DELTA DENTAL OF NORTH CAROLINA: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- DELTA DENTAL OF NORTH CAROLINA (EIN 56-1018068)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-14
- IRS object ID
- 202203189349310605
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-14T13:27:25-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1111 MICHIGAN AVE STE 100 | AddressLine1Txt |
| City | EAST LANSING | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48823 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 561018068 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA DENTAL OF NORTH CAROLINA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DELT | BusinessNameControlTxt |
| Phone | 8005879514 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4242 SIX FORKS ROAD 970 | AddressLine1Txt |
| City | RALEIGH | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27609 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AMY BASEL | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 8005879514 | PhoneNum |
| Signature | 2022-11-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | AMY | PersonFirstNm |
| Person Last | BASEL | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVID LOWENTHAL CPA | PreparerPersonNm |
| PTIN | P00378651 | PTIN |
| Phone | 5173326200 | PhoneNum |
| Preparation | 2022-11-08 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CURTIS R LADIG CPA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4242 SIX FORKS ROAD 970 | AddressLine1Txt |
| City | RALEIGH | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27609 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $108,631,377 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | WWW.DELTADENTALNC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1970 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | DELTA DENTAL OF NORTH CAROLINA'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH PREPAID DENTAL SERVICES, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 25 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $89,940,478 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $105,487,945 | CYProgramServiceRevenueAmt |
| PY Investment Income | $126,082 | PYInvestmentIncomeAmt |
| CY Investment Income | $683,522 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $90,066,560 | PYTotalRevenueAmt |
| CY Total Revenue | $106,171,467 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $425,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $125,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,765,211 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,475,919 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $76,361,015 | PYOtherExpensesAmt |
| CY Other Expenses | $97,967,809 | CYOtherExpensesAmt |
| PY Total Expenses | $81,551,226 | PYTotalExpensesAmt |
| CY Total Expenses | $102,568,728 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,515,334 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,602,739 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $31,368,287 | TotalAssetsBOYAmt |
| Total Assets EOY | $35,946,857 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,281,985 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,253,904 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $20,086,302 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $23,692,953 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE ODELTA DENTAL OF NORTH CAROLINA'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH PREPAID DENTAL SERVICES, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $98,497,432 | ExpenseAmt |
| Grant | $125,000 | GrantAmt |
| Revenue | $105,487,945 | RevenueAmt |
| Desc | PROMOTING DENTAL CAREDELTA DENTAL OF NORTH CAROLINA IS A LEADING GROUP DENTAL BENEFITS PROVIDER. THE PURPOSE OF THE ORGANIZATION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH. THIS IS DONE BY OFFERING INNOVATIVE, COST-EFFECTIVE PRODUCTS THAT MEET THE NEEDS OF CUSTOMERS. THIS WAS DEMONSTRATED IN 2021 BY PAYING OUT OVER $80 MILLION IN CLAIMS AND BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 1.3 MILLION CLAIMS WERE PROCESSED FOR OVER 768,000 MEMBERS. SEE SCHEDULE O FOR CONTINUATION COST SAVING STRATEGIESDELTA DENTAL BENEFIT PLANS ARE COMMITTED TO SAVING GROUPS AND MEMBERS MONEY. THE DELTA DIFFERENCE IS AN INTEGRATION OF ACTIVITIES SUCH AS COST MANAGEMENT POLICIES, FEE REDUCTION AGREEMENTS WITH DENTISTS, AND ANTI-FRAUD PROGRAMS, ALL OF WHICH ENSURE QUALITY, COST-EFFECTIVE DENTAL BENEFIT DELIVERY. COMMITMENT TO THE COMMUNITYTHE DELTA DENTAL FUND, THE COMPANY'S PHILANTHROPIC AFFILIATE, ENCOURAGES ADVANCES IN DENTISTRY AND SUPPORTS DENTAL EDUCATION AND RESEARCH. IN 2021, DELTA DENTAL FUND CONTRIBUTED OVER $200,000 TO ORGANIZATIONS IN NORTH CAROLINA TO SUPPORT THESE CAUSES. UNEQUALED ACCESS TO DENTISTS FOR FIVE DECADES, DELTA DENTAL HAS HELPED PROMOTE ORAL HEALTH BY DESIGNING AND ADMINISTERING INNOVATIVE, COST-EFFECTIVE DENTAL BENEFIT PROGRAMS. EXPERTS AT PLAN DESIGN, DELTA DENTAL HAS CREATED DENTAL BENEFIT PROGRAMS THAT MEET CUSTOMER COST-OBJECTIVES WHILE HELPING TO IMPROVE AND MAINTAIN ORAL HEALTH.OUR LONG STANDING RELATIONSHIPS WITH PROVIDERS IN THE COMMUNITIES WE SERVE ALLOW US TO MAINTAIN LARGE NETWORKS, ALLOWING BROAD ACCESS FOR MEMBERS AND COST-EFFECTIVE CARE. DELTA DENTAL'S GROUP MEMBERS ARE AFFORDED ADDED PROTECTION BECAUSE THEY GUARANTEE THAT PARTICIPATING DENTISTS WILL ACCEPT THEIR PAYMENT FOR COVERED SERVICES AND NO CHARGE, OTHER THAN CO-PAYMENTS AND DEDUCTIBLES ARE BILLED BACK TO THE MEMBER. THIS LOWERS CLAIM COSTS FOR CUSTOMERS AND REDUCES OUT-OF-POCKET COSTS FOR SUBSCRIBERS.WITH TWO NETWORKS OF FULL-TIME PARTICIPATING DENTISTS IN ONE INTEGRATED CLAIMS SYSTEM, DELTA DENTAL CAN DELIVER TO CUSTOMERS AND GROUP MEMBERS BROAD ACCESS TO CARE. | Desc |
| Total Program Service Expenses | $98,497,432 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 31254 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 25 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AMY BASEL CHIEF FINANCIAL OFFICER | PersonNm |
| Phone | 5173496000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4100 OKEMOS ROAD | AddressLine1Txt |
| City | OKEMOS | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48864 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|---|
| AMY L BASEL | |||||||||
| CHIEF FINANCIAL OFFICER | 5.00 | 45.00 | Yes (X) | $0 | $1,522,877 | $446,465 | |||
| CURT LADIG | |||||||||
| CHIEF EXECUTIVE OFFICER | 50.00 | 0.00 | Yes (X) | $703,069 | $0 | $32,421 | |||
| DEBORAH JONES | |||||||||
| SVP, SALES & CLIENT MGT | 40.00 | 0.00 | $340,440 | $0 | $34,799 | Yes (X) | |||
| MARIROSE STEIGERWALD | |||||||||
| SVP & CAO | 50.00 | 0.00 | $270,365 | $0 | $40,650 | Yes (X) | |||
| JOHN PEATTIE | |||||||||
| ACCOUNT EXECUTIVE | 40.00 | 0.00 | $252,554 | $0 | $40,670 | Yes (X) | |||
| JOHN SINGLETARY | |||||||||
| ACCOUNT EXECUTIVE | 40.00 | 0.00 | $168,566 | $0 | $36,492 | Yes (X) | |||
| ANNIE DONALDSON | |||||||||
| STRATEGIC CLIENT CONSULTANT | 40.00 | 0.00 | $152,205 | $0 | $35,584 | Yes (X) | |||
| DENISE SAUNDERS POWELL | |||||||||
| ACCOUNT EXECUTIVE | 40.00 | 0.00 | $121,970 | $0 | $30,689 | Yes (X) | |||
| TIA JONES | |||||||||
| DIR., OPERATIONS & PROVIDER NETWORK | 40.00 | 0.00 | $123,718 | $0 | $24,215 | Yes (X) | |||
| MOIRA LOCASCIO | |||||||||
| IMMEDIATE PAST CHAIR | 2.00 | 5.00 | Yes (X) | $16,251 | $24,996 | $0 | Yes (X) | ||
| JAMES R ROSE JR | |||||||||
| CHAIRPERSON | 2.00 | 0.00 | Yes (X) | $18,753 | $0 | $0 | Yes (X) | ||
| SHEILA AHLER CPA | |||||||||
| SECRETARY & TREASURER | 2.00 | 0.00 | Yes (X) | $17,250 | $0 | $0 | Yes (X) | ||
| COURTNEY CROWDER | |||||||||
| VICE CHAIRPERSON | 2.00 | 0.00 | Yes (X) | $15,000 | $0 | $0 | Yes (X) | ||
| STEWART DECLARE HOLMES | |||||||||
| DIRECTOR | 2.00 | 0.00 | $15,000 | $0 | $0 | Yes (X) | |||
| LEAH DEVLIN | |||||||||
| DIRECTOR | 2.00 | 0.00 | $15,000 | $0 | $0 | Yes (X) | |||
| CLAIR B NIVER | |||||||||
| DIRECTOR | 2.00 | 0.00 | $11,250 | $0 | $0 | Yes (X) | |||
| BRADFORD PRESSLEY | |||||||||
| DIRECTOR - THRU 7/21 | 2.00 | 0.00 | $8,750 | $0 | $0 | Yes (X) | |||
| RAJESH MANICKAM | |||||||||
| DIRECTOR | 2.00 | 0.00 | $6,250 | $0 | $0 | Yes (X) | |||
| CARL EXNER | |||||||||
| TREASURER - THRU 3/21 | 1.00 | 0.00 | Yes (X) | $4,500 | $0 | $0 | Yes (X) | ||
| ALAN CLARKE | |||||||||
| IMMEDIATE PAST CHAIR - THRU 3/21 | 2.00 | 0.00 | Yes (X) | $3,750 | $0 | $0 | Yes (X) | ||
| THOMAS J FLESZAR DDS MS | |||||||||
| DIRECTOR - THRU 3/21 | 2.00 | 0.00 | $3,750 | $0 | $0 | Yes (X) | |||
| KATHY TRUSCH | |||||||||
| SECRETARY - THRU 3/21 | 2.00 | 0.00 | Yes (X) | $3,750 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,272,141 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,547,873 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $721,985 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PIERCE GROUP BENEFITS LLC | |||||
| 4928 LINKSLAND DR | HOLLY SPRINGS | NC | 27540 | COMMISSIONS | $958,470 |
| USI INSURANCE SERVICES LLC | |||||
| PO BOX 601478 | CHARLOTTE | NC | 28260 | COMMISSIONS | $428,832 |
| MARSH & MCLENNAN AGENCY LLC | |||||
| ONE S JEFFERSON ST | ROANOKE | VA | 24011 | COMMISSIONS | $422,181 |
| JAMES A SCOTT & SON INC | |||||
| 628 GREEN VALLEY RD | GREENSBORO | NC | 27408 | COMMISSIONS | $362,893 |
| GALLAGHER BENEFITS SERICES INC | |||||
| TWO PIERCE PLACE | ITASCA | IL | 60143 | COMMISSIONS | $362,716 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 15 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| DENTAL CARE REVENUE | 524114 | $105,416,912 | $105,416,912 |
| SUBCRIBER FEE | 524114 | $71,033 | $71,033 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $105,487,945 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $246,079 | TotalRevenueColumnAmt |
| Exclusion | $246,079 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,882,012 | SecuritiesAmt |
| Other | $15,341 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,455,989 | SecuritiesAmt |
| Other | $3,921 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $426,023 | SecuritiesAmt |
| Other | $11,420 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $437,443 | TotalRevenueColumnAmt |
| Exclusion | $437,443 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $106,171,467 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $105,487,945 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $683,522 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125,000 | TotalAmt |
| Program Services | $125,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,591,436 | TotalAmt |
| Program Services | $1,164,002 | ProgramServicesAmt |
| Management And General | $427,434 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,157,071 | TotalAmt |
| Program Services | $1,982,436 | ProgramServicesAmt |
| Management And General | $174,635 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,886 | TotalAmt |
| Program Services | $82,753 | ProgramServicesAmt |
| Management And General | $6,133 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $454,262 | TotalAmt |
| Program Services | $392,706 | ProgramServicesAmt |
| Management And General | $61,556 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $184,264 | TotalAmt |
| Program Services | $162,232 | ProgramServicesAmt |
| Management And General | $22,032 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $215,579 | TotalAmt |
| Program Services | $65,237 | ProgramServicesAmt |
| Management And General | $150,342 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,822 | TotalAmt |
| Management And General | $102,822 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,605 | TotalAmt |
| Management And General | $51,605 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,864 | TotalAmt |
| Management And General | $24,864 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,416,432 | TotalAmt |
| Program Services | $81,334,685 | ProgramServicesAmt |
| Management And General | $1,081,747 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $394,195 | TotalAmt |
| Management And General | $394,195 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,123,935 | TotalAmt |
| Program Services | $847,228 | ProgramServicesAmt |
| Management And General | $276,707 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $417,876 | TotalAmt |
| Program Services | $1,964 | ProgramServicesAmt |
| Management And General | $415,912 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $330,915 | TotalAmt |
| Management And General | $330,915 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,199 | TotalAmt |
| Program Services | $134,042 | ProgramServicesAmt |
| Management And General | $32,157 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,982 | TotalAmt |
| Program Services | $2,673 | ProgramServicesAmt |
| Management And General | $4,309 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,800 | TotalAmt |
| Program Services | $17,050 | ProgramServicesAmt |
| Management And General | $11,750 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,188 | TotalAmt |
| Management And General | $59,188 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| COMMISSION | $5,849,380 | $5,849,380 | |
| PROCESSING FEES | $4,305,835 | $4,305,835 | |
| PREMIUM TAX | $1,891,185 | $1,891,185 | |
| TAXES, FEES & LICENSES | $498,754 | $55,761 | $442,993 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,263 | TotalAmt |
| Program Services | $83,263 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,568,728 | TotalAmt |
| Program Services | $98,497,432 | ProgramServicesAmt |
| Management And General | $4,071,296 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,603,518 | BOYAmt |
| EOY | $14,295,133 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,098,968 | BOYAmt |
| EOY | $7,579,074 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $103,318 | BOYAmt |
| EOY | $43,039 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $94,722 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $61,330 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,412 | BOYAmt |
| EOY | $33,392 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,245,771 | BOYAmt |
| EOY | $13,552,546 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $266,300 | BOYAmt |
| EOY | $443,673 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,368,287 | BOYAmt |
| EOY | $35,946,857 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,877,713 | BOYAmt |
| EOY | $7,564,881 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,361,577 | BOYAmt |
| EOY | $1,897,840 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,042,695 | BOYAmt |
| EOY | $2,791,183 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,281,985 | BOYAmt |
| EOY | $12,253,904 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,086,302 | BOYAmt |
| EOY | $23,692,953 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,086,302 | BOYAmt |
| EOY | $23,692,953 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,368,287 | BOYAmt |
| EOY | $35,946,857 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,602,739 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $3,912 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $94,722 | OtherCostOrOtherBasisAmt |
| Depreciation | $61,330 | DepreciationAmt |
| Book Value | $33,392 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $33,392 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $2,791,183 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,791,183 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $106,146,603 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $106,146,603 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $24,864 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $24,864 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $106,171,467 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $102,543,864 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $102,543,864 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $24,864 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $24,864 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $102,568,728 | TotalExpensesPerForm990Amt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|---|---|
| DELTA DENTAL FUND | ||||||||||
| PO BOX 30416 | LANSING | MI | 48909 | 382337000 | 501(C)(3) | $100,000 | $0 | N/A | N/A | GENERAL CONTRIBUTION |
| FRIENDS OF THE NC MUSEUM OF NATURAL SCIENCE | ||||||||||
| 11 WEST JONES ST | RALEIGH | NC | 27601 | 561240806 | 501(C)(3) | $25,000 | $0 | N/A | N/A | DUELING DINOSAURS PROGRAM |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | CONTRIBUTIONS ARE MADE AT MANAGEMENT DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF NORTH CAROLINA'S MISSION. CONTRIBUTIONS MADE TO THE DELTA DENTAL FUND ARE APPROVED BY THE BOARD OF DIRECTORS. IN ORDER FOR FUNDS TO BE DISBURSED, VOUCHER RECORDS MUST PASS THROUGH THE APPROVAL PROCESS, SIMILAR TO ANY OTHER EXPENDITURE MADE BY DELTA DENTAL PLAN OF NORTH CAROLINA. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AMY L BASEL | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $0 | $484,754 | $0 | $525,138 | $0 | $512,985 | $0 | $421,727 | $0 | $24,738 | $0 | $1,969,342 | $0 | $483,018 |
| CURT LADIG | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $509,099 | $0 | $168,750 | $0 | $25,220 | $0 | $14,500 | $0 | $17,921 | $0 | $735,490 | $0 | $0 | $0 |
| DEBORAH JONES | ||||||||||||||
| SVP, SALES & CLIENT MGT | $162,957 | $0 | $172,500 | $0 | $4,983 | $0 | $12,777 | $0 | $22,022 | $0 | $375,239 | $0 | $0 | $0 |
| MARIROSE STEIGERWALD | ||||||||||||||
| SVP & CAO | $207,377 | $0 | $60,000 | $0 | $2,988 | $0 | $13,708 | $0 | $26,942 | $0 | $311,015 | $0 | $0 | $0 |
| JOHN PEATTIE | ||||||||||||||
| ACCOUNT EXECUTIVE | $62,278 | $0 | $189,574 | $0 | $702 | $0 | $12,907 | $0 | $27,763 | $0 | $293,224 | $0 | $0 | $0 |
| JOHN SINGLETARY | ||||||||||||||
| ACCOUNT EXECUTIVE | $62,170 | $0 | $105,226 | $0 | $1,170 | $0 | $8,729 | $0 | $27,763 | $0 | $205,058 | $0 | $0 | $0 |
| ANNIE DONALDSON | ||||||||||||||
| STRATEGIC CLIENT CONSULTANT | $84,618 | $0 | $66,712 | $0 | $875 | $0 | $7,821 | $0 | $27,763 | $0 | $187,789 | $0 | $0 | $0 |
| DENISE SAUNDERS POWELL | ||||||||||||||
| ACCOUNT EXECUTIVE | $61,223 | $0 | $58,587 | $0 | $2,160 | $0 | $14,259 | $0 | $16,430 | $0 | $152,659 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | TRAVEL FOR COMPANIONS RELATED TO TRAVEL FOR A SPOUSE. THIS AMOUNT WAS TREATED AS TAXABLE TO THE BOARD MEMBER OR EMPLOYEE. THE CEO IS ELIGIBLE FOR REIMBURSEMENT OF SUBSTANTIATED HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES THAT HAVE A BUSINESS PURPOSE. THIS BENEFIT IS NOT TAXABLE BUT THE EXPENSES MUST BE SUBSTANTIATED AS A BUSINESS EXPENSE. |
| PART I, LINE 4B | A RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, HAS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). IN ORDER TO BE ELIGIBLE FOR THE SERP, AN EMPLOYEE MUST BE A SENIOR VICE PRESIDENT OR HIGHER AND ADDED TO THE PLAN BY THE BOARD OF DIRECTORS. THE SERP BENEFITS ARE REVIEWED AS PART OF THE TOTAL COMPENSATION BY AN INDEPENDENT CONSULTANT; TOWERS WATSON. IN 2021, AMY BASEL ACCRUED BENEFITS AS A PARTICIPANT IN THE SERP PLAN. AMY BASEL BECAME VESTED IN A PORTION OF HER ACCRUED BENEFITS AND, AS REQUIRED BY THE IRS, THE VESTED PORTION WAS TREATED AS TAXABLE WAGES DURING 2021. THESE WAGES WERE ALSO REPORTED ON SCHEDULE J AS COMPENSATION THAT HAS BEEN REPORTED AS DEFERRED ON PRIOR FORM 990S. EFFECTIVE SEPTEMBER 1, 2020, A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN UNDER SEC. 457(F) IS MAINTAINED BY THE ORGANIZATION FOR CERTAIN EXECUTIVE EMPLOYEES. UPON SEVERANCE FROM SERVICE PRIOR TO ATTAINMENT OF NORMAL RETIREMENT AGE, THE PARTICIPANT SHALL FORFEIT INELIGIBLE AMOUNTS IN THE PLAN UNLESS SUCH SEVERANCE IS DUE TO DEATH, DISABILITY, INVOLUNTARY TERMINATION WITHOUT CAUSE, OR A SEVERANCE FROM EMPLOYMENT FOR GOOD REASON. IN 2021, CURTIS LADIG ACCRUED BENEFITS AS A PARTICIPANT IN THE PLAN, BUT DID NOT RECEIVE A DISTRIBUTION. |
| PART I, LINE 7 | AS INDICATED IN SCHEDULE J, PART II, TOP MANAGEMENT OFFICIALS RECEIVED A BONUS BASED ON PERFORMANCE AND THE FINANCIAL RESULTS OF THE ORGANIZATION. THIS BONUS IS APPROVED BY THE BOARD OF DIRECTORS. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | DELTA DENTAL OF NORTH CAROLINA HAS A SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER HAS VOTING RIGHTS AND ELECTS DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE MEMBER HAS THE RIGHTS THAT ARE PRESCRIBED BY LAW, FOR MEMBERS OF NON-PROFIT CORPORATIONS, INCLUDING THE APPROVAL OF SIGNIFICANT EXPENDITURES AND CEO APPOINTMENT. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE INFORMATION PRESENTED ON THE FORM 990 IS GATHERED BY THE SENIOR TAX ADMINISTRATOR FOR THE ORGANIZATION. THE CFO REVIEWS THE INFORMATION. ONCE APPROVED THE INFORMATION IS GIVEN TO OUTSIDE TAX PREPARERS WHO PREPARE AND REVIEW THE FORM 990. ONCE COMPLETE, AN ELECTRONIC COPY OF THE FORM 990 IS PLACED IN A SECURE PORTAL FOR THE BOARD TO REVIEW. THIS IS DONE BEFORE THE RETURN IS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ENTERPRISE'S GENERAL COUNSEL IS CHARGED WITH REVIEWING AND MONITORING ANY POTENTIAL CONFLICT OF INTEREST TRANSACTIONS. ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO REVIEW AND EXECUTE A CONFLICT OF INTEREST POLICY. THIS POLICY REQUIRES THAT ANY CONFLICTS OF INTEREST BE DISCLOSED ON AN ANNUAL BASIS, OR AT ANY OTHER TIME THAT THE PERSON EXECUTING THE POLICY BECOMES AWARE OF A SITUATION OR TRANSACTION THAT ACTUALLY OR POTENTIALLY CREATES A CONFLICT OF INTEREST. ALL CONFLICT OF INTEREST DISCLOSURE FORMS ARE INITIALLY REVIEWED BY THE GENERAL COUNSEL. IF A PROHIBITED TRANSACTION IS IDENTIFIED, THE MATTER IS ESCALATED TO THE CEO AND TO THE AUDIT AND FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR FURTHER REVIEW AND APPROPRIATE ACTION. IN THE EVENT OF A CONFLICT OF INTEREST INVOLVING A MEMBER OF THE BOARD OF DIRECTORS, SUCH AS A VOTE, IN WHICH A MEMBER HAS AN INTEREST, THE MEMBER IS REQUIRED TO DISCLOSE THE POTENTIAL CONFLICT AND ABSTAIN FROM ANY VOTE ON THE MATTER. WHETHER FURTHER PRECAUTIONS ARE REQUIRED (E.G., PROHIBITING THE INTERESTED PARTY FROM ENGAGING IN DISCUSSIONS) WOULD DEPEND UPON THE SPECIFIC NATURE AND BACKGROUND OF THE CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15A | CEO COMPENSATION IS SET BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. MARKET DATA PROVIDED BY OUTSIDE CONSULTANTS, TOWERS WATSON, IS USED TO VALIDATE THE REASONABLENESS OF THE TOTAL COMPENSATION PACKAGE. COMPENSATION FOR CERTAIN OFFICERS, INCLUDING THE CFO, IS DETERMINED AND PAID THROUGH A RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, INC. |
| FORM 990, PART VI, SECTION C, LINE 19 | NO DOCUMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART VII: | CERTAIN EMPLOYEES ARE OFFICERS OF MULTIPLE COMPANIES WITHIN THE LARGER ORGANIZATION. THE AVERAGE HOURS WORKED REFLECTS APPROXIMATE TIME SPENT IN EACH OF THOSE INDIVIDUAL COMPANIES. WHILE THE HOURS ARE ALLOCATED TO INDIVIDUAL COMPANIES, MUCH OF THE OFFICERS' TIME IS SPENT WORKING ON ISSUES THAT IMPACT THE ENTIRE ORGANIZATION, NOT JUST ONE COMPANY. COMPENSATION IS REPORTED IN FULL TO AGREE TO THE EMPLOYEE'S W-2 AS REQUIRED BY IRS INSTRUCTIONS. ANY ALLOCATION OF COMPENSATION IS INCLUDED ON SCHEDULE R. |
| FORM 990, PART IX, LINE 11G | CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,217,774. MANAGEMENT AND GENERAL EXPENSES 1,081,747. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,299,521. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 80,116,911. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 80,116,911. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (13 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| RENAISSANCE HEALTH SERVICE CORPORATION | |||||||||||
| PO BOX 30416 | LANSING | MI | 489097916 | 381675667 | PROMOTING DENTAL CARE | MI | 501(C)(4) | N/A | N/A | 0 | |
| DELTA DENTAL FUND | |||||||||||
| PO BOX 30416 | LANSING | MI | 489097916 | 382337000 | SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMS | MI | 501(C)(3) | LINE 12A, I | 0 | DELTA DENTAL PLAN OF MICHIGAN INC | |
| DELTA DENTAL OF ARKANSAS FOUNDATION INC | |||||||||||
| 1513 COUNTRY CLUB RD | SHERWOOD | AR | 72120 | 261269324 | EMPHASIZE DENTAL HEALTH IN COMMUNITIES | AR | 501(C)(3) | PF | 0 | DELTA DENTAL OF ARKANSAS | |
| RENAISSANCE FAMILY FOUNDATION INC | |||||||||||
| 4100 OKEMOS ROAD | OKEMOS | MI | 48864 | 461376165 | EMPHASIZE DENTAL HEALTH IN COMMUNITIES | IN | 501(C)(3) | PF | 0 | RENAISSANCE HOLDING COMPANY | |
| SMILE 180 FOUNDATION | |||||||||||
| 240 VENTURE CIRCLE | NASHVILLE | TN | 37228 | 471654054 | EMPHASIZE DENTAL HEALTH IN COMMUNITIES | TN | 501(C)(3) | LINE 12A, I | 0 | DELTA DENTAL OF TENNESSEE INC | |
| DELTA DENTAL PLAN OF INDIANA INC | |||||||||||
| PO BOX 30416 | LANSING | MI | 489097916 | 351545647 | PROVIDE DENTAL SERVICE PLANS | IN | 501(C)(4) | N/A | 0 | DELTA DENTAL PLAN OF MICHIGAN INC | |
| DELTA DENTAL PLAN OF MICHIGAN INC | |||||||||||
| 4100 OKEMOS ROAD | OKEMOS | MI | 48864 | 381791480 | PROVIDE DENTAL SERVICE PLANS | MI | 501(C)(4) | N/A | 0 | RENAISSANCE HEALTH SERVICE CORPORATION | |
| DELTA DENTAL PLAN OF OHIO INC | |||||||||||
| PO BOX 30416 | LANSING | MI | 489097916 | 310685339 | PROVIDE DENTAL SERVICE PLANS | OH | 501(C)(4) | N/A | 0 | DELTA DENTAL PLAN OF MICHIGAN INC | |
| DELTA DENTAL PLAN OF NEW MEXICO INC | |||||||||||
| 100 SUN AVE NE SUITE 400 | ALBUQUERQUE | NM | 87109 | 850224562 | PROVIDE DENTAL SERVICE PLANS | NM | 501(C)(4) | N/A | 0 | RENAISSANCE HEALTH SERVICE CORPORATION | |
| DELTA DENTAL OF KENTUCKY INC | |||||||||||
| 10100 LINN STATION ROAD NO 700 | LOUISVILLE | KY | 40223 | 610659432 | PROVIDE DENTAL SERVICE PLANS | KY | 501(C)(4) | N/A | 0 | RENAISSANCE HEALTH SERVICE CORPORATION | |
| DELTA DENTAL OF TENNESSEE | |||||||||||
| 240 VENTURE CIRCLE | NASHVILLE | TN | 37228 | 620812197 | PROVIDE DENTAL SERVICE PLANS | TN | 501(C)(4) | N/A | 0 | RENAISSANCE HEALTH SERVICE CORPORATION | |
| DELTA DENTAL PLAN OF ARKANSAS INC | |||||||||||
| 1513 COUNTRY CLUB RD | SHERWOOD | AR | 72120 | 710561140 | PROVIDE DENTAL SERVICE PLANS | AR | 501(C)(4) | N/A | 0 | RENAISSANCE HEALTH SERVICE CORPORATION | |
| DELTA DENTAL OF KENTUCKY FOUNDATION INC | |||||||||||
| 10100 LINN STATION ROAD SUITE 700 | LOUISVILLE | KY | 40223 | 874045357 | EMPHASIZE DENTAL HEALTH IN COMMUNITIES | KY | 501(C)(3) | PF | 0 | DELTA DENTAL OF KENTUCKY | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| CHESME LLC | |||||||||
| 124 N BRIDGE ST | DEWITT | MI | 48820 | 200061957 | CAPITAL MANAGEMENT | MI | N/A | 0 | 0 |
| RED CEDAR INVESTMENT MANAGEMENT LLC | |||||||||
| 333 BRIDGE STREET NW SUITE 601 | GRAND RAPIDS | MI | 49546 | 462667997 | CAPITAL MANAGEMENT | MI | N/A | 0 | 0 |
| DH LOGIX LLC | |||||||||
| 1000 SOUTH MIAMI TRAIL | SARASOTA | FL | 34236 | 815265121 | CAPITAL MANAGEMENT | DE | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| RENAISSANCE HOLDING COMPANY | |||||||||
| PO BOX 30381 | LANSING | MI | 48909 | 412177193 | HOLDING COMPANY | MI | N/A | C | 0 |
| RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA | |||||||||
| PO BOX 30381 | LANSING | MI | 48909 | 470397286 | INSURANCE | IN | N/A | C | 0 |
| RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK | |||||||||
| PO BOX 30381 | LANSING | MI | 48909 | 134098096 | INSURANCE | NY | N/A | C | 0 |
| FORE HOLDING CORPORATION | |||||||||
| 240 VENTURE CIRCLE | NASHVILLE | TN | 37228 | 204116122 | EMPLOYEE BENEFITS | TN | N/A | C | 0 |
| DENTAL CHOICE INC | |||||||||
| 10100 LINN STATION RD SUITE 700 | LOUISVILLE | KY | 40223 | 611105118 | PROVIDE DENTAL SERVICE PLANS | KY | N/A | C | 0 |
| DENTAL CHOICE AGENCY INC | |||||||||
| 10100 LINN STATION RD SUITE 700 | LOUISVILLE | KY | 40223 | 611336003 | PRIMARY GENERAL AGENCY FOR DDKY & DENTAL CHOICE | KY | N/A | C | 0 |
| OMEGA ADMINISTRATORS INC | |||||||||
| 1513 COUNTRY CLUB ROAD | SHERWOOD | AR | 72120 | 043740469 | PROVIDING THIRD-PARTY ADMINISTRATIVE SERVICES | AR | N/A | C | 0 |
| THE 4100 GROUP | |||||||||
| 4100 OKEMOS ROAD | OKEMOS | MI | 48864 | 472557772 | INVESTMENT IN SUBSIDIARIES | MI | N/A | C | 0 |
| DEWPOINT INC | |||||||||
| 300 S WASHINGTON SQUARE | LANSING | MI | 48933 | 383300595 | IT CONSULTING | MI | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| DELTA DENTAL FUND | ||
| B | $100,000 | ACTUAL COST |
| DELTA DENTAL PLAN OF MICHIGAN INC | ||
| M | $5,759,989 | ACTUAL COST |
| RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA | ||
| M | $729,807 | ACTUAL COST |
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