development 247003 0 170429 0 6889 0 74960 0 27124 0 526405 0 0 0 Susan Siclari Webber Chief Human Resources Officer 232382 0 157795 0 10137 0 83977 0 19293 0 503584 0 0 0 Laura Jean Smith WDS Foundation, President & CEO 198387 0 110536 0 11426 0 50871 0 9655 0 380875 0 0 0 John Theodore Bursett Senior VP, Underwriting/Actuarial 190151 0 109302 0 -3520 0 38030 0 15488 0 349451 0 0 0 Eric Che-Teh Lo VP Actuarial & Underwriting 160909 0 109477 0 8429 0 53664 0 9614 0 342093 0 0 0 Dr David W Branch Board of Directors 59324 0 0 0 258894 0 0 0 0 0 318218 0 0 0 James Christopher Darnell Director of Sales 160797 0 81680 0 -2001 0 27857 0 25925 0 294258 0 0 0 Linda Jo Lay Director - Account Management 156308 0 75960 0 -2102 0 29604 0 16994 0 276764 0 0 0 Susan Lisa Curhan Director Marketing & Product Mgmt. 153797 0 56597 0 -2264 0 29804 0 22150 0 260084 0 0 0 Schedule J, Part I, Line 1a DDWA at times 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 or more hours a week, with a maximum payable of $40/month, or $480 a year, and 25% of approved expenses for part-time employees working 20 to 30 hours a week with a maximum payable of $20/month, or $240 a 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. Schedule J, Part I, Line 3 The Human Resources and Compensation Committee of the Board of Directors engages an external consultant to evaluate all key employees, including President and CEO, COO/CFO, VP Underwriting/Actuarial, CIO, CMO and VP Sales, VP of Planning and Corporate Development, Chief Human Resources Officer, and VP Dental Director & Professional Relations compensation in comparison to the practice of similar employers in the marketplace. This process is conducted on an annual basis. Schedule J, Part I, Line 4 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 2013 were as follows: Bradley Berg, Chief Operating and Financial Officer, $67,262; Dr Ronald E Inge, VP & Dental Director, $55,601; Eric Lo, VP Underwriting/Actuarial, $5,791; Thomas Gates, VP Planning and Corporate Development, $39,960; Venkataraman Chittor, CIO, $55,713; Susan Webber, Chief Human Resources Officer, $31,477; Kristin Merlo, Chief Marketing Officer and VP Sales, $43,974. In January 2013, the Company established 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 $38,630 to the plan for 2013. The plan had total assets of $43,017 at December 31, 2013. Schedule J, Part I, Line 6 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. Form 990, Part VI, Section A, Line 4 Based on a hearing held on May 9, 2013, approval was granted by the Washington State Office of the Insurance Commissioner (OIC) for the establishment of Washington Dental Service (WDS) as the parent holding company of DDWA, a dental benefits provider. DDWA and its affiliates, the Foundation, Institute for Oral Health, and WDS Holdings, LLC became wholly-owned and/or controlled affiliates of WDS on May 17, 2013. The restructuring is related to entities under common control. The restructuring also resulted in changes to the bylaws of DDWA. 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 WDS Board of Directors solicits advice on candidates and submits nominees to the WDS Board for consideration and approval to be voted upon. The entire WDS 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 WDS Board from nominees by the GNC. The MAP provides consultation to the GNC and DDWA 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 Form 990 is completed by the accounting staff. The Form 990 and supporting documentation is reviewed and approved by the Finance Manager, Director of Finance and the COO/CFO. An independent review is conducted by the Company's certified public accountants and Chairman of the Board and the Audit Committee of the Board of Directors. The Human Resources and Compensation Committee completes a review of the compensation information presented in the Form 990. Electronic copies of the Form 990 are provided to all Board members prior to submission to the IRS. Form 990, Part VI, Section B, Line 12c The 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 Conflicts 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, executive leadership and 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 are reviewed and any persons with actual or potential conflicts are informed via written communication. The procedures for addressing any conflict of interest includes, but is 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 if applicable; (5) any conflicting issues which cannot be resolved during the course of a Board meeting 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 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 each officer and key employee (including the CEO and 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 Governing documents, 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 OIC 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 Reportable compensation for board members David Branch and Kurt Labberton include compensation totaling $258,894 and $214,364, respectively, paid for dental treatment rendered to patients as a member dentist of DDWA. Form 990, Part XI, Line 9 $2,009,437 was contributed to Washington Dental Service (WDS) prior to re-organization. In addition, there was a $200,000 adjustment to investment in equity subsidiary relating to Healthentic. Lastly, there was a change in accumulated other comprehensive income of $88,844 and difference in 2013 Net Income relating to an other than temporary impairment of $31,594. Washington Dental Service Foundation LLC 9706 Fourth Ave NE Seattle WA 98115 910621480 Sponsor Oral Health Education WA 233373 4014175 Delta Dental of Washington Washington Dental Service Holdings LLC 9706 Fourth Ave NE Seattle WA 98115 910621480 Invest in Oral Health Activities WA -852215 13375345 Delta Dental of Washington Institute for Oral Health 9706 Fourth Ave NE Seattle WA 98115 910621480 Support Oral Health Education WA 0 193930 Delta Dental of Washington Washington Dental Service Fund 9706 Fourth Ave NE Seattle WA 98115 911281990 Sponsor Oral Health Education WA 501(c)(3) 9 Delta Dental of Washington 1 Washington Dental Service 9706 Fourth Ave NE Seattle WA 98115 270937829 Improving Oral Health WA 501(c)(4) N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Washington Dental Service Fund c 11700 Cash received from Washington Dental Service Fund to support dental care in underserved areas of Washington State through a program called the SmileMobile; a 40 foot modern dental clinic on wheels that has been serving children in need across Washington State since 1995. The SmileMobile was created to bring dental services - at little or no charge - directly to children who do not otherwise have access to dental care. Since it first hit the road, the mobile clinic has treated more than 30,000 children throughout the state.