2015-11-11T16:33:00-06:00 2014-12-31 341884125 CBIZ MHM LLC 3101 N CENTRAL AVE STE 300 PHOENIX AZ 85012 990 2014-01-01 860274899 ARIZONA DENTAL INSURANCE SERVICE INC ARIZ 6025883976 5656 WEST TALAVI BLVD GLENDALE AZ 85306 MARK ANDERSON CFO/VICE PRESIDENT 6025883976 2015-11-10 1 AMY A O'LOUGHLIN P00869687 6022646835 2014 2016-02-25 16:41:14Z DELTA DENTAL OF ARIZONA ALLAN ALLFORD 5656 WEST TALAVI BLVD GLENDALE AZ 85306 178203114 0 X WWW.DELTADENTALAZ.COM X 1972 AZ THE CORPORATION EXISTS TO IMPROVE LIVES BY PROMOTING OPTIMAL ORAL HEALTH. 13 11 88 0 0 30255 0 0 153484602 158125754 1288737 2003457 28605 43195 154801944 160172406 1708261 743472 0 0 7006588 7351855 0 0 0 146381903 149338528 155096752 157433855 -294808 2738551 88698942 91686976 17584810 17965508 71114132 73721468 X THE CORPORATION EXISTS TO IMPROVE LIVES BY PROMOTING OPTIMAL ORAL HEALTH. 0 0 46956884 53833316 THE ORGANIZATION PROVIDED DENTAL BENEFIT COVERAGE FOR 203,887 BENEFICIARIES. INCLUDED AMONG THESE BENEFICIARIES WERE (I) 12,368 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) 48,631 ENROLLEES WHO ARE OR WERE EMPLOYED WITH THE STATE OF ARIZONA, AND (III) 92 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 $133 MILLION FOR DENTAL CARE DURING 2014, WITH DENTAL BENEFITS COVERAGE BEING PROVIDED THROUGH CONTRACTS WITH INDEPENDENT PROFESSIONAL DENTAL SERVICE PROVIDERS. 98719578 98007004 AS ITS LARGEST CHARITABLE INITIATIVE, THE ORGANIZATION IS COMMITTED TO EDUCATING THE PUBLIC REGARDING ORAL HEALTH AND WELLNESS. THE ORGANIZATION'S EMPLOYEES PARTICIPATE IN CONTINUING EDUCATION SEMINARS THAT PROVIDE THE TRAINING NECESSARY FOR ORGANIZATION EMPLOYEES TO EDUCATE THE PUBLIC. PUBLIC EDUCATION OCCURS THROUGH IN-PERSON SEMINARS AND THROUGH THE DISSEMINATION OF INFORMATION IN PRINT, AS WELL AS THROUGH TV, RADIO AND ONLINE AWARENESS EFFORTS. ONE EXAMPLE OF THE ORGANIZATION'S COMMITMENT TO ORAL HEALTH EDUCATION CAN BE VIEWED ON ITS WEBSITE HTTP://ORALHEALTH.DELTADENTAL.COM/. THE ORGANIZATION MAINTAINS AN ONLINE DATABASE REGARDING ORAL HEALTH TOPICS AND TAILORS ORAL HEALTH INFORMATION TO INDIVIDUALS BY SEGREGATING INFORMATION BY AGE GROUP AND PROVIDING ACCESS TO AN INDIVIDUALIZED DENTAL RISK ASSESSMENT TOOL. THE ORGANIZATION ALSO MAINTAINS A BLOG FOR THE PUBLIC TO PROVIDE ADDITIONAL INFORMATION REGARDING ORAL HEALTH ISSUES. 743472 743472 THE ORGANIZATION ALSO MAKES GRANTS AND DONATES FACILITIES, EQUIPMENT AND EMPLOYEE TIME TO SUPPORT MANY CHARITABLE CAUSES. DURING 2014, THE ORGANIZATION PROVIDED OR SUPPORTED PREVENTATIVE DENTAL HEALTH SERVICES, CHILDREN'S ORAL HEALTH SERVICES, DENTAL CLINICS, IN-SCHOOL SCREENINGS, TOBACCO AND CHRONIC DISEASE PREVENTION PROGRAMS, EARLY CHILDHOOD PROGRAMS, PRENATAL AND POSTNATAL ORAL HEALTH, AND ACCESS TO DENTAL SERVICES. 146419934 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 0 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 10185 0 1 88 1 1 1 0 0 0 0 0 0 0 0 0 X 13 11 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 AZ X MARK ANDERSON 6029383131 5656 WEST TALAVI BLVD GLENDALE AZ 85306 CREG D OSTLER DIRECTOR 3.00 X 4000 0 0 PHILLIP J SANTUCCI DIRECTOR 3.00 X 24000 0 0 DALE HALLBERG DIRECTOR 3.00 X 24000 0 0 ALVIN MATTHEWS DIRECTOR 3.00 X 24000 0 0 DAVID DAY CHAIR 10.00 X X 32000 0 0 DONALD BAKER DIRECTOR 3.00 X 24000 0 0 JASON DITTBERNER DIRECTOR 3.00 X 24000 0 0 BRIEN HARVEY VICE CHAIR 3.00 X X 24000 0 0 JOYCE ROSENTHAL DIRECTOR 3.00 X 24000 0 0 WILLIAM PUTNAM DIRECTOR 3.00 X 24000 0 0 WILFORD CARDON SECRETARY/TREASURER 3.00 X X 24000 0 0 FREDERICK OLSEN DIRECTOR 3.00 X 24000 0 0 MARK B HUGHES DIRECTOR 3.00 X 24000 0 0 CANDICE WIEST DIRECTOR 3.00 X 20000 0 0 ALLAN ALLFORD PRESIDENT/CEO 40.00 X 549257 0 19288 MARK ANDERSON VICE PRESIDENT/CFO 40.00 X 317746 0 19288 JAY KOLKER VICE PRESIDENT OPS 40.00 X 158008 0 16403 CRAIG LIVESAY VICE PRESIDENT OPS 40.00 X 232162 0 18648 SANDRA ERNST PEREZ VICE PRESIDENT MARKETING 40.00 X 202805 0 6087 ASHLEE DAILEY DIRECTOR OF FINANCE 40.00 X 130289 0 12279 MARY LOVELESS DIRECTOR OF OPS 40.00 X 115385 0 8899 ANNE BISHOP VP/GENERAL COUNSEL 40.00 X 181687 0 10813 PATRICIA LARSON VICE PRESIDENT SALES 40.00 X 130433 0 4495 JEFF NEWBILL DATA ADMINISTRATOR 40.00 X 123193 0 9178 2460965 0 125378 12 0 1 0 DELTA DENTAL OF WISCONSIN PO BOX 828 STEVENS POINT WI 544810828 CLAIM PROCESSING SVS 1026260 ENCARA 4818 STARKLEY RD ROANOKE VA 24018 ADMINSTERS PRODUCTS 894790 BLACK GOULD & ASSOCIATES 3800 N CENTRAL AVENUE 9TH FLOOR PHOENIX AZ 85012 BROKERAGE SERVICES 667954 EMDEON PO BOX 572490 SALT LAKE CITY UT 84157 FULFILLMENT PAYMENTS 385827 FIRST EDGE 4230 N OAKLAND 290 MILWAUKEE WI 85069 PRINTING SERVICES 333053 8 REV - SELF-INSR GROUP 524114 98007004 98007004 DENTAL PREMIUMS 524114 53833316 53833316 MGMT FEE-IRC512(B)(13) 524292 6285434 6285434 158125754 1332251 1332251 18701914 18030708 671206 671206 671206 OTHER INCOME 900099 43195 43195 43195 160172406 151840320 0 8332086 743472 743472 1844856 923815 921041 4169028 4169028 275675 275675 688146 688146 374150 374150 6077747 6077747 155649 155649 83550 83550 322222 322222 4125333 4112171 13162 1404205 1404205 84833 84833 84387 84387 253181 253181 149853 149853 50097 50097 4298 4298 186699 186699 690605 690605 94611 94611 PROFESSIONAL DENTAL SVS 92641830 92641830 SERVICE TO SELF-INSURED 40546261 40546261 PREMIUM TAX 832639 832639 POSTAGE 392335 219777 172558 1158193 1158193 157433855 146419934 11013921 0 13925567 14323423 10587219 11954715 437128 402785 12674165 4943452 8070938 7730713 43103868 43895870 11919056 12167612 655166 1211858 88698942 91686976 12027730 10626993 1273631 1818519 57484 38714 4225965 5481282 17584810 17965508 X 71114132 73721468 71114132 73721468 88698942 91686976 2738551 -131215 0 X 0 1 X 1 0 1530763 1530763 6594137 1195386 5398751 4543890 3748066 795824 5375 5375 7730713 INVESTMENT IN SUBSIDIARY-SOUTHWEST BENEFIT ADM 943581 C INVESTMENT IN SUBSIDIARY-CANYON INSURANCE SVS 705000 C HEDGE FUNDS 10519031 F 12167612 UNCLAIMED PROPERTY LIABILITY 573296 CUSTOMER DEPOSIT LIABILITY 679092 OUTSTANDING BANK TRANSFER 4228894 5481282 X 153224896 7531552 7531552 145693344 14479062 14479062 160172406 151318319 7558325 7558325 143759994 13673861 13673861 157433855 PART X, LINE 2: THE ORGANIZATION EVALUATES ITS UNCERTAIN TAX POSITIONS, IF ANY, ON A CONTINUAL BASIS THROUGH REVIEW OF ITS POLICIES AND PROCEDURES, REVIEW OF ITS REGULAR TAX FILINGS, AND DISCUSSIONS WITH OUTSIDE EXPERTS. MANAGEMENT BELIEVES THAT AT DECEMBER 31, 2014 AND 2013 THE COMPANY DID NOT HAVE ANY UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: AFFILIATED REVENUE INCLUDED IN FINANCIAL STATEMENTS 7,531,552. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONSOLIDATING ELIMINATIONS 12,432,410. DIVIDENDS AND INTEREST 1,332,251. OTHER INCOME 43,195. GAIN ON SALE OF SECURITIES AND ASSETS 671,206. PART XII, LINE 2D - OTHER ADJUSTMENTS: AFFILIATED EXPENSES INCLUDED IN FINANCIAL STATEMENTS 7,558,325. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONSOLIDATING ELIMINATIONS 12,432,410. INTEREST EXPENSE 4,298. INVESTMENT FEES 322,222. CONTRIBUTIONS TO THE FOUNDATION 914,931. 1 DELTA DENTAL PLAN OF ARIZONA CHARITABLE FOUNDATION AND TRUST 5656 W TALAVI BLVD GLENDALE AZ 85306 860842694 501(C)(3) 724987 ANNUAL CONTRIBUTION BASED ON BOARD DIRECTIVE TO PROMOTE ORAL HEALTH. CENTRAL ARIZONA DENTAL SOCIETY FOUNDATION 3193 N DRINKWATER BLVD SCOTTSDALE AZ 85251 274537263 501(C)(3) 5334 TO PROMOTE ORAL HEALTH 2 PART I, LINE 2: 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. X X 1 1 X X X X X 0 1 0 1 0 1 0 1 0 ALLAN ALLFORD PRESIDENT/CEO 398484 0 140225 0 10548 0 7800 0 11488 0 568545 0 0 0 MARK ANDERSON VICE PRESIDENT/CFO 245957 0 64000 0 7789 0 7800 0 11488 0 337034 0 0 0 JAY KOLKER VICE PRESIDENT OPS 122516 0 35000 0 492 0 4915 0 11488 0 174411 0 0 0 CRAIG LIVESAY VICE PRESIDENT OPS 193850 0 38000 0 312 0 7160 0 11488 0 250810 0 0 0 SANDRA ERNST PEREZ VICE PRESIDENT MARKETING 169115 0 33000 0 690 0 6087 0 0 0 208892 0 0 0 ANNE BISHOP VP/GENERAL COUNSEL 166107 0 15000 0 580 0 5468 0 5345 0 192500 0 0 0 PART I, LINE 1A FIRST CLASS TRAVEL IS PROVIDED TO SENIOR MANAGEMENT FOR LENGTHY TRIPS. COMPANION TRAVEL IS PROVIDED TO THE CEO. PART I, LINE 4B THE ORGANIZATION ESTABLISHED A 457(F) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN FOR CERTAIN MEMBERS OF SENIOR MANAGEMENT AS DETERMINED BY THE BOARD OF DIRECTORS. UPON TERMINATION OF EMPLOYMENT DUE TO RETIREMENT, BENEFITS AS DETERMINED BY THE BOARD OF DIRECTORS WILL BE PAYABLE. THE FOLLOWING AMOUNTS WERE CONTRIBUTED TO THE PLAN: ALLAN ALLFORD - $100,564 MARK ANDERSON - $50,737 ANNE BISHOP - $17,903 JAY KOLKER - $11,025 CRAIG LIVESAY - $23,297 SANDRA ERNST PEREZ - $18,545 PART I, LINE 5 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, AMONG WHICH ARE INCENTIVES RELATED TO REVENUE GOALS. PART I, LINE 6 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, AMONG WHICH ARE INCENTIVES RELATED TO REVENUE GOALS. PART I, LINE 7 CONSISTENT WITH THE ORGANIZATION'S OVERALL COMPENSATION PHILOSOPHY, THE COMPENSATION OF OFFICERS AND HIGHLY COMPENSATED EMPLOYEES INCLUDE THE POTENTIAL FOR A BONUS BASED UPON FURTHERING THE CHARITABLE PURPOSES OF THE ORGANIZATION. THIS GOAL INCLUDES PRESERVATION OF INCOME WHICH PROVIDES THE ORGANIZATION WITH THE RESOURCES NECESSARY TO ACCOMPLISH ITS CHARITABLE PURPOSES. DONALD BAKER DIRECTOR 667954 0 DALE HALLBERG DIRECTOR 221669 0 SCHEDULE L, PART IV, COLUMN (C) PAYMENTS WERE MADE TO BLACK GOULD & ASSOCIATES FOR BROKERAGE SERVICES. BOARD MEMBER DONALD BAKER IS VICE PRESIDENT OF THE FIRM.CONTRACTED PROVIDER PAYMENTS WERE MADE TO BOARD MEMBER DALE HALLBERG CONSISTENT WITH REGULAR COMPANY REIMBURSEMENT RATES. 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 THESE 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 11 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. THE REVIEW OF THE DRAFT FORM 990 BY THE COMPANY'S AUDIT AND INVESTMENT COMMITTEE. 4. 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 COVERS 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 REMIND EMPLOYEES AND OFFICERS/DIRECTORS OF THE COMPANY OF THE POLICY AND OF THE NEED TO BE ATTENTIVE TO THE POSSIBILITY OF NEWLY CREATED CONFLICTS OF INTEREST. FURTHER, IN CONNECTION WITH THE ORGANIZATION'S DUE DILIGENCE ASSOCIATED WITH THE PREPARATION OF FILING OF THE FORM 990, A SEPARATE PROCESS IS USED TO OBTAIN INFORMATION FROM DIRECTORS AND EMPLOYEES TO ENABLE THE ORGANIZATION TO ASSESS THE EXISTENCE OF TRANSACTIONS OR RELATIONSHIPS THAT SHOULD BE DISCLOSED BY THE ORGANIZATION. POTENTIAL AND ACTUAL CONFLICTS INVOLVING EMPLOYEES OTHER THAN THE CEO AND CFO ARE REVIEWED BY THE CEO AND CFO. POTENTIAL AND ACTUAL CONFLICTS OF THE CEO, CFO AND BOARD MEMBERS ARE REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD. 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 AND BOARD COMPENSATION EVERY TWO YEARS. REVIEWS WERE LAST PERFORMED IN 2014. 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. AZ DENTAL INSURANCE SERVICE HOLDINGS LLC 5656 WEST TALAVI BLVD GLENDALE AZ 85306 HOLDING CO AZ 0 0 N/A DELTA DENTAL PLAN OF ARIZONA CHARITABLE FOUNDATION AND TRUST 5656 W TALAVI BLVD GLENDALE AZ 85306 860842694 ORAL HEALTH AZ 501(C)(3) PF N/A 0 CANYON INSURANCE SERVICES INC 5656 WEST TALAVI BLVD GLENDALE AZ 85306 412139223 INSURANCE AZ AZ DENTAL C 1380146 523124 1.00000 1 SOUTHWEST BENEFIT ADMINISTRATORS LLC 5656 WEST TALAVI BLVD GLENDALE AZ 85306 680586699 ADMIN. SVS AZ AZ DENTAL C 6147528 242743 1.00000 1 0 1 0 0 1 0 0 0 0 0 0 1 1 1 1 0 0 0 0 SOUTHWEST BENEFIT ADMINISTRATORS LLC L 6077747 FMV SOUTHWEST BENEFIT ADMINISTRATORS LLC M 6146976 FMV