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 260762771 DELTA DENTAL OF IOWA FOUNDATION DELT 5152615500 9000 NORTHPARK DRIVE JOHNSTON IA 50131 SHERRY PERKINS SECRETARY-TREASURER 5152615500 2023-11-14 1 SHERRY PERKINS 999009999 1 BRENT L ALEXANDER CPA P00075113 5157275700 2023-11-07 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z APRIL SCHMALTZ 9000 NORTHPARK DRIVE JOHNSTON IA 50131 6744772 0 X WWW.DELTADENTALIA.COM X 2007 IA THE CORPORATION IS ORGANIZED TO STRENGTHEN AND TRANSFORM THE HEALTH AND SMILES OF ALL IOWANS. THE FOUNDATION WILL PROVIDE FUNDS TO OTHER 501(C)(3) ORGANIZATIONS, GOVERNMENTS, OR ACADEMIC INSTITUTIONS THAT ARE UNDERTAKING PROJECTS THAT SUPPORT AND IMPROVE THE HEALTH OF ALL IOWANS. THE FOUNDATION WILL PROVIDE FUNDS TO OTHER TAX-EXEMPT ORGANIZATIONS THROUGH THEIR GRANT PROGRAM THAT ALIGN WITH THE PROJECTS OF ORAL HEALTH, ORAL AND OVERALL HEALTH INTEGRATION, AND OVERALL HEALTH. 14 10 0 0 0 0 5601500 6101500 0 0 2039070 642792 0 480 7640570 6744772 2207199 3426450 0 0 4200 5400 0 0 0 665516 703713 2876915 4135563 4763655 2609209 36005552 34090598 60166 203385 35945386 33887213 X THE CORPORATION IS ORGANIZED TO STRENGTHEN AND TRANSFORM THE HEALTH AND SMILES OF ALL IOWANS. THE FOUNDATION WILL PROVIDE FUNDS TO OTHER 501(C)(3) ORGANIZATIONS, GOVERNMENTS, OR ACADEMIC INSTITUTIONS THAT ARE UNDERTAKING PROJECTS THAT SUPPORT AND IMPROVE THE HEALTH OF ALL IOWANS. THE FOUNDATION WILL PROVIDE FUNDS TO OTHER TAX-EXEMPT ORGANIZATIONS THROUGH THEIR GRANT PROGRAM THAT ALIGN WITH THE PROJECTS OF ORAL HEALTH, ORAL AND OVERALL HEALTH INTEGRATION, AND OVERALL HEALTH. 0 0 2315632 2160907 0 ORAL HEALTH PROJECTS - ACTIVITIES THAT ENSURE HEALTHY SMILES FOR ALL IOWANS. 675802 589240 0 ORAL AND OVERALL HEALTH INTEGRATION PROJECTS - ACTIVITIES THAT PROMOTE TIGHTER CONNECTIONS BETWEEN DENTAL, PHYSICAL, AND BEHAVIORAL HEALTH. 835151 676303 0 OVERALL HEALTH PROJECTS - WELLNESS, VISION, AND RELATED ACTIVITIES THAT ENABLE IOWANS TO LIVE HEALTHY AND ACTIVE LIVES. 3826585 1 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 10 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 10 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 0 1 1 1 0 X SHERRY PERKINS 5152615500 9000 NORTHPARK DRIVE JOHNSTON IA 50131 JEFFREY S RUSSELL PRESIDENT 0.39 40.00 X X 0 1143975 62124 JEFF CHAFFIN DDS DIRECTOR 1.17 40.00 X 0 465386 26053 DONNA GRANT DDS DIRECTOR 0.50 1.60 X 900 37600 0 SUZANNA DE BACA DIRECTOR 0.50 X 900 0 0 JOEL WULF DIRECTOR, CHAIR 1.00 X X 900 0 0 MICHAEL METTS DIRECTOR, STARTING JUNE 2022 0.50 X 900 0 0 MISSY GOWEY DIRECTOR 0.50 X 600 0 0 NATHAN HEHR DIRECTOR, STARTING JUNE 2022 0.50 X 600 0 0 HAYLEY HARVEY DIRECTOR, STARTING JUNE 2022 0.50 X 600 0 0 SCOTT RAECKER DIRECTOR, VICE CHAIR 1.00 X X 0 0 0 DR NAFISSA CISSE EGBUONYE DIRECTOR 0.50 X 0 0 0 DAN CAPLAN DDS DIRECTOR 0.50 X 0 0 0 TRACY RODGERS DIRECTOR 0.50 X 0 0 0 JENNIFER VERMEER DIRECTOR 0.50 X 0 0 0 KEN JONES DIRECTOR THROUGH JUNE 2022 0.50 X 0 0 0 LYNN CURRY DDS DIRECTOR THROUGH JUNE 2022 0.50 X 0 0 0 HOWARD COWEN DDS DIRECTOR THROUGH JUNE 2022 0.50 X 0 0 0 SHERRY PERKINS SECRETARY-TREASURER 0.67 40.00 X 0 350149 26053 SUZANNE HECKENLAIBLE EXECUTIVE DIRECTOR 10.00 30.00 X 0 317139 62124 5400 2314249 176354 0 0 1 0 0 6100000 1500 6101500 642792 642792 MISCELLANEOUS INCOME 900099 480 480 480 6744772 480 0 642792 3426450 3426450 5400 5400 498415 326657 171758 11950 11950 50119 50119 1072 1072 9858 7388 2470 8236 552 7684 27243 2648 24595 12554 4016 8538 CONSULTING 45961 28911 17050 OUTREACH AND EDUCATION 26963 26963 MEMBERSHIP FEES 4745 3000 1745 TRAINING 2835 2835 3762 3762 4135563 3826585 308978 0 577508 74436 2419237 2618295 5600000 6100000 0 480 4107 9826 24673921 22421635 2730615 2864764 164 1162 36005552 34090598 1925 10459 550 141318 57691 51608 60166 203385 X 2889617 2486609 33055769 31400604 35945386 33887213 36005552 34090598 X 2609209 -4680146 12764 X 0 1 X 1 0 X X X 1 DELTA DENTAL OF IOWA 420959302 10 1 0 0 1 0 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 SCHEDULE A, PART 1, LINE 12G, COLUMN V: DELTA DENTAL OF IOWA'S MISSION IS TO STRENGTHEN AND TRANSFORM THE HEALTH AND SMILES OF THE PEOPLE WE SERVE. AN AMOUNT IS SET ASIDE EACH YEAR TO FUND THIS MISSION. THE AMOUNT IS DETERMINED BY THE PERFORMANCE AND FINANCIAL STRENGTH OF DELTA DENTAL. AFTER THE AUDITED FINANCIALS ARE COMPLETE, THE AMOUNT IS PAID TO THE FOUNDATION. THE 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 FOUNDATION IS TO STRENGTHEN AND TRANSFORM THE HEALTH AND SMILES OF ALL IOWANS. THE FOUNDATION WILL PROVIDE FUNDS TO OTHER SEC. 501(C)(3) ORGANIZATIONS, GOVERNMENTS, OR ACADEMIC INSTITUTIONS THROUGH THEIR GRANTS PROGRAM THAT ALIGN WITH THE PROJECTS OF ORAL HEALTH, ORAL AND OVERALL HEALTH INTEGRATION AND OVERALL HEALTH. THE AMOUNT CONTRIBUTED TO THE FOUNDATION IN 2022 WAS $6,100,000. SCHEDULE A, PART IV, LINE 3B: DELTA DENTAL OF IOWA HAS PROVIDED A COPY OF THEIR 501(C)(4) IRS DETERMINATION LETTER AND HAS COMPLETED THE PROFORMA PUBLIC SUPPORT CALCULATIONS FOR THE APPLICABLE YEARS. DURING THE CURRENT YEAR, DELTA DENTAL OF IOWA MET THE PUBLIC SUPPORT TEST REQUIREMENTS. DELTA DENTAL OF IOWA FOUNDATION HAS A FORMAL POLICY APPROVED BY THE BOARD TO ANNUALLY CONFIRM THAT DELTA DENTAL OF IOWA HAS MAINTAINED ITS SUPPORTED ORGANZATION STATUS AS A 501(C)(4) AND HAS SATISIFIED THE PUBLIC SUPPORT TESTS UNDER SECTION 509(A)(2) OF THE INTERNAL REVENUE CODE. SCHEDULE A, PART IV, LINE 3C: ALL GRANTEES THAT RECEIVE FUNDS FROM THE DELTA DENTAL OF IOWA FOUNDATION ARE REQUIRED TO COMPLETE AN OUTCOMES REPORT WITHIN 30 DAYS OF COMPLETION OF THE PROJECT. FOR GRANTEES UNDER $25,000, THIS INCLUDES INFORMATION SUCH AS NUMBER OF INDIVIDUALS SERVICED, CHALLENGES, OPPORTUNITIES AND LESSONS LEARNED. FOR GRANTEES THAT RECEIVE OVER $25,000 AN EVALUATION PLAN IS DEVELOPED IN COORDINATION WITH THE GRANTEE AND THE FOUNDATION SPECIFIC TO THE PROJECT AND TO ALIGN WITH A CORE SET OF INDICATORS OF SUCCESS. IN ADDITION, GRANTEES OVER $50,000 PRESENT TO THE DELTA DENTAL OF IOWA FOUNDATION BOARD AT THE COMPLETION OF THE PROJECT. GRANTEES MAY REQUEST A ONE TIME EXTENSION TO SPEND DOWN ANY UNUSED FUNDS, BUT IT MUST BE FOR THE SAME PROJECT OTHERWISE THEY FUNDS ARE REQUIRED TO BE RETURNED. ANY CHANGE FROM THE INITIAL REQUEST FOR FUNDS REQUIRES A WRITTEN REQUEST AND APPROVAL. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 29455769 2500000 -4112846 42319 27800604 23680453 2500000 3317048 41732 29455769 20030878 1000000 2684491 34916 23680453 14922781 2000000 3138857 30760 20030878 14214533 1650000 -914801 26951 14922781 0.00000 0.00000 1.00000 1 0 0 PRIVATE EQUITY SECURITIES 2864764 F 2864764 PAYABLE TO DELTA DENTAL OF IOWA 51608 51608 X 2039271 -4680146 4200 12764 -4663182 6702453 42319 42319 6744772 4097444 4200 4200 4093244 42319 42319 4135563 PART V, LINE 4: THE INTENDED USE OF THE ENDOWMENT FUND IS TO PROVIDE A FUTURE STREAM OF INCOME FOR THE FOUNDATION TO BE USED TO FUND THE MISSION OF THE FOUNDATION. PART X, LINE 2: 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 OR 2021. 0 CRESCENT COMMUNITY HEALTH CENTER 1690 ELM STREET STE 300 DUBUQUE IA 52001 481302204 501(C)3 991318 0 FUNDING FOR DENTAL CLINIC AND LAB EXPANSION; DENTAL/HYGIENIST DENTAL RESIDENCY/EDUCATION. IOWA DEPT OF HEALTH AND HUMAN SERVICES 321 EAST 12TH STREET DES MOINES IA 50319 426004523 STATE OF IOWA 180085 0 FUNDING CONTINUES TO SUPPORT THE PROGRESS OF THE I-SMILE SILVER PROJECT AND EXPAND THE REACH OF I-SMILE SILVER TO ALL AT-RISK IOWA ADULTS, PARTICULARLY ADULTS ENROLLED IN MEDICAID TO ACCESS ORAL HEALTH SERVICES AND MAINTAIN OVERALL AND ORAL HEALTH. IOWA DEPT OF PUBLIC HEALTH-ORAL HEALTH BUREAU 321 EAST 12TH STREET DES MOINES IA 50319 426004523 STATE OF IOWA 200000 0 FUNDING CONTINUES TO SUPPORT I-SMILE@SCHOOL, A STATE WIDE SCHOOL-BASED SEALANT PROGRAM FOR UNDERSERVED CHILDREN. IOWA DEPT OF PUBLIC HEALTH-ORAL HEALTH BUREAU 321 EAST 12TH STREET DES MOINES IA 50319 426004523 STATE OF IOWA 4980 0 FUNDING FOR ORAL HEALTH EDUCATION FOR DIABETES AND HEART DISEASE PREVENTION AND MANAGEMENT. IOWA PRIMARY CARE ASSOCIATION 500 SW 7TH STREET STE 300 DES MOINES IA 50309 421311646 501(C)3 266104 0 FUNDING THE INVESTMENT IN THE STATEWIDE HIT SYSTEM TO SUPPORT IMPLEMENTATION OF AN ELECTRONIC DENTAL HEALTH RECORD IN 11 OF 13 OF IOWA'S COMMUNITY HEALTH CENTERS. HAWKEYE COMMUNITY COLLEGE FOUNDATION 1501 E ORANGE ROAD WATERLOO IA 50704 420925362 501(C)3 249450 0 FUNDING FOR THE GRUNDY HALL RENOVATION - DENTAL CLINIC CENTER ASSOCIATES 9 N 4TH AVENUE MARSHALLTOWN IA 50158 420805386 501(C)3 150000 0 FUNDING FOR THE BEHAVIORAL HEALTH URGENT CARE CLINIC. DENTAL CONNECTIONS 1111 9TH STREET STE 190 DES MOINES IA 50314 420680421 501(C)3 34674 0 FUNDING WILL PROVIDE SUPPORT FOR CARE COORDINATION AND DENTAL EQUIPMENT TO ENHANCE AND SUPPORT ACCESS TO ORAL HEALTH CARE FOR REFUGEE POPULATIONS RESETTLING IN IOWA. DENTAL CONNECTIONS 1111 9TH STREET STE 190 DES MOINES IA 50314 420680421 501(C)3 25000 0 FUNDING WILL PROVIDE CARE COORDINATION, OUTREACH, REFERRAL, AND ORGANIZATIONAL ASSESSMENT AND PLANNING FOR THE NOLDEN GENTRY DENTAL CLINIC. DENTAL CONNECTIONS 1111 9TH STREET STE 190 DES MOINES IA 50314 420680421 501(C)3 5000 0 FUNDING WILL BE USED TO UPCYCLE AND RECONNECTION OF CHAIRS FOR DENTAL OPERATORIES. IOWA PUBLIC HEALTH ASSOCIATION FOUNDATION 6919 VISTA DRIVE WEST DES MOINES IA 50266 237327835 501(C)3 50000 0 FUNDING SUPPORTS IOWA'S PUBLIC HEALTH WORKFORCE'S RECOVERY FROM THE PANDEMIC, SO THEY IN TURN CAN SUPPORT THE HEALTH AND WELLNESS OF THEIR COMMUNITIES THROUGH DEVELOPMENT AND DELIVERY OF TOOLS, TRAININGS, AND RESOURCES AVAILABLE STATEWIDE. IOWA PUBLIC HEALTH ASSOCIATION FOUNDATION 6919 VISTA DRIVE WEST DES MOINES IA 50266 237327835 501(C)3 5000 0 FUNDING SPONSORSHIP OF THE PUBLIC HEALTH CONFERENCE OF IOWA TO PROVIDE A FOCUS ON ORAL HEALTH EDUCATION. IOWA PUBLIC HEALTH ASSOCIATION FOUNDATION 6919 VISTA DRIVE WEST DES MOINES IA 50266 237327835 501(C)3 0 208 AMOUNT PAID PROVIDED 576 TOOTHBRUSHES PROVIDED 576 TOOTHBRUSHES TO IOWA PUBLIC HEALTH ASSOCIATION. THE AMERICAN INSTITUTE OF DENTAL PUBLIC HEALTH 10650 CULEBRA RD 104-109 SAN ANTONIO TX 78251 842850098 501(C)3 49980 0 FUNDING TO SUPPORT A COMPREHENSIVE REPORT ON VETERAN ORAL HEALTH IN IOWA WILL BE CREATED AND DISSEMINATED. PRIMARY AREAS OF INVESTIGATION WILL INCLUDE ORAL HEALTH OUTCOMES, ACCESS TO DENTAL CARE, AND ASSOCIATED CHRONIC DISEASE CONDITIONS. THE AMERICAN INSTITUTE OF DENTAL PUBLIC HEALTH 10650 CULEBRA RD 104-109 SAN ANTONIO TX 78251 842850098 501(C)3 2500 0 FUNDING FOR CONFERENCE COSTS FOR THE 2022 AIDPH'S COLLOQUIUM SERIES "TRANSFORMING VETERAN ORAL HEALTH" PROJECT. INFINITY HEALTH 302 NE 14TH STREET LEON IA 50144 391908462 501(C)3 49999 0 FUNDING PROVIDES SUPPORT FOR EXPANSION OF SERVICES BY ADDING AN OPERATORY AND MOVE OF EQUIPMENT TO SUPPORT INFINITY HEALTH IN CLARK, DECATUR, AND RINGGOLD COUNTIES. YWCA OF THE QUAD CITIES 229 16TH STREET ROCK ISLAND IL 61201 362171176 501(C)3 45000 0 FUNDING TO SUPPORT THE IOWA EMPOWERMENT CENTER IN PROVIDING ORAL HEALTH OUTREACH, EDUCATION, AND COORDINATION OF PREVENTION SERVICES FOR MARGINALIZED NEIGHBORHOODS AND INDIVIDUALS FACING DISPARATE HEALTH OUTCOMES. KNOXVILLE HOSPITAL AND CLINICS 1002 SOUTH LINCOLN KNOXVILLE IA 50138 421087612 501(C)3 45000 0 FUNDING TO SUPPORT EQUIPMENT COSTS FOR PEDIATRIC DENTAL SURGERY SERVICES ASSOCIATED WITH CO-LOCATION OF THREE PEDIATRIC DENTISTS (ALTOONA, OTTUMWA, AND INDIANOLA) IN A RURAL HOSPITAL SETTING WITH SPECIFIC FOCUS ON THOSE INSURED WITH DENTAL WELLNESS PLAN. BROADLAWNS MEDICAL CENTER FOUNDATION 1801 HICKMAN ROAD DES MOINES IA 50314 421527407 501(C)3 39499 0 FUNDING WILL PROVIDE SUPPORT FOR CARE COORDINATION AND DENTAL EQUIPMENT TO ENHANCE AND SUPPORT ACCESS TO ORAL HEALTH CARE FOR REFUGEE POPULATIONS RESETTLING IN IOWA. IOWA ACES 360 501 SW 7TTH ST STE G DES MOINES IA 50309 843720619 501(C)3 30000 0 FUNDING PROJECT TO BUILD UPON ADVOCACY WORK DONE WITH THE COALITIONS AND AIMS TO ASSIST COALITIONS AND COMMUNITY GROUPS TO BETTER CO-CREATE POSSIBILITIES/SOLUTIONS AROUND COMMUNITY ISSUES AND BETTER DESIGN POLICY BY LEARNING HOW TO INCLUDE & CENTER INDIVIDUALS WITH LIVED EXPERIENCES IN THE SYSTEMS OF CHANGE AND ADVOCACY WORK. IOWA ACES 360 501 SW 7TTH ST STE G DES MOINES IA 50309 843720619 501(C)3 2000 0 FUNDING TO SUPPORT EDUCATION OPPORTUNITY AT STATEWIDE YOUTH ENGAGEMENT SUMMIT FOR 300 ATTENDEES SERVING YOUTH AND FAMILIES TO IMPROVE OVERALL HEALTH AND WELLBEING. FAMILY INC 3501 HARRY LANGDON BLVD STE 150 COUNCIL BLUFFS IA 51503 510657063 501(C)3 25000 0 FUNDING TO SUPPORT EXPANSION OF SW IA ORAL HEALTH COALITION AND MOBILE WELLNESS UNIT. FAMILY INC 3501 HARRY LANGDON BLVD STE 150 COUNCIL BLUFFS IA 51503 510657063 501(C)3 0 5001 AMOUNT PAID PROVIDED 15,264 TOOTHBRUSHES PROVIDED 15,264 TOOTHBRUSHES TO I-SMILE PROGRAM. ONESIGHT ESSILORLUXOTTICA FOUNDATION 4000 LUXOTTICA PLACE MASON OH 45040 311385607 501(C)3 30000 0 FUNDING TO SUPPORT THE 2022 FREE VISION CLINIC AT OAKRIDGE HAWKEYE AREA COMMUNITY ACTION PROGRAM 1515 HAWKEYE DRIVE CEDAR RAPIDS IA 52233 420898405 501(C)3 25000 0 FUNDING TO RAISE AWARENESS AND ACCESS TO MENTAL HEALTH RESOURCES FOR INDIVIDUALS BY BRINGING MENTAL HEALTH SCREENINGS AND REFERRAL RESOURCES TO COMMUNMITY OUTREACH OPPORTUNITIES. HAWKEYE AREA COMMUNITY ACTION PROGRAM 1515 HAWKEYE DRIVE CEDAR RAPIDS IA 52233 420898405 501(C)3 0 4772 AMOUNT PAID PROVIDED 13,536 TOOTHBRUSHES PROVIDED 4,032 TOOTHBRUSHES TO HEAD START PROGRAM AND 9,504 TOOTHBRUSHES TO I-SMILE PROGRAM. DES MOINES WATER WORKS PARK FOUNDATION 501 SW 7TH STREET STE G3 DES MOINES IA 50309 464894890 501(C)3 0 26588 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED A WATER BOTTLE FILLING STATION FOR WATER WORKS PARK INNOVATION LAWN AND WALK WAY. IOWA BLACK DOULA COLLECTIVE 413 HEADGATE DRIVE AUGUSTA GA 30907 852654232 501(C)3 20000 0 FUNDING WILL SUPPORT CONSULTING ENGAGEMENT FOR STRATEGIC PLANNING AND LEADERSHIP DEVELOPMENT AND 1-1 COACHING FOR ORGANIZATION WHICH AIMS TO SUPPORT AND EXPAND ACCESS TO DOULA SERVICES FOR BLACK AND INDIGENOUS WOMEN WHO OFTEN CAN'T AFFORD THESE SERVICES. IOWA BLACK DOULA COLLECTIVE 413 HEADGATE DRIVE AUGUSTA GA 30907 852654232 501(C)3 5000 0 FUNDING WILL BE USED TO PURCHASE AND/OR DISTRIBUTE PRODUCTS, SUPPLIES OR EDUCATION MATERIALS FOR BREASTFEEDING AND ORAL HEALTH EDUCATION. IOWA BLACK DOULA COLLECTIVE 413 HEADGATE DRIVE AUGUSTA GA 30907 852654232 501(C)3 0 1159 AMOUNT PAID PROVIDED 720 TOOTHBRUSHES PROVIDED 720 TOOTHBRUSHES TO IOWA BLACK DOULA COLLECTIVE YOUTH AND SHELTER SERVICES INC 420 KELLOGG AVE AMES IA 50010 421051609 501(C)3 25000 0 FUNDING SUPPORTS START-UP COSTS OF EMBEDDING OUTPATIENT THERAPY OFFICES ON THE STREET LEVEL RETAIL SPACE OF SIXTH AVENUE FLATS. YOUTH AND SHELTER SERVICES INC 420 KELLOGG AVE AMES IA 50010 421051609 501(C)3 0 1137 AMOUNT PAID PROVIDED 720 TOOTHBRUSHES PROVIDED 720 TOOTHBRUSHES TO IOWA HOMELESS YOUTH CENTER. LATINAS LATINOS AL EXITO INC PO BOX 93531 DES MOINES IA 50393 270933503 501(C)3 25000 0 FUNDING TO SUPPORT STATEWIDE EXPANSION OF THE IOWA LATINX PROJECT. PLANNED PARENTHOOD OF THE HEARTLAND 818 5TH AVENUE STE 200 DES MOINES IA 50309 420727488 501(C)3 25000 0 FUNDING TO SOLIDIFY AND EXPAND WORK OF THE IOWA LGBTQIA+ CARE COORDINATOR FRAMEWORK BUILT DURING PILOT PROJECT. HORIZONS - A FAMILY SERVICE ALLIANCE 819 5TH STREET CEDAR RAPIDS IA 52406 421135083 501(C)3 25000 0 FUNDING TO SUPPORT NEIGHBORHOOD TRANSPORTATION SERVICE TO DECREASE BARRIERS FOR PATIENTS IN ACCESSING MEDICAL APPOINTMENTS. CATHERINE MCAULEY CENTER 866 4TH AVENUE SE CEDAR RAPIDS IA 52403 421342872 501(C)3 25000 0 FUNDING TO SUPPORT HEALTHCARE NAVIGATION SERVICES AND HEALTH EDUCATION OPPORTUNITIES FOR REFUGEES AND IMMIGRANTS TO NAVIGATE THE AMERICAN HEALTHCARE SYSTEM AND PREVENTATIVE CARE. IOWA DENTAL FOUNDATION 666 GRAND AVENUE STE 901 DES MOINES IA 50309 421405188 501(C)3 25000 0 FUNDING SUPPORTS THE 2022 MISSION OF MERCY EVENT HELD IN DES MOINES PROVIDING FREE DENTAL CARE TO IOWANS. KEOKUK MUNICIPAL WATERWORKS 20 NORTH 4TH STREET KEOKUK IA 52632 426004831 CITY OF KEOKUK 25000 0 FUNDING COMMUNITY WATER FLUORIDATION EQUIPMENT TO MAINTAIN OPTIMAL FLUORIDATION IN THE CITY OF KEOKUK. PREVENT BLINDNESS IOWA 1111 NINTH STREET STE 250 DES MOINES IA 50314 426083207 501(C)3 25000 0 FUNDING TO SUPPORT CHILDREN'S VISION SCREENINGS IN IOWA. IOWA HEALTHIEST STATE INITIATIVE 301 GRAND AVENUE DES MOINES IA 50309 454570642 501(C)3 25000 0 FUNDING TO SUPPORT MAKE IT OK CAMPAIGN TO REDUCE STIGMA AROUND MENTAL HEALTH. HEALTHY BIRTH DAY 501 SW 7TH STREET STE G DES MOINES IA 50309 263998964 501(C)3 23500 0 FUNDING SUPPORTS EDUCATION CAMPAIGNS FOR THE PUBLIC AND TRAINING OF DENTAL PROFESSIONALS ON THE CONNECTION BETWEEN ORAL HEALTH CARE DURING PREGNANCY, IMPLICIT BIAS, AND CONNECTION TO OVERALL HEALTH AND BIRTH OUTCOMES. HEALTHY BIRTH DAY 501 SW 7TH STREET STE G DES MOINES IA 50309 263998964 501(C)3 0 1263 AMOUNT PAID PROVIDED 792 TOOTHBRUSHES, PASTE, AND FLOSS PROVIDED 792 TOOTHBRUSHES, PASTE, AND FLOSS TO HEALTHY BIRTH DAY. DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES IA 50312 426001433 STATE OF IOWA 0 13375 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED A WATER BOTTLE FILLING STATION FOR ROOSEVELT HIGH SCHOOL - BASEBALL AND SOFTBALL DUGOUT RENOVATIONS. DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES IA 50312 426001433 STATE OF IOWA 0 6688 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED A WATER BOTTLE FILLING STATION FOR EAST HIGH SCHOOL - BASEBALL AND SOFTBALL DUGOUT RENOVATIONS. DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES IA 50312 426001433 STATE OF IOWA 0 2684 AMOUNT PAID PROVIDED 3,600 TOOTHBRUSHES PROVIDED 288 TOOTHBRUSHES TO GREENWOOD ELEMENTARY SCHOOL, 432 TOOTHBRUSHES TO CAPITOL VIEW ELEMENTARY SCHOOL, 144 TOOTHBRUSHES TO STOWE ELEMENTARY SCHOOL, 2,304 TOOTHBRUSHES TO HEAD START PROGRAM AND 432 TOOTHBRUSHES TO DES MOINES PUBLIC SCHOOLS. MONTEZUMA MUNICIPAL WATER WORKS 501 E MAIN STREET MONTEZUMA IA 50171 426004980 CITY OF MONTEZUMA 21192 0 FUNDING FOR COMMUNITY WATER FLUORIDATION EQUIPMENT FOR THE CITY OF MONTEZUMA. QUAD CITIES COMMUNITY BROADCASTING GROUP 1800 3RD AVENUE STE 420 ROCK ISLAND IL 61201 320066891 501(C)3 20000 0 FUNDING SUPPORT TO MITIGATE THE DISPARITY IN ACCESS TO MENTAL HEALTH SERVICES BY INFORMING RADIO LISTENERS IN THE COMMUNITY ABOUT SERVICES AVAILABLE IN THE COMMUNITY AND HOW TO ACCESS THEM THROUGH THE CREATION OF PUBLIC SERVICE MESSAGING. FAMILY RESOURCES INC 2800 EASTERN AVENUE DAVENPORT IA 52803 420698225 501(C)3 20000 0 FUNDING TO SUPPORT HOLISTIC CARE COORDINATION FOR CHILDREN AND FAMILY WHO DO NOT QUALIFY FOR MEDICAID BUT STILL NEED SERVICES TO REDUCE BARRIERS TO CARE COORDINATION AND ACCESS TO HEALTH AND SOCIAL SERVICES. UNIVERSITY OF IOWA FOUNDATION ONE WEST PARK ROAD IOWA CITY IA 52244 420796760 501(C)3 20000 0 FUNDING TO SUPPORT FREE VISION SCREENING FOR IOWA CHILDREN AGES 6 MONTHS TO KINDERGARTEN. GIRLS INCORPORATED OF SIOUX CITY PO BOX 3380 SIOUX CITY IA 51102 421272032 501(C)3 20000 0 FUNDING WILL TAKE CURRENT RESEARCH-BASED CURRICULUM AND RETOOL IT TO MIND+BODY 20*32 ADDING DENTAL AND VISION HEALTH EDUCATION FOR GIRLS ENROLLED IN SUMMER AND SCHOOL PROGRAMMING. VISION TO LEARN 900 JACKSON STREET STE LL5-2C DUBUQUE IA 52001 453457853 501(C)3 20000 0 FUNDING TO SUPPORT VISION SERVICES AND GLASSES IF NEEDED FOR CHILDREN 5-19 YEARS OF AGE AT IOWA SCHOOLS. OAKRIDGE NEIGHBORHOOD SERVICES 1401 CENTER STREET DES MOINES IA 50314 421311721 501(C)3 17947 0 FUNDING FOR THE ONESIGHT VISION CLINIC FOR OAKRIDGE STAFF TIME AND OTHER ASSOCIATED COSTS. PRIMARY HEALTH CARE INC 1200 UNIVERSITY AVE 200 DES MOINES IA 50314 421350092 501(C)3 10000 0 FUNDING SUPPORTS COSTS OF UPGRADING EQUIPMENT AND FOUR HYGIENE SADDLE CHAIRS TO ASSIST WITH INCREASED EFFICIENCIES AND CAPACITY AT AMES AND MARSHALLTOWN PHC LOCATIONS. PRIMARY HEALTH CARE INC 1200 UNIVERSITY AVE 200 DES MOINES IA 50314 421350092 501(C)3 7000 0 FUNDING SUPPORTS EDUCATION AND TRAINING OF AN FQHC DENTAL DIRECTOR FOR THE NATIONAL NETWORK IN ORAL HEALTH ACCESS LEADERSHIP INITIATIVE. TMBC AT THE LINCOLN CENTER 318 E 7TH STREET DAVENPORT IA 52804 812252531 501(C)3 15700 0 FUNDING SUPPORTS CREATION OF HEALTH YOUTH DEVELOPMENT SERIES AIMED AT PROVIDING EDUCATION ON VARIOUS HEALTH RELATED TOPICS FOR BLACK YOUTH AND OTHER MINORITIES SERVED BY TMBC CENTER. IOWA DENTAL ASSOCIATION 666 GRAND AVENUE STE 901 DES MOINES IA 50309 420335455 501(C)3 15000 0 FUNDING TO SUPPORT THE 2022 IOWA DENTAL ASSOCIATION ANNUAL EDUCATIONAL CONFERENCE. UNITED WAY OF CENTRAL IOWA 1111 NINTH STREET STE 100 DES MOINES IA 50314 420680425 501(C)3 15000 0 FUNDING TO SUPPORT DEVELOPMENT OF A PLAN AND STRUCTURE FOR STATEWIDE ORAL HEALTH COALITIONS UMBRELLA ORGANIZATION AND LEADERSHIP. CITY OF IOWA CITY - WATER DIVISION 410 EAST WASHINGTON STREET IOWA CITY IA 52240 426004805 CITY OF IOWA CITY 13846 0 FUNDING FOR COMMUNITY WATER FLUORIDATION EQUIPMENT TO MAINTAIN OPTIMAL FLUORIDATION IN THE CITY OF IOWA CITY. SOUTHWEST IOWA FAMILIES INC 215 E WASHINGTON CLARINDA IA 51632 371451441 501(C)3 12395 0 FUNDING USED TO START A PILOT PROGRAM THAT WILL OFFER BREASTFEEDING SUPPORT PROGRAM, FOCUSING ON IMPORTANCE TO ORAL AND OVERALL HEALTH AND WILL PROVIDE COORDINATION WITH I-SMILE AND DENTIST BY 1. CITY OF STANTON PO BOX 189 STANTON IA 51573 426005247 CITY OF STANTON 0 12188 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED AN OUTSIDE WATER BOTTLE FILLING STATION FOR GREENBELT TRAIL. CITY OF MONONA 104 E CENTER MONONA IA 52159 426004974 CITY OF MONONA 0 11688 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED AN OUTSIDE WATER BOTTLE FILLING STATION FOR THE CITY OF MONONA. CERRO GORDO COUNTY DEPARTMENT PUBLIC HEALTH 2570 4TH STREET SW MASON CITY IA 50401 421351175 STATE OF IOWA 11156 0 FUNDING TO ASSIST PUBLIC HEALTH DEPARTMENT REESTABLISH AND EXPAND SERVICES SUPPORTING THE COUNTY'S OLDER ADULT POPULATION THROUGH THE SENIOR HEALTH CLINIC WHICH INCLUDES HEALTH ASSESSMENTS AND HEALTH EDUCATION SESSIONS. CITY OF WASHINGTON 215 E WASHINGTON WASHINGTON IA 52159 426004974 CITY OF WASHINGTON 0 10188 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED AN OUTSIDE WATER BOTTLE FILLING STATION IN THE WELLNESS PARK. MARY GREELEY FOUNDATION 111 DUFF AVE AMES IA 50010 237064009 501(C)3 10000 0 FUNDING SUPPORTS ESTABLISHING A NONEMERGENCY RESPONSE LINE FOR 911 CALLS. DAVENPORT COMMUNITY SCHOOLS 1702 N MAIN STREET DAVENPORT IA 52803 426001350 STATE OF IOWA 0 7782 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED A WATER BOTTLE FILLING STATION FOR DAVENPORT COMMUNITY SCHOOL. DAVENPORT COMMUNITY SCHOOLS 1702 N MAIN STREET DAVENPORT IA 52803 426001350 STATE OF IOWA 0 1926 AMOUNT PAID PROVIDED 1,512 TOOTHBRUSHES, FLOSS, AND TOOTHPASTE PROVIDED 1,368 TOOTHBRUSHES, FLOSS, AND TOOTHPASTE TO DAVENPORT COMMUNITY SCHOOL AND 144 TOOTHBRUSHES TO WILLIAMS INTERMEDIATE SCHOOL. UNITED COMMUNITY HEALTH CENTER 715 W MILWAUKEE AVE STORM LAKE IA 50588 300225826 501(C)3 0 9642 AMOUNT PAID PROVIDED 6,048 TOOTHBRUSHES, FLOSS, AND TOOTHPASTE. PROVIDED 6,048 TOOTHBRUSHES, FLOSS, AND PASTE TO UNITED COMMUNITY HEALTH CENTER. COMMUNITY FOUNDATION OF GREATER DUBUQUE 700 LOCUST STREET DUBUQUE IA 52001 421526614 501(C)3 5000 0 FUNDING FOR PRINTING OF A BE A HEALTHY YOU IN SCHOOL BOOK IN SPANISH, MARSHALLESE AND ENGLISH TO ENCOURAGE HEALTHY HABITS AT HOME AND TO IMPROVE ATTENDANCE AT SCHOOL. COMMUNITY FOUNDATION OF GREATER DUBUQUE 700 LOCUST STREET DUBUQUE IA 52001 421526614 501(C)3 4242 0 FUNDING USED TO PURCHASE AND/OR DISTRIBUTE PRODUCTS, SUPPLIES, OR EDUCATION MATERIALS FOR THE BRUSH, BOOK, BED PROJECT IN JONES COUNTY. CITY OF FREDERICKSBURG - PARK AND REC COMMITTEE 151 WEST MAIN STREET FREDERICKSBURG IA 50630 426004693 CITY OF FREDERICKSBU 0 8938 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED AN OUTSIDE WATER BOTTLE FILLING STATION. DUBUQUE VISITING NURSE ASSOCIATION 660 IOWA STREET DUBUQUE IA 52001 420680410 501(C)3 5000 0 FUNDING WILL BE USED TO PURCHASE AND/OR DISTRIBUTE PRODUCTS, SUPPLIES, OR EDUCATION MATERIALS FOR THE MOMMY & ME KITS PROJECT. DUBUQUE VISITING NURSE ASSOCIATION 660 IOWA STREET DUBUQUE IA 52001 420680410 501(C)3 0 3509 AMOUNT PAID PROVIDED 10,656 TOOTHBRUSHES PROVIDED 10,656 TOOTHBRUSHES TO DUBUQUE AND CLAYTON COUNTY VISITING NURSES ASSOCIATION. MATER DEI'S NATIVITY SCHOOL 4242 NATALIA WAY SIOUX CITY IA 51106 821815571 501(C)3 0 5210 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED A WATER BOTTLE FILLING STATION FOR MATER DEI NATIVITY CENTER. MATER DEI'S NATIVITY SCHOOL 4242 NATALIA WAY SIOUX CITY IA 51106 821815571 501(C)3 0 3210 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED A WATER BOTTLE FILLING STATION FOR MATER DEI IMMACULATE CONCEPTION. SCOTT COUNTY HEALTH DEPARTMENT 600 W 4TH STREET DAVENPORT IA 52801 426004465 501(C)3 0 7877 AMOUNT PAID PROVIDED 24,768 TOOTHBRUSHES PROVIDED 24,768 TOOTHBRUSHES TO I-SMILE PROGRAM. PRAIRIE CITY COMMUNITY SCHOOLS 309 E PLAINSMAN ROAD PRAIRIE CITY IA 50228 421358436 STATE OF IOWA 0 7782 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED A WATER BOTTLE FILING STATION FOR PRAIRIE CITY ELEMENTARY SCHOOL. AMERICAN HOME FINDING ASSOCIATION 217 E 5TH STREET OTTUMWA IA 52501 420713654 501(C)3 0 7744 AMOUNT PAID PROVIDED 24,480 TOOTHBRUSHES PROVIDED 24,480 TOOTHBRUSHES TO I-SMILE PROGRAM. EAGLE GROVE COMMUNITY SCHOOL DISTRICT 425 N FORT EAGLE GROVE IA 50533 426036569 STATE OF IOWA 5000 0 FUNDING WILL BE USED TO PURCHASE AND/OR DISTRIBUTE PRODUCTS, SUPPLIES, OR EDUCATION MATERIALS FOR HAPPY SMILES ORAL HEALTH PROJECT. EAGLE GROVE COMMUNITY SCHOOL DISTRICT 425 N FORT EAGLE GROVE IA 50533 426036569 STATE OF IOWA 0 2066 AMOUNT PAID PROVIDED 1,296 TOOTHBRUSHES, PASTE, AND FLOSS PROVIDED 1,296 TOOTHBRUSHES, PASTE, AND FLOSS TO EAGLE GROVE SCHOOLS. UNITY HEALTHCARE DBA TRINITY MUSCATINE PUBLIC HEALTH 1609 CEDAR STREET MUSCATINE IA 52761 420680337 501(C)3 0 6834 AMOUNT PAID PROVIDED 13,248 TOOTHBRUSHES PROVIDED 13,248 TOOTHBRUSHES TO UNITY HEALTHCARE DBS TRINITY MUSCATINE PUBLIC HEALTH. FRIENDS OF HIAWATHA PARK AND RECREATION FOUNDATION 101 EMMONS STREET HIAWATHA IA 52233 270633118 501(C)3 0 6282 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED AN OUTDOOR WATER BOTTLE FILLING STATION IN HIAWATHA TUCKER PARK. IOWA VALLEY COMMUNITY SCHOOL DISTRICT 151 E MAY STREET MARENGO IA 52301 426036800 STATE OF IOWA 0 5817 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED A WATER BOTTLE FILLING STATION FOR IOWA VALLEY ELEMENTARY SCHOOL. JONES COUNTY CONSERVATION 12515 CENTRAL PARK ROAD CENTER JUNCTION IA 52212 426004230 STATE OF IOWA 0 5132 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED AN OUTDOOR WATER BOTTLE FILLING STATION IN CENTRAL PARK NATURE CENTER. LEE COUNTY HEALTH DEPARTMENT 3 JOHN BENNETT DRIVE FORT MADISON IA 52627 426004689 501(C)3 0 5021 AMOUNT PAID PROVIDED 15,840 TOOTHBRUSHES PROVIDED 15,840 TOOTHBRUSHES TO LEE COUNTY HEALTH DEPARTMENT. 62 0 0 1 0 0 0 0 0 0 0 JEFFREY S RUSSELL PRESIDENT 0 640241 0 438097 0 65637 0 23800 0 38324 0 1206099 0 56116 JEFF CHAFFIN DDS DIRECTOR 0 289800 0 126514 0 49072 0 23800 0 2253 0 491439 0 46078 SUZANNE HECKENLAIBLE EXECUTIVE DIRECTOR 0 208934 0 98824 0 9381 0 23800 0 38324 0 379263 0 6964 SHERRY PERKINS SECRETARY-TREASURER 0 230633 0 104692 0 14824 0 23800 0 2253 0 376202 0 12688 PART I, LINE 4B EFFECTIVE JANUARY 1, 2016, THE OFFICERS OF DELTA DENTAL OF IOWA, A RELATED ORGANIZATION, 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 OFFICERS THAT RECEIVED PAYMENTS OF VESTED AMOUNTS IN 2022 AND THE AMOUNTS ARE: JEFFREY S. RUSSELL $ 56,116 SHERRY PERKINS $ 12,688 SUZANNE HECKENLAIBLE $ 6,964 JEFF CHAFFIN $ 46,078 THE OFFICERS OF DELTA DENTAL OF IOWA, A RELATED ORGANIZATION, 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. THERE WAS NO PAYOUT IN 2022 ON LTIP. SCHEDULE J, PART I, LINE 3 THE EXECUTIVE DIRECTOR AND OFFICERS EXCLUDING THE CHAIR AND VICE CHAIR OF THE BOARD OF THE FOUNDATION ARE EMPLOYEES OF DELTA DENTAL OF IOWA. DELTA DENTAL OF IOWA CHARGES THE FOUNDATION A MANAGEMENT FEE FOR THE TIME SPENT BY THE PRESIDENT, SECRETARY AND TREASURER, AND EXECUTIVE DIRECTOR. FORM 990, PART VI, SECTION A, LINE 2 J. RUSSELL HAD A GOVERNMENT PROGRAM RELATED BUSINESS RELATIONSHIP WITH BOARD MEMBER T. RODGERS IN 2022. J. CHAFFIN HAD A GOVERNMENT PROGRAM RELATED BUSINESS RELATIONSHIP WITH BOARD MEMBER T. RODGERS IN 2022. S. HECKENLAIBLE HAD A GOVERNMENT PROGRAM RELATED BUSINESS RELATIONSHIP WITH BOARD MEMBER T. RODGERS IN 2022. T. RODGERS HAD BUSINESS RELATIONSHIPS WITH D. CAPLAN, J. VERMEER, N. EGBUONYE, J. RUSSELL, S. HECKENLAIBLE, AND J. CHAFFIN IN 2022. D. CAPLAN HAD A BUSINESS RELATIONSHIP WITH T. RODGERS AND H. HARVEY IN 2022. H. HARVEY HAD A BUSINESS RELATIONSHIP WITH D. CAPLAN IN 2022. J. VERMEER HAD A BUSINESS RELATIONSHIP WITH T. RODGERS AND N. EGBUONYE IN 2022. N. EGBUONYE HAD A BUSINESS RELATIONSHIP WITH T. RODGERS AND J. VERMEER IN 2022. FORM 990, PART VI, SECTION A, LINE 6 THE FOUNDATION SHALL HAVE ONE MEMBER, WHICH SHALL BE DELTA DENTAL OF IOWA ("DELTA DENTAL"), A SECTION 501(C)(4) ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A EACH DIRECTOR SHALL BE ELECTED BY THE MEMBER. IN ELECTING DIRECTORS, THE MEMBER MAY SEEK RECOMMENDATIONS FROM THE FOUNDATION'S BOARD OR A COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 AND ALL RELATED SCHEDULES WERE REVIEWED BY BOTH THE MANAGEMENT OF THE FOUNDATION AND THE BOARD OF DIRECTORS PRIOR TO FILING. THE FORM 990 WAS REVIEWED BY MANAGEMENT OF THE FOUNDATION PRIOR TO PRESENTATION TO THE BOARD OF DIRECTORS. THE MEMBERS OF THE MANAGEMENT TEAM WHO REVIEWED THE FORM 990 WERE THE PRESIDENT, SECRETARY/TREASURER, AND EXECUTIVE DIRECTOR. A COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS FOR REVIEW PRIOR TO FILING THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C CONSISTENT WITH ITS CONFLICT OF INTEREST POLICY, ANNUALLY THE FOUNDATION CONDUCTS A CONFLICT OF INTEREST REVIEW FOR COMPLIANCE WITH FEDERAL AND STATE LAW AND COMPANY POLICY. THE REVIEW INCLUDES ALL OFFICERS AND DIRECTORS. COMPLETED CONFLICT OF INTEREST QUESTIONNAIRES AND DISCLOSURES ARE COMPARED TO THE GROUP FOR POTENTIALLY CONFLICTING TRANSACTIONS, BUSINESS AND FAMILY RELATIONSHIPS AND AFFILIATIONS. A WRITTEN REPORT OF THE FINDINGS IS GIVEN TO THE BOARD OF DIRECTORS AND OFFICERS. THE CONFLICT OF INTEREST POLICY PROVIDES GUIDANCE ON ACTIONS AND SPECIFIC SOLUTIONS TO ADDRESS CONFLICTS WHEN THEY OCCUR. THE SOLUTIONS PROVIDED BY THE GUIDANCE ARE DISCUSSED AND DOCUMENTED IN THE BOARD OF DIRECTOR'S MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR AND OFFICERS EXCLUDING THE CHAIR AND VICE CHAIR OF THE BOARD ARE EMPLOYEES OF DELTA DENTAL. DELTA DENTAL OF IOWA CHARGES THE FOUNDATION A MANAGEMENT FEE FOR THE TIME SPENT BY THE PRESIDENT, SECRETARY AND TREASURER, AND EXECUTIVE DIRECTOR. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION'S ARTICLES OF INCORPORATION 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 AS PART OF THE FORM 990 WITH THE IRS. THE CONFLICT OF INTEREST POLICY IS NOT FILED WITH ANY AGENCY; HOWEVER, IT WOULD BE MADE AVAILABLE UPON REQUEST. ALL GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS WOULD BE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: RETURN OF GRANTS 12,764. FORM 990, PART VI, SECTION B, LINE 13: THE FOUNDATION DOES NOT HAVE A WHISTELEBLOWER POLICY AS IT HAS NO EMPLOYEES. THE FOUNDATION PURCHASES MANAGEMENT SERVICES FROM DELTA DENTAL. DELTA DENTAL OF IOWA HAS A WRITTEN WHISTLEBLOWER POLICY THAT ALL EMPLOYEES ARE SUBJECT TO. DELTA DENTAL OF IOWA 9000 NORTHPARK DRIVE JOHNSTON IA 50131 420959302 NFP ORG. TO IMPROVE THE HEALTH AND SMILES OF THE PEOPLE IT SERVES IA 501(C)(4) 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 DELTA DENTAL OF IOWA C 6100000 SEE PART VII - SUPPLEMENTAL INFO. DELTA DENTAL OF IOWA O 498415 HOURS WORKED FORM 990, SCHEDULE R, PART V, LINE 2(1), COLUMN D: CASH RECEIVED BASED ON A PERCENTAGE OF DELTA DENTAL OF IOWA'S REVENUE APPROVED BY THEIR BOARD. THE AMOUNT REPORTED INCLUDES A CONTRIBUTION OF $6,100,000, WHICH IS A PROMISE TO GIVE. FORM 990, SCHEDULE R, PART V, LINE 2(2), COLUMN B: MANAGEMENT FEES OF $498,415 WERE PAID TO DELTA DENTAL OF IOWA WHICH COULD ALSO BE CLASSIFIED UNDER CODE M.