2024-11-12T13:53:50-06:00 2023-12-31 135565207 KPMG LLP 401 UNION STREET SUITE 2800 SEATTLE WA 98101 990 2023-01-01 911281990 WASHINGTON DENTAL SERVICE FUND WASH 2065221300 400 FAIRVIEW AVE N SUITE 800 SEATTLE WA 98109 VANETTA ABDELLATIF PRESIDENT & CEO 2065221300 2024-11-12 1 0 ZELJKO POPOVIC P01795951 2069134000 2023 2024-10-15 13:58:12Z VANETTA ABDELLATIF 400 FAIRVIEW AVE N SUITE SEATTLE WA 98109 28745 0 X N/A X 2004 WA WDS FUND'S PRIMARY PURPOSE IS TO PROMOTE SOCIAL WELFARE, INCLUDING PROMOTING THE ORAL HEALTH OF THE PUBLIC, AND TO SPONSOR AND INNOVATE FOR THE ADVANCEMENT OF ORAL HEALTH. 13 7 0 0 0 0 12500 15750 0 0 2859 7679 0 0 15359 23429 28931 21838 0 0 0 0 0 0 0 0 0 28931 21838 -13572 1591 193923 212025 0 0 193923 212025 X THE PRIMARY PURPOSE OF THE FUND IS TO PROMOTE SOCIAL WELFARE, INCLUDING PROMOTING THE ORAL HEALTH OF THE PUBLIC, AND TO SPONSOR AND INNOVATE FOR THE ADVANCEMENT OF ORAL HEALTH. THE FUND SUPPORTS THE MISSION OF DELTA DENTAL OF WASHINGTON (DDWA) AND WASHINGTON DENTAL SERVICE (WDS) BY SUPPORTING ACCESS TO ORAL HEALTH THROUGH A MOBILE CLINIC IN UNDERSERVED GEOGRAPHIC AREAS, AND THROUGH GRANTS TO SUPPORT ACCESS TO DENTAL CARE FOR CHILDREN. 0 0 12500 12500 THE FUND SUPPORTS DENTAL CARE IN UNDERSERVED AREAS OF WASHINGTON STATE THROUGH A PROGRAM CALLED THE SMILEMOBILE; A 39 FOOT MODERN DENTAL CLINIC ON WHEELS THAT HAS BEEN SERVING CHILDREN IN NEED ACROSS WASHINGTON STATE SINCE 1995. THE SMILEMOBILE WAS CREATED TO BRING DENTAL SERVICES - AT LITTLE OR NO CHARGE - DIRECTLY TO CHILDREN WHO DO NOT OTHERWISE HAVE ACCESS TO DENTAL CARE. SINCE IT FIRST HIT THE ROAD, THE MOBILE CLINIC HAS TREATED MORE THAN 45,000 CHILDREN THROUGHOUT THE STATE. 7831 7831 THE FUND SUPPORTS THE ACCESS TO BABY AND CHILD DENTISTRY PROGRAM (ABCD) IN WASHINGTON STATE THROUGH A GRANT TO THE CHOICE REGIONAL HEALTH PROGRAM IN THURSTON COUNTY FOR THEIR ABCD PROGRAM. THE ABCD PROGRAM PROVIDES PREVENTIVE AND RESTORATIVE DENTAL SERVICES TO MEDICAID-ENROLLED CHILDREN UP TO AGE 6. 1507 1507 THE FUND ADMINISTERS THE PATRICIA C. MCNALLY DENTAL TEAM EDUCATION ENDOWMENT TO SUPPORT SCHOLARSHIPS FOR DENTAL ASSISTING STUDENTS. THESE SCHOLARSHIPS ARE INTENDED TO ASSIST ECONOMICALLY DISADVANTAGED STUDENTS IN COMPLETING A DENTAL ASSISTING PROGRAM. 21838 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WA X RYAN BARTLETT 2065221300 400 FAIRVIEW AVE N SUITE 800 SEATTLE WA 98109 X CHOI JI TRUSTEE 0.50 3.00 X 0 11952 0 FINKBONNER JOSEPH TRUSTEE 0.50 3.00 X 0 13174 0 HOGAN RACHEL TRUSTEE 0.50 3.00 X 0 10180 0 KENNEDY SCOTT VICE CHAIR 0.50 3.00 X 0 13173 0 DAVIS BRENDEN TRUSTEE 0.50 3.00 X 0 13174 0 NELSON CAROL TRUSTEE 0.50 15.50 X 0 174920 0 LOFTON ANDREW CHAIR 0.50 3.00 X X 0 14761 0 MENDEZ MARIA DEL CARMEN TRUSTEE 0.50 3.00 X 0 13174 0 LINDEBLAD MARY TRUSTEE 0.50 3.00 X 0 11402 0 WILSON KIMBERLY TRUSTEE 0.50 3.00 X 0 10180 0 MORTON MATT TRUSTEE 0.50 3.00 X 0 10180 0 LOWRY-OAKES DIANE CHIEF MISSION OFFICER 0.50 39.50 X X 0 537199 102606 RUTHERFORD EVE M TRUSTEE - BRD. & DDS FEES 0.50 19.50 X 0 1169683 0 ABDELLATIF VANETTA PRESIDENT/CEO ARCORA FOUNDATION 0.50 39.50 X 0 458394 83503 LABBERTON WELLS K FORMER TRUSTEE 0.00 0.00 X 0 15000 0 0 2476546 186109 0 1 1 0 0 15750 15750 3607 3607 9388 5316 4072 4072 4072 23429 0 0 7679 21838 21838 21838 21838 0 0 6167 9467 187756 202558 193923 212025 0 0 X 163777 179502 30146 32523 193923 212025 193923 212025 1591 16511 0 X 0 1 X 1 0 X 11087 21695 17115 12500 15750 78147 11087 21695 17115 12500 15750 78147 0 0 0 78147 4953 4564 4130 4246 3607 21500 4953 4564 4130 4246 3607 21500 16040 26259 21245 16746 19357 99647 0.78420 0.77870 0.21580 0.22130 X 30146 3884 1507 32523 37942 -5899 1897 30146 36893 2894 1845 37942 34416 4178 1701 36893 30747 5206 1537 34416 0.84400 0.15600 0.00000 0 0 0 PART V, LINE 4: THE FUND ADMINISTERS THE PATRICIA C. MCNALLY DENTAL TEAM EDUCATION ENDOWMENT TO SUPPORT SCHOLARSHIPS FOR DENTAL ASSISTANT STUDENTS. THESE SCHOLARSHIPS ARE INTENDED TO ASSIST ECONOMICALLY DISADVANTAGED STUDENTS IN COMPLETING A DENTAL ASSISTANT PROGRAM. 1 CHOICE REGIONAL HEALTH NETWORK 1217 4TH AVENUE E SUITE 200 OLYMPIA WA 98506 911704039 501(C)(3) 7831 0 SUPPORT THURSTON COUNTY ABCD PROGRAM 1 0 PART I, LINE 2: THE GRANTEE IS REQUIRED TO SIGN A GRANT AGREEMENT STATING THAT THEY WILL USE THE FUNDS ONLY FOR PURPOSES OUTLINED IN THE GRANT AGREEMENT AND APPLICATION. THE GRANTEE FURTHER AGREES THAT THE FUNDS WILL BE USED EXCLUSIVELY FOR EXEMPT PURPOSES AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE GRANTEE IS REQUIRED TO FILE REPORTS ON REGULAR INTERVALS OUTLINING THE USE OF FUNDS. THE GRANTEE IS ALSO REQUIRED TO RETURN UNUSED FUNDING IF APPLICABLE. 0 1 0 0 0 0 0 0 0 RUTHERFORD EVE M TRUSTEE - BRD. & DDS FEES 0 193494 0 0 0 976189 0 0 0 0 0 1169683 0 0 LOWRY-OAKES DIANE CHIEF MISSION OFFICER 0 311590 0 183826 0 41783 0 66816 0 35790 0 639805 0 40847 ABDELLATIF VANETTA PRESIDENT/CEO ARCORA FOUNDATION 0 342531 0 109618 0 6245 0 61479 0 22024 0 541897 0 0 NELSON CAROL TRUSTEE 0 174920 0 0 0 0 0 0 0 0 0 174920 0 0 LABBERTON WELLS K FORMER TRUSTEE 0 0 0 0 0 15000 0 0 0 0 0 15000 0 0 PART I, LINE 3 OFFICERS AND TRUSTEES OF WASHINGTON DENTAL SERVICE FUND ARE NOT COMPENSATED BY WASHINGTON DENTAL SERVICE FUND. PART I, LINE 4B A RELATED ORGANIZATION MAKES CONTRIBUTIONS TO A NONQUALIFIED PERFORMANCE BASED COMPENSATION PLAN, AS DETERMINED BY THE BOARD OF DIRECTORS, WHICH IS SUBJECT TO CODE SECTION 457(B). A PLAN PARTICIPANT IS BOARD-APPROVED EXECUTIVE LEADERSHIP WHO RECEIVES AN ANNUAL CONTRIBUTION BASED ON A PERCENTAGE OF THE PRIOR YEAR EARNINGS LESS THE COMPANY MATCHING CONTRIBUTION TO THE 401(K) PLAN. COMPANY CONTRIBUTIONS ARE DIRECTED BY EACH PARTICIPANT, BUT VESTING OF THE BENEFIT IS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE AS REQUIRED BY CODE SECTION 409(A). CONTRIBUTIONS MADE IN 2023 WERE AS FOLLOWS: DIANE LOWRY-OAKES, $44,316 AND VANETTA ABDELLATIF, $38,979. IN ADDITION, A RELATED ORGANIZATION OFFERS ANOTHER 457(B) NONQUALIFIED SERP DEFERRED COMPENSATION PLAN FOR SENIOR MANAGEMENT THAT THE COMPANY DOES NOT MAKE ANY CONTRIBUTIONS TO. EACH OF THE FOLLOWING PARTICIPANTS CONTRIBUTED $22,500 TO THE PLAN DURING 2023 - DIANE LOWRY-OAKES & VANETTA ABDELLATIF. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS COMPLETED BY KPMG. THE 990 RETURN IS REVIEWED AND APPROVED BY THE DIRECTOR OF FINANCE AND THE CFO. 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 COMPLIANCE COMMITTEE OF THE TRUSTEES IS CHARGED WITH MONITORING PROPOSED OR ONGOING TRANSACTIONS FOR CONFLICT OF INTEREST AND ADDRESSING ANY POTENTIAL OR ACTUAL CONFLICTS. PURSUANT TO THE CONFLICT OF INTEREST POLICY (THE 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., TRUSTEES, OFFICERS AND EXECUTIVE LEADERSHIP). 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) HAD RECEIVED A COPY OF THE POLICY; (2) HAS READ THE POLICY AND UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE POLICY, INCLUDING COMPLETING THE CONFLICTS OF INTEREST QUESTIONNAIRE, IF ANY CONFLICTS EXIST. THE COMPLETED QUESTIONNAIRES ARE REVIEWED BY THE COMPLIANCE COMMITTEE AND ANY PERSONS WITH ACTUAL OR POTENTIAL CONFLICTS ARE INFORMED VIA WRITTEN COMMUNICATION. THE PROCEDURES FOR ADDRESSING ANY CONFLICT OF INTEREST INCLUDES, BUT IS NOT LIMITED TO, THE FOLLOWING: (1) THE CONFLICT OF INTEREST IS FULLY DISCLOSED TO THE TRUSTEES; (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 (AS APPROPRIATE); (5) ANY CONFLICTING ISSUES DURING THE COURSE OF A TRUSTEE MEETING WHICH CANNOT BE RESOLVED ARE REFERRED TO THE GOVERNANCE AND NOMINATING COMMITTEE; AND (6) THE TRANSACTION OR ACTION MUST BE APPROVED BY A MAJORITY OF DISINTERESTED PERSONS. FORM 990, PART VI, SECTION C, LINE 19 THE FUND MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990 PART VII SECTION A LINE 1 THE FOLLOWING DIRECTORS ALSO RECEIVED CLINICAL REIMBURSEMENTS IN ADDITION TO THEIR DIRECTOR'S FEES REPORTED IN COLUMN E - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS. RUTHERFORD, EVE M. - $1,169,183 TOTAL DIRECTOR FEE - $193,494 CLINICAL REIMBURSEMENT - $976,189 DELTA DENTAL OF WASHINGTON 400 FAIRVIEW AVE N SUITE 800 SEATTLE WA 98109 910621480 EDUCATION WA 501(C)(4) WDS 1 WASHINGTON DENTAL SERVICE 400 FAIRVIEW AVE N SUITE 800 SEATTLE WA 98109 270937829 EDUCATION WA 501(C)(4) N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 DELTA DENTAL OF WASHINGTON B 7831 CASH