TIN:
SCHEDULE O
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
(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.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Inspection
Name of the organization
Delta Dental of Washington
Employer identification number
91-0621480
91-0621480
| Return Reference | Explanation |
|---|---|
| Form 990 Part I Line 1 and Part III Line 1 | DDWA WILL REVOLUTIONIZE THE ORAL HEALTH INDUSTRY AND IMPROVE OVERALL HEALTH. THIS INCLUDES, but is not limited to, the following to provide dental service and provide dental benefits: TO SECURE DENTAL SERVICE FOR EMPLOYER GROUPS, INDIVIDUALS AND THEIR FAMILIES; PROVIDE INNOVATIVE PRODUCTS AND SERVICES; TO ENCOURAGE, foster and finance innovation, professional and scientific study AND RESEARCH IN THE GENERAL FIELD OF ORAL HEALTH; AND TO EDUCATE THE PUBLIC CONCERNING THE NEED FOR AND ADVANTAGE OF ADEQUATE DENTAL TREATMENT. |
| Form 990 Part III Line 3 | ON DECEMBER 21, 2018, DELTA DENTAL OF WASHINGTON DISTRIBUTED $17,600,000 IN CASH AND CASH EQUIVALENTS TO ITS SOLE MEMBER WASHINGTON DENTAL SERVICE. |
| Form 990 Part III Line 4a | DDWA provides dental insurance for over 3,226,000 primary subscribers and their dependents throughout the state of Washington and across the nation. Working collectively with producers and benefit managers, we offer standard insurance benefits, as well as highly customized plans to meet the needs of individuals and their families. We have contracted with nearly 4,600 dentists, creating a network of providers serving patients across the state. As a member of the Delta Dental Plans Association, a national association supporting Delta insurers nation-wide, our members are able to access Delta contracted providers in every state. In 2018, DDWA processed over 6,740,000 claims for subscribers and their dependents. To ensure providers are submitting claims appropriately, we audited over 33,000 individual claims, the results of which include education of dental office staff on the use of CDT codes, invoicing procedures and reducing common errors. Form 990 Part III Line 4b Delta Dental of Washington promotes the value of dental benefits and importance of oral health through marketing efforts in media advertising, public relations, event sponsorships and direct outreach to customers. Market research findings show these activities improve our ability to reach and encourage audiences to embrace good oral health and make wise use of dental benefits. Form 990 Part III Line 4c Dental decay is the single most common chronic disease of early childhood - five times more common than asthma. Nearly one in five adults, nationally, has untreated dental cavities. The Arcora Foundation (the Foundation), a wholly owned subsidiary of DDWA, supported almost exclusively by DDWA, focuses much of their work specifically on children and seniors, and works closely with partner organizations to develop and implement innovative programs. The Access to Baby and Child Dentistry (ABCD) programs expand access to dental care for young children in Washington State by facilitating access to dental services, both preventative and restorative - to Medicaid-enrolled children up to age six. In counties with ABCD, the utilization of dental services increased from 21% to 53% from 1997 to 2018. The Early Intervention in Medical Settings programs is training pediatricians in the advantages and techniques of oral screening, applying fluoridation and referring high risk patients for dental care. |
| Form 990 Part III Line 4d | 1. Water fluoridation is the most important step a community can take to improve the oral health of all residents. The Foundation promotes legislation to encourage fluoridation and provides assistance to groups who are committed to bringing the benefits of fluoride to their communities. Since 2001, an additional 280,000 Washingtonians are receiving the health benefits associated with fluoridated water as a result of the Foundation's work. 2. Assisting the work of the Foundation are DDWA employees volunteering their time. DDWA enables all employees to engage with the public regarding oral health through the use of two volunteer days per year. Volunteer time is spent working on the SmileMobile, a mobile dental facility traveling to underserved areas of the state. More than 20,000 low-income and at-risk-children state-wide received dental services in the last 10 years through the Foundation operated SmileMobile. Volunteer time is also spent handing out flyers promoting oral health to Washington citizens at fairs, the zoo, parades, and events across the state. 3. DDWA matches donations made by employees to non-profit organizations with official IRS 501(c)(3) status, although the following organizations/events are not eligible for matching: churches, political campaigns/organizations, capital funding, fraternal/labor organizations, trips/tours, mass mailings, organizations/groups that discriminate for any reason including, but not limited to, race, color, religion, creed, age, sex, sexual orientation or national origin. 4. DDWA supported Seattle Children's Hospital to equip and operationalize the new Odessa Brown Children's Clinic (OBCC) dental clinic. OBCC hub will be an innovative, forward thinking project that will test and promote new health delivery strategies in Washington State. DDWA also supported Providence Health Care Foundation for the purchase and installation of dental equipment at the Providence Sacred Heart Medical Center Dental Clinic and the Providence/ CHAS north dental clinic. The grant is made for the intended use of providing access to dental care for low-income and medically complex individuals. |
| Form 990 Part VI Line 6 | DDWA'S MEMBER DENTISTS ARE CONSIDERED MEMBERS OF THE COMPANY'S PARENT COMPANY, WDS. MEMBER DENTISTS ELECT THE dental members of the WDS Board of Directors, in accordance with the WDS bylaws. WDS directors also currently serve as DIRECTORS ON THE DDWA BOARD. |
| Form 990 Part VI Line 7a | THE GOVERNANCE & NOMINATING COMMITTEE (GNC) OF THE BOARD OF DIRECTORS SOLICITS ADVICE ON CANDIDATES AND SUBMITS NOMINEES TO THE BOARD FOR CONSIDERATION AND APPROVAL TO BE VOTED UPON. THE ENTIRE MEMBERSHIP ELECTS AND RE-ELECTS MEMBER DIRECTORS, WHO COMPRISE A MINORITY OF THE BOARD. THE INCUMBENT INDEPENDENT DIRECTORS NOMINATE AND ELECT OR RE-ELECT INDEPENDENT DIRECTORS. A MEMBER ADVISORY PANEL (MAP) CONSISTS OF TEN TO FIFTEEN MEMBERS THAT ARE SELECTED BY THE BOARD FROM NOMINEES BY THE GNC. THE MAP PROVIDES CONSULTATION TO THE COMPANY, INCLUDING THE GNC AND BOARD, ON A VARIETY OF MATTERS. |
| Form 990 Part VI Line 7b | Changes to the WDS Corporate By-laws by the WDS Board are subject to approval by the WDS member dentists. |
| Form 990 Part VI Line 11b | THE 990 IS COMPLETED BY KPMG. THE FORM 990 AND SUPPORTING DOCUMENTATION IS REVIEWED AND APPROVED BY THE ACCOUNTING MANAGER, DIRECTOR OF FINANCE AND THE CFO/COO. ELECTRONIC COPIES OF THE RETURN ARE PROVIDED FOR REVIEW TO ALL BOARD MEMBERS PRIOR TO SUBMISSION TO THE IRS. |
| Form 990 Part VI Line 12c | THE Investment and AUDIT COMMITTEE OF THE BOARD IS CHARGED WITH MONITORING PROPOSED OR ON-GOING TRANSACTIONS FOR CONFLICTS OF INTEREST AND ADDRESSING ANY POTENTIAL OR ACTUAL CONFLICTS. PURSUANT TO THE CONFLICT OF INTEREST POLICY, AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE, AIMED AT DETERMINING ANY FAMILY AND BUSINESS RELATIONSHIPS AND TRANSACTIONS, OR OTHER TRANSACTIONS THAT MAY POSE A POTENTIAL CONFLICT, IS DISTRIBUTED TO ALL COVERED PERSONS (I.E. BOARD MEMBERS, OFFICERS AND EXECUTIVE LEADERSHIP OR KEY EMPLOYEES). COVERED PERSONS ARE REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICTS AT THE TIME WHEN SUCH CONFLICTS ARISE. WHEN SOMEONE BECOMES A COVERED PERSON AND annually THEREAFTER, THEY ARE REQUIRED TO EXPLICITLY ACKNOWLEDGE A STATEMENT AFFIRMING THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (2) HAS READ THE POLICY AND UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE POLICY, INCLUDING COMPLETING THE CONFLICTS OF INTEREST QUESTIONNAIRE IF ANY CONFLICTS EXIST. THE COMPLETED QUESTIONNAIRES THAT NOTE ANY CONFLICTS ARE REVIEWED BY THE BOARD AND ANY PERSONS WITH ACTUAL OR POTENTIAL CONFLICTS ARE INFORMED of any action VIA WRITTEN COMMUNICATION. THE PROCEDURES FOR ADDRESSING ANY CONFLICT OF INTEREST INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: (1) THE CONFLICTING INTEREST IS FULLY DISCLOSED TO THE BOARD; (2) THE INTERESTED PERSON RESPONDS TO FACTUAL QUESTIONS RELATED TO THE SUBSTANCE OF THE TRANSACTION OR ARRANGEMENT BEING CONSIDERED, AFTER WHICH HE/SHE SHALL LEAVE THE MEETING; (3) THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION; (4) ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED, COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED if deemed appropriate; (5) CONFLICTING ISSUES DURING THE COURSE OF A BOARD MEETING WHICH CANNOT BE RESOLVED ARE REFERRED TO THE GOVERNANCE AND NOMINATING COMMITTEE; AND (6) THE TRANSACTION OR ACTION MUST BE APPROVED BY A MAJORITY OF DISINTERESTED PERSONS. |
| Form 990 Part VI Line 15 | THE BOARD APPOINTS A HUMAN RESOURCES AND COMPENSATION COMMITTEE OF THE BOARD (THE HRCC), NONE OF WHOM MAY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY COMPENSATION ARRANGEMENTS, TO BE ACCOUNTABLE FOR SETTING REASONABLE COMPENSATION PACKAGES FOR THE CEO. IN 2018, THE HRCC DEVELOPED, CONSISTENT WITH THE ORGANIZATION'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA FOR OFFICERS AND KEY EMPLOYEES. THE HRCC ALSO HIRES A QUALIFIED INDEPENDENT COMPENSATION AND BENEFITS SPECIALIST (INDEPENDENT EXPERT) TO REVIEW, ANALYZE AND PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFIT PACKAGES OF OFFICERS AND KEY EMPLOYEES. APPROPRIATE COMPARABILITY DATA IS OBTAINED FROM THE INDEPENDENT EXPERT, I.E., TOTAL ECONOMIC BENEFITS PAID BY SIMILAR SITUATED ORGANIZATIONS (BOTH TAXABLE AND TAX-EXEMPT) FOR SIMILAR JOB RESPONSIBILITIES. THE HRCC'S WRITTEN RECORDS INCLUDE THE (1) TERMS OF THE ARRANGEMENTS WITH THE OFFICERS AND KEY EMPLOYEES (INCLUDING THE DATE THE ARRANGEMENT WAS APPROVED); (2) A LIST OF MEMBERS PRESENT DURING THE DISCUSSION ON ANY ARRANGEMENTS; AND (3) A DESCRIPTION OF THE COMPARABLE DATA RELIED UPON BY THE HRCC. KEY DELIBERATIONS OF THE HRCC ARE ALSO DOCUMENTED IN MINUTES WHICH ARE APPROVED AT THE NEXT HRCC MEETING. |
| FORM 990, PART VI, LINE 19 | FINANCIAL STATEMENTS AND DISCLOSURES ARE FILED QUARTERLY AND ANNUALLY WITH THE WASHINGTON STATE OFFICE OF THE INSURANCE COMMISSIONER (OIC) AS A MATTER OF PUBLIC RECORD. ALL DOCUMENTS SO FILED ARE AVAILABLE TO THE PUBLIC ON THE OIC WEBSITE. AMENDMENTS TO BYLAWS ARE FILED WITH THE WASHINGTON SECRETARY OF STATE'S OFFICE FROM TIME-TO-TIME AS THEY ARE APPROVED BY THE GOVERNING BODY. GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VII, SECTION A, LINE 1A | THE FOLLOWING DIRECTORS ALSO RECEIVED CLINICAL REIMBURSEMENTS IN ADDITION TO THEIR DIRECTOR'S FEES, THE TOTAL OF WHICH IS REPORTED IN COLUMN D - REPORTABLE COMPENSATION FROM THE ORGANIZATION. LABBERTON, WELLS, K. - $323,166 ------------------------------- DIRECTOR FEE - $137,610 CLINICAL REIMBURSEMENT - $185,556 PHIPPS, GERALD S. - $188,797 ------------------------------- DIRECTOR FEE - $179,802 CLINICAL REIMBURSEMENT - $8,995 RUTHERFORD, EVE M. - $742,071 ------------------------------- DIRECTOR FEE - $132,490 CLINICAL REIMBURSEMENT - $609,581 |
| FORM 990, PART XI, LINE 9 | On December 21, 2018, Delta Dental of Washington distributed $17,600,000 in cash and cash equivalents to its sole member Washington Dental Service. |
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2018
Additional Data
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