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 510228088 DELTA DENTAL OF DELAWARE INC DELT 7177668500 ONE DELTA DRIVE MECHANICSBURG PA 17055 ALICIA F WEBER CFO 7177668500 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 89379579 0 X WWW.DELTADENTALINS.COM X 1987 DE TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS, SERVICE, TECHNOLOGY, AND PROFESSIONAL SUPPORT. 5 0 0 0 0 0 0 0 77406681 89078773 72247 269112 -221766 31694 77257162 89379579 0 0 66932429 77358882 0 0 0 0 0 7752858 8247627 74685287 85606509 2571875 3773070 18629043 23228309 11401279 12227475 7227764 11000834 TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS, SERVICE, TECHNOLOGY, AND PROFESSIONAL SUPPORT. 0 0 84767888 89379579 THE ORGANIZATION PROVIDED DENTAL BENEFIT COVERAGE FOR 230,299BENEFICIARIES IN 2022 PRIMARILY THROUGH CONTRACTS WITH INDEPENDENTDENTISTS SERVING 73 PURCHASING GROUPS. THE ORGANIZATION PAID MORETHAN $77.3 MILLION FOR DENTAL CARE DURING 2022. 84767888 0 0 0 0 0 0 0 0 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 12478 0 1 0 0 0 0 0 0 0 0 0 X 5 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 X 0 2317629 39631 TITCOMBE DOMINIC EVP/CHIEF INFORMATION OFFICER 1.00 49.00 X X 0 2103812 62579 SHEETZ MARTY A DIRECTOR 1.00 49.00 X 0 656125 47111 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 0 25009467 908014 0 0 1 0 0 DIRECT PREMIUMS 524114 89078773 89078773 89078773 269112 269112 BAD DEBT EXPENSE 524114 28837 28837 MISC INCOME 524114 2857 2857 31694 89379579 89379579 0 0 77358882 77358882 83204 83204 56471 56471 3254 3254 64280 58177 6103 3208 2903 305 250054 250054 50105 50105 ADMINISTRATIVE FEES 6889573 6235422 654151 BROKER FEES 477463 477463 OUTSIDE SERVICES 125938 113980 11958 244077 220902 23175 85606509 84767888 838621 0 8071781 2105216 2764303 5693384 7506817 2758662 12957189 18629043 23228309 4001156 5382017 280438 996082 7119685 5849376 11401279 12227475 X 0 0 0 0 7227764 11000834 7227764 11000834 18629043 23228309 3773070 0 X 0 1 X 1 0 0 PAYABLES TO AFFILIATES 619305 GROUP PREFUND DEPOSITS 140524 REFUNDABLE BALANCES 89547 INTERCOMPANY NOTE PAYABLE 5000000 5849376 X 41360166 0 41360166 3254 48016159 48019413 89379579 37587096 0 37587096 3254 48016159 48019413 85606509 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 XI, LINE 4B - OTHER ADJUSTMENTS: ADMINISTRATIVE SERVICE CONTRACTS CLAIM REIMBURSEMENT REVENUE PART XII, LINE 4B - OTHER ADJUSTMENTS: CLAIMS ACCRUED FOR ADMINISTRATIVE SERVICE CONTRACTS PART X, LINE 1, (5) 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 $2.9 MILLION. DURING 2022, RESERVE AMOUNTS WERE USED TO SUPPORT CUSTOMERS THROUGH ONGOING PAYMENT RELIEF AND OTHER PROGRAMS RESULTING IN A REMAINING BALANCE OF $89,548 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 SHEETZ MARTY A DIRECTOR 0 313793 0 323083 0 19249 0 32025 0 15086 0 703236 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/CFO 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. STATUTORY FINANCIAL STATEMENTS ARE INCLUDED IN QUARTERLY AND ANNUAL RETURNS TO STATE DEPARTMENTS OF INSURANCE REGULATING THE ORGANIZATION WHICH RETURNS ARE AVAILABLE TO THE PUBLIC. 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 DELAWARE DEPARTMENT OF INSURANCE, 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 EXCEEDED $9.8 BILLION IN 2022. THE ORGANIZATION REPRESENTS LESS THAN 1% OF TOTAL ENTERPRISE REVENUES. DELTA DENTAL OF PENNSYLVANIA ONE DELTA DRIVE MECHANICSBURG PA 17055 231667011 DENTAL INSURANCE PA 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 THE DISTRICT OF COLUMBIA ONE DELTA DRIVE MECHANICSBURG PA 17055 521479587 DENTAL INSURANCE DC 501(C)(4) DENTEGRA GROUP INC 0 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 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 CO 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 SEGUROS 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 INC 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 0 0 DELTA DENTAL OF CALIFORNIA P 152316 DELTA DENTAL INSURANCE COMPANY P 954 DELTA DENTAL OF PENNSYLVANIA P 12281 DENTEGRA INSURANCE COMPANY P 9721 DELTA DENTAL OF PENNSYLVANIA M 6889573 ALLIED ADMINISTRATORS INC M 79171