2011-11-08T12:54:32-06:00 2010-12-31 BLACKMAN KALLICK LLP 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2010-01-01 362612058 DELTA DENTAL OF ILLINOIS DELT 6307184700 111 SHUMAN BOULEVARD NAPERVILLE IL 60563 BERNARD GLOSSY 6307184700 2011-10-27 1 KIMBERLY HAUMANN 3122071040 2011-10-27 2010 2016-03-07 17:11:31Z BERNARD GLOSSY 111 SHUMAN BOULEVARD NAPERVILLE IL 60563 458159595 0 X WWW.DELTADENTALIL.COM X 1967 IL IMPROVE THE ORAL HEALTH OF ILLINOIS RESIDENTS BY PROVIDING DENTAL BENEFITS & OTHER SERVICES. 13 10 182 0 0 0 0 0 413916257 449918280 1616991 1587292 -128485 55018 415404763 451560590 0 256000 379014726 411178869 17486050 16621989 0 0 0 18923162 19784131 415423938 447840989 -19175 3719601 72101274 81234101 34569085 36949523 37532189 44284578 IMPROVE THE ORAL HEALTH OF ILLINOIS RESIDENTS BY PROVIDING DENTAL BENEFITS & OTHER SERVICES. 0 0 432859621 256000 449918280 PROMOTE ORAL HEALTH THROUGH THE PROVISION OF DENTAL BENEFITS TO OVER 1,600,000 INDIVIDUALS. 432859621 0 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 1 59588 0 1 182 1 0 0 0 0 0 0 X 13 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X DELTA DENTAL OF ILLINOIS 6307184700 111 SHUMAN BOULEVARD NAPERVILLE IL 60563 SHARON HEATON 3.00 X 38250 0 0 CRAIG GRANNON 2.00 X 4950 0 16500 DR ALEN KNOX 2.00 X 11425 0 0 DR FRANK MAGGIO 2.00 X 26625 0 0 DR RICHARD PERRY 2.00 X 24900 0 0 LORRAINE ARVIN 2.00 X 19400 0 0 THOMAS CRISWELL 2.00 X 18450 0 0 DR ALAN JURGENS 1.00 X 15475 0 0 DR NANCY COZZI 1.00 X 12325 0 0 DR RICHARD HESS 1.00 X 17325 0 0 JOHN MAPLES 1.00 X 19600 0 0 MICHAEL BUSSE 2.00 X 7600 0 16500 PATRICIA HUNT-PREHEIM 2.00 X 25992 0 0 DAVID BEHNKE 40.00 X 264476 0 32203 HAZEL FISHER-GABLE 40.00 X 353795 0 31501 IRENE VASQUEZ 40.00 X 304451 0 33075 THOMAS COLGAN 40.00 X 430002 0 35261 STACEY BONN 40.00 X 58747 0 4978 BERNARD GLOSSY 40.00 X 222526 0 2888 JEANETTE BATTISTA 40.00 X 274521 0 37202 STEPHEN RETZSCH 40.00 X 334582 0 25398 MICHAEL WHITE 40.00 X 180138 0 21102 LINDA NASTI 40.00 X 182343 0 34685 THOMAS GEARY 40.00 X 165450 0 36050 WILLIAM POLANCICH 40.00 X 177211 0 28145 TERRI BON 40.00 X 160759 0 36404 THERESA MARSHALL 40.00 X 217323 0 24474 DR ROBERT DENNISON 0.00 X 288520 0 5564 ROSS GOSNELL 0.00 X 256546 0 21336 TAMERA ROBINSON 0.00 X 252500 0 21336 4366207 0 464602 34 1 1 0 EMDEON BUSINESS SERVICES 3183 RIDER TRAIL SOUTH EARTH CITY MO 63045 INVOICE AND CLAIMS PRINTING 2232280 ADVANTECH INC 2801 HOOVER ROAD STEVENS POINT WI 54481 IT SYSTEM MAINTENANCE 2150803 GTESS 2435 N CENTERAL EXPRESSWAY SUITE RICHARDSON TX 75080 IMAGE RECOGNITION PROCESSING 575224 RICHARDS GRAPHIC COMMUNICATIONS 2700 VAN BUREN ST BELLWOOD IL 60104 COMMERCIAL PRINTER 536626 THE MEYOCKS GROUP 6800 LAKE DRIVE WEST DES MOINES IA 50266 ADVERTISING AND MARKETING 402938 16 PREMIUMS 524114 449918280 449918280 449918280 1741141 1741141 6445156 6599005 -153849 -153849 -153849 OTHER INCOME 900099 55018 55018 55018 451560590 449918280 0 1642310 256000 256000 411178869 411178869 4555492 615408 3940084 8394188 4614664 3779524 744322 386068 358254 2111722 1223599 888123 816265 432392 383873 176227 176227 128441 128441 194596 194596 961163 204796 756367 543845 65647 478198 850186 739615 110571 3083259 3028066 55193 848851 848851 220053 46556 173497 49749 20803 28946 248666 248666 807312 171267 636045 271689 271689 BROKER COMMISSIONS 7084614 7084614 PRINTING & PUBLICATIONS 2238651 1924572 314079 INSURANCE DEPT. FEES 615397 568607 46790 POSTAGE AND SHIPPING 300895 300415 480 BANK FEES 258878 0 258878 901659 -2337 903996 447840989 432859621 14981368 0 410390 8084742 8103380 806103 872826 20869845 815563 13424091 20054282 43808387 46704043 5316253 5259819 251308 239751 72101274 81234101 11059808 12144250 3315918 3475527 4044625 10302709 16148734 11027037 34569085 36949523 X 0 0 0 0 37532189 44284578 37532189 44284578 72101274 81234101 X 3719601 3032788 X 0 1 1 X 0 0 1 0 3096941 3096941 15917408 381069 15536339 270222 143353 126869 1585274 291141 1294133 20054282 5259819 F 5259819 UNPAID CLAIMS AND CLAIMS ADJUSTMENT EXPENSE 8615000 CHECKS ISSUED IN EXCESS OF FUNDS ON DEPOSIT 2412037 11027037 451560590 447840989 3719601 3032788 3032788 6752389 451365994 0 451365994 194596 194596 451560590 447646393 0 447646393 194596 194596 447840989 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE 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. 1 DELTA DENTAL OF ILLINOIS FOUNDATION 111 SHULMAN BLVD NAPERVILLE IL 60563 262700504 501(C)3 256000 CONTRIBTUTION TO THE FOUNDATION 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE 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. X X X 1 1 X X X X X 1 0 0 0 0 0 0 0 0 DAVID BEHNKE 243315 0 0 0 21161 0 0 0 32203 0 296679 0 0 0 HAZEL FISHER-GABLE 270316 0 74965 0 8514 0 0 0 31501 0 385296 0 0 0 IRENE VASQUEZ 178550 0 66671 0 59230 0 0 0 33075 0 337526 0 0 0 THOMAS COLGAN 283009 0 110587 0 36406 0 0 0 35261 0 465263 0 0 0 BERNARD GLOSSY 176923 0 37877 0 7726 0 0 0 2888 0 225414 0 0 0 JEANETTE BATTISTA 201807 0 33490 0 39224 0 0 0 37202 0 311723 0 0 0 STEPHEN RETZSCH 131811 0 22149 0 180622 0 0 0 25398 0 359980 0 0 0 MICHAEL WHITE 143580 0 25839 0 10719 0 0 0 21102 0 201240 0 0 0 LINDA NASTI 93811 0 6108 0 82424 0 0 0 34685 0 217028 0 0 0 THOMAS GEARY 94033 0 6182 0 65235 0 0 0 36050 0 201500 0 0 0 WILLIAM POLANCICH 127582 0 27446 0 22183 0 0 0 28145 0 205356 0 0 0 TERRI BON 131138 0 28377 0 1244 0 0 0 36404 0 197163 0 0 0 THERESA MARSHALL 69178 0 5255 0 142890 0 0 0 24474 0 241797 0 0 0 DR ROBERT DENNISON 0 0 0 0 288520 0 0 0 5564 0 294084 0 0 0 ROSS GOSNELL 0 0 62046 0 194500 0 0 0 21336 0 277882 0 0 0 TAMERA ROBINSON 0 0 0 0 252500 0 0 0 21336 0 273836 0 0 0 PART I, LINE 1A FIRST 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 4A IRENE 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 TRUASSURE SUBSIDIARY 138285 SALE OF INSURANCE PRODUCTS BY TRUASSURE TO DELTA DENTAL OF ILLINOIS. 0 DR ALAN JURGENS THROUGH JURGENS AN DIRECTOR 229462 PAYMENTS TO DENTAL PRACTICE FOR DENTAL SERVICES PROVIDED UNDER DENTAL INSURANCE POLICY. 0 SCHEDULE L PART V RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANZIATION BERNARD 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. FORM 990, PART VI, SECTION A, LINE 6 UNDER THE ENABLING STATUTE THAT GOVERNS THE ORGANIZATION - THE ILLINOIS DENTAL SERVICE PLAN ACT - THE MEMBERS OF DELTA DENTAL OF ILLINOIS ARE THE PARTICIPATING DENTISTS (DEFINED AS ANY DENTIST LICENSED IN ILLINOIS TO PRACTICE DENTISTRY WHO IS REPUTABLE AND IN GOOD STANDING AND HAS SIGNED AN AGREEMENT TO BECOME A PARTICIPATING DENTIST OF THE ORGANIZATION) AND THE GROUP SUBSCRIBERS WHO PURCHASE A DENTAL BENEFIT PROGRAM FROM THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A AT THE ANNUAL MEMBERSHIP MEETING OF THE ORGANIZATION, THE MEMBERS REFERENCED IN PART VI, LINE 6 ELECT THE MEMBERS OF THE GOVERNING BODY, I.E. DIRECTORS, WHOSE TERM OF DIRECTORSHIP HAS EXPIRED. FORM 990, PART VI, SECTION A, LINE 7B PLEASE SEE THE RESPONSE FOR ITEM 7A. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF THE ORGANIZATION RETAINS THE SERVICES OF AN INDEPENDENT CPA FIRM TO ASSIST IN THE PREPARATION OF THE ORGANIZATION'S FORM 990. THE CPA FIRM ASSISTS MANAGEMENT IN PREPARING AND FINALIZING FORM 990. THE DRAFT OF FORM 990, INCLUDING ALL SCHEDULES, IS REVIEWED BY THE AUDIT AND FINANCE COMMITTEE, AND THEN DISTRIBUTED TO ALL VOTING MEMBERS OF THE GOVERNING BODY, I.E. THE DIRECTORS. THE ORGANIZATION'S MANAGEMENT, AND IF NEEDED ITS CPA FIRM, ADDRESS ANY QUESTIONS OR COMMENTS SUBMITTED BY THE ORGANIZATION'S GOVERNING BODY BEFORE FILING ITS FORM 990. AFTER THE AUDIT AND FINANCE COMMITTEE'S REVIEW AND MANAGEMENT ADDRESSES QUESTIONS OR COMMENTS FROM THE DIRECTORS, THE DRAFT FORM 990 IS FINALIZED AND FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C LEGAL COUNSEL FOR THE ORGANIZATION REVIEWS THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ANNUALLY WITH THE OFFICERS, DIRECTORS (TRUSTEES) AND KEY EMPLOYEES. AFTER THIS REVIEW, THE INDIVIDUALS OCCUPYING THESE POSITIONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. POTENTIAL CONFLICTS ARE LOGGED WITH THE SECRETARY OF THE ORGANIZATION AND ANY CHANGES TO THE DISCLOSURE FORM ARE TO BE REPORTED TO THE CHIEF LEGAL OFFICER OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 CEO COMPENSATION IS REVIEWED BY THE BOARD OF DIRECTORS. THE BOARD PERIODICALLY ENGAGES AN INDEPENDENT CONSULTING FIRM TO ADVISE OF COMPENSATION LEVELS OF SIMILARLY SITUATED CEOS BASED UPON SURVEYS AND DATA PROVIDED BY OTHER ORGANIZATIONS AS LISTED ON THEIR FORM 990. THIS DATA, OR THE DATA REPRESENTED TO THE COMPENSATION COMMITTEE AT SCHEDULED MEETINGS AND MINUTES OF THESE MEETINGS ARE CONTEMPORANEOUSLY PREPARED. THE COMMITTEE MAKES A RECOMMENDATION TO THE BOARD FOR APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE THROUGH APPLICABLE GOVERNMENTAL AGENCIES; THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON WRITTEN REQUEST TO THE ORGANIZATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 3,032,788. DELTA DENTAL OF ILLINOIS FOUNDATION 111 SHULMAN BLVD NAPERVILLE IL 60563 262700504 PROMOTE ORAL HEALTH OF THE RESIDENTS OF ILLINOIS IL 501(C)(3) LINE 7 1 TRUASSURE INSURANCE COMPANY 111 SHUMAN BLVD NAPERVILLE IL 60563 363757528 GROUP LIFE AND HEALTH INSURANCE IL C 196814 5678230 1.00000 PYRAMID BUSINESS SERVICES COMPANY 111 SHUMAN BLVD NAPERVILLE IL 60563 201726963 EMPLOYEE LEASING COMPANY IA C 1.00000 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 TRUASSURE INSURANCE COMPANY L 138285 MAINTAINED RECORDS AT FMV TRUASSURE INSURANCE COMPANY P 94204 MAINTAINED RECORDS AT FMV TRUASSURE INSURANCE COMPANY Q 2718535 MAINTAINED RECORDS AT FMV TRUASSURE INSURANCE COMPANY R 507700 MAINTAINED RECORDS AT FMV DELTA DENTAL OF ILLINOIS FOUNDATION B 256000 MAINTAINED RECORDS AT FMV