2024-07-31T12:59:55-05:00 2023-12-31 390859910 BAKER TILLY ADVISORY GROUP LP 790 N WATER ST SUITE 2000 MILWAUKEE WI 53202 990 2023-01-01 820299431 DELTA DENTAL OF IDAHO DELT 2084893534 555 E PARKCENTER BLVD BOISE ID 83706 GREG DONACA PRESIDENT AND CEO 2084893534 2024-07-31 1 1 SHELBY NETZ CPA P01405265 4147775500 2024-07-31 2023 2024-08-08 14:25:15Z GREG DONACA 555 E PARKCENTER BLVD BOISE ID 83706 91840026 0 X WWW.DELTADENTALID.COM X 1971 ID DELTA DENTAL PLAN OF IDAHO, INC. WAS INCORPORATED IN 1971 AS A NON-PROFIT SERVICE (SEE SCHEDULE O) ORGANIZATION. DELTA DENTAL PLAN OF IDAHO, INC. PROVIDES PREPAYMENT DENTAL SERVICE PROGRAMS TO SUBSCRIBERS, THEIR ELIGIBLE DEPENDENTS, AND OTHER BENEFICIARES AS WELL AS PUBLIC BENEFIT PROGRAMS TO PROMOTE ORAL HEALTH. 13 8 125 0 675567 0 0 0 78904073 83432063 1722501 1403997 0 0 80626574 84836060 780626 783884 0 0 8995066 9973689 0 0 0 69793909 72281683 79569601 83039256 1056973 1796804 77033140 85966501 24400411 25091052 52632729 60875449 X DELTA DENTAL PLAN OF IDAHO, INC.'S MISSION IS "WE ARE THE TRUSTED LEADER THAT PROVIDES QUALITY DENTAL BENEFITS AND SERVICES." DELTA DENTAL PLAN OF IDAHO, INC. WAS INCORPORATED IN 1971 AS A NON-PROFIT SERVICE ORGANIZATION TO IMPROVE THE DENTAL HEALTH OF ALL IDAHOANS. 0 0 59825448 82756496 DENTAL HEALTH SERVICES: DENTAL HEALTH COVERAGE AND ADMINISTRATIVE SERVICES INCLUDING EXTERNAL COMMISSIONS PAID, PROVIDED FOR 445,063 MEMBERS. 1126443 268818 DENTAL SEALANT CLINICS: IN 2023, WE SAW 8,953 CHILDREN IN FREE SCHOOLBASED PREVENTIVE CLINICS AND AN ADDITIONAL 1,318 AT COORDINATED EVENTS WITH COMMUNITY PARTNERS. WE ALSO EDUCATED 18,624 CHILDREN ON THE IMPORTANCE OF GOOD ORAL HYGIENE THROUGH IN PERSON CLINICS AND 10,477 VIRTUALLY THROUGH THE LAND OF SMILES PROGRAM, AND 185 THROUGH THE GIRL SCOUTS PATCH PROGRAM. 674340 515066 COMMUNITY GRANTS: WE PARTIALLY FUNDED A FULL TIME COMMUNITY DENTAL HEALTH COORDINATOR AT TERRY REILLY DENTAL HEALTH CENTER WHO PROVIDED PREVENTION/EDUCATION SERVICE TO 546 PATIENTS AND DENTAL TREATMENT TO AN ADDITIONAL 759 PATIENTS. 596255 DENTAL SENIOR PLANS: WE PROVIDED 245 SENIORS AND 15 ADULTS AGES 26 - 34 WITH FREE SERVICES UP TO $1,850 PER PERSON AND MAINTAINED OVER 98 SENIORS ON A PREVENTIVE BENEFIT PLAN. WE PROVIDED 109 CHILDREN, UP TO AGE 18, WITH FREE SERVICES UP TO $2,000 PER CHILD. WE ALSO PARTNERED WITH VARIOUS ORGANIZATIONS TO PROVIDE 15 ORAL HEALTH SCHOLARSHIPS AND DONATED 117,673 DENTAL CARE KITS AND ORAL HEALTH EDUCATIONAL MATERIALS FOR IDAHOANS. 596255 62222486 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 15841 0 1 125 1 1 1 0 0 0 0 0 0 0 X 13 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X GREG DONACA 2084893580 555 E PARKCENTER BLVD BOISE ID 83706 GREG DONACA PRESIDENT AND CEO 40.00 X X 502361 0 72647 ANNETTE HERMAN CHAIR 5.00 X X 42726 0 0 KYLE SIEMEN DMD IMMEDIATE PAST CHAIR 4.00 X X 25665 0 0 MICHAEL FERY SECRETARY 4.00 X X 25500 0 0 JIM PIERCE DDS BOARD MEMBER 4.00 X 27312 0 0 JONATHAN L JUREVIC BOARD MEMBER 4.00 X 28408 0 0 MARK ALEXANDER DMD BOARD MEMBER 4.00 X 27610 0 0 KURT PETELLIN DDS BOARD MEMBER 4.00 X 26199 0 0 MIKE MOONEY CHAIR-ELECT 4.00 X X 26150 0 0 JACK LINCKS DDS BOARD MEMBER 4.00 X 28150 0 0 CHRISTINE NEUHOFF BOARD MEMBER 4.00 X 27150 0 0 NANCY BRIGGS BOARD MEMBER 4.00 X 25050 0 0 JOHN ECK MD BOARD MEMBER 4.00 X 23550 0 0 PARK PRICE BOARD MEMBER 4.00 X 23991 0 0 BILL SHRUM SVP, FINANCE AND ACCOUNTING 40.00 X 188469 0 41123 CORY VAUGHN THROUGH 112023 VP OF IT AND OPERATIONS 40.00 X 328063 0 45618 DONALD MURRAY SVP SALES ACCT MANAGEMENT AND GOVN'T RELATIONS 40.00 X 228509 0 46944 CHRIS FERGUSON DIRECTOR, ENTERPRISE APPLICATIONS 40.00 X 183434 0 28044 JOANNA RAMER STRATEGIC SALES ACCOUNT EXECUTIVE 40.00 X 186989 0 19510 JODY DIPALMA SENIOR ACCOUNT EXECUTIVE 40.00 X 174728 0 18146 HEATHER BROWN SR. DIR., COM. OUTREACH & ORAL HEALTH 40.00 X 139877 0 19249 JAMES PAULL MANAGER, SOFTWARE DEVELOPMENT 40.00 X 150512 0 17234 2440403 0 308515 28 0 1 0 SUMMIT DENTAL GROUP 782 SOUTH AMERICANA BLVD BOISE ID 83702 CLAIMS 1110140 RIVERSTONE DENTAL CARE PLLC 2344 N MERRITT CREEK LOOP COEUR D ALENE ID 83814 CLAIMS 852957 S W GRANT PC 2275 SOUTH EAGLE RD STE 140 MERIDIAN ID 83642 CLAIMS 787460 EASTERN IDAHO ENDODONTICS PLLC 3335 S HOLMES AVE IDAHO FALLS ID 83404 CLAIMS 731504 DFS PLLC 651 E PARKCENTER BLVD BOISE ID 83706 CLAIMS 730306 390 DENTAL PREMIUMS 524114 77483606 77483606 ADMINISTRATION FEES 524114 5272890 5272890 IT SERVICE REVENUE 541519 675567 675567 83432063 1320624 1320624 7087339 7003966 83373 83373 83373 84836060 82756496 675567 1403997 515066 515066 268818 268818 1811197 1811197 5706889 5706889 995305 995305 895081 895081 565217 565217 436471 436471 171904 171904 67671 67671 282082 282082 1546241 1546241 640366 640366 107273 107273 442740 442740 165875 165875 199977 199977 131081 131081 295208 295208 503040 503040 278623 278623 CLAIMS 59825445 59825445 EXTERNAL COMMISSIONS 4014685 4014685 COMMUNITY PROGRAMS 1613157 1613157 1559844 1559844 83039256 62222486 20816770 0 201741 127884 2956703 3282717 402096 406195 14690354 4765387 10058242 9924967 54580282 62187404 44489 0 8789587 10037334 77033140 85966501 4578748 3674387 4029875 3915959 15791788 17500706 24400411 25091052 X 52582729 60825449 50000 50000 52632729 60875449 77033140 85966501 1796804 6445916 0 X X 0 1 X 1 0 1177645 1177645 8405851 1378246 7027605 4163142 3387141 776001 943716 943716 9924967 DEFERRED COMPENSATION 10037334 10037334 DEFERRED COMPENSATION 10037334 ACCRUED DENTAL CLAIMS 4145000 UNEARNED PREMIUMS 1847934 ADVANCE DEPOSITS 814899 RETENTION ACCOUNT 363539 PROVISION FOR CLAIMS PROCESSINGS 292000 17500706 X 90999894 6445916 6445916 84553978 282082 282082 84836060 82757174 0 82757174 282082 282082 83039256 PART X, LINE 2: DELTA DENTAL PLAN OF IDAHO, INC. BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. DELTA DENTAL PLAN OF IDAHO, INC. WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. 1 COMMUNITY HEALTH CLINICS INC DBA TERRY REILLY HEALTH SERVICES STREET ADDRESS NAMPA ID 83653 820300537 501(C)(3) 50000 0 PARTIALLY FUND FULL TIME COMMUNITY DENTAL HEALTH COORDINATOR IDAHO STATE UNIVERSITY FOUNDATION PO BOX 9 POCATELLO ID 83209 826013543 501(C)(3) 8230 0 DENTAL HYGIENE SCHOLARSHIP IDAHO ORAL HEALTH ALLIANCE 921 S 8TH AVE STOP 8050 BOISE ID 83701 200454949 501(C)(3) 20000 0 1ST OF 3 YEAR SPONSORSHIP FOR INFRASTRUCTURE GENESIS COMMUNITY HEALTH PO BOX 2309 BOISE ID 83714 820505073 501(C)(3) 50000 0 FUNDS TO EMPLOYEE DENTAL HYGIENIST COLLEGE OF SOUTHERN IDAHO FOUNDATION INC 215 W 35TH ST TWIN FALLS ID 83303 820388193 501(C)(3) 15760 0 2 DA SCHOLARSHIPS NORTH IDAHO COLLEGE FOUNDATION PO BOX 1238 COUER D ALENE ID 83814 820337334 501(C)(3) 7640 0 2 DH SCHOLARSHIPS COLLEGE OF EASTERN IDAHO 8169 W VICOTRY ROAD IDAHO FALLS ID 83404 943160729 501(C)(3) 75000 0 ORAL HEALTH GRANT COMMUNITY COUNCIL OF IDAHO 1600 S 25TH E CALDWELL ID 83607 820299736 501(C)(3) 50000 0 ORAL HEALTH GRANT GENESIS COMMUNITY HEALTH 317 HAPPY DAY BLV SUITE 250 BOISE ID 83714 820505073 501(C)(3) 205000 0 DONATION TO FUND DENTAL EQUIPMENT AND SUPPLIES PANHANDLE HEALTH DISTRICT 8500 N ATLAS ROAD HAYDEN ID 83835 820537262 GOVERNMENTAL ENTITY 8436 0 FUNDS TO RUN NORTH IDAHO SCHOOL SEALANT CLINICS ON OUR BEHALF. BOISE PUBLIC SCHOOLS EDUCATION FOUNDATION INC 8169 W VICOTRY ROAD BOISE ID 83702 820400689 501(C)(3) 25000 0 ORAL HEALTH GRANT 10 1 SCHOLARSHIPS 15 47426 GRANTS TO INDIVIDUALS FOR CONFERENCES 8 6392 COMMUNITY OUTREACH - DENTAL KITS 117673 0 215000 FMV DENTAL KITS PART I, LINE 2: THE ORGANIZATION ENDEAVORS TO MONITOR ITS GRANTS AND DONATIONS TO ENSURE THAT THE FUNDS ARE USED FOR THEIR PROPER PURPOSES AND NOT OTHERWISE DIVERTED FROM THEIR INTENDED USE. THIS IS ACCOMPLISHED BY REQUESTING RECIPIENT ENTITIES TO AFFIRM THAT FUNDS MUST BE USED SOLELY IN ACCORDANCE WITH THE GRANT REQUEST AND BUDGET ON WHICH THE GRANT WAS BASED AND THAT FUNDS NOT EXPENDED FOR THE STATED PURPOSE ARE TO BE RETURNED TO THE ORGANIZATION. REPORT ARE REQUESTED FROM TIME TO TIME AS IS DEEMED APPROPRIATE. THE SCHOLARSHIP RECIPIENTS ARE DETERMINED BY THE SCHOOL IN LINE WITH CRITERIA THAT ARE SET IN OUR SCHOLARSHIP AGREEMENT. THE SCHOOL'S FOUNDATION RECEIVES THE FUNDS FROM THE ORGANIZATION AND WORKS WITH THE SCHOOL'S FINANCIAL AID OFFICE TO APPLY THE FUNDS TO RECIPIENTS' TUITION. SCHOOLS PROVIDE ANNUAL REPORTS AND/OR THANK YOU LETTERS STATING OUR FUNDS HAVE BEEN USED. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 GREG DONACA PRESIDENT AND CEO 341036 0 92148 0 69177 0 63438 0 9209 0 575008 0 45822 0 CORY VAUGHN THROUGH 112023 VP OF IT AND OPERATIONS 113634 0 108430 0 105999 0 39105 0 6513 0 373681 0 78387 0 DONALD MURRAY SVP SALES ACCT MANAGEMENT AND GOVN'T RELATIONS 155755 0 27408 0 45346 0 36214 0 10730 0 275453 0 22846 0 BILL SHRUM SVP, FINANCE AND ACCOUNTING 165962 0 19807 0 2700 0 32682 0 8441 0 229592 0 0 0 CHRIS FERGUSON DIRECTOR, ENTERPRISE APPLICATIONS 150342 0 33092 0 0 0 8329 0 19715 0 211478 0 0 0 JOANNA RAMER STRATEGIC SALES ACCOUNT EXECUTIVE 151586 0 35403 0 0 0 10303 0 9207 0 206499 0 0 0 JODY DIPALMA SENIOR ACCOUNT EXECUTIVE 145292 0 29436 0 0 0 8739 0 9407 0 192874 0 0 0 JAMES PAULL MANAGER, SOFTWARE DEVELOPMENT 143478 0 7034 0 0 0 9027 0 8207 0 167746 0 0 0 HEATHER BROWN SR. DIR., COM. OUTREACH & ORAL HEALT 129299 0 10578 0 0 0 8522 0 10727 0 159126 0 0 0 PART I, LINE 4B DELTA DENTAL OF IDAHO HAS A 457(F) PLAN IN PLACE. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE PLAN DURING THE TAX YEAR: GREG DONACA, CORY VAUGHN, DONALD MURRAY, AND BILL SHRUM. IN 2023 THE FOLLOWING INDIVIDUALS VESTED IN AND RECEIVED A PAYMENT FROM THE PLAN: - GREG DONACA $45,822 - CORY VAUGHN $105,999 - DONALD MURRAY $22,846 PART I, LINE 5A: THE CEO BONUS COMPENSATION IS A MIXTURE OF PERFORMANCE AND TARGETED GROWTH, MEMBERSHIP AND CONTROLLING OPERATING EXPENSE FOR THE YEAR. BONUS TARGETS ARE ESTABLISHED ANNUALLY BY THE BOARD TO ENSURE THE ONGOING FINANCIAL SUCCESS OF DELTA DENTAL OF IDAHO AND STRIVE TO MEET THE MISSION. AT THE BEGINNING OF THE YEAR, THE TARGETS ARE ESTABLISHED AND APPROVED BY THE BOARD WITH ACTUAL RESULTS ALSO APPROVED BY THE BOARD AT THE END OF THE YEAR. CALCULATIONS ARE COMPLETED BY THE VP OF FINANCE AND ACCOUNTING AND REVIEWED BY THE VP OF HUMAN RESOURCES BEFORE THEY ARE PRESENTED TO THE BOARD FOR APPROVAL. POCATELLO FAMILY DENTISTRY SEE PART V. 101192 DENTAL CLAIM PAYMENTS WERE MADE TO POCATELLO FAMILY DENTISTRY, WHICH IS MORE THAN 35% OWNED BY KYLE SIEMEN, A CURRENT BOARD MEMBER OF DELTA DENTAL OF IDAHO. 0 PERIODONTAL HEALTH SPECIALISTS OF IDAHO SEE PART V. 449439 DENTAL CLAIM PAYMENTS WERE MADE TO PERIODONTAL HEALTH SPECIALISTS OF IDAHO, WHICH IS MORE THAN 35% OWNED BY JACK LINCKS, A CURRENT BOARD MEMBER OF DELTA DENTAL OF IDAHO. 0 KURT PETELLIN DDS SEE PART V. 114599 DENTAL CLAIM PAYMENTS WERE MADE TO KURT PETELLIN, DDS., WHICH IS MORE THAN 35% OWNED BY KURT PETELLIN, A CURRENT BOARD MEMBER OF DELTA DENTAL OF IDAHO. 0 MARK ALEXANDER DDS SEE PART V. 101724 DENTAL CLAIM PAYMENTS WERE MADE TO ALEXANDER DENTAL GROUP, WHICH IS MORE THAN 35% OWNED BY MARK ALEXANDER, A CURRENT BOARD MEMBER OF DELTA DENTAL OF IDAHO. 0 FORM 990, PART VI, SECTION A, LINE 1A THE CHAIR, IMMEDIATE PAST-CHAIR, SECRETARY AND CEO CAN COMPRISE A STANDING EXECUTIVE COMMITTEE. ALTERNATIVELY, THE BOARD OF DIRECTORS ("BOD") MAY REPLACE THE STANDING EXECUTIVE COMMITTEE BY DESIGNATING TWO OR MORE DIRECTORS TO CONSTITUTE THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE CAN HAVE THE POWER AND AUTHORITY OF THE BOD IN THE DAY-TO-DAY MANAGEMENT OF THE BUSINESS OF THE COMPANY, SUBJECT TO THE LIMITATIONS IMPOSED BY THE IDAHO NONPROFIT CORPORATION ACT, OR THE BOD. FORM 990, PART VI, SECTION A, LINE 6 TO BE ELIGIBLE TO BECOME AND REMAIN A MEMBER OF DELTA DENTAL OF IDAHO, A PERSON MUST BE 1) HOLD A CURRENT LICENSE BY THE STATE OF IDAHO TO PRACTICE DENTISTRY; 2) CARRY AND MAINTAIN ADEQUATE PROFESSIONAL LIABILITY INSURANCE AND COMMERCIAL GENERAL LIABILITY POLICIES; 3) MEET THE CREDENTIALING CRITERIA; AND 4) EXECUTE A SERVICE AGREEMENT WITH DELTA DENTAL OF IDAHO. ALL MEMBERS SHALL ABIDE BY THE APPLICABLE RULES, REGULATIONS AND POLICIES THAT MAY BE ADOPTED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS INCLUDES TWO CLASSES OF DIRECTORS: MEMBER DIRECTORS AND INDEPENDENT DIRECTORS. A MAJORITY OF THE DIRECTORS ARE INDEPENDENT DIRECTORS APPOINTED BY THE BOARD OF DIRECTORS. THE MEMBER DIRECTORS ARE MEMBERS IN GOOD STANDING AND ARE ELECTED BY A MAJORITY OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B DELTA DENTAL OF IDAHO IS A MEMBER COMPANY OF THE DELTA DENTAL PLANS ASSOCIATION (DDPA) WHICH HAS GOVERNING RULES AND CRITERIA THAT ALL MEMBER COMPANIES MUST FOLLOW. THEREFORE CERTAIN BOARD DECISIONS ARE SUBJECT TO THESE GOVERNING RULES AND REQUIRE APPROVAL BY DDPA. IN ADDITION THE COMPANY IS SUBJECT TO RULES AND REGULATIONS ESTABLISHED BY THE IDAHO DEPARTMENT OF INSURANCE. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED BY AN EXTERNAL CPA FIRM AND REVIEWED IN DETAIL BY SENIOR MANAGEMENT AND ACCOUNTING STAFF. THE IRS FORM 990 IS REVIEWED AND APPROVED BY THE INVESTMENT AND FINANCE COMMITTEE. A COPY OF THE FORM IS PROVIDED TO THE FULL BOARD FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED AND SIGNED BY EACH BOARD MEMBER AND OFFICER OR KEY EMPLOYEE OF THE COMPANY ON AN ANNUAL BASIS. A DETAIL REVIEW OF THE SIGNED CONFLICT FORMS IS COMPLETED BY THE CEO AND THE GOVERNANCE COMMITTEE CHAIR. AFTER REVIEW, THE GOVERNANCE COMMITTEE CHAIR REPORTS TO THE FULL BOARD. IF A CONFLICT EXISTS, THE CHAIR IS RESPONSIBLE FOR ELIMINATION OF THE CONFLICT WITHIN A REASONABLE PERIOD OF TIME. THE EXTERNAL AUDITORS ARE CONSULTED AS NEEDED. FORM 990, PART VI, SECTION B, LINE 15 AT LEAST ANNUALLY, THE CEO COMPENSATION PACKAGES ARE REVIEWED BY THE COMPENSATION COMMITTEE USING COMPARABLE SALARY DATA AND OUTSIDE CONSULTANT DATA. THE COMPENSATION COMMITTEE CONSISTS OF 7 BOARD MEMBERS. IN ADDITION, A MARKET STUDY IS COMPLETED BY THE VP OF HR FOR ALL KEY EMPLOYEES AND IS REVIEWED BY THE CEO. OFFICER AND KEY EMPLOYEE COMPENSATION PROCESS CONSISTS OF SETTING GOALS AT THE BEGINNING OF THE YEAR FOR THE CALENDAR YEAR'S SALARY INCREASES AND BONUSES. THE GOALS ARE REVIEWED DURING THE YEAR WITH A FORMAL REVIEW AT THE END OF THE YEAR. DEPENDING ON THE PERFORMANCE OF THE COMPANY, INDIVIDUAL AND OVERALL ECONOMY, RAISES AND BONUSES ARE DETERMINED. DURING THE PROCESS, THE INDIVIDUALS AND COMPANY'S ACTUAL RESULTS ARE COMPARED AGAINST GOALS AND TARGETS. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE FILED WITH THE DEPARTMENT OF INSURANCE. INDIVIDUALS CAN MAKE REQUESTS FOR THE FINANCIAL STATEMENTS FOLLOWING THE DOI'S REGULAR PROCESS. IN ADDITION, FINANCIAL STATEMENTS ARE SHARED UPON REQUEST TO THE CEO AND CAN BE OBTAINED ONLINE THROUGH GUIDESTAR. FORM 990, PART XII, LINE 2C: NO CHANGE FROM PRIOR YEAR. HEALTH SERVICES GROUP 555 E PARKCENTER BLVD BOISE ID 83706 460920203 SUPPORT SERVICES ID 56372 14328 DELTA DENTAL OF IDAHO ADVANCED HEALTH SERVICES 555 E PARKCENTER BLVD BOISE ID 83706 352651482 IT SERVICES ID 619195 493893 DELTA DENTAL OF IDAHO