ARIZONA DENTAL INSURANCE SERVICE: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- ARIZONA DENTAL INSURANCE SERVICE (EIN 86-0274899)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-13
- IRS object ID
- 202033189349306083
- Schema version
- 2019v5.1
- 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) |
|---|---|---|
| Return | 2020-11-13T11:55:36-06:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 S RIVERSIDE PLAZA 9TH FLOOR | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860274899 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARIZONA DENTAL INSURANCE SERVICE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ARIZ | BusinessNameControlTxt |
| Phone | 6025883976 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5656 WEST TALAVI BLVD | AddressLine1Txt |
| City | GLENDALE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85306 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARK ANDERSON | PersonNm |
| Person Title | CFO/VICE PRESIDENT | PersonTitleTxt |
| Phone | 6029383131 | PhoneNum |
| Signature | 2020-11-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVID LOWENTHAL | PreparerPersonNm |
| PTIN | P00378651 | PTIN |
| Phone | 3122071040 | PhoneNum |
| Preparation | 2020-11-11 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 99.137.156.52 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-11-11 | IPDt |
| IP Tm | 22:19:46 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 23D9C3BAD3C11415BCA5E3AEE50D281DF37E870F | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-04-22 16:20:28Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA DENTAL OF ARIZONA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARK ANDERSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5656 WEST TALAVI BLVD | AddressLine1Txt |
| City | GLENDALE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85306 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $143,107,911 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | WWW.DELTADENTALAZ.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1972 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | THE CORPORATION EXISTS TO IMPROVE LIVES BY PROMOTING OPTIMAL ORAL HEALTH. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 133 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$41,387 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $234,009,196 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $111,454,232 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,602,812 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,501,766 | CYInvestmentIncomeAmt |
| PY Other Revenue | $100,510 | PYOtherRevenueAmt |
| CY Other Revenue | $134,383 | CYOtherRevenueAmt |
| PY Total Revenue | $236,712,518 | PYTotalRevenueAmt |
| CY Total Revenue | $113,090,381 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $869,161 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $351,249 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,264,480 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,571,179 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $220,941,321 | PYOtherExpensesAmt |
| CY Other Expenses | $89,952,240 | CYOtherExpensesAmt |
| PY Total Expenses | $233,074,962 | PYTotalExpensesAmt |
| CY Total Expenses | $102,874,668 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,637,556 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $10,215,713 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $108,664,836 | TotalAssetsBOYAmt |
| Total Assets EOY | $115,786,813 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $25,741,784 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $14,939,497 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $82,923,052 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $100,847,316 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE CORPORATION EXISTS TO IMPROVE LIVES BY PROMOTING OPTIMAL ORAL HEALTH. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $84,480,676 | ExpenseAmt |
| Revenue | $111,588,615 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDED DENTAL BENEFIT COVERAGE FOR 326,963 BENEFICIARIES INCLUDED AMONG THESE BENEFICIARIES WERE I) 22,920 INDIVIDUAL ENROLLEES, MANY OF WHOM ARE HIGH-RISK INDIVIDUALS WHO MAY NOT OTHERWISE RECEIVE ACCESS TO AFFORDABLE DENTAL BENEFIT COVERAGE. THESE INDIVIDUALS OBTAINED COVERAGE AS A RESULT OF THE ORGANIZATION'S COLLABORATION WITH CHARITABLE AND GOVERNMENTAL ORGANIZATIONS; II) 51,700 ENROLLEES WHO ARE OR WERE EMPLOYED WITH THE STATE OF ARIZONA, AND III) 129 ENROLLEES WHO WERE ABLE TO OBTAIN COVERAGE THROUGH THE ORGANIZATION'S COLLABORATION WITH ARIZONA SMALL BUSINESS ASSOCIATION. THESE INDIVIDUALS MAY OTHERWISE HAVE BEEN UNABLE TO OBTAIN AFFORDABLE COVERAGE DUE TO THE SIZE OF THE SMALL BUSINESS. THE ORGANIZATION EXPENDED MORE THAN $73 MILLION FOR DENTAL CARE DURING 2019, WITH DENTAL BENEFITS COVERAGE BEING PROVIDED THROUGH CONTRACTS WITH INDEPENDENT PROFESSIONAL DENTAL SERVICE PROVIDERS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $351,249 | ExpenseAmt |
| Grant | $351,249 | GrantAmt |
| Desc | THE ORGANIZATION ALSO MAKES GRANTS AND DONATES FACILITIES, EQUIPMENT, AND EMPLOYEE TIME TO SUPPORT MANY CHARITABLE CAUSES. DURING 2019, THE ORGANIZATION PROVIDED OR SUPPORTED PREVENTATIVE DENTAL HEALTH SERVICES, CHILDREN'S ORAL HEALTH SERVICE, DENTAL CLINICS, IN-SCHOOL SCREENINGS, TOBACCO AND CHRONIC DISEASE PREVENTION PROGRAMS, EARLY CHILDHOOD PROGRAMS, PRENATAL AND POSTNATAL ORAL HEALTH, AND ACCESS TO DENTAL SERVICES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $84,831,925 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 16351 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 133 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | Yes (1) | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | AZ | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARK ANDERSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6029383131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5656 WEST TALAVI BLVD | AddressLine1Txt |
| City | GLENDALE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85306 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| ALLAN ALLFORD | ||||||||
| PRESIDENT/CEO | 40.00 | 0.00 | Yes (X) | $1,081,855 | $0 | $192,774 | ||
| BRAD CLOTHIER | ||||||||
| EXECUTIVE VICE PRESIDENT | 40.00 | 0.00 | Yes (X) | $555,356 | $0 | $109,139 | ||
| MARK ANDERSON | ||||||||
| VICE PRESIDENT/CFO | 40.00 | 0.00 | Yes (X) | $434,035 | $0 | $95,565 | ||
| CRAIG LIVESAY | ||||||||
| VICE PRESIDENT/COO | 40.00 | 0.00 | Yes (X) | $381,576 | $0 | $76,691 | ||
| SCOTT PEDERSON | ||||||||
| VICE PRESIDENT | 40.00 | 0.00 | Yes (X) | $231,862 | $0 | $50,989 | ||
| LESLIE HESS | ||||||||
| CHIEF COMPLIANCE OFFICER | 40.00 | 0.00 | Yes (X) | $191,039 | $0 | $43,159 | ||
| JOHN BRULEY | ||||||||
| DIRECTOR OF IT | 40.00 | 0.00 | $158,589 | $0 | $25,165 | Yes (X) | ||
| ERIC SKARTVEIT | ||||||||
| DIRECTOR OF UNDERWRITING | 40.00 | 0.00 | $159,439 | $0 | $22,306 | Yes (X) | ||
| JOSHUA CUPERO | ||||||||
| DIRECTOR OF FINANCE | 40.00 | 0.00 | $154,187 | $0 | $7,700 | Yes (X) | ||
| KATHY MORROW | ||||||||
| DIRECTOR OF PROFESSIONAL RELATIONS | 40.00 | 0.00 | $135,716 | $0 | $12,484 | Yes (X) | ||
| HEATHER MOLLON | ||||||||
| DIRECTOR, CLIENT SERVICES | 40.00 | 0.00 | $131,345 | $0 | $14,522 | Yes (X) | ||
| CANDANCE HUNTER WIEST | ||||||||
| BOARD CHAIR | 10.00 | 0.00 | Yes (X) | $29,333 | $0 | $0 | Yes (X) | |
| JOYCE ROSENTHAL DDS | ||||||||
| VICE-CHAIRMAN | 3.00 | 0.00 | Yes (X) | $24,000 | $0 | $0 | Yes (X) | |
| STEPHEN MEYER HOUGHTON | ||||||||
| SECRETARY/TREASURER | 3.00 | 0.00 | Yes (X) | $24,000 | $0 | $0 | Yes (X) | |
| WILLIAM ALLEN CARDON | ||||||||
| BOARD MEMBER | 3.00 | 0.00 | $24,000 | $0 | $0 | Yes (X) | ||
| DALE RONALD HALLBERG DDS | ||||||||
| BOARD MEMBER | 3.00 | 0.00 | $24,000 | $0 | $0 | Yes (X) | ||
| RICHARD B HIGGS DDS | ||||||||
| BOARD MEMBER | 3.00 | 0.00 | $24,000 | $0 | $0 | Yes (X) | ||
| GARY OWEN JONES DDS | ||||||||
| BOARD MEMBER | 3.00 | 0.00 | $24,000 | $0 | $0 | Yes (X) | ||
| ALVIN CHARLES MATTHEWS | ||||||||
| BOARD MEMBER | 3.00 | 0.00 | $24,000 | $0 | $0 | Yes (X) | ||
| WILLIAM LUND PUTNAM | ||||||||
| BOARD MEMBER | 3.00 | 0.00 | $24,000 | $0 | $0 | Yes (X) | ||
| BRUCE ALLAN SPIGNER DDS | ||||||||
| BOARD MEMBER | 3.00 | 0.00 | $24,000 | $0 | $0 | Yes (X) | ||
| GERALD E LOE | ||||||||
| BOARD MEMBER | 3.00 | 0.00 | $16,000 | $0 | $0 | Yes (X) | ||
| BRIEN VOORHEES HARVEY | ||||||||
| BOARD MEMBER (THRU 4/19) | 3.00 | 0.00 | $10,667 | $0 | $0 | Yes (X) | ||
| DAVID MARLOW DAY | ||||||||
| BOARD MEMBER (THRU 4/19) | 3.00 | 0.00 | $8,000 | $0 | $0 | Yes (X) | ||
| FREDERICK BLACKBURN OLSEN III DDS | ||||||||
| BOARD MEMBER (THRU 4/19) | 3.00 | 0.00 | $8,000 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,902,999 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $650,494 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 16 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WYSSTA SERVICES INC | |||||
| PO BOX 86 | STEVENS POINT | WI | 54481 | ADMINISTRATIVE SERVICES | $1,453,310 |
| DELTA DENTAL OF WI | |||||
| PO BOX 828 | STEVENS POINT | WI | 54481 | CLAIMS PROCESSING SERVICES | $955,273 |
| CHANGE HEALTHCARE | |||||
| PO BOX 572490 | SALT LAKE CITY | UT | 84157 | FULFILLMENT PAYMENTS | $809,429 |
| MODERN IMPACT LLC | |||||
| 100 S 5TH ST SUITE 1000 | MINNEAPOLIS | MN | 55402 | ADVERTISING SERVICES | $534,701 |
| MTI CONNECT | |||||
| 4230 N OAKLAND AVE 290 | N OAKLAND AVE | WI | 83211 | IT SERVICES | $517,338 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 14 | CntrctRcvdGreaterThan100KCnt |
| Info In Schedule O Part VIII | Yes (X) | InfoInScheduleOPartVIIIInd |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| DENTAL PREMIUMS | 524114 | $94,110,309 | $94,110,309 |
| REV - SELF INSUR GROUP | 524114 | $7,985,977 | $7,985,977 |
| COST REIMBURSEMENT | 524292 | $6,443,048 | $6,443,048 |
| VISION PREMIUMS | 524114 | $2,914,898 | $2,914,898 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $111,454,232 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,174,696 | TotalRevenueColumnAmt |
| Exclusion | $2,174,696 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $29,344,600 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $30,017,530 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$672,930 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$672,930 | TotalRevenueColumnAmt |
| Exclusion | -$672,930 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $134,383 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $134,383 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $134,383 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $113,090,381 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $111,588,615 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,501,766 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $351,249 | TotalAmt |
| Program Services | $351,249 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,748,041 | TotalAmt |
| Management And General | $3,748,041 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,780,537 | TotalAmt |
| Management And General | $6,780,537 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $370,319 | TotalAmt |
| Management And General | $370,319 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,125,318 | TotalAmt |
| Management And General | $1,125,318 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $546,964 | TotalAmt |
| Management And General | $546,964 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $172,345 | TotalAmt |
| Management And General | $172,345 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,166 | TotalAmt |
| Management And General | $105,166 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $283,723 | TotalAmt |
| Management And General | $283,723 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,491,996 | TotalAmt |
| Program Services | $8,978,758 | ProgramServicesAmt |
| Management And General | $513,238 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,054,336 | TotalAmt |
| Management And General | $1,054,336 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,310 | TotalAmt |
| Management And General | $109,310 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $342,954 | TotalAmt |
| Management And General | $342,954 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $285,878 | TotalAmt |
| Management And General | $285,878 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $238,031 | TotalAmt |
| Management And General | $238,031 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,184 | TotalAmt |
| Management And General | $14,184 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $435,170 | TotalAmt |
| Management And General | $435,170 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $139,216 | TotalAmt |
| Management And General | $139,216 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PROFESSIONAL DENTAL SVS | $73,019,357 | $73,019,357 | |
| PREMIUM TAX | $1,450,216 | $1,450,216 | |
| DUES AND SUBSCRIPTIONS | $828,568 | $828,568 | |
| PRINTING | $477,926 | $477,926 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,503,864 | TotalAmt |
| Program Services | $1,032,345 | ProgramServicesAmt |
| Management And General | $471,519 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,874,668 | TotalAmt |
| Program Services | $84,831,925 | ProgramServicesAmt |
| Management And General | $18,042,743 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,254,002 | BOYAmt |
| EOY | $10,611,898 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,556,977 | BOYAmt |
| EOY | $7,451,691 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $557,077 | BOYAmt |
| EOY | $823,235 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $11,327,263 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,735,842 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,776,821 | BOYAmt |
| EOY | $7,591,421 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,204,810 | BOYAmt |
| EOY | $71,415,195 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,222,952 | BOYAmt |
| EOY | $14,189,329 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,092,197 | BOYAmt |
| EOY | $3,704,044 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $108,664,836 | BOYAmt |
| EOY | $115,786,813 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,878,288 | BOYAmt |
| EOY | $11,752,578 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,293,590 | BOYAmt |
| EOY | $2,572,536 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,285 | BOYAmt |
| EOY | $85,382 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $533,621 | BOYAmt |
| EOY | $529,001 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,741,784 | BOYAmt |
| EOY | $14,939,497 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,923,052 | BOYAmt |
| EOY | $100,847,316 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,923,052 | BOYAmt |
| EOY | $100,847,316 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $108,664,836 | BOYAmt |
| EOY | $115,786,813 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $10,215,713 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $7,723,064 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$14,513 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,530,763 | OtherCostOrOtherBasisAmt |
| Book Value | $1,530,763 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,465,995 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,071,130 | DepreciationAmt |
| Book Value | $5,394,865 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,330,505 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,664,712 | DepreciationAmt |
| Book Value | $665,793 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,591,421 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (3 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| INVESTMENT IN SUBSIDIARY-SOUTHWEST BENEFIT ADM | $207,440 | C |
| INVESTMENT IN SUBSIDIARY-CANYON INSURANCE SVS | $611,919 | C |
| HEDGE FUNDS | $13,369,970 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $14,189,329 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| UNCLAIMED PROPERTY LIABILITY | $133 |
| CUSTOMER DEPOSIT LIABILITY | $528,868 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $529,001 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $119,590,500 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $7,723,064 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$939,222 | OtherRevenueAmt |
| Revenue Not Reported | $6,783,842 | RevenueNotReportedAmt |
| Revenue Subtotal | $112,806,658 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $283,723 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $283,723 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $113,090,381 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $102,590,945 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $102,590,945 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $283,723 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $283,723 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $102,874,668 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | MANAGEMENT EVALUATES THE COMPANY'S EXPOSURE FOR UNCERTAIN TAX POSITIONS AT EACH REPORTING PERIOD. AS OF DECEMBER 31, 2019 AND 2018, MANAGEMENT BELIEVES THE COMPANY HAS NO MATERIAL UNCERTAIN TAX POSITIONS, AND, THEREFORE, NO SUCH LIABILITIES HAVE BEEN RECORDED. AS OF DECEMBER 31, 2019 AND 2018, THE COMPANY'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED DURING THE YEAR OR ACCRUED AT YEAR END. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | GAINS/LOSSES FROM CONSOLIDATED RELATED PARTIES -939,222. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt | Address Line2USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|---|---|
| DELTA DENTAL PLAN OF ARIZONA CHARITABLE FOUNDATION AND TRUST | ||||||||
| 5656 WEST TALAVI BLVD | GLENDALE | AZ | 85306 | 860842694 | 501(C)(3) | $259,090 | ANNUAL CONTRIBUTION BASED ON BOARD DIRECTIVE TO PROMOTE ORAL HEALTH | |
| BOYS AND GIRLS CLUB | ||||||||
| 4309 E BELLEVIEW STREET BUILDING 14 | PHOENIX | AZ | 85008 | 860107639 | 501(C)(3) | $10,000 | PROGRAM SUPPORT | 14 |
| HONORHEALTH FOUNDATION | ||||||||
| 8125 N HAYDEN ROAD | SCOTTSDALE | AZ | 85258 | 742355411 | 501(C)(3) | $15,500 | PROGRAM SUPPORT | |
| PHOENIX CHILDREN HOSPITAL FOUNDATION | ||||||||
| 2929 E CAMELBACK RD STE 122 | PHOENIX | AZ | 85016 | 742421549 | 501(C)(3) | $10,000 | PROGRAM SUPPORT | |
| ARIZONA DIAMONDBACKS FOUNDATION INC | ||||||||
| 401 E JEFFERSON STREET | PHOENIX | AZ | 85004 | 860901615 | 501(C)(3) | $10,000 | PROGRAM SUPPORT | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 5 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION'S BOARD RECEIVES REGULAR REPORTS ON THE ORGANIZATION'S ACTIVITIES AND EXPENDITURES OF GRANT FUNDS DONATIONS ARE MADE TO ESTABLISHED, WELL-RESPECTED, LOCAL PUBLIC CHARITY ORGANIZATIONS. AS A RESULT, ONGOING MONITORING OF THE USE OF GRANT FUNDS IS NOT CONSIDERED NECESSARY. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | Yes (X) | FirstClassOrCharterTravelInd |
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ALLAN ALLFORD | ||||||||||||||
| PRESIDENT/CEO | $532,819 | $0 | $368,428 | $0 | $180,608 | $0 | $163,697 | $0 | $29,077 | $0 | $1,274,629 | $0 | $171,608 | $0 |
| BRAD CLOTHIER | ||||||||||||||
| EXECUTIVE VICE PRESIDENT | $376,356 | $0 | $170,000 | $0 | $9,000 | $0 | $81,750 | $0 | $27,389 | $0 | $664,495 | $0 | $0 | $0 |
| MARK ANDERSON | ||||||||||||||
| VICE PRESIDENT/CFO | $310,835 | $0 | $116,000 | $0 | $7,200 | $0 | $64,800 | $0 | $30,765 | $0 | $529,600 | $0 | $0 | $0 |
| CRAIG LIVESAY | ||||||||||||||
| VICE PRESIDENT/COO | $278,576 | $0 | $103,000 | $0 | $0 | $0 | $46,320 | $0 | $30,371 | $0 | $458,267 | $0 | $0 | $0 |
| SCOTT PEDERSON | ||||||||||||||
| VICE PRESIDENT | $179,862 | $0 | $52,000 | $0 | $0 | $0 | $28,560 | $0 | $22,429 | $0 | $282,851 | $0 | $0 | $0 |
| LESLIE HESS | ||||||||||||||
| CHIEF COMPLIANCE OFFICER | $171,039 | $0 | $20,000 | $0 | $0 | $0 | $18,000 | $0 | $25,159 | $0 | $234,198 | $0 | $0 | $0 |
| JOHN BRULEY | ||||||||||||||
| DIRECTOR OF IT | $135,589 | $0 | $23,000 | $0 | $0 | $0 | $0 | $0 | $25,165 | $0 | $183,754 | $0 | $0 | $0 |
| ERIC SKARTVEIT | ||||||||||||||
| DIRECTOR OF UNDERWRITING | $135,939 | $0 | $23,500 | $0 | $0 | $0 | $0 | $0 | $22,306 | $0 | $181,745 | $0 | $0 | $0 |
| JOSHUA CUPERO | ||||||||||||||
| DIRECTOR OF FINANCE | $144,187 | $0 | $10,000 | $0 | $0 | $0 | $0 | $0 | $7,700 | $0 | $161,887 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | 1. FIRST CLASS TRAVEL - ALL SENIOR EXECUTIVES ARE OFFERED THIS BENEFIT FOR TRAVEL EXCEEDING 4 HOURS AND IT IS NOT TREATED AS TAXABLE COMPENSATION. 2. TRAVEL FOR COMPANIONS - THE PRESIDENT/CEO RECEIVES THIS BENEFIT AND IT IS NOT TREATED AS TAXABLE COMPENSATION. |
| PART I, LINE 4B | THE ORGANIZATION HAS A NONQUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN MEMBERS OF SENIOR MANAGEMENT AS DETERMINED BY THE DDAZ BOARD. PLAN BALANCES ARE CREDITED AT THE DISCRETION OF THE BOARD. IN 2019, ALLAN ALLFORD RECEIVED A DISTRIBUTION OF $171,608 FROM THE NONQAULIFIED DEFERRED COMPENSATION PLAN. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NONQUALIFIED DEFERRED COMPENSATION PLAN BUT DID NOT RECEIVE A DISTRIBUTION IN 2019: MARK ANDERSON, CRAIG LIVESAY, BRAD CLOTHIER, SCOTT PEDERSON, AND LESLIE HESS. |
| PART I, LINE 7 | CONSISTENT WITH THE ORGANIZATION'S OVERALL COMPENSATION PHILOSOPHY, OFFICERS, HIGHLY COMPENSATED, AND OTHER DESIGNATED EMPLOYEES PARTICIPATE IN AN ORGANIZATION INCENTIVE COMPENSATION PLAN. THE PLAN CONTAINS METRICS WHICH REPRESENT STRATEGIC PLAN MEASURES THAT ARE DETERMINED ANNUALLY BY THE BOARD OF DIRECTORS. AN OVERALL WEIGHTED SCORE IS CALCULATED BASED ON ACHIEVING A RANGE OF PLAN MEASURES. THE GOALS INCLUDE PRESERVATION OF INCOME WHICH PROVIDES THE ORGANIZATION WITH THE RESOURCES NECESSARY TO ACCOMPLISH ITS CHARITABLE PURPOSES. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| DALE HALLBERG | |||
| DIRECTOR | $278,948 | CONTRACTED PROVIDER PAYMENTS WERE MADE TO BOARD MEMBER DALE HALLBERG CONSISTENT WITH REGULAR COMPANY REIMBURSEMENT RATES. | 0 |
| BRUCE SPIGNER | |||
| DIRECTOR | $140,684 | CONTRACTED PROVIDER PAYMENTS WERE MADE TO BOARD MEMBER BRUCE SPIGNER CONSISTENT WITH REGULAR COMPANY REIMBURSEMENT RATES. | 0 |
| RICHARD HIGGS | |||
| DIRECTOR | $131,385 | CONTRACTED PROVIDER PAYMENTS WERE MADE TO BOARD MEMBER BRUCE SPIGNER CONSISTENT WITH REGULAR COMPANY REIMBURSEMENT RATES. | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | ANY ETHICAL DENTIST DULY LICENSED AND IN GOOD STANDING IN THE STATE OF ARIZONA IS ELIGIBLE TO BE A MEMBER OF THE ORGANIZATION. MEMBERS ELECT THE BOARD OF DIRECTORS. MEMBERS DO NOT HAVE AN OWNERSHIP INTEREST IN THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS OF THE ORGANIZATION HAVE AUTHORITY TO ELECT DELTA DENTAL'S GOVERNING BODY. NO OTHER GROUP OR PERSON CAN VOTE FOR THOSE WHO SERVE ON THE ORGANIZATION'S GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE ORGANIZATION'S BYLAWS MAY BE ALTERED, AMENDED OR REPEALED AND NEW BYLAWS MAY BE ADOPTED ONLY BY THE AFFIRMATIVE VOTE OF TWO THIRDS OF THE MEMBERS PRESENT AT A MEETING OF THE MEMBERS AT WHICH A QUORUM IS PRESENT. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION HAS A PROCESS FOR THE GOVERNING BODY TO RECEIVE AND REVIEW THE 990 BEFORE IT IS FILED. THAT PROCESS INCLUDES THE FOLLOWING STEPS 1. MANAGEMENT'S ENGAGEMENT OF OUTSIDE PROFESSIONAL SERVICES TO PREPARE AND DRAFT THE FORM 990. 2. MANAGEMENT'S REVIEW OF THE DRAFT FORM 990 TO CHECK FOR ACCURACY. 3. PROVIDING THE PROPOSED FINAL DRAFT OF THE FORM 990 TO THE BOARD OF DIRECTORS BEFORE FILING THE DOCUMENT WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION HAS A POLICY IN PLACE TO MONITOR AND ENFORCE COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICIES WHICH COVER BOTH BOARD MEMBERS AND EMPLOYEES UPON HIRE AND ANNUALLY. THEREAFTER, MEMBERS OF THE GOVERNING BOARD ARE REQUIRED TO EXECUTE THE CONFLICT OF INTEREST POLICY. UPON HIRE, EMPLOYEES ARE REQUIRED TO EXECUTE THE CONFLICT OF INTEREST POLICY. THE ORGANIZATION HAS PROCEDURES IN PLACE TO ALLOW EMPLOYEES AND OFFICERS/DIRECTORS OF THE COMPANY TO REPORT ANY NEWLY CREATED CONFLICTS OF INTEREST. IN ALL INSTANCES INVOLVING AN ACTUAL CONFLICT OF INTEREST, THE CONFLICTED EMPLOYEE OR BOARD MEMBER IS ASKED TO RECUSE HIMSELF FROM DELIBERATIONS ABOUT THE POTENTIAL TRANSACTION. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION HAS A PROCESS IN PLACE FOR INDEPENDENT CONSULTANTS TO REVIEW AND REPORT ON COMPENSATION OF THE CEO, OFFICERS, KEY EMPLOYEES, AND BOARD MEMBER COMPENSATION WITH FINAL REVIEW AND APPROVAL BY THE BOARD OF DIRECTORS. THIS INCLUDES REVIEW OF COMPARABILITY, DATA, AND OBTAINING THE INDEPENDENT CONSULTANT'S OPINION OF THE REASONABLENESS OF COMPENSATION DECISIONS MADE BY THE ORGANIZATION. INDEPENDENT CONSULTANT REVIEWS ARE PERFORMED FOR EXECUTIVE STAFF EVERY TWO YEARS AND BOARD COMPENSATION IS PERIODIC. THE INDEPENDENT CONSULTANT'S REPORT AND THE AFFIRMATION OF DISINTERESTED BOARD MEMBERS IS DOCUMENTED IN WRITING IN THE BOARD MINUTES. REVIEWS GENERALLY TAKE PLACE EVERY OTHER YEAR. REVIEWS WERE LAST PERFORMED IN 2018. |
| FORM 990, PART VI, SECTION C, LINE 19 | AS REQUIRED BY ARIZONA STATE LAW, THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. THE ORGANIZATION DOES NOT MAKE ITS CONFLICT OF INTEREST STATEMENT AVAILABLE TO ITS MEMBERS OR TO THE PUBLIC. MEMBERS OF THE PUBLIC MAY OBTAIN COPIES OF THE ARTICLES OF INCORPORATION FROM THE ARIZONA CORPORATION COMMISSION. MEMBERS OF THE PUBLIC ALSO MAY OBTAIN COPIES OF DELTA DENTAL'S STATUTORY FINANCIAL STATEMENTS FROM THE ARIZONA DEPARTMENT OF INSURANCE AND FROM THE NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS. |
| FORM 990, PART VIII, PROGRAM SERVICE REVENUE: | AS OF JANUARY 1, 2019, THE COMPANY ADOPTED FASB ASU NO. 2014-09, REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606). THE ASU IS BASED ON THE PRINCIPLE THAT REVENUE IS RECOGNIZED TO DEPICT THE TRANSFER OF GOODS OR SERVICES TO CUSTOMERS IN AN AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE ENTITY EXPECTS TO BE ENTITLED IN EXCHANGE FOR THOSE GOODS OR SERVICES. THE COMPANY'S REVENUE CONSISTS OF DENTAL CARE CONTRACTS, ADMINISTRATIVE SERVICE CONTRACTS, AND ADMINISTRATIVE FEES. ADMINISTRATIVE SERVICES CONTRACTS IN PLACE WITH CUSTOMERS PROVIDE ACCESS TO A NETWORK OF DENTAL PROVIDERS AND SERVICE COST PROCESSING SERVICES. AS A RESULT, ADMINISTRATIVE SERVICES CONTRACTS ARE NOT ACCOUNTED FOR AS DENTAL CARE CONTRACTS. PRIOR TO THE ADOPTION OF ASU 2014-09, ADMINISTRATIVE SERVICE CONTRACTS WERE REPORTED ON A GROSS BASIS. UPON ADOPTION OF ASU 2014-09 ADMINISTRATIVE SERVICE CONTRACTS ARE REPORTED NET AND ONLY THE ADMINISTRATIVE FEES ARE REPORTED AS DENTAL CARE REVENUE. THE CHANGE IN ACCOUNTING PRINCIPLE HAD NO CUMULATIVE EFFECT ON JANUARY 1, 2018 NET ASSETS. DURING 2019, THE COMPANY PAID DENTAL SERVICE EXPENSES, AND RECEIVED REIMBURSEMENT, TOTALING $136,587,237, WHICH HAS BEEN EXCLUDED FROM PROGRAM SERVICE REVENUE AND PURCHASED DENTAL SERVICE EXPENSE IN ACCORDANCE WITH ASU 2014-09. |
| FORM 990, PART XI, LINE 9: | LOSSES FROM CONSOLIDATED RELATED PARTIES -14,513. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AZ DELTA INSURANCE SERVICE HOLDINGS LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5656 WEST TALAVI BLVD | AddressLine1Txt |
| City | GLENDALE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85306 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | HOLDING COMPANY | PrimaryActivitiesTxt |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Total Income | $0 | TotalIncomeAmt |
| End Of Year Assets | $0 | EndOfYearAssetsAmt |
| Direct Controlling NA | N/A | DirectControllingNACd |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA DENTAL PLAN OF ARIZONA CHARITABLE FOUNDATION AND TRUST | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5656 W TALAVI BLVD | AddressLine1Txt |
| City | GLENDALE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85306 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860842694 | EIN |
| Primary Activities | TO IMPROVE ORAL HEALTH ACROSS ARIZONA FOR INDIVIDUALS AND COMMUNITIES | PrimaryActivitiesTxt |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | PF | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CANYON INSURANCE SERVICE INC | ||||||||||||
| 5656 WEST TALAVI BLVD | GLENDALE | AZ | 85306 | 412139223 | INSURANCE | AZ | AZ DENTAL | C | $1,624 | $616,250 | 1.00000 | Yes (1) |
| SOUTHWEST BENEFIT AMINISTRATORS LLC | ||||||||||||
| 5656 WEST TALAVI BLVD | GLENDALE | AZ | 85306 | 680586699 | ADMIN SERVICES | AZ | AZ DENTAL | C | -$78 | $207,440 | 1.00000 | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |