DELTA DENTAL OF SOUTH DAKOTA: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
DELTA DENTAL OF SOUTH DAKOTA (EIN 46-0309258)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-08-28
IRS object ID
201332409349300313
Schema version
2012v2.0
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)
Timestamp2013-08-28T08:36:29-07:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Stulken Petersen Lingle Walti & Jones LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO Box 578AddressLine1
CityPierreCity
StateSDState
ZIP Code575010578ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN460309258EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL PLAN OF SOUTH DAKOTABusinessNameLine1
FieldValueIRS element (for citing)
Name ControlDELTNameControl
Phone6052247345Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1157AddressLine1
CityPIERRECity
StateSDState
ZIP Code57501ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSCOTT JONESName
TitlePresident & CEOTitle
Date Signed2013-08-28DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDAVID J LINGLEName
PTINP00643442PTIN
Phone6052245828Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts98813687GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501cXOrganization501c
Web Sitewww.deltadentalsd.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1963YearFormation
State Legal DomicileSDStateLegalDomicile
Activity Or Mission DescriptionDELTA DENTAL OF SOUTH DAKOTA IS DEDICATED TO ADVANCING AND PROMOTING THE IMPROVEMENT OF ORAL HEALTH.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees67TotalNbrEmployees
Total Gross UBI1386639TotalGrossUBI
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year90705158ProgramServiceRevenuePriorYear
Program Service Revenue CY91892462ProgramServiceRevenueCY
Investment Income Prior Year820194InvestmentIncomePriorYear
Investment Income Current Year879684InvestmentIncomeCurrentYear
Other Revenue Prior Year1094659OtherRevenuePriorYear
Other Revenue Current Year1377053OtherRevenueCurrentYear
Total Revenue Prior Year92620011TotalRevenuePriorYear
Total Revenue Current Year94149199TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year2092314GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2315480GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4187020SalariesEtcPriorYear
Salaries Etc Current Year4438698SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year85160206OtherExpensePriorYear
Other Expenses Current Year86516073OtherExpensesCurrentYear
Total Expenses Prior Year91439540TotalExpensesPriorYear
Total Expenses Current Year93270251TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1180471RevenuesLessExpensesPriorYear
Revenues Less Expenses CY878948RevenuesLessExpensesCY
Total Assets BOY37956302TotalAssetsBOY
Total Assets EOY41192992TotalAssetsEOY
Total Liabilities BOY7739491TotalLiabilitiesBOY
Total Liabilities EOY8040647TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY30216811NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY33152345NetAssetsOrFundBalancesEOY
Mission DescriptionDELTA DENTAL OF SOUTH DAKOTA IS DEDICATED TO ADVANCING AND PROMOTING THE IMPROVEMENT OF ORAL HEALTH.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense84428694Expense
Grants2315480Grants
Revenue91892462Revenue
DescriptionDELTA DENTAL PAID THROUGH ITS CONTRACTS WITH INDEPENDENT DENTISTS 469,871 CLAIMS FOR DENTAL BENEFIT SERVICES FOR APPROXIMATELY 203,121 INDIVIDUALS WITH GROUP PLANS 26,000 INDIVIDUALS WITH DENTAL ACCIDENT PLANS, 115,000 SOUTH DAKOTA MEDICAID RECIPIANTS AND 95,000 NATIVE AMERICANS UNDER ABERDEEN AREA HEALTH SERVICES. DELTA DENTAL ALSO GRANTED THE DELTA DENTAL PHILANTHRIPIC FUND, A 501(C)(3) CHARITABLE ORGANIZATION, $2,220,206 TO PROMOTE THE IMPROVEMENT OF ORAL HEALTH.Description
Total Program Service Expense84428694TotalProgramServiceExpense
Described In501 C3falseDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiestrueReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10963118NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees67NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonKIRBY SCOTTNamePerson
Telephone Number6052247345TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1720 NORTH EUCLID PIERRE SDAddressLine1
CityPIERRECity
StateSDState
ZIP Code57501ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
JOHN CLAUSEN
Treasurer1.000.00X985000
JEFF FEIOCK
Director1.000.00X650000
JIM RUSSELL
Director1.000.00X685000
PAUL REZICH
Director1.000.00X650000
ANN LEE ROLA
Director1.000.00X500000
RYAN VAN LACKEN
Director1.000.00X375000
MARY HITZEMANN
Director1.000.00X650000
PAT HERMANSON
Director1.000.00X650000
GREG HANSON
Director1.000.00X650000
G VERNE GOODSELL
Director1.000.00X650000
DALE GIBSON
Chairman1.000.00X1150000
GREG GERTSEN
Secretary1.000.00X585000
STEVE CULHANE
Director1.000.00X550000
ELLEN LEE
Director1.000.00X650000
MONTY BECHTOLD
VICE CHAIRMAN1.000.00X500000
JEFF MILLER
VP-UNDERWRITING40.000.0015029400X
CONNIE HALVERSON
V.P.-PUBLIC REL40.000.0011811300X
MICK HECKENLAIBLE
VP-OPERATIONS40.000.0015521500X
GENE TETZLAFF
V.P.-INFO TECHN40.000.0014677700X
NANCE ORSBON
V.P.-PROF. RTNS40.000.0012632300X
KIRBY SCOTT
V PRES-FINANCE40.000.0015949000X
SCOTT JONES
President & CEO40.000.005602500263764X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1515262TotalReportableCompFromOrg
Total Other Compensation263764TotalOtherCompensation
Number Individuals GT100 K7NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionDELTA BENEFITS COVERAGEDescription
Total Revenue Column91892462TotalRevenueColumn
Related Or Exempt Function Income91892462RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue91892462TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column881066TotalRevenueColumn
Exclusion$881,066ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real38700Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real48286Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-9586Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-9586TotalRevenueColumn
Exclusion-$9,586ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities4614820Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities4616202Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-1382Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-1382TotalRevenueColumn
Exclusion-$1,382ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMANAGEMENT SERVICE FEESDescription
Total Revenue Column1386639TotalRevenueColumn
Unrelated Business Revenue1386639UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue1386639TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column94149199TotalRevenueColumn
Related Or Exempt Function Income91892462RelatedOrExemptFunctionIncome
Unrelated Business Revenue1386639UnrelatedBusinessRevenue
Exclusion$870,098ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total2315480Total
Program Services2315480ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1779026Total
Management And General1779026ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total1595375Total
Management And General1595375ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total310582Total
Management And General310582ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total581089Total
Management And General581089ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total172626Total
Management And General172626ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total2199Total
Management And General2199ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total67460Total
Management And General67460ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total54212Total
Management And General54212ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total40378Total
Management And General40378ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total122585Total
Management And General122585ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total0Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total82257Total
Management And General82257ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total49864Total
Management And General49864ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total333890Total
Management And General333890ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total42818Total
Management And General42818ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
DUES TAXES AND LICENCES656378656378
BROKERAGE AND COMMISSIONS838072838072
MANAGEMENT SERVICE EXPENSE13866391386639
CLAIMS PAID/INCURRED8211321482113214

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total726107Total
Management And General726107ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total93270251Total
Program Services84428694ProgramServices
Management And General8841557ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY100BOY
EOY194433EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1127342BOY
EOY1959192EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7546524BOY
EOY6618016EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY50792BOY
EOY99914EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis7276729LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2569019LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4780857BOY
EOY4707710EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY17539055BOY
EOY19201021EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY6663768BOY
EOY8155142EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY247864BOY
EOY257564EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY37956302BOY
EOY41192992EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3029248BOY
EOY3508045EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY4710243BOY
EOY4532602EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7739491BOY
EOY8040647EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY30216811BOY
EOY33152345EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY30216811BOY
EOY33152345EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY37956302BOY
EOY41192992EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses878948ReconcilationRevenueExpenses
Reconciliation Unrealized Invest2056586ReconciliationUnrealizedInvest
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis96552InvestmentCostOrOtherBasis
Other Cost Or Other Basis300819OtherCostOrOtherBasis
Book Value397371BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis855405InvestmentCostOrOtherBasis
Other Cost Or Other Basis3795641OtherCostOrOtherBasis
Depreciation989670Depreciation
Book Value3661376BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1628835OtherCostOrOtherBasis
Depreciation1295469Depreciation
Book Value333366BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis599477OtherCostOrOtherBasis
Depreciation283880Depreciation
Book Value315597BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings4707710TotalOfBookValueLandBuildings
Total Of Book Value Securities8155142TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
DEFERRED PREMIUMS$820,119
COST PLUS GROUP DEPOSITS$74,100
CLAIMS PAYABLE, DENTAL ACCIDENT$25,650
UNPAID CLAIMS PROCESSING COSTS$300,000
REPORTED CLAIMS INCURRED, NOT REPORTED$3,312,733
FieldValueIRS element (for citing)
Total Of Amounts4532602TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt94143273TotRevenueEtcAuditedFinclStmt
Other Revenues48286OtherRevenues
Revenue Not Rptd F99048286RevenueNotRptdF990
Revenue Subtotal94094987RevenueSubtotal
Investment Expenses Not Included54212InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt54212RevenueNotRptdOnFinStmt
Total Revenue Per Form99094149199TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt93270251TotExpensesEtcAuditedFinclStmt
Expenses Subtotal93270251ExpensesSubtotal
Total Expenses Per Form99093270251TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part XI, Line 2dPart XI, Line 2d: Other revenue amounts included in F/S but not included on form 990RENTAL REAL ESTATE DEPRECIATION EXPENSE $31949 INSURANCE $7092 REAL ESTATE TAXES $9245
Part XPart X : FIN48 FootnoteACCOUNTING 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, 2012, THE CORPORATION BELIEVES THAT THERE ARE NO UNCERTAIN TAX POSITIONS OR LIABILITES, OR INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS. IF THE CORPORATION HAD INTEREST AND PENALTIES RELATED TO UNCERTAIN TAX POSITIONS, IT WOULD BE ACCOUNTED FOR AS A COMPONENET OF INCOME TAX EXPENSE. IN ACCORDANCE WITH THE APPLICABLE STATUTE OF LIMITATIONS, THE CORPORATION'S TAX RETURNS COULD BE AUDITED BY THE INTERNAL REVENUE SERVICE FOR THE YEARS ENDED DECEMBER 31, 2009 TO 2012.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedfalseRecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientAmount Of Cash GrantAmountOfCashGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistancePurpose Of GrantPurposeOfGrant
CAPITAL AREA UNITED WAY
221 SOUTH CENTRAL AVEPIERRESD57501460403398356190DISTRIBUTING CHARITABLE DONATIONS
SO DAKOTA VOICES FOR CHILDREN
PO BOX 2196SIOUX FALLSSD57101460425502250000TO IMPROVE LIVES OF SD CHILDREN
DELTA DENTAL PHILANTHROPIC FU
804 NORTH EUCLID SUITE 1PIERRESD5750191177685722202060PROMOTE DENTAL HEALTH IN SOUTH DAK
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrg
JEFF MILLER
VP-UNDERWRITING11280037494150294
MICK HECKENLAIBLE
VP-OPERATIONS11400041215155215
KIRBY SCOTT
V PRES-FINANCE12000039490159490
SCOTT JONES
President & CEO3800001750008240145250263764

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSch J, Part I, Line 1aIdentifier
Return ReferencePart I, Line 1a: Relevant information in regards to selections on 1a.ReturnReference

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableALL DOCUMENTS AND POLICIES ARE AVAILABLE UPON REQUEST.
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesDelta Dental of South DakotaCompensation Committee CharterPurposeThe 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.MembershipThe Compensation Committee shall be comprised of the DDSD Chair and vice-chair and at least two other board members.TermCommittee members are appointed to annual terms and may be reappointed to unlimited consecutive terms.Responsibilities1.Develop and recommend DDSD's compensation philosophy.2.Develop and recommend DDSD's compensation and benefits policies and programs including incentive plans, pension plan, and any perquisites.3.Periodically review DDSD's compensation and benefits policies/programs to determine whether they are properly coordinated and appropriate/competitive for like organizations.4.Annually review the CEO's performance and determine salary adjustments and incentive payments for CEO, ensuring compliance with the IRS "Rebuttable Presumption" safety zone for executive comp matters.5.Reviews CEO's recommendations as to salary adjustments and incentive payments for executive staff, ensuring compensation within the ranges of the executive compensation philosophy.MeetingsThe Compensation Committee shall meet at least annually and more often as determined necessary to fulfill its responsibilities.Reporting & AuthorityThe Compensation Committee may exercise all of the powers of the Board as authorized in concert with this charter. All actions taken by the Compensation Committee will be reported to the Board at its next regularly scheduled meeting.
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsAT THE REGULARLY SCHEDULED BOARD MEETING TO ELECT BOD OFFICERS CONDUCTED IN MAY OF EACH YEAR, THE BOD AND OFFICERS OF DELTA DENTAL OF SOUTH DAKOTA ARE EACH GIVEN A CONFLICT OF INTEREST FORM TO FILL OUT. AT THE NEXT BOD MEETING EACH ONE IS READ AND ANY ACTION THAT NEEDS TO BE TAKEN IS DONE AT THAT TIME.
Form 990, Part VI, Line 11bForm 990, Part VI, Line 11b: Form 990 Review ProcessAT THE REGULARLY SCHEDULED BOARD MEETING IN MAY OF EACH YEAR , THE FORM 990 IS GIVEN TO EACH BOARD MEMBER AND A REVIEW IS CONDUCTED BY THE CHAIRMAN OF THE AUDIT AND FINANCE COMMITTEE.
Form 990, Part VI, Line 7bForm 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or ShareholdersALL MEMBER DENTISTS PRESENT AT THE ANNUAL MEETING ARE EACH ALLOWED ONE VOTE ON ALL ITEMS.
Form 990, Part VI, Line 7aForm 990, Part VI, Line 7a: How Members or Shareholders Elect Governing BodyALL MEMBER DENTISTS ARE INVITED TO THE ANNUAL MEETING AND IF PRESENT, HAVE ONE VOTE.
Form 990, Part VI, Line 6Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderDENTISTS LICENSED IN SOUTH DAKOTA THAT PAY A ONE-TIME MEMEBERSHIP DUES.
Client Note 1 - PAGE 10PART IX STATEMENT OF FUNCTIONAL EXPENSESLINE 22 DEPRECIATION (A)TOTAL (C)MANAGEMENT AND GENERALBUILDINGS STRAIGHT-LINE 28 YEARS $102,884 $102,884 MACHINERY & EQUIPMENT STRAIGHT-LINE 5-10 YEARS 177,755 177,755FURNITURE & FIXTURES STRAIGHT-LINE 5-10 YEARS 53,251 53,251TOTAL DEPRECIATION $333,890 $333,890PAGE 9PART VIII STATEMENT OF REVENUELINE 6B RENTAL EXPENSES DEPRECIATION BUILDINGS AND IMPROVEMENTS $31,949

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