2023-11-15T08:04:47-06:00 2022-12-31 411431613 BERGANKDV LTD 12100 MEREDITH DR SUITE 200 URBANDALE IA 50323 990 2022-01-01 420959302 DELTA DENTAL OF IOWA DELT 5152615500 9000 NORTHPARK DRIVE JOHNSTON IA 50131 SHERRY PERKINS VICE PRES FINANCE & CONTROLLER 5152615500 2023-11-14 1 SHERRY PERKINS 999009999 1 BRENT L ALEXANDER CPA P00075113 5157275700 2023-10-30 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z TODD HERREN 9000 NORTHPARK DRIVE JOHNSTON IA 50131 238097822 0 X WWW.DELTADENTALIA.COM X 1970 IA DELTA DENTAL OF IOWA IS COMMITED TO IMPROVING THE HEALTH AND SMILES OF THE PEOPLE WE SERVE. THIS IS ACCOMPLISHED WITH PROGRAMS, EDUCATION AND CONTRIBUTIONS TO VARIOUS HEALTH FOCUSED ENTITIES AND INITIATIVES. DELTA DENTAL OF IOWA INVESTS IN DENTAL PROGRAMS, VISION PROGRAMS, MENTAL HEALTH PROGRAMS AND OTHER HEALTH RELATED INITIATIVES TO SUPPORT THE OVERALL HEALTH OF THE PEOPLE WE SERVE. 9 5 218 0 478503 0 0 0 204217367 227020742 5893811 2398053 531564 687651 210642742 230106446 6206620 6625000 149329554 169007596 20826948 22901942 0 0 0 21194878 20886097 197558000 219420635 13084742 10685811 171274321 169991175 63553316 62319422 107721005 107671753 X DELTA DENTAL OF IOWA'S MISSION IS TO IMPROVE THE HEALTH AND SMILES OF THE PEOPLE WE SERVE. THE PRIMARY WAY THIS IS ACCOMPLISHED IS THROUGH THE PROVISION OF DENTAL BENEFTIS AND PUBLIC HEALTH CONTRIBUTIONS THAT FOCUS ON ACCESS TO ORAL HEALTH SERVICES AND EDUCATION RELATED TO GOOD ORAL HEALTH BEHAVIORS. DELTA DENTAL OF IOWA ALSO INVESTS IN OTHER HEALTH RELATED INITIATIVES SUCH AS VISION AND MENTAL HEALTH PROGRAMS. 0 0 208368380 6625000 227229890 SINCE 1970, DELTA DENTAL OF IOWA HAS EXPANDED ACCESS TO DENTAL CARE BY PROVIDING AFFORDABLE, NETWORK BASED DENTAL BENEFITS PLANS TO IOWA EMPLOYERS AND INDIVIDUALS THAT RESULT IN LONG-TERM COST SAVINGS AND SUPPORT GOOD ORAL HEALTH. DELTA DENTAL OF IOWA'S DENTAL BENEFIT PLANS STRIVE TO INCORPORATE THE CURRENT BEST PRACTICES IN DENTAL SCIENCE. DELTA DENTAL IS COMMITTED TO ITS MISSION OF IMPROVING THE HEALTH AND SMILES OF THE PEOPLE AND COMMUNITIES IT SERVES. DELTA DENTAL FULFILLS ITS NOT-FOR-PROFIT OJECTIVES BY ACTIVELY PARTICIPATING IN THE COMMUNITIES IT SERVES AS A CHAMPION AND MAJOR FUNDER OF ORAL HEALTH INITIATIVES IN THE STATE OF IOWA. DELTA DENTAL INVESTS IN ORAL HEALTH PROJECTS THAT MEET THE NEEDS OF UNDERSERVED POPULATIONS AND THAT FOCUS ON ACCESS TO CARE,PREVENTION, EDUCATION AND RESEARCH. 208368380 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 1 0 1 21030 0 1 218 1 1 1 0 0 0 0 0 0 0 X 9 5 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X SHERRY PERKINS 5152615500 9000 NORTHPARK DRIVE JOHNSTON IA 50131 CHARLES EDWARD BROWN DIRECTOR 2.50 X 43887 0 0 DONNA GRANT DIRECTOR 1.60 0.50 X 37600 900 0 ROWENA CROSBIE DIRECTOR 1.60 X 15100 0 20500 TOM MAHONEY DIRECTOR 1.60 X 12600 0 20500 KRISTA TANNER DIRECTOR 1.60 X 32047 0 0 MARIA FULLER DIRECTOR 1.60 X 30825 0 0 SCOTT YEGGE DDS DIRECTOR 1.60 X 9751 0 20500 GREGORY DUNN DIRECTOR 1.60 X 30200 0 0 JEFFREY S RUSSELL PRESIDENT AND CEO 40.00 0.39 X 1143975 0 62124 TODD HERREN SENIOR VP, TECHNOLOGY & OP 40.00 X 462487 0 48370 JEFF CHAFFIN DDS CHIEF DENTAL OFFICER 40.00 1.17 X 465386 0 26053 APRIL SCHMALTZ SENIOR VP, MARKETING & SALES 40.00 X 444105 0 26053 MICHAEL ELAM VP, UNDERWRITING & ACTUARIAL 40.00 X 364183 0 47833 SUZANNE HECKENLAIBLE VP, PUBLIC AFFAIRS 30.00 10.00 X 317139 0 62124 SHERRY PERKINS VP, FINANCE & CONTROLLER 40.00 0.67 X 350149 0 26053 ELIZABETH MYERS VP, OPERATIONS (RETIRED 3/4/22) 40.00 X 351822 0 14047 GRETCHEN HAGEMAN VP, GOVERNMENT PROGRAMS 40.00 X 309902 0 24979 RYAN BLACKARD DIRECTOR, MARKETING 40.00 X 210512 0 57666 TOM WALTON DIRECTOR, LEGAL SERVICES & GENERAL COUNSEL 40.00 X 198330 0 54937 RANAE CALVERT DIRECTOR, STRATEGIC BUSINESS 40.00 X 190547 0 54356 CORY BAUER DIRECTOR, SALES & CUSTOMER RELATIONS 40.00 X 207456 0 17637 BETH RUSSETT DIRECTOR, HUMAN RESOURCES 40.00 X 178797 0 27605 5406800 900 611337 50 0 1 0 UNIVERSITY OF IOWA 322 DENTAL SCIENCE BLDG S IOWA CITY IA 52242 DENTAL SERVICES 10134941 APPLEWHITE DENTAL IOWA PC 900 JACKSON ST SUITE 108 DUBUQUE IA 52001 DENTAL SERVICES 5660944 DENTISTRY FOR CHILDREN OF IOWA PLC 2970 BRANDYWINE RD SUITE 200 ATLANTA GA 30341 DENTAL SERVICES 3545432 ORAL SURGEONS PC 7400 FLEUR DRIVE SUITE 200 DES MOINES IA 50321 DENTAL SERVICES 3192877 KIMBALL & BEECHER FAMILY DENTISTRY 4015 HURST DRIVE WATERLOO IA 50701 DENTAL SERVICES 2998864 702 PREMIUMS EARNED 524114 209545560 209545560 ADMINISTRATIVE SERVICE REVENUE 524292 17475182 17475182 227020742 2410705 2410705 7978724 7991376 -12652 -12652 -12652 MANAGEMENT FEES 541610 478503 478503 OTHER INCOME 900099 209148 209148 687651 230106446 227229890 478503 2398053 6625000 6625000 169007596 169007596 4820294 2219351 2600943 13289207 10352801 2936406 2032675 1394608 638067 1474267 1742213 -267946 1285499 923381 362118 707477 50 707427 216575 60000 156575 30000 30000 182087 182087 3770489 3315216 455273 1375613 1284593 91020 3868532 3140860 727672 676295 676295 260684 142393 118291 172264 74475 97789 1295023 789862 505161 466561 466561 BROKER COMMISSIONS 6144119 6144119 PREMIUM TAXES 1044139 1044139 DDPA DUES 507110 507110 CIVIC AND CHARITABLE CO 100315 24971 75344 68814 82752 -13938 219420635 208368380 11052255 0 62665895 65445794 865139 759708 8464981 8167698 728714 985400 36153317 21873773 14580308 14279544 73343841 67497623 6169760 6719860 4455683 6135548 171274321 169991175 14371538 15738198 49181778 46581224 63553316 62319422 X 107721005 107671753 107721005 107671753 171274321 169991175 10685811 -10735063 0 X X 0 1 X 1 0 2665500 2665500 11851832 3113254 8738578 20300401 17866368 2434033 1335584 894151 441433 14279544 UNEARNED PREMIUMS 2847561 CLAIMS UNPAID AND RESERVE 7044169 OTHER POLICY RESERVES 32455601 INTERCOMPANY PAYABLE 655335 OTHER LONG TERM LIABILITIES 3578558 46581224 X PART X, LINE 2: DELTA DENTAL OF IOWA IS EXEMPT FROM FEDERAL INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE COMPANY ACCOUNTS FOR INCOME TAXES OF TAXABLE CONSOLIDATED ENTITIES, WHERE DEFERRED TAXES ARE PROVIDED ON TEMPORARY DIFFERENCES ARISING FROM ASSETS AND LIABILITIES WHOSE BASES ARE DIFFERENT FOR FINANCIAL REPORTING AND INCOME TAX PURPOSES. DEFERRED TAXES WERE NOT SIGNIFICANT TO THE CONSOLIDATED FINANCIAL STATEMENTS. AS OF DECEMBER 31, 2022 AND 2021, THE COMPANY'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED OR ACCRUED DURING 2022 AND 2021. 1 DELTA DENTAL OF IOWA FOUNDATION 9000 NORTHPARK DRIVE JOHNSTON IA 50131 260762771 501(C)(3) 6100000 0 CONTRIBUTION TO DELTA DENTAL OF IOWA FOUNDATION TO SUPPORT & IMPROVE THE ORAL HEALTH OF IOWANS. COMMUNITY FOUNDATION OF GREATER DES MOINES 1915 GRAND AVE DES MOINES IA 50309 426139033 501(C)(3) 400000 0 CONTRIBUTION TO CFGDM FOR THE DDIA DONOR ADVISED FUND. THE DONOR ADVISED FUND IS USED FOR THE REPAYMENT OF DENTAL EDUCATION DEBT FOR A DENTIST WHO AGREES TO ESTABLISH AN OFFICE IN A RURAL, UNDERSERVED AREA. WESLEY COMMUNITY SERVICES 5508 NW 88TH STREET JOHNSTON IA 50131 203970256 501(C)(3) 50000 0 WESLEYLIFE MEALS ON WHEELS GREAT OUTDOORS FOUNDATION 501 SW 7TH STREET SUITE G DES MOINES IA 50309 421441098 501(C)(3) 50000 0 EASTER LAKE NORTH SHORE PROJECT IOWA DENTAL FOUNDATION 666 GRAND AVENUE STE 901 DES MOINES IA 50131 421405188 501(C)(3) 25000 0 IMOM 5 0 PART I, LINE 2: DELTA DENTAL OF IOWA MAINTAINS A DONOR ADVISED FUND AT THE COMMUNITY FOUNDATION OF GREATER DES MOINES FOR THE PURPOSE OF AWARDING LOAN REPAYMENT AWARDS TO DENTISTS WHO AGREE TO PRACTICE IN AN UNDERSERVED AREA IN THE STATE OF IOWA AND TO DEDICATE A PORTION OF THEIR PRACTICE TO LOW INCOME PATIENTS. DELTA DENTAL OF IOWA ADVISES THE COMMUNITY FOUNDATION OF GREATER DES MOINES ON HOW TO AWARD THIS MONEY AND THE COMMUNITY FOUNDATION OF GREATER DES MOINES ONLY GRANTS THIS MONEY TO DENTISTS IN THE STATE OF IOWA. THE COMMUNITY FOUNDATION OF GREATER DES MOINES AND DELTA DENTAL OF IOWA MAINTAIN RECORDS TO SUBSTANTIATE THE AMOUNT OF GRANTS, THE GRANTEEES' ELIGIBILITY AND THE SELECTION CRITERIA. DELTA DENTAL OF IOWA ALSO MAKES GRANTS TO THE DELTA DENTAL OF IOWA FOUNDATION. THE DELTA DENTAL OF IOWA FOUNDATION MAINTAINS RECORDS TO SUBSTANTIATE THE AMOUNT OF GRANTS, THE GRANTEES' ELIGIBILITY AND THE SELECTION CRITERIA. ORGANIZATIONS RECEIVING GRANTS ARE REQUIRED TO SUBMIT FINANCIAL INFORMATION. X X X 1 1 X X X X X 0 1 0 1 0 1 0 0 0 JEFFREY S RUSSELL PRESIDENT AND CEO 640241 0 438097 0 65637 0 23800 0 38324 0 1206099 0 56116 0 TODD HERREN SENIOR VP, TECHNOLOGY & OP 301844 0 137801 0 22842 0 23800 0 24570 0 510857 0 20685 0 JEFF CHAFFIN DDS CHIEF DENTAL OFFICER 289800 0 126514 0 49072 0 23800 0 2253 0 491439 0 46078 0 APRIL SCHMALTZ SENIOR VP, MARKETING & SALES 294066 0 130385 0 19654 0 23800 0 2253 0 470158 0 17885 0 MICHAEL ELAM VP, UNDERWRITING & ACTUARIAL 194609 0 91389 0 78185 0 23263 0 24570 0 412016 0 75875 0 SUZANNE HECKENLAIBLE VP, PUBLIC AFFAIRS 208934 0 98824 0 9381 0 23800 0 38324 0 379263 0 6964 0 SHERRY PERKINS VP, FINANCE & CONTROLLER 230633 0 104692 0 14824 0 23800 0 2253 0 376202 0 12688 0 ELIZABETH MYERS VP, OPERATIONS (RETIRED 3/4/22) 184184 0 114984 0 52654 0 13667 0 380 0 365869 0 52294 0 GRETCHEN HAGEMAN VP, GOVERNMENT PROGRAMS 217374 0 90579 0 1949 0 22726 0 2253 0 334881 0 0 0 RYAN BLACKARD DIRECTOR, MARKETING 169685 0 39337 0 1490 0 17115 0 40551 0 268178 0 0 0 TOM WALTON DIRECTOR, LEGAL SERVICES & GENERAL C 158555 0 38285 0 1490 0 14386 0 40551 0 253267 0 0 0 RANAE CALVERT DIRECTOR, STRATEGIC BUSINESS 150683 0 38349 0 1515 0 16032 0 38324 0 244903 0 0 0 CORY BAUER DIRECTOR, SALES & CUSTOMER RELATIONS 134103 0 71813 0 1540 0 15425 0 2212 0 225093 0 0 0 BETH RUSSETT DIRECTOR, HUMAN RESOURCES 143821 0 33286 0 1690 0 14126 0 13479 0 206402 0 0 0 PART I, LINE 1A TRAVEL FOR THE SPOUSE OF THE PRESIDENT AND CEO IS PAID BY THE COMPANY. THE TOTAL AMOUNT OF THE TRAVEL IS INCLUDED IN TAXABLE WAGES FOR THE PRESIDENT AND CEO. DISCRETIONARY SPENDING ACCOUNT FOR THE PRESIDENT AND CEO USED TO PAY ADDITIONAL INSURANCE, MEMBERSHIPS, ETC. THESE AMOUNTS ARE INCLUDED IN JEFF RUSSELL'S SALARY. SOCIAL CLUB DUES FOR THE PRESIDENT AND CEO ARE PAID BY THE COMPANY. THE AMOUNT OF PERSONAL USAGE OF THE CLUB IS INCLUDED IN TAXABLE WAGES FOR THE PRESIDENT AND CEO. PART I, LINE 4B EFFECTIVE JANUARY 1, 2016, THE OFFICERS OF DELTA DENTAL OF IOWA PARTICIPATE IN A SEC. 457(F) PLAN. DELTA DENTAL OF IOWA MAKES A CONTRIBUTION TO THE PLAN ANNUALLY ON BEHALF OF THE OFFICERS. THIS CONTRIBUTION IS A PERCENTAGE OF SALARY AND IS SET AND APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF DELTA DENTAL OF IOWA. THE PORTION OF A PARTICIPANT'S ACCOUNT BALANCE ALLOCATED TO A PARTICULAR PLAN YEAR'S AWARD BECOMES VESTED ON JANUARY 1ST OF THE FOURTH YEAR FOLLOWING THE PLAN YEAR FOR WHICH THE AWARD IS GRANTED. THAT AMOUNT IS THEN PAID TO THE OFFICER. OTHER THAN THE VESTING CRITERIA, THE OFFICERS CANNOT ACCESS THE FUNDS UNTIL RETIREMENT, LEAVING THE COMPANY, OR DEATH. OFFICERS WHO RECEIVED DEPOSITS IN 2022 FROM DELTA DENTAL OF IOWA AND THE AMOUNTS ARE: JEFFREY S. RUSSELL - $106,577 SHERRY PERKINS - $47,396 SUZANNE HECKENLAIBLE - $50,419 JEFF CHAFFIN - $54,361 APRIL SCHMALTZ - $62,390 TODD HERREN - $72,441 MICHAEL ELAM - $48,973 GRETCHEN HAGEMAN - $45,262 OFFICERS THAT RECEIVED PAYMENTS OF VESTED AMOUNTS IN 2022 INCLUDE: JEFFREY S. RUSSELL - $56,116 SHERRY PERKINS - $12,688 SUZANNE HECKENLAIBLE - $6,964 JEFF CHAFFIN - $46,078 APRIL SCHMALTZ - $17,885 TODD HERREN - $20,685 ELIZABETH MYERS - $52,294 MICHAEL ELAM - $75,875 THE OFFICERS OF DELTA DENTAL OF IOWA ALSO PARTICIPATE IN A LONG-TERM INCENTIVE PLAN. THE PLAN IS INTENDED AND AT ALL TIMES SHALL BE AN UNFUNDED AND UNSECURED PLAN THAT IS LIMITED TO KEY MANAGEMENT EMPLOYEES OF THE ORGANIZATION DESIGNED TO ENHANCE THE BOARD'S EFFORT AT RETENTION OF ITS EXECUTIVE STAFF. OFFICERS THAT RECEIVED PAYMENTS IN LONG-TERM INCENTIVE PLAN: ELIZABETH MYERS - $88,130. PART I, LINE 5 ONE EMPLOYEE OF THE COMPANY HAS COMPENSATION CONTINGENT ON REVENUES. THE INDIVIDUAL WORKS IN THE SALES DEPARTMENT AND RECEIVES COMMISSIONS BASED ON SALES OF GROUP BUSINESS. THE INDIVIDUAL IS RESPONSIBLE FOR SELLING NEW BUSINESS. PART I, LINE 6 CONSISTENT WITH THE COMPANY'S TOTAL COMPENSATION POLICY, THE OFFICERS AND KEY EMPLOYEES, ALONG WITH ALL EMPLOYEES OF THE COMPANY, PARTICIPATE IN A COMPANY INCENTIVE COMPENSATION PLAN. THIS PLAN CONTAINS NINE METRICS WHICH REPRESENT KEY GOALS FOR THE PLAN YEAR. AN OVERALL WEIGHTED SCORE IS CALCULATED. A BONUS WILL BE PAID IF THE COMPANY MEETS A RANGE OF GOAL ACCOMPLISHMENTS FOR THE YEAR. THE AMOUNT OF THE BONUS IS BASED ON THE TOTAL SCORE. ONE OF THESE METRICS IS PROFITABILITY, WHICH IS DEFINED AS "TOTAL NET GAIN IN DOLLARS PRIOR TO PUBLIC BENEFIT CONTRIBUTIONS FOR THE FISCAL YEAR PER AUDITED FINANCIAL RESULTS." DONNA GRANT DIRECTOR 233363 INDEPENDENT CONTRACTOR PAYMENTS MADE FOR DENTAL SERVICES FROM DDIA THROUGH NORWALK FAMILY DENTISTRY. TRANSACTIONS WERE DONE AT FAIR MARKET VALUE. 0 SCOTT YEGGE DIRECTOR 283358 INDEPENDENT CONTRACTOR PAYMENTS MADE FOR DENTAL SERVICES FROM DDIA THROUGH ADVANCED FAMILY DENTRISTRY. TRANSACTIONS WERE DONE AT FAIR MARKET VALUE. 0 MARIA FULLER DIRECTOR 155833 INDEPENDENT CONTRACTOR PAYMENTS MADE FOR DENTAL SERVICES FROM DDIA THROUGH FULLER FAMILY DENTRISTRY. TRANSACTIONS WERE DONE AT FAIR MARKET VALUE. 0 FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE CORPORATION CONSIST OF THE PROVIDERS (PARTICIPATING DENTISTS), AND SUBSCRIBERS WHO ARE ELECTED BY THE BOARD. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS SHALL BE ELECTED BY THE MEMBERS. SUBSCRIBER MEMBERS MAY NOMINATE CANDIDATES FOR SUBSCRIBER DIRECTOR POSITIONS AND PROVIDER MEMBERS MAY NOMINATE CANDIDATES FOR THE PROVIDER DIRECTOR POSITIONS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 AND ALL RELATED SCHEDULES WERE REVIEWED BY BOTH THE MANAGEMENT OF THE COMPANY AND THE BOARD OF DIRECTORS PRIOR TO FILING. THE FORM 990 WAS REVIEWED BY MANAGEMENT OF THE COMPANY PRIOR TO PRESENTATION TO THE BOARD. THE MEMBERS OF THE MANAGEMENT TEAM WHO REVIEWED THE FORM 990 WERE THE CEO, COMPLIANCE MANAGER, AND VICE PRESIDENT FINANCE. AN ELECTRONIC DRAFT COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS. ALL MEMBERS OF THE BOARD REVIEWED THE FORM 990 AND RELATED SCHEDULES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE COMPLIANCE MANAGER, ON BEHALF OF THE GOVERNANCE COMMITTEE, CONDUCTS AN ANNUAL CONFLICT OF INTEREST REVIEW FOR COMPLIANCE WITH FEDERAL AND STATE LAW AND THE GOVERNANCE POLICY. THE REVIEW INCLUDES ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES. COMPLETED CONFLICT OF INTEREST QUESTIONNAIRES AND DISCLOSURES ARE COMPARED TO THE GROUP FOR POTENTIALLY CONFLICTING TRANSACTIONS, BUSINESS AND FAMILY RELATIONSHIPS, AND AFFILIATIONS. ANNUAL COMPENSATION, REIMBURSEMENTS, BENEFIT PAYMENTS, AND OTHER TRANSACTIONS ARE ALSO REVIEWED FOR APPROPRIATENESS. A WRITTEN REPORT OF THE FINDINGS IS PRESENTED TO THE GOVERNANACE COMMITTEE, BOARD OF DIRECTORS AND SENIOR MANAGEMENT. SOLUTIONS TO POTENTIAL CONFLICTS ARE DISCUSSED AND DOCUMENTED IN THE BOARD OF DIRECTOR'S MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 ON A BI-ANNUAL BASIS, DELTA DENTAL OF IOWA DOES A MARKET PRICE AND BENCHMARKING COMPARISON OF THE COMPENSATION OF THE LEADERSHIP TEAM AND THE STAFF. THIS ANALYSIS IS PERFORMED BY AN INDEPENDENT THIRD PARTY. THIS ANALYSIS INCLUDES THE USE OF DATA AS TO COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. THE DOCUMENTED RESULTS AND RECOMMENDATIONS OF THIS ANALYSIS ARE PRESENTED TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS REVIEWS THE DOCUMENTATION AND APPROVES THE COMPENSATION. THESE DECISIONS ARE DOCUMENTED IN THE MINUTES OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 DELTA DENTAL OF IOWA'S GOVERNING DOCUMENTS BECOME A MATTER OF PUBLIC RECORD WHEN THEY ARE FILED WITH THE IOWA SECRETARY OF STATE. THE FINANCIAL STATEMENTS BECOME A MATTER OF PUBLIC RECORD WHEN THEY ARE FILED WITH THE IOWA INSURANCE DIVISION. BOTH AGENCIES HAVE ONLINE PUBLIC VIEWING ACCESS. THE CONFLICT OF INTEREST POLICY IS NOT FILED WITH THE STATE AGENCIES; HOWEVER, IT WOULD BE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 2C: THE ORGANIZATION HAS A FINANCE AND AUDIT COMMITTEE THAT HAS RESPONSIBILITY FOR SELECTION OF THE INDEPENDENT ACCOUNTANT AND OVERSIGHT OF THE AUDIT. THE BOARD OF DIRECTORS APPROVES THE ANNUAL APPOINTMENT OF THE INDEPENDENT ACCOUNTANT. SCHEDULE R, PART I, COLUMN B: VERATRUS INVESTMENTS, LLC IS A FOR-PROFIT CORPORATION OWNED BY VERATRUS HEALTH, INC. VERATRUS INVESTMENTS, LLC INVESTS IN ORGANIZATIONS THAT FURTHER THE MISSION OF VERATRUS HEALTH, INC. SCHEDULE R, PART II, COLUMN B: DELTA DENTAL OF IOWA'S MISSION IS TO IMPROVE THE HEALTH AND SMILES OF THOSE WE SERVE. AN AMOUNT IS SET ASIDE EACH YEAR TO FUND THIS MISSION. THE AMOUNT IS DETERMINED BY THE PERFORMANCE AND FINANCIAL STRENGTH OF THE COMPANY. AFTER THE AUDITED FINANCIALS ARE COMPLETE, AN AMOUNT IS PAID TO THE DELTA DENTAL OF IOWA FOUNDATION. THE DELTA DENTAL OF IOWA FOUNDATION IS A SEC. 501(C)(3) ORGANIZATION AND IS A TYPE 1 SUPPORTING ORGANIZATION UNDER SEC. 509(A)(3). IT IS THE RESPONSIBILITY OF THE FOUNDATION TO DISTRIBUTE THE MONIES CONSISTENT WITH ITS MISSION AND FOUNDING DOCUMENTS. THE MISSION OF THE DELTA DENTAL OF IOWA FOUNDATION IS TO SUPPORT AND IMPROVE THE ORAL HEALTH OF IOWANS. THE FOUNDATION WILL PROVIDE FUNDS TO OTHER SEC. 501(C)(3) ORGANIZATIONS, GOVERNMENTS, OR ACADEMIC INSTITUTIONS THAT ARE UNDERTAKING PROJECTS THAT SUPPORT AND IMPROVE THE ORAL HEALTH OF IOWANS. THE FOUNDATION WILL PROVIDE FUNDS TO OTHER TAX-EXEMPT ORGANIZATIONS THROUGH THEIR GRANTS PROGRAM THAT ALIGN WITH THE PROJECTS OF ACCESS TO CARE, RESEARCH, EDUCATION AND PREVENTION. THE AMOUNT CONTRIBUTED TO THE FOUNDATION IN 2022 WAS $6,100,000 ADDITIONALLY, DELTA DENTAL OF IOWA PROVIDES MANAGEMENT SERVICES FOR THE FOUNDATION. THIS INCLUDES DUTIES PERFORMED BY THE CHIEF EXECUTIVE OFFICER AND THE VICE PRESIDENT, FINANCE. THE EXECUTIVE DIRECTOR OF THE FOUNDATION IS THE DIRECTOR OF GOVERNMENT AND COMMUNITY RELATIONS FOR DELTA DENTAL OF IOWA. ALSO, DELTA DENTAL OF IOWA PROVIDES SOME ACCOUNTING FUNCTIONS. THE FOUNDATION REIMBURSES DELTA DENTAL OF IOWA FOR ALL STAFF CHARGES RELATED TO THE FOUNDATION. THE AMOUNT REIMBURSED TO DELTA DENTAL OF IOWA IN 2022 WAS $498,415 FOR MANAGEMENT FEES AND $45,152 FOR OTHER EXPENSES. SCHEDULE R, PART IV, COLUMN B: VERATRUS BENEFIT SOLUTIONS, INC. IS A FOR-PROFIT CORPORATION AND A WHOLLY-OWNED SUBSIDIARY OF VERATRUS HEALTH. PRIOR TO 2017, IT WAS A WHOLLY OWNED SUBSIDIARY OF DELTA DENTAL OF IOWA. VERATRUS WAS ORGANIZED TO DISTRIBUTE THE DELTA VISION PRODUCT. DELTA DENTAL OF IOWA MADE NO ADDITIONAL INVESTMENTS IN PAID IN CAPITAL IN VERATRUS IN 2022. DELTA DENTAL OF IOWA COLLECTS PREMIUMS FROM GROUPS FOR VISION COVERAGE AND TRANSFERS THIS PREMIUM TO VERATRUS. IN 2022, DELTA DENTAL OF IOWA TRANSFERRED $8,797,794 TO VERATRUS FOR PREMIUM COLLECTED ON THEIR BEHALF. IN ADDITION, DELTA DENTAL OF IOWA PROVIDES MANAGEMENT SERVICES TO VERATRUS. VERATRUS REIMBURSES DELTA DENTAL OF IOWA FOR ALL STAFF CHARGES RELATED TO VERATRUS. THE AMOUNT REIMBURSED TO DELTA DENTAL OF IOWA IN 2022 WAS $478,503 FOR MANAGEMENT FEES AND $1,360,817 FOR OTHER EXPENSES. DELTA DENTAL OF IOWA ALSO PURCHASES VISION BENEFITS FROM VERATRUS FOR DDIA EMPLOYEES. THE AMOUNT PAID TO VERATRUS IN 2022 FOR VISION BENEFITS FOR DDIA EMPLOYEES WAS $35,596. SCHEDULE R, PART IV, COLUMN B: VERATRUS HEALTH, INC. IS A FOR PROFIT CORPORATION FORMED IN 2017 AND IS WHOLLY-OWNED BY DELTA DENTAL OF IOWA. IN 2017, DELTA DENTAL OF IOWA TRANSFERRED 100% OF THE OWNERSHIP OF VERATRUS BENEFIT SOLUTIONS TO VERATRUS HEALTH, INC. VALUED AT $624,541. VERATRUS INVESTMENTS LLC 9000 NORTHPARK DRIVE JOHNSTON IA 50131 384028167 INVESTING IN ORGANIZATIONS THAT FURTHER THE MISSION OF VERATRUS HEALTH, INC. IA 0 0 VERATRUS HEALTH INC DELTA DENTAL OF IOWA FOUNDATION 9000 NORTHPARK DRIVE JOHNSTON IA 50131 260762771 NP ORGANIZED TO STRENGTHEN AND TRANSFORM THE HEALTH AND SMILES OF ALL IOWANS IA 501(C)(3) LINE 12A, I DELTA DENTAL OF IOWA 1 VERATRUS HEALTH INC 9000 NORTHPARK DRIVE JOHNSTON IA 50131 815414506 HOLDING COMPANY IA DENTAL DENTAL OF IOWA C 8722436 13275805 1.00000 1 VERATRUS BENEFIT SOLUTIONS INC 9000 NORTHPARK DRIVE JOHNSTON IA 50131 271584394 CORP ORGANIZED TO DISTRIBUTE DELTA VISION PRODUCT IA VERATRUS HEALTH INC C 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 DELTA DENTAL OF IOWA FOUNDATION B 6100000 SEE PART VII - SUPPLEMENTAL INFO DELTA DENTAL OF IOWA FOUNDATION O 498415 SEE PART VII - SUPPLEMENTAL INFO VERATRUS BENEFIT SOLUTIONS INC O 478503 SEE PART VII - SUPPLEMENTAL INFO VERATRUS BENEFIT SOLUTIONS INC R 8797794 SEE PART VII - SUPPLEMENTAL INFO VERATRUS BENEFIT SOLUTIONS INC Q 1360817 SEE PART VII - SUPPLEMENTAL INFO FORM 990, SCHEDULE R, PART V, LINE 2(1), COLUMN D: PERCENTAGE OF REVENUE BASED ON BOARD APPROVED POLICY FORM 990, SCHEDULE R, PART V, LINE 2(2), COLUMN D: MANAGEMENT FEES CHARGED TO DELTA DENTAL OF IOWA FOUNDATION BASED ON HOURS WORKED FORM 990, SCHEDULE R, PART V, LINE 2(3), COLUMN D: MANAGEMENT FEES CHARGED TO VERATRUS BENEFIT SOLUTIONS, INC. BASED ON HOURS WORKED FORM 990, SCHEDULE R, PART V, LINE 2(4), COLUMN D: VISION PREMIUMS BILLED AND COLLECTED BY DDIA ON BEHALF OF VERATRUS BENEFIT SOLUTIONS, INC. CASH WAS TRANSFERRED FROM DDIA TO VERATRUS FOR THESE PREMIUMS. FORM 990, SCHEDULE R, PART V, LINE 2(5), COLUMN D: ACTUAL COST OF INVOICES PAID BY DDIA ON BEHALF OF VERATRUS BENEFIT SOLUTIONS, INC.