2023-05-23T16:33:11-05:00 2022-12-31 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2022-01-01 911776857 DELTA DENTAL OF SOUTH DAKOTA FOUNDATION DELT 6052247345 PO BOX 1157 PIERRE SD 57501 SCOTT JONES PRESIDENT 6052247345 2023-05-02 1 SCOTT JONES XXX-XX-XXXX 1 LAURIE HANSON CPA P00851848 6053391999 2023-05-02 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z SCOTT JONES PO BOX 1157 PIERRE SD 57501 5064105 0 X WWW.DELTADENTALSD.COM X 1996 SD TO SUPPORT PROGRAMS THAT PROMOTE ORAL HEALTH. 11 10 0 11 0 0 2143964 937014 995837 1314981 664205 620694 0 0 3804006 2872689 1619218 423355 0 0 0 0 0 0 45787 3687687 3114996 5306905 3538351 -1502899 -665662 12054282 8428074 562271 630552 11492011 7797522 TO INITIATE, COLLABORATE AND/OR SUPPORT PROGRAMS THAT INCREASE ACCESS TO CARE, ENSURE AN ADEQUATE DENTAL WORK FORCE AND PREVENT DENTAL DISEASE. 0 0 2086771 1020994 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 3,191 CHILDREN SERVED BY THE PROGRAM IN 2022, 1,571 HAD MEDICAID INSURANCE, 1,295 HAD NO DENTAL INSURANCE, AND 325 HAD PRIVATE INSURANCE. THE VALUE OF CARE PROVIDED WAS $3,029,036 FOR WHICH THE DELTA DENTAL OF SOUTH DAKOTA FOUNDATION RECEIVED $805,994 IN REVENUE. 672654 293987 THE DELTA DENTAL MOBILE PROGRAM (PREVENTION CLINICS) PROVIDES PREVENTIVE DENTAL CARE OF CHILDREN FROM HEAD START THROUGH EIGHTH GRADE IN NATIVE AMERICAN TRIBAL COMMUNITIES. OF THE 1,750 CHILDREN SERVED BY THE PROGRAM IN 2022, 1,534 HAD MEDICAID INSURANCE, 180 HAD NO DENTAL INSURANCE, AND 36 HAD PRIVATE DENTAL INSURANCE. THE VALUE OF CARE PROVIDED WAS $566,299 FOR WHICH THE DELTA DENTAL OF SOUTH DAKOTA FOUNDATION RECEIVED $81,987 IN REVENUE. 423355 423355 $388,355 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. 3182780 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 11 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 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 PRESIDENT 1.00 40.00 X X 0 798325 79437 PAUL REZICH DDS VICE PRESIDENT 1.00 2.00 X X 0 16350 0 JOHN CLAUSEN CPA TREASURER 1.00 2.00 X X 0 15750 0 ELLEN LEE SECRETARY 1.00 2.00 X X 0 9850 0 MONTY BECHTOLD DDS DIRECTOR 1.00 2.00 X 0 13218 0 ANLEE ROLA DDS DIRECTOR 1.00 2.00 X 0 9850 0 THANE CRUMP DDS DIRECTOR 1.00 2.00 X 0 8250 0 DALE GIBSON DDS DIRECTOR 1.00 0.00 X 0 0 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 TRAVIS BJORDAHL DIRECTOR 1.00 0.00 X 0 0 0 0 871593 79437 0 0 1 0 DELTA DENTAL OF SOUTH DAKOTA PO BOX 1157 PIERRE SD 57501 SHARED SERVICES 2212557 1 745787 131736 59491 937014 DAKOTA SMILES PROGRAM 621990 1314981 1314981 1314981 205112 205112 2606998 2191416 415582 415582 415582 2872689 1314981 0 620694 X 250077 250077 173278 173278 12499 12499 2282711 2090076 192635 24587 1510 23077 185950 185362 588 30000 24600 5400 294826 286124 8702 21849 2662 19187 7525 7525 37917 37917 INDIRECT COSTS 86281 44910 41371 MAINTENANCE AND REPAIRS 60629 60629 FUNDRAISING EXPENSES 45787 45787 ALL SMILES PROGRAM 12339 12339 12096 5771 6325 3538351 3182780 309784 45787 1426739 1430763 394497 282823 42830 287928 120469 30000 25231 20154 1371108 1367499 11134 3609 10019093 6355245 14289 17552 12054282 8428074 358435 382522 74170 79437 1500 0 128166 168593 562271 630552 X 11492011 7797522 11492011 7797522 12054282 8428074 X -665662 -2962948 -65879 X 0 1 X 1 0 X X 2 DELTA DENTAL OF SOUTH DAKOTA 460309258 10 1 0 2759425 CLASS OF SUPPORTED ORGANIZATIONS 460309258 7 1 423355 0 2 423355 2759425 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 1371108 1367499 3609 3609 PAYABLE TO DELTA DENTAL OF SOUTH DAKOTA 168593 168593 X -90259 -2962948 -2962948 2872689 0 2872689 3604230 81779 81779 3522451 15900 15900 3538351 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 2D - OTHER ADJUSTMENTS: LOAN PAYMENT FORGIVENESS 81,779. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPIRED CONTINUING EDUCATION CERTIFICATES 15,900. 1 SOUTH DAKOTA DENTAL FOUNDATION PO BOX 1194 PIERRE SD 57501 460363251 501(C)(6) 82000 0 GENERAL SUPPORT SOUTH DAKOTA DENTAL HYGIENE ASSOCIATION 7811 ALBERTTA DRIVE RAPID CITY SD 57702 460382580 501(C)(6) 10000 0 DENTAL EDUCATION ST FRANCIS MISSION PO BOX 499 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) 100000 0 COMMUNITY IMPROVEMENT SUPPORT LAKE AREA TECHNICAL COLLEGE 200 9TH STREET NE WATERTOWN SD 57201 466001273 GOV 10000 0 DENTAL EDUCATION UNIVERSITY OF SOUTH DAKOTA 414 E CLARK ST VERMILLION SD 57069 466000364 GOV 15000 0 HEALTHCARE & DENTAL EDUCATION BLACK HILLS WORKS INC 3650 RANGE ROAD RAPID CITY SD 57702 460341382 501(C)(3) 0 8077 BOOK ELECTRIC TOOTHBRUSHES DENTAL CARE 5 2 LOAN REPAYMENTS 2 30000 EDUCATION & PREVENTION ASSISTING NEEDY CHILDREN 17311 93278 CONTINUING EDUCATION CERTIFICATES 500 50000 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 PRESIDENT 0 554593 0 236843 0 6889 0 51000 0 28727 0 878052 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 $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 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 164,259. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 164,259. SHARED SERVICES: PROGRAM SERVICE EXPENSES 1,925,817. MANAGEMENT AND GENERAL EXPENSES 192,635. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,118,452. FORM 990, PART XI, LINE 9: EXPIRED CONTINUING EDUCATION CERTIFICATES 15,900. LOAN REPAYMENT FORGIVENESS -81,779. 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