2023-05-23T14:41:59-05:00 2022-12-31 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2022-01-01 460309258 DELTA DENTAL OF SOUTH DAKOTA DELT 6052247345 PO BOX 1157 PIERRE SD 57501 JEFFREY MILLER PRESIDENT & CEO 6052247345 2023-05-12 1 JEFFREY MILLER XXX-XX-XXXX 1 LAURIE HANSON CPA P00851848 6053391999 2023-05-02 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z JEFFREY MILLER PO BOX 1157 PIERRE SD 57501 105001744 0 X WWW.DELTADENTALSD.COM X 1963 SD DEDICATED TO ADVANCING AND PROMOTING THE IMPROVEMENT OF ORAL HEALTH. 15 9 95 0 2212558 0 0 0 85083285 95014007 3727722 578219 2548543 2193606 91359550 97785832 1999693 1251726 0 0 8106348 9084107 0 0 0 84000943 90943934 94106984 101279767 -2747434 -3493935 54773783 44015377 10761849 10483868 44011934 33531509 DELTA DENTAL OF SOUTH DAKOTA IS DEDICATED TO ADVANCING AND PROMOTING THE IMPROVEMENT OF ORAL HEALTH. 0 0 89732505 1251726 95014007 DELTA DENTAL PAID THROUGH ITS CONTRACTS WITH INDEPENDENT DENTISTS 705,482 CLAIMS FOR DENTAL BENEFIT SERVICES FOR APPROXIMATELY 327,260 INDIVIDUALS WITH GROUP PLANS, 2,216 INDIVIDUALS WITH DENTAL ACCIDENT PLANS, 145,749 SOUTH DAKOTA MEDICAID RECIPIENTS, 787 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, $745,787 TO PROMOTE THE IMPROVEMENT OF ORAL HEALTH. 89732505 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 4937 0 1 95 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 PAUL REZICH DDS CHAIR 2.00 1.00 X X 16350 0 0 MONTY BECHTOLD DDS VICE CHAIR 1.00 1.00 X X 13218 0 0 GREG GERTSEN DDS SECRETARY 1.00 0.00 X X 10250 1000 0 JOHN CLAUSEN CPA TREASURER 2.00 1.00 X X 15750 0 0 STEVE CULHANE DIRECTOR (END MAY) 1.00 0.00 X 6000 0 0 JEFF FEIOCK DDS DIRECTOR 1.00 0.00 X 9750 0 0 G VERNE GOODSELL DIRECTOR 1.00 0.00 X 11250 0 0 GREG HANSON DDS DIRECTOR 1.00 0.00 X 9750 15500 0 JASON AANENSON DDS DIRECTOR 1.00 0.00 X 9750 0 0 ELLEN LEE DIRECTOR 1.00 1.00 X 9850 0 0 ANLEE ROLA DDS DIRECTOR 1.00 1.00 X 9850 0 0 THANE CRUMP DDS DIRECTOR 1.00 1.00 X 8250 0 0 THOMAS HUBER MD DIRECTOR 1.00 0.00 X 9850 0 0 CHRIS MAXWELL DIRECTOR 1.00 0.00 X 10250 0 0 TOM SIMMONS DIRECTOR 1.00 0.00 X 9850 0 0 ROB WYLIE DIRECTOR (BEGIN JUNE) 1.00 0.00 X 1500 0 0 SCOTT JONES PRESIDENT & CEO 40.00 1.00 X 798325 0 79437 KIRBY SCOTT VP OF FINANCE 40.00 1.00 X 232439 0 59206 LAURIE MIKKONEN CFO 40.00 1.00 X 181895 0 36187 EUGENE TETZLAFF VP OF IT 40.00 1.00 X 221242 0 56920 MICK HECKENLAIBLE VP OF OPERATIONS 40.00 1.00 X 229048 0 43804 JEFFREY MILLER EXECUTIVE VICE PRESIDENT 40.00 1.00 X 311609 0 64678 CONNIE HALVERSON VP OF PUBLIC BENEFITS 10.00 30.00 X 191660 0 62385 JEFF HEPPNER - DIRECTOR OF DEVELOPMENT & MODERNIZATION 40.00 0.00 X 179052 0 58162 HOLLY HEIEN DENTIST FOR MOBILE PROGRAMS 0.00 40.00 X 162546 0 24672 SARA GREEN - DIRECTOR OF UNDERWRITING & PROVIDER COMPENSATION 40.00 0.00 X 139527 0 44126 DAYNA HEPPER - VP OF GROWTH & CUSTOMER EXPERIENCE 40.00 0.00 X 123992 0 39725 JAMEY HERR - DIRECTOR OF INFRASTRUCTURE & SECURITY 30.00 10.00 X 141489 0 38357 3074292 16500 607659 22 0 1 0 MIDWEST BENEFITS PO BOX 10481 DES MOINES IA 50306 COMMISSIONS 200000 MARSH & MCLENNAN AGENCY PO BOX 5113 SIOUX FALLS SD 57117 COMMISSIONS 120551 EIDE BAILLY 200 E 10TH ST STE 500 SIOUX FALLS SD 57117 ACCOUNTING SERVICES 117219 CHANGE HEALTHCARE SOLUTIONS LLC PO BOX 572490 MURRAY UT 84157 CLAIMS CLEARINGHOUSE 115114 4 PREMIUM EARNED 812900 95014007 95014007 95014007 225102 225102 38700 57652 -18952 -18952 -18952 7511377 7158260 353117 353117 353117 MANAGEMENT FEE INCOME 541610 2212558 2212558 2212558 97785832 95014007 2212558 559267 1251726 1251726 2738400 2738400 3232588 3232588 1487494 1487494 1199391 1199391 426234 426234 57858 57858 117219 117219 66217 66217 473025 473025 348436 348436 698092 698092 386476 386476 83401 83401 95453 95453 280042 280042 315235 315235 270880 270880 CLAIMS INCURRED 82493950 82493950 MANAGEMENT SERVICE EXPE 2212558 2212558 COMMISSIONS 1454138 1454138 ALLOCATED CLAIMS ADJUST 0 4532691 -4532691 1590954 1590954 101279767 89732505 11547262 0 6113 13900 5901561 4510821 8397109 7399042 367901 459253 8576187 5127552 3638367 3448635 32147121 24531544 3421996 2568205 893615 1083977 54773783 44015377 4544057 4867281 6217792 5616587 10761849 10483868 X 44011934 33531509 44011934 33531509 54773783 44015377 -3493935 -6986490 0 X 0 1 X 1 0 397371 397371 5144931 2386118 2758813 3033885 2741434 292451 3448635 INVESTMENT IN SPRINGROCK VENTURES II LLP 2568205 F 2568205 ADMINISTRATIVE REIMBURSEMENT PAYABLE 83274 AGGREGATE HEALTH POLICY RESERVE 1300000 COST PLUS GROUP DEPOSITS 74100 DEFERRED PREMIUMS 1298113 UNPAID CLAIMS ADJUSTMENT EXPENSES 260100 UNPAID CLAIMS AND CLAIMS INCURRED BUT NOT REPORTED 2601000 5616587 X 88578219 -6986490 -2212558 -9199048 97777267 66217 -57652 8565 97785832 99058644 57652 57652 99000992 66217 2212558 2278775 101279767 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, 2022 AND 2021 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 -2,212,558. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES RECLASSIFIED TO REVENUE FOR 990 -57,652. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES RECLASSIFIED TO REVENUE FOR 990 57,652. PART XII, LINE 4B - OTHER ADJUSTMENTS: ADMINISTRATION SERVICE EXPENSES RECLASSIFIED FOR 990 2,212,558. 1 DELTA DENTAL OF SOUTH DAKOTA FOUNDATION 804 NORTH EUCLID SUITE 1 PIERRE SD 57501 911776857 501(C)(3) 745787 0 PROMOTE DENTAL HEALTH IN SOUTH DAKOTA SD COMMUNITY FOUNDATION PO BOX 296 PIERRE SD 57501 460398115 501(C)(3) 112000 0 COMMUNITY IMPROVEMENT SUPPORT MISSOURI SHORES DOMESTIC VIOLENCE SHELTER PO BOX 398 PIERRE SD 57501 460352133 501(C)(3) 100419 0 PROGRAM SUPPORT CAPITAL AREA UNITED WAY 221 SOUTH CENTRAL AVE PIERRE SD 57501 460403398 501(C)(3) 75674 0 DISTRIBUTE CHARITABLE DONATIONS OAHE HOCKEY ASSOCIATION PO BOX 87 PIERRE SD 57501 460438508 501(C)(3) 52110 0 PROGRAM SUPPORT AVERA HEALTH FOUNDATION 3900 W AVERA DRIVE SIOUX FALLS SD 57108 460367530 501(C)(3) 50625 0 PROGRAM SUPPORT COMMUNITY & YOUTH INVOLVED CENTER 19 E MAIN AVE FT PIERRE SD 57532 460331926 501(C)(3) 50180 0 PROGRAM SUPPORT BOYS & GIRLS CLUB 100 S REE STREET PIERRE SD 57501 460250273 501(C)(3) 48150 0 PROGRAM SUPPORT 8 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 PRESIDENT & CEO 534093 0 236843 0 27389 0 51000 0 28727 0 878052 0 0 0 JEFFREY MILLER EXECUTIVE VICE PRESIDENT 232335 0 74470 0 4804 0 36650 0 29411 0 377670 0 0 0 KIRBY SCOTT VP OF FINANCE 169850 0 57363 0 5226 0 44209 0 16278 0 292926 0 0 0 EUGENE TETZLAFF VP OF IT 164500 0 55500 0 1242 0 27483 0 30805 0 279530 0 0 0 MICK HECKENLAIBLE VP OF OPERATIONS 171600 0 56284 0 1164 0 27856 0 17290 0 274194 0 0 0 CONNIE HALVERSON VP OF PUBLIC BENEFITS 141960 0 48633 0 1067 0 24061 0 39679 0 255400 0 0 0 JEFF HEPPNER - DIRECTOR OF DEVELOPMENT & MODERNIZATION 141925 0 36300 0 827 0 18658 0 40545 0 238255 0 0 0 LAURIE MIKKONEN CFO 173000 0 4500 0 4395 0 22240 0 15024 0 219159 0 0 0 HOLLY HEIEN DENTIST FOR MOBILE PROGRAMS 147360 0 14400 0 786 0 11684 0 14269 0 188499 0 0 0 SARA GREEN - DIRECTOR OF UNDERWRITING & PROVIDER COMPENSATION 113631 0 25185 0 711 0 14829 0 29610 0 183966 0 0 0 JAMEY HERR - DIRECTOR OF INFRASTRUCTURE & SECURITY 115400 0 25337 0 752 0 14609 0 24890 0 180988 0 0 0 DAYNA HEPPER - VP OF GROWTH & CUSTOMER EXPERIENCE 101300 0 22080 0 612 0 13576 0 27264 0 164832 0 0 0 PART I, LINE 1A COMPANION TRAVEL IS WRITTEN INTO THE 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 A 457F PLAN WAS ESTABLISHED FOR CERTAIN EMPLOYEES 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 $20,500, THE MAXIMUM AMOUNT ALLOWED, EXCLUDING THE CATCH-UP CONTRIBUTION AMOUNT FOR EMPLOYEES 50 AND OLDER. DETAIL CONTRIBUTIONS FOR SPECIFIED EMPLOYEES: SCOTT JONES $20,500.00 JEFFREY MILLER $6,150.00 KIRBY SCOTT $20,500.00 MICK HECKENLAIBLE $4,531.20 LAURIE MIKKONEN $3,690.00 CONNIE HALVERSON $3,910.80 GENE TETZLAFF $4,468.80 DAYNA HEPPER $1,158.00 ANN SCHWARTZ $1,158.00 JEFF FEIOCK DDS BOARD MEMBER 455591 INSURANCE REIMBURSEMENT 0 MONTY BECHTOLD DDS BOARD MEMBER 217943 INSURANCE REIMBURSEMENT 0 JASON AANENSON DDS BOARD MEMBER 238747 INSURANCE REIMBURSEMENT 0 THANE CRUMP DDS BOARD MEMBER 255591 INSURANCE REIMBURSEMENT 0 LEE GERTSEN DDS SON OF BOARD MEMBER GREG GERTSEN 373781 INSURANCE REIMBURSEMENT 0 KIM SUGA DDS DAUGTHER-IN-LAW OF BOARD MEMBER GREG GERTSEN 347838 INSURANCE REIMBURSEMENT 0 JACLYN SCHULER DDS DAUGHTER OF BOARD MEMBER ANLEE ROLA 595017 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 745787 CASH DELTA DENTAL OF SOUTH DAKOTA FOUNDATION O 2212558 CASH