DELTA DENTAL OF MISSOURI: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
DELTA DENTAL OF MISSOURI (EIN 43-0908349)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-15
IRS object ID
201203209349307130
Schema version
2011v1.3
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)
Timestamp2012-11-15T14:56:53-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1312 WALNUT STREET SUITE 3000AddressLine1
CityCINCINNATICity
StateOHState
ZIP Code45202ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN430908349EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL OF MISSOURIBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% BARBARA BENTRUPInCareOfName
Name ControlDELTNameControl
Phone3146563000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line112399 GRAVOIS ROADAddressLine1
CityST LOUISCity
StateMOState
ZIP Code631271702ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBARBARA BENTRUPName
TitleCFOTitle
Date Signed2012-11-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAaron HershbergerName
Phone5136218300Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonBARBARA BENTRUPNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line112399 GRAVOIS ROADAddressLine1
CityST LOUISCity
StateMOState
ZIP Code631271702ZIPCode
FieldValueIRS element (for citing)
Gross Receipts445793235GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.DELTADENTALMO.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1958YearFormation
State Legal DomicileMOStateLegalDomicile
Activity Or Mission DescriptionTHE ORGANIZATIONS PRIMARY PURPOSE IS TO IMPROVE THE DENTAL HEALTH OF THE PUBLIC BY PROMOTING PREVENTIVE DENTISTRY AND PROVIDING COMPREHENSIVE DENTAL CARE & MAINTENANCE ON A PREPAID BASIS.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees199TotalNbrEmployees
Total Gross UBI-14461TotalGrossUBI
Net Unrelated Business Txbl Income-14461NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year403887520ProgramServiceRevenuePriorYear
Program Service Revenue CY441642197ProgramServiceRevenueCY
Investment Income Prior Year1768546InvestmentIncomePriorYear
Investment Income Current Year2234351InvestmentIncomeCurrentYear
Other Revenue Prior Year-3936606OtherRevenuePriorYear
Other Revenue Current Year1480906OtherRevenueCurrentYear
Total Revenue Prior Year401719460TotalRevenuePriorYear
Total Revenue Current Year445357454TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year464979GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY691007GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year373423093BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY405880043BenefitsPaidToMembersCY
Salaries Etc Prior Year13021005SalariesEtcPriorYear
Salaries Etc Current Year15071148SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year15895988OtherExpensePriorYear
Other Expenses Current Year15988273OtherExpensesCurrentYear
Total Expenses Prior Year402805065TotalExpensesPriorYear
Total Expenses Current Year437630471TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1085605RevenuesLessExpensesPriorYear
Revenues Less Expenses CY7726983RevenuesLessExpensesCY
Total Assets BOY104155000TotalAssetsBOY
Total Assets EOY115132995TotalAssetsEOY
Total Liabilities BOY40878817TotalLiabilitiesBOY
Total Liabilities EOY44393926TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY63276183NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY70739069NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE ORGANIZATIONS PRIMARY PURPOSE IS TO IMPROVE THE DENTAL HEALTH OF THE PUBLIC BY PROMOTING PREVENTIVE DENTISTRY AND PROVIDING COMPREHENSIVE DENTAL CARE & MAINTENANCE ON A PREPAID BASIS.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense431130987Expense
Revenue441642197Revenue
DescriptionDELTA DENTAL OF MISSOURI IS A PREPAID DENTAL INSURANCE COMPANY. IN 2011, DELTA DENTAL PROCESSED 2,389,978 CLAIMS FROM CLIENT COMPANIES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense507786Expense
DescriptionSEE SCHEDULE ODescription

Activity3 Activity3

FieldValueIRS element (for citing)
Expense263000Expense
DescriptionSEE SCHEDULE ODescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp138000TotalOfOtherProgramServiceExp
Total Program Service Expense432039773TotalProgramServiceExpense
Described In501 C3falseDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
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 SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvesttrueReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
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 IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
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 RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109648189NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees199NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccounttrueForeignFinancialAccount
Name Of Foreign CountryTKNameOfForeignCountry
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
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 ChapterstrueLocalChapters
Policies Reference ChapterstruePoliciesReferenceChapters
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 PersonBARBARA BENTRUPNamePerson
Telephone Number3146563000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line112399 GRAVOIS ROADAddressLine1
CityST LOUISCity
StateMOState
ZIP Code631271702ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
BRIAN BERGLUND
DIRECTOR4.0X1860000
DEE JOYNER
DIRECTOR4.0X1480000
EDWARD C ROBISON DDS
DIRECTOR4.0X1395000
GUY P BATES JR DDS
DIRECTOR4.0X1480000
H R REDOHL
DIRECTOR4.0X1795000
MELVIN M BLOOM CPA
DIRECTOR4.0X1842300
OLLIE FISHER DMD
DIRECTOR4.0X1689900
RICHARD HAFFNER
DIRECTOR7.0X3586400
RICHARD W BRAUN
DIRECTOR4.0X1820000
ROBERT TAIT DDS
DIRECTOR4.0X1611700
SHANON KIRCHHOFF
DIRECTOR4.0X1225000
WILLIAM TUNNEY JR
DIRECTOR4.0X1565000
DAVID HAYNES
PRESIDENT & CEO60.0X6788530145478X
BARBARA BENTRUP
CFO AND CORPORATE COUNSEL60.0273838071608X
EB ROB GOREN
CHIEF ACTUARY AND VP SC MARKET60.0264534085229X
RICHARD KLASSEN
CHIEF SALES/MARKETING OFFICER60.0348891091421X
PAMELA MARTIN
CHIEF OPERATING OFFICER60.0257249091982X
ALCIDES MARTINEZ
VP GOVERNMENT AFFAIRS60.0205833046554X
KARL MUDRA
CHIEF INFORMATION OFFICER60.0307211084231X
NANCY SPENCER
VP SALES, SC60.0371088047066X
LYNN PYLE
REGIONAL VP SALES60.0210496049629X
JEANNE AUBUCHON
VP SALES60.0205749056014X
ROBERT WOZNIAK
ACCOUNT EXECUTIVE60.0166321049676X
PAMELA SUMMERS
MGR CUSTOMER/PROVIDER RELATION60.0159758032874X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3663324TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation851762TotalOtherCompensation
Number Individuals GT100 K30NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HEARTLAND FAMILY DENTAL CARE OF MIS
1100 SPUR DR STE 30MARSHFIELDMO65706DENTAL SERVICES2611224
WM GERALD ALBRECHT LTD
3555 SUNSET OFFICE DR STE 21ST LOUISMO63127DENTAL SERVICES1618649
JAY F HAUSER DDS PC
PO BOX 503094ST LOUISMO63150DENTAL SERVICES1177598
DAVID A DURHAM ASSOC DDS PC
10000 WATSON RD STE AST LOUISMO63126DENTAL SERVICES891794
SUNSET HILLS DENTAL LLC
PO BOX 8570ST LOUISMO63126DENTAL SERVICES875854
FieldValueIRS element (for citing)
Number Of Contractors GT100 K584NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionDENTAL PREMIUMSDescription
Business Code524114BusinessCode
Total Revenue Column441642197TotalRevenueColumn
Related Or Exempt Function Income441642197RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue441642197TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2139435TotalRevenueColumn
Exclusion$2,139,435ExclusionAmount

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)
Real413669Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real435781Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-22112Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-22120TotalRevenueColumn
Unrelated Business Revenue-14461UnrelatedBusinessRevenue
Exclusion-$7,659ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities94916Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities94916Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column94916TotalRevenueColumn
Exclusion$94,916ExclusionAmount

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 (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
MISCELLANEOUS INCOME90009913396$13,396
INVESTMENT IN SUBSIDIARY9000031489630$1,489,630
FieldValueIRS element (for citing)
Total Other Revenue1503026TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column445357454TotalRevenueColumn
Related Or Exempt Function Income441642197RelatedOrExemptFunctionIncome
Unrelated Business Revenue-14461UnrelatedBusinessRevenue
Exclusion$3,729,718ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total328369Total
Program Services328369ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total362638Total
Program Services362638ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total405880043Total
Program Services405880043ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total4515087Total
Program Services3702371ProgramServices
Management And General812716ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total6681447Total
Program Services5478787ProgramServices
Management And General1202660ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2271455Total
Program Services1862593ProgramServices
Management And General408862ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1058983Total
Program Services868366ProgramServices
Management And General190617ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total544176Total
Program Services446224ProgramServices
Management And General97952ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total260264Total
Program Services213416ProgramServices
Management And General46848ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total315608Total
Program Services258799ProgramServices
Management And General56809ManagementAndGeneral

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)
Total280761Total
Program Services230224ProgramServices
Management And General50537ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1310184Total
Program Services1074351ProgramServices
Management And General235833ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1352971Total
Program Services1109436ProgramServices
Management And General243535ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2369177Total
Program Services1942725ProgramServices
Management And General426452ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total358487Total
Program Services293959ProgramServices
Management And General64528ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total831525Total
Program Services681851ProgramServices
Management And General149674ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total160870Total
Program Services131913ProgramServices
Management And General28957ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total176463Total
Program Services144700ProgramServices
Management And General31763ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total495581Total
Program Services406376ProgramServices
Management And General89205ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total276798Total
Program Services226974ProgramServices
Management And General49824ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BOARD AND BUREAU DUES32111226331257800
SERVICE BUREAU FEES559312845863651006763
PUBLIC RELATIONS927588760622166966
SERVICE AGREEMENTS20982517205637769

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total747931Total
Program Services613303ProgramServices
Management And General134628ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total437630471Total
Program Services432039773ProgramServices
Management And General5590698ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY625BOY
EOY200EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY9697265BOY
EOY13948429EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY22572207BOY
EOY24571438EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY183868BOY
EOY335908EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis12574451LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6730073LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6123745BOY
EOY5844378EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY44906628BOY
EOY46861056EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY12927632BOY
EOY20200126EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY7743030BOY
EOY3371460EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY104155000BOY
EOY115132995EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY9207683BOY
EOY10090609EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3921027BOY
EOY3734739EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY27750107BOY
EOY30568578EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY40878817BOY
EOY44393926EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY63276183BOY
EOY70739069EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY63276183BOY
EOY70739069EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY104155000BOY
EOY115132995EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses7726983ReconcilationRevenueExpenses
Reconcilation Other Changes-264097ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1350000OtherCostOrOtherBasis
Book Value1350000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5549143OtherCostOrOtherBasis
Depreciation1955346Depreciation
Book Value3593797BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1685889OtherCostOrOtherBasis
Depreciation913361Depreciation
Book Value772528BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1457407OtherCostOrOtherBasis
Depreciation1443782Depreciation
Book Value13625BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2532012OtherCostOrOtherBasis
Depreciation2417584Depreciation
Book Value114428BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5844378TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
DescriptionINVEST. IN ADVANTICA HLDG CODescription
Book Value20200126BookValue
Method Of ValuationCMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Program Related20200126TotalOfBookValueProgramRelated
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
INCURRED BUT UNREPORTED CLAIMS$25,353,477
ESTIMATE UNPAID CLAIM PROCESS$596,561
UNEARNED PREMIUMS$2,892,793
EXPERIENCE RATED CREDIT LIAB$161,073
ADVANCE DEPOSITS$155,976
DUE TO/FROM AFFILIATES$1,408,698
FieldValueIRS element (for citing)
Total Of Amounts30568578TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierFIN 48 FOOTNOTEIdentifier
Return ReferenceSCHEDULE D, PART X, TEXT OF FIN 48 FOOTNOTEReturnReference
ExplanationTHE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. THE ORGANIZATION AND ITS SUBSIDIARIES ARE CURRENTLY OPEN TO EXAMINATION UNDER THE STATUE OF LIMITATIONS BY THE INTERNAL REVENUE SERVICE AND STATES IN WHICH IT FILES FOR THE YEARS ENDED DECEMBER 31, 2008 THROUGH 2010.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (10 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
RONALD MCDONALD HOUSE
949 E PRIMROSE STSPRINGFIELDMO65807431371143501(C)(3)10000DONATION
ST LOUIS UNIVERSITY
3437 CAROLINE MALLST LOUISMO63104430654872501(C)(3)10000DONATION
CYSTIC FIBROSIS FOUNDATION
10801 PEAR TREE LANEST ANNMO63074131930701501(C)(3)11000DONATION
CENTRAL CATHOLIC SCHOOL
1106 N JEFFERSON AVEST LOUISMO63106431530670501(C)(3)20000DONATION
SUNNYHILL INC
11140 S TOWNE SQUAREST LOUISMO63123431150250501(C)(3)25000DONATION
MAKE A WISH FOUNDATION
8251 MARYLAND AVENUEST LOUISMO63105431550697501(C)(3)6000DONATION
MISSOURI DENTAL ASSOCIATION
3340 AMERICAN AVEJEFFERSON CITYMO65109440535233501(C)(3)50000DONATION
AMERICA'S DENTIST CARE
9110 E 35TH ST NWICHITAKS67226262275291501(C)(3)36000DONATION
USC EDUCATION
1600 HAMPTON STCOLUMBIASC29208576017985501(C)(3)107500DONATION
BETTER BUSINESS BUREAU
211 N BROADWAYST LOUISMO63102430181430501(C)(3)6000DONATION
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants10TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantDENTAL SCHOLARSHIPSTypeOfGrant
Number Of Recipients4NumberOfRecipients
Amount Of Cash Grant362638AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S.Identifier
Return ReferencePART I, LINE 2.ReturnReference
ExplanationDELTA DENTAL MAINTAINS RECORDS TO SUBSTANTIATE THE AMOUNT OF ASSISTANCE THAT IT PROVIDES TO THE COMMUNITY ORGANIZATIONS. DELTA DENTAL WORKS WITH THE INDIVIDUAL ORGANIZATIONS TO UNDERSTAND THEIR MISSIONS AND TO DETERMINE THE BENEFITS OF DELTA'S PARTICIPATION.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
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

Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgs
DAVID HAYNES
4403420165200073311011962902584908243310
BARBARA BENTRUP
2100250560000781306102201058603454460
EB ROB GOREN
18135106808801509506044002478903497630
RICHARD KLASSEN
23967108050902871107276601865504403120
PAMELA MARTIN
18238006203001283907428701769503492310
ALCIDES MARTINEZ
14262204894501426602936301719102523870
KARL MUDRA
20800907339402580805869402553703914420
NANCY SPENCER
17103901946190543003675001031604181540
LYNN PYLE
7163401375200134203157001805902601250
JEANNE AUBUCHON
81713011401601002003017102584302617630
ROBERT WOZNIAK
703180939680203502496102471502159970
PAMELA SUMMERS
122489035809014600238130906101926320

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
INFORMATION REGARDING BENEFTIS PROVIDEDPART I, QUESTION 1ADELTA DENTAL OF MISSOURI REIMBURSES OFFICERS AND BOARD MEMBERS FOR TRAVEL EXPENSES INCURRED BY THEIR SPOUSES. TRAVEL FOR COMPANIONS WAS PROVIDED TO THE FOLLOWING LISTED BOARD MEMBERS: BLOOM, FISHER, HAFFNER AND TAIT. HEALTH CLUB DUES WERE PAID FOR THE FOLLOWING EMPLOYEES: HAYNES, GOREN, KLASSEN, MUDRA. THESE AMOUNTS ARE TREATED AS TAXABLE COMPENSATION.
NAMES, AMOUNTS, AND DETAILS OF ARRANGEMENTSPART 1, QUESTION 4THE ORGANIZATION HAS A NONQUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN FOR THE BENEFIT OF CERTAIN EMPLOYEES TO RECEIVE CONTRIBUTIONS IN EXCESS OF THE LIMITATIONS IMPOSED BY THE INTERNAL REVENUE CODE ON STANDARD EMPLOYEE PENSION PLANS. AMOUNTS PAID DURING 2011 FOR THE FOLLOWING INDIVIDUALS WERE: - DAVID HAYNES $57,025 - RICHARD KLASSEN $12,700 - KARL MUDRA $ 4,963 -------- TOTAL $74,688 THE ORGANIZATION HAS AN UNFUNDED NONQUALIFIED, DEFINED BENEFIT DEFERRED COMPENSATION PLAN FOR ITS CORPORATE OFFICERS, WITH VESTING OVER 15 YEARS OF SERVICE AS AN OFFICER TO THE ORGANIZATION. THE ACTUARIALLY DETERMINED LIABILITY IS BASED UPON ASSUMPTIONS FOR REMAINING YEARS OF SERVICE UNTIL RETIREMENT, PROJECTED SALARIES FOR THE FINAL THREE YEARS OF SERVICE, AND A PREDETERMINED BENEFIT PERCENTAGE BASED UPON TOTAL YEARS OF SERVICE. INDIVIDUALS WHO PARTICIPATE IN THIS PLAN DURING 2011 WERE THE FOLLOWING: DAVID HAYNES, BARBARA BENTRUP, E.B. ROB GOREN, RICHARD KLASSEN, JANICE LEES, PAMELA MARTIN, ALCIDES MARTINEZ AND KARL MUDRA.

Schedule L IRS990ScheduleL

FieldValueIRS element (for citing)
Total Balance Due0TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
FINNANE-ROBISON DENTAL
BOARD MEMBER AS OWNER213868DENTAL SERVICES PROVIDEDfalse
FISHER DENTAL CENTER
BOARD MEMBER AS OWNER110132DENTAL SERVICES PROVIDEDfalse

Form990 Schedule L Part V Form990ScheduleLPartV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
BUSINESS TRANSACTIONSPART IV, LINE 1BOARD MEMBER EDWARD ROBISON DDS HAS A REPORTABLE INTEREST IN FINNANCE-ROBISON DENTAL WHICH PROVIDES DENTAL SERVICES TO SUBSCRIBERS AND DEPENDENTS OF BENEFIT PLANS INSURED OR ADMINISTERED BY THE ORGANIZATION.
BUSINESS TRANSACTIONSPART IV, LINE 2BOARD MEMBER OLLIE FISHER DMD HAS A REPORTABLE INTEREST IN FISHER DENTAL CENTER WHICH PROVIDES DENTAL SERVICES TO SUBSCRIBERS AND DEPENDENTS OF BENEFIT PLANS INSURED OR ADMINISTERED BY THE ORGANIZATION.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF OTHER PROGRAM SERVICESPART III, LINE 4BDELTA DENTAL HEALTH THEATRE. CO-SPONSORS/COALITIONS INVOLVED: ST. LOUIS DENTAL SOCIETY AND VARIOUS CHARITABLE CORPORATE DONORS (E.G., CARDINALS CARE, MISSOURI FOUNDATION FOR HEALTH, AND OTHERS) PROGRAM DESCRIPTION: THE DELTA DENTAL HEALTH THEATRE (PREVIOUSLY NAMED DENTAL HEALTH THEATRE) HAS BEEN PROVIDING ORAL HEALTH EDUCATION AND ENTERTAINMENT TO YOUNG CHILDREN IN THE ST. LOUIS METROPOLITAN AREA FOR MORE THAN 30 YEARS, SINCE ITS INCEPTION IN 1977. APPROXIMATELY 10,000 VISITORS, PRIMARILY FROM SCHOOL FIELD TRIPS, VISIT THE THEATRE EACH YEAR. IN 2002 DELTA DENTAL OF MISSOURI BECAME THE PRIMARY, PERMANENT SPONSOR OF THE DELTA DENTAL HEALTH THEATRE, AND WE BEGAN WORKING WITH THE THEATRE'S BOARD OF DIRECTORS TO MAKE PROGRAM AND FACILITY IMPROVEMENTS. A FEATURE PRESENTATION NOW INCLUDES A VIDEO OF DDMO'S AWARD-WINNING LAND OF SMILES PROGRAM AND A NEW PUPPET VIDEO A VISIT TO "HEALTHY HOLLOW" INTRODUCING A CAST OF FANTASY CHARACTERS WHO EACH TEACH SOMETHING ABOUT GOOD ORAL HEALTH AND A HEALTHY LIFESTYLE. A MAJOR RECONSTRUCTION IN 2011 ENHANCED THE LEARNING EXPERIENCE BY OPENING UP SPACE, CREATING ATTRACTIVE MURALS AND ADDING INTERACTIVE EXHIBITS. WE WILL CONTINUE TO EXPAND THE PROGRAMMING TO INTEGRATE EDUCATION ON OVERALL HEALTH AND WELLNESS, FITNESS AND NUTRITION ALONG WITH ORAL HEALTH INFORMATION TO RAISE AWARENESS FOR THE IMPORTANCE OF ORAL HEALTH AND OF THE LINK BETWEEN ORAL HEALTH AND OVERALL HEALTH. THE THEATRE IS ALSO EXPANDING OUTREACH BY PARTICIPATING IN CIVIC EVENTS AND HEALTH FAIRS, SUCH AS WINTER ZOO AND BOO AT THE ZOO AT THE ST. LOUIS ZOO; BABY KIDS EXPO, WHERE THE THEATRE PROVIDES EDUCATIONAL PROGRAMS, PAMPHLETS, AND DENTAL CARE SUPPLIES; AND THE DDHT CANDY EXCHANGE WHERE THE THEATRE ACCEPTS EXCESS HALLOWEEN CANDY IN EXCHANGE FOR A CARNIVAL FOR THE KIDS. LONGEVITY: THEATRE HAS BEEN OPERATING FOR THIRTY-FOUR YEARS. DELTA DENTAL HAS BEEN A PRIMARY, PERMANENT SPONSOR FOR TEN YEARS, SINCE 2002.
DESCRIPTION OF OTHER PROGRAM SERVICESPART III, LINE 4CLAND OF SMILES TOURING THEATRICAL EDUCATION. PROGRAM DESCRIPTION: LAND OF SMILES IS A TOURING, THEATRICAL PROGRAM THAT FEATURES THE TOOTH WIZARD, HIS FUN-LOVING SIDEKICK P.A.N.D.A. AND THEIR ARCH ENEMY PLAQUEMAN. THE SHOW TRAVELED TO 300 SCHOOLS (K-3RD GRADE CLASSROOMS) THROUGHOUT THE STATE OF MISSOURI IN 2011, TEACHING CHILDREN THE IMPORTANCE OF ORAL HEALTH. AN ASSEMBLY-STYLE LIVE PERFORMANCE WITH AUDIENCE PARTICIPATION, THE PROGRAM CAPTURES EACH STUDENT'S ATTENTION THROUGH FUN, KID-FOCUSED ENTERTAINMENT. THE THREE CHARACTERS EXPLAIN PROPER BRUSHING TECHNIQUES, HOW TO FLOSS, GOOD AND BAD FOODS FOR THE TEETH AND WHY IT IS IMPORTANT TO VISIT THE DENTIST TWICE A YEAR. EACH CHILD IS GIVEN A TAKE-HOME "SMILE BAG" FILLED WITH A TOOTHBRUSH, TOOTHPASTE, FLOSS, A COLORING SHEET, AND CRAYONS. STUDENTS WHO COMPLETE THE PROGRAM ALSO EARN HEALTHY SMILE "CERTOOTHICATES." TO REINFORCE THE MESSAGES OF THE PROGRAM AFTER THE PERFORMANCE, DDMO DISTRIBUTES A CURRICULUM KIT THAT INCLUDES A DVD, A LARGE MODEL OF A MOUTH, A LARGE TOOTHBRUSH, AND AUDIO VISUAL EDUCATIONAL TOOLS FOR USE IN THE CLASSROOM, AS WELL AS BOOKS FOR THE LIBRARY. A KIDS' WEBSITE, WWW.LANDOFSMILEVIDEO.COM, PROVIDES ANOTHER SOURCE TO VIEW THE DVD ONLINE. THIS PROGRAM REACHES OVER 70,000 CHILDREN EACH YEAR. TEACHERS AND SCHOOL NURSES CONSISTENTLY RATE THE PROGRAM AS EXCELLENT, AND TYPICALLY FOLLOW UP EACH SHOW WITH A REQUEST TO BE ADDED TO THE LIST IN THE TWO-YEAR CYCLE. IN ADDITION TO THE SCHOOL TOUR, THE LAND OF SMILES PROGRAM IS PERFORMED AT THE GIVE KIDS A SMILE CLINICS IN ST. LOUIS AND AT MORE THAN 20 AREA HEALTH FAIRS, WITH NEARLY 50,000 KIDS AND FAMILIES ATTENDING THROUGH THE YEAR. LONGEVITY: TEN YEARS.
DESCRIPTION OF OTHER PROGRAM SERVICESPART III, LINE 4DGIVE KIDS A SMILE IN ST. LOUIS. CO-SPONSORS/COALITIONS INVOLVED: GREATER ST. LOUIS DENTAL SOCIETY (GSLDS). PROGRAM DESCRIPTION: ONE OF OUR MOST SUCCESSFUL OUTREACH INITIATIVES, GKAS WAS LAUNCHED IN ST. LOUIS, MISSOURI, IN FEBRUARY OF 2002 IN PARTNERSHIP WITH GSLDS. IN 2011, GKAS IN ST. LOUIS PROVIDED 3,901 CHILDREN WITH MORE THAN $1 MILLION WORTH OF FREE DENTAL CARE AND ORAL HEALTH EDUCATION AT ITS TWO CLINICS AND OTHER COMMUNITY PROGRAMS. AT THE TWO-DAY CLINICS, SEVERAL HUNDRED LOCAL DENTISTS, HYGIENISTS AND ASSISTANTS, SUPPORTED BY LAY VOLUNTEERS AND SPONSORS, SUCH AS DELTA DENTAL, PROVIDE CHILDREN WITH FREE, COMPREHENSIVE DENTAL CARE, INCLUDING EXAMS, SEALANTS, X-RAYS, PROFESSIONAL CLEANINGS, FLUORIDE TREATMENTS,RESTORATIONS AND MORE. ON-SITE ENTERTAINMENT SUCH AS FACE PAINTING,STORYTELLING, BALLOONISTS, DELTA DENTAL'S TOOTH WIZARD AND P.A.N.D.A. CHARACTERS, EDUCATIONAL VIDEOS, DENTAL CARE KITS, FREE TOYS AND BOOKS AND SACK LUNCHES ENSURE THAT THE CHILDRENS VISIT TO THE DENTIST IS ASSOCIATED WITH A FUN AND EDUCATIONAL EXPERIENCE. FOR EACH CLINIC, DELTA DENTAL OF MISSOURI FUNDS ALL PUBLIC RELATIONS AND MARKETING ACTIVITIES, FACILITY LIABILITY COVERAGE, VOLUNTEER T-SHIRTS, EVENT SIGNAGE, DECORATIONS, GIVEAWAYS, AND ENTERTAINERS. IN 2003, GIVE KIDS A SMILE WAS ADOPTED BY THE AMERICAN DENTAL ASSOCIATION AS A NATIONAL CAMPAIGN. IN 2006, GIVE KIDS A SMILE WAS RECOGNIZED BY CONGRESS AS AN EXEMPLARY GRASSROOTS EFFORT. LONGEVITY: TEN YEARS.
CLASSES OF MEMBERS OR STOCKHOLDERSPART VI, LINE 6THE MEMBERS OF THE ORGANIZATION ARE COMPRISED OF LICENSED DENTISTS IN THE STATES OF MISSOURI AND SOUTH CAROLINA WHO HAVE SIGNED A PARTICIPATING DENTIST AGREEMENT WITH THE ORGANIZATION. THE MEMBERS MEET ANNUALLY.
MEMBERS OR STOCKHOLDERS WHO CAN ELECT MEMBERS OF THE GOVERNING BODYPART VI, LINE 7ATHE ORGANIZATION HAS MEMBERS WHO ELECT THE INDIVIDUALS TO SERVE ON THE ORGANIZATION'S BOARD OF DIRECTORS. THE MEMBERS OF THE ORGANIZATION ARE COMPRISED OF LICENSED DENTISTS IN THE STATES OF MISSOURI AND SOUTH CAROLINA WHO HAVE SIGNED A PARTICIPATING DENTIST AGREEMENT WITH THE ORGANIZATION. THE MEMBERS MEET ANNUALLY.
MEMBERS OR STOCKHOLDERSPART VI, LINE 7BRECOMMENDED CHANGES TO THE CORPORATE BYLAWS BY THE BOARD ARE SUBJECT TO APPROVAL BY THE MEMBERS.
PROCESS TO REVIEW THE FORM 990PART VI, QUESTION 11BA COPY OF THE FORM 990 WAS REVIEWED IN DETAIL BY THE ORGANIZATION'S CFO AND PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO THE ELECTRONIC FILING OF THE FORM 990.
PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICYPART VI, LINE 12CDELTA DENTAL OF MISSOURI REGULARLY REQUIRES ITS OFFICERS, DIRECTORS, AND KEY EMPLOYEES TO COMPLETE A CONFLICT OF INTEREST STATEMENT. THE REVIEW OF THE STATEMENTS IS PART OF THE FINANCE AND AUDIT COMMITTEE'S RESPONSIBILITIES.
POLICIESPART VI, QUESTION 15A & 15BDELTA DENTAL OF MISSOURI HAS ESTABLISHED A COMPENSATION COMMITTEE (A SUBSET OF THE BOARD OF DIRECTORS) COMPOSED ENTIRELY OF PERSONS WITH NO CONFLICT OF INTEREST THAT REVIEWS AND SETS OFFICER COMPENSATION IN ACCORDANCE WITH THE PROCESS OUTLINED IN TREASURY REGULATION SECTION 53.4958-6 FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS OF THE COMPENSATION OF THE CEO AND ALL OTHER OFFICERS. THIS PROCESS INCLUDES EMPLOYING INDEPENDENT COMPENSATION CONSULTANTS, UTILIZING RELEVANT COMPENSATION SURVEYS AND STUDIES, CONTEMPORANEOUSLY DOCUMENTING AND RECORDING THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT, AND SEEKING APPROVAL ON FINALIZED COMPENSATION PROPOSALS BY THE COMMITTEE AND BOARD OF DIRECTORS.
DISCLOSUREPART VI, LINE 19THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FINANCIAL STATEMENTS AND REPORTINGPART XI, LINE 6UNREALIZED GAIN ON INVESTMENTS $453,043 CUMULATIVE EFFECT OF W/O OF GOODWILL IN ACCORDANCE WITH ASU 2010-28: $(717,140)

Schedule R IRS990ScheduleR

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1ADVANTICA HOLDING COMPANYBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line112399 GRAVOIS ROADAddressLine1
CityST LOUISCity
StateMOState
ZIP Code63127ZIPCode
FieldValueIRS element (for citing)
EIN261323283EIN
Primary ActivityHOLDING COMPANYPrimaryActivity
Legal Domicile StateMOLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityC-corpTypeOfEntity
Share Of Total Income92345119ShareOfTotalIncome
Share Of EOY Assets29441100ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
ADVANTICA HOLDING COMPANY
B6500000FMV
ADVANTICA HOLDING COMPANY
K507833ALLOCATIONS
ADVANTICA HOLDING COMPANY
L3048646EXPENSE BASED

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