2025-11-16T09:25:07-06:00 2024-12-31 471019942 CREATIVE PLANNING TAX LLC 100 E PARK AVE STE 300 WATERLOO IA 50703 990 2024-01-01 260762771 DELTA DENTAL OF IOWA FOUNDATION DELT 5152615500 9000 NORTHPARK DRIVE JOHNSTON IA 50131 SHERRY PERKINS SECRETARY-TREASURER 5152615500 2025-11-14 1 0 BRIAN ARONSON P01425251 3192346885 2025-11-14 2024 2025-03-06 01:10:19Z APRIL SCHMALTZ 9000 NORTHPARK DRIVE JOHNSTON IA 50131 10210932 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 9 0 0 0 0 5901500 5001500 0 0 335308 1216946 0 0 6236808 6218446 2937607 3035249 0 0 3600 4500 0 0 0 771184 808907 3712391 3848656 2524417 2369790 40465001 45386667 183367 51645 40281634 45335022 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 1647339 1462381 0 ORAL HEALTH PROJECTS - ACTIVITIES THAT ENSURE HEALTHY SMILES FOR ALL IOWANS. 1424400 1234679 0 OVERALL HEALTH PROJECTS - WELLNESS, VISION, AND RELATED ACTIVITIES THAT ENABLE IOWANS TO LIVE HEALTHY AND ACTIVE LIVES. 431109 338189 0 ORAL AND OVERALL HEALTH INTEGRATION PROJECTS - ACTIVITIES THAT PROMOTE TIGHTER CONNECTIONS BETWEEN DENTAL, PHYSICAL, AND BEHAVIORAL HEALTH. 3502848 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 8 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 9 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 APRIL SCHMALTZ PRESIDENT 0.39 40.00 X X 0 798793 29518 JEFF CHAFFIN DDS DIRECTOR 1.17 40.00 X 0 503159 28774 DONNA GRANT DDS DIRECTOR 0.50 1.60 X 900 45400 0 NATHAN HEHR DIRECTOR 0.50 1.60 X 900 37500 0 MICHAEL METTS DO DIRECTOR 0.50 X 900 0 0 SUZANNA DE BACA DIRECTOR 0.50 X 900 0 0 SCOTT RAECKER DIRECTOR, CHAIR 1.00 X X 0 0 0 NAFISSA CISSE EGBUONYEMPHPHD DIRECTOR, VICE CHAIR 1.00 X X 0 0 0 MISSY GOWEY DIRECTOR 0.50 X 0 0 0 HAYLEY HARVEY DDS DIRECTOR 0.50 X 0 0 0 DAN CAPLAN DDS PHD 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 HEIDI BELL OD DIRECTOR 0.50 X 900 0 0 SHERRY PERKINS SECRETARY-TREASURER 0.67 40.00 X 0 414157 29518 SUZANNE HECKENLAIBLE EXECUTIVE DIRECTOR 10.00 30.00 X 0 381611 62019 4500 2180620 149829 0 0 1 0 0 5000000 1500 5001500 1576133 1576133 3633299 3992486 -359187 -359187 -359187 6218446 0 0 1216946 3035249 3035249 4500 4500 560236 356324 203912 19200 19200 61843 61843 334 334 140 140 36255 33614 2641 6016 120 5896 34509 17120 17389 21322 3123 18199 CONSULTING 44306 40556 3750 OUTREACH AND EDUCATION 12768 12768 MEMBERSHIP FEES 5608 3500 2108 TRAINING 1990 1990 4380 4380 3848656 3502848 345808 0 233218 173374 2906728 2855208 5700000 5000000 3620 8647 28431430 33836325 3186147 3510534 3858 2579 40465001 45386667 5580 3911 137256 40531 47734 183367 51645 X 2840220 2904170 37441414 42430852 40281634 45335022 40465001 45386667 X 2369790 2680799 2799 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 2024 WAS $5,000,000. 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 $50,000, THIS INCLUDES INFORMATION SUCH AS NUMBER OF INDIVIDUALS SERVICED, CHALLENGES, OPPORTUNITIES AND LESSONS LEARNED. FOR GRANTEES THAT RECEIVE OVER $50,000 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 THE 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 33741414 1000000 3741683 52245 38430852 27800604 2000000 3985525 44715 33741414 29455769 2500000 -4112846 42319 27800604 23680453 2500000 3317048 41732 29455769 20030878 1000000 2684491 34916 23680453 0.00000 0.00000 1.00000 1 0 0 PRIVATE EQUITY SECURITIES 3510534 F 3510534 PAYABLE TO DELTA DENTAL OF IOWA 47734 47734 X 8854901 2680799 5100 2799 2688698 6166203 52243 52243 6218446 3801513 5100 5100 3796413 52243 52243 3848656 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, 2024 AND 2023, THE COMPANY'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED OR ACCRUED DURING 2024 AND 2023. 1 CITY OF CALMAR POOL 101 S WASHINGTON STREET CALMAR IA 52132 426004315 CITY OF CALMAR 6078 0 CITY OF CALMAR SWIMMING POOL'S FILLING STATIONS BUENA VISTA PUBLIC HEALTH 1709 RICHLAND ST STORM LAKE IA 50588 426005256 CITY OF BUENA VISTA 17776 0 TAP INTO HEALTH BUILD A BETTER BELMOND 1275 TAYLOR AVE BELMOND IA 50421 472152118 501(C)3 15499 0 UPSCALE THE TRAIL OUTDOOR FILLING BOTTLE STATION FRIENDS OF BELLEVUE STATE PARK 24668 HWY 52 BELLEVUE IA 52031 854244967 501(C)3 6859 0 COMMUNITY DRINKING FOUNTAIN AND BOTTLE STATION AT BELLEVUE STATE PARK IOWA DENTAL ASSOCIATION 666 GRAND AVENUE SUITE 901 DES MOINES IA 50309 420335455 501(C)3 15000 0 IDA ANNUAL SESSION 2024, IDEAS24 BUCHANAN COUNTY CONSERVATION BOARD 1883 125TH ST HAZLETON IA 50641 426004794 BUCHANAN COUNTY 14985 0 LEARNING AND DISCOVERY TRAIL OUTDOOR WATER FILL STATION ALL CARE HEALTH CENTER 902 SOUTH 6TH ST COUNCIL BLUFFS IA 51501 421466508 501(C)3 25000 0 INCREASED ACCESS TO INTEGRATED HEALTHCARE UNITED WAY OF CENTRAL IOWA 1111 NINTH ST SUITE 100 DES MOINES IA 50314 420680425 501(C)3 22299 0 ORAL HEALTH IOWA COLLABORATIVE COALITION CITY OF MENLO 417 SHERMAN ST MENLO IA 50164 426025986 CITY OF MENLO 12545 0 MENLO CITY PARK OUTDOOR BOTTLE REFILL STATION BUENA VISTA REGIONAL HEALTHCARE FOUNDATION 1525 W 5TH ST STORM LAKE IA 50588 421291649 501(C)3 10000 0 STORM LAKE CHILDREN'S DENTAL ACCESS PROJECT CITY OF DELAWARE IA 110 WASHINGTON ST DELAWARE IA 52036 421187882 CITY OF DELAWARE 7697 0 CITY OF DELAWARE CITY PARK PROJECT AQUIN EDUCATIONAL SYSTEMS 608 3RD AVE NW CASCADE IA 52033 420859383 501(C)3 5778 0 AQUIN SCHOOL FOUNTAIN/BOTTLE FILLING STATION DOMESTIC VIOLENCE INTERVENTION PROGRAM 1105 SOUTH GILBERT COURT SUITE 300 IOWA CITY IA 52240 421124902 501(C)3 30000 0 HOPE IN THE HEARTLAND: BOOSTING MENTAL HEALTH FOR RURAL DOMESTIC AND SEXUAL VIOLENCE SURVIVORS GRINNELL REGIONAL MEDICAL CENTER 210 FOURTH AVE GRINNELL IA 50112 420933383 501(C)3 30000 0 GRINNELL MENTAL HEALTH ACCESS EXPANSION THE SELF RELIANCE GROUP 1115 SUMMER ST BURLINGTON IA 52601 465304439 501(C)3 30000 0 SOUTHEAST IOWA DENTAL ACCESS SOLUTIONS DEVELOPMENT PLAN COMMUNITY HEALTH CENTER OF FORT DODGE INC 126 N 10TH ST FORT DODGE IA 50501 200597324 501(C)3 350000 0 CHCFD MOBILE DENTAL CLINIC FIREFLY (FORMERLY FAMILY INC) 830 N 14TH STREET SUITE 201 COUNCIL BLUFFS IA 51501 510657063 501(C)3 35000 0 CHILDREN'S ORAL HEALTH-MEDICAID DENTAL PROVIDERS; GIVE KIDS A SMILE 2024 GRANTS CHRYSALIS FOUNDATION 1248 8TH STREET SUITE 101 WEST DES MOINES IA 50265 421337635 501(C)3 15482 0 CHRYSALIS AFTER-SCHOOL STEM-DENTAL CONNECTION CITY OF DELHI 311 FRANKLIN ST DELHI IA 52223 426018235 CITY OF DELHI 12000 0 CITY OF DELHI PARK OUTDOOR BOTTLE REFILL STATION UNITED WAY OF JOHNSON & WASHINGTON COUNTIES 160 SOUTHGATE AVE SUITE A IOWA CITY IA 52240 426062055 501(C)3 20000 0 COMMUNITY COMPASS: UNITED WAY OF JOHNSON AND WASHINGTON COUNTIES' NEEDS ASSESSMENT DES MOINES COUNTY CONSERVATION 11627 STARRS CAVE RD BURLINGTON IA 52601 426004310 DES MOINES COUNTY 13485 0 DES MOINES COUNTY CONSERVATION OUTDOOR DRINKING STATION THE AMERICAN INSTITUTE OF DENTAL PUBLIC HEALTH 401 WILLIAMS STREET 5560 RIVER FOREST IL 60305 842850098 501(C)3 29519 0 DEVELOPING A STRATEGIC PLAN THAT ADVANCES ORAL HEALTH EQUITY FOR IOWA VETERANS CITY OF ELY PARKS & RECREATION 1570 ROWLEY STREET ELY IA 52227 162057007 CITY OF ELY PARKS & 15681 0 ELY WATER BOTTLE FILLING PROJECT THE RIVER ARC 1211 LOIS LANE WATERLOO IA 50702 830765216 501(C)3 28270 0 FRENCH COMMUNITY HEALTH RESOURCE FAIR; CONGOLESE AND AFRICAN IMMIGRANT COMMUNITY HEALTH IN WATERLOO GRANTS HEALTHY BIRTH DAY INC 1820 NW 118TH ST SUITE 220 CLIVE IA 50325 263998964 501(C)3 29649 0 GOOD ORAL HEALTH AND PRENATAL CARE GO HAND IN HAND; LEVERAGING AI TO ENHANCE BIRTH OUTCOMES AND ORAL HEALTH GRANTS IOWA BLACK DOULA COLLECTIVE 413 HEADGATE DR AUGUSTA GA 30907 852654232 501(C)3 30000 0 BIPOC BIRTH DOULA WORKSHOP REFUGEE & IMMIGRANT VOICES IN ACTION (RIVA) 4801 FRANKLIN AVE STE 103 DES MOINES IA 50310 461017191 501(C)3 43000 0 HEALTH EQUITY CAMPAIGN ONESIGHT ESSILORLUXOTTICA FOUNDATION PO BOX 637509 CINCINNATI OH 45263 311385607 501(C)3 25000 0 ONESIGHT DELTAVISION CLINIC 2024 CEDAR RAPIDS PLYMOUTH COUNTY CONSERVATION 25601 C60 HINTON IA 51024 426004873 PLYMOUTH COUNTY 10563 0 HILLVIEW WATER FOUNTAIN UPGRADES/ REPLACEMENTS MEDICAID MEDICARE CHIP SERVICES DENTAL ASSOCIATION PO BOX 1024 SANDWICH MA 02563 201957993 501(C)3 30000 0 2024 MSDA NATIONAL MEDICAID, MEDICARE & CHIP ORAL HEALTH SYMPOSIUM; EXPLORING IMPACT OF DENTAL PROVIDER REIMBURSEMENT RATES ON PROVIDER PARTICIPATION GRANTS ONE IOWA PO BOX 1419 DES MOINES IA 50305 721613927 501(C)3 29745 0 IMPROVING PROVIDER ACCESS FOR LGBTQ+ IOWANS IOWA HEALTHIEST STATE INITIATIVE 301 GRAND AVENUE DES MOINES IA 50309 454570642 501(C)3 25000 0 MAKE IT OK CAMPAIGN COMMUNITY FOUNDATION OF GREATER DUBUQUE 700 LOCUST ST 195 DUBUQUE IA 52001 421526614 501(C)3 50000 0 THE BETTER TOGETHER COMMITTEE- HEALTH INITIATIVE IOWA DENTAL HYGIENISTS' ASSOCIATION 2734 EAST TIFFIN AVENUE DES MOINES IA 50317 426095419 501(C)6 10000 0 IOWA DENTAL HYGIENISTS' ASSOC ANNUAL SESSION 2024; IDHA FALL EVENT 2024 GRANTS IOWA ACES 360 501 SW 7TH ST SUITE G DES MOINES IA 50309 843720619 501(C)3 25000 0 STATEWIDE HEALTH AND WELL-BEING ADVOCACY IOWA DENTAL FOUNDATION 666 GRAND AVENUE SUITE 901 DES MOINES IA 50309 421405188 501(C)3 180000 0 IOWA MISSION OF MERCY; PROVIDER MENTAL HEALTH: PILOT PROJECT; PROVIDER MENTAL HEALTH CRISIS PILOT PROJECT GRANTS IOWA CITY FREE MEDICAL CLINIC 2440 TOWNCREST DRIVE IOWA CITY IA 52240 420960955 501(C)3 50000 0 IOWA CITY FREE MEDICAL CLINIC EXPANSION IOWA DEPARTMENT OF HEALTH AND HUMAN SERVICES (FORMERLY IOWA DEPARTMENT OF P 321 E 12TH ST DES MOINES IA 50319 426004523 STATE OF IOWA 412988 0 I-SMILE @ SCHOOL FFY 25 AND I-SMILE SILVER GRANTS PREVENT BLINDNESS IOWA 1111 NINTH ST STE 250 DES MOINES IA 50314 426083207 501(C)3 25000 0 HEALTHY VISION IN IOWA CRESCENT COMMUNITY HEALTH CENTER 1690 ELM ST STE 300 DUBUQUE IA 52001 481302204 501(C)3 104599 0 MATCHING GRANT TO SUPPORT BUILDING ORAL HEALTH SERVICES AND WORKFORCE TO MEETING NEEDS OF UNDERSERVED POPULATIONS UNIVERSITY OF IOWA 801 NEWTON ST IOWA CITY IA 52242 426004813 STATE OF IOWA 99804 0 MEDICAL-DENTAL INTEGRATION AT FQHCS: SERVICES, BARRIERS, AND FACILITATORS; NATIONAL ORAL HEALTH CONFERENCE TRAVEL PROGRAM; EFFECTIVENESS OF THE VISION SCREENING PROGRAM FOR KINDERGARTENERS IN IOWA; INTERSECTING BARRIERS: DENTAL CARE ACCESS FOR INTERNATIONAL STUDENTS IN THE U.S; STUDENT HOUSING FOR UI EXTRAMURAL PROGRAM: A PILOT PROJECT; ORAL HEALTH IN PREGNANCY; TRANSFORMING ORAL HEALTH ACCESS FOR ADULTS WITH DISABILITIES IN RURAL IOWA GRANTS NEWBO CITY MARKET 1100 3RD ST SE CEDAR RAPIDS IA 52401 270600567 501(C)3 72500 0 MENTAL HEALTH EQUITY INCUBATION PROGRAM CATHERINE MCAULEY CENTER 1220 5TH AVENUE SE CEDAR RAPIDS IA 52403 421342872 501(C)3 10000 0 MENTAL HEALTH SUPPORT FOR REFUGEES AND IMMIGRANTS ORAL HEALTH PROGRAMS ALL SMILES MUNSTER 8933 WHITE OAK AVE MUNSTER IN 46321 851514886 501(C)3 35000 0 MOM HEALTH/DENTAL SUPPORT GROUP; SMILES AROUND: EMPOWERING COMMUNITY TO PROMOTE DENTAL AND OVERALL HEALTH GRANTS NEW VIRGINIA PUBLIC LIBRARY 504 BOOK ALLEY NEW VIRGINIA IA 50210 421027617 501(C)3 8103 0 NEW VIRGINIA PUBLIC LIBRARY - WATER FILLING STATION MERRILL MIDDLE SCHOOL 5301 GRAND AVE DES MOINES IA 50312 426001433 STATE OF IOWA 28215 0 OUTDOOR FILLING STATION DES MOINES PARKS AND RECREATION FOUNDATION 1551 E MARTIN LUTHER KING JR PKWY DES MOINES IA 50317 421390788 501(C)3 20640 0 OUTDOOR FILLING STATIONS FOR PRINCIPAL RIVERWALK PARK, PAPPAJOHN SCULPTURE PARK, AND LAURIDSEN SKATE PARK DES MOINES PUBLIC SCHOOLS FOUNDATION 2100 FLEUR DR DES MOINES IA 50309 270882762 501(C)3 31966 0 OUTDOOR FILLING STATIONS FOR TRACK AND PRACTICE FIELDS AT LINCOLN HIGH SCHOOL, HOOVER HIGH SCHOOL, NORTH HIGH SCHOOL, AND EAST HIGH SCHOOL. FRIENDS OF HIAWATHA PARKS AND RECREATION FOUNDATION 101 EMMONS STREET HIAWATHA IA 52233 270633118 501(C)3 9899 0 PICKLEBALL COURT WATER FOUNTAIN INSTALLATION COON RAPIDS-BAYARD EDUCATION FOUNDATION PO BOX 213 COON RAPIDS IA 50058 421504497 501(C)3 5778 0 QUENCHING THE ELEMENTARY'S THIRST WATER BOTTLE STATION CITY OF RYAN 405 FRANKLIN ST RYAN IA 52330 426005176 CITY OF RYAN 11600 0 RYAN BALLPARK IMPROVEMENT (RBI) FILLING STATION EASTERN IOWA HEALTH CENTER 1030 5TH AVE SE SUITE 2400 CEDAR RAPIDS IA 52403 202405575 501(C)3 284178 0 SCANNERS FOR CROWN AND DENTURE FABRICATION; 2024 DELTAVISION ONESIGHT VISION CLINIC - EIHC COMMUNITY PARTNER; TELE-OPTOMETRY: SEEING INTO THE FUTURE FOR OUR COMMUNITY AND THOSE IN NEED GRANTS SHELLSBURG AREA COMMUNITY GROUP PO BOX 71 SHELLSBURG IA 52332 452039430 501(C)3 15309 0 SHELLSBURG RETHINK YOUR DRINK WATER FILLING STATION QUAD CITIES COMMUNITY BROADCASTING GROUP 1800 3RD AVENUE SUITE 420 ROCK ISLAND IL 61201 320066891 501(C)3 30000 0 ACCESS TO OPPORTUNITY "TO CREATE A COMMUNITY FOCUSED ON ORAL AND SYSTEMIC HEALTH INTEGRATION; PROMOTING DIVERSITY IN THE IOWA DENTAL WORKFORCE BY BRIDGING THE COMMUNICATION GAP GRANTS IOWA PRIMARY CARE ASSOCIATION 500 SW 7TH ST SUITE 300 DES MOINES IA 50309 421311646 501(C)3 50000 0 IOWA PRIMARY CARE ASSOCIATION - DENTAL ASSISTANT APPRENTICESHIP PROGRAM ADVANCEMENT IOWA AFTERSCHOOL ALLIANCE 2910 WESTOWN PARKWAY SUITE 302 WEST DES MOINES IA 50266 421461422 501(C)3 21750 0 THRIVE TOGETHER: MINDFULNESS TRAINING FOR OUT OF SCHOOL TIME PROVIDERS PRIMARY HEALTH CARE 1200 UNIVERSITY AVE 200 DES MOINES IA 50314 421350092 501(C)3 16290 0 VISION SCREENERS FOR SCHOOL BASED HEALTH CLINICS STATE UNIVERSITY OF IOWA FOUNDATION (AKA UNIVERSITY OF IOWA CENTER FO ONE WEST PARK ROAD IOWA CITY IA 522444550 420796760 501(C)3 25000 0 IOWA KIDSIGHT: FOCUSING ON VISION SCREENING FOR UNDERSERVED COUNTIES IN IOWA VISION TO LEARN 900 JACKSON ST SUITE LL5-2C DUBUQUE IA 52001 453457853 501(C)3 270758 0 VISION TO LEARN IOWA - CAPACITY BUILDING TO INCREASE ACCESS TO VISION CARE - 2024 FUNDING/YEAR NORTH UNION ELEMENTARY SCHOOL 308 310TH ST FENTON IA 50539 465251968 STATE OF IOWA 5243 0 WARRIORS NEW WATER BOTTLE FILLING STATION CHRISTIAN COMMUNITY DEVELOPMENT DBA HOUSE OF HOPE 845 W 4TH ST WATERLOO IA 50702 421397528 501(C)3 20000 0 WELLNESS CASE MANAGEMENT AND SUPPORT FOR STABLE HOMES 60 1 0 1 0 0 0 0 0 0 0 APRIL SCHMALTZ PRESIDENT 0 541962 0 234784 0 22047 0 27000 0 2518 0 828311 0 12144 JEFF CHAFFIN DDS DIRECTOR 0 301343 0 166836 0 34980 0 27000 0 1774 0 531933 0 31936 SHERRY PERKINS SECRETARY-TREASURER 0 264677 0 137303 0 12177 0 27000 0 2518 0 443675 0 8761 SUZANNE HECKENLAIBLE EXECUTIVE DIRECTOR 0 239823 0 131823 0 9965 0 27000 0 35019 0 443630 0 7248 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 2024 FROM DELTA DENTAL OF IOWA AND THE AMOUNTS ARE: APRIL SCHMALTZ $134,969 SHERRY PERKINS $ 47,396 SUZANNE HECKENLAIBLE $ 52,055 JEFF CHAFFIN $ 40,053 OFFICERS THAT RECEIVED PAYMENTS OF VESTED AMOUNTS IN 2024 AND THE AMOUNTS ARE: APRIL SCHMALTZ $ 12,144 SHERRY PERKINS $ 8,761 SUZANNE HECKENLAIBLE $ 7,248 JEFF CHAFFIN $ 31,936 THE OFFICERS OF DELTA DENTAL OF IOWA, A RELATED ORGANIZATION, PARTICIPATE IN A LONG-TERM INCENTIVE PLAN. THE PLAN IS INTENDED AND AT ALL TIME 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 2024 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 A. SCHMALTZ HAD A GOVERNMENT PROGRAM RELATED BUSINESS RELATIONSHIP WITH BOARD MEMBER T. RODGERS IN 2024. J. CHAFFIN HAD A GOVERNMENT PROGRAM RELATED BUSINESS RELATIONSHIP WITH BOARD MEMBER T. RODGERS IN 2024 AND A BUSINESS RELATIONSHIP WITH D. CAPLAN IN 2024. S. HECKENLAIBLE HAD A GOVERNMENT PROGRAM RELATED BUSINESS RELATIONSHIP WITH BOARD MEMBER T. RODGERS IN 2024. T. RODGERS HAD BUSINESS RELATIONSHIPS WITH D. CAPLAN, J. VERMEER, N. EGBUONYE, J.M. METTS, A. SCHMALTZ, S. HECKENLAIBLE, AND J. CHAFFIN IN 2024. D. CAPLAN HAD A BUSINESS RELATIONSHIP WITH T. RODGERS, H. HARVEY AND J. CHAFFIN IN 2024. H. HARVEY HAD A BUSINESS RELATIONSHIP WITH D. CAPLAN IN 2024. J. VERMEER HAD A BUSINESS RELATIONSHIP WITH T. RODGERS AND N. EGBUONYE IN 2024. N. EGBUONYE HAD A BUSINESS RELATIONSHIP WITH T. RODGERS AND J. VERMEER IN 2024. J.M. METTS HAD A BUSINESS RELATIONSHIP WITH T. RODGERS IN 2024. 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 2,799. 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 5000000 SEE PART VII - SUPPLEMENTAL INFO. DELTA DENTAL OF IOWA O 560236 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 $5,000,000, WHICH IS A PROMISE TO GIVE. FORM 990, SCHEDULE R, PART V, LINE 2(2), COLUMN B: MANAGEMENT FEES OF $560,236 WERE PAID TO DELTA DENTAL OF IOWA WHICH COULD ALSO BE CLASSIFIED UNDER CODE M.