2012-11-07T09:45:48-06:00 2011-12-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2011-01-01 480793267 DELTA DENTAL OF KANSAS INC % MICHAEL HERBERT DELT 3162641099 1619 N WATERFRONT PARKWAY WICHITA KS 67206 MICHAEL HERBERT 2012-11-15 true ELIZABETH S HOGAN 3162652811 2011 2016-03-07 17:11:31Z MICHAEL HERBERT 1619 N WATERFRONT PARKWAY WICHITA KS 67206 244914812 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 NON-PROFIT PREPAYMENT DENTAL SERVICE PLAN. 10 6 115 0 344035 18474 0 0 236665873 242993827 1793145 1560517 372528 352321 238831546 244906665 1581632 1488375 0 0 8808013 9326127 0 0 0 226036187 230228062 236425832 241042564 2405714 3864101 52845160 56785026 13706788 13605627 39138372 43179399 SEE SCHEDULE O false false 220477263 235704012 DENTAL BENEFITS (COVERED CHARGES) PROVIDED TO SUBSCRIBERS. DELTA DENTAL SERVED APPROXIMATELY 906,843 PEOPLE THIS YEAR. 6905017 7289815 THE PROCESSING OF DENTAL BENEFIT CLAIMS. 1488375 1488375 CONTRIBUTION TO DELTA DENTAL OF KS FOUNDATION 228870655 false false false false false false false false false true true false false true true false true false false false false false false false false false true false true false false false false false true false true false false false false true true true true false true 29174 0 true 115 true true true 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 HERBERT 3162641099 1619 N WATERFRONT PARKWAY WICHITA KS 67206 X HUGH HERSCHEL BRUNER JR 1.3 X 17526 0 96 BRADLEY JAY CLOTHIER 0.83 X 12911 0 110 RONALD ROSS DAVIS 1.04 X 16611 0 110 GEROLD LYNNE GOFORTH 0.87 X X 16341 0 639 MARY ELIZABETH KINCH 0.86 X 14722 0 626 WILBERT JOHN LEIKER 0.86 X 14411 0 44 PATRICK MORIARTY 0.96 X 4069 0 0 LUCYNDA JANE RABEN 0.9 X 14611 0 269 MICHAEL J SANDERS 0.87 X 12115 0 1573 BRICK RANDALL SCHEER 1.03 X 14527 0 0 NANCY GWEN ZOGLEMAN 0.76 X 12215 0 235 LINDA BRANTNER 39.4 X 410141 0 48529 MICHAEL HERBERT 37.1 X 257764 0 44279 NANCY UMHOLTZ 39.7 X 86735 0 16076 DEAN NEWTON 37.2 X 263195 0 50121 FRANK CLEPPER 38.9 X 206292 0 37311 ROBERT EBENKAMP 39.3 X 178167 0 29868 JUNETTA EVERETT 37.4 X 176442 0 32601 AMELIA ELLISON 39.6 X 168679 0 28245 DR JON TILTON 40.0 X 193209 0 33283 MARY MCPHEETERS 34.9 X 148863 0 2029 2239546 0 326044 16 false true false GAGE CENTER DENTAL GROUP PA DENTAL SERVICES 1888086 JENKINS LEBLANC PA DENTAL SERVICES 1019176 DENTAL ASSOC OF WEST WICHITA PA DENTAL SERVICES 991465 CAMBRIDGE FAMILY DENTISTRY PA DENTAL SERVICES 966808 MARTIN AND FRANKENBERY DDS PA DENTAL SERVICES 942503 450 0 DENTAL SERVICES 524298 242993827 242993827 242993827 1217092 1217092 0 0 351572 8147 351572 -8147 343425 343425 0 0 0 OTHER INCOME 900099 8286 8286 MANAGEMENT FEE 561000 344035 344035 352321 244906665 242993827 344035 1568803 1488375 1488375 0 0 0 2565590 510078 2055512 0 5111012 2371439 2739573 536890 280468 256422 609699 316272 293427 502936 225391 277545 0 110351 110351 120000 120000 30395 30395 0 158541 158541 3282454 132334 3150120 673992 553 673439 1499120 1401737 97383 24215 11403 12812 0 156984 156984 431364 12452 418912 0 0 419873 214135 205738 0 552880 281948 270932 102622 102622 BANK SERVICES 144119 144119 CLAIMS 220477263 220477263 STATE PREMIUM TAXES 670317 670317 BOARDS, BUREAUS, AND ASSOCS. 234629 234629 1138943 476490 662453 241042564 228870655 12171909 0 226903 256032 3074167 3960953 0 0 3992714 4225184 0 0 0 0 0 0 0 0 290937 411854 11351302 2877717 8959898 8473585 31527375 32620141 4452173 6511387 0 0 0 0 320993 325890 52845160 56785026 6649661 7055786 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7057127 6549841 13706788 13605627 X 39138372 43179399 0 0 0 0 39138372 43179399 52845160 56785026 X 3864101 176926 X false true true X false 1401415 1401415 7332320 978891 6353429 2617567 1898826 718741 8473585 INV IN DELTA DENTAL OF KS FDN 1911304 F INV IN SURENCY LIFE & HEALTH 4600083 F 6511387 0 UNEARNED PREMIUMS 75196 UNEARNED RENT 86562 CITY OF WICHITA - IRB(TAXABLE) 6388083 6549841 FIN 48 FOOTNOTE 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) 1463699 24676 COST UTILITIES, OFFICE ASSISTANCE TO FOUNDATION 1 0 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S. SCHEDULE I, PART I, QUESTION 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 292510 0 85037 32594 39728 0 8801 0 458670 0 MICHAEL HERBERT 183620 0 49308 24836 33690 0 10589 0 302043 0 DEAN NEWTON 162768 0 74569 25858 39792 0 10329 0 313316 0 FRANK CLEPPER 143309 0 40127 22856 26866 0 10445 0 243603 0 ROBERT EBENKAMP 139344 0 29128 9695 22064 0 7804 0 208035 0 JUNETTA EVERETT 123462 0 29605 23375 22391 0 10210 0 209043 0 AMELIA ELLISON 118627 0 26927 23125 20981 0 7264 0 196924 0 DR JON TILTON 144701 0 31555 16953 24451 0 8832 0 226492 0 MARY MCPHEETERS 139359 0 9155 349 0 0 2029 0 150892 0 TRAVEL FOR COMPANIONS 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. HEALTH OR SOCIAL CLUB DUES 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. 0 DR RONALD DAVIS DIRECTOR 51867 PAYMENT OF DENTAL SERVICES false DR LUCYNDA RABEN DIRECTOR 168494 PAYMENT OF DENTAL SERVICES false DR HUGH BRUNER JR DIRECTOR 7888 PAYMENT OF DENTAL SERVICES false DR BRICK SCHEER DIRECTOR 145616 PAYMENT OF DENTAL SERVICES false SURENCY LIFE HEALTH COMPANY SHARED OFFICERS 344035 PAYMENT OF MANAGEMENT FEES false DR PATRICK MORIARTY DIRECTOR 197007 PAYMENT OF DENTAL SERVICES false BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS 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. DELTA DENTAL OF KANSAS HAS A MANAGEMENT CONTRACT WITH SURENCY LIFE & HEALTH. IN ACCORDANCE WITH THE MANAGEMENT CONTRACT, SURENCY PAYS DELTA DENTAL OF KANSAS MANAGEMENT FEES FOR SERVICES PROVIDED. ORGANIZATION'S MISSION 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. INDEPENDENT VOTING MEMBERS FORM 990, PART VI, SECTION A, LINE 1B BRICK SCHEER, LUCYNDA RABEN, PATRICK MORIARTY, AND RONALD DAVIS 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. BUSINESS RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 LINDA BRANTNER, MICHAEL HERBERT, DEAN NEWTON, NANCY UMHOLTZ, AND FRANK CLEPPER HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. LINDA BRANTNER, MICHAEL HERBERT, DEAN NEWTON, NANCY UMHOLTZ, AND FRANK CLEPPER 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. MEMBERS 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. MEMBERS WHO MAY ELECT THE GOVERNING BODY 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. DECISIONS SUBJECT TO APPROVAL BY MEMBERS 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 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUTING FIRM PREPARES THE FORM 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S CFO AND 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. CONFLICT OF INTEREST POLICY 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. COMPENSATION REVIEW 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 INSIGHT MANAGEMENT CONSULTING GROUP TO PROVIDE COMPENSATION STUDIES FOR OUR POSITIONS. INSIGHT 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. INSIGHT PROVIDES 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. AVAILABILITY OF DOCUMENTS 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. COMPENSATION OF OFFICERS 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. RECONCILIATION OF NET ASSETS FORM 990, PART XI, LINE 5 (261,580.00) UNREALIZED LOSS ON INVESTMENTS NOT INCLUDED ON RETURN (120,708.00) MARK-TO-MARKET ADJUSTMENT NOT INCLUDED ON RETURN 947,945.00 EARNINGS FROM SUBSIDIARY NOT ON RETURN - FOUNDATION (388,731.00) EARNINGS FROM SUBSIDIARY NOT ON RETURN - SURENCY ------------ 176,926.00 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HUGH HERSCHEL BRUNER JR TITLE:DIRECTOR HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BRADLEY JAY CLOTHIER TITLE:DIRECTOR HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RONALD ROSS DAVIS TITLE:DIRECTOR/VICE CHAIRPERSON HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARY ELIZABETH KINCH TITLE:DIRECTOR HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BRICK RANDALL SCHEER TITLE:DIRECTOR HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LINDA BRANTNER TITLE:PRESIDENT & CEO HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL HERBERT TITLE:TREASURER & CFO HOURS:3 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:NANCY UMHOLTZ TITLE:SECRETARY HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DEAN NEWTON TITLE:CHIEF MARKETING/SALES OFFICER HOURS:3 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:FRANK CLEPPER TITLE:CHIEF OPERATING OFFICER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT EBENKAMP TITLE:VP INFORMATION TECHNOLOGY HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JUNETTA EVERETT TITLE:VP PROFESSIONAL RELATIONS HOURS:3 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:AMELIA ELLISON TITLE:VP HUMAN RESOURCES HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARY MCPHEETERS TITLE:IN-HOUSE LEGAL COUNSEL HOURS:5 KSDD PROPERTIES LLC 1619 N WATERFRONT PARKWAY WICHITA KS 67206 480793267 REAL ESTATE KS 890191 8347156 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 -388731 5010589 1.00000 false true false false false false false false false false false false true true false false false false SURENCY LIFE & HEALTH INSURANCE COMPANY B 1200000 COST SURENCY LIFE & HEALTH INSURANCE COMPANY N 344035 COST