DELTA DENTAL OF W VIRGINIA INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- DELTA DENTAL OF W VIRGINIA INC (EIN 55-0523124)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201203209349301040
- Schema version
- 2011v1.2
- 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) |
|---|---|---|
| Timestamp | 2012-11-15T08:17:49-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341851358 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CBIZ MHM LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3625 CUMBERLAND BLVD STE 800 | AddressLine1 |
| City | ATLANTA | City |
| State | GA | State |
| ZIP Code | 30082 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550523124 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA DENTAL OF WEST VIRGINIA INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DELT | NameControl |
| Phone | 7177668500 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE DELTA DRIVE | AddressLine1 |
| City | MECHANICSBURG | City |
| State | PA | State |
| ZIP Code | 17055 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JEANNE FOSTER | Name |
| Title | VP, FINANCE | Title |
| Phone | 7177668500 | Phone |
| Date Signed | 2012-11-08 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| PTIN | P01064143 | PTIN |
| Phone | 7708584500 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JEANNE FOSTER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE DELTA DRIVE | AddressLine1 |
| City | MECHANICSBURG | City |
| State | PA | State |
| ZIP Code | 17055 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 5877064 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.DELTADENTALINS.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1962 | YearFormation |
| State Legal Domicile | WV | StateLegalDomicile |
| Activity Or Mission Description | TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS, SERVICE, TECHNOLOGY, AND PROFESSIONAL SUPPORT. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 6 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 5086319 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 5809978 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 68686 | InvestmentIncomePriorYear |
| Investment Income Current Year | 74531 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | -7445 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 5155005 | TotalRevenuePriorYear |
| Total Revenue Current Year | 5877064 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 50000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 45000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 1120753 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 1303437 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4000 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4000 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 3828393 | OtherExpensePriorYear |
| Other Expenses Current Year | 4349402 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 5003146 | TotalExpensesPriorYear |
| Total Expenses Current Year | 5701839 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 151859 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 175225 | RevenuesLessExpensesCY |
| Total Assets BOY | 6803883 | TotalAssetsBOY |
| Total Assets EOY | 7910356 | TotalAssetsEOY |
| Total Liabilities BOY | 4711448 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5651250 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2092435 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2259106 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS, SERVICE, TECHNOLOGY, AND PROFESSIONAL SUPPORT. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 5608376 | Expense |
| Revenue | 5809978 | Revenue |
| Description | THE ORGANIZATION PROVIDED DENTAL BENEFIT COVERAGE FOR 110,512BENEFICIARIES IN 2011 PRIMARILY THROUGH CONTRACTS WITH INDEPENDENTDENTISTS SERVING 295 PURCHASING GROUPS. THE ORGANIZATION PAIDMORE THAN $1.3 MILLION FOR DENTAL CARE DURING 2011. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 45000 | Expense |
| Grants | 45000 | Grants |
| Description | THE ORGANIZATION MADE GRANTS DURING 2011 TO FOSTER IMPROVED ACCESSTO DENTAL HEALTH CARE TREATMENT TO SUPPORT PROFESSIONAL DENTALEDUCATION AND TO PROVIDE ORAL HEALTH INSTRUCTION FOR PATIENTS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 5653376 | TotalProgramServiceExpense |
| Described In501 C3 | 0 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 1 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 4211 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 6 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEANNE FOSTER VP FINANCE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7177668500 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE DELTA DRIVE | AddressLine1 |
| City | MECHANICSBURG | City |
| State | PA | State |
| ZIP Code | 17055 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| KENNETH M PERDUE | ||||||
| TREASUER | 1.00 | X | 0 | 0 | 0 | |
| EVERETTE E SULLIVAN | ||||||
| SECRETARY | 1.00 | X | 600 | 0 | 0 | |
| RONALD N WALTERS | ||||||
| VICE CHAIRMAN | 1.00 | X | 600 | 0 | 0 | |
| JAMES S WILSON DDS | ||||||
| CHAIRMAN | 1.00 | X | 1222 | 0 | 0 | |
| POLLY E DILLER | ||||||
| DIRECTOR | 1.00 | X | 600 | 0 | 0 | |
| NANCY L KEATLEY | ||||||
| DIRECTOR | 1.00 | X | 600 | 0 | 0 | |
| GARY D RADINE | ||||||
| PRESIDENT | 1.00 | 0 | 18161370 | 41534 | X | |
| ANTHONY S BARTH | ||||||
| CHIEF OPERATING OFFICER | 1.00 | 0 | 1354247 | 2681145 | X | |
| ROY M HILLIARD | ||||||
| VICE PRESIDENT, SALES | 1.00 | 0 | 330392 | 25715 | X | |
| RENEE A FISHER | ||||||
| VP, QUALITY ASSURANCE & TRAINING | 1.00 | 0 | 278352 | 32186 | X | |
| PHILIP N ENGLE | ||||||
| VP, INFORMATION TECHNOLOGY | 1.00 | 0 | 272215 | 35172 | X | |
| MICHAEL J CASTRO | ||||||
| CHIEF FINANCIAL OFFICER | 1.00 | 0 | 927320 | 1183511 | X | |
| JEANNE M FOSTER | ||||||
| VICE PRESIDENT, FINANCE | 1.00 | 0 | 290814 | 37131 | X | |
| RICHARD C GRAYBILL | ||||||
| V.P. UNDERWRITING & ACTUAR | 1.00 | 0 | 240698 | 26125 | X | |
| CHARLES LAMONT ESQ | ||||||
| CHIEF LEGAL OFFICER | 1.00 | 0 | 815197 | 1427517 | X | |
| KAREN L ROBINSON | ||||||
| ASSISTANT SECRETARY | 1.00 | 0 | 117373 | 26065 | X | |
| WHITNEY H SHERBOCKER | ||||||
| ASSISTANT SECRETARY | 1.00 | 0 | 166950 | 30850 | X | |
| ALICIA F WEBER | ||||||
| SENIOR VICE PRES./CONTROLLER | 1.00 | 0 | 565786 | 55447 | X | |
| PATRICK S STEELE | ||||||
| CHIEF INFORMATION OFFICER | 1.00 | 0 | 940911 | 1929395 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3622 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 24461625 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 7531793 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|
| DIRECT PREMIUMS | 4959157 | 4959157 |
| ADMINISTRATIVE INCOME | 850821 | 850821 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 5809978 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 74531 | TotalRevenueColumn |
| Related Or Exempt Function Income | 74531 | RelatedOrExemptFunctionIncome |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -7445 | TotalRevenueColumn |
| Related Or Exempt Function Income | -7445 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | -7445 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5877064 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5877064 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45000 | Total |
| Program Services | 45000 | ProgramServices |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1303437 | Total |
| Program Services | 1303437 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4000 | Total |
| Management And General | 4000 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29100 | Total |
| Management And General | 29100 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6767 | Total |
| Program Services | 6308 | ProgramServices |
| Management And General | 459 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2992 | Total |
| Program Services | 2789 | ProgramServices |
| Management And General | 203 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27702 | Total |
| Program Services | 25821 | ProgramServices |
| Management And General | 1881 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4150 | Total |
| Program Services | 3868 | ProgramServices |
| Management And General | 282 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1085 | Total |
| Program Services | 1085 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| COMMISSIONS | 2164216 | 2164216 | |
| ADMINISTRATIVE FEES | 1928745 | 1928745 | |
| LICENSES, PERMITS, FEES | 67482 | 62899 | 4583 |
| BANK SERVICE CHARGES | 31258 | 29136 | 2122 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 85905 | Total |
| Program Services | 80072 | ProgramServices |
| Management And General | 5833 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5701839 | Total |
| Program Services | 5653376 | ProgramServices |
| Management And General | 48463 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53293 | BOY |
| EOY | 565701 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3048239 | BOY |
| EOY | 3616613 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3296508 | BOY |
| EOY | 3293136 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 370000 | BOY |
| EOY | 370000 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35843 | BOY |
| EOY | 64906 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6803883 | BOY |
| EOY | 7910356 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3038009 | BOY |
| EOY | 3423513 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 123439 | BOY |
| EOY | 114457 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1000000 | BOY |
| EOY | 1000000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 550000 | BOY |
| EOY | 1113280 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4711448 | BOY |
| EOY | 5651250 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2092435 | BOY |
| EOY | 2259106 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2092435 | BOY |
| EOY | 2259106 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6803883 | BOY |
| EOY | 7910356 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 175225 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -8554 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| PREFUNDED DEPOSITS | $113,280 |
| REINSURANCE DEPOSITS | $1,000,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1113280 | TotalOfAmounts |
| Total Revenue | 5877064 | TotalRevenue |
| Total Expenses | 5701839 | TotalExpenses |
| Excess Or Deficit For Year | 175225 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -8554 | NetUnrealizedGLOnInvestments |
| Total Adjustments | -8554 | TotalAdjustments |
| Excess Or Deficit Per FS | 166671 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 5877064 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 5877064 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 5877064 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 5701839 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 5701839 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 5701839 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | PART X, LINE 2 - FIN 48 (ASC 740) FOOTNOTE: 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. | Explanation |
Schedule F IRS990ScheduleF
Accts Actvs Out US Table AcctsActvsOutUSTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | CENTRAL AMERICA AND THE CARIBBEAN | Region |
| Number Of Offices | 0 | NumberOfOffices |
| Number Of Employees | 0 | NumberOfEmployees |
| Type Of Activities Conducted | PROGRAM SERVICES | TypeOfActivitiesConducted |
| Specific Services Provided | REINSURANCE | SpecificServicesProvided |
| Total Expenditures | 13042775 | TotalExpenditures |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Number Of Offices | 0 | SubtotalNumberOfOffices |
| Subtotal Number Of Employees | 0 | SubtotalNumberOfEmployees |
| Cont Number Of Offices | 0 | ContNumberOfOffices |
| Cont Number Of Employees | 0 | ContNumberOfEmployees |
| Total Number Of Offices | 0 | TotalNumberOfOffices |
| Total Number Of Employees | 0 | TotalNumberOfEmployees |
| Subtotal Amount Spent | 13042775 | SubtotalAmountSpent |
| Cont Amount Spent | 0 | ContAmountSpent |
| Total Amount Spent | 13042775 | TotalAmountSpent |
| Transfer To Foreign Corp | 0 | TransferToForeignCorp |
| Interest In Foreign Trust | 0 | InterestInForeignTrust |
| Own Foreign Corp | 1 | OwnForeignCorp |
| Passive Foreign Invest Co | 0 | PassiveForeignInvestCo |
| Foreign Partnership | 0 | ForeignPartnership |
| Boycott Countries | 0 | BoycottCountries |
Form990 Schedule F Part V Form990ScheduleFPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 3 - REINSURANCE: | ReturnReference |
| Explanation | THE ORGANIZATION REINSURES DENTAL SERVICE CONTRACTS WITH DELTA REINSURANCE CORPORATION, A BARBADOS INSURANCE COMPANY, AS A PROGRAM SERVICE WITHIN ITS EXEMPT PURPOSE. AS INDICATED IN PART I, THE ORGANIZATION'S REINSURANCE EXPENSES WERE $13,042,775. THE ORGANIZATION'S REINSURANCE RECEIPTS WERE $11,730,928. THE NET REINSURANCE LOSS WAS $1,311,847. | Explanation |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|
| WEST VIRGINIA HEALTH RIGHT CLINIC | ||||||
| 1520 WASHINGTON STREET E | CHARLESTON | WV | 25311 | 311066881 | 5000 | TO PROVIDE DENTAL EDUCATION |
| EBENEZER MEDICAL OUTREACH WORKING POOR PROGRAM | ||||||
| 1448 10TH AVENEUE STE 100 | HUNTINGTON | WV | 25701 | 550745033 | 7500 | TO PROVIDE DENTAL EDUCATION |
| WEST VIRGINIA UNIVERSITY FOUNDATION INC | ||||||
| PO BOX 1650 | MORGANTOWN | WV | 26507 | 556017181 | 5000 | TO PROVIDE DENTAL EDUCATION |
| KANAWHA COUNTY DENTALHEALTH | ||||||
| 1900 SCHOOL STREET | CHARLESTON | WV | 25387 | 550582056 | 10000 | TO PROVIDE DENTAL EDUCATION |
| DELTA DENTAL COMMUNITY CARE FOUNDATION | ||||||
| 100 FIRST STREET | SAN FRANCISCO | CA | 94105 | 371570764 | 17500 | TO PROVIDE DENTAL EDUCATION |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 5 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | X | FirstClassOrCharterTravel |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Personal Services | X | PersonalServices |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GARY D RADINE | |||||||||||||
| 0 | 1250004 | 0 | 1250000 | 0 | 15661366 | 0 | 24194 | 0 | 17340 | 0 | 18202904 | 0 | 4453200 |
| ANTHONY S BARTH | |||||||||||||
| 0 | 800004 | 0 | 450000 | 0 | 104243 | 0 | 2657145 | 0 | 24000 | 0 | 4035392 | 0 | 0 |
| ROY M HILLIARD | |||||||||||||
| 0 | 219593 | 0 | 92975 | 0 | 17824 | 0 | 10521 | 0 | 15194 | 0 | 356107 | 0 | 0 |
| RENEE A FISHER | |||||||||||||
| 0 | 213328 | 0 | 55000 | 0 | 10024 | 0 | 15569 | 0 | 16617 | 0 | 310538 | 0 | 0 |
| PHILIP N ENGLE | |||||||||||||
| 0 | 217869 | 0 | 45000 | 0 | 9346 | 0 | 18632 | 0 | 16540 | 0 | 307387 | 0 | 0 |
| MICHAEL J CASTRO | |||||||||||||
| 0 | 549996 | 0 | 350000 | 0 | 27324 | 0 | 1159511 | 0 | 24000 | 0 | 2110831 | 0 | 0 |
| JEANNE M FOSTER | |||||||||||||
| 0 | 233674 | 0 | 46000 | 0 | 11140 | 0 | 20510 | 0 | 16621 | 0 | 327945 | 0 | 0 |
| RICHARD C GRAYBILL | |||||||||||||
| 0 | 198009 | 0 | 35000 | 0 | 7689 | 0 | 19636 | 0 | 6489 | 0 | 266823 | 0 | 0 |
| CHARLES LAMONT ESQ | |||||||||||||
| 0 | 450000 | 0 | 325000 | 0 | 40197 | 0 | 1410177 | 0 | 17340 | 0 | 2242714 | 0 | 0 |
| WHITNEY H SHERBOCKER | |||||||||||||
| 0 | 149895 | 0 | 14400 | 0 | 2655 | 0 | 14283 | 0 | 16567 | 0 | 197800 | 0 | 0 |
| ALICIA F WEBER | |||||||||||||
| 0 | 370328 | 0 | 172000 | 0 | 23458 | 0 | 33843 | 0 | 21604 | 0 | 621233 | 0 | 0 |
| PATRICK S STEELE | |||||||||||||
| 0 | 525000 | 0 | 375000 | 0 | 40911 | 0 | 1912055 | 0 | 17340 | 0 | 2870306 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 2011. 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 | CERTAIN EXECUTIVES PAID BY A RELATED ORGANIZATION PARTICIPATE IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PROGRAM. THE RELATED 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 RELATED 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 2011, ANTHONY BARTH, MICHAEL CASTRO, GARY RADINE, AND CHARLES LAMONT PARTICIPATED IN THE PLAN. SEE ADDITIONAL NOTE IN SCHEDULE O REGARDING PAYMENTS RECEIVED BY PLAN PARTICIPANTS IN 2011. | |
| 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. | |
| PART III | PART II, LINE (II): THE ORGANIZATION'S OFFICERS ARE PAID BY A RELATED ORGANIZATION. ACCORDINGLY, THEIR COMPENSATION IS REPORTED IN LINE (II). | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION'S DIRECTORS ACT AS THE ORGANIZATION'S ONE CLASS OF MEMBERS, DESIGNATED MEMBERS. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE DESIGNATED MEMBERS ELECT NEW MEMBERS WHO AUTOMATICALLY BECOME DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBERS MUST APPROVE ANY CHANGES TO SPECIFIED BYLAWS PROVISIONS. | |
| 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 DELTA DENTAL OF PENNSYLVANIA AUDIT COMMITTEE, TO WHICH SUCH DUTIES HAVE BEEN DELEGATED. | |
| 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, WHO IS AN EMPLOYEE OF DENTEGRA GROUP, INC. ("DGI"), IS REVIEWED AND APPROVED BY THE DGI DIRECTORS. EXECUTIVE VICE PRESIDENTS' COMPENSATION IS EITHER APPROVED BY THE PRESIDENT OR IN ACCORDANCE WITH THE PROCEDURE OF DELTA DENTAL OF CALIFORNIA (BY WHOM THEY ARE EMPLOYED). ALL COMPENSATION FOR THE ENSUING YEAR IS ONLY APPROVED AFTER REVIEWING COMPARABILITY DATA PRESENTED BY AN OUTSIDE COMPENSATION CONSULTANT, AN ASSESSMENT OF EACH OFFICER'S PERFORMANCE OVER THE PRECEDING YEAR, AND THE ORGANIZATION'S PROGRAM ACCOMPLISHMENTS FOR THE YEAR. THIS PROCESS WAS FOLLOWED FOR 2011 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 WEST VIRGINIA OFFICES OF THE INSURANCE COMMISSIONER, 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 $6.7 BILLION IN 2011. THE ORGANIZATION REPRESENTS LESS THAN 1% OF TOTAL ENTERPRISE REVENUES. | |
| FORM 990, PART VII, SECTION A, COLUMN (B): | HOURS DEVOTED NAME AND TITLE TO RELATED ORGANIZATION GARY D. RADINE 59.00 PRESIDENT ANTHONY S. BARTH 49.00 CHIEF OPERATING OFFICER MICHAEL J. CASTRO 49.00 CHIEF FINANCIAL OFFICER PATRICK S. STEELE 49.00 CHIEF INFORMATION OFFICER CHARLES LAMONT 49.00 CHIEF LEGAL OFFICER ALICIA WEBER 49.00 SENIOR VICE PRES./CONTROLLER ROY M. HILLIARD 49.00 VICE PRESIDENT, SALES RENEE A. FISHER 49.00 VP, QUALITY ASSURANCE & TRAINING PHILIP N. ENGLE 49.00 VP, INFORMATION TECHNOLOGY JEANNE M. FOSTER 49.00 VICE PRESIDENT, FINANCE RICHARD C. GRAYBILL 49.00 VP, UNDERWRITING & ACTUARIAL KAREN L. ROBINSON 49.00 ASSISTANT SECRETARY WHITNEY H. SHERBOCKER 49.00 ASSISTANT SECRETARY | |
| 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 PRESIDENT IN 2011, PURSUANT TO THE TERMS OF THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN PROVIDED BY A RELATED ORGANIZATION. THIS PLAN IS DESIGNED FOR THE LONG-TERM RETENTION OF SENIOR EXECUTIVES (E.G., THE PRESIDENT HAS BEEN WITH THE ORGANIZATION FOR MORE THAN 34 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 PRESIDENT'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 2011 WHEN THE ORGANIZATION'S PRESIDENT 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 SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN PROVIDED BY THE RELATED ORGANIZATION. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -8,554. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| DELTA DENTAL COMMUNITY CARE FOUNDATION | ||||||||||
| 100 FIRST STREET | SAN FRANCISCO | CA | 94105 | 371570764 | CHARITABLE ORGANIZATION | CA | 501(C)(3) | PF | DENTEGRA GROUP INC | 0 |
| DELTA DENTAL OF PENNSYLVANIA | ||||||||||
| ONE DELTA DRIVE | MECHANICSBURG | PA | 17055 | 231667011 | DENTAL INSURANCE | PA | 501(C)(4) | DENTEGRA GROUP INC | 0 | |
| DELTA DENTAL OF DELAWARE INC | ||||||||||
| ONE DELTA DRIVE | MECHANICSBURG | PA | 17055 | 510228088 | DENTAL INSURANCE | DE | 501(C)(4) | DENTEGRA GROUP INC | 0 | |
| DELTA DENTAL OF THE DISTRICT OF COLUMBIA | ||||||||||
| ONE DELTA DRIVE | MECHANICSBURG | PA | 17055 | 521479587 | DENTAL INSURANCE | DC | 501(C)(4) | DENTEGRA GROUP INC | 0 | |
| DELTA DENTAL OF CALIFORNIA | ||||||||||
| 100 FIRST STREET | SAN FRANCISCO | CA | 94105 | 941461312 | DENTAL INSURANCE | CA | 501(C)(4) | DENTEGRA GROUP INC | 0 | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PACA MANAGEMENT LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE DELTA DRIVE | AddressLine1 |
| City | MECHANICSBURG | City |
| State | PA | State |
| ZIP Code | 17055 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 943277375 | EIN |
| Primary Activity | INSURANCE MANAGEMENT | PrimaryActivity |
| Legal Domicile State | DE | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA DENTAL OF CALIFORNIA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeType |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 0 | GeneralOrManagingPartner |
Form990 Schedule R Part IV Form990ScheduleRPartIV (15 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Address Line1AddressForeign/AddressLine1 | CityAddressForeign/City | Province Or StateAddressForeign/ProvinceOrState | CountryAddressForeign/Country | Legal Domicile Foreign CountryLegalDomicileForeignCountry | Postal CodeAddressForeign/PostalCode | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DENTEGRA GROUP INC | ||||||||||||||||
| 100 FIRST STREET | SAN FRANCISCO | CA | 94105 | 943386049 | HOLDING COMPANY | DE | N/A | C | ||||||||
| DENTEGRA INSURANCE COMPANY | ||||||||||||||||
| 100 FIRST STREET | SAN FRANCISCO | CA | 94105 | 751233841 | INSURANCE COMPANY | DE | C | DDC INSURANCE HOLDINGS INC | ||||||||
| DENTEGRA INSURANCE CO OF NEW ENGLAND | ||||||||||||||||
| 100 FIRST STREET | SAN FRANCISCO | CA | 94105 | 042890218 | INSURANCE COMPANY | MA | C | DDC INSURANCE HOLDINGS INC | ||||||||
| DELTA DENTAL INSURANCE COMPANY | ||||||||||||||||
| 100 FIRST STREET | SAN FRANCISCO | CA | 94105 | 942761537 | INSURANCE COMPANY | DE | C | DDC INSURANCE HOLDINGS INC | ||||||||
| ALPHA DENTAL OF NEVADA INC | ||||||||||||||||
| 100 FIRST STREET | SAN FRANCISCO | CA | 94105 | 880244893 | INSURANCE COMPANY | NV | C | DDC INSURANCE HOLDINGS INC | ||||||||
| ALPHA DENTAL OF UTAH INC | ||||||||||||||||
| 100 FIRST STREET | SAN FRANCISCO | CA | 94105 | 860672505 | INSURANCE COMPANY | UT | C | DDC INSURANCE HOLDINGS INC | ||||||||
| ALPHA DENTAL PROGRAMS INC | ||||||||||||||||
| 100 FIRST STREET | SAN FRANCISCO | CA | 94105 | 742447512 | INSURANCE COMPANY | TX | C | DDC INSURANCE HOLDINGS INC | ||||||||
| ALPHA DENTAL OF ALABAMA INC | ||||||||||||||||
| 100 FIRST STREET | SAN FRANCISCO | CA | 94105 | 630796079 | INSURANCE COMPANY | AL | C | DDC INSURANCE HOLDINGS INC | ||||||||
| ALPHA DENTAL OF NEW MEXICO INC | ||||||||||||||||
| 100 FIRST STREET | SAN FRANCISCO | CA | 94105 | 330279230 | INSURANCE COMPANY | NM | C | DDC INSURANCE HOLDINGS INC | ||||||||
| ALPHA DENTAL OF ARIZONA INC | ||||||||||||||||
| 100 FIRST STREET | SAN FRANCISCO | CA | 94105 | 930939835 | INSURANCE COMPANY | AZ | C | DDC INSURANCE HOLDINGS INC | ||||||||
| DENTEGRA SEGUROS DENTALES SA | ||||||||||||||||
| INSURANCE COMPANY | C | DENTEGRA INSURANCE COMPANY | INSURGENTES SUR 826 PISO 15 | COL DEL VALLE | FC DF 01300 | MX | MX | |||||||||
| DELTA DENTAL OF PUERTO RICO | ||||||||||||||||
| 660436769 | INSURANCE COMPANY | C | DELTA DENTAL OF CALIFORNIA | 14 CALLE 2 SUITE 200 | GUAYNABO | RQ | RQ | 00968 | ||||||||
| DELTA REINSURANCE CORPORATION | ||||||||||||||||
| 980096711 | REINSURANCE | C | DELTA DENTAL OF PENNSYLVANIA | CGI TOWER 2ND FLOOR | WARRENS | ST. MICHAEL | BB | BB | 0.06250 | |||||||
| SERVICIOS DENTALES DENTEGRA SA DE CV | ||||||||||||||||
| INSURANCE ADMINISTRATION | C | DENTEGRA INSURANCE COMPANY | INSURGENTES SUR 826 PISO 15 | COL DEL VALLE | FC DF 01300 | MX | MX | |||||||||
| DDC INSURANCE HOLDINGS INC | ||||||||||||||||
| 100 FIRST STREET | SAN FRANCISCO | CA | 94105 | 274251930 | HOLDING COMPANY | DE | C | DELTA DENTAL OF CALIFORNIA | ||||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| DELTA DENTAL OF PENNSYLVANIA | |
| L | 1376966 |
| DELTA REINSURANCE COMPANY | |
| R | 11730928 |
| DELTA REINSURANCE COMPANY | |
| Q | 13042775 |
| DELTA DENTAL INSURANCE COMPANY | |
| L | 22668 |
| DELTA DENTAL OF CALIFORNIA | |
| O | 45008 |