DELTA DENTAL OF ILLINOIS: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
DELTA DENTAL OF ILLINOIS (EIN 36-2612058)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-08
IRS object ID
201103129349301235
Schema version
2010v3.4
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)
Timestamp2011-11-08T12:54:32-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BLACKMAN KALLICK LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line110 S RIVERSIDE PLAZA 9TH FLOORAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60606ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN362612058EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL OF ILLINOISBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlDELTNameControl
Phone6307184700Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1111 SHUMAN BOULEVARDAddressLine1
CityNAPERVILLECity
StateILState
ZIP Code60563ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBERNARD GLOSSYName
TitlePRESIDENTTitle
Phone6307184700Phone
Date Signed2011-10-27DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKIMBERLY HAUMANNName
Phone3122071040Phone
Date Prepared2011-10-27DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonBERNARD GLOSSYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1111 SHUMAN BOULEVARDAddressLine1
CityNAPERVILLECity
StateILState
ZIP Code60563ZIPCode
FieldValueIRS element (for citing)
Gross Receipts458159595GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.DELTADENTALIL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1967YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionIMPROVE THE ORAL HEALTH OF ILLINOIS RESIDENTS BY PROVIDING DENTAL BENEFITS & OTHER SERVICES.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees182TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year413916257ProgramServiceRevenuePriorYear
Program Service Revenue CY449918280ProgramServiceRevenueCY
Investment Income Prior Year1616991InvestmentIncomePriorYear
Investment Income Current Year1587292InvestmentIncomeCurrentYear
Other Revenue Prior Year-128485OtherRevenuePriorYear
Other Revenue Current Year55018OtherRevenueCurrentYear
Total Revenue Prior Year415404763TotalRevenuePriorYear
Total Revenue Current Year451560590TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY256000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year379014726BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY411178869BenefitsPaidToMembersCY
Salaries Etc Prior Year17486050SalariesEtcPriorYear
Salaries Etc Current Year16621989SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year18923162OtherExpensePriorYear
Other Expenses Current Year19784131OtherExpensesCurrentYear
Total Expenses Prior Year415423938TotalExpensesPriorYear
Total Expenses Current Year447840989TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-19175RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3719601RevenuesLessExpensesCY
Total Assets BOY72101274TotalAssetsBOY
Total Assets EOY81234101TotalAssetsEOY
Total Liabilities BOY34569085TotalLiabilitiesBOY
Total Liabilities EOY36949523TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY37532189NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY44284578NetAssetsOrFundBalancesEOY
Mission DescriptionIMPROVE THE ORAL HEALTH OF ILLINOIS RESIDENTS BY PROVIDING DENTAL BENEFITS & OTHER SERVICES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense432859621Expense
Grants256000Grants
Revenue449918280Revenue
DescriptionPROMOTE ORAL HEALTH THROUGH THE PROVISION OF DENTAL BENEFITS TO OVER 1,600,000 INDIVIDUALS.Description
Total Program Service Expense432859621TotalProgramServiceExpense
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax1SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109659588NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees182NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL OF ILLINOISBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6307184700TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1111 SHUMAN BOULEVARDAddressLine1
CityNAPERVILLECity
StateILState
ZIP Code60563ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (30 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
SHARON HEATON
CHAIRMAN3.00X3825000
CRAIG GRANNON
COMMITTEE CHAIR2.00X4950016500
DR ALEN KNOX
COMMITTEE CHAIR2.00X1142500
DR FRANK MAGGIO
COMMITTEE CHAIR2.00X2662500
DR RICHARD PERRY
COMMITTEE CHAIR2.00X2490000
LORRAINE ARVIN
COMMITTEE CHAIR2.00X1940000
THOMAS CRISWELL
COMMITTEE CHAIR2.00X1845000
DR ALAN JURGENS
DIRECTOR1.00X1547500
DR NANCY COZZI
DIRECTOR1.00X1232500
DR RICHARD HESS
DIRECTOR1.00X1732500
JOHN MAPLES
DIRECTOR1.00X1960000
MICHAEL BUSSE
COMMITTEE CHAIR2.00X7600016500
PATRICIA HUNT-PREHEIM
COMMITTEE CHAIR2.00X2599200
DAVID BEHNKE
CFO40.00264476032203X
HAZEL FISHER-GABLE
SVP & CHIEF LEGAL COUNSEL40.00353795031501X
IRENE VASQUEZ
SVP OF OPERATIONS40.00304451033075X
THOMAS COLGAN
SVP OF MARKETING40.00430002035261X
STACEY BONN
INTERIM CFO40.005874704978X
BERNARD GLOSSY
PRESIDENT AND CEO40.0022252602888X
JEANETTE BATTISTA
VP SALES40.00274521037202X
STEPHEN RETZSCH
VP NATIONAL ACCOUNTS40.00334582025398X
MICHAEL WHITE
VP UNDERWRITING40.00180138021102X
LINDA NASTI
SENIOR SALES EXECUTIVE40.00182343034685X
THOMAS GEARY
SENIOR SALES EXECUTIVE40.00165450036050X
WILLIAM POLANCICH
VP SALES AND MARKETING40.00177211028145X
TERRI BON
CONTROLLER40.00160759036404X
THERESA MARSHALL
SALES EXECUTIVE40.00217323024474X
DR ROBERT DENNISON
FORMER PRESIDENT AND CEO0.0028852005564X
ROSS GOSNELL
FORMER SVP OF IT0.00256546021336X
TAMERA ROBINSON
FORMER SVP AND CFO0.00252500021336X
FieldValueIRS element (for citing)
Total Reportable Comp From Org4366207TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation464602TotalOtherCompensation
Number Individuals GT100 K34NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
EMDEON BUSINESS SERVICES
3183 RIDER TRAIL SOUTHEARTH CITYMO63045INVOICE AND CLAIMS PRINTING2232280
ADVANTECH INC
2801 HOOVER ROADSTEVENS POINTWI54481IT SYSTEM MAINTENANCE2150803
GTESS
2435 N CENTERAL EXPRESSWAY SUITERICHARDSONTX75080IMAGE RECOGNITION PROCESSING575224
RICHARDS GRAPHIC COMMUNICATIONS
2700 VAN BUREN STBELLWOODIL60104COMMERCIAL PRINTER536626
THE MEYOCKS GROUP
6800 LAKE DRIVEWEST DES MOINESIA50266ADVERTISING AND MARKETING402938
FieldValueIRS element (for citing)
Number Of Contractors GT100 K16NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPREMIUMSDescription
Business Code524114BusinessCode
Total Revenue Column449918280TotalRevenueColumn
Related Or Exempt Function Income449918280RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue449918280TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1741141TotalRevenueColumn
Exclusion$1,741,141ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities6445156Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities6599005Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-153849Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-153849TotalRevenueColumn
Exclusion-$153,849ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER INCOMEDescription
Business Code900099BusinessCode
Total Revenue Column55018TotalRevenueColumn
Exclusion$55,018ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue55018TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column451560590TotalRevenueColumn
Related Or Exempt Function Income449918280RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,642,310ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total256000Total
Program Services256000ProgramServices

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total411178869Total
Program Services411178869ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total4555492Total
Program Services615408ProgramServices
Management And General3940084ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8394188Total
Program Services4614664ProgramServices
Management And General3779524ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total744322Total
Program Services386068ProgramServices
Management And General358254ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2111722Total
Program Services1223599ProgramServices
Management And General888123ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total816265Total
Program Services432392ProgramServices
Management And General383873ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total176227Total
Management And General176227ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total128441Total
Management And General128441ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total194596Total
Management And General194596ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total961163Total
Program Services204796ProgramServices
Management And General756367ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total543845Total
Program Services65647ProgramServices
Management And General478198ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total850186Total
Program Services739615ProgramServices
Management And General110571ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total3083259Total
Program Services3028066ProgramServices
Management And General55193ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total848851Total
Management And General848851ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total220053Total
Program Services46556ProgramServices
Management And General173497ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total49749Total
Program Services20803ProgramServices
Management And General28946ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total248666Total
Management And General248666ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total807312Total
Program Services171267ProgramServices
Management And General636045ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total271689Total
Management And General271689ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BROKER COMMISSIONS70846147084614
PRINTING & PUBLICATIONS22386511924572314079
INSURANCE DEPT. FEES61539756860746790
POSTAGE AND SHIPPING300895300415480
BANK FEES2588780258878

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total901659Total
Program Services-2337ProgramServices
Management And General903996ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total447840989Total
Program Services432859621ProgramServices
Management And General14981368ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY410390BOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY8084742BOY
EOY8103380EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY806103BOY
EOY872826EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis20869845LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec815563LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY13424091BOY
EOY20054282EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY43808387BOY
EOY46704043EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY5316253BOY
EOY5259819EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY251308BOY
EOY239751EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY72101274BOY
EOY81234101EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY11059808BOY
EOY12144250EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY3315918BOY
EOY3475527EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4044625BOY
EOY10302709EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY16148734BOY
EOY11027037EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY34569085BOY
EOY36949523EOY
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)
BOY37532189BOY
EOY44284578EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY37532189BOY
EOY44284578EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY72101274BOY
EOY81234101EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3719601ReconcilationRevenueExpenses
Reconcilation Other Changes3032788ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Substantially All Dues Nondeduct0SubstantiallyAllDuesNondeduct
Only In House Lobbying1OnlyInHouseLobbying
Agree To Carryover Prior Year0AgreeToCarryoverPriorYear

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis3096941InvestmentCostOrOtherBasis
Book Value3096941BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis15917408InvestmentCostOrOtherBasis
Depreciation381069Depreciation
Book Value15536339BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis270222InvestmentCostOrOtherBasis
Depreciation143353Depreciation
Book Value126869BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1585274InvestmentCostOrOtherBasis
Depreciation291141Depreciation
Book Value1294133BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings20054282TotalOfBookValueLandBuildings

Closely Held Equity Interests CloselyHeldEquityInterests

FieldValueIRS element (for citing)
Book Value5259819BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities5259819TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
UNPAID CLAIMS AND CLAIMS ADJUSTMENT EXPENSE$8,615,000
CHECKS ISSUED IN EXCESS OF FUNDS ON DEPOSIT$2,412,037
FieldValueIRS element (for citing)
Total Of Amounts11027037TotalOfAmounts
Total Revenue451560590TotalRevenue
Total Expenses447840989TotalExpenses
Excess Or Deficit For Year3719601ExcessOrDeficitForYear
Net Unrealized GL On Investments3032788NetUnrealizedGLOnInvestments
Total Adjustments3032788TotalAdjustments
Excess Or Deficit Per FS6752389ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt451365994TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal451365994RevenueSubtotal
Investment Expenses Not Included194596InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt194596RevenueNotRptdOnFinStmt
Total Revenue Per Form990451560590TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt447646393TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal447646393ExpensesSubtotal
Investment Expenses Not Included2194596InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt194596ExpensesNotRptdOnFinStmt
Total Expenses Per Form990447840989TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE COMPANY'S APPLICATION OF GAAPUSA REGARDING UNCERTAIN TAX POSITIONS HAD NO EFFECT ON ITS FINANCIAL POSITION AS MANAGEMENT BELIEVES THE COMPANY HAS NO MATERIAL UNRECOGNIZED INCOME TAX BENEFITS. THE COMPANY WOULD ACCOUNT FOR ANY POTENTIAL INTEREST OR PENALTIES RELATED TO POSSIBLE FUTURE LIABILITIES FOR UNRECOGNIZED INCOME TAX BENEFITS AS INCOME TAX EXPENSE. THE COMPANY IS NO LONGER SUBJECT TO EXAMINATION BY TAX AUTHORITIES FOR FEDERAL, STATE OR LOCAL INCOME TAXES FOR PERIODS BEFORE 2006.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL OF ILLINOIS FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1111 SHULMAN BLVDAddressLine1
CityNAPERVILLECity
StateILState
ZIP Code60563ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient262700504EINOfRecipient
IRC Section501(C)3IRCSection
Amount Of Cash Grant256000AmountOfCashGrant
Purpose Of GrantCONTRIBTUTION TO THE FOUNDATIONPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: DELTA DENTAL OF ILLINOIS DIRECTORS AND OFFICERS HAVE THE MAJORITY OF SEATS ON THE DELTA DENTAL OF ILLINOIS FOUNDATION BOARD, AND THEREFORE MONITOR AND APPROVE HOW GRANT MONEY IS USED AND TRACKED.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
First Class Or Charter TravelXFirstClassOrCharterTravel
Travel For CompanionsXTravelForCompanions
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (16 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 OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DAVID BEHNKE
24331500021161000322030296679000
HAZEL FISHER-GABLE
27031607496508514000315010385296000
IRENE VASQUEZ
178550066671059230000330750337526000
THOMAS COLGAN
2830090110587036406000352610465263000
BERNARD GLOSSY
1769230378770772600028880225414000
JEANETTE BATTISTA
201807033490039224000372020311723000
STEPHEN RETZSCH
1318110221490180622000253980359980000
MICHAEL WHITE
143580025839010719000211020201240000
LINDA NASTI
9381106108082424000346850217028000
THOMAS GEARY
9403306182065235000360500201500000
WILLIAM POLANCICH
127582027446022183000281450205356000
TERRI BON
13113802837701244000364040197163000
THERESA MARSHALL
69178052550142890000244740241797000
DR ROBERT DENNISON
000028852000055640294084000
ROSS GOSNELL
00620460194500000213360277882000
TAMERA ROBINSON
0000252500000213360273836000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1AFIRST CLASS TRAVEL IS PERMITTED BY EXECUTIVES ONLY FOR FLIGHTS LONGER THAN 3 HOURS AND THE BENEFIT IS CONSIDERED A TAXABLE FRINGE BENEFIT. THE OFFICERS OF THE ORGANIZATION ARE REIMBURSED FOR HEALTH CLUB MEMBERSHIP DUES UP TO $100 PER MONTH PER COMPANY POLICY. IN ADDITION, WHEN TRAVELING TO CERTAIN ORGANIZATIONAL EVENTS, OFFICERS AND DIRECTORS ARE REIMBURSED FOR THEIR COMPANION'S TRAVEL EXPENSES AS A TAXABLE BENEFIT.
PART I, LINE 4AIRENE VASQUEZ, SVP OF OPERATIONS, RECEIVED SEVERANCE OF $52,732 WILLIAM POLANCICH, VP OF SALES AND MARKETING, RECEIVED SEVERANCE OF $16,959 ROSS GOSNELL, SVP OF IT, RECEIVED SEVERANCE OF $194,500 ROBERT DENNISON, PRESIDENT AND CEO, RECEIVED SEVERANCE OF $288,520 TAMERA ROBINSON, SVP AND CFO, RECEIVED SEVERANCE OF $252,500 THOMAS COLGAN, SVP OF MARKETING, RECEIVED SEVERANCE OF $19,102 DAVID BEHNKE, CFO, RECEIVED SEVERANCE OF $19,712

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
TRUASSURE
SUBSIDIARY138285SALE OF INSURANCE PRODUCTS BY TRUASSURE TO DELTA DENTAL OF ILLINOIS.0
DR ALAN JURGENS THROUGH JURGENS AN
DIRECTOR229462PAYMENTS TO DENTAL PRACTICE FOR DENTAL SERVICES PROVIDED UNDER DENTAL INSURANCE POLICY.0

Form990 Schedule L Part V Form990ScheduleLPartV

FieldValueIRS element (for citing)
IdentifierSCHEDULE L PART VIdentifier
Return ReferenceRELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANZIATIONReturnReference
ExplanationBERNARD GLOSSY, HAZEL FISHER-GABLE, AND STACEY BONN ARE OFFICERS/KEY EMPLOYEES IN BOTH DELTA DENTAL OF ILLINOIS AND TRUASSURE INSURANCE COMPANY. DR. RICHARD PERRY, MR. JOHN MAPLES, MS. SHARON HEATON, DR. FRANK MAGGIO, AND MS. PATRICIA HUNT-PREHEIM ARE DIRECTORS IN BOTH DELTA DENTAL OF ILLINOIS AND TRUASSURE INSURANCE COMPANY.BERNARD GLOSSY, HAZEL FISHER-GABLE, AND STACEY BONN ARE DIRECTORS/OFFICERS OF DELTA DENTAL OF ILLINOIS FOUNDATION. DR. FRANK MAGGIO, MR CRAIG GRANNON, AND MS. PATRICIA HUNT-PREHEIEM ARE DIRECTORS OF DELTA DENTAL OF ILLINOIS FOUNDATION.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 6UNDER THE ENABLING STATUTE THAT GOVERNS THE ORGANIZATION - THE ILLINOIS DENTAL SERVICE PLAN ACT - THE MEMBERS OF DELTA DENTAL OF ILLINOIS ARE THE PARTICIPATING DENTISTS (DEFINED AS ANY DENTIST LICENSED IN ILLINOIS TO PRACTICE DENTISTRY WHO IS REPUTABLE AND IN GOOD STANDING AND HAS SIGNED AN AGREEMENT TO BECOME A PARTICIPATING DENTIST OF THE ORGANIZATION) AND THE GROUP SUBSCRIBERS WHO PURCHASE A DENTAL BENEFIT PROGRAM FROM THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7AAT THE ANNUAL MEMBERSHIP MEETING OF THE ORGANIZATION, THE MEMBERS REFERENCED IN PART VI, LINE 6 ELECT THE MEMBERS OF THE GOVERNING BODY, I.E. DIRECTORS, WHOSE TERM OF DIRECTORSHIP HAS EXPIRED.
FORM 990, PART VI, SECTION A, LINE 7BPLEASE SEE THE RESPONSE FOR ITEM 7A.
FORM 990, PART VI, SECTION B, LINE 11THE BOARD OF THE ORGANIZATION RETAINS THE SERVICES OF AN INDEPENDENT CPA FIRM TO ASSIST IN THE PREPARATION OF THE ORGANIZATION'S FORM 990. THE CPA FIRM ASSISTS MANAGEMENT IN PREPARING AND FINALIZING FORM 990. THE DRAFT OF FORM 990, INCLUDING ALL SCHEDULES, IS REVIEWED BY THE AUDIT AND FINANCE COMMITTEE, AND THEN DISTRIBUTED TO ALL VOTING MEMBERS OF THE GOVERNING BODY, I.E. THE DIRECTORS. THE ORGANIZATION'S MANAGEMENT, AND IF NEEDED ITS CPA FIRM, ADDRESS ANY QUESTIONS OR COMMENTS SUBMITTED BY THE ORGANIZATION'S GOVERNING BODY BEFORE FILING ITS FORM 990. AFTER THE AUDIT AND FINANCE COMMITTEE'S REVIEW AND MANAGEMENT ADDRESSES QUESTIONS OR COMMENTS FROM THE DIRECTORS, THE DRAFT FORM 990 IS FINALIZED AND FILED WITH THE IRS.
LEGAL COUNSEL FOR THE ORGANIZATION REVIEWS THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ANNUALLY WITH THE OFFICERS, DIRECTORS (TRUSTEES) AND KEY EMPLOYEES. AFTER THIS REVIEW, THE INDIVIDUALS OCCUPYING THESE POSITIONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. POTENTIAL CONFLICTS ARE LOGGED WITH THE SECRETARY OF THE ORGANIZATION AND ANY CHANGES TO THE DISCLOSURE FORM ARE TO BE REPORTED TO THE CHIEF LEGAL OFFICER OF THE ORGANIZATION.FORM 990, PART VI, SECTION B, LINE 12C
CEO COMPENSATION IS REVIEWED BY THE BOARD OF DIRECTORS. THE BOARD PERIODICALLY ENGAGES AN INDEPENDENT CONSULTING FIRM TO ADVISE OF COMPENSATION LEVELS OF SIMILARLY SITUATED CEOS BASED UPON SURVEYS AND DATA PROVIDED BY OTHER ORGANIZATIONS AS LISTED ON THEIR FORM 990. THIS DATA, OR THE DATA REPRESENTED TO THE COMPENSATION COMMITTEE AT SCHEDULED MEETINGS AND MINUTES OF THESE MEETINGS ARE CONTEMPORANEOUSLY PREPARED. THE COMMITTEE MAKES A RECOMMENDATION TO THE BOARD FOR APPROVAL.FORM 990, PART VI, SECTION B, LINE 15
GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE THROUGH APPLICABLE GOVERNMENTAL AGENCIES; THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON WRITTEN REQUEST TO THE ORGANIZATION.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 3,032,788.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL OF ILLINOIS FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1111 SHULMAN BLVDAddressLine1
CityNAPERVILLECity
StateILState
ZIP Code60563ZIPCode
FieldValueIRS element (for citing)
EIN262700504EIN
Primary ActivitiesPROMOTE ORAL HEALTH OF THE RESIDENTS OF ILLINOISPrimaryActivities
Legal Domicile StateILLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusLINE 7PublicCharityStatus
Controlled Org1ControlledOrg

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateType Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
TRUASSURE INSURANCE COMPANY
111 SHUMAN BLVDNAPERVILLEIL60563363757528GROUP LIFE AND HEALTH INSURANCEILC19681456782301.00000
PYRAMID BUSINESS SERVICES COMPANY
111 SHUMAN BLVDNAPERVILLEIL60563201726963EMPLOYEE LEASING COMPANYIAC1.00000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
TRUASSURE INSURANCE COMPANY
L138285MAINTAINED RECORDS AT FMV
TRUASSURE INSURANCE COMPANY
P94204MAINTAINED RECORDS AT FMV
TRUASSURE INSURANCE COMPANY
Q2718535MAINTAINED RECORDS AT FMV
TRUASSURE INSURANCE COMPANY
R507700MAINTAINED RECORDS AT FMV
DELTA DENTAL OF ILLINOIS FOUNDATION
B256000MAINTAINED RECORDS AT FMV

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