2022-11-14T07:56:32-06:00 2021-12-31 FORVIS LLP 312 WALNUT STREET SUITE 3000 CINCINNATI OH 45202 990 2021-01-01 430908349 DELTA DENTAL OF MISSOURI % BARBARA C BENTRUP DELT 3146563000 12399 GRAVOIS ROAD ST LOUIS MO 631271702 BARBARA C BENTRUP CFO AND CORP COUNSEL 3146563000 2022-11-15 true BARBARA C BENTRUP 999009999 Aaron Hershberger P00961884 5136218300 3 2021 2022-09-23 18:48:47Z E B ROB GOREN 12399 GRAVOIS ROAD ST LOUIS MO 631271702 677009686 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. 15 12 266 0 0 0 0 551877993 670952587 3537176 5188318 857230 868781 556272399 677009686 1970018 1596408 490430889 609744540 34856897 36173740 0 0 0 20427542 19631526 547685346 667146214 8587053 9863472 193102771 206764296 30918722 34125285 162184049 172639011 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 655189633 670952587 DELTA DENTAL OF MISSOURI IS A PREPAID DENTAL INSURANCE COMPANY. IN 2021, DELTA DENTAL PROCESSED 3,565,893 CLAIMS FOR DENTAL SERVICES. 1397363 1397363 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 INDIVDUALS. IN 2021, DELTA DENTAL OF MISSOURI AWARDED MORE THAN $1.3 MILLION IN GRANTS TO 35 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 2021, DELTA DENTAL OF MISSOURI'S TOTAL CHARITABLE CONTRIBUTIONS ALSO INCLUDED MORE THAN $149,000 IN FLUORIDATION GRANTS FOR 15 MISSOURI COUNTIES 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 120,000 MISSOURIANS WHO LIVE IN THE IMPACTED COMMUNITIES. 216200 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 2021, THE PROGRAM REACHED MORE THAN 105,000 MISSOURI AND SOUTH CAROLINA KINDERGARTEN-THROUGH-3RD-GRADE STUDENTS THROUGH 441 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 100% RATED THE PROGRAM'S EDUCATIONAL VALUE AS EXCELLENT OR GOOD. PRE- AND POST-TEST DATA ALSO SHOWED AN 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. 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. Community Giving greater than $5,000 is included in Schedule I. 199045 189827 657002241 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 59233 0 true 266 true false false false false false false false false false false false false X 15 12 false false false false true true true true true false true true true true true true true true true true false X BARBARA C BENTRUP 3146563000 12399 GRAVOIS ROAD ST LOUIS MO 631271702 E B ROB GOREN President & CEO 60.0 0.0 X 928817 0 102943 BARBARA C BENTRUP CFO & CORPORATE COUNSEL 60.0 0.0 X 719082 0 130379 RONALD E INGE Chief Dental Officer & COO 60.0 0.0 X 581885 0 67801 JAMES J BARONE Chief Sales & Mktg Officer 60.0 0.0 X 498350 0 68527 JONATHAN R JENNINGS Chief Actuary & VP UW & PM 60.0 0.0 X 437772 0 75788 HENRY S LAFFITTE VP, Sales & Account Management 40.0 0.0 X 434130 0 72900 Vicki L Katzfey National Account Exec 60.0 0.0 X 370284 0 74206 KARL A MUDRA Chief Information Officer 60.0 0.0 X 367058 0 76391 ERIC W MANN Director of Operations 40.0 0.0 X 269082 0 78128 JANE STANHAUS Chief HR Officer 40.0 0.0 X 258493 0 68662 ELLEN R SAMUELS Director of Compliance 40.0 0.0 X 229632 0 82317 ALLISON M IZSAK Director of Mktg & Comm 60.0 0.0 X 203440 0 78014 EDWARD A PATTAROZZI Chief Sales & Mktg - RETIRED 60.0 0.0 X 277201 0 0 JAMES W RHEA Board Chairman/Director 2.0 0.0 X X 55800 0 0 MARK ZUST First Vice Chairman/Director 2.0 0.0 X X 43250 0 0 GARY WILLIAMS DIRECTOR 2.0 0.0 X 41100 0 0 ROSEMARY BISHOP Secretary/Director 2.0 0.0 X X 38200 0 0 WILLIAM J BENDER Treasurer/Director 2.0 0.0 X X 34750 0 0 WILLIAM EDWARDS - TERM ENDED 2nd Vice Chairman/Director 2.0 0.0 X X 33550 0 0 DEBORAH PATTERSON DIRECTOR 2.0 0.0 X 31450 0 0 TIMOTHY TAYLOR DIRECTOR 2.0 0.0 X 30900 0 0 STEVEN HARRIS DIRECTOR 2.0 0.0 X 30300 0 0 WILLIAM GRAY 2ND VICE CHAIRMAN/DIRECTOR 2.0 0.0 X X 30300 0 0 OLADIPUPO ADEFALA DIRECTOR 2.0 0.0 X 29350 0 0 JOHN R LANDGRAF JR DIRECTOR 2.0 0.0 X 28800 0 0 JOHNNY CUSTARDO DIRECTOR 2.0 0.0 X 28800 0 0 MARK MANCIN DIRECTOR 2.0 0.0 X 28200 0 0 KATHLEEN TUCKER DIRECTOR 2.0 0.0 X 27850 0 0 NOBLE COOPER JR DIRECTOR 2.0 0.0 X 2100 0 0 6002976 0 976056 63 true true false MISSOURI DENTAL PROFESSIONALS 1100 SPUR DR STE 30 MARSHFIELD MO 65706 DENTAL SERVICES 6984854 JAY F HAUSER DDS PC PO BOX 503094 SAINT LOUIS MO 63150 DENTAL SERVICES 3215241 M FERNANDEZ DDS E BROWN DDS J OSDIE 3555 SUNSET OFFICE DR STE 210 SAINT LOUIS MO 63127 DENTAL SERVICES 2902116 MICHAEL K PARSONS DDS PC 6 MCBRIDE AND SON CENTER DR STE 20 CHESTERFIELD MO 63005 DENTAL SERVICES 2839361 ST LOUIS PEDIATRIC DENTISTRY LLC 4142 KEATON CROSSING BLVD 102 O FALLON MO 63368 DENTAL SERVICES 2576734 991 0 DENTAL PREMIUMS 524114 670952587 670952587 670952587 2854748 2854748 0 0 0 0 0 2333570 2333570 2333570 2333570 0 0 0 0 0 0 0 0 0 MISCELLANEOUS INCOME 900099 397632 397632 INVESTMENT IN SUBSIDIARY 900003 471149 471149 868781 677009686 670952587 6057099 1596408 1596408 0 0 609744540 609744540 4896648 4896648 0 22763604 21073923 1689681 3162322 2827760 334562 3823665 3539845 283820 1527501 1414118 113383 0 257829 203617 54212 194017 153222 40795 0 0 293270 293270 3568452 2818129 750323 1504425 1392755 111670 3248592 3007458 241134 172183 159402 12781 0 647006 598980 48026 283352 262320 21032 0 78002 72213 5789 0 0 1611103 1491515 119588 594391 594391 BOARD AND BUREAU DUES 821759 760762 60997 SERVICE BUREAU FEES 3076650 2848278 228372 PUBLIC RELATIONS 338078 312984 25094 SERVICE AGREEMENTS 2462386 2279610 182776 480031 444402 35629 667146214 657002241 10143973 0 0 0 32465117 31835963 0 0 14807157 10745287 0 0 0 0 0 0 0 0 1053987 1043334 27761089 18415327 7903912 9345762 119177138 135498879 0 0 15531329 16002478 0 0 2164131 2292593 193102771 206764296 15173757 16719136 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15744965 17406149 30918722 34125285 X 0 0 0 0 162184049 172639011 162184049 172639011 193102771 206764296 9863472 591490 X false true X true false 1350000 1350000 8630866 4875103 3755763 1145351 995060 150291 6730740 5315295 1415445 9904132 7229869 2674263 9345762 INVEST. IN ADVANTICA HLDG CO 16002478 C 16002478 0 INCURRED BUT UNREPORTED CLAIMS 6892104 ESTIMATE UNPAID CLAIM PROCESS 1175782 UNEARNED PREMIUMS 8290783 EXPERIENCE RATED CREDIT LIAB 176479 ADVANCE DEPOSITS 871001 17406149 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 GAIN TOTALING $456,351 AND $480,022 AS OF DECEMBER 31, 2021 AND 2020, RESPECTIVELY. AT DECEMBER 31, 2021 AND 2020, ADVANTICA ADMINISTRATIVE HAD NET OPERATING LOSS CARRYFORWARDS OF APPROXIMATELY $20,941,000 AND $21,426,000, RESPECTIVELY. ADVANTICA ADMINISTRATIVE AND ITS SUBSIDIARIES HAD DEFERRED TAX ASSETS OF APPROXIMATELY $4,414,000 AND $4,408,000 AT DECEMBER 31, 2021 AND 2020, 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, 2021 AND 2020. 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, 2018 THROUGH 2021. true Healthworks Kids Museum St Louis 1100 Macklind Ave St Louis MO 63110 753018876 501(C)(3) 150000 General Support Gateway to Oral Health Foundation 2211 Olive Street St Louis MO 63103 113664960 501(C)(3) 100000 General Support Delta Area Economic Opp Corp 99 Skyview Road Portageville MO 63873 430834206 501(C)(3) 75000 General Support Truman Medical Center Charitable Foundation 2310 Holmes Street SUITE 505 Kansas City MO 64108 431194064 501(C)(3) 70000 General Support Upward Smiles Inc 2820 Anchor Drive Farmington MO 63640 452780221 501(C)(3) 70000 General Support Little River Medical Center Inc PO Box 547 Little River SC 29566 570672117 501(C)(3) 63000 General Support Give Kids a Smile 10 Worthington Dr MD Heights MO 63043 201287939 501(C)(3) 50000 General Support Greenville Tech Foundation Inc 556 Perry Avenue Greenville SC 29611 570565961 501(C)(3) 50000 General Support Missouri Dental Assocation Foundation 3340 American Ave Jefferson City MO 65109 431133855 501(C)(3) 50000 General Support Healthy Smiles of Spartanburg Inc PO Box 1441 Spartanburg SC 29304 030529473 501(C)(3) 50000 General Support Healthy Learners 2749 Laurel St Columbia SC 29204 571127197 501(C)(3) 50000 General Support AIDS Resource Center of Wisconsin Inc 648 N Plankinton Ave Milwaukee WI 53203 391534049 501(C)(3) 50000 General Support Medical University of South Carolina 1 South Park Circle Charleston SC 29425 576000722 501(C)(3) 50000 General Support Samuel U Rodgers Health Center Inc 825 Euclid Avenue Kansas City MO 64124 430899356 501(C)(3) 42267 General Support East Cooper Community Outreach 1145 Six Mile Rd Mount Pleasant MO 29466 570939280 501(C)(3) 40000 General Support Heartland Outreach Providers 1215 NW State Rte 7 Blue Springs SC 64014 274387842 501(C)(3) 35000 General Support HNC Living Foundation 6240 W 135th St Overland Park MO 66223 464214254 501(C)(3) 25000 General Support Our Lady of Mercy Community Outreach PO Box 607 Johns Island SC 29457 570905488 501(C)(3) 25000 General Support Missouri Dept of Health & Senior Service PO Box 570 Ste 130 Jefferson City MO 65102 446000987 Gov't 25000 General Support Jefferson County Water Authority 711 West Main Street Festus MO 63028 030407826 Gov't 25000 General Support Public Water Supply District 1 Cole Co Mo 4346 Rainbow Dr Ste 100 Jefferson City MO 65109 430861043 Gov't 25000 General Support St Louis Children's Hospital Foundation 1001 Highlands Plaza St Louis MO 63110 431626863 501(C)(3) 25000 General Support Children's Smile Center 601 N 21st Street Ozark MO 65721 571196229 501(C)(3) 25000 General Support City Utilities of Springfield MO 301 E Central Springfield MO 65801 440553154 Gov't 20864 General Support Volunteers In Medicine Clinic 15 Northridge Hilton Head Island SC 29926 570959206 501(C)(3) 20000 General Support Health Outreach Foundation 180 Hever Knoll Village of Loch Lloyd MO 64012 202367620 501(C)(3) 15000 General Support Mercy Medicine Free Clinic 500 S Colt Street Florence SC 29501 311693093 501(C)(3) 15000 General Support Community Clinic of Southwest Missouri 701 S Joplin Ave Joplin MO 64801 431643962 501(C)(3) 15000 General Support Ronald McDonald House of the Ozarks 949 E Primrose St Springfield MO 65807 431371143 501(C)(3) 15000 General Support Cass Community Health Foundation 2316 E Meyer Blvd Kansas City MO 64132 431349495 501(C)(3) 12564 General Support Midlands Technical College Foundation Inc 7300 College Street Irmo SC 29063 237085753 501(C)(3) 12500 General Support St Louis Community College Foundation 3221 McKelvey Rd Bridgeton MO 63044 431374500 501(C)(3) 14500 General Support City of Monroe City 109 Second Street Monroe City MO 63456 436002353 Gov't 11645 General Support City of Osage Beach 1000 City Parkway Osage Beach MO 65065 430887515 Gov't 11062 General Support City of Dexter 301 E Stoddard St Dexter MO 63841 436001012 Gov't 10927 General Support City of Glasgow 100 Market Street Glasgow MO 65254 436001425 Gov't 10685 General Support City of Slater 232 N Main Slater MO 65349 446000264 Gov't 10395 General Support RURAL PARISH CLINIC ARCHDIOCESE ST LOUIS 20 Archbishop May Drive St Louis MO 63119 843396327 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 Metro St Louis 3820 West Pine Blvd St Louis MO 63108 430653618 501(C)(3) 10000 General Support Dental Lifeline Network 1800 15th Street Denver CO 80202 846129064 501(C)(3) 8000 General Support City of Kahoka 250 N Morgan Kahoka MO 63445 436001872 Gov't 5672 General Support American Lung Association 55 W Wacker Dr Chicago IL 60601 131632524 501(c)(3) 10000 General Support 43 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 true true false false false false false false false BARBARA C BENTRUP CFO & CORPORATE COUNSEL 528551 0 133176 0 57355 0 105109 0 25270 0 849461 0 44272 E B ROB GOREN President & CEO 672059 0 190480 0 66278 0 70137 0 32806 0 1031760 0 65310 EDWARD A PATTAROZZI Chief Sales & Mktg - RETIRED 0 0 0 0 277201 0 0 0 0 0 277201 0 18139 JONATHAN R JENNINGS Chief Actuary & VP UW & PM 305887 0 112420 0 19465 0 44536 0 31252 0 513560 0 12891 KARL A MUDRA Chief Information Officer 281198 0 69181 0 16679 0 42585 0 33806 0 443449 0 9415 JAMES J BARONE Chief Sales & Mktg Officer 406656 0 81975 0 9719 0 43500 0 25027 0 566877 0 RONALD E INGE Chief Dental Officer & COO 423504 0 106724 0 51657 0 45347 0 22454 0 649686 0 31881 ALLISON M IZSAK Director of Mktg & Comm 163440 0 39463 0 537 0 44952 0 33062 0 281454 0 Vicki L Katzfey National Account Exec 101466 0 268005 0 813 0 43500 0 30706 0 444490 0 ELLEN R SAMUELS Director of Compliance 185488 0 42993 0 1151 0 54180 0 28137 0 311949 0 HENRY S LAFFITTE VP, Sales & Account Management 230613 0 202858 0 659 0 39595 0 33305 0 507030 0 ERIC W MANN Director of Operations 212262 0 47791 0 9029 0 56339 0 21789 0 347210 0 JANE STANHAUS Chief HR Officer 204139 0 44838 0 9516 0 38021 0 30641 0 327155 0 SCHEDULE J, PART I, LINE 4A SEVERANCE DURING THE TAX YEAR ENDED DECEMBER 31, 2021, EDWARD PATTAROZZI RECEIVED SEVERENCE PAYMENTS IN THE AMOUNT OF 259,062. 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 2021 FOR THE FOLLOWING INDIVIDUALS WERE: BARBARA BENTRUP - $44,272 E.B. ROB GOREN - $65,310 KARL MUDRA - $9,415 RONALD INGE - $31,881 JONATHAN JENNINGS - $12,891 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 2021 WERE THE FOLLOWING: BARBARA BENTRUP, E. B. ROB GOREN, JONATHAN JENNINGS, RONALD INGE AND KARL MUDRA. ALL INCREASES 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 COMPANY'S ACCRUAL HAS TO BE REPORTED ANNUALLY AS COMPENSATION ON THE FORM 990 FOR EACH OF THE PARTICIPANTS WHEN THERE WAS NO BENEFIT VALUE TO THEM PERSONALLY - IF PARTICIPANTS LEAVE THE COMPANY 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 IN THE COMPANY'S ACCRUAL. THE AMOUNTS PER PARTICIPANT ARE: BARBARA BENTRUP - $61,609 E.B. ROB GOREN - $26,637 KARL MUDRA - $(378) JONATHAN JENNINGS - $2,175 RONALD INGE - $1,847 MARK R ZUST DDS LTD BOARD MEMBER AS OWNER 278254 DENTAL SERVICES PROVIDED false WILLIAM A GRAY DMD LLC BOARD MEMBER AS OWNER 281694 DENTAL SERVICES PROVIDED false FLORISSANT DENTAL ASSOCIATES LLC FAMILY OF BOARD MEMBER 479422 DENTAL SERVICES PROVIDED false 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. 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 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 2021 WAS REVIEWED BY A THIRD PARTY COMPENSATION CONSULTANT AND THEN REVIEWED BY THE COMPENSATION COMMITTEE (SUBSECTION OF THE COMPANY'S BOARD OF DIRECTORS) IN MARCH, 2021. 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. ADVANTICA ADMINISTRATIVE SERVICES INC 12399 GRAVOIS ROAD ST LOUIS MO 63127 431826684 THIRD PARTY ADMIN MO NA C-CORP 3358941 16457757 1.00000 true false false false false false false false false false false false false true false false false false false false ADVANTICA ADMINISTRATIVE SERVICES INC M 166224 ALLOCATIONS