2021-11-11T12:01:40-06:00 2020-12-31 411431613 BERGANKDV LTD 12100 MEREDITH DR SUITE 200 URBANDALE IA 50323 990 2020-01-01 420959302 DELTA DENTAL OF IOWA DELT 5152615500 9000 NORTHPARK DRIVE JOHNSTON IA 50131 SHERRY PERKINS VICE PRES FINANCE & CONTROLLER 5152615500 2021-11-10 1 SHERRY PERKINS 999009999 BRENT L ALEXANDER CPA P00075113 5157275700 2021-11-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z JEFFREY S RUSSELL 9000 NORTHPARK DRIVE JOHNSTON IA 50131 177975622 0 X WWW.DELTADENTALIA.COM X 1970 IA DELTA DENTAL OF IOWA IS COMMITED TO IMPROVING THE HEALTH AND SMILES OF THE PEOPLE WE SERVE. THIS IS ACCOMPLISHED WITH PROGRAMS, EDUCATION AND CONTRIBUTIONS TO VARIOUS HEALTH FOCUSED ENTITIES AND INITIATIVES. DELTA DENTAL OF IOWA INVESTS IN DENTAL PROGRAMS, VISION PROGRAMS, MENTAL HEALTH PROGRAMS AND OTHER HEALTH RELATED INITIATIVES TO SUPPORT THE OVERALL HEALTH OF THE PEOPLE WE SERVE. 9 5 186 0 401773 0 0 0 173317011 165642750 2471775 2595165 398938 411146 176187724 168649061 5077979 6282243 128781110 114606543 17528287 19563881 0 0 0 20310240 21595156 171697616 162047823 4490108 6601238 119217674 151558803 33560936 55579927 85656738 95978876 X DELTA DENTAL OF IOWA'S MISSION IS TO IMPROVE THE HEALTH AND SMILES OF THE PEOPLE WE SERVE. THE PRIMARY WAY THIS IS ACCOMPLISHED IS THROUGH THE PROVISION OF DENTAL BENEFTIS AND PUBLIC HEALTH CONTRIBUTIONS THAT FOCUS ON ACCESS TO ORAL HEALTH SERVICES AND EDUCATION RELATED TO GOOD ORAL HEALTH BEHAVIORS. DELTA DENTAL OF IOWA ALSO INVESTS IN OTHER HEALTH RELATED INITIATIVES SUCH AS VISION AND MENTAL HEALTH PROGRAMS. 0 0 152435602 6282243 165652123 SINCE 1970, DELTA DENTAL OF IOWA HAS EXPANDED ACCESS TO DENTAL CARE BY PROVIDING AFFORDABLE, NETWORK BASED DENTAL BENEFITS PLANS TO IOWA EMPLOYERS AND INDIVIDUALS THAT RESULT IN LONG-TERM COST SAVINGS AND SUPPORT GOOD ORAL HEALTH. DELTA DENTAL OF IOWA'S DENTAL BENEFIT PLANS STRIVE TO INCORPORATE THE CURRENT BEST PRACTICES IN DENTAL SCIENCE. DELTA DENTAL IS COMMITTED TO ITS MISSION OF IMPROVING THE HEALTH AND SMILES OF THE PEOPLE AND COMMUNITIES IT SERVES. DELTA DENTAL FULFILLS ITS NOT-FOR-PROFIT OJECTIVES BY ACTIVELY PARTICIPATING IN THE COMMUNITIES IT SERVES AS A CHAMPION AND MAJOR FUNDER OF ORAL HEALTH INITIATIVES IN THE STATE OF IOWA. DELTA DENTAL INVESTS IN ORAL HEALTH PROJECTS THAT MEET THE NEEDS OF UNDERSERVED POPULATIONS AND THAT FOCUS ON ACCESS TO CARE,PREVENTION, EDUCATION AND RESEARCH. 152435602 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 1 18028 0 1 186 1 1 1 0 0 0 0 0 0 0 X 9 5 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X SHERRY PERKINS 5152615500 9000 NORTHPARK DRIVE JOHNSTON IA 50131 JEFFREY S RUSSELL PRESIDENT AND CEO 40.00 0.39 X X 1152205 0 60242 TODD HERREN SENIOR VP, TECHNOLOGY & OPERATIONS 40.00 X 505233 0 46622 JEFF CHAFFIN DENTAL DIRECTOR 40.00 1.17 X 522413 0 24656 APRIL SCHMALTZ SENIOR VP, MARKETING & SALES 40.00 X 452843 0 46620 ELIZABETH MYERS VP, OPERATIONS 40.00 X 464640 0 24656 MICHAEL ELAM VP, UNDERWRITING & ACTUARIAL 40.00 X 396027 0 46788 SHERRY PERKINS VP, FINANCE & CONTROLLER 40.00 0.67 X 406201 0 24487 SUZANNE HECKENLAIBLE VP, PUBLIC AFFAIRS 30.00 10.00 X 365508 0 60290 RANAE CALVERT DIRECTOR, STRATEGIC BUSINESS 40.00 X 188533 0 53245 RYAN BLACKARD DIRECTOR, MARKETING 40.00 X 185164 0 55376 CAROL RAMSEY SMITH DIRECTOR OF COMPLIANCE & QA 40.00 X 174520 0 52287 GRETCHEN HAGEMAN VP, GOVERNMENT PROGRAMS 40.00 X 200360 0 16548 BETH RUSSETT DIRECTOR, HUMAN RESOURCES 40.00 X 155447 0 25723 JILL GOEHRING-FEILMEIER DIRECTOR, CORPORATE COMMUNICATIONS 40.00 X 160697 0 14381 CHARLES EDWARD BROWN DIRECTOR 2.50 X 29600 0 0 JOHN MALETTA DDS DIRECTOR 1.60 X 3700 0 19500 ROWENA CROSBIE DIRECTOR 1.60 1.00 X 800 900 19500 GREGORY DUNN DIRECTOR 1.60 X 20000 0 0 KRISTA TANNER DIRECTOR 1.60 X 19500 0 0 DONNA GRANT DIRECTOR 1.60 X 18500 600 0 TOM MAHONEY DIRECTOR 1.60 X 1532 0 16968 WILLIAM WEVER DDS DIRECTOR 1.60 X 2550 0 11450 SCOTT YEGGE DDS DIRECTOR 1.60 X 11400 0 0 5437373 1500 619339 30 0 1 0 UNIVERSITY OF IOWA 322 DENTAL SCIENCE BLDG S IOWA CITY IA 52242 DENTAL SERVICES 6652522 APPLEWHITE DENTAL IOWA PC 1340 DELHI ST DUBUQUE IA 52001 DENTAL SERVICES 4125637 DENTISTRY FOR CHILDREN OF IOWA PLC 1350 SPRING ST NW SUITE 600 ATLANTA GA 30309 DENTAL SERVICES 2650541 ORAL SURGEONS PC 7400 FLEUR DRIVE SUITE 200 DES MOINES IA 50321 DENTAL SERVICES 2299703 IOWA DENTAL HEALTH PROFESSIONALS 1850 E 53RD STREET SUITE 5 DAVENPORT IA 52807 DENTAL SERVICES 1696775 631 PREMIUMS EARNED 524114 152285751 152285751 ADMINISTRATIVE SERVICE REVENUE 524292 13356999 13356999 165642750 2496553 2496553 9425173 9326561 98612 98612 98612 MANAGEMENT FEES 541610 401773 401773 OTHER INCOME 900099 9373 9373 411146 168649061 165652123 401773 2595165 6282243 6282243 114606543 114606543 4991337 2258107 2733230 10446898 8472077 1974821 1513429 961323 552106 1563241 1563115 126 1048976 745226 303750 258489 11346 247143 194178 50000 144178 46878 46878 179308 179308 3990050 3608799 381251 1162385 1104391 57994 3470688 2867229 603459 632667 632667 44563 28849 15714 51345 9198 42147 2202308 1726547 475761 246108 246108 BROKER COMMISSIONS 5976151 5976151 ACA HEALTH INSURERS 1147154 1147154 PREMIUM TAXES 891115 891115 DDPA DUES 439558 439558 662211 126189 536022 162047823 152435602 9612221 0 28567012 52171300 4021832 919703 3730047 6180746 488878 685705 33860393 18323769 17103182 15536624 60622116 69212809 2862372 3870960 1822235 2980956 119217674 151558803 10757841 15969419 22803095 39610508 33560936 55579927 X 85656738 95978876 85656738 95978876 119217674 151558803 6601238 3720900 0 X X 0 1 X 1 0 2665500 2665500 11851832 2479641 9372191 18007477 15128055 2879422 1335584 716073 619511 15536624 UNEARNED PREMIUMS 2788127 CLAIMS UNPAID AND RESERVE 6108228 OTHER POLICY RESERVES 27569595 INCENTIVE POOL RESERVE 554000 INTERCOMPANY PAYABLE 447485 OTHER LONG TERM LIABILITIES 2143073 39610508 X PART X, LINE 2: DELTA DENTAL OF IOWA IS EXEMPT FROM FEDERAL INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE COMPANY ACCOUNTS FOR INCOME TAXES OF TAXABLE CONSOLIDATED ENTITIES, WHEREBY DEFERRED TAXES ARE PROVIDED ON TEMPORARY DIFFERENCES ARISING FROM ASSETS AND LIABILITIES WHOSE BASES ARE DIFFERENT FOR FINANCIAL REPORTING AND INCOME TAX PURPOSES. DEFERRED TAXES WERE NOT SIGNIFICANT TO THE CONSOLIDATED FINANCIALS STATEMENTS. AS OF DECEMBER 31, 2020 AND 2019, THE COMPANY'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED OR ACCURED DURING 2020 AND 2019 1 DELTA DENTAL OF IOWA FOUNDATION 9000 NORTHPARK DRIVE JOHNSTON IA 50131 260762771 501(C)(3) 5608977 CONTRIBUTION TO DELTA DENTAL OF IOWA FOUNDATION TO SUPPORT & IMPROVE THE ORAL HEALTH OF IOWANS COMMUNITY FOUNDATION OF GREATER DES MOINES 1915 GRAND AVE DES MOINES IA 50309 426139033 501(C)(3) 150000 CONTRIBUTION TO CFGDM FOR THE DDIA DONOR ADVISED FUND. THE DONOR ADVISED FUND IS USED FOR THE REPAYMENT OF DENTAL EDUCATION DEBT FOR A DENTIST WHO AGREES TO ESTABLISH AN OFFICE IN A RURAL, UNDERSERVED AREA. UNITED WAYS OF IOWA 1111 NINTH STREET STE 295 DES MOINES IA 50314 421216277 501(C)(3) 25000 DONATION TO ESTABLISH A STATEWIDE ASSOCIATION TO SERVE AND STRENGTHEN IOWA'S NONPROFIT SECTOR IOWA RESTAURANT ASSOCIATION EDUCATION FOUNDATION 1501 42ND STREET WEST DES MOINES IA 50266 421505368 501(C)(3) 10000 DONATION TO THE IOWA RESTAURANT EMPLOYEE RELIEF FUND HYVEE INC 5820 WESTOWN PARKWAY WEST DES MOINES IA 50266 420325638 N/A 24750 DONATION FOR KIDS FIT THE IOWA CENTER FOR ECONOMIC SUCCESS 2210 GRAND AVE DES MOINES IA 50312 201037604 501(C)(3) 50000 SMALL BUSINESS GRANT IOWA FOOD BANK ASSOCIATION PO BOX 2397 WATERLOO IA 50704 271554605 501(C)(3) 140000 DONATION TO FOOD BANK DURING PANDEMIC - FEEDING IOWA 6 1 PART I, LINE 2: DELTA DENTAL OF IOWA MAINTAINS A DONOR ADVISED FUND AT THE COMMUNITY FOUNDATION OF GREATER DES MOINES FOR THE PURPOSE OF AWARDING LOAN REPAYMENT AWARDS TO DENTISTS WHO AGREE TO PRACTICE IN AN UNDERSERVED AREA IN THE STATE OF IOWA AND TO DEDICATE A PORTION OF THEIR PRACTICE TO LOW INCOME PATIENTS. DELTA DENTAL OF IOWA ADVISES THE COMMUNITY FOUNDATION OF GREATER DES MOINES ON HOW TO AWARD THIS MONEY AND THE COMMUNITY FOUNDATION OF GREATER DES MOINES ONLY GRANTS THIS MONEY TO DENTISTS IN THE STATE OF IOWA. THE COMMUNITY FOUNDATION OF GREATER DES MOINES AND DELTA DENTAL OF IOWA MAINTAIN RECORDS TO SUBSTANTIATE THE AMOUNT OF GRANTS, THE GRANTEEES' ELIGIBILITY AND THE SELECTION CRITERIA. DELTA DENTAL OF IOWA ALSO MAKES GRANTS TO THE DELTA DENTAL OF IOWA FOUNDATION. THE DELTA DENTAL OF IOWA FOUNDATION MAINTAINS RECORDS TO SUBSTANTIATE THE AMOUNT OF GRANTS, THE GRANTEES' ELIGIBILITY AND THE SELECTION CRITERIA. ORGANIZATIONS RECEIVING GRANTS ARE REQUIRED TO SUBMIT FINANCIAL INFORMATION. X X X 1 1 X X X X X 0 1 0 1 0 1 0 0 0 JEFFREY S RUSSELL PRESIDENT AND CEO 744733 0 270421 0 137051 0 22800 0 37442 0 1212447 0 121310 0 TODD HERREN SENIOR VP, TECHNOLOGY & OPERATIONS 339336 0 113045 0 52852 0 22800 0 23822 0 551855 0 50735 0 JEFF CHAFFIN DENTAL DIRECTOR 329636 0 105520 0 87257 0 22800 0 1856 0 547069 0 83715 0 APRIL SCHMALTZ SENIOR VP, MARKETING & SALES 314213 0 101664 0 36966 0 22800 0 23820 0 499463 0 35037 0 ELIZABETH MYERS VP, OPERATIONS 297805 0 98363 0 68472 0 22800 0 1856 0 489296 0 65112 0 MICHAEL ELAM VP, UNDERWRITING & ACTUARIAL 286483 0 107274 0 2270 0 22800 0 23988 0 442815 0 0 0 SHERRY PERKINS VP, FINANCE & CONTROLLER 271638 0 91121 0 43442 0 22800 0 1687 0 430688 0 41546 0 SUZANNE HECKENLAIBLE VP, PUBLIC AFFAIRS 249501 0 86024 0 29983 0 22800 0 37490 0 425798 0 28057 0 RANAE CALVERT DIRECTOR, STRATEGIC BUSINESS 151909 0 35134 0 1490 0 15756 0 37489 0 241778 0 0 0 RYAN BLACKARD DIRECTOR, MARKETING 149939 0 33735 0 1490 0 15549 0 39827 0 240540 0 0 0 CAROL RAMSEY SMITH DIRECTOR OF COMPLIANCE & QA 140229 0 32791 0 1500 0 14797 0 37490 0 226807 0 0 0 GRETCHEN HAGEMAN VP, GOVERNMENT PROGRAMS 166146 0 32240 0 1974 0 14860 0 1688 0 216908 0 0 0 BETH RUSSETT DIRECTOR, HUMAN RESOURCES 127348 0 26609 0 1490 0 12722 0 13001 0 181170 0 0 0 JILL GOEHRING-FEILMEIER DIRECTOR, CORPORATE COMMUNICATIONS 131787 0 27220 0 1690 0 12693 0 1688 0 175078 0 0 0 PART I, LINE 1A TRAVEL FOR THE SPOUSE OF THE PRESIDENT AND CEO IS PAID BY THE COMPANY. THE TOTAL AMOUNT OF THE TRAVEL IS INCLUDED IN TAXABLE WAGES FOR THE PRESIDENT AND CEO. TAX GROSS UP PAYMENTS ARE RELATED TO TAXABLE FRINGE BENEFITS INCLUDED AS COMPENSATION FOR ALL COMPANY EMPLOYEES INCLUDING THE PERSONS LISTED IN PART VII, SECTION A, LINE 1. THE PAYMENTS REPRESENT 1% OR LESS OF COMPENSATION FOR THE INDIVIDUALS. SOCIAL CLUB DUES FOR THE PRESIDENT & CEO ARE PAID BY THE COMPANY. THE AMOUNT OF PERSONAL USAGE OF THE CLUB IS INCLUDED IN TAXABLE WAGES FOR THE PRESIDENT & CEO. PART I, LINE 4B EFFECTIVE JANUARY 1, 2016, THE OFFICERS OF DELTA DENTAL OF IOWA PARTICIPATE IN A SEC. 457(F) PLAN. DELTA DENTAL OF IOWA MAKES A CONTRIBUTION TO THE PLAN ANNUALLY ON BEHALF OF THE OFFICERS. THIS CONTRIBUTION IS A PERCENTAGE OF SALARY AND IS SET AND APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF DELTA DENTAL OF IOWA. THE PORTION OF A PARTICIPANT'S ACCOUNT BALANCE ALLOCATED TO A PARTICULAR PLAN YEAR'S AWARD BECOMES VESTED ON JANUARY 1ST OF THE FOURTH YEAR FOLLOWING THE PLAN YEAR FOR WHICH THE AWARD IS GRANTED. THAT AMOUNT IS THEN PAID TO THE OFFICER. OTHER THAN THE VESTING CRITERIA, THE OFFICERS CANNOT ACCESS THE FUNDS UNTIL RETIREMENT, LEAVING THE COMPANY, OR DEATH. OFFICERS WHO RECEIVED DEPOSITS IN 2020 FROM DELTA DENTAL OF IOWA AND THE AMOUNTS ARE: SHERRY PERKINS - $8,162 SUZANNE HECKENLAIBLE - $6,792 JEFFREY S. RUSSELL - $54,727 JEFF CHAFFIN - $29,254 MICHAEL ELAM - $39,298 TODD HERREN - $20,173 APRIL SCHMALTZ - $10,984 ELIZABETH MYERS - $36,999 GRETCHEN HAGEMAN - $33,249 OFFICERS THAT RECEIVED PAYMENTS OF VESTED AMOUNTS IN 2020 AND THE AMOUNTS ARE: SHERRY PERKINS - $41,546 SUZANNE HECKENLAIBLE - $28,057 JEFFREY S. RUSSELL - $121,310 JEFF CHAFFIN - $83,715 TODD HERREN - $50,735 APRIL SCHMALTZ - $35,037 ELIZABETH MYERS - $65,112 MICHAEL ELAM - $53,908 THE OFFICERS OF DELTA DENTAL OF IOWA ALSO PARTICIPATE IN A LONG-TERM INCENTIVE PLAN. THE PLAN IS INTENDED AND AT ALL TIMES SHALL BE AN UNFUNDED AND UNSECURED PLAN THAT IS LIMITED TO KEY MANAGEMENT EMPLOYEES OF THE ORGANIZATION DESIGNED TO ENHANCE THE BOARD'S EFFORT AT RETENTION OF ITS EXECUTIVE STAFF. OFFICERS THAT RECEIVED PAYMENTS IN LONG-TERM INCENTIVE PLAN: SHERRY PERKINS - $60,459 SUZANNE HECKENLAIBLE - $56,064 JEFFREY S. RUSSELL - $185,762 JEFF CHAFFIN - $67,103 TODD HERREN - $71,453 APRIL SCHMALTZ - $60,794 ELIZABETH MYERS - $61,622 MICHAEL ELAM - $53,151 PART I, LINE 5 ONE EMPLOYEE OF THE COMPANY HAS COMPENSATION CONTINGENT ON REVENUES. THE INDIVIDUAL WORKS IN THE SALES DEPARTMENT AND RECEIVES COMMISSIONS BASED ON SALES OF GROUP BUSINESS. THE INDIVIDUAL IS RESPONSIBLE FOR SELLING NEW BUSINESS. PART I, LINE 6 CONSISTENT WITH THE COMPANY'S TOTAL COMPENSATION POLICY, THE OFFICERS AND KEY EMPLOYEES, ALONG WITH ALL EMPLOYEES OF THE COMPANY, PARTICIPATE IN A COMPANY INCENTIVE COMPENSATION PLAN. THIS PLAN CONTAINS NINE METRICS WHICH REPRESENT KEY GOALS FOR THE PLAN YEAR. AN OVERALL WEIGHTED SCORE IS CALCULATED. A BONUS WILL BE PAID IF THE COMPANY MEETS A RANGE OF GOAL ACCOMPLISHMENTS FOR THE YEAR. THE AMOUNT OF THE BONUS IS BASED ON THE TOTAL SCORE. ONE OF THESE METRICS IS PROFITABILITY, WHICH IS DEFINED AS "TOTAL NET GAIN IN DOLLARS PRIOR TO PUBLIC BENEFIT CONTRIBUTIONS FOR THE FISCAL YEAR PER AUDITED FINANCIAL RESULTS." DONNA GRANT DIRECTOR 232942 INDEPENDENT CONTRACTOR - PAYMENTS FROM DDIA FOR DENTAL SERVICES 0 SCOTT YEGGE DIRECTOR 271278 INDEPENDENT CONTRACTOR - PAYMENTS FROM DDIA FOR DENTAL SERVICES 0 GREG DUNN DIRECTOR 284893 EMPLOYED BY BROKER WITH CLIENTS OF DDIA; RECEIVES COMMISSIONS AND BONUS COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE CORPORATION CONSIST OF THE PROVIDERS (PARTICIPATING DENTISTS), AND SUBSCRIBERS WHO ARE ELECTED BY THE BOARD. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS SHALL BE ELECTED BY THE MEMBERS. SUBSCRIBER MEMBERS MAY NOMINATE CANDIDATES FOR SUBSCRIBER DIRECTOR POSITIONS AND PROVIDER MEMBERS MAY NOMINATE CANDIDATES FOR THE PROVIDER DIRECTOR POSITIONS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 AND ALL RELATED SCHEDULES WERE REVIEWED BY BOTH THE MANAGEMENT OF THE COMPANY AND THE BOARD OF DIRECTORS PRIOR TO FILING. THE FORM 990 WAS REVIEWED BY MANAGEMENT OF THE COMPANY PRIOR TO PRESENTATION TO THE BOARD. THE MEMBERS OF THE MANAGEMENT TEAM WHO REVIEWED THE FORM 990 WERE THE CEO, COMPLIANCE MANAGER, AND VICE PRESIDENT FINANCE. AN ELECTRONIC DRAFT COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS. ALL MEMBERS OF THE BOARD REVIEWED THE FORM 990 AND RELATED SCHEDULES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE COMPLIANCE MANAGER, ON BEHALF OF THE GOVERNANCE COMMITTEE, CONDUCTS AN ANNUAL CONFLICT OF INTEREST REVIEW FOR COMPLIANCE WITH FEDERAL AND STATE LAW AND THE GOVERNANCE POLICY. THE REVIEW INCLUDES ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES. COMPLETED CONFLICT OF INTEREST QUESTIONNAIRES AND DISCLOSURES ARE COMPARED TO THE GROUP FOR POTENTIALLY CONFLICTING TRANSACTIONS, BUSINESS AND FAMILY RELATIONSHIPS, AND AFFILIATIONS. ANNUAL COMPENSATION, REIMBURSEMENTS, BENEFIT PAYMENTS, AND OTHER TRANSACTIONS ARE ALSO REVIEWED FOR APPROPRIATENESS. A WRITTEN REPORT OF THE FINDINGS IS PRESENTED TO THE GOVERNANACE COMMITTEE, BOARD OF DIRECTORS AND SENIOR MANAGEMENT. SOLUTIONS TO POTENTIAL CONFLICTS ARE DISCUSSED AND DOCUMENTED IN THE BOARD OF DIRECTOR'S MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 ON A BI-ANNUAL BASIS, DELTA DENTAL OF IOWA DOES A MARKET PRICE AND BENCHMARKING COMPARISON OF THE COMPENSATION OF THE LEADERSHIP TEAM AND THE STAFF. THIS ANALYSIS IS PERFORMED BY AN INDEPENDENT THIRD PARTY. THIS ANALYSIS INCLUDES THE USE OF DATA AS TO COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. THE DOCUMENTED RESULTS AND RECOMMENDATIONS OF THIS ANALYSIS ARE PRESENTED TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS REVIEWS THE DOCUMENTATION AND APPROVES THE COMPENSATION. THESE DECISIONS ARE DOCUMENTED IN THE MINUTES OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 DELTA DENTAL OF IOWA'S GOVERNING DOCUMENTS BECOME A MATTER OF PUBLIC RECORD WHEN THEY ARE FILED WITH THE IOWA SECRETARY OF STATE. THE FINANCIAL STATEMENTS BECOME A MATTER OF PUBLIC RECORD WHEN THEY ARE FILED WITH THE IOWA INSURANCE DIVISION. BOTH AGENCIES HAVE ONLINE PUBLIC VIEWING ACCESS. THE CONFLICT OF INTEREST POLICY IS NOT FILED WITH THE STATE AGENCIES; HOWEVER, IT WOULD BE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 2C: THE ORGANIZATION HAS A FINANCE AND AUDIT COMMITTEE THAT HAS RESPONSIBILITY FOR SELECTION OF THE INDEPENDENT ACCOUNTANT AND OVERSIGHT OF THE AUDIT. THE BOARD OF DIRECTORS APPROVES THE ANNUAL APPOINTMENT OF THE INDEPENDENT ACCOUNTANT. SCHEDULE R, PART I, COLUMN B: VERATRUS INVESTMENTS, LLC IS A FOR-PROFIT CORPORATION OWNED BY VERATRUS HEALTH, INC. VERATRUS INVESTMENTS, LLC INVESTS IN ORGANIZATIONS THAT FURTHER THE MISSION OF VERATRUS HEALTH, INC. SCHEDULE R, PART II, COLUMN B: DELTA DENTAL OF IOWA'S MISSION IS TO IMPROVE THE HEALTH AND SMILES OF THOSE WE SERVE. AN AMOUNT IS SET ASIDE EACH YEAR TO FUND THIS MISSION. THE AMOUNT IS DETERMINED BY THE PERFORMANCE AND FINANCIAL STRENGTH OF THE COMPANY. AFTER THE AUDITED FINANCIALS ARE COMPLETE, AN AMOUNT IS PAID TO THE DELTA DENTAL OF IOWA FOUNDATION. THE DELTA DENTAL OF IOWA FOUNDATION IS A SEC. 501(C)3 ORGANIZATION AND IS A TYPE 1 SUPPORTING ORGANIZATION UNDER SEC. 509(A)(3). IT IS THE RESPONSIBILITY OF THE FOUNDATION TO DISTRIBUTE THE MONIES CONSISTENT WITH ITS MISSION AND FOUNDING DOCUMENTS. THE MISSION OF THE DELTA DENTAL OF IOWA FOUNDATION IS TO SUPPORT AND IMPROVE THE ORAL HEALTH OF IOWANS. THE FOUNDATION WILL PROVIDE FUNDS TO OTHER SEC. 501(C)(3) ORGANIZATIONS, GOVERNMENTS, OR ACADEMIC INSTITUTIONS THAT ARE UNDERTAKING PROJECTS THAT SUPPORT AND IMPROVE THE ORAL HEALTH OF IOWANS. THE FOUNDATION WILL PROVIDE FUNDS TO OTHER TAX-EXEMPT ORGANIZATIONS THROUGH THEIR GRANTS PROGRAM THAT ALIGN WITH THE PROJECTS OF ACCESS TO CARE, RESEARCH, EDUCATION AND PREVENTION. THE AMOUNT CONTRIBUTED TO THE FOUNDATION IN 2020 WAS $5,608,977 ADDITIONALLY, DELTA DENTAL OF IOWA PROVIDES MANAGEMENT SERVICES FOR THE FOUNDATION. THIS INCLUDES DUTIES PERFORMED BY THE CHIEF EXECUTIVE OFFICER AND THE VICE PRESIDENT, FINANCE. THE EXECUTIVE DIRECTOR OF THE FOUNDATION IS THE DIRECTOR OF GOVERNMENT AND COMMUNITY RELATIONS FOR DELTA DENTAL OF IOWA. ALSO, DELTA DENTAL OF IOWA PROVIDES SOME ACCOUNTING FUNCTIONS. THE FOUNDATION REIMBURSES DELTA DENTAL OF IOWA FOR ALL STAFF CHARGES RELATED TO THE FOUNDATION. THE AMOUNT REIMBURSED TO DELTA DENTAL OF IOWA IN 2020 WAS $464,045 FOR MANAGEMENT FEES AND $38,157 FOR OTHER EXPENSES. SCHEDULE R, PART IV, COLUMN B: VERATRUS BENEFIT SOLUTIONS, INC. IS A FOR-PROFIT CORPORATION AND A WHOLLY-OWNED SUBSIDIARY OF VERATRUS HEALTH. PRIOR TO 2017, IT WAS A WHOLLY OWNED SUBSIDIARY OF DELTA DENTAL OF IOWA. VERATRUS WAS ORGANIZED TO DISTRIBUTE THE DELTA VISION PRODUCT. DELTA DENTAL OF IOWA MADE NO ADDITIONAL INVESTMENTS IN PAID IN CAPITAL IN VERATRUS IN 2020. DELTA DENTAL OF IOWA COLLECTS PREMIUMS FROM GROUPS FOR VISION COVERAGE AND TRANSFERS THIS PREMIUM TO VERATRUS. IN 2020, DELTA DENTAL OF IOWA TRANSFERRED $5,692,563 TO VERATRUS FOR PREMIUM COLLECTED ON THEIR BEHALF. IN ADDITION, DELTA DENTAL OF IOWA PROVIDES MANAGEMENT SERVICES TO VERATRUS. VERATRUS REIMBURSES DELTA DENTAL OF IOWA FOR ALL STAFF CHARGES RELATED TO VERATRUS. THE AMOUNT REIMBURSED TO DELTA DENTAL OF IOWA IN 2020 WAS $401,773 FOR MANAGEMENT FEES AND $708,665 FOR OTHER EXPENSES. DELTA DENTAL OF IOWA ALSO PURCHASES VISION BENEFITS FROM VERATRUS FOR DDIA EMPLOYEES. THE AMOUNT PAID TO VERATRUS IN 2020 FOR VISION BENEFITS FOR DDIA EMPLOYEES WAS $30,934. SCHEDULE R, PART IV, COLUMN B: VERATRUS HEALTH, INC. IS A FOR PROFIT CORPORATION FORMED IN 2017 AND IS WHOLLY-OWNED BY DELTA DENTAL OF IOWA. IN 2017, DELTA DENTAL OF IOWA TRANSFERRED 100% OF THE OWNERSHIP OF VERATRUS BENEFIT SOLUTIONS TO VERATRUS HEALTH, INC. VALUED AT $624,541. VERATRUS INVESTMENTS LLC 9000 NORTHPARK DRIVE JOHNSTON IA 50131 384028167 INVESTING IN ORGANIZATIONS THAT FURTHER THE MISSION OF VERATRUS HEALTH, INC. IA 0 0 VERATRUS HEALTH INC DELTA DENTAL OF IOWA FOUNDATION 9000 NORTHPARK DRIVE JOHNSTON IA 50131 260762771 NP ORGANIZED TO STRENGTHEN AND TRANSFORM THE HEALTH AND SMILES OF ALL IOWANS IA 501(C)(3) LINE 12A, I DELTA DENTAL OF IOWA 1 VERATRUS HEALTH INC 9000 NORTHPARK DRIVE JOHNSTON IA 50131 815414506 HOLDING COMPANY IA DENTAL DENTAL OF IOWA C 5687109 3904453 1.00000 1 VERATRUS BENEFIT SOLUTIONS INC 9000 NORTHPARK DRIVE JOHNSTON IA 50131 271584394 FOR-PROFIT CORPORATION ORGANIZED TO DISTRIBUTE THE DELTA VISION PRODUCT. IA VERATRUS HEALTH INC C 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 DELTA DENTAL OF IOWA FOUNDATION B 5608977 SEE PART VII - SUPPLEMENTAL INFO. DELTA DENTAL OF IOWA FOUNDATION O 464045 SEE PART VII - SUPPLEMENTAL INFO. VERATRUS BENEFIT SOLUTIONS INC O 401773 SEE PART VII - SUPPLEMENTAL INFO. VERATRUS BENEFIT SOLUTIONS INC R 5692563 SEE PART VII - SUPPLEMENTAL INFO. VERATRUS BENEFIT SOLUTIONS INC Q 708665 SEE PART VII - SUPPLEMENTAL INFO. FORM 990, SCHEDULE R, PART V, LINE 2(1), COLUMN D: PERCENTAGE OF REVENUE BASED ON BOARD APPROVED POLICY FORM 990, SCHEDULE R, PART V, LINE 2(2), COLUMN D: MANAGEMENT FEES CHARGED TO DELTA DENTAL OF IOWA FOUNDATION BASED ON HOURS WORKED FORM 990, SCHEDULE R, PART V, LINE 2(3), COLUMN D: MANAGEMENT FEES CHARGED TO VERATRUS BENEFIT SOLUTIONS, INC. BASED ON HOURS WORKED FORM 990, SCHEDULE R, PART V, LINE 2(4), COLUMN D: VISION PREMIUMS BILLED AND COLLECTED BY DDIA ON BEHALF OF VERATRUS BENEFIT SOLUTIONS, INC. CASH WAS TRANSFERRED FROM DDIA TO VERATRUS FOR THESE PREMIUMS. FORM 990, SCHEDULE R, PART V, LINE 2(5), COLUMN D: ACTUAL COST OF INVOICES PAID BY DDIA ON BEHALF OF VERATRUS BENEFIT SOLUTIONS, INC.