2013-11-13T11:29:28-06:00 2012-12-31 341851358 CBIZ MHM LLC 3625 CUMBERLAND BLVD STE 800 ATLANTA GA 30082 990 2012-01-01 941461312 DELTA DENTAL OF CALIFORNIA DELT 4159728300 100 FIRST STREET SAN FRANCISCO CA 94105 MICHAEL J CASTRO 4159728300 2013-11-13 1 CBIZ MHM LLC P01064143 7708584500 2012 2016-02-25 16:41:14Z MICHAEL J CASTRO 100 FIRST STREET SAN FRANCISCO CA 94105 5038249911 0 X WWW.DELTADENTALINS.COM X 1954 CA TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS SERVICE, TECHNOLOGY AND PROFESSIONAL SUPPORT. 15 11 2238 0 0 55460 0 0 4702919119 5057677275 11832029 14623473 -16890494 -40281570 4697860654 5032019178 1314736 1369223 4170335413 4469854669 267733543 272521799 0 0 0 198944785 212948414 4638328477 4956694105 59532177 75325073 1314658307 1444091984 846364394 886592977 468293913 557499007 TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS SERVICE, TECHNOLOGY AND PROFESSIONAL SUPPORT. 0 0 4862293259 5032019178 THE ORGANIZATION PROVIDED DENTAL BENEFIT COVERAGE FOR 17,631,000BENEFICIARIES IN 2012, PRIMARILY THROUGH CONTRACTS WITHINDEPENDENT DENTISTS. INCLUDED WERE 7,647,000 ENROLLEES INMEDICAID, SCHIP AND OTHER PUBLICLY-SPONSORED DENTAL BENEFITPROGRAMS ADMINISTERED BY THE ORGANIZATION, AS WELL AS 1,363,000PERSONS VOLUNTARY ENROLLED IN THE TRDP PROGRAM FOR RETIREDMILITARY SERVICE PERSONNEL AND THEIR FAMILIES THAT THEORGANIZATION UNDERWRITES PURSUANT TO A CONTRACT WITH THEDEPARTMENT OF DEFENSE. THE ORGANIZATION PAID MORE THAN$4,469,855,000 FOR DENTAL CARE DURING 2012. 1369223 1369223 THE ORGANIZATION MADE GRANTS DURING 2012 TO FOSTER IMPROVED ACCESSTO DENTAL HEALTH CARE TREATMENT, TO SUPPORT PROFESSIONAL DENTALEDUCATION AND TO PROVIDE ORAL HEALTH INSTRUCTION FOR PATIENTS. 4863662482 0 0 0 0 0 0 0 0 0 1 0 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 1 0 0 0 0 1 1 1 0 0 1 117870 0 1 2238 1 1 1 0 0 0 0 0 X 15 11 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 TERRY A O'TOOLE 2.00 X 156829 0 0 ROY GONELLA 1.00 X 31000 0 0 BEVERLY A KODAMA 1.00 X 32829 0 0 R KENT FARNSWORTH DDS 1.00 X 112000 0 0 GLEN F BERGERT CPA 1.00 X 111025 0 0 GREGORY D KAPLAN DDS 1.00 X 69270 0 0 STEVEN F MCCANN 2.00 X 142829 0 0 RENUKA P PATEL 3.00 X 125000 0 0 JO BONITA RAINS 1.00 X 66500 0 0 CORAGENE I SAVIO DDS 1.00 X 66500 0 0 STEVEN W VOSS 1.00 X 76329 0 0 STEPHEN R PICKERING DDS 1.00 X 31000 0 0 ANDREW J REID 2.00 X 132829 0 0 DOUGLAS D CASSAT DDS 1.00 X 68705 0 0 DEVANG M GHANDI DDS 1.00 X 95329 0 0 THOMAS A ZIMMERMAN 1.00 X 76676 0 0 BARBARA J BURGEL 1.00 X 68500 0 0 LYNN L FRANZOI 1.00 X 66500 0 0 GARY D RADINE 51.00 9.00 X 4003190 0 163718 ANTHONY S BARTH 42.00 8.00 X 1660827 0 5030486 MICHAEL J CASTRO 42.00 8.00 X 1176734 0 1967480 PATRICK S STEELE 43.00 7.00 X 1236803 0 3453165 CHARLES LAMONT 42.00 8.00 X 6634339 0 158324 BELINDA MARTINEZ 50.00 X 801137 0 1922098 KEVIN JACKSON 50.00 X 459504 0 24764 NILESH PATEL 50.00 X 719869 0 14459 ALICIA WEBER 43.00 7.00 X 677395 0 60007 TERRI ANDERSON 50.00 X 350503 0 61037 DANIEL CROLEY 50.00 X 321018 0 26067 RICK R DOERING 50.00 X 563714 0 62777 PATRICK HENRY 50.00 X 445455 0 29031 EVA HOFFMAN 50.00 X 323017 0 33954 KATHY JONZZON 50.00 X 95252 0 419880 J DOUGLAS KONOVALOFF 50.00 X 264626 0 209731 GARRETT LEAF 50.00 X 388721 0 33159 JAMAL NASR 50.00 X 379120 0 31014 MOHAMMADREZA NAVID 50.00 X 446202 0 15362 DUANE PROFEIT 50.00 X 324289 0 68120 KATHERINE WATTS 50.00 X 120350 0 42931 TOM WONG 50.00 X 410091 0 52650 JEFFREY M ALBUM 50.00 X 384305 0 36281 HARI MAKKALA 50.00 X 433296 0 17651 JEFFREY SEYBOLD 50.00 X 220796 0 11242 JOHN YAMAMOTO 50.00 X 307374 0 28078 STEPHEN ADAMSON 50.00 X 340872 0 34259 THOMAS LEIBOWITZ 50.00 X 308166 0 40937 STEPHEN LOWRY 40.00 X 280884 0 40418 KEVIN O'TOOLE 40.00 X 256327 0 31416 TERI FORESTIERI 40.00 X 253852 0 16517 ELISE POMERANTZ-WATZKA 40.00 X 252613 0 60214 VALERIE LAYNE 40.00 X 269321 0 56688 ROBERT BECKER 40.00 X 313275 0 0 MICHAEL KAUFMANN 40.00 X 255208 0 0 27208095 0 14253915 535 1 1 0 HP ENTERPRISE SERVICES LLC PO BOX 848433 DALLAS TX 75284 CONSULTING SERVICES 10029290 ORACLE CORPORATION 12320 ORACLE BLVD COLORADO SPRINGS CO 80921 SOFTWARE MAINTENANCE SERVICES 6645735 CATALYST360 LLC 4 WALNUT GROVE DR HORSHAM PA 19044 CONSULTING SERVICES 3958581 IBM PO BOX 676623 DALLAS TX 75267 SOFTWARE MAINTENANCE SERVICES 3472543 KP CORPORATION DEPT LA 23670 PASADENA CA 91185 CONSULTING SERVICES 3331546 71 PROFESSIONAL SERVICES 3636837058 3636837058 FEES & CONTRACTS FROM GOVERNMENT 1420840217 1420840217 5057677275 15070639 15070639 5783567 6230733 -447166 -447166 -447166 -40281570 -40281570 -40281570 5032019178 5032019178 0 0 898618 898618 470605 470605 4469854669 4469854669 43549798 43549798 175841783 135372674 40469109 3887739 3887739 37423631 35436413 1987218 11818848 10650401 1168447 1707127 6881 1700246 1474358 449255 1025103 205837 205837 5002690 4921172 81518 30526581 30326379 200202 39673265 39640700 32565 8923495 8670175 253320 20601979 19098235 1503744 4683725 3704488 979237 622269 399270 222999 123636 123636 7271172 7227475 43697 30641637 30329609 312028 965457 965457 BROKER FEES 37182741 37182741 CONSULTANT FEES 23088643 21661434 1427209 OUTSIDE SERVICES 8572514 8328588 243926 UBI TAX 18856 18856 -8337568 -5203368 -3134200 4956694105 4863662482 93031623 0 191884540 278492524 112817440 81802158 286887945 285577097 45750000 55750000 16318657 14937697 560187816 266335949 330385626 293851867 230557931 332092503 55871557 57440855 6295206 6295206 37889405 37852077 1314658307 1444091984 516927508 556497074 36344253 32028619 293092633 298067284 846364394 886592977 X 0 0 0 0 468293913 557499007 468293913 557499007 1314658307 1444091984 X 75325073 9983657 3896364 X 0 1 X 1 0 28204818 23282649 4922169 503825578 219217281 284608297 28157420 23836019 4321401 293851867 ACCRUED RETIREMENT BENEFITS 83787939 DEFERRED COMPENSATION PLANS 37366389 GROUP PREFUNDING DEPOSITS 9301252 REFUNDABLE GROUP BALANCES 167611704 298067284 X 3087903178 0 3087903178 1944116000 1944116000 5032019178 3012578105 0 3012578105 1944116000 1944116000 4956694105 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 FINANCIAL STATEMENT 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 EVALUATED THE IMPACT OF THE ACCOUNTING PRONOUNCEMENT AND DETERMINED THAT IT HAD NO IMPACT ON THE COMPANY'S FINANCIAL STATEMENTS. 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 NATIONAL GUARD YOUTH FOUNDATION 1001 N FAIRFAX ST STE 205 ALEXANDRIA VA 22314 541940978 501(C)(3) 6000 CONTRIBUTION NATIONAL MILITARY FAMILY ASSOCIATION 2500 N VAN DORN ST STE 102 ALEXANDRIA VA 22302 520899384 501(C)(3) 20000 TITLE SPONSOR OF 2012 LEADERSHIP LUNCHEON UC REGENTS 1 SHIELDS AVE TAX ACCOUNTING DAVIS CA 95616 952226406 501(C)(3) 115397 VARIOUS GRANTS UNITED WAY CALIFORNIA CAPITAL REGION 10389 OLD PLACERVILLE RD SACRAMENTO CA 95827 237079003 501(C)(3) 42933 2012 MATCHING CONTRIBUTIONS UNITED WAY OF THE BAY AREA 221 MAIN STREET SUITE 300 SAN FRANCISCO CA 94105 941312348 501(C)(3) 84324 2012 MATCHING CONTRIBUTIONS CALIFORNIA ACADEMY OF GENERAL DENTISTRY 73 CASTLEWOOD DRIVE PLEASANTON CA 94566 942557207 501(C)(3) 20000 2012 COURSE SPONSORSHIP CDA FOUNDATION 1201 K STREET SUITE 1511 SACRAMENTO CA 95814 680411536 501(C)(3) 25000 CONTRIBUTION TO CDA CARES RESERVE OFFICERS ASSOCIATION ONE CONSTITUTION AVENUE NE WASHINGTON DC 20002 530132450 501(C)(3) 10000 CONTRIBUTION ROA INDUSTRY STARS RENEWAL AND FREEDOM SPONSOR AMERICAN RED CROSS PO BOX 37243 WASHINGTON DC 20013 530196605 501(C)(3) 10000 HURRICANE SANDY RELIEF INTERAGENCY INSTITUTE FOR FEDERAL HEALTH CARE EXECUTIVES 1500 WILSON BLVD ROSSLYN VA 22209 077421512 14600 CONTRIBUTIONS SAN FRANCISCO CHAMBER OF COMMERCE 235 MONTGOMERY STREET SUITE 760 SAN FRANCISCO CA 94104 940834950 501(C)(3) 9298 EXCELLENCE IN BUSINESS AWARDS, CITY BREAKFAST SPONSOR UCLA SCHOOL OF DENTISTRY 10833 LE CONTE AVE LOS ANGELES CA 90024 943191637 501(C)(3) 20000 2012 COURSE SPONSORSHIP UNIVERSITY OF TEXAS SCHOOL OF DENTISTRY 7703 FLOYD CURL DR SAN ANTONIO TX 78229 741586031 501(C)(3) 10275 SPONSORSHIP OF CE COURSE TEMPLE UNIVERSITY 3340 N BROAD STREET 4TH FLOOR PHILADELPHIA PA 19140 231365971 501(C)(3) 10000 SPONSORSHIP OF CE COURSE AMERICAN CANCER SOCIETY 1700 WEBSTER STREET OAKLAND CA 94612 941170350 501(C)(3) 25000 RELAY FOR LIFE DONATIONCHARITABLE CONTRIBUTION DELTA DENTAL COMMUNITY CARE FOUNDATION 100 FIRST STREET SAN FRANCISCO CA 94105 371570764 501(C)(3) 283800 HEALTH, RESEARCH, AND EDUCATION GRANTS UNITED WAY OF GREATER LOS ANGELES 523 WEST SIXTH STREET LOS ANGELES CA 90015 952274801 501(C)(3) 12623 2012 MATCHING CONTRIBUTIONS HISPANIC DENTAL ASSOCIATION 3085 STEVENSON DRIVE SPRINGFIELD IL 62703 363719494 501(C)(3) 10000 2012 CORPORATE ROUNDTABLE SPONSORSHIP TUOLUMNE COUNTY OFFICE OF EDUCATION 175 S FAIRVIEW LN SONORA CA 95370 946050189 501(C)(3) 15000 HEALTH, RESEARCH, AND EDUCATION GRANT USC SCHOOL OF DENTISTRY 925 WEST 34TH STREET - ROOM 202 LOS ANGELES CA 90089 951642394 501(C)(3) 9500 CONTINUING EDUCATION GRANT WOMEN'S INITIATIVE FOR SELF EMPLOYMENT 1398 VALENCIA STREET SAN FRANCISCO CA 94110 943081525 501(C)(3) 10000 GRANT FOR THE ALAS PROGRAM MISCELLANEOUS GRANTS LESS THAN 5000 134868 TO PROVIDE DENTAL EDUCATION STUDENT LEADERSHIP AWARDS 65 212500 HISPANIC SCHOLARSHIP 19 258105 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 1 1 X X X X X 0 1 0 0 0 0 0 1 0 TERRY A O'TOOLE 156829 0 0 0 0 0 0 0 0 0 156829 0 0 0 GARY D RADINE 1250004 0 2500000 0 253186 0 148842 0 14876 0 4166908 0 0 0 ANTHONY S BARTH 824004 0 800000 0 36823 0 5008436 0 22050 0 6691313 0 0 0 MICHAEL J CASTRO 566496 0 550000 0 60238 0 1946904 0 20576 0 3144214 0 0 0 PATRICK S STEELE 540756 0 656250 0 39797 0 3437238 0 15927 0 4689968 0 0 0 CHARLES LAMONT 463500 0 450000 0 5720839 0 142397 0 15927 0 6792663 0 3279320 0 BELINDA MARTINEZ 450000 0 308000 0 43137 0 1906471 0 15627 0 2723235 0 0 0 KEVIN JACKSON 293556 0 150000 0 15948 0 3164 0 21600 0 484268 0 0 0 NILESH PATEL 399996 0 300000 0 19873 0 7500 0 6959 0 734328 0 0 0 ALICIA WEBER 381200 0 271750 0 24445 0 38326 0 21681 0 737402 0 0 0 TERRI ANDERSON 261624 0 76500 0 12379 0 43883 0 17154 0 411540 0 0 0 DANIEL CROLEY 236904 0 75900 0 8214 0 5941 0 20126 0 347085 0 0 0 RICK R DOERING 367548 0 170000 0 26166 0 41039 0 21738 0 626491 0 0 0 PATRICK HENRY 252348 0 150000 0 43107 0 15506 0 13525 0 474486 0 0 0 EVA HOFFMAN 248316 0 68350 0 6351 0 11169 0 22785 0 356971 0 0 0 KATHY JONZZON 30525 0 48100 0 16627 0 415392 0 4488 0 515132 0 0 0 J DOUGLAS KONOVALOFF 196464 0 44616 0 23546 0 188513 0 21218 0 474357 0 0 0 GARRETT LEAF 283752 0 93760 0 11209 0 13508 0 19651 0 421880 0 0 0 JAMAL NASR 257328 0 100000 0 21792 0 12361 0 18653 0 410134 0 0 0 MOHAMMADREZA NAVID 251812 0 172100 0 22290 0 7500 0 7862 0 461564 0 0 0 DUANE PROFEIT 242296 0 69845 0 12148 0 52231 0 15889 0 392409 0 0 0 KATHERINE WATTS 48526 0 67500 0 4324 0 39928 0 3003 0 163281 0 0 0 TOM WONG 290004 0 110000 0 10087 0 32524 0 20126 0 462741 0 0 0 JEFFREY M ALBUM 247224 0 120000 0 17081 0 14681 0 21600 0 420586 0 0 0 HARI MAKKALA 300000 0 125000 0 8296 0 10842 0 6809 0 450947 0 0 0 JEFFREY SEYBOLD 52070 0 38110 0 130616 0 3651 0 7591 0 232038 0 0 0 JOHN YAMAMOTO 226596 0 72600 0 8178 0 7952 0 20126 0 335452 0 0 0 STEPHEN ADAMSON 254124 0 77926 0 8822 0 14852 0 19407 0 375131 0 0 0 THOMAS LEIBOWITZ 249996 0 51000 0 7170 0 33605 0 7332 0 349103 0 0 0 STEPHEN LOWRY 167305 0 99888 0 13691 0 37570 0 2848 0 321302 0 0 0 KEVIN O'TOOLE 175083 0 70818 0 10426 0 9906 0 21510 0 287743 0 0 0 TERI FORESTIERI 190300 0 40000 0 23552 0 8745 0 7772 0 270369 0 0 0 ELISE POMERANTZ-WATZKA 202800 0 41000 0 8813 0 44827 0 15387 0 312827 0 0 0 VALERIE LAYNE 212176 0 41221 0 15924 0 36652 0 20036 0 326009 0 0 0 ROBERT BECKER 313275 0 0 0 0 0 0 0 0 0 313275 0 0 0 MICHAEL KAUFMANN 255208 0 0 0 0 0 0 0 0 0 255208 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. 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 2012. 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 2012, EIGHT EXECUTIVES PARTICIPATED IN THE PLAN - ANTHONY BARTH, MICHAEL CASTRO, KATHY JONZZON, DOUGLAS KONOVALOFF, CHARLES LAMONT, BELINDA MARTINEZ, GARY RADINE, AND PATRICK STEELE. SEE ADDITIONAL NOTE IN SCHEDULE O REGARDING PAYMENTS RECEIVED BY PLAN PARTICIPANTS IN 2012. 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. D DOUGLAS CASSAT DDS PARTICIPATING PROVIDER 109141 DENTAL CLAIM PAYMENTS 0 CORAGENE I SAVIO DDS PARTICIPATING PROVIDER 233329 DENTAL CLAIM PAYMENTS 0 COPOWER MANAGEMENT AND LISI ORGANIZATION DIRECTOR, BECKY PATEL, WAS CEO/PRESIDENT OF COPOWER MANAGEMENT 1234083 BROKER ADMINISTRATION 0 STEPHEN R PICKERING DDS PARTICIPATING PROVIDER 161083 DENTAL CLAIM PAYMENTS 0 0 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, EXECUTIVE VICE PRESIDENTS, AND SENIOR 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 2012 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, 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 26 MILLION ENROLLEES AND HANDLING 37 MILLION CLAIMS. TOTAL REVENUE FOR THE ENTERPRISE EXCEEDED $7.2 BILLION IN 2012. THE ORGANIZATION AND ITS SUBSIDIARIES REPRESENT APPROXIMATELY 75% OF TOTAL ENTERPRISE REVENUES. 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/CLO IN 2012, 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/CLO HAS BEEN WITH THE ORGANIZATION FOR MORE THAN 27 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/CLO'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 2012 WHEN THE ORGANIZATION'S EXECUTIVE VICE PRESIDENT/CLO 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: PENSION LIABILITY AND POST-RETIREMENT ADJUSTMENTS 3,896,364. 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