DELTA DENTAL PLAN OF KANSAS INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
DELTA DENTAL PLAN OF KANSAS INC (EIN 48-0793267)
Tax period
2013-01-01 to 2013-12-31
Filed
2014-10-17
IRS object ID
201422909349300407
Schema version
2013v3.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2014-10-17T09:09:19-05:00ReturnTs
Tax Period End2013-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11551 N WATERFRONT PKWY STE 300AddressLine1
CityWICHITACity
StateKSState
ZIP Code672066601ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN480793267EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL OF KANSAS INCBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of% MICHAEL ELLISInCareOfNm
Business Name ControlDELTBusinessNameControlTxt
Phone3162641099PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11619 N WATERFRONT PARKWAYAddressLine1
Address Line2SuiteAddressLine2
CityWICHITACity
StateKSState
ZIP Code67206ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMICHAEL HERBERTPersonNm
Person TitleCFOPersonTitleTxt
Phone3162641099PhoneNum
Signature2014-11-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonELIZABETH S HOGANPreparerPersonNm
Phone3162652811PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerMICHAEL ELLISPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11619 N WATERFRONT PARKWAYAddressLine1
CityWICHITACity
StateKSState
ZIP Code67206ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$259,943,345GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressWWW.DELTADENTALKS.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1972FormationYr
Legal Domicile StateKSLegalDomicileStateCd
Activity Or MissionTO MAKE POSSIBLE AND FACILITATE A WIDER AND MORE TIMELY AVAILABILITY OF DENTAL CARE, THEREBY ADVANCING PUBLIC HEALTH AND DENTISTRY IN KANSAS, BY OPERATING A (SEE SCHEDULE O)ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee119TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$248,854,400PYProgramServiceRevenueAmt
CY Program Service Revenue$256,617,846CYProgramServiceRevenueAmt
PY Investment Income$1,778,840PYInvestmentIncomeAmt
CY Investment Income$1,375,500CYInvestmentIncomeAmt
PY Other Revenue$7,298PYOtherRevenueAmt
CY Other Revenue$7,725CYOtherRevenueAmt
PY Total Revenue$250,640,538PYTotalRevenueAmt
CY Total Revenue$258,001,071CYTotalRevenueAmt
PY Grants And Similar Paid$1,280,081PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$1,832,338CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$9,473,378PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$9,829,807CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$236,582,052PYOtherExpensesAmt
CY Other Expenses$242,309,351CYOtherExpensesAmt
PY Total Expenses$247,335,511PYTotalExpensesAmt
CY Total Expenses$253,971,496CYTotalExpensesAmt
PY Revenues Less Expenses$3,305,027PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$4,029,575CYRevenuesLessExpensesAmt
Total Assets BOY$60,258,514TotalAssetsBOYAmt
Total Assets EOY$65,878,612TotalAssetsEOYAmt
Total Liabilities BOY$13,644,258TotalLiabilitiesBOYAmt
Total Liabilities EOY$14,238,588TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$46,614,256NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$51,640,024NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionSEE SCHEDULE OMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$231,465,784ExpenseAmt
Revenue$248,570,172RevenueAmt
DescDENTAL BENEFITS (COVERED CHARGES) PROVIDED TO SUBSCRIBERS. DELTA DENTAL SERVED APPROXIMATELY 923,917 PEOPLE THIS YEAR.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$7,493,905ExpenseAmt
Revenue$8,047,674RevenueAmt
DescTHE PROCESSING OF DENTAL BENEFIT CLAIMS.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$1,832,338ExpenseAmt
Grant$1,832,338GrantAmt
DescCONTRIBUTION TO DELTA DENTAL OF KS FOUNDATION.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$240,792,027TotalProgramServiceExpensesAmt
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (true)ReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemYes (true)BusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityYes (true)DisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document29771IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee119EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMICHAEL ELLISPersonNm
Phone3162641099PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11619 N WATERFRONT PARKWAYAddressLine1
CityWICHITACity
StateKSState
ZIP Code67206ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
DR LUCYNDA JANE RABEN
DIRECTOR/CHAIRPERSON1.240.2Yes (X)Yes (X)$20,067$0$421
NANCY GWEN ZOGLEMAN
DIRECTOR/VICE CHAIRPERSON1.090.0Yes (X)Yes (X)$17,644$0$421
BRADLEY JAY CLOTHIER
DIRECTOR2.280.0Yes (X)$7,205$0$612
GEROLD LYNNE GOFORTH
DIRECTOR1.110.0Yes (X)$22,658$0$1,224
MARY ELIZABETH KINCH
DIRECTOR1.290.2Yes (X)$18,244$0$1,224
WILBERT JOHN LEIKER
DIRECTOR2.150.0Yes (X)$9,600$0$714
DR ALAN D MARCOTTE
DIRECTOR0.830.0Yes (X)$12,637$0$1,224
DR PATRICK MORIARTY
DIRECTOR0.690.0Yes (X)$11,783$0$0
MICHAEL J SANDERS
DIRECTOR0.970.0Yes (X)$15,962$0$1,224
DR BRICK RANDALL SCHEER
DIRECTOR1.270.2Yes (X)$17,424$0$154
BRUCE WITT
DIRECTOR0.870.0Yes (X)$6,065$0$510
GARY YAGER
DIRECTOR2.280.0Yes (X)$8,244$0$510
LINDA BRANTNER
PRESIDENT & CEO39.80.2Yes (X)$483,854$0$54,298
MICHAEL HERBERT
PRESIDENT & CEO39.60.4Yes (X)$280,103$0$54,928
MICHAEL ELLIS
TREASURER & VP FINANCE37.12.9Yes (X)$150,070$0$32,191
NANCY UMHOLTZ
SECRETARY39.40.6Yes (X)$92,484$0$19,697
DEAN NEWTON
MANAGING DIRECTOR & EXEC VP37.12.9$270,171$0$55,104Yes (X)
ROBERT EBENKAMP
VP INFORMATION TECHNOLOGY39.80.2$177,868$0$33,510Yes (X)
JUNETTA EVERETT
VP PROFESSIONAL RELATIONS38.11.9$176,615$0$37,989Yes (X)
MARY M MCPHEETERS
LEGAL COUNSEL40.00.0$174,593$0$25,507Yes (X)
DR JON TILTON
VP PROF REVIEW/DENTAL DIRECTOR40.00.0$194,589$0$38,555Yes (X)
JON CARLSON
COO36.04.0$218,506$0$6,404Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,386,386TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$366,421TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K21IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

ServicesServicesDescCompensationCompensationAmt
GAGE CENTER DENTAL GROUP PA
DENTAL SERVICES$1,806,695
JENKINS LEBLANC PA
DENTAL SERVICES$1,384,092
WICHITA FAMILY DENTAL
DENTAL SERVICES$1,127,151
DENTAL ASSOC OF WEST WICHITA PA
DENTAL SERVICES$1,064,296
MARTIN AND FRANKENBERY DDS PA
DENTAL SERVICES$1,031,359
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K459CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescDENTAL SERVICESDesc
Business524298BusinessCd
Total Revenue Column$256,617,846TotalRevenueColumnAmt
Related Or Exempt Func Income$256,617,846RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$256,617,846TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,228,898TotalRevenueColumnAmt
Exclusion$1,228,898ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$2,088,876SecuritiesAmt
Other$0OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$1,941,218SecuritiesAmt
Other$1,056OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$147,658SecuritiesAmt
Other-$1,056OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$146,602TotalRevenueColumnAmt
Exclusion$146,602ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER INCOMEDesc
Business900099BusinessCd
Total Revenue Column$7,725TotalRevenueColumnAmt
Exclusion$7,725ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$7,725OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$258,001,071TotalRevenueColumnAmt
Related Or Exempt Func Income$256,617,846RelatedOrExemptFuncIncomeAmt
Exclusion$1,383,225ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$1,832,338TotalAmt
Program Services$1,832,338ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,668,671TotalAmt
Program Services$182,261ProgramServicesAmt
Management And General$1,486,410ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,249,300TotalAmt
Program Services$2,783,697ProgramServicesAmt
Management And General$3,465,603ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$748,113TotalAmt
Program Services$391,806ProgramServicesAmt
Management And General$356,307ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$670,120TotalAmt
Program Services$343,772ProgramServicesAmt
Management And General$326,348ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$493,603TotalAmt
Program Services$215,898ProgramServicesAmt
Management And General$277,705ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$45,539TotalAmt
Management And General$45,539ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$158,388TotalAmt
Management And General$158,388ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$67,713TotalAmt
Management And General$67,713ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$193,559TotalAmt
Management And General$193,559ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$3,333,829TotalAmt
Program Services$100,263ProgramServicesAmt
Management And General$3,233,566ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$731,607TotalAmt
Management And General$731,607ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,621,509TotalAmt
Program Services$1,393,305ProgramServicesAmt
Management And General$228,204ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$86,194TotalAmt
Program Services$72,330ProgramServicesAmt
Management And General$13,864ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$168,358TotalAmt
Management And General$168,358ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$432,029TotalAmt
Program Services$21,038ProgramServicesAmt
Management And General$410,991ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$111,061TotalAmt
Program Services$12,414ProgramServicesAmt
Management And General$98,647ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$362,238TotalAmt
Program Services$156,931ProgramServicesAmt
Management And General$205,307ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$376,875TotalAmt
Program Services$163,644ProgramServicesAmt
Management And General$213,231ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$103,783TotalAmt
Management And General$103,783ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
CLAIMS$231,465,784$231,465,784
STATE PREMIUM TAXES$1,072,229$1,072,229
EQUIPMENT RENTAL & MAINT.$276,299$249,399$26,900
CLEARING HOUSE EXPENSE$339,535$328,062$11,473

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,362,822TotalAmt
Program Services$6,856ProgramServicesAmt
Management And General$1,355,966ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$253,971,496TotalAmt
Program Services$240,792,027ProgramServicesAmt
Management And General$13,179,469ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$410,073BOYAmt
EOY$576,550EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$7,623,438BOYAmt
EOY$6,964,565EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,634,694BOYAmt
EOY$3,266,566EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$357,269BOYAmt
EOY$316,024EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$11,440,174LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,630,320LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$8,070,606BOYAmt
EOY$7,809,854EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$33,660,417BOYAmt
EOY$37,069,929EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$6,131,718BOYAmt
EOY$9,426,321EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$370,299BOYAmt
EOY$448,803EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$60,258,514BOYAmt
EOY$65,878,612EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$7,521,496BOYAmt
EOY$8,549,243EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$6,122,762BOYAmt
EOY$5,689,345EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$13,644,258BOYAmt
EOY$14,238,588EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$46,614,256BOYAmt
EOY$51,640,024EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$46,614,256BOYAmt
EOY$51,640,024EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$60,258,514BOYAmt
EOY$65,878,612EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$4,029,575ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$289,998NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$706,195OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewYes (true)AccountantCompileOrReviewInd

Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,401,415OtherCostOrOtherBasisAmt
Book Value$1,401,415BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,332,320OtherCostOrOtherBasisAmt
Depreciation$1,354,907DepreciationAmt
Book Value$5,977,413BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,706,439OtherCostOrOtherBasisAmt
Depreciation$2,275,413DepreciationAmt
Book Value$431,026BookValueAmt
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildingsGrp
Total Book Value Land Buildings$7,809,854TotalBookValueLandBuildingsAmt
Financial DerivativesFinancialDerivativesGrp
Closely Held Equity InterestsCloselyHeldEquityInterestsGrp

Other Securities OtherSecuritiesGrp (2 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
INV IN SURENCY LIFE & HEALTH$6,510,403F
INV IN DELTA DENTAL OF KS FDN$2,915,918F
FieldValueIRS element (for citing)
Total Book Value Securities$9,426,321TotalBookValueSecuritiesAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
CITY OF WICHITA - IRB(TAXABLE)$5,393,067
UNEARNED PREMIUMS$215,745
UNEARNED RENT$79,568
SUSPENSE ACCOUNT$965
FieldValueIRS element (for citing)
Total Liability$5,689,345TotalLiabilityAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PART X, LINE 2FormAndLineReferenceDesc
ExplanationMANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.ExplanationTxt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL OF KS FOUNDATIONBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line11619 N WATERFRONT PARKWAYAddressLine1
CityWICHITACity
StateKSState
ZIP Code67206ZIPCode
FieldValueIRS element (for citing)
Recipient EIN680554527RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$1,798,328CashGrantAmt
Non Cash Assistance$34,010NonCashAssistanceAmt
Valuation Method UsedCOSTValuationMethodUsedDesc
Non Cash AssistanceUTILITIES, OFFICENonCashAssistanceDesc
Purpose Of GrantASSISTANCE TO FOUNDATIONPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PART I, LINE 2FormAndLineReferenceDesc
ExplanationDELTA DENTAL OF KANSAS PROVIDED CONTRIBUTIONS TO THEIR PRIVATE FOUNDATION, DELTA DENTAL OF KANSAS FOUNDATION. THE FOUNDATION'S EXECUTIVE DIRECTOR DOCUMENTS AND REPORTS ON THE FOUNDATION'S ACTIVITIES.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsYes (X)TravelForCompanionsInd
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
LINDA BRANTNER
PRESIDENT & CEO$364,918$0$81,621$0$37,315$0$44,602$0$9,696$0$538,152$0$0$0
MICHAEL HERBERT
PRESIDENT & CEO$206,485$0$46,299$0$27,319$0$42,657$0$12,271$0$335,031$0$0$0
MICHAEL ELLIS
TREASURER & VP FINANCE$113,674$0$18,603$0$17,793$0$22,480$0$9,711$0$182,261$0$0$0
DEAN NEWTON
MANAGING DIRECTOR & EXEC VP$166,334$0$76,867$0$26,970$0$42,770$0$12,334$0$325,275$0$0$0
ROBERT EBENKAMP
VP INFORMATION TECHNOLOGY$141,761$0$26,091$0$10,016$0$25,367$0$8,143$0$211,378$0$0$0
JUNETTA EVERETT
VP PROFESSIONAL RELATIONS$125,585$0$26,262$0$24,768$0$25,784$0$12,205$0$214,604$0$0$0
MARY M MCPHEETERS
LEGAL COUNSEL$134,873$0$30,551$0$9,169$0$23,328$0$2,179$0$200,100$0$0$0
DR JON TILTON
VP PROF REVIEW/DENTAL DIRECTOR$144,865$0$27,987$0$21,737$0$28,563$0$9,992$0$233,144$0$0$0
JON CARLSON
COO$128,628$0$31,080$0$58,798$0$709$0$5,695$0$224,910$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PART 1, LINE 1ADELTA DENTAL OF KANSAS DID PAY FOR THE COMPANION TRAVEL FOR BOARD OF DIRECTORS AND LEADERSHIP TEAM MEMBERS WHEN THEY ATTENDED OUT OF TOWN BUSINESS MEETINGS. THE COMPANION TRAVEL AMOUNT WAS TREATED AS TAXABLE COMPENSATION AND IS INCLUDED IN THE BOARD OF DIRECTORS' 1099-MISC AND THE LEADERSHIP TEAM MEMBERS' W-2.
SCHEDULE J, PART 1, LINE 1ATHE CHIEF EXECUTIVE OFFICER IS PAID A MONTHLY ALLOWANCE FOR MEMBERSHIP TO A COUNTRY CLUB. THE MONTHLY ALLOWANCE FOR MEMBERSHIP TO THE COUNTRY CLUB IS TREATED AS TAXABLE COMPENSATION AND IS INCLUDED IN THE CHIEF EXECUTIVE OFFICER'S FORM W-2.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
DR LUCYNDA JANE RABEN
DIRECTOR$120,504PAYMENT OF DENTAL SERVICESfalse
DR ALAN D MARCOTTE
DIRECTOR$112,403PAYMENT OF DENTAL SERVICESfalse
DR PATRICK MORIARTY
DIRECTOR$201,339PAYMENT OF DENTAL SERVICESfalse
DR BRICK RANDALL SCHEER
DIRECTOR$146,238PAYMENT OF DENTAL SERVICESfalse

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE L, PART IVFormAndLineReferenceDesc
ExplanationTHE DIRECTORS LISTED IN PART IV ARE ALSO PARTICIPATING DENTISTS WITH DELTA DENTAL OF KANSAS. AS A PARTICIPATING DENTIST, DELTA DENTAL OF KANSAS PAYS THE DIRECTORS LISTED IN PART IV FOR THE DENTAL SERVICES THEY PROVIDE TO OUR SUBSCRIBERS IN THE NORMAL COURSE OF THEIR BUSINESS.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART I, LINE 1NON-PROFIT PREPAYMENT DENTAL SERVICE PLAN. FORM 990, PART III, LINE 1 TO MAKE POSSIBLE AND FACILITATE A WIDER AND MORE TIMELY AVAILABILITY OF DENTAL CARE, THEREBY ADVANCING THE PUBLIC HEALTH AND THE SCIENCE AND ART OF DENTISTRY IN THE STATE OF KANSAS, BY ESTABLISHING, MAINTAINING, AND OPERATING A NON-PROFIT PREPAYMENT DENTAL SERVICE PLAN OR PLANS IN THE STATE OF KANSAS.
FORM 990, PART VI, SECTION A, LINE 1BBRICK SCHEER, LUCYNDA RABEN, PATRICK MORIARTY, AND ALAN MARCOTTE WERE ALL VOTING MEMBERS OF THE BOARD AS OF THE END OF THE ORGANIZATION'S TAX YEAR. THESE INDIVIDUALS WERE ALL INVOLVED IN TRANSACTIONS WITH THE ORGANIZATION THAT ARE REQUIRED TO BE REPORTED ON SCHEDULE L. CONSEQUENTLY, THESE MEMBERS HAVE NOT BEEN REPORTED AS INDEPENDENT.
FORM 990, PART VI, SECTION A, LINE 2LINDA BRANTNER, MICHAEL HERBERT, MICHAEL ELLIS, AND DEAN NEWTON HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. LINDA BRANTNER, MICHAEL HERBERT, MICHAEL ELLIS, AND DEAN NEWTON SERVE AS EITHER OFFICERS OR DIRECTORS OF SURENCY LIFE & HEALTH INSURANCE COMPANY, WHICH IS A RELATED FOR-PROFIT COMPANY. THE OFFICERS AND DIRECTORS DO NOT HAVE STOCK OWNERSHIP INTEREST IN THE RELATED FOR-PROFIT COMPANY.
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION HAS MEMBERS. THE MEMBERSHIP OF DELTA DENTAL OF KANSAS IS COMPRISED OF THE DENTISTS WHO HAVE CURRENT PARTICIPATING AGREEMENTS WITH DELTA DENTAL OF KANSAS. EACH MEMBER IS ENTITLED, AT EVERY MEETING OF THE MEMBERS, TO ONE VOTE PER PERSON, BUT NO MEMBER SHALL BE ENTITLED TO VOTE BY PROXY.
FORM 990, PART VI, SECTION A, LINE 7ATHE BOARD OF DIRECTORS ARE COMPRISED OF TEN (10) MEMBERS, FOUR (4) OF WHOM ARE ELECTED BY THE MEMBERSHIP AND ARE AMONG THE CORPORATION'S PARTICIPATING DENTISTS, TWO (2) ARE APPOINTED BY THE GOVERNOR OF THE STATE OF KANSAS, AND FOUR (4) ARE APPOINTED BY THE COMMISSIONER OF INSURANCE OF THE STATE OF KANSAS.
FORM 990, PART VI, SECTION A, LINE 7BANY PROPOSED CHANGES TO THE BY-LAWS ARE SUBJECT TO MEMBER APPROVAL. THE BOARD OF DIRECTORS ARE COMPRISED OF TEN (10) MEMBERS, FOUR (4) OF WHOM ARE ELECTED BY THE MEMBERSHIP AND ARE AMONG THE CORPORATION'S PARTICIPATING DENTISTS, TWO (2) ARE APPOINTED BY THE GOVERNOR OF THE STATE OF KANSAS, AND FOUR (4) ARE APPOINTED BY THE COMMISSIONER OF INSURANCE OF THE STATE OF KANSAS.
FORM 990, PART VI, SECTION B, LINE 11BAN INDEPENDENT ACCOUNTING FIRM PREPARES THE FORM 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S ACCOUNTING PERSONNEL. ANY QUESTIONS OR COMMENTS ARE ADDRESSED AND ANY NECESSARY CHANGES ARE MADE. THE FORM 990 WITH ALL RELATED SCHEDULES IS THEN PROVIDED TO THE ENTIRE GOVERNING BODY FOR REVIEW PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CTHE CHAIRPERSON OF THE BOARD AND THE GOVERNANCE COMMITTEE MONITOR AND ENFORCE OUR CONFLICT OF INTEREST POLICY. EACH DIRECTOR, OFFICER, AND KEY EMPLOYEE OF DELTA DENTAL OF KANSAS ANNUALLY FILES A STATEMENT REGARDING CONFLICTS OF INTEREST WHICH EXIST, OR WHICH MIGHT BE EXPECTED TO EXIST, WITHIN THE UPCOMING YEAR. THE STATEMENT DISCLOSES AS FULLY AS POSSIBLE THE NATURE OF POTENTIAL CONFLICTS AND THE NATURE OF THE DIRECTOR'S, OFFICER'S, OR KEY EMPLOYEE'S INTEREST IN THE POTENTIAL TRANSACTION. ALL STATEMENTS ARE REVIEWED BY THE PRESIDENT AND CHAIRPERSON AND MAY BE CIRCULATED TO MEMBERS OF THE BOARD OF DIRECTORS. EACH DIRECTOR, OFFICER, AND KEY EMPLOYEE AGREE TO ANSWER ANY QUESTIONS ABOUT POTENTIAL CONFLICTS THEY MAY HAVE. IF A CONFLICT IS IDENTIFIED, VOTING MAY BE RESTRICTED.
FORM 990, PART VI, SECTION B, LINES 15A AND 15BTHE DELTA DENTAL OF KANSAS PROCESS FOR DETERMINING COMPENSATION FOR THE CEO, OFFICERS, AND KEY EMPLOYEES DOES INCLUDE A REVIEW BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. DELTA DENTAL OF KANSAS HAS CONTRACTED WITH A CONSULTING GROUP TO PROVIDE COMPENSATION STUDIES FOR OUR POSITIONS. THE CONSULTANT USES PUBLISHED MARKET DATA SOURCES TO IDENTIFY THE RELEVANT MARKET FOR POSITIONS, WHICH ARE MATCHED BASED UPON THE DESCRIPTION OF DUTIES AND RESPONSIBILITIES PROVIDED. MARKET DATA IS USED AS APPROPRIATE FOR EACH POSITION, FROM LOCAL, REGIONAL, AND NATIONAL MARKETS. THEY PROVIDE A COMPLETE REPORT THAT DOCUMENTS THE FINDINGS OF THE MARKET REVIEW PROCESS FOR OUR POSITIONS AND THEIR RECOMMENDATION REGARDING THE GRADE LEVEL OF PLACEMENT OF THE POSITION. DELTA DENTAL OF KANSAS ALSO HAS A COMPENSATION COMMITTEE, COMPRISED OF SELECTED BOARD MEMBERS. ONE OF THE PURPOSES OF THE COMMITTEE IS TO REVIEW, REPORT, AND MAKE RECOMMENDATIONS TO THE BOARD REGARDING COMPENSATION OF ALL OFFICERS AND EXECUTIVE TEAM EMPLOYEES. THE COMMITTEE IS RESPONSIBLE TO MEET WITH THE PRESIDENT/CHIEF EXECUTIVE OFFICER ANNUALLY TO REVIEW HIS/HER PERFORMANCE AND EMPLOYMENT CONTRACT, MAKE RECOMMENDATIONS TO THE BOARD REGARDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER'S ANNUAL COMPENSATION AND BENEFITS PACKAGE AND TO REVIEW THE PRESIDENT/CHIEF EXECUTIVE OFFICER'S RECOMMENDATIONS AS TO SALARY ADJUSTMENTS AND INCENTIVE PAYMENTS FOR OFFICERS, EXECUTIVES, AND SENIOR MANAGEMENT.
FORM 990, PART VI, SECTION C, LINE 19DELTA DENTAL OF KANSAS ANNUAL REPORT IS AVAILABLE TO THE PUBLIC THROUGH OUR WEBSITE, WWW.DELTADENTALKS.COM; OUR GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VII, SECTION AALL OF THE ORGANIZATION'S BOARD MEMBERS RECEIVE COMPENSATION FROM THE ORGANIZATION FOR THEIR SERVICES AS DIRECTORS. THEY ARE NOT COMPENSATED AS INDEPENDENT CONTRACTORS.
FORM 990, PART XI, LINE 9263,080.00 MARK-TO-MARKET ADJUSTMENT NOT INCLUDED ON RETURN 807,485.00 EARNINGS FROM SUBSIDIARY NOT ON RETURN - FOUNDATION (364,370.00) EARNINGS FROM SUBSIDIARY NOT ON RETURN - SURENCY ------------ 706,195.00

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1KSDD PROPERTIES LLCBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line11619 N WATERFRONT PARKWAYAddressLine1
CityWICHITACity
StateKSState
ZIP Code67206ZIPCode
FieldValueIRS element (for citing)
EIN480793267EIN
Primary ActivitiesREAL ESTATEPrimaryActivitiesTxt
Legal Domicile StateKSLegalDomicileStateCd
Total Income$863,643TotalIncomeAmt
End Of Year Assets$7,932,758EndOfYearAssetsAmt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL OF KANSAS FOUNDATION INCBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line11619 N WATERFRONT PARKWAYAddressLine1
CityWICHITACity
StateKSState
ZIP Code67206ZIPCode
FieldValueIRS element (for citing)
EIN680554527EIN
Primary ActivitiesORAL HEALTHPrimaryActivitiesTxt
Legal Domicile StateKSLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusPFPublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrganizationfalseControlledOrganizationInd

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1SURENCY LIFE & HEALTH COMPANYBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line11619 N WATERFRONT PARKWAYAddressLine1
CityWICHITACity
StateKSState
ZIP Code67206ZIPCode
FieldValueIRS element (for citing)
EIN261969006EIN
Primary ActivitiesINSURANCEPrimaryActivitiesTxt
Legal Domicile StateKSLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Entity TypeC CORPORATIONEntityTypeTxt
Share Of Total Income-$364,370ShareOfTotalIncomeAmt
Share Of EOY Assets$7,680,527ShareOfEOYAssetsAmt
Ownership1.00000OwnershipPct
Controlled OrganizationYes (true)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
SURENCY LIFE & HEALTH INSURANCE COMPANY
N$152,316COST
SURENCY LIFE & HEALTH INSURANCE COMPANY
O$504,705COST

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