Civic Intelligence

Washington Dental Service

990 • Fiscal year 2014 • EIN 27-0937829

Jan 01, 2014 to Dec 31, 2014 • Filed on Aug 07, 2015

9706 4th Ave NESuiteSeattle, WA 98115

(206) 522-1300

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

15th percentile

0.00x

Higher debt load relative to assets than 15% of similar nonprofits.

2014 filings • $25M-$50M nonprofits • Source year 2014

Liabilities / Revenue

49th percentile

0.25x

Higher debt load relative to revenue than 49% of similar nonprofits.

2014 filings • $25M-$50M nonprofits • Source year 2014

Net Margin

2nd percentile

-226%

Higher net margin than 2% of similar nonprofits.

2014 filings • $25M-$50M nonprofits • Source year 2014

Top Officer Pay

97th percentile

$1,400,705

Higher top officer pay than 97% of similar nonprofits.

Top officer pay equals 1087.8% of source-year revenue.

2014 filings • $25M-$50M nonprofits • Source year 2014

Asset Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2014

Revenue Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2014

Assets

$43,140,374

No earlier filing loaded for comparison.

Net Assets

$43,108,030

No earlier filing loaded for comparison.

Liabilities

$32,344

No earlier filing loaded for comparison.

Revenue

$128,764

No earlier filing loaded for comparison.

Expenses

$419,817

No earlier filing loaded for comparison.

Net Income

-$291,053

No earlier filing loaded for comparison.

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$200M$150M$100M$50M$0Assets 2014: $43,140,374Liabilities 2014: $32,344Net Assets 2014: $43,108,0302014Assets 2015: $57,631,198Liabilities 2015: $246,381Net Assets 2015: $57,384,8172015Assets 2016: $72,365,850Liabilities 2016: $72,537Net Assets 2016: $72,293,3132016Assets 2017: $89,369,340Liabilities 2017: $1,605,292Net Assets 2017: $87,764,0482017Assets 2018: $96,734,074Liabilities 2018: $952,818Net Assets 2018: $95,781,2562018Assets 2019: $117,835,868Liabilities 2019: $860,836Net Assets 2019: $116,975,0322019Assets 2020: $135,639,888Liabilities 2020: $874,998Net Assets 2020: $134,764,8902020Assets 2021: $151,815,477Liabilities 2021: $2,183,737Net Assets 2021: $149,631,7402021Assets 2022: $139,346,327Liabilities 2022: $1,145,793Net Assets 2022: $138,200,5342022Assets 2023: $153,710,850Liabilities 2023: $469,573Net Assets 2023: $153,241,2772023Assets 2024: $173,923,354Liabilities 2024: $1,128,315Net Assets 2024: $172,795,0392024

Highlighted filing

2014

Assets$43,140,374
Liabilities$32,344
Net Assets$43,108,030

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$20M$10M$0-$10M-$20MRevenue 2014: $128,764Expenses 2014: $419,817Net Income 2014: -$291,0532014Revenue 2015: $275,012Expenses 2015: $2,232,222Net Income 2015: -$1,957,2102015Revenue 2016: $943,060Expenses 2016: $1,222,001Net Income 2016: -$278,9412016Revenue 2017: $1,187,025Expenses 2017: $3,017,826Net Income 2017: -$1,830,8012017Revenue 2018: -$4,466,364Expenses 2018: $3,369,728Net Income 2018: -$7,836,0922018Revenue 2019: $3,382,801Expenses 2019: $3,188,223Net Income 2019: $194,5782019Revenue 2020: $1,485,364Expenses 2020: $5,169,951Net Income 2020: -$3,684,5872020Revenue 2021: $6,192,998Expenses 2021: $6,135,350Net Income 2021: $57,6482021Revenue 2022: $891,081Expenses 2022: $8,293,573Net Income 2022: -$7,402,4922022Revenue 2023: $1,076,782Expenses 2023: $9,785,620Net Income 2023: -$8,708,8382023Revenue 2024: $3,208,968Expenses 2024: $14,515,844Net Income 2024: -$11,306,8762024

Highlighted filing

2014

Revenue$128,764
Expenses$419,817
Net Income-$291,053
Jump To
Filing Snapshot
Filing Period
Jan 1, 2014 to Dec 31, 2014
Signed
Aug 7, 2015
Return Version
2014v5.0
Gross Receipts
$449,570
Mission and Program Overview

Mission

The purpose of wds is: (a) to serve as a holding company of ddwa, an existing washington nonprofit corporation recognized as tax-exempt under section 501(c)(4) of the code, which provides prepaid dental services to its subscribers; (b) to serve as a holding company of other affiliated entites that provide services and engage in businesses that are supportive of ddwa's mission of improving the public's oral health; (c) guiding, monitoring, and coordinating the activities of ddwa and the other affiliated entities to achieve the tax-exempt health care purposes of ddwa in an efficient and integrated manner; (d) encouraging, fostering and financing professional and scientific study and research in the general field of dentistry and oral health; (e) conducting studies and investigations designed to develop information pertaining to all aspects of dental service coverage and payment plans; and (f) assisting in the education of the public concerning the need for and advantage of adequate denta

Washington dental service's purpose is to serve as a holding company of delta dental of wa and its affiliates in support of ddwa's mission of improving the public's oral health.

Balance Sheet Detail
LineBeginningEndChange
Assets
Investments in Publicly Traded Securities$0$26,452,115▲ $26,452,115
Savings and Temporary Cash Investments$1,939,036$8,999,601▲ $7,060,565
Investments Other Securities$0$7,165,562▲ $7,165,562
Cash and Non-Interest-Bearing Accounts$0$444,257▲ $444,257
Prepaid Expenses and Deferred Charges$0$15,118▲ $15,118
Accounts Receivable$0$0→ $0
Other Notes and Loans Receivable, Net$0$0→ $0
Pledges and Grants Receivable$0$0→ $0
Receivable From Disqualified Prsn$0$0→ $0
Receivables From Officers Etc$0$0→ $0
Investments Program Related$0$0→ $0
Land, Buildings, and Equipment, Net$0--
Intangible Assets$0$0→ $0
Inventories for Sale or Use$0$0→ $0
Loans From Officers Directors$0$0→ $0
Total Assets$1,939,036$43,140,374▲ $41,201,338
Other Assets Total$0$63,721▲ $63,721
Liabilities
Accounts Payable and Accrued Expenses$11,915$32,344▲ $20,429
Grants Payable$0$0→ $0
Mortgage Notes Payable Secured by Investment Property$0$0→ $0
Unsecured Notes Loans Payable$0$0→ $0
Other Liabilities$0$0→ $0
Deferred Revenue$0$0→ $0
Escrow Account Liability$0$0→ $0
Tax Exempt Bond Liabilities$0$0→ $0
Total Liabilities$11,915$32,344▲ $20,429
Net Assets / Fund Balance
Unrestricted Net Assets$1,927,121$43,108,030▲ $41,180,909
Permanently Rstr Net Assets$0$0→ $0
Temporarily Rstr Net Assets$0$0→ $0
Total Net Assets Fund Balance$1,927,121$43,108,030▲ $41,180,909
Total Liabilities and Net Assets / Fund Balance$1,939,036$43,140,374▲ $41,201,338

Asset Categories

AssetBook ValueDepreciationBasis
Other Securities$7,500,000--
Compensation and Service Providers

Employees

NameTitleOtherTotal
Branch David WDirector$135,252$135,252
Lohkamp Joanna LBoard Chair$89,305$89,305
Beck George DouglasVice Chair$87,012$87,012
Phipps Gerald SDirector$62,479$62,479
Dineen Patrick JosephTreasurer$58,899$58,899
Harwell Janis LDirector$58,899$58,899
Seely Jeffery ThomasDirector$54,833$54,833
Tune James FSecretary$53,833$53,833
Farrell Anne VDirector$41,594$41,594

Board Members and Trustees

NameTitle
Dwyer James DPresident & CEO
Labberton Wells KDirector

Highest Paid Contractors

ContractorServicesLocationCompensation
None---
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$0
Investment Income
$123,125
Other Revenue
$5,639
Change in Net Assets
$-291,053
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$419,817
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Fees for Services Management$177,752$47,871-$225,623
Fees for Services Other$71,876--$71,876
Conferences and Meetings$70,302--$70,302
Travel$25,629--$25,629
Advertising$13,673--$13,673
Office Expenses$5,043--$5,043
Occupancy$2,905$800-$3,705
Fees for Service Investment Mgmnt Fees$1,986$992-$2,978
Other Expenses$988--$988
Total Functional Expenses$370,154$49,663$0$419,817
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Loans from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Receivables from Disqualified Persons$0$0→ $0
Receivables from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Backup withholding compliance
Yes
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
Yes
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Section A, Line 6

Delta dental of washington's member dentists are considered members of the company. Member dentists elect the dental members of the board of directors.

Form 990, Part VI, Section A, Line 7A

The governance & nominating committee (gnc) of the board of directors solicits advice on candidates and submits nominees to the board for consideration and approval to be voted upon. The entire membership elects and re-elects member directors, who comprise a minority of the board. The incumbent independent directors nominate and elect or re-elect independent directors. A member advisory panel (map) consisting of ten to fifteen members are selected by the board from nominees by the gnc. The map provides consultation to the gnc and board on a variety of matters.

Form 990, Part VI, Section A, Line 7B

Recommended changes to the corporate by-laws by the board are subject to approval by the member dentists.

Form 990, Part VI, Section B, Line 11B

The 990 is completed by kpmg. The 990 return is reviewed and approved by the accounting supervisor, 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, Section B, Line 12C

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, each covered person is required to sign a statement affirming that he/she: (1) has received a copy of the conflicts of interest policy; (2) has read the policy and understands said policy; and (3) agrees to comply with all requirements of the policy, including completing the conflicts of interest questionnaire. The completed questionnaires that note any conflicts are reviewed by the board and any persons with actual or potential conflicts are informed 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; (5) and conflicting issues during the course of a board meeting which cannot be resolved are referred to the governance committee; and (6) the transaction or action must be approved by a majority of disinterested persons.

Form 990, Part VI, Section C, Line 19

Governing documents, financial statements and disclosures are available to the public upon request.

Form 990, Part VII, Section A, Line 1A

The following directors also received clinical reimbursements additional to their director's fees reported in column e - reportable compensation from the organization. Branch, david w. - $135,252 --------------------------- director fee - $62,983 clinical reimbursement - $72,269 labberton, wells, k. - $275,933 ------------------------------- director fee - $64,201 clinical reimbursement - $211,732

Filing and Contact Details

Filer

Filer Name
Washington Dental Service
EIN
27-0937829
In Care Of
% DELTA DENTAL OF WASHINGTON
Phone
2065221300
Address
9706 4TH AVE NE, Suite, SEATTLE, WA 98115

Signing Officer

Name
James D Dwyer
Title
President & CEO
Phone
2065221300
Signed
2015-08-07
Discuss with paid preparer
Yes

Organization Details

Principal Officer
James D Dwyer
Formed
2009
Legal Domicile
Wa
Voting Board Members
11
Independent Board Members
6
Employees
0

Preparer

Firm
Kpmg Llp
Address
1918 Eighth Avenue Suite 2900, Seattle, WA 98101
Preparer
Sue Robison
Phone
2069134000
Supplemental Narrative

Additional Explanations

Form 990, Part XI, Line 9

Distribution from delta dental of washington - $41,290,010

Form 990, Part III, Line 3

On july 16, 2014, delta dental of washington (ddwa) distributed $18,800,000 in cash to its sole member washington dental service (wds). On july 23, 2014, the ddwa board of directors approved, subject to office of the insurance commissioner (oic) review, an extraordinary distribution of ddwa's subsidiaries, wds holdings llc, the institute of oral health, and an investment c3 jian from ddwa to wds valued at approximately $22,630,000. On august 6, 2014, the oic approved the distribution request. On september 4, 2014, ddwa made the distribution to wds valued at $22,490,000.

Form 990 Part IX Line 11G

Description:consulting total fees:71876

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IRS990/Form990PartVIISectionAGrp/PersonNm9SEELY JEFFERY THOMAS
IRS990/Form990PartVIISectionAGrp/PersonNm10TUNE JAMES F
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IRS990/Form990PartVIISectionAGrp/TitleTxt0PRESIDENT & CEO
IRS990/Form990PartVIISectionAGrp/TitleTxt1VICE CHAIR
IRS990/Form990PartVIISectionAGrp/TitleTxt2DIRECTOR
IRS990/Form990PartVIISectionAGrp/TitleTxt3DIRECTOR
IRS990/Form990PartVIISectionAGrp/TitleTxt4TREASURER
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IRS990/Form990PartVIISectionAGrp/TitleTxt6DIRECTOR
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IRS990/MissionDesc0THE PURPOSE OF WDS IS: (A) TO SERVE AS A HOLDING COMPANY OF DDWA, AN EXISTING WASHINGTON NONPROFIT CORPORATION RECOGNIZED AS TAX-EXEMPT UNDER SECTION 501(C)(4) OF THE CODE, WHICH PROVIDES PREPAID DENTAL SERVICES TO ITS SUBSCRIBERS; (B) TO SERVE AS A HOLDING COMPANY OF OTHER AFFILIATED ENTITES THAT PROVIDE SERVICES AND ENGAGE IN BUSINESSES THAT ARE SUPPORTIVE OF DDWA'S MISSION OF IMPROVING THE PUBLIC'S ORAL HEALTH; (C) GUIDING, MONITORING, AND COORDINATING THE ACTIVITIES OF DDWA AND THE OTHER AFFILIATED ENTITIES TO ACHIEVE THE TAX-EXEMPT HEALTH CARE PURPOSES OF DDWA IN AN EFFICIENT AND INTEGRATED MANNER; (D) ENCOURAGING, FOSTERING AND FINANCING PROFESSIONAL AND SCIENTIFIC STUDY AND RESEARCH IN THE GENERAL FIELD OF DENTISTRY AND ORAL HEALTH; (E) CONDUCTING STUDIES AND INVESTIGATIONS DESIGNED TO DEVELOP INFORMATION PERTAINING TO ALL ASPECTS OF DENTAL SERVICE COVERAGE AND PAYMENT PLANS; AND (F) ASSISTING IN THE EDUCATION OF THE PUBLIC CONCERNING THE NEED FOR AND ADVANTAGE OF ADEQUATE DENTA
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IRS990/PrincipalOfficerNm0JAMES D DWYER
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IRS990ScheduleD/OtherSecuritiesGrp/Desc0INVESTMENT - HEALTHENTRIC
IRS990ScheduleD/OtherSecuritiesGrp/Desc1INVESTMENT - C3 JIAN
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IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationRltdOrgsAmt1211732
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm0DWYER JAMES D
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm1LABBERTON WELLS K
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt0PRESIDENT & CEO
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt1DIRECTOR
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt10
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IRS990ScheduleJ/SeverancePaymentInd0false
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt0SCHEDULE J, PART I, LINE 3 - WDS DOES NOT COMPENSATE THE CEO. DDWA, A RELATED ORGANIZATION, HAS A HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF ITS BOARD OF DIRECTORS THAT ENGAGES AN INDEPENDENT EXTERNAL CONSULTANT TO EVALUATE ALL KEY EMPLOYEES' COMPENSATION, INCLUDING THE PRESIDENT & CEO'S, IN COMPARISON TO THE PRACTICE OF SIMILAR EMPLOYER'S IN THE MARKETPLACE. COMPENSATION IS RECOMMENDED BY THE HRCC TO THE FULL BOARD OF DIRECTORS FOR APPROVAL. THIS PROCESS IS CONDUCTED ON AN ANNUAL BASIS.
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc0PART I, LINE 3
IRS990ScheduleJ/SupplementalNonqualRtrPlanInd0false
IRS990/ScheduleORequiredInd0true
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0DELTA DENTAL OF WASHINGTON'S MEMBER DENTISTS ARE CONSIDERED MEMBERS OF THE COMPANY. MEMBER DENTISTS ELECT THE DENTAL MEMBERS OF THE BOARD OF DIRECTORS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1THE GOVERNANCE & NOMINATING COMMITTEE (GNC) OF THE BOARD OF DIRECTORS SOLICITS ADVICE ON CANDIDATES AND SUBMITS NOMINEES TO THE BOARD FOR CONSIDERATION AND APPROVAL TO BE VOTED UPON. THE ENTIRE MEMBERSHIP ELECTS AND RE-ELECTS MEMBER DIRECTORS, WHO COMPRISE A MINORITY OF THE BOARD. THE INCUMBENT INDEPENDENT DIRECTORS NOMINATE AND ELECT OR RE-ELECT INDEPENDENT DIRECTORS. A MEMBER ADVISORY PANEL (MAP) CONSISTING OF TEN TO FIFTEEN MEMBERS ARE SELECTED BY THE BOARD FROM NOMINEES BY THE GNC. THE MAP PROVIDES CONSULTATION TO THE GNC AND BOARD ON A VARIETY OF MATTERS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2RECOMMENDED CHANGES TO THE CORPORATE BY-LAWS BY THE BOARD ARE SUBJECT TO APPROVAL BY THE MEMBER DENTISTS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3THE 990 IS COMPLETED BY KPMG. THE 990 RETURN IS REVIEWED AND APPROVED BY THE ACCOUNTING SUPERVISOR, 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4THE 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, EACH COVERED PERSON IS REQUIRED TO SIGN A STATEMENT AFFIRMING THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; (2) HAS READ THE POLICY AND UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE POLICY, INCLUDING COMPLETING THE CONFLICTS OF INTEREST QUESTIONNAIRE. THE COMPLETED QUESTIONNAIRES THAT NOTE ANY CONFLICTS ARE REVIEWED BY THE BOARD AND ANY PERSONS WITH ACTUAL OR POTENTIAL CONFLICTS ARE INFORMED 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; (5) AND CONFLICTING ISSUES DURING THE COURSE OF A BOARD MEETING WHICH CANNOT BE RESOLVED ARE REFERRED TO THE GOVERNANCE COMMITTEE; AND (6) THE TRANSACTION OR ACTION MUST BE APPROVED BY A MAJORITY OF DISINTERESTED PERSONS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND DISCLOSURES ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6DISTRIBUTION FROM DELTA DENTAL OF WASHINGTON - $41,290,010
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt7ON JULY 16, 2014, DELTA DENTAL OF WASHINGTON (DDWA) DISTRIBUTED $18,800,000 IN CASH TO ITS SOLE MEMBER WASHINGTON DENTAL SERVICE (WDS). ON JULY 23, 2014, THE DDWA BOARD OF DIRECTORS APPROVED, SUBJECT TO OFFICE OF THE INSURANCE COMMISSIONER (OIC) REVIEW, AN EXTRAORDINARY DISTRIBUTION OF DDWA'S SUBSIDIARIES, WDS HOLDINGS LLC, THE INSTITUTE OF ORAL HEALTH, AND AN INVESTMENT C3 JIAN FROM DDWA TO WDS VALUED AT APPROXIMATELY $22,630,000. ON AUGUST 6, 2014, THE OIC APPROVED THE DISTRIBUTION REQUEST. ON SEPTEMBER 4, 2014, DDWA MADE THE DISTRIBUTION TO WDS VALUED AT $22,490,000.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt8THE FOLLOWING DIRECTORS ALSO RECEIVED CLINICAL REIMBURSEMENTS ADDITIONAL TO THEIR DIRECTOR'S FEES REPORTED IN COLUMN E - REPORTABLE COMPENSATION FROM THE ORGANIZATION. BRANCH, DAVID W. - $135,252 --------------------------- DIRECTOR FEE - $62,983 CLINICAL REIMBURSEMENT - $72,269 LABBERTON, WELLS, K. - $275,933 ------------------------------- DIRECTOR FEE - $64,201 CLINICAL REIMBURSEMENT - $211,732
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt9DESCRIPTION:CONSULTING TOTAL FEES:71876
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART VI, SECTION A, LINE 6
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART VI, SECTION A, LINE 7A
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PART VI, SECTION A, LINE 7B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PART VI, SECTION B, LINE 11B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PART VI, SECTION B, LINE 12C
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5FORM 990, PART VI, SECTION C, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6FORM 990, PART XI, LINE 9
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc7FORM 990, PART III, LINE 3
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc8FORM 990, PART VII, SECTION A, LINE 1A
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc9FORM 990 PART IX LINE 11G

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