2016-11-14T16:58:41-06:00 2015-12-31 381357951 PLANTE & MORAN PLLC 10 S Riverside Plaza 9th Floor Chicago IL 60606 990 2015-01-01 362612058 DELTA DENTAL OF ILLINOIS DELT 6307184700 111 SHUMAN BOULEVARD NAPERVILLE IL 60563 STACEY K BONN CHIEF OPERATING OFFICER 6307184700 2016-11-14 1 David Lowenthal P00378651 3122071040 2016-11-14 2015 2017-02-10 21:41:12Z BERNARD GLOSSY 111 SHUMAN BOULEVARD NAPERVILLE IL 60563 666779834 0 X WWW.DELTADENTALIL.COM X 1967 IL Improve the oral health of Illinois residents by providing dental benefits & other services. 14 5 245 0 0 0 0 0 646399542 652835777 492223 548187 142594 97574 647034359 653481538 1055367 3910105 589713604 592934552 18340632 21287892 0 0 0 27652934 30245902 636762537 648378451 10271822 5103087 156837370 169279516 66367558 74697225 90469812 94582291 IMPROVE THE ORAL HEALTH OF ILLINOIS RESIDENTS BY PROVIDING DENTAL BENEFITS & OTHER SERVICES. 0 0 629964805 3910105 652327668 Delta Dental of Illinois (DDIL) is a Not-For-Profit Corporation which maintains and operates a dental care plan to approximately 2,000,000 individuals. DDIL is committed to its mission to deliver exceptional services to our stakeholders and improve the oral health of the communities we serve. In 2015, DDIL granted $3,910,105 to Delta Dental of Illinois Foundation, a 501(C)(3) charitable organization to promote the improvement of dental education and access to dental care in Illinois. 629964805 0 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 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 66670 0 1 245 1 0 0 0 0 0 0 X 14 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X DELTA DENTAL OF ILLINOIS 6307184700 111 SHUMAN BOULEVARD NAPERVILLE IL 60563 John Maples Chairman 5.00 0.00 X X 58500 0 0 Dr Frank Maggio Committee Chair 3.00 0.00 X 46500 0 0 Michael Busse Committee Chair 3.00 0.00 X 21000 0 18000 Craig Grannon Committee Chair 3.00 0.00 X 19818 0 18000 Jane Hays Committee Chair 3.00 0.00 X 39497 0 0 Dr David Miller Committee Chair 3.00 0.00 X 36500 0 0 Patricia Hunt-Preheim Committee Chair 3.00 0.00 X 36857 0 0 Brian Sammarco Committee Chair 3.00 0.00 X 34206 0 0 Dr Richard Perry Director 2.00 0.00 X 26000 0 0 Dr Richard Hess Director 2.00 0.00 X 31000 0 0 Sharon K Heaton Director 2.00 0.00 X 31780 0 0 Joseph Leo Director 2.00 0.00 X 29262 0 0 Dr Darryll Beard Director 2.00 0.00 X 26138 0 0 Nancy Cozzi Director 2.00 0.00 X 29956 0 0 Bernard Glossy President & CEO 40.00 0.00 X 1251617 0 42838 Stacey Bonn COO 40.00 0.00 X 568047 0 43633 Terri Bon Interim CFO 40.00 0.00 X 369052 0 45196 Karyn Glogowski VP / Director of Sales 40.00 0.00 X 401566 0 34346 Michael White VP Underwriting 40.00 0.00 X 290630 0 32074 Charles Kolker VP of IT 40.00 0.00 X 289709 0 48990 Terry Maddox Sr. Director of Operations 40.00 0.00 X 204998 0 47394 Robert Maxwell Sales Executive 40.00 0.00 X 340046 0 44377 Daniel Battista Sales Executive 40.00 0.00 X 246331 0 38137 Dr Katina Balukjian Dental Consultant 40.00 0.00 X 216087 0 22610 Linda Nasti Sr. Sales Executive 40.00 0.00 X 167893 0 42039 John DeCristofaro Controller 40.00 0.00 X 167433 0 44605 Hazel Fisher-Gable Former SVP & Chief Counsel 0.00 0.00 X 250140 0 1363 5230563 0 523602 39 1 1 0 EMDEON BUSINESS SERVICES 3183 RIDER TRAIL SOUTH EARTH CITY MO 63045 INVOICE AND CLAIMS PRINTING 2591349 Advantech Inc 2801 HOVER ROAD STEVENS POINT WI 54481 IT system maintenance 2301896 INTERACTIVE BUSINESS SYSTEMS INC 6650 EAGLE WAY CHICAGO IL 60678 IT STAFFING CONSULTANTS 1939793 THE MEYOCKS GROUP 6800 LAKE DRIVE WEST DES MOINES IA 50266 ADVERTISING & MARKETING 1075327 RICHARDS GRAPHIC COMMUNICATIONS 2700 VAN BUREN STREET BELLWOOD IL 60104 COMMERICAL PRINTING SERVICES 873953 25 PREMIUMS 524114 652327668 652327668 Building 531190 508109 508109 652835777 526102 526102 13320381 13298296 22085 22085 22085 other income 900099 97574 97574 97574 653481538 652327668 0 1153870 3910105 3910105 592934552 592934552 3908787 238696 3670091 12486831 7300895 5185936 1134077 561918 572159 1068355 580382 487973 2689842 1542312 1147530 336148 336148 156407 63624 92783 241921 241921 2478646 1221407 1257239 1522442 170516 1351926 963471 884993 78478 3904410 3804367 100043 467125 467125 181854 56844 125010 93353 16687 76666 2707 2707 1166056 386853 779203 333954 333954 BROKER COMMISSIONS 10323704 10323704 PRINTING & PUBLICATIONS 3172780 2831052 341728 INSURANCE DEPT. FEES 2641806 2587485 54321 BANK FEES 495566 495566 1763552 548413 1215139 648378451 629964805 18413646 0 8585204 15379618 55939558 59508398 899587 1305065 29693611 6010942 21189034 23682669 57438265 57712657 12520970 11408360 264752 282749 156837370 169279516 14775695 13970096 5187076 5573758 46404787 55153371 66367558 74697225 X 0 0 0 0 90469812 94582291 90469812 94582291 156837370 169279516 5103087 -990608 0 X 0 1 X 1 0 0 1 0 3096941 3096941 16066877 3611725 12455152 1227582 579728 647854 9302211 1819489 7482722 23682669 8569513 F limited partnerships 2838847 F 11408360 UNPAID CLAIMS AND CLAIMS ADJUSTMENT EXPENSE 11450000 SELF-INSURED UNPAID CLAIMS 42682656 INTERCOMPANY PAYABLE 1020715 55153371 X 652731508 0 652731508 241921 508109 750030 653481538 647628421 0 647628421 241921 508109 750030 648378451 Part X, Line 2: MANAGEMENT EVALUATES THE COMPANY'S EXPOSURE FOR UNCERTAIN TAX POSITIONS AT EACH REPORTING PERIOD. AS OF DECEMBER 31, 2015 AND 2014, MANAGEMENT BELIEVES THE COMPANY HAS NO MATERIAL UNCERTAIN TAX POSITIONS AND THEREFORE NO SUCH LIABILITIES HAVE BEEN RECORDED. THE COMPANY WOULD ACCOUNT FOR ANY POTENTIAL INTEREST OR PENALTIES RELATED TO POSSIBLE FUTURE LIABILITIES FOR UNRECOGNIZED INCOME TAX BENEFITS AS INCOME TAX EXPENSE. THE COMPANY IS NO LONGER SUBJECT TO TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE DECEMBER 31, 2012. Part XI, Line 4b - Other Adjustments: RENTAL INCOME REPORTED ON PART VII 508,109. Part XII, Line 4b - Other Adjustments: RENTAL INCOME REPORTED ON PART VII 508,109. 1 DELTA DENTAL OF ILLINOIS FOUNDATION 111 SHULMAN BLVD NAPERVILLE IL 60563 262700504 501(C)3 3910105 PROMOTE ORAL HEALTH OF THE RESIDENTS OF ILLINOIS 1 Part I, Line 2: DELTA DENTAL OF ILLINOIS DIRECTORS AND OFFICERS HAVE THE MAJORITY OF SEATS ON THE DELTA DENTAL OF ILLINOIS FOUNDATION BOARD, AND THEREFORE MONITOR AND APPROVE HOW GRANT MONEY IS USED AND TRACKED. X X X 1 1 X X X X X 1 0 0 0 0 0 0 0 0 Bernard Glossy President & CEO 683123 0 475200 0 93294 0 23850 0 18988 0 1294455 0 0 0 Stacey Bonn COO 382731 0 161568 0 23748 0 23850 0 19783 0 611680 0 0 0 Terri Bon Interim CFO 258666 0 109771 0 615 0 23850 0 21346 0 414248 0 0 0 Karyn Glogowski VP / Director of Sales 217577 0 63360 0 120629 0 23850 0 10496 0 435912 0 0 0 Michael White VP Underwriting 194831 0 85536 0 10263 0 21043 0 11031 0 322704 0 0 0 Charles Kolker VP of IT 243289 0 41945 0 4475 0 23850 0 25140 0 338699 0 0 0 Terry Maddox Sr. Director of Operations 152707 0 50542 0 1749 0 18226 0 29168 0 252392 0 0 0 Robert Maxwell Sales Executive 103846 0 0 0 236200 0 23850 0 20527 0 384423 0 0 0 Daniel Battista Sales Executive 65266 0 0 0 181065 0 21987 0 16150 0 284468 0 0 0 Dr Katina Balukjian Dental Consultant 182014 0 30357 0 3716 0 19282 0 3328 0 238697 0 0 0 Linda Nasti Sr. Sales Executive 77885 0 0 0 90008 0 13440 0 28599 0 209932 0 0 0 John DeCristofaro Controller 131826 0 35069 0 538 0 15577 0 29028 0 212038 0 0 0 Hazel Fisher-Gable Former SVP & Chief Counsel 0 0 0 0 250140 0 0 0 1363 0 251503 0 0 0 Part I, Line 1a OFFICERS ARE ALLOWED TO TRAVEL FIRST CLASS WHEN TRAVELING TO ORGANIZATIONAL EVENTS WHERE FLIGHTS ARE OVER 2 HOURS. THE BENEFIT IS CONSIDERED A TAXABLE BENEFIT. THE OFFICERS OF THE ORGANIZATION ARE REIMBURSED FOR HEALTH CLUB MEMBERSHIP DUES UP TO $100 PER MONTH PER COMPANY POLICY. IN ADDITION, OFFICERS COMPANION TRAVEL EXPENSES TO CERTAIN ORGANIZATIONAL EVENTS ARE REIMBURSED AS A TAXABLE BENEFIT. Part I, Line 4a Hazel Fisher-Gable, Former SVP and Chief Counsel, received severance of $250,140. DR ALAN JURGENS THROUGH JURGENS AN Former Director 258423 Payments to dental practice for dental services provided under dental insurance policy. 0 ProTec Subsidiary 174323 SALE OF INSURANCE PRODUCTS BY PROTEC TO DELTA DENTAL OF ILLINOIS. 0 Dr Darryll L Beard DMD LTD Director 138413 Payments to dental practice for dental services provided under dental insurance policy. 0 SCHEDULE L PART V BERNARD GLOSSY, STACEY BONN, AND TERRI BON ARE AN OFFICERS/KEY EMPLOYEES IN BOTH DELTA DENTAL OF ILLINOIS AND TRUASSURE INSURANCE COMPANY. DR. RICHARD PERRY, MR. JOHN MAPLES, DR. FRANK MAGGIO, MS. SHARON HEATON, AND MS. PATRICIA HUNT-PREHEIM ARE DIRECTORS IN DELTA DENTAL OF ILLINOIS, TRUASSURE INSURANCE COMPANY, AND PROTEC INSURANCE COMPANY. Form 990, Part VI, Section A, line 6 Under the enabling statute that governs the organization - the Illinois Dental Service Plan Act - the members of Delta Dental of Illinois are the participating dentists (defined as any dentist licensed in Illinois to practice dentistry who is reputable and in good standing and has signed an agreement to become a participating dentist of the organization) and the group subscribers who purchase a dental benefit program from the organization. Form 990, Part VI, Section A, line 7a At the annual membership meeting of the organization, the members referenced in Part VI, Line 6 elect the members of the governing body, i.e. Directors, whose term of directorship has expired. Form 990, Part VI, Section A, line 7b Please see the response for item 7a. Form 990, Part VI, Section B, line 11 The Board of the Organization retains the services of an independent CPA firm to assist in the preparation of the Organization's Form 990. The CPA firm assists management in preparing and finalizing Form 990. The draft of Form 990, including all schedules, is reviewed by the Audit and Finance Committee, and then distributed to all voting members of the Governing Body, i.e. the Directors. The Organization's management, and if needed its CPA firm, address any questions or comments submitted by the Organization's Governing Body before filing its Form 990. After the Audit and Finance Committee's review and Management addresses questions or comments from the Directors, the draft Form 990 is finalized and filed with the IRS. Form 990, Part VI, Section B, line 12c Legal counsel for the organization reviews the organization's Conflict of Interest policy annually with the Officers, Directors (Trustees) and Key Employees. After this review, the individuals occupying these positions are required to complete a Conflict of Interest Disclosure Statement. Potential conflicts are logged with the Secretary of the organization and any changes to the Disclosure Form are to be reported to the Chief Legal Officer of the organization. Form 990, Part VI, Section B, line 15 CEO Compensation is reviewed by the Board of Directors. The Board periodically engages an independent consulting firm to advise of compensation levels of similarly situated CEOs based upon surveys and data provided by other organizations as listed on their Form 990. This data, or the data represented to the Compensation Committee at scheduled meetings and minutes of these meetings are contemporaneously prepared. The committee makes a recommendation to the Board for approval. The last executive compensation review occurred in 2015. Form 990, Part VI, Section C, line 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE THROUGH APPLICABLE GOVERNMENTAL AGENCIES; THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON WRITTEN REQUEST TO THE ORGANIZATION. DELTA DENTAL OF ILLINOIS FOUNDATION 111 SHUMAN BLVD NAPERVILLE IL 60563 262700504 PROMOTE ORAL HEALTH OF THE RESIDENTS OF ILLINOIS IL 501(c)(3) Line 7 DELTA DENTAL OF ILLINOIS 1 TRUASSURE INSURANCE COMPANY 111 SHUMAN BLVD NAPERVILLE IL 60563 363757528 Individual and Group Dental Insurance IL C -1616398 6950398 1.00000 1 ProTec Insurance Company 111 SHUMAN BLVD Naperville IL 60563 320416457 GROUP LIFE AND HEALTH INSURANCE IL C 511907 3681922 1.00000 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 DELTA DENTAL OF ILLINOIS FOUNDATION B 3910105 MAINTAINED RECORDS AT FMV TRUASSURE INSURANCE COMPANY P 462995 MAINTAINED RECORDS AT FMV PROTEC INSURANCE COMPANY P 67529 MAINTAINED RECORDS AT FMV PROTEC INSURANCE COMPANY R 3291187 MAINTAINED RECORDS AT FMV PROTEC INSURANCE COMPANY S 310976 MAINTAINED RECORDS AT FMV PROTEC INSURANCE COMPANY M 174324 MAINTAINED RECORDS AT FMV