2011-11-02T11:04:41-07:00 2010-12-31 Stulken Petersen Lingle Walti & Jones LLP PO Box 578 Pierre SD 575010578 990 2010-01-01 460309258 DELTA DENTAL PLAN OF SOUTH DAKOTA DELT 6052247345 PO BOX 1157 PIERRE SD 57501 SCOTT JONES 2011-11-02 DAVID J LINGLE 6052245828 2010 2016-03-07 17:11:31Z X 98431813 false false X www.deltadentalsd.com X 1963 SD DELTA DENTAL OF SOUTH DAKOTA IS DEDICATED TO ADVANCING AND PROMOTING THE IMPROVEMENT OF ORAL HEALTH. 15 15 59 939914 -25500 51000 25500 78755005 85067583 176485 453073 903114 926529 79885604 86472685 0 0 3380298 3837461 0 0 75086531 81619318 78466829 85456779 1418775 1015906 34503693 37651027 7119087 7452629 27384606 30198398 DELTA DENTAL OF SOUTH DAKOTA IS DEDICATED TO ADVANCING AND PROMOTING THE IMPROVEMENT OF ORAL HEALTH. false false 75886131 1769303 85067583 DELTA DENTAL PAID THROUGH ITS CONTRACTS WITH INDEPENDENT DENTISTS 454,606 CLAIMS FOR DENTAL BENEFIT SERVICES FOR APPROXIMATELY 206,600 INDIVIDUALS WITH GROUP PLANS 26,000 INDIVIDUALS WITH DENTAL ACCIDENT PLANS AND 95,000 NATIVE AMERICANS UNDER ABERDEEN AREA HEALTH SERVICES. DELTA DENTAL ALSO GRANTED THE DELTA DENTAL PHILANTHRIPIC FUND, A 501(C)(3) CHARITABLE ORGANIZATION, $1,769,303 TO PROMOTE THE IMPROVEMENT OF ORAL HEALTH. 75886131 false false false false false false false false false false true true false false true false true false false false false false false false false false false false false true false false false false false false false false false false false false false false false false false false false false false true 2861 0 true 59 true true true false false false false false false false false false false false false false X 15 15 false false false false true true true true true false false false true true true true true true true true false false X KIRBY SCOTT 6052247345 720 NORTH EUCLID PIERRE SD PIERRE SD 57501 JEFF MILLER 40.00 X 124487 0 0 MIKE HOUK 1.00 X 3750 0 0 JOHN CLAUSEN 1.00 X 9050 0 0 JIM RUSSELL 1.00 X 6800 0 0 PAUL REZICH 1.00 X 4500 0 0 ANN LEE ROLA 1.00 X 750 0 0 RYAN VAN LACKEN 1.00 X 3500 0 0 MARY HITZEMANN 1.00 X 6000 0 0 PAT HERMANSON 1.00 X 4500 0 0 GREG HANSON 1.00 X 5250 0 0 G VERNE GOODSELL 1.00 X 6250 0 0 DALE GIBSON 1.00 X 9750 0 0 GREG GERTSEN 1.00 X 3700 0 0 STEVE CULHANE 1.00 X 4500 0 0 ELLEN LEE 1.00 X 3500 0 0 CONNIE HALVERSON 40.00 X 105974 0 0 MONTY BECHTOLD 1.00 X 3750 0 0 MICK HECKENLAIBLE 40.00 X 132635 0 0 GENE TETZLAFF 40.00 X 127390 0 0 NANCE ORSBON 40.00 X 112526 0 0 KIRBY SCOTT 40.00 X 143048 0 0 SCOTT JONES 40.00 X 472429 0 150598 1294039 150598 7 false true false 0 25500 25500 DELTA BENEFITS COVERAGE 85067583 85067583 85067583 640809 640809 0 0 30725 44110 -13385 -13385 -13385 11727282 11915018 -187736 -187736 -187736 0 0 0 MANAGEMENT SERVICE FEES 939914 939914 939914 86472685 85067583 939914 439688 0 0 0 0 1444637 1444637 0 1492993 1492993 271762 271762 457403 457403 170666 170666 0 5932 5932 59331 59331 0 0 49118 49118 10380 10380 96682 96682 0 0 0 0 66685 66685 0 26181 26181 0 0 341628 341628 49682 49682 DUES TAXES AND LICENCES 652552 652552 BROKERAGE AND COMMISSIONS 852288 852288 MANAGEMENT SERVICE EXPENSE 965414 965414 CONTRIBUTIONS 1856497 1856497 CLAIMS PAID/INCURRED 75886131 75886131 700817 700817 85456779 75886131 9570648 0 0 842608 900735 0 6424159 7450829 0 0 0 0 23886 18828 7592167 2597071 5180545 4995096 20187634 18271895 1589253 5749033 0 0 255608 264611 34503693 37651027 2503047 2622035 4616040 4830594 7119087 7452629 X 27384606 30198398 27384606 30198398 34503693 37651027 X 1015906 1797886 X false true true X false false 48657 348714 397371 565771 4081777 720025 3927523 1720075 1460164 259911 827173 416882 410291 4995096 5749033 DEFERRED PREMIUMS 833238 COST PLUS GROUP DEPOSITS 76600 CLAIMS PAYABLE, DENTAL ACCIDENT 36808 UNPAID CLAIMS PROCESSING COSTS 300000 REPORTED CLAIMS INCURRED, NOT REPORTED 3583948 4830594 86472685 85456779 1015906 1797886 1797886 2813792 86467677 44110 44110 86423567 49118 49118 86472685 85456779 85456779 85456779 Part XII, Line 2d Part XII, Line 2d: Other revenue amounts included in F/S but not included on form 990 RENTAL REAL ESTATE DEPRECIATION EXPENSE $31949 INSURANCE $3292 REAL ESTATE TAXES $8869 X true true X X X X X X false true false false false false false false false false SCOTT JONES 320000 140000 12429 150598 623027 Sch J, Part I, Line 1a Part I, Line 1a: Relevant information in regards to selections on 1a. Amended Explanation SUPERSEDED/AMENDED RETURN WAS PREPARED TO TIMELY ATTACH DOCUMENT CORRECTION REQUIRED BY REVENUE NOTICE 2010-6.SEE ATTACHED NOTICE Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available ALL DOCUMENTS AND POLICIES ARE AVAILABLE UPON REQUEST. Form 990, Part VI, Line 15b Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees Delta Dental of South DakotaCompensation Committee CharterPurposeThe purpose of the Compensation Committee is to review and report to the Board on compensation and personnel policies, programs and plans and to approve employee compensation and benefit plans.MembershipThe Compensation Committee shall be comprised of the DDSD Chair and vice-chair and at least two other board members.TermCommittee members are appointed to annual terms and may be reappointed to unlimited consecutive terms.Responsibilities1.Develop and recommend DDSD's compensation philosophy.2.Develop and recommend DDSD's compensation and benefits policies and programs including incentive plans, pension plan, and any perquisites.3.Periodically review DDSD's compensation and benefits policies/programs to determine whether they are properly coordinated and appropriate/competitive for like organizations.4.Annually review the CEO's performance and determine salary adjustments and incentive payments for CEO, ensuring compliance with the IRS "Rebuttable Presumption" safety zone for executive comp matters.5.Reviews CEO's recommendations as to salary adjustments and incentive payments for executive staff, ensuring compensation within the ranges of the executive compensation philosophy.MeetingsThe Compensation Committee shall meet at least annually and more often as determined necessary to fulfill its responsibilities.Reporting & AuthorityThe Compensation Committee may exercise all of the powers of the Board as authorized in concert with this charter. All actions taken by the Compensation Committee will be reported to the Board at its next regularly scheduled meeting. Form 990, Part VI, Line 12c Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts AT THE REGULARLY SCHEDULED BOARD MEETING TO ELECT BOD OFFICERS CONDUCTED IN MAY OF EACH YEAR, THE BOD AND OFFICERS OF DELTA DENTAL OF SOUTH DAKOTA ARE EACH GIVEN A CONFLICT OF INTEREST FORM TO FILL OUT. AT THE NEXT BOD MEETING EACH ONE IS READ AND ANY ACTION THAT NEEDS TO BE TAKEN IS DONE AT THAT TIME. Form 990, Part VI, Line 11 Form 990, Part VI, Line 11: Form 990 Review Process AT THE REGULARLY SCHEDULED BOARD MEETING IN MAY OF EACH YEAR , THE FORM 990 IS GIVEN TO EACH BOARD MEMBER AND A REVIEW IS CONDUCTED BY THE CHAIRMAN OF THE AUDIT AND FINANCE COMMITTEE. Form 990, Part VI, Line 7a Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body ALL MEMBER DENTISTS ARE INVITED TO THE ANNUAL MEETING AND IF PRESENT, HAVE ONE VOTE. Form 990, Part VI, Line 6 Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder DENTISTS LICENSED IN SOUTH DAKOTA THAT PAY A ONE-TIME MEMEBERSHIP DUES. Client Note 2 - 409A DOCUMENT CORRECTION UNDER IV AND V OF NOTICE 2010-61. The name and taxpayer identification number of each service provider affected by the document failure: Scott Jones SSN: 504-68-50302. Identification of Nonqualified Deferred Compensation Plan: Amended Supplemental Employment Agreement with Scott Jones.3. The document failures are eligible for correction under the terms of Notice 2010-6. The document failures were corrected under IV and V of Notice of 2010-6. Delta Dental Plan of South Dakota has taken all actions required and otherwise met all requirements for such correction as of the last day of its taxable year in which the correction was made, and also as of the last day of any subsequent taxable year of Scott Jones during which an amount, if any, is required to be included in income under 409A by Scott Jones as part of the correction. The date of correction was December 30, 2010 and there was no event causing the inclusion of an amount in income under 409A.4. Scott Jones has not included any income under 409A as part of this correction. The amount involved in each document failure was $534,898.00.DELTA DENTAL PLAN OFSOUTH DAKOTAEIN: 46-0309258 Client Note 1 - PAGE 10PART IX STATEMENT OF FUNCTIONAL EXPENSESLINE 22 DEPRECIATION (A)TOTAL (C)MANAGEMENT AND GENERALBUILDINGS STRAIGHT-LINE 28 YEARS $103,736 $103,736 MACHINERY & EQUIPMENT STRAIGHT-LINE 5-10 YEARS 180,788 180,788FURNITURE & FIXTURES STRAIGHT-LINE 5-10 YEARS 57,104 57,104TOTAL DEPRECIATION $341,628 $341,628PAGE 9PART VIII STATEMENT OF REVENUELINE 6B RENTAL EXPENSES DEPRECIATION BUILDINGS AND IMPROVEMENTS $31,949