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 private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 01-01-2013 , 2013, and ending 12-31-2013
BCheck if applicable:
CName of organization
Delta Dental of Washington
 
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 province, country, and ZIP or foreign postal code
Seattle, WA98115
D Employer identification number

91-0621480
E Telephone number

G Gross receipts $ 1,084,477,896
F Name and address of principal officer:
Bradley A Berg
9706 4th Ave NE
Seattle,WA98115
I
Tax-exempt status: ( 4 ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.deltadentalwa.com
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
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: Delta Dental of Washington (DDWA) will revolutionize the oral health industry and improve overall health.
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 2013 (Part V, line 2a) ...... 5 392
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) ......... 29,355 18,932
9 Program service revenue (Part VIII, line 2g) ......... 960,572,322 1,012,247,971
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 5,545,830 10,233,517
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 787,412 630,289
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 966,934,919 1,023,130,709
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,855,929 2,817,976
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 872,239,309 921,250,711
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 36,217,291 38,427,111
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–24e).... 36,673,445 44,387,862
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 946,985,974 1,006,883,660
19 Revenue less expenses. Subtract line 18 from line 12....... 19,948,945 16,247,049
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 256,524,052 264,323,604
21 Total liabilities (Part X, line 26)............. 50,215,555 48,592,063
22 Net assets or fund balances. Subtract line 21 from line 20..... 206,308,497 215,731,541
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 MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: DDWA will revolutionize the oral health industry and improve overall health. This includes, but is not limited to, the following: to secure dental services for employer groups, individuals and their families; provide innovative products and services; to encourage, foster and finance professional and scientific study and research in the general field of oral health; and 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 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 $ 951,353,955 including grants of $ 0 ) (Revenue $ 1,011,850,565 )
DDWA provides dental insurance for over 2,365,000 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 over 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 2013, DDWA processed over 5,175,000 claims for subscribers and their dependents. To ensure providers are submitting claims appropriately, we audited nearly 42,000 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 $ 2,432,266 including grants of $ 1,009,014 ) (Revenue $ 0 )
DDWA promotes the benefits of oral health through marketing efforts in print, direct mail, TV, radio, online media and event sponsorships. In 2013, the marketing and advertising campaign continued to reach 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 $ 1,699,434 including grants of $ 1,699,434 ) (Revenue $ 0 )
Dental decay is the single most common chronic disease of early childhood - five times more common than asthma. Nearly one in five adults, nationally, has untreated dental cavities. The Washington Dental Service Foundation (the Foundation), a wholly owned subsidiary of DDWA, supported almost exclusively by DDWA, 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 51% from 1997 to 2013. 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 $ 530,924 including grants of $ 0 ) (Revenue $ 0 )
DDWA is engaged in efforts to promote evidenced based dental care through the Institute for Oral Health (IOH), a non-profit wholly owned subsidiary of DDWA. 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 $ 132,000 including grants of $ 109,528 ) (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 $ 515,931 including grants of $ 0 ) (Revenue $ 105,546 )
Assisting the work of the Foundation are DDWA employees volunteering their time. DDWA 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 $ 160,542 including grants of $ 0 ) (Revenue $ 0 )
DDWA 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.
(Code:   ) (Expenses $ 826,000 including grants of $ 0 ) (Revenue $ 0 )
DDWA supported the University of Washington's School of Dentistry by creating the DDWA Dentist of the Future fund. This fund provides training for dental students and practicing dentists emphasizing evidence based instruction, inter-professional education, risk assessment and behavioral changes and more fully incorporating oral health into overall health in patient management.
4d Other program services (Describe in Schedule O.)
(Expenses $ 2,165,397 including grants of $ 109,528 ) (Revenue $ 105,546 )
4e Total program service expensesMediumBullet957,651,052
Form 990 (2013)
Form 990 (2013)
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 (see instructions)? ...
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, or have a section 501(h) election in effect during the tax year? 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 for escrow or custodial account liability; 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, line 10?
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 and XII .................
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 and XII 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, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
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 (see instructions)....
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 hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government 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 or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 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 lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................
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
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, 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 direct or indirect 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, Part II, III, or IV, and Part 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
 
 
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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
45,299
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
392
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” to line 3b, 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, securities account, or other financial 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 as charitable contributions?...
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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
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 or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
12
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
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
 
No
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 this 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:
MediumBulletBradley Berg9706 4th Avenue NESeattleWA981152157 (206) 522-1300
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line 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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Dr G Douglas Beck........................................................................
Board of Directors - Vice Chair
 10
........................5 		X   X       67,428 0 0
(2) Dr David W Branch........................................................................
Board of Directors
 10
........................5 		X           59,324 0 0
(3) Dr David W Branch - Dental Claims........................................................................
Clinical reimbursement
 0
.......................0 		X           258,894 0 0
(4) Mr Patrick J Dineen........................................................................
Board of Directors - Treasurer
 7
.......................0 		X   X       48,880 0 0
(5) Ms Janis L Harwell........................................................................
Board of Directors
 7.0
.......................0 		X           53,880 0 0
(6) Ms Anne Farrell........................................................................
Board of Directors
 5
.......................0 		X           0 0 0
(7) Ms Joanna L Lohkamp........................................................................
Board of Directors - Chair
 12.0
........................5 		X   X       80,708 0 0
(8) Dr Jack E Neal........................................................................
Board of Directors - Secretary
 6.0
.......................0 		X   X       44,808 0 0
(9) Dr Gerald Phipps........................................................................
Board of Directors / Board of Trustees
 15
........................5 		X           60,396 0 0
(10) Mr Allen W Puckett........................................................................
Board of Directors
 5.0
.......................0 		X           46,808 0 0
(11) Ms Kristin Stred........................................................................
Board of Directors
 5.0
.......................0 		X           53,880 0 0
(12) Mr James F Tune........................................................................
Board of Directors
 8.0
.......................0 		X           47,808 0 0
(13) W Kurt Labberton - Dental Claims........................................................................
Clinical reimbursement
 0
.......................0 		X           214,364 0 0
(14) James Daniel Dwyer........................................................................
President & Chief Executive Officer
 40
.......................0 		X   X X     1,163,101 0 78,109
(15) Ronald Edward Inge........................................................................
VP, Dental Director & Prof. Relations
 40
.......................0 		      X     1,089,971 0 129,454
(16) Bradley Alan Berg........................................................................
Chief Operating & Financial Officer
 40
.......................0 		      X     549,273 0 143,224
(17) Venkataraman Chittoor........................................................................
Chief Information Officer
 40
.......................0 		      X     447,790 0 134,601
Form 990 (2013)
Form 990 (2013)
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 (list any hours for related organizations below dotted line) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Kristin Nielsen Merlo........................................................................
Chief Marketing Officer, VP Sales
 40
.......................0 		      X     427,845 0 125,632
(19) Thomas Andrew Gates........................................................................
VP, Planning & Corp. Development
 40
.......................0 		      X     424,321 0 102,084
(20) Susan Siclari Webber........................................................................
Chief Human Resources Officer
 40
.......................0 		      X     400,314 0 103,270
(21) Eric Che-Teh Lo........................................................................
VP Actuarial & Underwriting
 40
.......................0 		      X     278,816 0 63,277
(22) Laura Jean Smith........................................................................
WDS Foundation, President & CEO
 40
.......................0 		        X   320,349 0 60,526
(23) John Theodore Bursett........................................................................
Senior VP, Underwriting/Actuarial
 32
.......................0 		        X   295,932 0 53,519
(24) James Christopher Darnell........................................................................
Director of Sales
 40
.......................0 		        X   240,476 0 53,782
(25) Linda Jo Lay........................................................................
Director - Account Management
 40
.......................0 		        X   230,166 0 46,598
(26) Susan Lisa Curhan........................................................................
Director Marketing & Product Mgmt.
 40
.......................0 		        X   208,130 0 51,954








1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 7,113,662 0 1,146,030
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet82
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
Emdeon Business ServicesPO BOX 572490MurrayUT841572490 Printing/mailing services 3,262,031
GreenRubino Inc1938 Fairview Ave ESeattleWA98102 Advertising agency 2,930,933
DeCare SystemsUnit 1 Curraheen RdCork IrelandEI Software Development 2,572,626
Presidio Networked Solutions7601 Ora Glen DriveSte 100GreenbeltMD20770 Network Infrastructure 1,558,562
Aon Consulting IncPO Box 905494CharlotteNC282905494 Insurance broker 1,350,638
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet73
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a 0
b Membership dues....1b 0
c Fundraising events....1c 0
d Related organizations...1d 11,700
e Government grants (contributions)1e 0
f All other contributions, gifts, grants, and
similar amounts not included above1f 		7,232
g Noncash contributions included in lines
1a-1f:$ 		0
h Total. Add lines 1a-1f.......MediumBullet 18,932
Program Service RevenueAmt Business Code
2a Premium Revenue 524114 1,011,850,565 1,011,850,565 0 0
b Smilemobile (Mobile Dentist Office) 621990 105,456 105,456 0 0
c Other Program Service Revenue 900099 291,950 291,950 0 0
d
e
f All other program service revenue . 0 0 0 0
g Total. Add lines 2a–2f........MediumBullet 1,012,247,971
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 6,213,677 6,213,677 0 0
4 Income from investment of tax-exempt bond proceeds..MediumBullet 288,026 288,026 0 0
5 Royalties...........MediumBullet 0 0 0 0
(i) Real (ii) Personal
6a Gross rents 630,289 0
b Less: rental expenses 0 0
c Rental income or (loss) 630,289 0
d Net rental income or (loss).......MediumBullet 630,289 0 0 630,289
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 65,079,001 0
b Less: cost or other basis and sales expenses 60,200,900 1,146,287
c Gain or (loss) 4,878,101 -1,146,287
d Net gain or (loss)..........MediumBullet 3,731,814 3,731,814 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 .... 0 0 0 0
e Total. Add lines 11a–11d ...... MediumBullet 0
12 Total revenue. See Instructions......MediumBullet 1,023,130,709 1,022,481,488 0 630,289
Form 990 (2013)
Form 990 (2013)
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).Check if Schedule O contains a response or note to any line 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 2,817,976 2,817,976
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0 0
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 921,250,711 921,250,711
5 Compensation of current officers, directors, trustees, and key employees .... 6,759,466 3,156,609 3,602,857 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 22,861,499 8,047,480 14,814,019 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,438,915 491,618 947,297  
9 Other employee benefits ....... 5,117,411 2,009,316 3,108,095  
10 Payroll taxes ........... 2,249,820 946,900 1,302,920  
11 Fees for services (non-employees):        
a Management ...... 0 0 0 0
b Legal ......... 712,355 26,718 685,637 0
c Accounting ........... 289,232 0 289,232  
d Lobbying ........... 73,255 73,255 0 0
e Professional fundraising services. See Part IV, line 17 0 0
f Investment management fees ...... 636,914 0 636,914 0
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 7,158,580 2,355,614 4,802,966 0
12 Advertising and promotion .... 4,462,809 2,432,266 2,030,543 0
13 Office expenses ....... 5,214,245 3,095,342 2,118,903 0
14 Information technology ...... 2,736,854 263,149 2,473,705 0
15 Royalties .. 0 0 0 0
16 Occupancy ........... 1,800,733 777,944 1,022,789 0
17 Travel ............ 1,456,270 504,708 951,562 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 .... 818,474 253,564 564,910 0
20 Interest ........... 0 0 0 0
21 Payments to affiliates ....... 0 0 0 0
22 Depreciation, depletion, and amortization ..... 4,246,207 38,053 4,208,154 0
23 Insurance .............. 230,117 0 230,117 0
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a Commissions 7,819,528 7,819,528 0 0
b Taxes & service charges 5,296,312 1,135,445 4,160,867 0
c Research & development 233,742 0 233,742 0
d Dues & subscriptions 684,539 77,888 606,651 0
e All other expenses 517,696 76,968 440,728 0
25 Total functional expenses. Add lines 1 through 24e 1,006,883,660 957,651,052 49,232,608 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 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. -12,598,875 1 -12,060,969
2 Savings and temporary cash investments ......... 39,572,792 2 42,521,769
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 16,841,663 4 12,989,640
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net ............. 70,000 7 100,000
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges .......... 2,154,361 9 2,672,736
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 57,384,135
b Less: accumulated depreciation ..... 10b 41,286,386 14,481,144 10c 16,097,749
11 Investments—publicly traded securities .......... 192,392,677 11 200,641,797
12 Investments—other securities. See Part IV, line 11 ..... 585,523 12 341,970
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 3,024,767 15 1,018,912
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 256,524,052 16 264,323,604
Liabilities 17 Accounts payable and accrued expenses ......... 45,790,243 17 44,602,557
18 Grants payable ................. 270,338 18 255,482
19 Deferred revenue ................ 4,154,974 19 3,734,024
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
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....................   25  
26 Total liabilities. Add lines 17 through 25......... 50,215,555 26 48,592,063
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 206,308,497 27 215,731,541
28 Temporarily restricted net assets ........... 0 28 0
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 206,308,497 33 215,731,541
34 Total liabilities and net assets/fund balances ........ 256,524,052 34 264,323,604
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
1,023,130,709
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
1,006,883,660
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
16,247,049
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
206,308,497
5
Net unrealized gains (losses) on investments ...............
5
-4,671,818
6
Donated services and use of facilities .................
6
0
7
Investment expenses .....................
7
0
8
Prior period adjustments .....................
8
0
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-2,152,187
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
215,731,541
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line 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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID: 13000241
Software Version: v1.00
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.SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Delta Dental of Washington
 
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
$ 124,850
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

$ 124,850
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$ 124,850
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) Friends of Derek Stanford
  		PO Box 2041
Bothell,WA98041 		27-2317624 900 0
(2) Committee to Elect JT Wilcox
  		PO Box 747
McKenna,WA98558 		27-0758934 900 0
(3) Friends of Marcus Riccelli
  		PO Box 1325
Spokane,WA99210 		45-5222828 900 0
(4) People for Timm Ormsby
  		PO Box 2177
Spokane,WA99210 		55-0876251 900 0
(5) Citizens for Chad Magendanz
  		PO Box 1362
Issaquah,WA98027 		61-1679658 500 0
(6) Friends for Jay Rodne
  		PO Box 2848
Issaquah,WA98027 		20-1125805 900 0
(7) Committee to Elect Kevin Parker
  		PO Box 198
Spokane,WA99210 		26-0348064 900 0
(8) Citizens for Michael Baumgartner
  		PO Box 48237
Spokane,WA99228 		27-1747900 900 0
(9) Committee to Elect Joel Kretz
  		1014 Toroda Creek Rd
Wauconda,WA98859 		27-2630585 900 0
(10) Shelly for State
  		127 N Wynne St
Colville,WA99114 		68-0674661 900 0
(11) Friends of John Smith
  		PO Box 183
Colville,WA98114 		46-1660411 1,700 0
(12) Committee to Elect Larry Haler
  		1860 McMurray Ave
Richland,WA99354 		20-1624033 900 0
(13) Friends of Sharon Brown
  		4309 W 27th Place
Ste 103
Kennewick,WA99338 		46-2639382 1,700 0
(14) Friends of Susan Fagan
  		PO Box 1471
Pullman,WA99163 		26-4513295 900 0
(15) People for Joe Schmick
  		PO Box 620
Colfax,WA99111 		45-0582705 900 0
(16) People for Zack Hudgins
  		4512 South 136th St
Tukwila,WA98168 		81-0555017 900 0
(17) Committee to Elect Cary Condotta
  		PO Box 3001
Wenatchee,WA98807 		71-0896890 900 0
(18) Committee to RE-Elect Janea Holmquist
  		PO Box 429
Moses Lake,WA98837 		80-0435914 900 0
(19) Norm Johnson for State Representative
  		55 west Washington Ave
Ste 33
Yakima,WA98903 		80-0190629 900 0
(20) Committee to RE-Elect Charles Ross
  		PO Box 996
Naches,WA98937 		26-3352534 900 0
(21) Bruce Chandler Campaign
  		PO Box 1108
Zillah,WA98953 		91-2066326 900 0
(22) Committee to Elect James Honeyford
  		PO BOx 844
Sunnyside,WA98944 		91-1561953 900 0
(23) Committee to Elect Terry Nealey
  		PO Box 7
Dayton,WA99328 		26-2195116 900 0
(24) Campaign to Elect Paul Harris
  		1916 SE 130th Ave
Vancouver,WA98683 		27-2531536 900 0
(25) Friends to Elect Liz Pike
  		PO Box 662
Camas,WA98607 		45-4280048 900 0
(26) Committee to Elect Brandon Vick
  		PO Box 1434
Battle Ground,WA98604 		27-1915545 900 0
(27) Committee to Elect Brian Blake
  		PO Box 1541
Longview,WA98632 		87-0699800 900 0
(28) Committee to Re-Elect Ed Orcutt
  		PO Box 1280
Kalama,WA98625 		90-0038949 900 0
(29) Samuel Hunt for State Representative
  		PO Box 2573
Olympia,WA98507 		90-0642727 900 0
(30) Friends of Chris Reykdal
  		855 Trosper Rd
Ste 108-177
Tumwater,WA98512 		27-1751460 900 0
(31) Committee to Elect Drew Hansen
  		PO Box 2140
Poulsbo,WA98370 		45-3489418 900 0
(32) Committee to Elect Kevin Van De Wege
  		10 Sable Court
Sequim,WA98382 		20-0522366 900 0
(33) Tharinger for State Representative
  		PO Box 834
Sequim,WA98382 		27-2555702 900 0
(34) Committee to Elect Dawn Morrell
  		2106 Manorwood Dr SE
Puyallup,WA98374 		01-0679962 900 0
(35) Friends of Hans Zeiger
  		PO Box 73303
Puyallup,WA98373 		27-0422184 500 0
(36) Citizens to Elect Larry Seaquist
  		PO Box 821
Gif Harbor,WA98335 		20-4220154 900 0
(37) Jan Angel for State Senate
  		5184 Granada Place SE
Port Orchard,WA98367 		46-1415980 1,700 0
(38) Friends of Laurie Jinkins
  		PO Box 2032
Tacoma,WA98401 		27-2214467 900 0
(39) Committee to Elect Tamara Green
  		10316 93rd St SW
Tacoma,WA98498 		60-2632403 900 0
(40) Friends of Steve O'Ban
  		PO Box 65335
University Place,WA98464 		27-1992105 900 0
(41) Voters for Dick Muri
  		PO Box 1581
Tacoma,WA98401 		91-1975610 900 0
(42) Friends of David Sawyer
  		1002 South 94th St
Tacoma,WA98444 		45-3660584 500 0
(43) Citizens to Elect Steve Conway
  		PO Box 112020
Tacoma,WA98411 		01-0735404 900 0
(44) Steve Kirby Campaign
  		9415 Tacoma Ave So
Tacoma,WA98444 		71-1000906 900 0
(45) Committee to Elect Linda Kochmar
  		30333 1st Ave So
Federal Way,WA98023 		91-1826508 900 0
(46) Citizens for Christopher Hurst
  		62504 Indian Summer Way E
Enumclaw,WA98022 		01-0841227 900 0
(47) Committee to Elect Cathy Dahlquist
  		1348 Florence St
Enumclaw,WA98022 		27-2819445 900 0
(48) Citizens for Pam Roach
  		PO Box 682
Auburn,WA98071 		26-3590667 900 0
(49) Citizens for Ruth Kagi
  		19553 35th NE
Lake Forest Park,WA98155 		91-1914967 900 0
(50) Firends for Cindy Ryu
  		PO Box 33548
Seattle,WA98133 		20-2771557 900 0
(51) Friends of Karen Keiser
  		PO Box 13290
Des Moines,WA98198 		91-1947669 900 0
(52) Committee to Elect Eileen Cody
  		6714 38th Ave SW
Seattle,WA98126 		91-1646573 900 0
(53) Friends of Joe Fitzgibbon
  		PO Box 66591
Burien,WA98166 		27-2265718 900 0
(54) Friends of Sharon Nelson
  		7318 SW 258th Pl
Vashon,WA98070 		26-1377785 900 0
(55) Committee To Re-Elect Kathy Haigh
  		87 E Walker Park Rd
Shelton,WA98584 		29-9527931 900 0
(56) Timothy Sheldon
  		PO Box G
Hoodsport,WA98548 		20-3465831 900 0
(57) Committee To Elect Drew C MacEwen
  		PO Box 651
Union,WA98592 		36-4732450 900 0
(58) Friends of Reuven Carlyle
  		PO Box 9100
Seattle,WA98109 		26-1852908 900 0
(59) Friends of Gael
  		PO Box 9100
Seattle,WA98109 		37-1666948 500 0
(60) Jeanne Kohl-Welles
  		2212 Queen Anne Ave S
PMB 256
Seattle,WA98109 		91-1559456 900 0
(61) Friends to Elect Eric Pettigrew
  		PO Box 28660
Seattle,WA98118 		53-4801080 900 0
(62) Friends of Santos
  		PO Box 78606
Seattle,WA98178 		91-1913482 900 0
(63) Friends for Dan Kristiansen
  		PO Box 2007
Snohomish,WA98291 		91-2064816 900 0
(64) Kristine Lytton Campaign
  		10074 Commercial Ave
PMB 349
Anacortes,WA98221 		27-2056758 900 0
(65) Judy Clibborn for State Representative
  		PO Box 808
Mercer Island,WA98040 		01-0649609 900 0
(66) Citizens for Vincent Buys
  		PO Box 25
Lynden,WA98264 		27-1476576 900 0
(67) Citizens to Elect Jason Overstreet
  		PO Box 1203
Blaine,WA98231 		27-2221211 500 0
(68) Committee to Elect Doug Ericksen
  		PO Box 748
Ferndale,WA98248 		82-0553277 900 0
(69) Citizens for Frank Chopp
  		1000 Aurora Ave N
Ste 100
Seattle,WA98109 		32-0020852 900 0
(70) People for Pedersen
  		815 First Ave
Ste 111
Seattle,WA98104 		20-3979617 900 0
(71) Committee to Elect Steve Hobbs
  		3309 114th Drive NE
Lake Stevens,WA98258 		20-4733784 1,800 0
(72) Committee to Elect Larry Springer
  		700 20th Ave W
Kirkland,WA98033 		83-0382872 900 0
(73) Friends of Roger Goodman
  		218 Main St
PMB 763
Kirkland,WA98033 		83-0458254 900 0
(74) Citizens for Andy Hill
  		23515 NE Novelty Hill Rd
Ste B211 1
Kirkland,WA98053 		27-2057163 1,800 0
(75) Gerry Pollet for State Representative
  		7750 17th Ave NE
Seattle,WA98115 		80-0147715 900 0
(76) Re-Elect Pat Sullivan Campaign
  		26513 168th Pl SE
Covington,WA98042 		04-3679431 900 0
(77) Hargrove for House
  		PO Box 7341
Covington,WA98042 		26-1973735 500 0
(78) Friends of Joe Fain
  		PO Box 7809
Covington,WA98042 		27-1654871 1,800 0
(79) Friends of Ross Hunter
  		PO Box 4204
Bellevue,WA98009 		04-3645222 900 0
(80) Friends of Cyrus
  		929 109th Ave NE
Bellevue,WA98004 		90-0791775 900 0
(81) Rodney Tom for State Senate
  		PO Box 594
Medina,WA98039 		57-1234123 1,800 0
(82) Committee to Elect Jim Moeller
  		1701 Broadway
Ste 328
Vancouver,WA98663 		45-0476516 900 0
(83) House Democratic Campaign Committee
  		1000 Aurora Ave N
Ste 100
Seattle,WA98109 		91-6178946 900 0
(84) The Kennedy Fund
  		3518 Fremont Ave NW
Ste 545
Seattle,WA98103 		46-2745811 5,000 0
(85) Senate Democratic Campaign Committee
  		PO Box 45042
Seattle,WA98145 		91-6163985 900 0
(86) Harry Truman Fund
  		PO Box 9100
Seattle,WA98109 		91-1769570 5,000 0
(87) Citizens to Re-Elect Brad Owen Lt Governor
  		PO Box 1426
Seattle,WA98584 		76-0843646 500 0
(88) People for Randy Dorn
  		2607 Mayes Rd SE
Lacey,WA98503 		61-1561950 500 0
(89) WA St Democrats
  		PO Box 4027
Seattle,WA98194 		91-1135732 2,500 0
(90) Jay Inslee for Washington
  		PO Box 21067
Seattle,WA98111 		45-2533952 1,000 0
(91) Friends of Bob Ferguson
  		PO Box 2405
Seattle,WA98111 		01-0699595 500 0
(92) House Republican Organizational Committee
  		PO Box 7222
Olympia,WA98507 		91-6177625 900 0
(93) The Leadership Council
  		PO Box 11025
Olympia,WA98508 		91-1714860 10,000 0
(94) Reagan Fund
  		PO Box 904
Olympia,WA98507 		91-1716818 10,000 0
(95) Senate Republican Campaign Committee
  		PO Box 11025
Olympia,WA98508 		91-0987396 900 0
(96) WA St Republicans
  		11811 NE 1st St
Ste A306
Bellevue,WA98005 		91-0486656 2,500 0
(97) Troy Kelley
  		2521 Fremont St
Tacoma,WA98406 		20-3888484 1,000 0
(98) Friends of Courtney Gregoire
  		603 Stewart St
Ste 819
Seattle,WA98101 		46-2279223 2,300 0
(99) Friends of Stephanie Bowman
  		PO Box 23011
Seattle,WA98102 		46-2755282 1,800 0
(100) Ed Murray for Mayor
  		3518 Fremont Avenue N
Seattle,WA98103 		46-1489838 1,400 0
(101) Michael Wolfe for Port
  		2518 S Brandon Ct
Seattle,WA98108 		46-2029973 250 0
(102) Friends of Dow Constantine
  		603 Stewart Street Suite 819
Seattle,WA98101 		26-4389886 900 0
(103) Citizens to Re-Elect Dave Somers
  		PO Box 1082
Snohomish,WA98290 		91-2115935 500 0
(104) Citizens for John Creighton
  		6619 132nd Ave NE
PMB 18
Kirkland,WA98033 		46-2047173 1,800 0
(105) Committee to Elect Matt Manweller
  		110 W 6th Avenue PMB 392
Ellensburg,WA98926 		45-4883829 900 0
(106) Committee to Elect Dave Taylor
  		1661 Beane Road
Moxee,WA98936 		26-4761911 900 0
(107) Committee to Elect Mary Helen Roberts
Return of 2010 contribution - no EIN available 		3924 149th Pl SW
Lynnwood,WA98087 		12-3456789 -500 0
(108) Maureen Walsh
Return of 2011 contribution - no EIN available 		PO Box 461
Walla Walla,WA99362 		12-3456789 -800 0
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2013

Schedule C (Form 990 or 990-EZ) 2013
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 SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
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) 2010 (b) 2011 (c) 2012 (d) 2013 (e) Total
2a Lobbying nontaxable 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) 2013


Schedule C (Form 990 or 990-EZ) 2013
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)
No
Yes
(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
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Schedule C, Part I-A, Line 1 DDWA provides direct campaign contributions to candidates for Washington State elected executive office, legislative office and political organizations in order to promote an environment for improved oral health and overall health care policy, as well as to support our overall mission of improving oral health in our state. DDWA also provides limited, direct support for local level candidates or initiatives that promote a positive business climate in Washington State. All contributions are conducted in accordance with federal and state laws and reporting requirements.
Schedule C (Form 990 or 990EZ) 2013

Additional Data


Software ID: 13000241
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. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Delta Dental of Washington
 
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 section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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 XIII, 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (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 current year end balance (line 1g, column (a)) 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 XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. 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 11,022,176 8,049,947 2,972,229
c Leasehold improvements ............ 0 1,191,527 656,303 535,224
d Equipment ................ 0 9,766,165 8,679,589 1,086,576
e Other ................. 0 34,193,076 23,900,547 10,292,529
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 16,097,749
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. 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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. 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. Liability for uncertain tax positions In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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 XIII.) ............ 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 XIII.) ........... 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 XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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 XIII.) ............ 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 XIII.) ............ 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 XIII
Supplemental Information
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
Schedule D (Form 990) 2013

Additional Data


Software ID: 13000241
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
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
Delta Dental of Washington
 
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. Part II can be duplicated if additional space is needed.
(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) Rural Resources Community Action
956 South Main Street
Ste A
Colville,WA99114 		91-0793447 501c3 32,196       Third Year ABCD Program
(2) Volunteers in Medicine of the Olympics Clinic (VIMO)
909 Georgiana
Port Angeles,WA98362 		01-0590704 501c3 55,000       Second Year ABCD Program in Clallam/Jefferson Counties
(3) DentaQuest Foundation
465 Medford Street
Boston,MA02129 		04-3265080 501c3 100,000       Engagement of primary care physicians in delivery of oral health services
(4) Empire Health Foundation
111 North Post Street
Ste 301
Spokane,WA99201 		26-3375286 501c3 38,000       Better Health Tomorrow ER Diversion Project
(5) Empire Health Foundation
111 North Post Street
Ste 301
Spokane,WA99201 		26-3375286 501c3 12,000       Oral Health Leadership Coordinator position
(6) Washington Early Learning Fund
1218 Third Avenue
Seattle,WA98101 		91-2041837 501c3 45,000       Yearly Thrive by Five funding
(7) Washington Early Learning Fund
1218 Third Avenue
Seattle,WA98101 		91-2041837 501c3 20,000       State Home Visiting Match Fund to expand home visiting programs for Washington's young children
(8) HealthPoint
955 Powell Ave SW
Renton,WA98057 		91-0884412 501c3 300,000       Dental equipment for Midway Clinic
(9) International Community Health Services
720 8th Ave S
2nd floor
Seattle,WA98104 		91-0947084 501c3 120,000       Equipment InterID dental clinic
(10) NE Washington Health Programs
509 East Main Avenue
Chewelah,WA99109 		91-1053847 501c3 377,888       Equipment upgrade for Colville Clinic
(11) NE Washington Health Programs
509 East Main Avenue
Chewelah,WA99109 		91-1053847 501c3 206,112       Equipment upgrade for three clinics
(12) Smile Partners
8112 Grand Ave NE
Bainbridge Island,WA98110 		20-0381039 501c3 12,500       Portable dental equipment for mobile program
(13) SonBridge Dental Clinic
1200 SE 12th St
College Place,WA99324 		20-2958334 501c3 81,500       Capital expenses and start-up costs
(14) Empire Health Foundation
111 North Post Street
Ste 301
Spokane,WA99201 		26-3375286 501c3 5,250       Oral health project consultant
(15) Healthy Kids Healthy Portland PAC
2419 NE Sandy Blvd
Portland,OR97232 		46-1743058   20,000       Additional fluoridation support for Portland
(16) Healthy Kids Healthy Portland PAC
2419 NE Sandy Blvd
Portland,OR97232 		46-1743058   50,000       Fluoridation support for Portland
(17) PEW Charitable Trust
901 E Street NW
10th Floor
Washington,DC20004 		56-2307147 501c3 50,000       Campaign for Dental Health
(18) Washington Association of Community & Migrant Health Centers (WACMHC)
510 Plum Street SE
Ste 101
Olympia,WA98501 		91-1323282 501c3 89,341       Funding for the Community Health Center Directors Collaborative
(19) Whatcom Alliance for Healthcare Access
800 East Chestnut Street
Ste 2
Bellingham,WA98225 		81-0677295 501c3 164,175       Dental/Medical collaboration referral services
(20) Whatcom Alliance for Healthcare Access
800 East Chestnut Street
Ste 2
Bellingham,WA98225 		81-0677295 501c3 30,000       Engaging a health care delivery system in Whatcom County for the purpose of establishing a dental/medical collaboration project.
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
14
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2013

Schedule I (Form 990) 2013
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.
Part III can be duplicated 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












Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
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 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) 2013


Additional Data


Software ID: 13000241
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, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Delta Dental of Washington
 
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 of 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
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
Yes
 
3
Indicate which, if any, of the following the filing organization used 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
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
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 (E) amounts for that individual.
(A) Name and Title (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 DwyerPresident & Chief Executive Officer (i)
(ii)		 603,086
0 		545,000
0 		15,015
0 		73,630
0 		21,979
0 		1,258,710
0 		0
0
(2)Ronald Edward IngeVP, Dental Director & Prof. Relations (i)
(ii)		 360,245
0 		255,557
0 		474,169
0 		108,101
0 		21,353
0 		1,219,425
0 		500,323
0
(3)Bradley Alan BergChief Operating & Financial Officer (i)
(ii)		 340,875
0 		197,038
0 		11,360
0 		119,762
0 		23,462
0 		692,497
0 		0
0
(4)Venkataraman ChittoorChief Information Officer (i)
(ii)		 262,212
0 		182,427
0 		3,151
0 		108,213
0 		26,388
0 		582,391
0 		0
0
(5)Kristin Nielsen MerloChief Marketing Officer, VP Sales (i)
(ii)		 250,045
0 		169,904
0 		7,896
0 		96,474
0 		29,158
0 		553,477
0 		0
0
(6)Thomas Andrew GatesVP, Planning & Corp. Development (i)
(ii)		 247,003
0 		170,429
0 		6,889
0 		74,960
0 		27,124
0 		526,405
0 		0
0
(7)Susan Siclari WebberChief Human Resources Officer (i)
(ii)		 232,382
0 		157,795
0 		10,137
0 		83,977
0 		19,293
0 		503,584
0 		0
0
(8)Laura Jean SmithWDS Foundation, President & CEO (i)
(ii)		 198,387
0 		110,536
0 		11,426
0 		50,871
0 		9,655
0 		380,875
0 		0
0
(9)John Theodore BursettSenior VP, Underwriting/Actuarial (i)
(ii)		 190,151
0 		109,302
0 		-3,520
0 		38,030
0 		15,488
0 		349,451
0 		0
0
(10)Eric Che-Teh LoVP Actuarial & Underwriting (i)
(ii)		 160,909
0 		109,477
0 		8,429
0 		53,664
0 		9,614
0 		342,093
0 		0
0
(11)Dr David W BranchBoard of Directors (i)
(ii)		 59,324
0 		0
0 		258,894
0 		0
0 		0
0 		318,218
0 		0
0
(12)James Christopher DarnellDirector of Sales (i)
(ii)		 160,797
0 		81,680
0 		-2,001
0 		27,857
0 		25,925
0 		294,258
0 		0
0
(13)Linda Jo LayDirector - Account Management (i)
(ii)		 156,308
0 		75,960
0 		-2,102
0 		29,604
0 		16,994
0 		276,764
0 		0
0
(14)Susan Lisa CurhanDirector Marketing & Product Mgmt. (i)
(ii)		 153,797
0 		56,597
0 		-2,264
0 		29,804
0 		22,150
0 		260,084
0 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
Schedule J, Part I, Line 1a DDWA at times pays for spousal travel for the CEO, which is treated as taxable income. Any first class travel is subject to the approval of the CEO. DDWA 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, health or luncheon club dues are paid in full for senior management which is included in taxable income.
Schedule J, Part I, Line 3 The Human Resources and Compensation Committee of the Board of Directors engages an external consultant to evaluate all key employees, including President and CEO, COO/CFO, VP Underwriting/Actuarial, CIO, CMO and VP Sales, VP of Planning and Corporate Development, Chief Human Resources Officer, 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.
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(b). 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). Contributions made in 2013 were as follows: Bradley Berg, Chief Operating and Financial Officer, $67,262; Dr Ronald E Inge, VP & Dental Director, $55,601; Eric Lo, VP Underwriting/Actuarial, $5,791; Thomas Gates, VP Planning and Corporate Development, $39,960; Venkataraman Chittor, CIO, $55,713; Susan Webber, Chief Human Resources Officer, $31,477; Kristin Merlo, Chief Marketing Officer and VP Sales, $43,974. In January 2013, the Company established a 457(f) non-qualified SERP, a defined contribution plan for the President and CEO due to age restrictions associated with the 457(b) plan. The Company contributed $38,630 to the plan for 2013. The plan had total assets of $43,017 at December 31, 2013.
Schedule J, Part I, Line 6 The Board of DDWA approved a company-wide bonus matrix based on seven metrics, one of which was based on the profit margin for the fiscal year. The other metrics were Administrative Cost, New Sales for small and large customers, Customer persistency, Network growth and Operational performance.
Schedule J, Part I, Line 7 DDWA paid commission to internal Sales staff based on the number of primary subscribers acquired by the company as a result of new employer group sales.
Schedule J (Form 990) 2013

Additional Data


Software ID: 13000241
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.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
Delta Dental of Washington
 
Employer identification number

91-0621480
Return Reference Explanation
Form 990, Part VI, Section A, Line 4 Based on a hearing held on May 9, 2013, approval was granted by the Washington State Office of the Insurance Commissioner (OIC) for the establishment of Washington Dental Service (WDS) as the parent holding company of DDWA, a dental benefits provider. DDWA and its affiliates, the Foundation, Institute for Oral Health, and WDS Holdings, LLC became wholly-owned and/or controlled affiliates of WDS on May 17, 2013. The restructuring is related to entities under common control. The restructuring also resulted in changes to the bylaws of DDWA.
Form 990, Part VI, Section A, Line 6 DDWA's member dentists are considered members of the company's parent company, WDS. Member dentists elect the dental members of the WDS Board of Directors. WDS directors also serve as directors on the DDWA Board.
Form 990, Part VI, Section A, Line 7a The Governance & Nominating Committee (GNC) of the WDS Board of Directors solicits advice on candidates and submits nominees to the WDS Board for consideration and approval to be voted upon. The entire WDS 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 WDS Board from nominees by the GNC. The MAP provides consultation to the GNC and DDWA Board on a variety of matters.
Form 990, Part VI, Section A, Line 7b Recommended changes to the WDS Corporate By-laws by the WDS Board are subject to approval by the WDS members.
Form 990, Part VI, Section B, Line 11b The Form 990 is completed by the accounting staff. The Form 990 and supporting documentation is reviewed and approved by the Finance Manager, Director of Finance and the COO/CFO. An independent review is conducted by the Company's certified public accountants and Chairman of the Board and the Audit Committee of the Board of Directors. The Human Resources and Compensation Committee completes a review of the compensation information presented in the Form 990. Electronic copies of the Form 990 are provided to all Board members prior to submission to the IRS.
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, executive leadership and 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 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 if applicable; (5) any conflicting issues which cannot be resolved during the course of a Board meeting are referred to the Governance Committee; and (6) the transaction or action must be approved by a majority of disinterested persons.
Form 990, Part VI, Section B, Line 15 The Board appoints a Human Resources and Compensation Committee of the Board (the HRCC), none of whom may have a conflict of interest with respect to any compensation arrangements, to be accountable for setting reasonable compensation packages for each officer and key employee (including the CEO and CFO). The HRCC 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 HRCC 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 HRCC's written records include the (1) terms of the arrangements with the officers and key employees (including the date the arrangement was approved); (2) a list of members present during the discussion on any arrangements; and (3) a description of the comparable data relied upon by the HRCC. Key deliberations of the HRCC are also documented in minutes which are approved at the next HRCC meeting.
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 Bylaws are filed with the OIC from time-to-time as they are approved by the governing body. Governing documents, Conflict of Interest policy and financial statements are available to the public upon request.
Form 990, Part VII, Section A, Line 1a Reportable compensation for board members David Branch and Kurt Labberton include compensation totaling $258,894 and $214,364, respectively, paid for dental treatment rendered to patients as a member dentist of DDWA.
Form 990, Part XI, Line 9 $2,009,437 was contributed to Washington Dental Service (WDS) prior to re-organization. In addition, there was a $200,000 adjustment to investment in equity subsidiary relating to Healthentic. Lastly, there was a change in accumulated other comprehensive income of $88,844 and difference in 2013 Net Income relating to an other than temporary impairment of $31,594.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID: 13000241
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" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Delta Dental of Washington
 
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 (if applicable) 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 233,373 4,014,175 Delta Dental of Washington
 
(2) Washington Dental Service Holdings LLC
9706 Fourth Ave NE
Seattle,WA98115
91-0621480 		Invest in Oral Health Activities WA -852,215 13,375,345 Delta Dental of Washington
 
(3) Institute for Oral Health
9706 Fourth Ave NE
Seattle,WA98115
91-0621480 		Support Oral Health Education WA 0 193,930 Delta Dental of Washington
 






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 entity?
Yes No
(1) Washington Dental Service Fund

9706 Fourth Ave NE

Seattle,WA98115
91-1281990 		Sponsor Oral Health Education WA 501(c)(3) 9 Delta Dental of Washington
 
Yes
 
(2) Washington Dental Service

9706 Fourth Ave NE

Seattle,WA98115
27-0937829 		Improving Oral Health WA 501(c)(4)   N/A
 
 










For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
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
 		(i)
Section 512(b)(13) controlled entity?
Yes No












Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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 or (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 Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
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 related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Washington Dental Service Fund

 c 11,700 Cash received from Washington Dental Service Fund to support dental care in underserved areas of Washington State through a program called the SmileMobile; a 40 foot modern dental clinic on wheels that has been serving children in need across Washington State since 1995. The SmileMobile was created to bring dental services - at little or no charge - directly to children who do not otherwise have access to dental care. Since it first hit the road, the mobile clinic has treated more than 30,000 children throughout the state.





Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
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) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2013
Additional Data


Software ID: 13000241
Software Version: v1.00