2023-11-14T15:42:35-06:00 2022-12-31 366055558 GRANT THORNTON LLP 75 STATE ST 13TH FLOOR BOSTON MA 02109 990 2022-01-01 362612058 DELTA DENTAL OF ILLINOIS DELT 6307184700 111 SHUMAN BOULEVARD NAPERVILLE IL 60563 TERRI BON VP FINANCE & CFO 6307184700 2023-11-14 1 TERRI BON 999009999 0 ERIN COUTURE P01390592 3128560200 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z TERRI BON 111 SHUMAN BOULEVARD NAPERVILLE IL 60563 963548155 0 X WWW.DELTADENTALIL.COM X 1967 IL IMPROVE THE ORAL HEALTH OF ILLINOIS RESIDENTS BY PROVIDING DENTAL BENEFITS & OTHER SERVICES. 12 7 216 0 0 0 0 0 891970991 952619490 -905738 2254136 25560 16440 891090813 954890066 3191505 2376458 813078791 864131081 21655562 23424127 0 0 0 46592271 59501881 884518129 949433547 6572684 5456519 236756385 202757790 78338425 51920177 158417960 150837613 IMPROVE THE ORAL HEALTH OF ILLINOIS RESIDENTS BY PROVIDING DENTAL BENEFITS & OTHER SERVICES. 0 0 926422603 2376458 952619490 DELTA DENTAL OF ILLINOIS (DDIL) IS A NOT-FOR-PROFIT CORPORATION WHICH MAINTAINS AND OPERATES A DENTAL CARE PLAN TO APPROXIMATELY 2,743,000 INDIVIDUALS. DDIL IS COMMITTED TO ITS MISSION TO DELIVER EXCEPTIONAL SERVICES TO OUR STAKEHOLDERS AND IMPROVE THE ORAL HEALTH OF THE COMMUNITIES WE SERVE. IN 2022, DDIL GRANTED $2,376,458 TO DELTA DENTAL OF ILLINOIS FOUNDATION, A 501(C)(3) CHARITABLE ORGANIZATION TO PROMOTE THE IMPROVEMENT OF DENTAL EDUCATION AND ACCESS TO DENTAL CARE IN ILLINOIS. 926422603 0 0 0 1 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 71096 0 1 216 1 0 0 0 0 0 0 1 0 X 12 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X TERRI BON 6307184700 111 SHUMAN BOULEVARD NAPERVILLE IL 60563 BRIAN SAMMARCO CHAIRMAN 5.00 0.00 X X 82827 0 0 DR GENARO ROMO VICE CHAIR 3.00 0.00 X 54894 0 0 OMAR DUQUE COMMITTEE CHAIR 3.00 0.00 X 52232 0 0 JANE HAYS COMMITTEE CHAIR 3.00 0.00 X 48668 0 0 DR FRANK MAGGIO PAST CHAIR 2.00 0.00 X 45800 0 0 JOSEPH LEO COMMITTEE CHAIR 3.00 0.00 X 44850 0 0 DEAN MALONE COMMITTEE CHAIR 3.00 0.00 X 42501 0 0 DR RON RIGGINS DIRECTOR 2.00 0.00 X 42300 0 0 DR CISSY FURUSHO DIRECTOR 2.00 0.00 X 42300 0 0 LORI GOLD PATTERSON DIRECTOR 2.00 0.00 X 38892 0 0 DR DAVID MILLER DIRECTOR 2.00 0.00 X 38800 0 0 DARRYL RODGERS DIRECTOR 2.00 0.00 X 22793 0 0 JOHN MAPLES PRESIDENT & CEO 40.00 5.00 X 1740272 0 6357 TERRI BON TREAS, SEC., VP OF FIN & CFO 40.00 5.00 X 657384 0 38234 ALEXANDRA KOTELON CORPORATE COUNSEL 40.00 5.00 X 405072 0 30937 KARYN GLOGOWSKI VP/DIRECTOR OF SALES 40.00 0.00 X 475038 0 38817 LORA VITEK EXECUTIVE DIRECTOR OF FOUNDATION 5.00 40.00 X 220779 0 17798 MICHAEL WHITE VP & GM TRUASSURE 40.00 0.00 X 362592 0 1885 DR SHELIA STROCK VP DENTAL SERVICES 40.00 0.00 X 338320 0 31117 RHEAANA TOWNER GUESS VP PEOPLE & DIVERSITY OFFICER 40.00 0.00 X 321577 0 17860 ANN MARIE WALKER VP CORP. COMMUNICATIONS 40.00 0.00 X 333604 0 28092 TERRY MADDOX VP SERVICE OPERATIONS 40.00 0.00 X 316734 0 33357 ROBERT MAXWELL SR. SALES EXECUTIVE 40.00 0.00 X 399448 0 27000 LINDA NASTI SR. SALES EXECUTIVE 40.00 0.00 X 278548 0 6643 STACY BEITZEL MANAGER CLIENT RELATIONS 40.00 0.00 X 243486 0 23798 JOHN DECRISTOFARO SR. DIRECTOR FINANCE & CONTROLLER 40.00 0.00 X 227942 0 22812 DR JASON GRINTER DENTAL DIRECTOR 40.00 0.00 X 213283 0 1885 BERNARD GLOSSY FORMER CEO & PRESIDENT 0.00 0.00 X 105794 0 0 MICHAEL BUSSE FORMER COMMITTEE CHAIR 0.00 0.00 X 62596 0 0 7259326 0 326592 41 1 1 0 CHANGE HEALTHCARE PAYMENT MANAGEMENT 3055 LEBANON PIKE STE 100 NASHVILLE TN 37214 INVOICE PRINTING 3802371 WYSSTA SERVICES 3100 BUSINESS PARK DRIVE STEVENS POINT WI 54482 ADMIN SYSTEMS 3139536 ENCARA INC 4818 STARKEY ROAD ROANOKE VA 24018 MARKETING 1029208 THE MEYOCKS GROUP 6800 LAKE DRIVE STE 150 WEST DES MOINES IA 50266 ADVT & MARKETING 958439 RYAN COMPANIES US INC 700 OAKMONT LANE SUITE 100 WESTMONT IL 60559 BUILDING MANAGER\CONTRACTOR 863589 30 PREMIUMS 524114 952619490 952619490 952619490 3126114 3126114 16440 0 16440 16440 16440 7786111 8658089 -871978 -871978 -871978 954890066 952619490 0 2270576 2376458 2376458 864131081 864131081 5808197 5808197 105794 105794 12674248 7053725 5620523 1231412 528404 703008 2290045 1194142 1095903 1314431 531635 782796 51635 51635 202651 202651 284997 284997 1505638 391482 1114156 2714183 171229 2542954 882586 851915 30671 30325411 30567600 -242189 3690705 2189227 1501478 112119 30612 81507 102642 13226 89416 844575 195818 648757 740259 740259 BROKER COMMISSIONS 13342583 13342583 PRINTING & PUBLICATIONS 1810744 1587316 223428 INSURANCE DEPT. FEES 1293967 1199378 94589 DDPA DUES 873087 873087 724099 66772 657327 949433547 926422603 23010944 0 33387443 33609271 59324266 36544421 1158608 1560777 24889487 13208288 12495586 11681199 92313993 81224282 37698193 37705615 0 378296 432225 236756385 202757790 19162450 21641135 7764962 6066696 51411013 24212346 78338425 51920177 X 0 0 0 0 158417960 150837613 158417960 150837613 236756385 202757790 5456519 -13036866 0 X X 0 1 X 1 0 0 0 0 0 1 0 3625539 3625539 16066877 8111959 7954918 0 2634287 2568866 65421 2562784 2527463 35321 11681199 CLOSELY-HELD EQUITY INTERESTS 21476484 F INVESTMENT IN JOINT VENTURES 10554633 F LIMITED PARTNERSHIP 5674498 F 37705615 UNPAID CLAIMS AND CLAIMS ADJUSTMENT 14155000 SELF-INSURED UNPAID CLAIMS 7811373 INTERCOMPANY PAYABLE 2245973 24212346 X 252425968 0 252425968 702464098 702464098 954890066 249719189 0 249719189 284997 699429361 699714358 949433547 PART X, LINE 2: ASC 740 FOOTNOTE DELTA DENTAL OF ILLINOIS IS ORGANIZED AS A NONPROFIT DENTAL CARE PLAN FOR FEDERAL INCOME TAX PURPOSES UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE AND, AS SUCH, DOES NOT PAY FEDERAL INCOME TAXES. DELTA DENTAL OF ILLINOIS IS EXEMPT FROM STATE INCOME TAXES. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED DURING THE YEAR OR ACCRUED AT YEAR END. PART XI, LINE 4B - OTHER ADJUSTMENTS: ASC REVENUE 699,950,436. GROSS RENTAL INCOME 16,440. NII\EQUITY IN SUBS 3,126,114. REALIZED (LOSSES) -871,978. MISC REVENUE 243,086. PART XII, LINE 4B - OTHER ADJUSTMENTS: SELF IMPOSED RENT -1,206,400. ASC CLAIMS 668,211,272. ASC ADMIN 31,739,164. DEPRECIATION 642,321. DISCOUNT TIRES CLAIMS 43,004. 1 DELTA DENTAL OF ILLINOIS FOUNDATION 111 SHUMAN BOULEVARD NAPERVILLE IL 60563 262700504 501(C)(3) 2376458 0 PROMOTE ORAL HEALTH OF IL RESIDENTS 1 PART I, LINE 2: GRANTS AND OTHER ASSISTANCE DELTA DENTAL OF ILLINOIS DIRECTORS AND OFFICERS HAVE THE MAJORITY OF SEATS ON THE DELTA DENTAL OF ILLINOIS FOUNDATION BOARD, AND THEREFORE MONITOR AND APPROVE HOW GRANT MONEY IS USED AND TRACKED. X 1 1 X X X X X 0 0 0 0 0 0 0 1 0 JOHN MAPLES PRESIDENT & CEO 814679 0 893729 0 31864 0 0 0 6357 0 1746629 0 0 0 TERRI BON TREAS, SEC., VP OF FIN & CFO 449086 0 198842 0 9456 0 27000 0 11234 0 695618 0 0 0 KARYN GLOGOWSKI VP/DIRECTOR OF SALES 284035 0 185147 0 5856 0 27000 0 11817 0 513855 0 0 0 ALEXANDRA KOTELON CORPORATE COUNSEL 272668 0 122845 0 9559 0 20500 0 10437 0 436009 0 0 0 ROBERT MAXWELL SR. SALES EXECUTIVE 96512 0 297236 0 5700 0 27000 0 0 0 426448 0 0 0 DR SHELIA STROCK VP DENTAL SERVICES 227896 0 100901 0 9523 0 26486 0 4631 0 369437 0 0 0 MICHAEL WHITE VP & GM TRUASSURE 244235 0 107750 0 10607 0 0 0 1885 0 364477 0 0 0 ANN MARIE WALKER VP CORP. COMMUNICATIONS 227173 0 96872 0 9559 0 25592 0 2500 0 361696 0 0 0 TERRY MADDOX VP SERVICE OPERATIONS 220831 0 86345 0 9558 0 27000 0 6357 0 350091 0 0 0 RHEAANA TOWNER GUESS VP PEOPLE & DIVERSITY OFFICER 250006 0 62013 0 9558 0 0 0 17860 0 339437 0 0 0 LINDA NASTI SR. SALES EXECUTIVE 69799 0 204243 0 4506 0 0 0 6643 0 285191 0 0 0 STACY BEITZEL MANAGER CLIENT RELATIONS 144523 0 92677 0 6286 0 23616 0 182 0 267284 0 0 0 JOHN DECRISTOFARO SR. DIRECTOR FINANCE & CONTROLLER 180681 0 44957 0 2304 0 16195 0 6617 0 250754 0 0 0 LORA VITEK EXECUTIVE DIRECTOR OF FOUNDATION 144979 0 66236 0 9564 0 10905 0 6893 0 238577 0 0 0 DR JASON GRINTER DENTAL DIRECTOR 187372 0 25383 0 528 0 0 0 1885 0 215168 0 0 0 BERNARD GLOSSY FORMER CEO & PRESIDENT 0 0 0 0 105794 0 0 0 0 0 105794 0 0 0 MICHAEL BUSSE FORMER COMMITTEE CHAIR 0 0 0 0 62596 0 0 0 0 0 62596 0 0 0 PART I, LINE 1A HEALTH AND SOCIAL DUES THE CEO'S SOCIAL DUES (COUNTRY CLUB) ARE PAID BY THE ORGANIZATION. PART I, LINE 7 NON-FIXED PAYMENTS AS INDICATED IN SCHEDULE J, PART II, PERSONS LISTED ON FORM 990, PART VII, SECTION A RECEIVED A BONUS BASED ON PERFORMANCE AND THE FINANCIAL RESULTS OF THE ORGANIZATION. THIS BONUS WAS APPROVED BY THE BOARD. DR CISSY FURUSHO DIRECTOR 285355 COMPENSATION 0 DR RONALD RIGGINS DIRECTOR 152825 COMPENSATION 0 DR GENARO ROMO DIRECTOR 598595 COMPENSATION 0 SCHEDULE L, PART IV: TRANSACTIONS WITH INTERESTED PERSONS(A) NAME OF PERSON: DR. CISSY FURUSHO THROUGH DRS KOLLMAN & FURUSHO DENTISTRY(D) DESCRIPTION OF TRANSACTION: PAYMENTS TO DENTAL PRACTICE FOR DENTAL SERVICES PROVIDED UNDER DENTAL INSURANCE POLICY. COMPENSATION WAS AT AN ARM'S LENGTH.(A) NAME OF PERSON: DR. RONALD RIGGINS THROUGH RIVERSIDE DENTISTRY LLC(D) DESCRIPTION OF TRANSACTION: PAYMENTS TO DENTAL PRACTICE FOR DENTAL SERVICES PROVIDED UNDER DENTAL INSURANCE POLICY. COMPENSATION WAS AT AN ARM'S LENGTH.(A) NAME OF PERSON: DR. GENARO ROMO THROUGH ROMO DENTAL PC & ROMO DENTAL II PC(D) DESCRIPTION OF TRANSACTION: PAYMENTS TO DENTAL PRACTICE FOR DENTAL SERVICES PROVIDED UNDER DENTAL INSURANCE POLICY. COMPENSATION WAS AT AN ARM'S LENGTH. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS UNDER THE ENABLING STATUTE THAT GOVERNS THE ORGANIZATION - THE ILLINOIS DENTAL SERVICE PLAN ACT - THE MEMBERS OF DELTA DENTAL OF ILLINOIS ARE THE PARTICIPATING DENTISTS (DEFINED AS ANY DENTIST LICENSED IN ILLINOIS TO PRACTICE DENTISTRY WHO IS REPUTABLE AND IN GOOD STANDING AND HAS SIGNED AN AGREEMENT TO BECOME A PARTICIPATING DENTIST OF THE ORGANIZATION) AND THE GROUP SUBSCRIBERS WHO PURCHASE A DENTAL BENEFIT PROGRAM FROM THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OR STOCKHOLDERS WHO MAY ELECT AT THE ANNUAL MEMBERSHIP MEETING OF THE ORGANIZATION, THE MEMBERS REFERENCED IN PART VI, LINE 6 ELECT THE MEMBERS OF THE GOVERNING BODY, I.E. DIRECTORS, WHOSE TERM OF DIRECTORSHIP HAS EXPIRED. FORM 990, PART VI, SECTION A, LINE 7B MEMBERS OR STOCKHOLDERS WHO MAY ELECT AT THE ANNUAL MEMBERSHIP MEETING OF THE ORGANIZATION, THE MEMBERS REFERENCED IN PART VI, LINE 6 ELECT THE MEMBERS OF THE GOVERNING BODY, I.E. DIRECTORS, WHOSE TERM OF DIRECTORSHIP HAS EXPIRED. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF THE ORGANIZATION RETAINS THE SERVICES OF AN INDEPENDENT CPA FIRM TO ASSIST IN THE PREPARATION OF THE ORGANIZATION'S FORM 990. THE CPA FIRM ASSISTS MANAGEMENT IN PREPARING AND FINALIZING THE FORM 990. THE DRAFT OF FORM 990, INCLUDING ALL SCHEDULES, IS REVIEWED BY THE AUDIT AND FINANCE COMMITTEE, AND THEN DISTRIBUTED TO ALL VOTING MEMBERS OF THE GOVERNING BODY, I.E. THE DIRECTORS. THE ORGANIZATION'S MANAGEMENT, AND IF NEEDED ITS CPA FIRM, ADDRESS ANY QUESTIONS OR COMMENTS SUBMITTED BY THE ORGANIZATION'S GOVERNING BODY BEFORE FILING ITS FORM 990. AFTER THE AUDIT AND FINANCE COMMITTEE'S REVIEW AND MANAGEMENT ADDRESSES QUESTIONS OR COMMENTS FROM THE DIRECTORS, THE DRAFT FORM 990 IS FINALIZED AND FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY MONITORING & ENFORCEMENT LEGAL COUNSEL FOR THE ORGANIZATION REVIEWS THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ANNUALLY WITH THE OFFICERS, DIRECTORS (TRUSTEES) AND KEY EMPLOYEES. AFTER THIS REVIEW, THE INDIVIDUALS OCCUPYING THESE POSITIONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. POTENTIAL CONFLICTS ARE LOGGED WITH THE SECRETARY OF THE ORGANIZATION AND ANY CHANGES TO THE DISCLOSURE FORM ARE TO BE REPORTED TO THE CORPORATE COUNSEL OF THE ORGANIZATION. IF A CONFLICT ARISES, THESE INDIVIDUALS ARE ASKED TO RECUSE THEMSELVES. FORM 990, PART VI, SECTION B, LINE 15 PROCESS OF DETERMINING COMPENSATION CEO AND OTHER TOP MANAGEMENT OFFICIALS COMPENSATION IS REVIEWED BY THE BOARD OF DIRECTORS. THE BOARD PERIODICALLY ENGAGES AN INDEPENDENT CONSULTING FIRM TO ADVISE OF COMPENSATION LEVELS OF SIMILARLY SITUATED CEOS AND OTHER TOP MANAGEMENT OFFICIALS BASED UPON SURVEYS AND DATA PROVIDED BY OTHER ORGANIZATIONS AS LISTED ON THEIR FORM 990. THIS DATA, OR THE DATA DELTA DENTAL OF ILLINOIS 36-2612058 REPRESENTED TO THE COMPENSATION COMMITTEE AT SCHEDULED MEETINGS AND MINUTES OF THESE MEETINGS ARE CONTEMPORANEOUSLY PREPARED. THE COMMITTEE MAKES A RECOMMENDATION FOR CEO COMPENSATION TO THE BOARD FOR APPROVAL. EXECUTIVE COMPENSATION IS REVIEWED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 HOW DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE THROUGH APPLICABLE GOVERNMENTAL AGENCIES; THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON WRITTEN REQUEST TO THE ORGANIZATION. PART XII, LINE 2B THE ORGANIZATION'S 2022 AUDITED FINANCIAL STATEMENTS WERE PREPARED ON THE STATUTORY BASIS OF ACCOUNTING. HOWEVER, IN ORDER TO PROVIDE FULL TRANSPARENCY AND ACCURATELY REPRESENT THE ACTIVITIES OF THE ORGANIZATION, THE FORM 990 IS PREPARED USING THE ACCRUAL METHOD OF ACCOUNTING. THE RECONCILIATION BETWEEN THE AUDITED STATUTORY FINANCIAL STATEMENTS AND THE FINANCIALS PRESENTED ON THE FORM 990 IS ILLUSTRATED IN THE SCHEDULE D RECONCILIATIONS. DELTA DENTAL OF ILLINOIS FOUNDATION 111 SHUMAN BLVD NAPERVILLE IL 60563 262700504 ORAL HEALTH IL 501(C)(3) LINE 7 DDIL 1 NORTHWINDS TECHNOLOGY SOLUTION 111 SHUMAN BOULEVARD NAPERVILLE IL 60563 TECHNOLOGY DE DDIL DDWI & CORVESTA -1414882 18156610 0 1 0.33330 TRUASSURE INSURANCE COMPANY 111 SHUMAN BLVD NAPERVILLE IL 60563 363757528 DENTAL INS. IL DDIL C 1483034 13326322 1.00000 1 PROTEC INSURANCE COMPANY 111 SHUMAN BLVD NAPERVILLE IL 60563 320416457 HEALTH INS. IL DDIL C 770824 8498679 1.00000 1 TRUASSURE INSURANCE COMPANY OF COLORADO 111 SHUMAN BLVD NAPERVILLE IL 60563 812595283 DENTAL INS CO DDIL C 3247 2125619 1.00000 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 DELTA DENTAL OF ILLINOIS FOUNDATION B 2031791 FMV NORTHWINDS TECHNOLOGY SOLUTIONS LLC M 23455592 FMV DELTA DENTAL OF ILLINOIS FOUNDATION O 344667 FMV TRUASSURE INSURANCE COMPANY Q 1382127 FMV PROTEC INSURANCE COMPANY Q 498137 FMV NORTHWINDS TECHNOLOGY SOLUTIONS LLC P 1825518 FMV NORTHWINDS TECHNOLOGY SOLUTIONS LLC Q 198773 FMV PROTEC INSURANCE COMPANY R 5215468 FMV