2019-11-01T17:17:30-05:00 2018-12-31 411431613 BERGANKDV LTD 1441 29TH STREET STE 305 WEST DES MOINES IA 50266 990 2018-01-01 420959302 DELTA DENTAL OF IOWA DELT 5152615500 9000 NORTHPARK DRIVE JOHNSTON IA 50131 SHERRY PERKINS VICE PRES FINANCE & CONTROLLER 5152615500 2019-11-01 1 BRENT L ALEXANDER P00075113 5152237300 2019-10-10 38.87.33.4 2019-11-01 11:00:22 CD P 0796FCE7583AE90769CEF6CA2A629B61E6D445D2 0796FCE7583AE90769CEF6CA2A629B61E6D445D2 2018 2020-03-31 21:24:44Z JEFFREY S RUSSELL 9000 NORTHPARK DRIVE JOHNSTON IA 50131 193621874 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 4 172 0 231092 20501 0 0 173892048 182991414 4440060 2676038 259350 231565 178591458 185899017 3071615 5659836 135173848 139699806 15428727 15796969 0 0 0 21609737 21252653 175283927 182409264 3307531 3489753 107956531 110828930 31195810 33607183 76760721 77221747 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 174425761 5659836 182991887 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. 174425761 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 1 0 0 0 0 0 1 1 1 0 1 18498 0 1 172 1 1 1 0 0 0 0 0 0 0 X 9 4 1 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 TOM ALLER DIRECTOR 2.50 X 28400 0 0 DONNA GRANT DIRECTOR 1.60 X 19400 0 0 WILLIAM WEVER DDS DIRECTOR 1.60 X 3943 0 18500 CHARLES EDWARD BROWN DIRECTOR 1.60 X 20600 0 0 ROWENA CROSBIE DIRECTOR 1.60 1.00 X 1700 400 18500 JOHN MALETTA DDS DIRECTOR 1.60 X 1270 0 17563 TOM MAHONEY DIRECTOR 1.60 X 737 0 18063 KRISTA TANNER DIRECTOR 1.60 X 18800 0 0 JEFFREY S RUSSELL PRESIDENT AND CEO 40.00 0.39 X X 783140 0 147082 SHERRY PERKINS VICE PRESIDENT FINANCE & CONTROLLER 40.00 0.67 X 250675 0 38097 SUZANNE HECKENLAIBLE VICE PRESIDENT PUBLIC AFFAIRS 30.00 10.00 X 239151 0 42585 JEFF CHAFFIN DENTAL DIRECTOR 40.00 1.17 X 326099 0 62991 APRIL SCHMALTZ VP MARKETING AND BUSINESS DEVELOPMENT 40.00 X 261816 0 31332 TODD HERREN VP TECHNOLOGY 40.00 X 299097 0 30892 ELIZABETH MYERS VICE-PRESIDENT, OPERATIONS 40.00 X 266347 0 26949 MICHAEL ELAM VP SALES & CUSTOMER RELATIONS 40.00 X 218555 0 19227 RANAE CALVERT DIRECTOR, STRATEGIC BUSINESS 40.00 X 174842 0 28491 JOHN FLEMING DIRECTOR, PRICING & UNDERWRITING 40.00 X 175962 0 26378 RYAN BLACKARD MARKETING DIRECTOR 40.00 X 165429 0 26606 GRETCHEN HAGEMAN DIRECTOR, GOVERNMENT PROGRAMS 40.00 X 161624 0 29384 CAROL RAMSEY SMITH DIRECTOR, COMPLIANCE & QA 40.00 X 153393 0 28186 JOHN KEARNS DDS FORMER DIRECTOR 0.00 X 31479 0 0 3602459 400 610826 30 1 1 0 UNIVERSITY OF IOWA 322 DENTAL SCIENCE BLDG S IOWA CITY IA 52242 DENTAL SERVICES 7701610 APPLEWHITE DENTAL IOWA PC 1340 DELHI ST DUBUQUE IA 52001 DENTAL SERVICES 5317688 ORAL SURGEONS PC 7400 FLEUR DRIVE SUITE 200 DES MOINES IA 50321 DENTAL SERVICES 2231849 CONSAMUS AND HAMPTON DENTAL CLINIC 3324 ORION DRIVE AMES IA 50010 DENTAL SERVICES 1804158 IOWA ORAL & MAXILL SURGEONS PC 1469 29TH ST WEST DES MOINES IA 50266 DENTAL SERVICES 1801154 673 PREMIUMS EARNED 524114 168291435 168291435 ADMINISTRATIVE SERVICE REVENUE 524292 14699979 14699979 182991414 2250503 2250503 8148392 7722857 425535 425535 425535 MANAGEMENT FEES 541610 231092 231092 OTHER INCOME 900099 473 473 231565 185899017 182991887 231092 2676038 5659836 5659836 139699806 139699806 3170363 1250009 1920354 9546520 7627944 1918576 956416 654718 301698 1257170 1223034 34136 866500 646018 220482 152238 54460 97778 201526 25000 176526 52504 52504 162584 162584 3743956 3529895 214061 744799 680597 64202 3224572 2826520 398052 105000 105000 589980 589980 269561 167494 102067 128783 46776 82007 3401545 2858942 542603 185966 185966 BROKER COMMISSIONS 5146956 5146956 ACA HEALTH INSURERS 1101451 1101451 PREMIUM TAXES 914276 914276 CIVIC AND CHARITABLE CO 443863 139250 304613 683093 67779 615314 182409264 174425761 7983503 0 11961241 15785183 718983 596812 16860381 18894062 317074 422791 33085358 13463799 22682126 19621559 52313496 51638868 1807225 2429590 1296005 1440065 107956531 110828930 7879078 10508722 23316732 23098461 31195810 33607183 X 0 0 475819 475819 76284902 76745928 76760721 77221747 107956531 110828930 X 3489753 -3028729 2 X X 0 1 X 1 0 2665500 2665500 11851832 1846028 10005804 17232442 11079776 6152666 1335584 537995 797589 19621559 UNEARNED PREMIUMS 1918080 CLAIMS UNPAID AND RESERVE 16831362 OTHER POLICY RESERVES 1041455 INCENTIVE POOL RESERVE 970379 INTERCOMPANY PAYABLE 345480 OTHER LONG TERM LIABILITIES 1991705 23098461 X 378257827 192752490 192752490 185505337 162584 231096 393680 185899017 374768072 192752490 192752490 182015582 162584 231098 393682 182409264 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 IS 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, 2018 AND 2017, THE COMPANY'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED OR ACCURED DURING 2018 AND 2017. PART XI, LINE 2D - OTHER ADJUSTMENTS: ADMINISTRATIVE SERVICE CLAIMS (NETTED WITH REVENUE) 192,752,490. PART XI, LINE 4B - OTHER ADJUSTMENTS: MANAGEMENT FEES (NETTED WITH EMPLOYEE BENEFITS) 231,092. ROUNDING AMOUNTS 4. PART XII, LINE 2D - OTHER ADJUSTMENTS: ADMINISTRATIVE SERVICE CLAIMS (NETTED WITH REVENUE) 192,752,490. PART XII, LINE 4B - OTHER ADJUSTMENTS: MANAGEMENT FEES - NETTED WITH EXPENSES FOR FINANCIALS 231,092. ROUNDING AMOUNTS 6. 1 DELTA DENTAL OF IOWA FOUNDATION 9000 NORTHPARK DRIVE JOHNSTON IA 50131 260762771 501(C)(3) 5001088 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) 500000 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. VISION TO LEARN 900 JACKSON STREET STE LL5-2C DUBUQUE IA 52001 453457853 501(C)(3) 10000 TO PROVIDE FOLLOW UP CARE TO CHILDREN SCREENED BY VISION TO LEARN BY PROVIDING THEM EYEGLASSES IOWA KIDSIGHT PROGRAM CO UNIVERSITY OF IOWA FOUNDATION 2431 CORAL COURT 5 CORALVILLE IA 52241 420796760 501(C)(3) 10000 TO PROVIDE FREE VISION SCREENING TO CHILDREN 6-MONTHS OF AGE THROUGH KINDERGARTEN WHO ARE LIVING IN IOWA YMCA OF GREATER DES MOINES 501 GRAND AVE DES MOINES IA 50309 420680438 501(C)(3) 10000 CONTRIBUTION TO "GIRLS ON THE RUN" PROGRAM OPPORTUNITY ON DECK 12719 LINCOLN CIRCLE CLIVE IA 50325 464974174 501(C)(3) 5000 DONATION TO PROVIDE EQUIPMENT FOR SUMMER SPORTS PROGRAMMING FOR AT-RISK YOUTH IN LOW INCOME COMMUNITIES IN CENTRAL IOWA. DES MOINES PASTORAL COUNSELING CENTER 8553 URBANDALE AVE URBANDALE IA 50322 420995074 501(C)(3) 10000 SUPPORT FOR MENTAL HEALTH COUNSELING AND EDUCATION FOR LOW-INCOME INDIVIDUALS DES MOINES UNIVERSITY OSTEOPATHIC MEDICAL CENTER 3200 GRAND AVE DES MOINES IA 50312 420730347 501(C)(3) 25000 CONTRIBUTION FOR MENTAL HEALTH INSTITUTE COMMUNITY YOUTH CONCEPTS 1446 MARTIN LUTHER KING JR PKWY DES MOINES IA 50314 262996028 501(C)(3) 5000 DONATION TO CYC'S YOUTH PROGRAM CITY OF MARION 1225 6TH AVE MARION IA 52302 426004932 10000 COMMUNITY BENEFIT CONTRIBUTION TO SAFE ROUTES TO SCHOOL PROJECT IOWA CITY COMMUNITY SCHOOLS 1725 N DODGE ST IOWA CITY IA 52245 426023567 5000 DONATION TO SUPPORT TRANSPORTATION FOR HY-VEE KIDSFIT EVENT THE HARKIN INSTITUTE FOR PUBLIC POLICY CO DRAKE UNIVERSITY 2429 UNIVERSITY AVE DES MOINES IA 50311 420680460 501(C)(3) 15000 RESEARCH & FOCUS GROUPS FOR SNAP POLICY DEVELOPMENT URBANDALE ALL-INCLUSIVE PLAYGROUND CO CITY OF URBANDALE 3600 86TH STREET URBANDALE IA 50322 426004576 5000 CONTRIBUTION FOR URBANDALE PLAYGROUND DESIGNED SPECIFICIALLY FOR CHILDREN SCIENCE CENTER OF IOWA 401 W MARTIN LUTHER KING JR PKWY DES MOINES IA 50309 426097912 501(C)(3) 10000 CONTRIBUTION TO MIND MATTERS - COMMUNITY MENTAL HEALTH INITIATIVE 2019 PREVENT BLINDNESS IOWA 1111 NINTH STREET STE 250 DES MOINES IA 50314 426083207 501(C)(3) 10000 PROVIDE SUPPORT FOR VISION SCREENING IN 20 IOWA SCHOOLS TARGETING UNDERSERVED CHILDREN 15 PART I, QUESTION 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 GRANTEES' 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. ALL 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 624850 0 145338 0 12952 0 129654 0 17428 0 930222 0 0 0 SHERRY PERKINS VICE PRESIDENT FINANCE & CONTROLLER 200334 0 47093 0 3248 0 27199 0 10898 0 288772 0 0 0 SUZANNE HECKENLAIBLE VICE PRESIDENT PUBLIC AFFAIRS 193498 0 43926 0 1727 0 25157 0 17428 0 281736 0 0 0 JEFF CHAFFIN DENTAL DIRECTOR 270574 0 51784 0 3741 0 61370 0 1621 0 389090 0 0 0 APRIL SCHMALTZ VP MARKETING AND BUSINESS DEVELOPMEN 211835 0 48252 0 1729 0 21147 0 10185 0 293148 0 0 0 TODD HERREN VP TECHNOLOGY 240436 0 56544 0 2117 0 22000 0 8892 0 329989 0 0 0 ELIZABETH MYERS VICE-PRESIDENT, OPERATIONS 213410 0 49377 0 3560 0 20962 0 5987 0 293296 0 0 0 MICHAEL ELAM VP SALES & CUSTOMER RELATIONS 173060 0 43225 0 2270 0 17485 0 1742 0 237782 0 0 0 RANAE CALVERT DIRECTOR, STRATEGIC BUSINESS 151630 0 21762 0 1450 0 14202 0 14289 0 203333 0 0 0 JOHN FLEMING DIRECTOR, PRICING & UNDERWRITING 152427 0 22085 0 1450 0 14059 0 12319 0 202340 0 0 0 RYAN BLACKARD MARKETING DIRECTOR 142642 0 21337 0 1450 0 13565 0 13041 0 192035 0 0 0 GRETCHEN HAGEMAN DIRECTOR, GOVERNMENT PROGRAMS 139283 0 20691 0 1650 0 13077 0 16307 0 191008 0 0 0 CAROL RAMSEY SMITH DIRECTOR, COMPLIANCE & QA 136715 0 15218 0 1460 0 12874 0 15312 0 181579 0 0 0 JOHN KEARNS DDS FORMER DIRECTOR 31479 0 0 0 0 0 0 0 0 0 31479 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 PRIOR TO JANUARY 1, 2016, THE OFFICERS OF THE COMPANY PARTICIPATED IN A NONQUALIFIED DEFERRED COMPENSATION PLAN AS SET FORTH IN SECTIONS 201(2), 301(A)(3), AND 401(A)(1) OF ERISA. THIS PLAN ENDED DECEMBER 31, 2015 AND PER THE PLAN DOCUMENT, VESTED EMPLOYEES RECEIVED FINAL PAYMENTS IN 2018. OFFICERS WHO RECEIVED PAYMENTS OF VESTED AMOUNTS IN 2018 AND THE AMOUNTS ARE: JEFFREY S. RUSSELL $ 107,654 SHERRY PERKINS $ 7,495 SUZANNE HECKENLAIBLE $ 6,263 JEFF CHAFFIN $ 39,370 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 2018 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 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. NO PAYMENTS WERE MADE IN 2018. PART I, LINE 5 TWO EMPLOYEES OF THE COMPANY HAVE COMPENSATION CONTINGENT ON REVENUES. THE INDIVIDUALS WORK IN THE SALES DEPARTMENT AND RECEIVE COMMISSIONS BASED ON SALES OF GROUP BUSINESS. THESE INDIVIDUALS ARE RESPONSIBLE FOR SELLING NEW BUSINESS. PART I, LINE 6 CONSISTENT WITH THE COMPANY'S TOTAL COMPENSATION POLICY, THE OFFICERS AND HIGHER COMPENSATED EMPLOYEES, ALONG WITH ALL EMPLOYEES OF THE COMPANY, PARTICIPATE IN A COMPANY INCENTIVE COMPENSATION PLAN. THIS PLAN CONTAINS EIGHT 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 ORAL HEALTH CONTRIBUTIONS FOR THE FISCAL YEAR PER AUDITED FINANCIAL RESULTS." DONNA GRANT DIRECTOR 257644 INDEPENDENT CONTRACTOR - PAYMENTS FROM DDIA FOR DENTAL SERVICES 0 WILLIAM WEVER DDS DIRECTOR 182996 INDEPENDENT CONTRACTOR - PAYMENTS FROM DDIA FOR DENTAL SERVICES 0 JOHN MALETTA DDS DIRECTOR 115052 INDEPENDENT CONTRACTOR - PAYMENTS FROM DDIA FOR DENTAL SERVICES 0 CHARLES EDWARD BROWN DDIA DIRECTOR & OFFICER OF EMPLOYER WHO PURCHASES DENTAL BENEFITS FROM DDIA 552786 PAYMENTS BY EMPLOYER TO DDIA FOR DENTAL BENEFITS 0 FORM 990, PART VI, SECTION A, LINE 2 E. BROWN AND J. MALETTA HAD A PROVIDER-RELATED BUSINESS RELATIONSHIP IN 2018. D. GRANT AND J. CHAFFIN HAD A PROVIDER-RELATED BUSINESS RELATIONSHIP IN 2018. 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 DIRECTOR, 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 DIRECTOR, 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 9: ROUNDING AMOUNTS 2. 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 2018 WAS $5,001,088.00. 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 2018 WAS $333,175 FOR MANAGEMENT FEES AND $14,079 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 BENEFIT SOLUTIONS WAS ORGANIZED TO DISTRIBUTE THE DELTA VISION PRODUCT. DELTA DENTAL OF IOWA MADE NO ADDITIONAL INVESTMENTS IN PAID IN CAPITAL IN VERATRUS IN 2018. DELTA DENTAL OF IOWA COLLECTS PREMIUMS FROM GROUPS FOR VISION COVERAGE AND TRANSFERS THIS PREMIUM TO VERATRUS. IN 2018, DELTA DENTAL OF IOWA TRANSFERRED $4,328,506 TO VERATRUS FOR PREMIUMS 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 2018 WAS $231,092 FOR MANAGEMENT FEES AND $557,238 FOR OTHER EXPENSES. DELTA DENTAL OF IOWA ALSO PURCHASES VISION BENEFITS FROM VERATRUS FOR DDIA EMPLOYEES. THE AMOUNT PAID TO VERATRUS IN 2018 FOR VISION BENEFITS FOR DDIA EMPLOYEES WAS $20,887. 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 CHARITABLE ORGANIZATION TO SUPPORT AND IMPROVE THE ORAL HEALTH OF 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 4409242 2471333 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 5001088 SEE PART VII - SUPPLEMENTAL INFO. DELTA DENTAL OF IOWA FOUNDATION O 333175 SEE PART VII - SUPPLEMENTAL INFO. VERATRUS BENEFIT SOLUTIONS INC O 231092 SEE PART VII - SUPPLEMENTAL INFO. VERATRUS BENEFIT SOLUTIONS INC R 4328506 SEE PART VII - SUPPLEMENTAL INFO. VERATRUS BENEFIT SOLUTIONS INC Q 557238 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.