2024-11-13T16:44:04-06:00 2023-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2023-01-01 480793267 Delta Dental of Kansas Inc DELT 3162641099 1619 N Waterfront Parkway Wichita KS 67206 Bryce Dougherty Treasurer and CFO 3162641099 2024-11-13 1 1 Kim Hunwardsen CPA P00484560 6122536500 2024-11-13 2023 2024-10-15 13:58:12Z Bryce Dougherty 1619 N Waterfront Parkway Wichita KS 67206 337552353 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 6 146 0 0 0 0 0 314288128 324066857 997737 2028196 11481 7984 315297346 326103037 1340306 1261687 0 0 13585655 14350208 0 0 0 296619614 307733675 311545575 323345570 3751771 2757467 98070333 106226263 9922895 10227060 88147438 95999203 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 288168644 314707523 Dental benefits (covered charges) provided to subscribers. Delta Dental served approximately 927,309 people this year. 14133604 9359334 The processing of dental benefit claims. 1410312 1261687 0 Grants paid out to 501(c)(3) organizations. 303712560 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 28301 0 1 146 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 6 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 1.10 0.10 X X 27995 0 0 Ruth Teichman Director 0.90 0.00 X 17682 0 0 Patrick Moriarty Director 1.00 0.00 X 21545 0 0 Nick Troilo Director 1.00 0.00 X 21594 0 0 Nancy Zogleman Director 1.10 0.00 X 19519 0 0 Shawn Naccarato Director 1.10 0.00 X 20448 0 0 Angela McClure Director 1.00 0.00 X 21681 0 0 Kimberly Borchers Director 1.10 0.00 X 23077 0 0 Lucynda Raben Vice Chairperson 1.00 0.20 X X 23718 0 0 Melinda Miner Director 1.00 0.00 X 19974 0 0 Bryce Dougherty CFO/Treasurer 49.10 0.90 X 318865 0 55759 Dean Newton President and CEO 49.00 1.00 X 653506 0 62312 Jennifer Bauer Secretary 49.30 0.70 X 310495 0 53253 Sarah Patterson - Chief Innovation & Marketing Officer 49.80 0.20 X 325164 0 39397 Natalie Daney Chief Sales Officer 49.30 0.70 X 346148 0 54380 James Tuttle COO (Jan-Nov) 49.40 0.60 X 280768 0 49138 Kristen Hoffman-VP Client Serv.(to Oct)/Interim COO(from Nov) 49.90 0.10 X 211058 0 38642 Preddis Sullivan Dental Director and EVP 50.00 0.00 X 262874 0 54403 Stephen Peppes Vice President of Sales 48.80 1.20 X 321436 0 57803 Kara Hunt VP HR 50.00 0.00 X 193736 0 26116 Robert Ebenkamp VP IT 49.90 0.10 X 234950 0 38255 Ambur Lynne Miller VP Professional Relations 50.00 0.00 X 180812 0 28600 Michael Ellis Controller (Former Officer) 48.80 1.20 X 214181 0 46923 4071226 0 604981 33 1 1 0 Wichita Endodontics 12219 E Central Ave Wichita KS 672062808 Dental Services 1622533 ICT Teeth LLC 2143 N Collective Ln Suite B Wichita KS 672063506 Dental Services 1588282 Frankenberry and Johnson DDS PA 3101 N Cypress St Wichita KS 672264017 Dental Services 1450369 Gage Center Dental Group PA 1271 SW Woodhull St Topeka KS 666041635 Dental Services 1293363 Jenkins & Leblanc PA 6810 Silverheel St Shawnee KS 662265300 Dental Services 1189354 562 Dental Services 524298 314707523 314707523 Administrative Services Plan Reve 524298 9359334 9359334 324066857 1950463 1950463 11527049 11449316 77733 77733 77733 Other Income 900099 7984 7984 7984 326103037 324066857 0 2036180 1261687 1261687 2444356 2444356 262136 262136 8713296 4329094 4384202 1244174 700201 543973 963580 559474 404106 722666 319419 403247 299099 299099 151203 151203 36000 36000 178847 178847 6048236 320792 5727444 987197 987197 1393205 1141016 252189 3866745 3817140 49605 191710 191710 722265 17974 704291 141890 19293 122597 3436 3436 546251 262200 284051 505694 505694 Claims 288162314 288162314 State Premium Tax 1209641 1209641 Equipment Rental & Main 844519 844519 Clearing House Expense 514130 489493 24637 1931293 258303 1672990 323345570 303712560 19633010 0 800 800 5909363 4432116 6918913 6648913 2229214 3346416 13410627 6885852 6447675 6524775 57096492 63933736 18535179 20627264 932697 712243 98070333 106226263 8739318 9366550 1183577 860510 9922895 10227060 X 88147438 95999203 88147438 95999203 98070333 106226263 X 2757467 3002533 2091765 X 0 1 X 1 0 1401415 1401415 7332320 3234989 4097331 490383 119773 370610 4186509 3531090 655419 6524775 Inv in Surency Life & Health 20627264 F 20627264 Advanced Premium 273243 Unearned Premium 321079 Ind Product-Advanced Prem 117130 Lease Liability 149058 860510 X 145256202 3002533 -183670521 -180667988 325924190 178847 178847 326103037 137404117 0 137404117 178847 185762606 185941453 323345570 Part X, Line 2: Management believes that each entity has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Company would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Reclass Expense Reimbursement to Expenses on Form 990 171,431. Earnings of C Corp 2,092,085. ASC Claims Expenses Reported in Expenses on Form 990 -185,934,037. Part XII, Line 4b - Other Adjustments: Reclass Expense Reimbursement from Revenue on Financials -171,431. ASC Claims Expenses Reported in Revenue on Financials 185,934,037. 1 AdventHealth Foundation Shawnee Mission 7315 E Frontage Rd Merriam KS 66204 480868859 501(c)(3) 10000 0 Charitable Giving Botanica Inc 701 Amidon St Wichita KS 67203 481007736 501(c)(3) 25000 0 Charitable Giving Central Plains Health Care Partnership - Project Access 1102 S Hillside St Wichita KS 67211 481200868 501(c)(3) 15000 0 Charitable Giving Children's Mercy Hospital 2401 Gilham Rd Kansas City MO 64108 440605373 501(c)(3) 130000 0 Charitable Giving Genesis Family Health PO Box 766 Garden City KS 67846 481049519 501(c)(3) 0 6260 Fair Market Value Supplies for 10,080 kits Charitable Giving Giving the Basics - Kansas City 927 S 7th Street Kansas City KS 66105 453069975 501(c)(3) 0 12665 Fair Market Value Supplies for 10,080 kits in Kansas City and 10,080 kits in Wichita Charitable Giving GraceMed Health Clinic Inc 1150 N Broadway St Wichita KS 67214 481159633 501(c)(3) 0 6285 Fair Market Value Supplies for 10,080 kits Charitable Giving Health Ministries Clinic Inc 126 Main St Halstead KS 67056 481091875 501(c)(3) 0 6343 Fair Market Value Supplies for 10,080 kits Charitable Giving Heartland Community Health Center 1312 W 6th Street Lawrence KS 66044 481221800 501(c)(3) 0 6280 Fair Market Value Supplies for 10,080 kits Charitable Giving HNC Living Foundation 8100 Newton St Suite 100 Overland Park KS 66204 464214254 501(c)(3) 255000 0 Charitable Giving Johnson County Christmas Bureau Association PO Box 14786 Lenexa KS 662854786 480884400 501(c)(3) 0 6401 Fair Market Value Supplies for 10,080 kits Charitable Giving Kansas City Sports Commissions - WIN for KC 1100 Walnut Street Suite 3450B Kansas City MO 64106 431521059 501(c)(3) 6500 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 6381 Fair Market Value Supplies for 10,080 kits Charitable Giving Kansas Food Bank 1919 E Douglas Ave Wichita KS 67211 480959213 501(c)(3) 0 17021 Fair Market Value 6,000 toothbrushes, 18,000 toothpastes, & 25,200 floss for children & adults Charitable Giving Kansas Insurance & Financial Services Education Foundation 815 SW Topeka Blvd Topeka KS 66612 480925186 State of Kansas 15000 0 Charitable Giving Kansas Society for Children with Challenges 100 N Main Suite 1002 Wichita KS 67202 480573804 501(c)(3) 10000 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) 10000 0 Charitable Giving Mark Arts 1307 N Rock Road Wichita KS 67206 480616251 501(c)(3) 10000 0 Charitable Giving Oracle Health Foundation 8779 Hillcrest Round Dock 2048 Kansas City MO 64138 431725294 501(c)(3) 0 6285 Fair Market Value Supplies for 10,080 kits Charitable Giving Oral Health Foundation of the Pierre Fauchard Academy PO Box 901 Reston VA 20190 770120371 501(c)(3) 15000 0 Charitable Giving Oral Health Kansas 800 SW Jackson St Suite 1120 Topeka KS 66612 200337278 501(c)(3) 10000 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 Ronald McDonald House Charities of Wichita Inc 551 N Hillside St Suite 102 Wichita KS 67214 480918101 501(c)(3) 5800 0 Charitable Giving Sedgwick County Health Department 1900 E 9th St Wichita KS 67214 486000798 Sedgwick County 0 6177 Fair Market Value Supplies for 10,080 kits Charitable Giving Sedgwick County Zoological Society Inc 5555 W Zoo Blvd Wichita KS 67212 486120530 501(c)(3) 8100 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 United Way of Greater Kansas City 801 W 47th St Suite 500 Kansas City MO 64112 440545812 501(c)(3) 350000 0 Charitable Giving Vibrant Health 21 N 12th St Kansas City KS 66102 481151382 501(c)(3) 0 5742 Fair Market Value Supplies for 10,080 kits Charitable Giving Wesley House 411 E 124th Street Pittsburg KS 66762 480559096 501(c)(3) 0 6431 Fair Market Value Supplies for 10,080 kits Charitable Giving 30 3 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 464750 0 178652 0 10104 0 60657 0 3600 0 717763 0 0 0 Natalie Daney Chief Sales Officer 231294 0 113601 0 1253 0 52724 0 3229 0 402101 0 0 0 Stephen Peppes Vice President of Sales 183677 0 137374 0 385 0 47079 0 12201 0 380716 0 0 0 Bryce Dougherty CFO/Treasurer 264034 0 54201 0 630 0 37756 0 19456 0 376077 0 0 0 Sarah Patterson - Chief Innovation & Marketing Officer 270483 0 54201 0 480 0 37742 0 3108 0 366014 0 0 0 Jennifer Bauer Secretary 255757 0 54038 0 700 0 37389 0 17286 0 365170 0 0 0 James Tuttle COO (Jan-Nov) 222519 0 56237 0 2012 0 38004 0 11134 0 329906 0 0 0 Preddis Sullivan Dental Director and EVP 214063 0 45653 0 3158 0 38539 0 17142 0 318555 0 0 0 Robert Ebenkamp VP IT 192755 0 39391 0 2804 0 31501 0 7845 0 274296 0 0 0 Michael Ellis Controller (Former Officer) 176449 0 36968 0 764 0 28919 0 19036 0 262136 0 0 0 Kristen Hoffman-VP Client Serv.(to Oct)/Interim COO(from Nov) 154485 0 56289 0 284 0 27918 0 11853 0 250829 0 0 0 Kara Hunt VP HR 160366 0 32428 0 942 0 24461 0 2559 0 220756 0 0 0 Ambur Lynne Miller VP Professional Relations 150890 0 29616 0 306 0 21840 0 7631 0 210283 0 0 0 Part I, Line 1a Delta Dental of Kansas did pay for companion travel for board of directors 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. Part I, Line 5 Total revenues for Delta Dental are a factor in the management bonus payout. Raben DDS PA Board Member Dr. Raben > 35% owner 114521 Payment of Dental Services 0 Rose Hill General & Cosmetic Dentistry Board Member Dr. Troilo > 35% owner 158907 Payment of Dental Services 0 The Dentist PA Board Member Dr. Miner > 35% owner 205906 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, 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 from 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 includes 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 2,092,085. Adjustment to Opening Net Assets Balance -320. Surency Life & Health Company 1619 N Waterfront Pkwy Wichita KS 67206 261969006 Insurance KS Delta Dental of Kansas Inc C 15511586 23776801 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 1043210 Cost Surency Life & Health Insurance Company N 171431 Cost