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ObjectId: 201733139349301003 - Submission: 2017-11-09
TIN: 94-1461312
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Attach to Form 990.
Information about Schedule J (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
16
Open to Public Inspection
Name of the organization
Delta Dental of California
Employer identification number
94-1461312
Part I
Questions Regarding Compensation
Yes
No
1a
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)
b
If any of the boxes in 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
.........
1b
Yes
2
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 in line 1a?
..
2
Yes
3
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
4
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:
a
Receive a severance payment or change-of-control payment?
.............
4a
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan?
.........
4b
Yes
c
Participate in, or receive payment from, an equity-based compensation arrangement?
.........
4c
No
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.
5
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:
a
The organization?
....................
5a
No
b
Any related organization?
.......................
5b
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization?
..................
6a
No
b
Any related organization?
......................
6b
No
If "Yes," on line 6a or 6b, describe in Part III.
7
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
............
7
Yes
8
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
..........................
8
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)?
.........................
9
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2016
Page 2
Schedule J (Form 990) 2016
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
(i)
Base
compensation
(ii)
Bonus & incentive
compensation
(iii)
Other
reportable compensation
1
Reid Andrew J
Chair
(i)
(ii)
222,784
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
222,784
-------------
0
0
-------------
0
2
Franzoi Lynn L
First Vice Chair
(i)
(ii)
174,287
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
174,287
-------------
0
0
-------------
0
3
Gonella Roy
Second Vice Chair
(i)
(ii)
171,787
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
171,787
-------------
0
0
-------------
0
4
Farnsworth Kent DDS
Secretary
(i)
(ii)
171,787
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
171,787
-------------
0
0
-------------
0
5
O'Toole Terry A
Treasurer
(i)
(ii)
211,044
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
211,044
-------------
0
0
-------------
0
6
Bergert Glen F CPA
Director
(i)
(ii)
175,592
-------------
27,791
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
175,592
-------------
27,791
0
-------------
0
7
Barth Anthony S
President/CEO
(i)
(ii)
1,146,154
-------------
0
4,729,756
-------------
0
167,800
-------------
0
8,254,288
-------------
0
29,834
-------------
0
14,327,832
-------------
0
0
-------------
0
8
Castro Michael J
Exe. Vice Pres./CFO
(i)
(ii)
566,496
-------------
0
2,074,616
-------------
0
70,852
-------------
0
35,000
-------------
0
25,636
-------------
0
2,772,600
-------------
0
0
-------------
0
9
Hankinson Michael G
Exe. Vice Pres./CLO
(i)
(ii)
459,996
-------------
0
1,477,601
-------------
0
103,348
-------------
0
35,000
-------------
0
25,636
-------------
0
2,101,581
-------------
0
0
-------------
0
10
Martinez Belinda
Exe. Vice Pres.
(i)
(ii)
509,137
-------------
0
1,360,625
-------------
0
58,831
-------------
0
35,000
-------------
0
19,984
-------------
0
1,983,577
-------------
0
0
-------------
0
11
Patel Nilesh C
Exe. Vice Pres.
(i)
(ii)
502,708
-------------
0
1,274,998
-------------
0
28,622
-------------
0
36,533
-------------
0
11,063
-------------
0
1,853,924
-------------
0
0
-------------
0
12
Doering Rick R
Sr. Vice Pres.
(i)
(ii)
399,846
-------------
0
1,135,078
-------------
0
26,968
-------------
0
37,671
-------------
0
21,183
-------------
0
1,620,746
-------------
0
0
-------------
0
13
Henry Patrick T
Sr. Vice Pres.
(i)
(ii)
142,116
-------------
0
814,618
-------------
0
63,567
-------------
0
44,848
-------------
0
9,107
-------------
0
1,074,256
-------------
0
0
-------------
0
14
Jackson Kevin L
Sr. Vice Pres.
(i)
(ii)
332,134
-------------
0
799,142
-------------
0
18,103
-------------
0
40,876
-------------
0
29,534
-------------
0
1,219,789
-------------
0
0
-------------
0
15
Weber Alicia F
Sr. Vice Pres.
(i)
(ii)
399,741
-------------
0
1,132,245
-------------
0
41,370
-------------
0
37,904
-------------
0
24,427
-------------
0
1,635,687
-------------
0
0
-------------
0
16
Makkala Srihari N
Grp .Vice Pres.
(i)
(ii)
330,000
-------------
0
655,000
-------------
0
17,226
-------------
0
36,136
-------------
0
9,114
-------------
0
1,047,476
-------------
0
0
-------------
0
17
Album Jeffrey M
Vice Pres.
(i)
(ii)
270,031
-------------
0
421,556
-------------
0
10,462
-------------
0
41,683
-------------
0
27,285
-------------
0
771,017
-------------
0
0
-------------
0
18
Anderson Terri E
Vice Pres.
(i)
(ii)
10,062
-------------
0
385,327
-------------
0
318,815
-------------
0
26,801
-------------
0
814
-------------
0
741,819
-------------
0
0
-------------
0
19
Bonfilio Michelle L
Vice Pres.
(i)
(ii)
274,615
-------------
0
0
-------------
0
9,580
-------------
0
35,127
-------------
0
931
-------------
0
320,253
-------------
0
0
-------------
0
20
Bradley Russell K
Vice Pres.
(i)
(ii)
0
-------------
99,707
0
-------------
241,569
0
-------------
7,303
0
-------------
5,434
0
-------------
6,395
0
-------------
360,408
0
-------------
0
21
Croley Daniel W
Vice Pres.
(i)
(ii)
287,384
-------------
0
407,752
-------------
0
11,384
-------------
0
38,771
-------------
0
29,384
-------------
0
774,675
-------------
0
0
-------------
0
22
Fegley Andrea M
Vice Pres.
(i)
(ii)
269,539
-------------
0
196,480
-------------
0
10,707
-------------
0
32,187
-------------
0
8,116
-------------
0
517,029
-------------
0
0
-------------
0
23
Fullerton Melissa
Vice Pres.
(i)
(ii)
0
-------------
239,818
0
-------------
445,453
0
-------------
28,956
0
-------------
38,038
0
-------------
24,646
0
-------------
776,911
0
-------------
0
24
Harlin Casey J
Vice Pres.
(i)
(ii)
182,362
-------------
0
129,250
-------------
0
-3,853
-------------
0
32,575
-------------
0
27,236
-------------
0
367,570
-------------
0
0
-------------
0
25
Hempelman Janine N
Vice Pres.
(i)
(ii)
241,296
-------------
0
222,574
-------------
0
7,574
-------------
0
34,709
-------------
0
22,581
-------------
0
528,734
-------------
0
0
-------------
0
26
Hoffman Eva C
Vice Pres.
(i)
(ii)
283,927
-------------
0
397,700
-------------
0
3,837
-------------
0
36,937
-------------
0
27,303
-------------
0
749,704
-------------
0
0
-------------
0
27
Holm Brian
Vice Pres.
(i)
(ii)
253,000
-------------
0
282,399
-------------
0
13,871
-------------
0
36,911
-------------
0
22,402
-------------
0
608,583
-------------
0
0
-------------
0
28
Konovaloff J Douglas
Vice Pres.
(i)
(ii)
196,464
-------------
0
202,348
-------------
0
13,056
-------------
0
35,000
-------------
0
25,186
-------------
0
472,054
-------------
0
0
-------------
0
29
Leibowitz Thomas J
Vice Pres.
(i)
(ii)
274,846
-------------
0
405,624
-------------
0
15,497
-------------
0
35,491
-------------
0
16,706
-------------
0
748,164
-------------
0
0
-------------
0
30
Menhart Robert A
Vice Pres.
(i)
(ii)
0
-------------
132,635
0
-------------
189,879
0
-------------
18,413
0
-------------
6,122
0
-------------
16,430
0
-------------
363,479
0
-------------
0
31
Nasr Jamal L
Vice Pres.
(i)
(ii)
263,883
-------------
0
388,630
-------------
0
27,305
-------------
0
41,129
-------------
0
25,186
-------------
0
746,133
-------------
0
0
-------------
0
32
Navid Mohammadreza
Vice Pres.
(i)
(ii)
279,326
-------------
0
520,406
-------------
0
12,804
-------------
0
36,185
-------------
0
17,127
-------------
0
865,848
-------------
0
0
-------------
0
33
Profeit Duane A
Vice Pres.
(i)
(ii)
264,914
-------------
0
379,943
-------------
0
43,237
-------------
0
63,141
-------------
0
17,402
-------------
0
768,637
-------------
0
0
-------------
0
34
Robinson Karen L
Vice Pres.
(i)
(ii)
84,039
-------------
147,290
0
-------------
152,719
4,372
-------------
3,572
9,504
-------------
40,781
3,577
-------------
4,620
101,492
-------------
348,982
0
-------------
0
35
Rodzinka Barbara A
Vice Pres.
(i)
(ii)
0
-------------
227,060
0
-------------
58,125
0
-------------
66,005
0
-------------
35,000
0
-------------
17,967
0
-------------
404,157
0
-------------
0
36
Ruiz Joseph F
Vice Pres.
(i)
(ii)
305,822
-------------
0
388,541
-------------
0
114,097
-------------
0
35,000
-------------
0
25,186
-------------
0
868,646
-------------
0
0
-------------
0
37
Sheetz Marty A
Vice Pres.
(i)
(ii)
259,715
-------------
0
313,690
-------------
0
5,356
-------------
0
35,000
-------------
0
22,402
-------------
0
636,163
-------------
0
0
-------------
0
38
Swaminathan Shanmuga S
Vice Pres.
(i)
(ii)
253,000
-------------
0
278,834
-------------
0
13,014
-------------
0
35,500
-------------
0
24,853
-------------
0
605,201
-------------
0
0
-------------
0
39
Yamamoto John M DDS
Vice Pres.
(i)
(ii)
254,896
-------------
0
371,229
-------------
0
10,780
-------------
0
36,251
-------------
0
27,285
-------------
0
700,441
-------------
0
0
-------------
0
40
Davis Rhett
Director Account Services
(i)
(ii)
169,711
-------------
0
162,656
-------------
0
125,382
-------------
0
33,454
-------------
0
16,155
-------------
0
507,358
-------------
0
0
-------------
0
41
Forestieri Teri A
Director HR Operations
(i)
(ii)
201,880
-------------
0
208,042
-------------
0
18,482
-------------
0
37,531
-------------
0
10,523
-------------
0
476,458
-------------
0
0
-------------
0
42
Gee Melissa K
Director & Corporate Counsel - Manag
(i)
(ii)
239,898
-------------
0
230,332
-------------
0
2,710
-------------
0
36,779
-------------
0
7,488
-------------
0
517,207
-------------
0
0
-------------
0
43
Layne Valerie W
Director National and Special Accoun
(i)
(ii)
215,962
-------------
0
202,409
-------------
0
14,520
-------------
0
49,785
-------------
0
24,763
-------------
0
507,439
-------------
0
0
-------------
0
44
Pomerantz-Watzka Elise S
Director Compensation & Benefits
(i)
(ii)
219,926
-------------
0
227,717
-------------
0
6,503
-------------
0
36,875
-------------
0
19,458
-------------
0
510,479
-------------
0
0
-------------
0
45
Radine Gary D
FORMER - President/CEO
(i)
(ii)
196,154
-------------
0
7,337,515
-------------
0
73,856
-------------
0
145,983
-------------
0
0
-------------
0
7,753,508
-------------
0
0
-------------
0
46
Wong Thomas
FORMER - Vice Pres.
(i)
(ii)
0
-------------
0
292,817
-------------
0
0
-------------
0
6,016
-------------
0
0
-------------
0
298,833
-------------
0
0
-------------
0
Schedule J (Form 990) 2016
Page 3
Schedule J (Form 990) 2016
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 1a
First class business travel is reimbursed to the executive vice presidents, senior vice presidents, and group vice presidents. First class business travel is not treated as taxable compensation. Travel for companions was provided to four board members with respect to their required attendance at the annual board meeting. The cost of this benefit was included in taxable compensation. A housing allowance is provided to one senior executive as a result of a 2013 relocation to California. The housing allowance has continued while the previous home is being marketed for sale. The cost of this benefit is included in taxable compensation. Reimbursement for company approved relocation costs are "grossed up" to cover any personal tax liability that would be incurred by the employee for the expense. Two officers and one highly compensated employee received this benefit in 2016. The total amount reimbursed is included in taxable compensation. The president and executive vice presidents may be reimbursed for one health or social club upon approval by the president. Two senior executives received this benefit in 2016. The cost of this benefit is included in taxable compensation. Financial and tax planning expenses are reimbursed to employees at the director or above levels of management. A company policy outlines the maximum reimbursement allowed for each management level. These reimbursements are included in the taxable compensation of the reimbursed employees.
Part I, Line 4b
The organization provides a supplemental non-qualified retirement plan to certain of its senior executives as selected by the Board of Directors. The supplemental retirement benefit is based on each executive's compensation and years of service to the enterprise. The benefit is subject to the risk of forfeiture if required years of service are not met. Annual deferred compensation related to this plan is reported in Schedule J, Part II, Column C for each participant and reflects the current year increase or decrease in the organization's pension benefit obligation ("PBO"), calculated pursuant to generally accepted accounting principles. The PBO increase or decrease includes changes in actuarial assumptions (e.g., applicable discount rate), as well as changes in compensation and years of service. In 2016, four executives participated in the plan - Anthony Barth, Michael Castro, Douglas Konovaloff, and Belinda Martinez.
Part I, Line 7
The President of the organization, with Board of Directors approval, may grant an annual bonus to all management employees. These amounts are included in taxable compensation.
Schedule J (Form 990) 2016
Additional Data
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