Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2010 and ending 12-31-2010
BCheck if applicable:
CName of organization
WASHINGTON DENTAL SERVICE
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
9706 4th Ave NE
 
Room/suite
City or town, state or country, and ZIP + 4
Seattle, WA98115
D Employer identification number

91-0621480
E Telephone number

G Gross receipts $ 1,027,285,694
F Name and address of principal officer:
Tracy Hoek-Warner
9706 4th Ave NE
Seattle,WA98115
I
Tax-exempt status: ( 4 ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.deltadentalwa.com
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1954
M State of legal domicile: WA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: 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.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 14
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 7
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 377
6 Total number of volunteers (estimate if necessary) .... 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 96,855 76,305
9 Program service revenue (Part VIII, line 2g) ......... 918,936,828 936,427,699
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 6,967,515 5,199,349
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 572,766 770,968
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 926,573,964 942,474,321
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 3,630,381 2,881,042
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 846,875,985 857,041,208
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 37,115,772 33,782,846
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 34,600,511 35,014,493
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 922,222,649 928,719,589
19 Revenue less expenses. Subtract line 18 from line 12...... 4,351,315 13,754,732
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 193,963,479 212,950,806
21 Total liabilities (Part X, line 26)............ 57,789,762 47,791,207
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 136,173,717 165,159,599
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: 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.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 882,344,413 including grants of $ 0 ) (Revenue $ 936,303,376 )
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.
4b (Code:   ) (Expenses $ 1,000,000 including grants of $ 0 ) (Revenue $ 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.
4c (Code:   ) (Expenses $ 1,358,736 including grants of $ 0 ) (Revenue $ 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.
(Code:   ) (Expenses $ 237,000 including grants of $ 0 ) (Revenue $ 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.
(Code:   ) (Expenses $ 475,782 including grants of $ 0 ) (Revenue $ 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.
(Code:   ) (Expenses $ 1,365,252 including grants of $ 0 ) (Revenue $ 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.
(Code:   ) (Expenses $ 603,875 including grants of $ 0 ) (Revenue $ 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.
(Code:   ) (Expenses $ 106,813 including grants of $ 0 ) (Revenue $ 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.
4d Other program services. (Describe in Schedule O.)
(Expenses $ 2,788,722 including grants of $ 0 ) (Revenue $ 0 )
4e Total program service expensesMediumBullet$ 887,491,871
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule A.....................
1
 
No
2
Is the organization required to complete Schedule B, Schedule of Contributors? ........
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
Yes
 
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part I.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part II...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III ....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IV...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part V
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. .....
20b
 
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II...........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III...............
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
 
No
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2...
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2...........
36
 
 
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
39,347
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
1
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
377
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
 
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
 
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
 
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
14
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
7
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
Washington Dental Service
9706 4th Avenue NE
Seattle,WA981152157
(206) 522-1300
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) James Daniel Dwyer
President & CEO, Board of Directors, Board of Trustees
 40 X     X     1,006,758 0 134,390
(2) Richard R Albrecht
Board of Directors
 3 X           42,937 0 0
(3) G Douglas Beck
Board of Directors - Treasurer
 3 X   X       39,862 0 0
(4) David W Branch
Board of Directors - Chair, Board of Trustees
 3 X   X       306,453 0 0
(5) Patrick J Dineen
Board of Directors
 3 X           36,458 0 0
(6) Roberta Greene
Board of Directors - Vice Chair / Board of Trustees - Chair
 3 X   X       50,852 0 0
(7) Robb B Heinrich
Board of Directors
 3 X           37,172 0 0
(8) John M Henricksen
Board of Directors
 3 X           391,278 0 0
(9) Christine M Johnson
Board of Directors
 3 X           48,493 0 0
(10) Joanna Lohkamp
Board of Directors
 3 X           44,457 0 0
(11) Jack E Neal
Board of Directors - Secretary
 3 X   X       33,448 0 0
(12) Gerald Phipps DMD
Board of Directors / Board of Trustees
 3 X           39,970 0 0
(13) Allen W Puckett
Board of Directors
 3 X           48,492 0 0
(14) R Gary Schweikhardt
Board of Directors
 3 X           42,957 0 0
(15) Remigius J Eussen
Trustee, Board of
 3 X           6,481 0 0
(16) Eve Rutherford
Trustee, Board of
 3 X           9,996 0 0
(17) Irene F Hunter
Trustee, Board of
 3 X           6,458 0 0
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Frederick C Kiga
Trustee, Board of
 3 X           6,458 0 0
(19) Kurt Labberton
Trustee, Board of
 3 X           211,216 0 0
(20) Thomas Locke
Trustee, Board of
 3 X           7,379 0 0
(21) Russell Maier MD
Trustee, Board of
 3 X           8,230 0 0
(22) Neil L McReynolds
Trustee, Board of
 3 X           6,372 0 0
(23) Alejandro Alex Narvaez DDS
Trustee, Board of
 3 X           79,968 0 0
(24) Diana Gale
Trustee, Board of Directors
 3 X           6,458 0 0
(25) Hyeok Kim
Trustee, Board of Directors
 3 X           6,458 0 0
(26) Tracy Lynn Hoek-Warner
Executive VP, CFO & COO
 40       X     497,686 0 101,989
(27) John Theodore Bursett
VP, Actuarial & Underwriting
 40       X     303,612 0 44,097
(28) John Poli
Vice President, CIO
 40       X     285,108 0 65,955
(29) Kristin Nielsen Merlo
VP, Sales & Marketing
 40       X     279,457 0 37,954
(30) Larry Leopold
VP Human Resources
 40       X     257,464 0 29,674
(31) Thomas Andrew Gates
VP, Planning & Corporate Development
 40       X     256,561 0 36,522
(32) Ronald Edward Inge
VP, Dental Director & Professional Relations
 40       X     448,308 0 96,880
(33) Laura Jean Smith
Foundation, President & CEO
 40         X   251,918 0 66,383
(34) Larry Van Kuhl DDS
Senior Dental Consultant
 40         X   194,090 0 23,683
(35) Vincent L Ippolito
Director Business Intelligence
 40         X   166,149 0 23,023
(36) Darryl J Liley
Director - Systems Operation
 40         X   156,052 0 28,447
(37) Jon P Allen
Director - Finance
 40         X   163,335 0 20,116
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 5,784,801 0 709,113
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet50
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
DeCare Systems
Unit 1 Curraheen Rd
  Cork Ireland  
EI 		Software Development 2,837,660
BIT LLC
710 SW 34th St
Renton,WA98057 		Printing and Mailing Services 2,264,703
PWC Advisory LLC
PO Box 514038
Los Angeles,CA900514038 		Consultants 1,686,117
TEK Systems
PO Box 198568
Atlanta,GA303848568 		IT contract labor and recruiting 986,409
Point B Solutions
PO Box 34935
Seattle,WA98124 		Business Process Consultants 886,212
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet47
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a 0
b Membership dues....1b 0
c Fundraising events....1c 0
d Related organizations...1d 18,785
e Government grants (contributions)1e 0
f All other contributions, gifts, grants, and
similar amounts not included above1f 		57,520
g Noncash contributions included in lines 1a-1f:$ 0
h Total. Add lines 1a-1f.......MediumBullet 76,305
Program Service Revenue Business Code
2a Premium Revenue 524,114 936,303,377 936,303,377 0 0
b Smile Mobile 621,990 124,322 124,322 0 0
c
d
e
f All other program service revenue . 0 0 0 0
g Total. Add lines 2a–2f........MediumBullet 936,427,699
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 4,731,399 4,731,399 0 0
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0 0 0 0
5 Royalties............MediumBullet 0 0 0 0
(i) Real (ii) Personal
6a Gross Rents 519,952 0
b Less: rental expenses 0 0
c Rental income or (loss) 519,952 0
d Net rental income or (loss).......MediumBullet 519,952 0 0 519,952
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 86,667,919 -1,388,596
b Less: cost or other basis and sales expenses 84,811,373 0
c Gain or (loss) 1,856,546 -1,388,596
d Net gain or (loss)..........MediumBullet 467,950 467,950 0 0
8a Gross income from fundraising events (not including
$ 0
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue .... 251,016 251,016 0 0
e Total. Add lines 11a–11d ......MediumBullet 251,016
12 Total revenue. See Instructions....MediumBullet 942,474,321 941,878,064 0 519,952
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 359,136 359,136
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 2,521,906 2,521,906
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16    
4 Benefits paid to or for members 857,041,208 857,041,208
5 Compensation of current officers, directors, trustees, and key employees .... 5,883,396 1,501,456 4,381,940 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0 0 0 0
7 Other salaries and wages 19,998,265 7,465,571 12,532,694 0
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 1,258,674 366,012 892,662 0
9 Other employee benefits ....... 4,404,311 1,491,410 2,912,901 0
10 Payroll taxes ........... 2,238,200 728,040 1,510,160 0
11 Fees for services (non-employees):        
a Management ...... 0 0 0 0
b Legal ......... 631,536 84,858 546,678 0
c Accounting ........... 250,399 0 250,399 0
d Lobbying ........... 67,407 67,407 0 0
e Professional fundraising. See Part IV, line 17.. 0 0
f Investment management fees ...... 615,729 0 615,729 0
g Other .......... 4,715,373 1,240,366 3,475,007 0
12 Advertising and promotion .... 2,161,993 1,365,253 796,740 0
13 Office expenses ....... 4,613,027 2,946,949 1,666,078 0
14 Information technology ...... 3,144,829 146,697 2,998,132 0
15 Royalties .. 0 0 0 0
16 Occupancy ........... 1,803,411 730,238 1,073,173 0
17 Travel ............ 840,145 339,612 500,533 0
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0 0 0 0
19 Conferences, conventions, and meetings .... 618,757 189,508 429,249 0
20 Interest ........... 0 0 0 0
21 Payments to affiliates ....... 0 0 0 0
22 Depreciation, depletion, and amortization ..... 3,712,636 206,659 3,505,977 0
23 Insurance .............. 179,424 0 179,424 0
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a Producer Commissions 7,042,022 7,042,022 0 0
b Taxes & Services Charges 4,129,514 1,608,126 2,521,388 0
c Research & Development 250,618 1,813 248,805 0
d Dues & Subscriptions 237,673 47,624 190,049 0
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 928,719,589 887,491,871 41,227,718 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... -23,012,669 1 -14,839,100
2 Savings and temporary cash investments ....... 66,761,860 2 34,439,212
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 38,107,122 4 25,239,659
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 0 8 0
9 Prepaid expenses and deferred charges ............ 3,313,075 9 3,103,325
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 60,562,957
b Less: accumulated depreciation. ..... 10b 43,077,890 15,197,308 10c 17,485,067
11 Investments—publicly traded securities .......... 89,925,577 11 147,371,767
12 Investments—other securities. See Part IV, line 11 ...... 1,320,007 12 150,876
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 2,351,199 15  
16 Total assets. Add lines 1 through 15 (must equal line 34)... 193,963,479 16 212,950,806
Liabilities 17 Accounts payable and accrued expenses . 54,493,561 17 43,716,496
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 3,296,201 19 4,074,711
20 Tax-exempt bond liabilities .......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities. Complete Part X of Schedule D.....   25 0
26 Total liabilities. Add lines 17 through 25..... 57,789,762 26 47,791,207
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 136,173,717 27 165,159,599
28 Temporarily restricted net assets ..... 0 28 0
29 Permanently restricted net assets ..... 0 29 0
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 136,173,717 33 165,159,599
34 Total liabilities and net assets/fund balances ..... 193,963,479 34 212,950,806
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
942,474,321
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
928,719,589
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
13,754,732
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
136,173,717
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
15,231,150
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
165,159,599
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID: 10000077
Software Version: v1.00
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
WASHINGTON DENTAL SERVICE
 
Employer identification number

91-0621480
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$ 78,400
3
Volunteer hours ........................................
0

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$ 0
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$ 78,400
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$ 78,400
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
(1) Gary Alexander for State Representative
  		PO Box 48
Olympia,WA98507 		51-0575921 800 0
(2) Committee to Elect Barbara Bailey
  		PO Box 374
Oak Harbor,WA98277 		02-0556800 800 0
(3) Committee to Elect Tom Campbell
  		PO Box 443
Spanaway,WA98387 		91-1558175 800 0
(4) Bruce Chandler Campaign
  		PO Box 1108
Zillah,WA98953 		91-2066326 800 0
(5) Citizens for Frank Chopp
  		1000 Aurora Ave N
N - 100
Seattle,WA98109 		32-0020852 800 0
(6) Judy Clibborn for State Representative
  		PO Box 808
Mercer Island,WA98040 		01-0649609 800 0
(7) The Committee to Elect Eileen Cody
  		5209 36th Ave SW
Seattle,WA98126 		91-1646573 800 0
(8) Citizens to Elect Steve Conway
  		PO Box 112020
Tacoma,WA98411 		01-0735404 500 0
(9) Committee to Elect Bruce Dammeier
  		PO Box 398
Puyallup,WA98371 		91-2141093 800 0
(10) Committe to Re-Elect Richard DeBolt
  		1673 South Market Blvd
PMB 159
Chehalis,WA98532 		20-3271760 800 0
(11) Committee to Elect Jerome Delvin
  		PO Box 1113
Richland,WA99352 		53-8587144 800 0
(12) Citizens for John Driscoll
  		2525 E 29th Ave SE
10B PMB 344
Spokane,WA99223 		27-0763404 800 0
(13) Committee to Re-Elect Tracey Eide
  		28303 Sound View Dr S
202
Des Moines,WA98198 		03-0430031 800 0
(14) Committee to Elect Doug Ericksen
  		PO Box 5191
Bellingham,WA98227 		82-0553277 800 0
(15) Committee to Elect Tami Green
  		10316 93rd St SW
Lakewood,WA98498 		60-2632403 800 0
(16) Kathryn Haigh Campaign Committee
  		81 SE Walker Park Rd
Shelton,WA98584 		29-9527931 500 0
(17) House Democratic Campaign Committee
  		1000 Aurora Ave N
N-100
Seattle,WA98109 		91-6178946 800 0
(18) Bob Hasegawa for State Representative
  		PO Box 84331
Seattle,WA98124 		20-1930625 500 0
(19) Campaign to Re-Elect Bill Hinkle
  		PO Box 919
Ellensburg,WA98926 		26-2768576 800 0
(20) Committee to Elect Steve Hobbs
  		3309 114th Dr NE
Lake Stevens,WA98258 		20-4733784 800 0
(21) Committee to Re-Elect Senator Holmquist
  		PO Box 429
Moses Lake,WA98823 		80-0435914 800 0
(22) Committee to Elect Jim Honeyford
  		PO Box 844
Sunnyside,WA98944 		91-2070291 800 0
(23) House Republican Organizational Committee
  		PO Box 7222
Olympia,WA98507 		91-6177625 800 0
(24) People for Zach Hudgins
  		4512 S 136th St
Tukwila,WA98168 		81-0555017 800 0
(25) Sam Hunt for State Representative
  		PO Box 2573
Olympia,WA98507 		33-1007463 500 0
(26) Friends for Ross Hunter
  		PO Box 4204
Bellevue,WA98009 		04-3645222 800 0
(27) Citizens for Christopher Hurst
  		62504 Indian Summer Way E
Enumclaw,WA98022 		01-0841227 800 0
(28) Friends of Jim Jacks
  		PO Box 65849
Vancouver,WA98665 		26-2365416 500 0
(29) Citizens for Ruth Kagi
  		19553 35th NE
Lake Forest Park,WA98155 		91-1914967 500 0
(30) Friends of Karen Keiser
  		25657 Marine View Dr S
Des Moines,WA98198 		91-1947669 800 0
(31) Friends of Troy Kelley
  		2521 Fremont St
Tacoma,WA98406 		20-3888484 800 0
(32) Committee to Re-Elect Phyllis Gutierrez Kenney
  		PO Box 15314
Seattle,WA98115 		91-1704805 250 0
(33) Friends of Derek Kilmer
  		PO Box 1574
Gig Harbor,WA98335 		73-1700577 800 0
(34) Steve Kirby Campaign
  		9415 Tacoma Ave S
Tacoma,WA98444 		71-1000906 800 0
(35) Committee to Re-Elect Senator Adam Kline
  		PO Box 28720
Seattle,WA98118 		03-0469833 800 0
(36) Friends of Jeanne Kohl-Welles
  		2212 Queen Anne Ave N
Seattle,WA98109 		91-1559456 800 0
(37) Committee to Elect Joel Kretz
  		1014 Toroda Creek Rd
Wauconda,WA98859 		27-2630585 800 0
(38) Friends for Dan Kristiansen
  		PO Box 2007
Snohomish,WA98291 		91-2064816 800 0
(39) People for Linville
  		PO Box 5782
Bellingham,WA98227 		32-0172179 800 0
(40) Chris Marr for State Senate
  		PO Box 2025
Spokane,WA99210 		20-4064476 800 0
(41) Re-Elect John R McCoy
  		PO Box 1821
Marysville,WA98270 		91-2068458 800 0
(42) Committee to Elect Jim Moeller
  		1701 Broadway
328
Vancouver,WA98663 		45-0476516 800 0
(43) Committee to Re-Elect Dawn Morrell
  		2106 Manorwood Dr SE
Puyallup,WA98374 		01-0679962 800 0
(44) Committee to Elect Jeff Morris
  		1004 Commercial Ave
303
Anacortes,WA98221 		91-1921313 800 0
(45) Friends of Ed Murray
  		1122 E Pike St
799
Seattle,WA98122 		91-1729391 800 0
(46) Friends of Sharon Nelson
  		7318 SW 258th Pl
Vashon,WA98070 		26-1377785 500 0
(47) Committee to Elect Kevin Parker
  		PO Box 198
Spokane,WA98210 		26-0348064 800 0
(48) People for Pedersen
  		815 First Ave
111
Seattle,WA98104 		20-3979617 800 0
(49) Friends to Elect Eric Pettigrew
  		PO Box 28660
Seattle,WA98118 		53-4801080 800 0
(50) Citizens for Pam Roach
  		22102 SE Green Valley Rd
Auburn,WA98002 		91-1940414 800 0
(51) The Roosevelt Fund
  		PO Box 45201
Seattle,WA98145 		91-1713677 2,500 0
(52) Committee to Re-Elect Charles Ross
  		PO Box 996
Naches,WA98937 		26-3352534 800 0
(53) People for Joe Schmick
  		PO Box 620
Colfax,WA99111 		45-0582705 800 0
(54) Senate Democratic Campaign Committee
  		PO Box 45042
Seattle,WA98145 		91-6163985 800 0
(55) Citizens to Elect Larry Seaquist
  		PO Box 821
Gig Harbor,WA98335 		20-4220154 800 0
(56) Committee to Re-Elect Geoff Simpson
  		27015 169th PL SE
Covington,WA98042 		91-1749036 800 0
(57) Committee to Elect Larry Springer
  		700 20th AVE W
Kirkland,WA98033 		83-0382872 800 0
(58) The Reagan Fund
  		PO Box 904
Olympia,WA98507 		91-1716818 5,000 0
(59) Senate Republican Campaign Committee
  		PO Box 11025
Olympia,WA98508 		91-0987396 800 0
(60) Re-Elect Pat Sullivan Campaign
  		26513 168th PL SE
Covington,WA98042 		04-3679431 800 0
(61) Friends for Rodney Tom
  		PO Box 594
Medina,WA98039 		57-1234123 800 0
(62) Harry Truman Fund
  		PO Box 9100
Seattle,WA98109 		91-1769570 2,500 0
(63) People for Scott White
  		9009 27th Ave NE
Seattle,WA98115 		26-0853518 500 0
(64) Friends of Hans Dunshee
  		1526 Lakeview Ave
Snohomish,WA98290 		91-1729071 500 0
(65) Citizens for Jim McIntire
  		PO Box 21941
Seattle,WA98111 		26-0820856 500 0
(66) Robert McKenna Campaign Committee
  		PO Box 955
Mercer Island,WA98040 		83-0377709 1,000 0
(67) Committee to Re-Elect Ed Orcutt
  		PO Box 1280
Kalama,WA98625 		90-0038949 800 0
(68) Committee to Elect Mary Helen Roberts
  		3924 149th PL SW
Lynnwood,WA98087 		77-0621137 500 0
(69) Friends for Jay Rodne
  		PO Box 2848
Issaquah,WA98027 		20-1125805 1,600 0
(70) People for Christine Rolfes
  		19689 7th AVE NE
PMB 118
Poulsbo,WA98370 		32-0172015 500 0
(71) Friends of Santos
  		PO Box 78606
Seattle,WA98178 		91-1913482 800 0
(72) Maureen Walsh
  		PO Box 461
Walla Walla,WA98362 		29-4723755 500 0
(73) The Leadership Council
  		401 NE Ravenna
110
Seattle,WA98115 		91-1714860 5,000 0
(74) Norm Johnson for State Representative
  		55 W Washington Ave
83
Yakima,WA98903 		80-0190629 1,600 0
(75) Liias for Legislature
  		PO Box 821
Mukilteo,WA98275 		26-0696977 250 0
(76) Elect Tim Probst
  		3205 NE 160th St
Ridgefield,WA98642 		26-2359148 500 0
(77) Friends of Susan Ragan
  		PO Box 1471
Pullman,WA99163 		26-4513295 500 0
(78) Committee for Robert Morton
  		3278 Pierre Lake Rd
Kettle falls,WA99141 		91-1549978 1,600 0
(79) Citizens for Andy Hill
  		23515 NE Novelty Hill Rd
Ste B2
Redmond,WA98053 		27-2057163 1,600 0
(80) Citizens for Stephen Litzow
  		7683 SE 27th St
Mercer Island,WA98040 		26-2303979 1,600 0
(81) Friends of Carol Gregory
  		PO Box 3796
Federal Way,WA98063 		26-2460820 500 0
(82) Friends of Mike Heavey
  		2348 Alki Ave SW
206
Seattle,WA98116 		27-2118176 500 0
(83) Citizens for Mary Lou Dickerson
  		3515 NE 103rd St
Seattle,WA98125 		68-0510673 250 0
(84) Friends of Andy Billig
  		PO Box 145
Spokane,WA99210 		27-1127517 500 0
(85) Friends for Luis Moscoso
  		PO Box 422
Mountlake Terrace,WA98043 		27-3021660 250 0
(86) Friends of Deb Eddy
  		6619 132nd Ave
PMB 149
Kirkland,WA98033 		20-4604798 500 0
(87) Committee to Elect Sherry Appleton
  		PO Box 2140
Poulsbo,WA98370 		01-0699667 500 0
(88) Friends of Chris Reykdal
  		855 Trosper Rd
Ste 108-117
Tumwater,WA98512 		27-1751460 500 0
(89) Friends of David Frockt
  		PO Box 2114
Seattle,WA98111 		27-1548039 250 0
(90) Paull Shin for State Senate
  		PO Box 5036
Lynnwood,WA98046 		52-9504029 250 0
For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
 
c
Media advertisements? ....................................
 
 
 
d
Mailings to members, legislators, or the public? .........................
 
 
 
e
Publications, or published or broadcast statements? .......................
 
 
 
f
Grants to other organizations for lobbying purposes? .......................
 
 
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
 
 
i
Other activities? If "Yes," describe in Part IV ..........................
 
 
 
j
Total. lines 1c through 1i ...................................
 
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
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
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID: 10000077
Software Version: v1.00

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
WASHINGTON DENTAL SERVICE
 
Employer identification number

91-0621480
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....      
b Contributions ........      
c Investment earnings or losses ...      
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses ....      
g End of year balance ......      
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet  
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ................. 0 1,211,191 1,211,191
b Buildings ................ 0 12,028,489 8,124,852 3,903,637
c Leasehold improvements ............ 0 1,161,103 726,878 434,225
d Equipment ................ 0 16,235,685 14,128,872 2,106,813
e Other ................. 0 29,926,489 20,097,288 9,829,201
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 17,485,067
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  








Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet  
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Schedule D (Form 990) 2010

Additional Data


Software ID: 10000077
Software Version: v1.00




Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
WASHINGTON DENTAL SERVICE
 
Employer identification number
91-0621480
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) Adams County Health District425 E Main St
Ste 700
Othello,WA99344 		91-6001294   20,500 0     Second year of Access to Baby and Child Dentistry program
(2) Asotin County Health Department431 Elm St
Clarkston,WA99403 		26-4483600   28,000 0     Third year of Access to Baby and Child Dentistry program
(3) City of Tacoma747 Market St
Ste 132
Tacoma,WA98402 		91-6001283   202,000 0     Fluoridation project for groundwater treatment
(4) Grant County Health District1038 W Ivy Ave
No 1
Moses Lake,WA98837 		91-6001319   40,791 0     Second year Access to Baby and Child Dentistry program
(5) Kittitas County Health Department507 Nanum
Ellensburg,WA98926 		91-6001349   21,787 0     First year of Access to Baby and Child Dentistry Program
(6) Spokane Regional Health District1101 W College Ave
Spokane,WA99201 		91-1527532   10,000 0     First year for Access to Baby and Child Dentistry program
(7) Department of Social Health ServicesPO Box 45010
Olympia,WA98504 		91-6001088   100,000 0     Development of the Washington state benefit portal










2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
7
3
Enter total number of other organizations ................................ . Bullet Image
0
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) Dental equipment to expand Wenatchee clinic 1 125,000 0    
(2) Engagement of primary care physicians in delivery of oral health services 1 100,000 0    
(3) Dental equipment to support a new clinic in Oroville, and expand access to care. 1 100,000 0    
(4) Partnership with early learning community to improve oral health in young children. 1 45,000 0    
(5) State Home Visiting Match Fund to expand home visiting programs for Washington's youngest children 1 15,000 0    
(6) Expand access to seniors by opening a new clinic in Vancouver 1 90,000 0    
(7) Increase capacity to serve more pregnant women and young children through purchasing equipment for two dental operatories 1 65,000 0    
(8) Maintain access to dental care for low-income residents of Snohomish, Skagit and Whatcom counties through dental van purchase. 1 50,000 0    
(9) Funding for mobile van to serve the North Puget Sound Region, and increase access to dental care. 1 32,000 0    
(10) Expand access to care for seniors by purchasing equipment and expanding an existing clinic 1 250,000 0    
(11) Develop research based messages and communication tools to promote community water fluoridation 1 35,000 0    
(12) Incorporate oral health into Aging and Long Term Care programs and services in Yakima. 1 54,780 0    
(13) New volunteer clinic in Spokane to increase access to dental care 1 192,000 0    
(14) Prenatal Curriculum for practicing dentists, in cooperation with the University of Washington 1 20,000 0    
(15) Funding to provide cumulative metrics for community health centers in Washington state 1 4,500 0    
(16) Funding for the Community Health Center Directors Dental Learning Network 1 58,321 0    

Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
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.
Schedule I (Form 990) 2010


Additional Data


Software ID: 10000077
Software Version: v1.00


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
WASHINGTON DENTAL SERVICE
 
Employer identification number

91-0621480
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) James Daniel Dwyer (i)
(ii)		 531,430
0 		450,000
0 		25,328
0 		113,831
0 		20,559
0 		1,141,148
0 		1,098,333
0
(2) Tracy Lynn Hoek-Warner (i)
(ii)		 346,038
0 		141,911
0 		9,737
0 		86,717
0 		15,272
0 		599,675
0 		656,149
0
(3) Ronald Edward Inge (i)
(ii)		 317,834
0 		122,046
0 		8,429
0 		78,545
0 		18,335
0 		545,189
0 		607,557
0
(4) John Theodore Bursett (i)
(ii)		 221,378
0 		67,693
0 		14,542
0 		24,750
0 		19,347
0 		347,710
0 		406,766
0
(5) John Poli (i)
(ii)		 203,220
0 		72,754
0 		9,133
0 		44,063
0 		21,892
0 		351,062
0 		396,336
0
(6) Kristin Nielsen Merlo (i)
(ii)		 201,323
0 		69,541
0 		8,593
0 		13,259
0 		24,694
0 		317,410
0 		356,642
0
(7) Thomas Andrew Gates (i)
(ii)		 184,225
0 		66,076
0 		7,164
0 		13,866
0 		22,656
0 		293,987
0 		333,769
0
(8) Larry Leopold (i)
(ii)		 175,508
0 		67,254
0 		13,799
0 		11,105
0 		18,570
0 		286,236
0 		332,393
0
(9) Laura Jean Smith (i)
(ii)		 173,328
0 		70,233
0 		8,357
0 		54,409
0 		11,974
0 		318,301
0 		347,148
0
(10) Larry Van Kuhl DDS (i)
(ii)		 162,021
0 		30,958
0 		1,111
0 		9,411
0 		14,272
0 		217,773
0 		228,037
0
(11) Vincent L Ippolito (i)
(ii)		 140,272
0 		25,231
0 		646
0 		11,222
0 		11,801
0 		189,172
0 		202,263
0
(12) Jon P Allen (i)
(ii)		 138,500
0 		24,792
0 		42
0 		11,080
0 		9,036
0 		183,450
0 		0
0
(13) Darryl J Liley (i)
(ii)		 132,999
0 		23,923
0 		-870
0 		9,931
0 		18,516
0 		184,499
0 		197,115
0



Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
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.
Schedule J (Form 990) 2010

Additional Data


Software ID: 10000077
Software Version: v1.00
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
WASHINGTON DENTAL SERVICE
 
Employer identification number

91-0621480
Identifier Return Reference Explanation
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).
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID: 10000077
Software Version: v1.00
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
WASHINGTON DENTAL SERVICE
 
Employer identification number

91-0621480
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity







(1) Washington Dental Service Foundation LLC
9706 Fourth Ave NE
Seattle,WA98115
91-0621480 		Sponsor Oral Health Education WA 5,040,243 4,479,402 N/A
(2) Washington Dental Service Holdings LLC
9706 Fourth Ave NE
Seattle,WA98115
91-0621480 		Invest in Oral Health Activities WA 53,922 13,779,025 N/A
(3) Institute for Oral Health
9706 Fourth Ave NE
Seattle,WA98115
91-0621480 		Support Oral Health Education WA 603,875 -10,383 N/A






Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) Washington Dental Service Fund

9706 Fourth Ave NE

Seattle,WA98115
91-1281990 		Sponsor Oral Health Education WA 501(c)(3) 9 N/A
 
No












For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership












Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Washington Dental Service Fund

 c 18,785 Cash
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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