2024-05-23T10:46:08-05:00 2023-12-31 450250958 EIDE BAILLY LLP 345 N REID PL STE 400 SIOUX FALLS SD 571037034 990 2023-01-01 460309258 DELTA DENTAL OF SOUTH DAKOTA DELT 6052247345 PO BOX 1157 PIERRE SD 57501 JEFFREY MILLER PRESIDENT/CEO 6052247345 2024-05-09 1 JEFFREY MILLER XXX-XX-XXXX 1 LAURIE HANSON CPA P00851848 6053391999 2024-04-24 2 AAL1 IAL1 2023 2023-04-26 12:10:37Z JEFFREY MILLER PO BOX 1157 PIERRE SD 57501 109718565 0 X WWW.DELTADENTALSD.COM X 1963 SD DEDICATED TO ADVANCING AND PROMOTING THE IMPROVEMENT OF ORAL HEALTH. 15 9 94 0 2069703 0 0 0 95014007 100500986 578219 487953 2193606 2052288 97785832 103041227 1251726 1925486 0 0 9084107 8781802 0 0 0 90943934 93539225 101279767 104246513 -3493935 -1205286 44015377 45726829 10483868 9185933 33531509 36540896 DELTA DENTAL OF SOUTH DAKOTA IS DEDICATED TO ADVANCING AND PROMOTING THE IMPROVEMENT OF ORAL HEALTH. 0 0 92884207 1925486 100500986 DELTA DENTAL PAID THROUGH ITS CONTRACTS WITH INDEPENDENT DENTISTS 716,626 CLAIMS FOR DENTAL BENEFIT SERVICES FOR APPROXIMATELY 329,339 INDIVIDUALS WITH GROUP PLANS, 1,861 INDIVIDUALS WITH DENTAL ACCIDENT PLANS, 125,924 SOUTH DAKOTA MEDICAID RECIPIENTS, 4,723 MEDICARE ADVANTAGE ENROLLEES, AND 130,000 NATIVE AMERICANS UNDER GREAT PLAINS AREA INDIAN HEALTH SERVICES. DELTA DENTAL ALSO GRANTED THE DELTA DENTAL OF SOUTH DAKOTA FOUNDATION, A 501(C)(3) CHARITABLE ORGANIZATION, $1,248,716 TO PROMOTE THE IMPROVEMENT OF ORAL HEALTH. 92884207 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 1 4919 0 1 94 1 1 1 0 0 0 0 0 0 0 X 15 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X LAURIE MIKKONEN 6054942479 720 N EUCLID AVE PIERRE SD 57501 MONTY BECHTOLD DDS VICE CHAIR/CHAIR (BEG 05/23) 2.00 1.00 X X 16876 0 0 THOMAS HUBER MD DIRECTOR/VICE CHAIR (BEG 05/23) 1.00 0.00 X X 9950 0 0 JOHN CLAUSEN CPA TREASURER 2.00 1.00 X X 15750 0 0 CHRIS MAXWELL DIRECTOR/SECRETARY (BEG 05/23) 1.00 0.00 X X 10250 0 0 JASON AANENSON DDS DIRECTOR 1.00 0.00 X 9750 0 0 THANE CRUMP DDS DIRECTOR 1.00 1.00 X 9750 0 0 JEFF FEIOCK DDS DIRECTOR 1.00 0.00 X 9750 0 0 GREG GERTSEN DDS SECRETARY/DIRECTOR (BEG 05/23) 1.00 0.00 X 10250 1000 0 G VERNE GOODSELL DIRECTOR 1.00 0.00 X 11250 0 0 GREG HANSON DDS DIRECTOR 1.00 0.00 X 9750 19500 0 ELLEN LEE DIRECTOR 1.00 1.00 X 9950 0 0 PAUL REZICH DDS CHAIR/DIRECTOR (BEG 05/23) 1.00 1.00 X 13609 0 0 ANLEE ROLA DDS DIRECTOR 1.00 1.00 X 9950 0 0 TOM SIMMONS DIRECTOR 1.00 0.00 X 9950 0 0 ROB WYLIE DIRECTOR 1.00 0.00 X 10250 0 0 JEFFREY MILLER EVP/PRESIDENT-CEO (BEG 04/2023) 40.00 1.00 X 411168 0 71509 SCOTT JONES DDSD PRES-CEO (END 04/2023)/PRES. OF FOUNDATION 30.00 10.00 X 474384 0 87131 LAURIE MIKKONEN CFO 40.00 1.00 X 236574 0 43882 KIRBY SCOTT VP OF FINANCE 40.00 0.00 X 224951 0 61513 MICK HECKENLAIBLE VP OF OPERATIONS 40.00 0.00 X 221508 0 44609 EUGENE TETZLAFF VP OF IT 40.00 0.00 X 213736 0 76446 CONNIE HALVERSON VP OF PUBLIC BENEFITS 10.00 30.00 X 185777 0 64377 DAYNA HEPPER - VP OF GROWTH & CUSTOMER EXPERIEN 40.00 0.00 X 149091 0 46196 ANN SCHWARTZ - VP OF PROVIDER SERVICES & GOVT PROGRAMS 40.00 0.00 X 146591 0 59375 JAMEY HERR - DIRECTOR OF INFRASTRUCTURE & SECURITY 40.00 0.00 X 153480 0 38796 EUGENE CAMPBELL - DIRECTOR OF DEVELOPMENT & MODERNIZATIO 40.00 0.00 X 144988 0 42751 LORI HALL - DIRECTOR OF CLAIMS PROCESSING 40.00 0.00 X 124429 0 25110 2853712 20500 661695 20 0 1 0 MIDWEST BENEFITS PO BOX 10481 DES MOINES IA 50306 COMMISSIONS 200000 CHANGE HEALTHCARE SOLUTIONS LLC PO BOX 572490 MURRAY UT 84157 CLAIMS CLEARINGHOUSE 133242 MARSH & MCLENNAN AGENCY PO BOX 5113 SIOUX FALLS SD 57117 COMMISSIONS 130553 EIDE BAILLY PO BOX 5125 SIOUX FALLS SD 57117 ACCOUNTING SERVICES 122512 4 PREMIUM EARNED 812900 100500986 100500986 100500986 920355 920355 38700 56115 -17415 -17415 -17415 6188821 6621223 -432402 -432402 -432402 MANAGEMENT FEE INCOME 541610 2069703 2069703 2069703 103041227 100500986 2069703 470538 1925486 1925486 2593888 2593888 3198371 3198371 1381765 1381765 1179228 1179228 428550 428550 90219 90219 122512 122512 66026 66026 770580 770580 377097 377097 746390 746390 278475 278475 88101 88101 67048 67048 244550 244550 303013 303013 284856 284856 CLAIMS INCURRED 84814336 84814336 MANAGEMENT SERVICE EXPE 2069703 2069703 COMMISSIONS 1588307 1588307 ALLOCATED CLAIMS ADJUST 0 4556078 -4556078 1628012 1628012 104246513 92884207 11362306 0 13900 1661513 4510821 256951 7399042 8283307 459253 345704 8892412 5460850 3448635 3431562 24531544 27241294 2568205 3320559 1083977 1185939 44015377 45726829 4867281 4882089 5616587 4303844 10483868 9185933 X 33531509 36540896 33531509 36540896 44015377 45726829 -1205286 4214673 0 X 0 1 X 1 0 397371 397371 5146729 2516754 2629975 3348312 2944096 404216 3431562 INVESTMENT IN SPRINGROCK VENTURES II LLP 3320559 F 3320559 ADMINISTRATIVE REIMBURSEMENT PAYABLE 274028 COST PLUS GROUP DEPOSITS 74100 DEFERRED PREMIUMS 1180416 UNPAID CLAIMS ADJUSTMENT EXPENSES 252300 UNPAID CLAIMS AND CLAIMS INCURRED BUT NOT REPORTED 2523000 4303844 X 105176286 4214673 -2069703 2144970 103031316 66026 -56115 9911 103041227 102166899 56115 56115 102110784 66026 2069703 2135729 104246513 PART X, LINE 2: ACCOUNTING STANDARDS PRESCRIBE A RECOGNITION THRESHOLD OF MORE LIKELY THAN NOT, AND A MEASUREMENT ATTRIBUTE FOR ALL TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN, IN ORDER FOR THOSE TAX POSITIONS TO BE RECOGNIZED IN THE FINANCIAL STATEMENTS. AT DECEMBER 31, 2023 AND 2022, THE COMPANY BELIEVES THAT THERE ARE NO UNCERTAIN TAX POSITIONS OR LIABILITIES, OR INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS. IF THE COMPANY HAD INTEREST AND PENALTIES RELATED TO UNCERTAIN TAX POSITIONS, IT WOULD BE ACCOUNTED FOR AS A COMPONENT OF INCOME TAX EXPENSE. PART XI, LINE 2D - OTHER ADJUSTMENTS: ADMINISTRATION SERVICE EXPENSES RECLASSIFIED FOR 990 -2,069,703. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES RECLASSIFIED TO REVENUE FOR 990 -56,115. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES RECLASSIFIED TO REVENUE FOR 990 56,115. PART XII, LINE 4B - OTHER ADJUSTMENTS: ADMINISTRATION SERVICE EXPENSES RECLASSIFIED FOR 990 2,069,703. 1 DELTA DENTAL OF SOUTH DAKOTA FOUNDATION 804 NORTH EUCLID SUITE 1 PIERRE SD 57501 911776857 501(C)(3) 1248716 0 PROMOTE DENTAL HEALTH IN SOUTH DAKOTA CAPITAL AREA UNITED WAY 221 SOUTH CENTRAL AVE PIERRE SD 57501 460403398 501(C)(3) 79005 0 DISTRIBUTE CHARITABLE DONATIONS BOYS & GIRLS CLUB 100 S REE STREET PIERRE SD 57501 460250273 501(C)(3) 41164 0 PROGRAM SUPPORT SD COMMUNITY FOUNDATION PO BOX 296 PIERRE SD 57501 460398115 501(C)(3) 70546 0 COMMUNITY IMPROVEMENT SUPPORT AVERA HEALTH FOUNDATION 3900 W AVERA DRIVE SIOUX FALLS SD 57108 460367530 501(C)(3) 50500 0 PROGRAM SUPPORT OAHE FOUNDATION PO BOX 998 PIERRE SD 57501 363309554 501(C)(3) 200000 0 COMMUNITY IMPROVEMENT SUPPORT OAHE YMCA 900 E CHURCH ST PIERRE SD 57501 237169291 501(C)(3) 202600 0 PROGRAM SUPPORT SD DENTAL FOUNDATION PO BOX 1194 PIERRE SD 57501 460367045 501(C)(3) 5350 0 GENERAL SUPPORT 8 0 PART I, LINE 2: GRANTS MADE TO ORGANIZATIONS ARE APPROVED BY THE BOARD OF DIRECTORS. GRANTS MADE TO 501(C)(3) ORGANIZATIONS, GOVERNMENTAL ENTITIES, AND OTHER ORGANIZATIONS WITH AN INTEREST IN FURTHERING DENTAL RESEARCH, EDUCATION, AND SERVICES TO DISADVANTAGED POPULATIONS ARE APPROVED BY THE BOARD. X X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 SCOTT JONES DDSD PRES-CEO (END 04/2023)/PRES. OF FOUNDATION 225998 0 224997 0 23389 0 55500 0 32974 0 562858 0 0 0 JEFFREY MILLER EVP/PRESIDENT-CEO (BEG 04/2023) 329364 0 60000 0 21804 0 41400 0 31492 0 484060 0 0 0 EUGENE TETZLAFF VP OF IT 169150 0 43350 0 1236 0 44812 0 33008 0 291556 0 0 0 KIRBY SCOTT VP OF FINANCE 156570 0 44625 0 23756 0 45451 0 17352 0 287754 0 0 0 LAURIE MIKKONEN CFO 168072 0 45000 0 23502 0 28830 0 16226 0 281630 0 0 0 MICK HECKENLAIBLE VP OF OPERATIONS 176400 0 43950 0 1158 0 27125 0 18852 0 267485 0 0 0 CONNIE HALVERSON VP OF PUBLIC BENEFITS 131760 0 37950 0 16067 0 23522 0 42212 0 251511 0 0 0 ANN SCHWARTZ - VP OF PROVIDER SERVICES & GOVT PROGRAMS 121250 0 24555 0 786 0 18810 0 41675 0 207076 0 0 0 DAYNA HEPPER - VP OF GROWTH & CUSTOMER EXPERIEN 123750 0 24555 0 786 0 18073 0 29254 0 196418 0 0 0 JAMEY HERR - DIRECTOR OF INFRASTRUCTURE & SECURITY 128700 0 24000 0 780 0 15623 0 24324 0 193427 0 0 0 EUGENE CAMPBELL - DIRECTOR OF DEVELOPMENT & MODERNIZATIO 121960 0 22320 0 708 0 14470 0 29192 0 188650 0 0 0 LORI HALL - DIRECTOR OF CLAIMS PROCESSING 103768 0 20040 0 621 0 9048 0 17119 0 150596 0 0 0 PART I, LINE 1A COMPANION TRAVEL WAS WRITTEN INTO THE PREVIOUS CEO'S EMPLOYMENT AGREEMENT. COMPANION TRAVEL COSTS ARE INCLUDED IN THE W-2 OF THE CEO AS TAXABLE WAGES. ALL EMPLOYEES ARE ELIGIBLE FOR THE ORGANIZATION TO PAY 50% OF LOCAL GYM MEMBERSHIP. PART I, LINE 4B THE ORGANIZATION CONTRIBUTES TO A 457F PLAN ON THE BEHALF OF CERTAIN EMPLOYEES. THE CONTRIBUTION AMOUNT IS 2% OF SALARY AND BONUS FOR DESIGNATED EMPLOYEES AGE 62 OR LESS DURING THE CALENDAR YEAR. THE CONTRIBUTION AMOUNT FOR EMPLOYEES AGE 63 OR OLDER DURING THE CALENDAR YEAR = $22,500. THE CONTRIBUTIONS WILL VEST JANUARY 5, 2027. THE INDIVIDUALS INVOLVED & THE CONTRIBUTION AMOUNTS ON THEIR BEHALF FOLLOWS: JEFFREY MILLER $8,400.00 MICK HECKENLAIBLE $4,515.00 LAURIE MIKKONEN $4,800.00 KIRBY SCOTT $22,500.00 SCOTT JONES $22,500.00 CONNIE HALVERSON $3,915.00 GENE TETZLAFF $22,500.00 DAYNA HEPPER $3,131.00 ANN SCHWARTZ $3,131.00 JEFF FEIOCK DDS BOARD MEMBER 414605 INSURANCE REIMBURSEMENT 0 MONTY BECHTOLD DDS BOARD MEMBER 103424 INSURANCE REIMBURSEMENT 0 JASON AANENSON DDS BOARD MEMBER 252886 INSURANCE REIMBURSEMENT 0 THANE CRUMP DDS BOARD MEMBER 193802 INSURANCE REIMBURSEMENT 0 LEE GERTSEN DDS SON OF BOARD MEMBER GREG GERTSEN 334418 INSURANCE REIMBURSEMENT 0 KIM SUGA DDS DAUGTHER-IN-LAW OF BOARD MEMBER GREG GERTSEN 322855 INSURANCE REIMBURSEMENT 0 JACLYN SCHULER DDS DAUGHTER OF BOARD MEMBER ANLEE ROLA 610144 INSURANCE REIMBURSEMENT 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE CHAIRMAN, VICE-CHAIRMAN, SECRETARY, TREASURER, AND SUCH OTHER MEMBERS AS THE BOARD DESIGNATES AND SHALL BE VESTED WITH SUCH POWERS AS THE BOARD OF DIRECTORS SHALL BY RESOLUTION DETERMINE. IT SHALL MAKE A WRITTEN REPORT OF ITS PROCEEDINGS AND ACTIONS AT THE NEXT SUCCEEDING MEETING OF THE BOARD OF DIRECTORS. THE CHAIRMAN SHALL BE THE CHAIRMAN OF THE EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP CONSISTS OF DENTISTS LICENSED IN SOUTH DAKOTA THAT PAY ONE-TIME MEMBERSHIP DUES. FORM 990, PART VI, SECTION A, LINE 7A ALL MEMBER DENTISTS IN ATTENDANCE AT THE ANNUAL MEETING HAVE ONE VOTE. FORM 990, PART VI, SECTION A, LINE 7B ALL MEMBER DENTISTS IN ATTENDANCE AT THE ANNUAL MEETING ARE ALLOWED ONE VOTE ON ALL AGENDA ITEMS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AT THE MAY BOARD MEETING. A REVIEW OF THE FORM IS CONDUCTED BY THE CHAIR OF THE AUDIT AND FINANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY, IN MAY, AT THE REGULARLY SCHEDULED BOARD MEETING. EACH FORM IS READ AT THE FOLLOWING MEETING, WITH ACTION TAKEN AS NEEDED. ACTION MAY INCLUDE ABSTENTION FROM DISCUSSION AND VOTING AND POSSIBLE TERMINATION AS A BOARD MEMBER. FORM 990, PART VI, SECTION B, LINE 15 DELTA DENTAL OF SOUTH DAKOTA HAS A COMPENSATION COMMITTEE CHARTER, WHICH STATES THE PURPOSE OF THE COMPENSATION COMMITTEE IS TO REVIEW AND REPORT TO THE BOARD ON COMPENSATION AND PERSONNEL POLICIES, PROGRAMS AND PLANS AND TO APPROVE EMPLOYEE COMPENSATION AND BENEFIT PLANS. THE COMMITTEE CONSISTS OF THE BOARD CHAIR, VICE-CHAIR, AND AT LEAST TWO OTHER BOARD MEMBERS. COMMITTEE MEMBERS ARE APPOINTED TO ANNUAL TERMS AND MAY BE REAPPOINTED TO UNLIMITED CONSECUTIVE TERMS. THE COMMITTEE ANNUALLY REVIEWS THE CEO'S PERFORMANCE AND DETERMINES SALARY ADJUSTMENTS AND INCENTIVE PAYMENTS FOR THE CEO, ENSURING COMPLIANCE WITH THE IRS "REBUTTABLE PRESUMPTION" SAFETY ZONE FOR EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE ALSO REVIEWS THE CEO'S RECOMMENDATIONS AS TO SALARY ADJUSTMENTS AND INCENTIVE PAYMENTS FOR EXECUTIVE STAFF, ENSURING COMPENSATION WITHIN THE RANGES OF THE EXECUTIVE COMPENSATION PHILOSOPHY. FORM 990, PART VI, SECTION C, LINE 19 ALL DOCUMENTS AND POLICIES ARE AVAILABLE UPON REQUEST. DELTA DENTAL OF SOUTH DAKOTA FOUNDATION PO BOX 1157 PIERRE SD 57501 911776857 ACCESS TO DENTAL CARE SD 501(C)(3) LINE 12A, I DELTA DENTAL OF SOUTH DAKOTA 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 DELTA DENTAL OF SOUTH DAKOTA FOUNDATION B 1248716 CASH DELTA DENTAL OF SOUTH DAKOTA FOUNDATION O 2069703 CASH