2024-05-29T07:51:56-05:00 2023-12-31 450250958 EIDE BAILLY LLP 345 N REID PL STE 400 SIOUX FALLS SD 571037034 990 2023-01-01 911776857 DELTA DENTAL OF SOUTH DAKOTA FOUNDATION DELT 6052247345 PO BOX 1157 PIERRE SD 57501 JEFF MILLER DDSD PRESIDENT-CEO/OFFICER 6052247345 2024-05-09 1 JEFF MILLER XXX-XX-XXXX 1 LAURIE HANSON CPA P00851848 6053391999 2024-05-08 2 AAL1 IAL1 2023 2023-04-26 12:10:37Z JEFF MILLER PO BOX 1157 PIERRE SD 57501 4721923 0 X WWW.DELTADENTALSD.COM X 1996 SD TO SUPPORT PROGRAMS THAT PROMOTE ORAL HEALTH. 12 10 0 10 0 0 937014 1500018 1314981 1508363 620694 272326 0 0 2872689 3280707 423355 576170 0 0 0 0 0 0 48716 3114996 3251581 3538351 3827751 -665662 -547044 8428074 9260958 630552 721529 7797522 8539429 TO INITIATE, COLLABORATE AND/OR SUPPORT PROGRAMS THAT INCREASE ACCESS TO CARE, ENSURE AN ADEQUATE DENTAL WORK FORCE AND PREVENT DENTAL DISEASE. 0 0 1819423 942450 THE DELTA DENTAL MOBILE PROGRAM (TRUCK CLINIC) - IS A STATEWIDE PROGRAM TO PROVIDE RESTORATIVE AND PREVENTATIVE DENTAL CARE TO UNDERSERVED SOUTH DAKOTA CHILDREN. OF THE 2,724 CHILDREN SERVED BY THE PROGRAM IN 2023, 1,227 HAD MEDICAID INSURANCE, 1,209 HAD NO DENTAL INSURANCE, AND 288 HAD PRIVATE INSURANCE. THE VALUE OF CARE PROVIDED WAS $2,413,790 FOR WHICH THE DELTA DENTAL OF SOUTH DAKOTA FOUNDATION RECEIVED $716,970 IN SERVICE REVENUE AND $225,480 IN SITE PARTNER REVENUE. 883024 565913 THE DELTA DENTAL MOBILE PROGRAM (PREVENTION CLINICS) PROVIDES PREVENTIVE DENTAL CARE FOR CHILDREN FROM HEAD START THROUGH EIGHTH GRADE IN NATIVE AMERICAN TRIBAL COMMUNITIES. OF THE 1,881 CHILDREN SERVED BY THE PROGRAM IN 2023, 1,598 HAD MEDICAID INSURANCE, 219 HAD NO DENTAL INSURANCE, AND 64 HAD PRIVATE DENTAL INSURANCE. THE VALUE OF CARE PROVIDED WAS $657,885 FOR WHICH THE DELTA DENTAL OF SOUTH DAKOTA FOUNDATION RECEIVED $565,913 IN REVENUE. 576170 576170 $263,466 HAS BEEN CONTRIBUTED TO 501(C)(3) ORGANIZATIONS, GOVERNMENTAL ENTITIES AND OTHER ORGANIZATIONS WITH AN INTEREST IN FURTHERING DENTAL RESEARCH EDUCATION & SERVICES TO DISADVANTAGED POPULATIONS. ADDITIONAL ASSISTANCE PROVIDED INCLUDE A) $135,000 HAS BEEN ADVANCED THROUGH THE FUND LOAN REPAYMENT FOR SERVICE PROGRAM, B) $55,000 IN CONTINUING EDUCATION CERTIFICATES WERE ISSUED AND C) $122,724 CONTRIBUTED TO EDUCATION & PREVENTION ACTIVITIES FOR ASSISTING DISADVANTAGED CHILDREN. 3278617 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 15 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X X LAURIE MIKKONEN 6054942479 720 N EUCLID AVE PIERRE SD 57501 SCOTT JONES DDSD PRES-CEO END 04/2023)/PRESIDENT OF FOUNDATION 10.00 30.00 X X 0 474384 87131 JEFF MILLER DDSD PRES-CEO/OFFICER (BEG 04/2023) 1.00 40.00 X X 0 411168 71509 MONTY BECHTOLD DDS DIRECTOR/VICE PRESIDENT (BEG 05/23) 1.00 2.00 X 0 16876 0 JOHN CLAUSEN CPA TREASURER 1.00 2.00 X X 0 15750 0 ELLEN LEE SECRETARY 1.00 1.00 X X 0 9950 0 TRAVIS BJORDAHL DIRECTOR 1.00 0.00 X 0 0 0 THANE CRUMP DDS DIRECTOR 1.00 1.00 X 0 9750 0 DALE GIBSON DDS DIRECTOR 1.00 0.00 X 0 0 0 PAUL REZICH DDS VICE PRESIDENT/DIRECTOR (BEG 05/23) 1.00 1.00 X X 0 13609 0 ANLEE ROLA DDS DIRECTOR 1.00 1.00 X 0 9950 0 STEPHANIE SCHMITZ DDS DIRECTOR 1.00 0.00 X 0 0 0 ROGER WILSON DDS DIRECTOR 1.00 0.00 X 0 0 0 0 961437 158640 0 0 1 0 DELTA DENTAL OF SOUTH DAKOTA PO BOX 1157 PIERRE SD 57501 MANAGEMENT SERVICES 2069703 1 1248716 190430 60872 1500018 DAKOTA SMILES PROGRAM 621990 1508363 1508363 1508363 176301 176301 1537241 1441216 96025 96025 96025 3280707 1508363 0 272326 X 263446 263446 312724 312724 14915 14915 2444080 2050250 393830 20100 20100 179090 178834 256 30000 24600 5400 259961 250785 9176 1380 1244 136 4501 4501 32201 32201 INDIRECT COSTS 94189 45290 48899 MAINTENANCE AND REPAIRS 87176 87176 FUNDRAISING EXPENSES 48716 48716 ALL SMILES PROGRAM 25096 25096 10176 2470 7706 3827751 3278617 500418 48716 1430763 1133864 282823 484014 287928 172320 30000 135000 20154 22334 1424886 1372000 3609 52886 6355245 7239003 17552 21537 8428074 9260958 382522 553849 79437 58941 168593 108739 630552 721529 X 7797522 8539429 7797522 8539429 8428074 9260958 X -547044 1166151 122800 X 0 1 X 1 0 X X 2 DELTA DENTAL OF SOUTH DAKOTA 460309258 10 1 0 2579647 CLASS OF SUPPORTED ORGANIZATIONS 460309258 7 1 576170 0 2 576170 2579647 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART I, LINE 11G, COLUMN (III) TYPE OF ORGANIZATION: DELTA DENTAL OF SOUTH DAKOTA: 501(C)(4) CLASS OF SUPPORTED ORGANIZATIONS: 6, 7, AND 10 PART I, LINE 11G, COLUMN (VI): THE DELTA DENTAL MOBILE PROGRAM IS A STATEWIDE PROGRAM TO PROVIDE RESTORATIVE AND PREVENTIVE DENTAL CARE TO UNDERSERVED CHILDREN ACROSS SOUTH DAKOTA. DELTA DENTAL OF SOUTH DAKOTA IS INDIRECTLY SUPPORTED BY PROVIDING THE DELTA DENTAL MOBILE PROGRAM. PART IV, SECTION A, LINE 1: DELTA DENTAL OF SOUTH DAKOTA IS SPECIFIED BY NAME IN THE ARTICLES OF INCORPORATION. OTHER ORGANIZATIONS ARE SPECIFIED BY CLASS. THE ARTICLES OF INCORPORATION STATE THAT THE FUND WILL MAKE DISTRIBUTIONS TO ORGANIZATIONS THAT QUALIFY AS EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) AND/OR SECTION 170(C)(2) AND/OR SECTION 501(A) OF THE INTERNAL REVENUE CODE THAT ARE CLOSELY RELATED IN PURPOSE OR FUNCTION TO DELTA DENTAL OF SOUTH DAKOTA. PART IV, SECTION A, LINE 3B: DELTA DENTAL OF SOUTH DAKOTA ANNUALLY PERFORMS A PUBLIC SUPPORT TEST UNDER SECTION 509(A)(2) TO CONFIRM THAT IT QUALIFIES AS A SUPPORTED ORGANIZATION. THIS IS PERFORMED DURING PREPARATION OF THE DELTA DENTAL OF SOUTH DAKOTA FORM 990 EXEMPT ORGANIZATION INCOME TAX RETURN. PART IV, SECTION A, LINE 3C: THE FOUNDATION WORKS CLOSELY WITH DELTA DENTAL OF SOUTH DAKOTA (DDSD) THROUGH OPERATING THE DELTA DENTAL MOBILE PROGRAM EXCLUSIVELY FOR SECTION 170(C)(2)(B) PURPOSES AND BY PROVIDING GRANTS TO OTHER ORGANIZATIONS THAT ARE EXEMPT AS 501(C)(3) OR GOVERNMENTAL ENTITIES THAT FURTHER DDSD'S MISSION OF ADVANCING AND PROMOTING THE IMPROVEMENT OF ORAL HEALTH. THE CEO AND PRESIDENT OF DDSD IS A DIRECTOR OF THE FOUNDATION, ALONG WITH 6 OF THE 15 CORPORATE BOARD MEMBERS OF DDSD. GRANTS ARE NOT DIRECTLY PROVIDED TO DDSD. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1424886 1372000 52886 52886 PAYABLE TO DELTA DENTAL OF SOUTH DAKOTA 108739 108739 X 4446858 1166151 1166151 3280707 0 3280707 3704951 0 3704951 122800 122800 3827751 PART X, LINE 2: THE FOUNDATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE FOUNDATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPIRED CONTINUING EDUCATION CERTIFICATES 17,800. LOAN PAYMENT FORGIVENESS 105,000. 1 SOUTH DAKOTA DENTAL FOUNDATION PO BOX 1194 PIERRE SD 57501 460363251 501(C)(3) 88400 0 GENERAL SUPPORT ST FRANCIS MISSION 350 OAK ST ST FRANCIS SD 57572 466000411 501(C)(3) 25000 0 DENTAL CARE SOUTH DAKOTA COMMUNITY FOUNDATION PO BOX 296 PIERRE SD 57501 460398115 501(C)(3) 50000 0 COMMUNITY IMPROVEMENT SUPPORT UNIVERSITY OF SOUTH DAKOTA 414 E CLARK ST VERMILLION SD 57069 466000364 GOVERNMENT 15000 0 HEALTHCARE & DENTAL EDUCATION USD DEPT OF DENTAL HYGIENE 120 C EAST HALL 414 E CLARK ST VERMILLION SD 57069 466000364 GOVERNMENT 25000 0 HEALTHCARE & DENTAL EDUCATION WESTERN DAKOTA TECH COLLEGE 800 MICKELSON DR RAPID CITY SD 57703 460340050 GOVERNMENT 24046 0 DENTAL EDUCATION SOUTHEAST TECHNICAL COLLEGE 2320 N CAREER AVE SIOUX FALLS SD 57107 466002586 GOVERNMENT 20000 0 DENTAL EDUCATION AMERICA'S TOOTHFAIRY 4530 PARK ROAD STE 320 CHARLOTTE NC 28209 203921574 501(C)(3) 6000 0 DENTAL EDUCATION 8 0 CONTINUING EDUCATION CERTIFICATES 550 55000 EDUCATION & PREVENTION ASSISTING NEEDY CHILDREN 15036 122724 LOAN REPAYMENTS 7 135000 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. 0 1 0 0 0 0 0 0 0 SCOTT JONES DDSD PRES-CEO END 04/2023)/PRESIDENT OF FOUNDATION 0 225998 0 224997 0 23389 0 55500 0 32974 0 562858 0 0 JEFF MILLER DDSD PRES-CEO/OFFICER (BEG 04/2023) 0 329364 0 60000 0 21804 0 41400 0 31492 0 484060 0 0 PART I, LINE 3 THE ORGANIZATION RELIED ON ITS PARENT, DELTA DENTAL OF SOUTH DAKOTA, TO ESTABLISH THE COMPENSATION OF THE PRESIDENT. PART I, LINE 4B A 457F PLAN WAS ESTABLISHED FOR CERTAIN EMPLOYEES OF THE RELATED ORGANIZATION AND A CONTRIBUTION WAS MADE ON THEIR BEHALF. THE CONTRIBUTION AMOUNT IS 2% OF SALARY AND BONUS FOR DESIGNATED EMPLOYEES AGE 62 OR LESS DURING THE CALENDAR YEAR. THE CONTRIBUTIONS WILL VEST ON JANUARY 6, 2026. THE CONTRIBUTION FOR EMPLOYEES AGE 63 OR OLDER DURING THE CALENDAR YEAR IS $22,500, THE MAXIMUM AMOUNT ALLOWED, EXCLUDING THE CATCH-UP CONTRIBUTION AMOUNT FOR EMPLOYEES 50 AND OLDER. DETAIL CONTRIBUTIONS FOR SPECIFIED EMPLOYEES: SCOTT JONES $22,500.00 JEFF MILLER $8,400.00 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE VOTING MEMBER. IT IS DELTA DENTAL OF SOUTH DAKOTA. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER, DELTA DENTAL OF SOUTH DAKOTA, APPOINTS MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE COMMITTEES. 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 DELTA DENTAL OF SOUTH DAKOTA CHAIRMAN OF THE AUDIT AND FINANCE COMMITTEE. THE BOARD OF DIRECTORS IS PROVIDED A COPY OF THE 990 PRIOR TO ITS FILING WITH THE IRS. 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 C, LINE 19 ALL DOCUMENTS AND POLICIES ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACT STAFF: PROGRAM SERVICE EXPENSES 341,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 341,000. SHARED SERVICES: PROGRAM SERVICE EXPENSES 1,709,250. MANAGEMENT AND GENERAL EXPENSES 393,830. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,103,080. FORM 990, PART XI, LINE 9: LOAN REPAYMENT FORGIVENESS 105,000. EXPIRED CONTINUING EDUCATION CERTIFICATES 17,800. DELTA DENTAL OF SOUTH DAKOTA 720 NORTH EUCLID AVE PIERRE SD 57501 460309258 IMPROVEMENT OF ORAL HEALTH SD 501(C)(4) 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 1