2022-11-15T17:03:41-06:00 2021-12-31 135565207 KPMG LLP 401 UNION STREET SUITE 2800 SEATTLE WA 98101 990 2021-01-01 910621480 DELTA DENTAL OF WASHINGTON DELT 2065221300 400 FAIRVIEW AVE N SUITE 800 SEATTLE WA 98109 RYAN BARTLETT VICE PRESIDENT OF FINANCE & CFO 2065221300 2022-11-11 1 RYAN BARTLETT 999009999 JAMES R LANCASTER P00742579 2069134000 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z RYAN BARTLETT 400 FAIRVIEW AVE N SUITE SEATTLE WA 98109 1655517109 0 X WWW.DELTADENTALWA.COM X 1954 WA DDWA WILL REVOLUTIONIZE THE ORAL HEALTH INDUSTRY AND IMPROVE OVERALL HEALTH. 11 6 508 79 0 0 69771 21695 1343703436 1617648578 9754901 12420481 188683 240167 1353716791 1630330921 33751957 4947592 1200384852 1476312672 58802586 60663511 0 0 0 69641695 69467008 1362581090 1611390783 -8864299 18940138 259998031 260648362 75371464 73217260 184626567 187431102 X SEE SCHEDULE ODDWA WILL REVOLUTIONIZE THE ORAL HEALTH INDUSTRY AND IMPROVE OVERALL HEALTH. THIS INCLUDES, BUT IS NOT LIMITED TO, THE FOLLOWING: TO SECURE DENTAL SERVICE FOR EMPLOYER GROUPS, INDIVIDUALS AND THEIR FAMILIES; PROVIDE INNOVATIVE PRODUCTS AND SERVICES; TO ENCOURAGE, FOSTER AND FINANCE PROFESSIONAL AND SCIENTIFIC STUDY AND RESEARCH IN THE GENERAL FIELD OF ORAL HEALTH; AND TO EDUCATE THE PUBLIC CONCERNING THE NEED FOR AND ADVANTAGE OF ADEQUATE DENTAL TREATMENT. 0 0 1524358612 2402368 1617598612 SEE SCHEDULE ODDWA PROVIDES DENTAL INSURANCE FOR OVER 3,736,000 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 4,700 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 2021, DDWA PROCESSED OVER 6,266,000 CLAIMS FOR SUBSCRIBERS AND THEIR DEPENDENTS. TO ENSURE PROVIDERS ARE SUBMITTED CLAIMS APPROPRIATELY, WE AUDITED OVER 38,000 INDIVIDUAL CLAIMS, THE RESULTS OF WHICH INCLUDE EDUCATION OF DENTAL OFFICE STAFF ON THE USE OF CDT CODES, INVOICING PROCEDURES AND REDUCING COMMON ERRORS. 5047773 SEE SCHEDULE ODELTA DENTAL OF WASHINGTON PROMOTES THE VALUE OF DENTAL BENEFITS AND IMPORTANCE OF ORAL HEALTH THROUGH MARKETING EFFORTS IN MEDIA ADVERTISING, PUBLIC RELATIONS, EVENT SPONSORSHIPS AND DIRECT OUTREACH TO CUSTOMERS. MARKET RESEARCH FINDINGS SHOW THESE ACTIVITIES IMPROVE OUR ABILITY TO REACH AND ENCOURAGE AUDIENCES TO EMBRACE GOOD ORAL HEALTH AND MAKE WISE USE OF DENTAL BENEFITS. 1511351 1511351 SEE SCHEDULE ODENTAL DISEASE IS THE SINGLE MOST COMMON CHRONIC DISEASE OF EARLY CHILDHOOD - FIVE TIMES MORE COMMON THAN ASTHMA. NEARLY ONE IN FIVE ADULTS, NATIONALLY, HAS UNTREATED DENTAL CAVITIES. THE ARCORA FOUNDATION (THE FOUNDATION), A WHOLLY OWNED SUBSIDIARY OF DDWA, SUPPORTED ALMOST EXCLUSIVELY BY DDWA, FOCUSES MUCH OF THEIR WORK ON COMMUNITIES EXPERIENCING ORAL HEALTH DISPARITIES, INCLUDING CHILDREN AND SENIORS, AND WORKS CLOSELY WITH PARTNER ORGANIZATIONS TO DEVELOP AND IMPLEMENT INNOVATIVE PROGRAMS THAT IMPROVE ORAL HEALTH. THE ACCESS TO BABY AND CHILD DENTISTRY (ABCD) SYSTEM OF CARE EXPANDS ACCESS TO DENTAL CARE FOR YOUNG MEDICAID INSURED CHILDREN UNDER SIX IN WASHINGTON STATE BY PROVIDING DENTAL SERVICES, BOTH PREVENTATIVE AND RESTORATIVE. IN COUNTIES WITH ABCD, THE UTILIZATION OF DENTAL SERVICES INCREASED FROM 21% TO 51% FROM 1997 TO 2021. THE EARLY INTERVENTION IN MEDICAL SETTINGS PROGRAMS, MOUTHMATTERS, TRAINS PEDIATRIC MEDICAL PROVIDERS IN THE ADVANTAGES AND TECHNIQUES OF EARLY INTERVENTION AND PREVENTION THROUGH ORAL SCREENING AND EDUCATION, APPLYING FLUORIDATION AND REFERRING HIGH RISK PATIENTS FOR DENTAL CARE. 1575854 1033873 49966 1. 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, AN ADDITIONAL 280,000 WASHINGTONIANS ARE RECEIVING THE HEALTH BENEFITS ASSOCIATED WITH FLUORIDATED WATER AS A RESULT OF THE FOUNDATION'S WORK.2. ASSISTING THE WORK OF THE FOUNDATION ARE DDWA EMPLOYEES VOLUNTEERING THEIR TIME. DDWA 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 SMILEMOBILE, A MOBILE DENTALFACILITY TRAVELING TO UNDERSERVED AREAS OF THE STATE. MORE THAN 20,000 LOW-INCOME AND AT-RISK-CHILDREN STATE-WIDE RECEIVED DENTAL SERVICES IN THE LAST 10 YEARS THROUGH THE FOUNDATION OPERATED SMILEMOBILE. VOLUNTEER TIME IS ALSO SPENT HANDING OUT FLYERS PROMOTING ORAL HEALTH TO WASHINGTON CITIZENS AT FAIRS, THE ZOO, PARADES, AND EVENTS ACROSS THE STATE.3. DDWA 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.4. DDWA PROVIDED UW SCHOOL OF DENTISTRY A GRANT OF $500K TO SUPPORT COSTS ASSOCIATED WITH SPACE RENOVATIONS FOR THE DENTAL HYGIENE PROGRAM IN SHORELINE. DDWA ALSO PROVIDED $253K TO THE UW SCHOOL OF DENTISTRY TO COVER WASHINGTON STATE DEPARTMENT OF ORAL HEALTH DENTAL EXAMS FOR ITS GRADUATING CLASS. 1575854 1033873 49966 1532493590 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 1 72235 0 1 508 1 0 0 0 0 0 0 1 0 X 11 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X RYAN BARTLETT 2065221300 400 FAIRVIEW AVE N SUITE 800 SEATTLE WA 98109 X MITCHKE MARK PRESIDENT & CHIEF EXECUTIVE OFFICER 36.00 4.00 X X 3450187 0 368181 LABBERTON WELLS K CHAIR - BRD. & DDS FEES 15.00 5.00 X X 380306 0 0 SEELY JEFFREY T SECRETARY 12.00 4.00 X X 155737 0 0 BROWN COLLEEN BIRDNOW TREASURER 7.00 2.00 X X 149629 0 0 RUTHERFORD EVE M VICE CHAIR - BRD. & DDS FEES 11.00 4.00 X X 904561 0 0 HAKES KATHERINE DIRECTOR - BRD. & DDS FEES 11.00 3.00 X 836565 0 0 FARRELL ANNE V DIRECTOR 9.00 3.00 X 129261 0 0 NELSON CAROL K DIRECTOR 9.00 3.00 X 121113 0 0 TUNE JAMES F DIRECTOR 9.00 3.00 X 121113 0 0 ARMSTRONG SCOTT DIRECTOR 9.00 3.00 X 129261 0 0 PICKEL DR CHRISTOPHER DIRECTOR - BRD. & DDS FEES 9.00 3.00 X 533908 0 0 BERG BRADLEY CHIEF OPERATING & FINANCIAL OFFICER 36.00 4.00 X 1450098 0 186440 ALIABADI KAREN CHIEF HR STRATEGIST 40.00 0.00 X 813055 0 110109 WHITNEY GARRETT CHIEF INFORMATION OFFICER 40.00 0.00 X 696880 0 104763 SNYDER CINDY VP, NTWRK & BUS MGMT 40.00 0.00 X 690342 0 89440 LAY LINDA VP, SALES 40.00 0.00 X 633990 0 74888 LO ERIC VP, ACTUARIAL AND UNDERWRITING 40.00 0.00 X 496039 0 100898 ABDELLATIF VANETTA PRES/CEO ARCORA FDN 39.50 0.50 X 403842 0 39193 BARTLETT RYAN DIRECTOR OF FINANCE 40.00 0.00 X 308510 0 50834 CHEUNG STEPHEN DIRECTOR, MKTG & PROD STRAT 40.00 0.00 X 285923 0 52236 JAHRMAN CHRIS DIRECTOR, OPER & PATIENT EXP 40.00 0.00 X 259045 0 38695 LIPTON NICOLE DIRECTOR OF HR THRU 08/2021 40.00 0.00 X 380285 0 20372 PAURUS LINDA DIRECTOR OF PROV REL THRU 07/2021 40.00 0.00 X 288502 0 16972 13618152 0 1253021 155 0 1 0 8 WEST UNIT 1 CURRAHEEN ROAD CORK EI SOFTWARE DEVELOPMENT 7008283 WYSSTA SERVICES INC PO BOX 86 STEVENS POINT WI 54481 INDIVIDUAL PLAN TPA 6943506 RED CARD SYSTEM LLC 744 OFFICE PARKWAY ST LOUIS MO 63141 PRINTING/MAIL SVCS 4607808 ENCARA INC 4818 STARKEY ROAD SW ROANOKE VA 24018 INDIVIDUAL PLAN TPA 2867401 SLALOM LLC PO BOX 101416 PASADENA CA 91189 CONSULTING 1710716 176 21695 21695 PREMIUM REVENUE 524114 1617598612 1617598612 SMILEMOBILE 621990 49966 49966 1617648578 6360106 6360106 9705 9705 31236858 24881902 304286 6354956 -304286 6050670 6050670 240167 240167 240167 1630330921 1617888745 0 12420481 2545224 2545224 2402368 2402368 1476312672 1476312672 12754705 4086675 8668030 33970089 13725046 20245043 2399708 969562 1430146 8112500 3764937 4347563 3426509 1369488 2057021 146327 18067 128260 351000 351000 78507 78507 478071 478071 5649530 2945328 2704202 8832885 5047773 3785112 6877344 3967605 2909739 7134511 67008 7067503 4091308 99994 3991314 364644 99367 265277 583800 130618 453182 2525 2525 6032295 37884 5994411 369719 369719 TAXES & SERVICE CHARGES 13935928 2174632 11761296 COMMISSIONS 12519894 12519894 0 DUES & SUBSCRIPTIONS 1431244 99952 1331292 RESEARCH & DEVELOPMENT 27617 7829 19788 559859 23160 536699 1611390783 1532493590 78897193 0 1946358 2345020 2262030 2371933 26552962 31893597 6249788 7199137 87557036 60678606 29158759 26878430 191955284 187737103 1169548 1113506 703302 1109636 259998031 260648362 63230353 63094547 425985 560600 11715126 9562113 75371464 73217260 X 184626567 187431102 184626567 187431102 259998031 260648362 X 18940138 -2835603 -13300000 X 0 1 X 1 0 239000 239000 239000 1 THE LEADERSHIP COUNCIL PO BOX 11025 OLYMPIA WA 98508 272555702 15000 0 REAGAN FUND PO BOX 904 OLYMPIA WA 98507 825044633 15000 0 HARRY TRUMAN FUND PO BOX 9100 SEATTLE WA 98109 821646290 15000 0 THE KENNEDY FUND 401 2ND AVENUE SOUTH 303 SEATTLE WA 98104 823809530 15000 0 REPUBLICAN STATE LEADERSHIP COMMITTEE 1201 F STREET NW SUITE 675 WASHINGTON DC 20004 464305309 20000 0 ENTERPRISE WASHINGTON 1603 116TH AVE NE SUITE 120 BELLEVUE WA 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463326224 1000 0 COMMITTEE TO ELECT MIKE VOLZ PO BOX 10163 SPOKANE WA 99209 272265718 1000 0 SHELLY FOR STATE 127 N WYNNE STREET COLVILLE WA 99114 364732450 1000 0 COMMITTEE TO ELECT JACQUELIN MAYCUMBER 127 N WYNNE STREET COLVILLE WA 99114 261852908 1000 0 COMMITTEE TO ELECT JOEL KRETZ 127 N WYNNE STREET COLVILLE WA 99114 454760606 1000 0 COMMITTEE TO ELECT MATT BOEHNKE 6855 W CLEARWATER AVENUE SUITE 10 KENNEWICK WA 99336 911913482 1000 0 COMMITTEE TO ELECT MARY DYE 127 N WYNNE STREET COLVILLE WA 99114 844344747 1000 0 PEOPLE FOR JOE SCHMICK PO BOX 620 COLFAX WA 99111 463757260 1000 0 FRIENDS OF GREG GILDAY PO BOX 1472 STANWOOD WA 98292 824927031 1000 0 CITIZENS FOR STEVE BERGQUIST PO BOX 2050 RENTON WA 98059 203979617 1000 0 COMMITTEE TO ELECT KEITH GOEHNER PO BOX 38 LEAVENWORTH WA 98826 811159785 1000 0 CITIZENS TO ELECT MIKE STEELE PO BOX 1072 CHELAN WA 98816 320020852 1000 0 COMMITTEE TO ELECT TOM DENT 601 S PIONEER WAY SUITE F PMB 396 MOSES LAKE WA 98837 900040477 1000 0 FRIENDS OF ALEX YBARRA PO BOX 175 QUINCY WA 98848 850659766 1000 0 FRIENDS OF CHRIS CORRY 2010 WEST HOB HILL SUITE 1 YAKIMA WA 98902 815223744 1000 0 FRIENDS OF JEREMIE DUFAULT PO BOX 579 SELAH WA 98942 830382872 1000 0 COMMITTEE TO ELECT SKYLER RUDE PO BOX 502 WALLA WALLA WA 99362 800147715 1000 0 CAMPAIGN TO ELECT PAUL HARRIS 237 CHKALOV DRIVE VANCOUVER WA 98684 821748162 1000 0 COMMITTEE TO ELECT BRANDON VICK PO BOX 1434 BATTLE GROUND WA 98604 475315866 1000 0 FRIENDS TO ELECT LARRY HOFF 10013 NE HAZEL DELL AVE BOX 136 VANCOUVER WA 98685 461880322 1000 0 COMMITTEE TO RE-ELECT ED ORCUTT PO BOX 1280 KALAMA WA 98625 824989832 1000 0 FRIENDS OF JESSICA BATEMAN 120 STATE AVENUE 1462 OLYMPIA WA 98501 451965188 1000 0 PEOPLE FOR TARRA SIMMONS PO BOX 774 TRACYTON WA 98393 271504430 1000 0 COMMITTEE TO ELECT DREW HANSEN PO BOX 9100 SEATTLE WA 98109 271751460 1000 0 MIKE CHAPMAN FOR STATE REPRESENTATIVE 1321 SOUTH LAUREL STREET PORT ANGELES WA 98362 916178946 1000 0 THARINGER FOR STATE REPRESENTATIVE PO BOX 834 SEQUIM WA 98382 916177625 1000 0 FRIENDS OF KELLY CHAMBERS 1002 N MERIDIAN SUITE 100 PMB 207 PUYALLUP WA 98371 910987396 1000 0 FRIENDS OF CYNDY JACOBSEN PO BOX 709 PUYALLUP WA 98371 462614068 1000 0 EMILY RANDALL FOR STATE SENATE PO BOX 1883 PORT ORCHARD WA 98366 812324084 1000 0 MICHELLE CALDIER FOR STATE REP PO BOX 1710 PORT ORCHARD WA 98366 850575085 1000 0 PEOPLE FOR YASMIN TRUDEAU PO BOX 12066 SEATTLE WA 98102 473697034 1000 0 FRIENDS OF LAURIE JINKINS PO BOX 2032 TACOMA WA 98401 471385570 1000 0 FRIENDS OF DAN BRONOSKE PO BOX 64998 TACOMA WA 98464 463819721 1000 0 STEVE KIRBY CAMPAIGN 9415 TACOMA AVE SOUTH TACOMA WA 98444 812668177 1000 0 PEOPLE FOR JESSE JOHNSON PO BOX 4972 FEDERAL WAY WA 98003 824403196 1000 0 FRIENDS OF PHIL FORTUNATO PO BOX 2201 AUBURN WA 98071 833917287 1000 0 FRIENDS OF DREW STOKESBARY PO BOX 92 AUBURN WA 98071 825037835 1000 0 ELECT JESSE SALOMON 15521 14TH AVE NE SHORELINE WA 98155 272697662 1000 0 FRIENDS FOR CINDY RYU PO BOX 33548 SHORELINE WA 98133 814617205 1000 0 ELECT LAUREN DAVIS PO BOX 9100 SEATTLE WA 98109 850807481 1000 0 FRIENDS OF KAREN KEISER PO BOX 13290 DES MOINES WA 98198 830700073 1000 0 FRIENDS OF TINA ORWALL 17837 FIRST AVE S PMB 299 NORMANDY PARK WA 98148 825493030 1000 0 PEOPLE FOR MIA GREGERSON PO BOX 297 SEAHURST WA 98062 830458254 1000 0 FRIENDS OF JOE FITZGIBBON PO BOX 66235 BURIEN WA 98166 854338175 1000 0 COMMITTEE TO ELECT DREW C MACEWEN PO BOX 651 UNION WA 98592 861804424 1000 0 FRIENDS OF REUVEN CARLYLE PO BOX 9100 SEATTLE WA 98109 1000 0 FRIENDS OF NOEL FRAME PO BOX 99143 SEATTLE WA 98139 1000 0 FRIENDS OF SANTOS PO BOX 78606 SEATTLE WA 98178 500 0 COMMUNITY FOR KIRSTEN HARRIS-TALLEY PO BOX 23026 SEATTLE WA 98102 1000 0 FRIENDS OF TANA SENN PO BOX 771 MERCER ISLAND WA 98040 1000 0 FRIENDS OF MY-LIHN THAI 11900 NE 1ST STREET 300 BELLEVUE WA 98005 1000 0 PEOPLE FOR PEDERSEN 815 FIRST AVENUE 111 SEATTLE WA 98104 1000 0 FRIENDS OF NICOLE MACRI PO BOX 9100 SEATTLE WA 98109 1000 0 CITIZENS FOR FRANK CHOPP 4209 SUNNYSIDE AVE NORTH SEATTLE WA 98103 1000 0 COMMITTEE TO RE-ELECT JOHN LOVICK 2403 157TH PLACE SE MILL CREEK WA 98012 1000 0 FRIENDS OF APRIL BERG PO BOX 14893 MILL CREEK WA 98082 1000 0 FRIENDS OF MANKA DHINGRA 17221 NE 115TH CT REDMOND WA 98052 1000 0 FRIENDS OF ELECT LARRY SPRINGER 10536 NE 122ND STREET KIRKLAND WA 98034 1000 0 GERRY POLLET FOR STATE REPRESENTATIVE 7750 17TH AVE NE SEATTLE WA 98115 1000 0 JAVIER VALDEZ FOR STATE REP 9800 ROOSEVELT WAY NE 23 SEATTLE WA 98115 1000 0 FRIENDS OF PATTY KUDERER PO BOX 23037 SEATTLE WA 98102 1000 0 FRIENDS OF VANDANA SLATTER 11900 NE 1ST STREET SUITE 300 BELLEVUE WA 98005 1000 0 AMY WALEN FOR STATE HOUSE PO BOX 853 REDMOND WA 98073 1000 0 COMMITTEE TO ELECT SHARON WYLIE 400 NE HIGHWAY 99 SUITE G340 VANCOUVER WA 98665 1000 0 ELECT MONICA STONIER PO BOX 61762 VANCOUVER WA 98666 1000 0 FRIENDS OF CHRIS REYKDAL 855 TROSPER ROIAD SUITE 108-117 TUMWATER WA 98512 1000 0 HOUSE DEMOCRATIC CAMPAIGN COMMITTEE 4130 1ST AVE S SUITE D SEATTLE WA 98134 1000 0 HOUSE REPUBLICAN ORGANIZATIONAL COMMITTEE PO BOX 7222 OLYMPIA WA 985077222 1000 0 SENATE REPUBLICAN CAMPAIGN COMMITTEE PO BOX 11025 OLYMPIA WA 98508 1000 0 WASHINGTON SENATE DEMOCRATIC CAMPAIGN 4130 1ST AVE S SUITE D SEATTLE WA 98134 1000 0 FRIENDS OF HILARY FRANZ 401 2ND AVENUE SOUTH 303 SEATTLE WA 98104 1000 0 DENNY HECK FOR LT GOVERNOR PO BOX 235 OLYMPIA WA 98507 1000 0 COMMITTEE TO ELECT PETER ABBARNO PO BOX 94 CENTRALIA WA 98351 500 0 FRIENDS OF STROM PETERSON PO BOX 12066 SEATTLE WA 98102 500 0 FRIENDS OF LILLIAN ORTIZ-SELF PO BOX 581 MUKILTEO WA 98275 500 0 FRIENDS OF MARI LEAVITT PO BOX 65195 TACOMA WA 98466 500 0 CLAIRE WILSON FOR SENATE 31811 PACIFIC HWY S SUITE B288 FEDERAL WAY WA 98003 500 0 ELECT JAMILA TAYLOR PO BOX 3996 FEDERAL WAY WA 98063 500 0 PEOPLE FOR JOEL NGUYEN PO BOX 23037 SEATTLE WA 98102 500 0 GRIFFEY 4 STATE HOUSE PO BOX 83 ALLYN WA 98524 500 0 PEOPLE FOR REBECCA SALDANA PO BOX 20776 SEATTLE WA 98102 500 0 FRIENDS OF EMILY WICKS 1730 BAKER AVENUE EVERETT WA 98201 500 0 CAROLYN ESLICK FOR STATE PO BOX 776 SULTAN WA 98294 500 0 VOTE ALICIA RULE PO BOX 9100 SEATTLE WA 98109 500 0 FRIENDS OF ROGER GOODMAN 218 MAIN STREET PMB 763 KIRKLAND WA 98033 500 0 FRIENDS OF VICTORIA WOODARDS PO BOX 1771 TACOMA WA 98401 1000 0 PEOPLE FOR BETSY WILKERSON PO BOX 8442 SPOKANE WA 99203 1000 0 PART I-A, LINE 1: DDWA PROVIDES DIRECT CAMPAIGN CONTRIBUTIONS TO CANDIDATES FOR WASHINGTON STATE ELECTED EXECUTIVE OFFICE, LEGISLATIVE OFFICE, AND POLITICAL ORGANIZATIONS IN ORDER TO PROMOTE AN ENVIRONMENT FOR IMPROVED ORAL HEALTHAND OVERALL HEALTH CARE POLICY, AS WELL AS TO SUPPORT OUR OVERALL MISSION OF IMPROVING HEALTH IN OUR STATE. DDWA ALSO PROVIDES LIMITED DIRECT SUPPORT FOR LOCAL LEVEL CANDIDATES OR INITIATIVES THAT PROMOTE A POSITIVE BUSINESS CLIMATE IN WASHINGTON STATE. ALL CONTRIBUTIONS ARE CONDUCTED IN ACCORDANCE WITH FEDERAL AND STATE LAWS AND REPORTING REQUIREMENTS. 351239 351239 6816578 184112 6632466 12809795 4524656 8285139 5630296 4765068 865228 61949128 51204770 10744358 26878430 1 UW SCHOOL OF DENTISTRY BOX 357137 SEATTLE WA 98195 943079432 501(C)(3) 753302 0 UNDERWRITE WREB FEES NORTH SOUND 1204 RAILROAD AVE BELLINGHAM WA 98225 814680689 501(C)(3) 217152 0 FUNDING FOR DENTAL SUPPORT AGING IN PACE WASHINGTON PO BOX 3007 SEATTLE WA 981143007 810856014 501(C)(3) 200000 0 FUNDING FOR DENTAL SUPPORT COMMUNITY HEALTH ASSOCIATION OF SPOKANE 611 NORTH IRON BRIDGE WAY SPOKANE WA 99111 911641797 501(C)(3) 150000 0 FUNDING FOR DENTAL SUPPORT LHAQ'TEMISH FOUNDATIONS 2665 KWINA RD BELLINGHAM WA 98226 911836621 501(C)(3) 128000 0 FUNDING FOR DENTAL SUPPORT LINDQUIST CLINIC FOR CHILDREN 130 131ST ST SOUTH TACOMA WA 98444 910615378 501(C)(3) 100000 0 FUNDING FOR DENTAL SUPPORT BETTER HEALTH TOGETHER 1023 W RIVERSIDE SPOKANE WA 99201 900997482 501(C)(3) 78000 0 LEAD PARTNER FUNDING FOR SPOKANE LIN UNITED WAY OF KING COUNTY 720 SECOND AVE SEATTLE WA 98104 910565555 501(C)(3) 72522 0 ANNUAL GIVING CAMPAIGN FRONTIER BEHAVIORAL HEALTH 107 S DIVISION ST SPOKANE WA 99202 910853801 501(C)(3) 70442 0 FUNDING FOR DENTAL SUPPORT NORTHWEST PORTLAND AREA INDIAN HEALTH BOARD 2121 SW BROADWAY PORTLAND OR 97201 930718154 501(C)(3) 60000 0 FUNDING FOR DENTAL SUPPORT MAKAH TRIBE COUNCIL PO BOX 115 NEAH BAY WA 98357 320178311 50000 0 FUNDING FOR DENTAL SUPPORT EAST AFRICAN COMMUNITY SERVICES 7050 32ND AVE SOUTH SEATTLE WA 98118 912138852 501(C)(3) 50000 0 FUNDING FOR DENTAL SUPPORT MEDICAL TEAMS INTERNATIONAL 9680 153RD AVE NW REDOMND WA 98052 930878944 501(C)(3) 50000 0 FUNDING FOR DENTAL SUPPORT SWINOMISH HEALTH SERVICES (DIDGWALIC WELLNESS CENTER) 8212 S MARCH POINT RD ANACOSTA WA 98221 611955704 50000 0 FUNDING FOR DENTAL SUPPORT UNION GOSPEL MISSION OF YAKIMA 1300 N FIRST STREET YAKIMA WA 26373 237050061 501(C)(3) 50000 0 FUNDING FOR DENTAL SUPPORT AMERICAN ACADEMY OF PEDIATRICS 45 PARK BLVD ITASCA IL 60143 362275597 501(C)(3) 50000 0 DENTAL HEALTH GRANT FREE CLINIC OF SW WASHINGTON 4100 PLOMONDON ST VANCOUVER WA 94111 911707542 501(C)(3) 50000 0 FUNDING FOR DENTAL SUPPORT SPOKANE NEIGHBORHOOD ACTION PARTNERS 3102 W FT GEORGE WRIGHT SPOKANE WA 99224 911311127 501(C)(3) 44254 0 FUNDING FOR DENTAL SUPPORT FOOD LIFELINE 815 SOUTH 96TH SEATTLE WA 98108 911090450 501(C)(3) 30081 0 FOOD INSECURITY LATINO COMMUNITY FUND OF WA STATE PO BOX 30669 SEATTLE WA 98103 205987399 501(C)(3) 30000 0 FUNDING FOR DENTAL SUPPORT ARTS FUND PO BOX 19780 SEATTLE WA 98109 910839644 501(C)(3) 25100 0 FUNDING SUPPORT FOR THE ARTS SQUAXIN ISLAND TRIBE 10 SE SQUAXIN LANE SHELTON WA 98584 910922254 25000 0 FUNDING FOR DENTAL SUPPORT TACOMA PIERCE COUNTY HEALTH DEPARTMENT 3629 SOUTH D STREET TACOMA WA 96111 911488160 LOCAL GOVERNMENT 18333 0 FUNDING FOR DENTAL SUPPORT OLYMPIA UNION GOSPEL MISSION PO BOX 7668 OLYMPIA WA 985077668 911680748 501(C)(3) 18186 0 FUNDING FOR DENTAL SUPPORT SECOND HARVEST FOOD BANK 1234 E FRONT AVE SPOKANE WA 992022148 237173826 501(C)(3) 15214 0 FOOD INSECURITY JUNIOR ACHIEVEMENT OF WASHINGTON 1700 WESTLAKE AVE N SEATTLE WA 98109 910604913 501(C)(3) 10750 0 PROGRAM SPONSORSHIP NORTHWEST HARVEST PO BOX 12272 SEATTLE WA 98102 910826037 501(C)(3) 10000 0 FOOD INSECURITY INTERNATIONAL COMMUNITY HEALTH SERVICES PO BOX 3007 SEATTLE WA 981143007 910947084 501(C)(3) 10000 0 FUNDING FOR DENTAL SUPPORT YOUTH AND FAMILY LINK 907 DOUGLAS ST LONGVIEW WA 98632 910726260 501(C)(3) 10000 0 FUNDING FOR DENTAL SUPPORT UNITED WAY OF KITSAP COUNTY 645 4TH ST SUITE 101 BREMERTON WA 99101 910623990 501(C)(3) 8000 0 MOUTHMATTERS/ABCD COLLABORATIVE COMMUNITIES IN SCHOOLS OF SPOKANE COUNTY 104 S FREYAYELLOW FLAG B SPOKANE WA 99202 261581358 501(C)(3) 5904 0 2021 SPOKANE LIN GRANT AGREEMENT 32 4 COVID-19 PRACTICE SUPPORT GRANTS 2589 2402368 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 IS REQUIRED TO FILE REPORTS ON REGULAR INTERVALS OUTLINING THE USE OF FUNDS. GRANTEE IS ALSO REQUIRED TO RETURN UNUSED FUNDING IF APPLICABLE. SCHEDULE I PART III PRSP PAYMENT -IN JULY DDWA APPROVED AN ADDITIONAL COVID-19 PRACTICE SUPPORT PAYMENT FOR WDS MEMBER PRACTICES ENROLLED IN ELECTRONIC FUNDS TRANSFER (EFT) TO HELP DENTISTS OFFSET THE ONGOING THE BUSINESS CHALLENGES THEY ARE EXPERIENCING DURING THE COVID PANDEMIC. PAYMENT WAS MADE SEPTEMBER 27TH AND TOTALED APPROXIMATELY $2.4M. DATA WAS GATHERED THROUGH A JOINT EFFORT BETWEEN FINANCE AND BUSINESS INTELLIGENCE. X X 1 1 X X X X 1 1 0 0 0 0 0 0 0 MITCHKE MARK PRESIDENT & CHIEF EXECUTIVE OFFICER 1073500 0 2365000 0 11687 0 330098 0 38083 0 3818368 0 0 0 BERG BRADLEY CHIEF OPERATING & FINANCIAL OFFICER 767564 0 675019 0 7515 0 154628 0 31812 0 1636538 0 0 0 ALIABADI KAREN CHIEF HR STRATEGIST 438431 0 364169 0 10455 0 88322 0 21787 0 923164 0 0 0 RUTHERFORD EVE M VICE CHAIR - BRD. & DDS FEES 158789 0 0 0 745772 0 0 0 0 0 904561 0 0 0 HAKES KATHERINE DIRECTOR - BRD. & DDS FEES 129261 0 0 0 707304 0 0 0 0 0 836565 0 0 0 WHITNEY GARRETT CHIEF INFORMATION OFFICER 369283 0 319349 0 8248 0 66684 0 38079 0 801643 0 0 0 SNYDER CINDY VP, NTWRK & BUS MGMT 349862 0 331333 0 9147 0 66101 0 23339 0 779782 0 0 0 LAY LINDA VP, SALES 328110 0 291485 0 14395 0 60390 0 14498 0 708878 0 0 0 LO ERIC VP, ACTUARIAL AND UNDERWRITING 306665 0 186184 0 3190 0 67310 0 33588 0 596937 0 0 0 PICKEL DR CHRISTOPHER DIRECTOR - BRD. & DDS FEES 121113 0 0 0 412795 0 0 0 0 0 533908 0 0 0 ABDELLATIF VANETTA PRES/CEO ARCORA FDN 328401 0 75441 0 0 0 19500 0 19693 0 443035 0 0 0 LIPTON NICOLE DIRECTOR OF HR THRU 08/2021 135515 0 50021 0 194749 0 9334 0 11038 0 400657 0 0 0 LABBERTON WELLS K CHAIR - BRD. & DDS FEES 172029 0 0 0 208277 0 0 0 0 0 380306 0 0 0 BARTLETT RYAN DIRECTOR OF FINANCE 244299 0 64211 0 0 0 19500 0 31334 0 359344 0 0 0 CHEUNG STEPHEN DIRECTOR, MKTG & PROD STRAT 221055 0 64868 0 0 0 17724 0 34512 0 338159 0 0 0 PAURUS LINDA DIRECTOR OF PROV REL THRU 07/2021 104790 0 34931 0 148781 0 6577 0 10395 0 305474 0 0 0 JAHRMAN CHRIS DIRECTOR, OPER & PATIENT EXP 209036 0 50009 0 0 0 16873 0 21822 0 297740 0 0 0 SEELY JEFFREY T SECRETARY 155737 0 0 0 0 0 0 0 0 0 155737 0 0 0 PART I, LINE 1A ANY FIRST CLASS TRAVEL IS SUBJECT TO THE APPROVAL OF THE CEO OR CFO. DDWA PROVIDES A WELLNESS PROGRAM WHICH REIMBURSES APPROVED EXPENSES FOR ALL EMPLOYEES WORKING 30 HOURS OR MORE A WEEK, WITH A MAXIMUM PAYABLE OF $480 PER 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. DDWA GROSSES UP BOARD MEMBER FEES TO COVER B&O TAXES ASSESSED ON DIRECTOR FEES PAID TO THE BOARD. PART I, LINE 3 THE HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD OF DIRECTORS ENGAGES AN INDEPENDENT EXTERNAL CONSULTANT TO EVALUATE THE COMPENSATION OF ALL KEY EMPLOYEES, INCLUDING PRESIDENT AND CEO, COO/CFO,VP UNDERWRITING/ACTUARIAL, CIO, VP OF SALES, CHIEF HUMAN RESOURCE STRATEGIST, VP NETWORK STRATEGY AND BUSINESS ENABLEMENT, CEO/PRESIDENT OF ARCORA FOUNDATION, AND CHIEF MISSION OFFICER AND VP, CORPORATE DEVELOPMENT OF WASHINGTON DENTAL SERVICE, IN COMPARISON TO THE PRACTICE OF SIMILAR EMPLOYERS IN THE MARKETPLACE. THE PROCESS IS CONDUCTED ON AN ANNUAL BASIS. PART I, LINES 4A-B NICOLE LIPTON ($194,609) AND LINDA PAURUS ($148,512) RECEIVED SEVERANCE PAYMENTS DURING THE YEAR. THE COMPANY MAKES CONTRIBUTIONS TO A NONQUALIFIED PERFORMANCE BASED COMPENSATION PLAN, AS DETERMINED BY THE BOARD OF DIRECTORS, WHICH IS SUBJECT TO CODE SECTION 457(B). PLAN PARTICIPANTS ARE BOARD-APPROVED EXECUTIVE LEADERSHIP WHO RECEIVE AN ANNUAL CONTRIBUTION BASED ON A PERCENTAGE OF THE PRIOR YEAR EARNINGS LESS THE COMPANY MATCHING CONTRIBUTION TO THE 401(K) PLAN. COMPANY CONTRIBUTIONS ARE DIRECTED BY EACH PARTICIPANT, BUT VESTING OF THE BENEFIT IS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE AS REQUIRED BY CODE SECTION 409(A). CONTRIBUTIONS MADE IN 2021 WERE AS FOLLOWS: MARK MITCHKE, PRESIDENT/CEO, $310,598; BRADLEY BERG, CHIEF OPERATING AND FINANCIAL OFFICER, $135,128; ERIC LO, VP UNDERWRITING/ACTUARIAL, $47,810; CINDY SNYDER, VP NETWORK STRATEGY AND BUSINESS ENABLEMENT, $46,601; KAREN ALIABADI, CHIEF HR STRATEGIST, $68,822; GARRETT WHITNEY, CHIEF INFORMATION OFFICER, $47,184; LINDA LAY, VP OF SALES, $40,890. THE 457(B) PLAN HAD TOTAL ASSETS OF $2,383,486 AT DECEMBER 31, 2021. IN ADDITION, THERE IS ANOTHER 457(B) NONQUALIFIED SERP DEFERRED COMPENSATION PLAN FOR SENIOR MANAGEMENT THAT THE COMPANY DOES NOT MAKE ANY CONTRIBUTIONS TO. EACH OF THE FOLLOWING PARTICIPANTS CONTRIBUTED $19,500 TO THE PLAN DURING 2021 - MARK MITCHKE, BRADLEY BERG, ERIC LO, GARRETT WHITNEY, AND LINDA LAY. THE PLAN HAD TOTAL ASSETS OF $1,830,320 AT DECEMBER 31, 2021. SCHEDULE J PART I LINE 6A THE BOARD OF DDWA ANNUALLY APPROVES A COMPANY-WIDE BONUS MATRIX BASED ON FOUR METRICS, ONE OF WHICH WAS BASED ON THE OPERATING PROFIT MARGIN FOR THE FISCAL YEAR. THE OTHER METRICS ARE ADMINISTRATIVE COST, NEW GROUP SALES, AND GROUP CUSTOMER PERSISTENCY (RETENTION). FORM 990, PART VI, SECTION A, LINE 6 DDWA'S MEMBER DENTISTS ARE CONSIDERED MEMBERS OF THE COMPANY'S PARENT COMPANY, WDS. MEMBER DENTISTS ELECT THE DENTAL MEMBERS OF THE WDS BOARD OF DIRECTORS, IN ACCORDANCE WITH THE WDS BYLAWS. WDS DIRECTORS ALSO CURRENTLY SERVE AS DIRECTORS ON THE DDWA BOARD. 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 WDS/DDWA 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) CONSISTS OF TEN TO FIFTEEN MEMBERS THAT ARE SELECTED BY THE WDS BOARD FROM NOMINEES BY THE GNC. THE MAP PROVIDES CONSULTATION TO THE COMPANY, INCLUDING THE GNC AND BOARD, ON A VARIETY OF MATTERS. FORM 990, PART VI, SECTION A, LINE 7B SEE ABOVE FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS COMPLETED BY KPMG. THE FORM 990 AND SUPPORTING DOCUMENTATION IS REVIEWED AND APPROVED BY THE DIRECTOR OF FINANCE AND THE CFO/COO. ELECTRONIC COPIES OF THE RETURN ARE PROVIDED FOR REVIEW TO ALL BOARD MEMBERS PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE INVESTMENT AND 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 CONFLICT 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, THEY ARE REQUIRED TO EXPLICITLY ACKNOWLEDGE A STATEMENT AFFIRMING THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE CONFLICT 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 IF ANY CONFLICTS EXIST. THE COMPLETED QUESTIONNAIRES THAT NOTE ANY CONFLICTS ARE REVIEWED BY THE BOARD AND ANY PERSONS WITH ACTUAL OR POTENTIAL CONFLICTS ARE INFORMED OF ANY ACTION VIA WRITTEN COMMUNICATION. THE PROCEDURES FOR ADDRESSING ANY CONFLICT OF INTEREST INCLUDE, BUT ARE 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 OR DISAPPROVAL OF SUCH TRANSACTION; (4) ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED AND COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED IF DEEMED APPROPRIATE; (5) CONFLICTING ISSUES DURING THE COURSE OF A BOARD MEETING WHICH CANNOT BE RESOLVED ARE REFERRED TO THE GOVERNANCE AND NOMINATING COMMITTEE; AND (6) THE TRANSACTION OR ACTION MUST BE APPROVED BY A MAJORITY OF DISINTERESTED PERSONS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD APPOINTS A HUMAN RESOURCES AND COMPENSATION COMMITTEE OF THE BOARD (THE HRCC), NONE OF WHOM MAY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY COMPENSATION ARRANGEMENTS, TO BE ACCOUNTABLE FOR SETTING REASONABLE COMPENSATION PACKAGES FOR THE CEO. IN 2019, THE HRCC DEVELOPED, 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 HRCC 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 EXPERT, I.E., TOTAL ECONOMIC BENEFITS PAID BY SIMILAR SITUATED ORGANIZATIONS (BOTH TAXABLE AND TAX-EXEMPT) FOR SIMILAR JOB RESPONSIBILITIES. THE HRCC'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 MEMBERS PRESENT DURING THE DISCUSSION ON ANY ARRANGEMENTS; AND (3) A DESCRIPTION OF THE COMPARABLE DATA RELIED UPON BY THE HRCC. KEY DELIBERATIONS OF THE HRCC ARE ALSO DOCUMENTED IN MINUTES WHICH ARE APPROVED AT THE NEXT HRCC MEETING. THE MOST RECENT COMPENSATION REVIEW WAS COMPLETED IN 2021 FOR DIRECTORS AND 2020 FOR SMT, AND INCLUDED THE PRESIDENT/CHIEF EXECUTIVE OFFICER, CHAIR, VICE CHAIR, SECRETARY, TREASURER, OTHER C-LEVEL EXECUTIVES AND OTHER VICE PRESIDENT ROLES. FORM 990, PART VI, SECTION C, LINE 19 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 BYLAWS ARE FILED WITH THE WASHINGTON SECRETARY OF STATE'S OFFICE FROM TIME-TO-TIME AS THEY ARE APPROVED BY THE GOVERNING BODY. GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1A THE FOLLOWING DIRECTORS ALSO RECEIVED CLINICAL REIMBURSEMENTS IN ADDITION TO THEIR DIRECTOR'S FEES, THE TOTAL OF WHICH IS REPORTED IN COLUMN D - REPORTABLE COMPENSATION FROM THE ORGANIZATION. LABBERTON, WELLS, K. - $380,306 DIRECTOR FEE AND BENEFITS - $172,029 CLINICAL REIMBURSEMENT - $208,277 PICKEL, CHRISTOPHER - $533,908 DIRECTOR FEE - $121,113 CLINICAL REIMBURSEMENT - $412,795 RUTHERFORD, EVE M. - $904,561 DIRECTOR FEE - $158,789 CLINICAL REIMBURSEMENT - $745,772 HAKES, KATHERINE - $836,565 DIRECTOR FEE - $129,261 CLINICAL REIMBURSEMENT - $707,304 FORM 990, PART XI, LINE 9: DISTRIBUTION TO WASHINGTON DENTAL SERVICES -13,300,000. ARCORA FOUNDATION 400 FAIRVIEW AVE N SEATTLE WA 98109 910621480 EDUCATION WA -23000 2406000 DDWA WASHINGTON DENTAL SERVICE FUND 400 FAIRVIEW AVE N SEATTLE WA 98109 911281990 ORAL HEALTH EDUCATION WA 501(C)(3) LINE 10 ARCORA 1 WASHINGTON DENTAL SERVICE 400 FAIRVIEW AVE N SEATTLE WA 98109 270937829 HOLDING CO WA 501(C)(4) N/A 0 SPRINGROCK VENTURES II LP 2001 6TH AVE SUITE 3400 SEATTLE WA 98101 851520667 INVEST ORAL HEALTH DE SRMC 0 0 SPRINGROCK MANAGEMENT COMPANY (SRMC) 2001 6TH AVE SUITE 3400 SEATTLE WA 98101 851502581 MGMT/GP IN SRV II WA WDS C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 WASHINGTON DENTAL SERVICE R 13300000 CASH WASHINGTON DENTAL SERVICE O 3316839 BOOK WASHINGTON DENTAL SERVICE N 29400 BOOK SPRINGROCK MANAGEMENT COMPANY O 627474 BOOK