2021-05-19T15:54:17-05:00 2020-12-31 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2020-01-01 460309258 DELTA DENTAL OF SOUTH DAKOTA DELT 6052247345 PO BOX 1157 PIERRE SD 57501 SCOTT JONES PRESIDENT & CEO 6052247345 2021-05-06 1 SCOTT JONES 999009999 LAURIE HANSON CPA P00851848 6053391999 2021-05-06 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z SCOTT JONES PO BOX 1157 PIERRE SD 57501 93425364 0 X WWW.DELTADENTALSD.COM X 1963 SD DEDICATED TO ADVANCING AND PROMOTING THE IMPROVEMENT OF ORAL HEALTH. 15 8 94 0 2651728 0 0 0 78548655 82070230 1929412 2068744 2585178 2638742 83063245 86777716 3324874 4725369 0 0 7376934 7976569 0 0 0 70650386 73739618 81352194 86441556 1711051 336160 51433670 57304768 7210990 10545400 44222680 46759368 DELTA DENTAL OF SOUTH DAKOTA IS DEDICATED TO ADVANCING AND PROMOTING THE IMPROVEMENT OF ORAL HEALTH. 0 0 75977665 4725369 82070230 DELTA DENTAL PAID THROUGH ITS CONTRACTS WITH INDEPENDENT DENTISTS 585,442 CLAIMS FOR DENTAL BENEFIT SERVICES FOR APPROXIMATELY 317,028 INDIVIDUALS WITH GROUP PLANS, 2,645 INDIVIDUALS WITH DENTAL ACCIDENT PLANS, 123,920 SOUTH DAKOTA MEDICAID RECIPIENTS, AND 95,000 NATIVE AMERICANS UNDER ABERDEEN AREA HEALTH SERVICES. DELTA DENTAL ALSO GRANTED THE DELTA DENTAL OF SOUTH DAKOTA FOUNDATION, A 501(C)(3) CHARITABLE ORGANIZATION, $4,425,000 TO PROMOTE THE IMPROVEMENT OF ORAL HEALTH. 75977665 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 1 4404 0 1 94 1 1 1 0 0 0 0 0 0 0 X 15 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X KIRBY SCOTT 6052247345 720 N EUCLID AVE PIERRE SD 57501 PAUL REZICH DDS CHAIR 2.00 1.00 X X 15200 0 0 MONTY BECHTOLD DDS VICE CHAIR 1.00 1.00 X X 13035 0 0 GREG GERTSEN DDS SECRETARY 1.00 0.00 X X 9100 5550 0 JOHN CLAUSEN CPA TREASURER 2.00 1.00 X X 14350 0 0 STEVE CULHANE DIRECTOR 1.00 0.00 X 7850 0 0 JEFF FEIOCK DDS DIRECTOR 1.00 0.00 X 8825 0 0 G VERNE GOODSELL DIRECTOR 1.00 0.00 X 10200 0 0 GREG HANSON DDS DIRECTOR 1.00 0.00 X 8950 14250 0 JASON AANENSON DDS DIRECTOR 1.00 0.00 X 8950 0 0 ELLEN LEE DIRECTOR 1.00 1.00 X 8950 0 0 ANLEE ROLA DDS DIRECTOR 1.00 1.00 X 8950 0 0 THANE CRUMP DDS DIRECTOR 1.00 1.00 X 8950 0 0 THOMAS HUBER MD DIRECTOR 1.00 0.00 X 8950 0 0 CHRIS MAXWELL DIRECTOR 1.00 0.00 X 8950 0 0 TOM SIMMONS DIRECTOR 1.00 0.00 X 8950 0 0 SCOTT JONES PRESIDENT & CEO 40.00 1.00 X 957735 0 53307 KIRBY SCOTT VP OF FINANCE/CFO 40.00 1.00 X 219344 0 38792 EUGENE TETZLAFF VP OF IT 40.00 1.00 X 207503 0 50375 MICK HECKENLAIBLE VP OF OPERATIONS 40.00 1.00 X 239805 0 54328 JEFF MILLER EXECUTIVE DIRECTOR 40.00 1.00 X 272442 0 56384 CONNIE HALVERSON VP OF PUBLIC RELATIONS 10.00 30.00 X 176720 0 53668 JEFF HEPPNER DIRECTOR OF MODERNIZATION 40.00 0.00 X 166535 0 47197 GEORGE ALLEN DATA ANALYST 40.00 0.00 X 185095 0 16929 SARA GREEN UNDERWRITING ANALYST 40.00 0.00 X 125054 0 37854 LORI HALL DIRECTOR OF CLAIMS PROCESSING 40.00 0.00 X 117070 0 20729 JAMEY HERR SYSTEM NETWORK ADMINISTRATOR 40.00 0.00 X 120013 0 34043 2937476 19800 463606 16 0 1 0 MIDWEST BENEFITS PO BOX 10481 DES MOINES IA 50306 COMMISSIONS 200000 1 PREMIUM EARNED 812900 82070230 82070230 82070230 1609575 1609575 38700 51686 -12986 -12986 -12986 7055131 6595962 459169 459169 459169 MANAGEMENT FEE INCOME 541610 2651728 2651728 2651728 86777716 82070230 2651728 2055758 4725369 4725369 2391933 2391933 2510495 2510495 1701174 1701174 1030877 1030877 342090 342090 69412 69412 103661 103661 72177 72177 389242 389242 356984 356984 585045 585045 125435 125435 88851 88851 17332 17332 215655 215655 338232 338232 173206 173206 CLAIMS INCURRED 65593535 65593535 MANAGEMENT SERVICE EXPE 2468516 2468516 COMMISSIONS 1404844 1404844 ALLOCATED CLAIMS ADJUST 0 4253917 -4253917 1737491 1737491 86441556 75977665 10463891 0 108321 9353 5764441 5389171 7195928 8172818 218981 371936 8196413 4442790 3775103 3753623 26161015 34366795 7950799 3556087 259082 1684985 51433670 57304768 3978249 4304122 3232741 6241278 7210990 10545400 X 44222680 46759368 44222680 46759368 51433670 57304768 336160 2200528 0 X 0 1 X 1 0 397371 397371 5068171 2120738 2947433 2730871 2322052 408819 3753623 INVESTMENT IN SPRINGROCK VENTURES II LP 561945 F INVESTMENT IN LINK DDS 2994142 F 3556087 UNPAID CLAIMS AND CLAIMS INCURRED BUT NOT REPORTED 2237000 UNPAID CLAIMS ADJUSTMENT EXPENSES 223700 COST PLUS GROUP DEPOSITS 74100 DEFERRED PREMIUMS 1341306 AGGREGATE HEALTH POLICY RESERVE 2100000 ADMINISTRATIVE REIMBURSEMENT PAYABLE 265172 6241278 X 86489237 2200528 -2468516 -267988 86757225 72177 -51686 20491 86777716 83952549 51686 51686 83900863 72177 2468516 2540693 86441556 PART X, LINE 2: ACCOUNTING STANDARDS PRESCRIBE A RECOGNITION THRESHOLD OF MORE LIKELY THAN NOT, AND A MEASUREMENT ATTRIBUTE FOR ALL TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN, IN ORDER FOR THOSE TAX POSITIONS TO BE RECOGNIZED IN THE FINANCIAL STATEMENTS. AT DECEMBER 31, 2020 AND 2019 THE COMPANY BELIEVES THAT THERE ARE NO UNCERTAIN TAX POSITIONS OR LIABILITIES, OR INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS. IF THE COMPANY HAD INTEREST AND PENALTIES RELATED TO UNCERTAIN TAX POSITIONS, IT WOULD BE ACCOUNTED FOR AS A COMPONENT OF INCOME TAX EXPENSE. PART XI, LINE 2D - OTHER ADJUSTMENTS: ADMINISTRATION SERVICE EXPENSES RECLASSIFIED FOR 990 -2,468,516. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES RECLASSIFIED TO REVENUE FOR 990 -51,686. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES RECLASSIFIED TO REVENUE FOR 990 51,686. PART XII, LINE 4B - OTHER ADJUSTMENTS: ADMINISTRATION SERVICE EXPENSES RECLASSIFIED FOR 990 2,468,516. 1 DELTA DENTAL OF SOUTH DAKOTA FOUNDATION 804 NORTH EUCLID SUITE 1 PIERRE SD 57501 911776857 501(C)(3) 4425000 PROMOTE DENTAL HEALTH IN SOUTH DAKOTA CAPITAL AREA UNITED WAY 221 SOUTH CENTRAL AVE PIERRE SD 57501 460403398 501(C)(3) 86018 DISTRIBUTE CHARITABLE DONATIONS PIERRE EDUCATION FOUNDATION PO BOX 94 PIERRE SD 57501 311574457 501(C)(3) 10300 ACADEMIC EXCELLENCE IN PIERRE, SD CAPITAL AREA COUNSELING 19 E MAIN ST FT PIERRE SD 57501 460305571 501(C)(3) 49300 PROGRAM SUPPORT OAHE YMCA 900 E CHURCH PIERRE SD 57501 237139291 501(C)(3) 35000 PROGRAM SUPPORT SD COMMUNITY FOUNDATION PO BOX 296 PIERRE SD 57501 460398115 501(C)(3) 102150 COMMUNITY IMPROVEMENT SUPPORT 6 0 PART I, LINE 2: GRANTS MADE TO ORGANIZATIONS ARE APPROVED BY THE BOARD OF DIRECTORS. GRANTS MADE TO 501(C)(3) ORGANIZATIONS, GOVERNMENTAL ENTITIES, AND OTHER ORGANIZATIONS WITH AN INTEREST IN FURTHERING DENTAL RESEARCH, EDUCATION, AND SERVICES TO DISADVANTAGED POPULATIONS ARE APPROVED BY THE BOARD. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 SCOTT JONES PRESIDENT & CEO 511956 0 438890 0 6889 0 28500 0 24807 0 1011042 0 0 0 JEFF MILLER EXECUTIVE DIRECTOR 201900 0 65100 0 5442 0 32813 0 23571 0 328826 0 0 0 MICK HECKENLAIBLE VP OF OPERATIONS 155700 0 54810 0 29295 0 30421 0 23907 0 294133 0 0 0 KIRBY SCOTT VP OF FINANCE/CFO 162250 0 55965 0 1129 0 26492 0 12300 0 258136 0 0 0 EUGENE TETZLAFF VP OF IT 152400 0 53970 0 1133 0 25568 0 24807 0 257878 0 0 0 CONNIE HALVERSON VP OF PUBLIC RELATIONS 131100 0 44625 0 995 0 22818 0 30850 0 230388 0 0 0 JEFF HEPPNER DIRECTOR OF MODERNIZATION 132100 0 31512 0 2923 0 16447 0 30750 0 213732 0 0 0 GEORGE ALLEN DATA ANALYST 159823 0 25272 0 0 0 8579 0 8350 0 202024 0 0 0 SARA GREEN UNDERWRITING ANALYST 98100 0 26286 0 668 0 13947 0 23907 0 162908 0 0 0 JAMEY HERR SYSTEM NETWORK ADMINISTRATOR 95200 0 24180 0 633 0 11951 0 22092 0 154056 0 0 0 PART I, LINE 1A COMPANION TRAVEL IS WRITTEN INTO THE CEO'S EMPLOYMENT AGREEMENT. COMPANION TRAVEL COSTS ARE INCLUDED IN THE W-2 OF THE CEO AS TAXABLE WAGES. JEFF FEIOCK DDS BOARD MEMBER 434612 INSURANCE REIMBURSEMENT 0 PAUL REZICH DDS BOARD MEMBER 132199 INSURANCE REIMBURSEMENT 0 MONTY BECHTOLD DDS BOARD MEMBER 277165 INSURANCE REIMBURSEMENT 0 JASON AANENSON DDS BOARD MEMBER 186792 INSURANCE REIMBURSEMENT 0 THANE CRUMP DDS BOARD MEMBER 766495 INSURANCE REIMBURSEMENT 0 LEE GERTSEN DDS SON OF BOARD MEMBER GREG GERTSEN 306681 INSURANCE REIMBURSEMENT 0 KIM SUGA DDS DAUGTHER-IN-LAW OF BOARD MEMBER GREG GERTSEN 288815 INSURANCE REIMBURSEMENT 0 JACLYN SCHULER DDS DAUGHTER OF BOARD MEMBER ANLEE ROLA 867350 INSURANCE REIMBURSEMENT 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE CHAIRMAN, VICE-CHAIRMAN, SECRETARY, TREASURER, AND SUCH OTHER MEMBERS AS THE BOARD DESIGNATES AND SHALL BE VESTED WITH SUCH POWERS AS THE BOARD OF DIRECTORS SHALL BY RESOLUTION DETERMINE. IT SHALL MAKE A WRITTEN REPORT OF ITS PROCEEDINGS AND ACTIONS AT THE NEXT SUCCEEDING MEETING OF THE BOARD OF DIRECTORS. THE CHAIRMAN SHALL BE THE CHAIRMAN OF THE EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION A, LINE 2 ELLEN LEE AND SCOTT JONES ARE DIRECTORS AT A COMMUNITY BANK. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP CONSISTS OF DENTISTS LICENSED IN SOUTH DAKOTA THAT PAY ONE-TIME MEMBERSHIP DUES. FORM 990, PART VI, SECTION A, LINE 7A ALL MEMBER DENTISTS IN ATTENDANCE AT THE ANNUAL MEETING HAVE ONE VOTE. FORM 990, PART VI, SECTION A, LINE 7B ALL MEMBER DENTISTS IN ATTENDANCE AT THE ANNUAL MEETING ARE ALLOWED ONE VOTE ON ALL AGENDA ITEMS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AT THE MAY BOARD MEETING. A REVIEW OF THE FORM IS CONDUCTED BY THE CHAIR OF THE AUDIT AND FINANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY, IN MAY, AT THE REGULARLY SCHEDULED BOARD MEETING. EACH FORM IS READ AT THE FOLLOWING MEETING, WITH ACTION TAKEN AS NEEDED. ACTION MAY INCLUDE ABSTENTION FROM DISCUSSION AND VOTING AND POSSIBLE TERMINATION AS A BOARD MEMBER. FORM 990, PART VI, SECTION B, LINE 15 DELTA DENTAL OF SOUTH DAKOTA HAS A COMPENSATION COMMITTEE CHARTER, WHICH STATES THE PURPOSE OF THE COMPENSATION COMMITTEE IS TO REVIEW AND REPORT TO THE BOARD ON COMPENSATION AND PERSONNEL POLICIES, PROGRAMS AND PLANS AND TO APPROVE EMPLOYEE COMPENSATION AND BENEFIT PLANS. THE COMMITTEE CONSISTS OF THE BOARD CHAIR, VICE-CHAIR, AND AT LEAST TWO OTHER BOARD MEMBERS. COMMITTEE MEMBERS ARE APPOINTED TO ANNUAL TERMS AND MAY BE REAPPOINTED TO UNLIMITED CONSECUTIVE TERMS. THE COMMITTEE ANNUALLY REVIEWS THE CEO'S PERFORMANCE AND DETERMINES SALARY ADJUSTMENTS AND INCENTIVE PAYMENTS FOR THE CEO, ENSURING COMPLIANCE WITH THE IRS "REBUTTABLE PRESUMPTION" SAFETY ZONE FOR EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE ALSO REVIEWS THE CEO'S RECOMMENDATIONS AS TO SALARY ADJUSTMENTS AND INCENTIVE PAYMENTS FOR EXECUTIVE STAFF, ENSURING COMPENSATION WITHIN THE RANGES OF THE EXECUTIVE COMPENSATION PHILOSOPHY. FORM 990, PART VI, SECTION C, LINE 19 ALL DOCUMENTS AND POLICIES ARE AVAILABLE UPON REQUEST. DELTA DENTAL OF SOUTH DAKOTA FOUNDATION PO BOX 1157 PIERRE SD 57501 911776857 ACCESS TO DENTAL CARE SD 501(C)(3) LINE 12A, I DELTA DENTAL OF SOUTH DAKOTA 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 DELTA DENTAL OF SOUTH DAKOTA FOUNDATION B 4425000 CASH DELTA DENTAL OF SOUTH DAKOTA FOUNDATION O 2468516 CASH