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
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
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 $ 1,002,799,764
F Name and address of principal officer:
James D Dwyer
9706 Fourth 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 alloow us to deliver on our mission, 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 12
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 2011 (Part V, line 2a) ... 5 405
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) ......... 76,305 79,751
9 Program service revenue (Part VIII, line 2g) ......... 936,427,699 944,224,669
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 5,199,349 5,598,568
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 770,968 697,824
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 942,474,321 950,600,812
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 2,881,042 2,202,373
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 857,041,208 858,981,240
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 33,782,846 33,483,196
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).... 35,014,493 41,719,380
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 928,719,589 936,386,189
19 Revenue less expenses. Subtract line 18 from line 12....... 13,754,732 14,214,623
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 212,950,806 234,593,256
21 Total liabilities (Part X, line 26)............. 47,791,207 53,472,130
22 Net assets or fund balances. Subtract line 21 from line 20..... 165,159,599 181,121,126
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 use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
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 for employer 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 organization’s program service accomplishments for each of its three largest program services, as measured 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 $ 883,672,062 including grants of $ 0 ) (Revenue $ 944,079,845 )
Washington Dental Service (WDS) provides dental insurance for over 2,144,000 primary subscribers and their dependents throughout the state of Washington and across the nation. Working collectively with producers and benefit managers, we offer standard insurance benefits, as well as highly customized plans to meet the needs of individuals and their families. 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 2011, WDS processed over 4,775,000 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 the use of CDT codes, invoicing procedures and reducing common errors.
4b (Code:   ) (Expenses $ 1,489,300 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 2011, 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.
4c (Code:   ) (Expenses $ 1,313,371 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 six. In counties with ABCD, the utilization of dental services increased from 21% to 49% from 1997 to 2011. 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 their overall health.
(Code:   ) (Expenses $ 663,572 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 $ 560,000 including grants of $ 0 ) (Revenue $ 0 )
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 access to fluoridated water to more than 208,000 Washington residents.
(Code:   ) (Expenses $ 500,901 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 30,000 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 $ 333,018 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 $ 2,057,491 including grants of $ 0 ) (Revenue $ 0 )
4e Total program service expensesMediumBullet$ 888,532,224
Form 990 (2011)
Form 990 (2011)
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 for which 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 temporarily restricted endowments, permanent endowments, 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, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? 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
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements.
20b
 
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization 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 employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? 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
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, 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...
35b
 
No
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 (2011)
Form 990 (2011)
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
41,904
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
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
405
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 (2011)
Form 990 (2011)
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
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
12
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
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
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
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete 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
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did 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 15a or 15b, 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,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take 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
WA
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 made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
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 (2011)
Form 990 (2011)
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 (do not check more than one box, unless person is both an officer and a director/trustee) 		(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) Richard R Albrecht
Board of Directors
 5.5 X           55,396 0 0
(2) G Douglas Beck
Board of Directors - Treasurer
 8 X   X       51,324 0 0
(3) David W Branch
Board of Directors - Chair
 9 X   X       72,708 0 0
(4) David W Branch - Dental Claims
Clinical reimbursement
 0 X           236,036 0 0
(5) Patrick J Dineen
Board of Directors
 6 X           48,880 0 0
(6) Janis Harwell
Board of Directors
 6 X           44,808 0 0
(7) Robb B Heinrich
Board of Directors
 4.5 X           48,880 0 0
(8) John M Henricksen
Board of Directors
 6 X           45,308 0 0
(9) John M Henricksen - Dental Claims
Clinical reimbursement
 0 X           334,121 0 0
(10) Christine M Johnson
Board of Directors
 5.5 X           49,435 0 0
(11) Joanna Lohkamp
Board of Directors - Vice Chair
 7 X   X       62,526 0 0
(12) Jack E Neal
Board of Directors - Secretary
 4 X   X       44,808 0 0
(13) Gerald Phipps
Board of Directors / Board of Trustees
 7 X           51,324 0 0
(14) Allen W Puckett
Board of Directors
 5.5 X           48,880 0 0
(15) R Gary Schweikhardt
Board of Directors
 4 X           55,396 0 0
(16) Kristin Stred
Board of Directors
 3 X           4,000 0 0
(17) Remigius J Eussen
Trustee, Board of
 .5 X           6,516 0 0
Form 990 (2011)
Form 990 (2011)
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 (do not check more than one box, unless person is both an officer and a director/trustee) 		(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) Diana Gale
Trustee, Board of
 .5 X           6,516 0 0
(19) Frederick C Kiga
Trustee, Board of
 .5 X           6,516 0 0
(20) Hyeok Kim
Trustee, Board of
 .5 X           6,516 0 0
(21) W Kurt Labberton
Trustee, Board of
 .5 X           9,126 0 0
(22) W Kurt Labberton - Dental Claims
Clinical reimbursement
 0 X           184,045 0 0
(23) Thomas Locke
Trustee, Board of
 .5 X           7,868 0 0
(24) Russell Maier
Trustee, Board of
 .5 X           8,394 0 0
(25) Alejandro Narvaez
Chair; Trustee, Board of
 .5 X           7,432 0 0
(26) Eve Rutherford
Trustee, Board of
 .5 X           12,691 0 0
(27) James Daniel Dwyer
President & Chief Executive Officer
 40 X   X X     1,053,745 0 135,200
(28) Tracy Lynn Hoek-Warner
Senior VP, CFO, COO
 40     X X     631,355 0 101,719
(29) Ronald Edward Inge
VP, Dental Director & Professional Relations
 40       X     509,564 0 91,901
(30) John Theodore Bursett
Senior VP, Actuarial & Underwritting
 40       X     360,242 0 43,970
(31) Kristin Nielsen Merlo
VP, Sales & Marketing, CMO
 40       X     328,961 0 38,080
(32) Thomas Andrew Gates
VP, Planning & Corporate Development
 40       X     319,596 0 36,035
(33) John Poli
VP, CIO
 40       X     318,192 0 66,844
(34) Larry Leopold
VP, Human Resource
 40       X     223,722 0 7,929
(35) Laura Jean Smith
WDS Foundation, President & CEO
 40         X   291,342 0 68,923
(36) Larry Van Kuhl DDS
Senior Dental Consultant
 40         X   218,149 0 22,977
(37) Darryl J Liley
Director - Systems Operation
 40         X   188,274 0 29,628
(38) Jon P Allen
Director - Finance
 40         X   174,490 0 23,263
(39) Vincent L Ippolito
Director - Business Intelligence
 40         X   173,208 0 19,161
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 6,300,290 0 685,630
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet62
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. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
DeCare Systems
Unit 1 Curraheen Rd
  Cork Ireland  
EI 		Software Development 3,377,838
BIT LLC
710 SW 34th St
Renton,WA98057 		Printing and Mailing Services 2,628,182
TEK Systems
PO Box 198568
Atlanta,GA303848568 		IT contract labor and recruiting 2,216,549
PWC Advisory LLC
PO Box 514038
Los Angeles,CA900514038 		Consultants 1,475,185
TIG
PO Box 85244
San Diego,CA921865244 		Computer hardware vendor 1,143,891
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet70
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a 0
b Membership dues....1b 0
c Fundraising events....1c 0
d Related organizations...1d 20,480
e Government grants (contributions)1e 0
f All other contributions, gifts, grants, and
similar amounts not included above1f 		59,271
g Noncash contributions included in lines 1a-1f:$ 0
h Total. Add lines 1a-1f.......MediumBullet 79,751
Program Service Revenue Business Code
2a Premium Revenue 524,114 944,079,845 944,079,845 0 0
b Smilemobile (Mobile Dentist Office) 621,990 144,824 144,824 0 0
c
d
e
f All other program service revenue . 0 0 0 0
g Total. Add lines 2a–2f........MediumBullet 944,224,669
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 5,124,197 5,124,197 0 0
4 Income from investment of tax-exempt bond proceeds..MediumBullet 148,431 148,431 0 0
5 Royalties............MediumBullet 0 0 0 0
(i) Real (ii) Personal
6a Gross rents 551,929 0
b Less: rental expenses 0 0
c Rental income or (loss) 551,929 0
d Net rental income or (loss).......MediumBullet 551,929 0 0 551,929
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 53,486,359 -961,467
b Less: cost or other basis and sales expenses 52,198,952 0
c Gain or (loss) 1,287,407 -961,467
d Net gain or (loss)..........MediumBullet 325,940 325,940 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 .... 145,895 145,895 0 0
e Total. Add lines 11a–11d ......MediumBullet 145,895
12 Total revenue. See Instructions....MediumBullet 950,600,812 949,969,132 0 551,929
Form 990 (2011)
Form 990 (2011)
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).
Check if Schedule O contains a response to any question in this Part IX. .........
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 United States. See Part IV, line 21 587,240 587,240
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 1,615,133 1,615,133
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0 0
4 Benefits paid to or for members 858,981,240 858,981,240
5 Compensation of current officers, directors, trustees, and key employees .... 7,166,797 1,842,122 5,324,675 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 18,389,839 7,073,884 11,315,955 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,247,472 405,825 841,647 0
9 Other employee benefits ....... 4,611,140 1,709,321 2,901,819 0
10 Payroll taxes ........... 2,067,948 784,217 1,283,731 0
11 Fees for services (non-employees):        
a Management ...... 0 0 0 0
b Legal ......... 615,275 49,743 565,532 0
c Accounting ........... 317,225 4,800 312,425 0
d Lobbying ........... 74,108 74,108 0 0
e Professional fundraising. See Part IV, line 17.. 0 0
f Investment management fees ...... 521,696 0 521,696 0
g Other .......... 8,795,844 1,329,371 7,466,473 0
12 Advertising and promotion .... 2,520,684 1,489,300 1,031,384 0
13 Office expenses ....... 5,024,981 3,057,015 1,967,966 0
14 Information technology ...... 4,110,618 28,946 4,081,672 0
15 Royalties .. 0 0 0 0
16 Occupancy ........... 1,764,048 334,199 1,429,849 0
17 Travel ............ 1,007,598 396,458 611,140 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 .... 674,658 223,512 451,146 0
20 Interest ........... 30 0 30 0
21 Payments to affiliates ....... 0 0 0 0
22 Depreciation, depletion, and amortization ..... 3,622,617 48,935 3,573,682 0
23 Insurance .............. 185,322 0 185,322 0
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a Commissions 7,144,693 7,144,693 0 0
b Taxes and service charges 4,552,994 1,221,696 3,331,298 0
c Research & development 581,349 82,500 498,849 0
d Dues & subscriptions 205,640 47,966 157,674 0
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 936,386,189 888,532,224 47,853,965 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... -14,839,100 1 -15,486,692
2 Savings and temporary cash investments ....... 34,439,212 2 43,912,427
3 Pledges and grants receivable, net ......... 0 3  
4 Accounts receivable, net ......... 25,239,659 4 20,624,111
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5  
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  
7 Notes and loans receivable, net ............. 0 7 90,000
8 Inventories for sale or use .............. 0 8  
9 Prepaid expenses and deferred charges ............ 3,103,325 9 3,090,688
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 49,864,851
b Less: accumulated depreciation. ..... 10b 34,939,774 17,485,067 10c 14,925,077
11 Investments—publicly traded securities .......... 147,371,767 11 163,953,262
12 Investments—other securities. See Part IV, line 11 ...... 150,876 12 566,067
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ......... 0 14  
15 Other assets. See Part IV, line 11 ...........   15 2,918,316
16 Total assets. Add lines 1 through 15 (must equal line 34)... 212,950,806 16 234,593,256
Liabilities 17 Accounts payable and accrued expenses . 43,716,496 17 48,773,205
18 Grants payable .......... 0 18 1,163,185
19 Deferred revenue .......... 4,074,711 19 3,535,740
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 (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 0 25  
26 Total liabilities. Add lines 17 through 25..... 47,791,207 26 53,472,130
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 ..... 165,159,599 27 181,121,126
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 ..... 165,159,599 33 181,121,126
34 Total liabilities and net assets/fund balances ..... 212,950,806 34 234,593,256
Form 990 (2011)
Form 990 (2011)
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
950,600,812
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
936,386,189
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
14,214,623
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
165,159,599
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
1,746,904
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
181,121,126
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 (2011)
Additional Data


Software ID: 11000129
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
2011
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, line 35c (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 in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$ 126,100
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 function activities ...................................SchCMd Bullet

$ 126,100
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$ 126,100
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) Senate Republican Leadership Council
  		PO Box 11025
Olympia,WA98508 		91-1714860 10,000 0
(2) The Reagan Fund
  		PO Box 904
Olympia,WA98507 		91-1716818 10,000 0
(3) The Roosevelt Fund
  		Po Box 45201
Seattle,WA98145 		91-1713677 5,000 0
(4) Harry Truman Fund
  		PO Box 9100
Seattle,WA98109 		91-1769570 5,000 0
(5) Citizens for Lt Governor Brad Owen
  		PO Box 1426
Seattle,WA98584 		76-0843646 3,200 0
(6) Washington State Democrats
  		PO Box 4027
Seattle,WA98194 		91-1135732 2,500 0
(7) Washington State Republicans
  		11811 NE 1st St Suite A306
Bellevue,WA98005 		91-0486656 2,500 0
(8) Gael Tarleton for Port Commissioner
  		PO Box 9100
Seattle,WA98109 		20-8378002 1,600 0
(9) Gary Alexander for State Representative
  		PO Box 48
Olympia,WA985070048 		51-0575921 1,600 0
(10) Committee to Elect Barbara Bailey
  		PO Box 374
Oak Harbor,WA98277 		02-0556800 1,600 0
(11) Committee to Elect Don Benton
  		PO Box 5076
Vancouver,WA98686 		51-0645142 1,600 0
(12) The Committee to Elect Eileen Cody
  		5209 36th Ave SW
Seattle,WA98126 		91-1646573 1,600 0
(13) Jeanne Darneille
  		PO Box 7753
Tacoma,WA984170753 		21-6521757 1,600 0
(14) Committee to Re-Elect Richard DeBolt
  		1673 South Market Blvd PMB 159
Chehalis,WA985323830 		20-3271760 1,600 0
(15) Friends to Re-Elect Mike Hewitt
  		177 Electric Ave
Walla Walla,WA99362 		33-1084713 1,600 0
(16) Friends of Laurie Jinkins
  		PO Box 2032
Tacoma,WA98401 		27-2214467 1,600 0
(17) Steve Kirby Campaign
  		9415 Tacoma Ave South
Tacoma,WA98444 		71-1000906 1,600 0
(18) Committee to Elect Joel Kretz
  		1014 Toroda Creek Rd
Wauconda,WA98859 		27-2630585 1,600 0
(19) Citizens for Stephen Litzow
  		7683 SE 27th Street
Mercer Island,WA98040 		26-2303979 1,600 0
(20) People for Joe Schmick
  		PO Box 620
Colfax,WA99111 		45-0582705 1,600 0
(21) People for Zarelli
  		PO Box 65727
Vancouver,WA98665 		91-2067783 1,600 0
(22) Bill Bryant for Seattle Port Commission
  		PO Box 2756
Seattle,WA98111 		20-8451661 1,600 0
(23) Citizens for Glenn Anderson
  		PO Box 1682
Issaquah,WA98027 		91-1985715 800 0
(24) Committee to Elect Jan Angel
  		5184 Granada Place SE
Port Orchard,WA98367 		26-2302911 800 0
(25) Committee to Re-Elect Mike Armstrong
  		PO Box 2974
Wenatchee,WA98801 		20-3767438 800 0
(26) Committee to Elect Kartina Asay
  		PO Box 766
Milton,WA98354 		27-2777880 800 0
(27) Committee to Elect Brian Blake
  		PO Box 1514
Longview,WA98632 		87-0699800 800 0
(28) Citizens for Jeff Baxter
  		1521 N Argonne Road C137
Spokane Valley,WA99212 		45-1660683 800 0
(29) Friends to Elect Randi Becker
  		PO Box 83
Graham,WA98338 		77-0708976 800 0
(30) Friends of Andy Billig
  		PO Box 145
Spokane,WA99210 		27-1127517 800 0
(31) Campaign for Lisa Brown
  		1428 W 14th Ave
Spokane,WA99204 		91-1576127 800 0
(32) Citizens for Vincent Buys
  		PO Box 25
Lynden,WA98264 		27-1476576 800 0
(33) Bruce Chandler Campaign
  		PO Box 1108
Zillah,WA98953 		91-2066326 800 0
(34) Reuven Carlyle for State Representative
  		PO Box 9100
Seattle,WA98109 		26-1852908 800 0
(35) Citizens for Mike Carrell
  		10210 Lake Louise Dr SW
Lakewood,WA98498 		74-2968382 800 0
(36) Citizens for Frank Chopp
  		1000 Aurora Ave North N100
Seattle,WA98109 		32-0020852 800 0
(37) Judy Clibborn for State Representative
  		PO Box 808
Mercer Island,WA98040 		01-0649609 800 0
(38) Committee to Elect Cary Condotta
  		PO Box 3001
Wenatchee,WA98807 		71-0896890 800 0
(39) Committee to Elect Cathy Dahlquist
  		1348 Florence St
Enumclaw,WA98022 		27-2819445 800 0
(40) Committee to Elect Bruce Dammeier
  		PO Box 398
Puyallup,WA98371 		91-2141093 800 0
(41) Citizens for Mary Lou Dickerson
  		3515 NE 103rd St
Seattle,WA98125 		68-0510673 800 0
(42) Friends of Susan Fagan
  		PO Box 1471
Pullman,WA99163 		26-4513295 800 0
(43) Friends of David Frockt
  		PO Box 2114
Seattle,WA98111 		27-1548039 800 0
(44) Committee to Elect Tami Green
  		10316 93rd St SW
Lakewood,WA984981957 		20-5073891 800 0
(45) Kathryn Haigh Campaign Committee
  		81 SE Walker Park Road
Shelton,WA98584 		27-0763404 800 0
(46) House Democratic Campaign Committee
  		1000 Aurora Ave North N100
Seattle,WA98109 		91-6178946 800 0
(47) Committee to Elect Larry Haler
  		1860 McMurray Ave
Richland,WA99354 		20-1624033 800 0
(48) Campaign to Elect Paul Harris
  		1916 SE 130th Ave
Vancouver,WA98683 		27-2531536 800 0
(49) Bob Hasegawa for State Representative
  		PO Box 84331
Seattle,WA98124 		20-1930625 800 0
(50) Committee to Elect Jim Hargrove
  		556 Ocean Beach Road
Hoquim,WA98550 		45-3697171 800 0
(51) People for Brian Hatfield
  		226 Fir Street
Raymond,WA98577 		43-1966915 800 0
(52) Committee to Re-Elect Mary Margaret Haugen
  		1268 N Olsen Road
Camano Island,WA98282 		91-2085148 800 0
(53) Campaign to Re-Elect Bill Hinkle
  		PO Box 919
Ellensburg,WA98926 		26-2768576 800 0
(54) House Republican Organizational Committee
  		PO Box 7222
Olympia,WA985077222 		91-6177625 800 0
(55) People for Zack Hudgins
  		4512 South 136th St
Tukwila,WA981683271 		81-0555017 800 0
(56) Sam Hunt for State Representative
  		PO Box 2573
Olympia,WA98507 		33-1007463 800 0
(57) Friends for Ross Hunter
  		PO Box 4204
Bellevue,WA980094204 		04-3645222 800 0
(58) Citizens for Christopher Hurst
  		62504 Indian Summer Way E
Enumclaw,WA98022 		01-0841227 800 0
(59) Norm Johnson for State Representative
  		55 West Washington Ave Ste 83
Yakima,WA98903 		80-0190629 800 0
(60) Citizens for Ruth Kagi
  		19553 35th NE
Lake Forest Park,WA98155 		91-1914967 800 0
(61) Friends of Troy Kelley
  		2521 Fremont St
Tacoma,WA98406 		20-3888484 800 0
(62) Committee to Re-Elect Phyllis Gutierrez Kenney
  		PO Box 15314
Seattle,WA98115 		91-1704805 800 0
(63) Curtis King for State Senate
  		PO Box 10025
Yakima,WA98909 		20-8314962 800 0
(64) Friends for Dan Kristiansen
  		PO Box 2007
Snohomish,WA98291 		91-2064816 800 0
(65) Connie Ladenburg Campaign Committee
  		PO Box 111928
Tacoma,WA98411 		27-2793228 800 0
(66) Citizens for Marcie Maxwell
  		PO Box 2048
Renton,WA98056 		26-1784481 800 0
(67) Committee to Elect Jim Moeller
  		1701 Broadway Ste 328
Vancouver,WA98663 		45-0476516 800 0
(68) Committee to Elect Jeff Morris
  		1004 Commercial Ave Ste 303
Anacortes,WA98221 		91-1921313 800 0
(69) Committee to Re-Elect Ed Orcutt
  		PO Box 1280
Kalama,WA98625 		90-0038949 800 0
(70) People for Timm Ormsby
  		PO Box 2177
Spokane,WA992102177 		55-0876251 800 0
(71) Friends of Tina Orwell
  		17837 First Ave S PMB 299
Normandy Park,WA98148 		45-3602805 800 0
(72) Citizens to Elect Jason Overstreet
  		PO Box 1203
Blaine,WA98231 		27-2221211 800 0
(73) Committee to Elect Kevin Parker
  		PO Box 198
Spokane,WA99210 		26-0348064 800 0
(74) Committee to Re-Elect Linda Evans Parlette
  		PO Box 2151
Wenatchee,WA98807 		91-1715910 800 0
(75) People for Pedersen
  		815 First Ave Ste 111
Seattle,WA98104 		20-3979617 800 0
(76) Friends to Elect Eric Pettigrew
  		PO Box 28660
Seattle,WA98118 		53-4801080 800 0
(77) Friends of Cheryl Pflug
  		23705 230th Place SE
Maple Valley,WA98038 		91-2000754 800 0
(78) Committee to Elect Margarita Prentice
  		6245 South Langston Road
Seattle,WA98178 		91-2066629 800 0
(79) Pridemore for State Senate
  		1111 Main Street Ste 400
Vancouver,WA98660 		20-0665954 800 0
(80) Elect Tim Probst
  		3205 NE 160th St
Ridgefield,WA98642 		26-2359148 800 0
(81) Citizens for Kevin Ranker
  		PO Box 92
Deer Harbor,WA98243 		26-2438684 800 0
(82) Friends of Ann Rivers
  		PO Box 957
La Center,WA98629 		27-1512372 800 0
(83) Committee to Elect Mary Helen Roberts
  		3924 149th PL SW
Lynnwood,WA98087 		77-0621137 800 0
(84) Friends for Jay Rodne
  		PO Box 2848
Issaquah,WA98027 		47-3922332 800 0
(85) People for Christine Rolfes
  		19689 7th Ave NE PMB 118
Poulsbo,WA98370 		32-0172015 800 0
(86) Committee to Re-Elect Charles Ross
  		PO Box 996
Naches,WA98937 		26-3352534 800 0
(87) Friends for Cindy Ryu
  		15021 Aurora Ave N
Shoreline,WA98133 		20-2771557 800 0
(88) Senate Committee for Mark Schoesler
  		1588 East Rosenoff
Ritzville,WA99169 		04-3779321 800 0
(89) Senate Democratic Campaign Committee
  		PO Box 45042
Seattle,WA98145 		91-6163985 800 0
(90) Citizens to Elect Larry Seaquist
  		PO Box 821
Gig Harbor,WA98335 		20-4220154 800 0
(91) Shelly for State
  		PO Box 37
Addy,WA99101 		68-0674661 800 0
(92) Committee to Elect Larry Springer
  		700 20th Ave W
Kirkland,WA98033 		83-0382872 800 0
(93) Senate Republican Campaign Committee
  		PO Box 11025
Olympia,WA98508 		91-0987396 800 0
(94) Friends of Derek Stanford
  		PO Box 2041
Bothell,WA98041 		27-2317624 800 0
(95) Citizens for Val Stevens
  		PO Box 3236
Arlington,WA98223 		91-1550229 800 0
(96) Re-Elect Pat Sullivan Campaign
  		26513 168th PL SE
Covington,WA98042 		04-3679431 800 0
(97) Committee to Elect Dave Taylor
  		1661 Beane Road
Moxee,WA98936 		26-4761911 800 0
(98) Maureen Walsh
  		PO Box 461
Walla Walla,WA99362 		29-4723755 800 0
(99) Committee to Elect Kevin Van De Wege
  		10 Sable Court
Sequim,WA98382 		20-0522366 800 0
(100) Committee to Elect JT Wilcox
  		PO Box 747
McKenna,WA98558 		27-0758934 800 0
(101) Citizens for Jim McIntire
  		PO Box 21941
Seattle,WA98111 		26-0820856 500 0
(102) People for Randi Dorn
  		3718 19th Ave CT SE
Puyallup,WA98372 		61-1561950 500 0
(103) Jim Kastama Secretary of State
  		PO Box 1271
Tacoma,WA98401 		53-3504205 500 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) 2011

Schedule C (Form 990 or 990-EZ) 2011
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 expenses, and share of excess lobbying expenditures).
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) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
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)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(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? ..........................
 
 
 
j
Total. Add 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 carry over 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) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible 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, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
SchC_P1A_S00_L01 Schedule C, Part I-A, Line 1 Washington Dental Service contributed $126,100.00 to 104 political campaigns for individuals running for Washington state political offices. Contributions to each campaign ranged from a low of $500.00 to a high of $10,000.00.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID: 11000129
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, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
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 can 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 through 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, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax 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 (ASC 958), 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 (ASC 958), 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 (ASC 958), 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) 2011

Schedule D (Form 990) 2011
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 Net investment earnings, gains, and 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 (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
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
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (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 11,944,240 8,405,559 3,538,681
c Leasehold improvements ............ 0 1,214,757 749,744 465,013
d Equipment ................ 0 9,293,767 7,365,273 1,928,494
e Other ................. 0 26,200,896 18,419,198 7,781,698
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 14,925,077
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
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) must 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) must 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) must 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) Book value
Federal Income Taxes  








Total. (Column (b) must 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) 2011

Schedule D (Form 990) 2011
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 through 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 must 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 must 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) 2011

Additional Data


Software ID: 11000129
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
2011
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) King County Water District III27224 144th Ave SE
Kent,WA98042 		91-0825473   510,000       Fluoridation equipment
(2) Kittitas County Health Department507 Nanum
Ellensburg,WA98926 		91-6001349   27,134 0     Second year of Access to Baby and Child Dentistry Program
(3) Grant County Health District1038 W Ivy Ave
No 1
Moses Lake,WA98837 		91-6001319   20,106 0     Third year of Access to Baby and Child Dentistry Program
(4) Adams County Health District425 E Main Street
Suite 700
Othello,WA99344 		91-6001294   20,000 0     Third year of Access to Baby and Child Dentistry program
(5) Spokane Regional Health District1101 West College Avenue
Spokane,WA99201 		91-1527532   10,000 0     Second year of Access to Baby and Child Dentistry program for Lincoln County














2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
19
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
0
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
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) Expand Yakima clinic 1 250,000 0    
(2) Equipment for new clinic in Hilltop area - Tacoma 1 200,000 0    
(3) Dental care for the uninsured in King County 1 182,103 0    
(4) Portable oral health services for Seniors 1 123,159 0    
(5) Engagement of primary care physicians in delvery of oral health services 1 100,000 0    
(6) Expand access to dental care for low-income uninsured adults and seniors 1 90,015 0    
(7) Two year grant to integrate oral health into early learning coalition by developing a toolkit. 1 75,020 0    
(8) Community Health Center Learning Sessions 1 65,024 0    
(9) New volunteer clinic in Spokane in partnership with Yakima Valley Farmworkers Community Health Center 1 50,810 0    
(10) Develop research based messages and communication tools to promote community water fluoridation 1 50,000 0    
(11) Partnership with early learning community to improve oral health in young children 1 45,000 0    
(12) First year of Accrss to Baby and Child Dentistry program 1 35,000 0    
(13) State Home Visiting Match to expand home visiting programs for Washington's youngest children 1 20,000 0    
(14) Returned grant funds from Community Health Association 1 -4,016 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) 2011


Additional Data


Software ID: 11000129
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
2011
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 or provision 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. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
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
Yes
 
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 Regulations 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) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(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 as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) James Daniel Dwyer (i)
(ii)		 543,400
0 		487,734
0 		22,611
0 		113,831
0 		21,369
0 		1,188,945
0 		1,141,148
0
(2) Tracy Lynn Hoek-Warner (i)
(ii)		 418,645
0 		181,534
0 		31,177
0 		86,717
0 		15,002
0 		733,075
0 		599,675
0
(3) Ronald Edward Inge (i)
(ii)		 329,740
0 		163,878
0 		15,945
0 		78,545
0 		13,356
0 		601,464
0 		545,189
0
(4) Laura Jean Smith (i)
(ii)		 183,419
0 		95,650
0 		12,273
0 		274,465
0 		11,704
0 		577,511
0 		318,301
0
(5) Thomas Andrew Gates (i)
(ii)		 224,463
0 		86,133
0 		9,001
0 		96,919
0 		22,753
0 		439,269
0 		293,987
0
(6) John Theodore Bursett (i)
(ii)		 228,006
0 		116,885
0 		15,351
0 		24,750
0 		19,220
0 		404,212
0 		347,710
0
(7) Kristin Nielsen Merlo (i)
(ii)		 223,760
0 		99,269
0 		5,932
0 		13,289
0 		24,791
0 		367,041
0 		317,410
0
(8) John Poli (i)
(ii)		 216,865
0 		96,709
0 		4,618
0 		47,209
0 		19,635
0 		385,036
0 		351,062
0
(9) Larry Leopold (i)
(ii)		 119,940
0 		92,821
0 		10,961
0 		2,215
0 		5,714
0 		231,651
0 		286,236
0
(10) Larry Van Kuhl DDS (i)
(ii)		 170,634
0 		44,490
0 		3,026
0 		8,917
0 		14,060
0 		241,127
0 		217,773
0
(11) Darryl J Liley (i)
(ii)		 155,358
0 		34,007
0 		-1,091
0 		11,117
0 		18,511
0 		217,902
0 		184,499
0
(12) Jon P Allen (i)
(ii)		 143,353
0 		31,895
0 		-758
0 		9,262
0 		14,001
0 		197,753
0 		183,450
0
(13) Vincent L Ippolito (i)
(ii)		 135,584
0 		37,220
0 		485
0 		8,032
0 		11,129
0 		192,450
0 		189,172
0



Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 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, for those occasional trips where spousal travel is customary, 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 a 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 a 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, automobile allowance, certain auto expenses and health club dues are paid for senior Management, 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, which 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 substantial risk of forfeiture as required by Code section 409(a): James Daniel Dwyer, President and CEO $97,331; Tracy Lynn Hoek-Warner, Exec VP COO/CFO $70,217; Ronald Edward Inge, VP & Dental Director, $62,045; John Poli, VP CIO, $36,052; Laura Jean Smith, Foundation President, $47,062.
Schedule J (Form 990) 2011

Additional Data


Software ID: 11000129
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
2011
Open to Public
Inspection
Name of the organization
WASHINGTON DENTAL SERVICE
 
Employer identification number

91-0621480
Identifier Return Reference Explanation
F990_P06_S0A_L04 Form 990, Part VI, Section A, Line 4 The following changes to Washington Dental Service's By-laws were made in 2011: Change the definition of "Public" director to the "independence" concept defined by the IRS, as required by DDPA; clarify that the CEO is no longer counted as a "Public" director since employees are not "independent" under the IRS definition; eliminate the "equal numbers" requirement for Member and Public directors, and replace it with the DDPA requirement for an independent majority; change the range of Board sizes from 10-to-14 down to 9-to-13; add typical language describing how staggered terms of directors work, and authorizing the Board to maintain roughly equal classes as Board size is gradually reduced; clarify that directors who have reached their 3-full-terms limit can in some cases be appointed to short transitional terms if needed for continuity purposes; clarify that the Board Chair is elected every year and will usually serve two 1-year terms, or sometimes three if needed for continuity or to address extraordinary circumstances; members may vote by proxy; most Committee members will now be appointed by the full Board of Directors, rather than by the Board Chair; the vote requirement for amending or repealing Bylaws is increased to two-thirds of the members' votes; the Corporation must now prepare and mail an annual report to each member; the date of the annual meeting of members is now fixed on the second Friday of November unless impracticable; the minimum notice for the annual meeting is shortened to 30 days from 45 days; the annual meeting venue must be within 20 miles of the principal corporate office and must accommodate 25% of the members; the variable quorum percentage for annual board elections is eliminated, and now requires at least a 10% turnout; authorization of the use of ballots in voting for directors, on plebiscites and on Bylaws amendments is now eliminated and explicit "majority voting" procedures are no longer included as part of the member-director election process.
F990_P06_S0A_L06 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 The Governance & Nominating Committee (GNC) of the Board of Directors solicits advice on candidates and submits nominees to the Board for consideration and approval to be voted upon. The entire membership elects and re-elects Member Directors, who comprise a minority of the Board. The incumbent Independent Directors nominate and elect or re-elect Independent Directors. A Member Advisory Panel (MAP) consisting of ten to fifteen members are selected by the Board from nominees by the GNC. The MAP provides consultation to the GNC and Board on a variety of matters.
F990_P06_S0A_L07b 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_L11b Form 990, Part VI, Section B, Line 11b 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 The Audit 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 The board appoints a Human Resources and Compensation Committee of the Board, none of whom has 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 CEO). 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 similar 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 committee members present during the discussion of compensation packages (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 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 website. 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 Reportable compensation for board members David Branch, John Henrickson and Kurt Labberton include compensation paid, under their personal tax ID number, for dental treatment services rendered as a member dentist of Washington Dental Service of: $236,036, $334,121 and $184,045, respectively.
F990_P11_S00_L05 Form 990, Part XI, Line 5 Prior year adjustment ($31,000); Change in unrealized gains (losses) $2,265,490; Change in accumulated other comprehensive income (AOCI) $89,304; and other than temporary impairment (OTTI) of investments ($576,890).
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID: 11000129
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
2011
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 5,445,044 3,244,414 N/A
(2) Washington Dental Service Holdings LLC
9706 Fourth Ave NE
Seattle,WA98115
91-0621480 		Invest in Oral Health Activities WA -415,789 13,842,237 N/A
(3) Institute for Oral Health
9706 Fourth Ave NE
Seattle,WA98115
91-0621480 		Support Oral Health Education WA 663,572 13,446 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) 2011
Schedule R (Form 990) 2011
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) 2011
Schedule R (Form 990) 2011
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 related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related 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)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(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 Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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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