2023-11-02T13:23:38-05:00 2022-12-31 341851358 CBIZ MHM LLC 530 HOWELL ROAD SUITE 209 GREENVILLE SC 29615 990 2022-01-01 521479587 DELTA DENTAL OF THE DISTRICT OF COLUMBIA DELT 7177668500 ONE DELTA DRIVE MECHANICSBURG PA 17055 ALICIA F WEBER CFO 4159748577 2023-11-01 1 ALICIA WEBER 999009999 0 KELLIE A LANFORD P00538614 8642412001 2023-11-02 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ALICIA F WEBER 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 2543786 0 X WWW.DELTADENTALINS.COM X 1985 DC TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS, SERVICE, TECHNOLOGY, AND PROFESSIONAL SUPPORT. 4 0 0 0 0 0 0 0 2537978 2557073 0 0 -22113 -13287 2515865 2543786 0 0 0 0 3200 2400 0 0 0 2512665 2541386 2515865 2543786 0 0 2544015 1953791 2439951 1849727 104064 104064 TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS, SERVICE, TECHNOLOGY, AND PROFESSIONAL SUPPORT. 0 0 2239714 2543786 THE ORGANIZATION IS THE GENERAL AGENT FOR DENTAL INSURANCECONTRACTS PROVIDING COVERAGE FOR 80,978 BENEFICIARIES IN 2022PRIMARILY THROUGH CONTRACTS WITH INDEPENDENT DENTISTS SERVING 61PURCHASING GROUPS. 2239714 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 7348 0 1 0 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X ALICIA F WEBER CFO 4159748577 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 X CASTRO MICHAEL J CHIEF EXECUTIVE OFFICER 1.00 49.00 X X 0 5009544 222178 GILBERT LEROY R JR EVP/CHIEF OPERATIONS OFFICER 1.00 49.00 X 0 3118124 13644 WEBER ALICIA F EVP CHIEF FINANCIAL OFFICER 1.00 49.00 X X 0 3009258 48312 CHAVARRIA SARAH PRESIDENT 1.00 49.00 X X 0 2805685 62579 HANKINSON MICHAEL G EVP CHIEF LEGAL OFFICER 1.00 49.00 X X 0 2509654 52087 JACKSON KEVIN L EVP/CHIEF GROWTH OFFICER 1.00 49.00 X 0 2317629 39631 TITCOMBE DOMINIC EVP/CHIEF INFORMATION OFFICER 1.00 49.00 X 0 2103812 62579 FEGLEY ANDREA M SENIOR VICE PRESIDENT DEPUTY GENERAL COUNSEL 1.00 49.00 X 0 777866 50763 CEMBROLA MICHAEL VP SALES 1.00 49.00 X 0 638317 55974 GRAYBILL RICHARD C VP UNDERWRITING AND ACTUARIAL 1.00 49.00 X 0 581034 42424 FOSTER JEANNE M VP FINANCE 1.00 49.00 X 0 566685 37570 RODZINKA BARBARA A VP ENT OPER SHARED SERVICES 1.00 49.00 X 0 532732 46265 CLARKE JAMIE VICE PRESIDENT NETWORK DEVELOPMENT 1.00 49.00 X 0 420333 58670 DAVIS CHRISTOPHER T VICE PRESIDENT SALES 1.00 49.00 X 0 376574 58601 MACGILVRAY JENNIFER VICE PRESIDENT CLAIMS PROCESSING 1.00 49.00 X 0 363961 60389 BROWN ALECIA DIRECTOR 1.00 0.00 X 800 0 0 KREUTZIGER CHRISTINA DIRECTOR 1.00 0.00 X 800 0 0 SINGER ALAN H DDS DIRECTOR 1.00 0.00 X 800 0 0 2400 25131208 911666 0 0 1 0 0 ADMIN FEES (ASC) 524298 1339476 1339476 ADMIN FEES (INSURED) 524298 1217597 1217597 2557073 MISC EXPENSE 524298 -3002 -3002 BAD DEBT EXPENSE 524298 -10285 -10285 -13287 2543786 2543786 0 0 2400 2400 73100 73100 15471 15471 65807 59559 6248 185537 185537 2400 2172 228 ADMINISTRATIVE FEES 2093821 1895017 198804 MISC. OUTSIDE SERVICES 85750 79780 5970 19500 17649 1851 2543786 2239714 304072 0 456729 288516 1315863 930009 771423 735266 2544015 1953791 92676 91725 123363 4656 1315863 930009 908049 823337 2439951 1849727 X 0 0 0 0 104064 104064 104064 104064 2544015 1953791 0 0 X 0 1 X 1 0 0 1 X 0 PREFUNDED DEPOSITS 7000 PAYABLE TO AFFILIATES 707969 REFUNDABLE BALANCES 108368 823337 X 2543786 0 2543786 0 2543786 2543786 0 2543786 0 2543786 PART IV, LINE 2B: THE COMPANY HOLDS SHORT-TERM INVESTMENTS AND ADMINISTERS FUNDS CONTRIBUTED TO THE DELTA FEDERAL MARKETING GROUP BY VARIOUS DELTA DENTAL MEMBER COMPANIES. THE FEDERAL MARKETING GROUP WAS FORMED FOR THE PURPOSE OF PROMOTING AND SUPPORTING A COORDINATED EFFORT TO SECURE CONTRACTS FOR DENTAL PROGRAMS WITH FEDERAL AGENCIES. SUCH FUNDS ARE HELD BY THE COMPANY IN A FIDUCIARY CAPACITY. PART X, LINE 2: THE COMPANY IS A TAX-EXEMPT ORGANIZATION ORGANIZED UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE AND, AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE FINANCIAL STATEMENTS. CURRENT ACCOUNTING GUIDANCE CLARIFIES HOW UNCERTAINTIES IN TAX POSITIONS ARE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE PRESCRIBES A FINANCIAL STATEMENT RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. POSITIONS INCLUDE THOSE WITH RESPECT TO THE COMPANY'S TAX EXEMPT STATUS AND WITH RESPECT TO INCOME TAXES ON UNRELATED BUSINESS INCOME. THE COMPANY HAS DETERMINED THAT SUCH TAX POSITIONS DO NOT RESULT IN UNCERTAINTIES REQUIRING RECOGNITION. PART X, LINE 1, (4) REFUNDABLE BALANCES: ON MARCH 11, 2020, THE WORLD HEALTH ORGANIZATION DECLARED A NOVEL STRAIN OF CORONAVIRUS (COVID-19) AS A GLOBAL PANDEMIC. THE COVID-19 OUTBREAK HAS CAUSED BUSINESS DISRUPTION THROUGH MANDATED AND VOLUNTARY CLOSINGS OF BUSINESSES AND SHELTER IN PLACE ORDERS. THESE DISRUPTIONS IMPACTED THE ORGANIZATION'S CUSTOMERS' ABILITY TO OBTAIN DENTAL SERVICES. THE ORGANIZATION HAS TAKEN A POSITION AND COMMITTED TO ITS CUSTOMERS, PROVIDERS, AND REGULATORS TO NOT EXCESSIVELY PROFIT FROM THE PANDEMIC. TO THIS END, IN 2020, THE ORGANIZATION ESTABLISHED ESTIMATED RESERVES REPRESENTING EXCESS UNDERWRITING GAINS IN THE AMOUNT OF $1.1 MILLION. DURING 2022, RESERVE AMOUNTS WERE USED TO SUPPORT CUSTOMERS THROUGH ONGOING PAYMENT RELIEF AND OTHER PROGRAMS RESULTING IN A REMAINING BALANCE OF $108,368 AT DECEMBER 31, 2022. 1 0 0 0 0 0 0 0 0 CASTRO MICHAEL J CHIEF EXECUTIVE OFFICER 0 1198364 0 3612501 0 198679 0 191624 0 30554 0 5231722 0 0 GILBERT LEROY R JR EVP/CHIEF OPERATIONS OFFICER 0 106043 0 1194486 0 1817595 0 9150 0 4494 0 3131768 0 0 WEBER ALICIA F EVP CHIEF FINANCIAL OFFICER 0 774996 0 2112618 0 121644 0 29618 0 18694 0 3057570 0 0 CHAVARRIA SARAH PRESIDENT 0 772692 0 1963784 0 69209 0 32025 0 30554 0 2868264 0 0 HANKINSON MICHAEL G EVP CHIEF LEGAL OFFICER 0 624038 0 1782943 0 102673 0 32025 0 20062 0 2561741 0 0 JACKSON KEVIN L EVP/CHIEF GROWTH OFFICER 0 638460 0 1493182 0 185987 0 9077 0 30554 0 2357260 0 0 TITCOMBE DOMINIC EVP/CHIEF INFORMATION OFFICER 0 549045 0 1487229 0 67538 0 32025 0 30554 0 2166391 0 0 FEGLEY ANDREA M SENIOR VICE PRESIDENT DEPUTY GENERAL 0 357654 0 371326 0 48886 0 33923 0 16840 0 828629 0 0 CEMBROLA MICHAEL VP SALES 0 268763 0 356954 0 12600 0 32025 0 23949 0 694291 0 0 GRAYBILL RICHARD C VP UNDERWRITING AND ACTUARIAL 0 257469 0 293235 0 30330 0 32025 0 10399 0 623458 0 0 FOSTER JEANNE M VP FINANCE 0 138650 0 366021 0 62014 0 32025 0 5545 0 604255 0 0 RODZINKA BARBARA A VP ENT OPER SHARED SERVICES 0 167774 0 326465 0 38493 0 32025 0 14240 0 578997 0 0 CLARKE JAMIE VICE PRESIDENT NETWORK DEVELOPMENT 0 317376 0 95459 0 7498 0 32025 0 26645 0 479003 0 0 DAVIS CHRISTOPHER T VICE PRESIDENT SALES 0 241437 0 124723 0 10414 0 32025 0 26576 0 435175 0 0 MACGILVRAY JENNIFER VICE PRESIDENT CLAIMS PROCESSING 0 309810 0 43413 0 10738 0 32025 0 28364 0 424350 0 0 PART I, LINE 3 COMPENSATION PAID TO THE CEO AND EXECUTIVE VICE PRESIDENTS IS APPROVED BY THE COMPENSATION COMMITTEE OF THE RELATED ORGANIZATION. THE COMPENSATION COMMITTEE APPROVES COMPENSATION FOR THE ENSUING YEAR AFTER REVIEWING COMPARABILITY DATA PRESENTED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT, AN ASSESSMENT OF EACH OFFICER'S PERFORMANCE OVER THE PRECEDING YEAR, AND THE RELATED ORGANIZATION'S PROGRAM ACCOMPLISHMENTS FOR THE PRIOR YEAR. COMPENSATION PAID TO DIRECTORS IS ALSO APPROVED BY THE COMPENSATION COMMITTEE AFTER REVIEWING COMPARABILITY DATA IN A BENCHMARKING STUDY PREPARED AND PRESENTED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT RETAINED BY THE BOARD OF DIRECTORS. THESE PROCESSES WERE FOLLOWED FOR 2022 COMPENSATION. PART I, LINE 4A DURING 2022, ONE EXECUTIVE, LEROY R. GILBERT, JR. RECEIVED A SEVERANCE PAYMENT UPON SEPARATION FROM THE ORGANIZATION. THIS PAYMENT IS INCLUDED ON SCHEDULE J AND REPORTED IN PART II, COLUMN(B)(III). PART II, ROW (II): SOME OF THE ORGANIZATION'S OFFICERS ARE PAID BY A RELATED ORGANIZATION. ACCORDINGLY, THEIR COMPENSATION IS REPORTED ON ROW (II). FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE CLASS OF MEMBERS, DESIGNATED CORPORATE MEMBERS, WHO ARE DIRECTORS OF DENTEGRA GROUP, INC., THE ORGANIZATION'S PARENT HOLDING COMPANY. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S DIRECTORS VOTE ON PERSONS NOMINATED AS DIRECTORS FOR ENDORSEMENT TO THE CORPORATE MEMBERS, WHO ELECT THE DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE CORPORATE MEMBERS MUST APPROVE ANY CHANGES TO SPECIFIED BYLAWS PROVISIONS. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S CFO AND LEGAL COUNSEL OVERSEE THE COMPLETION OF THE FORM 990 AND, PRIOR TO FILING, REVIEW IT WITH THE PRESIDENT/CEO AND WITH THE DELTA DENTAL OF PENNSYLVANIA AUDIT COMMITTEE TO WHICH SUCH DUTIES HAVE BEEN DELEGATED. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY, AND BETWEEN ANNUAL STATEMENTS IS REQUIRED TO DISCLOSE ANY NEW POSITION OR RELATIONSHIP FORMED THAT POTENTIALLY RAISES A CONFLICT OF INTEREST. LEGAL COUNSEL REVIEWS THESE DISCLOSURES AND REPORTS THE INFORMATION TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PAID TO THE CEO AND EXECUTIVE VICE PRESIDENTS IS APPROVED BY THE COMPENSATION COMMITTEE OF THE RELATED ORGANIZATION. THE COMPENSATION COMMITTEE APPROVES COMPENSATION FOR THE ENSUING YEAR AFTER REVIEWING COMPARABILITY DATA PRESENTED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT, AN ASSESSMENT OF EACH OFFICER'S PERFORMANCE OVER THE PRECEDING YEAR, AND THE RELATED ORGANIZATION'S PROGRAM ACCOMPLISHMENTS FOR THE PRIOR YEAR. COMPENSATION PAID TO DIRECTORS IS ALSO APPROVED BY THE COMPENSATION COMMITTEE AFTER REVIEWING COMPARABILITY DATA IN A BENCHMARKING STUDY PREPARED AND PRESENTED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT RETAINED BY THE BOARD OF DIRECTORS. THESE PROCESSES WERE FOLLOWED FOR 2022 COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION ANNUALLY INCLUDES MAJOR PORTIONS OF ITS FINANCIAL STATEMENT IN A PUBLISHED ANNUAL REPORT THAT IS MADE AVAILABLE TO PERSONS OR ENTITIES KNOWN TO HAVE AN INTEREST IN THE ORGANIZATION, AND IS AVAILABLE TO THE LARGER PUBLIC UPON REQUEST. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990, PART VII; SCHEDULE J; SCHEDULE R: THE ORGANIZATION, REGULATED BY THE DISTRICT OF COLUMBIA DEPARTMENT OF INSURANCE, SECURITIES, AND BANKING, IS A MEMBER OF THE DELTA DENTAL OF CALIFORNIA ENTERPRISE COMPANIES, WHICH INCLUDE DELTA DENTAL OF CALIFORNIA, DELTA DENTAL OF PENNSYLVANIA AND AFFILIATED COMPANIES OPERATING IN 15 STATES, THE DISTRICT OF COLUMBIA, PUERTO RICO AND THE U.S. VIRGIN ISLANDS. THE ENTERPRISE COMPANIES COMPRISE ONE OF THE NATION'S LARGEST DENTAL BENEFITS DELIVERY SYSTEMS COVERING 45 MILLION ENROLLEES AND PROCESSING 57 MILLION CLAIMS. TOTAL REVENUE FOR THE ENTERPRISE WAS APPROXIMATELY $9.8 BILLION IN 2022. THE ORGANIZATION REPRESENTS LESS THAN 1% OF TOTAL ENTERPRISE REVENUES. DELTA DENTAL COMMUNITY CARE FOUNDATION 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 371570764 CHARITABLE ORGANIZATION CA 501(C)(3) PF DENTEGRA GROUP INC 0 DELTA DENTAL OF PENNSYLVANIA ONE DELTA DRIVE MECHANICSBURG PA 17055 231667011 DENTAL INSURANCE PA 501(C)(4) DENTEGRA GROUP INC 0 DELTA DENTAL OF DELAWARE INC ONE DELTA DRIVE MECHANICSBURG PA 17055 510228088 DENTAL INSURANCE DE 501(C)(4) DENTEGRA GROUP INC 0 DELTA DENTAL OF WEST VIRGINIA INC ONE DELTA DRIVE MECHANICSBURG PA 17055 550523124 DENTAL INSURANCE WV 501(C)(4) DENTEGRA GROUP INC 0 DELTA DENTAL OF CALIFORNIA 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 941461312 DENTAL INSURANCE CA 501(C)(4) DENTEGRA GROUP INC 0 DELTA DENTAL OF NEW YORK ONE DELTA DRIVE MECHANICSBURG PA 17055 111980218 DENTAL INSURANCE NY 501(C)(4) DENTEGRA GROUP INC 0 DENTEGRA GROUP INC 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 943386049 HOLDING COMPANY DE N/A C 0 DENTEGRA INSURANCE COMPANY 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 751233841 INSURANCE COMPANY DE DDC INSURANCE HOLDINGS INC C 0 DENTEGRA INSURANCE COMP OF NEW ENGLAND 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 300318743 INSURANCE COMPANY MA DDC INSURANCE HOLDINGS INC C 0 DELTA DENTAL INSURANCE COMPANY 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 942761537 INSURANCE COMPANY DE DDC INSURANCE HOLDINGS INC C 0 ALPHA DENTAL OF NEVADA INC 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 880244893 INSURANCE COMPANY NV DDC INSURANCE HOLDINGS INC C 0 ALPHA DENTAL OF UTAH INC 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 860672505 INSURANCE COMPANY UT DDC INSURANCE HOLDINGS INC C 0 ALPHA DENTAL PROGRAMS INC 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 742447512 INSURANCE COMPANY TX DDC INSURANCE HOLDINGS INC C 0 ALPHA DENTAL OF ALABAMA INC 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 630796079 INSURANCE COMPANY AL DDC INSURANCE HOLDINGS INC C 0 ALPHA DENTAL OF NEW MEXICO INC 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 330279230 INSURANCE COMPANY NM DDC INSURANCE HOLDINGS INC C 0 ALPHA DENTAL OF ARIZONA INC 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 930939835 INSURANCE COMPANY AZ DDC INSURANCE HOLDINGS INC C 0 DENTEGRA SEGURO DENTALES SA INSURGENTES SUR 826 PISO 15 COL DEL VALLE FC DF 01300 MX INSURANCE COMPANY MX DENTEGRA INSURANCE COMPANY C 0 DELTA DENTAL OF PUERTO RICO 14 CALLE 2 SUITE 200 GUAYNABO RQ 00968 660436769 INSURANCE COMPANY RQ DELTA DENTAL OF CALIFORNIA C 0 SERVICIOS DENTALES DENTEGRA SA DE CV INSURGENTES SUR 826 PISO 15 COL DEL VALLE FC DF 01300 MX INACTIVE MX DENTEGRA INSURANCE COMPANY C 0 DDC INSURANCE HOLDINGS INC 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 274251930 HOLDING COMPANY DE DELTA DENTAL OF CALIFORNIA C 0 ALLIED ADMINISTRATORS INC 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 941713371 THIRD PARTY ADMIN SERVICES CA DDC INSURANCE HOLDINGS INC C 0 DELTA DENTAL IPA OF NEW YORK 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 384063658 INDEPENDENT PRACTICE ASSOCIATION NY DDC INSURANCE HOLDINGS INC C 0 CONVECTION HUB INC 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 825288274 INACTIVE DE DDC INSURANCE HOLDINGS INC C 0 ORAL HEALTH INNOVATION CENTER INC 560 MISSION STREET STE 1300 SAN FRANCISCO CA 94105 920778836 INACTIVE DE DDC INSURANCE HOLDINGS INC C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 DELTA DENTAL OF CALIFORNIA P 120988 DELTA DENTAL INSURANCE COMPANY M 635648 DELTA DENTAL OF PENNSYLVANIA M 2046952 DELTA DENTAL INSURANCE COMPANY R 8710940 DELTA DENTAL INSURANCE COMPANY S 7786422 ALLIED ADMINISTRATORS INC M 94438 DELTA DENTAL OF PENNSYLVANIA P 78