2015-11-11T07:13:32-06:00 2014-12-31 341851358 CBIZ MHM LLC 3625 CUMBERLAND BLVD STE 800 ATLANTA GA 30082 990 2014-01-01 941461312 DELTA DENTAL OF CALIFORNIA DELT 4159728300 100 FIRST STREET SAN FRANCISCO CA 94105 MICHAEL J CASTRO CFO 4159728300 2015-11-03 1 CRAIG T WILLIAMS P00621386 7708584500 2014 2016-03-07 17:11:31Z MICHAEL J CASTRO 100 FIRST STREET SAN FRANCISCO CA 94105 5404068791 0 X WWW.DELTADENTALINS.COM X 1954 CA TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS SERVICE, TECHNOLOGY AND PROFESSIONAL SUPPORT. 15 12 2088 0 0 -247844 0 0 4717648513 5300932834 17081248 20709088 -34231817 -3546019 4700497944 5318095903 1382745 1514693 4139632023 4710789029 269596488 284306565 0 0 0 197482596 225645472 4608093852 5222255759 92404092 95840144 1575285367 1614974955 884498179 809480389 690787188 805494566 TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS SERVICE, TECHNOLOGY AND PROFESSIONAL SUPPORT. 0 0 5149337243 5318095903 THE ORGANIZATION PROVIDED DENTAL BENEFIT COVERAGE FOR 22,084,000 BENEFICIARIES IN 2014, PRIMARILY THROUGH CONTRACTS WITH INDEPENDENT DENTISTS. INCLUDED WERE 11,402,000 ENROLLEES IN MEDI-CAL AND OTHER PUBLICLY-SPONSORED DENTAL BENEFIT PROGRAMS ADMINISTERED BY THE ORGANIZATION, AS WELL AS 1,429,000 PERSONS VOLUNTARY ENROLLED IN THE TRDP PROGRAM FOR RETIRED MILITARY SERVICE PERSONNEL AND THEIR FAMILIES THAT THE ORGANIZATION UNDERWRITES PURSUANT TO A CONTRACT WITH THE DEPARTMENT OF DEFENSE. THE ORGANIZATION PAID MORE THAN $4,710,789,000 FOR DENTAL CARE DURING 2014. 1514693 1514693 THE ORGANIZATION MADE GRANTS DURING 2014 TO FOSTER IMPROVED ACCESSTO DENTAL HEALTH CARE TREATMENT, TO SUPPORT PROFESSIONAL DENTALEDUCATION AND TO PROVIDE ORAL HEALTH INSTRUCTION FOR PATIENTS. 5150851936 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 109101 0 1 2088 1 1 1 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 0 X MICHAEL J CASTRO CFO 4159728300 100 FIRST STREET SAN FRANCISCO CA 94105 X ANDREW J REID CHAIRMAN OF THE BOARD / DIRECTOR 2.00 X 168079 0 0 STEPHEN R PICKERING DDS FIRST VICE CHAIRMAN / DIRECTOR 1.00 X 142000 0 0 LYNN L FRANZOI SECOND VICE CHAIR / DIRECTOR 1.00 X 110579 0 0 DEVANG M GANDHI DDS SECRETARY/DIRECTOR 1.00 X 144420 0 0 TERRY A O'TOOLE TREASURER/DIRECTOR 2.00 X 186000 0 0 GLEN F BERGERT CPA DIRECTOR 2.00 1.00 X 186878 27972 0 BARBARA J BURGEL DIRECTOR 1.00 X 75500 0 0 D DOUGLAS CASSAT DDS DIRECTOR 1.00 X 78500 0 0 R KENT FARNSWORTH DDS DIRECTOR 1.00 X 128579 0 0 ROY GONELLA DIRECTOR 1.00 X 74579 0 0 GREGORY D KAPLAN DDS DIRECTOR 1.00 X 75642 0 0 BEVERLY A KODAMA DDS DIRECTOR 1.00 X 83579 0 0 STEVEN F MCCANN DIRECTOR 2.00 X 188079 0 0 JO BONITA RAINS DIRECTOR 1.00 X 81500 0 0 CORAGENE I SAVIO DDS DIRECTOR 1.00 X 68500 0 0 THOMAS A ZIMMERMAN DIRECTOR 2.00 X 106010 0 0 GARY D RADINE PRESIDENT/CEO 48.00 12.00 X 4332864 0 435375 ANTHONY S BARTH EVP/COO 40.00 10.00 X 1963022 0 3883325 MICHAEL J CASTRO EVP/CFO 40.00 10.00 X 1340198 0 2190161 MICHAEL HANKINSON EVP/CLO 40.00 10.00 X 843255 0 58166 PATRICK S STEELE EVP/CIO 40.00 10.00 X 11166136 0 2441976 RICK R DOERING SR. VICE PRES. 40.00 10.00 X 797033 0 59326 PATRICK HENRY SR. VICE PRES. 50.00 0.00 X 536708 0 60317 BELINDA MARTINEZ SR. VICE PRES. 40.00 10.00 X 980396 0 2489983 NILESH C PATEL SR. VICE PRES. 40.00 10.00 X 898791 0 46267 ALICIA WEBER SR. VICE PRES. 40.00 10.00 X 800642 0 62779 KEVIN JACKSON GRP. VICE PRES. 40.00 10.00 X 557614 0 67934 STEPHEN ADAMSON VICE PRES. 40.00 10.00 X 24441 0 6043 JEFFREY M ALBUM VICE PRES. 40.00 10.00 X 411277 0 70601 TERRI ANDERSON VICE PRES. 40.00 10.00 X 383821 0 65482 RUSSELL BRADLEY VICE PRES. 40.00 10.00 X 179365 0 15617 DANIEL CROLEY VICE PRES. 40.00 10.00 X 405521 0 68089 EVA HOFFMAN VICE PRES. 40.00 10.00 X 371058 0 67300 GARRETT LEAF VICE PRES. 40.00 10.00 X 258007 0 13792 THOMAS LEIBOWITZ VICE PRES. 40.00 10.00 X 379075 0 48478 HARI MAKKALA VICE PRES. 40.00 10.00 X 559985 0 46790 BOB MENHART VICE PRES. 40.00 10.00 X 247326 0 35878 JAMAL NASR VICE PRES. 40.00 10.00 X 382241 0 66127 MOHAMMADREZA NAVID VICE PRES. 50.00 0.00 X 486706 0 44282 DUANE PROFEIT VICE PRES. 40.00 10.00 X 360865 0 72210 JOSEPH RUIZ VICE PRES. 50.00 0.00 X 357188 0 61499 MARTY A SHEETZ VICE PRES. 40.00 10.00 X 162222 165109 72716 TOM WONG VICE PRES. 40.00 10.00 X 449890 0 65046 JOHN YAMAMOTO VICE PRES. 40.00 10.00 X 347456 0 65164 ELISE POMERANTZ-WATZKA DIRECTOR COMPENSATION & BE 40.00 0.00 X 284230 0 57969 MELISSA GEE DIRECTOR & CORPORATE COUNS 40.00 0.00 X 292601 0 44446 STEPHEN LOWRY DIRECTOR SALES 50.00 0.00 X 299224 0 40943 J DOUGLAS KONOVALOFF DIRECTOR FEDERAL SVC OPERATIONS 50.00 0.00 X 270784 0 219940 KEVIN O'TOOLE DIRECTOR SALES 50.00 0.00 X 275655 0 64438 CHARLES LAMONT FORMER EVP/CLO 0.00 0.00 X 585615 0 6503 CHARLES LAMONT CONSULTANT/FORMER OFFICER 10.00 0.00 X 210000 0 0 34099636 193081 13114962 586 1 1 0 RAUXA DIRECT 275 A MCCORMICK AVE COSTA MESA CA 92626 ADVERTISING SERVICES 8984185 HP ENTERPRISE SERVICES LLC PO BOX 848433 DALLAS TX 75284 CONSULTING SERVICES 7839685 CATALYST360 LLC 4 WALNUT GROVE DR HORSHAM PA 19044 CONSULTING SERVICES 7142297 KP CORPORATION DEPT LA 23670 PASADENA CA 91185 CONSULTING SERVICES 5934593 WASHINGTON DENTAL SERVICE PO BOX 75688 SEATTLE WA 98125 DENTAL CLAIMS PROCESSING SERVICES 5240393 71 PROFESSIONAL SERVICES 524114 3926485067 3926485067 FEES & CONTRACTS FROM GOVERNMENT 524114 1374447767 1374447767 5300932834 20708183 20708183 85973793 85972888 905 905 905 INCOME/LOSS FROM SUBSIDIARIES 524298 15603783 15603783 MANAGEMENT FEE INCOME 524298 3692255 3692255 MISC INCOME 524298 364443 364443 -23206500 -23206500 -3546019 5318095903 5318095903 0 0 1092193 1092193 422500 422500 4710789029 4710789029 46981199 46981199 176870771 161570084 15300687 12840741 11790468 1050273 36607036 34007719 2599317 11006818 10167466 839352 3423752 3253111 170641 1594784 616550 978234 405864 405864 2601153 2496940 104213 27109271 26843521 265750 32904518 32725956 178562 10411224 9978090 433134 21193088 19362971 1830117 4883711 4070965 812746 653928 530490 123438 142744 142744 2271161 2227468 43693 27565056 27177796 387260 967474 967474 BROKER FEES 43055205 43055205 CONSULTANT FEES 32474200 30210966 2263234 ACA TAX 16516204 16516204 OUTSIDE SERVICES 12166641 11967739 198902 -14694506 -11537577 -3156929 5222255759 5150851936 71403823 0 183621640 76565901 64161919 30824946 291061448 375773512 65750000 75750000 18216631 17867793 534583903 303698424 236224671 230885479 592782937 647976402 79683953 101380686 15000000 6295206 6295206 37486962 36655030 1575285367 1614974955 544769259 468777891 66180204 70078417 273548716 270624081 884498179 809480389 X 0 0 0 0 690787188 805494566 690787188 805494566 1575285367 1614974955 X 95840144 9473085 9394149 X 0 1 X 1 0 32759060 25422755 7336305 49815898 40186678 9629220 452008945 238088991 213919954 230885479 INVESTMENT IN SUBSIDIARIES 101380686 C 101380686 ACCRUED RETIREMENT BENEFITS 61669511 DEFERRED COMPENSATION PLANS 36467618 GROUP PREFUNDING DEPOSITS 11142312 REFUNDABLE GROUP BALANCES 161344640 270624081 X 3295959903 0 3295959903 2022136000 2022136000 5318095903 3200119759 0 3200119759 2022136000 2022136000 5222255759 PART X, LINE 2: THE COMPANY IS A TAX-EXEMPT ORGANIZATION ORGANIZED UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE AND, AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE FINANCIAL STATEMENTS. CURRENT ACCOUNTING GUIDANCE CLARIFIES HOW UNCERTAINTIES IN TAX POSITIONS ARE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. POSITIONS INCLUDE THOSE WITH RESPECT TO THE COMPANY'S TAX EXEMPT STATUS AND WITH RESPECT TO INCOME TAXES ON UNRELATED BUSINESS INCOME. THE COMPANY HAS DETERMINED THAT SUCH TAX POSITIONS DO NOT RESULT IN UNCERTAINTIES REQUIRING RECOGNITION. PART XI, LINE 4B - OTHER ADJUSTMENTS: ADMINISTRATIVE SERVICE CONTRACTS CLAIM REIMBURSEMENT REVENUE PART XII, LINE 4B - OTHER ADJUSTMENTS: CLAIMS INCURRED FOR ADMINISTRATIVE SERVICE CONTRACTS 1 CADP ONE CAPITOL MALL SUITE 320 SACRAMENTO CA 95814 330385553 501(C)(6) 7000 SPONSORSHIP ANNUAL CONFERENCE, 6/5-8/14 CALAVERAS CHILDREN'S DENTAL PROJECT C/O CALAVERAS COUNTY OFFICE OF EDUCATION PO BOX 2762 MURPHYS CA 95247 941638758 20000 HEALTH, RESEARCH & EDUCATION GRANT CALIFORNIA ACADEMY OF GENERAL DENTISTRY 2063 MAIN STREET 418 OAKLEY CA 945613302 942557207 501(C)(3) 20000 SPONSORSHIP FOR CE COURSE 11-15-14 CAMBRA COALITION 804 RIVAGE CIRCLE FOLSOM CA 95630 460633229 501(C)(3) 5000 SPONSORSHIP FOR CONFERENCE ON 11/07/14 CHALLENGED ATHLETES FOUNDATION 9591 WAPLES ST SAN DIEGO CA 92121 330739596 501(C)(3) 6000 CONTRIBUTION CHILDREN'S ORAL HEALTH INSTITUTE 9199 REISTERTOWN RD 203A OWINGS MILLS MD 21117 522048036 10000 SPONSORSHIP: "LESSONS IN A LUNCHBOX" COMMUNITY CLINIC ASSOCIATION OF LA COUNTY 700 S FLOWER STE 3150 LOS ANGELES CA 90017 954576023 501(C)(3) 8000 THE LOS ANGELES DENTAL FORUM DELTA DENTAL COMMUNITY CARE FOUNDATION 100 FIRST ST SAN FRANCISCO CA 94105 371570764 501(C)(3) 431000 CONTRIBUTION TO THE FOUNDATION FROM DDC FINE ARTS MUSEUM GOLDEN GATE PARK 50 HAGIWARA TEA GARDEN DR SAN FRANCISCO CA 94118 943045948 501(C)(3) 5000 CORPORATE COMMUNITY CONTRIBUTION HENRY M JACKSON FOUNDATION ADVANCEMENT OF MILITARY MEDICINE INC 6720 A ROCKLEDGE DR STE 100 BETHESDA MD 20817 521317896 501(C)(3) 10000 2014 CONTRIBUTION INTERAGENCY INSTITUTE FOR FEDERAL HEALTH CARE EXECUTIVES THE GEORGE WASHINGTON UNIVERSITY MEDICAL CENTER 5325 MACARTHUR BLVD WASHINGTON DC 20016 077421512 16500 CONTRIBUTION FOR CONTINUING EDUCATION LA CLINICA DE LA RAZA PO BOX 22210 OAKLAND CA 946232210 941744108 501(C)(3) 5000 GRANT FOR "ALL THAT JAZZ" EVENT NATIONAL ASSOCIATION OF DENTAL PLANS 12700 PARK CENTRAL DR SUITE 400 DALLAS TX 75251 752801959 501(C)(6) 5000 CONVERGE 2014 SPONSORSHIP NATIONAL CHILDREN'S ORAL HEALTH FOUNDATION 4108 PARK RD STE 300 CHARLOTTE NC 28209 203921574 501(C)(3) 50000 ORAL HEALTH ZONE IN ORANGE COUNTY, CA NATIONAL GUARD YOUTH FOUNDATION 1001 N FAIRFAX ST STE 205 ALEXANDRIA VA 22314 541940978 501(C)(3) 8000 CONTRIBUTION NATIONAL MILITARY FAMILY ASSOCIATION 3601 EISENHOWER AVE STE 425 ALEXANDRIA VA 22304 520899384 501(C)(3) 10000 CONTRIBUTION NATIONAL NETWORK FOR ORAL HEALTH ACCESS 181 E 56TH AVE STE 501 DENVER CO 80216 841186592 501(C)(3) 5000 NAT'L ORAL HEALTH LEARNING INSTITUTE PARTNERS IN CARE FOUNDATION 732 MOTT STREET SUITE 150 SAN FERNANDO CA 91340 953954057 501(C)(3) 5000 PCF GOLF CLASSIC ON 9-22-14 PENNSYLVANIA COALITION FOR ORAL HEALTH C/O TFEL 200 N 3RD ST 8TH FL HARRISBURG PA 17101 010564355 501(C)(3) 10000 HEALTH, EDUCATION & RESEARCH GRANT SACRAMENTO DISTRICT DENTAL FOUNDATION 2035 HURLEY WAY STE 200 SACRAMENTO CA 95825 237067087 501(C)(3) 5000 SPONSORSHIP: SMILES FOR SACRAMENTO, 10-18-14 SAN FRANCISCO BALLET 455 FRANKLIN STREET SAN FRANCISCO CA 94102 941415298 501(C)(3) 5000 CORPORATE COMMUNITY CONTRIBUTION SAN FRANCISCO GENERAL HOSPITAL FOUNDATION 1001 POTRERO AVE RM 1N1 SAN FRANCISCO CA 94110 943189424 501(C)(3) 30000 GRANT FOR SERGERY SVC DENTAL LAB SMILE KEEPERS DENTAL PROJECT C/O TUOLUMNE COUNTY OFFICE OF EDUCATION 175 S FAIRVIEW LANE SONORA CA 95370 946050189 501(C)(3) 20000 HEALTH, RESEARCH & EDUCATION GRANT TEMPLE UNIVERSITY 3223 NORTH BROAD ST 301 PHILADELPHIA PA 19140 231365971 501(C)(3) 8000 SPONSORSHIP FOR DR. WYNN CE COURSE 11-14-14 THE CENTERS FOR ORAL HEALTH 309 EAST 2ND ST POMONA CA 91766 943000350 501(C)(3) 15000 GRANT FOR: ORAL HEALTH 2020 SYMPOSIUM THE ROA STARS FOUNDATION ONE CONSTITUTION AVE NE CAITLIN DONNELLY RESEARCH MANGER DEVELOPMEN WASHINGTON DC 200025618 461374538 501(C)(3) 5000 ROA STARS FOUNDATION 2014 GALA SPONSORSHIP UC REGENTS 745 PARNASSUS AVE SAN FRANCISCO CA 94143 952226406 5000 118TH ANNUAL SCIENTIFIC SESSION, 5/30-31/14 UC REGENTS 513 PARNASSUS AVE MED S619A SAN FRANCISCO CA 94143 952226406 6000 GRANT FOR SUMMER FELLOWSHIP UC REGENTS 513 PARNASSUS AVE ROOM S-630 SAN FRANCISCO CA 94143 952226406 8000 SPONSORSHIP FOR CONTINUING EDUCATION UC REGENTS 513 PARNASSUS AVE ROOM S619A SAN FRANCISCO CA 94143 952226406 10000 SPONSOR: UCSF RESEARCH & EXCELLANCE DAY UCLA SCHOOL OF DENTISTRY 650 CHARLES YOUNG DR SOUTH LOS ANGELES CA 90095 943191637 8000 SPONSORSHIP FOR CE COURSE 11-08-14 UNITED WAY CALIFORNIA CAPITAL REGION 10389 OLD PLACERVILLE RD ATTN ACCOUNTS RECEIVABLE SACRAMENTO CA 958272506 237079003 43384 SACRAMENTO UNITED WAY MATCHING CHECK UNITED WAY OF GREATER LOS ANGELES 1150 S OLIVE STREET SUITE T500 LOS ANGELES CA 90015 952274801 501(C)(3) 6001 CERRITOS UNITED WAY MATCHING CHECK UNITED WAY OF THE BAY AREA 550 KEARNY STREET 1000 SAN FRANCISCO CA 94108 941312348 501(C)(3) 152158 SAN FRANCISCO UNITED WAY MATCHING CHECK UNIVERSITY OF ALABAMA 1720 2ND AVE SOUTH SDB 207 BIRMINGHAM AL 35294 636001138 9000 GRANT FOR CE COURSE ON 5-16-14 UNIVERSITY OF FLORIDA PO BOX 113200 GAINESVILLE FL 32611 590974739 501(C)(3) 10000 CE COURSE SPONSORSHIP OCT14 UNIVERSITY OF THE PACIFIC 155 5TH STREET SAN FRANCISCO CA 94103 941156266 501(C)(3) 5000 KIDS IN THE KLINIC GOLF CLASSIC UNIVERSITY OF THE PACIFIC (UOP) ARTHUR DUGONI SCHOOL OF DENTISTRY 3601 PACIFIC AVE STOCKTON CA 95211 941156266 501(C)(3) 39950 GRANT FOR SCOPE PROGRAM UNIVERSITY OF TX SCHOOL OF DENTISTRY HOUSTON 7500 CAMBRIDGE ST STE 6130 HOUSTON TX 77054 741761309 8000 SPONSORSHIP FOR CONTINUING EDUCATION MISCELLANEOUS ITEMS LESS THAN 5000 57200 CONTRIBUTION STUDENT LEADERSHIP AWARDS 65 212500 HISPANIC SCHOLARSHIP 23 210000 PART I, LINE 2: THE ORGANIZATION AWARDS GRANTS FOR PROGRAMS THAT FOSTER DENTAL HEALTH AND EDUCATION. THROUGH THESE GRANTS THE ORGANIZATION HELPS FINANCE HEALTH, EDUCATION, AND RESEARCH PROJECTS IN DENTISTRY, HEALTH AND HUMAN SERVICES, AND CIVIC AND COMMUNITY AFFAIRS. THE TWO GRANTS ARE: (1) THE DENTAL HEALTH AND EDUCATION CONTRIBUTION, WHICH SUPPORTS DENTAL HEALTH AND AWARENESS PROGRAMS AND (2) THE STANDARD DENTAL RESEARCH GRANT, WHICH SUPPORTS PROFESSIONAL RESEARCH RELATED TO DENTAL HEALTH. GRANTS ARE AWARDED TO GROUPS THAT: (1) PROVIDE DENTISTRY FOR INDIGENTS; (2) PROVIDE DENTISTRY FOR GROUPS THAT ARE DENTALLY UNDERSERVED; (3) PROVIDE EDUCATION TO ADVANCE THE AWARENESS OR THE SCIENCE OF DENTISTRY; (4) PROMOTE PUBLIC DENTAL HEALTH; AND (5) ARE INVOLVED IN COMMUNITY ACTIVITIES RELATED TO DENTAL CARE. GRANT GUIDELINES: PRIORITY WILL GO TO PROJECTS THAT FOCUS ON ISSUES RELATED TO THE DELIVERY OF ORAL HEALTH CARE, INCLUDING THOSE WITH SIGNIFICANT POTENTIAL FOR IMPROVING ORAL HEALTH AND REDUCING TREATMENT COSTS. PRIORITY CONSIDERATION WILL GO TO RESEARCHERS FROM THE DENTAL SCHOOLS IN THE ENTERPRISE STATES, BUT WILL NOT BE LIMITED TO THESE INSTITUTIONS. PRIORITY WILL GO TO TWO TYPES OF STUDIES: (1) PILOT OR FEASIBILITY STUDIES LIKELY TO ENHANCE THE INVESTIGATOR'S CHANCE FOR LONG-TERM FUNDING FROM OTHER SOURCES; AND (2) COMPLETE PROJECTS CONSIDERED TO BE OF INTEREST TO THE HEALTH, EDUCATION, AND RESEARCH FUND, FOR WHICH OTHER SOURCES OF FUNDS ARE TRADITIONALLY UNAVAILABLE OR INSUFFICIENT. PRIORITY WILL GO TO STUDIES THAT EVALUATE THE OUTCOME OF PREVENTATIVE AND TREATMENT PROCEDURES. RETROSPECTIVE STUDIES OR THOSE INVOLVING ANALYSIS OF EXISTING DATA SHOULD BE CONSIDERED, RATHER THAN LONG-TERM FOLLOW-UP STUDIES, IN ORDER TO REDUCE THE YEARS REQUIRED TO OBTAIN DATA. OVERHEAD CHARGES WITHIN EACH ELIGIBLE GRANT WILL BE LIMITED TO EIGHT PERCENT. THE FUND WILL NORMALLY MAKE ONE TO TWO STANDARD RESEARCH GRANTS PER YEAR. INDIVIDUAL GRANTS WILL GENERALLY NOT EXCEED $40,000. GRANTS WILL BE LIMITED TO ONE-YEAR PROJECTS, SUBJECT TO RENEWAL. EXCEPT IN SPECIAL CASES, AN ORGANIZATION/ENTITY WILL NOT BE ELIGIBLE FOR MORE THAN ONE GRANT DURING ANY YEAR. A SCREENING COMMITTEE REVIEWS ALL APPLICATIONS, WITH FINAL GRANT DECISIONS MADE BY THE FUND'S ADMINISTRATIVE COMMITTEE. X X X X X X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 ANDREW J REID CHAIRMAN OF THE BOARD / DIRECTOR 168079 0 0 0 0 0 0 0 0 0 168079 0 0 0 TERRY A O'TOOLE TREASURER/DIRECTOR 186000 0 0 0 0 0 0 0 0 0 186000 0 0 0 GLEN F BERGERT CPA DIRECTOR 186878 27972 0 0 0 0 0 0 0 0 186878 27972 0 0 STEVEN F MCCANN DIRECTOR 188079 0 0 0 0 0 0 0 0 0 188079 0 0 0 GARY D RADINE PRESIDENT/CEO 1250004 0 2889385 0 193475 0 418284 0 17091 0 4768239 0 0 0 ANTHONY S BARTH EVP/COO 824004 0 1026663 0 112355 0 3855876 0 27449 0 5846347 0 0 0 MICHAEL J CASTRO EVP/CFO 566496 0 706644 0 67058 0 2164603 0 25558 0 3530359 0 0 0 MICHAEL HANKINSON EVP/CLO 399615 0 299682 0 143958 0 34500 0 23666 0 901421 0 0 0 PATRICK S STEELE EVP/CIO 544916 0 771706 0 9849514 0 2422183 0 19793 0 13608112 0 9780574 0 RICK R DOERING SR. VICE PRES. 378489 0 391693 0 26851 0 38557 0 20769 0 856359 0 0 0 PATRICK HENRY SR. VICE PRES. 267656 0 243169 0 25883 0 43526 0 16791 0 597025 0 0 0 BELINDA MARTINEZ SR. VICE PRES. 463396 0 481662 0 35338 0 2470490 0 19493 0 3470379 0 0 0 NILESH C PATEL SR. VICE PRES. 419846 0 454450 0 24495 0 37687 0 8580 0 945058 0 0 0 ALICIA WEBER SR. VICE PRES. 383123 0 391883 0 25636 0 38491 0 24288 0 863421 0 0 0 KEVIN JACKSON GRP. VICE PRES. 302295 0 222675 0 32644 0 40935 0 26999 0 625548 0 0 0 JEFFREY M ALBUM VICE PRES. 254584 0 133751 0 22942 0 43602 0 26999 0 481878 0 0 0 TERRI ANDERSON VICE PRES. 261624 0 107150 0 15047 0 46694 0 18788 0 449303 0 0 0 RUSSELL BRADLEY VICE PRES. 127211 0 0 0 52154 0 9847 0 5770 0 194982 0 0 0 DANIEL CROLEY VICE PRES. 268816 0 104211 0 32494 0 41090 0 26999 0 473610 0 0 0 EVA HOFFMAN VICE PRES. 236996 0 111643 0 22419 0 40301 0 26999 0 438358 0 0 0 GARRETT LEAF VICE PRES. 21827 0 71049 0 165131 0 11689 0 2103 0 271799 0 0 0 THOMAS LEIBOWITZ VICE PRES. 259923 0 106075 0 13077 0 36093 0 12385 0 427553 0 0 0 HARI MAKKALA VICE PRES. 319846 0 187037 0 53102 0 38360 0 8430 0 606775 0 0 0 BOB MENHART VICE PRES. 153619 0 0 0 93707 0 20453 0 15425 0 283204 0 0 0 JAMAL NASR VICE PRES. 251328 0 109787 0 21126 0 42911 0 23216 0 448368 0 0 0 MOHAMMADREZA NAVID VICE PRES. 279247 0 188220 0 19239 0 34500 0 9782 0 530988 0 0 0 DUANE PROFEIT VICE PRES. 246935 0 99603 0 14327 0 54907 0 17303 0 433075 0 0 0 JOSEPH RUIZ VICE PRES. 288335 0 50000 0 18853 0 34500 0 26999 0 418687 0 0 0 MARTY A SHEETZ VICE PRES. 115000 106341 0 30000 47222 28768 26500 25321 13500 7395 202222 197825 0 0 TOM WONG VICE PRES. 290004 0 150480 0 9406 0 39938 0 25108 0 514936 0 0 0 JOHN YAMAMOTO VICE PRES. 240966 0 95199 0 11291 0 38165 0 26999 0 412620 0 0 0 ELISE POMERANTZ-WATZKA DIRECTOR COMPENSATION & BE 208853 0 59458 0 15919 0 38716 0 19253 0 342199 0 0 0 MELISSA GEE DIRECTOR & CORPORATE COUNS 226549 0 64458 0 1594 0 36970 0 7476 0 337047 0 0 0 STEPHEN LOWRY DIRECTOR SALES 166271 0 118226 0 14727 0 37996 0 2947 0 340167 0 0 0 J DOUGLAS KONOVALOFF DIRECTOR FEDERAL SVC OPERATIONS 196464 0 63059 0 11261 0 196590 0 23350 0 490724 0 0 0 KEVIN O'TOOLE DIRECTOR SALES 173472 0 91341 0 10842 0 38727 0 25711 0 340093 0 0 0 CHARLES LAMONT FORMER EVP/CLO 0 0 584708 0 907 0 6503 0 0 0 592118 0 0 0 CHARLES LAMONT CONSULTANT/FORMER OFFICER 210000 0 0 0 0 0 0 0 0 0 210000 0 0 0 PART I, LINE 1A FIRST CLASS BUSINESS TRAVEL IS REIMBURSED TO THE EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, AND GROUP VICE PRESIDENTS. FIRST CLASS BUSINESS TRAVEL IS NOT TREATED AS TAXABLE COMPENSATION. TRAVEL FOR COMPANIONS WAS PROVIDED TO SIX BOARD MEMBERS WITH RESPECT TO THEIR REQUIRED ATTENDANCE AT THE ANNUAL BOARD MEETING. THE COST OF THIS BENEFIT WAS INCLUDED IN TAXABLE COMPENSATION. A HOUSING ALLOWANCE IS PROVIDED TO ONE SENIOR EXECUTIVE AS A RESULT OF A 2013 RELOCATION TO CALIFORNIA. THE HOUSING ALLOWANCE HAS CONTINUED WHILE THE PREVIOUS HOME IS BEING MARKETED FOR SALE. THE COST OF THIS BENEFIT IS INCLUDED IN TAXABLE COMPENSATION. REIMBURSEMENT FOR COMPANY APPROVED REALLOCATION COSTS ARE "GROSSED UP" TO COVER ANY PERSONAL TAX LIABILITY THAT WOULD BE INCURRED BY THE EMPLOYEE FOR THE EXPENSE. ONE HIGHLY COMPENSATED EMPLOYEE RECEIVED THIS BENEFIT IN 2014. THE TOTAL AMOUNT REIMBURSED IS INCLUDED IN TAXABLE COMPENSATION. THE PRESIDENT AND EXECUTIVE VICE PRESIDENTS MAY BE REIMBURSED FOR ONE HEALTH OR SOCIAL CLUB UPON APPROVAL BY THE PRESIDENT. TWO SENIOR EXECUTIVES RECEIVED THIS BENEFIT IN 2014. THE COST OF THIS BENEFIT IS INCLUDED IN TAXABLE COMPENSATION. FINANCIAL AND TAX PLANNING EXPENSES ARE REIMBURSED TO EMPLOYEES AT THE DIRECTOR OR ABOVE LEVELS OF MANAGEMENT. A COMPANY POLICY OUTLINES THE MAXIMUM REIMBURSEMENT ALLOWED FOR EACH MANAGEMENT LEVEL. THESE REIMBURSEMENTS ARE INCLUDED IN THE TAXABLE COMPENSATION OF THE REIMBURSED EMPLOYEES. PART I, LINE 4B THE ORGANIZATION PROVIDES A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN TO CERTAIN OF ITS SENIOR EXECUTIVES AS SELECTED BY THE BOARD OF DIRECTORS. THE SUPPLEMENTAL RETIREMENT BENEFIT IS BASED ON EACH EXECUTIVE'S COMPENSATION AND YEARS OF SERVICE TO THE ENTERPRISE. THE BENEFIT IS SUBJECT TO THE RISK OF FORFEITURE IF REQUIRED YEARS OF SERVICE ARE NOT MET. ANNUAL DEFERRED COMPENSATION RELATED TO THIS PLAN IS REPORTED IN SCHEDULE J, PART II, COLUMN C FOR EACH PARTICIPANT AND REFLECTS THE CURRENT YEAR INCREASE OR DECREASE IN THE ORGANIZATION'S PENSION BENEFIT OBLIGATION ("PBO"), CALCULATED PURSUANT TO GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. THE PBO INCREASE OR DECREASE INCLUDES CHANGES IN ACTUARIAL ASSUMPTIONS (E.G., APPLICABLE DISCOUNT RATE), AS WELL AS CHANGES IN COMPENSATION AND YEARS OF SERVICE. IN 2014, FIVE EXECUTIVES PARTICIPATED IN THE PLAN - ANTHONY BARTH, MICHAEL CASTRO, DOUGLAS KONOVALOFF, BELINDA MARTINEZ, AND PATRICK STEELE. PART I, LINE 7 THE PRESIDENT OF THE ORGANIZATION, WITH BOARD OF DIRECTORS APPROVAL, MAY GRANT AN ANNUAL BONUS TO ALL MANAGEMENT EMPLOYEES. THESE AMOUNTS ARE INCLUDED IN TAXABLE COMPENSATION. GREGORY D KAPLAN DDS PARTICIPATING PROVIDER 1072358 DENTAL CLAIM PAYMENTS 0 CORAGENE I SAVIO DDS PARTICIPATING PROVIDER 208556 DENTAL CLAIM PAYMENTS 0 STEPHEN R PICKERING DDS PARTICIPATING PROVIDER 159310 DENTAL CLAIM PAYMENTS 0 DEVANG GANDHI DDS PARTICIPATING PROVIDER 104093 DENTAL CLAIM PAYMENTS 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S BYLAWS NAME TWO CLASSES OF "MEMBERS," "CORPORATE MEMBERS" AND "DENTIST MEMBERS." ALL CORPORATE MEMBERS ARE ALSO DIRECTORS OF THE ORGANIZATION AND SO ARE NOT "MEMBERS" AS DEFINED IN THE INSTRUCTIONS TO FORM 990, PART VI, QUESTION 6. HOWEVER, THE ORGANIZATION'S DIRECTORS ARE ELECTED BY ITS PARENT HOLDING COMPANY BOARD OF DIRECTORS, TWO OF WHOM ARE NOT ALSO DIRECTORS OF THE ORGANIZATION AND THUS MAY BE CONSIDERED "MEMBERS" PURSUANT TO THE INSTRUCTION. THE DENTIST MEMBERS HAVE A RIGHT TO VOTE UPON PROPOSED CHANGES TO THE PROPORTION OF THE DENTISTS SERVING AS DIRECTORS AND CORPORATE MEMBERS, AND SO MAY BE CONSIDERED "MEMBERS" UNDER THE INSTRUCTION. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S DIRECTORS ARE ELECTED BY THE PARENT HOLDING COMPANY BOARD OF DIRECTORS, WHICH INCLUDES TWO PERSONS WHO ARE NOT ALSO DIRECTORS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE DENTIST MEMBERS HAVE A RIGHT TO VOTE ONLY UPON PROPOSED CHANGES TO THE BYLAWS PROVISIONS THAT SPECIFY THE PROPORTION OF DENTISTS AND LAY PERSONS SERVING AS DIRECTORS AND CORPORATE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S CFO AND LEGAL COUNSEL OVERSEE THE COMPLETION OF THE FORM 990, AND, PRIOR TO FILING, REVIEW IT WITH THE PRESIDENT/CEO AND WITH THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY, AND BETWEEN ANNUAL STATEMENTS IS REQUIRED TO DISCLOSE ANY NEW POSITION OR RELATIONSHIP FORMED THAT POTENTIALLY RAISES A CONFLICT OF INTEREST. LEGAL COUNSEL REVIEWS THESE DISCLOSURES AND REPORTS THE INFORMATION TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PAID TO THE CEO AND EXECUTIVE VICE PRESIDENTS IS APPROVED BY THE EXECUTIVE COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS. THE COMMITTEE APPROVES COMPENSATION FOR THE ENSUING YEAR AFTER REVIEWING COMPARABILITY DATA PRESENTED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT, AN ASSESSMENT OF EACH OFFICER'S PERFORMANCE OVER THE PRECEDING YEAR, AND THE ORGANIZATION'S PROGRAM ACCOMPLISHMENTS FOR THE YEAR. COMPENSATION PAID TO DIRECTORS IS APPROVED BY THE EXECUTIVE COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS AFTER REVIEWING COMPARABILITY DATA IN A BENCHMARKING STUDY PREPARED AND PRESENTED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT RETAINED BY THE BOARD OF DIRECTORS. THESE PROCESSES WERE FOLLOWED FOR 2014 COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION ANNUALLY INCLUDES MAJOR PORTIONS OF ITS FINANCIAL STATEMENT IN A PUBLISHED ANNUAL REPORT THAT IS MADE AVAILABLE TO PERSONS OR ENTITIES KNOWN TO HAVE AN INTEREST IN THE ORGANIZATION, AND IS AVAILABLE TO THE LARGER PUBLIC UPON REQUEST. STATUTORY FINANCIAL STATEMENTS ARE INCLUDED IN QUARTERLY AND ANNUAL RETURNS TO STATE DEPARTMENTS OF INSURANCE REGULATING THE ORGANIZATION WHICH RETURNS ARE AVAILABLE TO THE PUBLIC. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990, PT. VII, SEC. A, COL. (D); SCH. J, PT. II, LINE 1, COL. (B)(III) A ONE-TIME LUMP SUM PENSION BENEFIT PAYMENT WAS RECEIVED BY THE ORGANIZATION'S EXECUTIVE VICE PRESIDENT/CIO IN 2014, PURSUANT TO THE TERMS OF THE ORGANIZATION'S SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THIS PLAN IS DESIGNED FOR THE LONG-TERM RETENTION OF SENIOR EXECUTIVES (E.G., THE EXECUTIVE VICE PRESIDENT/CIO HAD BEEN WITH THE ORGANIZATION FOR MORE THAN 10 YEARS) AND IS BASED ON A PERCENTAGE OF HIS AVERAGE ANNUAL COMPENSATION RECEIVED FOR THE THREE YEARS PRIOR TO AGE 65 OR RETIREMENT, WHICHEVER COMES FIRST, AND ON HIS LIFE EXPECTANCY AS DETERMINED PURSUANT TO THE INTERNAL REVENUE CODE. THE EXECUTIVE VICE PRESIDENT/CIO'S ANNUAL COMPENSATION, UPON WHICH THE PENSION BENEFIT PAYMENT IS BASED, HAS BEEN ESTABLISHED IN ACCORDANCE WITH THE PROCESS OUTLINED IN TREASURY REGULATION SECTION 53.4958-6 FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS. THIS PROCESS INVOLVES REVIEW AND APPROVAL OF COMPENSATION BY THE ORGANIZATION'S BOARD OF DIRECTORS, RELIANCE ON COMPARABILITY DATA PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTANT, AND CONTEMPORANEOUS DOCUMENTATION OF DELIBERATIONS AND DECISIONS REGARDING COMPENSATION. FEDERAL TAX LAW APPLICABLE TO THE ORGANIZATION'S SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN DOES NOT PERMIT A PARTICIPANT TO RECEIVE AND PAY TAX ON ANNUAL PAYMENTS RECEIVED FROM THE PLAN OVER THE COURSE OF A PARTICIPANT'S RETIREMENT. INSTEAD, THE ENTIRE VALUE OF THE BENEFIT BECOMES TAXABLE WHEN THE PARTICIPANT RETIRES OR REACHES AGE 65, WHICHEVER COMES FIRST. THE LUMP SUM PAYMENT SHOWN IN SCHEDULE J, PART II, LINE 1, COLUMN (B)(III) (AND CARRIED TO FORM 990, PART VII, SECTION A, COLUMN (D)) WAS THEREFORE TRIGGERED IN 2014 WHEN THE ORGANIZATION'S EXECUTIVE VICE PRESIDENT/CIO TURNED 65 AND THE ENTIRE VALUE OF THE RETIREMENT BENEFIT WAS TAXABLE IN THAT YEAR. SEE RELATED NOTE IN SCHEDULE J, PART III, WHICH DESCRIBES THE ORGANIZATION'S SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. FORM 990, PART VII; SCHEDULE J; SCHEDULE R THE ORGANIZATION, REGULATED BY THE CALIFORNIA DEPARTMENT OF MANAGED HEALTH CARE, IS A MEMBER OF THE DELTA DENTAL OF CALIFORNIA ENTERPRISE COMPANIES, WHICH INCLUDE DELTA DENTAL OF CALIFORNIA, DELTA DENTAL OF PENNSYLVANIA AND AFFILIATED COMPANIES OPERATING IN 15 STATES, THE DISTRICT OF COLUMBIA, PUERTO RICO AND THE U.S. VIRGIN ISLANDS. THE ENTERPRISE COMPANIES COMPRISE ONE OF THE NATION'S LARGEST DENTAL BENEFITS DELIVERY SYSTEMS COVERING 31.2 MILLION ENROLLEES AND HANDLING 42.5 MILLION CLAIMS. TOTAL REVENUE FOR THE ENTERPRISE EXCEEDED $7.9 BILLION IN 2014. THE ORGANIZATION AND ITS SUBSIDIARIES REPRESENT APPROXIMATELY 67% OF TOTAL ENTERPRISE REVENUES. FORM 990, PART VII AND SCHEDULE J: EFFECTIVE JANUARY 1,2012 DELTA DENTAL OF CALIFORNIA ESTABLISHED THE LONG-TERM INCENTIVE PLAN(LTIP) FOR ELIGIBLE EMPLOYEES OF THE COMPANY. THE PURPOSE OF THE LTIP IS TO PROVIDE INCENTIVE FOR ELIGIBLE EMPLOYEES' CONTRIBUTION TO THE COMPANY'S LONG-TERM SUCCESS. THE LTIP IS UNFUNDED AND ALL PAYMENTS FROM THE LTIP ARE DERIVED FROM THE EQUITY GAINS OF THE COMPANY. AS SUCH THERE IS NO GUARANTEE OF INCENTIVE PAYMENTS UNDER THE LTIP. UPON DELEGATION BY CERTAIN OFFICERS OF THE BOARD, THE CEO AND MANAGEMENT COMMITTEE HAS THE SOLE AND ABSOLUTE DISCRETION TO DETERMINE THE PERFORMANCE OBJECTIVES, BOTH FINANCIAL AND NONFINANCIAL, UPON WHICH PAYMENT OF AWARDS ARE BASED AND THE TIME PERIOD DURING WHICH PERFORMANCE SHALL BE MEASURED (LTIP CYCLE). THE CURRENT LTIP CYCLE IS JANUARY 1, 2013 THROUGH DECEMBER 31, 2015. FORM 990, PART XI, LINE 9: PENSION LIABILITY AND POST-RETIREMENT ADJUSTMENTS 9,394,149. 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