2019-10-14T11:04:29-05:00 2018-12-31 420714325 RSM US LLP 801 NICOLLET MALL WEST TOWER STE 1100 MINNEAPOLIS MN 554022526 990 2018-01-01 840568337 COLORADO DENTAL SERVICE INC COLO 8002330860 4582 SO ULSTER STREET NO 800 DENVER CO 80237 GREGORY VOCHIS CPA CFO AND TREASURER 8002330860 2019-10-01 1 KACIE MCEWEN P01599614 6123324300 66.98.98.1 2019-10-01 08:50:00 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 B56786F7D21A8F39D00ED83C272556B8DDCB8C36 2018 2020-01-14 16:20:31Z DELTA DENTAL OF COLORADO HELEN WEISS DREXLER 4582 SO ULSTER STREET NO 800 DENVER CO 80237 450533977 0 X WWW.DELTADENTALCO.COM X 1958 CO TO IMPROVE THE ORAL HEALTH OF THE COMMUNITIES WE SERVE. 15 12 246 0 597932 430973 0 0 410867241 446875292 4640070 3652615 6294 6070 415513605 450533977 7316312 7098833 356259552 387405578 17553711 19816373 0 0 0 30835339 33795150 411964914 448115934 3548691 2418043 134333332 129980594 38372923 37854441 95960409 92126153 X DELTA DENTAL OF COLORADO (DDCO) WAS FORMED AS A 501(C)(4) ORGANIZATION IN ORDER TO IMPROVE THE ORAL HEALTH OF THE COMMUNITIES IT SERVES. BECAUSE PEOPLE WITH DENTAL INSURANCE OVER TIME HAVE BETTER ORAL HEALTH OUTCOMES, DELTA DENTAL OF COLORADO DEVOTES ITSELF TO PROVIDING HIGH QUALITY AFFORDABLE DENTAL INSURANCE TO AS MANY COLORADANS AS POSSIBLE. UNFORTUNATELY, THERE ARE MANY PEOPLE FOR WHOM DENTAL INSURANCE IS NOT POSSIBLE. FOR THESE PEOPLE, DELTA DENTAL HAS A NUMBER OF DIFFERENT PROGRAMS ESTABLISHED TO PROVIDE THEM WITH ORAL HEALTH EDUCATION, DIRECT PATIENT DENTAL SERVICES, AND FREE DENTAL INSURANCE SO THAT GOOD ORAL HEALTH WILL ALSO BE ACHIEVABLE FOR THEM. 0 0 435999058 0 446875292 PROVISION OF RISK AND SELF-FUNDED PLANS TO SUBSCRIBERSDELTA DENTAL OF COLORADO DEVOTES ITSELF TO ITS MISSION OF IMPROVING THE ORAL HEALTH OF COLORADO'S PEOPLE. BECAUSE PEOPLE WITH DENTAL INSURANCE ARE OVER TWICE AS LIKELY TO VISIT A DENTIST REGULARLY, DELTA DENTAL OF COLORADO WORKS HARD TO MAKE DENTAL INSURANCE AS AFFORDABLE AND ACCESSIBLE AS POSSIBLE, AND TO THAT END, INSURES OVER 1,000,000 PEOPLE IN COLORADO AND 300,000 IN OTHER VARIOUS STATES. THE REVENUE GENERATED IS USED TO FUND THE COMMUNITY BENEFIT EFFORTS DESCRIBED IN LINE 4B. 7098833 7098833 0 COMMUNITY BENEFIT PROGRAMSAS A NONPROFIT, DELTA DENTAL OF COLORADO DEVOTES SIGNIFICANT RESOURCES TO FULFILLING OUR MISSION OF IMPROVING THE ORAL HEALTH OF THE COMMUNITIES WE SERVE. DELTA DENTAL OF COLORADO PROVIDES DENTAL BENEFITS AND ORAL HEALTH INFORMATION AND SERVICES TO AS MANY PEOPLE AS POSSIBLE. OVER THE PAST FIFTEEN YEARS, DELTA DENTAL OF COLORADO HAS DEVOTED A SUBSTANTIAL AMOUNT OF ITS ADJUSTED NET GAIN TO ITS COMMUNITY ENGAGEMENT PROGRAM, INCLUDING $1.2 MILLION IN 2018. THESE ACTIVITIES INCLUDE TABLES, DONATIONS CORPORATE SPONSORSHIPS WITH MANY ORGANIZATIONS INCLUDING THE AMERICAN HEART ASSOCIATION AND MILE HIGH UNITED WAY. THE COMPANY ALSO SPONSORS LOCAL NONPROFIT ORGANIZATIONS AND COMMUNITY EVENTS AND DONATED OVER 206,000 ORAL HEALTH ITEMS REACHING MORE THAN 129,000 PEOPLE THROUGHOUT COLORADO. IN 2018, DELTA DENTAL OF COLORADO ALSO SPONSORED IGIVE, AN EMPLOYEE-DRIVEN CAMPAIGN THAT CONTRIBUTED $120,000 TO TEN COLORADO-BASED NONPROFIT ORGANIZATIONS, IN HONOR OF THE COMPANY'S 60TH ANNIVERSARY. THROUGH THESE COMMUNITY BENEFIT EFFORTS, A PORTION OF THE FUNDING SUPPORT GOES TO DELTA DENTAL OF COLORADO FOUNDATION, WHICH RECEIVED $5.8 MILLION IN 2018 TO ADVANCE ORAL HEALTH EQUITY THROUGH GRANT MAKING. 443097891 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 1 29371 0 1 246 1 1 1 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X GREGORY VOCHIS 7204894718 4582 SO ULSTER STREET NO 800 DENVER CO 80237 KELLY BROUGH CHAIR 5.00 0.00 X X 22760 0 0 MARY MARGARET NOONAN VICE CHAIR 3.00 2.00 X X 27497 0 0 ANN BLOCK TRUSTEE 5.00 0.00 X 21592 0 0 ANN SOMERS DDS TRUSTEE 5.00 0.00 X 16500 0 0 BRANDON OWEN DDS TRUSTEE 5.00 0.00 X 25000 0 0 HASSAN SALEM TRUSTEE 5.00 0.00 X 18000 0 0 JOHN PAUL HOPKINS TRUSTEE 5.00 0.00 X 22726 0 0 KIMBERLY ANN KRETSCH DDS TRUSTEE 3.00 2.00 X 29000 0 0 LEO TOKAR TRUSTEE 5.00 0.00 X 12571 0 0 MARILYN TAYLOR TRUSTEE 3.00 2.00 X 29368 0 0 MARK WEHRLE CPA RETIRED TRUSTEE 5.00 0.00 X 33439 0 0 NED CALONGE MD TRUSTEE 5.00 0.00 X 26000 0 0 RICHARD CALL DMD TRUSTEE 3.00 2.00 X 24476 0 0 THOMAS SWAIN DDS TRUSTEE 5.00 0.00 X 19750 0 0 WALT VOGL DDS TRUSTEE 5.00 0.00 X 24750 0 0 HELEN WEISS DREXLER CEO/PRESIDENT 43.00 2.00 X 587225 0 53906 GREGORY VOCHIS CFO/TREASURER 43.00 2.00 X 335548 0 51862 DAVID GERBUS JD VICE PRESIDENT/ASST. SECRETARY 45.00 0.00 X 327010 0 50083 ALLISON CUSICK MPA EXECUTIVE DIRECTOR OF FOUNDATION 12.00 28.00 X 61445 143373 20298 CHERYL ANN LERNER DMD VICE PRESIDENT 45.00 0.00 X 260290 0 37310 KATHLEEN JACOBY VICE PRESIDENT 45.00 0.00 X 253691 0 45425 ROBERT MARK THOMPSON VICE PRESIDENT 45.00 0.00 X 363520 0 53179 BRIAN STEELE DIRECTOR OF CLIENT SERVICES 45.00 0.00 X 231996 0 47647 BROOKE BODART DIRECTOR OF BUSINESS PROGRAMS 45.00 0.00 X 164476 0 26379 LORRI KOHLE SENIOR SALES EXECUTIVE 45.00 0.00 X 174080 0 37158 MATTHEW CASSADY DIRECTOR OF COMPLIANCE 45.00 0.00 X 161565 0 35562 STEPHANIE RAUZI SENIOR SALES EXECUTIVE 45.00 0.00 X 246325 0 50123 JESSICA JEAN LAWHEAD FORMER KEY EMPLOYEE 0.00 0.00 X 236452 0 1949 KATHRYN ANN PAUL FORMER OFFICER 0.00 0.00 X 171494 0 0 LINDA MARIE ARNESON FORMER OFFICER 0.00 0.00 X 549144 0 0 4477690 143373 510881 41 1 1 0 WYSSTA SERVICES INC PO BOX 86 STEVENS POINT WI 54481 3RD PARTY INSURANCE PROCESSING 2658467 DELTA DENTAL OF VIRGINIA 4818 STARKEY ROAD SOUTHWEST ROANOKE VA 24018 IT SUPPORT & CLAIMS PROCESSING 2075441 ENCARA INC 4818 STARKEY RD ROANOKE VA 24018 MARKETING AND MANAGEMENT 1166271 PROSONO LLC 1624 MARKET ST SUITE 301 DENVER CO 80202 STRATEGIC PLANNING CONSULTANTS 1013794 BMS DIRECT INC 37 MILLRACE DR LYNCHBURG VA 24502 POSTAGE AND PRINTING 774269 121 SELF FUNDED PLAN PREMIUMS 524114 227541507 227541507 RISK PLAN PREMIUMS 524114 204069202 204069202 ADMINISTRATION - SELF FUNDED PLAN 524298 14513223 14513223 RISK SHARING 524298 450877 450877 DISCOUNT PLAN FEES 524114 300483 300483 446875292 2949943 591862 2358081 702672 0 702672 702672 702672 VISION PREMIUMS 524298 6070 6070 6070 450533977 446875292 597932 3060753 7098833 7098833 387405578 387405578 3798565 3722594 75971 11309579 11083387 226192 796952 781013 15939 2976755 2917220 59535 934522 915832 18690 4911488 3929190 982298 422140 337712 84428 144465 144465 294430 294430 2745188 1921632 823556 2258518 2258518 716411 501488 214923 2745590 2196472 549118 1050599 840479 210120 255831 51166 204665 59007 11801 47206 1457371 801554 655817 COMMISSIONS 8822340 8822340 DATA PROCESSING 5282600 5282600 POSTAGE & MAILING 2053449 1642759 410690 575723 575723 448115934 443097891 5018043 0 3812283 7623670 7262593 4136882 23843112 22507392 955129 1163871 15377053 12082985 4344920 3294068 91663968 90236210 1120010 734388 1331317 284113 134333332 129980594 11115634 8369004 5750000 6440000 2764894 4267914 18742395 18777523 38372923 37854441 X 95960409 92126153 95960409 92126153 134333332 129980594 X 2418043 -6282387 30088 X 0 1 X 1 0 2457482 1702952 754530 3771494 2214069 1557425 9148077 8165964 982113 3294068 PROVISION FOR UNPAID CLAIMS 18777523 18777523 X 450327632 -206345 -206345 450533977 0 450533977 447909588 -206345 -206345 448115933 0 448115933 PART X, LINE 2: THE COMPANY IS EXEMPT FROM FEDERAL INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE. GENERALLY, THE COMPANY IS NO LONGER SUBJECT TO FEDERAL INCOME TAX RETURN EXAMINATIONS FOR THE YEARS PRIOR TO 2015. PART XI, LINE 2D - OTHER ADJUSTMENTS: PATIENT DIRECT FEES -206,345. PART XII, LINE 2D - OTHER ADJUSTMENTS: PATIENT DIRECT FEES -206,345. 1 A KID PLACE 1640 25TH AVE GREELEY CO 80634 831087616 501(C)(3) 10800 FUNDING TO SUPPORT LOCAL ORGANIZATION DEDICATED TO IMPROVE ACCESS TO HEALTHCARE FOR UNDERPRIVILEGED FAMILIES. ALZHEIMER'S ASSOCIATION 455 SHERMAN ST DENVER CO 80203 135613797 501(C)(3) 13450 FUNDING TO SUPPORT LOCAL HEALTH ORGANIZATION AMERICAN DENTAL ASSOCIATION 211 E CHICAGO AVE CHICAGO IL 60611 360724690 501(C)(6) 10000 FUNDING TO SUPPORT NATIONAL ORAL HEALTH ORGANIZATION. AMERICAN RED CROSS 444 SHERMAN ST DENVER CO 80203 530196605 501(C)(3) 10000 FUNDING TO SUPPORT LOCAL CHAPTER OF A NATIONAL ORGANIZATION'S RELIEF EFFORTS FOR WILDFIRE AFFECTED AREAS. ASPEN COMMUNITY FOUNDATION 455 GOLD RIVERS COURT BASALT CO 81621 840829226 501(C)(3) 10000 FUNDING TO SUPPORT RELIEF EFFORTS RELATED TO LAKE CHRISTINE FIRE ASSOCIATION OF FUNDRAISING PROFESSIONALS CO CHAPTER PO BOX 24745 DENVER CO 80221 742256322 501(C)(3) 5000 FUNDING TO SUPPORT LOCAL CHAPTER OF NATIONAL ORGANIZATION. BOYS & GIRLS CLUBS OF METRO DENVER 2017 W 9TH AVE DENVER CO 80204 840510404 501(C)(3) 5000 FUNDING TO SUPPORT ORGANIZATION'S YOUTH EMPOWERMENT EFFORTS BOYS AND GIRLS CLUBS IN COLORADO 2017 W 9TH AVE DENVER CO 80204 471955928 501(C)(3) 5000 FUNDING TO SUPPORT ORGANIZATION'S YOUTH EMPOWERMENT EFFORTS BRIGHT BEGINNINGS 3605 MARTING LUTHER KING BLVD DENVER CO 80205 841382420 501(C)(3) 5000 FUNDING TO SUPPORT EARLY CHILDHOOD ORAL HEALTH INITIATIVE CARE AND SHARE INC 2605 PREAMBLE POINT COLORADO SPRINGS CO 80915 840731930 501(C)(3) 10000 FUNDING TO SUPPORT DISASTER RELIEF EFFORTS CENTER FOR HEALTH PROGRESS PO BOX 18877 DENVER CO 80218 432007393 501(C)(3) 62500 FUNDING TO SUPPORT IMPROVED ACCESS TO ORAL HEALTH FOR COLORADANS CHILDREN FIRST OF THE ROCKIES P O BOX 2174 LONGMONT CO 805022174 841497910 501(C)(3) 5000 FUNDING TO SUPPORT ORGANIZATION'S PROGRAM TO OFFER HEALTHCARE TO CHILDREN OF FAMILIES EXPERIENCING CONFLICT CHILDRENS HOSPITAL CO FOUNDATION 13123 E 16TH AVE BOX 045 AURORA CO 80045 840813462 501(C)(3) 7500 FUNDING TO SUPPORT LOCAL HEALTH ORGANIZATION CIRCLE 128 S ULSTER ST DENVER CO 80230 472199655 501(C)(3) 5000 FUNDING TO SUPPORT LOCAL ORGANIZATION CLINICA TEPEYAC 4725 HIGH STREET DENVER CO 80216 841285505 501(C)(3) 5000 FUNDING TO SUPPORT LOCAL HEALTH ORGANIZATION TO INCREASE ACCESS TO HEALTHCARE FOR UNDERPRIVILEGED COMMUNITIES COLO WOMENS CHAMBER OF COMM 1350 17TH ST DENVER CO 80202 841145793 501(C)(3) 7075 FUNDING TO SUPPORT LOCAL ORGANIZATION COLORADO CHILDRENS CAMPAIGN 1580 LINCOLN STREET DENVER CO 80203 742374672 501(C)(3) 37500 FUNDING TO SUPPORT LOCAL CHILDREN'S BENEFIT ORGANIZATION COLORADO HEALTH INSTITUTE 303 E 17TH AVE SUITE 930 DENVER CO 80203 743082235 501(C)(3) 5000 FUNDING TO SUPPORT LOCAL HEALTH ORGANIZATION IN ITS EFFORTS TO INCREASE ACCESS TO OVERALL HEALTHCARE TO COLORADANS COLORADO MISSION OF MERCY 712 9TH STREET PENROSE CO 81240 742374672 501(C)(3) 60000 FUNDING TO SUPPORT LOCAL ORGANIZATION'S OVERALL HEALTHCARE EVENT COLORADO SUCCEEDS 1390 LAWRENCE ST DENVER CO 80204 753221270 501(C)(3) 5000 FUNDING FOR LOCAL ORGANIZATION COLORADO SYMPHONY ASSOCIATION 1000 14TH ST UNIT 15 DENVER CO 80202 840511458 501(C)(3) 5000 FUNDING TO SUPPORT LOCAL CULTURE AND HUMANITIES ORGANIZATION. COMMUNITY FOUNDATION SERVING SW COLORADO 1309 E THIRD AVE DURANGO CO 81301 841474900 501(C)(3) 10000 FUNDING TO SUPPORT LOCAL ORGANIZATION CRAIG HOSPITAL FOUNDATION 3425 SOUTH CLARKSON STREET ENGLEWOOD CO 80113 237352287 501(C)(3) 6000 FUNDING TO SUPPORT IMPROVED ACCESS TO OVERALL HEALTH FOR COLORADANS DELTA DENTAL PLAN OF PUERTO RICO METRO OFFICE PARK 14 CALLE 2 GUAYNABO RQ 00968 660408212 11885 FUNDING TO SUPPORT DISASTER RELIEF EFFORTS DENTAL LIFELINE NETWORK 1800 15TH STREET SUITE 100 DENVER CO 80202 846129064 501(C)(3) 5000 FUNDING TO SUPPORT LOCAL ORGANIZATION'S EFFORTS TO INCREASE ORAL HEALTH ACCESS TO COLORADANS DENVER CENTER FOR PERF ARTS 1101 13TH STREET DENVER CO 80204 840407760 501(C)(3) 7438 FUNDING TO SUPPORT LOCAL CULTURE AND HUMANITIES ORGANIZATION. DENVER DUMB FRIENDS LEAGUE 2080 S QUEBEC ST DENVER CO 80231 840405254 501(C)(3) 32100 FUNDING FOR LOCAL ORGANIZATION DENVER HEALTH FOUNDATION 601 BROADWAY DENVER CO 80203 841085196 501(C)(3) 5000 FUNDING TO SUPPORT IMPROVED ACCESS TO OVERALL HEALTH FOR COLORADANS DENVER PUBLIC SCHOOLS FOUNDATN 1860 LINCOLN ST DENVER CO 80203 846001099 501(C)(3) 10000 FUNDING FOR LOCAL ORGANIZATION DENVER SCHOLARSHIP FOUNDATION 789 SHERMAN ST DENVER CO 80203 205143175 501(C)(3) 5000 FUNDING FOR LOCAL ORGANIZATION DENVER ZOOLOGICAL FOUNDATION 2300 STEELE ST GATES CENTER DENVER CO 80205 840502539 501(C)(3) 30000 FUNDING FOR LOCAL ORGANIZATION FOOD FOR THOUGHT DENVER 5288 COORS STREET ARVADA CO 80002 812971428 501(C)(3) 19550 FUNDING FOR LOCAL ORGANIZATION'S EFFORTS TO INCREASE ACCESS TO HEALTHY FOOD OPTIONS FOR UNDERPRIVILEGED COMMUNITIES FOOTHILLS ART CENTER 809 15TH ST GOLDEN CO 80401 840612999 501(C)(3) 5000 FUNDING TO SUPPORT LOCAL CULTURE AND HUMANITIES ORGANIZATION. GIRL SCOUTS OF COLORADO 3801 E FLORIDA AVE DENVER CO 80210 840410630 501(C)(3) 5000 FUNDING TO SUPPORT ORGANIZATION'S YOUTH EMPOWERMENT EFFORTS JUVENILE DIABETES RESEARCH FND 2727 BRYANT ST SUITE 380 DENVER CO 80211 231907729 501(C)(3) 7500 FUNDING TO SUPPORT ORGANIZATION'S PROGRAM TO OFFER GREATER ACCESS TO HEALTHCARE OPTIONS FOR PEOPLE AFFECTED BY DIABETES. LIGHT FOR LIFE FOUNDATION INTERNATIONAL PO BOX 644 WESTMINSTER CO 800360644 841304474 501(C)(3) 9000 FUNDING FOR LOCAL ORGANIZATION MEDICAID MEDICARE CHIP SERVICES DENTAL ASSOC 2 GROVE STREET SANDWICH MA 02563 201957993 501(C)(3) 10000 FUNDING TO SUPPORT LOCAL HEALTH ORGANIZATION TO INCREASE ACCESS TO HEALTHCARE FOR UNDERPRIVILEGED COMMUNITIES MILE HIGH UNITED WAY PO BOX 5547 DENVER CO 802179425 840404235 501(C)(3) 30640 FUNDING TO SUPPORT NATIONAL ORGANIZATION NATIONAL KIDNEY FOUNDATION INC 500 TAYLOR STREET COLUMBIA SC 29201 131673104 501(C)(3) 5000 FUNDING TO SUPPORT NATIONAL HEALTH ORGANIZATION NEWSED COMMUNITY DEVELOPMENT CORPORAT'N 901 W 10TH AVE UNIT 2A DENVER CO 80204 742275534 501(C)(3) 7000 FUNDING TO SUPPORT LOCAL CULTURE AND HUMANITIES ORGANIZATION. NORTHWEST COLORADO VISITING NURSE ASSOCIATION INC 940 CENTRAL PARK DR STE 101 STEAMBOAT SPRINGS CO 80487 840564998 501(C)(3) 9000 FUNDING TO SUPPORT LOCAL HEALTH ORGANIZATION IN ITS EFFORTS TO INCREASE ACCESS TO OVERALL HEALTHCARE TO COLORADANS ORAL HEALTH COLORADO 4950 S YOSEMITE ST GREENWOOD VILLAGE CO 80111 900137772 501(C)(3) 10000 FUNDING TO SUPPORT LOCAL HEALTH ORGANIZATION IN ITS EFFORTS TO INCREASE ACCESS TO ORAL HEALTHCARE TO COLORADANS PROJECT WORTHMORE 1609 HAVANA STREET AURORA CO 80010 450933835 501(C)(3) 17100 FUNDING FOR LOCAL ORGANIZATION PUEBLO COMMUNITY HEALTH CENTER 110 E ROUTT AVE PUEBLO CO 81004 840921521 501(C)(3) 9000 FUNDING TO SUPPORT LOCAL HEALTH ORGANIZATION IN ITS EFFORTS TO INCREASE ACCESS TO OVERALL HEALTHCARE TO COLORADANS ROCKY MOUNTAIN PBS 1089 BANNOCK STREET DENVER CO 80204 840510785 501(C)(3) 10000 FUNDING TO SUPPORT LOCAL CULTURE AND HUMANITIES ORGANIZATION. SUN VALLEY YOUTH CENTER INC 1230 DECATUR DENVER CO 80204 841471356 501(C)(3) 5000 FUNDING FOR LOCAL ORGANIZATION TASK FORCE ISO 670 E 20TH AVE UNIT 4611 DENVER CO 80205 813101536 501(C)(3) 9000 FUNDING FOR LOCAL ORGANIZATION THE BLUE BENCH PO BOX 18951 DENVER CO 80218 840905184 501(C)(3) 5000 FUNDING FOR LOCAL ORGANIZATION THE DENVER POST COMMUNITY FOUNDATION 5990 WASHINGTON ST DENVER CO 80216 274328521 501(C)(3) 10000 FUNDING FOR LOCAL ORGANIZATION THE LATINO CHAMBER 332 MAIN STREET LONGMONT CO 80501 201467359 501(C)(3) 5000 FUNDING FOR LOCAL ORGANIZATION TRANSPLANT FOUNDATION INC 600 17TH STREET DENVER DENVER CO 80202 020744032 501(C)(3) 10600 FUNDING TO SUPPORT HEALTH ORGANIZATION UNITED WAY OF NORTHERN CALIFORNIA 2280 BENTON DRIVE REDDING CA 96003 941251675 501(C)(3) 7500 FUNDING TO SUPPORT NATIONAL ORGANIZATION'S DISASTER RELIEF EFFORTS. UNIVERSITY OF CO FOUNDATION CAMPUS BOX 165 PO BOX 173364 DENVER DENVER CO 80217 846049811 501(C)(3) 12200 FUNDING FOR LOCAL ORGANIZATION UNIVERSITY OF COLORADO DENVER BUSINESS SCHOOL CAMPUS BOX 165 PO BOX 173364 DENVER DENVER CO 80217 846044833 501(C)(3) 5000 FUNDING FOR LOCAL ORGANIZATION VALLEY SETTLEMENT 520 S 3RD ST CARBONDALE CO 81623 812401368 501(C)(3) 5000 FUNDING FOR LOCAL ORGANIZATION WAPIYAPI 7148 S ANDES CIRCLE CENTENNIAL CO 80206 841475930 501(C)(3) 10800 FUNDING FOR LOCAL ORGANIZATION WOMENS FOUNDATION OF COLORADO 1901 EAST ASBURY AVE DENVER CO 80208 841039305 501(C)(3) 7500 FUNDING FOR LOCAL ORGANIZATION DELTA DENTAL OF COLORADO FOUNDATION 4582 S ULSTER STREET 800 DENVER CO 80237 841389431 501(C)(3) 6440000 SUPPORTED ORGANIZATION OF THE COMPANY 56 2 PART I, LINE 2: THE COMPANY HAS PROCEDURES TO ASCERTAIN THAT ALL GRANTS ARE MADE TO 501(C)(3) ORGANIZATIONS AND ARE PROPERLY APPROVED BY MANAGEMENT. ADDITIONALLY, THE ORGANIZATION REQUIRES PERIODIC REPORTS TO ASCERTAIN THAT SUBSTANTIAL GRANTS ARE USED FOR THEIR PROPER INTENDED PURPOSE. X X X X X 1 0 0 1 0 1 0 0 0 HELEN WEISS DREXLER CEO/PRESIDENT 411174 0 175458 0 593 0 37104 0 16802 0 641131 0 0 0 GREGORY VOCHIS CFO/TREASURER 265593 0 69816 0 139 0 35983 0 15879 0 387410 0 0 0 DAVID GERBUS JD VICE PRESIDENT/ASST. SECRETARY 255040 0 71059 0 911 0 34756 0 15327 0 377093 0 0 0 ALLISON CUSICK MPA EXECUTIVE DIRECTOR OF FOUNDATION 48685 112199 12719 31078 41 96 5144 13623 459 1072 67048 158068 0 0 CHERYL ANN LERNER DMD VICE PRESIDENT 181381 0 77554 0 1355 0 23294 0 14016 0 297600 0 0 0 KATHLEEN JACOBY VICE PRESIDENT 225201 0 27526 0 964 0 28153 0 17272 0 299116 0 0 0 ROBERT MARK THOMPSON VICE PRESIDENT 239377 0 123801 0 342 0 36669 0 16510 0 416699 0 0 0 BRIAN STEELE DIRECTOR OF CLIENT SERVICES 162205 0 69449 0 342 0 26603 0 21044 0 279643 0 0 0 BROOKE BODART DIRECTOR OF BUSINESS PROGRAMS 151246 0 13096 0 134 0 11911 0 14468 0 190855 0 0 0 LORRI KOHLE SENIOR SALES EXECUTIVE 103236 0 70300 0 544 0 14630 0 22528 0 211238 0 0 0 MATTHEW CASSADY DIRECTOR OF COMPLIANCE 142714 0 18727 0 124 0 12484 0 23078 0 197127 0 0 0 STEPHANIE RAUZI SENIOR SALES EXECUTIVE 102979 0 143154 0 192 0 24960 0 25163 0 296448 0 0 0 JESSICA JEAN LAWHEAD FORMER KEY EMPLOYEE 81192 0 154879 0 381 0 1868 0 81 0 238401 0 0 0 KATHRYN ANN PAUL FORMER OFFICER 46983 0 124511 0 0 0 0 0 0 0 171494 0 0 0 LINDA MARIE ARNESON FORMER OFFICER 209543 0 339601 0 0 0 0 0 0 0 549144 0 0 0 PART I, LINE 4A LINDA ARNESON RECEIVED $339,601 DURING 2018. PART I, LINE 5 THE COMPANY HAS AN INCENTIVE COMPENSATION PLAN AND A SALES INCENTIVE PLAN WHICH PROVIDES AN ANNUAL BONUS FOR ALL ELIGIBLE EMPLOYEES IF THE COMPANY REACHES CERTAIN GOALS INCLUDING A MINIMUN NET GAIN GOAL. ALL ACTIVE FULL TIME EMPLOYEES ARE ELIGIBLE FOR ONE OF THE INCENTIVE PLANS. THE COMPANY ALSO HAS A LONG-TERM INCENTIVE PROGRAM FOR EXECUTIVES, WHICH IS BASED ON BOTH A MEMBERSHIP GROWTH AND RETURN ON REVENUE FACTOR. THE LONG-TERM INCENTIVE PROGRAM HAS THREE-YEAR TARGETS AND PAYOUTS, AND IN MARCH OF 2019 THE PLAN ENDING DECEMBER 31, 2018 WAS PAID. PART I, LINE 6 SEE NARRATIVE FOR LINE 5A ABOVE. ROCK VIEW DENTAL CARE WALT VOGL, DDCO DIRECTOR, IS SOLE OWENER OF ROCK VIEW DENTAL CARE 104919 CLAIMS PAID FOR DENTAL SERVICES PROVIDED 0 OWEN AND TIMOCK ORTHODONTICS BRANDON OWEN, DDCO DIRECTOR, IS A PARTNER OF OWEN AND TIMOCK ORTHODONTICS 131834 CLAIMS PAID FOR DENTAL SERVICES PROVIDED 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS WHO ARE DEFINED AS PARTICIPATING DENTISTS WHO ARE ENGAGED IN THE PRACTICE OF DENTISTRY IN THE STATE OF COLORADO. THE PARTICIPATING DENTISTS ARE THOSE THAT HAVE SIGNED A PARTICIPATING DENTIST AGREEMENT WITH THE ORGANIZATION AS PRESCRIBED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE ORGANIZATION HAVE THE AUTHORITY TO ELECT THE BOARD OF TRUSTEES AT THE ANNUAL MEETING OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN MATTERS OF THE ORGANIZATION ARE SUBJECT TO A VOTE OF THE MEMBERS. A QUORUM OF 15% OF MEMBERSHIP, OR 500 MEMBERS, WHICHEVER IS GREATER, IS REQUIRED. FORM 990, PART VI, SECTION B, LINE 11B WE ENGAGE AN INDEPENDENT CPA TAX PROFESSIONAL TO PREPARE OUR 990, AND BOARD MEMBERS GENERALLY FEEL THIS IS THE APPROPRIATE FIDUCIARY PROCESS. THE AUDIT, INVESTMENT AND FINANCE COMMITTEE'S ROLE THEN IS TO EVALUATE THE FIRM HIRED TO PREPARE THE RETURN AND TO DETERMINE IT IS APPROPRIATELY FILED. WE HAVE TAKEN THOSE STEPS WITH OUR AUDIT, INVESTMENT AND FINANCE COMMITTEE. THE BOARD OF TRUSTEES REVIEWS AND APPROVES FORM 990 PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C DDCO CONDUCTS AN ANNUAL COMPLIANCE TRAINING, WHICH IS MANDATORY FOR ALL EMPLOYEES TO ATTEND. THE CONFLICTS OF INTEREST POLICY IS DISCUSSED AT THIS TRAINING. ON AN ANNUAL BASIS, ALL EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT AND SUBMIT ANY POTENTIAL OR PERCEIVED CONFLICT OF INTEREST. RECEIPT OF ALL SIGNED & COMPLETED FORMS ARE TRACKED IN AN EXCEL FILE; ORIGINAL FORMS ARE KEPT IN THE PERSONNEL FILE IN THE HUMAN RESOURCES OFFICE. ANY REPORTED POTENTIAL OR PERCEIVED CONFLICTS OF INTEREST ARE REVIEWED AND, IF NECESSARY, EMPLOYEES AND THEIR MANAGER ARE ADVISED TO REMOVE THEMSELVES FROM ANY SITUATION INVOLVING THE POTENTIAL CONFLICT. ADDITIONALLY, ALL NEW EMPLOYEES RECEIVE COMPLIANCE TRAINING AND ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT. EMPLOYEES ARE INSTRUCTED TO COMPLETE A NEW CONFLICT OF INTEREST STATEMENT DURING THE COURSE OF THE YEAR, SHOULD THEIR SITUATION CHANGE. THE CONFLICT OF INTEREST POLICY AND STATEMENT FORMS ARE POSTED ON THE COMPANY INTRANET. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION HAS A COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES THAT IS RESPONSIBLE FOR SETTING THE COMPENSATION OF THE PRESIDENT AND CEO. THE COMMITTEE ENGAGES THE SERVICES OF A THIRD PARTY TO PROVIDE RANGES OF COMPENSATION THAT ARE APPROPRIATE FOR THE DUTIES REQUIRED BY THE POSITION OF THE PRESIDENT, AS WELL AS THE POSITION OF THE VICE PRESIDENTS. THE CEO AND PRESIDENT OF THE CORPORATION IS RESPONSIBLE FOR THE COMPENSATION PROCESS OF THE REMAINING EXECUTIVES OF THE ORGANIZATION. THE ORGANIZATION ENGAGES A THIRD PARTY TO PROVIDE RANGES OF ACCEPTABLE INCREASES AND COMPENSATION LEVELS OF AVERAGE SALARIES BY SALARY GRADE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAINTAINS COPIES OF THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS THAT ARE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION HAS A STATEMENT ON ITS WEBSITE, WWW.DELTADENTALCO.COM, THAT INFORMS THE PUBLIC THAT THESE DOCUMENTS ARE AVAILABLE FOR PUBLIC INSPECTION AT ITS CORPORATE HEADQUARTERS. THE ORGANIZATION'S ANNUAL REPORT IS ALSO POSTED ON ITS WEBSITE, WHICH STATES THAT "COMPLETE AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR INSPECTION AT OUR CORPORATE OFFICES UPON REQUEST". DOCUMENTS ARE AVAILABLE FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990, PART XI, LINE 9: UNRECOGNIZED ACTUARIAL GAINS ON OPEB 30,987. ROUNDING -899. DELTA DENTAL PLAN OF COLORADO FOUNDATION 4582 S ULSTER ST 800 DENVER CO 80237 841389431 DENTAL HEALTH AND EDUCATION CO 501(C)(3) LINE 12A, I DELTA DENTAL OF COLORADO 1 SPRINGROCK DENTAL INC 4582 S ULSTER ST 800 DENVER CO 80237 475247650 DELIVERING QUALITY ORAL HEALTHCARE TO UNDERSERVED PATIENTS CO 501(C)(3) LINE 10 DELTA DENTAL OF COLORADO 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 DELTA DENTAL PLAN OF COLORADO FOUNDATION INC B 6440000 ARMS LENGTH DELTA DENTAL PLAN OF COLORADO FOUNDATION INC O 837869 ARMS LENGTH DELTA DENTAL PLAN OF COLORADO FOUNDATION INC Q 1255253 ARMS LENGTH SPRINGROCK DENTAL INC D 270000 ARMS LENGTH