2012-08-03T11:05:27-07:00 2011-12-31 990 2011-01-01 910621480 WASHINGTON DENTAL SERVICE WASH 2065521300 9706 4th Ave NE Seattle WA 98115 Bradley A Berg 2065282340 2012-08-03 2011 2016-02-24 21:20:13Z James D Dwyer 9706 Fourth Ave NE Seattle WA 98115 1002799764 0 X www.deltadentalwa.com X 1954 WA Washington Dental Service will revolutionize the oral health industry and improve overall health. Our success will be defined by: Providing innovative products, services and technology beyond the traditional definition of dental benefits, Moving into new markets, ventures and partnerships to execute our vision, Sustaining levels of profitability that alloow us to deliver on our mission, and assembling, developing, fostering and retaining the best team to execute our vision. 12 7 405 0 0 0 76305 79751 936427699 944224669 5199349 5598568 770968 697824 942474321 950600812 2881042 2202373 857041208 858981240 33782846 33483196 0 0 0 35014493 41719380 928719589 936386189 13754732 14214623 212950806 234593256 47791207 53472130 165159599 181121126 The purposes of Washington Dental Service include, but are not limited to, the following; To secure dental services for employer groups, individuals and their families. To encourage, foster and finance professional and scientific study and research in the general field of oral health. To educate the public concerning the need for and advantage of adequate dental treatment. 0 0 883672062 0 944079845 Washington Dental Service (WDS) provides dental insurance for over 2,144,000 primary subscribers and their dependents throughout the state of Washington and across the nation. Working collectively with producers and benefit managers, we offer standard insurance benefits, as well as highly customized plans to meet the needs of individuals and their families. We have contracted with nearly 4,000 dentists, creating a network of providers serving patients across the state. As a member of the Delta Dental Plans Association, a national association supporting Delta insurers nation-wide, our members are able to access Delta contracted providers in every state. In addition to traditional benefit plans, we offer evidence based plans focused on the specific needs of the individual, which promotes appropriate care on a case-by-case basis. In 2011, WDS processed over 4,775,000 claims for subscribers and their dependents. To ensure providers are submitting claims appropriately, we audited more than 40,000 individual claims, the results of which include education of dental office staff on the use of CDT codes, invoicing procedures and reducing common errors. 1489300 0 0 WDS promotes the benefits of oral health through marketing efforts in the print, direct mail, TV, radio, online media and event sponsorships. In 2011, the marketing and advertising campaign reached out to new audiences via promotional sponsorships in an attempt to promote the benefits of good oral health in a more direct and interactive way. 1313371 0 0 Dental decay is the single most common chronic disease of early childhood - five times more common than asthma. Nearly one in five older adults, nationally, has untreated dental cavities. The Washington Dental Service Foundation, a wholly owned subsidiary of WDS, supported almost exclusively by WDS, focuses their work specifically on young children and seniors, and works closely with partner organizations to develop and implement innovative programs. The Access to Baby and Child Dentistry (ABCD) programs expand access to dental care for young children in Washington state by providing dental services - both preventative and restorative - to Medicaid-enrolled children up to age six. In counties with ABCD, the utilization of dental services increased from 21% to 49% from 1997 to 2011. The Early Intervention in Medical Settings program is training pediatricians in the advantages and techniques of oral screening, applying fluoridation and referring high risk patients for dental care. The Foundation is engaging health professionals, including pharmacists and home health aides, to take preventative steps with seniors before oral health problems affect their overall health. 663572 0 0 Washington Dental Service is engaged in efforts to promote evidenced based dental care through the Institute for Oral Health (IOH), a non-profit wholly owned subsidiary of WDS. The purpose of the IOH is to educate dental providers throughout the country on the latest research related to oral health, and correlations between oral health and overall health. The IOH conducts an annual conference nationally that has attracted hundreds of providers. 560000 0 0 Water fluoridation is the most important step a community can take to improve the oral health of all residents. The Foundation promotes legislation to encourage fluoridation and provides assistance to groups who are committed to bringing the benefits of fluoride to their communities. Since 2001, the Foundation's work in local communities has increased access to fluoridated water to more than 208,000 Washington residents. 500901 0 0 Assisting the work of the Foundation are WDS employees volunteering their time. WDS enables all employees to engage with the public regarding oral health through the use of two volunteer days per year. Volunteer time is spent working on the Smile Mobile, a mobile dental facility traveling to underserved areas of the state. The Smile Mobile has delivered dental care to more than 30,000 children state-wide. Volunteer time is also spent handing out flyers promoting oral health to Washington citizens at fairs, the zoo, parades, and events across the state. 333018 0 0 The Company matches donations made by employees to non-profit organizations with official IRS 501(c)(3) status, although the following organizations/events are not eligible for matching; churches, political campaigns/organizations, capital funding, fraternal/labor organizations, trips/tours, mass mailings, organizations/groups that discriminate for any reason including, but not limited to, race, color, religion, creed, age, sex, sexual orientation or national origin. 2057491 0 0 888532224 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 41904 0 1 405 1 0 0 0 0 0 0 X 12 7 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WA X Washington Dental Service 2065221300 9706 4th Avenue NE Seattle WA 981152157 X Richard R Albrecht 5.5 X 55396 0 0 G Douglas Beck 8 X X 51324 0 0 David W Branch 9 X X 72708 0 0 David W Branch - Dental Claims 0 X 236036 0 0 Patrick J Dineen 6 X 48880 0 0 Janis Harwell 6 X 44808 0 0 Robb B Heinrich 4.5 X 48880 0 0 John M Henricksen 6 X 45308 0 0 John M Henricksen - Dental Claims 0 X 334121 0 0 Christine M Johnson 5.5 X 49435 0 0 Joanna Lohkamp 7 X X 62526 0 0 Jack E Neal 4 X X 44808 0 0 Gerald Phipps 7 X 51324 0 0 Allen W Puckett 5.5 X 48880 0 0 R Gary Schweikhardt 4 X 55396 0 0 Kristin Stred 3 X 4000 0 0 Remigius J Eussen 0.5 X 6516 0 0 Diana Gale 0.5 X 6516 0 0 Frederick C Kiga 0.5 X 6516 0 0 Hyeok Kim 0.5 X 6516 0 0 W Kurt Labberton 0.5 X 9126 0 0 W Kurt Labberton - Dental Claims 0 X 184045 0 0 Thomas Locke 0.5 X 7868 0 0 Russell Maier 0.5 X 8394 0 0 Alejandro Narvaez 0.5 X 7432 0 0 Eve Rutherford 0.5 X 12691 0 0 James Daniel Dwyer 40 X X X 1053745 0 135200 Tracy Lynn Hoek-Warner 40 X X 631355 0 101719 Ronald Edward Inge 40 X 509564 0 91901 John Theodore Bursett 40 X 360242 0 43970 Kristin Nielsen Merlo 40 X 328961 0 38080 Thomas Andrew Gates 40 X 319596 0 36035 John Poli 40 X 318192 0 66844 Larry Leopold 40 X 223722 0 7929 Laura Jean Smith 40 X 291342 0 68923 Larry Van Kuhl DDS 40 X 218149 0 22977 Darryl J Liley 40 X 188274 0 29628 Jon P Allen 40 X 174490 0 23263 Vincent L Ippolito 40 X 173208 0 19161 6300290 0 685630 62 0 1 0 DeCare Systems Unit 1 Curraheen Rd Cork Ireland EI Software Development 3377838 BIT LLC 710 SW 34th St Renton WA 98057 Printing and Mailing Services 2628182 TEK Systems PO Box 198568 Atlanta GA 303848568 IT contract labor and recruiting 2216549 PWC Advisory LLC PO Box 514038 Los Angeles CA 900514038 Consultants 1475185 TIG PO Box 85244 San Diego CA 921865244 Computer hardware vendor 1143891 70 0 0 0 20480 0 59271 0 79751 Premium Revenue 524114 944079845 944079845 0 0 Smilemobile (Mobile Dentist Office) 621990 144824 144824 0 0 0 0 0 0 944224669 5124197 5124197 0 0 148431 148431 0 0 0 0 0 0 551929 0 0 0 551929 0 551929 0 0 551929 53486359 -961467 52198952 0 1287407 -961467 325940 325940 0 0 0 145895 145895 0 0 145895 950600812 949969132 0 551929 587240 587240 1615133 1615133 0 0 858981240 858981240 7166797 1842122 5324675 0 0 0 0 0 18389839 7073884 11315955 0 1247472 405825 841647 0 4611140 1709321 2901819 0 2067948 784217 1283731 0 0 0 0 0 615275 49743 565532 0 317225 4800 312425 0 74108 74108 0 0 0 0 521696 0 521696 0 8795844 1329371 7466473 0 2520684 1489300 1031384 0 5024981 3057015 1967966 0 4110618 28946 4081672 0 0 0 0 0 1764048 334199 1429849 0 1007598 396458 611140 0 0 0 0 0 674658 223512 451146 0 30 0 30 0 0 0 0 0 3622617 48935 3573682 0 185322 0 185322 0 Commissions 7144693 7144693 0 0 Taxes and service charges 4552994 1221696 3331298 0 Research & development 581349 82500 498849 0 Dues & subscriptions 205640 47966 157674 0 936386189 888532224 47853965 0 -14839100 -15486692 34439212 43912427 0 25239659 20624111 0 0 0 90000 0 3103325 3090688 49864851 34939774 17485067 14925077 147371767 163953262 150876 566067 0 2918316 212950806 234593256 43716496 48773205 0 1163185 4074711 3535740 0 0 0 0 0 0 0 0 0 0 0 47791207 53472130 X 165159599 181121126 0 0 0 0 165159599 181121126 212950806 234593256 X 14214623 1746904 X 0 1 1 X 0 126100 0 0 126100 126100 1 Senate Republican Leadership Council PO Box 11025 Olympia WA 98508 911714860 10000 0 The Reagan Fund PO Box 904 Olympia WA 98507 911716818 10000 0 The Roosevelt Fund Po Box 45201 Seattle WA 98145 911713677 5000 0 Harry Truman Fund PO Box 9100 Seattle WA 98109 911769570 5000 0 Citizens for Lt Governor Brad Owen PO Box 1426 Seattle WA 98584 760843646 3200 0 Washington State Democrats PO Box 4027 Seattle WA 98194 911135732 2500 0 Washington State Republicans 11811 NE 1st St Suite A306 Bellevue WA 98005 910486656 2500 0 Gael Tarleton for Port Commissioner PO Box 9100 Seattle WA 98109 208378002 1600 0 Gary Alexander for State Representative PO Box 48 Olympia WA 985070048 510575921 1600 0 Committee to Elect Barbara Bailey PO Box 374 Oak Harbor WA 98277 020556800 1600 0 Committee to Elect Don Benton PO Box 5076 Vancouver WA 98686 510645142 1600 0 The Committee to Elect Eileen Cody 5209 36th Ave SW Seattle WA 98126 911646573 1600 0 Jeanne Darneille PO Box 7753 Tacoma WA 984170753 216521757 1600 0 Committee to Re-Elect Richard DeBolt 1673 South Market Blvd PMB 159 Chehalis WA 985323830 203271760 1600 0 Friends to Re-Elect Mike Hewitt 177 Electric Ave Walla Walla WA 99362 331084713 1600 0 Friends of Laurie Jinkins PO Box 2032 Tacoma WA 98401 272214467 1600 0 Steve Kirby Campaign 9415 Tacoma Ave South Tacoma WA 98444 711000906 1600 0 Committee to Elect Joel Kretz 1014 Toroda Creek Rd Wauconda WA 98859 272630585 1600 0 Citizens for Stephen Litzow 7683 SE 27th Street Mercer Island WA 98040 262303979 1600 0 People for Joe Schmick PO Box 620 Colfax WA 99111 450582705 1600 0 People for Zarelli PO Box 65727 Vancouver WA 98665 912067783 1600 0 Bill Bryant for Seattle Port Commission PO Box 2756 Seattle WA 98111 208451661 1600 0 Citizens for Glenn Anderson PO Box 1682 Issaquah WA 98027 911985715 800 0 Committee to Elect Jan Angel 5184 Granada Place SE Port Orchard WA 98367 262302911 800 0 Committee to Re-Elect Mike Armstrong PO Box 2974 Wenatchee WA 98801 203767438 800 0 Committee to Elect Kartina Asay PO Box 766 Milton WA 98354 272777880 800 0 Committee to Elect Brian Blake PO Box 1514 Longview WA 98632 870699800 800 0 Citizens for Jeff Baxter 1521 N Argonne Road C137 Spokane Valley WA 99212 451660683 800 0 Friends to Elect Randi Becker PO Box 83 Graham WA 98338 770708976 800 0 Friends of Andy Billig PO Box 145 Spokane WA 99210 271127517 800 0 Campaign for Lisa Brown 1428 W 14th Ave Spokane WA 99204 911576127 800 0 Citizens for Vincent Buys PO Box 25 Lynden WA 98264 271476576 800 0 Bruce Chandler Campaign PO Box 1108 Zillah WA 98953 912066326 800 0 Reuven Carlyle for State Representative PO Box 9100 Seattle WA 98109 261852908 800 0 Citizens for Mike Carrell 10210 Lake Louise Dr SW Lakewood WA 98498 742968382 800 0 Citizens for Frank Chopp 1000 Aurora Ave North N100 Seattle WA 98109 320020852 800 0 Judy Clibborn for State Representative PO Box 808 Mercer Island WA 98040 010649609 800 0 Committee to Elect Cary Condotta PO Box 3001 Wenatchee WA 98807 710896890 800 0 Committee to Elect Cathy Dahlquist 1348 Florence St Enumclaw WA 98022 272819445 800 0 Committee to Elect Bruce Dammeier PO Box 398 Puyallup WA 98371 912141093 800 0 Citizens for Mary Lou Dickerson 3515 NE 103rd St Seattle WA 98125 680510673 800 0 Friends of Susan Fagan PO Box 1471 Pullman WA 99163 264513295 800 0 Friends of David Frockt PO Box 2114 Seattle WA 98111 271548039 800 0 Committee to Elect Tami Green 10316 93rd St SW Lakewood WA 984981957 205073891 800 0 Kathryn Haigh Campaign Committee 81 SE Walker Park Road Shelton WA 98584 270763404 800 0 House Democratic Campaign Committee 1000 Aurora Ave North N100 Seattle WA 98109 916178946 800 0 Committee to Elect Larry Haler 1860 McMurray Ave Richland WA 99354 201624033 800 0 Campaign to Elect Paul Harris 1916 SE 130th Ave Vancouver WA 98683 272531536 800 0 Bob Hasegawa for State Representative PO Box 84331 Seattle WA 98124 201930625 800 0 Committee to Elect Jim Hargrove 556 Ocean Beach Road Hoquim WA 98550 453697171 800 0 People for Brian Hatfield 226 Fir Street Raymond WA 98577 431966915 800 0 Committee to Re-Elect Mary Margaret Haugen 1268 N Olsen Road Camano Island WA 98282 912085148 800 0 Campaign to Re-Elect Bill Hinkle PO Box 919 Ellensburg WA 98926 262768576 800 0 House Republican Organizational Committee PO Box 7222 Olympia WA 985077222 916177625 800 0 People for Zack Hudgins 4512 South 136th St Tukwila WA 981683271 810555017 800 0 Sam Hunt for State Representative PO Box 2573 Olympia WA 98507 331007463 800 0 Friends for Ross Hunter PO Box 4204 Bellevue WA 980094204 043645222 800 0 Citizens for Christopher Hurst 62504 Indian Summer Way E Enumclaw WA 98022 010841227 800 0 Norm Johnson for State Representative 55 West Washington Ave Ste 83 Yakima WA 98903 800190629 800 0 Citizens for Ruth Kagi 19553 35th NE Lake Forest Park WA 98155 911914967 800 0 Friends of Troy Kelley 2521 Fremont St Tacoma WA 98406 203888484 800 0 Committee to Re-Elect Phyllis Gutierrez Kenney PO Box 15314 Seattle WA 98115 911704805 800 0 Curtis King for State Senate PO Box 10025 Yakima WA 98909 208314962 800 0 Friends for Dan Kristiansen PO Box 2007 Snohomish WA 98291 912064816 800 0 Connie Ladenburg Campaign Committee PO Box 111928 Tacoma WA 98411 272793228 800 0 Citizens for Marcie Maxwell PO Box 2048 Renton WA 98056 261784481 800 0 Committee to Elect Jim Moeller 1701 Broadway Ste 328 Vancouver WA 98663 450476516 800 0 Committee to Elect Jeff Morris 1004 Commercial Ave Ste 303 Anacortes WA 98221 911921313 800 0 Committee to Re-Elect Ed Orcutt PO Box 1280 Kalama WA 98625 900038949 800 0 People for Timm Ormsby PO Box 2177 Spokane WA 992102177 550876251 800 0 Friends of Tina Orwell 17837 First Ave S PMB 299 Normandy Park WA 98148 453602805 800 0 Citizens to Elect Jason Overstreet PO Box 1203 Blaine WA 98231 272221211 800 0 Committee to Elect Kevin Parker PO Box 198 Spokane WA 99210 260348064 800 0 Committee to Re-Elect Linda Evans Parlette PO Box 2151 Wenatchee WA 98807 911715910 800 0 People for Pedersen 815 First Ave Ste 111 Seattle WA 98104 203979617 800 0 Friends to Elect Eric Pettigrew PO Box 28660 Seattle WA 98118 534801080 800 0 Friends of Cheryl Pflug 23705 230th Place SE Maple Valley WA 98038 912000754 800 0 Committee to Elect Margarita Prentice 6245 South Langston Road Seattle WA 98178 912066629 800 0 Pridemore for State Senate 1111 Main Street Ste 400 Vancouver WA 98660 200665954 800 0 Elect Tim Probst 3205 NE 160th St Ridgefield WA 98642 262359148 800 0 Citizens for Kevin Ranker PO Box 92 Deer Harbor WA 98243 262438684 800 0 Friends of Ann Rivers PO Box 957 La Center WA 98629 271512372 800 0 Committee to Elect Mary Helen Roberts 3924 149th PL SW Lynnwood WA 98087 770621137 800 0 Friends for Jay Rodne PO Box 2848 Issaquah WA 98027 473922332 800 0 People for Christine Rolfes 19689 7th Ave NE PMB 118 Poulsbo WA 98370 320172015 800 0 Committee to Re-Elect Charles Ross PO Box 996 Naches WA 98937 263352534 800 0 Friends for Cindy Ryu 15021 Aurora Ave N Shoreline WA 98133 202771557 800 0 Senate Committee for Mark Schoesler 1588 East Rosenoff Ritzville WA 99169 043779321 800 0 Senate Democratic Campaign Committee PO Box 45042 Seattle WA 98145 916163985 800 0 Citizens to Elect Larry Seaquist PO Box 821 Gig Harbor WA 98335 204220154 800 0 Shelly for State PO Box 37 Addy WA 99101 680674661 800 0 Committee to Elect Larry Springer 700 20th Ave W Kirkland WA 98033 830382872 800 0 Senate Republican Campaign Committee PO Box 11025 Olympia WA 98508 910987396 800 0 Friends of Derek Stanford PO Box 2041 Bothell WA 98041 272317624 800 0 Citizens for Val Stevens PO Box 3236 Arlington WA 98223 911550229 800 0 Re-Elect Pat Sullivan Campaign 26513 168th PL SE Covington WA 98042 043679431 800 0 Committee to Elect Dave Taylor 1661 Beane Road Moxee WA 98936 264761911 800 0 Maureen Walsh PO Box 461 Walla Walla WA 99362 294723755 800 0 Committee to Elect Kevin Van De Wege 10 Sable Court Sequim WA 98382 200522366 800 0 Committee to Elect JT Wilcox PO Box 747 McKenna WA 98558 270758934 800 0 Citizens for Jim McIntire PO Box 21941 Seattle WA 98111 260820856 500 0 People for Randi Dorn 3718 19th Ave CT SE Puyallup WA 98372 611561950 500 0 Jim Kastama Secretary of State PO Box 1271 Tacoma WA 98401 533504205 500 0 SchC_P1A_S00_L01 Schedule C, Part I-A, Line 1 Washington Dental Service contributed $126,100.00 to 104 political campaigns for individuals running for Washington state political offices. Contributions to each campaign ranged from a low of $500.00 to a high of $10,000.00. 0 1211191 1211191 0 11944240 8405559 3538681 0 1214757 749744 465013 0 9293767 7365273 1928494 0 26200896 18419198 7781698 14925077 1 King County Water District III 27224 144th Ave SE Kent WA 98042 910825473 510000 Fluoridation equipment Kittitas County Health Department 507 Nanum Ellensburg WA 98926 916001349 27134 0 Second year of Access to Baby and Child Dentistry Program Grant County Health District 1038 W Ivy Ave No 1 Moses Lake WA 98837 916001319 20106 0 Third year of Access to Baby and Child Dentistry Program Adams County Health District 425 E Main Street Suite 700 Othello WA 99344 916001294 20000 0 Third year of Access to Baby and Child Dentistry program Spokane Regional Health District 1101 West College Avenue Spokane WA 99201 911527532 10000 0 Second year of Access to Baby and Child Dentistry program for Lincoln County 19 0 Expand Yakima clinic 1 250000 0 Equipment for new clinic in Hilltop area - Tacoma 1 200000 0 Dental care for the uninsured in King County 1 182103 0 Portable oral health services for Seniors 1 123159 0 Engagement of primary care physicians in delvery of oral health services 1 100000 0 Expand access to dental care for low-income uninsured adults and seniors 1 90015 0 Two year grant to integrate oral health into early learning coalition by developing a toolkit. 1 75020 0 Community Health Center Learning Sessions 1 65024 0 New volunteer clinic in Spokane in partnership with Yakima Valley Farmworkers Community Health Center 1 50810 0 Develop research based messages and communication tools to promote community water fluoridation 1 50000 0 Partnership with early learning community to improve oral health in young children 1 45000 0 First year of Accrss to Baby and Child Dentistry program 1 35000 0 State Home Visiting Match to expand home visiting programs for Washington's youngest children 1 20000 0 Returned grant funds from Community Health Association 1 -4016 0 SchI_P01_S00_L02 Schedule I, Part I, Line 2 The grantee is required to sign a grant agreement stating that they will use the funds only for purposes outlined in the grant agreement and application. The grantee further agrees that the funds will be used exclusively for exempt purposes as described in Section 501(c)(3) of the Internal Revenue Code. The grantee is required to file reports on regular intervals outlining use of funds. Grantee is also required to return unused funding if applicable. X X X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 James Daniel Dwyer 543400 0 487734 0 22611 0 113831 0 21369 0 1188945 0 1141148 0 Tracy Lynn Hoek-Warner 418645 0 181534 0 31177 0 86717 0 15002 0 733075 0 599675 0 Ronald Edward Inge 329740 0 163878 0 15945 0 78545 0 13356 0 601464 0 545189 0 Laura Jean Smith 183419 0 95650 0 12273 0 274465 0 11704 0 577511 0 318301 0 Thomas Andrew Gates 224463 0 86133 0 9001 0 96919 0 22753 0 439269 0 293987 0 John Theodore Bursett 228006 0 116885 0 15351 0 24750 0 19220 0 404212 0 347710 0 Kristin Nielsen Merlo 223760 0 99269 0 5932 0 13289 0 24791 0 367041 0 317410 0 John Poli 216865 0 96709 0 4618 0 47209 0 19635 0 385036 0 351062 0 Larry Leopold 119940 0 92821 0 10961 0 2215 0 5714 0 231651 0 286236 0 Larry Van Kuhl DDS 170634 0 44490 0 3026 0 8917 0 14060 0 241127 0 217773 0 Darryl J Liley 155358 0 34007 0 -1091 0 11117 0 18511 0 217902 0 184499 0 Jon P Allen 143353 0 31895 0 -758 0 9262 0 14001 0 197753 0 183450 0 Vincent L Ippolito 135584 0 37220 0 485 0 8032 0 11129 0 192450 0 189172 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Washington Dental Service pays for spousal travel for the CEO, for those occasional trips where spousal travel is customary, which is treated as taxable income. Washington Dental Service provides a Wellness program which reimburses 50% of approved expenses for all employees working 30 or more hours a week, with a maximum payable of $40/month, or $480 a year, and 25% of approved expenses for part time employees working 20 to 30 hours a week with a maximum payable of $20/month, or $240 a year for health club memberships, aerobic or general exercise classes, weight loss programs, stress management and massage therapy. These reimbursements are treated as taxable income. Additionally, automobile allowance, certain auto expenses and health club dues are paid for senior Management, which is included in taxable income. SchJ_P01_S00_L03 Schedule J, Part I, Line 3 The Human Resources and Compensation Committee of the Board of Directors engages an external compensation consultant to evaluate all key employees, including President and CEO, Executive VP COO/CFO, Senior VP Underwriting, VP of Sales and Marketing, CIO, VP of Planning and Corporate Development, VP Human Resources, and VP Dental Director & Professional Relations compensation in comparison to the practice of similar employers in the marketplace. This process is conducted on an annual basis. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 The company makes contributions to a non-qualified, supplemental executive retirement plan (SERP), as determined by the Board of Directors, which is subject to Code Section 457(f). Plan participants are "key employees" who receive an annual contribution based on their age, earnings and projected 401(k) investment returns. The investment of the company contributions is directed by each participant, but vesting of the benefit is subject to a substantial risk of forfeiture as required by Code section 409(a): James Daniel Dwyer, President and CEO $97,331; Tracy Lynn Hoek-Warner, Exec VP COO/CFO $70,217; Ronald Edward Inge, VP & Dental Director, $62,045; John Poli, VP CIO, $36,052; Laura Jean Smith, Foundation President, $47,062. F990_P06_S0A_L04 Form 990, Part VI, Section A, Line 4 The following changes to Washington Dental Service's By-laws were made in 2011: Change the definition of "Public" director to the "independence" concept defined by the IRS, as required by DDPA; clarify that the CEO is no longer counted as a "Public" director since employees are not "independent" under the IRS definition; eliminate the "equal numbers" requirement for Member and Public directors, and replace it with the DDPA requirement for an independent majority; change the range of Board sizes from 10-to-14 down to 9-to-13; add typical language describing how staggered terms of directors work, and authorizing the Board to maintain roughly equal classes as Board size is gradually reduced; clarify that directors who have reached their 3-full-terms limit can in some cases be appointed to short transitional terms if needed for continuity purposes; clarify that the Board Chair is elected every year and will usually serve two 1-year terms, or sometimes three if needed for continuity or to address extraordinary circumstances; members may vote by proxy; most Committee members will now be appointed by the full Board of Directors, rather than by the Board Chair; the vote requirement for amending or repealing Bylaws is increased to two-thirds of the members' votes; the Corporation must now prepare and mail an annual report to each member; the date of the annual meeting of members is now fixed on the second Friday of November unless impracticable; the minimum notice for the annual meeting is shortened to 30 days from 45 days; the annual meeting venue must be within 20 miles of the principal corporate office and must accommodate 25% of the members; the variable quorum percentage for annual board elections is eliminated, and now requires at least a 10% turnout; authorization of the use of ballots in voting for directors, on plebiscites and on Bylaws amendments is now eliminated and explicit "majority voting" procedures are no longer included as part of the member-director election process. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 Washington Dental Service's member Dentists are considered members of the company. Member dentists elect the Dental members of the Board of Directors. F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a The Governance & Nominating Committee (GNC) of the Board of Directors solicits advice on candidates and submits nominees to the Board for consideration and approval to be voted upon. The entire membership elects and re-elects Member Directors, who comprise a minority of the Board. The incumbent Independent Directors nominate and elect or re-elect Independent Directors. A Member Advisory Panel (MAP) consisting of ten to fifteen members are selected by the Board from nominees by the GNC. The MAP provides consultation to the GNC and Board on a variety of matters. F990_P06_S0A_L07b Form 990, Part VI, Section A, Line 7b Recommended changes to the Corporate By-laws by the Board are subject to approval by the member dentists. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The 990 is completed by the accounting staff. The 990 return and supporting documentation is reviewed and approved by the Director of Finance and the CFO. An independent review is conducted by the Chairman of the Human Resources and Compensation Committee of the Board of Directors. Electronic copies of the return are provided to all Board members prior to submission to the IRS. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The Audit Committee of the Board is charged with monitoring proposed or on-going transactions for conflicts of interest and addressing any potential or actual conflicts. Pursuant to the Conflicts of Interest Policy, an annual conflict of interest questionnaire, aimed at determining any family and business relationships and transactions, or other transactions that may pose a potential conflict, is distributed to all covered persons (i.e. board members, officers and executive leadership or key employees). Covered persons are required to disclose real or potential conflicts at the time when such conflicts arise. When someone becomes a covered person and annually thereafter, each covered person is required to sign a statement affirming that he/she: (1) has received a copy of the conflicts of Interest Policy; (2) has read the policy and understands said Policy; and (3) agrees to comply with all requirements of the Policy, including completing the conflicts of interest questionnaire. The completed questionnaires are reviewed by the Compliance Committee and any persons with actual or potential conflicts are informed via written communication. The procedures for addressing any conflict of interest includes, but is not limited to, the following; (1) the conflicting interest is fully disclosed to the Board; (2) the interested person responds to factual questions related to the substance of the transaction or arrangement being considered, after which he/she shall leave the meeting; (3) the person with the conflict of interest is excluded from the discussion and approval of such transaction; (4) alternatives to the proposed transaction are investigated, competitive bids or comparable valuations are obtained; (5) any conflicting issues during the course of a Board meeting which cannot be resolved are referred to the Governance Committee; and (6) the transaction or action must be approved by a majority of disinterested persons. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The board appoints a Human Resources and Compensation Committee of the Board, none of whom has a conflict of interest with respect to the compensation arrangement, to be accountable for setting reasonable compensation packages for each officer or key employee (including the CEO). The Human Resources and Compensation Committee of the Board develops, consistent with the organization's philosophy and principles, the annual performance goals and criteria to be used in determining merit increases and variable compensation criteria for officers and key employees. The Human Resources and Compensation Committee of the Board also hires a qualified independent compensation and benefits specialist (independent expert) to review, analyze and provide benchmarking data for the total compensation and benefit packages of officers and key employees. Appropriate comparability data is obtained from the independent experts, i.e., total economic benefits paid by similar situated organizations (both taxable and tax-exempt) for similar job responsibilities. The committee's written records include the (1) terms of the arrangements with the officers and key employees (including the date the arrangement was approved); (2) a list of committee members present during the discussion of compensation packages (and how the members voted when it was approved); and (3) a description of the comparable data relied upon by the committee. Key deliberations of the committee are also documented in minutes which are approved at the next Committee meeting. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Governing documents, financial statements and disclosures are filed quarterly and annually with the Washington State Office of the Insurance Commissioner (OIC) as a matter of public record. All documents so filed are available to the public on the OIC website. Amendments to By-laws are filed with the OIC from time-to-time as they are approved by the governing body. All governing documents, conflict of interest policy and financial statements are available to the public upon request. F990_P07_S0A_L01a Form 990, Part VII, Section A, Line 1a Reportable compensation for board members David Branch, John Henrickson and Kurt Labberton include compensation paid, under their personal tax ID number, for dental treatment services rendered as a member dentist of Washington Dental Service of: $236,036, $334,121 and $184,045, respectively. F990_P11_S00_L05 Form 990, Part XI, Line 5 Prior year adjustment ($31,000); Change in unrealized gains (losses) $2,265,490; Change in accumulated other comprehensive income (AOCI) $89,304; and other than temporary impairment (OTTI) of investments ($576,890). Washington Dental Service Foundation LLC 9706 Fourth Ave NE Seattle WA 98115 910621480 Sponsor Oral Health Education WA 5445044 3244414 N/A Washington Dental Service Holdings LLC 9706 Fourth Ave NE Seattle WA 98115 910621480 Invest in Oral Health Activities WA -415789 13842237 N/A Institute for Oral Health 9706 Fourth Ave NE Seattle WA 98115 910621480 Support Oral Health Education WA 663572 13446 N/A Washington Dental Service Fund 9706 Fourth Ave NE Seattle WA 98115 911281990 Sponsor Oral Health Education WA 501(c)(3) 9 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0