2011-08-09T13:35:15-07:00 2010-12-31 990 2010-01-01 910621480 WASHINGTON DENTAL SERVICE WASH 2065521300 9706 4th Ave NE Seattle WA 98115 Tracy Hoek-Warner 2065282340 2011-08-09 2010 2016-02-24 21:20:13Z Tracy Hoek-Warner 9706 4th Ave NE Seattle WA 98115 1027285694 0 X www.deltadentalwa.com X 1954 WA Washington Dental Service will revolutionize the oral health industry and improve overall health. Our success will be defined by: Providing innovative products, services and technology beyond the traditional definition of dental benefits, Moving into new markets, ventures and partnerships to execute our vision, Sustaining levels of profitability that meet or exceed industry benchmarks, and assembling, developing, fostering and retaining the best team to execute our vision. 14 7 377 0 0 0 96855 76305 918936828 936427699 6967515 5199349 572766 770968 926573964 942474321 3630381 2881042 846875985 857041208 37115772 33782846 0 0 0 34600511 35014493 922222649 928719589 4351315 13754732 193963479 212950806 57789762 47791207 136173717 165159599 The purposes of Washington Dental Service include, but are not limited to, the following; To secure dental services to groups, individuals and their families. To encourage, foster and finance professional and scientific study and research in the general field of oral health. To educate the public concerning the need for and advantage of adequate dental treatment. 0 0 882344413 0 936303376 Washington Dental Service (WDS) provides dental insurance for over 2,100,000 primary subscribers and their dependents throughout the state of Washington, and across the nation. Working collectively with brokers and benefit managers, we offer standard insurance benefits, as well as highly customized plans to meet the needs of individuals and their families. Since 1954, WDS has been engaging dentists in dialogue to maintain fees at affordable levels. We have contracted with nearly 4,000 dentists, creating a network of providers serving patients across the state. As a member of the Delta Dental Plans Association, a national association supporting Delta insurers nation-wide, our members are able to access Delta contracted providers in every state. In addition to traditional benefit plans, we offer evidence based plans focused on the specific needs of the individual, which promotes appropriate care on a case-by-case basis. In 2010, WDS processed over 4,600,000 claims for subscribers and their dependents. To ensure providers are submitting claims appropriately, we audited more than 40,000 individual claims, the results of which include: education of dental office staff on use of CDT codes, invoicing procedures, and common errors. 1000000 0 0 WDS has joined forces with the University of Washington School of Dentistry and Seattle Children's Hospital to form the Early Childhood Oral Health (ECOH) Program. ECOH opened to the public in September 2010. It is housed in a new pediatric dental facility, the Washington Dental Service Building for Early Childhood Oral Health. ECOH's 28,000 square foot facility includes 31 dental chairs and three operating rooms, where they expect to provide service for 30,000 visits in the first year of operation, with an expected 40,000 visits per year at full capacity. ECOH will serve both healthy children and those with urgent or complex oral health needs. The ECOH facility will accommodate progressive clinical research and training programs to address the ever-growing crisis of childhood dental disease. WDS has committed to donate a total of $5,000,000 to the project as benchmarks are reached. $2,000,000 was donated in 2007, 2009, and the final contribution of $1,000,000 was made in 2010. 1358736 0 0 Dental decay is the single most common chronic disease of early childhood - five times more common than asthma. Nearly one in five older adults, nationally, has untreated dental cavities. The Washington Dental Service Foundation, a wholly owned subsidiary of WDS, supported almost exclusively by WDS, focuses their work specifically on young children and seniors, and works closely with partner organizations to develop and implement innovative programs. The Access to Baby and Child Dentistry (ABCD) programs expand access to dental care for young children in Washington state by providing dental services - both preventative and restorative - to Medicaid-enrolled children up to age 6. In counties with ABCD, the utilization of dental services increased from 21% to 38% from 1997 to 2010. The Early Intervention in Medical Settings program is training pediatricians in the advantages and techniques of oral screening, applying fluoridation, and referring high risk patients for dental care. The Foundation is engaging health professionals, including pharmacists and home health aides to take preventative steps with seniors before oral health problems affect overall health. 237000 0 0 To promote oral health in pre-school Head Start programs, the Foundation developed a curriculum called Cavity Free Kids to help teachers, parents and children learn about tooth decay and what they can do to prevent it. Since 2000, more than 85% of Washington Head Start programs have been trained. Water fluoridation is the most important step a community can take to improve the oral health of all residents. The Foundation promotes legislation to encourage fluoridation and provides assistance to groups who are committed to bringing the benefits of fluoride to their communities. Since 2001, the Foundation's work in local communities has increased fluoridated water to more than 208,000 Washington residents. 475782 0 0 Assisting the work of the Foundation are WDS employees volunteering their time. WDS enables all employees to engage with the public regarding oral health through the use of two volunteer days per year. Volunteer time is spent working on the Smile Mobile, a mobile dental facility traveling to underserved areas of the state. The Smile Mobile has delivered dental care to more than 28,000 children state-wide. Volunteer time is also spent handing out flyers promoting oral health to Washington citizens at fairs, the zoo, parades, and events across the state. 1365252 0 0 WDS promotes the benefits of oral health through marketing efforts in the print, direct mail, TV, radio, online media and event sponsorships. In 2010, the marketing and advertising campaign reached out to new audiences via promotional sponsorships in an attempt to promote the benefits of good oral health in a more direct and interactive way. Hundreds of thousands of patrons were exposed to WDS and our mission. Also in 2010, WDS presented the messages of the "Green" campaign to radically reduce the cost of communications with dental providers and subscribers by enhanced web capabilities, and promotion of dental health through specific product offerings. WDS, together with the WDS Foundation, utilized advertising across the state to communicate the importance of oral health to overall health. 603875 0 0 Washington Dental Service is engaged in efforts to promote evidenced based dental care through the Institute for Oral Health (IOH), a non-profit wholly owned subsidiary of WDS. The purpose of the IOH is to educate dental providers throughout the country on the latest research related to oral health, and correlations between oral health and overall health. The IOH conducts an annual conference nationally that has attracted hundreds of providers. 106813 0 0 The Company matches donations made by employees to non-profit organizations with official IRS 501(c)(3) status, although the following organizations/events are not eligible for matching; churches, political campaigns/organizations, capital funding, fraternal/labor organizations, trips/tours, mass mailings, organizations/groups that discriminate for any reason including, but not limited to, race, color, religion, creed, age, sex, sexual orientation or national origin. 2788722 0 0 887491871 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 39347 1 1 377 1 0 0 0 0 0 0 X 14 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Washington Dental Service 2065221300 9706 4th Avenue NE Seattle WA 981152157 X James Daniel Dwyer 40 X X 1006758 0 134390 Richard R Albrecht 3 X 42937 0 0 G Douglas Beck 3 X X 39862 0 0 David W Branch 3 X X 306453 0 0 Patrick J Dineen 3 X 36458 0 0 Roberta Greene 3 X X 50852 0 0 Robb B Heinrich 3 X 37172 0 0 John M Henricksen 3 X 391278 0 0 Christine M Johnson 3 X 48493 0 0 Joanna Lohkamp 3 X 44457 0 0 Jack E Neal 3 X X 33448 0 0 Gerald Phipps DMD 3 X 39970 0 0 Allen W Puckett 3 X 48492 0 0 R Gary Schweikhardt 3 X 42957 0 0 Remigius J Eussen 3 X 6481 0 0 Eve Rutherford 3 X 9996 0 0 Irene F Hunter 3 X 6458 0 0 Frederick C Kiga 3 X 6458 0 0 Kurt Labberton 3 X 211216 0 0 Thomas Locke 3 X 7379 0 0 Russell Maier MD 3 X 8230 0 0 Neil L McReynolds 3 X 6372 0 0 Alejandro Alex Narvaez DDS 3 X 79968 0 0 Diana Gale 3 X 6458 0 0 Hyeok Kim 3 X 6458 0 0 Tracy Lynn Hoek-Warner 40 X 497686 0 101989 John Theodore Bursett 40 X 303612 0 44097 John Poli 40 X 285108 0 65955 Kristin Nielsen Merlo 40 X 279457 0 37954 Larry Leopold 40 X 257464 0 29674 Thomas Andrew Gates 40 X 256561 0 36522 Ronald Edward Inge 40 X 448308 0 96880 Laura Jean Smith 40 X 251918 0 66383 Larry Van Kuhl DDS 40 X 194090 0 23683 Vincent L Ippolito 40 X 166149 0 23023 Darryl J Liley 40 X 156052 0 28447 Jon P Allen 40 X 163335 0 20116 5784801 0 709113 50 0 1 0 DeCare Systems Unit 1 Curraheen Rd Cork Ireland EI Software Development 2837660 BIT LLC 710 SW 34th St Renton WA 98057 Printing and Mailing Services 2264703 PWC Advisory LLC PO Box 514038 Los Angeles CA 900514038 Consultants 1686117 TEK Systems PO Box 198568 Atlanta GA 303848568 IT contract labor and recruiting 986409 Point B Solutions PO Box 34935 Seattle WA 98124 Business Process Consultants 886212 47 0 0 0 18785 0 57520 0 76305 Premium Revenue 524114 936303377 936303377 0 0 Smile Mobile 621990 124322 124322 0 0 0 0 0 0 936427699 4731399 4731399 0 0 0 0 0 0 0 0 0 0 519952 0 0 0 519952 0 519952 0 0 519952 86667919 -1388596 84811373 0 1856546 -1388596 467950 467950 0 0 0 251016 251016 0 0 251016 942474321 941878064 0 519952 359136 359136 2521906 2521906 857041208 857041208 5883396 1501456 4381940 0 0 0 0 0 19998265 7465571 12532694 0 1258674 366012 892662 0 4404311 1491410 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State Representative PO Box 48 Olympia WA 98507 510575921 800 0 Committee to Elect Barbara Bailey PO Box 374 Oak Harbor WA 98277 020556800 800 0 Committee to Elect Tom Campbell PO Box 443 Spanaway WA 98387 911558175 800 0 Bruce Chandler Campaign PO Box 1108 Zillah WA 98953 912066326 800 0 Citizens for Frank Chopp 1000 Aurora Ave N N - 100 Seattle WA 98109 320020852 800 0 Judy Clibborn for State Representative PO Box 808 Mercer Island WA 98040 010649609 800 0 The Committee to Elect Eileen Cody 5209 36th Ave SW Seattle WA 98126 911646573 800 0 Citizens to Elect Steve Conway PO Box 112020 Tacoma WA 98411 010735404 500 0 Committee to Elect Bruce Dammeier PO Box 398 Puyallup WA 98371 912141093 800 0 Committe to Re-Elect Richard DeBolt 1673 South Market Blvd PMB 159 Chehalis WA 98532 203271760 800 0 Committee to Elect Jerome Delvin PO Box 1113 Richland WA 99352 538587144 800 0 Citizens for John Driscoll 2525 E 29th Ave SE 10B PMB 344 Spokane WA 99223 270763404 800 0 Committee to Re-Elect Tracey Eide 28303 Sound View Dr S 202 Des Moines WA 98198 030430031 800 0 Committee to Elect Doug Ericksen PO Box 5191 Bellingham WA 98227 820553277 800 0 Committee to Elect Tami Green 10316 93rd St SW Lakewood WA 98498 602632403 800 0 Kathryn Haigh Campaign Committee 81 SE Walker Park Rd Shelton WA 98584 299527931 500 0 House Democratic Campaign Committee 1000 Aurora Ave N N-100 Seattle WA 98109 916178946 800 0 Bob Hasegawa for State Representative PO Box 84331 Seattle WA 98124 201930625 500 0 Campaign to Re-Elect Bill Hinkle PO Box 919 Ellensburg WA 98926 262768576 800 0 Committee to Elect Steve Hobbs 3309 114th Dr NE Lake Stevens WA 98258 204733784 800 0 Committee to Re-Elect Senator Holmquist PO Box 429 Moses Lake WA 98823 800435914 800 0 Committee to Elect Jim Honeyford PO Box 844 Sunnyside WA 98944 912070291 800 0 House Republican Organizational Committee PO Box 7222 Olympia WA 98507 916177625 800 0 People for Zach Hudgins 4512 S 136th St Tukwila WA 98168 810555017 800 0 Sam Hunt for State Representative PO Box 2573 Olympia WA 98507 331007463 500 0 Friends for Ross Hunter PO Box 4204 Bellevue WA 98009 043645222 800 0 Citizens for Christopher Hurst 62504 Indian Summer Way E Enumclaw WA 98022 010841227 800 0 Friends of Jim Jacks PO Box 65849 Vancouver WA 98665 262365416 500 0 Citizens for Ruth Kagi 19553 35th NE Lake Forest Park WA 98155 911914967 500 0 Friends of Karen Keiser 25657 Marine View Dr S Des Moines WA 98198 911947669 800 0 Friends of Troy Kelley 2521 Fremont St Tacoma WA 98406 203888484 800 0 Committee to Re-Elect Phyllis Gutierrez Kenney PO Box 15314 Seattle WA 98115 911704805 250 0 Friends of Derek Kilmer PO Box 1574 Gig Harbor WA 98335 731700577 800 0 Steve Kirby Campaign 9415 Tacoma Ave S Tacoma WA 98444 711000906 800 0 Committee to Re-Elect Senator Adam Kline PO Box 28720 Seattle WA 98118 030469833 800 0 Friends of Jeanne Kohl-Welles 2212 Queen Anne Ave N Seattle WA 98109 911559456 800 0 Committee to Elect Joel Kretz 1014 Toroda Creek Rd Wauconda WA 98859 272630585 800 0 Friends for Dan Kristiansen PO Box 2007 Snohomish WA 98291 912064816 800 0 People for Linville PO Box 5782 Bellingham WA 98227 320172179 800 0 Chris Marr for State Senate PO Box 2025 Spokane WA 99210 204064476 800 0 Re-Elect John R McCoy PO Box 1821 Marysville WA 98270 912068458 800 0 Committee to Elect Jim Moeller 1701 Broadway 328 Vancouver WA 98663 450476516 800 0 Committee to Re-Elect Dawn Morrell 2106 Manorwood Dr SE Puyallup WA 98374 010679962 800 0 Committee to Elect Jeff Morris 1004 Commercial Ave 303 Anacortes WA 98221 911921313 800 0 Friends of Ed Murray 1122 E Pike St 799 Seattle WA 98122 911729391 800 0 Friends of Sharon Nelson 7318 SW 258th Pl Vashon WA 98070 261377785 500 0 Committee to Elect Kevin Parker PO Box 198 Spokane WA 98210 260348064 800 0 People for Pedersen 815 First Ave 111 Seattle WA 98104 203979617 800 0 Friends to Elect Eric Pettigrew PO Box 28660 Seattle WA 98118 534801080 800 0 Citizens for Pam Roach 22102 SE Green Valley Rd Auburn WA 98002 911940414 800 0 The Roosevelt Fund PO Box 45201 Seattle WA 98145 911713677 2500 0 Committee to Re-Elect Charles Ross PO Box 996 Naches WA 98937 263352534 800 0 People for Joe Schmick PO Box 620 Colfax WA 99111 450582705 800 0 Senate Democratic Campaign Committee PO Box 45042 Seattle WA 98145 916163985 800 0 Citizens to Elect Larry Seaquist PO Box 821 Gig Harbor WA 98335 204220154 800 0 Committee to Re-Elect Geoff Simpson 27015 169th PL SE Covington WA 98042 911749036 800 0 Committee to Elect Larry Springer 700 20th AVE W Kirkland WA 98033 830382872 800 0 The Reagan Fund PO Box 904 Olympia WA 98507 911716818 5000 0 Senate Republican Campaign Committee PO Box 11025 Olympia WA 98508 910987396 800 0 Re-Elect Pat Sullivan Campaign 26513 168th PL SE Covington WA 98042 043679431 800 0 Friends for Rodney Tom PO Box 594 Medina WA 98039 571234123 800 0 Harry Truman Fund PO Box 9100 Seattle WA 98109 911769570 2500 0 People for Scott White 9009 27th Ave NE Seattle WA 98115 260853518 500 0 Friends of Hans Dunshee 1526 Lakeview Ave Snohomish WA 98290 911729071 500 0 Citizens for Jim McIntire PO Box 21941 Seattle WA 98111 260820856 500 0 Robert McKenna Campaign Committee PO Box 955 Mercer Island WA 98040 830377709 1000 0 Committee to Re-Elect Ed Orcutt PO Box 1280 Kalama WA 98625 900038949 800 0 Committee to Elect Mary Helen Roberts 3924 149th PL SW Lynnwood WA 98087 770621137 500 0 Friends for Jay Rodne PO Box 2848 Issaquah WA 98027 201125805 1600 0 People for Christine Rolfes 19689 7th AVE NE PMB 118 Poulsbo WA 98370 320172015 500 0 Friends of Santos PO Box 78606 Seattle WA 98178 911913482 800 0 Maureen Walsh PO Box 461 Walla Walla WA 98362 294723755 500 0 The Leadership Council 401 NE Ravenna 110 Seattle WA 98115 911714860 5000 0 Norm Johnson for State Representative 55 W Washington Ave 83 Yakima WA 98903 800190629 1600 0 Liias for Legislature PO Box 821 Mukilteo WA 98275 260696977 250 0 Elect Tim Probst 3205 NE 160th St Ridgefield WA 98642 262359148 500 0 Friends of Susan Ragan PO Box 1471 Pullman WA 99163 264513295 500 0 Committee for Robert Morton 3278 Pierre Lake Rd Kettle falls WA 99141 911549978 1600 0 Citizens for Andy Hill 23515 NE Novelty Hill Rd Ste B2 Redmond WA 98053 272057163 1600 0 Citizens for Stephen Litzow 7683 SE 27th St Mercer Island WA 98040 262303979 1600 0 Friends of Carol Gregory PO Box 3796 Federal Way WA 98063 262460820 500 0 Friends of Mike Heavey 2348 Alki Ave SW 206 Seattle WA 98116 272118176 500 0 Citizens for Mary Lou Dickerson 3515 NE 103rd St Seattle WA 98125 680510673 250 0 Friends of Andy Billig PO Box 145 Spokane WA 99210 271127517 500 0 Friends for Luis Moscoso PO Box 422 Mountlake Terrace WA 98043 273021660 250 0 Friends of Deb Eddy 6619 132nd Ave PMB 149 Kirkland WA 98033 204604798 500 0 Committee to Elect Sherry Appleton PO Box 2140 Poulsbo WA 98370 010699667 500 0 Friends of Chris Reykdal 855 Trosper Rd Ste 108-117 Tumwater WA 98512 271751460 500 0 Friends of David Frockt PO Box 2114 Seattle WA 98111 271548039 250 0 Paull Shin for State Senate PO Box 5036 Lynnwood WA 98046 529504029 250 0 SchC_P1A_S00_L01 Schedule C, Part I-A, Line 1 Schedule C, Part I-A, Line 1 - Washington Dental Service contributed $78,400.00 to 90 political campaigns for individuals running for Washington state political offices. Contributions to each campaign ranged from a low of $250.00 to a high of $5000.00 0 1211191 1211191 0 12028489 8124852 3903637 0 1161103 726878 434225 0 16235685 14128872 2106813 0 29926489 20097288 9829201 17485067 1 Adams County Health District 425 E Main St Ste 700 Othello WA 99344 916001294 20500 0 Second year of Access to Baby and Child Dentistry program Asotin County Health Department 431 Elm St Clarkston WA 99403 264483600 28000 0 Third year of Access to Baby and Child Dentistry program City of Tacoma 747 Market St Ste 132 Tacoma WA 98402 916001283 202000 0 Fluoridation project for groundwater treatment Grant County Health District 1038 W Ivy Ave No 1 Moses Lake WA 98837 916001319 40791 0 Second year Access to Baby and Child Dentistry program Kittitas County Health Department 507 Nanum Ellensburg WA 98926 916001349 21787 0 First year of Access to Baby and Child Dentistry Program Spokane Regional Health District 1101 W College Ave Spokane WA 99201 911527532 10000 0 First year for Access to Baby and Child Dentistry program Department of Social Health Services PO Box 45010 Olympia WA 98504 916001088 100000 0 Development of the Washington state benefit portal 7 0 Dental equipment to expand Wenatchee clinic 1 125000 0 Engagement of primary care physicians in delivery of oral health services 1 100000 0 Dental equipment to support a new clinic in Oroville, and expand access to care. 1 100000 0 Partnership with early learning community to improve oral health in young children. 1 45000 0 State Home Visiting Match Fund to expand home visiting programs for Washington's youngest children 1 15000 0 Expand access to seniors by opening a new clinic in Vancouver 1 90000 0 Increase capacity to serve more pregnant women and young children through purchasing equipment for two dental operatories 1 65000 0 Maintain access to dental care for low-income residents of Snohomish, Skagit and Whatcom counties through dental van purchase. 1 50000 0 Funding for mobile van to serve the North Puget Sound Region, and increase access to dental care. 1 32000 0 Expand access to care for seniors by purchasing equipment and expanding an existing clinic 1 250000 0 Develop research based messages and communication tools to promote community water fluoridation 1 35000 0 Incorporate oral health into Aging and Long Term Care programs and services in Yakima. 1 54780 0 New volunteer clinic in Spokane to increase access to dental care 1 192000 0 Prenatal Curriculum for practicing dentists, in cooperation with the University of Washington 1 20000 0 Funding to provide cumulative metrics for community health centers in Washington state 1 4500 0 Funding for the Community Health Center Directors Dental Learning Network 1 58321 0 SchI_P01_S00_L02 Schedule I, Part I, Line 2 The grantee is required to sign a grant agreement stating that they will use the funds only for purposes outlined in the grant agreement and application. The grantee further agrees that the funds will be used exclusively for exempt purposes as described in Section 501(c)(3) of the Internal Revenue Code. The grantee is required to file reports on regular intervals outlining use of funds. Grantee is also required to return unused funding if applicable. X X X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 James Daniel Dwyer 531430 0 450000 0 25328 0 113831 0 20559 0 1141148 0 1098333 0 Tracy Lynn Hoek-Warner 346038 0 141911 0 9737 0 86717 0 15272 0 599675 0 656149 0 Ronald Edward Inge 317834 0 122046 0 8429 0 78545 0 18335 0 545189 0 607557 0 John Theodore Bursett 221378 0 67693 0 14542 0 24750 0 19347 0 347710 0 406766 0 John Poli 203220 0 72754 0 9133 0 44063 0 21892 0 351062 0 396336 0 Kristin Nielsen Merlo 201323 0 69541 0 8593 0 13259 0 24694 0 317410 0 356642 0 Thomas Andrew Gates 184225 0 66076 0 7164 0 13866 0 22656 0 293987 0 333769 0 Larry Leopold 175508 0 67254 0 13799 0 11105 0 18570 0 286236 0 332393 0 Laura Jean Smith 173328 0 70233 0 8357 0 54409 0 11974 0 318301 0 347148 0 Larry Van Kuhl DDS 162021 0 30958 0 1111 0 9411 0 14272 0 217773 0 228037 0 Vincent L Ippolito 140272 0 25231 0 646 0 11222 0 11801 0 189172 0 202263 0 Jon P Allen 138500 0 24792 0 42 0 11080 0 9036 0 183450 0 0 0 Darryl J Liley 132999 0 23923 0 -870 0 9931 0 18516 0 184499 0 197115 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Washington Dental Service pays for spousal travel for the CEO, which is treated as taxable income. Washington Dental Service provides a Wellness Program which reimburses 50% of approved expenses for all employees working 30 or more hours a week, with a maximum payable of $40/month or $480/year, and 25% of approved expenses for part time employees working 20 to 30 hours a week with a maximum payable of $20/month or $240/year for health club memberships, aerobic or general exercise classes, weight loss programs, stress management and massage therapy. These reimbursements are treated as taxable income. Additionally, club dues are paid in full for Senior Management who use the facilities for meetings, which is included in taxable income. SchJ_P01_S00_L03 Schedule J, Part I, Line 3 The Human Resources and Compensation Committee of the Board of Directors engages an external compensation consultant to evaluate all key employees, including President and CEO, Executive VP COO/CFO, Senior VP Underwriting, VP of Sales and Marketing, CIO, VP of Planning and Corporate Development, VP Human Resources, and VP Dental Director & Professional Relations compensation in comparison to the practice of similar employers in the marketplace. This process is conducted on an annual basis. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 The Company makes contributions to a non-qualified, supplemental executive retirement plan (SERP), as determined by the Board of Directors, that is subject to Code Section 457(f). Plan participants are "key employees" who receive an annual contribution based on their age, earnings and projected 401(k) investment returns. The investment of the Company contributions is directed by each participant, but vesting of the benefit is subject to a subsantial risk of forfeiture as required by Code Section 409(a): James D Dwyer, President and CEO $97,331;Tracy L. Hoek-Warner, Executive VP COO/CFO $70,217; Dr. Ronald E Inge, VP & Dental Director $62,045; John Poli, VP & CIO $36,052; Laura Jean Smith, Foundation President $47,062. F990_P04_S00_L21 Form 990, Part IV, Line 21 Clark County Health Department, 2000 Ft Vancouver Way, Vancouver WA 98666, FID 916001299, returned an unused Grant during 2010 in the amount of 63,942. Amount reported in Schedule I, Part IV, Statement 1 is 423,078. This schedule does not allow an entry of a negative number, therefore reporting the reduction in expense in Schedule O in order to reconcile to the total reported in Part IX, Line 1 Column A in the amount of 359,136. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 Form 990, Part VI, Section A, Line 6 - Washington Dental Service's Member Dentists are considered members of the company. Member Dentists elect the Dental members of the Board of Directors. F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a Form 990, Part VI, Section A, Line 7a - The Board of Directors nominates Dental members of the board. The entire membership elects Dental members of the Board. Member Dentists approve all changes to the By-laws. The Public members of the board nominate and elect new Public members of the Board. No members may receive a share of the organization's profits or excess dues or a share of the organization's assets upon the organization's dissolution. F990_P06_S0A_L07b Form 990, Part VI, Section A, Line 7b Form 990, Part VI, Section A, Line 7b - Recommended changes to the Corporate By-laws by the Board are subject to approval by the member dentists. F990_P06_S0B_L11a Form 990, Part VI, Section B, Line 11a Form 990, Part VI, Section B, Line 11 - The 990 is completed by the accounting staff. The 990 return and supporting documentation is reviewed and approved by the Director of Finance and the CFO. An independent review is conducted by the Chairman of the Human Resources and Compensation Committee of the Board of Directors. Electronic copies of the return are provided to all Board members prior to submission to the IRS. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Form 990, Part VI, Section B, Line 12c - The Compliance Committee of the Board is charged with monitoring proposed or on-going transactions for conflicts of interest and addressing any potential or actual conflicts. Pursuant to the Conflicts of Interest Policy, an annual conflict of interest questionnaire, aimed at determining any family and business relationships and transactions, or other transactions that may pose a potential conflict, is distributed to all covered persons (i.e., board members, officers and executive leadership or key employees). Covered persons are required to disclose real or potential conflicts at the time when such conflicts arise. When someone becomes a covered person and annually thereafter, each covered person is required to sign a statement affirming that he/she: (1) has received a copy of the Conflicts of Interest Policy; (2) has read the Policy and understands said Policy; and (3) agrees to comply with all requirements of the Policy, including completing the conflicts of interest questionnaire. The completed questionnaires are reviewed by the Compliance Committee and any persons with actual or potential conflicts are informed via written communication. The procedures for addressing any conflict of interest includes, but is not limited to, the following: (1) the conflicting interest is fully disclosed to the Board; (2) the interested person responds to factual questions related to the substance of the transaction or arrangement being considered, after which he/she shall leave the meeting; (3) the person with the conflict of interest is excluded from the discussion and approval of such transaction; (4) alternatives to the proposed transaction are investigated, competitive bids or comparable valuations are obtained; (5) any conflicting issues during the course of a Board meeting which cannot be resolved are referred to the Governance Committee; and (6) the transaction or action must be approved by a majority of disinterested persons. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Form 990, Part VI, Section B, Line 15 - The board appoints a Human Resources and Compensation Committee of the Board, none of whom have a conflict of interest with respect to the compensation arrangement, to be accountable for setting reasonable compensation packages for each officer or key employee (including the CFO). The Human Resources and Compensation Committee of the Board develops, consistent with the organization's philosophy and principles, the annual performance goals and criteria to be used in determining merit increases and variable compensation criteria for officers and key employees. The Human Resources and Compensation Committee of the Board also hires a qualified independent compensation and benefits specialist (independent expert) to review, analyze and provide benchmarking data for the total compensation and benefit packages of officers and key employees. Appropriate comparability data is obtained from the independent experts, i.e., total economic benefits paid by similarly situated organizations (both taxable and tax-exempt) for similar job responsibilities. The Committee's written records include the (1) terms of the arrangements with the officers and key employees (including the date the arrangement was approved); (2) a list of members present during the debate on the transaction (and how the members voted when it was approved); and (3) a description of the comparable data relied upon by the Committee. Key deliberations of the Committee are also documented in minutes which are approved at the next Committee meeting. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Form 990, Part VI, Section C, Line 19 - Governing documents, financial statements and disclosures are filed quarterly and annually with the Washington State Office of the Insurance Commissioner (OIC) as a matter of public record. All documents so filed are available to the public on the OIC web site. Amendments to By-laws are filed with the OIC from time-to-time as they are approved by the governing body. All governing documents, conflict of interest policy and financial statements are available to the public upon request. F990_P07_S0A_L01a Form 990, Part VII, Section A, Line 1a Of the compensation listed in Form 990,Part VII Section A, Line 1a, Column (D), following is the Board Compensation for members with other 1099-MISC income: David W Branch $73,091, John M Hendrickson $44,442, Kurt Labberton $8,496 and Alejandro Alex Narvaez DDS $6,458. F990_P11_S00_L05 Form 990, Part XI, Line 5 Prior year adjustment to net assets $10,207,587, Change in unrealized gains (losses) $4,589,635, Change in accumulated other comprehensive income $652,455, and Other than temporary impairment of investments (OTTI) ($218,526). Washington Dental Service Foundation LLC 9706 Fourth Ave NE Seattle WA 98115 910621480 Sponsor Oral Health Education WA 5040243 4479402 N/A Washington Dental Service Holdings LLC 9706 Fourth Ave NE Seattle WA 98115 910621480 Invest in Oral Health Activities WA 53922 13779025 N/A Institute for Oral Health 9706 Fourth Ave NE Seattle WA 98115 910621480 Support Oral Health Education WA 603875 -10383 N/A Washington Dental Service Fund 9706 Fourth Ave NE Seattle WA 98115 911281990 Sponsor Oral Health Education WA 501(c)(3) 9 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Washington Dental Service Fund c 18785 Cash