2016-11-09T09:07:07-06:00 2015-12-31 421229486 BROOKS LODDEN PC 1441 29TH STREET STE 305 WEST DES MOINES IA 502661357 990 2015-01-01 420959302 DELTA DENTAL OF IOWA DELT 5152615500 9000 NORTHPARK DRIVE JOHNSTON IA 50131 SHERRY PERKINS VICE PRES FINANCE & CONTROLLER 5152615500 2016-11-08 1 BRENT L ALEXANDER P00075113 5152237300 2015 2017-02-10 21:41:12Z JEFFREY S RUSSELL 9000 NORTHPARK DRIVE JOHNSTON IA 50131 156397627 0 X WWW.DELTADENTALIA.COM X 1970 IA DENTAL HEALTH CARE: TO IMPROVE THE ORAL HEALTH OF THE PEOPLE WE SERVE. THIS IS ACCOMPLISHED THROUGH THE PROVISION OF DENTAL INSURANCE AND PUBLIC HEALTH CONTRIBUTIONS THAT FOCUS ON ACCESS TO ORAL HEALTH SERVICES AND EDUCATION RELATED TO GOOD ORAL HEALTH BEHAVIORS. 9 3 122 0 109278 1092 0 0 121886777 148034215 5233718 2144063 79165 109879 127199660 150288157 2874454 3900772 90536418 112195291 10153775 11754717 0 0 0 15935369 19086217 119500016 146936997 7699644 3351160 90683380 96862865 25243781 29699926 65439599 67162939 DENTAL HEALTH CARE: TO IMPROVE THE ORAL HEALTH OF THE PEOPLE WE SERVE. THIS IS ACCOMPLISHED THROUGH THE PROVISION OF DENTAL INSURANCE AND PUBLIC HEALTH CONTRIBUTIONS THAT FOCUS ON ACCESS TO ORAL HEALTH SERVICES AND EDUCATION RELATED TO GOOD ORAL HEALTH BEHAVIORS. 0 0 138938465 3900772 148034816 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 VISION OF IMPROVING THE ORAL HEALTH OF THE PEOPLE AND COMMUNITIES IT SERVES. DELTA DENTAL FULFILLS ITS NOT-FOR-PROFIT VISION 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. 138938465 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 17844 0 1 122 1 1 1 0 0 0 0 0 X 9 3 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 21700 0 0 WILLIAM WEVER DDS DIRECTOR 1.60 X 13500 0 0 ANNE HENNESSEY DDS DIRECTOR 2.20 X 15100 0 0 JOHN KEARNS DDS DIRECTOR 2.20 X 3000 0 15500 RENIE NEUBERGER DIRECTOR 2.20 0.50 X 13100 0 0 JEFF PLAGGE DIRECTOR 1.60 X 139336 0 139336 CHARLES EDWARD BROWN DIRECTOR 1.60 X 12200 0 0 ED HANSELL DIRECTOR 2.20 X 13100 0 0 ROWENA CROSBIE DIRECTOR 1.60 0.50 X 13900 0 0 JOHN MALETTA DDS DIRECTOR 1.60 X 500 0 7000 TOM MAHONEY DIRECTOR 1.60 X 500 0 3000 KRISTA TANNER DIRECTOR 1.60 X 3400 0 0 JEFFREY S RUSSELL PRESIDENT AND CEO 40.00 1.00 X X 650050 0 154172 CHERYL HARDING VICE PRESIDENT AND COO 40.00 X 385156 0 21084 GREGORY SHIREMAN VP SALES AND CUSTOMER RELATIONS 40.00 X 342235 0 13167 SHERRY PERKINS VICE PRESIDENT FINANCE & CONTROLLER 40.00 1.00 X 225412 0 64837 SUZANNE HECKENLAIBLE VICE PRESIDENT PUBLIC AFFAIRS 30.00 10.00 X 219992 0 61581 GREGG ROUNDS VP TECHNOLOGY 40.00 X 33770 0 2285 JEFF CHAFFIN DENTAL DIRECTOR 40.00 1.00 X 227530 0 83921 DONN HUTCHINS FORMER OFFICER & DIRECTOR 0.00 0.00 X 815438 0 0 APRIL SCHMALTZ VP MARKETING AND BUSINESS DEVELOPMENT 40.00 X 151644 0 60854 TODD HERREN VP TECHNOLOGY 40.00 X 139674 0 53551 ELIZABETH MYERS DIRECTOR, OPERATIONS 40.00 X 212221 0 28221 BRENDA JENSEN ACCOUNT EXECUTIVE 40.00 X 242703 0 20511 RICHARD RUSSELL DIRECTOR, STRATEGIC BUSINESS OPERATIONS 40.00 X 240026 0 34391 RANAE CALVERT DIRECTOR, RISK MANAGEMENT 40.00 X 164521 0 30912 GRETCHEN HAGEMAN DENTAL WELLNESS PLANNING DIRECTOR 40.00 X 146455 0 29075 CAROL RAMSEY-SMITH DIRECTOR COMPLIANCE & QUALITY ASSURANCE 40.00 X 144532 0 29065 4590695 0 852463 16 1 1 0 UNIVERSITY OF IOWA 322 DENTAL SCIENCE BLDG S IOWA CITY IA 52242 DENTAL SERVICES 4280455 APPLEWHITE DENTAL IOWA PC 1340 DELHI ST DUBUQUE IA 52001 DENTAL SERVICES 3654424 ORAL SURGEONS PC 7400 FLEUR DRIVE SUITE 200 DES MOINES IA 50321 DENTAL SERVICES 1638641 IOWA ORAL & MAXILL SURGEONS PC 1469 29TH ST WEST DES MOINES IA 50266 DENTAL SERVICES 1636209 CONSAMUS AND HAMPTON DENTAL CLINIC PLC 3324 ORION DR AMES IA 50010 DENTAL SERVICES 1632760 556 PREMIUMS EARNED 524114 135928457 135928457 ADMINISTRATIVE SERVICE REVENUE 524292 12105758 12105758 148034215 1820269 1820269 6433264 6109470 323794 323794 323794 MANAGEMENT FEES 541610 109278 109278 OTHER INCOME 900099 601 601 109879 150288157 148034816 109278 2144063 3900772 3900772 112195291 112195291 3545529 1513909 2031620 6379617 4874086 1505531 203097 136439 66658 873758 822134 51624 752716 501293 251423 99358 35617 63741 120700 120700 50629 50629 175936 175936 3816239 3177185 639054 642455 585676 56779 3725128 3007603 717525 1155494 1155494 541580 541580 279568 185905 93663 164831 75595 89236 1877228 1293900 583328 232073 232073 BROKER COMMISSIONS 4062434 4062434 PREMIUM TAXES 699903 699903 ACA HEALTH INSURERS 584394 584394 DDPA DUES 323224 323224 535043 130835 404208 146936997 138938465 7998532 0 13245867 7266147 1338022 427651 4388789 14275228 395174 28371795 5105004 20931221 23266791 49569921 49580244 471258 576506 738302 1075124 90683380 96862865 14946967 9542613 10296814 20157313 25243781 29699926 X 0 0 475819 475819 64963780 66687120 65439599 67162939 90683380 96862865 3351160 -1627820 0 X X 0 1 X 1 0 2665500 2665500 11851832 895609 10956223 12518879 3938517 8580362 1335584 270878 1064706 23266791 UNEARNED PREMIUMS 1798050 CLAIMS UNPAID AND RESERVE 14030999 OTHER POLICY RESERVES 968449 INCENTIVE POOL RESERVE 2345000 INTERCOMPANY PAYABLE 137504 OTHER LONG TERM LIABILITIES 877311 20157313 X 323993322 173990379 173990379 150002943 175936 109278 285214 150288157 320642162 173990379 173990379 146651783 175936 109278 285214 146936997 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, 2015 AND 2014, THE COMPANY'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED OR ACCURED DURING 2015 AND 2014. PART XI, LINE 2D - OTHER ADJUSTMENTS: ADMINISTRATIVE SERVICE CLAIMS (NETTED WITH REVENUE) 173,990,379. PART XI, LINE 4B - OTHER ADJUSTMENTS: MANAGEMENT FEES (NETTED WITH EMPLOYEE BENEFITS) 109,278. PART XII, LINE 2D - OTHER ADJUSTMENTS: ADMINISTRATIVE SERVICE CLAIMS (NETTED WITH REVENUE) 173,990,379. PART XII, LINE 4B - OTHER ADJUSTMENTS: MANAGEMENT FEES - NETTED WITH EXPENSES FOR FINANCIALS 109,278. 1 DELTA DENTAL OF IOWA FOUNDATION 9000 NORTHPARK DRIVE JOHNSTON IA 50131 260762771 501(C)(3) 3679395 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 DENTISTS WHO AGREE TO ESTABLISH AN OFFICE IN A RURAL, UNDERSERVED AREA. PART 1, QUESTION 1: PART 1, QUESTION 1: IN 2015, DELTA DENTAL OF IOWA GRANTED $150,000 TO THE COMMUNITY FOUNDATION OF GREATER DES MOINES. 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. 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 465635 0 159231 0 25184 0 136973 0 17199 0 804222 0 0 0 CHERYL HARDING VICE PRESIDENT AND COO 286760 0 92653 0 5743 0 8891 0 12193 0 406240 0 0 0 GREGORY SHIREMAN VP SALES AND CUSTOMER RELATIONS 263655 0 77163 0 1417 0 5861 0 7306 0 355402 0 0 0 SHERRY PERKINS VICE PRESIDENT FINANCE & CONTROLLER 170081 0 53074 0 2257 0 47638 0 17199 0 290249 0 0 0 SUZANNE HECKENLAIBLE VICE PRESIDENT PUBLIC AFFAIRS 165791 0 52012 0 2189 0 44352 0 17229 0 281573 0 0 0 JEFF CHAFFIN DENTAL DIRECTOR 200634 0 23951 0 2945 0 82316 0 1605 0 311451 0 0 0 DONN HUTCHINS FORMER OFFICER & DIRECTOR 0 0 0 0 815438 0 0 0 0 0 815438 0 28527 0 APRIL SCHMALTZ VP MARKETING AND BUSINESS DEVELOPMEN 149480 0 0 0 2164 0 43329 0 17525 0 212498 0 0 0 TODD HERREN VP TECHNOLOGY 137534 0 0 0 2140 0 46694 0 6857 0 193225 0 0 0 ELIZABETH MYERS DIRECTOR, OPERATIONS 175669 0 33725 0 2827 0 21193 0 7028 0 240442 0 0 0 BRENDA JENSEN ACCOUNT EXECUTIVE 60942 0 180280 0 1481 0 19229 0 1282 0 263214 0 0 0 RICHARD RUSSELL DIRECTOR, STRATEGIC BUSINESS OPERATI 199630 0 37908 0 2488 0 17192 0 17199 0 274417 0 0 0 RANAE CALVERT DIRECTOR, RISK MANAGEMENT 135190 0 27648 0 1683 0 13683 0 17229 0 195433 0 0 0 GRETCHEN HAGEMAN DENTAL WELLNESS PLANNING DIRECTOR 128839 0 15923 0 1693 0 11876 0 17199 0 175530 0 0 0 CAROL RAMSEY-SMITH DIRECTOR COMPLIANCE & QUALITY ASSURA 119697 0 23352 0 1483 0 11836 0 17229 0 173597 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 OFFICERS OF THE COMPANY PARTICIPATE IN A SEC. 457(F) PLAN. THE COMPANY 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. AFTER FIVE YEARS OF PARTICIPATION IN THE PLAN, AN OFFICER BECOMES VESTED IN 20% OF THE BALANCE OF THE ACCOUNT AND THAT AMOUNT IS 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 2015 AND AMOUNTS ARE: JEFFREY S. RUSSELL $ 115,773 SHERRY PERKINS $ 31,678 SUZANNE HECKENLAIBLE $ 26,776 JEFF CHAFFIN $ 64,377 APRIL SCHMALTZ $ 31,071 TODD HERREN $ 36,314 ELIZABETH MYERS $ 4,466 OFFICERS WHO RECEIVED PAYMENTS OF VESTED AMOUNTS IN 2015 AND THE AMOUNTS ARE: CHERYL HARDING $ 41,205 GREG SHIREMAN $ 26,749 PART I, LINE 5 ONE EMPLOYEE OF THE COMPANY HAS COMPENSATION CONTINGENT ON REVENUES. THE INDIVIDUAL IS AN ACCOUNT EXECUTIVE OF THE COMPANY WHO RECEIVES COMMISSIONS BASED ON SALES OF GROUP BUSINESS. THIS ACCOUNT EXECUTIVE 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 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." SCHEDULE J, PART II, LINE 7 THE W-2 COMPENSATION REPORTED FOR DONN HUTCHINS OF $28,527 IS PART OF THE $815,438 OF DEFERRED COMPENSATION THAT WAS PREVIOUSLY REPORTED ON PRIOR YEARS FORM 990 RETURNS. WHEN REPORTED IN PRIOR YEARS, THE FULL AMOUNT WAS INCLUDED IN BOX 5 OF THE FORM W-2 AS MEDICARE WAGES. IN 2015 $28,527 WAS PAID AND INCLUDED IN BOX 1 OF THE FORM W-2. JOHN KEARNS DDS DIRECTOR 235154 INDEPENDENT CONTRACTOR - PAYMENTS FROM DDIA FOR DENTAL SERVICES 0 ANNE HENNESSEY DDS DIRECTOR 129980 INDEPENDENT CONTRACTOR - PAYMENTS FROM DDIA FOR DENTAL SERVICES 0 WILLIAM WEVER DDS DIRECTOR 171521 INDEPENDENT CONTRACTOR - PAYMENTS FROM DDIA FOR DENTAL SERVICES 0 JOHN MALETTA DDS DIRECTOR 323636 INDEPENDENT CONTRACTOR - PAYMENTS FROM DDIA FOR DENTAL SERVICES 0 CHARLES EDWARD BROWN DDIA DIRECTOR & OFFICER OF EMPLOYER WHO PURCHASES DENTAL BENEFITS FROM DDIA 328741 PAYMENTS BY EMPLOYER TO DDIA FOR DENTAL BENEFITS 0 TOM MAHONEY DDIA DIRECTOR & OFFICER OF EMPLOYER WHO PURCHASES DENTAL BENEFITS FROM DDIA 257837 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 2015. 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 DECISIONS OF THE GOVERNING BODY ARE NOT SUBJECT TO APPROVAL BY THE MEMBERSHIP WITH THE EXCEPTION OF CHANGES TO THE ARTICLES OF INCORPORATION. THOSE CHANGES MUST BE APPROVED BY THE MEMBERSHIP. FORM 990, PART VI, SECTION B, LINE 11 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, COO, COMPLIANCE DIRECTOR, AND VICE PRESIDENT FINANCE. AN ELECTRONIC COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS IN OCTOBER OF 2016. 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 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 II, COLUMN B: DELTA DENTAL OF IOWA'S VISION IS TO IMPROVE THE ORAL HEALTH 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 IT'S 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 2015 WAS $3,679,395. 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 ACOUNTING 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 2015 WAS $290,505 FOR MANAGEMENT FEES AND $21,217 FOR OTHER EXPENSES. SCHEDULE R, PART IV, COLUMN B: VERATRUS BENEFIT SOLUTIONS, INC. (VERATRUS) IS A FOR-PROFIT CORPORATION AND 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 2015. DELTA DENTAL OF IOWA COLLECTS PREMIUMS FROM GROUPS FOR VISION COVERAGE AND TRANSFERS THIS PREMIUM TO VERATRUS. IN 2015, DELTA DENTAL OF IOWA TRANSFERRED $2,009,097 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 2015 WAS $109,278 FOR MANAGEMENT FEES AND $229,551 FOR OTHER EXPENSES. DELTA DENTAL OF IOWA ALSO PURCHASES VISION BENEFITS FROM VERATRUS FOR DDIA EMPLOYEES. THE AMOUNT PAID TO VERATRUS IN 2015 FOR VISION BENEFITS FOR DDIA EMPLOYEES WAS $18,692. 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 11A, I DELTA DENTAL OF IOWA 1 VERATRUS BENEFIT SOLUTIONS INC 9000 NORTHPARK DRIVE JOHNSTON IA 50131 271584394 FOR-PROFIT CORPORATION ORGANIZED TO DISTRIBUTE THE DELTA VISION PRODUCT. IA DENTAL DENTAL OF IOWA C 105247 848354 1.00000 1 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 3679395 SEE PART VII - SUPPLEMENTAL INFO. DELTA DENTAL OF IOWA FOUNDATION O 290505 SEE PART VII - SUPPLEMENTAL INFO. VERATRUS BENEFIT SOLUTIONS INC O 109278 SEE PART VII - SUPPLEMENTAL INFO. VERATRUS BENEFIT SOLUTIONS INC R 2009097 SEE PART VII - SUPPLEMENTAL INFO. VERATRUS BENEFIT SOLUTIONS INC Q 229551 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: 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. FORM 990, SCHEDULE R, PART V, LINE 2(6), COLUMN D: ACTUAL COST OF INVOICES PAID BY DDIA ON BEHALF OF DELTA DENTAL OF IOWA FOUNDATION.