2023-11-13T06:38:49-06:00 2022-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-01-01 480793267 Delta Dental of Kansas Inc DELT 3162641099 1619 N Waterfront Parkway Wichita KS 67206 Bryce Dougherty CFO 3162641099 2023-11-10 1 Bryce Dougherty 999009999 1 Kim Hunwardsen CPA P00484560 6122536500 2023-11-09 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Bryce Dougherty 1619 N Waterfront Parkway Wichita KS 67206 327579681 0 X www.deltadentalks.com X 1972 KS To make possible a wider availability of oral health care by offering affordable benefits and exceptional service. 10 5 136 0 0 0 0 0 298797684 314288128 3931216 997737 21324 11481 302750224 315297346 1362217 1340306 0 0 13177983 13585655 0 0 0 281736444 296619614 296276644 311545575 6473580 3751771 101442259 98070333 10347660 9922895 91094599 88147438 To make possible and facilitate a wider and more timely availability of dental care, thereby advancing the public health and the science and art of dentistry in the state of Kansas by offering affordable benefits and exceptional service to Kansans and Kansas employers. 0 0 277840889 305300261 Dental benefits (covered charges) provided to subscribers. Delta Dental served approximately 916,628 people this year. 13595469 8987867 The processing of dental benefit claims. 1340306 1340306 0 Grants paid out to 501(c)(3) organizations. 292776664 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 1 28288 0 1 136 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 5 1 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X Bryce Dougherty 3162641099 1619 N Waterfront Parkway Wichita KS 67206 Gary Yager Chairperson 1.30 0.10 X X 29475 0 0 Ruth Teichman Director 1.30 0.00 X 23265 0 0 Patrick Moriarty Director 1.20 0.00 X 21059 0 0 Nick Troilo Director 1.30 0.00 X 23302 0 0 Nancy Zogleman Director 1.30 0.00 X 21706 0 0 Shawn Naccarato Director 1.30 0.00 X 22329 0 0 Angela McClure Director 1.30 0.00 X 23908 0 0 Kimberly Borchers Director 1.30 0.00 X 22525 0 0 Lucynda Raben - Director Jan- Jul)/Vice Chairperson (Aug-Dec) 1.30 0.30 X X 22359 0 0 Brick Scheer Vice Chairperson (Jan-Aug) 0.60 0.20 X X 12540 0 0 Melinda Miner Director (Aug-Dec) 0.50 0.00 X 8531 0 0 Bryce Dougherty CFO/Treasurer 49.30 0.70 X 261573 0 49483 Dean Newton President and CEO 49.70 0.30 X 590394 0 58113 Jennifer Bauer Secretary 49.70 0.30 X 260595 0 47675 Sarah Patterson Chief Innovation & Marketing Officer 49.70 0.30 X 275198 0 35695 Natalie Daney Chief Sales Officer 49.70 0.30 X 290433 0 53525 James Tuttle COO 49.70 0.30 X 281749 0 48176 Preddis Sullivan Dental Director and EVP 40.00 0.00 X 258294 0 51574 Kristen Hoffman Vice President Client Service 32.50 7.50 X 182003 0 32521 Stephen Peppes Vice President of Sales 38.10 1.90 X 254378 0 53770 Kara Hunt VP HR 40.00 0.00 X 190358 0 25760 Robert Ebenkamp VP IT 39.20 0.80 X 237256 0 36791 Michael Ellis Controller (Former Officer) 38.60 1.40 X 211375 0 43401 3524605 0 536484 32 1 1 0 Wichita Endodontics LLC 12219 E Central Avenue Wichita KS 67206 Dental Services 1677869 Frankenbery and Johnson DDS PA 3101 N Cypress Street Wichita KS 67226 Dental Services 1488833 Icteeth LLC 2143 N Collective Ln Suite B Wichita KS 67206 Dental Services 1464503 Gage CEnter Dental Group PA 1271 SW Woodhull Street Topeka KS 66604 Dental Services 1268340 Wichita Family Dental Partnership 9339 E 21 St N Wichita KS 67206 Dental Services 1172519 548 Dental Services 524298 305339705 305339705 Administrative Services Plan 524298 8948423 8948423 314288128 1303977 1303977 11976095 12281805 530 -305710 -530 -306240 -306240 Other Income 900099 11481 11481 11481 315297346 314288128 0 1009218 1340306 1340306 2492120 2492120 255781 255781 8127514 4002724 4124790 1232315 693156 539159 788772 492528 296244 689153 302222 386931 192852 192852 177095 177095 40130 40130 176352 176352 6085619 428127 5657492 1047160 1047160 1239902 987720 252182 3853146 3825021 28125 210049 210049 593453 21345 572108 120735 19459 101276 12497 12497 512212 245862 266350 466389 466389 Claims 277840888 277840888 State Premium Tax 1257621 1257621 Equipment Rental & Main 751270 751270 Clearing House Expense 487786 459061 28725 1554458 109354 1445104 311545575 292776664 18768911 0 800 800 11970210 5909363 6024313 6918913 504195 2229214 12928976 6481301 6517149 6447675 56920025 57096492 18435372 18535179 1070195 932697 101442259 98070333 9472482 8739318 875178 1183577 10347660 9922895 X 91094599 88147438 91094599 88147438 101442259 98070333 X 3751771 -6798641 99709 X 0 1 X 1 0 1401415 1401415 7332320 3046981 4285339 254335 81879 172456 3940906 3352441 588465 6447675 Inv in Surency Life & Health 18535179 F 18535179 Advanced Premium 383109 Unearned Premium 492935 Ind Product-Advanced Prem 14492 Lease Liability 293041 1183577 X 129827827 -6798641 -178495056 -185293697 315121524 176352 -530 175822 315297346 132774890 530 530 132774360 176352 178594863 178771215 311545575 Part X, Line 2: The company evaluates its tax positions that have been taken or are expected to be taken on income tax returns to determine if an accrual is necessary for uncertain tax positions. As of December 31, 2022 and 2021, the unrecognized tax benefits accrual was zero. The company will recognize future accrued interest and penalties related to unrecognized tax benefits in income tax expense if incurred. Part XI, Line 2d - Other Adjustments: Reclass Expense Reimbursement to Expenses on Form 990 197,081. Earnings of C Corp 99,807. ASC Claims Expenses Reported in Expenses on Form 990 -178,791,944. Part XI, Line 4b - Other Adjustments: Loss on Sale of Asset -530. Part XII, Line 2d - Other Adjustments: Loss on Sale of Asset 530. Part XII, Line 4b - Other Adjustments: Reclass Expense Reimbursement from Revenue on Financials -197,081. ASC Claims Expenses Reported in Revenue on Financials 178,791,944. 1 AdventHealth Foundation Shawnee Mission 7315 E Frontage Rd Merriam KS 66204 480868859 501(c)(3) 15200 0 Charitable Giving Air Capital Charities Inc (Wichita Open) 9727 Shannon Woods Suite 100 Wichita KS 67226 462001743 501(c)(3) 17000 0 Charitable Giving Botanica Inc 701 Amidon St Wichita KS 67203 481007736 501(c)(3) 25000 0 Charitable Giving Chamber of Commerce of Greater Kansas City 30 W Pershing Rd Suite 301 Kansas City MO 64108 440196840 501(c)(6) 38750 0 Charitable Giving Children's Mercy Hospital 2401 Gilham Rd Kansas City MO 64108 440605373 501(c)(3) 50000 0 Charitable Giving Exploration Place 300 N McLean Boulevard Wichita KS 67203 481000295 501(c)(3) 116700 0 Charitable Giving Giving the Basics - Kansas City 927 S 7th Street Kansas City KS 66105 453069975 501(c)(3) 0 6270 Fair Market Value Supplies for 10,080 kits Charitable Giving GraceMed Health Clinic Inc 1150 N Broadway St Wichita KS 67214 481159633 501(c)(3) 1000 6177 Fair Market Value Supplies for 10,080 kits Charitable Giving Greater Wichita Partnership Inc 505 E Douglas Ave Wichita KS 67202 474134110 501(c)(3) 10000 0 Charitable Giving Health Ministries Clinic Inc 126 Main St Halstead KS 67056 481091875 501(c)(3) 0 6234 Fair Market Value Supplies for 10,080 kits Charitable Giving Heartspring 8700 E 29th St N Wichita KS 67226 480561969 501(c)(3) 45000 0 Charitable Giving Johnson County Christmas Bureau Association PO Box 14786 Lenexa KS 662854786 480884400 501(c)(3) 0 6290 Fair Market Value Supplies for 10,080 kits Charitable Giving Juvenile Diabetes Research Foundation (JDRF) International 200 Vesey St 28th Flr New York NY 10281 231907729 501(c)(3) 15000 0 Charitable Giving Kansas Athletics Incorporated 1651 Naismith Dr Lawrence KS 66045 486033929 501(c)(3) 31000 0 Charitable Giving Kansas Chamber of Commerce & Industry Education Foundation Inc 835 SW Topeka Blvd Topeka KS 66612 237339573 501(c)(6) 6000 0 Charitable Giving Kansas City Area Development Council 30 W Pershing Rd Suite 200 Kansas City MO 64108 431852671 501(c)(6) 35000 0 Charitable Giving Kansas Department of Health & Environment Bureau of Oral Health 1000 SW Jackson St Suite 300 Topeka KS 66612 481124839 State of Kansas 0 6271 Fair Market Value Supplies for 10,080 kits Charitable Giving Kansas Insurance & Financial Services Education Foundation 815 SW Topeka Blvd Topeka KS 66612 480925186 State of Kansas 15000 0 Charitable Giving Kansas University Endowment Association (philanthropic partner of The Unive 2330 Shawnee Mission Pkwy Suite 305 MS 5004 Westwood KS 66205 480547734 501(c)(3) 30000 0 Charitable Giving Prairiestar Health Center 2700 E 30th Ave Hutchinson KS 67502 481154210 501(c)(3) 0 6240 Fair Market Value Supplies for 10,080 kits Charitable Giving Project 2 Restore 6021 SW 29th St A259 Topeka KS 66614 853679539 501(c)(3) 10000 0 Charitable Giving Ronald McDonald House Charities of Wichita Inc 551 N Hillside St Suite 102 Wichita KS 67214 480918101 501(c)(3) 5400 0 Charitable Giving Rose Brooks Center Inc PO Box 320599 Kansas City MO 64132 510231573 501(c)(3) 50000 0 Charitable Giving Sedgwick County Zoological Society Inc 5555 W Zoo Blvd Wichita KS 67212 486120530 501(c)(3) 7500 0 Charitable Giving Starlight Theatre Association of Kansas City Inc 4600 Starlight Rd Kansas City KS 64132 440552079 501(c)(3) 10000 0 Charitable Giving Topeka Rescue Mission 600 N Kansas Avenue Topeka KS 66608 480688068 501(c)(3) 65000 0 Charitable Giving United Way of Greater Kansas City 801 W 47th St Suite 500 Kansas City MO 64112 440545812 501(c)(3) 525000 0 Charitable Giving Wesley House 411 E 124th Street Pittsburg KS 66762 480559096 501(c)(3) 0 5279 Fair Market Value Supplies for 10,080 kits Charitable Giving Wichita Regional Chamber of Commerce Inc 350 W Douglas Ave Wichita KS 67202 480477290 501(c)(6) 37375 0 Charitable Giving 24 5 Part I, Line 2: Delta Dental of Kansas provided grants to public charities, governmental organizations, and other organizations. For each organization that receives a grant, Delta Dental of Kansas requires acceptance of the grant, the grant reporting requirements and the due date for reporting via a signed agreement letter. The Grant Reporting Package requires completion of a Narrative Report addressing the details of the project, Project Budget Summary Form (including submission of invoices if appropriate), Acknowledgement Plan and any additional components as indicated in the agreement letter. X 1 1 X X X X X 0 0 0 1 0 0 0 0 0 Dean Newton President and CEO 438366 0 141924 0 10104 0 56457 0 3507 0 650358 0 0 0 Natalie Daney Chief Sales Officer 209352 0 80235 0 846 0 51869 0 3193 0 345495 0 0 0 James Tuttle COO 215969 0 64505 0 1275 0 37193 0 12232 0 331174 0 0 0 Bryce Dougherty CFO/Treasurer 207535 0 53457 0 581 0 34052 0 16630 0 312255 0 0 0 Sarah Patterson Chief Innovation & Marketing Officer 211626 0 63145 0 427 0 34040 0 2855 0 312093 0 0 0 Preddis Sullivan Dental Director and EVP 210461 0 44744 0 3089 0 37937 0 14891 0 311122 0 0 0 Jennifer Bauer Secretary 206868 0 53086 0 641 0 34039 0 15110 0 309744 0 0 0 Stephen Peppes Vice President of Sales 166747 0 87115 0 516 0 44468 0 10776 0 309622 0 0 0 Robert Ebenkamp VP IT 188928 0 45598 0 2730 0 31008 0 6849 0 275113 0 0 0 Michael Ellis Controller (Former Officer) 171569 0 39067 0 739 0 27969 0 16437 0 255781 0 0 0 Kara Hunt VP HR 157758 0 31904 0 696 0 24104 0 2543 0 217005 0 0 0 Kristen Hoffman Vice President Client Service 122542 0 59270 0 191 0 23219 0 10219 0 215441 0 0 0 Part I, Line 1a Delta Dental of Kansas did pay for the companion travel for board of directors and leadership team members when they attended out of town business meetings. The companion travel amount was treated as taxable compensation and is included in the board of directors' 1099-MISC and the leadership team members' W-2. Part I, Line 5 Total revenues for Delta Dental are a determining factor in the management bonus payout. Raben DDS PA Board Member Dr. Raben > 35% owner 133900 Payment of Dental Services 0 Northrock Dental Board Member Dr. Scheer > 35% owner 100844 Payment of Dental Services 0 Rose Hill General & Cosmetic Dentistry Board Member Dr. Troilo > 35% owner 239061 Payment of Dental Services 0 Enhance Dental Care of Lawrence Board Member Dr. Moriarty > 35% owner 135633 Payment of Dental Services 0 The Dentist PA Board Member Dr. Miner > 35% owner 309842 Payment of Dental Services 0 Form 990, Part VI, Section A, line 2 Dean Newton, James Tuttle, Gary Yager, Bryce Dougherty, Jennifer Bauer, Natalie Daney, Dr. Brick Sheer, Sarah Patterson, and Dr. Lucynda Raben have a business relationship with each other. They all serve as either officers or directors of Surency Life & Health Insurance Company, a related for-profit company. The officers and directors do not have stock ownership interest in the related for-profit company. Form 990, Part VI, Section A, line 6 The organization has members. The membership of Delta Dental of Kansas is comprised of the dentists who have current participating agreements with Delta Dental of Kansas. Form 990, Part VI, Section A, line 7a The board of directors is comprised of ten (10) members. The membership elects Four (4) board members and are among the corporation's participating dentists. Two (2) are appointed by the governor of the state of Kansas, and four (4) are appointed by the Commissioner of Insurance of the state of Kansas. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing board. Form 990, Part VI, Section B, line 11b An independent accounting firm prepares the Form 990. The 990 is then reviewed by the organization's accounting personnel. Any questions or comments are addressed and any necessary changes are made. The Form 990 with all related schedules is then provided to the entire governing body for review prior to filing. Form 990, Part VI, Section B, line 12c The chairperson of the board and the governance committee monitor and enforce our conflict of interest policy. Each director, officer, and key employee of Delta Dental of Kansas annually files a statement regarding conflicts of interest which exist, or which might be expected to exist, within the upcoming year. The statement discloses as fully as possible the nature of potential conflicts and the nature of the director's, officer's, or key employee's interest in the potential transaction. All statements are reviewed by the president and chairperson and may be circulated to members of the board of directors. Each director, officer, and key employee agree to answer any questions about potential conflicts they may have. If a conflict is identified, voting may be restricted. Form 990, Part VI, Section B, line 15 The Delta Dental of Kansas process for determining compensation for the CEO, officers, and key employees does include an annual review by a national, independent 3rd party compensation expert to benchmark for every employee in our company. The consultant uses proprietary and published market data sources to identify the relevant duties and responsibilities provided for each position. Market data is used as appropriate for each position, from local, regional, and national markets. They provided a complete report that documents the findings of market review process for our positions and their recommendation regarding the grade level of placement of the position. The Board is responsible to meet with the President/Chief Executive Officer annually to review his/her performance and to approve the President/Chief Executive Officer's annual compensation and benefits package. Form 990, Part VI, Section C, line 19 Our governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part XI, line 9: Equity Earnings of Subsidiary 99,807. Adjustment to Opening Net Assets Balance -98. Surency Life & Health Company 1619 N Waterfront Pkwy Wichita KS 67206 261969006 Insurance KS Delta Dental of Kansas Inc C 12818587 21726886 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 Surency Life & Health Insurance Company O 935754 Cost Surency Life & Health Insurance Company N 197081 Cost