Download Florida Dental Association House of Delegates Annual Session

Florida Dental Association
House of Delegates
Annual Session
AGENDA
FIRST SESSION
NOTICED START OF MEETING:
DATE:
LOCATION:
SPEAKER-OF-THE-HOUSE:
PRESIDENT:
1 p.m.
Friday, June 12, 2015
Osceola D, Gaylord Palms Hotel
Dr. Ethan Pansick
Dr. Rick Stevenson
To facilitate a paperless House of Delegates, power outlets will be available. Please download your
agenda prior to the meeting so you will have access to the digital document. Link to agenda (.pdf):
http://www.floridadental.org/docs/default-source/members/agendas/agenda-hod-2015-june.pdf
1.
Call to Order
Dr. Ethan Pansick
(1:00 p.m.)
2.
Invocation and Americanism
Dr. Ralph Attanasi
(1:01 p.m.)
3.
Recognition of Special Guests
Dr. Stevenson
(1:03 p.m.)
4.
Legal Compliance Statement
(regarding: conflicts of interest, anti-trust, and confidentiality)
Exhibit HOD-4
(1:05 p.m.)
Page 7
5.
Report of the FDA President
Dr. Stevenson
(1:06 p.m.)
A.
Dr. Tim Marshall
Treasurer’s Report (Powerpoint Presentation)
6.
FDA Foundation Activities Update
Dr. David Russell
(1:25 p.m.)
7.
ADPAC Matters
Dr. Rick Huot
(1:30 p.m.)
8.
Dental School Updates
(1:35 p.m.)
Page 1
A.
Dr. Anton Gotlieb,
Lake Erie College of Osteopathic Medicine
(reports from UNFC and Nova will take place during Session 2)
9.
Report of the Credentials Committee
Dr. Lucien Johnson, Chair
(1:50 p.m.)
A. Credentials Committee Composition
Exhibit HOD-9(A)
Page 11
B. Report on Quorum
Dr. Johnson
Consent Agenda (see agenda items with asterisks)
Exhibit HOD-10
(1:55 p.m.)
Page 12
11.
Approval of Minutes of January 23, 24, 2015 Meeting
Exhibit HOD-11
(2:00 p.m.)
Page 13
12.
Nominations and Elections
(2:01 p.m.)
10.
*
*A.
Nomination and Election of Line Officers
Exhibit HOD-12(A)
Page 20
13.
Overview of the Reference Committee Process
(2:10 p.m.)
Exhibit HOD-13
Page 22
14.
Composition of Reference Committees
(2:15p.m.)
Exhibit HOD-14
Page 29
15. Reference Committee Assignments
B.
(2:20 p.m.)
MATTERS ASSIGNED TO REFERENCE COMMITTEE A
*1.
Qualifications for Council on the New Dentist
Exhibit HOD-15(A)(1)
Page 30
2.
Date of Determination of Membership
Exhibit HOD-15(A)(2)
Page 32
3.
Strategic Planning Task Group Recommendations
for Councils and Committees
Exhibit HOD-15(A)(3)
Page 35
*4. Rescission of Strategic Planning Meeting Format
Policy
Page 2
Exhibit HOD-15(A)(4)
Page 38
B.
5.
Dr. Robert Hayling Honorary Membership
Exhibit HOD-15(A)(5)
Page 44
6.
Redefining Dual Membership
Exhibit HOD-15(A)(6)
Page 45
7.
New business items assigned by the Speaker, if any
MATTERS ASSIGNED TO REFERENCE COMMITTEE B
*1.
FDA Operating Fund FY 2015-2016 Budget
Exhibit HOD-15(B)(1)
& Attachment
Page 47
2.
Bylaws Change: Adoption of New Bylaws and
Workgroups Manual
Exhibit HOD-15(B)(2)
Page 68
3.
Dental Therapy Prior to Medications (MRONJ)
Exhibit HOD-15(B)(3)
& 2 Attachments
Page 90
*4. Florida Specialty License Plate - Dental
5.
FDA Campaign Fund for ADA President-elects
Exhibit HOD-15(B)(4)
& Attachment
Page 121
Exhibit HOD-15(B)(5)
Page 146
6. New business items assigned by the Speaker, if any
16. Announcements
(2:28 p.m.)
Location of Reference Committee Hearings:
o Reference Committee A: Osceola 4
o Reference Committee B: Osceola D
17. Adjournment of the First Session
(2:30 p.m. estimated)
Page 3
SECOND SESSION
NOTICED START OF MEETING:
DATE:
LOCATION:
SPEAKER-OF-THE-HOUSE:
9 a.m.
Saturday, June 15, 2013
Osceola D, Gaylord Palms Hotel
Dr. Ethan Pansick
(Continuation of numbering sequence)
18.
Call to Order
Dr. Pansick
(9:00 a.m.)
19.
Report of the Credentials Committee
Dr. Johnson
(9:01 a.m.)
20.
Recognition of Special Guests
Dr. Stevenson
(9:02 a.m.)
21.
Legal Compliance Statement
(regarding: conflicts of interest, anti-trust, and confidentiality)
see Exhibit HOD-4
(9:05 a.m.)
Page 7
22.
Report of the 17th District Trustee
Dr. Terry Buckenheimer
(9:20 a.m.)
23.
Report of the Chairman of the Board of Dentistry
Dr. William Kochenour
(9:35 a.m.)
24.
Dental School Updates (continued)
(9:45 a.m.)
25.
A.
Dr. Linda Niessen, Nova Southeastern University
School of Dental Medicine
B.
Dr. Isabel Garcia, University of Florida College of
Dental Medicine
Update on ADA Activities
A.
26.
Dr. Jonathan Shenkin
ADA First Vice-President
(10:15 a.m.)
Award to Outgoing FDA President
Necrology Report
Dr. Jolene Paramore,
Secretary
Exhibit HOD-26
Page 147
(10:30 a.m.)
Page 4
27.
Installation of FDA Officers
Dr. Pansick
(10:33 a.m.)
28.
Report of the Newly Installed FDA President
(term commencing at close of House of Delegates)
Dr. Ralph Attanasi
(10:45 a.m.)
29.
Consideration of Reference Committee Reports
(11:00 a.m.)
Note: Reference Committee Reports will be distributed electronically to Component
Executive Directors and posted on the HOD Forum at the link provided at the top of this
agenda in advance of each districts’ caucus breakfast
A.
Reference Committee A
Leandra Dopazo, Chair
B.
Reference Committee B
Oscar Menendez, Chair
30.
Conflict of Interest Policy and Form
(Form on Page 148 to be separated and returned)
Exhibit HOD-30
Page 148
(11:30 a.m.)
31.
Date of Next House of Delegates meeting:
(11:39 a.m.)
January 22-23, 2016 (Friday-Saturday)
Tampa Airport Marriott Hotel
31.
Announcements
(11:40 a.m.)
32.
Adjournment of Second Session
(11:45 a.m. estimated)
Page 5
____________________________________________
Appendix: Reports to the House of Delegates
NOTE: These items are available only in the digital (expanded) version of the
agenda via the download link provided in the "Special Notice"
at the top of the agenda.
A-1
Report of the Treasurer
Appendix A-1
A-2
Report of the Board of Trustees
Appendix A-2
A-3
Reports of FDA Councils
A-4
A-5
A.
Council on Communications
Appendix A-3(A)
B.
Council on Dental Benefits and Care
Appendix A-3(B)
C.
Council on Dental Health
Appendix A-3(C)
D.
Council on Dental Education and Licensure
Appendix A-3(D)
E.
Council on Ethics, Bylaws & Judicial Affairs
Appendix A-3(E)
F.
Council on Financial Affairs
Appendix A-3(F)
G.
Council on Membership
Appendix A-3(G)
H.
Council on the New Dentist
Appendix A-3(H)
Reports of standing FDA Committees
A.
FDC Committee
Appendix A-4(A)
B.
Governmental Action Committee
Appendix A-4(B)
C.
Strategic Planning Task Group
Appendix A-4(C)
Reports of Allied Dental Organizations
A.
FDA Services, Inc.
Appendix A-5(A)
B.
FDADPAC
Appendix A-5(B)
C.
FDAF
Appendix A-5(C)
Page 6
Exhibit HOD-4
Page 1 of 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
LEGAL COMPLIANCE STATEMENT
BACKGROUND: For reference purposes at this meeting, all participants are advised of the
following regarding legal compliance:
Association representatives who act in good faith in compliance with the standards below will be
indemnified by the association for actions occurring under the course and scope of their official
representation. Defamation, intentional interference with an advantageous business relationship and
antitrust violations are the areas the FDA has identified for which strict compliance is necessary.
Defamation occurs when one person makes untrue statements of fact to another person about a third
party. Potential examples include disparaging comments about a dentist’s ability to practice his or her
chosen profession; untruths about claims reimbursement policies regarding an insurer or managed care
payer; untrue allegations regarding ability to pay claims, etc.
Intentional interference occurs when one person tries to influence the conduct of another person who
is under contract with a third party. Potential examples include influencing dentists to not sign up, or
to cancel participating provider agreements with, a payer; encouraging a dentist to break his or her
contract with one practice to come to work for another practice, etc.
Antitrust law prohibits the FDA from facilitating agreements between competing dentists that
unreasonably restrain trade. Thus, attendees at FDA meetings may not discuss prices they charge for
dental services; price-related terms (e.g., their hours of operation, credit policies, salaries paid to
ancillary staff, etc.); or the boycott of dental benefit plans (e.g., because of reimbursement policies),
suppliers, or other dentists (e.g., by refusing to refer patients to them).
Certain collective conduct by competitors is “per se” or automatically illegal regardless of the group’s
economic power in the marketplace (i.e., whether the group has the ability to reduce output of dental
services or increase the cost of those services). Per se violations are likely to result in criminal sanctions
(prison terms and fines) as well as civil damages (triple the amount of the actual loss suffered by a
plaintiff plus reimbursement of the plaintiff’s court costs and attorneys’ fees). Such sanctions and awards
can apply to both the dental society as well as its representatives if the alleged conduct is found to have
restrained trade. Very importantly, dental society insurance coverage may not apply to indemnify against
criminal prosecutions. For these reasons, it is important for all association employees and representatives
to follow these standards and avoid any conduct that gives even the appearance of impropriety.
Representatives of organized dentistry should pay close attention to the following areas because they
carry high risk of per se violations:
I. Price-fixing: Agreements facilitated by dental societies under which competing dentists agree to deal
in concert with one another towards third party payers or purchasers of dental services on price or pricerelated terms are per se illegal. Dental societies and their designated representatives must therefore avoid
any action that may constitute price-fixing or a conspiracy among competing dentists to engage in pricefixing. The term “price” in this context should be broadly construed to include:
Page 7
Exhibit HOD-4
Page 2 of 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
•
•
•
•
Pricing methodologies, fee schedules or the actual fees to be charged by doctors for dental
services, including their criteria for fee waivers.
Acceptable levels of co-payments, fee withholds, UCR discounts, reimbursement
methodology or claims administration procedures should doctors accept assignment of
benefits or claim reimbursement from third party payers.
Terms of credit to be offered to patients by doctors.
Prices to be paid by doctors for “inputs” necessary to provide dental services such as dental
equipment, supplies and office space or ancillary services from hygienists and assistants.
II. Group boycott and market allocation: Agreements facilitated by dental societies under which
competing dentists threaten, or actually engage in, collective non-participation or create “barriers to
entry” into the marketplace by another actual or potential competitor are per se illegal. In this context,
“actual competitor” means another dentist currently in the same geographic and specialty (if applicable)
area of practice; “potential competitor” means someone with the present ability to enter the marketplace
within one year; “collective non-participation” or “barriers to entry” include agreements that dental
society members:
•
•
•
•
•
•
Will not refer otherwise appropriate patients to targeted actual or potential competitors
unless, for example, the targeted competitor limits its hours or the scope of services it
provides.
Will not accept referrals of otherwise appropriate patients from targeted competitors unless,
for example, the targeted competitor limits the patients to whom it markets its services,
agrees to a policy on fee waivers, or agrees that it will not do business with a managed care
payer.
Will otherwise try to coerce or intimidate competitors from locating their practices
where they want or otherwise engaging in lawful conduct.
Will prohibit or attempt to influence members’ individual decisions about whether to
accept or decline offers of participating provider agreements or the scope of the
agreements (e.g., what services will be provided, for which patients, how much will
be charged for services, etc.). Dental societies must avoid appointing a representative
to negotiate participation levels with payers (e.g., whether and under what conditions
the dentist-members will participate with [or withhold participation from] payers or
patients in general).
Will refuse to deal with payers based on non-price terms. For example, local
societies must not facilitate agreements among members that x-rays or study models
needed for claims processing will be withheld from the payer.
Will all participate with (or withhold participation from) payers regardless of how
meritorious (or unmeritorious) the reasons. While this violation is subtle, the essence of it is
that the individual judgment (business or otherwise) of members is subverted to the collective
will of the dental society.
As representatives of organized dentistry, volunteer-leaders and staff should DO the following:
•
Self-police against restraint of trade and avoid any conduct that would organize or further
a conspiracy to engage in price-fixing, group boycott or market allocation as described
above.
Page 8
Exhibit HOD-4
Page 3 of 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
•
•
•
•
If one becomes aware of prohibited conduct, take all reasonable steps to avoid the
perception that the association has encouraged or supported the activity.
Contact the FDA Department of Legal Affairs before taking any action that violates the
standards set forth herein rather than engaging in the conduct until told to refrain.
Distribute these rules to all representatives of organized dentistry (employees, leadership
and “contact dentists”) and encourage them to contact FDA legal staff if there is any
question as to what is acceptable before taking the action. If a representative of organized
dentistry is unwilling to abide by the standards of conduct, then the dental society should
immediately cease using that dentist as an informational resource or volunteer.
Fairly and truthfully educate members about proposed and known developments in the
marketplace.
As representatives of organized dentistry, volunteer-leaders and staff should NOT DO the following:
•
•
•
•
•
•
•
Meet without FDA support staff in attendance. FDA support staff is expected to notice the
meeting, prepare agendas, keep minutes, etc. Further, FDA support staff is expected to work
closely with the FDA’s legal department should assistance be needed on risk management
practices. FDA legal staff may also sit in on meetings to ensure improper conduct does not
occur.
Meet without approval of the chair.
Allow one volunteer representative to unilaterally designate another doctor to serve in an
official capacity as an informational resource, association representative or “contact dentist.”
Rather, all such representatives should be selected and supervised by the FDA agency
sponsoring the activity in accordance with the FDA bylaws and these guidelines. Allowing
one representative to designate another person to serve (whether temporarily or permanently)
as dental society spokesperson or representative about marketplace issues probably violates
most societies’ bylaws and policies and, even more serious, may make the society itself
responsible for what was said or done by the alternate.
Publish an article or organize/sponsor a meeting between one or more competing dentists
(including dental society meetings) in order to organize or facilitate collective conduct such as
price-fixing, market allocation or boycott as described above.
Promulgate a survey of member-dentists regarding participation levels in, and/or members’
willingness to accept (or to refuse to accept) participating provider agreements from insurers
and managed care payers.
Distribute information to dental society members or others about participation levels in the
insurance programs or managed care organizations. For example, it is improper to distribute
lists of participating and/or non-participating dentists to the dental community. Similarly, it is
improper for the dental society to exchange information among competing dentists about the
terms and conditions of other dentists’ participation or refusal to participate.
Appoint a single individual to collectively provide information to or negotiate and bargain
with payers about dentists’ participation levels; fees charged by the dentists to patients or
third-party payers (governmental or otherwise); the scope of services to be provided and to
what category of patient (e.g., underserved or indigent only); or price-related terms such as fee
waivers, timing of claims reimbursement, and the like.
Page 9
Exhibit HOD-4
Page 4 of 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
•
Sign letters or sponsor petitions sent to payers or other potential or actual competitors
encouraging them not to locate clinics in their dental society’s jurisdiction or to locate it
elsewhere.
III. Confidentiality: When the agency chair calls for an executive session, FDA support staff (or in
the absence of staff, the chair of the executive session) is directed to verbally read the following
statement:
Confidentiality is an integral part of how an association works. Agencies often require access to
sensitive or potentially embarrassing information and must be able to disclose this information freely
in executive session to make recommendations on association policy or candidates for office. To
deliberate honestly and openly, the agency must know that the trust they have placed in other agency
members will not be broken by an individual improperly disclosing information outside of the
executive session. Unauthorized disclosure of information that was provided to the group with the
understanding that it will be kept confidential is serious. It impairs the association’s ability to
function effectively and presents liability risk. Once the group’s trust is broken by making improper
disclosure, it is very difficult to restore a positive working relationship.
Only information discussed during a formally announced executive session is confidential. The chair
must announce the start and end of the executive session and the minutes must reflect this. No official
action can be taken during executive session (i.e., the group must come out of executive session
before voting). Executive session is mandatory for discussion of personnel matters, Corporate
Affiliation Program proposals, dues waivers, legislation or regulatory matters, litigation or when the
chair determines information is sensitive.
“Confidential” means the information may not be disclosed at any time in any manner (including but
not limited to verbally, in writing, electronically, or through social media) to anyone (including but
not limited to friends outside of dentistry; spouses or significant others; business partners or
employees; association staff; dental or dental hygiene schools; licensure agencies; accrediting
organizations; governmental agencies; association leadership serving on other agencies; associations
or specialty groups at other levels of organized dentistry; or public media). It may not be discussed
between members who participated in the executive session after the executive session concludes.
STRATEGIC PLAN LINK: This matter relates to Program Goal 5: Ensure that the FDA is
organized to effectively carry out its strategic plan.
RECOMMENDATION: Accept for information.
UNBUDGETED IMPACT: None.
Page 10
Exhibit HOD-9(A)
Page 1 of 1
CREDENTIALS COMMITTEE
The following individuals have been appointed to the Florida Dental Association House
of Delegates’ Credentials Committee for the January 2015 and June 2015 meetings:
Capacity
Member
Member
Member
Member
Member
Member
Liaison
Representing
ACDDA
CFDDA
NEDDA
NWDDA
SFDDA
WCDDA
BOT
Person
Braverman, Charles
Lucien Johnson
Hanania, Sam
Martin, Eddie
Limosani, Mark
Busch, Ed
Huot, Rick
Page 11
Exhibit HOD-10
Page 1 of 1
AGENDA ITEMS FOR UNANIMOUS CONSENT
Items marked with an asterisk (*) to the left of their item number in the agenda’s Table of
Contents are suggested consent items by the Speaker of the House.
In addition to House action on these items, individual reference committees may present one or
more items for consent at the outset of their respective report to the House.
2014H-073
consent:
Pulled Item
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Resolved, that the following items are hereby approved by unanimous
Exhibit No.
HOD-11
HOD-12(A)
HOD-15(A)(1)
HOD-15(A)(4)
HOD-15(B)(1)
HOD-15(B)(4)
Resolution No.
N/A
2014H-057
2014H-039
2014H-061
2014H-064bs
2014H-072
Topic
Approval of Minutes of January 23, 24, 2015 Meeting
Nomination and Election of Line Officers
Qualifications for Council on the New Dentist
Rescission of Strategic Planning Meeting Format
FDA FY 2015-2016 Operating Fund Budget
Florida Specialty License Plate - Dental
Page 12
Exhibit HOD-11
Page 1 of 7
1
2
3
4
5
6
7
8
9
10
11
Florida Dental Association
House of Delegates
Semi-Annual Session
January 2015
NOTICED START OF MEETING: 1 p.m.
12
DATE:
Friday, January 23, 2015
13
LOCATION:
Tampa Airport Marriott
14
PRESIDENT:
Dr. Rick Stevenson
15
SPEAKER-OF-THE-HOUSE:
Dr. Ethan Pansick
DRAFT MINUTES
(pending approval at June 2015 HOD)
FIRST SESSION
16
17
18
_____________________________________________________
Contents
FIRST SESSION ........................................................................................................................... 1
19
Call to Order of First Session.......................................................................................................... 2
20
Legal Compliance Statement .......................................................................................................... 2
21
Report of the President.................................................................................................................... 2
22
Special Report on Membership....................................................................................................... 3
23
Special Report on South Carolina Dental Therapist Bill ................................................................ 3
24
17th District Trustee Report............................................................................................................. 3
25
Report of the Board of Dentistry Chair........................................................................................... 3
26
Report of the Credentials Committee ............................................................................................. 3
27
Consent Agenda .............................................................................................................................. 3
28
June 2015 Openings on Delegation to ADA House ....................................................................... 4
29
Streamlining of FDA Bylaws ......................................................................................................... 4
30
Overview of the Reference Committee Process ............................................................................. 4
31
Composition of Reference Committees .......................................................................................... 4
32
Announcements............................................................................................................................... 4
33
Adjournment of First Session ......................................................................................................... 4
Page 13
Minutes of the January 2015 House of Delegates Semi-Annual Session
Page 2 of 7
1
SECOND SESSION ...................................................................................................................... 5
2
Call to Order of Second Session ..................................................................................................... 5
3
Report of the Credentials Committee ............................................................................................. 5
4
Legal Compliance Reminder .......................................................................................................... 5
5
ADPAC Report ............................................................................................................................... 5
6
Prescription Drug Monitoring Program .......................................................................................... 6
7
Necrology Report ............................................................................................................................ 6
8
Confirmation of ADA Officers ....................................................................................................... 6
9
Election of Alternate Delegates to the ADA................................................................................... 6
10
Consideration of Reference Committee Report .............................................................................. 6
11
Bylaws Task Group Proposal to Streamline Bylaws ...................................................................... 6
12
One HOD Session Per Year ............................................................................................................ 6
13
Dental Therapy Prior to Prescription of Medications with Risk of Oral Ulcerations ..................... 7
14
Date of Next Meeting...................................................................................................................... 7
15
Adjournment ................................................................................................................................... 7
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
___________________________________________________
CALL TO ORDER OF FIRST SESSION
Dr. Ethan Pansick, Speaker of the House, called the meeting to order at 1:00 p.m.
LEGAL COMPLIANCE STATEMENT
Dr. Pansick reminded the House of legal compliance.
REPORT OF THE PRESIDENT
Dr. Stevenson stated that many positive changes have occurred over the last six months and
pointed out the Executive Director’s personal theme for the year: “relentless positive action.” He
said the Building Committee, Workforce Innovation and Bylaws task groups have all been
working hard and are making recommendations for action. He showed two marketing videos:
one on what it means to be an FDA member and the “Dr. Ann” promotion of Gold Crown
Savings. He reported with pride that the FDA is the first state dental association to have
implemented a consistent single brand for the association and nearly all of its affiliated entities.
He reported that the Foundation has hired a new director and plans to have an annual FLA-MOM
event. He asked for volunteers for the next event, which will be in Jacksonville. He thanked Dr.
Andy Brown for his work on FLA-MOMS and thanked Dr. Don Ilkka for his work on the BOD
records rule, which was resolved to the association’s satisfaction.
Page 14
Minutes of the January 2015 House of Delegates Semi-Annual Session
Page 3 of 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
SPECIAL REPORT ON MEMBERSHIP
Dr. Terry Buckenheimer and Mr. Drew Eason announced that only one of five target states in the
nation had increased market share and that was Florida – by one full percentage point. The
House recognized how significant an accomplishment this was due to the numbers of retiring
members and the influx of newly licensed dentists. 316 new dentists entered Florida yet the
FDA nevertheless added 271 more members than last year.
SPECIAL REPORT ON SOUTH CAROLINA DENTAL THERAPIST BILL
Dr. Mike Eggnatz briefed the House of Delegates on a bill pending in South Carolina that would
greatly expand the scope of practice for “dental therapists.”
17TH DISTRICT TRUSTEE REPORT
Dr. Buckenheimer congratulated Drew Eason and the FDA staff for its achievement at not only
reversing the downward trend but also actually increasing the FDA’s membership. He thanked
his wife Karen for her support as well as her own activities that contribute to organized dentistry.
He also stated that no other state has ever had five ADA council chairs or vice-chairs. He said
Florida’s Action for Dental Health is a welcome response to South Carolina’s dental therapist
bill and activism by other groups. He said he enjoyed serving as both FDA trustee and FDA
president but was relieved that his term has successfully concluded. He reported that the ADA’s
strategic plan puts membership needs first and focuses on programs that help individual
members succeed. He also said the ADA headquarters now has a fully operational video
production facility that is generating income for the ADA.
REPORT OF THE BOARD OF DENTISTRY CHAIR
Dr. Kochenour praised the FDA for maintaining close relationships with the Board of Dentistry,
even though their missions are distinct. He shared statistics in the State of Florida on complaints,
disciplinary actions, and unlicensed activity. He thanked the FDA for its peer review process
and mentioned that it is the best benefit that a dentist can have. Dr. Kochenour mentioned that
upcoming challenges include do-it-yourself dental procedures and technology. He pledged his
support for the FLA-MOM events. He asked for Florida licensed dentists to volunteer as dental
licensure examiners and indicated that a licensure assessment may be necessary in the future.
REPORT OF THE CREDENTIALS COMMITTEE
Dr. Ethan Pansick polled the Credentials Committee and confirmed their attendance and Dr.
Lucien Johnson reported that a quorum was present.
CONSENT AGENDA
 The House unanimously approved the following item of business:
1) The minutes of the June 2014 House of Delegates were adopted as presented.
2) The proposed bylaws change (2014H-026) converting the sub-council on new dentists
to a council.
3) The dues increase for graduate dental students (2014H-028).
4) The SFDDA’s recommendations on the BOD records rule (2014H-035).
5) Approved Florida’s Action for Dental Health and directed staff to implement its policy
objectives and strategies (2014H-036)
Page 15
Minutes of the January 2015 House of Delegates Semi-Annual Session
Page 4 of 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
JUNE 2015 OPENINGS ON DELEGATION TO ADA HOUSE
 The House unanimously approved by acclimation the component-designated delegates. It
then elected Drs. Dave Boden, Rick Huot and Paul Miller as at-large delegates and nominated
Drs. Zack Kalarickal and John Harrington as alternate at-large delegates. Dr. Pansick announced
that the election for alternate at-large delegates would be held during the second session of the
House of Delegates.
STREAMLINING OF FDA BYLAWS
Dr. Pansick, as chair of the Bylaws Task Group, made a presentation to the House of Delegates
on the task group’s work to date and recommendations to simplify the bylaws.
OVERVIEW OF THE REFERENCE COMMITTEE PROCESS
Dr. Pansick reminded delegates that an overview of the reference committee process is found in
the agenda.
COMPOSITION OF REFERENCE COMMITTEES
Dr. Pansick announced that the House would meet as a reference committee of the whole
immediately after adjourning its first session. He then verbally reviewed all matters assigned to
the reference committees.
ANNOUNCEMENTS
Dr. Pansick announced that the House will reconvene at 9 a.m. tomorrow morning.
ADJOURNMENT OF FIRST SESSION
Without objection, the first session of the House was declared adjourned at 3:00 p.m. on Friday,
January 23, 2015.
Page 16
Minutes of the January 2015 House of Delegates Semi-Annual Session
Page 5 of 7
1
2
3
4
5
6
7
8
9
10
NOTICED START OF MEETING: 9:00 a.m.
11
DATE:
Saturday, January 24, 2015
12
LOCATION:
Tampa Airport Marriott
13
PRESIDENT:
Dr. Rick Stevenson
14
SPEAKER-OF-THE-HOUSE:
Dr. Ethan Pansick
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Florida Dental Association
House of Delegates
Annual Session
January 23 - 24, 2015
MINUTES
SECOND SESSION
_____________________________________________________
CALL TO ORDER OF SECOND SESSION
Dr. Ethan Pansick, FDA Speaker of the House, called the meeting to order at 9:00 a.m.
REPORT OF THE CREDENTIALS COMMITTEE
Dr. Lucien Johnson, Chair of the Credentials Committee, reported that a quorum was present.
LEGAL COMPLIANCE REMINDER
Dr. Pansick reminded all House members to disclose any conflicts of interest they might have
before speaking for or against a given issue and gave the anti-trust and legal compliance
reminders.
ADPAC REPORT
Dr. Bird reported that three dentists are elected to the U.S. Congress and that he serves on the
ADPAC selection committee. He reported a 90% success rate in the Senate and a 93% success
rate in the House of Representatives. Of the Florida ADPAC-supported candidates, all were
elected except for Steve Southerland. He stated that ADPAC is just short of reaching its goal of
$2 million in contributions and that ADPAC is one of the most well-funded health care PACs
nationally.
Mr. Mike Graham, ADA chief lobbyist, reported that the new Congress will be better than the
old Congress and that the tax on medical devices will get a hearing and will hopefully be
repealed. He also discussed changes to the Affordable Care Act, the student loan problem and
the ADA’s campaign school.
Page 17
Minutes of the January 2015 House of Delegates Semi-Annual Session
Page 6 of 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
PRESCRIPTION DRUG MONITORING PROGRAM
Mr. Bob Macdonald, executive director of the Prescription Drug Monitoring Program, gave an
overview of how the program can benefit dentists in managing their patients’ prescriptions. Mr.
Macdonald encouraged the delegates to register and to let their constituents know about the
program as well.
NECROLOGY REPORT
Dr. Jolene Paramore read the names of members who have passed away since the previous
session and the House of Delegates honored them with a moment of silence.
CONFIRMATION OF ADA OFFICERS
The House of Delegates confirmed Dr. Buckenheimer’s nomination by the delegation to run for
ADA president-elect and Dr. Cesar Sabates nomination to serve as ADA trustee-elect for the
FDA.
ELECTION OF ALTERNATE DELEGATES TO THE ADA
The House of Delegates elected the following to serve as alternate at-large delegates to the ADA:
Drs. Chris Bulnes, John Cordoba, Zack Kalarickal, Bert Hughes, James Paladino, Paul Palo,
Robert Payne and Linda Trotter with Dr. Paramore being elected to serve the unexpired term of
Dr. Boden.
CONSIDERATION OF REFERENCE COMMITTEE REPORTS
BYLAWS TASK GROUP PROPOSAL TO STREAMLINE BYLAWS
 The House ADOPTED resolution 2014H-028:
WHEREAS, the Bylaws Task Group is trying to simplify the bylaws and is
recommending shifting content from the bylaws to a new Agencies Manual and wants to
get as much input from the House of Delegates and FDA members as possible; therefore
be it
[Policy] RESOLVED that the January 2015 House of Delegates review the task group’s
recommendations (see attached draft) and invite FDA members to attend an electronic
town-hall meeting in March and to submit written comments through April 1, 2015; and
that the Council on Ethics, Bylaws and Judicial Affairs review the comments and make
final recommendations to the June 2015 House of Delegates.
ONE HOD SESSION PER YEAR
 The House DEFEATED resolution 2014H-xxx:
WHEREAS, one of the FDA’s objectives is to operate within its budget and the January
House of Delegates session is a considerable expense if no substantive business occurs
and the FDA is currently in the process of re-writing its Bylaws to promote efficiency;
Therefore, be it
Page 18
Minutes of the January 2015 House of Delegates Semi-Annual Session
Page 7 of 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
[Procedure] RESOLVED that FDA staff be directed to eliminate the January HOD
session from the Bylaws draft and report back to the June HOD with draft bylaws for
adoption that eliminate the January HOD session. And be it further,
[Procedure] RESOLVED, that cost-savings be used to fund in-person council meetings.
DENTAL THERAPY PRIOR TO PRESCRIPTION OF MEDICATIONS
WITH RISK OF ORAL ULCERATIONS
 The House REFERRED to the Council on Dental Health the following resolution:
WHEREAS, Oral and IV delivery of Bisphosphonate and RANK ligand inhibitors
medications are a common and necessary treatment for treatment and minimization of the
effects of osteoporosis and osteopenia in many individuals, and antiangiogenic
medications have been useful for certain types of carcinomas; and;
WHEREAS, the dental profession is aware there is a significantly increased risk of
debilitating oral ulcerations, now known as Medication-related Osteonecrosis of the Jaw
(MRONJ) (previously known as Bisphosphonate Associated Osteonecrosis of the Jaw
(BONJ)), that can occur following even simple and necessary oral surgical procedures
such as routine extractions and implant placement, and that these lesions are particularly
persistent, clinically difficult to manage, and often result in significantly compromised
dental treatment; and
WHEREAS, Medical patients about to begin these medications could greatly benefit
from early execution of portions of their dental treatment plans, similar to protocols
utilized for pre-radiation patients; therefore be it
RESOLVED, that the FDA develop a communication in cooperation with the Florida
Medical Association designed to help inform Florida physicians of the benefit of a dental
consultation prior to initiating medications prone to the risk of MRONJ; and be it further,
RESOLVED, that this matter be referred to the Council on Dental Health with a
resolution back to the House of Delegates at its June 2015 session.
DATE OF NEXT HOUSE OF DELEGATES MEETING
Dr. Pansick announced the next meeting would be June 12 - 13, 2015 at the Gaylord Palms
Resort and Convention Center in Kissimmee.
ADJOURNMENT
Without objection, Dr. Pansick declared the meeting adjourned at 11:30 a.m.
Page 19
Exhibit HOD-12(A)
Page 1 of 2
1
2
3
4
5
6
7
8
9
10
11
12
13
DATE:
May 19, 2015
SUBMITTED BY:
Drew Eason, Executive Director
NOMINATION AND ELECTION OF FDA LINE OFFICERS
BOARD OF TRUSTEES RECOMMENDATION:
The West Coast District Dental
Association has nominated Dr. Rudy Liddell for the office of Secretary for the 2015-2016 fiscal
year. Via the following resolution, the Board of Trustees has nominated the following slate of
persons to serve in the below referenced elected positions with one year terms commencing in
June 2015:
2014H-057
[Procedure] RESOLVED, that, via nomination by the Board of Trustees,
14
the below designated individuals are hereby elected to the following
15
offices for the 2015-2016 fiscal year:
16
Office of President-Elect:
Dr. Bill D’Aiuto
17
Office of First Vice President:
Dr. Mike Eggnatz
18
Office of Second Vice President:
Dr. Jolene Paramore
19
Office of Secretary:
Dr. Rudy Liddell
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Board vote:
Abstain:
Stevenson
Yes:
Attanasi; Boden; Huot; D’Aiuto, Pranikoff; Antoon; Brown; Cochran (for
Setzer); Ottley (for Jernigan); Eggnatz; Centurion; Terry; Liddell;
Churney
No:
None
UNBUDGETED IMPACT: None.
BACKGROUND: Nominations for the offices of president-elect, first vice president, second
vice president and secretary are presented annually to the House of Delegates by the Board of
Trustees. Each of these offices serves one-year terms and are elected by the House of Delegates
at the annual session of the House. Nominations for the office of secretary are rotated in series
among the component dental associations and submitted to the Board of Trustees by the
president of the respective component dental association prior to the Board meeting in May.
As background, the FDA’s Board of Trustees consists of the immediate past-president, president,
president-elect, first vice president, second vice president, secretary and a maximum of two
trustees elected from each component dental association of the FDA. Trustees may not be a
delegate to the FDA’s House of Delegates (but alternate trustees can).
Page 20
Exhibit HOD-12(A)
Page 2 of 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
The officers of the Board of Trustees are the chair, vice-chair and a secretary with the FDA
president serving as chair, the president-elect serving as vice-chair, and the FDA secretary
serving as secretary of the Board of Trustees. 1 Other elective officers of the FDA are the
Treasurer, Treasurer-elect, and Speaker of the House. 2 The Speaker of the House serves as
parliamentarian of the Board of Trustees.
Appointive offices of the FDA include the Editor and the Executive Director. All elected
officers are selected by the House of Delegates. All appointive officers are selected by the Board
of Trustees. The Treasurer and Executive Director are ex-officio members of the Board of
Trustees without vote.
Trustees serve two-year terms and component dental associations may limit the number of
consecutive terms of their trustees. Terms of alternate trustees are determined by the respective
component dental associations. 3 Trustees are elected by their component dental associations
prior to the annual session of the House of Delegates. Components with more than one trustee
must stagger their trustees’ terms (currently ACDDA, CFDDA, SFDDA and WCDDA).
Alternate trustees “may be called to serve on the board”, i.e., it is not mandatory that alternate
trustees always be present at Board meetings, e.g., executive sessions, BOT Strategic Planning
Session, etc., except as may be provided in the Board of Trustees’ manual or otherwise directed
by decision of the voting members of the Board of Trustees.
The president-elect, upon completion of the term of office, automatically succeeds to the office
of president without election to serve a one year term. Likewise, the president, upon completion
of the term of office, automatically succeeds to the office of immediate past-president without
election to serve a one year term. Elective officers assume office upon adjournment of the
annual session of the House of Delegates at which they were elected.
Additional nominations for each elective office may be made from the floor of the House
provided that the nominees for the office of secretary must be members of the component dental
association that has the present authority to nominate a candidate for the position of secretary. 4
The FDA’s current elective line officers through the FY 2014-2015 term are:
Office
President
President-elect
First Vice President
Second Vice President
Secretary
Immediate Past President
Member
Dr. Rick Stevenson
Dr. Ralph Attanasi
Dr. Bill D’Auito
Dr. Mike Eggnatz
Dr. Jolene Paramore
Dr. Terry Buckenheimer
34
FDA bylaws, Chapter VI, Section 20 and 20(A).
The separate office of Speaker of the House began at the close of the House of Delegates’ Annual Session in June of 2006.
3 FDA bylaws, Chapter VII, Section 10(C)(4).
4 FDA bylaws, Chapter VII, Section 10(E).
1
2
Page 21
Exhibit HOD-13
Page 1 of 7
OVERVIEW OF CREDENTIALS AND REFERENCE
COMMITTEE PROCESSES
Credentials Committee:
A) An important standing committee of the House of Delegates
B) Composed of six members with representation from each component appointed by the
Speaker
C) Duties of the credentials committee:
1) It is on duty throughout each session of the House of Delegates.
2) It oversees the credentialing of all delegates and alternate delegates.
3) It ensures that only properly credentialed delegates or their alternates are seated on
the floor of the House.
4) It makes recommendations on the eligibility of persons to serve as delegates and
alternate delegates when a seat is contested.
5) It determines the presence of a quorum (69 voting delegates are needed for a
quorum).
6) It supervises voting and election procedures including distributing and collecting
electronic voting mechanisms to delegates as instructed by the Speaker of the House,
7) Its members serve as tellers from their respective component who are responsible for
counting all votes, except for votes electronically tabulated under the supervision of the
Speaker.
8) It assists the Speaker of the House in escorting award recipients to the podium and in
assuring that the awards process is handled expeditiously (awards are generally handled
at the HOD annual session).
D)
Voting methods at the House of Delegates:
1) Typical voting methods:
(a) Voice vote
(b) Show of cards
Page 22
Exhibit HOD-13
Page 2 of 7
(c) Written ballots
(d) Electronic submission
E)
Known potential written ballots for this House of Delegates:
1) Ballot for the approval of at-large delegates to the ADA House of Delegates
(typically January only)
2) Ballot for electing at-large alternate delegates (typically January only)
3) Possible ballot (if requested) for approval of component-designated delegates and
alternate delegates (January only)
4) Generic ballot (if requested) on any other issue before the house
F) When used, the exact number of ballots are issued to each component's delegation chair
based on the number of eligible voters from that district. Written ballots will be
completed in a physical area designated by the Speaker of the House which allows voters
the freedom and privacy to vote without undue pressure.
G) A special “ballot tally” form is available to assist in counting ballots and recording votes
(the chair of the Credentials Committee has the tally forms).
H) Seating for credentials committee members at the House of Delegates are on the aisles –
look for place cards.
I) Overview of the electronic voting system:
FDA delegates will be using an electronic voting system from Turning Technologies to
facilitate voting at the HOD. The response card fits in the palm of your hand. Delegates
will enter their vote into the response card and the results will be shown in a matter of
seconds on a projection screen. This system is a great tool for voting on the many
resolutions covered by the HOD. We will use the following procedures to distribute,
utilize, and collect these devices:
•
Each district will be assigned the number of response cards for your district according
to the current component delegate allocation. The back of the response card will be
labeled with initials for the district in consecutive numbering. For example, the
Atlantic Coast district will be labeled AC1, AC2, AC3…up to AC19.
•
Response cards for Student Delegates will be numbered S1 and S2 and distributed to
the appropriate component.
Page 23
Exhibit HOD-13
Page 3 of 7
•
Each component member of the credentials committee will be given an envelope
containing the response cards for their district as well as the student cards (if your
component is hosting a student delegate). The outside of the envelope will identify
the number of response cards your component is assigned.
•
IMPORTANT: Each credentials committee member is responsible for distributing
response cards to their component at the beginning of the House of Delegates first
session (when instructed to do so by the Speaker-of-the-House) and for collecting
response cards of their delegates at the close of the House.
•
The House will conduct several test votes at the beginning of the House. The
procedure is as follows:
o
o
o
o
o
o
o
o
On the projection screen the delegates will see a brief description of a test
resolution in which a test vote will be conducted.
The Speaker of the House will instruct the House on the vote to be taken,
with a reminder to press “1” for yes, “2” for no, and “3” for abstain. Then
the Speaker will state “vote now on your response card.”
Delegates will push the appropriate button on the response card.
The operator of the voting system will wait until all 102 votes are shown to
be tabulated and enter the result on the projection screen (this will take 10-15
seconds).
Although someone can change their vote (using the clicker) while voting is
still “open”, once voting is closed (by direction of the Speaker), only one vote
per clicker is allowed.
Results will appear on the projection screen after several seconds.
If the tabulation is questionable or a delegate asks for a re-vote, the system
can “clear” the votes taken for that resolution and the vote can be re-taken.
The system operator has the ability to see which clickers have not been
utilized on a given vote (which will facilitate testing the system’s overall
integrity and replacing a clicker if need be).
•
This electronic system of voting will only be used for resolutions as directed by the
Speaker of the House. It will not be used for elections or when card voting is
preferred by the Speaker. Paper ballots will be distributed for all elections at the
House of Delegates.
•
At the conclusion of the House of Delegates second session when instructed by the
Speaker-of-the-House, Credentials Committee members will collect the response
cards, insert the devices back into the envelope and turn their envelope into
appropriate FDA staff (determined on-site). FDA staff will count the devices
according to the number on the envelope to ensure that all response cards have been
returned for safe keeping.
Page 24
Exhibit HOD-13
Page 4 of 7
•
The clickers are useless to anyone outside of HOD deliberations and, should a clicker
not be returned, it will be blocked by the system from future unauthorized use.
REFERENCE COMMITTEES:
A)
Number and composition:
1) Usually three reference committees are formed for the January and June House of
Delegates meetings but, when a key issue arises, a special “reference committee of
the whole” House may be convened in addition to normal reference committees.
Reference committee start times may also be staggered to accommodate delegate
attendance preferences when time allows.
2) Components designate members of reference committees. The Speaker assigns
persons to specific reference committees and the President designates reference
committee chairs.
3) The Speaker-of-the-House can form more reference committees if needed (with
solicitation for more designees from the six components as needed).
4) Subjects assigned to each reference committee are clustered as much as possible by
corresponding FDA staff support in consultation with the Executive Director.
5) Members of each reference committee are listed in the House of Delegates agenda.
6) If any reference committee member is expected to be absent, the corresponding
component is responsible for designating a substitute as far in advance as possible.
B) Roles of reference committees:
1) The primary duty of reference committees (based upon testimony in hearings) is to
recommend to the House of Delegates a course of action on matters which have been
assigned to it by the Speaker of the House of Delegates.
2) Each reference committee must recommend a starting position on each issue upon
which the House of Delegates may deliberate.
C) Essential reference committee process:
1) Reference committees hold hearings on each matter assigned to them by the
Speaker-of-the-House of Delegates
2) During the hearing, reference committee members should listen to the testimony, ask
non-rhetorical questions as necessary but never engage in debate or commentary with
persons testifying
Page 25
Exhibit HOD-13
Page 5 of 7
3) Following the committee's open hearing on all matters assigned to it, the committee
will meet in executive session to determine the appropriate course of action to
recommend on each matter assigned to it for its review.
4) After completion of its deliberations, and approval of the report of the reference
committee, members must not reveal the contents of their report to any one until the
entire document is officially released to the entire House of Delegates.
D)
Reference Committee duties:
1) A reference committee cannot ignore an item assigned to it
2) The reference committee must formulate a recommendation on all matters assigned to
it by the Speaker so the House of Delegates will have an initial position upon which
to react.
E) Staff assistance:
1) Staff serve as informational resources and assist in drafting reference committee
recommendations;
2) Staff do not engage in debate or take a position on an issue.
3) Staff are instructed to hold all reference committee deliberations in confidence.
4) Staff must prepare reference committee reports with assistance from the reference
committee chairs and oversight by the Speaker of the House.
5) FDA officers and trustees, including the treasurer and editor, serve as informational
resources.
6) Board liaisons “float” among all reference committee hearings but are generally
expected to attend hearings on subjects germane to their assigned councils and
committees of the FDA and be available to answer questions as needed.
F) Reference Committee hearings:
1) No motions or voting takes place during the hearing phase of each reference
committee meeting
2) The Reference Committee's chair can limit testimony if it is redundant
3) All FDA members have a right to attend a reference committee hearing
Page 26
Exhibit HOD-13
Page 6 of 7
4) Non-members must identify themselves and the identity of the entity whose interests
they represent, if any. Such persons may only attend upon invitation by the reference
committee chair and with the approval of the majority of the committee's members.
5) All reference committee members (or their component-designated substitutes) are
expected to be present at hearings
6) Per the HOD manual, FDA officers are ex-officio members of each reference
committee.
G) Reference Committee executive sessions:
1) Reference Committees may request resources, including persons in addition to staff
and officers to assist in their deliberations.
2) Bylaws changes must be reviewed by the Speaker of the House in consultation with
the Chief Legal Counsel and Executive Director.
H) Reference Committee reports:
1) Reference Committees should render a “recommendation” with respect to each
matter assigned to them. Such recommendations consist of one of the following:
(a) At the inception of the reference committee chair’s report to the House, any items
for a proposed consent agenda of that reference committee; or
(b) Move the resolution on an item referred to the Reference Committee and
recommend its adoption [or to vote “Yes”]; or
(c) Move the resolution on an item referred to the Reference Committee and
recommend its defeat [or to vote “No”]; or
(d) Move a substitute resolution in lieu of a resolution on an item referred to the
Reference Committee on an item referred to the Reference Committee and
recommend it be “Adopted” [and present the substitute]; or
(e) Refer the resolution on an item referred to the Reference Committee [to a
specified body] “for [specify the purpose of the referral] and [optional: “to report
back to the House of Delegates [[at its next meeting][at its meeting on [date]]”];
or
(f) Move to postpone consideration of the resolution definitely until [a specified
date].
Page 27
Exhibit HOD-13
Page 7 of 7
2) Written recommendations should include a brief rationale and/or justification (unless
the reference committee is simply recommending adoption of the resolution as it was
presented to the committee itself).
3) All resolutions must be self-explanatory with appropriate use of "whereas" clauses
(establishing important background and understandings for historical reference)
followed by one or more resolving clauses as appropriate.
4) Reference committees can initiate independent motions but only if the motion is
germane to a matter that has been assigned to it as determined by the Speaker of the
House.
5) Resolutions requiring funds that are not budgeted must cite the proposed source of
the fund.
6) It is permissible for reference committees to make minor grammatical and format
corrections without instituting formal amendments.
7) Resolutions containing more than one topic should be subdivided.
8) Every effort should be made for reference committees to reach unanimous agreement.
If not, reference committees can tender majority and minority positions.
9) Copies of reference committee reports will be available for pickup by component
delegation chairs or their designees outside of the ballroom of this hotel at the close
of the “Informal Session” of the House (Semi-Annual Session in January) and
beginning at 6:30 a.m. on the morning of the “Second Session” of the House (Annual
Session in June).
10) Reference committee reports are presented to the House of Delegates as outlined in
the HOD manual.
11) Reference committee chairs and members can reply to questions at the House of
Delegates or comment – but only after they are recognized by the Speaker.
12) The reference committee chair can give a brief rationale and/or justification (unless
the reference committee is simply recommending adoption of the resolution as it
was presented to the reference committee)
I) VERY IMPORTANT: Reference committee chairs should briefly orient their
committee members prior to convening each reference committee hearing
J) Reference committee hearings will begin as noticed in the House of Delegates’ agenda or
as otherwise announced by the Speaker of the House.
Page 28
Exhibit HOD-14
Page 1 of 1
COMPOSITION OF REFERENCE COMMITTEES
Listed below are Reference Committee members and chairs for the January and June 2015 House of
Delegates. Typically, three Reference Committee members are designated by each component with
chairs chosen by the President.
Reference Committee A:
ACDDA
CFDDA
NEDDA - Chair
NWDDA
SFDDA
WCDDA
BOT
DeTure, Nick
Markham, Sam
Dopazo, Leandra
Ottley, Jeff
Diaz, Marcos
Churchill, Wendy
Eggnatz, Mike
Staff Support: Joe Anne Hart, Director of Governmental Affairs
Kerry Gomez-Rios, Director of Member Relations
Reference Committee B:
ACDDA
CFDDA
NEDDA
NWDDA
SFDDA
WCDDA - Chair
BOT
Mitchell, Glen
Jay “Drew” Johnson
Hanania, Sam
Hall, Nathan
Sanchez, Carlos
Menendez, Oscar
D’Aiuto, Bill
Staff Support: Greg Gruber, Chief Financial Officer
Jack Moore, Director of Accounting
Graham Nicol, Chief Legal Counsel
Page 29
Exhibit HOD-15(A)(1)
Page 1 of 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
DATE:
January 29, 2015
SUBMITTED BY:
FDA Board of Trustees
QUALIFICATIONS FOR COUNCIL ON THE NEW DENTIST
BOARD OF TRUSTEES RECOMMENDATION: Adopt.
Board vote:
Abstain:
Stevenson
Yes:
Attanasi; Huot; D’Aiuto; Pranikoff;; Setzer; Paramore; Ottley (for
Jernigan); Eggnatz; Pena-Hall (for Centurion); Terry; Churney
No:
Boden; Antoon; Liddell
2014H-039
[Policy]
RESOLVED, that the House of Delegates hereby creates a
15
Council on the New Dentist as follows:
16
________________ = BOT-recommended language
17
The Council on the New Dentist is established by the House of Delegates
18
and
19
circumstances and special needs of newer dentists and to bring the new
20
dentist perspective to FDA programs, services and leadership. The
21
Council on the New Dentist shall be maintained in existence and shall
22
meet as necessary and as funded to accomplish its assigned projects and/or
23
oversee its assigned programs relating to the circumstances and special
24
needs of newer dentists. The Council on the New Dentist shall consist of a
25
representative from each component designated by the component and
26
approved by the Board of Trustees who has been a dentist for ten (10)
27
years or less at the time of an appointment, with each such representative
28
on the Council on the New Dentist serving two year terms limited to three
29
consecutive terms on the same council plus, when applicable, service in
charged
with
developing
Page 30
recommendations
relating to
the
Exhibit HOD-15(A)(1)
Page 2 of 2
30
fulfillment of a predecessor’s unexpired term on the same council. The
31
chair of the Council on the New Dentist shall be one of the component
32
representatives to the council and shall be elected by the members of the
33
council for a maximum of three consecutive one year terms plus, when
34
applicable, service in fulfillment of a predecessor’s unexpired term as
35
chair of the same council. The chair of the Council on the New Dentist
36
shall report at regular intervals and submit recommendations and
37
resolutions as needed to the Board of Trustees and/or House of Delegates.
38
All members of the Council on the New Dentist, including its chair, shall
39
have the right to vote. In addition to members of the Council on New
40
Dentist, the President shall recommend and the Board of Trustees shall
41
approve one non-voting liaison from the Board of Trustees to attend all
42
Council on the New Dentist meetings.
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
BACKGROUND: At the January 2015 House of Delegate’s meeting, the HOD adopted via
consent a resolution to convert the Sub-Council on the New Dentists to a full council. The
resolution as it appeared in the written agenda failed to include a phrase recommended by the
Board of Trustees. This phrase was to be added to the resolution verbally but this didn’t occur
because the item was moved via the consent agenda.
At this time, the House of Delegates is being asked to add the BOT-recommended language to
the resolution creating the Council on New Dentist. The language is intended to ensure that
younger members serve on the Council on New Dentist
STRATEGIC PLAN LINK: This matter relates to Objective 3.1: Increase number of younger
members in engagement opportunities.
UNBUDGETED IMPACT: None.
REFERENCE COMMITTEE RECOMMENDATION: Pending.
Page 31
Exhibit HOD-15(A)(2)
Page 1 of 3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
DATE:
March 9, 2015
SUBMITTED BY:
FDA Staff
AMENDMENTS TO BOT AND HOD MANUALS REGARDING ADA END
OF YEAR REPORT AND DATE OF DETERMINATION OF MEMBERSHIP
NUMBERS
BOARD OF TRUSTEES RECOMMENDATION: Adopt.
Board vote:
Abstain:
Stevenson
Yes:
Attanasi; Boden; Huot; Pranikoff; Antoon; Setzer; Paramore; Ottley (for
Jernigan); Buckenheimer; Eggnatz; Centurion; Terry; Liddell; Churney
No:
None
2014H-053
WHEREAS, the FDA wants to use the ADA’s End-Of-Year Report
18
published on December 31 of each year rather than the FDA-generated
19
membership cancellation report formerly generated on March 31 to determine
20
component membership numbers for purposes of FDA trustee and delegate
21
representation. Therefore, be it
22
[Policy] RESOLVED that Page 5, lines 14-16, of the House of Delegates
23
Manual be amended to read as follows:
24
--- = deletion
25
__ = addition
26
“The allocation of delegates among the component dental associations is
27
made proportionately on the basis of membership as of March December 31st
28
of the preceding membership year as reported by the ADA in its End-of-Year
29
Membership Statement.” And, be it further
30
[Policy] RESOLVED that page 3, lines 17 – 19, of the Board of Trustees
31
Manual be amended to read as follows:
Page 32
Exhibit HOD-15(A)(2)
Page 2 of 3
1
--- = deletion
2
__ = addition
3
“Each of the component dental associations is to elect no more than two (2)
4
Trustees and no more than two (2) Alternate Trustees based on a ratio of one
5
(1) Trustee and one (1) Alternate Trustee per 500 voting members or fraction
6
thereof. The number of voting members in each delegate shall be determined
7
as of December 31st of the preceding membership year as reported by the
8
ADA in its End-Of-Year Membership Statement.”
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
BACKGROUND: The number of trustees and alternate trustees is determined by components’
membership numbers. For each 500 members or fraction thereof, a component gets an additional
trustee/alternate up to a maximum of two per component. Likewise, the number of delegates to the
FDA House of Delegates is based on components’ membership numbers as a percentage of the
entire FDA membership.
In the past, March 31 was the date used to determine membership numbers. This date was the
deadline for membership dues to be received by the FDA or else membership was canceled.
Now, the ADA, FDA and components are all on Aptify and share access to common data. The
ADA publishes an “End-of-Year Report” that tracks membership throughout the tripartite as of
December 31 of each year.
The statistics in the ADA report are more accurate than those generated by the FDA based on the
March 31 cancellation date. The ADA End-of-Year report is also more reliable because it is
published by the ADA based on Aptify data easily verified by each level of the tripartite.
FDA staff recommends that the date used to determine each component’s membership change from
March 31 to December 31 and that the ADA End-of-Year Report be used as the gold standard to
determine membership numbers.
If the BOT and HOD agree it is necessary to amend the BOT manual and the HOD manual to
reflect the change in date and the use of the ADA report rather than one generated by the FDA. The
FDA bylaws do not set forth the date to be used or the data report. Rather, this level of detail is
specified in the respective manuals.
STRATEGIC PLAN LINK: This matter relates to Objective 6: Ensure Decisions are driven by
the strategic plan
Page 33
Exhibit HOD-15(A)(2)
Page 3 of 3
1
2
3
UNBUDGETED IMPACT: None.
REFERENCE COMMITTEE RECOMMENATION: Pending.
Page 34
Exhibit HOD-15(A)(3)
Page 1 of 3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
DATE:
April 2, 2015
SUBMITTED BY:
Strategic Planning Task Group
STRATEGIC PLANNING TASK GROUP
RECOMMENDATIONS FOR COUNCILS AND COMMITTEES
BOARD OF TRUSTEES RECOMMENDATION: Adopt.
Board vote:
Abstain:
Stevenson
Yes:
Attanasi; Boden; Huot; D’Aiuto, Pranikoff; Antoon; Brown; Cochran (for
Setzer); Ottley (for Jernigan); Eggnatz; Centurion; Terry; Liddell;
Churney
No:
None
[Policy] RESOLVED, that the Board of Trustees and the House of
18
Delegates take the following action regarding each FDA Council and
19
Committee. The question has been divided:
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
•
2014H-063d
Council on Dental Health: the Council on Dental Health should be sunsetted and,
instead, create a task force when needed that is needs/skills based.
•
2014H-064d
Council on Dental Benefits and Care: the Council on Dental Benefits and Care should
be sunsetted and, instead, create a task force when needed that is needs/skills based.
•
2014H-065d
Council on Ethics, Bylaws and Judicial Affairs: CEBJA should be charged with
reviewing FDA, Component, and Affiliate Bylaws and compare to the ADA Bylaws
with the goal of streamlining. Additionally, the FDA Secretary should be an exofficio member of this committee and charged with an annual review of the FDA
Bylaws to ensure they are current and accurate and report back to the full Council.
•
2014H-066d
Council on Dental Education and Licensure: Eliminate two duties: — (1) Develop
mechanisms to teach school-age children the importance of proper dental health care
and oversee the FDA’s role with respect to organized dentistry’s annual observance
of Children’s Dental Health Month; (2) Monitor continuing education programs
provided for dentists and allied dental personnel. Additionally, this Council should
review and make necessary recommendation on existing policies – especially
Page 35
Exhibit HOD-15(A)(3)
Page 2 of 3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
workforce. There could be consideration to sunsetting this Council and, instead,
create a task force when needed that is needs/skills based.
•
2014H-068d
Council on the New Dentist: The scope of the Council on the New Dentist is to infuse
the new dentist perspective into all the FDA does. They should provide feedback to
leadership, other councils, the editor, staff, etc. on the views of the new dentists.
•
2014H-069d
Leadership Development Committee: Sunset this committee, move the nominating
role for Speaker, Editor and Treasurer to the BOT, redirect leadership at constituent
event (FDC), monitor and mirror ADA Leadership Track (ADA Leadership Institute
in the Center for Professional Success), and FDA BOT consider funding a “leadership
day” where all Councils and Committees meet individually and then come together
for part of the day for leadership training.
•
2014H-070d
Council on Communication: Sunset the Council and create a new Communication
Advisory Group that is less formal and FDA staff and leadership can run ideas by,
etc. for a broad perspective.
•
2014H-071d
Council on Convention & CE: No recommendations.
•
2014H-072d
Council on Financial Affairs: No recommendations.
RESOLUTION BACKGROUND CHECKLIST REVIEWED ON: April 2, 2015
BACKGROUND: The Board of Trustees met on Nov. 6-8 in Delray Beach, FL for its Board
Development Session with a portion of the meeting devoted to Strategic Planning. Board
members have heard concerns from the HOD that some councils/committees were becoming
inactive. Additionally, liaisons spoke with Council and Committee chairs for feedback as well.
The Board shares the same desire to be more flexible with the needs of the association as it
relates to dealing with critical issues that are handled by councils and committees. The members
reviewed the role and need for each council and committee and devised a list of
recommendations for the 2015-2016 fiscal year and beyond.
Councils/Committees that have met since January 2015:
Council on Financial Affairs
2/11/5
3/27/15
4/21/15
Council on Communications
4/13/15
Page 36
Exhibit HOD-15(A)(3)
Page 3 of 3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Council on Dental Benefits and Care
3/23/15
Council on Dental Health
2/24/15
Council on Dental Education & Licensure
No meetings as of Jan. 1, 2015
Council on Membership
2/26/15
3/26/15
4/30/15
Council on the New Dentist
1/6/15
STRATEGIC PLAN LINK: This matter relates to Goal 6: Ensure decisions are driven by the
strategic plan; and Goal 7: Increase member engagement in leadership, programs, and services.
UNBUDGETED IMPACT: Nominal Savings for Councils and Committees that are
recommended for sunsetting.
REFERENCE COMMITTEE RECOMMENDATION: Pending.
Page 37
Exhibit HOD-15(A)(4)
Page 1 of 6
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
DATE:
April 7, 2015
SUBMITTED BY:
FDA Staff
RESCISSION OF POLICY ON BOT STRATEGIC PLANNING
MEETING FORMAT
BOARD OF TRUSTEES RECOMMENDATION: Adopt.
Board vote:
Abstain:
Stevenson
Yes:
Attanasi; Boden; Huot; D’Aiuto, Pranikoff; Kahn (for Antoon); Brown;
Cochran (for Setzer); Ottley (for Jernigan); Eggnatz; Centurion; Terry;
Liddell; Churney
No:
None
2014H-061
[Policy] RESOLVED, that resolution 2008H-040 is hereby rescinded.
RESOLUTION BACKGROUND CHECKLIST REVIEWED ON: 4/7/2015
BACKGROUND: In January of 2009, resolution 2008H-040 was passed that gives very specific
guidelines as to how and when the Annual FDA Board of Trustees Strategic Planning session is
conducted. As a result of the new strategic plan, strategic planning will be a part of every
regularly scheduled board meeting and a separate meeting is no longer required. This will
eliminate the travel costs for an entire meeting while, at the same time, allowing the association
to schedule meetings at times of the year when hotel rates are the most favorable – again,
keeping costs down. Planning is very important and the Board will add an extra day to one of the
board meetings to focus on planning – but the new format will eliminate the need of scheduling a
separate date and incurring additional travel costs.
The following is the resolution adopted by the House of Delegates on Jan. 10, 2009:
Format of Future BOT Strategic Planning Sessions
 The House ADOPTED the following substitute resolution:
2008H-040
WHEREAS, it is important that the FDA develop, deploy and update at
annual intervals a strategic plan that is consistent with FDA policy and/or
which includes changes in FDA policy that first necessitate House of
Delegates’ approval; and
WHEREAS, this annual process necessitates considerable advance
preparation in assessing trends and conditions affecting dentistry and
making various assumptions of future foreseeable impacts; and
Page 38
Exhibit HOD-15(A)(4)
Page 2 of 6
WHEREAS, the primary agency within the FDA to undertake and oversee
this process is the Board of Trustees; and
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
WHEREAS, the ability of the Board of Trustees (herein “BOT”) to engage
in strategic thinking is closely linked to the knowledge, wisdom, and
cohesiveness of every member of the Board which can best be
maximized in strategic planning session-like settings that include a
significant emphasis on team building and less formal but stimulated
exploration of ideas and visions. Therefore, be it
[Policy] RESOLVED, that, effective immediately except where the FDA is
contractually precluded from implementing prior to the expiration of such
contractual limitations, and at each Board of Trustees Strategic Planning
Session 1 thereafter, the following guidelines be observed in planning,
budgeting, and holding Board of Trustees’ Strategic Planning Sessions:
17
18
19
20
21
22
23
24
25
26
27
1. Each annual Strategic Planning Session of the Board shall occur in
the spring on days other than national holidays and be held as soon
as possible following the Board’s routine spring business
deliberations over such matters as the FDA’s annual budget and
FDA agency appointments;
28
29
30
31
32
33
34
35
36
37
38
39
3. All Strategic Planning Sessions of the Board shall be held in Florida
unless the Board specifically approves an alternative location at
least 16 months in advance of the event and provided that the
FDA’s budget for the year of the Strategic Planning Session (which
undergoes review by the Executive Director, Council on Financial
Affairs, Board of Trustees and House of Delegates) specifically
identifies the geographic location, facility, group activities,
consulting, and all other material costs that are projected to be
incurred in planning and holding the Strategic Planning Session
(and, for budgeting purposes, does not rely on cost-averaging as
used elsewhere in the FDA’s budget in estimating travel, lodging
and meals);
40
41
4. BOT Strategic Planning Sessions focus on strategic planning and
team building (with or without professional facilitation as determined
2. The budgeting and planning of each Strategic Planning Session
shall be the primary responsibility of the officer of the FDA who shall
be President-elect of the FDA at the time the Strategic Planning
Session is to be held in close coordination with assigned staff to
ensure proper logistical support, contracting and budgeting;
The Board of Trustees voted to refer to future “Retreats” as “Strategic Planning Sessions” at its December 2008 meeting. With
consent from the House, all references in this resolution to “retreat” have been editorially changed to reflect the change in name.
1
Page 39
Exhibit HOD-15(A)(4)
Page 3 of 6
1
2
3
by a majority of the Board and as budgeted) and not be used for the
purpose of holding routine business deliberations that are generally
governed by parliamentary procedure;
4
5
6
7
8
9
5. The strategic planning exercises during BOT Strategic Planning
Sessions focus on establishing goals and objectives for the
organization given reasonably foreseeable trends and conditions
affecting dentistry with such deliberations placing primary emphasis
on plan implementation and the achievement of meaningful and
timely outcomes;
10
11
12
13
14
15
16
6.
The team building exercises during BOT Strategic Planning
Sessions include Board members and staff as appropriate (but not
spouses) with such exercises that entail separate enumerable
expense being limited to one such exercise per Strategic Planning
Session and occurring whenever possible during planning sessions
or other group activities of Board members only rather than during
social activities where spouses may be present;
17
18
19
20
21
22
23
7. A determination of which group meals in which spouses are invited
to attend (regardless of at whose expense) shall be made by the
Board of Trustees prior to the Strategic Planning Session in
consultation with the President-elect. Thereafter, the Presidentelect shall be responsible for designating and communicating to all
anticipated attendees who shall be invitees at each group meal that
may be held during the Strategic Planning Session;
24
25
26
27
28
8. Attendees at the BOT’s Strategic Planning Session shall include the
members of the Executive Cabinet and Board of Trustees but not
alternate trustees (except in instances where an alternate trustee is
being substituted for (but not attending in addition to) a trustee
whose term is expiring in June of the same year).
29
30
31
32
33
9. The treasurer (or the treasurer-elect when the treasurer’s term
expires in June of the same year) may be invited to attend the
Strategic Planning Session by a majority the Board of Trustees if
considerable focus on financial matters is anticipated and funding is
authorized in advance.
34
35
36
10. The editor may be invited to attend the Strategic Planning Session
by a majority the Board of Trustees if considerable focus on FDA
publications is anticipated and funding is authorized in advance.
37
38
39
40
41
11. The Speaker of the House may be invited to attend the Strategic
Planning Session and serve as parliamentarian by a majority the
Board of Trustees if considerable business is expected to be
undertaken which may necessitate the support of a parliamentarian
and which falls outside of the normal realm of strategic planning.
Page 40
Exhibit HOD-15(A)(4)
Page 4 of 6
1
2
3
4
5
12. Special consultants such as a strategic planning facilitator and key
subject experts may be invited to attend the Strategic Planning
Session and participate in discussions and activities provided an
invitation and funding is authorized in advance by a majority the
Board of Trustees.
6
7
13. The Executive Director (along with appropriate support staff) shall
also attend the Strategic Planning Session as budgeted.
8
9
10
11
12
13
14
15
16
17
18
14. Spouses of invitees (who are not themselves participants in the
Board’s strategic planning and team-building exercises) may attend
meal functions held during the Strategic Planning Session (except
those meal functions that are limited to Strategic Planning Session
attendees only) with the cost of everyone’s meals (including
spouses who care to attend) at the dinner event on the second day
of the Strategic Planning Session to be borne by the FDA and the
cost of all other spouse meals and expenses (including spouserelated expenses that may have been inadvertently allocated to the
FDA’s master account) to be borne by the applicable trustee or
invitee.
19
20
15. The format and sequencing of each Strategic Planning Session
shall consist of:
21
a. attendee travel to the facility on the afternoon of the first day;
22
23
b. a reception in the suite or other designated gathering place to
be held during the early evening of the first day;
24
25
26
27
c. meals “on your own” for all attendees following the reception
on the evening of the first day or, if a group meal is to be
held, the cost of spouses in attendance to be borne by the
respective member of the Board;
28
29
30
31
d. breakfast “on your own” on the second day of the Strategic
Planning Session or, if a group meal is to be held, the cost of
spouses in attendance to be borne by the respective member
of the Board;
32
33
34
35
e. first planning session of board members commencing no later
than 9 a.m. and ending no sooner than four hours later shall
be at least four hours on the second day of the Strategic
Planning Session;
36
37
38
39
f.
40
41
g. team building exercise or other designated group activity that
includes Board members and designated substitutes, other
lunch “on your own” on the second day of the Strategic
Planning Session or, if a group meal is to be held, the cost of
spouses in attendance to be borne by the respective member
of the Board;
Page 41
Exhibit HOD-15(A)(4)
Page 5 of 6
1
2
3
4
invited officers, consultants, and staff as appropriate (but
without spouses) occurring after lunch on the afternoon of the
second day of the Strategic Planning Session (no specified
duration);
5
6
7
8
h. group dinner with all participants and their spouses (but
optional to each spouse) to be held on the second day of the
Strategic Planning Session with all costs borne by the FDA
(as budgeted);
9
10
11
12
i.
breakfast “on your own” on the third day of the Strategic
Planning Session or, if a group meal is to be held, the cost of
spouses in attendance to be borne by the respective member
of the Board;
13
14
15
16
j.
second planning session of board members commencing no
later than 9 a.m. and ending no sooner than shall be at least
four hours later on the third day of the Strategic Planning
Session;
17
18
19
20
k. lunch “on your own” on the third day of the Strategic Planning
Session or, if a group meal is to be held, the cost of spouses
in attendance to be borne by the respective member of the
Board;
21
22
23
l.
following lunch, attendees travel home on the afternoon of
the third day (or stay longer at their own expense and without
FDA support);
24
25
26
27
16. The cost of meals, hotel rooms, travel and portal (but not
incidentals) of all members of the Board, other invitees and staff to
attend the Strategic Planning Session shall be borne by the FDA as
budgeted;
28
29
30
31
32
17. The cost of meals (except the group dinner on the evening of the
second day of the Strategic Planning Session), hotel rooms apart
from the Board member or staff’s assigned guest room, travel and
portal, and any incidentals associated with spouses shall not be
borne by the FDA;
33
34
35
36
37
38
18. Surveillance materials that are helpful to the Board’s assessment of
trends and conditions that are impacting dentistry in Florida shall be
identified by the Board’s Strategic Oversight Committee in
consultation with the Executive Director and distilled as much as
practical before dissemination to Board members as far in advance
of each Strategic Planning Session as possible;
39
40
41
19. Planning sessions during each Strategic Planning Session shall
include segments devoted to one or more group problem solving or
dilemma management exercises based on hypothetical scenarios
Page 42
Exhibit HOD-15(A)(4)
Page 6 of 6
1
2
posing significant potential harm and/or significant potential
opportunity to dentistry in Florida;
3
4
5
6
7
8
9
10
11
12
13
14
15
20. All persons associated with the Board who are invited to attend the
Strategic Planning Session be reminded well in advance that the
inclusion of their spouse during any segment of the Strategic
Planning Session, including group meals or other social events is
wholly optional with the FDA’s reimbursement of expenses for
spouses only as specifically enumerated herein and budgeted.
STRATEGIC PLAN LINK: This matter relates to Goal 6: Ensure decisions are driven by the
strategic plan.
UNBUDGETED IMPACT: None
REFERENCE COMMITTEE RECOMMENDATION: Pending.
Page 43
Exhibit HOD-15(A)(5)
Page 1 of 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
DATE:
April 21, 2015
SUBMITTED BY:
Kerry Gómez-Ríos, Director of Member Relations
INDUCTION OF DR. ROBERT HAYLING
AS HONORARY FDA MEMBER
BOARD OF TRUSTEES RECOMMENDATION: Adopt.
Board vote:
Abstain:
Stevenson
Yes:
Attanasi; Boden; Huot; D’Aiuto, Pranikoff; Antoon; Brown; Cochran (for
Setzer); Ottley (for Jernigan); Eggnatz; Centurion; Terry; Liddell;
Churney
No:
None
2014H-062
[Procedure] RESOLVED, that Dr. Robert Hayling is hereby designated as
an honorary member of the Florida Dental Association.
RESOLUTION BACKGROUND CHECKLIST REVIEWED ON: 4/21/15
BACKGROUND: At the August 2014 FDA Board of Trustees meeting in Tallahassee, the
Board voted to direct the Awards Committee to bestow a special recognition tribute for Dr.
Robert Hayling at the June 2015 Florida Dental Convention for being the first African-American
tripartite member in Florida and for his lifetime dedication to serving his country, dentistry and
the civil rights movement. They further instructed staff to move forward with the process of
making him an honorary member of the FDA. FDA bylaws allow the designation of honorary
members as a class of non-voting member. Chapter I Section 30 - Non voting members,
provides:
“D. Honorary Member
An individual who has made valuable contributions to the science, art or literature
of dentistry or medicine, or who has rendered conspicuous service to dentistry,
may become an honorary member of the FDA by unanimous vote of the Board of
Trustees and majority vote of the House of Delegates upon compliance with and
maintenance of the Requirements and Conditions of Membership as adopted by
the FDA’s House of Delegates.”
STRATEGIC PLAN LINK: This matter relates to Goal 1: The public will recognize the FDA
and its members as leaders and advocates for oral health.
UNBUDGETED IMPACT: None
REFERENCE COMMITTEE RECOMMENDATION: Pending.
Page 44
Exhibit HOD-15(A)(6)
Page 1 of 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
DATE:
May 8, 2015
SUBMITTED BY:
FDA Staff
REDEFINING DUAL MEMBERSHIP
BOARD OF TRUSTEESS RECOMMENDATION: Adopt.
Board vote:
Abstain:
Stevenson
Yes:
Attanasi; Boden; Huot; D’Aiuto, Pranikoff; Antoon; Brown; Cochran (for
Setzer); Ottley
(for Jernigan); Eggnatz; Centurion; Terry; Liddell;
Churney
No:
None
2014H-068
[Policy] RESOLVED, that dues for dual members be reduced from full
17
dues (currently $415) to $100 per year and not have a requirement for
18
FDA component membership or requiring he/she reside in Florida for part
19
of the year.
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
RESOLUTION BACKGROUND CHECKLIST REVIEWED ON: April 30, 2015
BACKGROUND: The FDA has approximately ten (10) members who are “dual members”
defined as “ethical dentists who are not eligible for voting membership in the FDA, but are
members in good standing of the American Dental Association (ADA), and residing any part of
the year in the state of Florida.” Dual members are dentists who are often times already paying
full tripartite dues through another state and choose to join the FDA. However, because these
dentists are members through another state, paying full FDA dues is a deterrent to joining the
FDA as a dual member.
There are many reasons a dentist may seek to belong to this category:
• The dentist was a member of Florida once and moved to another state – but wishes to
maintain a Florida connection.
• The dentist is a retired member of another state who resides much of the year in Florida.
Dual membership allows the dentist to maintain his/her membership in his/her “home”
state while having the ability to get Today’s FDA and attend the Florida Dental
Convention (FDC).
• The dentist is a full active member in another state who is interested in having an FDA
connection in order to attend FDC.
• Since military or federally-employed dentists are direct ADA members, this would
provide a way for them to stay connected with the FDA. Additionally, when their federal
Page 45
Exhibit HOD-15(A)(6)
Page 2 of 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
service is finished, this makes it much more likely they would join the FDA should they
practice here.
Dual members receive the Today’s FDA and member rate at the Florida Dental Convention
(FDC). This helps the FDA by expanding the audience for our Today’s FDA advertisers and
FDC exhibitors as well as potentially increasing attendance at FDC. It is the recommendation of
the Council on Membership to reduce the dual membership dues to encourage growth of this
membership category and enhance the reputation of the FDA with dentists from across the
country. Additionally, components are encouraged to create their own “dual membership”
categories for dentists who might wish to join the component for CE and social activities.
Only the House of Delegates can change dues for members. Because this resolution reduces (not
increases) dues, it may be adopted by the House of Delegates with a simple majority vote. In
contrast, if dues are increased, then the HOD must do so with a two-thirds affirmative vote.
STRATEGIC PLAN LINK: This matter relates to:
Objective 4: Increase sources of non-dues revenue
Objective 5: Maintain “loyal” members
UNBUDGETED IMPACT: None.
REFERENCE COMMITTEE RECOMMENDATION: Pending.
Page 46
Exhibit HOD-15(B)(1)
Page 1 of 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
DATE:
April 21, 2015
SUBMITTED BY:
Council on Financial Affairs
FDA OPERATING FISCAL YEAR 2015-2016 BUDGET
BOARD OF TRUSTEES RECOMMENDATION: Adopt as amended.
Board vote:
Abstain:
Stevenson
Yes:
Attanasi; Boden; Huot; D’Aiuto, Pranikoff; Antoon; Brown; Cochran (for
Setzer); Ottley (for Jernigan); Eggnatz; Centurion; Terry; Liddell; Churney
No:
None
These Board’s changes are reflected in the following substitute resolution:
xxxxxxxx = deletion (from original CFA resolution)
xxxxxxxx = addition (to the original CFA resolution)
2014H-064bs [Procedure] BE IT RESOLVED,
23
that the Florida Dental Association’s Fiscal Year 2015-2016 Operating Fund
24
budget as amended, is hereby adopted. And, be it further
25
26
RESOLVED, that the Florida Dental Association’s Fiscal Year 2015-2016
27
Operating Fund budget as amended to encumber $8,000 for 17th District
28
Delegation expenses that were inadvertently left out of the budget and for
29
unanticipated expenses involved with a meeting in D.C., is hereby adopted.
30
And, be it further
31
32
RESOLVED, that the Executive Director, in consultation with the FDA
33
President, is authorized to incur or approve any automatic encumbrance
Page 47
Exhibit HOD-15(B)(1)
Page 2 of 7
1
budget expenses listed in the 2015-2016 Fiscal Year FDA Budget if deemed
2
to be needed by the Association. And, be it further
3
4
RESOLVED, if any automatic encumbrance expenses are incurred, the
5
Board of Trustees at its next regular business meeting shall determine
6
whether the automatic encumbrance will reduce the unallocated contingency
7
balance or be paid via funding from the Reserve Fund. And, be it further
8
9
RESOLVED, that beginning with the Fiscal Year 2015-2016 Budget that the
10
Reserve Fund current investment earnings each quarter (composed of
11
dividends, capital gains and bond interest) be utilized as Operating Fund
12
budgeted investment revenue and that after each quarter these investment
13
earnings be transferred to the FDA Operating Fund from the FDA Reserve
14
Fund. And be it further
15
16
RESOLVED, that the 2016 calendar-year mandatory FDAPAC dues
17
[political support portion pass-through dues revenue to the Florida Dental
18
Association Political Action Committee for full-dues-paying members be
19
[decreased $13] to [$36] from the current $49 for the current 2015 calendar-
20
year dues level (based on $75/k or equivalent 2016 calculated dues factor of
21
$18 FDA dues of former FDAPAC budgeted expenses have been
22
incorporated into the FDA Budget beginning FY 2015-2016, in order to
23
comply with Florida Division of Elections revised interpretation and
Page 48
Exhibit HOD-15(B)(1)
Page 3 of 7
1
enforcement of reimbursements by political committees to related entities
2
such as the FDA). And be it further
3
4
RESOLVED, that the FDA membership 2016 calendar-year dues for full-
5
dues-paying members be [increased $18] from the $415 current 2015
6
calendar-year dues level to [$433] (in which this total $18 dues increase is
7
composed of two amounts: (1) for the shift of $13 from FDAPAC/political
8
support dues by incorporating or shifting $75/k former PAC expenses within
9
the FDA Budget plus (2) a net $5 increase based on the previous year’s
consumer price index 1% for 2014).
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
BACKGROUND: The FDA’s budget for next fiscal year (FY 2015-2016) per the FDA Bylaws
is approved by the House of Delegates each year.
The budget presented by the Council on Financial Affairs is balanced with the following
important caveats:
•
For calendar year 2016, the FDA recommended dues be [increased $18] from the current
calendar year 2015 $415 amount to [$433], and the FDAPAC/political support dues be
[reduced $13] from the current year 2015 $49 amount to [$36].
o The CFA considered the effects of inflation upon expenses (with the previous
year’s CPI at 1%/year), dues were increased $5 to offset anticipated inflationary
pressures.
o Also, due to new Florida Division of Elections interpretations and enforcement of
political committees’ Campaign Reports relating to reimbursement checks issued
to related entities such as the Florida Dental Association, that a total of $75/k
long-standing traditional FDAPAC expenses are shifted to the FDA Budget
beginning FY 2015-2016 (which is equal to $18 of full-member dues based on the
calculated dues factor of $4,293 for 2016 upcoming calendar-year dues).
o This important “dues factor” for 2016 C-Y dues is calculated at [$4,293] (based
on the full dues paying members rate) and this represents the estimated amount
that would be generated for each $1 FDA dues increase. For the 2015 C-Y dues
the due factor was $4,417, and this dues factor has been declining each year for
many years.
Page 49
Exhibit HOD-15(B)(1)
Page 4 of 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
•
No lump sum transfer from the operating budget to the FDA Reserve Fund, since the
Reserve Fund has incurred large investment earnings over the last few years and current
the reserves to combined FDA/FDA Services budgets ratio is at 66.9%, with 35% ratio
mandated by the FDA House.
•
As presented by the Council on Financial Affairs, the budget includes total Operating
revenue of $5.3/million representing an increase of $196.6/k from the current year’s
budget (FY 2014-2015) of $5.1/million.
•
Also the budget is balanced via $188,320 for transfers from the Reserve Fund of $38,320
(equal to 50% value of the $18 calendar year 2016 FDA dues increase which is deferred
to the following fiscal year of 2016-2017) and a reinstituting of an account titled
“Transfer from FDA Net Assets” for $150/k conservative calculation based on a review
of the last two fiscal years of FDA budgeted expenses that will most likely not occur.
o To explain this concept further: What this account does is conservatively record
the estimated budgeted expenses for FY 2015-16, which will most likely NOT
occur. By utilizing this account, the FDA budget can be more efficiently balanced
without needing to increase FDA dues for FDA members, when this action is not
really required. The end result of this “Transfer from FDA Net Assets” account is
to more conservatively budget for the FDA Operating expenses. This method was
utilized in the FDA Services and FDA Budgets from FY 2002-2003 to FY 20062007 and then again beginning FY 2013-2014 for FDA Services.
Total FDA Services payments to the FDA are calculated at $1,060,160 which is $33/k more than
the FY14-15 original budgeted payments from FDAS to the FDA and represents about 20% of
the FDA’s operating sources of revenue for next fiscal year (FY15-16). These payments from
FDAS include dividends, office space rental, sponsorships, advertising and exhibit booth
payments, and contract service reimbursements for personnel and other overhead;
The projected FDA Services dividend to the FDA for next budget year is $263/k compared to the
current year’s budget of $243.4/k and last year’s (FY13-14) actual dividend of $241/k;
FDA Services payments to the FDA for next year (FY15-16) include:
Dividends
$ 263,030
Personnel and office overhead reimbursements
$ 475,700
Office space lease
$ 87,864
Today’s FDA, website ads (insurance, Crown Savings, GPO) $ 86,951
FDC major sponsorship
$ 81,500
Membership recruitment sponsorships
$ 39,050
FDC exhibit booth & advertising fees
$ 23,365
Leadership sponsorships (House & Awards luncheon)
$
2,700
TOTAL FDAS PAYMENTS:
$1,060,160
Page 50
(LA DP#20)
(LA DP#20)
(ACCT DP #60)
(COM DP#40)
(FDC DP#50)
(MBR DP#10)
(FDC DP#50)
(LA DP#20)
Exhibit HOD-15(B)(1)
Page 5 of 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
Other sources of FDA revenue for next fiscal year plus FDAS payments include:
FDA membership dues and fees
FDC revenue (excluding FDA Services)
FDA Crown Savings Program royalties
Today’s FDA advertising (excluding FDA Services)
FDAF personnel (direct) reimbursement to FDA
Investment revenue (derived mostly from Reserve Fund)
Other: (Outside sponsorships/reimbursements/ADA grants)
SUBTOTAL OUTSIDE SOURCES
$1,758,454
$1,607,762
$ 352,083
$ 143,010
$ 149,850
$ 200,140
$ 52,288
$4,263,587
31.9%
29.1%
6.4%
2.5%
2.7%
3.6%
1.1%
77.3%
FDA Services payments (see above)
Transfer from FDA Net Assets
FDA Reserve Fund (50% of the 2016 C-Y dues increase)
$1,060,160
$ 150,000
$ 38,320
19.4%
2.7%
0.6%
$5,512,067
100%
TOTAL FDA REVENUE
Note, this FY 2015-2016 Budget is funded via $38,320 transfers from the Reserve Fund. For the
previous year (FY 2014-2015), the original House approved budget was funded via a total of
$361,874 transfers from the Reserve Fund (including FDA Board budget amendments).
Also, this recommended Budget includes the new concept of utilizing the Reserve Fund projected
FY 2015-2016 investment earnings each quarter (composed of dividends, capital gains and bond
interest) as Operating Fund budgeted investment revenue, with a budgeted estimate of $200/k, and
that after each quarter these investment earnings be transferred to the FDA Operating Fund from the
FDA Reserve Fund.
Each section of the budget for next fiscal year includes an overview of the major budget changes
from the current year’s budget.
As with previous budgets, the FDA’s budget for next fiscal year incorporates the use of
“automatic encumbrances” as a means of pre-authorizing certain expenses that may occur but are
not currently planned to occur. If an automatic encumbrance needs to be expended, the
Executive Director and President must first confer. Thereafter, the Board of Trustees must
authorize funding of all such measures that have been triggered. In next year’s proposed budget,
the total value of all automatic encumbrances equals $58,600 (or an estimated $14 in additional
dues if these encumbered expenses had otherwise been fully funded in the budget. (As noted
above, for budget planning purposes, each $1 of dues is projected to generate [$4,293] in
additional revenue to the FDA for the C-Y 2015 dues.)
The CFA’s recommended budget for next fiscal year includes an annual unallocated contingency
balance of $46,231 (compared to $30/k for the current year’s original budget). This contingency
balance provides funding for potential new, previously unknown expenses for the Board of
Trustees to utilize before needing to tap FDA reserves for that purpose.
Page 51
Exhibit HOD-15(B)(1)
Page 6 of 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
In conjunction with the Council’s normal annual budgeting process, there has also been a review of
the stipends of the FDA President, President-elect and Today’s FDA Editor. As approved by the
June 2013 House, these stipends for the FY 2015-2016 Budget have been increased 1% for the
2014 calendar year actual CPI index percentage increase of that same percentage.
Also, next year’s budget includes a review of coverages and costs associated with current and
proposed insurance (by lines) for the FDA and its related entities.
Attached to this budget resolution is the fourteen page “Summary Budget”, which the Council
believes can provide a quick overview of this budget.
STRATEGIC PLAN LINK: This matter relates to the goal: Finance Goal: Assure organizational
sustainability. Objective 1.0: Revenue will exceed expense annually. The FDA House of Delegates
has assigned the duty to the Council on Financial Affairs to review and recommend a yearly fiscal
budget to the Board of Trustees and House of Delegates including the amount of FDA membership
dues, fees and assessments, the officer stipend amounts and a review of reimbursements from FDA
Services and FDA Foundation.
BUDGETED FINANCIAL IMPACT: The general financial impact of the aforementioned
includes:
• The FDA recommended Fiscal Year 2015-2016 Budget is balanced and only includes a
net increase of mandatory dues (FDA regular dues combined with FDAPAC/political
support dues) for full-dues paying members of $5.
o
This net $5 total full-dues-paying members tier increase is derived by the
recommended changes to the two mandatory dues products: (1) There is a $18
dues increase to the current FDA regular $415 dues amount and; (2) Also, the
separate FDAPAC/political support mandatory dues will decrease $13 from the
current $49 dues amount (since $75/k of long-standing PAC budgeted expenses
are being shifted to the FDA Budget to comply with new Florida Division of
Elections interpretation and enforcement of existing Campaign Report filing
regulations).
•
Also, this recommended Budget includes the new concept of utilizing the Reserve Fund
projected FY 2015-2016 investment earnings each quarter (composed of dividends, capital
gains and bond interest) as Operating Fund budgeted investment revenue, with a budgeted
estimate of $200/k, and that after each quarter these investment earnings be transferred to
the FDA Operating Fund from the FDA Reserve Fund.
•
The budget is also balanced via a $38,320 transfer from the FDA Reserve Fund and a
conservative assumption at about $150/k of budgeted expenses will not occur and is listed
as “Transfer from FDA Net Assets” in the revenue section after the total Operating
revenue amount of $5,323,747.
Page 52
Exhibit HOD-15(B)(1)
Page 7 of 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
•
This recommended Budget includes an unallocated contingency fund amount available of
$46,231; along with a continued reliance on the utilization of the automatic encumbrance
contingency expense method.
A ratio of Reserve Fund cash and investments continues to be higher at 66.9% (with a ratio of
75.8% if utilizing 50% of the FDA owned building and land assessed Leon County property
values). The House policy mandates at least a ratio of 35%, which has been exceeded by the
actual reserve to budget ratio for several years.
REFERENCE COMMITTEE RECOMMENDATION: Pending.
ATTACHMENT: FDA Summary Budget (fourteen pages)
M:\moore\Jammtg\BOT May15Exh FDA Budget FY15-16 (to HOD)
Page 53
Sect # 1 Page #1
Attachment to HOD-15(B)(1)
14 Pages
Attachment to FDA Budget Resolution [House Agenda ]
(14 Pages)
FLORIDA DENTAL ASSOCIATION
FDA BUDGET SUMMARY
2015-2016 FISCAL YEAR
Fiscal Year Period from July 1, 2015 to June 30, 2016
[Please refer to the detail budget for specific information].
[Note: The top right corner page # refers to the detail budget page # of this overview excerpt]
CFA Recommendation to the FDA House of Delegates
excel\Budget FY15-16\Budget1opr FY15-16 FDA Part I Budget Prep Budget (WKBK)
FDA Budget 2013-2014 Summary
Sect #1 - Page #1
Page 54
Staff Recommend Printed: 5/12/2015
Detail: Sect #1 - Page #2
FLORIDA DENTAL ASSOCIATION (CO./FUND #01)
OPERATING FUND BUDGET
2015-2016 BUDGET
FDA BUDGET OVERVIEW
Updated 5/7/15 5:00 pm
AT 6/30/2014
2013-14 Actual
$1,872,199
REVENUE:
DEPT. #020 Leadership Affairs(LA)
$20,000
DEPT. #030 Governmental Affairs (GAO)
$277,252
DEPT. #040 Communications (COMM)
$1,737,648
$478,605
$5,322,214
Current Year
2014-15 BUDGET
Recommend
2015-2016 Budget
$1,861,545
$1,803,539
($58,006)
(3%)
33%
$912,899
$923,622
$10,723
1%
17%
DEPT. #010 Membership [MBR]
$936,511
CFA Recommended Budget
DEPT. #050 Fl. Dental Convention (FDC)
DEPT. #060 Accounting & Data Systems (ACCT/DS)
TOTAL OPERATING REVENUE
BUDGET CHANGE
$ AMOUNT
%
% of Total
Revenue
$0
$0
$0
n/a
0%
$274,197
$229,961
($44,236)
(16%)
4%
$1,649,128
$429,314
$1,712,627
$653,998
$63,499
$224,684
4%
52%
31%
$5,127,083
$5,323,747
$196,665
4%
97%
12%
$0
DEPT. #095 Inter-Fund- Reserve Fund/Bd Designated
$361,874
$188,320
($173,555)
(48%)
3%
$5,322,214
TOTAL REVENUE
$5,488,957
$5,512,067
$23,110
0%
100%
EXPENSES:
$469,653
DEPT. #020 Leadership Affairs (LA)
$557,697
$531,889
($25,808)
(5%)
10%
$139,233
DEPT. #010 Membership (MBR)
$242,400
$293,020
$50,620
21%
5%
$156,528
DEPT. #030 Governmental Affairs (GAO)
$173,721
$209,450
$35,729
21%
4%
$149,319
DEPT. #040 Communications (COMM)
$227,612
$214,010
($13,602)
(6%)
4%
$775,269
DEPT. #050 Fl. Dental Convention (FDC)
DEPT. #060 Accounting/Data Systems (ACCT/DS)
$986,254
$1,040,253
$53,999
5%
19%
$117,416
$125,990
$8,574
7%
2%
$2,847,876
$260,926
$2,753,168
$257,406
($94,708)
($3,520)
(3%)
(1%)
50%
5%
$20,405
$46,231
$25,826
127%
1%
$54,650
$0
$40,650
$0
($14,000)
$0
(26%)
0%
1%
$5,488,957
$5,512,067
$23,110
0%
100%
($0)
($0)
$0
0%
(0%)
$113,168
$2,844,684
$280,226
$0
$0
$0
DEPT. #090 Admin (A) Personnel (all FDA EEs)
DEPT. #090 Admin (B) [Telecom,Occupancy,Equip.,etc]
DEPT. #095 Contingency
DEPT. #095 Property Improvements
DEPT.#095 (a) Inter-Fund- Reserve Fund/Bd Designated
$4,928,080
$394,134
$0
$0
($683)
$393,451
TOTAL EXPENSES
NET INCOME (after taxes)
($0)
Less:Interfund Transfers from Reserve to Operating funds
$415
Add: CPA Rounding Adjustment
Spreadsheet correction/Add back fixed assets purch. which is a Bal.Sheet transaction
= Ending 6/30/14 Actual CPA Audited Net Gain of $
$4,293
= $1 Dues Increase Value for Current Budget
$46,231
= Unallocated contingency & % Revenue =
0.8%
$58,600
= Total Auto Encumbrance & % Revenue =
1.1%
$0
= FY2015-2016 Transfer Oper. Fund to Reserve Fund
$38,320
= 50% of 2016 FDA dues increase funded from reserves
$0
= Transfer from reserves required to balance the budget
Control totals for actual net income:
= Amt. of Budget OVER or Balanced
= 2015 current Oper. full dues
$18
= Operating Dues Amt Change
$49
($13)
= 2015 FDAPAC Dues
$433
0%
= 2016 propose Reg. full dues
<<< I
<<< I
<<< I
= 2016 propose FDAPAC Dues
<<< I
<<< I
<<< I
$469
= Calculated ALL 2016 Dues
<<< I
N/A
= FDA Assessment (if any)
<<< I
$36
= PAC Dues Support Change
2013-2014 Fiscal Year ending 6/30/2014: net income control total of $393,451 per audit.
FDA Oper. Fund REVENUE FY15-16 Page #2
Page 55
CFA Recommend Printed 5/11/2015
Detail: Sect #1 - Page #3
FLORIDA DENTAL ASSOCIATION (CO./FUND #01)
OPERATING FUND BUDGET SUMMARY
2015-2016 BUDGET
SUMMARY OF REVENUE
Updated 5/7/15 5:00 pm
AT 6/30/2014
2013-14 Actual
Current Year
2014-15 BUDGET ACCT.NO.
OPERATING REVENUE
(2015-2016 Fiscal Year Budget Computations)
Staff Recommended Budget
Cur Yr 6 Mo.
FY14-15 Actual
PAGE NO.
Recommended
2015-2016 Budget
Budget Change
$ Amount
%
$5,322,214
$5,488,957 FDA OPERATING FUND GRAND TOTAL REVENUE $2,474,757
1.3 - 1.29
$5,512,067
$23,110
$1,872,199
$1,861,545
($58,006) (3%)
$1,827,843
$2,000
$31,592
$10,730
$33
$936,511
$6,135
$0
$32,415
$241,019
$484,777
$110,096
$2,285
$50,750
$9,034
$20,000
$20,000
$277,252
$210,441
$41,464
$1,804
$23,543
$1,737,648
$845,951
$105,261
$469,204
$52,375
$28,586
$12,215
$72,800
$12,500
$104,437
$34,319
$478,605
$234
$0
$382,274
$95,760
$337
$0
$0
$0
$0
$0
$1,793,010
$0
$46,500
$22,000
$35
3010-3049
3250-3259
3550-3599
3600-3699
3800-3869
DEPT #010 - MEMBERSHIP [MBR]
Membership Dues and Fees
Advertising - Horizon Recruitment
[Bi-annual]
FDAS Sponsorships (recruitment)
Sponsorships (Outside Non-FDA Related Entities)
Administrative Reimbursements
$912,899
DEPT #020 - LEADERSHIP AFFAIRS [LA]
$7,000
3131
Registration Fees- FNDC Awards Luncheon
$2,700
3559
FDA Services Leadership Events Sponsorships
$24,044
3585
Sponsorships- ADA Grant
$243,435
3695
Dividends (from FDA Services)
$454,150 3810-3819 FDAS Contract Service Reimbursements
$131,945
3821
FDAF Contract Services Reimbursements
$2,600
3822
Student Loan Fund Administrative Reimb.
$38,000
3823
FDAPAC Contract Services Reimbursements
$9,025 3830-3839 Admin. Reimb.-Components/Affiliates Insurance
$0
DEPT #030 - GOVERNMENTAL AFFAIRS OFFICE
$0
3640
ADA Grant- Non-covered Services [one-time]
$274,197
DEPT #040 - COMMUNICATIONS
$199,288 3210-3229 Advertising - Today's FDA
$45,900 3260-3269 Advertising - FDA Website
$1,665 3270-3279 Subscriptions & Reprint Fees (TFDA)
$27,344
3640
ADA Grant- Public Affairs [one-time]
$1,649,128
DEPT #050 - FLORIDA DENTAL CONVENTION (FDC)
$816,893 3110-3119 Exhibitor's Registration Fees
$108,200 3130-3139 Registration Fees
$494,035 3140-3159 Educational Presentations at FDC
$28,425 3150-3159 Mini-Residency and Mastery Series Courses
$26,000 3180-3189 Special Functions Revenue
$10,075 3200-3299 Advertising
$80,000
3560
FDA Services Major Sponsorship
$12,500
3562
FDAF Sponsorship
Sponsorships (Outside Non-FDA Related Entities)
$55,000
3621
$18,000 3890-3899 Other Revenue
$429,314
DEPT #060 - ACCOUNTING & DATA SYSTEMS
$175
3601
Interest Revenue - Bank Accounts
Investment Earnings-Reserves (dividends & bond int.)
$0
3601
$328,465 3700-3749 Crown Savings Program (royalties)
$100,444 3870-3879 Property Lease Revenue
$230 3900-3998 Other Revenue
$361,874
DEPT #095 - TRANSFERS FROM THE RESERVE FUND
$13,346
3951
Transfer for 50% of the Deferred Dues Increase
Transfer for the contingency account (by BOT/HOD)
$323,528
3952
$25,000
3953
Transfers Operating Fund Bd. Designated Net Assets
Anticipated FDA Expense Surplus (see note below *)
$0
3956
0%
1.5 - 1.8
1.5 - 1.6
1.7
1.7
1.7 - 1.8
1.8
$1,803,539
$1,300,469
$325,469
$0
$0
$11,512
$0
$227,075
$58,475
$2,600
$19,000
$6,808
$1,166
$1,166
$138,254
$110,212
$22,842
$1,110
$4,090
$418,923
$335,928
$0
$1,905
$0
$0
$1,500
$40,000
$0
$38,750
$840
$245,430
$77
$0
$195,198
$50,029
$126
$0
$0
$0
$0
1.8 - 1.11
$923,622
$10,723
1%
$0
$0
N/A
$1,345,514
$0
$22,344
$22,702
$0
$1,758,454
$0
$39,050
$6,000
$35
1.8
1.8
1.8 - 1.9
1.9
1.10
1.11
1.11
1.11
1.11
1.12
1.12
$6,135
$2,700
$14,367
$263,030
$475,700
$149,850
$2,710
$0
$9,130
$0
($34,556) (2%)
$0
0%
($7,450) (16%)
($16,000) (73%)
$0
0%
($865) (12%)
$0
0%
($9,677) (40%)
$19,595
8%
$21,550
5%
$17,905 14%
$110
4%
($38,000) (100%)
$105
1%
$0
1.13 - 1.14
$229,961
1.15 - 1.19
$1,712,627
$63,499
1.20 - 1.25
$653,998
$224,684
1.13 - 1.14
1.14
1.14
1.14
1.16
1.16
1.17
1.17
1.18
1.18
1.18
1.18
1.19
1.19
1.20
1.20
1.21- 1.24
1.25
1.25
1.26 - 1.27
1.26
1.26 - 1.27
1.27
1.27
$191,296
$37,000
$1,665
$0
$872,492
$100,320
$477,280
$30,320
$41,215
$12,250
$81,500
$0
$75,050
$22,200
$140
$200,000
$352,083
$101,545
$230
$188,320
$38,320
$0
$0
$150,000
N/A
($44,236) (16%)
($7,992) (4%)
($8,900) (19%)
$0
0%
($27,344) N/A
4%
$55,599
7%
($7,880) (7%)
($16,755) (3%)
$1,895
7%
$15,215 59%
$2,175 22%
$1,500
2%
($12,500) (100%)
$20,050 36%
$4,200 23%
($35)
$200,000
$23,618
$1,101
$0
($173,555)
$24,974
($323,528)
($25,000)
$150,000
52%
(20%)
NEW
7%
1%
0%
(48%)
187%
(100%)
(100%)
NEW
(* Note: "Actual Less than Budgeted Expenses")
FDA Oper. Fund REVENUE FY15-16 Page #3
Page 56
CFA Recommend Printed 5/11/2015
Detail: Sect #1 - Page #4
FLORIDA DENTAL ASSOCIATION (CO./FUND #01)
OPERATING FUND BUDGET SUMMARY
2015-2016 BUDGET
FDA SERVICES, INC. PAYMENTS TO FDA
AT 6/30/2014
2013-14 Actual
Current Year
2014-15 BUDGET ACCT.NO.
Cur Yr 6 Mo.
FY14-15 Actual
$1,021,043
$1,027,131
GRAND TOTAL PAYMENTS TO THE FDA
19%
19%
Percentage of FDAS Payments of FDA Total Revenue
$241,019
$243,435
$570,799
$541,317
$33,092
$46,500
$1,500
$12,050
$7,000
$12,542
$0
$12,050
$7,000
$27,450
$0
$2,700
$0
$2,700
$92,767
$92,951
$83,366
$100,228
$241,019
$115,677
$369,100
$86,022
$54,949
$8,368
$9,900
$19,550
$8,016
$2,550
$72,800
$243,435
$93,010
$361,140
$87,167
$58,751
$6,900
$6,900
$20,400
$18,528
$1,700
$80,000
DIVIDENDS TO THE FDA
20-3695 Dividends- FDA Services
PAGE NO.
Recommended
2015-2016 Budget
$1,060,160
$377,954
19%
$0
$0
Budget Change
$ Amount
%
$33,029
3%
1%
1.9
1.1
$263,030
$19,595
$19,595
8%
8%
$22,247
4%
$263,030
20-3811 FDAS Overhead Reimbursement
20-3812 FDAS Personnel Contract Services
20-3876 FDAS Office Space Lease Revenue
CONTRACT SERVICE AGREEMENTS TO FDA
$270,514
$46,505
$180,570
$43,439
VARIOUS
1.10
1.1
1.25
$563,564
MEMBERSHIP DEPT. #010
$17,526
1.7
$39,050
($7,450) (16%)
$0
$6,026
$3,500
$8,000
1.7
1.7
1.7
1.7
$0
$18,050
$13,000
$8,000
$0
0%
$6,000 50%
$6,000 86%
($19,450) (71%)
$0
1.7
$2,700
$0
0%
$0
1.7
$2,700
$0
0%
(Recruitment Sponsorships & Advertisements)
3521 FDAS Advertising- Horizon Brochure
3551 General Recuitment Sponsorship
3553 Student Recruitment Sponsorship
3555 Students Professional Insur. Sponsorship
LEADERSHIP AFFAIRS DEPT. #020
3559
(Sponsorships)
FDAS Sponsorship- Leadership Affairs Events
3213
3217
3218
3268
FDAS Advertising (insurance) - Today's FDA ads
FDAS-Crown Savings Program TFDA ads
FDAS-Group Purchasing Organ(GPO) TFDA ads
FDAS Advertising- FDA Website (Insur &new GPO)
3115
3215
3641
$94,300
$381,400
$87,864
$1,290
$20,260
$697
1%
6%
1%
COMMUNICATIONS DEPT. #040
$49,914
1.12 - 1.13
1.13- 1.14
1.13 - 1.14
1.13 - 1.14
1.14
$86,951
($6,000)
(6%)
FNDC DEPT. #050
$40,000
VARIOUS
1.16
1.18
1.18
$104,865
$4,637
5%
FDAS Display/Exhibit booths
FDAS Advertising - FNDC Program
FDC Sponsorship
FDA Oper. Fund REVENUE FY15-16 Page #4
Page 57
$30,594
$5,460
$3,660
$10,200
$0
$0
$40,000
$58,751
$7,200
$6,000
$15,000
$21,665
$1,700
$81,500
$0
0%
$300
4%
($900) (13%)
($5,400) (26%)
$3,137
$0
$1,500
17%
0%
2%
CFA Recommend Printed 5/11/2015
Detail: Sect #2 - Page #1
FLORIDA DENTAL ASSOCIATION (CO./FUND #01)
OPERATING FUND - BUDGET SUMMARY
2015-2016
Total Dept. Expense % of Total Revenue=
Revised 5/7/15 12:30pam
10%
CFA Recommended
DEPT. #020 LEADERSHIP AFFAIRS EXPENSES
DEPT.#020 LEADERSHIP AFFAIRS (LA)
AT 6/30/14
Cur. Year
FY13-14 Actual FY14-15 Budget ACCT.NO.
(2015-2016 Fiscal Year Budget Computations)
Cur Yr 6 Mo.
14-15 Actual
PAGE NO.
Recommend
2015-2016 Budget
Budget Change
$ Amount
%
$468,302
$557,697 4000-9999
DEPT. #020 - LA EXPENSES
$305,861
2.1 - 2.18
$531,889
($25,808)
$220,151
$283,743 4000-5199
ASSOCIATION MEETINGS
$157,472
2.3 - 2.11
$313,991
$30,247 11%
$15,985
70%
$18,369
53%
$11,097
37%
$0
N/A
($20,779) (100%)
$513
13%
$0
N/A
$15,379
11%
($10,316) (31%)
$12,181
$30,671
$28,075
$450
$16,121
$3,636
$46
$107,192
$21,779
$28,381
$0
$0
$25,807
$0
$1,547
$1,026
$79,914
$6,797
$63,050
$5,229
$4,837
$7,176
$5,842
$999
$335
$132,681
$35,578
$12,261
$1,400
$16,543
$180
$27,218
$2,860
$1,956
$1,141
$1,130
$32,415
$0
$22,861 4000-4099 House Of Delegates- Semi-Annual Session (HOD1-Jan)
$0
$34,950 4100-4199 House Of Delegates- Annual Session (HOD2-June)
$0
$30,281 4300-4399 Board Of Directors (BOT)
$17,360
$0 4490-4490 Executive Officers (EO) Conf. Calls
INACTIVE
$0
$20,779 4500-4599 Board Strategic Plan Session [Nov.]
INACTIVE $14,832
$3,913 4600-4699 All Councils' Meetings (8 Councils)
$0
$0 4700-4799 Committee Meetings
INACTIVE
$0
$137,799 5000-5099 ADA House of Delegates Meeting (ADA Mtg)
$103,003
$33,160 5100-5199 ADA 17th District Caucus (& Caucus Building)
$22,278
$29,650 5210-5229
$420
$730
$23,000
$3,000
$1,800
$700
5211
5212
5313
5215
5216
5218
$86,300 5240-5279
$9,300
$65,000
$5,000
$7,000
5251
5255
5261
5268
$21,140 5300-5699
LEADERSHIP EVENTS AT FDC Event
Officers & VIPs Hosting
Officers & VIPs Dinner and Reception
Awards Event
Presidential Reception
Past President's Reception
Incoming Presidents' Event
INACTIVE
INACTIVE
LEADERSHIP EXPENSES
$40,491
$9,045
$1,000
$10,500
$3,000
$51,600
$3,260
$2,253
$420
$250
$15,044
$20,000
5850-5869
6481-6482
6487
6506
6520
6525
6580-6589
6700-6799
7300
8300-8399
8705
President Travel Expense
Leadership Stipends
President-Elect Travel Expense
Exec. Dir/COO Other Travel Expense
$3,256
$65,000
$68
$2,030
OTHER TRAVEL
OTHER EXPENSES
General Insurance- FDA
FDA Promotion- Association & Leadership
Contributions
Strategic Planning Facilitator
Professional Fees - Legal
Consulting- Other
Memberships
Office Supplies and Resources
FDA Leadership Website Expenses
Leadership Development Courses
ADA Grant Expenses-Fluoride Grant
9995
NOTES:
$0
$0
$0
$0
$0
$0
$70,353
$9,251 5300-5399 Conferences- Staff Travel
$6,500 5500-5599 FDA Representatives
$5,389 5610-5610 Component Executive Directors Meetings
$136,863 5800-6899
$0
INACTIVE
AUTOMATIC ENCUMBRANCES TO THE
CONTINGENCY FUND DEPT. #095
$7,442
$4,417
$979
$2,045
$70,593
$39,894
$5,780
$0
$7,835
$28
$0
$2,663
$1,892
$991
$0
$11,512
$0
2.3 - 2.4
2.4 - 2.6
2.6 - 2.7
2.7
2.8
2.8- 2.9
2.9
2.9 - 2.10
2.11
2.12
2.12
2.12
2.12
2.12
2.12
2.12
2.13
2.13
2.13
2.13
2.13
2.13 - 2.14
2.13
2.14
2.14
2.15- 2.17
2.15
2.15
2.15
2.16
2.16
2.16
2.16
2.16 - 2.17
2.17
2.17
2.17
See Page
2.18
$38,846
$53,319
$41,378
$0
$0
$4,426
$0
$153,177
$22,843
$29,605
($45)
$420
$0
$26,285
$0
$1,800
$1,100
$0
($730)
$3,285
($3,000)
$0
$400
$9,432
$65,650
$5,000
$7,000
$131
$650
$0
$0
$87,082
$21,836
$11,929
$6,500
$3,407
$782
$696
$2,678
$0
($1,982)
(5%)
(0%)
0%
N/A
14%
N/A
0%
57%
1%
1%
1%
0%
0%
3%
29%
0%
(37%)
$79,376
($57,488) (42%)
$17,000
($3,000) (15%)
$40,171
$8,975
$2,000
$2,000
$2,000
$1,600
$3,790
$2,463
$2,010
$0
$14,367
($321) (1%)
($70) (1%)
$1,000 100%
($8,500) (81%)
($1,000) (33%)
($50,000) (97%)
$530
16%
$210
9%
$1,590 379%
($250) (100%)
($677) (5%)
1. The automatic encumbrance amounts are not included in the above budgeted expenses.
2. See below for a summary listing of Leadership Affairs Dept #20 expenses major enhancements & other changes.
3. See Administration Dept. #90 for Personnel Costs & Mahan telephone, occupancy, equipment & tangible tax & general office supplies.
FDA LA. Dept.#020 FY15-16 Expense
Page
58#1
Sect
#2 - Page
CFA Recommend Printed 5/11/2015
Detail: Sect #2 - Page #2
FLORIDA DENTAL ASSOCIATION (CO./FUND #01)
OPERATING FUND - BUDGET SUMMARY
2015-2016
DEPT. #020 LEADERSHIP AFFAIRS EXPENSES (continued)
FY 2015-2016 BUDGET: LISTING OF MAJOR ENHANCMENTS & CHANGES
Type
Acct #
Lower
20-4100
20-4100
20-4300
20-4500
20-5000
20-5100
20-5300
20-5213
20-5215
20-5320
20-5610
20-6482
20-6487
20-4506
20-6525
20-6520
20-7300
20-8705
DEPT #20
Various
Higher
Higher
Higher
Lower
Higher
Lower
Higher
Higher
Lower
Higher
Lower
Lower
Higher
Lower
Lower
Lower
Higher
Account Name
Reason for Enhancement/ Budget Change
House of Delegates- January
House of Delegates- June at FNDC
Board of Trustees (BOT) Meetings
Board Development Meeting Costs
ADA Meeting- Delegation Travel
ADA Caucus Travel
Conferences-Staff Travel
Awards Event at FDC
Presidential Reception
Conferences-Staff Travel
Component Exec. Directors' Meeting
Leadership Promotion
Contributions
Strategic Planning Consultant
Other Consulting
Legal Fees
FDA Leadership Website Expenses
ADA Grant Expenses-Fluoride Grant
Alternate BOT travel now included to Jan HOD
$15,985
Alternate BOT travel now included to Jan HOD
$18,369
Change venue to FtL. & Orlando & 2day Dec'15 meeting
$11,097
Various projections & changes from FY13-14 Budget
($20,779)
Various projections & changes from FY14-15 Budget
$15,379
Various projections & changes from FY14-15 Budget
($10,316)
Increase for budgeted staff attended conferences
$2,678
Higher projected cost for new awards event held at FNDC
$3,285
Inactive Event, not planned for FY15-16
($3,000)
Additional costs for new FDA CFO to attend ADA confs.
$2,678
FY14-15 Budget included one-time Aptify training
($1,982)
Increase for new BOT headshot photographer fees
($1,225)
Rebudget for FDHA table display sponsorship at FDC
$1,000
Reduction for ADA consultant for FY15-16, travel cost only
($8,500)
FY14-15 one-time HQ bldg. study consulting fee
($50,000)
Increase the auto encumbrance amount by ($1/k)
($1,000)
Correct budget for the actual costs for website fee/maintenan
$1,590
FY15-16 estimated unspent grant available change from FY1
($677)
Various All Other Dept Leadership Affairs (LA) #20 Budget Expense Changes:
($389)
TOTAL LA DEPT #20 FY 2015-2016 BUDGET CHANGES (From FY 2014-15 Budget):
FDA LA. Dept.#020 FY15-16 Expense
14-15 Budget
Change
Page
59#2
Sect
#2 - Page
($25,808)
CFA Recommend Printed 5/11/2015
Detail: Sect #3 - Page #1
FLORIDA DENTAL ASSOCIATION (CO./FUND #01)
OPERATING FUND - BUDGET SUMMARY
2015-2016
Total Dept. Expense % of Total Revenue=
Revised 5/7/15 5:00 pm
6%
CFA Recommended
DEPT. #010 MEMBERSHIP DEPARTMENT
General Department & Budget Oversight Agency(s): Councils on Membership and New Dentist]
Staff Department Head: Director of Member Relations
AT 6/30/14
CUR. YEAR
FY13-14 Actual FY14-15 Budget ACCT.NO.
$139,233
$6,794
$85
$111
$6,598
$63,014
$6,054
$17,426
$38,324
$1,209
$11,520
$11,520
$0
$0
$49,530
$49,530
$4,028
$4,028
$4,347
$4,347
$0
$242,400 4000-9999
DEPT. #010 -MEMBERSHIP DEPARTMENT
Cur Yr 6 Mo.
14-15 Actual
PAGE NO.
DEPT. #010 MEMBERSHIP DEPT. EXPENSES
$119,873
3.1 - 3.8
$293,020
$50,620
21%
$3,334
3.2 - 3.3
3.2
3.2
3.3
$14,738
$1,625
12%
$63,462
3.3 - 3.5
3.3 - 3.4
3.4
3.4 - 3.5
3.5
$191,808
$50,825
36%
3.6
3.6
$11,682
3.6
3.6
$620
3.6
3.6
$71,472
3.7
3.7
$2,700
3.7
3.7
$0
See Page
3.8
$0
$13,113 4600-5599 AGENCY MEETINGS AND TRAVEL EXPENSE
$0 4600-4699 Council on Membership (COM)
$191 4900-4999 Council on the New Dentist (CND)
$12,922 5300-5399 Conference Travel
$140,983 6200-6299
$16,275
$34,780
$49,728
$40,200
6205-6229
6230-6249
6250-6269
6270-6289
$8,833 6470-6479
[see LA Dept#20)
RECRUITMENT & RETENTION PROJECTS
Dental Student Recruitment
New Dentist Recruitment
Non-Member Recruitment
Membership Retention & Recruitment
$155
MARKETING AND PROMOTION
6515
6515
Memberships
$0
$0
MEMBERSHIPS
$0
$0
$62,186 6600-6699
NEW BUSINESS, BILLING & COLLECTIONS
$62,186 6600-6689 Dentists Mbr New Business, Billing & Collections
$2,130 6700-6799
OFFICE SUPPLIES & RESOURCES
8705
$15,000
8705
$0
9995
NOTES:
$29,198
$29,198
$1,177
$2,130 6700-6799 Office supplies & Resources
$15,000
$0
$137
$3,197
$4,785
$12,818
$45,073
$787
$8,833 6470-6479 Membership Awards
$155
Recommended
2015-2016 Budget
(2015-2016 Fiscal Year Budget Computations)
$1,177
ADA GRANT EXPENSES
$22,702
ADA Grant Expenses (offset against grant revenue)
$22,702
AUTOMATIC ENCUMBRANCES TO THE
CONTINGENCY FUND DEPT. #095
$0
$0
$14,738
$23,305
$61,330
$49,728
$57,445
$11,682
$620
$71,472
$2,700
$0
Budget Change
$ Amount
$0
N/A
($191) (100%)
$1,816 14%
$7,030
$26,550
$0
$17,245
$2,849
$2,849
Acct #
Higher
10-5320
10-6228
10-6231
10-6285
10-6645
10-6471
10-8705
N/A
Various
Higher
Higher
Higher
New Cost
Higher
Higher
FY 2015-2016 BUDGET: LISTING OF MAJOR ENHANCMENTS & CHANGES
Account Name
Reason for Enhancement/ Budget Change
ADA Recruitment Conference
Student Recruitment Pilot Projects
Students Recruitment-Insur.Premium-FDAS
Membership Booth at FDC/Staff Travel FDC
Dues Credit Card PSA Fees
Membership Awards
ADA Grant
Add a second membership staff to attend
Increase $7/k for Assoc. Video w/ $6/k higher FDAS reimb
Net $0 FDA effect- FDAS sponsor to FDA up same amount
New enhanced FDA MBR.booth at FDC costs w/staff travel
End FDAPAC reimb of PSA credit card fees for its dues/CC
Using realistic cost w/o CFA FY12-13 proj. bids savings cut
No ADA grant projected for FY15-16
All Other Membership Dept #10 Expense Changes:
Membership #010 FY15-16 Expense
60( 3.1 )
Sect Page
#3 - Page #1
32%
32%
$465
300%
$9,286
15%
$9,286
$570
$570
15%
27%
27%
($15,000) (100%)
($15,000) (100%)
$0
15-16 Budget
Change
$1,746
$7,000
$25,550
$17,245
$8,400
$2,849
($15,000)
$2,830
TOTAL MBR. DEPT #10 FY 2015-2016 BUDGET CHANGES (From FY 2014-2015 Budget):
43%
76%
0%
43%
$465 300%
1. The automatic encumbrance amounts are not included in the above budgeted expenses.
2. See Administration Dept. #90 for Personnel Costs & Mahan telephone, occupancy, equipment & tangible tax & general office supplies.
Type
%
$50,620
CFA Recommend Printed 5/11/2015
0%
Detail: Sect #4 - Page #1
FLORIDA DENTAL ASSOCIATION (CO./FUND #01)
OPERATING FUND BUDGET SUMMARY
2015-2016
DEPT. #030 GOVERNMENTAL AFFAIRS OFFICE (GAO) EXPENSES
General Department & Budget Oversight Agency(s): Committee on Governmental Affairs
Staff Department Head: FDA Director of Governmental Affairs
Total Dept. Expense % of Total Revenue=
Revised 4/29/15 12:30 pm
AT 6/30/14 Current Year
13-14 Actual 14-15 Budget
DEPT.#030 - GOVERNMENTAL AFFAIRS OFFICE (GAO) EXPENSES
ACCT.NO.
(2015-2016 Fiscal Year Budget Computations)
$156,528 $173,721 4000-9999
$1,371
$1,371
$32,133
$17,357
$2,891
$5,883
$6,002
$50,361
$9,513
$8,156
$32,693
$5,417
$0
$5,417
$31,970
$30,000
$1,970
$10,321
$10,321
$4,305
$4,305
$650
$650
$20,000
$20,000
$0
DEPT. #030-GOVERNMENTAL AFFAIRS OFFICE EXP
ASSOCIATION MEETINGS
$6,380 4600-4799
$22,052
$5,855
$7,686
$4,637
5300-5399
5505-5529
5530-5599
5600-5699
$44,569 5800-6099
OTHER TRAVEL
MARKETING AND PROMOTION
PROFESSIONAL COSTS
OFFICE RESOURCES & RESOURCES
REPORTS, MANUALS AND NEWSLETTERS
TAXES, LICENSES AND FEES
8705
$22,700
9995
$1,076
$1,076
$45
$623 6950-6969 Licenses & Fees
$0
$30,000
$960
$7,721
$5,720 6800-6899 Reports, Manuals & Newsletters
$0 8705-8705
$30,960
$7,721
$8,435 6700-6799 Office Supplies & Resources
$623 6900-6999
$6,228
$1,653
$17,586
$0
$843
$61,000 6505-6589 Professional Services- Leg.Consultant &Expert Testimony
$1,765 6590-6599 Memberships
$5,720 6800-6899
$25,467
$843
$0 6480-6480 Legislative Reception
$5,000 6483-6483 Other Legislative Promotion
$8,435 6700-6799
4.1 - 4.8
$1,633
$2,090
$6,071
$0
TELEPHONE AND OCCUPANCY COSTS
$62,765 6500-6599
$79,507
$9,795
$10,188 5810-5829 Telephone/Internet Service
$3,240 5870-5879 Equipment Costs
$31,141 6000-6099 Building & Facilities Costs
$5,000 6200-6499
PAGE NO.
$546
GAO Conferences Travel
Board of Dentistry Meetings Travel
Other GAO Travel
Legislative Contact Dentist Program
$45
ADA GRANT PROGRAMS
ADA- GAO Non-covered Services Grant [one-time]
$3,055
$3,055
$0
AUTOMATIC ENCUMBRANCES TO THE
CONTINGENCY FUND DEPT. #095
CFA Recommended
Cur Yr 6 Mo.
14-15 Actual
$546
$6,380 4700-4799 Governmental Action Committee (GAC)
$40,230 5300-5699
4%
Recommended
$209,450
4.2
4.2
$4,450
4.3 - 4.4
4.3
4.3
4.4
4.4
$56,071
4.4 - 4.5
4.4
4.5
4.5 - 4.6
$46,144
4.6
4.5
4.6
$23,250
4.6
4.6
4.6
$62,975
4.7
4.7
$9,495
4.7
4.7
$6,440
4.7
4.7
$625
4.8
4.8
$0
See Page
4.8
Acct #
Account Name
Higher
Governmental Action Committee (GAC)
Lobbyist/FDA Leader Lobbying Travel
LCD Training Program
Telephone/internet costs
Building Maintenance
Legislative Reception (held at FDC)
Legislative Promotion
Legislative Consultant
N/A
Various
All Other Dept #30 Budget Expense Changes
Higher
New Prog.
Higher
Lower
New Prog.
Higher
FDA GAO. Dept.# 030 FY15-16 Expense
Page
61#1
Sect
#4 - Page
$35,729
21%
$15,841
$22,295
$5,389
$17,785
$10,603
$243
($466)
$10,099
$5,966
$1,575
$12,959
$4,002
$29,183
$2,771
$762
($1,958)
$18,250
$14,750
$8,500
$14,750
$3,500
$210
$61,000
$1,975
$9,495
$2
$0
$0
$20,900
4%
27%
24%
(6%)
365%
NEW
70%
0%
13%
$2
$0
1%
(8%)
131%
129%
$1,060
$720
$625
39%
0%
12%
$720
$6,440
(30%)
$0
$210
$1,060
($1,800)
13%
13%
13%
0%
0%
N/A
N/A
(8%)
2015-16 Budget
One-time FY14-15 addon 9/24/14 GAC Tampa w/Caucus
Reclass FDAPAC travel of $8.1/k to FDA Budget
New GAO yr. expense formerly in FY14-15 ADA grant
Projected higher GAO internet costs based on FDA overall a
Changes in major bldg. maint. projects for each fiscal year
Reclass FDAPAC legislative reception to FDA Budget
Increase $3/k for new legislative radio/media updates
Change to annual legislative consultant fee
TOTAL GAO. DEPT #30 FY 2015-2016 BUDGET CHANGES (From FY2014-15 Budget):
%
($1,930)
Reason for Enhancement/ Budget Change
30-4700
30-5531
30-5650
30-5811
30-6050
30-6480
30-6483
30-6515
Lower
$ Amount
($1,930) (30%)
$4,450
FY2015-16 BUDGET: LISTING OF MAJOR ENHANCEMENTS & CHANGES FOR THIS DEPARTMENT:
Type
Budget Change
2015-2016 Budget
Change
($1,930)
$8,099
$5,800
$2,771
($1,100)
$14,750
$3,200
$0
$4,139
$35,729
CFA Recommend Printed 5/11/2015
Detail: Sect #5 - Page #1
FLORIDA DENTAL ASSOCIATION (CO./FUND #01)
OPERATING FUND BUDGET SUMMARY
2015-2016
DEPT. #040 COMMUNICATIONS EXPENSES
Total Dept. Expense % of Total Revenue=
Revised 5/7/15 5:00 pm
4%
CFA Recommended
General Department & Budget Oversight Agency(s): Council on Communications & FDA Today's FDA Editor
Staff Department Head: Communications Manager with total of 3 staff
AT 6/30/14
Cur. Year
13-14 ACTUAL 14-15 Budget
DEPT. #40 COMMUNICATIONS (COM) EXPENSES
(2015-2016 Fiscal Year Budget Computations)
Cur Yr 6 Mo.
14-15 Actual
ACCT.NO.
$149,319 $227,612 4600-9899 DEPT. #040 - COMMUNICATIONS TOTAL EXPENSES $92,380
$3,801
$0
$885
$2,916
$207
$207
$0
$10,797
$10,556
$241
$3,009
$3,009
$4,603 4600-5599
AGENCY MEETINGS AND TRAVEL
$0
4600 Council on Communications (COC) [See LLA Dept#20)
$2,130 5230-5270 Leadership Meetings: Editors' Travel and Expenses
$2,473
5310 Conference Travel- Editors
$2,410 6300-6499
$2,310
$100
6311
6478
$70,092 6500-6599
$69,581
$511
6518
6581
$2,030 6700-6799
MARKETING AND PROMOTION
$0
$560
$3,133
$468
Social Media Marketing & Ads Promotion
Awards (Media & Com.Dept Competition)
$96
$372
PROFESSIONAL COSTS
$29,398
Consultant- Editorial Services
Memberships
$29,028
$370
OFFICE SUPPLIES AND RESOURCES
$524
$2,030 6710-6799 Office Supplies and Resources
$114,577 $121,133 7000-7999
$3,693
$524
PUBLICATIONS
PAGE NO.
Recommended
2015-2016 Budget
%
$214,010
($13,602)
(6%)
5.2
5.2
5.2
5.2
$5,333
$0
$1,814
$3,519
$730
$0
($316)
$1,046
16%
N/A
(15%)
42%
5.2 - 5.3
5.2
5.3
$5,710
$3,300
137%
5.3
5.3
5.3
$90,660
5.3
5.3
$1,910
5.2 - 5.5
$5,310
$400
$90,000
$660
$1,910
$110,397
$110,665
$796
$0
$3,117
$112,801 7005-7099 Today's FDA
$870
7211 News Bite Email Publication
$2,000
7245 Mobile App. (development & marketing)
$5,462
7305 FDA Web Sites Expenses
$54,157
$52,000
$354
$60
$1,743
5.4 - 5.5
5.4 - 5.5
5.5
5.5
5.5
$16,928
$27,344
$4,141
5.5
5.5
$0
See Page
5.5
$0
$16,928
$0
PUBLIC OUTREACH PROGRAM
8100
$27,344
8108
$0
9995
ADA Grant Program (via Bd.Designated Grant)
$4,141
AUTOMATIC ENCUMBRANCES TO THE
CONTINGENCY FUND DEPT. #095
Budget Change
$ Amount
$105,585
$810
$0
$4,002
$0
$3,000
$300
$20,568
$20,419
$149
($120)
($120)
($10,736)
($7,216)
($60)
($2,000)
($1,460)
130%
300%
29%
29%
29%
(6%)
(6%)
(9%)
(6%)
(7%)
NEW
(27%)
($27,344) (100%)
($27,344) (100%)
$0
N/A
NOTES:
1. The automatic encumbrance amounts are not included in the above budgeted expenses.
2. See below for a summary listing of Communications Dept #40 expenses major enhancements & other changes.
3. See Administration Dept. #90 for Personnel Costs & Mahan telephone, occupancy, equipment & tangible tax & general office supplies.
Type
FY 2014-2015 BUDGET: LISTING OF MAJOR ENHANCMENTS & CHANGES
Acct #
Account Name
Social Media Marketing
Consultants-Com. Dept.
Today's FDA -Printing
Today's FDA -Other costs
Travel & Story Development
Moble App.
Web-site Expenses
Lower
40-6310
40-6518
40-7010
40-7045
40-7060
40-7245
40-7305
40-8705
ADA Grant Utilized:
N/A
Various
All Other COM. Dept #40 Expense Changes:
New cost
Higher
Lower
Higher
Lower
Lower
Lower
Reason for Enhancement/ Budget Change
New proposed budget account (for entire FDA use)
All Moore Communication consulting costs in COM. DP
Lower printing costs based on 1 & 1/2 years actuals
Higher TFDA postage costs based on current rates
Reduction of photographer FDA EE photos/head shots
New development & marketing of mobile app did not occur
Reduction for E-classified fee not being incurred for 2 years
ADA public relations grant fully utilized in FY14-15
Page
62#1
Sect
#5 - Page
$3,000
$20,419
($10,688)
$4,200
($1,048)
($2,000)
($1,460)
($27,344)
$1,319
TOTAL COM. DEPT #40 FY 2015-2016 BUDGET CHANGES (From FY 2014-15 Budget) :
FDA COM. Dept.#040 FY15-16 Expense
14-15 Budget
Change
($13,602)
CFA Recommend Printed 5/11/2015
Detail: Sect #6 - Page #1
FLORIDA DENTAL ASSOCIATION (CO./FUND #01)
OPERATING FUND BUDGET SUMMARY
2015-2016
DEPT. #050 FL. DENTAL CONVENTION (FDC) EXPENSES
Total Dept. Expense % of Total Revenue=
Revised 5/7/15 5:00 pm
20%
CFA Recommended
General Department & Budget Oversight Agency(s): Committee on Conventions & Continuing Education
Staff Department Head: FDC- Convention Director
Notes: (1) See Administration Dept. #90 for Personnel Costs & Mahan telephone, occupancy, equipment & tangible tax & general office supplies.
AT 6/30/2014
13-14 Actual
Current Year
14-15 Budget
DEPT.#050 FL. DENTAL CONVENTION (FDC) EXPENSES
ACCT.NO.
(2015-2016 Fiscal Year Budget Computations)
$775,269
$986,872 4000-9999
$51,288
$67,998 4700-5599
$24,751
$17,108
$4,819
$4,610
$6,828
$6,828
$59,862
$59,862
$810
$810
$32,919
$18,666
$9,219
$7,194
4700-4799
5200-5299
5300-5399
5500-5599
Recommended
2015-2016 Budget
DEPT. #050 - FL. DENTAL CONVENTION (FDC)
$67,842
6.2 - 6.11
AGENCY MEETINGS & TRAVEL EXPENSE
$28,887
6.2 - 6.4
FDC Committee Meetings
FDC Leadership Expense
Dental Conventions Travel
Staff Other Travel
INSURANCE COSTS
$111,100 6300-6399
$0
MARKETING AND PROMOTION
$111,100 6300-6399 Marketing & Promotion
$970 6500-6599
$970 6580-6589 Memberships
$653,150
$797,724 8000-8899
MEMBERSHIPS
$0
$0
8000-8059
8060-8069
8100-8199
8200-8299
8300-8399
8600-8699
8899
9995
$10,353
$10,353
$868
$868
OFFICE RESOURCES
$860
$1,940 6700-6799 Office Supplies & Resources
$22,600
$1,500
$115,535
$189,986
$398,388
$69,715
$0
$26,170
$76
$2,162
$480
$0
$7,140 5850-5859 Insurance (FDC Event Insurance)
$1,940 6700-6799
$15,538
$0
$87,996
$141,347
$339,758
$68,511
$0
PAGE NO.
$7,140 5800-5899
$3,331
$3,331
Cur Yr 6 Mo.
14-15 Actual
$860
FDC MEETING
$26,873
Headquarters Expenses
FDC Web Site
Exhibit Expenses
Registration Expenses
Educational Presentations at FDC
Social Functions
Prior Year FDC Expenses
$0
$0
$6,877
$9,903
$9,436
$657
$0
AUTOMATIC ENCUMBRANCES TO CONTINGENCY DP#95
%
$1,040,253
$53,381
5%
$78,940
$10,943
16%
6.2
6.3
6.3
6.3 - 6.4
$35,755
$20,020
$15,558
$7,608
6.5
$7,428
$7,428
6.5
$116,348
6.5 - 6.6
$116,348
6.5 - 6.6
$970
6.6
6.6
$970
6.6
$2,090
$2,090
6.6
$834,477
Acct #
Account Name
Higher
FDC Committee Meetings
FDC Mgr's Convention Travel
FDC Registration Marketing
FDC Exhibit Hall Rental
Exhibit Hall Evaluator
Other FDC Marketing
WiFi in Exhibit Hall
Traffic Builders for Exhibit Hall
Shuttle Service
Credit Card Merchant Fees
Hosting Materials
Contingent Honoraria
AV & Special Electrical for Courses
Signs for FDC
Online CE Software/Fees
Membership Event
N/A
Various
All Other FDC Dept #50 Budget Expense Changes:
Higher
Higher
Lower
New cost
Higher
New cost
Higher
Higher
Higher
Lower
Lower
Higher
Higher
Higher
FDC Dept. #050 FY15-16 Expense
$288
$5,248
$5,248
$0
$0
$150
$150
4%
4%
5%
5%
0%
0%
8%
8%
$22,600
$500
$125,525
$197,535
$399,210
$89,107
$0
6.11
$10,700
$10,700 NEW
Event based on higher FDA member reg revenue
SectPage
#6 - Page 63
#1 ( 6.1 )
$288
9%
7%
69%
6%
6.6
6.7
6.7 - 6.7
6.7 - 6.8
6.8 - 6.10
6.10
6.10
Reason for Enhancement/ Budget Change
Higher overall costs
Add additional convention travel
Higher projected marketing costs
Exhibit hall rental all encumbered as no cost 2013 or 2014
New account for exh. Hall evaluation of 300 companies
Higher projected other-FDC marketing costs
New $20/k prog.potential cost, April'15 CFA not recommendin
Increase for new Coupon Book cost
Increase for addon hours/stops for overflow hotel
Higher budget based on actual costs
Just purchase of new Committee mbrs' hosting materials
Honoraria directly based on # of projected attendees
Higher AV/electrical costs based on actuals
More signs for FDAS & based on 2012 actual
Two new marketing mailings to members about CE Track
50-4700
50-5320
50-6311
50-8110
50-8123
50-6315
50-8185
50-8190
50-8280
50-8290
50-8358
50-8311
50-8325
50-8330
50-8394
50-8610
Higher
$2,836
$1,354
$6,339
$414
$36,753
5%
$0
0%
($1,000) (67%)
$9,990
9%
$7,549
4%
$822
0%
$19,392
28%
$0
N/A
6.6 - 6.10
FY 2015-2016 BUDGET: LISTING OF MAJOR ENHANCEMENTS & CHANGES FOR THIS DEPARTMENT:
Type
Budget Change
$ Amount
15-16 Budget
Change
$2,836
$5,650
$1,248
($10,700)
$12,500
$4,000
$0
$5,000
$4,700
$3,500
($2,450)
($18,023)
$6,000
$3,000
$10,000
$15,215
$10,905
CFA Recommend Printed 5/11/2015
Detail: Sect #7 - Page #1
ACCOUNTING-INFO. SYSTEMS DEPT. #60/#65 EXPENSE BUDGET
FLORIDA DENTAL ASSOCIATION (CO./FUND #01)
OPERATING FUND BUDGET SUMMARY
2015-2016
DEPT. #060 ACCOUNTING (ACCT) EXPENSES
Total Dept. Expense % of Total Revenue=
Revised 5/7/15 12:30 pm
2%
CFA Recommended
General Department & Budget Oversight Agency(s): Council on Financial Affairs, Audit Committee & FDA Treasurer
Staff Department Head: Director of Accounting reporting to FDA CFO
AT 6/30/14
Cur. Year
13-14 Actual 14-15 Budget
$113,168
$117,416 4000-9999 DEPT. #060 - ACCT EXPENSES (Before Income Taxes)
$204
$645 4600-5599
$46,193
$47,062 6100-6199
$0
$124
$81
$46,193
$14,958
$14,958
AGENCY MEETINGS AND TRAVEL EXPENSE
Inactive
$0 4600-4699 Council on Financial Affairs (CFA) Exp.
Inactive
$600 4700-4799 Audit Committee (AC) Expenses
$45 5500-5599 Other Travel
(local mileage)
$678
$678
$15,130
$15,130
$0
$76,815
7.2 - 7.4
$94
$0
$0
$94
$50
7.2
7.2
7.2
7.2
7.3
7.3
NEW BUSINESS, BILLING & COLLECTIONS
$6,884 6600-6699 Bank Fees
$4,093
$3,390 6700-6799
$1,330
$5,309
(audit & payroll svcs)
$4,093
OFFICE SUPPLIES & RESOURCES
$3,390 6700-6799 Office Supplies & Resources
$707 6950-6969
$1,330
LICENSES AND FEES
$415
$707 6950-6969 Licenses & Fees
$16,300 9300-9399
$415
CONTRACT SERVICES TO FDAS
$8,150
$16,300 9300-9399 FDAS Personnel Contract Services
$0
$8,150
AUTOMATIC ENCUMBRANCES TO THE
CONTINGENCY FUND DEPT. #095
9995
$20,422
$ Amount
%
$8,574
7%
($595) (92%)
$0
$0
$50
$20,422
$5,309
(BoA royalty prog)
PROFESSIONAL COSTS
$28,135 6505-6579 Professional Services
$37,002
Budget Change
$125,990
$11,050
MARKETING AND PROMOTION
$14,293 6205-6229 Component Royalties- FDA
$37,002
Recommended
2015-2016 Budget
7.3
7.3
$14,293 6200-6499
$6,884 6600-6699
$2,361
PAGE NO.
$49,235
$7,607
$2,361
Cur Yr 6 Mo.
14-15 Actual
7.2 - 7.3
7.2 - 7.3
$28,135 6500-6599
$7,607
BLDG #13 (Leased) SPACE EXPENSES
$47,062 6100-6199 Bldg. & Facilities- Leased Space (fdas % Bldg #13)
$26,038
$26,038
DEPT. #060 ACCT EXPENSES
(2015-2016 Fiscal Year Budget Computations)
ACCT.NO.
$0
N/A
($600) (100%)
$5
11%
$2,173
$49,235
$2,173
5%
5%
($3,243) (23%)
$11,050
($3,243)
(23%)
$29,230
$1,095
4%
7.3
7.3
$10,250
$3,366
49%
7.4
7.4
$2,660
7.4
7.4
$315
7.4
7.4
$23,200
$29,230
$1,095
$10,250
$3,366
49%
($730) (22%)
$2,660
($730)
(22%)
($392) (55%)
$315
($392)
$6,900
$23,200
$6,900
$0
See Page
7.4
4%
$0
(55%)
42%
42%
N/A
NOTES:
1. The automatic encumbrance amounts are not included in the above budgeted expenses.
2. See bottom of page # 7.1 for a summary listing of Accounting Dept #60 expenses major enhancements & other changes.
3. See Administration Dept. #090 for Personnel Costs & Mahan telephone, occupancy, equipment & tangible tax & general office supplies.
FY 2015-2016 BUDGET: LISTING OF MAJOR ENHANCEMENTS & CHANGES FOR THIS DEPARTMENT:
Type
Acct #
Account Name
Reason for Enhancement/ Budget Change
Leased Property Exp- (Tenants 36% share)
Higher
60-6110
60-6206
60-6540
60-6640
60-9340
N/A
Various
All Other ACCT. Dept #60 budget Changes:
Higher
Lower
About same
Higher
Component Royalties
CPA Audit Fees
Bank Fees
FDAS Contract Services
Fluctuates based on 36% of the budgeted Mahan costs
Prorata reduction projected BOA credit card royalty revenue
Overall 5% CPA fee increase but revised interco allocation
Higher SunTrust services but lower mo. Earnings credit
Higher Crown Savings prog (FDA share) FDAS personnel $
Page
64#1
Sect
#7 - Page
$2,173
($3,243)
$200
$3,366
$6,900
($822)
TOTAL ACCT. DEPT #60 FY 2015-2016 BUDGET CHANGES (From FY 2014-15 Budget) :
FDA ACCT/IS DEPT.#060 FY15-16 EXP
2015-16 Budget
Change
$8,574
CFA Recommend Printed 5/11/2015
Detail: Sect #8 - Page #1
FLORIDA DENTAL ASSOCIATION (CO./FUND #01)
OPERATING FUND BUDGET SUMMARY
2015-2016
DEPT. #90 PERSONNEL COSTS [Section A] :
(This section includes personnel expenses for all FDA departments)
$5,323,747
Total Projected FDA FY 2015-2016 All Revenue=
DEPT. #090 -ADMINISTRATIVE COSTS
AT 6/30/14
FY13-14 Actual
CUR. YEAR
FY14-15 Budget
$2,844,684
$2,847,876 5700-5799
$2,209,890
$2,212,423 5700-5719
$2,353,207
($173,091)
$29,775
$182,869
$170,437
$12,433
$219,084
$154,390
$16,657
$14,225
$4,043
$29,768
$221,677
$151,765
$69,912
$11,163
$1,800
$5,018
$4,345
$2,185,235
$19,400
$7,788
ACCT.NO.
5711
5716
5719
$171,974 5730-5799
$159,419
$12,555
5731
5737
$256,316 5751-5759
$187,733
$21,260
$16,732
$7,911
$22,680
5751
5752
5753
5755
5758
$194,763 5770-5779
$12,400 5780-5789
$2,700
$6,000
$3,700
5781
5782
5788
$0
9995
$0
$0
CFA Recommended
Recommended
2015-2016 Budget
(2015-2016 Fiscal Year Budget Computations)
Cur Yr 6 Mo.
fy14-15 Actual
PAGE NO.
DEPT. #90 PERSONNEL EXPENSES-All FDA [Section]
$1,177,678
8.2 - 8.6
$2,753,168
($94,708) (3%)
$932,584
8.3 - 8.4
8.30
8.3
8.4
$2,162,449
$2,136,601
$17,400
$8,448
($49,974) (2%)
($48,634) (2%)
($2,000) (10%)
$660
8%
WAGES (Includes Accrued Vacation/Sick Time)
Wages
Accrued Employee Vacation/Sick Time Benefits
Contract Payments
$996,066
($68,451)
$4,969
8.4
8.4
8.4
$165,198
($6,776) (4%)
INSURANCE BENEFITS
$110,732
8.4 - 8.5
8.4
8.5
8.5
8.5
8.5
$204,181
($52,135) (20%)
RETIREMENT FUNDS
$80,831
8.5
8.5
8.5
$206,490
$11,727
8.6
8.6
8.6
8.6
$14,850
$50,132
$1,320
Group Health & Life Insurance
Group Disability Insurance
Group Term & AD&D Insurance
Workers' Compensation Insurance
Dental Direct Reimbursement Benefits
$81,244
$8,895
$4,910
$5,540
$10,143
$50,940
$29,891
OTHER PERSONNEL EXPENSES
$2,078
Staff Recruitment- General
Staff Training & Education Seminars
Coffee/Water Service
$1,063
($979)
$1,994
AUTOMATIC ENCUMBRANCES TO THE
CONTINGENCY FUND DEPT. #095
90-5700 Personnel Section -Automatic Encumbrances
$0
$158,069
$7,129
$139,975
$18,921
$16,608
$5,619
$23,058
$139,523
$66,967
$2,700
$8,000
$4,150
See Page
8.6
Lower
Higher
Lower
Higher
Higher
($1,350) (1%)
($5,426) (43%)
($47,758) (25%)
($2,339) (11%)
($124) (1%)
($2,292) (29%)
$378
2%
Acct #
90-5711
90-5716
Various
Various
Various
Various
Account Name
10%
(2%)
$2,450
20%
$0
$2,000
$450
NEW
$0
$0
0%
Various.changes-wages
Various.changes- probable FY14-15 net expense
Less FICA tax & decrease for FDA Florida UCT tax
Lower group health insurance for Dec'2014
Various for additional staffing and average wage increases
$2/k addon CFO continuing education training
TOTAL FDA PERSONNEL SECTION A - DEPT #090 FY 2015-16 BUDGET CHANGES (From FY2014-15 Budget):
#090 Admin. Dept. FY15-16 Exp
Page
65#1
Sect
#8 - Page
0%
33%
12%
$0
Reason for Enhancement/ Budget Change
Wages
Accrued Employee Benefits
Payroll and Unemployment Tax
Insurance Costs
Retirement-MPP & 401k Plans
Other Personnel Costs
6%
$13,055
($1,328)
$0
FY 2015-2016 BUDGET: LISTING OF MAJOR ENHANCMENTS & CHANGES FOR THIS DEPARTMENT:
Type
%
$51,452
(The automatic encumbrance amounts are not included in the above budgeted expenses).
NOTES:
Lower
Budget Change
$ Amount
PAYROLL TAXES
Employer's FICA Tax Expense
Unemployment Tax Expense (federal & state)
$126,468
5775 Retirement (Pension-MPP) Trust Plan Contrib.
$68,295 6930-6939 401k Plan Contribution
$0
52%
Total Dept. #090 Personnel Expense % of Total Revenue=
Revised 5/7/15 5:00 pm
2015-16 Budget
Change
($48,634)
($2,000)
($6,776)
($52,135)
$11,727
$3,110
($94,708)
CFA Recommend Printed 5/11/2015
Detail: Sect #8 - Page #7
FLORIDA DENTAL ASSOCIATION (CO./FUND #01)
OPERATING FUND BUDGET SUMMARY
2015-2016
DEPT. #90 ADMINISTRATIVE EXPENSES [Section B] (Includes Telephone, Occupancy,
Equipment, Joint Office Supplies & Employee Benefit Plans & Tangible Tax Costs)
[This section excludes GAO telephone, occupancy and equipment, office supplies & tangible tax expense costs for its separate location]
AT 6/30/14
FY13-14 Actual
$5,323,747
Total Projected FDA FY 2015-2016 All Revenue=
Total Dept. #090 Administration Expenses % of Total Revenue=
Revised 3/23/15 7am
CUR. YEAR
FY14-15 Budget
DEPT. #090 -ADMINISTRATIVE COSTS
ACCT.NO.
(2015-2016 Fiscal Year Budget Computations)
Budget Prep
5%
Cur Yr 6 Mo.
fy14-15 Actual
PAGE NO.
Recommended
2015-2016 Budget
Budget Change
$ Amount
%
$280,226
$260,926 4000-9999
DEPT. #090 ADMINISTRATIVE EXPENSES [Section]
$163,395
8.7 - 8.13
$257,406
($3,520) (1%)
$224,186
$230,707 5800-5899
TELEPHONE AND OCCUPANCY COSTS
$119,433
$21,843
$33,561
$64,029
8.7 - 8.10
$207,216
$35,100
$84,588
$87,528
($23,491) (10%)
8.7
8.7 - 8.8
8.9 - 8.10
($484) (5%)
$29,478
$114,482
$80,226
$32,700 5810-5829 Telephone/Internet Service- Mahan
$65,402 5870-5889 Equipment Costs- Mahan
$132,605 6000-6099 Occupancy Costs - Mahan
$2,400
7%
$19,186 29%
($45,077) (34%)
$11,646
$8,854 6500-6599
PROFESSIONAL COSTS
$6,599
8.10 - 8.11
8.10
8.11
$8,370
$17,402
$6,405 6700-6799
OFFICE SUPPLIES & RESOURCES
$3,309
8.11
8.11
$7,710
8.12
8.12
8.12
$34,110
$19,150 128%
$0
($5,000) (100%)
$11,271
$375
$17,402
$26,992
$25,137
$1,855
$0
$7,854 6505-6599 Employee Benefit Plans
$1,000
6580 Memberships
$5,994
$605
$6,405 6700-6799 Office supplies & Resources- Mahan
$14,960 6930-6939
$3,309
TAXES
$34,054
$13,000 6930-6939 Income Taxes- Federal & State
$1,960 6930-6939 Tangible Taxes- Mahan
$5,000
9995
$32,300
$1,754
AUTOMATIC ENCUMBRANCES TO THE
CONTINGENCY FUND DEPT. #095
$7,370
$1,000
$7,710
$32,400
$1,710
See Page
8.12
($484) (6%)
$0 NEW
$1,305
$1,305
Acct #
Lower
90-5811
90-5871
90-6050
90-6085
90-6098
90-6700
Higher
90-6910/6911
Higher
Higher
Lower
Higher
Lower
N/A
Various
Account Name
Reason for Enhancement/ Budget Change
Telephone
Equipment/Software Costs
Building Maintenance- Mahan
Package & Liability Insurance-Mahan
Leased Building Expenses
Office Supplies & Resources
Federal & State Income Taxes
$2,400
$19,592
($33,645)
Higher Mahan allocation of about same insur.cost(FDAS less)
$3,818
Revised computation for lower FY15-16 project HQ bldg costs ($17,796)
Reduction for new FDA logo stationary supplies spring'14
$1,305
Based on proj. revenue & actual FY13-14 tax expense
$19,400
TOTAL MAHAN ADMIN DEPT #090 FY 2015-16 BUDGET CHANGES (From FY 2014-15 Budget):
#090 Admin. Dept. FY15-16 Exp
2015-16 Budget
Change
Higher actual FY14-15 telecom/internet connections
Higher costs & end $5/k encumbrance from FY14-15 budget
Reduce major improvements-carpet from FY14-15 budget
Various All Other Admin. Dept #90 Occupancy Expense Changes:
Page
66#7
Sect
#8 - Page
20%
$19,400 149%
($250) (13%)
FY 2015-2016 BUDGET: LISTING OF MAJOR ENHANCMENTS & CHANGES FOR THIS DEPARTMENT:
Type
20%
$1,406
($3,520)
CFA Recommend Printed 5/11/2015
Detail: Sect #11 - Page #1
FLORIDA DENTAL ASSOCIATION (CO./FUND #01)
OPERATING FUND BUDGET SUMMARY
2015-2016
DEPT. #95 INTERFUND ACCOUNTS
Revised 5/7/15 5pm
CFA Recommended
CONTINGENCY, TRANSFERS TO RESERVE & PROPERTY IMPROVEMENTS
AT 6/30/14
13-14 Actual
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
Cur. Year
DEPT. #95- FDA VARIOUS INTERFUND ACCOUNTS
2014-15 Budget ACCT.NO.
(2015-2016 Fiscal Year Budget Computations)
$20,405
9995
$50,000
9905
$50,000
9905
$54,650
9900
$35,250
$0
$14,400
$0
$5,000
$0
$0
DEPT. #95 CONTINGENCY
9995
$20,405
9910
9911
9912
9917
9941
9942
9948
Unallocated Contingency
DEPT. #95 TRANSFERS: RESERVE FUND/OTHER
Transfer to the Reserve Fund- Other Transfer
DEPT.#95 PROPERTY IMPROVEMENTS
Office Furnishings and Equipment
Addon Special One-time Equipment/Software
Computer Equipment Replacements
In-house Computer Software Creations
Building Improvements
Unanticipated Building Improvements
Jefferson Street GAO Building Improvements
INTERFUND Various Depts. FY15-16 Exp.
67 ( 11.1 )
Sect #9 Page
- Page #[Page]
Cur Yr 6 Mo.
14-15 Actual
PAGE NO.
Recommend
2015-2016 Budget
Budget Change
$ Amt.
%
$0
11.4
11.4
$46,231
$0
$0
11.5
11.5
$0
$0
($50,000) (100%)
($50,000) (100%)
$40,650
($14,000) (26%)
$0
$7,188
$4,944
$0
$2,244
$0
$0
$0
$0
$46,231
11.6 - 11.7
11.6
11.6
11.6 - 11.7
11.7
11.7
11.7
11.7
$20,250
$0
$15,400
$0
$5,000
$0
$0
$25,826
$25,826
($15,000)
$0
$1,000
$0
$0
$0
$0
CFA Recommend Printed 5/11/2015
127%
127%
(43%)
0%
7%
0%
0%
0%
0%
Exhibit HOD-15(B)(2)
Page 1 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
DATE:
May 1, 2015
SUBMITTED BY:
Council on Ethics, Bylaws and Judicial Affairs
ADOPTION OF NEW BYLAWS AND WORKGROUPS MANUAL
BOARD OF TRUSTEES RECOMMENDATION: Adopt.
Board vote:
Abstain:
Stevenson
Yes:
Attanasi; Boden; Huot; D’Aiuto, Pranikoff; Antoon; Brown; Cochran (for
Setzer); Ottley (for Jernigan); Eggnatz; Centurion; Terry; Liddell;
Churney
No:
None
2014H-069
[Policy] RESOLVED, that the FDA adopt the proposed Bylaws and
Workgroups Manual attached below.
BACKGROUND: Over one year ago, the Bylaws Task Group initially drafted the proposed
Bylaws and Workgroups Manual to make it easier to find information, to eliminate potential
inconsistencies, and to become more efficient in operations. Since then, the proposal has been
reviewed by the BOT several times, the HOD reviewed it in January 2015, an electronic town
hall meeting was held in March for all interested parties, and in May the Council on Ethics,
Bylaws and Judicial Affairs acted to recommend adoption of the proposal.
Since the HOD reviewed it in January, several non-substantive changes have been made based
on input from the town hall meeting and CEBJA, as follows:
• Include the previous bylaws change regarding the Council on New Dentist
• Include any other bylaws changes made by the June (e.g. calculation of component
membership to rely on ADA data from Aptify as of December 31 rather than FDA data as
of March 31)
• Change one HOD general meeting to two
• Clarify that ASDA dental students vote in the HOD but are not “voting members”
eligible to serve in FDA offices
• Update the name of the parliamentary manual used by the FDA from Sturgis to that used
by the American Academy of Parliamentarians
• Clarify that a minimum of sixty-nine (69) delegates (i.e. a minimum of two-thirds of 103
delegates) constitutes a HOD quorum
• Clarify that there will be at least one in-person BOT meeting annually
• Authorize HOD voting for officers to be by written anonymous or electronic ballot
• Replace “agencies” with “workgroups” to sound less governmental
• For councils, allow the FDA President to appoint a council member from any component
in the event that a component cannot locate a volunteer to serve on the council
• Include the Notice of Confidentiality (when applicable) in FDA agendas
Page 68
Exhibit HOD-15(B)(2)
Page 2 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
•
•
Clarify that the FDA President appoints a member of the Council on the New Dentist as
an ex-officio consultant to the Leadership Development Committee, and
Typographical errors have been corrected.
STRATEGIC PLAN LINK: This matter relates to Objective 6.2: Review and ensure FDA’s
governance structure facilitates implementation of the strategic plan and is efficient, cost
effective and meets organizational needs.
UNBUDGETED IMPACT: None.
REFERENCE COMMITTEE RECOMMENDATION: Pending.
PROPOSED FDA Bylaws
2015-2016
(Current as of XXX)
PREAMBLE
These bylaws are intended to be read in conjunction with the FDA Articles of Incorporation, the
FDA Workgroups Manual and other procedural manuals adopted by the FDA. No conflicts
between the Articles, Bylaws and Workgroups Manual are believed to exist; however, if a
conflict does exist between the Articles and the Bylaws, the Articles control; if a conflict exists
between the Manual and the Bylaws, the Bylaws control. In order to understand fully the FDA
procedures and policies all three documents must be read together as one.
CHAPTER I. MEMBERSHIP
SECTION 10. CLASSIFICATION
Florida Dental Association (“FDA”) members are voting or nonvoting. The Membership
Manual governs membership categories, good standing, dues, assessments, waivers and
discounts.
SECTION 20. VOTING MEMBERS
Active, privileged, retired and life members are voting members.
SECTION 30. NONVOTING MEMBERS
Applicants, dual, dental student, honorary and associate members are nonvoting members,
except where it is specified that certain dental students can vote in the FDA House of Delegates.
SECTION 40. RIGHTS OF VOTING MEMBERS
Voting members have the right to:
A. a membership card;
Page 69
Exhibit HOD-15(B)(2)
Page 3 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
B. eligibility for election, appointment or admission to the FDA House of Delegates
(“HOD”), Board of Trustees (“BOT”) and other FDA offices, councils, committees, or
similar positions as governed by the FDA Workgroups Manual;
C. FDA official publications; and
D. other rights as the BOT or HOD determines.
SECTION 50. RIGHTS OF NONVOTING MEMBERS
Nonvoting members shall be entitled to:
A. a membership card;
B. admission to any FDA HOD session;
C. FDA official publications; and
D. other rights as the BOT or HOD determines.
SECTION 60. DISCIPLINE
The FDA Code of Ethics governs professional conduct of all members. The FDA Ethics Manual
governs discipline and disciplinary procedures.
SECTION 70. MEETINGS
There shall be two general meetings of the FDA each year, at which will be scheduled the annual
and semi-annual sessions of the HOD and other activities as directed by the HOD or BOT. The
general meeting in June shall be known as the annual session of the FDA and the one in January
as the semi-annual session. The time and place of each session of the FDA will be determined
by the BOT as far in advance as possible, but no later than the time of the previous session. The
secretary of the House shall notice the time and place of sessions. A scientific session will be
conducted each year for the purpose of presenting scientific, technical, and educational
information designed to encourage advancement of the art and science of dentistry and educate
members of the dental profession. The BOT may schedule additional scientific sessions.
CHAPTER II. COMPONENT DENTAL ASSOCIATIONS
SECTION 10. DEFINITION
Component dental associations (“components”) consist of all FDA voting members in their
territory.
SECTION 20. NAME & TERRITORY
The FDA charters components by recognizing them in these Bylaws. All component
communications must include “a component of the Florida and American Dental Associations”
next to the component’s name. The following counties comprise each component’s territory and
are hereby chartered:
A. Northwest: Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson,
Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton, Washington.
B. Northeast: Baker, Bradford, Clay, Columbia, Dixie, Duval, Hamilton, Lafayette,
Madison, Nassau, Putnam, St. Johns, Suwannee, Taylor, Union.
C. Central Florida: Alachua, Brevard, Flagler, Gilchrist, Lake, Levy, Marion, Orange,
Osceola, Seminole, Sumter, Volusia.
Page 70
Exhibit HOD-15(B)(2)
Page 4 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
D. Atlantic Coast: Broward (north of the south New River canal extension of the Dania
cutoff canal), Indian River, Martin, Okeechobee, Palm Beach, St. Lucie.
E. South Florida: Broward (south of the south New River canal extension of the Dania
cutoff canal), Dade, Monroe.
F. West Coast: Charlotte, Citrus, Collier, DeSoto, Glades, Hardee, Hendry, Hernando,
Highlands, Hillsborough, Lee, Manatee, Pasco, Pinellas, Polk, Sarasota.
SECTION 30. SUSPENSION & REVOCATION OF CHARTER
A component’s charter may be suspended only after the HOD concludes by two-thirds
affirmative vote that the component has violated the FDA’s Articles of Incorporation or Bylaws.
Upon such a finding, the HOD must give the component notice of the specific violation and one
year within which to correct it. At the expiration of the year, if the HOD again concludes by
two-thirds affirmative vote that the violation has not been corrected, the component’s charter will
stand revoked.
SECTION 40. REDISTRICTING
The FDA shall review redistricting of components at least every three years. Redistricting must
occur when a component’s membership exceeds 34 percent of the FDA’s total membership.
SECTION 50. RIGHTS AND DUTIES
Each component has the right or duty to:
A. adopt, maintain and file with the FDA current articles of incorporation and bylaws that
do not conflict with the FDA’s;
B. discipline members as governed by the FDA Ethics Manual;
C. hold an annual business session;
E. assess component dues to be collected by the FDA and remitted annually to the
component;
F. elect delegates and alternate delegates to the HOD;
G. elect trustees and alternate trustees up to a maximum of two trustees and two
alternates from each component, based proportionately on one trustee per 500 voting
members or fraction thereof in the component;
H. appoint one member to serve on each FDA council;
I. appoint one delegate and one alternate delegate to the American Dental Association’s
(“ADA”) HOD;
J. determine the number of FDA members required to comprise an affiliate dental
association (“affiliate”) and charter affiliates as governed by these bylaws.
CHAPTER III. AFFILIATE DENTAL ASSOCIATIONS
SECTION 10. DEFINITION
An affiliate must be chartered by a component and consists of all FDA members in the affiliate’s
territory.
SECTION 20. RIGHTS AND DUTIES
Each affiliate has the right or duty to:
Page 71
Exhibit HOD-15(B)(2)
Page 5 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
A. adopt, maintain and file with the component current organizational rules (for
unincorporated affiliates) or articles and bylaws (for incorporated affiliates) that do not
conflict with the component’s;
B. assess affiliate dues collected by the affiliate or the component.
CHAPTER IV. GOVERNMENT
SECTION 10. QUORUM
A minimum of sixty-nine (69) delegates (i.e. a minimum of two-thirds of 103 delegates)
constitutes a HOD quorum. A majority of voting members constitutes a quorum for all other
FDA Workgroups.
SECTION 20. VOTING
A majority vote decides all questions coming before all FDA Workgroups, unless otherwise
required by Florida law, the FDA Articles of Incorporation, or these Bylaws. The President
normally abstains but may vote or abstain in order to pass or defeat a motion (i.e., only when the
vote count is evenly divided).
SECTION 30. PARLIAMENTARY AUTHORITY
The Standard Code of Parliamentary Procedure used by the American Institute of Parliamentary
Procedure governs the FDA in all applicable cases unless otherwise required by Florida law, the
FDA Articles of Incorporation, these Bylaws, or any manual referenced herein.
CHAPTER V. HOUSE OF DELEGATES
SECTION 10. RIGHTS & DUTIES
The HOD is the FDA’s legislative body, vested with full power to determine all policies that
govern the FDA in all its activities, subject only to applicable laws and the FDA Articles of
Incorporation and Bylaws. The HOD may create, amend, repeal or suspend:
A. the FDA’s Articles of Incorporation and Bylaws;
B. the FDA Code of Ethics;
C. component charters;
D. HOD councils, sub-councils, committees and sub-committees;
E. memorials, resolutions or opinions issued in the FDA’s name.
SECTION 20. REPRESENTATION
The HOD has 103 certified delegates: 100 delegates from the components and one student
delegate from each of the three accredited Florida dental schools. FDA line-officers and trustees
may not be delegates or alternates to the FDA HOD.
The FDA allocates the number of delegates and alternates available to each component
proportionate to its number of voting members as of March 31 (author’s note: this will change to
December 31 if the June 2015 House of Delegates adopts a separate pending resolution) of the
previous fiscal year using the “Method of Least Proportionate Error.” Components annually
elect delegates and alternates to the HOD for one-year terms with no consecutive or cumulative
Page 72
Exhibit HOD-15(B)(2)
Page 6 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
limit on the number of terms they may serve. The American Student Dental Association
(ASDA) chapters for each of the three accredited Florida dental schools annually elect one
delegate and alternate to the HOD for one-year terms.
Components and ASDA chapters identify their delegates and alternates to the FDA at least 60
days before the annual (June) HOD session. Delegates and alternates assume office upon
adjournment of the annual session of the HOD at which their election is confirmed by the HOD.
They start their terms at the semi-annual (January) session of the House of Delegates. The
student delegate and alternate from each school rotate together through the component dental
associations as set forth in the HOD Manual.
To be eligible for election and confirmation, delegates and alternates to the FDA House of
Delegates must be voting members of the FDA and the component represented or members of
the ASDA chapter at the school they represent. Alternates vote only when their respective
delegate is absent (i.e., not physically present at the time of the vote).
SECTION 30. SPEAKER OF THE HOD (“SPEAKER”)
The Speaker:
A. plans and presides over all HOD meetings in a fair, objective and impartial fashion as a
parliamentarian and not as an advocate of causes or a representative of any group (i.e.,
the Speaker has no vote);
B. serves as ex officio (without vote) parliamentarian of the Board of Trustees;
C. performs such other duties as governed by the HOD Manual.
A. QUALIFICATIONS
Each candidate for Speaker must be an FDA member who has completed at least one course or
practicum on parliamentary procedure provided by the American Institute of Parliamentarians.
B. NOMINATIONS
Nominations for Speaker are presented when needed to the HOD session immediately before the
anticipated vacancy. The Leadership Development Committee makes up to three nominations.
Additional nominations are allowed from the HOD floor.
C. TERM OF OFFICE
The Speaker serves a term of two years with a cumulative limit of four terms (eight years), which
may be consecutive.
D. INSTALLATION
Unless re-elected, the Speaker’s term ends at the conclusion of the appropriate annual (June)
HOD session at which time the newly elected Speaker’s term begins.
Page 73
Exhibit HOD-15(B)(2)
Page 7 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
SECTION 40. MEETINGS
A. ANNUAL & SEMI-ANNUAL SESSION
There shall be at least one regularly scheduled HOD annual session and one regularly scheduled
semi-annual HOD session on a day or days the BOT specifies. The Speaker may divide the
annual and semi-annual session into several meetings.
B. SPECIAL SESSIONS
HOD special sessions to consider an item of business without amendment, alteration, or
substitution, may be required by presenting the Speaker with a written petition signed by either
fifteen percent of the voting members of each of four components; seventy-five percent of the
voting members of any one component; or thirty-five or more certified HOD delegates. The
session must be held within thirty (30) days after receipt of the petition and notice of the special
session must occur at least two (2) days before the scheduled date of the session. The petition
must state the business to be considered. Other business may be transacted at the session
following the special order of business.
C. OFFICIAL CALL
The Speaker shall notice the time and place of each HOD session.
CHAPTER VI. BOARD OF TRUSTEES
SECTION 10. RIGHTS AND DUTIES
The BOT is the FDA’s administrative body, vested with full power to conduct all business of the
association. The BOT recommends policies and enacts interim policies when the HOD is not in
session if it deems such policies are necessary to conduct FDA business properly. Policies, but
not procedures, are presented to the HOD for ratification at the next HOD session. BOT duties
include, but are not limited to:
A. selecting future Executive Director(s) according to the procedure governed by the FDA
Workgroups Manual,
B. providing, maintaining and being responsible for all property, real or personal, owned or
held by the FDA including the FDA office facilities;
C. bonding all officers and employees entrusted with such property;
D. establishing the FDA’s fiscal year;
E. causing the FDA’s accounts to be audited annually by a certified public accountant;
F. preparing an itemized budget of the funds necessary to conduct FDA activities for the
upcoming fiscal year;
G. submitting an annual report to the HOD;
H. reviewing the officers’ and councils’ reports and making recommendations to the HOD
about same;
I. providing effective leadership for the FDA;
J. serving as innovators and initiators of FDA activities, policies and positions and
communicating such recommendations to other FDA Workgroups;
K. maintaining continuing surveillance of all FDA activities;
L. adopting procedures intended to ensure a properly functioning FDA;
M. maintaining continuing awareness of the organizational needs of the FDA;
Page 74
Exhibit HOD-15(B)(2)
Page 8 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
N. performing such other duties as prescribed by Florida law, the FDA Articles of
Incorporation and Bylaws, HOD mandates, and the FDA Workgroups Manual.
SECTION 20: COMPOSITION
The BOT consists of the immediate past president, president, president-elect, first vice president,
second vice president, secretary and a maximum of two trustees and alternates elected from each
FDA-chartered component. Components with more than one trustee must stagger the terms of
their respective trustees. In any given year, those components electing trustee(s) must do so
before the HOD annual (June) session. Except as provided herein, the HOD Speaker, the
treasurer, treasurer-elect and executive director shall be ex officio members of the BOT without
vote.
SECTION 30: TRUSTEE’S ABSENCE OR VACANCY
If a trustee is absent (i.e., not physically present at the time of the vote), then the component’s
alternate serves on the BOT until the trustee returns. If the office of a trustee or alternate is
vacant, then the component shall elect another trustee or alternate to serve for the unexpired
term.
SECTION 40. OFFICERS
The FDA president serves as BOT chair and presides at BOT meetings. The FDA presidentelect serves as vice-chair and presides at BOT meetings when the FDA president is absent (i.e.,
not physically present at the time of the vote). The FDA first vice president serves when the
president-elect is absent. The BOT shall elect a trustee to serve as chair pro-tem when the FDA
president, president-elect, and first vice president are absent.
The FDA secretary records BOT and HOD actions and serves as the FDA’s records-custodian.
The BOT chair will appoint a trustee to serve as secretary pro-tem when the secretary is absent.
SECTION 50. MEETINGS
A. REGULAR MEETINGS
The BOT must have at least one regularly scheduled in-person meeting annually. Between
regularly scheduled meetings, the BOT may have telephone conference calls or meet by
appropriate electronic means. Before the BOT adjourns a meeting, it must announce the date,
time and place of the next regularly scheduled in-person meeting or the arrangements for the
next telephone conference call or electronic meeting.
B. SPECIAL MEETINGS
BOT special meetings may be called by either the president or upon written request to the FDA
office by five or more BOT voting members. The meeting must be held before the issue
becomes moot but in no case later than fifteen (15) days from the president’s instruction or the
receipt of the written request. At least two (2) days before the meeting, notice must be given that
state the business to be considered and the date, time and place (if in-person) of the meeting.
Other business may be transacted at the meeting following the special order of business.
Page 75
Exhibit HOD-15(B)(2)
Page 9 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
C. BALLOTING
Actions taken by a majority of the BOT voting members by authenticated ballot (including ballot
by voice roll call, U.S. mail, e-mail or facsimile) are binding and effective as if such actions were
taken at an in-person BOT meeting; provided, however, that a BOT voting member may
challenge the validity of a voice roll call, U.S. mail, e-mail or facsimile ballot on the grounds that
insufficient information is available to ensure proper consideration of the question. If the issue is
subsequently corrected to the satisfaction of the challenger, the challenge may be withdrawn and
the vote taken. Otherwise, the question must be postponed until the next BOT in-person meeting.
The act of a majority of the voting members present at a meeting at which a quorum is present
shall be the act of the BOT unless the act of a greater number is required by law or by these
Bylaws. Any action required or permitted to be taken at a BOT meeting may be taken without a
meeting if a written consent, setting forth the action to be taken, is signed by all the BOT voting
members. Such consent shall have the same force and effect as a unanimous vote of the BOT.
D. COMPENSATION
BOT members do not receive stated salaries for their service; but by HOD resolution may be
reimbursed for reasonable expenses incurred in pursuing the interests of the FDA according to
policies approved by the BOT. The FDA may not loan money or property to or guarantee the
obligations of any BOT member.
E. RESIGNATION
Any BOT member may resign at any time by giving written notice to the President or to the
Immediate Past President. The resignation of any BOT member shall take effect upon receipt of
notice thereof or at such later time as shall be specified in such notice. Unless otherwise
specified therein, the acceptance of such resignation is unnecessary to make it effective.
CHAPTER VII. OFFICERS
SECTION 10. ELECTIVE OFFICERS
A. COMPOSITION
The elective officers of the FDA shall be the president, president-elect, first vice president,
second vice president, secretary, treasurer, treasurer-elect, immediate past president, and a
maximum of two trustees elected from each component dental association, as set forth in these
bylaws.
B. QUALIFICATIONS
1. Candidates for president-elect, first vice president, second vice president, secretary, treasurer
and treasurer-elect must be voting members of the FDA, a component, and meet other
qualifications (if any) stated in these Bylaws.
2. Candidate for trustee must be voting members of the FDA and the component represented.
C. TERMS
1. The president-elect, first vice president, second vice president and secretary are elected for
one-year terms or until their successors are elected.
Page 76
Exhibit HOD-15(B)(2)
Page 10 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
2. The president-elect, upon completion of his or her term, becomes president without election
for a one-year term.
3. The president, upon completion of his or her term, becomes immediate past president without
election for a one-year term.
4. Trustees serve two-year terms. Components may limit the number of consecutive terms of
their trustees. Components determine terms of their alternate trustees.
5. The treasurer serves a two-year term with a cumulative limit of three terms (six years), which
may be consecutive, or until a successor is elected.
6. A treasurer-elect serves a one-year term concurrent with the treasurer’s last year. The office
of treasurer-elect remains unfilled unless the treasurer indicates he or she is unable or unwilling
to serve an additional term but expects to complete his or her last year in office. The treasurerelect, upon completion of his or her initial one-year term, becomes treasurer without election.
The treasurer-elect assures continuity in FDA financial matters.
D. NOMINATIONS, ELECTIONS & INSTALLATION
1. The BOT nominates candidates to fill upcoming vacancies in the offices of president-elect,
first vice-president, second vice-president, and secretary. The HOD may make additional
nominations except for the component-nominated secretary position. Election for these officers
occurs at the HOD annual (June) session.
2. Nominations for secretary rotate annually in series among the components. The president of
the component whose turn it is to nominate a secretary submits the nomination to the BOT at
least forty-five days before the BOT meeting immediately preceding the HOD annual (June)
session where the BOT nominates officers. Only the component whose turn it is to nominate a
secretary may make additional nominations from the HOD floor.
3. Nominations for treasurer are presented when needed to the HOD semi-annual (January)
session immediately before the anticipated vacancy. The LDC makes up to three nominations.
The HOD may make additional nominations. The election occurs at the HOD semi-annual
(January) session immediately preceding the end of the current treasurer’s term in office.
4. Nominations for the office of treasurer-elect are presented only when the current treasurer has
indicated that he or she is unable or unwilling to seek another term. The LDC makes up to three
nominations. The HOD may make additional nominations. The election occurs at the HOD
session immediately preceding the commencement of the current treasurer’s final year in office.
If a treasurer-elect is elected, no election for treasurer shall be held and the treasurer-elect will
automatically assume the office of treasurer when the term of the current treasurer ends.
5. The secretary presents a slate of officers (i.e., president-elect, first vice-president, second vicepresident) and other BOT, LDC and HOD nominees (if any), along with each nominee’s
qualifications, to the HOD at least twenty-one days before the session where the election is to be
held. The HOD may always make additional nominations from the floor except for secretary.
6. If called for by a certified delegate, HOD voting for officers may be by written anonymous or
electronic ballot. The President normally abstains but may vote or abstain in order to pass or
defeat a motion (i.e., only when the vote count is evenly divided). If no candidate in any
election gets a majority of all votes cast, then a run-off election is held between the two
candidates who received the greatest number of votes.
7. Elective officers assume office upon adjournment of the HOD session where they were
elected.
Page 77
Exhibit HOD-15(B)(2)
Page 11 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
E. VACANCIES
1. President - If the president’s office is vacant, then the president-elect serves as president for
the unexpired term and for the full term immediately following.
2. President-elect - If the president-elect’s office is vacant, then the first vice president serves the
unexpired term and for the full term immediately following.
3. President and President-elect - If both the offices of president and president-elect are vacant,
then the first vice president serves as president for the unexpired term and for the full term
immediately following.
4. First vice president - If the first vice president fills an unexpired term of the president-elect,
then the former president-elect’s component nominates a voting member from that component to
fill the unexpired term of the first vice president, subject to BOT approval. If the first vice
president’s office is vacant, then the former first vice president’s component nominates a voting
member from that component to fill the unexpired term of the first vice president, subject to
BOT approval.
5. Second vice president – If the second vice president’s office is vacant, then the former second
vice president’s component nominates a voting member from that component to fill the
unexpired term of the second vice president, subject to BOT approval.
6. Secretary – If the secretary’s office is vacant, then the former secretary’s component
nominates a voting member from that component to fill the unexpired term of the secretary,
subject to BOT approval.
7. Trustee, treasurer and treasurer-elect – Vacancies in these offices are filled as set forth
elsewhere in these Bylaws.
F. REMOVAL FROM OFFICE
Any elective officer or trustee found guilty of malfeasance by the HOD or BOT while in office
shall be removed from office. Any twenty (20) voting members of the FDA may submit a written
complaint with substantiating evidence to the executive director of the FDA. The BOT shall
appoint a committee from its members to investigate the charge and report back to the BOT in
executive session. A two-thirds (2/3) affirmative vote of the BOT shall be required to uphold the
charge and immediately suspend the individual from the rights and responsibilities of his or her
office or position within the FDA. Upon suspension, the office is deemed to be temporarily
vacant and the individual suspended is no longer authorized to act on behalf of the FDA. If an
officer or trustee is suspended from office by the BOT, then the charge, the BOT committee’s
report, and recommended adjudication shall be presented to the HOD at its next regularly
scheduled session unless a special session is called to determine if the officer or trustee shall be
reinstated or permanently removed from office. During the suspension of duty of an officer or
trustee and before final adjudication of the matter, the Bylaws regarding vacancies apply. If the
accused officer or trustee is reinstated, then the vacancy in his or her position shall be deemed to
no longer exist and all offices affected by the vacant office provisions in these bylaws shall be
re-occupied by those individuals who occupied such positions before the suspension occurred.
Whether a component may remove a trustee previously appointed by the component will be
determined as governed by the component’s bylaws or procedures.
Page 78
Exhibit HOD-15(B)(2)
Page 12 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
G. DUTIES
Elective officers have authority to perform duties prescribed by the BOT as governed by the
FDA Workgroups Manual.
H. EVALUATIONS
The BOT, by majority vote of those present and voting after a quorum has been established, and
in consultation with LDC, may undertake periodic performance evaluations of the treasurer
and/or treasurer-elect.
SECTION 20. APPOINTIVE OFFICERS
A. COMPOSITION
The FDA appointive officers are the editor and the executive director and such others needed to
conduct FDA affairs properly.
B. QUALIFICATIONS
Qualifications for appointive officers other than the executive director shall be determined by the
BOT in consultation with LDC. Qualifications for executive director(s) are governed by the FDA
Workgroups Manual.
C. TERMS
The editor serves a two-year term with no cumulative or consecutive limits. The executive
director serves as determined by majority vote of BOT members present and voting after a
quorum has been established.
D. NOMINATIONS & APPOINTMENTS
The editor is appointed annually, by BOT majority vote at its final in-person meeting before the
HOD’s annual (June) session. LDC nominates up to three members to serve as editor.
Additional nominations for the office of editor may be made by any BOT member. The
appointed editor takes office immediately following the close of the HOD’s annual (June)
session.
The executive director is appointed by BOT majority vote and takes office as governed by the
FDA Workgroups Manual.
E. VACANCIES
Vacancies in appointive offices are filled so that the unfinished term is completed as they occur
by BOT majority vote.
F. DUTIES AND AUTHORITY
Appointive officers have authority to perform duties prescribed by the BOT as governed by the
FDA Workgroups Manual.
Page 79
Exhibit HOD-15(B)(2)
Page 13 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
G. EVALUATIONS
The BOT, by majority vote of those present and voting after a quorum has been established, may
authorize periodic critiques of association publications and performance appraisals of appointive
officers.
CHAPTER VIII: AUDIT COMMITTEE
The Audit Committee is responsible for the planning and review of the FDA’s and related
entities’ CPA audit, CPA audited financial statements, internal accounting controls and
accounting procedures and policies, review and recommendation of audit and tax proposal
engagement agreements for presentation to the BOT.
The Audit Committee consists of a general chair, who is the current FDA Treasurer, two “atlarge” members, and two other FDA members appointed by the FDA President and approved by
the BOT. The current Treasurer-elect, when applicable, will automatically serve as a non-voting
member of the Audit Committee. The general chair of the Audit Committee shall serve for a
term congruent with their term as FDA Treasurer. The term of the other two members of the
Audit Committee shall be designated by the BOT for a term of two (2) years in duration subject
to a maximum number of two (2) consecutive terms plus, when applicable, service in fulfillment
of a predecessor’s unexpired term on the same committee. Training and experience prerequisites
for serving on the Audit Committee may be established by the HOD. The Treasurer as general
chair shall also serve as liaison to the BOT. The two “at-large” members of the Audit Committee
shall be appointed based on their expertise and knowledge of non-profit association audits,
internal accounting controls and accounting procedures and policies via their education,
experience or membership of one of the following types of service to organized dentistry in
Florida:
• FDA or related FDA-entity (FDA Services, Florida Dental Health Foundation or
FLADPAC) current or recent past (within the past six years) Treasurer;
• Component of the FDA current or recent past (within the past six years) Treasurer;
• Past officer of the Florida Dental Association; and
• Past member within the last six years of the FDA Council on Financial Affairs.
One or more consultants may be appointed to assist the committee in, among other matters,
evaluating CPA firms’ audit and tax engagement proposals, the results of the fiscal year audit
results, internal accounting control matters that effect the Association’s financial statements and
assets. No current component representative on the Council on Financial Affairs may serve as a
voting member, consultant or general chair of the Audit Committee.
CHAPTER IX.
OTHER FDA WORKGROUPS
The FDA hereby designates and authorizes councils, committees, liaisons and other work groups
as governed by the FDA Workgroups Manual. The FDA Workgroups Manual governs
appointment of BOT and/or HOD liaisons to FDA Workgroups.
Page 80
Exhibit HOD-15(B)(2)
Page 14 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
CHAPTER X. DELEGATION TO THE HOD OF THE AMERICAN DENTAL
ASSOCIATION AND ADA DISTRICT TRUSTEE
SECTION 10. REPRESENTATION TO ADA HOD
The representatives of the FDA to the HOD of the American Dental Association (referred to in
this chapter as “delegation”) shall consist of voting members of the FDA who are selected to
serve as delegates and alternate delegates. ADA delegation members are selected by and have
authority to perform duties as governed by the delegation manual.
SECTION 20. DELEGATION MANUAL
The delegation may establish operating procedures to govern its effectiveness and establish
rights and duties of its officers and members provided such procedures are approved by the HOD
and are not otherwise in conflict with these bylaws.
CHAPTER XI. INDEMNIFICATION AND NON-DISCRIMINATION
The FDA shall indemnify and hold harmless each association trustee, officer, council member,
committee member, staff member, component and affiliate officer, and those members of the
association acting in an official capacity on behalf of the association from and against any and all
claims and liabilities to which they may be or become subject by any reason of acting in their
official or representative capacity of the FDA, or any reason of alleged acts, or omissions as an
officer, or representative member, or employee as aforesaid, and shall reimburse each person
defined herein for all legal and other expenses reasonably incurred in connection with defending
against any such claims or liabilities, provided, however, that no person as defined shall be
indemnified against or reimbursed for any expenses incurred because of willful misconduct. The
foregoing rights shall not be exclusive of any rights to which said persons may be lawfully
entitled.
The officers, directors, committee members, employees and persons served by this Association
shall be selected entirely on a nondiscriminatory basis with respect to age, sex, race, religion,
national origin and sexual orientation.
CHAPTER XII. AMENDMENTS
The bylaws and the Code of Ethics of the FDA may be amended, altered, adopted, or rescinded
as follows:
A. by a two-thirds affirmative vote of the members of the HOD present and voting at any
session of the HOD, provided the proposed alterations, amendments, or revisions are
posted on the members-only side of the FDA’s main website and that an e-mail blast to
all members for whom the association has e-mail addresses is done at least 30 days in
advance of that session of the HOD; or
B. at any session of the HOD by a three-fourths affirmative vote of the members present
and voting, provided the proposed alterations, amendments, or revisions shall have been
presented in writing at a previous meeting of the session and provided that unanimous
consent has been obtained for their consideration.
Page 81
Exhibit HOD-15(B)(2)
Page 15 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
CHAPTER XIII. FINANCIAL MATTERS
SECTION A. AUTHORIZATION
The BOT may authorize any officer or officers, agent or agents, of the FDA, in addition to the
officers so authorized by these Bylaws, to enter into any contract or execute and deliver any
instrument in the name of and on behalf of the FDA; and such authority may be general or
confined to specific instances.
SECTION B. LOANS
No loans shall be contracted on behalf of the FDA and no evidences of indebtedness shall be
issued in its name unless authorized by a BOT resolution. Such authority may be general or
confined to specific instances.
SECTION C. CHECKS, DRAFTS, OR ORDERS FOR PAYMENT
All checks, drafts, or orders for payment of money, notes, or other evidences of indebtedness
issued in the name of the FDA shall be signed by such officer or officers, agent or agents, of the
FDA and in such manner as shall from time to time be determined by BOT resolution. In the
absence of such determination by the BOT, such instruments shall be signed by the FDA
Executive Director.
SECTION D. DEPOSITS
All FDA funds must be deposited from time to time to the credit of the FDA in such banks, trust
companies, or other depositories as the BOT selects.
SECTION E. GIFTS
The BOT may accept on behalf of the FDA any contribution, gift, bequest, or devise for the
general purposes, or for any special purpose, of the FDA. Similarly, the BOT may reject any
contribution, gift, bequest or devise that the BOT determines is not in the FDA’s best interest.
SECTION F. FISCAL AGENTS
The FDA may designate such fiscal agents, investment advisors and custodians as the BOT
selects by resolution. The BOT may at any time, with or without cause, discontinue the use of
the services of any such fiscal agent, investment advisor, or custodian.
SECTION G. DISSOLUTION
No part of net income, revenue, and grants of the FDA shall inure to the benefit of any member,
officer or any individual except that reasonable compensation may be paid for services rendered.
No members, officers or individuals shall be entitled to share in the distribution of any part of the
assets of the FDA on its dissolution or liquidation. In the event of such dissolution or liquidation,
the assets of the FDA, after payments of debts and obligations, shall be transferred to an
organization with federal tax exemptions for charitable and educational purposes similar to those
of the FDA; which exempt organization shall be designated by the final BOT resolution.
PROPOSED DRAFT
FLORIDA DENTAL ASSOCIATION
Page 82
Exhibit HOD-15(B)(2)
Page 16 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
WORKGROUPS’ MANUAL
This manual applies to Florida Dental Association (“FDA”) councils, committees, sub-councils,
sub-committees, and task groups (collectively referred to as “Workgroups”). Procedures for the
FDA Board of Trustees (“BOT”) and House of Delegates (“HOD”) are found in their respective
manuals or the Bylaws. The Articles of Incorporation, the Bylaws and this Workgroups Manual
are to be read together and considered as one document. If the Articles contradict the Bylaws or
this Manual, the Articles control. If the Bylaws conflict with this Manual, then the Bylaws
control.
I. Definitions
A. Councils are:
1. Established by the HOD, and
2. Exist until the HOD terminates them, and
3. Develop recommended changes in FDA policy for the BOT and HOD to act upon, and
4. Have their duties and responsibilities listed in the HOD-enabling resolution, and
5. Are organized so as to enable and maintain expertise in a related group of subjects, and
6. Make recommendations to the BOT and HOD on how to implement the FDA strategic plan,
and
7. Have one voting member from each component (unless the component can’t find a volunteer,
in which case the FDA President may appoint a council member from any component) and one
non-voting liaison to the BOT, and
8. May appoint however many non-voting consultants as needed to accomplish its goals, and
currently consist of the:
9a. Council on Dental Care and Health – focuses on accessibility and availability of dental care,
infection control, disposal of biomedical waste, and dental office workplace hazards; and
promotes quality dental benefit plans based on direct assignment and direct reimbursement
concepts;
9b. Council on Communications – improves internal and external FDA communications;
evaluates the effectiveness of FDA publications in coordination with the editor; recommends
advertising guidelines for FDA publications; develops programs to improve the public’s
perception of organized dentistry; coordinates the association’s Media Contact Dentists and
Spokespersons programs; monitors marketing programs; and chooses Media Awards recipients;
9c. Council on Dental Education and Licensure -- oversee issues associated with dental
education, licensure, dental accreditation; Childrens’ Dental Health Month; Project SELECT to
attract secondary and nontraditional education students to the allied dental health professions; the
FDA’s student loan program; monitor continuing education programs provided for dentists and
allied dental personnel; monitor Commission on Dental Accreditation issues; evaluate trends in
professional licensure (including faculty and student permitting); and recommend changes in
FDA policy relative to such trends;
9d. Council on Financial Affairs -- oversees budget development, budgetary performance,
corporate affiliation program, unrelated business income tax strategies, and investment policies
and practices; develop an annual FDA budget; reviews proposed budgets for closely affiliated
companies; monitors budgetary performance;
Page 83
Exhibit HOD-15(B)(2)
Page 17 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
9e. Council on New Dentist -- responsible for developing recommendations relating to the
circumstances and special needs of newer dentists and to bring the new dentist perspective to
FDA programs, services and leadership.
9f. Council on Ethics, Bylaws & Judicial Affairs -- maintains and enforces the Code of Ethics;
the patient relations peer review program; ensures the FDA’s Articles of Incorporation, Bylaws
and Manuals are correctly drafted and procedurally correct; and advises the HOD on potential
conflicts with association policies, procedures and bylaws.
B. Standing sub-councils are:
1. Established by the HOD and funded by the FDA with due regard to longevity, pertinence,
subject overlap, component representation, expertise and expense;
2. To work under the direction of, and report to a council, and
3. Exist until the HOD terminates them.
C. Committees are:
1. Created by the BOT or HOD, and
2a. Are designated by the creating agency as either standing (they exist until the creating agency
terminates them) or
2b. As ad hoc (they automatically terminate upon completion of their charge), and
3a. Either investigate matters affecting the association or its members or
3b. Administer a project, program or event where there is little need for direct oversight or
policy interpretation, and
4. generally consist of six voting members, one from each component, and
5. Currently include
5a. Committee on Conventions and Continuing Education – a standing committee that has 13
members as follows: 2 from each component, approved by the BOT; and 1 BOT-appointed
general chair; all members vote; responsible for planning, managing, evaluating, and improving
the FDA’s scientific programs and other membership activities held annually at the general
membership meeting; planning and coordinating all aspects of the annual meeting including
professional education, exhibits, entertainment and local arrangements; coordinating FDA
agency business meetings, hotel relations, registration, and other special events and programs
associated with the general meeting or scientific session.
5b. Governmental Action Committee – a standing committee that has 10 members as follows: 1
from each component; the FDA president; the FDA president-elect; the FDA immediate pastpresident; the FDA’s chief liaison to the Board of Dentistry who is appointed by the president
and approved by the Board of Trustees; all members vote except for the FDA president who only
votes in the case of a tie; responsible for FDA governmental-relations activities; monitoring and
directing FDA activities and positions on matters affecting the dental profession and the dental
health of the public in Florida in between sessions of the House of Delegates and Board of
Trustees; developing and coordinating a viable contact dentists program; communicating with
the ADA Washington office on any state action needed to support or oppose federal legislation
effecting dentistry; communicating with FDA political action committees and the FDA Alliance.
5c. Leadership Development Committee -- a standing committee that has 6 members as follows:
1 from each component; and 1 BOT-appointed general chair who serves for a term of 2 years
subject to a maximum number of 2 consecutive terms plus, when applicable, service in
fulfillment of a predecessor’s unexpired term; all members vote except for the general chair who
only votes in case of a tie; responsible for the FDA Leadership Development Institute; criteria
for soliciting, confidentially evaluating, and nominating up to 3 candidates each for the offices of
Page 84
Exhibit HOD-15(B)(2)
Page 18 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
Speaker of the House, Treasurer and Treasurer-elect (when needed) for election at the semiannual session of the HOD immediately prior to the commencement of their terms; nominating
up to 3 candidates for Editor for appointment by the BOT at its spring meeting before the HOD
annual session; developing and enforcing criteria to govern campaigns for these offices; plays no
role in soliciting, determining the qualifications of, and evaluating candidates for future
replacement executive directors.
5d. Political action committees – standing or ad hoc as designated; authorized under Florida or
federal law; composition determined by each such committee’s bylaws.
5e. Audit Committee – a standing committee set forth and governed by the FDA Bylaws;
responsible for FDA financial audits.
5f. Executive Director Review Committee -- a BOT standing committee chaired by the FDA
president (who has the right to vote) consisting of all FDA line-officers, the FDA Treasurer and
Treasurer-elect (if any) as non-voting consultants, and up to 2 consultants without vote to be
appointed by the FDA President with approval from the BOT from former line officers or BOT
members with experience in managing the executive director; exclusively responsible for
reviewing the executive director’s performance and making annual recommendations to the
BOT;
5g. Future Replacement Executive Director Committee (if created) -- an ad hoc committee of
the BOT that, if created, consists of six trustees (one from each component), one member dentist
representative of the Florida Dental Health Foundation, one representative of FDA Services, one
representative of the HOD, the then current chair of the Leadership Development Committee (or
his or her designee), and an FDA voting member appointed by the then current FDA President;
committee chair is the then current FDA President (or his or her designee), who shall vote only
in case of a tie; solely responsible for soliciting, determining the qualifications of, and evaluating
candidates for future replacement executive directors.
D. Task Groups are:
1. Formed by and report to the BOT, and
2. Serve on an ad-hoc, short-term basis to address a particular issue, and
3. Automatically expire when they have served their function, and
4. Generally consist of a chair who is a member of the BOT and 2 additional members from
different components if possible selected by the task group chair based on expertise in the
specific area from inside or outside the BOT; all 3 members vote.
II. Meetings
A. General Rules. Workgroups meet only as necessary and as funded to accomplish in a timely
manner their assigned projects and programs. Chairs and liaisons are expected to report at
regular intervals to their parent agency. Councils are responsible for making recommendations
and resolutions as needed for submission to the BOT and HOD. Workgroups other than the BOT
and HOD generally confine their activities to their assigned subject areas so as to minimize
overlap with other Workgroups and function within such strategic guidelines as established.
B. Do’s and Don’ts. Agency members, consultants and liaisons should:
1. Do keep up with FDA resources assigned to their agency and use them in a fiscally
responsible manner.
2. Do keep informed about FDA policies, procedures, goals, objectives, and strategies that
pertain to their agency.
3. Do act with diligent care and unbiased judgment when acting on behalf of their agency.
Page 85
Exhibit HOD-15(B)(2)
Page 19 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
4. Do promptly and fully disclose to the agency’s chair any possible conflict pertaining to an
ownership, contractual, financial, or fiduciary interest.
5. Do not unilaterally designate another dentist to serve in an official capacity as an
informational resource, association representative, or “contact dentist” for their agency. All
agency members, consultants, liaisons, and representatives must be selected and supervised as
governed by the FDA Bylaws and this manual
6. Do not publish information, organize or attend a meeting to facilitate collective conduct such
as price-fixing, market allocation, or boycott.
7. Do not survey dentists pertaining to participation levels in insurance programs or managed
care organizations.
8. Do not appoint a single individual to collectively provide information to or negotiate and
bargain with payers.
9. Do not sign letters or sponsor petitions that interfere with potential or actual competitors.
10. Do not meet as an agency unless it has been authorized by the chair, properly noticed, an
agenda is prepared, and at least one FDA staff member is in attendance (by telephone or in
person); however, the Executive Director Review Committee may meet without staff.
C. Location. The agency chair and assigned staff determine time and place based on funding
and suitability of telephone conference calls.
D. Notice. FDA staff sends meeting notices to all members and consultants, the BOT liaison,
the FDA president and the component executive directors. When possible, FDA staff will send
meeting notices 30 days before the meeting.
E. Agenda. FDA staff and the agency chair prepare the agenda and send it to those who get
notice of the meeting. All agendas include the following: Call to order; Notice of Confidentiality
(when applicable); Legal Compliance Statement; Adoption of agenda; Consent agenda; Minutes
of last meeting; Date of next meeting; and Adjournment.
F. Reimbursement. Agency members and consultants eligible for FDA reimbursement should
submit the official FDA reimbursement form with receipts as soon as possible after attending the
meeting. No reimbursement will be made if the form and receipts pertain to a fiscal year other
than the current one.
G. Minutes. FDA staff prepares official minutes for all agency meetings. As soon as possible
after the meeting, minutes are sent to those who got notice of the meeting. Minutes include the
following: name of the agency and chair; the meeting’s time, date and location (or conference
call); members, consultants, liaisons and visitors who were present and absent; time of the call to
order; all agenda items discussed (including any additional items added at the meeting) followed
by the agency action taken (if any); resolutions adopted or defeated; time and date of
adjournment. Minutes convey the primary issues discussed from a broad perspective but
generally not include reference to individual comments or matters discussed in executive session.
If a disagreement exists over the accuracy of minutes relating to a matter, the matter shall be
treated as if no action was taken and staff shall advise the agency of the need to readdress the
matter as quickly as possible. The minutes are officially approved at the next meeting of the
agency and become part of the FDA’s official records.
H. Absences. Members missing two consecutive meetings without being excused by the chair
are removed from the respective agency and their position becomes vacant. If an agency
member cannot attend a meeting, he or she should work with the component to find a temporary
replacement.
Page 86
Exhibit HOD-15(B)(2)
Page 20 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
I. Visitors. Any FDA member who wants to attend an agency meeting should contact the
appropriate chair for approval. Only visitors approved by the chair may attend agency meetings.
J. Voting and quorum. As governed by the FDA Bylaws.
III. Members, Liaisons and Consultants
Voting members of FDA Workgroups must be voting members in good standing with the FDA
at the time of their appointment and throughout their term. The FDA president (except where
this manual states he or she is a voting member) and an FDA staff-person serve as ex-officio
members to Workgroups. Ex-officio members cannot make motions or vote but can discuss and
debate pending motions.
The FDA President-elect, for the year in which he or she serves as president, recommends to the
Board of Trustees for its approval the appointment of one (1) liaison from the Board of Trustees
for each council, sub-council and committee. The BOT liaison is either an officer or a trustee
who serves as a resource to their assigned Workgroups without the right to vote.
FDA Workgroups may request the assistance of one or more non-voting consultants when the
need for special assistance can be demonstrated, such as technical qualifications, dental
specialization, and/or geographical advantages deemed essential to the fulfillment of a specific
task or program. Such requests are made to the president with funding requirements subject to
Board of Trustees’ approval. Specialty consultants, when needed, are solicited through state
specialty societies. Consultants only serve for the duration funded and are ex-officio.
IV. Terms, Term Limits and Chairs
A. Council: terms are 2-years with a maximum of 4 consecutive terms per council. Each
council elects its own chair and vice-chair, with both offices subject to BOT-approval for an
annual term ending at the close of the HOD’s annual (June) session. Council chairs and vicechairs may serve up to three consecutive terms in their position.
B. Sub-council: terms are 2-years with a maximum of 3 consecutive terms per sub-council.
C. Standing committee: terms vary, as follows:
• Committee on Conventions and Continuing Education terms are 3-years with no limit on
the number of terms; chair’s term is 3-years, with a maximum of consecutive terms.
• Governmental Action Committee terms are 1-year with a maximum of 6 consecutive
terms; chair’s term is 1-year tied to the current FDA-president.
• Leadership Development Committee terms are 2-years with a limit of 3 consecutive
terms; chair’s term is 2-years with a limit of 2 consecutive terms.
• Executive Director Review Committee terms are congruent with respective terms as line
officers, the Treasurer and the Treasurer-elect (if any); consultants’ terms are 1-year with
a limit of 2 consecutive terms and 4 cumulative terms plus, when applicable, service in
fulfillment of a predecessor’s unexpired term on the committee.
D. Ad hoc committee: terms, unless otherwise specified in this manual, coincide with that of
the FDA president or president-elect who makes the appointment. Because appointments are
based on expertise, there is no limit on consecutive terms. If an ad hoc committee is formed
before March 31, then the FDA president with BOT approval appoints committee members and
designates one member as chair. If an ad hoc committee is formed after March 31, and not
Page 87
Exhibit HOD-15(B)(2)
Page 21 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
expected to fulfill its charge prior to the close of the HOD’s next annual session, then the
president-elect with BOT approval appoints committee members and designates one member as
chair such that the initial terms of committee members runs through the conclusion of the
president-elect’s upcoming term as president.
E. Task group: terms are ad-hoc, depend on expertise and therefore have no limit on
consecutive terms. Task group chairs’ terms are 1-year with a limit of 2 consecutive terms.
Council, sub-council, committee and task group members may serve additional time if fulfilling
a predecessor’s unexpired term.
V. Appointments
A. Council: Each component nominates 1 of its members to fill council terms that are about to
expire. The FDA President-elect, for the year in which he or she serves as president, appoints
with BOT approval council members from the list of component nominees.
B. Sub-council: Each component nominates 1 of its members to sub-council terms that are
about to expire. The FDA President-elect, for the year in which he or she serves as president,
appoints with BOT approval sub-council members from the list of component nominees.
C. Standing Committee: Appointment process varies as follows:
• Committee on Conventions and Continuing Education. Each component nominates 2 of
its members to committee terms that are about to expire. The BOT appoints committee
members from the list of component nominees.
• Governmental Action Committee. Each component nominates 1 of its members to
committee terms that are about to expire. The president-elect with BOT-approval
appoints committee members from the list of component nominees. Automatic
appointees to the committee include the FDA’s BOD liaison (appointed by FDA
president with BOT approval); the FDA president (chair); FDA president-elect; and FDA
immediate past president.
• Leadership Development Committee. Each component nominates 1 of its members to fill
terms that are about to expire. The FDA President with BOT approval appoints
committee members from the list of component nominees. The BOT appoints the chair.
Automatic ex-officio consultants include a member of the Council on the New Dentist
(appointed by the FDA President) and the BOT liaison.
D. Ad hoc committee: Members and the chair are appointed by, respectively, the FDA
president if created before March 31 or the FDA president-elect if created after March 31.
E. Task group: Chairs must be a voting member of the creating agency and are appointed by
the chair of the parent council or committee. The task group chair appoints up to 2 task group
members based on expertise who may, but are not required to, serve on the parent council or
committee.
VI. Vacancies
A. Council: The FDA president, in consultation with the affected component’s president and
with BOT-approval, appoints a member from that component to fill the vacancy for the
unexpired term. If the council’s chair is vacant, the vice-chair serves the unexpired term. If the
council vice-chair is vacant, then the council holds another election to fill the vice-chair’s
unexpired term.
Page 88
Exhibit HOD-15(B)(2)
Page 22 of 22
1
2
3
4
5
6
7
8
9
10
11
12
13
B. Sub-council: The chair of the parent council appoints another member of the council to fill
the vacancy on the sub-council for the unexpired term. If the sub-council’s chair is vacant the
chair of the parent council appoints another chair.
C. Standing Committee: The FDA president, in consultation with the affected component’s
president and with BOT-approval, appoints a member from that component to fill the vacancy
for the unexpired term. If the committee’s chair is vacant, the FDA president with BOTapproval appoints another chair to fill the unexpired term.
D. Ad Hoc Committee: The FDA president with BOT-approval appoints another member with
subject-matter expertise to fill the unexpired term.
E. Task Group: The FDA president with BOT approval appoints another member to fill the
unexpired term. If the task group’s chair is vacant, the FDA president with BOT approval
appoints another member with subject-matter expertise to fill the unexpired term.
Page 89
Exhibit HOD-15(B)(3)
Page 1 of 3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
DATE:
May 12, 2015
SUBMITTED BY:
Council on Dental Health
COORDINATION OF CARE BY MEDICAL AND DENTAL
PRACTITIONERS FOR PATIENTS AT RISK FOR
MEDICATION-RELATED OSTEONECROSIS OF THE JAW
BOARD OF TRUSTEES RECOMMENDATION: Adopt.
Board vote:
Abstain:
Stevenson
Yes:
Attanasi; Boden; Huot; D’Aiuto, Pranikoff; Kahn (for Antoon); Brown;
Cochran (for Setzer); Ottley (for Jernigan); Liddell; Churney
No:
None
2014H-071
[Procedure] RESOLVED, that the FDA accept and support the American
18
Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper
19
on Medication-Related Osteonecrosis of the Jaw – 2014 Update, and, be it
20
further
21
22
[Procedure] RESOLVED, that the FDA provide pertinent information to
23
the Florida Medical Association (FMA) designed to help inform Florida
24
physicians of the importance and benefit of a dental consultation prior to
25
initiating medications prone to the risk of medication-related osteonecrosis
26
of the jaw (MRONJ), and, be it further
27
28
[Procedure] RESOLVED, that an article (along with supporting
29
documentation) on MRONJ be shared with the FMA to publish in a
30
newsletter sent to their members.
Page 90
Exhibit HOD-15(B)(3)
Page 2 of 3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a clinical condition
characterized by non-vital, non-healing exposed bone within the oral cavity, which has produced
significant morbidity, and has adversely affected the quality of life for so many patients - but yet,
has benefitted from only marginal or, at best, widely varying levels of awareness among those
within the dental and medical professions.
45
The 2014 Position Paper more specifically recommends, for patients about to initiate IV
This has resulted in a lack of effective strategies - not only for the treatment of patients within
our own individual clinical practices - but moreover, for optimal communication and
coordination of care between medical and dental practitioners.
As such, more effective strategies are needed for increasing awareness of this condition among
both dental and medical professionals engaged in the treatment of patients receiving, or who are
about to receive, intravenous (IV) bisphosphonates/antiresorbtive or antiangiogenic medications
for cancer therapy, or antiresorbtive medications for treatment of osteoporosis. Establishing a
protocol for more effective direct communication and planning of care for patients receiving
such therapy similar to previous protocols for patients planned for radiation therapy to the jaws
(and now familiar to most oncologists and dentists) has heretofore been nonexistent for MRONJ.
If such protocols were put into place and followed, it would in turn have the desired effect of
reducing the incidence and severity of the untoward oral complications of MRONJ, as well as the
associated significant morbidity and adverse effects on the quality of life of our patients.
The American Association of Oral and Maxillofacial Surgeons (AAOMS) appointed a Special
Committee of distinguished clinicians with extensive experience in caring for patients with this
condition, in addition to basic science researchers, which set forth opinions and strategies for
management in a Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaws in 2009.
Since 2009, in response to patients receiving newer causative medications outside the
bisphosphonate group, and by appraisal of the most current literature, the prior opinions and
guidelines were revised to reflect current knowledge in this field. As a result, the Special
Committee met in September 2013, and formulated an updated 2014 Position Paper1, 2, which in
addition to changing the name of the condition (from “Bisphosphonate-Related” to “MedicationRelated”), provided guidance to physicians, dentists, dental specialists and patients in making
medical decisions relative to the risk of developing MRONJ, as well as the risks and benefits of
those medications related to osteonecrosis of the jaw (ONJ). The Position Paper also provided
guidance to clinicians regarding diagnosis, as well as preventive measures and management
strategies for patients.
Most important for the purpose of this resolution is the recommendation by the Special
Committee on MRONJ, “…that patients who are about to be prescribed antiresorptive or
antiangiogenic therapy should undergo a thorough oral examination and a radiographic
assessment when indicated in order to identify both acute infection and sites of potential
infection that could be exacerbated once drug therapy begins. The paper cautions that any
decisions relating to drug therapy must be made in conjunction with the treating physician,
dentist and other specialists involved in caring for the patient.”1
Page 91
Exhibit HOD-15(B)(3)
Page 3 of 3
1
2
3
4
5
6
antiresorbtive or antiangiogenic treatment for cancer (clearly representing the more potent and
higher risk group, and more closely paralleling patients about to undergo jaw irradiation), and in
order to reduce the risk of spontaneous ONJ, or far more common, ONJ following dentoalveolar
surgery – “…if systemic conditions permit, initiation of antiresorptive therapy should be delayed
until dental health is optimized. This decision must be made in conjunction with the treating
physician and dentist and other specialists involved in the care of the patient.”2
7
8
9
10
This would include removal of non-restorable teeth or those with a poor prognosis, or any other
necessary dentoalveolar surgery, and delay medical therapy until surgical sites have mucosalized
(14-21 days). Other more specific ongoing dental management strategies are enumerated within
the 2014 Position Paper.
11
12
13
14
15
For patients about to initiate the less potent and lower risk antiresorptive treatment for
osteoporosis, the 2014 Position Paper recommends that, “At the initiation of treatment, patients
should be educated as to the potential risks of MRONJ as the antiresorptive therapy is likely to
exceed beyond 4 years treatment. The importance of optimizing dental health throughout this
treatment period and beyond should be stressed.”
16
References:
17
18
19
20
1. AAOMS position paper renames and expands the scope of Bisphosphonate Related
Osteonecrosis of the Jaw – now Medication Related Osteonecrosis of the Jaw,
AAOMS.org, http://www.aaoms.org/members/news/aaoms-position-paper-renames-andexpands-the-scope-of-bisphosphonate-relate, June 26, 2014.
21
22
2. American Association of Oral and Maxillofacial Surgeons Position Paper: MedicationRelated Osteonecrosis of the Jaw—2014 Update.
23
24
25
26
27
28
STRATEGIC PLAN LINK: This matter relates to Goal 6: Ensure decisions are driven by the
strategic plan.
UNBUDGETED IMPACT: None
REFERENCE COMMITTEE RECOMMENDATION: Pending.
Page 92
AAOMS position paper renames and expands the scope of Bisphosphonat…ow Medication Related Osteonecrosis of the Jaw (MRONJ) | AAOMS.org
2/10/15 8:37 AM
Attachment 1 to HOD-15(B)(3)
2 Pages
AAOMS position paper renames and expands the
scope of Bisphosphonate Related Osteonecrosis of
the Jaw – now Medication Related Osteonecrosis
of the Jaw (MRONJ)
JUNE 26TH, 2014
A new position paper on Medication Related Osteonecrosis of the
Jaw (MRONJ) released today by the American Association of Oral
and Maxillofacial Surgeons expands the scope of the condition
previously referred to as Bisphosphonate-Related Osteonecrosis of
the Jaw (BRONJ) and changes its name to reflect the antiresorptive
(denosumab) and antiangiogenic therapies that have recently been
associated with the condition.
In addition to changing the name of the condition, the MRONJ
position paper provides guidance to:
1. physicians, dentists, dental specialists, and patients in making medical decisions relating to the
risk of developing MRONJ, as well as the risks and benefits of those medications related to
osteonecrosis of the jaw (ONJ);
2. clinicians regarding diagnosis of MRONJ in patients with a history of exposure to antiresorptive
and/or antiangiogenic agents; and to
3. clinicians regarding MRONJ prevention measures and management strategies for patients with
MRONJ, based on their disease stage.
MRONJ appears as a non-healing exposed bone in the mouth and
may affect patients undergoing intravenous cancer-related
therapy, or more rarely, patients treated with oral or IV
bisphosphonates for osteoporosis.
Written by the members of the distinguished AAOMS Special
Committee that prepared previous position papers on BRONJ in
2006 and 2009, the new MRONJ paper contains revisions to
diagnosis, staging, and management strategies, and highlights the
status of current research relating to this condition.
In order to distinguish Medication Related ONJ from other delayed
healing conditions and to address concerns about under-reporting
of the disease, the new position paper redefines the diagnosis
characteristics of MRONJ as follows:
Patients may be considered to have MRONJ if all of the following
characteristics are present:
1. Current or previous treatment with antiresorptive or antiangiogenic agents;
2. Exposed bone or bone that can be probed through an intraoral or extraoral fistula(e) in the
maxillofacial region that has persisted for more than eight weeks; and
3. No history of radiation therapy to the jaws or obvious metastatic disease to the jaws.
The majority of patients on antiresorptive or antiangiogenic
therapy who experience MRONJ do so following a dental procedure,
such as a tooth extraction. Therefore if systemic conditions permit,
http://www.aaoms.org/members/news/aaoms-position-paper-renames-and-expands-the-scope-of-bisphosphonate-relate
Page 93
Page 1 of 2
AAOMS position paper renames and expands the scope of Bisphosphonat…ow Medication Related Osteonecrosis of the Jaw (MRONJ) | AAOMS.org
2/10/15 8:37 AM
the position paper suggests that the start of antiresorptive therapy
should be delayed until the patient’s dental health is optimized.
The MRONJ position paper further recommends that patients who
are about to be prescribed antiresorptive or antiangiogenic therapy
should undergo a thorough oral examination and a radiographic
assessment when indicated in order to identify both acute infection
and sites of potential infection that could be exacerbated once drug
therapy begin. The paper cautions that any decisions relating to
drug therapy must be made in conjunction with the treating
physician, dentist and other specialists involved in caring for the
patient.
MRONJ is painful and difficult to treat. While osteonecrosis of the
jaw has been recognized by dental and medical practitioners for
many years, the identification of bisphosphonates as a contributory
factor to the condition was first reported by oral and maxillofacial
surgeons about 10 years ago when they noticed an increase in the
number of patients exhibiting the signs of ONJ. A review of these
cases indicated that bisphosphonate therapy was a common
thread.
In 2006, the AAOMS appointed the Special Committee on BRONJ to
review the existing literature and prepare a position paper that
synthesized the findings for the dental and medical communities.
This Special Committee was reconstituted in 2009 and again in
2013 to review current research findings. The 2014 Position Paper
on Medication Related Osteonecrosis of the Jaws offers the most
recent and up to date diagnosis and treatment information to
dental and medical professionals, clinicians and patients.
The complete 2014 MRONJ Position Paper is available at
aaoms.org.
http://www.aaoms.org/members/news/aaoms-position-paper-renames-and-expands-the-scope-of-bisphosphonate-relate
Page 94
Page 2 of 2
saving faces|changing lives
Position Paper
®
American Association of Oral and Maxillofacial Surgeons
Attachment 2 to HOD-15(B)(3)
26 Pages
Medication-­Related Osteonecrosis of the Jaw—2014 Update
Introduction
Special Committee on Medication-­ Related Osteonecrosis of the Jaws:
Salvatore L. Ruggiero, DMD, MD, Clinical Professor, Division of Oral and Maxillofacial Surgery, Stony Brook School of Dental Medicine, Hofstra North Shore-­LIJ School of Medicine, New York Center for Orthognathic and Maxillo-­
facial Surgery, Lake Success, NY
Thomas B. Dodson, DMD, MPH, Professor and Chair, Associate Dean for Hospital Affairs, University of Washington School of Dentistry, Department of Oral and Maxillofacial Surgery, Seattle, WA
John Fantasia, DDS, Chief, Division of Oral Pathology, Hofstra North Shore-­LIJ School of Medicine , New Hyde Park, NY
Reginald Goodday, Professor, Department of Oral and Maxillofacial Sciences, Dalhousie University, Halifax, NS
Tara Aghaloo DDS, MD, PhD, Associate Pro-­
fessor, Oral and Maxillofacial Surgery, Assistant Dean for Clinical Research, UCLA School of Dentistry, Los Angeles, CA
Bhoomi Mehrotra, MD, Director, Cancer Institute at St. Francis Hospital, Roslyn, NY
Felice O’Ryan, DDS, Division of Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA The Special Committee recommends changing the nomenclature of bisphosphonate-­related osteonecrosis of the jaw (BRONJ). The Special Committee favors the term medication-­related osteonecrosis of the jaw (MRONJ). 7KHFKDQJHLVMXVWL¿HGWRDFFRPPRGDWHWKHJURZLQJ
number of osteonecrosis cases involving the maxilla and mandible associated with other antiresorptive (denosumab) and antiangiogenic therapies.
MRONJ adversely affects the quality of life, produc-­
LQJVLJQL¿FDQWPRUELGLW\6WUDWHJLHVIRUPDQDJHPHQWRI
patients with, or at risk for, MRONJ were set forth in the American Association of Oral and Maxillofacial Sur-­
geons (AAOMS) updated Position Paper on Bisphospho-­
nate-­Related Osteonecrosis of the Jaws and approved by the Board of Trustees in 2009.1 The Position Paper was developed by a Special Committee appointed by the Board and composed of clinicians with extensive experience in caring for these patients and basic science researchers. The knowledge base and experience in addressing MRONJ KDVH[SDQGHGQHFHVVLWDWLQJPRGL¿FDWLRQVDQGUH¿QHPHQWV
to the previous Position Paper. This Special Committee met in September 2013 to appraise the current literature DQGUHYLVHWKHJXLGHOLQHVDVLQGLFDWHGWRUHÀHFWFXUUHQW
NQRZOHGJHLQWKLV¿HOG7KLVXSGDWHFRQWDLQVUHYLVLRQVWR
diagnosis, staging, and management strategies, and high-­
lights current research status. AAOMS considers it vitally important that this information be disseminated to other relevant health care professionals and organizations.
Purpose
The purpose of this updated position paper is to provide:
1. Risk estimates of developing MRONJ
&RPSDULVRQVRIWKHULVNVDQGEHQH¿WVRIPHGLFDWLRQV
related to osteonecrosis of the jaw (ONJ) in order to facilitate medical decision-­making for the treating physician, dentist, dental specialist, and patients
3. Guidance to clinicians regarding:
Page 95
PAGE 1 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
a. the differential diagnosis of MRONJ in patients with a history of exposure to antiresorptive and/or antiangiogenic agents
b. MRONJ prevention measures and management strategies for patients with MRONJ based on the disease stage
Background
Antiresorptive medications
Intravenous (IV) bisphosphonates (BPs) are antiresorp-­
tive medications used to manage cancer-­related conditions including hypercalcemia of malignancy, skeletal-­related events (SRE) associated with bone metastases in the con-­
text of solid tumors such as breast cancer, prostate cancer and lung cancers, and for management of lytic lesions in the setting of multiple myeloma.2-­13 While the potential IRUELVSKRVSKRQDWHVWRLPSURYHFDQFHUVSHFL¿FVXUYLYDO
remains controversial, these medications have had a signif-­
icant positive effect on the quality of life for patients with advanced cancer involving the skeleton.
IV BPs, ie once yearly infusion of zolendronate (Reclast®) and a parenteral formulation of ibandronate (Boniva®) administered every three months, have FDA approval for management of osteoporosis.14
Oral bisphosphonates are approved for treatment of osteoporosis and are frequently used to treat osteopenia as well.15 They are also used for a variety of less common conditions such as Paget’s disease of bone, and osteogen-­
esis imperfecta.16,17 The most common use, however, is for osteopenia and osteoporosis.18,19
RANK ligand inhibitor (denosumab) is an antiresorptive agent that exists as a fully humanized antibody against RANK ligand (RANK-­L) and inhibits osteoclast func-­
tion and associated bone resorption. When denosumab (Prolia®) is administered subcutaneously every 6 months there is a reduction in the risk of vertebral, non-­vertebral, and hip fractures in osteoporotic patients.20,21 Denosumab (Xgeva®) is also effective in reducing SRE related to met-­
astatic bone disease from solid tumors when administered monthly.22,23 Denosumab therapy is not indicated for the treatment of multiple myeloma. Interestingly, in contrast to bisphosphonates, RANK ligand inhibitors do not bind to bone and their effects on bone remodeling are mostly diminished within 6 months of treatment cessation.
Antiangiogenic medications
Angiogenesis inhibitors interfere with the formation of new blood vessels by binding to various signaling mol-­
ecules disrupting the angiogenesis-­signaling cascade. 7KHVHQRYHOPHGLFDWLRQVKDYHGHPRQVWUDWHGHI¿FDF\LQWKH
treatment of gastrointestinal tumors, renal cell carcinomas, neuroendocrine tumors and others.
Risks of jaw necrosis related to antiresorptive therapy
2UDODQGPD[LOORIDFLDOVXUJHRQV¿UVWUHFRJQL]HGDQG
reported cases of non-­healing exposed bone in the max-­
illofacial region in patients treated with IV bisphospho-­
nates.24,25 In September 2004, Novartis, the manufacturer of the IV bisphosphonates pamidronate (Aredia®) and ]ROHGURQLFDFLG=RPHWDŠQRWL¿HGKHDOWKFDUHSURIHVVLRQ-­
als of additions to the labeling of these products, which provided cautionary language related to the development of osteonecrosis of the jaws.26 This was followed in 2005 by a broader drug class warning of this complication for all bisphosphonates including the oral preparations.27,28 More recently, other antiresorptive agents and novel anti-­cancer drugs have been linked to the development of jaw necrosis (Appendix I, II).
0521-&DVH'H¿QLWLRQ
In order to distinguish MRONJ from other delayed healing conditions and address evolving clinical observations and concerns about under-­reporting of disease, the working GH¿QLWLRQRI0521-KDVEHHQPRGL¿HGIURPWKH
AAOMS Position Paper:1
Patients may be considered to have MRONJ if all of the following characteristics are present:
1. Current or previous treatment with antire-­
sorptive or antiangiogenic agents;;
2. Exposed bone or bone that can be probed WKURXJKDQLQWUDRUDORUH[WUDRUDO¿VWXODHLQ
the maxillofacial region that has persisted for more than eight weeks;; and
3. No history of radiation therapy to the jaws or obvious metastatic disease to the jaws.
It is important to understand that patients at risk for or with established MRONJ can also present with other com-­
mon clinical conditions not to be confused with MRONJ. Page 96
PAGE 2 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
Commonly misdiagnosed conditions may include, but are not limited to: alveolar osteitis, sinusitis, gingivitis/
SHULRGRQWLWLVFDULHVSHULDSLFDOSDWKRORJ\¿EURRVVHRXV
lesion, sarcoma, chronic sclerosing osteomyelitis, and TMJ disorders. It is also important to remember that ONJ occurs in patients not exposed to antiresorptive or antiangiogenic agents.
infection.53-­55 Although tooth extraction was performed in most of the initial reported cases of ONJ, these teeth commonly had existing periodontal or periapical disease.1,56-­59 From these clinical studies, several animal models have been developed to demonstrate that ERWKLQÀDPPDWLRQRUEDFWHULDOLQIHFWLRQDQGV\VWHPLF
DQWLUHVRUSWLYHVDUHVXI¿FLHQWWRLQGXFH21-46,60-­64
Pathophysiology
$OWKRXJKWKH¿UVW0521-FDVHZDVUHSRUWHGRYHUDGH-­
cade ago, the pathophysiology of the disease has not been fully elucidated.24,25 A source of great debate among clini-­
cians and researchers are the potential mechanisms under-­
lying MRONJ pathophysiology.29-­32 Proposed hypotheses that attempt to explain the unique localization of MRONJ exclusively to the jaws include altered bone remodel-­
ing or oversuppression of bone resorption, angiogenesis inhibition, constant microtrauma, suppression of innate or DFTXLUHGLPPXQLW\YLWDPLQ'GH¿FLHQF\VRIWWLVVXH%3
WR[LFLW\DQGLQÀDPPDWLRQRULQIHFWLRQ29,33-­40
A. Inhibition of osteoclastic bone resorption and remodeling
Bisphosphonates (BP), and other antiresorptives such as denosumab, inhibit osteoclast differentiation and function, and increase apoptosis, all leading to decreased bone resorption and remodeling.41-­45 Osteoclast differentiation and function plays a vital role in bone healing and remodeling in all skeletal sites, but osteonecrosis of the jaws only occurs primarily within the alveolar bone of the maxilla and mandible.46 An increased remodeling rate in the jaws may explain the differential predisposition to ONJ compared to other bones in the axial or appendicular skeleton. Long term studies in the large animal model demonstrate decreased intracortical bone turnover with dynamic histomorphometry.30,47 The central role of bone remodeling inhibition is further corroborated by a similar incidence of ONJ observed with other antiresorptive medications such as denosumab.48-­50 Preliminary evidence exists demonstrating the improved extraction socket healing in animals receiving systemic zoledronic acid when treated with parathyroid hormone, possibly due to its positive effect on osteoclasts to increase bone remodeling.51,52
% ,QÀDPPDWLRQ,QIHFWLRQ
Both systemic and local oral risk factors have been implicated in ONJ pathogenesis, where several human studies have implicated dental disease or bacterial ,QÀDPPDWLRQRULQIHFWLRQKDVORQJEHHQFRQVLGHUHGDQ
LPSRUWDQWFRPSRQHQWRI21-(DUO\VWXGLHVLGHQWL¿HG
bacteria, especially Actinomyces species, in biopsied specimens of necrotic bone removed in patients with ONJ.65 The presence of bacteria has prompted studies WRHYDOXDWHWKHSRVVLELOLW\RIDFRPSOH[ELR¿OPRQ
exposed bone.667KHVHVWXGLHVKDYHLGHQWL¿HGEDFWHULD
in combination with fungi and viruses, which may require more sophisticated therapies to combat the PXOWLRUJDQLVP21-DVVRFLDWHGELR¿OP67-­70
C. Inhibition of Angiogenesis
Angiogenesis is a process that involves growth, migra-­
tion and differentiation of endothelial cells to form new EORRGYHVVHOV$QJLRJHQHVLVIDYRUDEO\LQÀXHQFHVWXPRU
JURZWKDQGDOVRLQÀXHQFHVWXPRULQYDVLRQRIYHVVHOV
resulting in tumor metastasis. Angiogenesis requires binding of signaling molecules such as vascular endothelial growth factor (VEGF) to receptors on the endothelial cells. This signaling promotes new blood vessel growth.
Osteonecrosis is classically considered an interruption in vascular supply or avascular necrosis, and therefore, it is not surprising that inhibition of angiogenesis is a leading hypothesis in ONJ pathophysiology.30-­32,71 In vitro experiments consistently demonstrate a reduction in angiogenesis in response to zoledronic acid.40,72 Studies in cancer patients treated with zoledronic acid support these data with decreased circulating VEGF levels.73 Moreover, there is a growing body of literature linking osteonecrosis of the jaw and other bones in patients receiving novel antiangiogenic drugs (tyrosine kinase inhibitors and monoclonal antibody targeting VEGF). However, inhibition of angiogenesis has not been reported with denosumab.
Page 97
PAGE 3 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
D. Other Hypotheses
1. Soft tissue toxicity
Although BPs primarily target the osteoclast and bind to hydroxyapatite in bone, soft tissue toxicity has been reported.29,74 Multiple cell types underwent increased apoptosis or decreased proliferation after exposure to BPs in vitro including cervical, prostate, and oral epithelial cells.75-­77 Since BPs are excreted renally after only a few hours in the circulation, their concentration in tissues outside bone is minimal.78 In contrast to BP’s, no soft tissue toxicity has been reported with denosumab.
to limit the inclusion of studies to: 1) those published since the last report (2009), 2) studies with the highest levels of evidence for the available topic, eg systematic reviews of several randomized control trials (RCTs) or prospective cohort studies, individual RCTs, pro-­
spective cohort studies, retrospective cohort studies, or case-­control studies, and 3) studies with clinical ascertainment of MRONJ. Older studies, case reports and case series, and studies that rely on medical record review or insurance-­claim data were excluded from analyses.
2. Innate or acquired immune dysfunction
7KH¿UVWDQLPDOPRGHOFRXOGQRWFRQVLVWHQWO\LQGXFH
ONJ unless BPs were combined with steroids in a tooth extraction defect.37 Since then, many other studies showed mucosal ulceration, delayed healing, H[SRVHGERQHDQGKLVWRORJLFQHFURVLVDQGLQÀDP-­
mation when BPs and chemotherapy are adminis-­
tered in rodents undergoing extractions.34,63,79,80
As described above, many hypotheses exist, and many of the animal models above show evidence that the disease may be multifactorial. To begin to develop effective therapies for patients with ONJ, clinically relevant animal models are para-­
mount. Whether it is early diagnosis, prevention, or targeted therapy, therapeutic strategies cannot be developed or tested without these models. As more studies uncover the mechanisms, large animal models will be critical in closely replicating human MRONJ with frank bone exposure and stage 0 disease.
Risk factors for MRONJ
A. Medication-­related risk factors
To interpret MRONJ disease frequency estimates, two parameters need to be considered: therapeutic indica-­
tions and type of medications. The therapeutic indi-­
cations are grouped into two categories: osteoporosis/
osteopenia or malignancy. Medications will be grouped into two categories, BP and non-­BP (other antiresorp-­
tive or antiangiogenic medications). Disease frequency will be reported as incidence (number of new cases per sample [or population] per unit time) or prevalence (number of cases in the sample [or population] reported as a percentage).
Given the proliferation of data since MRONJ was originally reported in 2003, the committee has tried Due to the low frequency of disease, studies with small samples (<500 subjects) need to be interpreted cautiously. It is particularly challenging to obtain good estimates of disease frequency when studying low frequency events, ie cases of MRONJ. Consistently, as the sample size increases, MRONJ disease frequency estimates get smaller. Therefore when reviewing the literature cited below, the reader should weight more heavily studies with large sample sizes than a com-­
parable study with a smaller sample size (ie disease estimates of a study with a sample size of 10,000 should be weighted more heavily than a study with 500 subjects).
1. MRONJ risk among cancer patients
To measure the risk for ONJ among patients exposed to a medication, we must know the risk for ONJ in patients not exposed to antiresorptive or antiangiogenic medications. The risk for ONJ among cancer patients enrolled in clinical trials and assigned to placebo groups ranges from 0% to 0.019% (0-­1.9 cases per 10,000 cancer pa-­
tients).81-­83
Among cancer patients exposed to zolendronate, the cumulative incidence of MRONJ is in the low single digits (range = 0.7% -­ 6.7%).82,84 When lim-­
ited to studies with Level 1 evidence, ie systematic reviews or RCTs, the risk of MRONJ in subjects exposed to zolendronate approximates 1% (100 cases per 10,000 patients).81-­83,85 The risk of ONJ among cancer patients exposed to zolendronate ranges between 50-­100 times higher than cancer patients treated with placebo.
Page 98
PAGE 4 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
Among cancer patients exposed to denosumab, a RANK L inhibitor, the risk of MRONJ ranges from 0.7% -­ 1.9% (70-­90 cases per 10,000 patients).81,85 The risk for ONJ among cancer patient exposed to denosumab is comparable to the risk of ONJ in patients exposed to zolendronate.22,23,86
The risk for ONJ among cancer patients exposed to bevacizumab, an antiangiogenic agent, is 0.2%. (20 cases per 10,000).87 The risk may be higher among patients exposed to both bevacizumab and zolen-­
dronate, 0.9% (90 cases per 10,000).87
There are several case reports describing jaw necro-­
sis in cancer patients receiving targeted therapies, VSHFL¿FDOO\W\URVLQHNLQDVHLQKLELWRUV7.,VDQG
monoclonal antibody targeting VEGF.88-­90 In 2009 Brunello and colleagues reported consecutive HSLVRGHVRI21-FKDUDFWHUL]HGE\FXWDQHRXV¿VWXOD
and bone sequestration, in a patient with renal cell carcinoma treated with bisphosphonates and the tyrosine kinase inhibitor (TKI) sunitinib.91 Disease improved after discontinuation of sunitinib and then rapidly worsened with resumption of sunitinib. The investigators hypothesized “that the antiangiogenic activity of sunitinib may amplify the inhibition of bone remodeling exerted by amino bisphosphonates entrapped within the osteonecrotic matrix, antag-­
onize mucosal healing and expose to infections during treatment.” Subsequent reports have high-­
lighted the potential additive toxic effect of anti-­
angiogenic drugs (TKIs and monoclonal antibody targeting VEGF) in patients receiving or having a history of bisphosphonate medication use.87,92-­98 Beuselink, et al, reported an overall incidence of ONJ to be 10% in renal cell carcinoma patients with bone metastasis treated with oral TKIs and con-­
comitant bisphosphonates.97 They concluded that the combined use of bisphosphonates and TKIs in renal cell carcinoma patients with bone involvement SUREDEO\LPSURYHVWUHDWPHQWHI¿FDF\EXWLVDVVRFL-­
ated with a high incidence of ONJ. Smidt-­Hansen, et al, in a retrospective study of renal cell carcinoma patients who received zoledronic acid and sirolimus found that patients who developed ONJ had a sig-­
QL¿FDQWO\LPSURYHGPHGLDQVXUYLYDORIPRQWKV
compared to 14.5 months in patients without ONJ.98
Moreover, there have been multiple case reports detailing the development of ONJ in patients re-­
ceiving these targeted antiangiogenic therapies who are bisphosphonate naïve.88-­90 These case reports underscore the potential for novel medications such as TKIs and VEGF inhibitors being implicated in the development of ONJ in the absence of concomi-­
tant antiresorptive medication use.
This preliminary level of evidence supporting the association of antiangiogenic medications with the development of jaw necrosis is primarily based on case reports (Level V evidence). While the FDA has issued an ONJ advisory only for bevacizumab and sunitinib99,100 the committee remains concerned about a similar potential risk associated with several other medications within the same drug class which have a similar mechanism of action. Further controlled, prospective studies will be required to characterize the risk of jaw necrosis associated with these agents.
2. MRONJ risk among osteoporosis patients
Most dentists and oral and maxillofacial surgeons see patients in their practices who have been exposed to antiresorptive therapy, eg oral BPs, for management of osteoporosis. When evaluated by age, 5.1 million patients over the age of 55 years received a prescription for a bisphosphonate in year 2008. A recent federal study estimated that the prevalence of BP exposure was 7 for every 100 US population receiving a prescription for a bisphos-­
phonate in the outpatient setting for the treatment of osteoporosis.101 Ironically, the studies estimating MRONJ risk in this patient population have the weakest levels of evidence of the various study groups, eg survey or retrospective cohort studies with ascertainment of disease based on a combina-­
tion of examination or review of medical records.101
2a. Risk for ONJ among osteoporotic patients exposed to oral BPs
In a survey study of over 13,000 Kaiser Permanente members, the prevalence of BRONJ in patients receiving long-­term oral bisphosphonate therapy was reported at 0.1% (10 cases per 10,000) which increased to 0.21 (21 cases per 10,000) among patients with greater than 4 years of oral BP ex-­
posure.102 Felsenberg and Hoffmeister reported a prevalence of MRONJ among patients treated with Page 99
PAGE 5 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
bisphosphonates for osteoporosis of 0.00038% (<1 case per 100,000 exposed), based on reports of 3 cases to the German Central Registry of Necrosis of the Jaw.103 In a more recent report, Malden, et al, derived an incidence of 0.004% (0.4 cases per 10,000 patient-­years of exposure to alendronate) from 11 cases of MRONJ reported in a population of 90,000 people living in southeast Scotland.104
2b. MRONJ risk among osteoporotic patients exposed to IV BP or RANK-­L inhibitors
Studies analyzing patients with osteoporosis ex-­
posed to yearly zolendronate therapy for 3 years reported a risk for MRONJ of 0.017% (1.7 cases per 10,000 subjects).105 An extension of this study through 6 years did not demonstrate a change in frequency of MRONJ.106 In recent reports study-­
ing patients exposed to denosumab, the risk for MRONJ is 0.04% (4 cases per 10,000 subjects).21 Interestingly, among patients with osteoporosis exposed to placebo medications, the risk for ONJ ranges from 0% to 0.02% (0-­2 cases per 10,000 subjects).21,105 The risk for ONJ among patients treated with either zolendronate or denosumab (0.017 – 0.04%) approximates the risk for ONJ of patients enrolled in placebo groups (0%-­
0.02%).
Based on this current review of data, the risk of de-­
veloping ONJ among osteoporotic patients exposed to oral, IV BPs, or denosumab is real but remains very low. The frequency of cases reported in the population (albeit very small) is best explained by the large number of patients, 5.1 million over the age of 55, exposed to these drugs.107
3. Duration of medication therapy as a risk factor for MRONJ
Regardless of indications for therapy, the duration of BP or antiresorptive therapy continues to be a risk factor for developing ONJ. Among cancer patients exposed to zolendronate or denosumab, the incidence of developing ONJ was, respectively, 0.6 and 0.5% at 1 year, 0.9 and 1.1% at 2 years, and 1.3 and 1.1% at 3 years with the risk for ONJ among denosumab-­exposed subjects plateauing between years 2 and 3.86 In a study by Saad, et al, the investigators combined three-­blinded phase three trials and found similar results, including a plateau after 2-­years for patients exposed to denosumab.108 Among cancer patients exposed to zolendronate or denosumab (n=5723), the incidence of developing ONJ was, respectively, 0.5 and 0.8% at 1 year, 1.0 and 1.8% at 2 years, and 1.3 and 1.8% at 3 years.86
For patients receiving oral bisphosphonate therapy to manage osteoporosis, the prevalence of ONJ increases over time from near 0 at baseline to 0.21% after four or more years of BP exposure (see Figure 1). The median duration of BP exposure for patients with ONJ and ONJ-­like features was 4.4 years. For patients without ONJ, the median exposure to oral BPs was 3.5 years.101,102
When compared to cancer patients receiving antiresorptive treatment, the risk of ONJ for patients with osteoporosis exposed to antiresorp-­
tive medications is about 100 times smaller.
B. Local factors
1. Operative treatment
Dentoalveolar surgery is considered a major risk factor for developing MRONJ. Several studies report that among patients with MRONJ, tooth extraction is a common predisposing event rang-­
ing from 52 to 61% of patients reporting tooth extraction as the precipitating event.84,108,109 In a case-­control study among cancer patients exposed to zolendronate, tooth extraction was associated with a 16-­fold increased risk for ONJ when com-­
pared to cancer patients without ONJ (odds ratio >25@ FRQ¿GHQFHLQWHUYDO>&,@±
79.6).110 In a longitudinal cohort study in a sample of cancer patients exposed to intravenous BPs (predominately zolendronate), tooth extraction was associated with a 33-­fold increased risk for ONJ.84
The above information, while important, is not what most patients or clinicians want to know. Most cli-­
nicians and patients want to know: “Among patients exposed to antiresorptive medications, what is the risk for developing ONJ following tooth extraction (or other dentoalveolar procedures such as implant placement or periodontal procedures)?” The best current estimate for the risk of ONJ among patients exposed to oral bisphosphonates following tooth extraction is 0.5%.111 The estimate was derived from a prospective evaluation of 194 patients exposed to Page 100
PAGE 6 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
oral BPs that underwent extraction of > 1 tooth. In this sample, one patient developed ONJ after tooth extraction.
Estimates for developing ONJ after tooth extraction among cancer patients exposed to intravenous BPs ranges from 1.6 to 14.8%. In a retrospective cohort study composed of a sample of cancer patients exposed to zolendronate (n=27), 4 (14.8%) subjects develop ONJ after tooth extraction.112 In a prospec-­
tive cohort study composed of 176 subjects with cancer who were exposed to zolendronate, 5 (2.8%) developed ONJ.113 In a prospective cohort study of 63 subjects with a history of cancer and intravenous BP exposure who underwent extraction of > 1 tooth, one subject (1.6%) developed ONJ.114 Among the studies reported above, the prospective studies should be weighted more heavily due to the larger sample sizes and the prospective, not retrospective, study designs.
LQÀDPPDWRU\GHQWDOGLVHDVHLVWRRWKH[WUDFWLRQ
pre-­existing dental disease may confound the relationship between tooth extraction and risk for MRONJ noted above. It would be valuable to see an estimate of the association between tooth extraction DQG0521-DGMXVWHGIRUSUHH[LVWLQJLQÀDPPDWRU\
dental disease.
C. Demographic and systemic factors and other medication factors
Age and sex are variably reported as risk factors for MRONJ.84,108,110,112,115 The higher prevalence of this complication in the female population is likely DUHÀHFWLRQRIWKHXQGHUO\LQJGLVHDVHIRUZKLFKWKH
agents are being prescribed (ie osteoporosis, breast cancer). There are very limited data describing the occurrence of MRONJ in the pediatric population. In an observational study, Brown, et al, reviewed a total of 42 pediatric patients who had received IV bisphos-­
phonate therapy (mean duration of therapy 6.5 years) for a variety of metabolic bone diseases. No cases of ONJ were reported despite invasive dental treatment in 11 patients.116 The risk of developing MRONJ in the pediatric population certainly requires more complete investigation.
Corticosteroids are associated with an increased risk for MRONJ.108,115 Antiangiogenic agents, when given in addition to antiresorptive medications, are associated with an increased risk of ONJ.87,108
Co-­morbid conditions among cancer patients that are inconsistently reported to be associated with an increased risk for MRONJ include anemia (hemoglo-­
bin < 10g/dL) and diabetes.108,115 Cancer type is also variably reported as a risk factor.81,84
Tobacco use has been inconsistently reported as a risk factor for MRONJ. In a case-­control study, tobacco XVHDSSURDFKHGVWDWLVWLFDOVLJQL¿FDQFHDVDULVNIDFWRU
for ONJ in cancer patients (OR=3.0;; 95% CI= 0.8 -­ 10.4).110 In a more recent case-­controlled study, tobacco use was not associated with ONJ in a sample of cancer patients exposed to zolendronate.115 Vahtsevanos did not report an association between tobacco use and MRONJ.84
The risk of developing ONJ among patients who have been exposed to antiresorptive medications for other dentoalveolar operations such as dental implant placement and endodontic or periodontal procedures is unknown. Absent data, the committee considers the risk for ONJ after dental implant placement and endodontic or periodontal proce-­
dures that require exposure and manipulation of bone to comparable to the risk associated with tooth extraction.
2. Anatomic factors
Limited new information regarding anatomic risk factors for MRONJ is available. MRONJ is more likely to appear in the mandible (73%) than the maxilla (22.5%) but can appear in both jaws (4.5%).108 Denture use was associated with an increased risk for ONJ among cancer patients H[SRVHGWR]ROHQGURQDWH25 &, ±
20.1).110 In a study by Vahtsevanos, et al, a sample of 1,621 cancer patients treated with intravenous zolendronate, ibandronate, or pamidronate, there was a 2-­fold increased risk for ONJ among denture wearers.84
3. Concomitant oral disease
3UHH[LVWLQJLQÀDPPDWRU\GHQWDOGLVHDVHVXFKDV
periodontal disease or periapical pathology is a well-­recognized risk factor.112,115 Among cancer SDWLHQWVZLWK0521-SUHH[LVWLQJLQÀDPPDWRU\
dental disease was a risk factor among 50% of the cases.108,112 Given that a common treatment of Page 101
PAGE 7 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
D. Genetic factors
Since the previous position paper there have been several reports describing single nucleotide polymor-­
phisms (SNPs) that were associated with the devel-­
opment MRONJ. Most of these SNPs were located within regions of the gene associated with either bone turnover, collagen formation, or certain metabolic bone diseases. Katz reported an ONJ event rate of 57% when SNPs were present in 5 candidate genes that were re-­
sponsible for bone turnover.117 In a genome wide study, Nicoletti reported that patients with an SNP in the RBMS3 gene (associated with bone density and colla-­
gen formation) were 5.8 times more likely to develop ONJ.118 In a study that analyzed polymorphisms related to farnesyl diphosphate synthase activity (the enzyme VSHFL¿FDOO\LQKLELWHGE\ELVSKRVSKRQDWHVDSRVLWLYH
correlation was established with the carrier status and ONJ.119 Collectively, these studies suggest that a germ line sensitivity to bisphosphonates may exist.
,QVXPPDU\WKHFXUUHQWOLWHUDWXUHUHDI¿UPVWKDWWKH
ULVNRI0521-LVVLJQL¿FDQWO\JUHDWHULQFDQFHU
patients receiving antiresorptive therapy as compared to treatment regimens for osteoporosis. Moreover, the risk of MRONJ in osteoporosis patients receiving antiresorptive therapy continues to be very low re-­
gardless of drug type (bisphosphonates, denosumab) or dosing schedule. Targeted cancer therapies (VEGF and tyrosine kinase inhibitors) are also associated jaw necrosis but further studies with these medications are warranted.
Management Strategies for Patients Treated with Antiresorptives or Antiangiogenics
1. Prevention of MRONJ
The AAOMS Special Committee on MRONJ supports a multi-­disciplinary approach to the treatment of pa-­
WLHQWVZKREHQH¿WIURPDQWLUHVRUSWLYHRUDQWLDQJLRJHQLF
medications. This approach would include consultation with an appropriate dental professional when it is GHWHUPLQHGDSDWLHQWZRXOGEHQH¿WIURPDQDQWLUH-­
sorptive or antiangiogenic drug. There is considerable support for early screening and initiation of appropriate dental care, which not only decreases the incidence of 21-EXWZRXOGDOVRDFFUXHWKHEHQH¿WVWKDWDOOSDWLHQWV
enjoy with optimum oral health.32,87,98,109,110,120-­136
The implementation of dental screening and appropriate dental measures before initiating antiresorptive therapy reduced the risk of ONJ in several prospective studies when compared in a retrospective fashion to patients who did not undergo dental preventive measures.53,55,108,137,138
'LPRSRXORVIRXQGDVWDWLVWLFDOO\VLJQL¿FDQWDOPRVW
threefold reduction in the incidence of osteonecrosis in patients when preventive measures were applied.53 Bonacina did not report any new cases of ONJ in patients who received dental screening and necessary dental treatment before initiating IV bisphosphonate treatment.137 Vandone found the incidence rate of developing ONJ was reduced by 50% in patients who were screened and received preventive dental care before initiating drug therapy.138
Treatment planning for patients who may be prescribed antiresorptive or antiangiogenic therapy should include thorough examination of the oral cavity and a radio-­
graphic assessment when indicated. It is important to identify both acute infection and sites of potential infection to prevent future sequelae that could be exacerbated once drug therapies begin. Considerations during the clinical and radiographic assessment in-­
clude: patient motivation, patient education regarding GHQWDOFDUHÀXRULGHDSSOLFDWLRQFKORUKH[LGLQHULQVHV
tooth mobility, periodontal disease, presence of root fragments, caries, periapical pathology, edentulism, and denture stability.139
$QDGGLWLRQDOEHQH¿WRIHDUO\GHQWDOFRQVXOWDWLRQZKHQ
the use of antiresorptive or antiangiogenic therapy is being considered is that the patient is being informed of the low risk associated with these drug therapies and the risk incurred by not undergoing recommended den-­
tal preventive measures before consenting to treatment.
2. Cessation of at-­risk medication therapy prior to tooth extraction or other procedures, which involve osseous injury (eg dental implant placement, periodontal or apical endodontic treatment)
a. Antiresorptive Therapy for Osteoporosis/Osteopenia
The concept of a drug holiday in individuals receiving oral bisphosphonates or denosumab who require tooth extractions has been an ongoing area of controversy with little data to support current recommendations. The AAOMS Position Paper on Bisphosphonate-­Related Osteonecrosis of the Jaw, Page 102
PAGE 8 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
revised in 2009, recommended discontinuing oral bisphosphonates for 3 months prior to and 3 months IROORZLQJLQYDVLYHGHQWDOVXUJHU\±V\VWHPLFFRQ-­
ditions permitting.1 However there is currently no evidence that interrupting bisphosphonate therapy alters the risk of ONJ in patients following tooth H[WUDFWLRQ,QWKH$'$&RXQFLORQ6FLHQWL¿F
Affairs revised their prior recommendation of a drug holiday and suggested that patients receiving lower cumulative doses of bisphosphonate (<2 years) or denosumab may continue antiresorptive therapy during invasive dental treatment.126 An International ONJ Task Force recommended a drug holiday in patients at higher risk for developing ONJ, including those with greater cumulative bisphosphonate exposure (>4 years), and those with comorbid risk factors such as rheumatoid arthritis, prior or current glucocorticoid exposure, diabetes and smoking until the site has healed.140 In a 2011 summary document on the long term safety of bisphosphonate therapy for osteoporosis, the FDA determined that there was “no substantial data available to guide decisions regarding the initiation or duration of a drug holiday.”101
Damm and Jones proposed several alternatives to a drug holiday in BP-­exposed patients who require invasive dental treatment.141 While there are no studies to support these recommendations their ap-­
proach is based on bone physiology and pharmaco-­
kinetics of the antiresorptive medications and merit consideration (Level 5 evidence). They note that since 50% of serum BP undergoes renal excretion the major reservoir of BP is the osteoclast whose life span is 2 weeks. Thus the majority of free BP within the serum would be extremely low 2 months following the last dose of an oral bisphosphonate and a 2-­month drug free period should be adequate prior to an invasive dental procedure.
This committee recognized that there are limited GDWDWRVXSSRUWRUUHIXWHWKHEHQH¿WVRIDGUXJ
holiday for osteoporosis patients receiving antire-­
VRUSWLYHWKHUDS\+RZHYHUDWKHRUHWLFDOEHQH¿WPD\
still apply for those patients with extended exposure histories (>4 yrs). Therefore the committee consid-­
HUVWKHPRGL¿HGGUXJKROLGD\VWUDWHJ\DVGHVFULEHG
by Damm and Jones to be a prudent approach for those patients at risk.141
b. Oncology Patients Receiving Monthly Antiresorp-­
tive Therapy
Position Paper
Individuals receiving monthly intravenous bisphos-­
phonates or denosumab for treatment of oncologic disease have an increased risk of developing ONJ following tooth extraction and thus these proce-­
dures should be avoided if possible. Increased awareness, preventive dental care and early recogni-­
tion of the signs and symptoms of ONJ have result-­
ed in earlier detection. Data are scant regarding the effect of discontinuing intravenous bisphosphonates prior to invasive dental treatments should these be necessary. However, if ONJ develops the oncologist may consider discontinuing antiresorptive therapy until soft tissue closure has occurred, depending on disease status.
As a fully humanized antibody, denosumab blocks the receptor-­mediated activation of osteoclasts and KDVQRELQGLQJDI¿QLW\IRUERQHPDWUL[7KHUHIRUH
unlike bisphosphonates, the antiresorptive effects of denosumab should be mostly dissipated within 6 months of stopping the drug. However, there are no studies to support or refute the strategy of stopping denosumab therapy in the prevention or treatment of MRONJ.
There are no data to support or refute the cessation of antiangiogenic therapy in the prevention or management of MRONJ and therefore continued research in the area is indicated.
Treatment Goals
The major goals of treatment for patients at risk of devel-­
oping or who have MRONJ are:
• Prioritization and support of continued oncologic treatment in patients receiving IV antiresorptive and antiangiogenic therapy.
R 2QFRORJ\SDWLHQWVFDQEHQH¿WJUHDWO\IURPWKH
therapeutic effect of antiresorptive therapy by controlling bone pain and reducing the incidence of other skeletal complications
o The antiangiogenic class of chemotherapy agents KDYHGHPRQVWUDWHGHI¿FDF\LQWKHWUHDWPHQWRIDYD-­
ULHW\RIPDOLJQDQFLHVZLWKSURYHQVXUYLYDOEHQH¿WV
Page 103
PAGE 9 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
• Preservation of quality of life through:
o Patient education and reassurance
o Control of pain
o Control of secondary infection
o Prevention of extension of lesion and development of new areas of necrosis
Management Strategies
A. Patients about to initiate intravenous antiresorptive or antiangiogenic treatment for cancer therapy
The treatment objective for this group of patients is to minimize the risk of developing MRONJ. Although a small percentage of patients receiving antiresorptives develop osteonecrosis of the jaw spontaneously, the majority of affected patients experience this com-­
plication following dentoalveolar surgery.108,112,142-­144 Therefore if systemic conditions permit, initiation of antiresorptive therapy should be delayed until dental health is optimized.53,55,145 This decision must be made in conjunction with the treating physician and dentist and other specialists involved in the care of the patient.
Non-­restorable teeth and those with a poor prognosis should be extracted. Other necessary elective den-­
toalveolar surgery should also be completed at this time. Based on experience with osteoradionecrosis, it appears advisable that antiresorptive or antiangiogenic therapy should be delayed, if systemic conditions permit, until the extraction site has mucosalized (14-­21 days) or until there is adequate osseous healing. Dental prophylaxis, caries control and conservative restorative dentistry are critical to maintaining functionally sound WHHWK7KLVOHYHORIFDUHPXVWEHFRQWLQXHGLQGH¿QLWHO\
Patients with full or partial dentures should be exam-­
ined for areas of mucosal trauma, especially along WKHOLQJXDOÀDQJHUHJLRQ,WLVFULWLFDOWKDWSDWLHQWVEH
educated as to the importance of dental hygiene and UHJXODUGHQWDOHYDOXDWLRQVDQGVSHFL¿FDOO\LQVWUXFWHG
to report any pain, swelling or exposed bone.
Medical oncologists should evaluate and manage patients scheduled to receive IV antiresorptive or anti-­
angiogenic therapy similar to those patients scheduled to initiate radiation therapy to the head and neck. The osteoradionecrosis prevention protocols are guidelines that are familiar to most oncologists and general dentists.
B. Patients about to initiate antiresorptive treatment for osteoporosis
At the initiation of treatment, patients should be educated as to the potential risks of MRONJ as the an-­
tiresorptive therapy is likely to exceed beyond 4 years treatment. The importance of optimizing dental health throughout this treatment period and beyond should be stressed.
C. Asymptomatic patients receiving intravenous bisphos-­
phonates or antiangiogenic drugs for cancer
Maintaining good oral hygiene and dental care is of paramount importance in preventing dental disease that may require dentoalveolar surgery. Procedures that involve direct osseous injury should be avoided. Non-­restorable teeth may be treated by removal of the crown and endodontic treatment of the remaining roots.146 Placement of dental implants should be avoided in the oncology patient receiving intravenous antiresorptive therapy or antiangiogenic medications. There is no data regarding the risk of ONJ associated with implant placement in patients receiving antiangiogenic medications.
D. Asymptomatic patients receiving antiresorptive therapy for osteoporosis
Sound recommendations based on strong clinical re-­
search designs are still lacking for patients taking oral bisphosphonates. The committee strategies outlined below have been updated from those in the original Position Paper and are based on clinical studies that demonstrate a low prevalence of disease. The risk of developing MRONJ associated with oral bisphospho-­
nates increased when duration of therapy exceeded four years.102 Although the current level of evidence is not strong, the committee continues to consider these strategies for patients receiving oral bisphosphonates as a prudent set of guidelines that will not compromise the long-­term management of their osteoporosis. As more data become available and a better level of evidence is REWDLQHGWKHVHVWUDWHJLHVZLOOEHXSGDWHGDQGPRGL¿HG
as necessary.
Patients receiving antiresorptive therapy for osteopo-­
rosis are also at risk for developing MRONJ, but to a much lesser degree than those treated with intravenous antiresorptive therapy.101,102 MRONJ can develop Page 104
PAGE 10 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
spontaneously or after minor trauma. In general, these patients seem to have less severe manifestations of QHFURVLVDQGUHVSRQGPRUHUHDGLO\WRVWDJHVSHFL¿F
treatment regimens.147,148 Elective dentoalveolar surgery does not appear to be contraindicated in this group. It is recommended that patients be adequately informed of the very small risk (<1%) of compromised bone healing. The risk of developing MRONJ associated with oral bisphosphonates, while exceedingly small, appears to increase when the duration of therapy ex-­
ceeds 4 years.101 This time frame may be shortened in the presence of certain comorbidities, such as chronic corticosteroid or antiangiogenic use.87,108,115 If systemic conditions permit, the clinician may consider discon-­
tinuation of oral bisphosphonates for a period of two months prior to and three months following elective invasive dental surgery in order to lower the risk of MRONJ. The rationale for this approach is based on H[WUDSRODWHGGDWDWKDWGHPRQVWUDWHÀXFWXDWLRQVRI
osteoclast function, which is related to bisphospho-­
nate therapy, and recent outcomes studies that show improved outcome of MRONJ treatment with drug cessation.141
2. For those patients who have taken an oral bis-­
phosphonate for less than four years and have also taken corticosteroids or antiangiogenic medications concomitantly, the prescribing provider should be contacted to consider discontinuation of the oral bisphosphonate (drug holiday) for at least two months prior to oral surgery, if systemic conditions permit. The antiresorptive should not be restarted until osseous healing has occurred. These strategies are based on reports that corticosteroid and antian-­
giogenic agents, in combination with antiresorptive therapy, may increase the risk of developing MRONJ and that a drug holiday may mitigate this risk. Long-­term, prospective studies however DUHVWLOOUHTXLUHGWRHVWDEOLVKWKHHI¿FDF\RIGUXJ
holidays in reducing the risk of MRONJ for these patients.
7KHHI¿FDF\RIXWLOL]LQJDV\VWHPLFPDUNHURIERQH
turnover to assess the risk of developing jaw necrosis in patients at risk has not been validated.111,149-­153 Therefore the use of systemic markers of bone turnover as a measure of MRONJ risk is not recommended although the Committee supports continued research in this area.53,55,145,154
1. For individuals who have taken an oral bisphospho-­
nate for less than four years and have no clinical risk factors, no alteration or delay in the planned surgery is necessary. This includes any and all pro-­
cedures common to oral and maxillofacial surgeons, periodontists and other dental providers.
It is suggested that if dental implants are placed, informed consent should be provided related to possible long-­term implant failure and the low risk of developing osteonecrosis of the jaws if the patient continues to take an antiresorptive agent. These concerns are based on recent animal studies that have demonstrated impaired long-­term implant healing.155 Such patients should be placed on a regular recall schedule. It is also advisable to contact the provider who originally prescribed the oral bisphosphonate and suggest monitoring such patients and considering either alternate dosing of the bisphosphonate, drug holidays, or an alternative to the bisphosphonate therapy.
3. For those patients who have taken an oral bisphos-­
phonate for more than four years with or without any concomitant medical therapy, the prescribing provider should be contacted to consider discon-­
tinuation of the antiresorptive for two months prior to oral surgery, if systemic conditions permit. The bisphosphonate should not be restarted until osse-­
ous healing has occurred. The risk of long-­term oral bisphosphonate therapy requires continued analysis and research.
E. Patients with established MRONJ
Treatment objectives for patients with an established diagnosis of MRONJ are to eliminate pain, control infection of the soft and hard tissue, and minimize the progression or occurrence of bone necrosis. Patients with established MRONJ should avoid elective den-­
toalveolar surgical procedures, since these surgical sites may result in additional areas of exposed necrotic bone.
Since the publication of the 2009 guidelines there have been several reports of successful treatment outcomes for all stages of MRONJ following operative therapy (sequestrectomy, resection)148,156-­160 and non-­operative therapy.161-­165 Except for the more advanced cases of 6WDJHGLVHDVHRULQWKRVHFDVHVZLWKDZHOOGH¿QHG
Page 105
PAGE 11 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
sequestrum, it appears that a more prudent approach would be to consider operative therapies when non-­
operative strategies have failed.161,163 Regardless of the stage of disease, areas of necrotic bone that are a constant source of soft tissue irritation and loose bony sequestra should be removed or recontoured so that soft tissue healing can be optimized.166 The extraction of symptomatic teeth within exposed, necrotic bone should be considered, since it appears unlikely that the extraction will exacerbate the established necrotic process.
A randomized controlled trial of hyperbaric oxygen therapy (HBO) as an adjunct to non-­surgical and surgical treatment of MRONJ demonstrated some improvement in wound healing, long-­term pain scores and quality of life scores.167,168 However given the VPDOOVDPSOHVL]HWKHUHZDVQRVWDWLVWLFDOO\VLJQL¿FDQW
difference between the control and HBO group with regard to complete gingival coverage which was a major study endpoint. Therefore the use of HBO as the sole treatment modality for MRONJ cannot be supported at this time.
Case reports with small sample sizes have documented the use of other non-­surgical treatment strategies, such as platelet rich plasma,169,170 low-­level laser irradiation,128,171,172 parathyroid hormone173, and bone morphogenic protein.169,1747KHHI¿FDF\RIWKHVH
treatment modalities needs to be established through additional research and controlled studies.
Staging and Treatment Strategies (See Table 1)
Position Paper
URVLVSHUVLVWHQWH[WUDFWLRQVRFNHWVHWFWRGH¿QHDFDVHRI
MRONJ.177,178 The Special Committee members recognize WKHSRWHQWLDOEHQH¿WVDQGULVNVRIGLDJQRVLQJ0521-
based on radiographic signs alone. The Special Committee HOHFWHGWRQRWXVHUDGLRJUDSKLFVLJQVDORQHLQWKHFDVHGH¿-­
nition. The committee members accepted the consequence WKDWWKHFXUUHQWFDVHGH¿QLWLRQPD\XQGHUHVWLPDWHWKHWUXH
IUHTXHQF\RIWKHGLVHDVH5HYLVLQJWKHGH¿QLWLRQWRLQFOXGH
cases with radiographic signs alone may overestimate the true disease frequency by including false positives in the QXPHUDWRUHJFDVHVZLWKUDGLRJUDSKLF¿QGLQJVVXJJHVWLYH
of MRONJ, but are not MRONJ.
In order to direct rational treatment guidelines and collect data to assess the prognosis in patients who have used either IV or oral antiresorptive and antiangiogenic agents, the Committee proposes use of the following revised stag-­
ing system:
Patients at risk
No apparent necrotic bone in asymptomatic patients who have been treated with IV or oral antiresorptive or antian-­
giogenic therapy
Stage 0 (Non-­exposed bone variant)
1. Staging
0RGL¿FDWLRQVLQWKHVWDJLQJV\VWHPDUHQHFHVVDU\WR
HQVXUHWKDWLWUHPDLQVDQDFFXUDWHUHÀHFWLRQRIGLVHDVH
SUHVHQWDWLRQDQGWRDVVLVWLQWKHDSSURSULDWHVWUDWL¿FDWLRQ
of patients. A Stage 0 category was added in 2009 to in-­
FOXGHSDWLHQWVZLWKQRQVSHFL¿FV\PSWRPVRUFOLQLFDODQG
radiographic abnormalities that may be due to exposure to an antiresorptive agent. At that time the risk of a patient with Stage 0 disease advancing to a higher disease stage was unknown. Since then several case studies have report-­
ed that up to 50% of patients with Stage 0 have progressed to Stage 1, 2 or 3.175,176 Therefore, it appears that Stage 0 may be a valid disease category that captures patients with SURGURPDOGLVHDVHQRQH[SRVHGYDULDQW$OVRWKHGH¿QL-­
tion of exposed bone was broadened (see above) to include WKHSUHVHQFHRIFXWDQHRXVRUPXFRVDO¿VWXODHWKDWSUREHWR
bone for Stage 1, 2 and 3 categories. Other research groups have proposed including radiographic signs alone, eg scle-­
Patients with no clinical evidence of necrotic bone, but SUHVHQWZLWKQRQVSHFL¿FV\PSWRPVRUFOLQLFDOand radio-­
JUDSKLF¿QGLQJVVXFKDV
Symptoms
• odontalgia not explained by an odontogenic cause
• dull, aching bone pain in the body of the mandible, which may radiate to the temporomandibular joint region
‡ VLQXVSDLQZKLFKPD\EHDVVRFLDWHGZLWKLQÀDPPD-­
tion and thickening of the maxillary sinus wall
• altered neurosensory function
Clinical Findings
• loosening of teeth not explained by chronic peri-­
odontal disease
‡ SHULDSLFDOSHULRGRQWDO¿VWXODWKDWLVQRWDVVRFLDWHG
with pulpal necrosis due to caries
Page 106
PAGE 12 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
Radiographic Findings
• alveolar bone loss or resorption not attributable to chronic periodontal disease
• changes to trabecular pattern—dense woven bone and persistence of unremodeled bone in extraction sockets
• regions of osteosclerosis involving the alveolar bone and/or the surrounding basilar bone
• thickening/obscuring of periodontal ligament (thickening of the lamina dura and decreased size of the periodontal ligament space)153
7KHVHQRQVSHFL¿F¿QGLQJVZKLFKFKDUDFWHUL]HWKLV
non-­exposed variant of ONJ, may occur in patients with a prior history of Stage 1, 2, or 3 disease who have healed and have no clinical evidence of exposed bone.
Stage 1
([SRVHGDQGQHFURWLFERQHRU¿VWXODHWKDWSUREHVWRERQH
in patients who are asymptomatic and have no evidence of infection. These patients may also present with radiograph-­
LF¿QGLQJVPHQWLRQHGIRU6WDJHZKLFKDUHORFDOL]HGWR
the alveolar bone region.
Stage 2
([SRVHGDQGQHFURWLFERQHRU¿VWXODHWKDWSUREHWRERQH
with evidence of infection. These patients are typically symptomatic. These patients may also present with radio-­
JUDSKLF¿QGLQJVPHQWLRQHGIRU6WDJHZKLFKDUHORFDOL]HG
to the alveolar bone region.
Stage 3
([SRVHGDQGQHFURWLFERQHRU¿VWXODHWKDWSUREHWR
bone, with evidence of infection, and one or more of the following:
• exposed necrotic bone extending beyond the region of alveolar bone, ie, inferior border and ramus in the mandible, maxillary sinus and zygoma in the maxilla
• pathologic fracture
‡ H[WUDRUDO¿VWXOD
• oral antral/oral nasal communication
• osteolysis extending to the inferior border of the PDQGLEOHRUVLQXVÀRRU
6WDJH6SHFL¿F7UHDWPHQW6WUDWHJLHV
$WULVN±3DWLHQWVZKRDUHDWULVNRIGHYHORSLQJ0521-
due to an exposure history with an antiresorptive or an antiangiogenic drug. They do not have exposed bone nor do they require any treatment. However, these patients should be informed of the risks of developing MRONJ, as well as the signs and symptoms of this disease process.
6WDJH±3URYLGHV\PSWRPDWLFWUHDWPHQWDQG
conservatively manage other local factors, such as caries and periodontal disease. Systemic management may include the use of medication for chronic pain and control of infection with antibiotics, when indicated. These patients will require close monitoring given the potential for progression to a higher stage of disease. Among patients with radiographic signs alone suggesting Stage 0, (see above), the committee recommends close monitoring for progression to a higher stage of disease. Other GLDJQRVHVHJ¿EURRVVHRXVGLVHDVHFKURQLFVFOHURVLQJ
osteomyelitis should also be considered.
6WDJH±7KHVHSDWLHQWVEHQH¿WIURPPHGLFDOPDQDJHPHQW
including the use of oral antimicrobial rinses, such as chlorhexidine 0.12%. No immediate operative treatment is required.
6WDJH±7KHVHSDWLHQWVEHQH¿WIURPWKHXVHRIRUDO
antimicrobial rinses in combination with antibiotic therapy. Although local bone and soft tissue infection is not considered the primary etiology for this process, the colonization of the exposed bone is a very common occurrence. Most of the isolated microbes have been sensitive to the penicillin group of antibiotics. Quinolones, metronidazole, clindamycin, doxycycline and erythromycin have been used with success in those patients who are allergic to penicillin. Microbial cultures should also be analyzed and the antibiotic regimen VKRXOGEHDGMXVWHGDFFRUGLQJO\%LR¿OPIRUPDWLRQRQWKH
surface of the exposed bone has been reported in several reports and may be responsible for the failure of systemic antibiotic therapies that are described in some refractory cases.66,70,179 In such cases, operative therapy directed at reducing the volume of colonized, necrotic bone may serve DVDEHQH¿FLDODGMXQFWWRDQWLELRWLFWKHUDS\
Page 107
PAGE 13 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
6WDJH±7KHVHSDWLHQWVEHQH¿WIURPGHEULGHPHQW
including resection, in combination with antibiotic therapy, which may offer long-­term palliation with resolution of acute infection and pain. Symptomatic patients with stage 3 disease may require resection and immediate reconstruction with a reconstruction plate or an obturator. The potential for failure of the reconstruction plate because of the generalized effects of the bisphosphonate exposure needs to be recognized by the clinician and patient. Case reports with small sample sizes describe successful immediate reconstruction with vascularized bone.180-­182
Regardless of the disease stage, mobile bony sequestra should be removed to facilitate soft tissue healing. The extraction of symptomatic teeth within exposed, necrotic bone should be considered since it is unlikely that the extraction will exacerbate the established necrotic process. A thorough histologic analysis is indicated for all resected bone specimens (especially for patients with a history a malignant disease) since metastatic cancer has been reported in such specimens.183
Table 1 Staging and Treatment Strategies
MRONJ† Staging
Treatment Strategies‡
At risk category No apparent necrotic bone in patients who have • No treatment indicated
been treated with either oral or IV bisphosphonates
• Patient education
Stage 01RFOLQLFDOHYLGHQFHRIQHFURWLFERQHEXWQRQVSHFL¿F
FOLQLFDO¿QGLQJVUDGLRJUDSKLFFKDQJHVDQGV\PSWRPV
‡6\VWHPLFPDQDJHPHQWLQFOXGLQJWKHXVHRISDLQPHGLFDWLRQ and antibiotics
• Antibacterial mouth rinse
Stage 1([SRVHGDQGQHFURWLFERQHRU¿VWXODHWKDWSUREHVWR
ERQHLQSDWLHQWVZKRDUHDV\PSWRPDWLFDQGKDYHQRHYLGHQFHRI
‡&OLQLFDOIROORZXSRQDTXDUWHUO\EDVLV
infection
• Patient education and review of indications for continued ELVSKRVSKRQDWHWKHUDS\
Stage 2([SRVHGDQGQHFURWLFERQHRU¿VWXODHWKDWSUREHVWR
ERQHDVVRFLDWHGZLWKLQIHFWLRQDVHYLGHQFHGE\SDLQDQGHU\-­
WKHPDLQWKHUHJLRQRIWKHH[SRVHGERQHZLWKRUZLWKRXWSXUXOHQW
GUDLQDJH
‡6\PSWRPDWLFWUHDWPHQWZLWKRUDODQWLELRWLFV
• Oral antibacterial mouth rinse
• Pain control
• Debridement to relieve soft tissue irritation and infection control
Stage 3 ([SRVHGDQGQHFURWLFERQHRUD¿VWXODWKDWSUREHVWR
bone in patients with pain, infection, and one or more of the fol-­
ORZLQJH[SRVHGDQGQHFURWLFERQHH[WHQGLQJEH\RQGWKHUHJLRQ
of alveolar bone,(i.e., inferior border and ramus in the mandible, PD[LOODU\VLQXVDQG]\JRPDLQWKHPD[LOODUHVXOWLQJLQSDWKRORJLF
IUDFWXUHH[WUDRUDO¿VWXODRUDODQWUDORUDOQDVDOFRPPXQLFDWLRQ
RURVWHRO\VLVH[WHQGLQJWRWKHLQIHULRUERUGHURIWKHPDQGLEOHRI
VLQXVÀRRU
• Antibacterial mouth rinse
‡$QWLELRWLFWKHUDS\DQGSDLQFRQWURO
‡6XUJLFDOGHEULGHPHQWUHVHFWLRQIRUORQJHUWHUPSDOOLDWLRQRI infection and pain
‚ ([SRVHGRUSUREDEOHERQHLQWKHPD[LOORIDFLDOUHJLRQZLWKRXWUHVROXWLRQIRUJUHDWHUWKDQZHHNVLQSDWLHQWVWUHDWHGZLWKDQDQWLUH-­
VRUSWLYHDQGRUDQDQWLDQJLRJHQLFDJHQWZKRKDYHQRWUHFHLYHGUDGLDWLRQWKHUDS\WRWKHMDZV
Á 5HJDUGOHVVRIWKHGLVHDVHVWDJHPRELOHVHJPHQWVRIERQ\VHTXHVWUXPVKRXOGEHUHPRYHGZLWKRXWH[SRVLQJXQLQYROYHGERQH
7KHH[WUDFWLRQRIV\PSWRPDWLFWHHWKZLWKLQH[SRVHGQHFURWLFERQHVKRXOGEHFRQVLGHUHGVLQFHLWLVXQOLNHO\WKDWWKHH[WUDFWLRQZLOO
exacerbate the established necrotic process.
Page 108
PAGE 14 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
Future Research
The National Institutes of Health have provided fund-­
ing opportunities for research on the pathophysiology of bisphosphonate-­associated osteonecrosis of the jaw.184 This has resulted in multiple research efforts focusing on sever-­
al facets of this disease entity that have occurred since the last position paper. These studies are responsible for many of the new data and information that was presented in this paper. Areas of continued investigation include, but are not limited to: 1) analysis of alveolar bone hemostasis and the response to antiresorptive therapies;; 2) the role of novel antiangiogenic medications and their effects on jaw bone healing;; 3) pharmacogenetic research;; 4) development of valid MRONJ risk assessment tools;; 5) animal studies to validate existing and proposed treatment and prevention strategies.
Continued governmental and institutional support is re-­
quired in order to further elucidate the underlying patho-­
physiological mechanisms of MRONJ at the cellular and molecular level. Moreover, improved strategies for the prevention, risk reduction, and treatment of MRONJ need to be developed further so that more accurate judgments about risk, prognosis, treatment selection, and outcome can be established for patients with MRONJ.
DISCLAIMER
7KH$PHULFDQ$VVRFLDWLRQRI2UDODQG0D[LOORIDFLDO6XUJHRQV
$$206LVSURYLGLQJWKLVSRVLWLRQSDSHURQ0HGLFDWLRQ5HODW-­
HG2VWHRQHFURVLVRIWKH-DZ0521-WRLQIRUPSUDFWLWLRQHUV
patients and other interested parties. The position paper is based RQDUHYLHZRIWKHH[LVWLQJOLWHUDWXUHDQGWKHFOLQLFDOREVHUYD-­
tions of a Special Committee composed of oral and maxillofacial VXUJHRQVRUDOSDWKRORJLVWVDQGRQFRORJLVWVH[SHULHQFHGLQWKH
GLDJQRVLVVXUJLFDODQGDGMXQFWLYHWUHDWPHQWRIGLVHDVHVLQMXULHV
DQGGHIHFWVLQYROYLQJERWKWKHIXQFWLRQDODQGHVWKHWLFDVSHFWV
RIWKHKDUGDQGVRIWWLVVXHVRIWKHRUDODQGPD[LOORIDFLDOUHJLRQV
HSLGHPLRORJLVWVDQGEDVLFUHVHDUFKHUV
The position paper is informational in nature and is not intended WRVHWDQ\VWDQGDUGVRIFDUH$$206FDXWLRQVDOOUHDGHUVWKDW
WKHVWUDWHJLHVGHVFULEHGLQWKHSRVLWLRQSDSHUDUH127SUDFWLFH
SDUDPHWHUVRUJXLGHOLQHVDQGPD\127EHVXLWDEOHIRUHYHU\RU
DQ\SXUSRVHRUDSSOLFDWLRQ7KLVSRVLWLRQSDSHUFDQQRWVXEVWLWXWH
IRUWKHLQGLYLGXDOMXGJPHQWEURXJKWWRHDFKFOLQLFDOVLWXDWLRQE\
WKHSDWLHQW
VRUDODQGPD[LOORIDFLDOVXUJHRQ$VZLWKDOOFOLQLFDO
PDWHULDOVWKHSRVLWLRQSDSHUUHÀHFWVWKHVFLHQFHUHODWHGWR
MRONJ at the time of the paper’s development, and it should EHXVHGZLWKWKHFOHDUXQGHUVWDQGLQJWKDWFRQWLQXHGUHVHDUFK
DQGSUDFWLFHPD\UHVXOWLQQHZNQRZOHGJHRUUHFRPPHQGDWLRQV
$$206PDNHVQRH[SUHVVRULPSOLHGZDUUDQW\UHJDUGLQJWKHDF-­
FXUDF\FRQWHQWFRPSOHWHQHVVUHOLDELOLW\RSHUDELOLW\RUOHJDOLW\RI
LQIRUPDWLRQFRQWDLQHGZLWKLQWKHSRVLWLRQSDSHULQFOXGLQJZLWKRXW
OLPLWDWLRQWKHZDUUDQWLHVRIPHUFKDQWDELOLW\¿WQHVVIRUDSDUWLFXODU
SXUSRVHDQGQRQLQIULQJHPHQWRISURSULHWDU\ULJKWV,QQRHYHQW
shall the AAOMS be liable to the user of the position paper or DQ\RQHHOVHIRUDQ\GHFLVLRQPDGHRUDFWLRQWDNHQE\KLPRUKHU
in reliance on such information.
Page 109
PAGE 15 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
Appendix I: Antiresorptive Preparations Commonly Used in the U.S.
Alendronate
(Fosamax®)
Risedronate
(Actonel®)
Ibandronate
(Boniva®)
Primary
Indication
Osteoporosis
Nitrogen
Containing
Yes
Osteoporosis
Yes
Osteoporosis
Yes
Pamidronate
(Aredia®)
Zolendronate
(Zometa®)
Bone
Metastases
Bone
Metastases
(Reclast®)
Osteoporosis
Denosumab
(Xgeva®)
Bone
metastases
®
(Prolia )
Yes
Yes
No
Osteoporosis
Route
10 mg/day
70 mg/week
5 mg/day
35 mg/week
2.5 mg/day
150
mg/month
Oral
3 mg every 3
months
90 mg/3
weeks
4 mg/3
weeks
IV
5 mg/year
IV
120 mg/4
weeks
SQ
Humanized
monoclonal 60 mg/6
antibody
months
Page 110
PAGE 16 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Dose
Oral
Oral
IV
IV
SQ
Position Paper
Appendix II: Medications Used in the Treatment of Various Cancers that are
Antiangiogenic or Targets of the Vascular Endothelial Growth Factor (VEGF)
Pathway that have been Associated with Jaw Necrosis*.
Drug
Sunitinib
(Sutent)
Sorafenib
(Nexavar)
Bevacizumab
(Avastin)
Sirolimus
(Rapamune)
Mechanism of action
Primary indication
Tyrosine kinase inhibitor GIST, RCC, pNET
Tyrosine kinase inhibitor HCC, RCC
Humanized
monoclonal antibody
Mammalian target of
rapamycin pathway
mCRC, NSCLC, Glio, mRCC
Organ rejection in renal transplant
Abbreviations: GIST gastrointestinal stromal tumor; RCC renal cell carcinoma; pNET
pancreatic neuroendocrine tumor, HCC hepatocellular carcinoma; mCRC metastatic
colorectal carcinoma; NSCLC non-squamous non-small cell lung carcinoma; Glio
Glioblastoma; mRCC metastatic renal cell carcinoma
* While the FDA has issued an ONJ advisory only forbevacizumab and sunitinib,99,100
the committee remains concerned about a similar potential risk associated with several
other medications within the same drug class which have a similar mechanism of action.
Therefore further controlled, prospective studies will be required to more fully
characterize the risk of jaw necrosis associated with these agents.
Page 111
PAGE 17 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
22
Position Paper
Figure 1 – Frequency of ONJ Over Time107
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drug
s/DrugSafetyandRiskManagementAdvisoryCommittee/UCM270958.pdf (last accessed
4/7/2014) page 19.
Prevalence of ONJ by BP Duration
Oral BP Duration (years)
Page 112
PAGE 18 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
Figure 2 –
MRONJ Disease Frequency Grouped by Disease Status vs Medication Status Placebo
Zol2
Medications
Oral BP
Denosumab
Bevacizumab
Indications for Treatment
Bevacizumab Study Design
and Zolendronate
Malignancy
Guarneri, et al 4LHWDO
0.2% 1
0% 6FDJOLRWWLHWDO
Coleman, et al 0% Vahtsevanos, HWDO
Mauri, et al 0.019% 0.9% 6\VWHPDWLF
Review
1.1% 1.9% 6\VWHPDWLF
Review
0.8% 0.7% RCT
0.7% RCT
6.7% Prospective FRKRUWVWXG\
0.33% 6\VWHPDWLF
Review
Osteoporosis
Papapoulos, HWDO
0% Grbic, et al 0.020% Malden, 2012
Lo, 2010
0.04% 0.017% RCT
6\VWHPDWLF
Review
0.004% Prospective FRKRUWVWXG\
0.1%3 Cross-­ sectional
1
6DPSOHVL]HLQSDUHQWKHVHV
2
Zolendronate
3
3UHYDOHQFHHVWLPDWH$OORWKHUIUHTXHQFLHVUHSRUWHGLQWKH¿JXUHDUHLQFLGHQFHV
Page 113
PAGE 19 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
References 1. Ruggiero SL, Dodson TB, Assael LA, et al: American Association of Oral and Maxillofacial Surgeons position paper on bisphos-­
phonate-­related osteonecrosis of the jaws-­-­2009 update. J Oral Maxillofac Surg 67:2, 2009.
2. Nussbaum SR, Younger J, Vandepol CJ, et al: Single-­dose intrave-­
nous therapy with pamidronate for the treatment of hypercalcemia of malignancy: comparison of 30-­, 60-­, and 90-­mg dosages. Am J Med 95:297, 1993.
3. Major P, Lortholary A, Hon J, et al: Zoledronic acid is superior to pamidronate in the treatment of hypercalcemia of malignancy: a pooled analysis of two randomized, controlled clinical trials. J Clin Oncol 19:558, 2001.
+RUWREDJ\L*17KHULDXOW5/3RUWHU/HWDO(I¿FDF\RISDPLGUR-­
nate in reducing skeletal complications in patients with breast can-­
cer and lytic bone metastases. Protocol 19 Aredia Breast Cancer Study Group. N Engl J Med 335:1785, 1996.
5. 6. 7. Hortobagyi GN, Theriault RL, Lipton A, et al: Long-­term preven-­
tion of skeletal complications of metastatic breast cancer with pamidronate. Protocol 19 Aredia Breast Cancer Study Group. J Clin Oncol 16:2038, 1998.
Hillner BE, Ingle JN, Chlebowski RT, et al: American Society of Clinical Oncology 2003 update on the role of bisphosphonates and bone health issues in women with breast cancer. J Clin Oncol 21:4042, 2003.
Saad F, Gleason DM, Murray R, et al: A randomized, placebo-­con-­
trolled trial of zoledronic acid in patients with hormone-­refractory metastatic prostate carcinoma. J Natl Cancer Inst 94:1458, 2002.
6DDG)*OHDVRQ'00XUUD\5HWDO/RQJWHUPHI¿FDF\RI]ROH-­
dronic acid for the prevention of skeletal complications in patients with metastatic hormone-­refractory prostate cancer. J Natl Cancer Inst 96:879, 2004.
5RVHQ/6*RUGRQ'7FKHNPHG\LDQ16HWDO/RQJWHUPHI¿FDF\
and safety of zoledronic acid in the treatment of skeletal metasta-­
ses in patients with nonsmall cell lung carcinoma and other solid tumors: a randomized, Phase III, double-­blind, placebo-­controlled trial. Cancer 100:2613, 2004.
%HUHQVRQ-5/LFKWHQVWHLQ$3RUWHU/HWDO(I¿FDF\RISDPLGUR-­
nate in reducing skeletal events in patients with advanced multiple myeloma. Myeloma Aredia Study Group. N Engl J Med 334:488, 1996.
11. Berenson JR, Lichtenstein A, Porter L, et al: Long-­term pamid-­
ronate treatment of advanced multiple myeloma patients reduces skeletal events. Myeloma Aredia Study Group. J Clin Oncol 16:593, 1998.
12. Rosen LS, Gordon D, Kaminski M, et al: Zoledronic acid versus pamidronate in the treatment of skeletal metastases in patients with breast cancer or osteolytic lesions of multiple myeloma: a phase III, double-­blind, comparative trial. Cancer J 7:377, 2001.
13. Berenson JR, Hillner BE, Kyle RA, et al: American Society of Clin-­
ical Oncology clinical practice guidelines: the role of bisphospho-­
nates in multiple myeloma. J Clin Oncol 20:3719, 2002.
14. United States. Food and Drug Administration. Center for Drug Evaluation and Research. http://www.accessdata.fda.gov/scripts/
cder/drugsatfda/index.cfm?CFID=22255647&CFTOKEN=bb-­
f41c75f8cb0109-­1F350AA8-­A3B1-­DF88-­62056BCE97C69DB1 Accessed February 10, 2014.
15. Physicians' Desk Reference. 57th ed. Montvale, NJ: Medical Eco-­
nomics;; 2003.
16. Delmas PD, Meunier PJ: The management of Paget's disease of bone. N Engl J Med 336:558, 1997.
17. Letocha AD, Cintas HL, Troendle JF, et al: Controlled trial of pamidronate in children with types III and IV osteogenesis LPSHUIHFWDFRQ¿UPVYHUWHEUDOJDLQVEXWQRWVKRUWWHUPIXQFWLRQDO
improvement. J Bone Miner Res 20:977, 2005.
18. Watts NB: Bisphosphonate treatment of osteoporosis. Clin Geriatr Med 19:395, 2003.
19. Delmas PD: The use of bisphosphonates in the treatment of osteo-­
porosis. Curr Opin Rheumatol 17:462, 2005.
20. Cummings SR, San Martin J, McClung MR, et al: Denosumab for prevention of fractures in postmenopausal women with osteoporo-­
sis. N Engl J Med 361:756, 2009.
21. Papapoulos S, Chapurlat R, Libanati C, et al: Five years of de-­
nosumab exposure in women with postmenopausal osteoporosis: UHVXOWVIURPWKH¿UVWWZR\HDUVRIWKH)5(('20H[WHQVLRQ-%RQH
Miner Res 27:694, 2012.
22. Fizazi K, Carducci M, Smith M, et al: Denosumab versus zoledron-­
ic acid for treatment of bone metastases in men with castration-­re-­
sistant prostate cancer: a randomised, double-­blind study. Lancet 377:813, 2011.
23. Stopeck A, Body JJ, Fujiwara Y, et al: Denosumab versus zolen-­
dronic acid for the treatment of breast cancer patients with bone metastases: results of a randomized phase 3 study. Eur J Cancer Supplements [EJC supplements] 7:2, 2009.
24. Marx RE: Pamidronate (Aredia) and zoledronate (Zometa) in-­
duced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 61:1115, 2003.
25. Ruggiero SL, Mehrotra B, Rosenberg TJ, et al: Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 62:527, 2004.
Page 114
PAGE 20 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
26. Hohnecker JA: Dear Doctor. Precautions added to the label of Aredia and Zometa ed. East Hanover, NJ: Novartis Oncology;; September 24, 2004:2.
27. United States. Food and Drug Administration. Oncologic Drugs $GYLVRU\&RPPLWWHH&RPELGH[EULH¿QJLQIRUPDWLRQ http://www.
IGDJRYRKUPVGRFNHWVDFEULH¿QJ%BB$G-­
vancedMag-­Combidex.pdf Accessed February 10, 2014.
8QLWHG6WDWHV)RRGDQG'UXJ$GPLQLVWUDWLRQ2I¿FHRI'UXJ6DIH-­
ty. Postmarketing Safety Review. Bisphosphonates. http://www.
IGDJRYRKUPVGRFNHWVDFEULH¿QJ%BB)'$
Tab3.pdf Accessed February 10, 2014.
29. Reid IR, Bolland MJ, Grey AB: Is bisphosphonate-­associated os-­
teonecrosis of the jaw caused by soft tissue toxicity? Bone 41:318, 2007.
30. Allen MR, Burr DB: The pathogenesis of bisphosphonate-­related osteonecrosis of the jaw: so many hypotheses, so few data. J Oral Maxillofac Surg 67:61, 2009.
31. Landesberg R, Woo V, Cremers S, et al: Potential pathophysio-­
logical mechanisms in osteonecrosis of the jaw. Ann N Y Acad Sci 1218:62, 2011.
32. Yamashita J, McCauley LK: Antiresorptives and osteonecrosis of the jaw. J Evid Based Dent Pract 12:233, 2012.
33. Bamias A, Kastritis E, Bamia C, et al: Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol 23:8580, 2005.
34. Bi Y, Gao Y, Ehirchiou D, et al: Bisphosphonates cause osteone-­
crosis of the jaw-­like disease in mice. Am J Pathol 177:280, 2010.
35. Hokugo A, Christensen R, Chung EM, et al: Increased prevalence of bisphosphonate-­related osteonecrosis of the jaw with vitamin D GH¿FLHQF\LQUDWV-%RQH0LQHU5HV
36. Mortensen M, Lawson W, Montazem A: Osteonecrosis of the jaw associated with bisphosphonate use: Presentation of seven cases and literature review. Laryngoscope 117:30, 2007.
37. Sonis ST, Watkins BA, Lyng GD, et al: Bony changes in the jaws of rats treated with zoledronic acid and dexamethasone before dental extractions mimic bisphosphonate-­related osteonecrosis in cancer patients. Oral Oncol 45:164, 2009.
38. Mehrotra B, Ruggiero S: Bisphosphonate complications including osteonecrosis of the jaw. Hematology Am Soc Hematol Educ Pro-­
gram:356, 2006.
39. Ruggiero SL, Fantasia J, Carlson E: Bisphosphonate-­related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102:433, 2006.
40. Wood J, Bonjean K, Ruetz S, et al: Novel antiangiogenic effects of the bisphosphonate compound zoledronic acid. J Pharmacol Exp Ther 302:1055, 2002.
41. Baron R, Ferrari S, Russell RG: Denosumab and bisphosphonates: different mechanisms of action and effects. Bone 48:677, 2011.
42. Lacey DL, Boyle WJ, Simonet WS, et al: Bench to bedside: eluci-­
dation of the OPG-­RANK-­RANKL pathway and the development of denosumab. Nat Rev Drug Discov 11:401, 2012.
43. Russell RG, Watts NB, Ebetino FH, et al: Mechanisms of action of bisphosphonates: similarities and differences and their potential LQÀXHQFHRQFOLQLFDOHI¿FDF\2VWHRSRURV,QW
44. Roelofs AJ, Thompson K, Gordon S, et al: Molecular mechanisms of action of bisphosphonates: current status. Clin Cancer Res 12:6222s, 2006.
45. Russell RG, Rogers MJ: Bisphosphonates: from the laboratory to the clinic and back again. Bone 25:97, 1999.
46. Aghaloo TL, Kang B, Sung EC, et al: Periodontal disease and bisphosphonates induce osteonecrosis of the jaws in the rat. J Bone Miner Res 26:1871, 2011.
47. Allen MR, Burr DB: Mandible matrix necrosis in beagle dogs after 3 years of daily oral bisphosphonate treatment. J Oral Maxillofac Surg 66:987, 2008.
48. Lipton A, Fizazi K, Stopeck AT, et al: Superiority of denosumab to zoledronic acid for prevention of skeletal-­related events: a combined analysis of 3 pivotal, randomised, phase 3 trials. Eur J Cancer 48:3082, 2012.
49. Sinningen K, Tsourdi E, Rauner M, et al: Skeletal and extraskeletal actions of denosumab. Endocrine 42:52, 2012.
50. Aghaloo TL, Felsenfeld AL, Tetradis S: Osteonecrosis of the jaw in a patient on denosumab. J Oral Maxillofac Surg 68:959, 2010.
51. Kuroshima S, Kovacic BL, Kozloff KM, et al: Intra-­oral PTH ad-­
ministration promotes tooth extraction socket healing. J Dent Res 92:553, 2013.
52. Dayisoylu EH, Senel FC, Ungor C, et al: The effects of adjunctive parathyroid hormone injection on bisphosphonate-­related osteo-­
necrosis of the jaws: an animal study. Int J Oral Maxillofac Surg 42:1475, 2013.
53. Dimopoulos MA, Kastritis E, Bamia C, et al: Reduction of os-­
teonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zoledronic acid. Ann Oncol 20:117, 2009.
54. Hoff AO, Toth BB, Altundag K, et al: Frequency and risk factors associated with osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. J Bone Miner Res 23:826, 2008.
Page 115
PAGE 21 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
55. Ripamonti CI, Maniezzo M, Campa T, et al: Decreased occurrence of osteonecrosis of the jaw after implementation of dental preven-­
tive measures in solid tumour patients with bone metastases treated with bisphosphonates. The experience of the National Cancer Institute of Milan. Ann Oncol 20:137, 2009.
56. Boonyapakorn T, Schirmer I, Reichart PA, et al: Bisphospho-­
nate-­induced osteonecrosis of the jaws: prospective study of 80 patients with multiple myeloma and other malignancies. Oral Oncol 44:857, 2008.
57. Marx R: Oral and Intravenous Bisphosphonate Induced Osteone-­
crosis of the Jaws: History, etiology, prevention, and treatment. 2nd ed. Hanover Park, IL: Quintessence Publishing Co;; 2011.
58. Marx RE, Sawatari Y, Fortin M, et al: Bisphosphonate-­induced ex-­
posed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 63:1567, 2005.
59. Ficarra G, Beninati F, Rubino I, et al: Osteonecrosis of the jaws in periodontal patients with a history of bisphosphonates treatment. J Clin Periodontol 32:1123, 2005.
69. Sedghizadeh PP, Yooseph S, Fadrosh DW, et al: Metagenomic investigation of microbes and viruses in patients with jaw osteo-­
necrosis associated with bisphosphonate therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 114:764, 2012.
70. Wanger G, Gorby Y, El-­Naggar MY, et al: Electrically conductive bacterial nanowires in bisphosphonate-­related osteonecrosis of the MDZELR¿OPV2UDO6XUJ2UDO0HG2UDO3DWKRO2UDO5DGLRO
2013.
71. Kim HK: Introduction to osteonecrosis of the femoral head (OFH) and osteonecrosis of the jaw (ONJ). J Musculoskelet Neuronal Interact 7:350, 2007.
60. Aguirre JI, Akhter MP, Kimmel DB, et al: Oncologic doses of zoledronic acid induce osteonecrosis of the jaw-­like lesions in rice rats (Oryzomys palustris) with periodontitis. J Bone Miner Res 27:2130, 2012.
72. Bezzi M, Hasmim M, Bieler G, et al: Zoledronate sensitizes en-­
dothelial cells to tumor necrosis factor-­induced programmed cell death: evidence for the suppression of sustained activation of focal adhesion kinase and protein kinase B/Akt. J Biol Chem 278:43603, 2003.
61. Kang B, Cheong S, Chaichanasakul T, et al: Periapical disease and bisphosphonates induce osteonecrosis of the jaws in mice. J Bone Miner Res 28:1631, 2013.
73. Santini D, Vincenzi B, Dicuonzo G, et al: Zoledronic acid induces VLJQL¿FDQWDQGORQJODVWLQJPRGL¿FDWLRQVRIFLUFXODWLQJDQJLRJHQLF
factors in cancer patients. Clin Cancer Res 9:2893, 2003.
62. Mawardi H, Treister N, Richardson P, et al: Sinus tracts-­-­an early sign of bisphosphonate-­associated osteonecrosis of the jaws? J Oral Maxillofac Surg 67:593, 2009.
74. Lin JH: Bisphosphonates: a review of their pharmacokinetic prop-­
erties. Bone 18:75, 1996.
63. Lopez-­Jornet P, Camacho-­Alonso F, Martinez-­Canovas A, et al: Perioperative antibiotic regimen in rats treated with pamidronate plus dexamethasone and subjected to dental extraction: a study of the changes in the jaws. J Oral Maxillofac Surg 69:2488, 2011.
64. Gotcher JE, Jee WS: The progress of the periodontal syndrome in the rice rat. I. Morphometric and autoradiographic studies. J Periodontal Res 16:275, 1981.
65. Hansen T, Kunkel M, Weber A, et al: Osteonecrosis of the jaws in patients treated with bisphosphonates -­ histomorphologic analysis in comparison with infected osteoradionecrosis. J Oral Pathol Med 35:155, 2006.
6HGJKL]DGHK33.XPDU6.*RUXU$HWDO,GHQWL¿FDWLRQRIPLFUR-­
ELDOELR¿OPVLQRVWHRQHFURVLVRIWKHMDZVVHFRQGDU\WRELVSKRVSKR-­
nate therapy. J Oral Maxillofac Surg 66:767, 2008.
67. Kos M, Junka A, Smutnicka D, et al: Pamidronate enhances bacterial adhesion to bone hydroxyapatite. Another puzzle in the pathology of bisphosphonate-­related osteonecrosis of the jaw? J Oral Maxillofac Surg 71:1010, 2013.
6HGJKL]DGHK33.XPDU6.*RUXU$HWDO0LFURELDOELR¿OPVLQ
osteomyelitis of the jaw and osteonecrosis of the jaw secondary to bisphosphonate therapy. J Am Dent Assoc 140:1259, 2009.
75. Giraudo E, Inoue M, Hanahan D: An amino-­bisphosphonate tar-­
gets MMP-­9-­expressing macrophages and angiogenesis to impair cervical carcinogenesis. J Clin Invest 114:623, 2004.
76. Montague R, Hart CA, George NJ, et al: Differential inhibition of invasion and proliferation by bisphosphonates: anti-­metastatic potential of Zoledronic acid in prostate cancer. Eur Urol 46:389, 2004.
77. Landesberg R, Cozin M, Cremers S, et al: Inhibition of oral muco-­
sal cell wound healing by bisphosphonates. J Oral Maxillofac Surg 66:839, 2008.
78. Reid IR, Cornish J: Epidemiology and pathogenesis of osteonecro-­
sis of the jaw. Nat Rev Rheumatol 8:90, 2012.
79. Ali-­Erdem M, Burak-­Cankaya A, Cemil-­Isler S, et al: Extraction socket healing in rats treated with bisphosphonate: animal model for bisphosphonate related osteonecrosis of jaws in multiple my-­
eloma patients. Med Oral Patol Oral Cir Bucal 16:e879, 2011.
80. Kikuiri T, Kim I, Yamaza T, et al: Cell-­based immunotherapy with mesenchymal stem cells cures bisphosphonate-­related osteone-­
crosis of the jaw-­like disease in mice. J Bone Miner Res 25:1668, 2010.
Page 116
PAGE 22 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
81. Qi WX, Tang LN, He AN, et al: Risk of osteonecrosis of the jaw in cancer patients receiving denosumab: a meta-­analysis of seven randomized controlled trials. Int J Clin Oncol, 2013.
82. Coleman R, Woodward E, Brown J, et al: Safety of zoledronic acid and incidence of osteonecrosis of the jaw (ONJ) during adjuvant therapy in a randomised phase III trial (AZURE: BIG 01-­04) for women with stage II/III breast cancer. Breast Cancer Res Treat 127:429, 2011.
83. Mauri D, Valachis A, Polyzos IP, et al: Osteonecrosis of the jaw and use of bisphosphonates in adjuvant breast cancer treatment: a meta-­analysis. Breast Cancer Res Treat 116:433, 2009.
+RHIHUW6(X¿QJHU+6XQLWLQLEPD\UDLVHWKHULVNRIELVSKRVSKR-­
nate-­related osteonecrosis of the jaw: presentation of three cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 110:463, 2010.
84. Vahtsevanos K, Kyrgidis A, Verrou E, et al: Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-­related osteonecrosis of the jaw. J Clin Oncol 27:5356, 2009.
96. Bozas G, Roy A, Ramasamy V, et al: Osteonecrosis of the jaw after a single bisphosphonate infusion in a patient with metastatic renal cancer treated with sunitinib. Onkologie 33:321, 2010.
85. Scagliotti GV, Hirsh V, Siena S, et al: Overall survival improve-­
ment in patients with lung cancer and bone metastases treated with denosumab versus zoledronic acid: subgroup analysis from a randomized phase 3 study. J Thorac Oncol 7:1823, 2012.
97. Beuselinck B, Wolter P, Karadimou A, et al: Concomitant oral tyrosine kinase inhibitors and bisphosphonates in advanced renal cell carcinoma with bone metastases. Br J Cancer 107:1665, 2012.
86. Henry DH, Costa L, Goldwasser F, et al: Randomized, dou-­
ble-­blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol 29:1125, 2011.
87. Guarneri V, Miles D, Robert N, et al: Bevacizumab and osteone-­
crosis of the jaw: incidence and association with bisphosphonate therapy in three large prospective trials in advanced breast cancer. Breast Cancer Res Treat 122:181, 2010.
88. Koch FP, Walter C, Hansen T, et al: Osteonecrosis of the jaw relat-­
ed to sunitinib. Oral Maxillofac Surg 15:63, 2011.
89. Nicolatou-­Galitis O, Migkou M, Psyrri A, et al: Gingival bleeding and jaw bone necrosis in patients with metastatic renal cell carci-­
noma receiving sunitinib: report of 2 cases with clinical implica-­
tions. Oral Surg Oral Med Oral Pathol Oral Radiol 113:234, 2012.
90. Fleissig Y, Regev E, Lehman H: Sunitinib related osteonecrosis of jaw: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 113:e1, 2012.
91. Brunello A, Saia G, Bedogni A, et al: Worsening of osteonecrosis of the jaw during treatment with sunitinib in a patient with meta-­
static renal cell carcinoma. Bone 44:173, 2009.
92. Ayllon J, Launay-­Vacher V, Medioni J, et al: Osteonecrosis of the jaw under bisphosphonate and antiangiogenic therapies: cumula-­
WLYHWR[LFLW\SUR¿OH"$QQ2QFRO
93. Christodoulou C, Pervena A, Klouvas G, et al: Combination of bisphosphonates and antiangiogenic factors induces osteonecrosis of the jaw more frequently than bisphosphonates alone. Oncology 76:209, 2009.
94. Balmor GR, Yarom N, Weitzen R: Drug-­induced palate osteonecro-­
sis following nasal surgery. Isr Med Assoc J 14:193, 2012.
98. Smidt-­Hansen T, Folkmar TB, Fode K, et al: Combination of zole-­
dronic acid and targeted therapy is active but may induce osteone-­
crosis of the jaw in patients with metastatic renal cell carcinoma. J Oral Maxillofac Surg 71:1532, 2013.
99. United States. Food and Drug Administration. Avastin (bevaci-­
zumab) Safety Information. http://www.fda.gov/Safety/MedWatch/
SafetyInformation/ucm275758.htm Accessed March 13, 2014.
100. United States. Food and Drug Administration. Sutent (sunitinib malate) capsules Safety Information. http://www.fda.gov/safety/
medwatch/safetyinformation/ucm224050.htm. Accessed March 13, 2014.
101. Background Document for Meeting of Advisory Committee for Reproductive Health Drugs and Drug Safety and Risk Management Advisory Committee. United States. Food and Drug Administra-­
tion. September 9, 2011;; http://www.fda.gov/downloads/Advisory-­
Committees/CommitteesMeetingMaterials/drugs/DrugSafetyan-­
dRiskManagementAdvisoryCommittee/ucm270958.pdf Accessed February 10, 2014.
102. Lo JC, O'Ryan FS, Gordon NP, et al: Prevalence of osteonecrosis of the jaw in patients with oral bisphosphonate exposure. J Oral Maxillofac Surg 68:243, 2010.
103. Felsenberg D, Hoffmeister B: [Necrosis of the jaw after high-­dose bisphosphonate therapy.] Kiefernekrosen nach hoch dosierter Bisphosphonattherapie. Dtsch Arztebl 103:3078, 2006.
104. Malden N, Lopes V: An epidemiological study of alendronate-­re-­
lated osteonecrosis of the jaws. A case series from the south-­east of 6FRWODQGZLWKDWWHQWLRQJLYHQWRFDVHGH¿QLWLRQDQGSUHYDOHQFH-
Bone Miner Metab 30:171, 2012.
105. Grbic JT, Black DM, Lyles KW, et al: The incidence of osteone-­
crosis of the jaw in patients receiving 5 milligrams of zoledronic acid: data from the health outcomes and reduced incidence with zoledronic acid once yearly clinical trials program. J Am Dent Assoc 141:1365, 2010.
Page 117
PAGE 23 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
106. Black DM, Reid IR, Boonen S, et al: The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized exten-­
sion to the HORIZON-­Pivotal Fracture Trial (PFT). J Bone Miner Res 27:243, 2012.
%ULH¿QJ,QIRUPDWLRQIRUWKH6HSWHPEHU-RLQW0HHWLQJRI
the Reproductive Health Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee. Septemer 9, 2011;; http://www.fda.gov/AdvisoryCommittees/CommitteesMeet-­
ingMaterials/Drugs/DrugSafetyandRiskManagementAdvisoryCom-­
mittee/ucm270957.htm. Accessed April 7, 2014.
108. Saad F, Brown JE, Van Poznak C, et al: Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-­controlled phase III trials in cancer patients with bone metastases. Ann Oncol 23:1341, 2012.
109. Fehm T, Beck V, Banys M, et al: Bisphosphonate-­induced osteone-­
crosis of the jaw (ONJ): Incidence and risk factors in patients with breast cancer and gynecological malignancies. Gynecol Oncol 112:605, 2009.
110. Kyrgidis A, Vahtsevanos K, Koloutsos G, et al: Bisphosphonate-­re-­
lated osteonecrosis of the jaws: a case-­control study of risk factors in breast cancer patients. J Clin Oncol 26:4634, 2008.
111. Kunchur R, Need A, Hughes T, et al: Clinical investigation of C-­terminal cross-­linking telopeptide test in prevention and man-­
agement of bisphosphonate-­associated osteonecrosis of the jaws. J Oral Maxillofac Surg 67:1167, 2009.
112. Yamazaki T, Yamori M, Ishizaki T, et al: Increased incidence of osteonecrosis of the jaw after tooth extraction in patients treated with bisphosphonates: a cohort study. Int J Oral Maxillofac Surg 41:1397, 2012.
113. Mozzati M, Arata V, Gallesio G: Tooth extraction in patients on zoledronic acid therapy. Oral Oncol 48:817, 2012.
114. Scoletta M, Arata V, Arduino PG, et al: Tooth extractions in intra-­
YHQRXVELVSKRVSKRQDWHWUHDWHGSDWLHQWVDUH¿QHGSURWRFRO-2UDO
Maxillofac Surg 71:994, 2013.
115. Tsao C, Darby I, Ebeling PR, et al: Oral health risk factors for bisphosphonate-­associated jaw osteonecrosis. J Oral Maxillofac Surg 71:1360, 2013.
116. Brown JJ, Ramalingam L, Zacharin MR: Bisphosphonate-­asso-­
ciated osteonecrosis of the jaw: does it occur in children? Clin Endocrinol (Oxf) 68:863, 2008.
117. Katz J, Gong Y, Salmasinia D, et al: Genetic polymorphisms and other risk factors associated with bisphosphonate induced osteone-­
crosis of the jaw. Int J Oral Maxillofac Surg 40:605, 2011.
118. Nicoletti P, Cartsos VM, Palaska PK, et al: Genomewide pharma-­
cogenetics of bisphosphonate-­induced osteonecrosis of the jaw: the role of RBMS3. Oncologist 17:279, 2012.
119. Marini F, Tonelli P, Cavalli L, et al: Pharmacogenetics of bisphos-­
phonate-­associated osteonecrosis of the jaw. Front Biosci (Elite Ed) 3:364, 2011.
120. Sivolella S, Lumachi F, Stellini E, et al: Denosumab and anti-­an-­
giogenetic drug-­related osteonecrosis of the jaw: an uncommon but potentially severe disease. Anticancer Res 33:1793, 2013.
121. Epstein MS, Epstein JB, Ephros HD: The effects of osteoclast PRGL¿HUVRQWKHRUDOFDYLW\DUHYLHZIRUSUHVFULEHUV&XUU2SLQ
Support Palliat Care 6:337, 2012.
122. Vescovi P, Merigo E, Meleti M, et al: Bisphosphonates-­related osteonecrosis of the jaws: a concise review of the literature and a report of a single-­centre experience with 151 patients. J Oral Pathol Med 41:214, 2012.
123. Schubert M, Klatte I, Linek W, et al: The Saxon bisphosphonate register -­ therapy and prevention of bisphosphonate-­related osteo-­
necrosis of the jaws. Oral Oncol 48:349, 2012.
124. Shannon J, Shannon J, Modelevsky S, et al: Bisphosphonates and osteonecrosis of the jaw. J Am Geriatr Soc 59:2350, 2011.
125. Lo JC, O'Ryan F, Yang J, et al: Oral health considerations in older women receiving oral bisphosphonate therapy. J Am Geriatr Soc 59:916, 2011.
126. Hellstein JW, Adler RA, Edwards B, et al: Managing the care of patients receiving antiresorptive therapy for prevention and treat-­
ment of osteoporosis: executive summary of recommendations from WKH$PHULFDQ'HQWDO$VVRFLDWLRQ&RXQFLORQ6FLHQWL¿F$IIDLUV-
Am Dent Assoc 142:1243, 2011.
127. Patel V, McLeod NM, Rogers SN, et al: Bisphosphonate osteone-­
crosis of the jaw—a literature review of UK policies versus inter-­
national policies on bisphosphonates, risk factors and prevention. Br J Oral Maxillofac Surg 49:251, 2011.
128. Atalay B, Yalcin S, Emes Y, et al: Bisphosphonate-­related osteone-­
crosis: laser-­assisted surgical treatment or conventional surgery? Lasers Med Sci 26:815, 2011.
$DSUR06DDG)&RVWD/2SWLPL]LQJFOLQLFDOEHQH¿WVRIELV-­
phosphonates in cancer patients with bone metastases. Oncologist 15:1147, 2010.
130. Fehm T, Felsenberg D, Krimmel M, et al: Bisphosphonate-­associ-­
ated osteonecrosis of the jaw in breast cancer patients: recommen-­
dations for prevention and treatment. Breast 18:213, 2009.
131. Walter C, Al-­Nawas B, du Bois A, et al: Incidence of bisphospho-­
nate-­associated osteonecrosis of the jaws in breast cancer patients. Cancer 115:1631, 2009.
132. Khan AA, Sandor GK, Dore E, et al: Bisphosphonate associated osteonecrosis of the jaw. J Rheumatol 36:478, 2009.
Page 118
PAGE 24 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
133. Dickinson M, Prince HM, Kirsa S, et al: Osteonecrosis of the jaw complicating bisphosphonate treatment for bone disease in multi-­
ple myeloma: an overview with recommendations for prevention and treatment. Intern Med J 39:304, 2009.
134. Edwards BJ, Hellstein JW, Jacobsen PL, et al: Updated rec-­
ommendations for managing the care of patients receiving oral bisphosphonate therapy: an advisory statement from the American 'HQWDO$VVRFLDWLRQ&RXQFLORQ6FLHQWL¿F$IIDLUV-$P'HQW$VVRF
139:1674, 2008.
135. Abu-­Id MH, Warnke PH, Gottschalk J, et al: "Bis-­phossy jaws" -­ high and low risk factors for bisphosphonate-­induced osteonecro-­
sis of the jaw. J Craniomaxillofac Surg 36:95, 2008.
.\OH5$<HH*&6RPHU¿HOG05HWDO$PHULFDQ6RFLHW\RI&OLQ-­
ical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma. J Clin Oncol 25:2464, 2007.
137. Bonacina R, Mariani U, Villa F, et al: Preventive strategies and clinical implications for bisphosphonate-­related osteonecrosis of the jaw: a review of 282 patients. J Can Dent Assoc 77:b147, 2011.
138. Vandone AM, Donadio M, Mozzati M, et al: Impact of dental care in the prevention of bisphosphonate-­associated osteonecrosis of the jaw: a single-­center clinical experience. Ann Oncol 23:193, 2012.
139. Hinchy NV, Jayaprakash V, Rossitto RA, et al: Osteonecrosis of the jaw -­ prevention and treatment strategies for oral health profes-­
sionals. Oral Oncol 49:878, 2013.
140. Khan AA, Morrison A, Hanley DA, et al: International Consen-­
sus on Diagnosis and Management of Osteonecrosis of the Jaw. 2013:22.
141. Damm DD, Jones DM: Bisphosphonate-­related osteonecrosis of the jaws: a potential alternative to drug holidays. Gen Dent 61:33, 2013.
142. Durie BG, Katz M, Crowley J: Osteonecrosis of the jaw and bis-­
phosphonates. N Engl J Med 353:99, 2005.
143. Hoff AO, Toth BB, Altundag K, et al: Osteonecrosis of the jaw in patients receiving intravenous bisphosphonate therapy. J Clin Oncol 24:8528, 2006.
144. Badros A, Weikel D, Salama A, et al: Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol 24:945, 2006.
145. Mehrotra B, Fantasia J, Ruggiero SL: Outcomes of bisphos-­
phonate related osteonecrosis of the jaw. Importance of staging and management. A large single institution update. J Clin Oncol 26:20526, 2008.
146. Endodontic Implications of Bisphosphonate-­Associated Osteone-­
crosis of the Jaws. Chicago, IL: American Association of Endodon-­
tists;; 2010:4.
147. Marx RE, Cillo JE, Jr., Ulloa JJ: Oral bisphosphonate-­induced os-­
teonecrosis: risk factors, prediction of risk using serum CTX test-­
ing, prevention, and treatment. J Oral Maxillofac Surg 65:2397, 2007.
148. Carlson ER, Basile JD: The role of surgical resection in the management of bisphosphonate-­related osteonecrosis of the jaws. J Oral Maxillofac Surg 67:85, 2009.
149. Bagan JV, Jimenez Y, Gomez D, et al: Collagen telopeptide (serum CTX) and its relationship with the size and number of lesions in os-­
teonecrosis of the jaws in cancer patients on intravenous bisphos-­
phonates. Oral Oncol 44:1088, 2008.
150. Kwon YD, Kim DY, Ohe JY, et al: Correlation between serum C-­terminal cross-­linking telopeptide of type I collagen and staging of oral bisphosphonate-­related osteonecrosis of the jaws. J Oral Maxillofac Surg 67:2644, 2009.
151. Lehrer S, Montazem A, Ramanathan L, et al: Normal serum bone markers in bisphosphonate-­induced osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:389, 2008.
152. Migliorati CA, Saunders D, Conlon MS, et al: Assessing the as-­
sociation between bisphosphonate exposure and delayed mucosal healing after tooth extraction. J Am Dent Assoc 144:406, 2013.
153. Fleisher KE, Welch G, Kottal S, et al: Predicting risk for bisphos-­
phonate-­related osteonecrosis of the jaws: CTX versus radiograph-­
ic markers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 110:509, 2010.
154. Rosen HN, Moses AC, Garber J, et al: Serum CTX: a new marker of bone resorption that shows treatment effect more often than RWKHUPDUNHUVEHFDXVHRIORZFRHI¿FLHQWRIYDULDELOLW\DQGODUJH
changes with bisphosphonate therapy. Calcif Tissue Int 66:100, 2000.
155. Kim I, Ki H, Lee W, et al: The effect of systemically administered bisphosphonates on bony healing after tooth extraction and os-­
seointegration of dental implants in the rabbit maxilla. Int J Oral Maxillofac Implants 28:1194, 2013.
156. Graziani F, Vescovi P, Campisi G, et al: Resective surgical ap-­
proach shows a high performance in the management of advanced cases of bisphosphonate-­related osteonecrosis of the jaws: a retrospective survey of 347 cases. J Oral Maxillofac Surg 70:2501, 2012.
157. Stanton DC, Balasanian E: Outcome of surgical management of bisphosphonate-­related osteonecrosis of the jaws: review of 33 surgical cases. J Oral Maxillofac Surg 67:943, 2009.
158. Stockmann P, Vairaktaris E, Wehrhan F, et al: Osteotomy and pri-­
mary wound closure in bisphosphonate-­associated osteonecrosis of the jaw: a prospective clinical study with 12 months follow-­up. Support Care Cancer 18:449, 2010.
Page 119
PAGE 25 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Position Paper
159. Mucke T, Koschinski J, Deppe H, et al: Outcome of treatment and SDUDPHWHUVLQÀXHQFLQJUHFXUUHQFHLQSDWLHQWVZLWKELVSKRVSKR-­
nate-­related osteonecrosis of the jaws. J Cancer Res Clin Oncol 137:907, 2011.
160. Eckardt AM, Lemound J, Lindhorst D, et al: Surgical management of bisphosphonate-­related osteonecrosis of the jaw in oncologic patients: a challenging problem. Anticancer Res 31:2313, 2011.
161. Ferlito S, Puzzo S, Palermo F, et al: Treatment of bisphospho-­
nate-­related osteonecrosis of the jaws: presentation of a protocol and an observational longitudinal study of an Italian series of cases. Br J Oral Maxillofac Surg 50:425, 2012.
162. Saussez S, Javadian R, Hupin C, et al: Bisphosphonate-­related osteonecrosis of the jaw and its associated risk factors: a Belgian case series. Laryngoscope 119:323, 2009.
163. Scoletta M, Arduino PG, Dalmasso P, et al: Treatment outcomes in patients with bisphosphonate-­related osteonecrosis of the jaws: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 110:46, 2010.
164. Van den Wyngaert T, Claeys T, Huizing MT, et al: Initial experience with conservative treatment in cancer patients with osteonecrosis of the jaw (ONJ) and predictors of outcome. Ann Oncol 20:331, 2009.
165. Wutzl A, Biedermann E, Wanschitz F, et al: Treatment results of bisphosphonate-­related osteonecrosis of the jaws. Head Neck 30:1224, 2008.
166. Kademani D, Koka S, Lacy MQ, et al: Primary surgical therapy for osteonecrosis of the jaw secondary to bisphosphonate therapy. Mayo Clin Proc 81:1100, 2006.
167. Freiberger JJ, Padilla-­Burgos R, McGraw T, et al: What is the role of hyperbaric oxygen in the management of bisphosphonate-­re-­
lated osteonecrosis of the jaw: a randomized controlled trial of hyperbaric oxygen as an adjunct to surgery and antibiotics. J Oral Maxillofac Surg 70:1573, 2012.
168. Freiberger JJ: Utility of hyperbaric oxygen in treatment of bis-­
phosphonate-­related osteonecrosis of the jaws. J Oral Maxillofac Surg 67:96, 2009.
169. Lee CY, David T, Nishime M: Use of platelet-­rich plasma in the management of oral biphosphonate-­associated osteonecrosis of the jaw: a report of 2 cases. J Oral Implantol 33:371, 2007.
170. Soydan SS, Uckan S: Management of bisphosphonate-­related RVWHRQHFURVLVRIWKHMDZZLWKDSODWHOHWULFK¿EULQPHPEUDQH
technical report. J Oral Maxillofac Surg 72:322, 2014.
171. Scoletta M, Arduino PG, Reggio L, et al: Effect of low-­level laser irradiation on bisphosphonate-­induced osteonecrosis of the jaws: preliminary results of a prospective study. Photomed Laser Surg 28:179, 2010.
172. Vescovi P, Merigo E, Manfredi M, et al: Nd:YAG laser biostimula-­
tion in the treatment of bisphosphonate-­associated osteonecrosis of the jaw: clinical experience in 28 cases. Photomed Laser Surg 26:37, 2008.
173. Bashutski JD, Eber RM, Kinney JS, et al: Teriparatide and osseous regeneration in the oral cavity. N Engl J Med 363:2396, 2010.
174. Gerard DA, Carlson ER, Gotcher JE, et al: Early inhibitory effects of zoledronic acid in tooth extraction sockets in dogs are negated by recombinant human bone morphogenetic protein. J Oral Maxil-­
lofac Surg 72:61, 2014.
175. Fedele S, Porter SR, D'Aiuto F, et al: Nonexposed variant of bisphosphonate-­associated osteonecrosis of the jaw: a case series. Am J Med 123:1060, 2010.
176. O'Ryan FS, Khoury S, Liao W, et al: Intravenous bisphospho-­
nate-­related osteonecrosis of the jaw: bone scintigraphy as an early indicator. J Oral Maxillofac Surg 67:1363, 2009.
177. Bedogni A, Fusco V, Agrillo A, et al: Learning from experience. 3URSRVDORIDUH¿QHGGH¿QLWLRQDQGVWDJLQJV\VWHPIRUELVSKRVSKR-­
nate-­related osteonecrosis of the jaw (BRONJ). Oral Dis 18:621, 2012.
178. Schiodt M, Reibel J, Oturai P, et al: Comparison of nonexposed and exposed bisphosphonate-­induced osteonecrosis of the jaws: a retrospective analysis from the Copenhagen cohort and a proposal IRUDQXSGDWHGFODVVL¿FDWLRQV\VWHP2UDO6XUJ2UDO0HG2UDO
Pathol Oral Radiol 117:204, 2014.
179. Kumar SK, Gorur A, Schaudinn C, et al: The role of microbial ELR¿OPVLQRVWHRQHFURVLVRIWKHMDZDVVRFLDWHGZLWKELVSKRVSKRQDWH
therapy. Curr Osteoporos Rep 8:40, 2010.
180. Engroff SL, Kim DD: Treating bisphosphonate osteonecrosis of the jaws: is there a role for resection and vascularized reconstruction? J Oral Maxillofac Surg 65:2374, 2007.
)HUUDUL6%LDQFKL%6DYL$HWDO)LEXODIUHHÀDSZLWKHQGRVVH-­
ous implants for reconstructing a resected mandible in bisphospho-­
nate osteonecrosis. J Oral Maxillofac Surg 66:999, 2008.
182. Seth R, Futran ND, Alam DS, et al: Outcomes of vascularized bone graft reconstruction of the mandible in bisphosphonate-­related osteonecrosis of the jaws. Laryngoscope 120:2165, 2010.
183. Carlson ER, Fleisher KE, Ruggiero SL: Metastatic cancer iden-­
WL¿HGLQRVWHRQHFURVLVVSHFLPHQVRIWKHMDZVLQSDWLHQWVUHFHLYLQJ
intravenous bisphosphonate medications. J Oral Maxillofac Surg 71:2077, 2013.
184. United States. National Institutes of Health. Funding Opportunities and Notices Search Results. http://grants.nih.gov/grants/guide/
VHDUFKBUHVXOWVKWP"WH[WBFXUU RVWHRQHFURVLVVFRSH SDUID-­
year=active&sort=&Search.x=10&Search.y=8. Accessed February 10, 2014.
Page 120
PAGE 26 Medication-­Related Osteonecrosis of the Jaw – 2014 Update
Exhibit HOD-15(B)(4)
Page 1 of 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
DATE:
April 27, 2015
SUBMITTED BY:
Central Florida District Dental Association
FLORIDA SPECIALTY LICENSE PLATE - DENTAL
BOARD OF TRUSTEES RECOMMENDATION: Adopt.
Board vote:
Abstain:
Stevenson
Yes:
Attanasi; Boden; Huot; D’Aiuto, Pranikoff; Kahn (for Antoon); Brown;
Cochran (for Setzer); Ottley (for Jernigan); Eggnatz; Centurion; Terry;
Liddell; Churney
No:
None
2014H-072
[Procedure or Policy] RESOLVED, that the appropriate FDA agencies
17
investigate the potential profitability for creating a State of Florida
18
specialty automobile license plate to promote the importance of dental
19
health in Florida and report its findings to the January 2016 HOD.
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
RESOLUTION BACKGROUND CHECKLIST REVIEWED ON:
BACKGROUND: Several years ago the CFDDA appointed a subcommittee to evaluate other
states’ websites in order to update and improve the CFDDA website. In evaluating these
websites, our investigation noticed that the state of Kentucky offers a specialized state
automobile license plate promoting oral health. The cost of the plate in the state of Kentucky is
$44.00 which includes an optional donation of $10.00 to the Kentucky Dental Foundation to help
support community service projects like the sealant program at their state fair.
We then discussed the possibility of a specialty license plate in the state of Florida to promote
oral health and to increase non-dues revenue for the FDA. There are presently 122 specialty
license plates in the state of Florida. The average annual special fee associated with specialty
plates is $15-25.00. This specialty fee is directed back to the organization which applied for the
specialty plate and revenues are distributed as determined by the organization. Example
specialty plates include “A State of Vision”, a Florida Association of Agencies Serving the
Blind, Inc. with annual revenues of $46,900.00; Police Athletic League with annual revenues of
Page 121
Exhibit HOD-15(B)(4)
Page 2 of 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
$249,480.00; Share the Road-Bike Florida with annual revenues of $151,500.00; Special
Olympics with annual revenues of $47,190.00; Florida State University with annual revenues of
$1,550,825.00; University of Florida with annual revenues of $2,220,125.00.
The number of active dentists in the state of Florida is 10,464. The number of active hygienists
is 10,923. The number of dental assistants, receptions, laboratory technicians and sales
representatives is unknown but must be larger than the above mentioned numbers in total. There
is a potential of over 40,000 plates purchased if everyone in the dental field would own a dental
specialty license plate. If 1/4th of this population purchased a license plate, there is still
significant revenue to be used for oral health in Florida.
STRATEGIC PLAN LINK: This matter relates to Objective 2: Increase sources of non-dues
revenue.
UNBUDGETED IMPACT: None to $29,000 depending on the marketing plan chosen (see
attachment).
REFERENCE COMMITTEE RECOMMENDATION: Pending.
Page 122
Should the FDA/FDHF Pursue a Specialty License Plate
as a Source of Recurring Revenue?
Prepared by Rusty Payton
April 6, 2014
Prepared for: EMB 698
1
Page 123
Table of Contents
Executive Summary
Page 3
Introduction
Page 4
Fundraising Trends
Page 4
Program Expenses
Page 6
Seeking Legislative Authorization for a Specialty License Plate
Page 8
Allowable 501(c)(3) Lobbying Activities
Page 9
The Specialty License Plate Market Trends
Page 10
Specialty License Plate Life Cycle Stage
Page 13
The Promotional Plan
Page 14
SWOT Matrix for Proposed FDHF Specialty Plate
Page 15
Porter’s Forces Five Analysis
Page 16
Alternative Fundraising Strategies
Page 17
Recommendation
Page 21
Bibliography
Page 22
Appendices:
Proposed Legislation
Page 23
2
Page 124
Executive Summary
The Florida Dental Health Foundation is considering a number of future fundraising alternatives.
Amongst those is whether to pursue a specialty license plate from which the resulting proceeds
would be deposited into the Foundation’s coffers for use in carrying out its mission of charitable
and oral health programs. The data utilized for this analysis was taken from annual reports
prepared by the Florida Department of Highway Safety and Motor Vehicles and financial
statements from the Florida Dental Health Foundation. To ensure that the appropriate legislative
considerations were taken into account, the Director of Governmental Affairs for the Florida
Dental Association and State Senator Alan Hays, a Florida licensed dentists and an FDA
member, were interviewed.
Though the foundation is in a strong financial position, programming expenses are trending
upward while fundraising totals are trending downward. The greatest potential for increasing
fundraising lies outside reliance upon sustaining dues and more on other “special” fundraising
activities. The State of Florida allows proceeds from specialty license plates to be deposited into
the account of specified 501(c)(3) organizations. Organizational infrastructure requirements
including political advocacy, accounting, and marketing exist within the FDA and its affiliates to
implement specialty license plate fundraising activities.
The specialty license plate market is where the concern lies. Having been around since 1986 with
over 120 plate offerings, the specialty license plate market is in the mature phase of its life cycle.
If the FDHF were to enter the market and carve out a significant segment, the proposed oral
health plate would have to be differentiated from the more established plates and those posturing
to enter the market. Significant differentiation is not possible as the supplier (in this instance the
state) controls 3 of the 4 marketing elements: Price, Product, and Placement. There is not a
significant growth trend in vehicle registration or renewals. Since entry into the market is not
difficult, 4 additional plates are vying to pre-sell 1,000 plates and at least two more entities are
seeking authorization for specialty plates.
The foundation would be better served by seeking alternative fundraising opportunities which
can be better differentiated and which can expand the special fundraising base beyond attendees
at is annual convention.
3
Page 125
Introduction
The Florida Dental Health Foundation (FDHF) is a not-for-profit 501(C)(3) organization
registered in the state of Florida. The FDHF is the charitable arm of the Florida Dental
Association (FDA), a-not-for-profit 501(C)(6) entity whose membership is comprised of licensed
dentists in the State of Florida. The FDHF website lists the following under the organization’s
mission statement:
The mission of the FDHF is to generate and direct resources for charitable and
educational oral health programs for the people of Florida (Mission Statement).
In order to fulfill its stated mission, the FDHF Board of directors must raise the necessary funds.
Prudent management requires the board to identify stable, recurring sources of income to
supplement the giving of the sustaining members. A recurring question for the FDHF is whether
it should pursue the establishment of a specialty license plate for purchase by Florida residents
with a portion of the proceeds being given to the FDHF. This study will analyze the need for
establishing another source of recurring funding, review the legislative and political requirements
to create such a plate, explore the state of the specialty license plate market, create a potential
marketing plan, and recommend whether the FDHF Board should pursue the establishment of a
specialty plate. This report will result in only a recommendation to the FDHF Board and is not
intended to the bind Board’s decision to pursue specialty license plate funding.
Fund Raising Trends
The majority of the FDHF’s annual funding is derived from donations by sustaining members.
Sustaining members are those who agree to donate $125 to the foundation as part of their annual
membership dues to the FDA. Sustaining members contributed over $274,000 to the FDHF in in
fiscal year 2012-2013.
Over the past three fiscal years, the growth rate of the annual membership and resulting revenues
declined. The decline in this revenue source is demonstrated in the graph below entitled
Sustaining Membership Dues in Dollars. The foundation’s sustaining membership dues have
declined as has the membership of the FDA. The Foundation’s membership of 2,313 represents
approximately 37% of the FDA’s overall membership. Ultimately, the foundation’s goal is to
attract 50% of the FDA’s membership. With respect to building a case for or against the pursuit
of a designated specialty plate, the important aspect is that sustaining dues revenues have
significantly declined in recent years.
4
Page 126
Sustaining Membership Dues in Dollars
320000
310000
300000
290000
Sustaining Membership Dues
in Dollars
280000
270000
260000
250000
FY 2008- FY 2009- FY 2010- FY 2011- FY 20122009
2010
2011
2012
2013
Number of Sustaining Members
2500
2450
2400
2350
2300
Number of Sustaining
Members
2250
2200
2150
2100
FY 20082009
FY 20092010
FY 20102011
FY 20112012
FY 20122013
5
Page 127
A similar fate has beset the Foundation’s special fundraising events. The special fundraising
event was traditionally a raffle for a two year lease on an automobile such as a Lexus. The
drawing was conducted at the membership party held in conjunction with the organization’s
annual meeting in June. Revenues from raffle tickets exhibited a significant downward trended
over the past several years. The raffle was supplemented by a silent auction and two years ago by
an online auction. The car raffle was abandoned in FY 2012-2013.
Special Event Fundrasiers
100000
90000
80000
70000
60000
50000
Special Event Fundrasiers
40000
30000
20000
10000
0
FY 20082009
FY 20092010
FY 20102011
FY 20112012
FY 20122013
Forms of foundation revenue other than sustaining membership dues and special fundraisers are
realized through investment earnings. These earnings can vary widely from a loss to a gain of
over $150,000, as experienced in FY 20012-20013. The greatest potential for recurring income
growth lies in increasing the number of sustaining members and more aggressive special event
fundraising.
Program Expenses
Over the past few years, the FDHF increased its philanthropic activity and subsequently its
program-related expenses. In 2011, the Foundation partnered for the first time with the
Department of Children and Families providing free dental care to foster children in conjunction
with the FDA’s annual meeting, the Florida National Dental Convention. The event was not only
repeated in 2012, but a second event benefiting foster children was conducted in conjunction
with the association’s lobby day at the State Capital and was preceded by a radio public relations
6
Page 128
campaign in the major metropolitan areas of the state. The campaign sought to educate
individuals about the importance of maintaining appropriate oral health habits. These new
expenses were in addition to annual grants provided to affiliated dental clinics through the
Foundation’s Project Dentists Care Program and scholarships provided to senior dental students.
Program expenses are projected to increase greatly. In its 2013-2014 fiscal year budget, the
Foundation provided $35,000 to bring to Florida a Dental Life Line Coordinator who matches
elderly and disabled adults with dentists who volunteer to treat these patients. Most impressively,
the foundation committed over $100,000 for its first Mission of Mercy to be held at the Florida
State Fairgrounds in Tampa, Florida on March 27 and 28 1. It is anticipated pro-bono care will be
provided to nearly 2,000 individuals. Though the FDHF Board plans to review and analyze its
return on investment prior to scheduling additional Mission of Mercy events, dentists in Miami,
Jacksonville and the Panhandle have expressed a desire to hold a future event.
The chart below, which includes projected expenses for fiscal year 2013-2014, demonstrates the
Foundation’s recent commitment to expanding its philanthropic and educational programming.
Dental Health & Education Programming
160000
140000
120000
100000
80000
Dental Health & Education
Programming
60000
40000
20000
0
FY 20082009
FY 20092010
FY 20102011
FY 20112012
FY 20122013
1
Though the Mission of Mercy has occurred as this report is being finalized, total expenses and contributions are
not tallied. The general idea that Mission of Mercy events in the future will require significant monetary allocation
remains a valid point.
7
Page 129
The upward trend in programming expenses contrasts with the downward trends in special event
fundraising and sustaining membership dues. The data presented does not suggest that the FDHF
is spending beyond its means. It only suggests that program expenses are growing while
traditional sources of income are declining. Reserve amounts are healthy and capable of
sustaining the projected spending levels for several years, even if fundraising continues its
downward trends. Prudent planning and financial management suggest that the FDHF board
must consider methods to enhance its fundraising if the organization wishes to continue
providing care to foster children, funding the Dental Lifeline Coordinator, and hosting mass
charity events such as a Mission of Mercy.
Seeking Legislative Authorization for a Specialty License Plate
A recurring suggestion from some FDA members is that the FDHF seek a specialty license plate
as a source of recurring funding to augment its sustaining membership campaign. The state of
Florida provides a specific process in which 501(c)(3) organizations may petition the legislature
and receive approval for marketing a specialty license plate and retaining up to $25 per plate sold
for their particular cause. In the case of the FDHF, the monies could be used to fund charitable
and educational oral health programs.
Legislative proposals such as this require that a member of both the Florida House of
Representatives and the Florida Senate sponsor such legislation and that the proposal be
navigated through the legislative process to the extent that both chambers approve the same bill.
Then the Governor has the option to approve the bill or veto it. In Florida, legislative success
often requires the expertise of professional lobbying assistance. In this instance, the professional
lobbyists of the FDA could be utilized.
The State of Florida recently amended its legislative requirements for establishing a specialty
license plate. Prior to the change, entities seeking a specialty plate were required to file a form
with Department of Motor Vehicles, develop a marketing plan and pre-sale a minimum number
of plates prior to even seeking legislative authorization. Under the new guidelines, a marketing
plan is not required at any juncture and a minimum pre-sale of 1,000 plates is required after
legislative approval but prior to the actual printing of the plates.
Section 320.08053(3)(a), (b), and (c), Florida Statutes, provides the following requirements for
legislation seeking the creation of a new specialty license plate (Legislature):
•
•
•
Be generic to be consistent with all other existing specialty license plates; and
Provide for the specialty license plate to be issued to the owner or lessee of any motor
vehicle, except vehicles that require a restricted, apportioned, motorcycle size, or
dual(two) truck license plates; and
Specify the annual use fee in addition to the regular license plate fee and $5.00 for
handling by the Department of Motor Vehicles: and
8
Page 130
•
•
•
Provide how the funds are to be expended; and
Design the specific design specifications; and
Specify audit requirements pursuant to section 320.08062, Florida Statutes.
Though the statutory requirements for what is included in the legislation are relatively minimal,
the competition for legislative attention and action is considerable. Greater preparation and
information enhances the probability of success. According to State Senator and FDA Member
Dr. Alan Hays, “Advocacy groups which submit marketing plans and favorable market research
are more likely than those who do not to obtain legislative approval for specialty license plates
(Hays, 2014).” Although a bill may be officially filed for consideration absent a marketing plan,
such a plan should be developed and submitted along with other supporting materials.
Other supporting materials will be needed to document the entity’s 501(c)(3) status to document
the purpose of the organization, to document the need for additional resources and document
how the monies raised from the license plate will be expended to meet the organization’s
purpose.
FDA lobbyists work on the issues identified as a priority by the organization’s Board of Trustees.
Costs associated with approving the pursuit of a license plate as a priority is fixed. The Board, its
Governmental Committee, Political Action Committee and other agencies routinely meet to
review and prioritize issues of importance. The Foundation meets routinely as well. Since the
FDHF and FDA are separate Boards, the Foundation Board would vote to request that the FDA
make passage of creating an FDHF license plate as a legislative priority. Next, the FDA Board
would consider the request, and if approved, move the item to its House of Delegates for final
approval. Exhibits with background research are provided to each agency for use in its
deliberations.
The FDA’s political presence is constant from year to year. Neither the hiring of additional
legislative lobbyists nor additional political donations is expected as a result of pursuing this type
of legislation (Hart, 2014). To fully comply with Florida’s lobbyist registration requirements, the
FDA’s lobbying staff would need to add the FDHF as an additional entity on whose behalf they
are lobbying. Total costs would be $600 for all six registered lobbyists to register on behalf of
the FDHF and represent the organization before both the Legislative and Executive Branches
(Lobbyist Information). The FDA’s six lobbyists are comprised of the Director of Governmental
Affairs, two staff lobbyists, the Executive Director, the Chief Operating Officer and the Chief
Legal Counsel. The FDA and its affiliates possess the ability to prioritize the passage of a
specialty plate authorization and the professional staff to garner legislative approval.
Allowable 501(c)(3) Lobbying Activities
While the FDHF is absolutely prohibited from engaging in political activity for or against any
candidate in order to maintain its not-for-profit 501(c)(3) status, it can engage in significant
lobbying activity if carefully orchestrated (Tenebaum, 2002). Careful orchestration refers to
9
Page 131
keeping associated lobbing expenses within established safe harbors. These limits are up to 20%
of exempt related expenses (Tenebaum, 2002). For the purposes of the FDHF, this amounts to
about $40,000.
Lobbying resources expended by the Association on behalf of the Foundation need to be
accounted for and appropriately reported to the IRS either as a donation by the FDA or an
expense of the FDHF. One can compute the associated costs with the activity by either requiring
FDA lobbyists to account for the amount of time allocated to lobbying the bill through the
process and then computing the value of the donated amount of time each lobbyist spends on
pursing the bill, or by the two entities entering into a contract specifying set amount as
consideration for such services. The market to engage services of a lobbying firm varies broadly
from $10,000-$60,000 annually. Since revenues from such an agreement could be subject to
unrelated business income taxes, reporting expended resources as a donation from the FDA to
the FDHF should be explored. Given the FDA’s sophistication with respect operating a 501(c)(6)
organization, a for-profit entity, the Foundation and multiple political action committees, it
possess the ability to appropriately account for expenses and monitor the activity to ensure safe
harbors are not exceeded.
The Specialty License Plate Market Trends
The specialty license plate market-place remains a revenue generator in Florida. Though
revenues experienced a downturn of 4% between fiscal years 2009/10 and 2010/11, the market
gained in the two succeeding fiscal years (Recurring Periodic Reports). Many capital observers
expect the 2014 Legislature to reduce motor vehicle registration fees back to the pre-2009 levels
potentially spurring more sales of specialty license plates.
License plate fees for the state of Florida were increased during the 2009 legislative session for
an average $12 increase in motor vehicle fees, which vary depending upon the weight of the car
and whether or not the renewal purchased is for one-year or two-years (Turner, 2013). Since the
fee increase, the actual number of specialty plates sold per year decreased from 1.62 million to
1.34 million in 2011 (Turner, 2013). Since that low point, the graph below demonstrates that
revenues form specialty license plates are beginning to approach sales revenues realized prior to
the increase.
10
Page 132
Specialty Plate Revenues
35,000,000
34,000,000
33,000,000
32,000,000
31,000,000
Specialty Plate Revenues
30,000,000
29,000,000
28,000,000
27,000,000
FY 20082009
FY 20092010
FY 20102011
FY 20112012
FY 20122013
Advocates who solely blame the fee increase for the dip in revenues fail to consider the impact
of the general economy. The overall strength of the economy may have more long-term impact
than the basic renewal fees. The graph above indicates that specialty tag generating capacity has
improved in-spite of existing fee which remains for now $12 more than the 2009 fee.
Another impact worth exploring is the growth trends of renewals. The figure below indicates a
flattening of reported DMV total renewals with a corresponding slow growth of on-line renewals
(Recurring Periodic Reports).
11
Page 133
20000000
18000000
16000000
14000000
12000000
Total Vehicle Registration
Renewals
10000000
Internet Vehicle Registation
Renewals
8000000
6000000
4000000
2000000
0
FY 08-09
FY 09-10
FY 10-11
FY 11-12
FY 12-13
Nothing in the historical data indicates a boom in the number of vehicle registrations or renewals
or that the market for specialty plates will experience a significant uptick with respect to the
number sold or revenue generating capacity. As the market plateaus competition continues to
grow. Several specialty plates were approved during the 2013 Legislative session. Each of these
four is required to meet the pre-sales mandate prior to the plates being produced. Results to date
have been mixed (Presale Specialty License Plate Vouchers, 2014).
Pre-Sale Specialty License Plate
Pre-Sales Start Date
Total Sold
American Legion
July 1, 2013
100
Big Brothers Big Sisters
July 1, 2013
44
Lauren's Kids
July 1, 2013
1046
Freemasonry
October 1, 2013
1221
The 2014 Florida legislature will consider at least 2 additional proposals for specialty license
plates. Sen. Alan Hays, Chairman of the General Government Appropriations Committee,
believes that non-profits will continue to pursue specialty plate authorization and the legislature
will continue approving a handful per year (Hays, 2014).
12
Page 134
Specialty License Plate Life Cycle Stage
The specialty license plate has been authorized in Florida since 1987 and its appeal has grown to
1.6-1.3 million customers per year. Its position in the product lifecycle could be an instrumental
factor in determining the successful entry by new entities. Product life cycle stages are generally
categorizes into one of four classifications:
•
•
•
•
The introduction stage
The growth stage
The mature stage
The decline stage
Each stage possesses unique challenges for entrants into the market. In the introduction stage,
entrants are uncertain which market segments to target and customers are unfamiliar with the
products. In the growth stage competition is intense. The mature stage is more competitively
stable and new entrants must develop the ability to differentiate its product. The declining stage
is regarded as an unattractive market to enter. The graph below suggests that the specialty license
plate market in Florida is in the mature state. Annualized sales have hovered between $30
million and $35 million since 2006 2 with no expectation that sales will eclipse $35 million in the
current fiscal year.
Specialty Plate Annualized Revenue
40000000
35000000
30000000
25000000
20000000
Specialty Plate Annualized
Revenue
15000000
10000000
5000000
FY 12-13
FY 11-12
FY 10-11
FY 09-10
FY 08-09
FY 07-08
FY 06-07
FY 04-05
FY 03-04
FY 02-03
FY 01-02
FY 2000-01
FY 99-2000
0
Being in the mature stage, new entrants into the market need to differentiate themselves from
more established products. Product differentiation is created by manipulating price, product,
promotion and placement. Price is established by the state based upon the term of the renewal (1
year or two years) and the weight of the vehicle. Prices for specialty plates differ by $10. The
2
Annualized sales figures for the State of Florida Fiscal Year 2005-2006 were not readily available
13
Page 135
enabling legislation establishes a fee of $15 or $25 for the plate, the proceeds of which are
provided to the not-for-profit for specified purposes. Other than the variation of the graphic
imprint, all license plates, including specialty plates, are the same. Placement or where the
product is sold is prescribed by law and must be purchased at a county tax collector’s office or
through their web-portal. Distribution via additional venues is not allowed by law. Promotion is
the only marketing arena in which the FDHF could distinguish its plate from others.
The Promotional Plan
Should the foundation decide to pursue a specialty plate, a marketing plan must be developed.
The likelihood of receiving legislative authorization for such a plate is enhanced if a plan has
been developed and it has already been established that promotion is the only means by which
the FDHF plate can distinguish itself from the competition.
The FDHF, through its parent company the Florida Dental Association (FDA), is in a unique
position to market a plate dedicated to oral health. The FDA boasts a membership of
approximately 6,200 members. Most of the members maintain on file an active e-mail address,
and an active street address. All members receive a bi-monthly issue of the association’s
publication Today’s FDA. Those with an e-mail on file, 4,500 members, receive a monthly
electronic newsletter and other electronic bulletins on a routine basis. Website banner advertising
and signage at the annual meeting are other popular methods for marketing to members. A
majority of member’s birthdates, which the state ties to renewal deadlines, are recorded in the
membership database.
A promotional plan for new association products being marketed to both FDA and non-FDA
dental professionals typically involve the following:
Promotion to FDA Members
Article in Today’s FDA
E-mail Blasts Promoting specialty tag purpose with link to state’s web
page for ordering specialty plates
Web-site banner with click though to state web page for ordering
specialty plates
Cover Wrap on Today’s FDA
Sponsorship of membership party at FNDC 3
Signage at FNDC
Postcard mailed to each FDA member 60 days prior to birthdate 4
Flyers for distribution to component and affiliate meetings
FDA Social Media Sources
Promotion to Non Members
Earned Media
Social Media Campaign
Post card mailed to non-member dentists and dental hygienists
Total Projected Expenses
Price
Free
Free
Free
$2,500
$10,000
$2,000
$5,000
$2,500
Free
Price
$2,500 5
Free
$7,000
$29,000
The dentist members of the FDA are a captured market to whom promotional messaging is
relatively cost-effective. They are, however, not an exclusive market. Many members already
3
FNDC is the Florida National Dental Convention, the annual continuing education meeting of the FDA
Florida vehicle registration renewals dates are one’s birthdate
5
Reflects anticipated modest fee to engage the FDA’s public relations firm to develop earned media opportunities
4
14
Page 136
possess specialty plates representative of their preferred University or outdoor hobby such as
biking. Competition for attention of our own members is competitive. The marketing plan is an
outline of costs to maximize the program’s chances of success.
SWOT Matrix for Proposed FDHF Specialty Plate
A SWOT analysis is a simple but useful framework which helps an organization analyze its
strengths, weaknesses, opportunities and threats.
I
N
T
E
R
N
A
L
Strengths:
•
•
•
•
•
•
•
E
X
T
E
R
N
A
L
Weaknesses:
Membership of 6,200 licensed dentists
Ability to promote plate to member dentists
relatively inexpensive
The programming and staff required to gain
legislative authorization
Dentist contact information on file with FDA
membership records
Birthdates of many members in membership data
base
Accounting sophistication to account for
foundation lobbying expenses and record receipts
and expenses associated with the specialty plate
Ample monies to launch an initial marketing
campaign
Opportunities:
•
•
•
•
•
•
•
•
•
Demonstrated difficulty in marking the
association to non-members
The Foundation cannot control 3 of the
4 marketing “Ps”: Product, Place, and
Price
Not all member birthdates are accurate
Car registration renewals may not be
processed by the member dentist
Threats:
FDA/FDHF recognized as oral health expert
Projected reduction in costs of license plates
Slight up-tick in specialty plates resulting from
general economic improvement
More attention is being placed on the importance
of oral health care in the media and by other
advocacy groups
No other specialty tag revenues are dedicated to the
advancement of oral health care
•
•
•
•
•
•
15
Page 137
Market appears to be at a mature state,
requiring a new product to differentiate
itself
Accepting license plate monies opens
Foundation books to be audited by the
state
License plate monies can only be spent
on specified purposes
The number of specialty plates
continues to increase
The number of vehicle registration
renewals has plateaued
Passion for College football plates,
environmental issues and hobbies may
be much stronger than oral health
Strengths: The FDA possesses the staffing ability and sophisticated infrastructure to have the
plate approved and appropriately account for all receipts and expenses associated with the
specialty plate monies. FDA membership records contain addresses, birth-dates and emails for
over 50% of the licensed dentists in the state of Florida. Accurate birthdates could be invaluable
marketing information as state vehicle registration renewals are tied to one’s birthdate. Member
dentists value FDA and are therefore a natural target market.
Weaknesses: The FDA has demonstrated weakness with respect to marketing to nonmembers,
particularly those who have practiced in Florida for a few years or more without joining the
FDA. It is undetermined if the FDA can effectively craft and deliver a message which will
resonate with nonmembers. The birthdates on file for FDA members are admittedly not accurate
or complete. Many of the records are accurate, but many are not. Messaging directly to our
members assumes that the member dentist is the decision maker as to whether a specialty license
plate will be purchased. FDA records contain no data to indicate whether or not the dentist owns
or registers a car.
Opportunities: There is a renewed interest in access to oral health from policy makers and
advocacy groups and the media by extension. The Florida Dental Association and its affiliates
(such as the FDHF) are recognized as experts by policy makers, seek input and representation on
meaningful coalition groups and have engaged a professional PR firm to enhance their reputation
amongst the media. In terms of its target market, FDA members, the organization is the expert in
oral health care. Among more than 100 specialty tags available in Florida, none are dedicated to
the cause of oral health. As the economy post improving numbers, the sales of specialty are
trending slightly upwards.
Threats: The specialty tag market in Florida is positioned as mature, and as such, differentiation
is required to be competitive in the market. Of the four marketing “P’s”, only promotion can be
manipulated to distinguish itself from its competitors. Even within the primary target market,
FDA members, competition from college football and hobbies such as tags promoting hunting
and bicycling will be intense. The legislature continues to approve multiple plates each year,
meaning competition will grow while the number of vehicle renewals plateaus. The regulatory
threat of having the state audit the foundation’s books for compliance with the statutory specified
use of such funds may seem innocuous, but could expose the organization to extensive fines.
Porter’s Five Forces Analysis
Porter’s five forces analysis is a useful tool in evaluating the intensity and attractiveness of a
market and can be used to determine if new products can be profitable.
Buyer Power: Buyers of specialty plates possess little to no power over price or design. The
price is dictated by legislative fiat, while the design is approved by the Florida Department of
Highway Safety and Motor Vehicles. Plates can be redesigned with departmental approval, but
only after the supply of existing plates is exhausted. Plates can be bought or renewed in person at
the tax collector’s office, by mail or online.
16
Page 138
Supplier Power: In this instance, the supplier (the State of Florida) possesses a great deal of
power. The price of the basic registration and renewal fee is set by the state, along with the
specialty license plate surcharge. The frequency of renewals is dictated by laws as well as for
what purposed the proceeds can be used. The number of plates produced and timing of redesign
are also dictated by regulators.
Degree of Rivalry: Florida currently allows for 120 specialty plates to be sold. Meanwhile, the
total number of vehicles registered remains considerable flat. Though the FDHF will target FDA
members, and to a lesser degree licensed dentists as potential purchasers of its specialty plate,
these same members exhibit loyalty to State universities, major league sporting teams, and
outdoor enthusiast organizations. The FDA and its affiliates do not maintain a monopoly with
respect to marketing to its membership.
Threat of New Entrants: The state already allows over 120 specialty plates to be sold and four
additional plates are in the process of pre-selling orders. At least two groups are seeking
authorization from the Florida legislature for a specialty plate. Any special interest group which
maintains a political presence and relationship to a 501(c)(3) not-for-profit can apply and
eventually receive the right to market a specialty plate. The capital investment is minimal,
outside of the political capital required for the legislative fiat.
Threat of Substitution: There is only one substitute for a specialty plate: a vanity plate. All
vehicles must be registered and have displayed a Florida License plate. A vanity plate allows the
individual to personalize the plate’s alphanumeric sequence. For example, one of the team
doctors for Florida State Football has a plate with the alphanumeric sequence of FSUDOC1. The
vanity plate costs $15. Though a threat to be substituted, the vanity plate and specialty plate can
be coupled as a single product.
In terms of entering the specialty license plate market in Florida, Porter’s analysis suggests that
buyers possess little power over this market and the threat of substation is low. The supplier
possesses virtually all the power, as the state maintains the ability to set the price, significantly
limit the design, and determine when new designs can be reordered. Rivalry from groups such as
universities and sporting enthusiasts is high. Meanwhile, new entrants will continually seek to
enter the market. Porter’s Five Forces analysis strongly suggests that the market is intense and
not attractive at this juncture.
Alternative Fundraising Strategies
Several alternative fundraising activities exist for the foundation to consider. Foundations
associated with 501(c)(6) organizations commonly engage in golf outings, raffles and events
such as casino nights at their annual meeting to augment their fundraising activities. The FDHF
has hosted a number of fundraising activities at the FDA’s annual convention. Live Auctions,
silent auctions, an online auction and even a casino night have all been utilized. The live auction
was abandoned due do staffing constraints, the rising costs of hosting at the annual meeting, and
the increasing difficulty to find items of interest. An online auction was incorporated, but raised
very little revenue. The one casino night attempted in 2009 only broke even, but it provided a
17
Page 139
“significant fun factor.” Given the costs associated with hosting a casino night at the annual
meeting, it remains a financially neutral proposition at best.
Online Auction
The online auction continues to be intriguing. Its overall revenue ($910) was unimpressive.
However, its expenses were only $1,100 (plus staff time). The low expense correctly suggests
the absence of a coordinated marketing plan concerning the change in approach from a live silent
auction to an online experience. Hosting an online auction costs only $700 and items are donated
or provided on a commission basis. Although the foundation attempted to communicate the
decision to migrate from a live silent auction to an online event, it only utilized the
organization’s traditional approach of blast e-mails to the membership; on-line banner
advertising on the FDA site; and articles in the organization’s publication, Today’s FDA. The
limited marketing approach did not effectively communicate the change in approach.
Individual’s sent in items for the silent auction, and even brought them to the event expecting
they would be displayed and bided upon at the meeting. This is only anecdotal evidence that
members did not grasp the change in approach, yet it is compelling given the drastic reduction in
revenue.
The on-site auctions (those live and silent at the annual meeting) limited the market to those
attending the meeting. An on-line auction potentially allows a much larger universe, especially
those 5,000 member dentists who do not attend the meeting to participate. An active marketing
campaign would have reached out to these non-attendees, expanding the event’s universe.
A key factor for a successful on-line auction is the quality of auction items. The one online
auction included items traditionally used for the silent auction such as sporting event tickets,
trips, sports memorabilia, cigars, electronics and fine wine. Working with our corporate
affiliation partners and other dental related industry representatives, the auction could be
expanded to include dental supplies, business consulting services, and other dental officer related
items. In essence, an online auction allows the foundation to control the four marketing P’s
(price, product, promotion and placement). A key element to a successful event is committing for
multiple years, allowing members to understand and embrace the new format.
18
Page 140
SWOT Matrix for Proposed FDHF On-line Auction
I
N
T
E
R
N
A
L
Strengths:
•
•
•
•
•
•
E
X
T
E
R
N
A
L
Weaknesses:
Opportunities:
•
•
•
•
•
Membership of 6,200 licensed dentists
Ability to promote auction to member
dentists relatively inexpensive
Staffing ability to implement necessary
software for on-line auction
Possess relationship with dental services and
product providers who can offer meaningful
“products”
Ample monies to launch an initial marketing
campaign
Relatively minimal start-up money or
process required
•
Demonstrated difficulty in marketing new
programs to members and messaging to nonmembers
Ability to offer meaningful, exciting auction
items relevant to the target market of dentists
Threats:
Ability to tap into members who do not
attend the annual meeting
Potential to expand fundraising to those outside of dentistry
Younger generations are more comfortable
with electronic and on-line business
transactions
Ability to hold multiple auctions in a single
year
•
•
•
Inability to distinguish ourselves from on-line
noise
Confusion of members as migrated from inperson auctions, to on-line auctions and no
auction in 2013 and 2014
Uncertainty if members will embrace an online auction
Though the organization has experienced difficulty in marketing new services or products to its
members and returning to an-online auction presents uncertainty concerning the member’s
willingness to participate, the risk is relatively low. If provided enough resources to market the
plan and a commitment for several years so that member dentists understand the process, an
online auction remains a viable option.
50/50 Raffle
Another fundraising alternative is the 50/50 raffle. A 50/50 raffle involves selling tickets for a
prize which splits the proceeds between the winner of the raffle and the sponsoring organization.
A major concern regarding a 50/50 raffle is the legality and how to describe the prizes required
to be incorporated into the official rules. According to the FDA’s General Counsel, rules can be
crafted to disclose a minimal amount of prizes to be given, provided what is disclosed is a prize
won. (Nicol, 2014). For example, the rule may disclose that a prize will include a 52’ Samsung
19
Page 141
big screen television valued at $2,500, a gift certificate to Burns Steak House valued at $200 and
a grand prize of at least $10,000 or 40% of the of the revenue collected. It is legally possible to
conduct a 50/50 raffle and comply with required notices and rules publication.
With respect to the 4 P’s of marketing, the FDHF can control the price, promotion, placement
and product. Though the door prizes can be completely controlled by the foundation, buyers
control the prize ceiling which is a percentage of sales.
Normal association marketing may be utilized. Software is available which allows the foundation
to operate the processing of payments, distribution of tickets and random drawing of winning
ticket numbers. These programs can be purchased anywhere from $1,100 to $2,500. Much like
the on-line auction, a 50/50 raffle provides an opportunity to expand the market beyond member
dentists. The FDA conducted a car raffle for several years raising as much as $46,000 in revenue
to a low of only $13,000 in fiscal year 2012-2013. All winners of the car raffle accepted the cash
alternative.
SWOT Matrix for Proposed FDHF 50/50 Raffle
I
N
T
E
R
N
A
L
Strengths:
•
•
•
•
•
E
X
T
E
R
N
A
L
Weaknesses:
Opportunities:
•
•
•
•
•
Membership of 6,200 licensed dentists
Ability to promote to member dentists
relatively inexpensive
Staffing ability to implement necessary
software for ticket distribution and random
drawing of winners auction
Ample monies to launch an initial marketing
campaign
Relatively minimal operational expenses
•
•
Demonstrated difficulty in marketing new
programs to members and messaging to nonmembers
Uncertainty whether or not enough tickets
will sale to create excitement
Must guarantee substantial cash and prize
pay-out to create excitement for initial ticket
sales
Threats:
Ability to tap into members who do not attend
the annual meeting
Potential to expand fundraising to those outside of dentistry
Younger generations are more comfortable
with electronic and on-line business
transactions
Proven record of dentists buying raffle tickets
20
Page 142
•
•
•
Inability to distinguish ourselves from online noise
Confusion of members as migrated from inperson auctions, to on-line auctions and no
auction in 2013 and 2014
Uncertainty if members will embrace a
50/50 raffle
The primary strength of a 50/50 raffle is the re-introduction of a raffle, a concept which proved
successful in the past. Reliance upon the volunteer board solely for direct sales became the car
raffle’s Achilles heel. The 50/50 raffle presents an intriguing option. Though offering more risk
than an online auction (considering the costs of guaranteed prizes), the upside is much greater.
The ability to sale the tickers via the web removes the dependence upon board members as the
sole point of sale, and dentists have embraced a raffle in the past.
Recommendation
The prospects of the Florida Dental Health Foundation entering into the specialty license plate
market are intriguing. Minimal capital is required, and the organization possesses the
sophistication to lobby for legislative approval. The organization’s membership is also a built-in
target market. The concerns of entering the specialty plate market are not with the organization’s
ability to execute a business plan but with the general business environment of the market itself.
The market is already saturated with over 120 plates and plateauing specialty plate revenues.
Little ability exists for product differentiation as the supplier controls the price, placement, and
product. Though not required, the marketing plan would need to be implemented to effectively
capture its target market. The $29,000 plan does not include indirect expenses such as the
political capital to pass the legislation, staff time to design and execute the marketing strategies
and general business processes such as accounting for the expenses.
The foundation is considering a variety of fundraising options including a year-long 50/50 raffle
and other games of chance. This market-the market of fundraising game of chances- though
competitive, can be more easily manipulated with respect to the product, price, placement and
promotion. In addition a 50/50 raffle has the potential to augment the fundraising market beyond
dentists on-site at the FDA annual meeting. History suggests that dentists will participate in a
raffle-the car raffle was a successful fundraiser for many years. Too many alternative fundraising
strategies exist to risk entering a mature market in which product differential is nearly impossible
and governmental audits can are a very possible result. It is with these thoughts in mind that the
FDHF not pursue a specialty license plate.
21
Page 143
Bibliography
Hart, J. A. (2014, January 27). Director of Governmental Affairs. (R. Payton, Interviewer)
Hays, A. (2014, January 31). Florida State Senator. (R. Payton, Interviewer)
Legislature, F. (n.d.). The 2013 Florida Statutes. Retrieved January 26, 2014, from Online Sunshine:
http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&UR
L=0300-0399/0320/Sections/0320.08056.html
Lobbyist Information. (n.d.). Retrieved January 26, 2014, from On Line Sunshine:
http://www.leg.state.fl.us/Lobbyist/index.cfm?Tab=lobbyist&CFID=305192489&CFTOKEN=2906
4433
Mission Statement. (n.d.). Retrieved January 19, 2014, from The Florida Dental Health Foundatoin:
http://www.fdhf.info/mission-statement.html
Nicol, G. (2014, March 16). FDA Chief Legal Officer. (R. Payton, Interviewer)
Presale Specialty License Plate Vouchers. (2014, Janaury 23). Retrieved January 31, 2014, from Florida
Dempartment of Highway Safetey and Motor Vehicles:
http://flhsmv.gov/specialtytags/PreSaleData.html
Recurring Periodic Reports. (n.d.). Retrieved February 1, 2014, from Florida Department of Highway
Safety and Motor Vehicles: http://www.flhsmv.gov/html/safety.html
Tenebaum, J. (2002, May). Limitations on Lobbying Activitives: Guidelines for 501(c)(3) Organizations.
Retrieved January 31, 2014, from ASAE:
http://www.asaecenter.org/Resources/whitepaperdetail.cfm?ItemNumber=12212
Turner, J. (2013, November 8). Specialty Plate Sales Sag. Retrieved February 1, 2014, from Herald
Tribune: http://politics.heraldtribune.com/2013/11/08/specialty-plate-sales-sag/
22
Page 144
APPENDIX 1:
Proposed Draft Legislation
Be It Enacted by the Legislature of the State of Florida:
Section 1. Paragraph (eeee) is added to subsection (4) of section 320.08056, Florida Statutes, to
read:
320.08056 Specialty license plates.—
(4) The following license plate annual use fees shall be collected for the appropriate specialty
license plates
(eeee) license plate, $25.
Section 2. Subsection (83) is added to section 320.08058,Florida Statutes, to read:
320.08058 Specialty license plates.—
(83) HEALTHY MOUTH/HEALTHY BODY LICENSE PLATES.—
a) Notwithstanding s. 45, chapter 2008-176, Laws of Florida, as amended by s. 21, chapter
2010-223, Laws of Florida, and s. 320.08053(1), the department shall develop a “Save that
Smile” license plate as provided in s. 320.08053(2) and (3) and this section. The plates must bear
the colors and design approved by the department. The word “Florida” must appear at the top of
the plate, and the words “Save that Smile ” must appear at the bottom of the plate.
(b) The annual use fees shall be distributed to the Florida Dental Health Foundation, Inc.,
which may use a maximum of 10 percent of the proceeds for administrative costs and to
promote and market the plate. The remainder of the proceeds shall be used by the Florida Dental
Health Foundation,Inc., for charitable and educational oral health programs.
Section 3.
This act shall take effect October 1, 2014.
Underlines = Additions to current law
Strikethroughs = Deletions to current law
23
Page 145
Exhibit HOD-15(B)(5)
Page 1 of 1
1
2
3
4
5
DATE:
May 21, 2015
SUBMITTED BY:
FDA Board of Trustees
FDA CAMPAIGN FUND FOR ADA
PRESIDENT-ELECT CANDIDATES
6
7
8
9
10
11
12
13
14
15
RECOMMENDATION: The following resolution is submitted for consideration:
Board vote:
Abstain:
Stevenson
Yes:
Attanasi; Boden; Huot; D’Aiuto, Pranikoff; Kahn (for Antoon); Brown;
Cochran (for Setzer); Ottley (for Jernigan); Liddell; Churney
No:
None
2014H-079
[Procedure] RESOLVED, that starting Fiscal Year _______ (to be determined by
16
the HOD), the FDA create a campaign “war chest” to fund ADA President-Elect
17
campaigns for candidates who are approved by both the 17th District Delegation
18
and the FDA House of Delegates and that $20,000 each fiscal year be budgeted
19
for funding the war chest until such time as the war chest totals the sum of
20
$80,000.
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
BACKGROUND: At the May 2015 Board of Trustees’ meeting, the BOT adopted the following
resolution:
2014H-079
[Procedure] RESOLVED, that starting Fiscal Year _______ (to be determined by
the HOD), the FDA create a campaign “war chest” to fund ADA President-Elect
campaigns for candidates who are approved by both the 17th District Delegation
and the FDA House of Delegates and that $20,000 each fiscal year be budgeted
for funding the war chest until such time as the war chest totals the sum of
$80,000.
At this time, the House of Delegates is being asked to approve the resolution.
STRATEGIC PLAN LINK: This matter relates to Objective 7.0: Increase member
engagement in leadership, programs, and services.
UNBUDGETED IMPACT: $20,000 per year; up to $80,000.
Page 146
Exhibit HOD-26
Page 1 of 1
NECROLOGY REPORT
The names of those members of the Florida Dental Association who have expired since
the 2015 Bi-Annual Scientific Session of this Association are listed below, as well as the
dates of their demise:
H Wayne Todd
Lake Mary, FL
January 26, 2015
Phil Levine
Pensacola, FL
January 27, 2015
Richard Saal
Ft. Lauderdale, FL
January 28, 2015
Geoffrey Banga
Ponte Vedra Beach, FL
February 1, 2015
John Stanton
New Smyrna Beach, FL
February 1, 2015
Louis Pasetti
Lutz, FL
February 10, 2015
John Harris
Chattahoochee, FL
February 22, 2015
Alan Marder
Naples, FL
March 18, 2015
John Egitto
Palm Beach, FL
March 19, 2015
James Dillard
Brooksville, FL
April 17, 2015
Benjamin Brown
Defuniak Springs, FL
April 19, 2015
Richard Suttell
Seminole, FL
April 19, 2015
Daniel Thomas Jr.
Jacksonville, FL
May 2, 2015
Page 147
Exhibit HOD-30
Page 1 of 1
Florida Dental Association
Annual Conflict of Interest Disclosure Form
FY 2015-16
You are receiving this form because you are a Florida Dental Association representative or key employee. You are
being asked to disclose, in good faith, any financial interest (as defined in Article II of the attached Conflict of
Interest Policy) you may have that creates an actual or potential conflict of interest in connection with your FDA
leadership role. You have a financial interest that should be disclosed on this form if you have, directly or
indirectly, through business, investment, or family:
a. An ownership or investment interest in an entity with which the association has a business transaction or
arrangement,
b. A compensation arrangement with an entity with which the association has a business transaction or
arrangement, or
c. A potential ownership or investment interest in, or compensation arrangement with, an entity with which
the association is negotiating a business transaction or arrangement.
d. A compensation relationship or ownership interest in a business with another FDA volunteer leader.
For example, a doctor’s participating provider agreement with a managed care organization is not a potential conflict
of interest because the FDA itself does no business with the managed care organization. Also, travel
reimbursement, honoraria and stipends paid according to the association’s annual budget are not potential conflicts
of interest. However, if you own an interest in or have a financial relationship with a business that, in turn, does
business with the association, then you have a potential conflict of interest to disclose. Also, if you practice dentistry
with a spouse or significant other who is also an FDA volunteer, then you should disclose that on your form.
You should complete this form at your first FDA meeting of the fiscal year as directed by the chair of the meeting.
Your form will be reviewed by the FDA Board of Trustees. If the board determines there is a potential conflict, they
will contact you and you will be given an opportunity to disclose all material facts. Your forms are otherwise kept
confidential unless the FDA is required by law to disclose them, in which instance you will be notified.
By my signature below I acknowledge that I have read and understand the association’s conflict of interest policy;
that I agree to comply with it on an on-going basis; and that I understand the association is a tax-exempt
organization that must engage primarily in activities which accomplish one or more of its tax-exempt purposes and
that it must also avoid transactions with leadership that result in inurement, impermissible private benefit or an
excess-benefit transaction.
QUESTION 1: Listen to the chair’s instructions as to which companies are in the FDA’s Corporate Affiliation
Program (CAP) – the list changes each year. This question applies only to CAP Programs identified by the chair.
At present, I am aware of the following potential conflicts of interest in regard to my position as a leader of the
Florida Dental Association (if none, write “none”):
QUESTION 2: List all family or business relationships you have with another FDA volunteer (e.g., trustee,
alternate trustee, officer, council or committee member) or FDA key employee (e.g., Eason, Gruber and/or Nicol):
(if none, write “none”):
If I become aware of a potential conflict of interest, family relationship or business relationship in the future, I will
disclose it to the FDA Board of Trustees along with all the material facts so the board can determine whether a
conflict exists.
NAME (please print): ______________________________________
SIGNATURE: __________________________ DATE: ____________
Page 148
Appendix A-1
Annual Report to the House of Delegates
Page 1 of 2
1
FDA TREASURER REPORT - DR. TIM MARSHALL
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
May 19, 2015
The following is a summary of important financial activities/information since the January 2015 House of
Delegates’ meeting:
Reserves to Budget Ratio: The liquid reserves to budget ratio is computed as of April 30, 2015 as 67%
(an increase of 3% during this fiscal year). This includes the combined reserves of FDA and FDA
Services as well as their combined Fiscal Year 2014-2015 budgets, net of intercompany transactions. The
achievement of exceeding the House of Delegates’ mandated 35% liquid reserves policy goal occurred not
only because of recent stock market earnings but also from a continued focus on expense control.
In addition, the House in June 2011 expanded the reserves to budget ratio by including 50% of the Leon
County tax annual assessed land/buildings value (valued at $1,423,650 for the two Tallahassee properties
on the November 2014 tax notices) be also utilized which would equal $711,825. Added to the liquid
reserves balance (cash and investments) this gives a more comprehensive measurement of available
reserves including a conservative 50% of the unencumbered FDA headquarters and governmental affairs
real property. The resulting ratio is 76% at 4/30/15 (74% ratio at 6/30/14).
It is also important to note at this point, that the original reserves to budget ratio policy also included
FDHF operations. But, since the Florida Dental Health Foundation’s reserves and excess operating cash
and investments equal over 100% of its current operating budget, therefore the FDA has not taken the
Foundation’s budget into account for this ratio.
Fiscal Year 2015-2016 Council on Financial Affairs’ Recommended FDA Budget Overview: The
Council on Financial Affairs/Board are recommending a balanced FDA Budget for Fiscal Year 2015-2016
with a recommended net $5 FDA dues increase (the C-Y 2014 CPI increase was 1% equivalent to about a
$5 dues increase).
However, the breakdown of mandatory FDA dues has shifted because of reporting requirements enforced
by the Florida Board of Elections which impacts FDAPAC. The result is that about $75,000 of expenses
traditionally recorded in the PAC will now be recorded in the FDA Income Statement. Because of the reapportionment of PAC expenses to FDA, the CFA proposes a $13 shift in dues from PAC dues
(decreasing those dues from $49 to $36) to required general FDA dues (increasing those from $415 to
$428). This shift coupled with the proposed net $5 increase in overall FDA dues results in mandatory
FDA dues increasing from $464 to $469.
The Council’s recommended budget does not include a calculated lump-sum transfer to increase the
Reserve Fund. This is the result of the large reserve investment earnings over the last three years and also
the current high reserve to budget to ratio (67% at 4/30/15).
The FDA Budget Resolution Exhibit includes a “Summary Budget” document, which presents the
summary revenue and expense budget information for each department section.
Page 149
Appendix A-1
Annual Report to the House of Delegates
Page 2 of 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
FDA Reserve Fund: The FDA Reserve Fund cash and investment balance as of the April 30, 2015 is
$5,041,710. This is a $370/k increase during the current fiscal year. Also, FDA Services maintains its
own separate reserve fund which currently sits at $160/k.
The FDA’s dependence on non-dues revenue emphasizes the importance for the FDA to continue to
maintain a large Reserve Fund balance.
It is important to remember that in addition to the liquid cash and invested reserves, the Association also
owns both of its Tallahassee properties free of any mortgage and in April 2004 purchased the adjacent
vacant lot to the FDA headquarters for $214,281. As noted above, the November 2014 tax assessed value
of all FDA land and buildings in Tallahassee is $1,423,650. As the Building Committee completes its
project of evaluating current and future FDA facilities needs, an updated market value will be determined
for FDA’s current facilities.
Audit Committee of the FDA: The Audit Committee, on 5/7/15, reviewed the CPA firm prepared draft
federal non-profit Form 990 information tax returns for the FDA, Florida Dental Health Foundation and
FLADPAC. These returns were submitted to the Boards of each entity to review prior to their being
digital filed by Carr Riggs Ingram, CPA firm.
The Committee and Board of Trustees also approved changing auditors from Carr Riggs Ingram to
Thomas Howell Ferguson (THF) during the most recent Request for Proposals (RFP) for a period of at
least three years. THF will complete the audit and tax filings beginning with FYE 6/30/15.
Summary: FDA members continue to have lower state constituent dues payments than at least half of the
dental constituents. FDA recommended 2015 dues of $415 will still represent only 35% of the total Fiscal
Year 2014-2015 budget.
Based on the above, I can report to you that the Association’s finances and reserves are strong, thanks to
the continued vigilance of the Council on Financial Affairs, Board of Trustees and House of Delegates as
well as the stock market improvement. Also, over the last year, the FDA has reversed the trend of
declining membership and moved on many other fronts to improve the financial position of the
Association.
Acknowledgement: The Audit Committee has been punctual in meeting the deadlines for all the priorities
assigned to it. The Audit Committee has also been very well-served by members and I would like to
commend each of them for their diligent work over the entire Fiscal Year 2014-2015:
Dr. Don Ilkka (member)
Dr. Cesar Sabates (member)
Dr. Paul Miller (consultant as FDA immediate past Treasurer)
Respectfully submitted,
Tim Marshall, DDS, FDA Treasurer
Page 150
Appendix A-2
Page 1 of 3
BOT Annual Report to House of Delegates
H= Policy (requires House of Delegates approval)
B= Procedure (Administrative in nature, only BOT approval required)
“2014” is the number used for the entire 2014-2015 fiscal year.
Year H/B #
Mtg.
Group
Staff
2014
B
001 June 14 BOT CFA
Moore
2014
H
002 June HOD
SFDDA
GAO
2014
B
003 August BOT
Exec Dir
Moore
2014
004 August BOT
Strategic Planning
Eason
Task Force
2014
H
006 August BOT
Exec. Dir.
Stone
2014
B
007 August BOT
CDBC
Nicol
2014
2014
B
B
008
009
August BOT
August BOT
CEBJA
CEBJA
Nicol
Nicol
2014
2014
2014
2014
B
B
B
B
010
011
012
013
August BOT
August BOT
August BOT
August BOT
CEBJA
Exec Dir
FDA Staff
COM
Nicol
Stone
Payton
Gomez
2014
2014
B
B
014
015
August BOT
August BOT
Runyan
Moore
2014
2014
2014
B
B
B
016
017
018
October CC
October CC
October CC
COC
FDA Foundation
Board
LALA
LALA
FDA staff
2014
2014
2014
2014
2014
2014
2014
2014
B
B
B
B
B
B
B
H
019
020
021
022
023
024
025
026
Oct. BOT
Oct. BOT
Oct. BOT
Dec. BOT
Dec. BOT
Dec. BOT
Dec. BOT
Dec. BOT
FDA Treasurer
Exec. Director
C-CCE
LALA
LALA
Audit Committee
Audit Committee
Sub-Council on
Moore
Moore
Tallman
Stone
Stone
Moore
Moore
Gomez-
Stone
Stone
Moore
Title
Authorization of Treasurer
Oppose BOD Records Rule
FY14-15 Budget Amendments-Funding from Contingency
Strategic Planning Task Force Report
Outcome
BOT Adopted
HOD Adopted
BOT Adopted
BOT Adopted
Interim Appointments
Retain Practice Management or Accounting Expert to
Educate Members on How to Integrate Their Practices
Promote Patient Relations Peer Review Program
Hire Insurance Consultant to Develop Dentists’ In-house
Dental Assistance Savings Plan
Conflict of Interest Disclosures for 2014-2015
Consent Agenda
Use of Membership Mailing Lists for Surveys
2015 Dues Statement
BOT Recommended Adoption
BOT Defeated and referred back to
Council on Dental Benefits
BOT Defeated
BOT Defeated
Secure Moore Communications for 2015-2015
Fund New FDA Foundation Director Position (additional
agenda item for BOT)
Consent Agenda
Ratification on Interim Appointments
FDA Employee Retirement Plans- 401(k) & Pension Plans:
New Treasurer Successor Trustee Amendments
Close out FDA SunTrust Bank Savings Account
FDA FY 2014-2015 Budget Amendments
CEU Tracking at Florida Dental Convention
Ratification on Interim Appointments
Consent Agenda
FDA Audit Results
Operating Fund FY 2013-2014 Net Assets Balance
Bylaws Change: Converting Sub-Council on New Dentist to
Page 151
BOT Adopted
BOT Adopted
BOT Defeated
BOT Directed $49 FDAPAC amount into
dues and amend statement
BOT Adopted
BOT Adopted
BOT Adopted
BOT Adopted
BOT Adopted
BOT Adopted
BOT Adopted
BOT Adopted
BOT Adopted
BOT Adopted
BOT Adopted
BOT Adopted
BOT Recommended Adoption as
Appendix A-2
Page 2 of 3
New Dentist
Rios
Council
Task Group on
Bylaws
Council on
Membership
LALA
Workforce Innv.
Executive Director
Executive Director
Executive Director
SFDDA
Nicol
Proposal to Revise Bylaws
GomezRios
Stone
Hart
Jack Moore
Eason
Eason
Nicol
Dues Increase for Graduate Dental Students
Nicol
Florida’s Action for Dental Health
BOT Recommended Adoption
HOD Adopted
BOT Adopted
BOT Adopted
BOT Adopted
BOT Adopted as amended
HOD Adopted
BOT Adopted
HOD Adopted
HOD Adopted
Nicol
Ruthstrom
Nicol
Eason
Nicol
Eason
Eason
Runyan /
Nicol
Eason
Fowler
Gruber
Tallman
Eason
GomezRios / Nicol
One House Resolution
New Graduate Professional Liability Program
Qualifications for Council on the New Dentist
FDA Participation in Oral Health Florida
Florida Academy of Pediatric Dentistry Litigation Support
FDC Proposed Program of Speakers
Consent Agenda
Shift in Social Media Efforts
HOD Defeated
BOT Adopted
BOT Recommended Adoption
BOT Adopted
Postponed to May BOT
BOT Adopted
BOT Adopted
BOT Adopted
OFH Roadmap
Strategic Plan Update
Audit Engagement/Firm Selection
CE Broker Proposal
Resolution Background Checklist
Amendments to BOT and HOD Manuals Regarding ADA
End-Of-Year Report and Date of Determination of
Membership Numbers
(New Business) Temporary Suspension of Annual Policy
Sunset
Funding for Plant Moran Proposal
Ratification of Strategic Plan
BOT Adopted Non-Support
BOT Adopted
BOT Adopted
Postponed
BOT Adopted
BOT Recommended Adoption
2014
H
027
Dec. BOT
2014
H
028
Dec. BOT
2014
2014
2014
2014
2014
2014
B
B
B
B
H
H
029
030
031
032
033
035
Dec. BOT
Dec. BOT
Dec. BOT
Dec. BOT
2014
H
036
Jan HOD
2014
2014
2014
2014
2014
2014
2014
2014
H
B
H
B
B
B
B
B
037
038
039
040
043
045
046
047
Jan HOD
Special
June HOD
March BOT
March BOT
Dec BOT
March BOT
March BOT
2014
2014
2014
2014
2014
2014
B
B
B
B
B
H
048
049
050
051
052
053
March BOT
Email
March BOT
March BOT
March BOT
March BOT
Workforce
Innovation Task
Group
WCDDA
FDAS
BOT
ED
FDA Staff
C-CCE
Executive Director
Council on
Communications
FDA Pres
Executive Director
Audit Committee
C-CCE
ED
ED
2014
B
054
March BOT
FDA Staff or Editor
Stone
2014
2014
B
B
055
056
March BOT
March BOT
Bldg Task Grp
St. Pln. Comm.
Moore
Eason
Jan HOD
Jan HOD
Funding for ADA Delegates to attend Delegation Meeting
Florida’s Action for Dental Health
Amend the FDA Bank Accounts Signers
Additional Funding for Electronic Voting Systems
Consent Agenda
SFDDA Recommendations on the BOD Records Rule
Page 152
amended
HOD Adopted
BOT Recommended Adoption
BOT Adopted
BOT Adopted
BOT Adopted
Appendix A-2
Page 3 of 3
2014
2014
2014
H
B
H
057
058
060
May BOT
May BOT
May BOT
Pres-elect
Pres-elect
SP Task Group
Stone
Stone
Stone
2014
2014
H
H
061
062
May BOT
May BOT
FDA Staff
FDA Staff
2014
2014
2014
2014
2014
2014
2014
2014
B
H
B
B
B
H
B
H
063
064
065
066
067
069
070
071
May BOT
May BOT
May BOT
May BOT
May BOT
May BOT
May BOT
June HOD
FDA Staff
CFA
CFA/FDAF Bd
Audit Committee
FDA Staff
CEBJA
FDA Services
CDH
Stone
GomezRios
Stone
Moore
Moore
Moore
Moore
Nicol
Ruthstrom
Hart
2014
2014
2014
H
H
B
072
073
077
June HOD
June HOD
May BOT
CFDDA
FDA Staff
Boden
Altschuler
Stone
Eason
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
B
H
H
H
H
H
H
H
H
H
H
078
079
063d
064d
065d
066d
068d
069d
070d
071d
072d
May BOT
June HOD
May BOT
May BOT
May BOT
May BOT
May BOT
May BOT
May BOT
May BOT
May BOT
Boden
BOT
Strat. Pl. Committee
Strat. Pl. Committee
Strat. Pl. Committee
Strat. Pl. Committee
Strat. Pl. Committee
Strat. Pl. Committee
Strat. Pl. Committee
Strat. Pl. Committee
Strat. Pl. Committee
Eason
Eason
Eason
Eason
Eason
Eason
Eason
Eason
Eason
Eason
Eason
Composition of FY 2015-2016 BOT Officers
All Other 2015-2016 Appointments
Strategic Planning Task Group Recommendations for
Councils and Committees
Suspension of SPS Meeting Format Policy
Dr. Robert Hayling Honorary Membership
BOT Recommended Adoption
BOT Adopted
BOT Recommended Adoption
Consent Agenda
FDA Fiscal Year 2015-16 Budget
FDA Foundation Fiscal Year 2015-16 Budget
FDA Form 990 FY 2013-14 Tax Return Review
FDA FY 2014-15 Budget Amendments
Adoption of New Bylaws and Workgroups Manual
New Graduate Professional Liability Program
Dental Therapy Prior to Prescription of Medications with
Risk of Oral Ulcerations
Specialty License Plate
Consent Agenda
BOT Adopted
BOT Recommended Adoption
BOT Adopted as amended
BOT Adopted
Postponed
BOT Recommended Adoption
BOT Adopted
BOT Recommended Adoption
University Affairs Committee
Deans’ Report and Conference
FDA Campaign Fund for ADA President-Elects
Council on Dental Health
Council on Dental Benefits and Care
Council on Ethics, Bylaws and Judicial Affairs
Council on Dental Education and Licensure
Council on the New Dentist
Leadership Development Committee
Council on Communication
Council on Convention & CE
Council on Financial Affairs
Page 153
BOT Recommended Adoption
BOT Recommended Adoption
BOT Recommended Adoption
Pending
Postponed until FDA / Moore Comm.
Study and focus group
BOT Adopted
BOT Recommended Adoption
BOT Recommended Adoption
BOT Recommended Adoption
BOT Recommended Adoption
BOT Recommended Adoption
BOT Recommended Adoption
BOT Recommended Adoption
BOT Recommended Adoption
BOT Recommended Adoption
BOT Recommended Adoption
Appendix A-3(A)
Annual Report to the House of Delegates
Page 1 of 4
COUNCIL ON COMMUNICATIONS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
June 2015
The Council on Communications (COC) is pleased to report on its progress from January 2015
to June 2015:
Social Media
In the past six months, the Council on Communications (COC) has increased its followers on the
FDA Facebook page, generating interest by posting more public interest-type posts and photos as
well as FDA legislative activities and successes. The FDA Twitter account, which attracts
followers from the public, media, legislative arenas and dentists has also experienced an increase
over the past six months. Posts on the FDA Twitter account include information about legislative
battles that affect the public such as non-covered services, as well as general oral health
information, and feature articles about dentistry and FDA-member dentists. The FDA LinkedIn
page typically receives several requests a week to become a follower and tends to have
information about webinars and upcoming events, as well as followers posting their questions
about certain topics. The FDA Facebook page has over 1,035 followers, FDA Twitter has more
than 5,480 followers and FDA LinkedIn page has 1,065 members. Jessica Lauria, the
Communications Department’s Publication Coordinator, does the majority of all social media
posts. The COC voted on and agreed to reclassify the mobile app. budget into a social media
budget. This was done as one way to increase the FDA’s presence in social media. The mobile
app. is no longer needed since the new website can be viewed across different platforms
including phones and iPads. $2,000 of this money was reclassified into a social media budget
which will allow for more Facebook “boosts” where we can target certain age groups, areas,
length of time, etc. The remainder of the mobile app. budget was repurposed back into the
FDA’s overall budget.
Moore Communications Group (MCG) is currently helping the FDA develop more of an overall
social media presence for members and the public. We had great success with our first endeavor
back in the fall, “Halloween Tips” and we just launched our latest boost, “New Mom” video
from the ADA. This boost will to teach expectant mothers the importance of taking care of their
teeth and gums during pregnancy as well as how to care for their baby’s teeth when they erupt.
Our next boost will feature the FDA/ADA video and why you should see an FDA member
dentist. Liz, from MCG, participated on a COC conference call in April to discuss different
forms of advertising and what would be the best avenue for the FDA. From the call it was
determined by COC members that digital and social media would be the best avenue to start
with. Television and billboards were discussed as possible avenues as well, however it was
decided that due to cost and other factors those scenarios would not be pursued at this time. The
goals with digital and social media are:
Page 154
Appendix A-3(A)
Annual Report to the House of Delegates
Page 2 of 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
•
•
•
Raise awareness of the FDA brand among consumers, FDA members and prospective
members.
Educate consumers on why they should choose and FDA dentist.
Increase the number of consumers who choose an FDA dentist.
With digital and social media advertising, as compared to TV and billboards, we can target
specific audiences, including demographics, geographic location and behavior, as well as drive
target audiences to take specific action. We can also gauge effectiveness of messaging and are
able to easily alter the content to maximize engagement as well as monitor and track analytics to
gauge and maximize effectiveness of the campaign. The COC is reviewing the digital and social
media information given by MCG and will analyze the results from the ADA: New Mom video
as well as the FDA/ADA video and the importance on seeing an FDA member dentist, and will
then decide what the next step will be in the social media process.
FDA Blog
As the FDA continues to work to help members succeed, we are launching the official FDA
blog: Beyond the Bite. The blog will provide members with information on industry trends, tips
to strengthen your practice, FDA programs and events, best practices and other and resources.
From boosting social media presence to building patient referrals to understanding insurance and
regulatory changes, Beyond the Bite will cover a range of topics. Expertise will come from a
variety of sources, including submissions from FDA staff, fellow FDA members, partners and
other industry leaders. We welcome FDA members to share topics that they would like to see on
the blog or to contribute a blog post!
Websites
The online classified system (www.floridabiz.org) is still a popular feature the FDA offers and
continues to receive new ads on a regular basis. The online classified system allows FDA
advertisers to have control over their accounts, such as: creating and maintaining their own
account; creating and modifying/updating their ad; adding special features to highlight their ad;
and paying for their new ad or paying to renew a current ad. The online classified system has
been going well and we have received positive feedback from advertisers. The online system has
generated the following revenue so far for this fiscal year: July - $1,439; August - $1,188;
September - $3,042; October $719; November - $1,291; December - $1,709; January - $2,089;
February - $2,751; March - $3,421; April - $1,658; May - $647. The classified total so far this
year is $19,959 and we expect the total for May to be higher.
Our IT Department has completely redone the FDA’s website, which has given it a much cleaner
and updated look, as well as easier navigation throughout the site. The new website can be
viewed across different platforms, such as laptops, phones, iPads and much more. The updated
website is now live and receiving great reviews on the new look, feel and navigation.
Page 155
Appendix A-3(A)
Annual Report to the House of Delegates
Page 3 of 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
Today’s FDA
Today’s FDA continues to maintain a practical approach to content, and communication staff has
been publishing more original articles than have run in the past. Communication staff personally
reaches out to dentists, regarding writing and submitting certain articles to send in for
consideration to be published in upcoming issues, and has had a very good rate of success. We
have also asked members, as well as FDA staff, to take photos when they are out and about at
events, meetings, etc. and send them to the communications department for publication in
Today’s FDA and also be posted on Twitter, Facebook and Instagram. Photos have been a very
popular feature in Today’s FDA as well as social media.
Display advertising in Today’s FDA for 2015 has decreased somewhat as compared to this time
last year. We have talked to the advertisers who have not renewed and the main reasons seem to
be their marketing/advertising budgets have been cut, reduced or put on hold. We are continuing
to contact potential/new advertisers as well as reaching out to past and present advertisers for the
remaining issues in 2015, via mail, email and telephone calls.
E-Newsletters
The council has continued to provide timely dental industry and FDA updates electronically via
the FDA’s membership e-newsletter, News Bites and other electronic emails. By tracking articles
that are most clicked on and open rates, the council continues to monitor topics that members are
most interested in and tailor the newsletters to feature that information. News Bites is currently
being opened by 22.56 percent of members which is more than 1.26 percent higher than the
industry standard (21.3 percent). News Bites Special Alerts are currently being opened by
roughly 26% of our members. Capital Report’s open rate is typically slightly higher at 23.7%.
Moore Communications
Moore Communications (MCG) continues to work on and contribute to: key talking points for
members when talking to the media on specific topics; talks to the media when needed and
organizes calls, interviews, etc.; continues to prepare and send out press releases; participated in
Council on Communications conference call and emails; currently working on Florida Action for
Dental Health; recently finished developing the Crisis Communication Plan with assistance from
the FDA.
Media Relations
Staff and MCG have kept careful watch on hot topics in the media such as access-to-care,
fluoride, anesthesia and sedation and Medicaid as well as attention aimed at a Jacksonville lifemember of the FDA. Press releases, media advisories and calendar announcements were
distributed when appropriate. Liz Shawen, Senior Director at Moore Communications serves as
the main contact for media inquiries and works directly with the Dr. Rick Stevenson, FDA
President and Drew Eason, Executive Director to coordinate media inquiry responses. Moore
Page 156
Appendix A-3(A)
Annual Report to the House of Delegates
Page 4 of 4
1
2
Communications has helped coordinate press releases and send them out, as well as set up times
for Dr. Stevenson and other FDA members to meet with the press.
3
Page 157
Appendix A-3(B)
Annual Report to the House of Delegates
Page 1 of 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
COUNCIL ON DENTAL BENEFITS AND CARE
June 2015
Council Activity
The FDA’s Council on Dental Benefits and Care has representation from all six districts. The
Council elected Dr. Linda Trotter from NEDDA as Chair and Dr. Craig Kara from CFDDA as ViceChair during the meeting at the Florida National Dental Convention (FNDC) in June of 2014.
The Florida Dental Association Council on Dental Benefits and Care has acted by:
• CDBC will continue to monitor, and seek to influence through the American Dental
Association, the federal government’s implementation of the Affordable Care Act (ACA)
with the objective to have both pediatric and adult dental care provided through ACA policy
initiatives such as Medicaid expansion, health insurance exchanges, and the definition of
“essential health benefits.” Currently, insurance sold through the marketplace (exchanges)
provide no adult dental care. Nor do they mandate that children actually receive care, merely
that the coverage be offered to them through the marketplace.
• CDBC has developed job descriptions for council members.
• CDBC has also met with the Dental Quality Alliance and discussed evidence-based dentistry.
Under the ADA Council on Dental Benefits there are three committees: the Committee on
Current Dental Terminology; the Committee on Dental Benefits and Information that liaisons
with insurance companies and managed care payers; and the Committee on Quality
Assessment and Improvement that is responsible for peer review and the Dental Quality
Alliance (DQA).
• The Dental Quality Alliance was established in 1988 at the request of the federal Center for
Medicare and Medicaid Services (CMS). CMS presently serves on the DQA, which is
intended to fulfill goals of the Patient Protection and Affordable Care Act (ACA) to
emphasize preventive care and promote evidence-based procedures. Other members of DQA
include insurance companies, managed care organizations such as DentaQuest, and dentists.
DQA is therefore independent of the ADA.
• DQA is charged with developing performance measures, oral health care initiatives and
evidence-based dentistry. Performance measures are a feature of ACA and include standards
as to how many pediatric patients were seen; how many of those patients received fluoride
treatments; how many cavities remained after the treatment, etc.
Submitted on behalf of the members of the Council on Dental Benefits and Care:
Council on Dental Benefits and Care
Dr. Linda Trotter, Chair, Northeast
Dr. Craig Kara, Vice-Chair, Central Florida
Dr. Walt Colon, Northwest
Dr. Jose Sarasola, Atlantic Coast
Dr. Frank Giunta, West Coast
Dr. Carlos Sanchez, South Florida
Page 158
Appendix A-3(C)
Annual Report to the House of Delegates
Page 1 of 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
COUNCIL ON DENTAL HEALTH
May 8, 2015
Since January 2015, the Council on Dental Health has held two conference calls (February 24
and May 12) to discuss a resolution that was referred to the council during the January House of
Delegates meeting relating to medication-related osteonecrosis of the jaw (MRONJ).
The council developed a resolution entitled, “Coordination of Care by Medical and Dental
Practitioners for Patients at Risk from Medication-Related Osteonecrosis of the Jaw” to be
presented to the June House of Delegates. The purpose of the resolution is to help establish
protocols for patients who are at risk and share this information to medical providers through
their professional association (Florida Medical Association). Dr. Richard Mufson served as a
consultant on the council to assist on this issue.
I would like to thank the members and consultants of the Council on Dental Health for their
commitment and dedication.
Dr. Andy Brown
Dr. Suzanne Ebert
Dr. Joe Gay
Dr. Robert Payne
Dr. Keith Riley
Dr. Cesar Sabates
Dr. Jeff Smith
Dr. Ed Zapert
Respectfully Submitted,
Dr. Phil Bilger, Chairman
Page 159
Appendix A-3(D)
Annual Report to the House of Delegates
Page 1 of 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
COUNCIL ON DENTAL EDUCATION AND LICENSURE
May 22, 2015
The Council on Dental Education and Licensure (CDEL) has not held any meetings since
the January 2015 Semi-annual report to the House of Delegates, therefore no new
information is provided.
However, the CDEL Task Group on Student Loans has been very busy with the
processing and reviewing of qualified dental student applicants to grant loans through the
Student Loan Program in 2014. There are 8 applicants under consideration.
CDEL continues to work hard to fulfill its charge. I would like to thank each of the
following for their hard work and dedication to the council.
Dr. Chris Cowell – CFDDA
Dr. Thomas Brown – NEDDA
Dr. Mike Grand – NWDDA
Dr. Jeff Albert – ACDDA
Dr. Laurie Gordon-Brown – SFDDA
Dr. Barry Setzer – BOT Liaison
Mr. Danny Sabra – ASDA Consultant
Respectfully Submitted,
Dr. Eva Ackley, Chair, WCDDA
Page 160
Appendix A-3(E)
Annual Report to the House of Delegates
Page 1 of 1
COUNCIL ON ETHICS, BYLAWS & JUDICIAL AFFAIRS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
June 2015
Council Activity
The FDA’s Council on Ethics, Bylaws and Judicial Affairs has full representation from all six
districts. Dr. Kris Scales from NEDDA was elected chair and Dr. Drew Johnson from CFDDA
was elected vice-chair during the meeting at the Florida National Dental Convention (FNDC) in
June of 2014.
The Florida Dental Association Council on Ethics, Bylaws and Judicial Affairs has maintained
on-going programs such as the patient relations peer review program; the ethics review program;
reviewing the strategic plan and FDA policies; and updating FDA Bylaws. Also, it has acted by:
•
The Council updated the business associate agreement for the patient relations peer
review manual to comply with the HIPAA Omnibus Act.
•
Carefully reviewing the proposed re-write of the Florida Dental Association’s Bylaws
and Workgroups Manual. The initial proposal was reviewed at the January 2015 FDA
House of Delegates. The January House was not asked to vote on the recommendations
but rather to take them back to their caucuses and submit written recommendations and
comments on the proposal. Since then the FDA has had an electronic town hall meeting
and the Board of Trustees has also reviewed the proposal. FDA CEBJA compiled all the
recommendations from the various meetings and has incorporated them into a document
that will be presented to the June 2015 House of Delegates for final action.
Council on Ethics, Bylaws and Judicial Affairs
Dr. Kris Scales, Chair, Northeast
Dr. Drew Johnson, Vice-Chair, Central Florida
Dr. Bradley Jergins, West Coast
Dr. Mark Limosani, South Florida
Dr. Jay Heider, Atlantic Coast
Dr. Craig Oldham, West Coast
Dr. Jack Pruett, Northwest
Page 161
Appendix A-3(F)
Annual Report to the House of Delegates
Page 1 of 5
COUNCIL ON FINANCIAL AFFAIRS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
May 16, 2015
The following is a summary of Council on Financial Affairs activities since the January 2015 House
of Delegates’ meeting:
Budget Matters: The Council on Financial Affairs (CFA) reviewed the recommended FDA, FDA
Services (FDAS), and Florida Dental Association Foundation (FDAF) operating budgets. The CFA
conducted, via several conference calls and an in-person meeting, a detailed review of the
recommended FDA Operating Fund Fiscal Year 2014-2016 Budget with a balanced budget being
presented to the House of Delegates.
The CFA’s recommended FDA Fiscal Year 2015-2016 Budget includes a FDA $5 dues increase
from the current $415 FDA 2015 calendar-year dues. This recommendation took into account the
2014 calendar year CPI increase of 1% which would equate to about a $5 dues increase for FDA
dues.
The Council reviewed the FDAPAC cash flow needs in which it was recognized that the PAC
mandatory dues should be increased about $5, so as to provide the necessary source of funding for
the FDAPAC to carry-on necessary activities and expenditures.
Also, the Council is recommending that a total of $75/k of long-time PAC expenditures (including
the administrative and personnel cost reimbursement to the FDA) be incorporated into the FDA
Budget for Fiscal Year 2015-2016. The reason for this change was to comply with new
interpretation and enforcement of Campaign Report filing rules by the Florida Division of Elections;
which relate to check reimbursements by political committees to their related organizations, such as
the FDA. The reporting rules are now so onerous relating to these types of transactions that FDA
Management and our lobbying/PAC legal advisor recommended this course of action. This change
affects the FDAPAC and FDA dues in several ways:
•
This $75/k reduction of FDAPAC budgeted expenses for FY15-16 will have the effect of
reducing required PAC funding equal to $18 of mandatory PAC dues.
•
With this impact equal to $18 in PAC dues, the Council is recommending that FDAPAC
dues only be decreased $13 for 2016 calendar year dues from $49 current dues to $36.
•
At the same time the FDA dues would be correspondingly increased $13 in addition to the
$5 dues increase based on the 2014 CPI 1% increase for a grand total FDA dues increase of
$18 from $415 (for 2015 C-Y) to $433 for 2016 C-Y dues), for full-dues paying category
FDA members.
•
But for FDA full-dues paying members the bottom line net result of the all of the above will
still only be a $5 increase of mandatory FDA/FDAPAC dues products.
Page 162
Appendix A-3(F)
Annual Report to the House of Delegates
Page 2 of 5
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
The CFA’s recommended budget does not include a lump sum calculated transfer from the
Operating Fund to the FDA Reserve Fund. This recommendation was based on consideration of the
large balance of the Reserve Fund and the large investment earnings over the last three years, along
with the resulting current positive reserve to budget ratio of 67%.
A “Summary Budget” version of the FDA budget (submitted with the budget resolution exhibit)
was also compiled for presentation to the Board of Trustees and House of Delegates in order to
provide a quicker reference at 15 pages in length. Upon request, the FDA Treasurer or CFO can
provide information about any specific budget account, from the full detail budget version which
contains all the detailed spreadsheet calculations.
The CFA concurred with the proposed budgets presented from the Boards of FDA Services and
Florida Dental Association Foundation (FDAF). These budgets were, subsequently, approved in
May 2015 by the FDA Board as serving as the FDA Services’ Shareholders.
FDA Corporate Affinity Programs: Since its January 2015 semi-annual report to the House, the
CFA has continued to monitor the long-time Crown Savings royalty programs, including: the Bank
of America Affinity Credit Card and other financial services, Bank of America equipment/practice
financing, Elavon Merchant PSA credit card processing, CareCredit patient dental credit card, the
I.C. System, Inc. collection program, Vantiv (Midwest Payment Systems) merchant credit card,
Office Depot office supplies discount program, Land’s End apparel, Scientific Metals scrap metal
refining services, Officite dental website developer, ClaimX electronic dental claims, Demandforce
dental office marketing, Insurance Credentialing Specialist, and also the new CE Tracker system
and ADA Mercedes- Benz purchase incentive royalty programs.
Mr. Scott Ruthstrom, Director of the FDA Crown Savings royalty program, has provided excellent
support to the Council for his status reports of these royalty programs and review of new potential
programs. The Darby Dental Supply, the group purchasing organization discounted dental supplies
program, is totally managed and marketed by FDA Services.
The CFA continues to monitor all new developments in these Crown Savings royalty programs, the
royalty revenue being received by the FDA, as well as the quality of service provided to FDA
members. During its budget review, the CFA and the FDAS Board of Directors reviewed the
current 10% Corporate Affiliation Program marketing royalty earned by FDA Services. We believe
that this percentage should be increased to a 15% marketing royalty for FDA Services (85%/15%
FDA/FDAS split), for the upcoming Fiscal Year 2015-2016 Budget. Both companies’
recommended budgets do reflect this revised Crown Savings royalty allocation for specific review
by the Board of Trustees at its May 2015 meeting.
The projected FDA Crown Savings Program (royalty) revenue in the Council’s recommended
Fiscal Year 2015-2016 Operating Fund budget is $352,083 or 6.5% of total operating revenue. This
is an increase of $23,618 from the $328,465 amended Fiscal Year 2014-2015 budgeted royalty
revenue.
Page 163
Appendix A-3(F)
Annual Report to the House of Delegates
Page 3 of 5
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
Without this projected $352,083 royalty revenue, the 2016 FDA dues (for full dues-paying
members) would have to be increased an additional $82 (based on the projected dues factor of
$4,293 revenue received per $1 of FDA dues), from the 2016 recommended FDA dues level of
$433. As outlined in the FDA Strategic Plan, the CFA continues to seek new sources of non-dues
revenue from royalty programs that meet the primary objective of providing a positive benefit to
both the FDA and its membership.
Financial Matters: The CFA reviewed the FDA Reserve Fund investment earnings and
performance with Mr. Steven Miller, Senior Vice-President with Morgan Stanley Wealth
Management, for the first nine months of Fiscal Year 2014-2015. The reserve investments have
shown significant gains and earnings trends this year. Under the Treasurer, Dr. Tim Marshall’s
leadership, the FDA’s reserves have a significant portion of funds that are “liquid”, and a portfolio
that is well-diversified in terms of their bond/equity allocation. We are also poised to continue to
benefit from potential continued future growth in the stock market. As Dr. Tim Marshall (FDA
Treasurer) will outline in his report to the HOD, the FDA (combined with FDAS) has far exceeded
the HOD-mandated reserve-to-budget ratio of 35%, for the Fiscal Year 2014-2015 budget (the
liquid reserves balance ratio of 67% at 4/30/15 is our current reference). Including, the June 2011
House amended ratio computation formula, which also includes a formula of 50% of the
$1.479/million Tallahassee assessed real property (as well as liquid reserves), this ratio is at 76%.
Acknowledgement: The CFA has been punctual in meeting the deadlines for all the Strategic Plan
priorities assigned to it. The CFA has also been very well-served by its council members and I
would like to commend each of them for their diligent work over the second half of Fiscal Year
2014-2015:
•
•
•
•
•
•
•
•
•
•
Dr. Rodrigo Romano (SFDDA), CFA Vice-chair
Dr. Steven Bryan (NWDDA)
Dr. Andre Grenier (ACDDA)
Dr. James Paladino (CFDDA)
Dr. Cecil White (NEDDA)
Dr. Ralph Attanasi, FDA President-Elect, Trustee Liaison
Dr. Tim Marshall, FDA Treasurer, Trustee Liaison
Dr. Paul Miller, Consultant to the Council, FDA Immediate-Past Treasurer
Dr. Rick Stevenson, FDA President (who as a consultant participated in all the Council’s
regular and budget conference calls & also attended the March 27th in-person budget
meeting in Tampa)
Dr. Bill D’Aiuto, incoming FDA President-Elect (who attended the in-person Tampa budget
meeting and follow-up April 21st final budget conference call meeting)
It has been a pleasure working with Mr. Greg Gruber, the new FDA Chief Financial Officer, who
started his employment in early December 2014. Greg has provided a valuable range of past
experience, knowledge, information to the FDA and provided new overview investment, budget and
Page 164
Appendix A-3(F)
Annual Report to the House of Delegates
Page 4 of 5
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
financial explanatory reports to the Council, which have been much appreciated by the Council
members, as the CFA deals with a great deal of information and documents.
Dr. Ralph Attanasi has provided valuable advice and exemplary service to the CFA during this
fiscal year. We wish him continued success as he assumes the office of FDA President.
In addition, Dr. Paul Miller served this Council with excellent service and advice from his
perspective and past experience of Immediate-Past FDA Treasurer, and also as long-time member
and Chair of this Council.
I know that the CFA also looks forward to working with Dr. Bill D’Aiuto, as incoming PresidentElect/board liaison for the next year, and who attended the two FDA budget meetings this year.
Also, the CFA looks forward to welcoming the new Council representatives who include: Dr. Fred
Grassin (from the West Coast) and returning to the CFA, Dr. Larry Shapiro (from the Atlantic
Coast). Also, the Northwest District is in the process of appointing a new representative to the CFA,
who will be announced.
Also, my thanks to Dr. Steven Bryan and Dr. Andre Grenier for their service to the CFA for this
year. Dr. Bryan in particular, returned to the CFA in March 2013, to fill a vacancy as the
representative for Northwest (after previously serving previously many years on the forerunner of
this Council, the Council on Association Affairs). Also, Dr. Bryan, as current President of FDA
Services and long-time former member of the FDA Audit Committee, provided valuable
background information to this Council on FDA Services insurance matters and programs as well as
investments, financial, the royalty programs and budgeting matters.
The Council also appreciates the exemplary support that our council has received from the FDA
staff support: Mr. Jack Moore, Mr. Greg Gruber and Mr. Scott Ruthstrom.
Last House Report as CFA Chair:
This is my last report to the House as Chair and member of Council on Financial Affairs. It has been
an honor and privilege to serve the Association as a member of this Council and then as it’s Chair
over the last six years.
This Council with its assigned duties of overseeing the FDA Reserve Fund investments
performance, the Crown Savings royalty program review of proposed new and existing vendors,
reviewing FDA Services and FDA Foundation financial matters (on behalf of the FDA Board) and
the budget preparation, review and recommendation process of the FDA Budget to the House
provides a very important service of FDA member driven control of Association matters.
I am also pleased and proud for the hard work of CFA members; that in polls of FDA leadership
and members, the Council on Financial Affairs has been viewed and rated as one of the most hardworking and accomplished council agencies of the FDA.
Page 165
Appendix A-3(F)
Annual Report to the House of Delegates
Page 5 of 5
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
For this upcoming fiscal year, Dr. Rodrigo Romano will be serving as Chair of this Council, and
with his past experience on this Council and Board of Trustees, will provide excellent leadership.
And combined with Dr. Tim Marshall continuing his consultation to the Council on Financial
Affairs as FDA Treasurer and Board liaison; the Association’s finances, reserves and future are in
good hands with this Council. As noted above Dr. Bill D’Aiuto will be serving on the CFA as
Board liaison as incoming FDA President-Elect and also Dr. James Paladino will be serving as
Vice-Chair for the CFA. Based on my experience with working with all four Council leaders, they
will be providing valuable consultation and service to the FDA membership on the CFA for this
upcoming year.
Respectfully Submitted,
Rudy Liddell, DMD
Chairperson, Council on Financial Affairs
CFA_HOD rp June2015 HOD agenda
Page 166
Appendix A-3(G)
Annual Report to the House of Delegates
Page 1 of 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
COUNCIL ON MEMBERSHIP
May 20, 2015
Council Activity
The FDA Council on Membership (COM) chair, Dr. Craig Oldham attended the ADA
Recruitment and Retention Conference from April 16 – 18, 2015, in Chicago along with the six
component executive directors, Dr. Rodrigo Romano (FDA rep. to the ADA COM), and FDA
staff—Drew Eason, Kerry Gomez-Rios and Christine Mortham. Drew Eason and Kerry GomezRios did a presentation entitled “Little Parts of a Bigger Strategy” outlining all of the efforts that
contributed to the FDA’s one percent market share increase and growth in membership of 401
new members in 2014. Florida’s 2014 success was reflected by the six awards the FDA received
in the following categories for states with 3,501 to 7,500 members:
• Greatest Nonmembers to Membership
• Most Improved Active Member Retention Rate
• Greatest Net Gain of New Dentists
• Greatest Net Gain in Membership
• Highest Percentage of Diverse Dentists to Membership
• Highest Percentage of Women to Membership
Resolutions
Redefining of Dual Membership – The FDA has approximately ten (10) members who are
“dual members” defined as “ethical dentists who are not eligible for voting membership in the
FDA, but are members in good standing of the American Dental Association (ADA), and
residing any part of the year in the state of Florida.” Dual members are dentists who are often
times already paying full tripartite dues through another state and choose to join the FDA.
However, because these dentists are members through another state, paying full FDA dues is a
deterrent to joining the FDA as a dual member. The resolution reduces dual membership dues
from full dues (currently $415 in 2015) to $100 annually. The resolution was approved
unanimously by the FDA Board of Trustees on May 16, 2015, and will go before the HOD in
June, 2015.
Submitted on behalf of the members of the Council on Membership:
Dr. Craig Oldham, West Coast, Chair
Dr. Susan Byrne, Northwest, Vice Chair
Dr. Valerie Marino, Atlantic Coast
Dr. Edward Kennedy, Central Florida
Dr. Michael DeLucia, Northeast
Dr. Joseph Pechter, South Florida
Page 167
Appendix A-3(H)
Annual Report to the House of Delegates
Page 1 of 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
COUNCIL ON THE NEW DENTIST
May 20, 2015
Council Activity
The FDA Council on the New Dentist (CND) has had numerous activities at each of the dental
school since the beginning of the year.
• UF – FDA & CFDDA sponsored the third UF dentist/dental student mixer on January 29.
The event was well-attended by 80 students, 20 – 25 member dentists and FDA/CFDDA
staff.
• LECOM – On February 11, 2015, Graham Nicol, FDA Chief Legal Counsel and Kerry
Gomez-Rios, Director of Member Relations, visited LECOM to host a Peer Review
Dinner & Learn. The session was attended by close to 50 students
• Nova – On February 24, ten FDA member-dentists participated in a New Dentist Panel
which allowed the 40 students in attendance to ask a range of questions from the panelists
who represented different career paths. This event was followed by Nova’s Signing Day
on February 25 in conjunction with their ASDA Vendor Day. A total of 102 fourth-year
dental students signed up for membership. ADA, FDA, ACDDA, SFDDA staff and
volunteer dentist Dr. Mike Starr were on hand to help students with questions and
completing applications. Since this school had 77% participation in Signing Day, they
will be receiving a $200 bonus check from the ADA for their ASDA chapter.
• UF – On May 13, FDA staff Drew Eason and Kerry Gomez-Rios met with the new dean,
Dr. Isabel Garcia, prior to UF’s Signing Day during the 4th year students’ graduation
rehearsal. FDA, FDAS, CFDDA staff and volunteer dentist Dr. Matthew Waite were on
hand to sign all 80 of the dental graduates for membership. Since this school had 100%
participation in Signing Day, they will be receiving a $500 bonus check for their ASDA
chapter.
• UF – On May 15, FDA president Rick Stevenson participated in the dental school
commencement ceremony.
• LECOM – On May 26, LECOM will have half of its first senior class in DeFuniak
Springs, FL (the other fifty will be at the Erie, PA campus). To welcome the fifty
students to the panhandle, FDA and FDAS will host a welcome party on June 7 in Destin.
Submitted on behalf of the members of the Council on Membership and the Subcouncil on the
New Dentist:
Council on the New Dentist
Dr. Dr. Brett Zak, Central Florida, Chair
Dr. Robin Nguyen, West Coast, Vice Chair
Dr. Michael Starr, Atlantic Coast
Dr. Marcus Higgins, Northeast
Dr. Erin Shiveler, Northwest
Dr. Esteban Leon, South Florida
Page 168
Appendix A-4(A)
Annual Report to the House of Delegates
Page 1 of 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
COMMITTEE ON CONVENTIONS & CONTINUING
EDUCATION
May 21, 2015
Council Activity
The Committee on Conventions and Continuing Education continued its charge to provide topquality continuing education for dental professionals in 2015. FDC2015 features the theme
“Dentistry Beyond the Tooth: Career & Life in Balance.” Dr. Yvette Godet (CFDDA) chaired a
scientific program that is highlighted by a broad range of offerings including: three 1-hour
keynote presentations, 1, 2 and 3-hour courses, 3-day mini-residencies, 2-day cadaver workshop,
and a laser certification.
In an effort to continue reestablishing the member dentist attendance and drive the importance of
membership in FDA there are 23 courses offered for free to members. Free courses were offered
on a first come, first served basis. Five of the free courses are part of the new “So You Think
You Can Speak” sessions that give up and coming speakers the opportunity to hone their
speaking skills. Sessions are one hour and provide 1 CE credit to attendees. The speaker with the
highest evaluation will be asked back in 2016 to present a full three hour course. This is the
second year we’ve offered this and had great feedback from 2014. Eleven of these courses will
be offered in the exhibit hall to help increase the traffic in the hall in support of our exhibiting
companies. One hour of CE each day will be offered for visiting the table clinics in the exhibit
hall. Exhibiting company registrations will provide an estimated $860,280 in revenue to the FDA
operating budget in 2015.
Additionally, the committee worked on creating additional benefits for FDA Member dentists’
staff at FDC by offering reduced staff pricing and tiered member pricing (early, regular, onsite)
for courses and workshops. Popular hands-on training courses for teams and free keynote
presentations also were offered. For the first time, ADA Members were given access to the free
member courses.
Sponsorship revenue is up from $113,572 in 2014 to $132,642 in 2015. This is attributed to the
increase in sponsorship from the Florida Dental Association Foundation, the new ad on the back
of the badge, as well as speaker sponsorships being routed directly to the FDA instead of the
speaker.
The C-CCE is acutely aware of its responsibilities and continually seeks to be innovative at
increasing income, while reducing expenses. The committee is working to ensure a true FDA
member benefit. They are working in 2015-2016 to increase traffic to the exhibit hall floor by
using a third party to conduct exhibit booth evaluations. These evaluations are used to determine
if the content and size of booths are conducive to selling. This will help the exhibits planner to
effectively sell more space and provide metrics for traffic. Also, with the addition of the
Page 169
Appendix A-4(A)
Annual Report to the House of Delegates
Page 2 of 2
1
2
3
4
5
6
scanning technology, we will be able to ascertain the exact amount of people that visited the hall
and the amount of time spent there during the three days.
FDC2015 does not fall on Father’s Day weekend. Dates for FDC2016 have been scheduled for
June 16-18, 2016 and will fall on Father’s Day weekend. Subsequent years however will not
coincide with Father’s Day weekend.
Page 170
Appendix A-4(B)
Annual Report to the House of Delegates
Page 1 of 4
1
GOVERNMENTAL ACTION COMMITTEE
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
May 08, 2015
The Governmental Action Committee (GAC) is pleased to provide this report to the FDA House
of Delegates.
Since January 2015, the GAC has been monitoring the activities of the Board of Dentistry
(BOD), as well as preparing for the 2015 Legislative Session.
This session, Dr. Bill Kochenour was confirmed by the full Senate to serve through his term
which expires on October 31, 2017.
We would like to thank the following dentists for taking time out of their busy schedule to
participate in this year’s Legislative Contact Dentists (LCD) Capitol Visits:
Tuesday, February 3, 2015
Dr. Rudy Liddell
Dr. Rick Stevenson
Wednesday, February 4, 2015
Dr. Steven Bryan
Dr. Terry Buckenheimer
Dr. Jolene Paramore
Tuesday, February 10, 2015
Dr. Betty Hughes
Dr. Paul Miller
Wednesday, February 11, 2015
Dr. Mel Kessler
Dr. Robert Payne
Dr. Paul Werner
Tuesday, February 17, 2015
Dr. Gerald Bird
Dr. Bernie Kahn
Dr. Anthony Schweiger
Wednesday, February 18, 2015
Dr. Lance Grenevicki
Dr. Zack Kalarickal
Dr. Louis Traci
Page 171
Appendix A-4(B)
Annual Report to the House of Delegates
Page 2 of 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
We would also like to thank all of those involved in Florida’s Action for Dental Health. This
initiative was rolled-out at the Capitol early February with a press conference and a legislative
reception on the 22nd floor.
Participants in the press conference included:
• Sen. Alan Hays
• Dr. Jolene Paramore
• Rep. Travis Cummings
• Dr. Brittany Craig
• Dr. Terry Buckenheimer
Florida’s Action for Dental Health is a comprehensive approach to developing and implementing
solutions to improve the oral health and the resulting overall health of all Floridians. Participants
on the following workgroup help develop and guide the direction of Florida’s Action for Dental
Health:
Workforce Innovation Task Group
Dr. Jolene Paramore, Chair
Dr. Terry Buckenheimer / WCDDA
Dr. Bill D’Aiuto / CFDDA
Dr. Kim Jernigan / NWDDA
Dr. George Kolos / ACDDA
Dr. Rodrigo Romano / SFDDA
Dr. Barry Setzer, NEDDA
Dr. Jim Antoon, Consultant
Dr. Ralph Attanasi, Consultant
Dr. Mike Eggnatz, Consultant
Dr. Rick Huot, Consultant
Dr. Rick Stevenson, Consultant
Sub-Workgroup on Elder Care
Dr. Nolan Allen, Chair
Dr. Terry Buckenheimer
Dr. Don Ilkka
Dr. Cesar Sabates
Dr. Rick Stevenson
Bob Macdonald
On February 3, Marko Vujicic (ADA Health Policy Institute) presented to the Senate Health
Policy Committee on access to dental care in Florida and outlined options for improving the
Medicaid program.
Page 172
Appendix A-4(B)
Annual Report to the House of Delegates
Page 3 of 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
During the 2015 Legislative Session, the FDA filed SB 606 by Sen. Don Gaetz (R-Destin) and
HB 657 by Rep. Travis Cummings (R-Orange Park), which did not pass this year. These bills
would have created dental care access accounts that could have been used for repayment of
dental student loan debt if the dentist worked in a public health program. If the dentist secured
local funds, the state would have matched it up to three times and these funds could have been
used for investment in property and dental equipment, as well as relocating or opening a private
practice in an underserved area. Funds accumulated into these account could have been no more
than $100,000 and dentists could have participated in the program up to 5 years.
Additionally, the FDA pursued state funding for Donated Dental Services ($150,000 for two fulltime coordinators and operating expenses) and community water fluoridation ($1 million).
Unfortunately, the Legislature could not come to a mutual agreement on budget priorities and
finished the 2015 Legislative Session without passing a budget. Since Florida is required to
operate the state with a balanced budget, the Legislature has been called back to Tallahassee for
a special session on the budget which is scheduled to start on Monday, June 1 and is scheduled to
end on Saturday, June 20. Based on this news, the FDA may be able to pursue items that are
budget specific. It will be difficult to achieve since these will be new items included in the
budget, but would be applicable to the call of the special session.
Approving a state budget will be challenging considering that Florida is scheduled to lose $1.9
billion in federal funds by June 30, 2015, with the elimination of the Low Income Pool (LIP)
program, which are funds used to help hospitals treat poor and uninsured patients. Furthermore,
the House and the governor oppose an initiative supported by the Senate that would expand
health care coverage to over 800,000 Floridians. All of these issues will have to be resolved and
worked-out before a state budget is approved. In the meantime, the governor has created the
“Commission on Healthcare and Hospital Funding” through an executive order to address a
number of issues as it relates to health care.
Dentists’ Day on the Hill was held on Wednesday, March 25 with nearly 200 dentists, spouses
and dental students in attendance. A legislative briefing was held the night before on Tuesday,
March 24, to prepare everyone for their visits with legislators. The FDA thanks Mrs. Carol
Nissan and the Alliance of the FDA for sponsoring and coordinating Dentists’ Day on the Hill.
The FDA will recognize several legislators for their commitment and support for dental issues.
Sen. Don Gaetz and Rep. Travis Cummings are the FDA’s 2015 Legislators of the Year. Sen.
Andy Gardiner (R-Orlando) is the 2015 Champion for Dentistry.
The following legislators will be recognized with the Dr. Lewis Earle Legislative Service Award:
•
•
•
•
Rep. Matt Hudson (R-Naples)
Sen. Arthenia Joyner (D-Tampa)
Rep. Irv Slosberg (D-Delray Beach)
Rep. Ritch Workman (R-Melbourne)
Page 173
Appendix A-4(B)
Annual Report to the House of Delegates
Page 4 of 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
I would like to thank the GAC members for their commitment and dedication to organized
dentistry.
Dr. Ralph Attanasi
Dr. Gerald Bird
Dr. Dave Boden
Dr. Andy Brown
Dr. Terry Buckenheimer
Dr. Bill D’Aiuto
Dr. Mike Eggnatz
Dr. Vaughn Holland
Dr. Don Ilkka
Dr. Doug Jungman
Dr. Zack Kalarickal
Dr. Alana Keough
Dr. Jason Larkin
Dr. Irene Marron-Tarrazzi
Dr. Jolene Paramore
Dr. Cesar Sabates
Dr. Beatriz Terry
Respectfully submitted,
Dr. Rick Stevenson
GAC Chair
Page 174
Appendix A-4(C)
Annual Report to the House of Delegates
Page 1 of 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
STRATEGIC PLANNING TASK GROUP
May 6, 2015
The Strategic Planning Task Group met several times via conference call following the
January 2015 House of Delegates. The group continues to work with staff and Councils
to develop tactics to fulfill the goals and objectives of the plan (attached).
The Group developed a “resolution background checklist” (attached) that the Board of
Trustees adopted and will use when considering new resolutions. The checklist was sent
to all staff, councils, components, etc. for their consideration when considering a
resolution.
The Group reviewed a list of ideas created by the Board of Trustees on ways to
strengthen FDA’s Councils and Committees. These ideas came from interviews with
Council Chairs as well as from feedback from the last House of Delegates meeting in
which it was clear the House wanted the Councils to be reviewed and more active. The
Strategic Planning Task Group proposed several resolutions to the Board for
consideration and to potentially send on to the House of Delegates for consideration.
The Group will continue to evaluate and update the plan with reports at every Board of
Trustees meeting.
I would like to thank the members and consultants of the Strategic Plan Steering
Committee for their commitment and dedication.
Dr. Beatrice Terry
Dr. Ralph Attanasi
Dr. Rick Stevenson
Dr. Terry Buckenheimer
Drew Eason, FDA Staff Support
Blair Fowler, FDA Staff Support
Respectfully Submitted,
Dr. Jim Antoon, Chairman
Page 175
Appendix A-4(C)
Annual Report to the House of Delegates
Page 2 of 4
41
42
43
44
45
46
DRAFT
Florida Dental Association Strategic Plan
Mission: Helping Members Succeed
Goals/Objectives/Strategies
Finance Goal: Assure organizational sustainability
Objective 1.0: Revenue will exceed expense annually
1.1
Cull non-value programs
1.3
Maximize the price point of dues and services, based on data
1.2
1.4
Ensure programs are cost-efficient
Modify the budget process to enable more timely and accurate budget
decisions to support the strategic plan
Objective 2.0: Increase sources of non-dues revenue
2.1 Create new sources of non-dues revenue
2.2 Increase utilization of existing revenue generating products and services
2.3 Offer revenue generating products and services to new markets
2.4 Optimize price of products and services
Membership Goal: Increase member loyalty and investment
Objective 3.0: Have a .5% increase in market share by year-end 2015
3.1 Make joining fast and easy while maintaining ethical standards
3.2 Continue to increase number of younger members in engagement
opportunities
3.3 Continue to stratify and segment recruitment and retention marketing
strategies
3.4 Explore options for multiple-year or automatic renewals membership
Page 176
Appendix A-4(C)
Annual Report to the House of Delegates
Page 3 of 4
Objective 4.0: Increase “loyal” members by 7%
4.1
4.2
4.3
4.4
4.5
Reward member loyalty and encourage referral of new members
To the greatest degree possible, align organizational activities and
policies with members’ key interests
Increase loyalty of “at risk” members
Ensure member benefits are member focused and data driven
Insure that dues and value offerings are member dentist centered
Objective 5.0: The public will recognize the FDA and its members as leaders
and advocates for oral health
5.1
Educate members on ways in which they can become leaders and advocates
in oral health
5.3
Provide members with tools that help them promote their activities related
to leadership activities in their communities
5.2
5.4
Provide members with tools that assist them in becoming leaders in oral
health within their local communities
Continue to sponsor high visibility programs that highlight FDA’s
commitment to oral health (e.g., Mission of Mercy)
Organizational Goal: FDA’s capacity will be sufficient to meet the needs of our
members
Objective 6.0: Ensure decisions are driven by the strategic plan
6.1 Develop and implement program and service evaluation criteria
6.2 Review and ensure FDA’s governance structure facilitates implementation of the
strategic plan and is efficient, cost effective and meets organizational needs
Objective 7.0: Increase member engagement in leadership, programs, and
services
7.1
Establish a database of membership involvement at the state and local level
7.3
Use baseline data to identify potential leaders
7.2
Increase users of FDA products and services
Page 177
Appendix A-4(C)
Annual Report to the House of Delegates
Page 4 of 4
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
7.4
Provide leadership training in partnership with the ADA
Resolution Background Checklist
Can you answer “YES” to all of the following as appropriate?
1.
2.
3.
4.
Is the solution clearly linked to the problem?
Is it legal & ethical?
Is it consistent with the Mission and Strategic Plan?
Does the FDA have a demonstrated capacity to accomplish it? (e.g.
financial resources, human capital, time)
5. Will it reach a critical mass of members?
6. Will it have a measurable impact?
7. Is the FDA the most effective entity to accomplish it?
8. Does it have positive long-term consequences?
9. Will the benefit outweigh the cost?
10.Could it alienate a critical mass of members?
66
Page 178
Appendix A-5(A)
Annual Report to the House of Delegates
4 Pages
May 12, 2015
TO:
FDA HOUSE OF DELEGATES
FROM:
SCOTT RUTHSTROM
SUBJECT: FDA SERVICES ANNUAL REPORT
Doctors, as another year draws to a conclusion it is once again time to provide the leadership
and all FDA members with the annual report of your for-profit subsidiary corporation – FDA
Services, Inc.
This report will cover the major activities that have taken place within FDAS over the past
2014/2015 fiscal year and will provide insight concerning where we are headed in the next
fiscal year which begins July 1, 2015.
On behalf of the entire staff at FDAS, it is our pleasure to recognize the FDAS Board of
Directors who continues to devote their time and energy guiding the activities of FDAS. The
success of your subsidiary is in part attributed to their commitment and dedication.
The 2014/2015 FDA Services Board of Directors is comprised of the following volunteer
dentists:
Dr. Steven Bryan
Dr. Howard Pranikoff
Dr. Paul Palo
Dr. Robert Eckelson
Dr. Michael Stratton
Dr. Richard Stevenson
President
Vice-President
Treasurer
Secretary
Dr. James Paladino
Dr. Orlando Dominguez
Dr. Bill D’Aiuto
Dr. David Boden
Dr. Jorge Centurion
We also recognize our Executive Director, Drew Eason, and his entire staff whose support
enables FDA Services to operate in a productive and efficient manner.
Page 179
FISCAL YEAR 2014/2015 HIGHLIGHTS
Some of the noteworthy accomplishments achieved by FDA Services this fiscal year are as
follows:
-
Annual premium under administration now stands at $40.7 million.
FDA Corporate Affiliation Program rebranded to Crown Savings
Achieved “Presidents Award” status for 2014 with Liberty Mutual Ins Co.
On pace to sell more than 1,000 new policies for ninth consecutive year.
A 5% increase in policies on the books to 13,023
Policy retention level remains above 90%.
As in the past, the continued success of FDA Services may be attributed to a number of
factors including:
-
Promotion of FDAS by the FDAS Board and other leadership dentists.
Flexibility in updating insurance carriers, programs and services.
Maintaining a fully trained and aggressive sales and service force.
Aggressive marketing campaign utilizing personal contact, direct mail, internet, exhibitions
and revenue sharing with components.
Adhering to a policy where the best interest of the policyholder is always primary with
monetary considerations secondary.
INCOME AND NEW SALES
FDAS commission income collected through eight months ending April 30 th, 2015
amounted to $3,107,500; on pace to meet our annual 2014/2015 fiscal year budget
projection.
New policies written through 43 weeks of the fiscal year are 967, with total new annualized
premium of $2,300,000. New sales are on pace to surpass one thousand policies in a single
fiscal year for the ninth consecutive year. This achievement is primarily due to the
knowledgeable and dedicated sales force that interacts with our FDA members and
association clients on a daily basis.
BONUS INCOME RECIEVED
FDAS recently received three bonus checks for calendar year 2014 - one from The Doctors
Company in the amount of $101,232, a second from The Hartford for $70,505, and a third
from Liberty Mutual for $109,255. TDC’s bonus is calculated based on the volume of our
business they have on their books. The Hartford and Liberty Mutual bonuses are based on
growth, retention, and loss ratio – FDAS excelled in all three areas.
Page 180
TOTAL POLICIES UNDER ADMINISTRATION
A breakdown of ALL business at FDAS as of April 2015 is as follows:
Line of Business
Policy Count
Annual Prem
+/- one yr ago
Professional Liability
Term Life
Long-Term Care
Disability Income
Health Insurance
Office Package
Workers’ Compensation
Misc (bonds, auto, dental)
4,843
468
703
1,855
1,376
2,093
1,319
366
$11,625,437
$537,849
$1,347,261
$3,011,745
$15,917,015
$5,693,065
$1,971,024
$654,907
+471
+40
+24
+71
+2
+94
-15
+23
Total
13,023
$40,758,303
+710
FDAS STRATEGIC PLANNING
FDAS Strategic Planning session took place back on February 27-28 at the Orlando World
Center Marriott. Jeff Grady, CEO/President of the Florida Association of Insurance Agents,
did a fantastic job facilitating the event and guiding the board to draft key objectives that will
successfully shape the future of the subsidiary, while aligning our vision with the Florida
Dental Association.
A task group formed by the FDAS Board has already begun working on one of the initiatives
which is to review and implement a new board structure. The size of the board, competency,
diversity, term limits, student and new dentist perspective, and meeting formats are some of
the factors the task group is reviewing to modernize the FDAS Board to improve its
effectiveness.
FIRST-YEAR PROFESSIONAL LIABILITY PROGRAM LAUNCH
Beginning this June, graduates from dental school who are FDA members and become
insured with The Doctors Company will have their first-year professional liability premium paid
for by their FDA colleagues. An informational video, emails, and a letter from the FDA
president are part of the full marketing program. Not only does this help level the playing field
with chief competitors, it is estimated (with current retention levels) the additional commissions
earned over five years makes financial sense.
Page 181
CROWN SAVINGS
The eighteen non-insurance royalty programs that fall within the Crown Savings program
provide our members with valuable services at preferred pricing. With the new branding, our
marketing department has implemented a coordinated plan to increase utilization in each
program. The more members participate, the more value they will perceive from membership,
and the more non-dues revenue that can be realized for the FDA. Revenue received to date
for the 2014/2015 fiscal year amounts to $230,055 (several large 3rd quarter royalties yet to be
received).
Bank of America (affinity credit card)
Bank of America
CareCredit
(patient financing)
Elavon
IC Systems
(debt collection service)
Office Depot
Fifth Third Bank (credit card processing)
Claim X
Scientific Metals (scrap metal refining)
Officite
Darby Dental
(discounted supplies)
Demandforce
Sure Payroll
(payroll processing)
Lands’ End
In Touch
(messages on hold)
UPS
Mercedes-Benz
(luxury auto)
CE Broker
Insurance Credentialing Specialists (credentialing)
(practice financing)
(credit card processing)
(office supplies)
(electronic dental claims)
(website developer)
(office marketing)
(uniform apparel)
(shipping services)
(CE reporting)
Staff will be on hand during the meeting at FDC to answer any questions the Council and/or
the leadership may have relating to any of these programs.
Regards,
Scott Ruthstrom
Chief Operating Officer
Page 182
Appendix A-5(B)
Annual Report to the House of Delegates
Page 1 of 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
FLORIDA DENTAL ASSOCIATION
POLITICAL ACTION COMMITTEE (FDAPAC)
BOARD OF DIRECTORS
May 8, 2015
FDAPAC continues to be a valuable resource to organized dentistry. FDPAAC campaign
contributions are key to establishing relationships with legislators and candidates.
During the 2014 election cycle, the FDAPAC provided support in several races where all
but two candidates were elected or re-elected. Campaigning for the 2016 election cycle
has already commenced and the FDAPAC is beginning to receive requests from
candidates for support. There will also be 140 legislative races around the state, including
all 120 House members and half of the Senate or the 20 members in odd numbered
districts.
The FDAPAC Board has already participated in supporting several dental-friendly
candidates for the 2016 primary election.
I would like to thank the members of the FDAPAC Board of Directors for their
commitment and dedication to FDAPAC.
Dr. David Boden
Dr. Daniel Crofton
Dr. David Hanle
Dr. Rick Huot
Dr. Zack Kalarickal
Dr. Greg Langston
Dr. Irene Marron-Tarrazzi
Mrs. Carol Nissen
Dr. Ethan Pansick
Dr. Rick Stevenson
Dr. Beatriz Terry
Dr. Donald Thomas
Respectfully submitted,
Dr. Gerald Bird, FDAPAC Chairman
Page 183
Appendix A-5(C)
Annual Report to the House of Delegates
Page 1 of 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
FLORIDA DENTAL ASSOCIATION FOUNDATION
June 11, 2015
Foundation Activity
The FDA Foundation Board of Directors will have two days of meeting in the fall for strategic
planning. They will address a number of key areas including the Foundation’s focus initiatives,
mission statement, Board composition and program impact. Leadership terms will be held over
until the New Year to allow for the implementation of new programs.
In March, the Foundation hired a new Program Coordinator, Meghan Murphy. Ms. Murphy
reports to Heather Gioia, Director of Foundation of Affairs and manages the administrative,
clerical and logistical activities of the office.
Mission of Mercy
The 2016 FLA-MOM will be April 23-24, 2016 at the Prime Osborne Convention Center in
downtown Jacksonville. Led by Dr. Rick Stevenson and Dr. Andy Brown, a committee of
approximately 40 leads will plan the 2-day clinic which will provide free treatment to
approximately 2-3,000 patients. With more than 90,000 sq ft of space to work with, the
committee is making some exciting new changes to the program:
WHAT’S NEW
• Statewide Clinical Committee made up of representation from all 6 components- 3 year
terms
• 3 year Impact Study led by Dr. Paramore
• Multi-year/ statewide sponsorship opportunities
• Patient Registration Software (requires an extra day of setup)
• Volunteer Registration Launching in time for FDC
Applications for future years are currently being considered on a first come, first serve basis. All
components are encouraged to submit.
Submitted on behalf of Dr. David Russell, President of the Board of Directors for the Florida
Dental Association Foundation:
Dr. Bob Payne, First Vice President
Dr. Idalia Lastra, Treasurer
Dr. Bill D'Aiuto, Secretary
Dr. James Walton, Immediate Past President
Dr. Nolan Allen
Dr. Ralph Attanasi
Dr. Terry Buckenheimer
Mrs. Karen Buckenheimer
Dr. Natalie Carr
Page 184
Appendix A-5(C)
Annual Report to the House of Delegates
Page 2 of 2
1
2
3
4
5
6
7
8
9
Dr. Leo Cullinan
Dr. Bob Ferris
Dr. Harry Futrell
Dr. Audrey Galka
Dr. Bruce Gordy
Dr. Nancy Havens
Dr. Kim Jernigan
Dr. Rick Stevenson
Dr. Lew Walker
Page 185