DELTA DENTAL PLAN OF WYOMING: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- DELTA DENTAL PLAN OF WYOMING (EIN 83-0209667)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-10-11
- IRS object ID
- 201332849349300143
- Schema version
- 2012v2.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-10-11T16:18:41-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 830331229 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGEE HEARNE & PAIZ LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O BOX 1088 | AddressLine1 |
| City | CHEYENNE | City |
| State | WY | State |
| ZIP Code | 82003 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 830209667 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA DENTAL PLAN OF WYOMING | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DELT | NameControl |
| Phone | 3076323313 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6234 YELLOWSTONE RD | AddressLine1 |
| City | CHEYENNE | City |
| State | WY | State |
| ZIP Code | 82009 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KERRY HALL | Name |
| Title | PRESIDENT/CEO | Title |
| Phone | 3076323313 | Phone |
| Date Signed | 2013-10-08 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RUSSELL E HAY | Name |
| PTIN | P00028728 | PTIN |
| Phone | 3076342151 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA DENTAL OF WYOMING | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | KERRY HALL | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6234 YELLOWSTONE RD | AddressLine1 |
| City | CHEYENNE | City |
| State | WY | State |
| ZIP Code | 82009 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 32479138 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1968 | YearFormation |
| State Legal Domicile | WY | StateLegalDomicile |
| Activity Or Mission Description | TO BE THE LEADING WYOMING PROVIDER OF HIGH QUALITY DENTAL CARE PROGRAMS WHICH ARE RESPONSIVE TO SUBSCRIBERS, PURCHASERS AND PARTICIPATING DENTISTS ALIKE WITH THE GOAL OF MAKING AFFORDABLE DENTAL CARE AVAILABLE TO ALL WYOMING EMPLOYEES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 8 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 28721931 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 30669313 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 645710 | InvestmentIncomePriorYear |
| Investment Income Current Year | 363501 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -12984 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 29354657 | TotalRevenuePriorYear |
| Total Revenue Current Year | 31032814 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 819554 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 899949 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 27261041 | OtherExpensePriorYear |
| Other Expenses Current Year | 29242364 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 28080595 | TotalExpensesPriorYear |
| Total Expenses Current Year | 30142313 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1274062 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 890501 | RevenuesLessExpensesCY |
| Total Assets BOY | 10428867 | TotalAssetsBOY |
| Total Assets EOY | 11911873 | TotalAssetsEOY |
| Total Liabilities BOY | 3322345 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3662016 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7106522 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 8249857 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO BE THE LEADING WYOMING PROVIDER OF HIGH QUALITY DENTAL CARE PROGRAMS WHICH ARE RESPONSIVE TO SUBSCRIBERS, PURCHASERS AND PARTICIPATING DENTISTS ALIKE WITH THE GOAL OF MAKING AFFORDABLE DENTAL CARE AVAILABLE TO ALL WYOMING EMPLOYEES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 29250945 | Expense |
| Revenue | 30669313 | Revenue |
| Description | PROVIDE PROCESSING OF DENTAL PLANS, PAYMENTS AND CLAIMS FOR PURCHASERS, SUBSCRIBERS AND PARTICIPATING DENTISTS WITH THE GOAL OF MAKING AFFORDABLE DENTAL CARE AVAILABLE TO ALL WYOMING EMPLOYEES. | Description |
| Total Program Service Expense | 29250945 | TotalProgramServiceExpense |
| Described In501 C3 | 0 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 1 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 1265 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 8 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 1 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 1 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KERRY HALL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3076323313 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6234 YELLOWSTONE RD | AddressLine1 |
| City | CHEYENNE | City |
| State | WY | State |
| ZIP Code | 82009 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | FormerFormer |
|---|---|---|---|---|---|---|---|
| DR BRUCE HOLWELL | |||||||
| CHAIRMAN | 1.00 | X | X | 1834 | 0 | 0 | |
| DR JAMES GILMAN | |||||||
| VICE CHAIRMAN | 1.00 | X | X | 1552 | 0 | 0 | |
| DR ROBERT TYRRELL | |||||||
| SECRETARY | 1.00 | X | X | 1710 | 0 | 0 | |
| BRUCE HINCHEY | |||||||
| TREASURER | 1.00 | X | X | 1372 | 0 | 1452 | |
| DR SCOTT HOUFEK | |||||||
| DIRECTOR | 1.00 | X | 1200 | 0 | 0 | ||
| DR BYRON KILLPACK | |||||||
| DIRECTOR | 1.00 | X | 772 | 0 | 0 | ||
| ROXANNE OSTLUND | |||||||
| DIRECTOR | 1.00 | X | 1496 | 0 | 1452 | ||
| BOB PALMER | |||||||
| DIRECTOR | 1.00 | X | 1426 | 0 | 0 | ||
| DR ROY PAULSON | |||||||
| DIRECTOR | 1.00 | X | 1422 | 0 | 0 | ||
| DR BILL GERN | |||||||
| DIRECTOR | 1.00 | X | 1064 | 0 | 0 | ||
| ROD CHISHOLM | |||||||
| DIRECTOR | 1.00 | X | 1260 | 0 | 0 | ||
| RAY BISHOP | |||||||
| DIRECTOR | 1.00 | X | 788 | 0 | 0 | ||
| DR ED CLARK | |||||||
| DIRECTOR/PRIOR CHAIRMAN | 1.00 | X | 4222 | 0 | 0 | ||
| KERRY HALL | |||||||
| PRESIDENT/CEO | 40.00 | X | 202353 | 0 | 100129 | ||
| STACY ZASTOUPIL | |||||||
| VP FINANCE & ACCOUNTING | 40.00 | X | 101153 | 0 | 27978 | ||
| DR EARL KINCHELOE | |||||||
| VP PROFESSIONAL RELATIONS | 5.00 | X | 61078 | 0 | 1452 | ||
| JEFF MARSH | |||||||
| PRIOR DIRECTOR | 1.00 | 804 | 0 | 1452 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 385506 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 133915 | TotalOtherCompensation |
| Number Individuals GT100 K | 2 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA DENTAL OF SOUTH DAKOTA | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 N EUCLID AVE | AddressLine1 |
| City | PIERRE | City |
| State | SD | State |
| ZIP Code | 57501 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | CLAIMS PROCESSING & SUPPLIES | DescriptionOfServices |
| Compensation | 462208 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DENTAL PREMIUMS & ADMI | Description |
| Business Code | 524114 | BusinessCode |
| Total Revenue Column | 30669313 | TotalRevenueColumn |
| Related Or Exempt Function Income | 30669313 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 30669313 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 248380 | TotalRevenueColumn |
| Exclusion | $248,380 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1561445 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1446324 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 115121 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 115121 | TotalRevenueColumn |
| Exclusion | $115,121 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 31032814 | TotalRevenueColumn |
| Related Or Exempt Function Income | 30669313 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $363,501 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 385506 | Total |
| Program Services | 206246 | ProgramServices |
| Management And General | 179260 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 276103 | Total |
| Program Services | 147715 | ProgramServices |
| Management And General | 128388 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 110141 | Total |
| Program Services | 58925 | ProgramServices |
| Management And General | 51216 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 83544 | Total |
| Program Services | 44696 | ProgramServices |
| Management And General | 38848 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44655 | Total |
| Program Services | 23891 | ProgramServices |
| Management And General | 20764 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3809 | Total |
| Program Services | 857 | ProgramServices |
| Management And General | 2952 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27410 | Total |
| Program Services | 6167 | ProgramServices |
| Management And General | 21243 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29088 | Total |
| Management And General | 29088 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 112091 | Total |
| Program Services | 14011 | ProgramServices |
| Management And General | 98080 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 73730 | Total |
| Program Services | 38708 | ProgramServices |
| Management And General | 35022 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54609 | Total |
| Program Services | 20206 | ProgramServices |
| Management And General | 34403 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23327 | Total |
| Program Services | 6648 | ProgramServices |
| Management And General | 16679 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69224 | Total |
| Program Services | 19729 | ProgramServices |
| Management And General | 49495 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11868 | Total |
| Program Services | 4628 | ProgramServices |
| Management And General | 7240 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13474 | Total |
| Program Services | 4716 | ProgramServices |
| Management And General | 8758 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| DENTAL CLAIMS PAID | 27181399 | 27181399 | |
| COMMISSIONS | 617548 | 617548 | |
| COMPUTER - CLAIMS | 354596 | 320909 | 33687 |
| POSTAGE & SHIPPING | 125968 | 90697 | 35271 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 544223 | Total |
| Program Services | 443249 | ProgramServices |
| Management And General | 100974 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30142313 | Total |
| Program Services | 29250945 | ProgramServices |
| Management And General | 891368 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1675139 | BOY |
| EOY | 1611715 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 334559 | BOY |
| EOY | 309288 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1879009 | BOY |
| EOY | 1978157 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33938 | BOY |
| EOY | 28742 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 218046 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 146923 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21270 | BOY |
| EOY | 71123 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4415858 | BOY |
| EOY | 5764116 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2054547 | BOY |
| EOY | 2126985 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14547 | BOY |
| EOY | 21747 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10428867 | BOY |
| EOY | 11911873 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 955173 | BOY |
| EOY | 1307701 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 255248 | BOY |
| EOY | 278346 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2111924 | BOY |
| EOY | 2075969 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3322345 | BOY |
| EOY | 3662016 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7106522 | BOY |
| EOY | 8249857 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7106522 | BOY |
| EOY | 8249857 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10428867 | BOY |
| EOY | 11911873 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 890501 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 252834 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 56078 | OtherCostOrOtherBasis |
| Depreciation | 4673 | Depreciation |
| Book Value | 51405 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 138189 | OtherCostOrOtherBasis |
| Depreciation | 120765 | Depreciation |
| Book Value | 17424 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 23779 | OtherCostOrOtherBasis |
| Depreciation | 21485 | Depreciation |
| Book Value | 2294 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 71123 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| INVESTMENT IN LIFE INSURANCE CONTRACT | 1400333 | F |
| CERTIFICATE OF DEPOSIT | 726652 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 2126985 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED COMPENSATION PAYABLE | $906,946 |
| MEMBER REPURCHASE PLAN PAYABLE | $1,169,023 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2075969 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 30669313 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 30669313 | RevenueSubtotal |
| Other Revenues Not Included | 363501 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 363501 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 31032814 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 29756940 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 29756940 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 29089 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 356284 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 385373 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 30142313 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | MANAGEMENT EVALUATED THE COMPANY'S TAX POSITIONS AND CONCLUDED THAT THE COMPANY HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS. WITH FEW EXCEPTIONS, THE COMPANY IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL TAX AUTHORITIES EXCEPT FOR THE LAST THREE YEARS FILED. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | INVESTMENT INCOME 248,380. GAIN ON SALE OF INVESTMENTS 115,121. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | NET AMORTIZATION OF PREMIUMS AND DISCOUNTS 16,284. DONATION TO DELTA DENTAL FOUNDATION 340,000. | |
| AUDITED FINANCIALS CONTAIN SEPARATE "FINANCIAL INCOME" COMPONENT. THIS COMPONENT TOTALS $318,128 WHICH CONSISTS OF: $363,501 FROM PART XI AND $45,373 FROM PART XII. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Compensation Survey | X | CompensationSurvey |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | KERRY HALL | NamePerson |
| Title | PRESIDENT/CEO | Title |
| Base Compensation Filing Org | 189000 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 0 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 10000 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 3353 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 79264 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 0 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 20865 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 0 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 302482 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 0 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 287025 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | DELTA DENTAL OF WYOMING HAS ADOPTED A COMPENSATION POLICY PURSUANT TO WHICH IT FOLLOWS THE PROCESS OUTLINED IN TREASURY REGULATION SECTION 53.4958-6 TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS AS TO THE COMPENSATION OF ITS CEO. THIS PROCESS INCLUDES REVIEW AND APPROVAL OF THE COMPENSATION ARRANGEMENT BY A COMPENSATION COMMITTEE COMPOSED ENTIRELY OF PERSONS WITH NO CONFLICT OF INTEREST (AS DEFINED IN REGULATIONS SECTION 53-4958-6(C)(1)(III)), RELIANCE ON COMPARABILITY DATA COMPILED BY AN INDEPENDENT COMPENSATION CONSULTANT AND CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT. THIS PROCESS IS UNDERTAKEN ANNUALLY WITH RESPECT TO THE CEO AND ALL OTHER DISQUALIFIED PERSONS. IT WAS CONDUCTED ON SEPTEMBER 29, 2012. DELTA DENTAL PAID COUNTRY CLUB DUES FOR KERRY HALL. THIS IS INCLUDED AS PART OF EMPLOYMENT CONTRACT AND WAS INCLUDED IN W-2 WAGES. |
| PART I, LINE 4B | KERRY HALL PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN ACCRUING $62,511 IN 2012. DR. EARL KINCHELOE PARTICIPATED IN A SUPPLEMENT NONQUALIFIED RETIREMENT PLAN BUT RECEIVED $0 IN 2012. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (5 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| DR ED CLARK | |||
| BOARD MEMBER | 289942 | DENTIST WHO PARTICIPATES IN THE ORGANIZATION'S PROVIDER NETWORK AND RECEIVES REIMBURSEMENT FOR PATIENT CLAIMS FROM THE ORGANIZATION. | 0 |
| DR BYRON KILLPACK | |||
| BOARD MEMBER | 322738 | DENTIST WHO PARTICIPATES IN THE ORGANIZATION'S PROVIDER NETWORK AND RECEIVES REIMBURSEMENT FOR PATIENT CLAIMS FROM THE ORGANIZATION. | 0 |
| DR ROY PAULSON | |||
| BOARD MEMBER | 233109 | DENTIST WHO PARTICIPATES IN THE ORGANIZATION'S PROVIDER NETWORK AND RECEIVES REIMBURSEMENT FOR PATIENT CLAIMS FROM THE ORGANIZATION. | 0 |
| (no name) | |||
| 0 | |||
| KERRY HALL | |||
| CEO | 11854 | ELECTRICAL SYSTEM IN NEW OFFICE CONTRACTED WITH MCKEE HALL ELECTRICAL SYSTEMS WHICH IS CO-OWNED BY THE CEO'S BROTHER. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERS ARE COMPRISED OF DENTISTS WHO HAVE CONTRACTS WITH DELTA DENTAL OF WYOMING. | |
| FORM 990, PART VI, SECTION A, LINE 7A | STATE IS DIVIDED INTO SIX REGIONS WHERE DENTISTS ELECT PARTICIPATING MEMBERS TO THE GOVERNING BODY. SEVEN AT LARGE DIRECTORS (TWO MEMBERS AND FIVE AT LARGE INDIVIDUALS) ARE ALSO ELECTED BY THE MEMBERSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 7B | AMENDMENTS TO THE ORGANIZATION'S ARTICLES OF INCORPORATION AND BYLAWS MAY BE INITIATED BY THE BOARD OF DIRECTORS BUT REQUIRE APPROVAL OF THE MEMBERS TO BE EFFECTIVE. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE ORGANIZATION FOLLOWS A POLICY THAT IS DESIGNED TO ENSURE APPROPRIATE OVERSIGHT AND REVIEW OF THE FORM 990. AN INTERNAL WORKING GROUP INCLUDING THE ORGANIZATION'S CEO, VICE PRESIDENT OF FINANCE, OUTSIDE TAX PREPARER, LEGAL COUNSEL AND OTHERS HELP COMPILE AN INITIAL DRAFT OF FORM 990.ONCE A COMPLETE DRAFT IS DEVELOPED AND REVIEWED BY THE WORKING GROUP, THE DRAFT (WITH ALL ATTACHMENTS) IS SUBMITTED TO THE ORGANIZATION'S BOARD OF DIRECTORS FOR REVIEW AND QUESTIONS. THE BOARD COMPLETED ITS REVIEW AT THE SEPTEMBER 2012 BOARD MEETING, PRIOR TO THE FILING OF FORM 990. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION'S WRITTEN CONFLICT OF INTEREST POLICY COVERS ANY DIRECTOR OR OFFICER. IT REQUIRES DISCLOSURE OF ALL MATERIAL FACTS REGARDING ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST ON AN ONGOING BASIS. THE BOARD DETERMINES, BY A MAJORITY OF ITS DISINTERESTED BOARD MEMBERS, WHETHER A CONFLICT OF INTEREST EXISTS. THE BOARD DETERMINES, BY A MAJORITY OF ITS DISINTERESTED PARTIES, WHETHER THE ORGANIZATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION UNDER THE CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT AND, IF NOT, WHETHER IT IS IN THE ORGANIZATION'S BEST INTERESTS TO GO FORWARD WITH THE TRANSACTION. EACH PERSON SUBJECT TO THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM AND HAS A CONTINUING DUTY TO UPDATE SUCH STATEMENT. CONFLICT OF INTEREST DISCLOSURE FORMS ARE REVIEWED ANNUALLY. | |
| FORM 990, PART VI, SECTION B, LINE 15A | DELTA DENTAL OF WYOMING HAS ADOPTED A COMPENSATION POLICY PURSUANT TO WHICH IT FOLLOWS THE PROCESS OUTLINED IN TREASURY REGULATION SECTION 53.4958-6 TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONALBENESS AS TO THE COMPENSATION OF ITS CEO. THIS PROCESS INCLUDES REVIEW AND APPROVAL OF THE COMPENSATION ARRANGEMENT BY A COMPENSATION COMMITTEE COMPOSED ENTIRELY OF PERSONS WITH NO CONFLICT OF INTEREST (AS DEFINED IN REGULATIONS SECTION 53-4958-6(C)(1)(III)), RELIANCE ON COMPARABILITY DATA COMPILED BY AN INDEPENDENT COMPENSATION CONSULTANT AND CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT. THIS PROCESS IS UNDERTAKEN ANNUALLY WITH RESPECT TO THE CEO AND ALL OTHER DISQUALIFIED PERSONS. IT WAS CONDUCTED ON SEPTEMBER 29, 2012. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FINANCIAL STATEMENTS ARE PROVIDED ANNUALLY TO ALL PARTICIPATING MEMBERS. | |
| FORM 990, PART VII | DR. BRUCE HOLWELL - PO BOX 187, BIG HORN, WY 82833. DR. JAMES GILMAN - 209 S. 7TH, WORLAND, WY 82401. DR. ROBERT TYRRELL - 1702 ANTELOPE, KEMMERER, WY 83101. BRUCE HINCHEY - 1600 ELKHORN VALLEY DRIVE, CASPER, WY 82609. DR. SCOTT HOUFEK - 16 WEST 3RD, BIG PINEY, WY 83113. DR. BYRON KILLPACK - PO BOX 1150, LARAMIE, WY 82070. ROXANNE OSTLUND - 5920 YELLOWSTONE ROAD, CHEYENNE, WY 82009. BOB PALMER - 5302 TARRY ST., GILLETTE, WY 82718. DR. ROY PAULSON - 102 N. KENWOOD, CASPER, WY 82601. DR. BILL GERN - 1000 E. UNIVERSITY, DEPT 3355, LARAMIE, WY 82071. ROD CHISHOLM - 1051 BONITA DR., LARAMIE, WY 82072. RAY BISHOP - P.O. BOX 485, MOOSE, WY 83012. DR. ED CLARK - 5211 YELLOWSTONE ROAD, CHEYENNE, WY 82009. JEFF MARSH - 120 WEST 22ND AVE., TORRINGTON, WY 82240. | CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC |
| PART XI, LINE 2C: | DELTA DENTAL HAS A COMMITTEE THAT OVERSEES THE AUDIT |
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