DELTA DENTAL OF SOUTH DAKOTA: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
DELTA DENTAL OF SOUTH DAKOTA (EIN 46-0309258)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-09-26
IRS object ID
201642709349300519
Schema version
2015v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2016-09-26T09:46:56-05:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN450250958PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1200 EAST 10TH ST PO BOX 5125AddressLine1Txt
CitySIOUX FALLSCityNm
State AbbreviationSDStateAbbreviationCd
ZIP571175125ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN460309258EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL PLAN OF SOUTH DAKOTABusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlDELTBusinessNameControlTxt
Phone6052247345PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1157AddressLine1Txt
CityPIERRECityNm
State AbbreviationSDStateAbbreviationCd
ZIP57501ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSCOTT JONESPersonNm
Person TitlePRESIDENT & CEOPersonTitleTxt
Phone6052247345PhoneNum
Signature2016-09-20SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonLAURIE HANSONPreparerPersonNm
PTINP00851848PTIN
Phone6053391999PhoneNum
Preparation2016-09-20PreparationDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSCOTT JONESPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1157AddressLine1Txt
CityPIERRECityNm
State AbbreviationSDStateAbbreviationCd
ZIP57501ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$139,191,855GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressWWW.DELTADENTALSD.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1963FormationYr
Legal Domicile StateSDLegalDomicileStateCd
Activity Or MissionDELTA DENTAL PLAN OF SOUTH DAKOTA IS DEDICATED TO ADVANCING AND PROMOTING THE IMPROVEMENT OF ORAL HEALTH.ActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent15VotingMembersIndependentCnt
Total Employee91TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$2,087,782TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$122,355,318PYProgramServiceRevenueAmt
CY Program Service Revenue$136,730,384CYProgramServiceRevenueAmt
PY Investment Income$937,616PYInvestmentIncomeAmt
CY Investment Income$334,989CYInvestmentIncomeAmt
PY Other Revenue$2,158,563PYOtherRevenueAmt
CY Other Revenue$2,076,483CYOtherRevenueAmt
PY Total Revenue$125,451,497PYTotalRevenueAmt
CY Total Revenue$139,141,856CYTotalRevenueAmt
PY Grants And Similar Paid$2,847,871PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$2,145,512CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$5,172,298PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$5,681,807CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$118,185,471PYOtherExpensesAmt
CY Other Expenses$129,863,339CYOtherExpensesAmt
PY Total Expenses$126,205,640PYTotalExpensesAmt
CY Total Expenses$137,690,658CYTotalExpensesAmt
PY Revenues Less Expenses-$754,143PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,451,198CYRevenuesLessExpensesAmt
Total Assets BOY$45,852,452TotalAssetsBOYAmt
Total Assets EOY$45,512,106TotalAssetsEOYAmt
Total Liabilities BOY$12,938,013TotalLiabilitiesBOYAmt
Total Liabilities EOY$12,523,317TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$32,914,439NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$32,988,789NetAssetsOrFundBalancesEOYAmt
MissionDELTA DENTAL PLAN OF SOUTH DAKOTA IS DEDICATED TO ADVANCING AND PROMOTING THE IMPROVEMENT OF ORAL HEALTH.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$125,941,543ExpenseAmt
Grant$2,145,512GrantAmt
Revenue$136,730,384RevenueAmt
DescDELTA DENTAL PAID THROUGH ITS CONTRACTS WITH INDEPENDENT DENTISTS 562,839 CLAIMS FOR DENTAL BENEFIT SERVICES FOR APPROXIMATELY 272,462 INDIVIDUALS WITH GROUP PLANS, 26,000 INDIVIDUALS WITH DENTAL ACCIDENT PLANS, 112,000 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, $2,030,051 TO PROMOTE THE IMPROVEMENT OF ORAL HEALTH.Desc
Total Program Service Expenses$125,941,543TotalProgramServiceExpensesAmt
Described In Section501c30DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer EntYes (1)BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document3465IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee91EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member15IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1KIRBY SCOTTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6052247345PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1720 N EUCLID AVEAddressLine1Txt
CityPIERRECityNm
State AbbreviationSDStateAbbreviationCd
ZIP57501ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
DALE GIBSON DDS
CHAIR2.001.00Yes (X)Yes (X)$11,250$0$0
PAUL REZICH DDS
VICE CHAIR1.001.00Yes (X)Yes (X)$6,500$0$0
GREG GERTSEN DDS
SECRETARY1.000.00Yes (X)Yes (X)$6,900$0$0
JOHN CLAUSEN
TREASURER2.001.00Yes (X)Yes (X)$10,900$0$0
MONTY BECHTOLD DDS
DIRECTOR1.001.00Yes (X)$6,500$0$0
STEVE CULHANE
DIRECTOR1.000.00Yes (X)$5,500$0$0
JEFF FEIOCK DDS
DIRECTOR1.000.00Yes (X)$6,500$0$0
G VERNE GOODSELL
DIRECTOR1.000.00Yes (X)$7,600$0$0
GREG HANSON DDS
DIRECTOR1.000.00Yes (X)$6,500$0$0
PAT HERMANSON DDS
DIRECTOR1.000.00Yes (X)$6,500$0$0
MARY HITZEMANN
DIRECTOR1.000.00Yes (X)$7,500$0$0
ELLEN LEE
DIRECTOR1.001.00Yes (X)$6,500$0$0
ANLEE ROLA DDS
DIRECTOR1.001.00Yes (X)$5,500$0$0
JIM RUSSELL
DIRECTOR1.000.00Yes (X)$7,900$0$0
THANE CRUMP DDS
DIRECTOR1.001.00Yes (X)$6,500$0$0
SCOTT JONES
PRESIDENT & CEO40.001.00Yes (X)$2,919,635$0$43,593
KIRBY SCOTT
VICE PRESIDENT OF FINANCE/CFO40.001.00Yes (X)$180,392$0$32,140
GENE TETZLAFF
VP - INFO TECHNICIAN40.001.00$171,166$0$43,072Yes (X)
MICK HECKENLAIBLE
VP OF OPERATIONS40.001.00$181,468$0$44,394Yes (X)
JEFF MILLER
VP OF UNDERWRITING40.001.00$171,510$0$43,722Yes (X)
NANCE ORSBON
VP - PROF RELATIONS40.001.00$147,138$0$43,878Yes (X)
CONNIE HALVERSON
VP - PUBLIC RELATIONS20.0020.00$132,240$0$38,718Yes (X)
GARY BJERRUM DDS
DENTIST0.0040.00$148,107$0$24,965Yes (X)
CARRIE MIKKONEN
PROGRAM MANAGER0.0040.00$114,860$0$19,447Yes (X)
SARA GREEN
UNDERWRITING ANALYST40.000.00$102,549$0$26,807Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$4,377,615TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$360,736TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K11IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PREMIUM EARNED812900$136,349,525$136,349,525
MISCELLANEOUS900099$380,859$380,859
FieldValueIRS element (for citing)
Total Program Service Revenue$136,730,384TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$334,989TotalRevenueColumnAmt
Exclusion$334,989ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$38,700RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$49,999RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real-$11,299RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column-$11,299TotalRevenueColumnAmt
Exclusion-$11,299ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMANAGEMENT SERVICE FEESDesc
Business541610BusinessCd
Total Revenue Column$2,087,782TotalRevenueColumnAmt
Unrelated Business Revenue$2,087,782UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Other Revenue Total$2,087,782OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$139,141,856TotalRevenueColumnAmt
Related Or Exempt Func Income$136,730,384RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$2,087,782UnrelatedBusinessRevenueAmt
Exclusion$323,690ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$2,145,512TotalAmt
Program Services$2,145,512ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$2,013,152TotalAmt
Management And General$2,013,152ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$1,546,117TotalAmt
Management And General$1,546,117ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,202,580TotalAmt
Management And General$1,202,580ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$641,410TotalAmt
Management And General$641,410ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$278,548TotalAmt
Management And General$278,548ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$3,901TotalAmt
Management And General$3,901ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$77,421TotalAmt
Management And General$77,421ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$183,473TotalAmt
Management And General$183,473ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$329,027TotalAmt
Management And General$329,027ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$450,103TotalAmt
Management And General$450,103ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$19,512TotalAmt
Management And General$19,512ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$57,890TotalAmt
Management And General$57,890ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$69,914TotalAmt
Management And General$69,914ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$206,132TotalAmt
Management And General$206,132ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$343,686TotalAmt
Management And General$343,686ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$67,317TotalAmt
Management And General$67,317ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
CLAIMS INCURRED$123,796,031$123,796,031
MANAGEMENT SERVICE EXPE$2,087,782$2,087,782
COMMISSIONS$1,033,100$1,033,100
PREMIUM TAXES$700,824$700,824

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$437,226TotalAmt
Management And General$437,226ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$137,690,658TotalAmt
Program Services$125,941,543ProgramServicesAmt
Management And General$11,749,115ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$8,555BOYAmt
EOY$5,071EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$3,316,289BOYAmt
EOY$4,075,184EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$8,107,044BOYAmt
EOY$9,260,917EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$109,674BOYAmt
EOY$128,382EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$6,883,033LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$2,840,602LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$4,368,978BOYAmt
EOY$4,042,431EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$29,645,373BOYAmt
EOY$27,102,495EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
EOY$671,821EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$296,539BOYAmt
EOY$225,805EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$45,852,452BOYAmt
EOY$45,512,106EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,088,186BOYAmt
EOY$3,425,848EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$9,849,827BOYAmt
EOY$9,097,469EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$12,938,013BOYAmt
EOY$12,523,317EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$32,914,439BOYAmt
EOY$32,988,789EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$32,914,439BOYAmt
EOY$32,988,789EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$45,852,452BOYAmt
EOY$45,512,106EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$1,451,198ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$1,376,848NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$397,371OtherCostOrOtherBasisAmt
Book Value$397,371BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,715,351OtherCostOrOtherBasisAmt
Depreciation$1,399,730DepreciationAmt
Book Value$3,315,621BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,770,311OtherCostOrOtherBasisAmt
Depreciation$1,440,872DepreciationAmt
Book Value$329,439BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$4,042,431TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDescAmtAmt
UNPAID CLAIMS AND CLAIMS INCURRED BUT NOT REPORTED$5,023,646
UNPAID CLAIMS ADJUSTMENT EXPENSES$452,000
COST PLUS GROUP DEPOSITS$74,100
DEFERRED PREMIUMS$1,305,924
SUPPLEMENTAL RETIREMENT PLAN LIABILITY$2,241,799
FieldValueIRS element (for citing)
Total Liability$9,097,469TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$137,104,073TotalRevEtcAuditedFinclStmtAmt
Other Revenue-$2,087,782OtherRevenueAmt
Revenue Not Reported-$2,087,782RevenueNotReportedAmt
Revenue Subtotal$139,191,855RevenueSubtotalAmt
Other Revenues Not Included-$49,999OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt-$49,999RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$139,141,856TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$135,652,875TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$49,999OtherExpensesIncludedAmt
Expenses Not Reported$49,999ExpensesNotReportedAmt
Expenses Subtotal$135,602,876ExpensesSubtotalAmt
Other Expenses Not Included$2,087,782OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$2,087,782ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$137,690,658TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART X, LINE 2:THE COMPANY HAS BEEN DETERMINED TO BE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE, EXCEPT FOR UNRELATED BUSINESS INCOME. 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, 2015, 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:EXPENSES RECORDED IN REVENUE ON FINANCIAL STATEMENTS -2,087,782.
PART XI, LINE 4B - OTHER ADJUSTMENTS:RENTAL EXPENSES RECORDED IN EXPENSES ON FINANCIAL STATEMENTS -49,999.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES RECORDED IN EXPENSES ON FINANCIAL STATEMENTS 49,999.
PART XII, LINE 4B - OTHER ADJUSTMENTS:EXPENSES RECORDED IN REVENUE ON FINANCIAL STATEMENTS 2,087,782.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records Maintained0GrantRecordsMaintainedInd

Recipient Table RecipientTable (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
DELTA DENTAL OF SOUTH DAKOTA FOUNDATION
804 NORTH EUCLID SUITE 1PIERRESD57501911776857501(C)(3)$2,030,051PROMOTE DENTAL HEALTH IN SOUTH DAKOTA
CAPITAL AREA UNITED WAY
221 SOUTH CENTRAL AVEPIERRESD57501460403398501(C)(3)$45,295DISTRIBUTING CHARITABLE DONATIONS
SD VOICES FOR CHILDREN
PO BOX 2196SIOUX FALLSSD57101460425502501(C)(3)$25,000TO IMPROVE LIVES OF SD CHILDREN
FieldValueIRS element (for citing)
Total501c3 Org3Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsYes (X)TravelForCompanionsInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
SCOTT JONES
PRESIDENT & CEO$2,348,487$0$571,148$0$0$0$26,000$0$17,593$0$2,963,228$0$1,926,490$0
KIRBY SCOTT
VICE PRESIDENT OF FINANCE/CFO$133,650$0$45,990$0$752$0$21,987$0$10,153$0$212,532$0$0$0
GENE TETZLAFF
VP - INFO TECHNICIAN$127,200$0$43,260$0$706$0$20,865$0$22,207$0$214,238$0$0$0
MICK HECKENLAIBLE
VP OF OPERATIONS$130,200$0$44,310$0$6,958$0$21,973$0$22,421$0$225,862$0$0$0
JEFF MILLER
VP OF UNDERWRITING$126,552$0$44,310$0$648$0$21,655$0$22,067$0$215,232$0$0$0
NANCE ORSBON
VP - PROF RELATIONS$111,420$0$35,070$0$648$0$32,830$0$11,048$0$191,016$0$0$0
CONNIE HALVERSON
VP - PUBLIC RELATIONS$97,152$0$34,440$0$648$0$16,635$0$22,083$0$170,958$0$0$0
GARY BJERRUM DDS
DENTIST$133,938$0$13,440$0$729$0$14,936$0$10,029$0$173,072$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1ACOMPANION TRAVEL IS WRITTEN INTO THE CEO'S EMPLOYMENT AGREEMENT. COMPANION TRAVEL COSTS ARE INCLUDED IN THE W-2 OF THE CEO AS TAXABLE WAGES.
PART I, LINE 4BSCOTT JONES, PRESIDENT & CEO, PARTICIPATED IN A SUPPLEMENTAL EMPLOYEE RETIREMENT PLAN (SERP). COMPENSATION REPORTED AS DEFERRED IN PRIOR YEAR FORM 990'S WAS A TOTAL OF $1,926,490. BECAUSE SCOTT JONES VESTED IN MARCH OF 2015, HE WAS REQUIRED TO CATCH UP THE DEFERRED AMOUNTS FROM PRIOR YEARS. HIS SERP AMOUNT OF CATCH UP INCOME AMOUNTED TO $1,926,490, WHICH WAS ALL DEFERRED FROM PRIOR YEARS. THE AMOUNT OF HIS 2015 SERP CONTRIBUTION WAS $251,262 WHICH HE ALSO HAD TO INCLUDE IN WAGES AS HE IS FULLY VESTED IN THE SERP.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (7 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
JEFF FEIOCK DDS
BOARD MEMBER$329,584INSURANCE REIMBURSEMENTS0
PAUL REZICH DDS
BOARD MEMBER$187,848INSURANCE REIMBURSEMENT0
MONTY BECHTOLD DDS
BOARD MEMBER$267,867INSURANCE REIMBURSEMENT0
GREG HANSON DDS
BOARD MEMBER$263,607INSURANCE REIMBURSEMENT0
PAT HERMANSON DDS
BOARD MEMBER$291,743INSURANCE REIMBURSEMENT0
ANLEE ROLA DDS
BOARD MEMBER$459,913INSURANCE REIMBURSEMENT0
THANE CRUMP DDS
BOARD MEMBER$772,149INSURANCE REIMBURSEMENT0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2ELLEN LEE AND SCOTT JONES ARE BOTH DIRECTORS OF A COMMUNITY BANK.
FORM 990, PART VI, SECTION A, LINE 6THE MEMBERSHIP CONSISTS OF DENTISTS LICENSED IN SOUTH DAKOTA THAT PAY ONE-TIME MEMBERSHIP DUES.
FORM 990, PART VI, SECTION A, LINE 7AALL MEMBER DENTISTS IN ATTENDANCE AT THE ANNUAL MEETING HAVE ONE VOTE.
FORM 990, PART VI, SECTION A, LINE 7BALL MEMBER DENTISTS IN ATTENDANCE AT THE ANNUAL MEETING ARE ALLOWED ONE VOTE ON ALL AGENDA ITEMS.
FORM 990, PART VI, SECTION A, LINE 8BTHE ORGANIZATION DOES NOT HAVE COMMITTEES WITH BROAD AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD.
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CTHE 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 15DELTA DENTAL PLAN 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 19ALL DOCUMENTS AND POLICIES ARE AVAILABLE UPON REQUEST.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL OF SOUTH DAKOTA FOUNDATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1157AddressLine1Txt
CityPIERRECityNm
State AbbreviationSDStateAbbreviationCd
ZIP57501ZIPCd
FieldValueIRS element (for citing)
EIN911776857EIN
Primary ActivitiesACCESS TO DENTAL CAREPrimaryActivitiesTxt
Legal Domicile StateSDLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 11B, IIPublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL PLAN OF SOUTH DAKOTABusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationYes (1)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
DELTA DENTAL OF SOUTH DAKOTA FOUNDATION
B$2,030,051CASH
DELTA DENTAL OF SOUTH DAKOTA FOUNDATION
O$2,087,782CASH

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