2011-10-27T15:52:11-05:00 2010-12-31 RSM MCGLADREY INC 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2010-01-01 840568337 COLORADO DENTAL SERVICE INC DBA DELTA DENTAL OF COLORADO COLO 8002330860 4582 SO ULSTER STREET NO 800 DENVER CO 80237 DAVID BEAL 8002330860 2011-10-27 1 COLLIN F BUZZELL 6125738750 2010 2016-03-07 17:11:31Z DELTA DENTAL OF COLORADO KATHRYN ANN PAUL 4582 SO ULSTER STREET NO 800 DENVER CO 80237 249600471 0 X WWW.DELTADENTALCO.COM X 1958 CO TO IMPROVE THE ORAL HEALTH OF THE COMMUNITIES WE SERVE. 15 10 112 0 7698 0 0 0 232889220 247068203 329055 2326752 169740 205516 233388015 249600471 3123922 3934906 202423901 218333495 10970630 11872318 0 0 0 14058714 12041841 230577167 246182560 2810848 3417911 76007094 83466505 20647689 21466488 55359405 62000017 X DELTA DENTAL OF COLORADO (DDCO) WAS FORMED AS A 501(C)(4) ORGANIZATION IN ORDER TO IMPROVE THE ORAL HEALTH OF THE COMMUNITIES IT SERVES. BECAUSE PEOPLE WITH DENTAL INSURANCE OVER TIME HAVE BETTER ORAL HEALTH OUTCOMES, DELTA DENTAL OF COLORADO DEVOTES ITSELF TO PROVIDING HIGH QUALITY, AFFORDABLE DENTAL INSURANCE TO AS MANY COLORADOANS AS POSSIBLE. UNFORTUNATELY, THERE ARE MANY PEOPLE FOR WHOM DENTAL INSURANCE IS NOT POSSIBLE. FOR THESE PEOPLE, DELTA DENTAL HAS A NUMBER OF DIFFERENT PROGRAMS ESTABLISHED TO PROVIDE THEM WITH ORAL HEALTH EDUCATION, DIRECT PATIENT DENTAL SERVICES, AND FREE DENTAL INSURANCE SO THAT GOOD ORAL HEALTH WILL ALSO BE ACHIEVABLE FOR THEM. 0 0 238006149 247068203 PROVISION OF RISK AND SELF-FUNDED PLANS TO SUBSCRIBERS. 4177000 3934906 COMMUNITY BENEFIT PROGRAMS INCLUDING A PLEDGE OF $3,766,828 TO THE DELTA DENTAL OF COLORADO FOUNDATION. 242183149 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 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 15533 0 1 112 1 1 1 0 0 0 0 0 X 15 10 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X GREG VOCHIS 7204894715 4582 SO ULSTER STREET NO 800 DENVER CO 80237 KATHRYN ANN PAUL 45.00 X X 604216 0 37438 CYNTHIA ANNE EVANS 5.00 X X 39750 0 3103 CHARLES DAVID KIKUMOTO 5.00 X X 22750 0 471 DENISE KAY KASSEBAUM - DDS MS 4.00 X 18500 0 0 MARILYN E TAYLOR 4.00 X 21750 0 1819 CHERYL ANN WENZINGER CPA 4.00 X 17000 0 1392 DONALD S SAFER DDS MS 5.00 X 24750 0 244 OLIVIA THOMPSON 5.00 X 22250 0 0 GAIL SCHOETTLER PHD 4.00 X 25500 0 236 DOUGLAS BERKEY DMD MPH MS 4.00 X 19500 0 109 RICHARD L CALL DMD MS 4.00 X 19500 0 228 VICTOR LAZZARO JR 4.00 X 20250 0 1893 JONATHAN M ANDERSON - DDS 4.00 X 18750 0 0 THOMAS B SWAIN - DDS 4.00 X 18750 0 0 LARAE ORULLIAN 4.00 X 23500 0 236 RUSSELL JOSEPH SCHREIER 45.00 X 276703 0 17520 DAVID ANDREW BEAL 45.00 X 88514 0 2194 LINDA MARIE ARNESON 45.00 X 310753 0 36207 JESSICA JEAN LAWHEAD 45.00 X 328657 0 38879 BARBARA B SPRINGER JD 45.00 X 284725 0 42655 LORRI KOHLE 45.00 X 136971 0 15111 STEPHANIE RAZUI 45.00 X 159049 0 31721 MARY PEARCE 45.00 X 151313 0 17430 WILLIAM BAIER 45.00 X 0 0 0 DANEEN STANG 45.00 X 166751 0 25037 ROBERT MARK THOMPSON 45.00 X 209717 0 41838 3029869 0 315761 18 0 1 0 DELTA DENTAL OF VIRGINIA 4818 STARKEY ROAD SW ROANOKE VA 24018 CLAIMS PROCESSING 1577443 BMS DIRECT 37 MILLRACE DRIVE LUNCHBURG VA 24502 MAILING SERVICES 702086 BETA HEALTH SERVICES 9725 E HAMPDEN AVE 400 DENVER CO 80231 BROKERAGE SERVICES 402419 LOCKTON COMPANIES 8110 E UNION AVE 700 DENVER CO 80237 BROKERAGE SERVICES 356895 EMDEON 3055 LEBANON PIKE SUITE 1000 NASHVILLE TN 37214 CLAIMS CLEARING HOUSE 244611 29 RISK PLAN PREMIUMS 524114 120981789 120981789 SELF FUNDED PLAN PREMI 524114 116810824 116810824 ADMINISTRATION - SELF 524298 9275590 9275590 247068203 2125309 2125309 201443 201443 201443 201443 MISCELLANEOUS REVENUE 524298 205516 197818 7698 205516 249600471 247266021 7698 2326752 3934906 3934906 218333495 218333495 2345927 1876742 469185 7423582 5938866 1484716 364265 291412 72853 1118469 894775 223694 620075 496060 124015 90157 90157 101990 101990 1519253 1222550 296703 15737 15737 110846 88677 22169 532183 425746 106437 733531 586825 146706 271577 217262 54315 1142174 913739 228435 COMMISSIONS 4634220 4634220 DATA PROCESSING 1109988 887990 221998 POSTAGE 717059 573647 143412 PROMOTIONS 613241 490593 122648 FEES, LICENSES & DUES 449885 359907 89978 246182560 242183149 3999411 0 6636041 4975220 490436 182016 12700997 12884388 215154 239811 12590722 8983614 4050628 3607108 51476230 61112902 20010 20010 417598 445050 76007094 83466505 5078368 4669375 2772000 3766828 1545321 1781168 11252000 11249117 20647689 21466488 X 55359405 62000017 55359405 62000017 76007094 83466505 X 3417911 3222701 X 0 1 1 X 0 1065709 923421 142288 2194624 1758544 436080 9330389 6301649 3028740 3607108 PROVISION FOR UNPAID CLAIMS 11249117 11249117 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE COMPANY ADOPTED CERTAIN PROVISIONS OF ASC 740, INCOME TAXES, AS OF JANUARY 1, 2009. THE PROVISIONS CLARIFY THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS AND PRESCRIBE A RECOGNITION THRESHOLD AND MEASUREMENT STANDARD FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF AN INCOME TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE COMPANY HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN TAX YEARS AND HAS CONCLUDED THAT THE ADOPTION OF THE PROVISIONS DID NOT HAVE AN IMPACT ON THEIR CONSOLIDATED FINANCIAL STATEMENT PRESENTATION. 1 DELTA DENTAL OF COLORADO FOUNDATION 4582 S ULSTER ST SUITE 800 DENVER CO 80237 841389431 501(C)(3) 3767000 SUPPORTED ORGANIZATION OF THE COMPANY AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 5000 SUPPORT LOCAL 501(C)(3) ORGANIZATION BOYS & GIRLS CLUBS OF METRO DENVER 2017 WEST 9TH AVENUE DENVER CO 80204 840510404 501(C)(3) 5000 SUPPORT LOCAL 501(C)(3) ORGANIZATION BUSINESS COMMITTEE FOR THE ARTS INC (BCA) 29-27 QUEENS PLAZA NORTH LONG ISLAND CITY NY 11101 132596741 501(C)(3) 5000 CULTURE AND HUMANITIES COLORADO MISSION OF MERCY 3690 S YOSEMITE ST STE 100 DENVER CO 80237 271586585 501(C)(3) 10000 SUPPORT LOCAL 501(C)(3) ORGANIZATION COLORADO SYMPHONY ORCHESTRA 1000 14TH ST UNIT 15 DENVER CO 80202 840511458 501(C)(3) 5000 CULTURE AND HUMANITIES DENTAL AID 877 SOUTH BOULDER ROAD LOUISVILLE CO 80027 840717588 501(C)(3) 5000 SUPPORT LOCAL 501(C)(3) ORGANIZATION DENTAL ELITE 2009 N PIEDRA STREET MESA AZ 85207 320031941 501(C)(3) 6906 SUPPORT LOCAL 501(C)(3) ORGANIZATION DENVER ART MUSEUM 100 WEST 14TH AVE PARKWAY DENVER CO 80204 846038240 501(C)(3) 25000 CULTURE AND HUMANITIES DENVER CENTER FOR PERFORMING ARTS 1101 13ST STREET DENVER CO 80204 840407760 501(C)(3) 5000 CULTURE AND HUMANITIES DENVER HEALTH FOUNDATION 655 BROADWAY STE 750 MSC 0111 DENVER CO 802033420 841085196 501(C)(3) 10000 SUPPORT LOCAL 501(C)(3) ORGANIZATION DMNS-DENVER MUSEUM OF NATURE & SCIENCE 2001 COLORADO BLVD DENVER CO 80205 841035262 501(C)(3) 5000 CULTURE AND HUMANITIES EXCELSIOR YOUTH CENTER 3754 W INDIAN TRAIL RD SPOKANE WA 99208 911189908 501(C)(3) 5000 SUPPORT LOCAL 501(C)(3) ORGANIZATION GOODWILL INDUSTRIES OF DENVER 6850 N FEDERAL BLVD DENVER CO 80221 840405513 501(C)(3) 6000 SUPPORT LOCAL 501(C)(3) ORGANIZATION HOWARD DENTAL CENTER 1420 OGDEN ST DENVER CO 80218 841312498 501(C)(3) 5000 SUPPORT LOCAL 501(C)(3) ORGANIZATION JUVENILE DIABETES RESEARCH 120 WALL ST 19TH FLOOR NEW YORK NY 10005 231907729 501(C)(3) 10000 SUPPORT LOCAL 501(C)(3) ORGANIZATION KIND - KIDS IN NEED OF DENTISTRY 2465 S DOWNING SUITE 207 DENVER CO 80210 846038681 501(C)(3) 5000 SUPPORT LOCAL 501(C)(3) ORGANIZATION LONGMONT SYMPHONY SOCIETY PO BOX 74 LONGMONT CO 80502 840611954 501(C)(3) 5000 SUPPORT LOCAL 501(C)(3) ORGANIZATION MILE HIGH UNITED WAY 2505 18TH ST DENVER CO 80211 840404235 501(C)(3) 5000 SUPPORT LOCAL 501(C)(3) ORGANIZATION NAT FOUNDATION FOR DENTISTRY 1800 15TH ST STE 100 DENVER CO 80202 846129064 501(C)(3) 5000 SUPPORT LOCAL 501(C)(3) ORGANIZATION SAMARITAN INSTITUTE 2696 S COLORADO BLVD DENVER CO 80222 310951606 501(C)(3) 5000 SUPPORT LOCAL 501(C)(3) ORGANIZATION 22 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE COMPANY HAS PROCEDURES TO ASCERTAIN THAT ALL GRANTS ARE MADE TO 501C3 ORGANIZATIONS AND ARE PROPERLY APPROVED BY MANAGEMENT. ADDITIONALLY, THE ORGANIZATION REQUIRES PERIODIC REPORTS TO ASCERTAIN THAT SUBSTANTIAL GRANTS ARE USED FOR THEIR PROPER INTEDED PURPOSE. X X X X X 1 1 0 0 0 1 0 0 0 KATHRYN ANN PAUL 349481 0 246827 0 7908 0 32500 0 4938 0 641654 0 0 0 RUSSELL JOSEPH SCHREIER 108192 0 68442 0 100069 0 13607 0 3913 0 294223 0 0 0 LINDA MARIE ARNESON 216365 0 87080 0 7308 0 28139 0 8068 0 346960 0 0 0 JESSICA JEAN LAWHEAD 208305 0 113044 0 7308 0 27444 0 11435 0 367536 0 0 0 BARBARA B SPRINGER JD 197290 0 79527 0 7908 0 28436 0 14219 0 327380 0 0 0 LORRI KOHLE 97464 0 38907 0 600 0 13108 0 2003 0 152082 0 0 0 STEPHANIE RAZUI 79310 0 79739 0 0 0 16733 0 14988 0 190770 0 0 0 MARY PEARCE 138363 0 12350 0 600 0 14387 0 3043 0 168743 0 0 0 DANEEN STANG 76946 0 89205 0 600 0 9518 0 15519 0 191788 0 0 0 ROBERT MARK THOMPSON 141371 0 68146 0 200 0 24953 0 16885 0 251555 0 0 0 PART I, LINES 4A-B PART I, LINES 4A-B: IN 2010 RUSSELL JOSEPH SCHREIER RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $96,114.50 THE FOLLOWING PARTICIAPATED IN A NON-QUALIFIED RETIREMENT PLAN; HOWEVER NO DISBURSEMENTS WERE PAID IN 2010: KATHRYN ANN PAUL LINDA MARIE ARNESON ROBERT MARK THOMPSON PART I, LINE 6 THE COMPANY HAS AN INCENTIVE COMPENSATION PLAN AND A SALES INCENTIVE PLAN WHICH PROVIDES AN ANNUAL BONUS FOR ALL ELLGIBLE EMPLOYEES IF THE COMPANY REACHES CERTAIN GOALS INCLUDING A MINIMUM NET GAIN GOAL. ALL ACTIVE FULL TIME EMPLOYEES ARE ELIGIBLE FOR ONE OF THE INCENTIVE PLANS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS WHO ARE DEFINED AS PARTICIPATING DENTISTS WHO ARE ENGAGED IN THE PRACTICE OF DENTISTRY IN THE STATE OF COLORADO. THE PARTICIPATING DENTISTS ARE THOSE THAT HAVE SIGNED A PARTICIPATING DENTIST AGREEMENT WITH THE ORGANIZATION AS PRESCRIBED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE ORGANIZATION HAVE THE AUTHORITY TO ELECT THE BOARD OF TRUSTEES AT THE ANNUAL MEETING OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN MATTERS OF THE ORGANIZATION ARE SUBJECT TO A VOTE OF THE MEMBERS. A QUORUM OF 2% OF THE MEMBERSHIP IS REQUIRED. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION HAS AN AUDIT, INVESTMENT AND FINANCE COMMITTEE OF THE BOARD OF TRUSTEES THAT IS RESPONSIBLE FOR REVIEWING AND APPROVING THE FORM 990. THE ORGANIZATION ALSO HAS A COMPENSATION COMMITTEE THAT IS RESPONSIBLE FOR REVIEWING AND APPROVING THE COMPENSATION SCHEDULES WITHIN THE FORM 990. A DRAFT OF THE 990 IS ALSO PRESENTED TO THE GOVERNING BOARD OF TRUSTEES FOR REVIEW PRIOR TO BEING FILED. ONCE THE 990 HAS BEEN REVIEWED BY THE AUDIT, INVESTMENT AND FINANCE COMMITTEE AND THE GOVERNING BOARD OF TRUSTEES, THE AUDIT, INVESTMENT AND FINANCE COMMITTEE APPROVES THE 990 FOR FILING WITH THE INTERNAL REVENUE SERVICE. WE ENGAGE AN INDEPENDENT CPA TAX PROFESSIONAL TO PREPARE OUR 990, AND BOARD MEMBERS GENERALLY FEEL THIS IS THE APPROPRIATE FIDUCIARY PROCESS. THE AUDIT, INVESTMENT AND FINANCE COMMITTEE'S ROLE THEN IS TO EVALUATE THE FIRM HIRED TO PREPARE THE RETURN AND TO DETERMINE IT IS APPROPRIATELY FILED. WE HAVE TAKEN THOSE STEPS WITH OUR AUDIT, INVESTMENT AND FINANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 12C DDCO CONDUCTS ANNUAL COMPLIANCE TRAINING, WHICH IS MANDATORY FOR ALL EMPLOYEES TO ATTEND. THE CONFLICTS OF INTEREST POLICY IS DISCUSSED AT THIS TRAINING. ON AN ANNUAL BASIS, ALL EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT AND SUBMIT ANY POTENTIAL OR PERCEIVED CONFLICT OF INTEREST. RECEIPT OF ALL SIGNED & COMPLETED FORMS ARE TRACKED IN AN EXCEL FILE; ORIGINAL FORMS ARE KEPT IN THE PERSONNEL FILE IN THE HUMAN RESOURCES OFFICE. ANY REPORTED POTENTIAL OR PERCEIVED CONFLICTS ARE REVIEWED AND, IF NECESSARY, EMPLOYEES AND THEIR MANAGER ARE ADVISED TO REMOVE THEMSELVES FROM ANY SITUATION INVOLVING THE POTENTIAL CONFLICT. ADDITIONALLY, ALL NEW EMPLOYEES RECEIVE COMPLIANCE TRAINING AND ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT. EMPLOYEES ARE INSTRUCTED TO COMPLETE A NEW CONFLICT OF INTEREST STATEMENT DURING THE COURSE OF THE YEAR, SHOULD THEIR SITUATION CHANGE. THE CONFLICT OF INTEREST POLICY AND STATEMENT FORMS ARE POSTED ON THE COMPANY INTRANET. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION HAS A COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES THAT IS RESPONSIBLE FOR SETTING THE COMPENSATION OF THE PRESIDENT AND CEO. THE COMMITTEE ENGAGES THE SERVICES OF A THIRD PARTY TO PROVIDE RANGES OF COMPENSATION THAT ARE APPRORPRIATE FOR THE DUTIES REQUIRED BY THE POSITION OF THE PRESIDENT, AS WELL AS THE POSITIONS OF THE VICE PRESIDENTS. THE CEO AND PRESIDENT OF THE CORPORATION IS RESPONSIBLE FOR THE COMPENSATION PROCESS OF THE REMAINING OFFICERS OF THE ORGANIZATION. THE ORGANIZATION ENGAGES A THIRD PARTY TO PROVIDE RANGES OF ACCEPTABLE INCREASES AND COMPENSATION LEVELS OF AVERAGE SALARIES BY SALARY GRADE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAINTAINS COPIES OF THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS THAT ARE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION HAS A STATEMENT ON ITS WEBSITE THAT INFORMS THE PUBLIC THAT THESE DOCUMENTS ARE AVAILABLE FOR PUBLIC INSPECTION AT ITS CORPORATE HEADQUARTERS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 3,164,000. NET CHANGE IN UNRECOGNIZED NET PERIODIC BENEFIT COST 58,000. ROUNDING ADJUSTMENT 701. TOTAL TO FORM 990, PART XI, LINE 5: 3,222,701. DELTA DENTAL PLAN OF COLORADO FOUNDATION 4582 S ULSTER ST 800 DENVER CO 80237 841389431 DENTAL HEALTH AND EDUCATION CO 501(C)(3) LINE 11A, I N/A 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 DELTA DENTAL PLAN OF COLORADO FOUNDATION INC B 3766828 ACTUAL COST DELTA DENTAL PLAN OF COLORADO FOUNDATION INC I 123748 ACTUAL COST