TY 2020 Form 990

- TIN:

Form990

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)

Do not enter social security numbers on this form as it may be made public.

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

A For the 2020 calendar year, or tax year beginning 01-01-2020 , and ending 12-31-2020

BCheck if applicable: Address change Name change Initial return Final return/terminated Amended return Application pending

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)
6465 GREENWOOD PLAZA BLVD NO 900

Room/suite

City or town, state or province, country, and ZIP or foreign postal code
CENTENNIAL, CO80111

D Employer identification number

84-0568337

E Telephone number

G Gross receipts $ 233,393,351

F Name and address of principal officer:
HELEN WEISS DREXLER
6465 GREENWOOD PLAZA BLVD NO 900
CENTENNIAL,CO80111

Tax-exempt status: 501(c)(3) 501(c) ( 4 ) LeftBullet

(insert no.) 4947(a)(1) or 527

Website:

WWW.DELTADENTALCO.COM

H(a)

Is this a group return for
subordinates? Yes No

H(b)

Are all subordinates
included?

Yes No

If "No," attach a list. (see instructions)

H(c)

Group exemption number MediumBullet

K Form of organization: Corporation Trust Association Other MediumBullet

L Year of formation: 1958

M State of legal domicile: CO

Part I

Summary

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
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	12
5	Total number of individuals employed in calendar year 2020 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	0
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	282
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	464,909,728	230,803,927
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	4,623,521	2,589,142
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,704	282
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	469,534,953	233,393,351
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	6,635,410	4,411,766
14	Benefits paid to or for members (Part IX, column (A), line 4).....	403,568,026	189,395,952
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	20,729,890	12,709,170
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	31,887,487	18,573,392
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	462,820,813	225,090,280
19	Revenue less expenses. Subtract line 18 from line 12.......	6,714,140	8,303,071
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	143,965,290	0
21	Total liabilities (Part X, line 26).............	39,024,496	0
22	Net assets or fund balances. Subtract line 21 from line 20.....	104,940,794	0

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

	Signature of officer	Date

	Type or print name and title

Paid Preparer Use Only

Print/Type preparer's name

Preparer's signature

Date

Check if
self-employed

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) ..........YesNo

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11282Y Form 990 (2020)

Form 990 (2020)

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..............

Briefly describe the organization’s mission: COLORADO DENTAL SERVICES (DBA DELTA DENTAL OF COLORADO) 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, DELTA DENTAL OF COLORADO 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, DELTA DENTAL 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.

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ..................... Yes No

If "Yes," describe these new services on Schedule O.

Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ........................... Yes No

If "Yes," describe these changes on Schedule O.

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 $ 217,493,763 including grants of $ ) (Revenue $ 230,803,927 )
	PROVISION OF RISK AND SELF-FUNDED PLANS TO SUBSCRIBERSDELTA 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 1,000,000 PEOPLE IN COLORADO AND 300,000 IN OTHER VARIOUS STATES. THE REVENUE GENERATED IS USED TO FUND THE COMMUNITY BENEFIT EFFORTS DESCRIBED IN LINE 4B.

4b	(Code: ) (Expenses $ 4,368,021 including grants of $ 4,411,766 ) (Revenue $ )
	COMMUNITY BENEFIT PROGRAMSAS A NONPROFIT, COLORADO DENTAL SERVICES (DBA DELTA DENTAL OF COLORADO) DEVOTES SIGNIFICANT RESOURCES TO FULFILLING OUR MISSION OF IMPROVING THE ORAL HEALTH OF THE COMMUNITIES WE SERVE. DELTA DENTAL OF COLORADO PROVIDES DENTAL BENEFITS AND ORAL HEALTH INFORMATION AND SERVICES TO AS MANY PEOPLE AS POSSIBLE. OVER THE PAST FIFTEEN YEARS, DELTA DENTAL OF COLORADO HAS DEVOTED A SUBSTANTIAL AMOUNT OF ITS ADJUSTED NET GAIN TO ITS COMMUNITY ENGAGEMENT PROGRAM, INCLUDING $1.4 MILLION IN 2019. THESE ACTIVITIES INCLUDE TABLES, DONATIONS, CORPORATE SPONSORSHIPS WITH MANY ORGANIZATIONS INCLUDING THE AMERICAN HEART ASSOCIATION AND MILE HIGH UNITED WAY. THE COMPANY ALSO SPONSORS LOCAL NONPROFIT ORGANIZATIONS AND COMMUNITY EVENTS AND DONATED OVER 206,000 ORAL HEALTH ITEMS REACHING MORE THAN 129,000 PEOPLE THROUGHOUT COLORADO. A PORTION OF THE FUNDING SUPPORT GOES TO DELTA DENTAL OF COLORADO FOUNDATION, WHICH RECEIVED $3.75 MILLION IN 2020 TO ADVANCE ORAL HEALTH EQUITY THROUGH GRANT MAKING. THE COMPANY SUPPORTS ENGAGEMENT IN THE COMMUNITY THROUGH ITS VOLUNTEER PROGRAM WITH 116 OF ITS 200 EMPLOYEES CONTRIBUTING THEIR TIME IN 2020.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses221,861,784

Form 990 (2020)

Page 3

Part IV

Checklist of Required Schedules

Yes

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A.....................

Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? ...

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.............

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.........

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..

Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I.........................

Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II....

Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part III..............

Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............

Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......

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.

Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. ...................

11a

Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......

11b

Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......

11c

Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX............

11d

Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X

11e

Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X

11f

12a

Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII......................

12a

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

12b

Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E

14a

Did the organization maintain an office, employees, or agents outside of the United States? .....

14a

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

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.....

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...

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) ....

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............

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...................

20a

Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....

20a

If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?

20b

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

Yes

Form 990 (2020)

Page 4

Part IV

Checklist of Required Schedules (continued)

Yes

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

Yes

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

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

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...

24b

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

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

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

Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II Click to see attachment

...........

Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?

If "Yes," complete

Schedule L, Part III Click to see attachment

.........................

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 current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV...................... Click to see attachment

28a

A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV..... Click to see attachment

28b

A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? If "Yes," complete Schedule L, Part IV.....................

28c

Yes

Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................

Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I Click to see attachment

Yes

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................ Click to see attachment

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

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

Yes

35a

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

35a

Yes

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

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.............

Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI Click to see attachment

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. ............

Yes

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

Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ..

21,233

Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................

Yes

Form 990 (2020)

Page 5

Part V

Statements Regarding Other IRS Filings and Tax Compliance (continued)

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 ..................

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)

Did the organization have unrelated business gross income of $1,000 or more during the year?...

If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...

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)? ..

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).

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............

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? ...

If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................

Organizations that may receive deductible contributions under section 170(c).

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? ....................

If "Yes," did the organization notify the donor of the value of the goods or services provided? .....

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................

If "Yes," indicate the number of Forms 8282 filed during the year ....

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................

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? ........

Sponsoring organizations maintaining donor advised funds.

Did the sponsoring organization make any taxable distributions under section 4966?........

Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...

Section 501(c)(7) organizations. Enter:

Initiation fees and capital contributions included on Part VIII, line 12 ...

10a

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

10b

Section 501(c)(12) organizations. Enter:

Gross income from members or shareholders .........

11a

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

If "Yes," enter the amount of tax-exempt interest received or accrued during the year.

12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

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

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

Enter the amount of reserves on hand ............

13c

14a

Did the organization receive any payments for indoor tanning services during the tax year?.....

14a

If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..

14b

Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see instructions and file Form 4720, Schedule N.

Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.

Form 990 (2020)

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

Enter the number of voting members of the governing body at the end of the tax year

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.

Enter the number of voting members included in line 1a, above, who are independent

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? .................

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? .

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .

Did the organization become aware during the year of a significant diversion of the organization’s assets? .

Did the organization have members or stockholders? ................

Yes

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? ....................

Yes

Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................

Yes

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

The governing body? .......................

Yes

Each committee with authority to act on behalf of the governing body? ............

Yes

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.......

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)

Yes

10a

Did the organization have local chapters, branches, or affiliates? ............

10a

If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?

10b

11a

Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................

11a

Yes

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

Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................

12b

Yes

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

Did the organization have a written whistleblower policy? ...............

Yes

Did the organization have a written document retention and destruction policy? .........

Yes

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?

The organization’s CEO, Executive Director, or top management official ...........

15a

Yes

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

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

List the states with which a copy of this Form 990 is required to be filed MediumBullet

Section 6104 requires an organization to make its Form 1023 (or 1024-A 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.

Own website Another's website Upon request Other (explain in Schedule O)

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.

State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBullet

GREGORY VOCHIS CPA6465 GREENWOOD PLAZA BLVD 900 CENTENNIAL,CO80111 (720) 489-4718

Form 990 (2020)

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.

List all of the organization’s current key employees, if any. See instructions for definition of "key employee."

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.

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.

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.

See instructions for the order in which to list the persons above.

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
(A) Name and title
(1) HELEN W DREXLER...................................................................... PRESIDENT AND CHIEF EXECUTIVE OFFICER	45.00 ................. 2.00	X	X	0	750,751	50,627
(2) ANN BLOCK...................................................................... TRUSTEE	2.00 .................	X		36,734	31,167	0
(3) KELLY J BROUGH...................................................................... TRUSTEE	2.00 .................	X		33,000	21,517	0
(4) RICHARD CALL DMD...................................................................... TRUSTEE	2.00 .................	X		35,759	28,793	0
(5) NED CALONGE MD...................................................................... TRUSTEE	2.00 .................	X		34,500	20,250	0
(6) JAMES COUSIN II...................................................................... TRUSTEE	2.00 .................	X		30,750	22,450	0
(7) KIM KRETSCH DDS...................................................................... TRUSTEE	2.00 .................	X		39,000	23,250	0
(8) MARY MARGARET NOONAN...................................................................... CHAIR	3.00 .................	X	X	58,559	35,750	0
(9) HASSAN SALEM...................................................................... TRUSTEE	2.00 .................	X		30,000	18,750	0
(10) ANN SOMERS DDS...................................................................... TRUSTEE	2.00 .................	X		30,000	18,750	0
(11) TAMANNA TIWARI MPH MDS BDS...................................................................... SECRETARY	2.00 .................	X	X	30,750	19,500	0
(12) LEO TOKAR...................................................................... VICE CHAIR	2.00 .................	X	X	30,093	35,190	0
(13) WALT VOGL DDS...................................................................... TRUSTEE	2.00 .................	X		33,750	12,750	0
(14) MARK WEHRLE CPA RETIRED...................................................................... TRUSTEE	2.00 .................	X		45,724	18,407	0
(15) ANDREA JEAN YOUNG...................................................................... TRUSTEE	2.00 .................	X		33,750	21,750	0
(16) GREGORY C VOCHIS CPA...................................................................... CHIEF FINANCIAL OFFICER AND TREASURER	45.00 .................		X	0	455,328	56,199
(17) DAVID W GERBUS...................................................................... CHIEF ADMIN OFFICER, GENERAL COUNSEL, & ASST. SECR	45.00 .................		X	0	443,745	45,319

Form 990 (2020)

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)				(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
(A) Name and title
(18) BRAD T GUYTON DDS MBA MPH........................................................................ CHIEF DENTAL OFFICER	22.00 .......................	X			0	231,548	20,278
(19) ROBERT M THOMPSON........................................................................ VICE PRESIDENT SALES AND CLIENT/BROKER EXPERIENCE	45.00 .......................		X		0	368,931	47,269
(20) KATHLEEN S JACOBY........................................................................ VICE PRESIDENT MARKETING AND MEMBER EXPERIENCE	45.00 .......................		X		0	358,829	40,222
(21) ADEEB A KHAN........................................................................ EXECUTIVE DIRECTOR OF FOUNDATION AND VP OF CSR	22.00 .......................23.00		X		0	227,213	25,441
(22) DEVIN W FARRELL........................................................................ DIRECTOR, SALES STRATEGY AND PROVIDER RELATIONS	45.00 .......................			X	0	250,321	45,210
(23) BRIAN L STEELE........................................................................ DIRECTOR OF CLIENT SERVICES	45.00 .......................			X	0	238,388	43,452
(24) BROOKE S BODART RDH MPA........................................................................ DIRECTOR OF BUSINESS PROGRAMS	45.00 .......................			X	0	195,409	26,694
(25) TIMOTHY J CATRON........................................................................ DIRECTOR OF GROUP ADMINISTRATION, EDI & CLAIMS	45.00 .......................			X	0	195,307	17,072
(26) SUNDAY A SOTOMAYOR........................................................................ DIRECTOR OF HUMAN RESOURCES	45.00 .......................			X	0	189,937	28,328

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	502,369	4,233,981	446,111

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet

Yes

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 ..............

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...........................

Yes

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 ........

Section B. Independent Contractors

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
DDP OF VIRGINIA 4818 STARKEY RD SOUTHWEST ROANOKE,VA24014	IT SUPPORT & CLAIMS PROCESSING	2,068,249
WYSSTA SERVICES INC PO BOX 86 STEVENS POINT,WI54481	3RD PARTY INSURANCE PROCESSING	1,592,090
REVGEN PARTNERS INC 6300 S SYRACUSE WAY STE 760 CENTINNIAL,CO80111	BUSINESS VALIDATION AND TECHNOLOGY	1,110,201
POINTB INC P O BOX 45527 SAN FRANCISCO,CA94145	STRATEGIC CONSULTING SERVICES	1,056,044
RAND CONSTRUCTION CORPORATION 1029 N ROYAL STREET ALEXANDRIA,VA22134	CONSTRUCTION SERVICES	909,835
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 42

Form 990 (2020)

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

(D)
Revenue
excluded from
tax under sections
512 - 514

1a	Federated campaigns..	1a
b	Membership dues..	1b
c	Fundraising events..	1c
d	Related organizations	1d
e	Government grants (contributions)	1e

f	All other contributions, gifts, grants, and similar amounts not included above	1f

g	Noncash contributions included in lines 1a - 1f:$	1g

h Total. Add lines 1a-1f.......

		Business Code
2a	SELF FUNDED PLAN PREMI	524114	122,127,588	122,127,588
b	RISK PLAN PREMIUMS	524114	99,764,086	99,764,086
c	ADMIN - SELF FUND PLAN	524298	8,303,353	8,303,353
d	RISK SHARING	524298	549,710	549,710
e	DISCOUNT PLAN FEES	524114	59,190	59,190
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		230,803,927

3 Investment income (including dividends, interest, and othersimilar amounts) ......			993,342			993,342
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		1,595,800	7a
b	Less: cost or other basis and sales expenses		0	7b
c	Gain or (loss)		1,595,800	7c
d	Net gain or (loss).........			1,595,800			1,595,800
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	VISION PREMIUMS		524298	282		282
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			282
12	Total revenue. See instructions.....			233,393,351	230,803,927	282	2,589,142

Form 990 (2020)

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 ....	4,367,221	4,367,221
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	44,545	44,545
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......	189,395,952	189,395,952
5	Compensation of current officers, directors, trustees, and key employees ...........	2,580,556	2,528,945	51,611
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	7,388,728	7,240,953	147,775
7	Other salaries and wages........	476,057	466,536	9,521
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,543,247	1,512,382	30,865
9	Other employee benefits .......	720,582	706,170	14,412
10	Payroll taxes ...........
11	Fees for services (non-employees):
a	Management ......	2,853,198	2,282,558	570,640
b	Legal .........	234,405	187,524	46,881
c	Accounting ...........	53,606	42,885	10,721
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	264,562		264,562
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	70,909	49,636	21,273
12	Advertising and promotion ....	604,543	604,543
13	Office expenses .......	450,047	315,033	135,014
14	Information technology ......	2,498,569	1,998,855	499,714
15	Royalties ..
16	Occupancy ...........	691,450	553,160	138,290
17	Travel ............	47,829	9,566	38,263
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	660,834	363,459	297,375
23	Insurance ...	163,965	131,172	32,793
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	5,082,729	5,082,729
b	CONSULTING/OUTSOURCING	2,330,533	1,864,426	466,107
c	DATA PROCESSING (CLAIMS	964,578	964,578
d	POSTAGE AND MAILING	933,096	746,477	186,619
e	All other expenses	668,539	402,479	266,060
25	Total functional expenses. Add lines 1 through 24e	225,090,280	221,861,784	3,228,496	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 if following SOP 98-2 (ASC 958-720).

Form 990 (2020)

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

1	Cash–non-interest-bearing ........			797,536	1	0
2	Savings and temporary cash investments .........			16,118,173	2	0
3	Pledges and grants receivable, net ......				3	0
4	Accounts receivable, net .............			26,558,224	4	0
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6	0
7	Notes and loans receivable, net ...........			2,000,000	7	0
8	Inventories for sale or use ............				8	0
9	Prepaid expenses and deferred charges ......				9	0
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	0
b	Less: accumulated depreciation	10b		3,548,797	10c	0
11	Investments—publicly traded securities .			33,573,165	11	0
12	Investments—other securities. See Part IV, line 11 .....			47,119,615	12	0
13	Investments—program-related. See Part IV, line 11 ..				13	0
14	Intangible assets ...............				14	0
15	Other assets. See Part IV, line 11 ...........			14,249,780	15	0
16	Total assets. Add lines 1 through 15 (must equal line 33)...			143,965,290	16	0

17	Accounts payable and accrued expenses .....	10,450,845	17
18	Grants payable ...	5,000,000	18
19	Deferred revenue .........	3,866,925	19
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 any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			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	19,706,726	25	0
26	Total liabilities. Add lines 17 through 25..	39,024,496	26	0

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	104,940,794	27	0
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	104,940,794	32	0
33	Total liabilities and net assets/fund balances ........	143,965,290	33	0

Form 990 (2020)

Page 12

Part XI

Reconcilliation of Net Assets

Check if Schedule O contains a response or note to any line in this Part XI..............

Total revenue (must equal Part VIII, column (A), line 12) ............

233,393,351

Total expenses (must equal Part IX, column (A), line 25) ............

225,090,280

Revenue less expenses. Subtract line 2 from line 1 ..............

8,303,071

Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..

104,940,794

Net unrealized gains (losses) on investments ...............

Donated services and use of facilities .................

Investment expenses .....................

Prior period adjustments .....................

Other changes in net assets or fund balances (explain in Schedule O) ........

-113,243,865

Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))

Part XII

Financial Statements and Reporting

Check if Schedule O contains a response or note to any line in this Part XII.............

Yes

Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.

Were the organization’s financial statements compiled or reviewed by an independent accountant?

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:

Separate basis Consolidated basis Both consolidated and separate basis

Were the organization’s financial statements audited by an independent accountant?

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:

Separate basis Consolidated basis Both consolidated and separate basis

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?

Yes

If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.

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?

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.

Form 990 (2020)

Additional Data

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Form 990, Special Condition Description:

Special Condition Description

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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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

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

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? ........................

Yes No

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	(h) Purpose of grant or assistance
(1) DELTA DENTAL OF COLORADO FOUNDATION 6465 GREENWOOD PLAZA BLVD SUITE 900 900 CENTENNIAL,CO80111	84-1389431	501(C)(3)	3,750,000	FUNDING TO SUPPORT DELTA DENTAL FOUNDATION AND FURTHER ITS MISSION
(2) A PRECIOUS CHILD INC 7051 W 118TH AVE BROOMFIELD,CO80020	26-3349334	501(C)(3)	10,257	SPONSORSHIP FOR LOCAL ORGANIZATION
(3) AMERICAN HEART ASSOCIATION 1280 S PARKER RD DENVER,CO80231	13-5613797	501(C)(3)	75,000	SUPPORT LOCAL HEALTH ORGANIZATION
(4) COLORADO MISSION OF MERCY 712 9TH STREET PENROSE,CO81240	74-2374672	501(C)(3)	10,000	FUNDING TO SUPPORT LOCAL ORGANIZATION'S OVERALL HEALTH EVENT
(5) COLORADO SUCCEEDS 1390 LAWRENCE ST DENVER,CO80204	75-3221270	501(C)(3)	11,264	FUNDING FOR LOCAL ORGANIZATION
(6) CRAIG HOSPITAL FOUNDATION 3425 S CLARKSON ST ENGLEWOOD,CO80113	23-7352287	501(C)(3)	14,500	FUNDING TO SUPPORT IMPROVED ACCESS TO OVERALL HEALTH FOR COLORADANS
(7) DENVER HEALTH FOUNDATION 601 BROADWAY SUITE 750 DENVER,CO80203	84-1085196	501(C)(3)	6,000	FUNDING TO SUPPORT IMPROVED ACCESS TO OVERALL HEALTH FOR COLORADANS
(8) DENVER METRO CHAMBER COMMERCE 1445 MARKET ST 4TH FLOOR DENVER,CO80202	84-0186760	501(C)(6)	14,000	SUPPORT LOCAL ORGANIZATION
(9) DENVER PUBLIC SCHOOLS FOUNDATN 1860 LINCOLN ST DENVER,CO80203	84-6001099	501(C)(3)	15,050	FUNDING FOR LOCAL SCHOOL ORGANIZATION
(10) METRO CARING 1100 E 18TH AVE DENVER,CO80218	84-6116951	501(C)(3)	20,150	SUPPORT LOCAL HEALTH ORGANIZATION
(11) MILE HIGH BEHAVIORAL HEALTHCARE PO BOX 919 AURORA,CO80040	84-0512896		10,000	SUPPORT LOCAL HEALTH ORGANIZATION
(12) MILE HIGH UNITED WAY PO BOX 5547 DENVER,CO80217	84-0404235	501(C)(3)	58,150	FUNDING TO SUPPORT NATIONAL ORGANIZATION
(13) NATIONAL KIDNEY FOUNDATION INC 500 TAYLOR ST COLUMBIA,SC29201	13-1673104	501(C)(3)	17,000	FUNDING TO SUPPORT NATIONAL HEALTH ORGANIZATION
(14) PROJECT WORTHMORE 1609 HAVANA ST AURORA,CO80010	45-0933835	501(C)(3)	7,500	FUNDING FOR LOCAL ORGANIZATION
(15) BCIVIC 1445 MARKET ST 4TH FLOOR DENVER,CO80202	46-5262657	501(C)(3)	8,500	FUNDING TO SUPPORT LOCAL ORGANIZATION
(16) BROTHER JEFF'S CULTURAL CENTER 2836 WELTON ST DENVER,CO80205	32-0034993	501(C)(3)	20,000	FUNDING TO SUPPORT LOCAL ORGANIZATION
(17) CARE AND SHARE INC 2605 PREAMBLE POINT COLORADO SPRINGS,CO80915	84-0731930	501(C)(3)	15,263	FUNDING TO SUPPORT LOCAL ORGANIZATION
(18) COLORADO COALITION FOR THE HOMELESS PO BOX 1560 DENVER,CO80201	84-0951575	501(C)(3)	20,000	FUNDING TO SUPPORT LOCAL ORGANIZATION
(19) DENVER RESCUE MISSION 1130 PARK AVE WEST DENVER,CO80205	84-6038762	501(C)(3)	15,258	FUNDING TO SUPPORT LOCAL ORGANIZATION
(20) DOWNTOWN DENVER INC 1515 ARAPAHOE ST STE 100 DENVER,CO80202	84-0449936	501(C)(3)	6,000	FUNDING TO SUPPORT LOCAL ORGANIZATION
(21) FOOD BANK FOR LARIMER COUNTY 5706 WRIGHT DR LOVELAND,CO80538	74-2336171	501(C)(3)	10,000	FUNDING TO SUPPORT LOCAL ORGANIZATION
(22) FOOD BANK OF THE ROCKIES 10700 E 45TH AVE DENVER,CO80239	84-0772672	501(C)(3)	20,200	FUNDING TO SUPPORT LOCAL ORGANIZATION
(23) THE GROWHAUS 4751 YORK ST DENVER,CO80216	20-3533527	501(C)(3)	10,000	FUNDING TO SUPPORT LOCAL ORGANIZATION
(24) JEFFCO ACTION CENTER INC 8755 W 14TH AVE LAKEWOOD,CO80215	23-7019679	501(C)(3)	10,000	FUNDING TO SUPPORT LOCAL ORGANIZATION
(25) MENTAL HEALTH CENTER OF DENVER 4141 E DICKENSON PL DENVER,CO80222	74-2499946		10,000	FUNDING TO SUPPORT LOCAL ORGANIZATION
(26) NAACP EMPOWERMENT PROGRAMS 1156 15TH NW STE 915 WASHINGTON,DC20005	13-1084135	501(C)(3)	20,000	FUNDING TO SUPPORT NATIONAL ORGANIZATION
(27) PROJECT ANGEL HEART 4950 WASHINGTON ST DENVER,CO80216	84-1199481	501(C)(3)	10,000	FUNDING TO SUPPORT NATIONAL ORGANIZATION
(28) SMILEMAKERS INC PO BOX 2543 SPARTANBURG,SC293042543	57-0647221	501(C)(3)	20,816	FUNDING TO SUPPORT NATIONAL ORGANIZATION
(29) SO ALL MAY EAT INC 2023 E COLFAX AVE DENVER,CO80206	20-4765519	501(C)(3)	10,000	FUNDING TO SUPPORT LOCAL ORGANIZATION
(30) VOLUNTEERS OF AMERICA 2660 LARIMER ST DENVER,CO80205	84-1590666	501(C)(3)	15,000	FUNDING TO SUPPORT NATIONAL ORGANIZATION
(31) WELD FOOD BANK 1108 H ST GREELEY,CO80634	74-2244826	501(C)(3)	10,000	FUNDING TO SUPPORT LOCAL ORGANIZATION
(32) YMCA OF METROPOLITAN DENVER 2625 S COLORADO BLVD DENVER,CO80222	84-0402696	501(C)(3)	10,000	FUNDING TO SUPPORT LOCAL ORGANIZATION

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

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) 2020

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
(1) EMPLOYEE ASSISTANCE FUND	35	44,545
(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 501(C)(3) 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) 2020

Additional Data

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Software Version:

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow

Attach to Form 990.
Graphic Arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

COLORADO DENTAL SERVICE INC

Employer identification number

84-0568337

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on 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 .....

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 on Line 1a? ....

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

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:

The organization? ....................

Yes

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

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:

The organization? ..................

Yes

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

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 ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2020

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1HELEN W DREXLER PRESIDENT AND CHIEF EXECUTIVE OFFICE	(i) (ii)	0 ------------- 468,056	0 ------------- 263,088	0 ------------- 19,607	0 ------------- 37,500	0 ------------- 13,127	0 ------------- 801,378	0 ------------- 0
2GREGORY C VOCHIS CPA CHIEF FINANCIAL OFFICER AND TREASURE	(i) (ii)	0 ------------- 316,084	0 ------------- 121,473	0 ------------- 17,771	0 ------------- 35,455	0 ------------- 20,744	0 ------------- 511,527	0 ------------- 0
3DAVID W GERBUS CHIEF ADMIN OFFICER, GENERAL COUNSEL	(i) (ii)	0 ------------- 300,733	0 ------------- 122,586	0 ------------- 20,426	0 ------------- 33,528	0 ------------- 11,791	0 ------------- 489,064	0 ------------- 0
4ROBERT M THOMPSON VICE PRESIDENT SALES AND CLIENT/BROK	(i) (ii)	0 ------------- 255,554	0 ------------- 94,427	0 ------------- 18,950	0 ------------- 29,073	0 ------------- 18,196	0 ------------- 416,200	0 ------------- 0
5KATHLEEN S JACOBY VICE PRESIDENT MARKETING AND MEMBER	(i) (ii)	0 ------------- 246,034	0 ------------- 92,940	0 ------------- 19,855	0 ------------- 26,240	0 ------------- 13,982	0 ------------- 399,051	0 ------------- 0
6DEVIN W FARRELL DIRECTOR, SALES STRATEGY AND PROVIDE	(i) (ii)	0 ------------- 159,374	0 ------------- 88,409	0 ------------- 2,538	0 ------------- 24,693	0 ------------- 20,517	0 ------------- 295,531	0 ------------- 0
7BRIAN L STEELE DIRECTOR OF CLIENT SERVICES	(i) (ii)	0 ------------- 171,602	0 ------------- 63,797	0 ------------- 2,989	0 ------------- 22,985	0 ------------- 20,467	0 ------------- 281,840	0 ------------- 0
8ADEEB A KHAN EXECUTIVE DIRECTOR OF FOUNDATION AND	(i) (ii)	0 ------------- 192,273	0 ------------- 18,833	0 ------------- 16,107	0 ------------- 7,385	0 ------------- 18,056	0 ------------- 252,654	0 ------------- 0
9BRAD T GUYTON DDS MBA MPH CHIEF DENTAL OFFICER	(i) (ii)	0 ------------- 183,663	0 ------------- 38,630	0 ------------- 9,255	0 ------------- 9,860	0 ------------- 10,418	0 ------------- 251,826	0 ------------- 0
10BROOKE S BODART RDH MPA DIRECTOR OF BUSINESS PROGRAMS	(i) (ii)	0 ------------- 158,174	0 ------------- 34,491	0 ------------- 2,744	0 ------------- 13,033	0 ------------- 13,661	0 ------------- 222,103	0 ------------- 0
11SUNDAY A SOTOMAYOR DIRECTOR OF HUMAN RESOURCES	(i) (ii)	0 ------------- 155,407	0 ------------- 30,156	0 ------------- 4,374	0 ------------- 14,599	0 ------------- 13,729	0 ------------- 218,265	0 ------------- 0
12TIMOTHY J CATRON DIRECTOR OF GROUP ADMINISTRATION, ED	(i) (ii)	0 ------------- 160,363	0 ------------- 29,023	0 ------------- 5,921	0 ------------- 14,596	0 ------------- 2,476	0 ------------- 212,379	0 ------------- 0

Schedule J (Form 990) 2020

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 2021 THE PLAN YEAR ENDING DECEMBER 31, 2020 WAS PAID.
PART I, LINE 6:	SEE NARRATIVE FOR LINE 5A ABOVE.

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 2021 THE PLAN YEAR ENDING DECEMBER 31, 2020 WAS PAID.

PART I, LINE 6:

SEE NARRATIVE FOR LINE 5A ABOVE.

Schedule J (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

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 section 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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

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) 2020

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) ROCKY VIEW DENTAL CARE	WALT VOGL, DELTA DENTAL OF COLORADO TRUSTEE	99,449	CLAIMS PAID FOR DENTAL SERVICES PROVIDED		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
FORM 990 SCHEDULE L PART IV	CLAIMS PAID TO ROCKY VIEW DENTAL CARE ARE MADE UNDER A STANDARD PROVIDER AGREEMENT.

Schedule L (Form 990 or 990-EZ) 2020

Additional Data

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Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

SCHEDULE N
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Liquidation, Termination, Dissolution, or Significant Disposition of Assets
bullet

Complete if the organization answered "Yes" on Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.
bullet

Attach certified copies of any articles of dissolution, resolutions, or plans.
bullet

Attach to Form 990 or 990-EZ.
bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization
COLORADO DENTAL SERVICE INC

Employer identification number
84-0568337

Part I

Liquidation, Termination, or Dissolution. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 31, or Form 990-EZ, line 36. Part I can be duplicated if additional space is needed.

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity
CASH AND CASH EQUIVALENTS	08-01-2020	35,399,000	BOOK VALUE	83-4416613	DELTA DENTAL OF COLORADO 6465 GREENWOOD PLAZA BLVD CENTENNIAL,CO80111	501(C)(4)
BONDS AND INVESTMENTS	08-01-2020	75,380,000	BOOK VALUE	83-4416613	DELTA DENTAL OF COLORADO 6465 GREENWOOD PLAZA BLVD CENTENNIAL,CO80111	501(C)(4)
FIXED ASSETS	08-01-2020	6,158,000	BOOK VALUE	83-4416613	DELTA DENTAL OF COLORADO 6465 GREENWOOD PLAZA BLVD CENTENNIAL,CO80111	501(C)(4)
ACCOUNT RECEIVABLES	08-01-2020	27,333,000	BOOK VALUE	83-4416613	DELTA DENTAL OF COLORADO 6465 GREENWOOD PLAZA BLVD CENTENNIAL,CO80111	501(C)(4)
PREPAID EXPENSES	08-01-2020	1,479,000	BOOK VALUE	83-4416613	DELTA DENTAL OF COLORADO 6465 GREENWOOD PLAZA BLVD CENTENNIAL,CO80111	501(C)(4)

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? ...........................

Yes

Become an employee of, or independent contractor for, a successor or transferee organization? .....................

Yes

Become a direct or indirect owner of a successor or transferee organization? .....................

Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? ........

If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ.

Cat. No. 50087Z

Schedule N (Form 990 or 990-EZ) (2020)

Page 2

Part I

Liquidation, Termination, or Dissolution (continued)

Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.

Yes

Did the organization distribute its assets in accordance with its governing instrument(s)? If "No," describe in Part III .............

Yes

Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? ......

Yes

If "Yes," did the organization provide such notice? .....................

Yes

Did the organization discharge or pay all of its liabilities in accordance with state laws? .....................

Yes

Did the organization have any tax-exempt bonds outstanding during the year? .....................

If "Yes" on line 6a, did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws?

If "Yes" on line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If "No" on line 6b, explain in Part III.

Part II

Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? .........................

Yes

Become an employee of, or independent contractor for, a successor or transferee organization? .....................

Yes

Become a direct or indirect owner of a successor or transferee organization? .....................

Receive, or become entitled to, compensation or other similar payments as a result of the organization's significant disposition of assets? ........

If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ.

Cat. No. 50087Z

Schedule N (Form 990 or 990-EZ) (2020)

Page 3

Part III

Supplemental Information. Provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.

Return Reference	Explanation

PART I, LINE 2E:	PERSON(S) INVOLVED: ALL BOARD MEMBERS AND OFFICERS OF COLORDO DENTAL SERVICE INC.
PART I, LINE 2E:	EXPLANATION OF INVOLVEMENT: ON AUGUST 1, 2020 COLORADO DENTAL SERVICE INC MERGED WITH A NEWLY CREATED SUCCESSOR ENTITY TO FORM DELTA DENTAL OF COLORADO. THE BOARD AND EMPLOYEES CONTINUED IN THEIR EXISTING ROLES.

Schedule N (Form 990 or 990-EZ) (2020)

Additional Data

Software ID:
Software Version:

- TIN:

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

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 15% OF MEMBERSHIP, OR 500 MEMBERS, WHICHEVER IS GREATER, IS REQUIRED.
FORM 990, PART VI, SECTION B, LINE 11B	WE ENGAGE AN INDEPENDENT CPA TAX PROFESSIONAL TO PREPARE OUR FORM 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 TRUSTEES REVIEWS AND APPROVES FORM 990 PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	ON AN ANNUAL BASIS, BOARD DIRECTORS ARE REQUIRED TO COMPLETE AN ELECTRONIC CONFLICT OF INTEREST SURVEY AND AN INDEPENDENT/DEPENDENT DIRECTOR SURVEY. COMPLETED SURVEYS ARE REVIEWED BY BOARD COUNSEL. ANY POTENTIAL OR PERCEIVED CONFLICT OR DEPENDENCY ISSUES ARE REPORTED TO AND ADDRESSED BY THE BOARD GOVERNANCE COMMITTEE. IF NECESSARY, THE IMPACTED DIRECTOR IS REMOVED FROM ANY SITUATION INVOLVING THE POTENTIAL CONFLICT. COMPLIANCE PRESENTS EACH QUARTER TO THE BOARD GOVERNANCE COMMITTEE, AND EACH SUCH PRESENTATION INCLUDES TRAINING MATERIALS ON THE BOARD'S RESPONSIBILITIES FOR COMPLIANCE OVERSIGHT AND MONITORING OF THE HEALTHCARE AND CORPORATE COMPLIANCE LANDSCAPE. GOVERNANCE CHAIR IS RESPONSIBLE FOR SHARING PERTINENT CONTENTS WITH THE ENTIRE BOARD AT EACH BOARD MEETING. CDS CONDUCTS AN ANNUAL COMPLIANCE TRAINING, WHICH IS MANDATORY FOR ALL EMPLOYEES TO ATTEND. THE CONFLICT 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 AND COMPLETED FORMS ARE TRACKED; 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 EXECUTIVES 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 VII	COLORADO DENTAL SERVICES MERGED INTO DELTA DENTAL OF COLORADO ON AUGUST 1, 2020, AN ENTITY FORMED TO CONTINUE THE OPERATIONS AND ASSUME THE CONTRACTUAL RELATIONSHIPS OF COLORADO DENTAL SERVICES. THE EMPLOYEES OF COLORADO DENTAL SERVICES BECAME EMPLOYEES OF DELTA DENTAL OF COLORADO AND RECEIVED FORM W-2 FOR 2020 SOLELY FROM DELTA DENTAL OF COLORADO.
FORM 990, PART XI, LINE 9:	TRANSFER TO DELTA DENTAL OF COLORADO -113,243,865.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

Additional Data

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Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

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?
(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	Yes	No
(1)DELTA DENTAL PLAN OF COLORADO FOUNDATION 6465 GREENWOOD PLAZA BLVD CENTENNIAL,CO80111 84-1389431	DENTAL HEALTH AND EDUCATION	CO	501(C)(3)	LINE 12A, I	DELTA DENTAL OF COLORADO	Yes
(2)DELTA DENTAL OF COLORADO 6465 GREENWOOD PLAZA BLVD CENTENNIAL,CO80111 83-4416613	DENTAL INSURANCE-SUCCESSOR COMPANY TO COLORADO DENTAL SERVICES ON 8/1/2020	CO	501(C)(4)		DELTA DENTAL OF COLORADO	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2020

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	(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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

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?
(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	Yes	No

Schedule R (Form 990) 2020

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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

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	B	3,750,000	FMV
(2) DELTA DENTAL PLAN OF COLORADO FOUNDATION	J	23,124	FMV
(3) DELTA DENTAL PLAN OF COLORADO FOUNDATION	O	427,956	FMV
(4) DELTA DENTAL PLAN OF COLORADO FOUNDATION	Q	53,712	FMV
(5) DELTA DENTAL OF COLORADO	R	113,243,865	FMV

Schedule R (Form 990) 2020

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)	(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
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2020

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) 2020

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