2014-10-17T09:09:19-05:00 2013-12-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2013-01-01 480793267 DELTA DENTAL OF KANSAS INC % MICHAEL ELLIS DELT 3162641099 1619 N WATERFRONT PARKWAY Suite WICHITA KS 67206 MICHAEL HERBERT CFO 3162641099 2014-11-15 true ELIZABETH S HOGAN 3162652811 2013 2015-11-30 17:44:51Z MICHAEL ELLIS 1619 N WATERFRONT PARKWAY WICHITA KS 67206 259943345 false X WWW.DELTADENTALKS.COM X 1972 KS TO 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) 10 6 119 0 0 0 0 248854400 256617846 1778840 1375500 7298 7725 250640538 258001071 1280081 1832338 0 0 9473378 9829807 0 0 0 236582052 242309351 247335511 253971496 3305027 4029575 60258514 65878612 13644258 14238588 46614256 51640024 X SEE SCHEDULE O false false 231465784 248570172 DENTAL BENEFITS (COVERED CHARGES) PROVIDED TO SUBSCRIBERS. DELTA DENTAL SERVED APPROXIMATELY 923,917 PEOPLE THIS YEAR. 7493905 8047674 THE PROCESSING OF DENTAL BENEFIT CLAIMS. 1832338 1832338 CONTRIBUTION TO DELTA DENTAL OF KS FOUNDATION. 240792027 false false false false false false false false false true true false false true false false true false false false false false false false false false true false true false false false false false true false false false false false false true true true true false true 29771 0 true 119 true false false false false false false false false false false X 10 6 true false false false true true true true true false false true true true true true true true true false X MICHAEL ELLIS 3162641099 1619 N WATERFRONT PARKWAY WICHITA KS 67206 DR LUCYNDA JANE RABEN DIRECTOR/CHAIRPERSON 1.24 0.2 X X 20067 0 421 NANCY GWEN ZOGLEMAN DIRECTOR/VICE CHAIRPERSON 1.09 0.0 X X 17644 0 421 BRADLEY JAY CLOTHIER DIRECTOR 2.28 0.0 X 7205 0 612 GEROLD LYNNE GOFORTH DIRECTOR 1.11 0.0 X 22658 0 1224 MARY ELIZABETH KINCH DIRECTOR 1.29 0.2 X 18244 0 1224 WILBERT JOHN LEIKER DIRECTOR 2.15 0.0 X 9600 0 714 DR ALAN D MARCOTTE DIRECTOR 0.83 0.0 X 12637 0 1224 DR PATRICK MORIARTY DIRECTOR 0.69 0.0 X 11783 0 0 MICHAEL J SANDERS DIRECTOR 0.97 0.0 X 15962 0 1224 DR BRICK RANDALL SCHEER DIRECTOR 1.27 0.2 X 17424 0 154 BRUCE WITT DIRECTOR 0.87 0.0 X 6065 0 510 GARY YAGER DIRECTOR 2.28 0.0 X 8244 0 510 LINDA BRANTNER PRESIDENT & CEO 39.8 0.2 X 483854 0 54298 MICHAEL HERBERT PRESIDENT & CEO 39.6 0.4 X 280103 0 54928 MICHAEL ELLIS TREASURER & VP FINANCE 37.1 2.9 X 150070 0 32191 NANCY UMHOLTZ SECRETARY 39.4 0.6 X 92484 0 19697 DEAN NEWTON MANAGING DIRECTOR & EXEC VP 37.1 2.9 X 270171 0 55104 ROBERT EBENKAMP VP INFORMATION TECHNOLOGY 39.8 0.2 X 177868 0 33510 JUNETTA EVERETT VP PROFESSIONAL RELATIONS 38.1 1.9 X 176615 0 37989 MARY M MCPHEETERS LEGAL COUNSEL 40.0 0.0 X 174593 0 25507 DR JON TILTON VP PROF REVIEW/DENTAL DIRECTOR 40.0 0.0 X 194589 0 38555 JON CARLSON COO 36.0 4.0 X 218506 0 6404 2386386 0 366421 21 false true false GAGE CENTER DENTAL GROUP PA DENTAL SERVICES 1806695 JENKINS LEBLANC PA DENTAL SERVICES 1384092 WICHITA FAMILY DENTAL DENTAL SERVICES 1127151 DENTAL ASSOC OF WEST WICHITA PA DENTAL SERVICES 1064296 MARTIN AND FRANKENBERY DDS PA DENTAL SERVICES 1031359 459 0 DENTAL SERVICES 524298 256617846 256617846 256617846 1228898 1228898 0 0 0 0 0 2088876 0 1941218 1056 147658 -1056 146602 146602 0 0 0 OTHER INCOME 900099 7725 7725 7725 258001071 256617846 1383225 1832338 1832338 0 0 0 1668671 182261 1486410 0 6249300 2783697 3465603 748113 391806 356307 670120 343772 326348 493603 215898 277705 0 45539 45539 158388 158388 67713 67713 0 193559 193559 3333829 100263 3233566 731607 731607 1621509 1393305 228204 86194 72330 13864 0 168358 168358 432029 21038 410991 0 111061 12414 98647 362238 156931 205307 0 376875 163644 213231 103783 103783 CLAIMS 231465784 231465784 STATE PREMIUM TAXES 1072229 1072229 EQUIPMENT RENTAL & MAINT. 276299 249399 26900 CLEARING HOUSE EXPENSE 339535 328062 11473 1362822 6856 1355966 253971496 240792027 13179469 0 410073 576550 7623438 6964565 0 0 3634694 3266566 0 0 0 0 0 0 0 0 357269 316024 11440174 3630320 8070606 7809854 33660417 37069929 6131718 9426321 0 0 0 0 370299 448803 60258514 65878612 7521496 8549243 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6122762 5689345 13644258 14238588 X 46614256 51640024 0 0 0 0 46614256 51640024 60258514 65878612 X 4029575 289998 706195 X true X true X true false 1401415 1401415 7332320 1354907 5977413 2706439 2275413 431026 7809854 INV IN SURENCY LIFE & HEALTH 6510403 F INV IN DELTA DENTAL OF KS FDN 2915918 F 9426321 0 CITY OF WICHITA - IRB(TAXABLE) 5393067 UNEARNED PREMIUMS 215745 UNEARNED RENT 79568 SUSPENSE ACCOUNT 965 5689345 SCHEDULE D, PART X, LINE 2 MANAGEMENT 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. true DELTA DENTAL OF KS FOUNDATION 1619 N WATERFRONT PARKWAY WICHITA KS 67206 680554527 501(C)(3) 1798328 34010 COST UTILITIES, OFFICE ASSISTANCE TO FOUNDATION 1 0 SCHEDULE I, PART I, LINE 2 DELTA 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. X X true true X X X X X X false false false false false false false false false LINDA BRANTNER PRESIDENT & CEO 364918 0 81621 0 37315 0 44602 0 9696 0 538152 0 0 0 MICHAEL HERBERT PRESIDENT & CEO 206485 0 46299 0 27319 0 42657 0 12271 0 335031 0 0 0 MICHAEL ELLIS TREASURER & VP FINANCE 113674 0 18603 0 17793 0 22480 0 9711 0 182261 0 0 0 DEAN NEWTON MANAGING DIRECTOR & EXEC VP 166334 0 76867 0 26970 0 42770 0 12334 0 325275 0 0 0 ROBERT EBENKAMP VP INFORMATION TECHNOLOGY 141761 0 26091 0 10016 0 25367 0 8143 0 211378 0 0 0 JUNETTA EVERETT VP PROFESSIONAL RELATIONS 125585 0 26262 0 24768 0 25784 0 12205 0 214604 0 0 0 MARY M MCPHEETERS LEGAL COUNSEL 134873 0 30551 0 9169 0 23328 0 2179 0 200100 0 0 0 DR JON TILTON VP PROF REVIEW/DENTAL DIRECTOR 144865 0 27987 0 21737 0 28563 0 9992 0 233144 0 0 0 JON CARLSON COO 128628 0 31080 0 58798 0 709 0 5695 0 224910 0 0 0 SCHEDULE J, PART 1, LINE 1A DELTA 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 1A THE 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. DR LUCYNDA JANE RABEN DIRECTOR 120504 PAYMENT OF DENTAL SERVICES false DR ALAN D MARCOTTE DIRECTOR 112403 PAYMENT OF DENTAL SERVICES false DR PATRICK MORIARTY DIRECTOR 201339 PAYMENT OF DENTAL SERVICES false DR BRICK RANDALL SCHEER DIRECTOR 146238 PAYMENT OF DENTAL SERVICES false SCHEDULE L, PART IV THE 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. FORM 990, PART I, LINE 1 NON-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 1B BRICK 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 2 LINDA 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 6 THE 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 7A 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 A, LINE 7B ANY 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 11B AN 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 12C THE 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 15B THE 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 19 DELTA 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 A ALL 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 9 263,080.00 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 KSDD PROPERTIES LLC 1619 N WATERFRONT PARKWAY WICHITA KS 67206 480793267 REAL ESTATE KS 863643 7932758 NA DELTA DENTAL OF KANSAS FOUNDATION INC 1619 N WATERFRONT PARKWAY WICHITA KS 67206 680554527 ORAL HEALTH KS 501(C)(3) PF NA false SURENCY LIFE & HEALTH COMPANY 1619 N WATERFRONT PARKWAY WICHITA KS 67206 261969006 INSURANCE KS NA C CORPORATION -364370 7680527 1.00000 true false false false false false false false false false false false false false true true false false false false SURENCY LIFE & HEALTH INSURANCE COMPANY N 152316 COST SURENCY LIFE & HEALTH INSURANCE COMPANY O 504705 COST