Form990
Click to see attachment
Department of the TreasuryInternal 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.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
A For the 2015 calendar year, or tax year beginning 01-01-2015 , and ending 12-31-2015
BCheck if applicable:
CName of organization
COLORADO DENTAL SERVICE INC
 
 
Doing business as
DELTA DENTAL OF COLORADO
 
Number and street (or P.O. box if mail is not delivered to street address)
4582 SO ULSTER STREET NO 800
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
DENVER, CO80237
D Employer identification number

84-0568337
E Telephone number

G Gross receipts $ 468,904,713
F Name and address of principal officer:
KATHRYN ANN PAUL
4582 SO ULSTER STREET NO 800
DENVER,CO80237
I
Tax-exempt status: ( 4 ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.DELTADENTALCO.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: 1958
M State of legal domicile: CO
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO IMPROVE THE ORAL HEALTH OF THE COMMUNITIES WE SERVE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 11
5 Total number of individuals employed in calendar year 2015 (Part V, line 2a) ...... 5 151
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a -7,808
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b -7,808
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 329,571,076 358,221,231
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 8,283,584 2,764,979
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 5,230 230,480
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 337,859,890 361,216,690
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 4,735,694 9,927,165
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 287,088,635 307,169,809
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 13,554,802 14,620,548
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).... 24,225,184 24,486,662
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 329,604,315 356,204,184
19 Revenue less expenses. Subtract line 18 from line 12....... 8,255,575 5,012,506
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 113,011,707 119,979,541
21 Total liabilities (Part X, line 26)............. 31,872,226 37,486,269
22 Net assets or fund balances. Subtract line 21 from line 20..... 81,139,481 82,493,272
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 (2015)
Form 990 (2015)
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: DELTA DENTAL OF COLORADO (DDCO) WAS FORMED AS A 501(C)(4) ORGANIZATION IN ORDER TO IMPROVE THE ORAL HEALTH OF THE COMMUNITIES IT SERVES. BECAUSE PEOPLE WITH DENTAL INSURANCE OVER TIME HAVE BETTER ORAL HEALTH OUTCOMES, DDCO DEVOTES ITSELF TO PROVIDING HIGH QUALITY AFFORDABLE DENTAL INSURANCE TO AS MANY COLORADANS AS POSSIBLE. UNFORTUNATELY, THERE ARE MANY PEOPLE FOR WHOM DENTAL INSURANCE IS NOT POSSIBLE. FOR THESE PEOPLE, DDCO HAS A NUMBER OF DIFFERENT PROGRAMS ESTABLISHED TO PROVIDE THEM WITH ORAL HEALTH EDUCATION, DIRECT PATIENT DENTAL SERVICES, AND FREE DENTAL INSURANCE SO THAT GOOD ORAL HEALTH WILL ALSO BE ACHIEVABLE FOR THEM.
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 $ 341,727,456 including grants of $   ) (Revenue $ 358,221,981 )
PROVISION OF RISK AND SELF-FUNDED PLANS TO SUBSCRIBERS.DELTA DENTAL OF COLORADO DEVOTES ITSELF TO ITS MISSION OF IMPROVING THE ORAL HEALTH OF COLORADO'S PEOPLE. BECAUSE PEOPLE WITH DENTAL INSURANCE ARE OVER TWICE AS LIKELY TO VISIT A DENTIST REGULARLY, DELTA DENTAL OF COLORADO WORKS HARD TO MAKE DENTAL INSURANCE AS AFFORDABLE AND ACCESSIBLE AS POSSIBLE, AND TO THAT END, INSURES OVER 1,200,000 PEOPLE IN COLORADO. THE REVENUE GENERATED IS USED TO FUND THE COMMUNITY BENEFIT EFFORTS DESCRIBED IN LINE 4B.
4b (Code:   ) (Expenses $ 10,690,000 including grants of $ 9,927,165 ) (Revenue $   )
COMMUNITY BENEFITS PROGRAMSBECAUSE DENTAL INSURANCE IS NOT POSSIBLE FOR EVERYONE, DELTA DENTAL OF COLORADO DEVOTES SIGNIFICANT RESOURCES AND MONEY TO PROVIDING DENTAL SERVICES AND DENTAL HYGIENE INFORMATION TO AS MANY PEOPLE AS POSSIBLE; PARTICULARLY THOSE UNDERSERVED POPULATIONS, WHERE ORAL DISEASE IS MORE PREVALENT. TO THAT END, DELTA DENTAL OF COLORADO, OVER THE PAST THIRTEEN YEARS, HAS DEVOTED 55% OF ITS ADJUSTED NET GAIN TO ITS COMMUNITY BENEFIT PROGRAM AND THE DELTA DENTAL OF COLORADO FOUNDATION. IN 2015, DELTA DENTAL OF COLORADO PLEDGED $6,407,000 TO THE DELTA DENTAL OF COLORADO FOUNDATION. DELTA DENTAL OF COLORADO ALSO PLEDGED $1,000,000 TO SPRINGROCK DENTAL, INC., A NON-PROFIT ORGANIZATION WHOSE PURPOSE IS TO PROVIDE ORAL HEALTHCARE TO UNDERSERVED COLORADANS. FURTHERMORE, DELTA DENTAL OF COLORADO SPENT $2,500,000 ON A NUMBER OF INITIATIVES THROUGH ITS COMMUNITY BENEFIT PROGRAM. THESE PROGRAMS INCLUDED NUMEROUS COMMUNITY EVENTS WHERE COMPANY EMPLOYEES PROVIDED OVER 76,000 BAGS OF FREE ORAL HYGIENE SUPPLIES AND ORAL HEALTH INSTRUCTION. IT ALSO INCLUDED APPROXIMATELY $140,000 TO OPERATE AN EDUCATIONAL ORAL HEALTH TROUPE. THIS THEATER TROUPE, CALLED "THE LAND OF SMILES" PUT ON FREE PERFORMANCES AT COLORADO GRAMMAR SCHOOLS AND TAUGHT CHILDREN THE IMPORTANCE OF GOOD ORAL HEALTH AND HOW TO TAKE CARE OF THEIR TEETH. EIGHTY-SIX SCHOOLS AND OVER 21,000 CHILDREN WERE REACHED THROUGH THE FREE "LAND OF SMILES" PROGRAM. FREE ORAL HYGENE SUPPLIES WERE ALSO PROVIDED TO ALL THE STUDENTS.IN ALIGNMENT WITH OUR COMMITMENT TO COLORADO'S COMMUNITIES, DELTA DENTAL OF COLORADO ENCOURAGES ITS EMPLOYEES TO VOLUNTEER THEIR SERVICES TO OTHER CHARTIABLE ORGANIZATIONS DOING WORK IN COLORADO. TO THAT END, DELTA DENTAL OF COLORADO DONATES $5,000 TO ANY CHARITABLE ORGANIZATION DOING WORK IN COLORADO ON WHICH ANY OF ITS LEADERSHIP TEAM SERVES ON THE BOARD OF DIRECTORS. DELTA DENTAL OF COLORADO ALSO HAS A DEEP COMMITMENT TO THE UNITED WAY MILE-HIGH CHAPTER, AND IN 2015 HAD A HIGH-LEVEL OF PARTICIPATION FROM ITS EMPLOYEES AND BOARD. DURING 2015, DELTA DENTAL OF COLORADO EMPLOYEES PARTICIPATED IN IGIVE. 2015 IS THE THIRD YEAR EMPLOYEES HAVE PARTICIPATED IN IGIVE. THROUGH IGIVE, DELTA DENTAL OF COLORADO GAVE EACH FULL-TIME EMPLOYEE $1,000 AND EACH TEMPORARY EMPLOYEE $700 TO DONATE TO THE CHARITY OF THEIR CHOICE.
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet352,417,456
Form 990 (2015)
Form 990 (2015)
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 I.............
3
 
No
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 IClick to see attachment..................
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 IIClick to see attachment...
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 Click to see attachment.............
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 IVClick to see attachment..............
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 VClick to see attachment......
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 VIIClick to see attachment.......
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 VIIIClick to see attachment.......
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 IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
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 XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
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 (2015)
Form 990 (2015)
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 domestic 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 or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
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), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............ Click to see attachment
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 ...................Click to see attachment
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 "Yes," complete Schedule L, Part II ................Click to see attachment
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......... Click to see attachment
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 ........................Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................Click to see attachment
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... Click to see attachment
28c
Yes
 
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
 
No
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
Yes
 
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 ...Click to see attachment
35b
Yes
 
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 VIClick to see attachment
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 (2015)
Form 990 (2015)
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
26,068
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
151
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
Yes
 
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
Yes
 
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 FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
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.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring 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 (2015)
Form 990 (2015)
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
15
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
11
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
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
Yes
 
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
 
No
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
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you 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, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletSHERWIN LOUIE4582 SO ULSTER STREET NO 800   DENVER,CO80237 (720) 489-4718
Form 990 (2015)
Form 990 (2015)
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) KATHRYN ANN PAUL......................................................................
CEO/PRESIDENT
 43.00
.................
2.00 		X   X       712,572 0 37,901
(2) MARILYN E TAYLOR......................................................................
CHAIR
 5.00
.................
3.00 		X   X       45,127 0 2,287
(3) JOHNATHAN M ANDERSON DDS......................................................................
VICE CHAIR
 4.00
.................
0.00 		X   X       27,494 0 2,101
(4) VICTOR LAZZARO JR......................................................................
TRUSTEE/SECRETARY
 4.00
.................
0.00 		X   X       27,028 0 287
(5) WALT VOGL DDS......................................................................
TRUSTEE
 4.00
.................
0.00 		X           20,000 0 0
(6) DOUGLAS B BERKEY DMD MPH MS......................................................................
TRUSTEE
 4.00
.................
0.00 		X           23,589 0 1,598
(7) JOHN PAUL HOPKINS......................................................................
TRUSTEE
 4.00
.................
0.00 		X           29,750 0 9
(8) KELLY J BROUGH......................................................................
TRUSTEE
 4.00
.................
0.00 		X           19,076 0 2,279
(9) HASSAN SALEM......................................................................
TRUSTEE
 4.00
.................
0.00 		X           15,750 0 0
(10) DONALD S SAFER DDS MS......................................................................
TRUSTEE
 4.00
.................
2.00 		X           20,508 0 417
(11) MARY NOONAN......................................................................
TRUSTEE
 4.00
.................
2.00 		X           31,907 0 1,572
(12) GAIL S SCHOETTLER PHD......................................................................
TRUSTEE
 4.00
.................
2.00 		X           27,351 0 426
(13) MARK WEHRLE CPA RETIRED......................................................................
TRUSTEE
 4.00
.................
0.00 		X           19,918 0 927
(14) THOMAS B SWAIN DDS......................................................................
TRUSTEE
 4.00
.................
0.00 		X           27,500 0 0
(15) DENISE K KASSEBAUM DDS MS......................................................................
TRUSTEE
 4.00
.................
0.00 		X           22,583 0 0
(16) DAVID A BEAL......................................................................
CFO/TREASURER
 43.00
.................
2.00 		    X       470,195 31,791 48,706
(17) GREGORY VOCHIS......................................................................
INTERIM CFO/TREASURER
 45.00
.................
0.00 		    X       192,291 0 27,339
Form 990 (2015)
Form 990 (2015)
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) BARBARA BLACKBURN SPRINGER JD........................................................................
VICE PRESIDENT/GENERAL COUNSEL
 23.00
.......................23.00 		      X     164,748 164,748 52,394
(19) JESSICA JEAN LAWHEAD........................................................................
VICE PRESIDENT
 45.00
.......................0.00 		      X     384,080 0 45,698
(20) LINDA MARIE ARNESON........................................................................
COO/ASSISTANT SECRETARY
 45.00
.......................0.00 		      X     397,408 0 41,525
(21) KATHLEEN S JACOBY........................................................................
DIRECTOR OF MARKETING
 45.00
.......................0.00 		        X   173,944 0 27,251
(22) LORRI KOHLE........................................................................
SENIOR SALES EXECUTIVE
 45.00
.......................0.00 		        X   184,971 0 24,256
(23) MICHAEL OKUJI DDS........................................................................
DENTAL DIRECTOR
 45.00
.......................0.00 		        X   209,793 0 35,322
(24) ROBERT MARK THOMPSON........................................................................
DIRECTOR OF SALES & CLIENT SERVICES
 45.00
.......................0.00 		        X   289,676 0 57,992
(25) STEPHANIE RAUZI........................................................................
SENIOR SALES EXECUTIVE
 45.00
.......................0.00 		        X   183,411 0 38,579










1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 3,720,670 196,539 448,866
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet31
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
ENCARA INC

4818 STARKEY ROAD SOUTHWEST
ROANOKE,VA24018 		ADVERTISING, PRODUCT MGMNT, MKTG 1,865,751
DELTA DENTAL OF VIRGINIA

4818 STARKEY ROAD SOUTHWEST
ROANOKE,VA24018 		IT SUPPORT CLAIMS PROCESSING 1,671,326
BMS DIRECT INC

37 MILLRACE DRIVE
LYNCHBURG,VA24502 		POSTAGE AND PRINTING 919,364
OPTIMEDIA INTERNATIONAL US INC

375 HUDSON ST 7TH FLOOR
NEW YORK,NY10014 		MARKETING & ADVERTISING 906,074
TROMBA TECHNOLOGIES INC

PO BOX 460184
AURORA,CO80046 		IT DEVELOPMENT 804,478
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet43
Form 990 (2015)
Form 990 (2015)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a-1f:$  
h Total.Add lines 1a-1f.......MediumBullet  
Program Service RevenueAmt Business Code
2a SELF FUNDED PLAN PREMIUMS 524114 186,273,125 186,273,125    
b RISK PLAN PREMIUMS 524114 158,394,985 158,394,985    
c ADMINISTRATION - SELF FUNDED PLAN 524298 12,635,091 12,635,091    
d RISK SHARING 524298 594,888 594,888    
e DISCOUNT PLAN FEES 524114 323,142 323,142    
f All other program service revenue.        
g Total.Add lines 2a–2f.....MediumBullet 358,221,231
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ..........MediumBullet 2,499,294     2,499,294
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss)......MediumBullet        
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory   107,953,708
b Less: cost or other basis and sales expenses   107,688,023
c Gain or (loss)   265,685
d Net gain or (loss).....MediumBullet 265,685     265,685
8a Gross income from fundraising events (not including $   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        
Business Code Miscellaneous Revenue
11a PARTNERSHIP UBIT K-1 INCOME 524298 224,854   -12,684 237,538
b VISION PREMIUMS 524298 4,876   4,876  
c OTHER REVENUE 524298 750 750    
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 230,480
12 Total revenue. See Instructions......MediumBullet 361,216,690 358,221,981 -7,808 3,002,517
Form 990 (2015)
Form 990 (2015)
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 domestic organizations and domestic governments. See Part IV, line 21 9,927,165 9,927,165
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members 307,169,809 307,169,809
5 Compensation of current officers, directors, trustees, and key employees .... 2,678,876 2,625,298 53,578  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 8,714,837 8,540,540 174,297  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 590,693 578,879 11,814  
9 Other employee benefits ....... 1,992,482 1,952,632 39,850  
10 Payroll taxes ........... 643,660 630,787 12,873  
11 Fees for services (non-employees):        
a Management ...... 1,853,584 1,482,867 370,717  
b Legal ......... 111,579 89,263 22,316  
c Accounting ........... 174,785   174,785  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 251,658   251,658  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 1,832,677 1,282,874 549,803  
12 Advertising and promotion .... 2,783,536 2,783,536    
13 Office expenses ....... 539,916 377,941 161,975  
14 Information technology ...... 1,889,852 1,511,882 377,970  
15 Royalties ..        
16 Occupancy ........... 657,335 525,868 131,467  
17 Travel ............ 230,803 46,161 184,642  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 95,695 19,139 76,556  
19 Conferences, conventions, and meetings ....        
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 1,767,635 972,199 795,436  
23 Insurance ...        
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 6,288,238 6,288,238    
b DATA PROCESSING 3,380,447 3,380,447    
c POSTAGE & MAILING 1,984,954 1,587,963 396,991  
d DISCOUNT PLAN FEES 223,603 223,603    
e All other expenses 420,365 420,365    
25 Total functional expenses. Add lines 1 through 24e 356,204,184 352,417,456 3,786,728 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 (2015)
Form 990 (2015)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 5,712,416 1 11,542,195
2 Savings and temporary cash investments ......... 10,983,181 2 7,630,162
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 18,056,010 4 20,072,626
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 ....   7  
8 Inventories for sale or use ........   8  
9 Prepaid expenses and deferred charges ...... 934,510 9 1,249,889
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 12,318,373
b Less: accumulated depreciation 10b 8,124,305 4,689,500 10c 4,194,068
11 Investments—publicly traded securities . 72,391,676 11 75,069,733
12 Investments—other securities. See Part IV, line 11 ..... 20,010 12 20,010
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 224,404 15 200,858
16 Total assets. Add lines 1 through 15 (must equal line 34)... 113,011,707 16 119,979,541
Liabilities 17 Accounts payable and accrued expenses ..... 10,398,897 17 10,320,317
18 Grants payable ... 3,400,000 18 7,157,000
19 Deferred revenue ......... 3,816,071 19 4,216,185
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 14,257,258 25 15,792,767
26 Total liabilities. Add lines 17 through 25.. 31,872,226 26 37,486,269
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 81,139,481 27 82,493,272
28 Temporarily restricted net assets ...........   28  
29 Permanently restricted net assets   29  
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 ........... 81,139,481 33 82,493,272
34 Total liabilities and net assets/fund balances ........ 113,011,707 34 119,979,541
Form 990 (2015)
Form 990 (2015)
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
361,216,690
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
356,204,184
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
5,012,506
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
81,139,481
5
Net unrealized gains (losses) on investments ...............
5
-3,463,485
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-195,230
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
82,493,272
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 (2015)
Form 990 (2015)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
COLORADO DENTAL SERVICE INC
 
Employer identification number

84-0568337
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year ....    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of 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" on 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, 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" on 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)
Revenue included on 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
Revenue included on 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) 2015

Schedule D (Form 990) 2015
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" on 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, for escrow or custodial account liability?
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" on Form 990, Part IV, line 10.
(a)Current year (b)Prior year (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the 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 on 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" on 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' on 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 ...      
b Buildings        
c Leasehold improvements   1,460,993 732,702 728,291
d Equipment ...   8,730,712 6,440,851 2,289,861
e Other ...   2,126,668 950,752 1,175,916
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 4,194,068
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' on 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    
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
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' on 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
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
PROVISION FOR UNPAID CLAIMS 15,792,767
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 15,792,767
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) 2015

Schedule D (Form 990) 2015
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on 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 (losses) 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' on 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
PART X, LINE 2: THE COMPANY IS EXEMPT FROM FEDERAL INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE. GENERALLY, THE COMPANY IS NO LONGER SUBJECT TO FEDERAL INCOME TAX RETURN EXAMINATIONS FOR THE YEARS PRIOR TO 2012.
Schedule D (Form 990) 2015


Additional Data


Software ID:  
Software Version:  




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," on 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
2015
Open to Public
Inspection
Name of the organization
COLORADO DENTAL SERVICE INC
 
Employer identification number
84-0568337
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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 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) UNIVERSITY OF COLORADO FOUNDATION
1800 GRANT STREET SUITE 725
DENVER,CO80203 		84-6049811 501(C)(3) 1,001,500       SUPPORT LOCAL ORGANIZATION DIRECTED TO ORAL HEALTH SERVICES FOR VETERANS
(2) CHILDRENS HOSPITAL CO FOUNDATION
13123 E 16TH AVE BOX 045
AURORA,CO80045 		84-0813462 501(C)(3) 800,500       SUPPORT LOCAL HEALTH ORGANIZATION
(3) ORAL HEALTH COLORADO
PO BOX 150668
LAKEWOOD,CO80215 		90-0137772 501(C)(3) 112,850       SUPPORT LOCAL HEALTH ORGANIZATION
(4) AMERICAN DIABETES ASSOCIATION
2480 W 26 AVE STE 120 B
DENVER,CO80211 		13-1623888 501(C)(3) 50,000       SUPPORT LOCAL CHAPTER OF NATIONAL ORGANIZATION
(5) COLORADO MISSION OF MERCY
430 COLORADO AVE
PUEBLO,CO81004 		27-1586585 501(C)(3) 40,000       SUPPORT LOCAL HEALTH ORGANIZATION
(6) DENTAL LIFELINE NETWORK
1800 15TH STREET SUITE 100
DENVER,CO80202 		84-6129064 501(C)(3) 30,000       SUPPORT LOCAL HEALTH ORGANIZATION
(7) COLORADO SYMPHONY ASSOCIATION
1000 14TH ST UNIT 15
DENVER,CO80202 		84-0511458 501(C)(3) 25,000       CULTURE AND HUMANITIES
(8) AMERICAS DENTISTS CARE FOUNDATION
9110 E 35TH ST N
WICHITA,KS67226 		26-2275291 501(C)(3) 23,000       SUPPORT LOCAL ORGANIZATION
(9) DENVER DUMB FRIENDS LEAGUE
2080 S QUEBEC ST
DENVER,CO80231 		84-0405254 501(C)(3) 23,000       SUPPORT LOCAL ORGANIZATION
(10) FLORENCE CRITTENTON SERVICES OF COLORADO
55 SOUTH ZUNI STREET
DENVER,CO80223 		84-0429686 501(C)(3) 21,200       SUPPORT LOCAL ORGANIZATION
(11) SAFEHOUSE DENVER INC
1649 DOWNING STREET
DENVER,CO80218 		84-0745911 501(C)(3) 15,500       SUPPORT LOCAL ORGANIZATION
(12) CLINICA TEPEYAC
4725 HIGH STREET
DENVER,CO80216 		84-1285505 501(C)(3) 15,000       SUPPORT LOCAL HEALTH ORGANIZATION
(13) MILE HIGH UNITED WAY
711 PARK AVE W
DENVER,CO80205 		84-0404235 501(C)(3) 13,500       SUPPORT LOCAL ORGANIZATION
(14) CHILDREN FIRST OF THE ROCKIES
P O BOX 2174
LONGMONT,CO80502 		84-1497910 501(C)(3) 11,700       SUPPORT LOCAL ORGANIZATION
(15) AMERICAN HEART ASSOCIATION
1280 S PARKER ROAD
DENVER,CO80231 		13-5613797 501(C)(3) 11,250       SUPPORT LOCAL CHAPTER OF NATIONAL ORGANIZATION
(16) KIDS IN NEED OF DENTISTRY
2465 S DOWNING ST STE 210
DENVER,CO80210 		84-6038681 501(C)(3) 11,200       SUPPORT LOCAL ORGANIZATION
(17) ART STUDENTS LEAGUE OF DENVER
200 GRANT ST
DENVER,CO80203 		84-1042289 501(C)(3) 11,000       CULTURE AND HUMANITIES
(18) BOYS & GIRLS CLUBS OF METRO DENVER
2017 W 9TH AVE
DENVER,CO80204 		84-0510404 501(C)(3) 10,000       SUPPORT LOCAL ORGANIZATION
(19) JUVENILE DIABETES RESEARCH FND
5613 DTC PRKWY SUITE 810
GREENWOOD VILLAGE,CO80111 		23-1907729 501(C)(3) 10,000       SUPPORT LOCAL CHAPTER OF NATIONAL ORGANIZATION
(20) ROCKY MOUNTAIN PBS
1089 BANNOCK STREET
DENVER,CO80204 		84-0510785 501(C)(3) 10,000       CULTURE AND HUMANITIES
(21) GLOBAL DENTAL RELIEF
4105 E FLORIDA AVE STE 200
DENVER,CO80222 		84-1569747 501(C)(3) 10,000       SUPPORT LOCAL ORGANIZATION
(22) CONCERTS FOR KIDS
1616 17TH ST SUITE 462
DENVER,CO80202 		20-1706475 501(C)(3) 10,000       CULTURE AND HUMANITIES
(23) DENVER ART MUSEUM
100 W 14TH AVE PKWY
DENVER,CO80204 		84-6038240 501(C)(3) 10,000       CULTURE AND HUMANITIES
(24) FAMILIES FORWARD RESOURCE CENTER
4800 TELLURIDE ST-Z PLACE BLDG 5
162
DENVER,CO80249 		84-1493585 501(C)(3) 9,400       SUPPORT LOCAL ORGANIZATION
(25) GOODWILL INDUSTRIES OF DENVER
6850 NORTH FEDERAL BLVD
DENVER,CO80221 		84-0405513 501(C)(3) 8,500       SUPPORT LOCAL ORGANIZATION
(26) COLORADO WOMEN'S CHAMBER OF COMMERCE
1350 17TH ST SUITE 100
DENVER,CO80202 		84-1145793 501(C)(6) 8,105       SUPPORT LOCAL ORGANIZATION
(27) GIRL SCOUTS OF COLORADO
3801 E FLORIDA AVE
DENVER,CO80210 		84-0410630 501(C)(3) 7,500       SUPPORT LOCAL ORGANIZATION
(28) COLORADO BUSINESS COMMITEE OF THE ARTS
130 WEST 12TH AVE
DENVER,CO80204 		74-2368958 501(C)(3) 6,500       CULTURE AND HUMANITIES
(29) COLORADO BALLET COMPANY
1075 SANTA FE DRIVE
DENVER,CO80204 		84-6038137 501(C)(3) 6,000       CULTURE AND HUMANITIES
(30) VOLUNTEERS OF AMERICA
2660 LARIMER STREET
DENVER,CO80205 		84-0430995 501(C)(3) 6,000       SUPPORT LOCAL ORGANIZATION
(31) FOOTHILLS ART CENTER
809 15TH ST
GOLDEN,CO80401 		84-0612999 501(C)(3) 6,000       CULTURE AND HUMANITIES
(32) COLORADO COALITION FOR THE MEDICALLY UNDERSERVED
PO BOX 18877
DENVER,CO80218 		43-2007393 501(C)(3) 5,400       SUPPORT LOCAL HEALTH ORGANIZATION
(33) COLFAX MARATHON PARTNERSHIP INC
P O BOX 6117
DENVER,CO80206 		87-0737183 501(C)(3) 5,000       SUPPORT LOCAL ORGANIZATION
(34) BRIGHT BEGINNINGS
730 COLORADO BLVD SUITE 202
DENVER,CO80206 		84-1382420 501(C)(3) 5,000       SUPPORT LOCAL ORGANIZATION
(35) DENVER HEALTH FOUNDATION
655 BROADWAY SUITE 750
DENVER,CO80203 		84-1085196 501(C)(3) 5,000       SUPPORT LOCAL HEALTH ORGANIZATION
(36) ROCKY MOUNTAIN YOUTH MEDICAL AND NURSING CONSULTANTS INC
9197 GRANT ST STE 100
THORNTON,CO80229 		84-1321485 501(C)(3) 5,000       SUPPORT LOCAL ORGANIZATION
(37) COLORADO METH PROJECT
11880 UPHAM STREET SUITE F
BROOMFIELD,CO80020 		26-3359868 501(C)(3) 5,000       SUPPORT LOCAL ORGANIZATION
(38) UNC FOUNDATION
CAMPUS BOX 20
GREELEY,CO80639 		84-6044833 501(C)(3) 5,000       SUPPORT LOCAL ORGANIZATION
(39) NEWSED COMMUNITY DEVELOPMENT CORPORAT'N
901 W 10TH AVE UNIT 2A
DENVER,CO80204 		74-2275534 501(C)(3) 5,000       CULTURE AND HUMANITIES
(40) HISPANIC CHAMBER OF COMMERCE
924 W COLFAX AVENUE SUITE 201
DENVER,CO80204 		84-0845219 501(C)(6) 5,000       SUPPORT LOCAL ORGANIZATION
(41) NATIONAL JEWISH HEALTH
1400 JACKSON STREET S721
DENVER,CO80206 		74-2044647 501(C)(3) 5,000       SUPPORT LOCAL HEALTH ORGANIZATION
(42) DELTA DENTAL OF COLORADO FOUNDATION
4582 S ULSTER ST SUITE 800
DENVER,CO80237 		84-1389431 501(C)(3) 6,407,000       PROGRAM SUPPORT
(43) SPRINGROCK DENTAL INC
4582 S ULSTER ST SUITE 800
DENVER,CO80237 		47-5247650 PENDING 501(C)(3) 1,000,000       PROGRAM SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
43
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2015

Schedule I (Form 990) 2015
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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
(1)
(2)
(3)
(4)
(5)
(6)
(7)
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
PART I, LINE 2: THE COMPANY HAS PROCEDURES TO ASCERTAIN THAT ALL GRANTS ARE MADE TO 501C3 ORGANIZATIONS AND ARE PROPERLY APPROVED BY MANAGEMENT. ADDITIONALLY, THE ORGANIZATION REQUIRES PERIODIC REPORTS TO ASCERTAIN THAT SUBSTANTIAL GRANTS ARE USED FOR THEIR PROPER INTENDED PURPOSE.
Schedule I (Form 990) 2015



Additional Data


Software ID:  
Software Version:  


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" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
COLORADO DENTAL SERVICE INC
 
Employer identification number

84-0568337
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 on 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
 
 
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
 
 
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 on 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
 
No
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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on 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
Yes
 
b
Any related organization?
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on 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
Yes
 
b
Any related organization? .........................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on 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 on 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" on 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) 2015

Schedule J (Form 990) 2015
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 on 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 in column(B) reported as deferred on prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1KATHRYN ANN PAULCEO/PRESIDENT (i)

(ii)		 423,632
-------------
0 		286,883
-------------
0 		2,057
-------------
0 		35,000
-------------
0 		2,901
-------------
0 		750,473
-------------
0 		0
-------------
0
2DAVID A BEALCFO/TREASURER (i)

(ii)		 342,652
-------------
31,791 		125,723
-------------
0 		1,820
-------------
0 		35,071
-------------
0 		13,635
-------------
0 		518,901
-------------
31,791 		0
-------------
0
3GREGORY VOCHISINTERIM CFO/TREASURER (i)

(ii)		 173,093
-------------
0 		19,079
-------------
0 		119
-------------
0 		18,043
-------------
0 		9,296
-------------
0 		219,630
-------------
0 		0
-------------
0
4BARBARA BLACKBURN SPRINGER JDVICE PRESIDENT/GENERAL COUNSEL (i)

(ii)		 117,568
-------------
117,568 		46,154
-------------
46,154 		1,026
-------------
1,026 		16,485
-------------
16,484 		9,712
-------------
9,711 		190,945
-------------
190,943 		0
-------------
0
5JESSICA JEAN LAWHEADVICE PRESIDENT (i)

(ii)		 242,923
-------------
0 		139,065
-------------
0 		2,092
-------------
0 		33,368
-------------
0 		12,330
-------------
0 		429,778
-------------
0 		0
-------------
0
6LINDA MARIE ARNESONCOO/ASSISTANT SECRETARY (i)

(ii)		 267,833
-------------
0 		127,476
-------------
0 		2,099
-------------
0 		34,719
-------------
0 		6,806
-------------
0 		438,933
-------------
0 		0
-------------
0
7KATHLEEN S JACOBYDIRECTOR OF MARKETING (i)

(ii)		 153,500
-------------
0 		19,851
-------------
0 		593
-------------
0 		14,660
-------------
0 		12,591
-------------
0 		201,195
-------------
0 		0
-------------
0
8LORRI KOHLESENIOR SALES EXECUTIVE (i)

(ii)		 107,263
-------------
0 		77,328
-------------
0 		380
-------------
0 		16,839
-------------
0 		7,417
-------------
0 		209,227
-------------
0 		0
-------------
0
9MICHAEL OKUJI DDSDENTAL DIRECTOR (i)

(ii)		 183,927
-------------
0 		24,113
-------------
0 		1,753
-------------
0 		20,098
-------------
0 		15,224
-------------
0 		245,115
-------------
0 		0
-------------
0
10ROBERT MARK THOMPSONDIRECTOR OF SALES & CLIENT SERVICES (i)

(ii)		 199,737
-------------
0 		89,488
-------------
0 		451
-------------
0 		35,988
-------------
0 		22,004
-------------
0 		347,668
-------------
0 		0
-------------
0
11STEPHANIE RAUZISENIOR SALES EXECUTIVE (i)

(ii)		 103,338
-------------
0 		79,874
-------------
0 		199
-------------
0 		18,161
-------------
0 		20,418
-------------
0 		221,990
-------------
0 		0
-------------
0
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
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
PART I, LINE 5 THE COMPANY HAS AN INCENTIVE COMPENSATION PLAN AND A SALES INCENTIVE PLAN WHICH PROVIDES AN ANNUAL BONUS FOR ALL ELIGIBLE EMPLOYEES IF THE COMPANY REACHES CERTAIN GOALS INCLUDING A MINIMUM NET GAIN GOAL. ALL ACTIVE FULL TIME EMPLOYEES ARE ELIGIBLE FOR ONE OF THE INCENTIVE PLANS. THE COMPANY ALSO HAS A LONG-TERM INCENTIVE PROGRAM FOR EXECUTIVES, WHICH IS BASED ON BOTH A MEMBERSHIP GROWTH AND RETURN ON REVENUE FACTOR. THE LONG-TERM INCENTIVE PROGRAM HAS THREE-YEAR TARGETS AND PAYOUTS, AND IN MARCH OF 2015 THE PLAN ENDING DECEMBER 31, 2014 WAS PAID.
PART I, LINE 6 SEE NARRATIVE FOR LINE 5A ABOVE.
Schedule J (Form 990) 2015
Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
COLORADO DENTAL SERVICE INC
 
Employer identification number

84-0568337
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2015
Schedule L (Form 990 or 990-EZ) 2015
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) 4TH AVENUE FAMILY DENTISTRY LLC
  		THOMAS B SWAIN, DELTA DIRECTOR & PARTNER OF 4TH AVENUE FAMILY DENTISTRY LLC 125,056 4TH AVENUE FAMILY DENTISTRY PARTICIPATES WITH DELTA DENTAL USING A STANDARD DENTAL PROVIDER CONTRACT AND IS PAID FOR DENTAL SERVICES PROVIDED TO PATIENTS.   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2015


Additional Data


Software ID:  
Software Version:  




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 990-EZ 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
2015
Open to Public
Inspection
Name of the organization
COLORADO DENTAL SERVICE INC
 
Employer identification number

84-0568337
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS WHO ARE DEFINED AS PARTICIPATING DENTISTS WHO ARE ENGAGED IN THE PRACTICE OF DENTISTRY IN THE STATE OF COLORADO. THE PARTICIPATING DENTISTS ARE THOSE THAT HAVE SIGNED A PARTICIPATING DENTIST AGREEMENT WITH THE ORGANIZATION AS PRESCRIBED BY THE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE ORGANIZATION HAVE THE AUTHORITY TO ELECT THE BOARD OF TRUSTEES AT THE ANNUAL MEETING OF THE MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7B CERTAIN MATTERS OF THE ORGANIZATION ARE SUBJECT TO A VOTE OF THE MEMBERS. A QUORUM OF 2% OF MEMBERSHIP IS REQUIRED.
FORM 990, PART VI, SECTION B, LINE 11 WE ENGAGE AN INDEPENDENT CPA TAX PROFESSIONAL TO PREPARE OUR 990, AND BOARD MEMBERS GENERALLY FEEL THIS IS THE APPROPRIATE FIDUCIARY PROCESS. THE AUDIT, INVESTMENT AND FINANCE COMMITTEE'S ROLE THEN IS TO EVALUATE THE FIRM HIRED TO PREPARE THE RETURN AND TO DETERMINE IT IS APPROPRIATELY FILED. WE HAVE TAKEN THOSE STEPS WITH OUR AUDIT, INVESTMENT AND FINANCE COMMITTEE. THE BOARD OF DIRECTORS REVIEWS AND APPROVES FORM 990 PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C DDCO CONDUCTS AN ANNUAL COMPLIANCE TRAINING, WHICH IS MANDATORY FOR ALL EMPLOYEES TO ATTEND. THE CONFLICTS OF INTEREST POLICY IS DISCUSSED AT THIS TRAINING. ON AN ANNUAL BASIS, ALL EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT AND SUBMIT ANY POTENTIAL OR PERCEIVED CONFLICT OF INTEREST. RECEIPT OF ALL SIGNED & COMPLETED FORMS ARE TRACKED IN AN EXCEL FILE; ORIGINAL FORMS ARE KEPT IN THE PERSONNEL FILE IN THE HUMAN RESOURCES OFFICE. ANY REPORTED POTENTIAL OR PERCEIVED CONFLICTS OF INTEREST ARE REVIEWED AND, IF NECESSARY, EMPLOYEES AND THEIR MANAGER ARE ADVISED TO REMOVE THEMSELVES FROM ANY SITUATION INVOLVING THE POTENTIAL CONFLICT. ADDITIONALLY, ALL NEW EMPLOYEES RECEIVE COMPLIANCE TRAINING AND ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT. EMPLOYEES ARE INSTRUCTED TO COMPLETE A NEW CONFLICT OF INTEREST STATEMENT DURING THE COURSE OF THE YEAR, SHOULD THEIR SITUATION CHANGE. THE CONFLICT OF INTEREST POLICY AND STATEMENT FORMS ARE POSTED ON THE COMPANY INTRANET.
FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION HAS A COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES THAT IS RESPONSIBLE FOR SETTING THE COMPENSATION OF THE PRESIDENT AND CEO. THE COMMITTEE ENGAGES THE SERVICES OF A THIRD PARTY TO PROVIDE RANGES OF COMPENSATION THAT ARE APPROPRIATE FOR THE DUTIES REQUIRED BY THE POSITION OF THE PRESIDENT, AS WELL AS THE POSITION OF THE VICE PRESIDENTS. THE CEO AND PRESIDENT OF THE CORPORATION IS RESPONSIBLE FOR THE COMPENSATION PROCESS OF THE REMAINING OFFICERS OF THE ORGANIZATION. THE ORGANIZATION ENGAGES A THIRD PARTY TO PROVIDE RANGES OF ACCEPTABLE INCREASES AND COMPENSATION LEVELS OF AVERAGE SALARIES BY SALARY GRADE.
FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAINTAINS COPIES OF THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS THAT ARE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION HAS A STATEMENT ON ITS WEBSITE, WWW.DELTADENTALCO.COM, THAT INFORMS THE PUBLIC THAT THESE DOCUMENTS ARE AVAILABLE FOR PUBLIC INSPECTION AT ITS CORPORATE HEADQUARTERS. THE ORGANIZATION'S ANNUAL REPORT IS ALSO POSTED ON ITS WEBSITE, WHICH STATES THAT "COMPLETE AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR INSPECTION AT OUR CORPORATE OFFICES UPON REQUEST". DOCUMENTS ARE AVAILABLE FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D).
FORM 990, PART XI, LINE 9: UNRECOGNIZED ACTUARIAL GAINS ON OPEB 29,624. PARTNERSHIP K-1 INCOME NOT RECOGNIZED ON FINANCIALS -224,854.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2015


Additional Data


Software ID:  
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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 Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
COLORADO DENTAL SERVICE INC
 
Employer identification number

84-0568337
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










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)DELTA DENTAL PLAN OF COLORADO FOUNDATION
4582 S ULSTER ST 800

DENVER,CO80237
84-1389431 		DENTAL HEALTH AND EDUCATION CO 501(C)(3) LINE 11A, I DELTA DENTAL OF COLORADO
 
Yes
 
(2)SPRINGROCK DENTAL INC
4582 S ULSTER ST 800

DENVER,CO80237
47-5247650 		DENTAL HEALTH AND EDUCATION CO PENDING 501(C)(3) LINE 11A, I DELTA DENTAL OF COLORADO
 
Yes
 










For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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) 2015
Schedule R (Form 990) 2015
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
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
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
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
 
No
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
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) DELTA DENTAL PLAN OF COLORADO FOUNDATION INC

 B 6,407,000 ACTUAL COST
(2) SPRINGROCK DENTAL INC

 B 1,000,000 ACTUAL COST
(3) DELTA DENTAL PLAN OF COLORADO FOUNDATION INC

 O 565,465 ACTUAL COST
(4) SPRINGROCK DENTAL INC

 O 95,973 ACTUAL COST
(5) DELTA DENTAL PLAN OF COLORADO FOUNDATION INC

 Q 201,555 ACTUAL COST

Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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) 2015
Schedule R (Form 990) 2015
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) 2015

Additional Data


Software ID:  
Software Version: