2023-11-10T09:53:47-06:00 2022-12-31 FORVIS LLP 312 WALNUT STREET SUITE 3000 CINCINNATI OH 45202 990 2022-01-01 430908349 DELTA DENTAL OF MISSOURI % BRIAN GILMORE DELT 3146563000 12399 GRAVOIS ROAD ST LOUIS MO 631271702 E B ROB GOREN PRESIDENT & CEO 3146563000 2023-11-15 true E B ROB GOREN 999009999 AARON HERSHBERGER P00961884 5136218300 2 2022 2023-04-26 12:10:37Z E B ROB GOREN 12399 GRAVOIS ROAD ST LOUIS MO 631271702 689198301 false X WWW.DELTADENTALMO.COM X 1958 MO OUR PURPOSE IS TO IMPROVE THE DENTAL HEALTH OF THE PUBLIC BY PROMOTING PREVENTIVE DENTISTRY AND PROVIDING COMPREHENSIVE DENTAL CARE AND MAINTENANCE ON A PREPAID BASIS. 16 12 291 0 0 0 0 670952587 685242188 5188318 3190930 868781 427490 677009686 688860608 1596408 1556217 609744540 619415503 36173740 39042316 0 0 0 19631526 22486136 667146214 682500172 9863472 6360436 206764296 200900199 34125285 40574417 172639011 160325782 X THE ORGANIZATION'S PRIMARY PURPOSE IS TO IMPROVE THE DENTAL HEALTH OF THE PUBLIC BY PROMOTING PREVENTIVE DENTISTRY AND PROVIDING COMPREHENSIVE DENTAL CARE AND MAINTENANCE ON A PREPAID BASIS. false false 670117076 685242188 DELTA DENTAL OF MISSOURI IS A PREPAID DENTAL INSURANCE COMPANY. IN 2022, DELTA DENTAL PROCESSED 3,287,932 CLAIMS FOR DENTAL SERVICES. 1310887 1310887 ORAL HEALTH GRANT PROGRAM PROGRAM DESCRIPTION: DELTA DENTAL OF MISSOURI'S ORAL HEALTH GRANT PROGRAM HELPS REDUCE DENTAL DISEASE THROUGH EDUCATION, PREVENTION AND TREATMENT; ENSURE ACCESS TO AFFORDABLE, TIMELY AND HIGH-QUALITY DENTAL CARE; AND ENHANCE AWARENESS OF GOOD ORAL HEALTH WITH A FOCUS ON CHILDREN AND UNDERSERVED INDIVIDUALS. IN 2022, DELTA DENTAL OF MISSOURI AWARDED MORE THAN $1.3 MILLION IN GRANTS TO 39 MISSOURI AND SOUTH CAROLINA ORGANIZATIONS, WHICH ALIGN WITH ITS NON-PROFIT MISSION TO IMPROVE ORAL HEALTH. FUNDING INCLUDED DIRECT CARE GRANTS; EQUIPMENT/CAPITAL GRANTS; EDUCATIONAL GRANTS; AND LOAN REPAYMENT GRANTS FOR DENTISTS WHO COMMIT TO SERVING IN A DENTAL HEALTH PROFESSIONAL SHORTAGE AREA. THE COMPANY ACCEPTS GRANT APPLICATIONS IN TWO GRANT CYCLES ANNUALLY. TO BE ELIGIBLE FOR AN ORAL HEALTH GRANT, APPLICANTS IN BOTH STATES MUST FIRST COMPLETE A LETTER OF INTENT THROUGH THE ONLINE GRANT APPLICATION SYSTEM. APPLICANTS MUST BE CONSIDERED TAX-EXEMPT UNDER 501(C)(3) OF THE INTERNAL REVENUE SERVICE CODE, OR BE A PUBLIC OR GOVERNMENTAL ENTITY, SUCH AS A PUBLIC SCHOOL OR HEALTH DEPARTMENT, AND SERVE THE PEOPLE OF MISSOURI OR SOUTH CAROLINA. THE MINIMUM GRANT AMOUNT IS $5,000. ORAL HEALTH GRANTS GREATER THAN $5,000 ARE INCLUDED IN SCHEDULE I. DELTA DENTAL OF MISSOURI BEGAN ADMINISTERING THIS ORAL HEALTH GRANT PROGRAM ONLINE IN 2017. DURING 2022, DELTA DENTAL OF MISSOURI'S TOTAL CHARITABLE CONTRIBUTIONS ALSO INCLUDED MORE THAN $96,000 IN FLUORIDATION GRANTS FOR 5 MISSOURI WATER SYSTEMS IN NEED OF NEW OR REPLACEMENT EQUIPMENT TO START OR CONTINUE COMMUNITY WATER FLUORIDATION. THIS FUNDING IS HELPING TO PROTECT THE ORAL HEALTH OF NEARLY 43,000 MISSOURIANS WHO LIVE IN THE IMPACTED COMMUNITIES. 256048 LAND OF SMILES PROGRAM PROGRAM DESCRIPTION: DELTA DENTAL OF MISSOURI'S LAND OF SMILES IS AN EDUCATIONAL PROGRAM THAT FEATURES CAPTIVATING CHARACTERS, WHO TEACH GRADESCHOOLERS GOOD DENTAL HEALTH HABITS. IN 2020, THE COVID-19 PANDEMIC PREVENTED THE PROGRAM FROM VISITING ELEMENTARY SCHOOLS AS USUAL. DELTA DENTAL OF MISSOURI LAUNCHED AN INNOVATIVE VIRTUAL EXPERIENCE, FEATURING A VIBRANT VIDEO WITH NEW SUPERHERO CHARACTERS, USED FOR STUDENTS IN THE CLASSROOM AND FOR THOSE INVOLVED IN PARTIAL OR FULL-TIME VIRTUAL LEARNING. IN 2022, THE PROGRAM REACHED MORE THAN 110,000 MISSOURI AND SOUTH CAROLINA KINDERGARTEN-THROUGH-3RD-GRADE STUDENTS THROUGH 462 ONLINE PERFORMANCES. STUDENTS LEARN THE IMPORTANCE OF BRUSHING TEETH TWICE A DAY, FLOSSING, EATING HEALTHY FOODS AND VISITING THE DENTIST REGULARLY. DELTA DENTAL OF MISSOURI OFFERS FREE "SMILE BAGS" TO SCHOOLS FOR STUDENTS WHO PARTICIPATE IN THE PROGRAM. EACH BAG INCLUDES A TOOTHBRUSH, TOOTHPASTE AND DENTAL FLOSS TO HELP STUDENTS PRACTICE THE GOOD ORAL HEALTH HABITS THAT THEY LEARN. EACH SCHOOL IS RESPONSIBLE FOR DISTRIBUTING THE BAGS TO PARTICIPATING STUDENTS WHO ATTEND SCHOOL IN PERSON OR VIRTUALLY. A SURVEY OF SCHOOL NURSES SHOWED THAT 97% RATED THE PROGRAM'S EDUCATIONAL VALUE AS EXCELLENT OR GOOD. PRE- AND POST-TEST DATA ALSO SHOWED A 32% INCREASE IN CHILDREN'S ORAL HEALTH KNOWLEDGE AFTER VIEWING THE PROGRAM. LONGEVITY: THIS PROGRAM HAS BEEN IN PLACE IN MISSOURI SINCE 2002, AND IN SOUTH CAROLINA SINCE 2014. LINE 4D, PROGRAM SERVICE ------------------------- COMMUNITY GIVING PROGRAM PROGRAM DESCRIPTION: THROUGH DELTA DENTAL OF MISSOURI'S COMMMUNITY GIVING PROGRAM, THE COMPANY SUPPORTS CHARITABLE ORGANIZATIONS AND PROGRAMS THAT ARE WORKING TO MAKE A DIFFERENCE IN MISSOURI AND SOUTH CAROLINA COMMUNITIES. DELTA DENTAL OF MISSOURI CONSIDERS COMMUNITY GIVING REQUESTS EACH QUARTER FROM REGISTERED 501(C)(3) CHARITABLE ORGANIZATIONS, WHICH SERVE INDIVIDUALS IN MISSOURI OR SOUTH CAROLINA, AND SUPPORT THE OVERALL HEALTH AND WELL-BEING OF THE COMMUNITY WITH A FOCUS ON AT-RISK POPULATIONS. NEARLY $90,000 IN COMMUNITY DONATIONS WERE AWARDED IN 2022. ORGANIZATIONS MAY APPLY FOR FUNDING ONCE PER YEAR. DELTA DENTAL OF MISSOURI'S COMMUNITY GIVING INCLUDES ORAL HEALTH SUPPLY DONATIONS OF TOOTHBRUSHES AND DENTAL FLOSS TO ORGANIZATIONS TO HELP INDIVIDUALS MAINTAIN GOOD ORAL HYGIENE FOR BETTER DENTAL HEALTH. IN 2022, DELTA DENTAL OF MISSOURI DONATED MORE THAN 185,000 SUPPLIES TO 53 ORGANIZATIONS. 245330 245330 0 see schedule O 245330 245330 0 671929341 false false false false false false false false false true false true false true true false true false false false false false false false false false true false true false false false false false false false true false false false false false true true true false true 59412 0 true 291 true false false false false false false false false false false true false X 16 12 false false false false true true true true true false true true true true true true true true true true false X BRIAN GILMORE 3146563000 12399 GRAVOIS ROAD ST LOUIS MO 631271702 E B ROB GOREN President & CEO 60.0 0.0 X 1048313 0 106023 BARBARA C BENTRUP CFO & CORPORATE COUNSEL 60.0 0.0 X 805228 0 132081 JAMES J BARONE Chief Sales & Mktg Officer 60.0 0.0 X 594923 0 71519 RONALD E INGE Chief Dental Officer & COO 60.0 0.0 X 610608 0 50446 JONATHAN R JENNINGS Chief Actuary & VP UW & PM 60.0 0.0 X 530731 0 82146 Vicki L Katzfey National Account Exec 60.0 0.0 X 314132 0 80650 JANE STANHAUS Chief HR Officer 60.0 0.0 X 297679 0 77731 ERIC W MANN Director of Operations 40.0 0.0 X 291916 0 57960 ELLEN R SAMUELS Director of Compliance 40.0 0.0 X 258557 0 87305 ALLISON M IZSAK Director of Mktg & Comm 60.0 0.0 X 227721 0 86884 ROBERT WOZNIAK ACCOUNT EXECUTIVE 40.0 0.0 X 231673 0 63030 JAMES W RHEA Board Chairman/Director 2.0 0.0 X X 61000 0 0 MARK ZUST First Vice Chairman/Director 2.0 0.0 X X 45750 0 0 GARY WILLIAMS DIRECTOR 2.0 0.0 X 42300 0 0 OLADIPUPO ADEFALA DIRECTOR 2.0 0.0 X 38550 0 0 TIMOTHY TAYLOR DIRECTOR 2.0 0.0 X 38450 0 0 ROSEMARY BISHOP Secretary/Director 2.0 0.0 X X 37750 0 0 DEBORAH PATTERSON DIRECTOR 2.0 0.0 X 37400 0 0 WILLIAM J BENDER Treasurer/Director 2.0 0.0 X X 37250 0 0 NOBLE COOPER JR DIRECTOR 2.0 0.0 X 36350 0 0 KATHLEEN TUCKER DIRECTOR 2.0 0.0 X 35400 0 0 WILLIAM GRAY 2ND VICE CHAIRMAN/DIRECTOR 2.0 0.0 X X 33400 0 0 JOHNNY CUSTARDO DIRECTOR 2.0 0.0 X 33300 0 0 JOHN R LANDGRAF JR DIRECTOR 2.0 0.0 X 31300 0 0 MARK MANCIN DIRECTOR 2.0 0.0 X 31200 0 0 STEVEN HARRIS DIRECTOR 2.0 0.0 X 28250 0 0 NATHAN SUTER DIRECTOR 0.5 0.0 X 0 0 0 KARL A MUDRA Chief Information Officer 60.0 0.0 X 376558 0 -726351 5750881 0 895775 78 false true false MISSOURI DENTAL PROFESSIONALS 1100 SPUR DR STE 30 MARSHFIELD MO 65706 DENTAL SERVICES 7292524 MICHAEL K PARSONS DDS PC 6 MCBRIDE AND SON CENTER DR STE 20 CHESTERFIELD MO 63005 DENTAL SERVICES 3069700 ST LOUIS PEDIATRIC DENTISTRY LLC 4142 KEATON CROSSING BLVD 102 O FALLON MO 63368 DENTAL SERVICES 2904931 M FERNANDEZ DDS E BROWN DDS J OSDIE 3555 SUNSET OFFICE DR STE 210 SAINT LOUIS MO 63127 DENTAL SERVICES 2689824 JAY F HAUSER DDS PC PO BOX 503094 SAINT LOUIS MO 63150 DENTAL SERVICES 2653832 937 0 DENTAL PREMIUMS 524114 685242188 685242188 685242188 3528623 3528623 0 0 0 0 0 337693 -337693 -337693 -337693 0 0 0 0 0 0 0 0 0 MISCELLANEOUS INCOME 900099 442319 442319 INVESTMENT IN SUBSIDIARY 900003 -14829 -14829 427490 688860608 685242188 3618420 1556217 1556217 0 0 619415503 619415503 4625285 4625285 0 23670432 21913440 1756992 5139645 4595890 543755 4018823 3720517 298306 1588131 1470248 117883 0 240436 189881 50555 193128 152520 40608 0 0 312696 312696 3880211 3064336 815875 0 1511458 1399266 112192 3463929 3206811 257118 406344 376181 30163 0 782705 724606 58099 601050 556437 44613 0 225305 208584 16721 0 0 1349713 1249527 100186 737986 737986 BOARD AND BUREAU DUES 961399 890037 71362 SERVICE BUREAU FEES 2812772 2603987 208785 PUBLIC RELATIONS 336508 311531 24977 SERVICE AGREEMENTS 3728847 3452065 276782 941649 871757 69892 682500172 671929341 10570831 0 0 0 31835963 37405011 0 0 10745287 14098097 0 0 0 0 0 0 0 0 1043334 1006829 30681704 19888847 9345762 10792857 135498879 118726364 0 46906 16002478 15987649 0 0 2292593 2836486 206764296 200900199 16719136 19215170 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17406149 21359247 34125285 40574417 X 0 0 0 0 172639011 160325782 172639011 160325782 206764296 200900199 6360436 -18673665 X false true X true false 1350000 1350000 8630866 5323698 3307168 1145351 1008915 136436 6946135 5826418 1119717 12609352 7729816 4879536 10792857 INVEST. IN ADVANTICA HLDG CO 15987649 C 15987649 0 CLAIMS PAYABLE 9575537 UNPAID CLAIM PROCESSING COST 1471531 ADVANCE PREMIUM 8731349 ADVANCE DEPOSITS 1580830 21359247 X SCHEDULE D, PART X, LINE 2 FIN 48 FOOTNOTE THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. ADVANTICA ADMINISTRATIVE SERVICES, INC. AND ITS WHOLLY-OWNED SUBSIDIARIES ARE SUBJECT TO BOTH FEDERAL AND STATE INCOME TAXES AND ACCOUNT FOR INCOME TAXES IN ACCORDANCE WITH INCOME TAX ACCOUNTING GUIDANCE (ASC 740 INCOME TAXES). THE INCOME TAX ACCOUNTING GUIDANCE RESULTS IN TWO COMPONENTS OF INCOME TAX EXPENSE: CURRENT AND DEFERRED. CURRENT INCOME TAX EXPENSE REFLECTS TAXES TO BE PAID OR REFUNDED FOR THE CURRENT PERIOD BY APPLYING THE PROVISIONS OF THE ENACTED TAX LAW TO THE TAXABLE INCOME OR EXCESS OF DEDUCTIONS OVER REVENUES. THE COMPANY DETERMINES DEFERRED INCOME TAXES USING THE LIABILITY (OR BALANCE SHEET) METHOD. UNDER THIS METHOD, THE NET DEFERRED TAX ASSET OR LIABILITY IS BASED ON THE TAX EFFECTS OF THE DIFFERENCES BETWEEN THE BOOK AND TAX BASES OF ASSETS AND LIABILITIES, AND ENACTED CHANGES IN TAX RATES AND LAWS ARE RECOGNIZED IN THE PERIOD IN WHICH THEY OCCUR. DEFERRED INCOME TAX EXPENSE RESULTS FROM CHANGES IN DEFERRED TAX ASSETS AND LIABILITIES BETWEEN PERIODS. DEFERRED TAX ASSETS ARE REDUCED BY A VALUATION ALLOWANCE IF, BASED ON THE WEIGHT OF EVIDENCE AVAILABLE, IT IS MORE LIKELY THAN NOT THAT SOME PORTION OR ALL OF A DEFERRED TAX ASSET WILL NOT BE REALIZED. UNCERTAIN TAX POSITIONS ARE RECOGNIZED IF IT IS MORE LIKELY THAN NOT, BASED ON THE TECHNICAL MERITS, THAT THE TAX POSITION WILL BE REALIZED OR SUSTAINED UPON EXAMINATION. THE TERM MORE LIKELY THAN NOT MEANS A LIKELIHOOD OF MORE THAN 50 PERCENT; THE TERMS EXAMINED AND UPON EXAMINATION ALSO INCLUDE RESOLUTION OF THE RELATED APPEALS OR LITIGATION PROCESSES, IF ANY. A TAX POSITION THAT MEETS THE MORE LIKELY-THAN-NOT RECOGNITION THRESHOLD IS INITIALLY AND SUBSEQUENTLY MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT HAS A GREATER THAN 50 PERCENT LIKELIHOOD OF BEING REALIZED UPON SETTLEMENT WITH A TAXING AUTHORITY THAT HAS FULL KNOWLEDGE OF ALL RELEVANT INFORMATION. THE DETERMINATION OF WHETHER OR NOT A TAX POSITION HAS MET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD CONSIDERS THE FACTS, CIRCUMSTANCES AND INFORMATION AVAILABLE AT THE REPORTING DATE AND IS SUBJECT TO MANAGEMENT'S JUDGMENT. THE ORGANIZATION RECOGNIZES INTEREST AND PENALTIES ON INCOME TAXES AS A COMPONENT OF INCOME TAX EXPENSE. ON A CONSOLIDATED BASIS, ADVANTICA ADMINISTRATIVE SERVICES, INC. AND ITS SUBSIDIARIES HAD AN OPERATING (LOSS) GAIN TOTALING $(14,829) AND $456,351 AS OF DECEMBER 31, 2022 AND 2021, RESPECTIVELY. AT DECEMBER 31, 2022 AND 2021, ADVANTICA ADMINISTRATIVE HAD NET OPERATING LOSS CARRYFORWARDS OF APPROXIMATELY $18,659,000 AND $20,941,000, RESPECTIVELY. ADVANTICA ADMINISTRATIVE AND ITS SUBSIDIARIES HAD DEFERRED TAX ASSETS OF APPROXIMATELY $1,315,000 AND $4,414,000 AT DECEMBER 31, 2022 AND 2021, RESPECTIVELY, NEARLY ALL OF WHICH ARISE FROM THESE NET OPERATING LOSS CARRYFORWARDS. DUE TO THE REMAINING UNCERTAINTY REGARDING WHETHER THESE WILL BE REALIZED, A FULL VALUATION ALLOWANCE HAS BEEN RECORDED AGAINST THESE DEFERRED TAX ASSETS AT DECEMBER 31, 2022 AND 2021. THE ORGANIZATION AND ITS SUBSIDIARIES ARE CURRENTLY OPEN TO EXAMINATION UNDER THE STATUTE OF LIMITATIONS BY THE INTERNAL REVENUE SERVICE AND STATES IN WHICH IT FILES FOR THE YEARS ENDED DECEMBER 31, 2019 THROUGH 2022. true Healthworks Kids Museum St Louis 1100 Macklind Ave St Louis MO 63110 753018876 501(C)(3) 100000 General Support Prisma Health Midlands Foundation 1600 Marion St Columbia SC 29201 570725699 501(C)(3) 98296 General Support Swope Health Services 3801 MLK JR Blvd Kansas City MO 64130 430957840 501(C)(3) 70000 General Support Big Springs Medical Association Inc 110 S 2nd Street Ellington MO 63638 431068291 501(C)(3) 50000 General Support Camden County Public Water Supply District #4 62 Bittersweet Rd Lake Ozark MO 65049 431966206 Gov't 50000 General Support Healthy Learners 2749 Laurel Street Columbia SC 29204 571127197 501(C)(3) 50000 General Support Medical University of South Carolina 1 Southpark Circle Charleston SC 29407 576000722 501(C)(3) 50000 General Support North Charleston Dental Outreach PO Box 30994 Charleston SC 29417 271629125 501(C)(3) 50000 General Support Missouri Dept of Health & Senior Service PO Box 570 Jefferson City MO 65102 446000987 Gov't 50000 General Support United Way of Midlands 1818 Blanding Street Columbia SC 29201 570314396 501(C)(3) 50000 General Support Vivent Health Inc 648 N Plankinton Ave Milwaukee WI 53203 391534049 501(C)(3) 50000 General Support Ronald McDonald House of the Ozarks 949 E Primrose St Springfield MO 65807 431371143 501(C)(3) 49250 General Support Give Kids a Smile PO BOX 712 St Peters MO 63376 201287939 501(C)(3) 40000 General Support The Foundation for Barnes - Jewish Hospital 100 Highlands Plaza Dr St Louis MO 63110 431648435 501(C)(3) 40000 General Support Children's Smile Center 601 N 21st Street Ozark MO 65721 571196229 501(C)(3) 35000 General Support McLeod Health Foundation PO Box 100551 Florence SC 29502 570818672 501(C)(3) 35000 General Support Compass Health Inc PO Box 954259 St Louis MO 63195 431032835 501(C)(3) 30000 General Support Midlands Technical College Foundation Inc 7300 College Street Irmo SC 29063 237085753 501(C)(3) 26500 General Support Baptist-Trinity Lutheran Legacy Foundation 6675 Holmes Rd Kansas City MO 64131 237432481 501(C)(3) 25000 General Support Bluffton Jasper County Volunteers 29 Plantation Park Dr Bluffton SC 29910 320298086 501(C)(3) 25000 General Support Catholic Charities of South Carolina Inc 901 Orange Grove Road Charleston SC 29407 510314369 501(C)(3) 25000 General Support Child Center Marygrove 2705 Mullanphy Lane Florissant MO 63031 431024440 501(C)(3) 25000 General Support City of Higginsville Office of City Clerk 1922 Main Higginsville MO 63047 446000186 Gov't 25000 General Support Curators of the University of Missouri 650 East 25th Street Kansas City MO 64108 436003859 501(C)(3) 25000 General Support Mission Dental South Carolina Inc 631 North Church St Spartanburg SC 29303 842189149 501(C)(3) 25000 General Support Neighbors Together 2105 Cosgrove North Charleston SC 29405 570794782 501(C)(3) 25000 General Support Ready Readers 10403 Baur Blvd St Louis MO 63132 431841631 501(C)(3) 25000 General Support Rural Parish Clinic Archdiocese St Louis 20 Archbishop May Drive St Louis MO 63119 843396327 501(C)(3) 25000 General Support We Care Mobile Dental Foundation 6523 Walsh Street St Louis MO 63109 882243851 501(C)(3) 25000 General Support York County Partners in Free Dentistry 172 S Cherry Road Rock Hill SC 29732 830524295 501(C)(3) 25000 General Support Cass Community Health Foundation 2316 E Meyer Blvd Kansas City MO 64132 431349495 501(C)(3) 23053 General Support Greenville Free Medical Clinic PO Box 8993 Greenville SC 29604 570855205 501(C)(3) 22000 General Support HNC Living Foundation 8100 Newton Street Overland Park KS 66204 464214254 501(C)(3) 20000 General Support Ozark Action Inc 710 East Main St West Plains MO 65775 430838508 501(C)(3) 19635 General Support Anderson School District Five Educ Fdn PO Box 439 Anderson SC 29622 472373444 501(C)(3) 15000 General Support Hope House Inc PO Box 577 Lees Summit MO 64063 431265685 501(C)(3) 15000 General Support Children's Mercy Hospital 2401 Gillham Kansas City MO 64108 440605373 501(C)(3) 14024 General Support City of Harrisonville PO Box 367 Harrison MO 64701 446000184 Gov't 12000 General Support Dental Lifeline Network 1800 15th Street Denver CO 80202 846129064 501(C)(3) 12000 General Support Central Missouri Community Action 807B N Providence Rd Columbia MO 65203 430835026 501(C)(3) 10000 General Support LevelUP Kids Inc 5416 NE Antioch Road Kansas City MO 64119 203664224 501(C)(3) 10000 General Support YWCA 1155 Olivette Exec Pkwy St Louis MO 63132 430653618 501(C)(3) 10000 General Support Chillicothe Municipal Utilities 920 Washington St Chillicothe MO 64601 446000163 Gov't 9129 General Support American Lung Association in Missouri 211 N Broadway St Louis MO 63102 131632524 501(C)(3) 5700 General Support 44 SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S. DELTA DENTAL MAINTAINS RECORDS TO SUBSTANTIATE THE AMOUNT OF ASSISTANCE THAT IT PROVIDES TO THE COMMUNITY ORGANIZATIONS. DELTA DENTAL WORKS WITH THE INDIVIDUAL ORGANIZATIONS TO UNDERSTAND THEIR MISSIONS AND TO DETERMINE THE BENEFITS OF DELTA DENTAL'S PARTICIPATION. X X X X X false true false false false false false false false BARBARA C BENTRUP CFO & CORPORATE COUNSEL 556173 0 189080 0 59975 0 105870 0 26211 0 937309 0 E B ROB GOREN President & CEO 710077 0 267759 0 70477 0 71868 0 34155 0 1154336 0 JONATHAN R JENNINGS Chief Actuary & VP UW & PM 318366 0 188766 0 23599 0 46741 0 35405 0 612877 0 KARL A MUDRA Chief Information Officer 282814 0 77303 0 16441 0 -761967 0 35616 0 -349793 0 JAMES J BARONE Chief Sales & Mktg Officer 423040 0 144695 0 27188 0 45750 0 25769 0 666442 0 RONALD E INGE Chief Dental Officer & COO 436050 0 123208 0 51350 0 26732 0 23714 0 661054 0 ALLISON M IZSAK Director of Mktg & Comm 175428 0 51667 0 626 0 51770 0 35114 0 314605 0 Vicki L Katzfey National Account Exec 103142 0 208417 0 2573 0 45750 0 34900 0 394782 0 ELLEN R SAMUELS Director of Compliance 194158 0 58467 0 5932 0 59093 0 28212 0 345862 0 ERIC W MANN Director of Operations 218903 0 63684 0 9329 0 34759 0 23201 0 349876 0 JANE STANHAUS Chief HR Officer 215715 0 72638 0 9326 0 45492 0 32239 0 375410 0 ROBERT WOZNIAK ACCOUNT EXECUTIVE 92105 0 132591 0 6977 0 36842 0 26188 0 294703 0 SCHEDULE J, PART I, LINE 4B NAMES, AMOUNTS, AND DETAILS OF ARRANGEMENTS THE ORGANIZATION HAS A NONQUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN FOR THE BENEFIT OF CERTAIN EMPLOYEES TO RECEIVE CONTRIBUTIONS IN EXCESS OF THE LIMITATIONS IMPOSED BY THE INTERNAL REVENUE CODE ON STANDARD EMPLOYEE PENSION PLANS. AMOUNTS PAID DURING 2022 FOR THE FOLLOWING INDIVIDUALS WERE: BARBARA BENTRUP - $46,447 E.B. ROB GOREN - $69,559 JONATHAN R JENNINGS - $16,798 RONALD INGE - $31,181 JAMES J BARONE - $25,468 KARL MUDRA - $8,787 THE ORGANIZATION HAS AN UNFUNDED NONQUALIFIED, DEFINED BENEFIT DEFERRED COMPENSATION PLAN (DBDCP) FOR ITS SENIOR LEVEL EXECUTIVES, WITH VESTING AT AGE 60 AND 10 YEARS OF SERVICE FOR EARLY RETIREMENT OR AGE 65 AND FIVE YEARS OF SERVICE FOR NORMAL RETIREMENT. THE PLAN WAS AMENDED TO CURTAIL BENEFITS ACCRUED AS OF DECEMBER 31, 2020 SUBJECT TO THE CONTINUING VESTING PROVISIONS IN THE DBDCP. THE ACTUARIALLY DETERMINED LIABILITY IS BASED UPON ASSUMPTIONS FOR REMAINING YEARS OF SERVICE UNTIL RETIREMENT, PROJECTED SALARIES FOR THE FINAL THREE YEARS OF SERVICE BUT IN NO CASE CONSIDERING ANY SALARY AFTER DECEMBER 31, 2020, AND A PREDETERMINED BENEFIT PERCENTAGE BASED UPON THE PARTICIPANT'S POSITION. INDIVIDUALS WHO PARTICIPATED IN THIS PLAN DURING 2022 WERE THE FOLLOWING: BARBARA C BENTRUP, E. B. ROB GOREN, JONATHAN JENNINGS, RONALD INGE, AND KARL MUDRA. THE INCREASE OR DECREASE IN THE PROJECTED BENEFIT ACCRUALS FOR THIS DBDCP ARE REPORTED ANNUALLY IN THE FORM 990 FOR EACH PARTICIPANT. IT IS IMPORTANT TO NOTE THAT SEVERAL PARTICIPANTS IN THIS PROGRAM ARE NOT YET VESTED, YET THE INCREASE IN THE VALUE OF THE ACCRUAL HAS TO BE REPORTED ANNUALLY AS COMPENSATION ON THE FORM 990 WHEN THERE WAS NO BENEFIT VALUE TO THEM PERSONALLY - IF PARTICIPANTS LEAVE THE ORGANIZATION PRIOR TO MEETING THE AGE AND SERVICE REQUIREMENTS, THERE IS NO BENEFIT PAYABLE. SCHEDULE J, PART II, COLUMN C INCLUDES THESE AMOUNTS FOR THE INCREASES OR DECREASES IN THE COMPANY'S ACCRUAL. THE AMOUNTS PER PARTICIPANT ARE: BARBARA BENTRUP - $60,120 E.B. ROB GOREN - $26,118 JONATHAN R JENNINGS - $2,138 RONALD INGE - $(18,643) KARL MUDRA - $(807,717) MARK R ZUST DDS LTD BOARD MEMBER AS OWNER 281860 DENTAL SERVICES PROVIDED true FLORISSANT DENTAL ASSOCIATES FAMILY OF BOARD MEMBER 408185 DENTAL SERVICES PROVIDED true PEDIATRIC DENTISTRY OF OZARKS FAMILY OF BOARD MEMBER 166286 DENTAL SERVICES PROVIDED true WILLIAM R GRAY DMD LLC BOARD MEMBER AS OWNER 324041 DENTAL SERVICES PROVIDED true PART IV, LINE 1 BUSINESS TRANSACTIONS BOARD MEMBER MARK ZUST AND DANIELLE RIORDAN, DAUGHTER OF BOARD MEMBER MARK ZUST, HAVE A REPORTABLE INTEREST IN MARK R ZUST DDS LTD WHICH PROVIDES DENTAL SERVICES TO SUBSCRIBERS AND DEPENDENTS OF BENEFIT PLANS INSURED OR ADMINISTERED BY THE ORGANIZATION. BOARD MEMBER WILLIAM GRAY HAS A REPORTABLE INTEREST IN WILLIAM A GRAY DMD LLC WHICH PROVIDES DENTAL SERVICES TO SUBSCRIBERS AND DEPENDENTS OF BENEFIT PLANS INSURED OR ADMINISTERED BY THE ORGANIZATION. SEAN LANDGRAF, SON OF BOARD MEMBER JOHN R LANDGRAF JR, HAS A REPORTABLE INTEREST IN FLORISSANT DENTAL ASSOCIATES LLC WHICH PROVIDES DENTAL SERVICES TO THE SUBSCRIBERS AND DEPENDENTS OF BENEFIT PLANS INSURED OR ADMINISTERED BY THE ORGANIZATION. DR. EMILY TAYLOR, DAUGHTER OF BOARD MEMBER TIMOTHY TAYLOR, HAS A REPORTABLE INTEREST IN PEDIATRIC DENTISTRY OF THE OZARKS WHICH PROVIDES DENTAL SERVICES TO THE SUBSCRIBER AND DEPENDENTS OF BENEFIT PLANS INSURED OR ADMINISTERED BY THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS THE MEMBERS OF THE ORGANIZATION ARE COMPRISED OF LICENSED DENTISTS IN THE STATES OF MISSOURI AND SOUTH CAROLINA WHO HAVE AN EFFECTIVE SIGNED AND ACCEPTED PARTICIPATING DENTIST AGREEMENT WITH THE ORGANIZATION. THE MEMBERS MEET ANNUALLY. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OR STOCKHOLDERS WHO CAN ELECT MEMBERS OF THE GOVERNING BODY THE ORGANIZATION HAS MEMBERS WHO ELECT THE INDIVIDUALS TO SERVE ON THE ORGANIZATION'S BOARD OF DIRECTORS. THE MEMBERS OF THE ORGANIZATION ARE COMPRISED OF LICENSED DENTISTS IN THE STATES OF MISSOURI AND SOUTH CAROLINA WHO HAVE AN EFFECTIVE SIGNED AND ACCEPTED PARTICIPATING DENTIST AGREEMENT WITH THE ORGANIZATION. THE MEMBERS MEET ANNUALLY. FORM 990, PART VI, SECTION A, LINE 7B GOVERNANCE DECISIONS CHANGES TO THE CORPORATE BYLAWS BY THE BOARD ARE SUBJECT TO APPROVAL BY THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990 THE FORM 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. THE FORM 990 IS THEN REVIEWED IN DETAIL BY THE ORGANIZATION'S CONTROLLER & INTERIM CFO AND PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO THE ELECTRONIC FILING OF THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY DELTA DENTAL OF MISSOURI REGULARLY REQUIRES ITS OFFICERS, DIRECTORS, AND KEY EMPLOYEES TO COMPLETE A CONFLICT OF INTEREST STATEMENT. THE REVIEW OF THE STATEMENTS IS PART OF THE FINANCE AND AUDIT COMMITTEE'S RESPONSIBILITIES. FORM 990, PART VI, SECTION B, LINE 15A & 15B COMPENSATION APPROVAL PROCESS DELTA DENTAL OF MISSOURI HAS ESTABLISHED A COMPENSATION COMMITTEE (A SUBSET OF THE BOARD OF DIRECTORS) COMPOSED ENTIRELY OF PERSONS WITH NO CONFLICT OF INTEREST THAT REVIEWS AND SETS OFFICER COMPENSATION IN ACCORDANCE WITH THE PROCESS OUTLINED IN TREASURY REGULATION SECTION 53.4958-6 FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS OF THE COMPENSATION OF THE CEO AND ALL OTHER OFFICERS. THIS PROCESS INCLUDES EMPLOYING INDEPENDENT COMPENSATION CONSULTANTS, UTILIZING RELEVANT COMPENSATION SURVEYS AND STUDIES, CONTEMPORANEOUSLY DOCUMENTING AND RECORDING THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT, AND SEEKING APPROVAL ON FINALIZED COMPENSATION PROPOSALS BY THE COMPENSATION COMMITTEE. REVIEWS ARE CONDUCTED AND APPROVED BY THE COMPENSATION COMMITTEE ON AN ANNUAL BASIS. THE ANNUAL COMPENSATION FOR 2022 WAS REVIEWED BY A THIRD PARTY COMPENSATION CONSULTANT, WILLIS TOWERS WATSON, AND THEN REVIEWED BY THE COMPENSATION COMMITTEE (SUBSECTION OF THE COMPANY'S BOARD OF DIRECTORS). FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. 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