2024-11-15T14:11:22+00:00 2023-12-31 440160260 Forvis Mazars LLP 312 Walnut Street Suite 3000 Cincinnati OH 45202 990 2023-01-01 430908349 Delta Dental of Missouri DELT 3146563000 12399 GRAVOIS ROAD ST LOUIS MO 631271702 E B ROB GOREN PRESIDENT & CEO 3146563000 2024-11-15 true true Aaron Hershberger P00961884 5136218300 2024-11-15 2023 2024-10-15 13:58:12Z E B ROB GOREN 12399 GRAVOIS ROAD ST LOUIS MO 631271702 724582263 false X WWW.DELTADENTALMO.COM X 1958 MO OUR PURPOSE IS TO IMPROVE THE DENTAL HEALTH OF THE PUBLIC BY PROMOTING PREVENTIVE DENTISTRY AND PROVIDING COMPREHENSIVE DENTAL CARE AND MAINTENANCE ON A PREPAID BASIS. 15 12 291 0 0 0 0 0 685242188 718655430 3190930 4126810 427490 1292409 688860608 724074649 1556217 1289928 619415503 653748728 39042316 40019351 0 0 0 22486136 25648448 682500172 720706455 6360436 3368194 200900199 216935116 40574417 42869395 160325782 174065721 X THE ORGANIZATION'S PRIMARY PURPOSE IS TO IMPROVE THE DENTAL HEALTH OF THE PUBLIC BY PROMOTING PREVENTIVE DENTISTRY AND PROVIDING COMPREHENSIVE DENTAL CARE AND MAINTENANCE ON A PREPAID BASIS. false false 704593996 718655430 DELTA DENTAL OF MISSOURI IS A PREPAID DENTAL INSURANCE COMPANY. IN 2023, DELTA DENTAL PROCESSED 3,406,675 CLAIMS FOR DENTAL SERVICES. 1168352 1168352 ORAL HEALTH GRANT PROGRAM PROGRAM DESCRIPTION: DELTA DENTAL OF MISSOURI'S ORAL HEALTH GRANT PROGRAM HELPS REDUCE DENTAL DISEASE THROUGH EDUCATION, PREVENTION AND TREATMENT; ENSURE ACCESS TO AFFORDABLE, TIMELY AND HIGH-QUALITY DENTAL CARE; AND ENHANCE AWARENESS OF GOOD ORAL HEALTH WITH A FOCUS ON CHILDREN AND UNDERSERVED INDIVIDUALS. IN 2023, DELTA DENTAL OF MISSOURI AWARDED NEARLY $1.2 MILLION IN GRANTS TO 27 MISSOURI AND SOUTH CAROLINA ORGANIZATIONS, WHICH ALIGN WITH ITS NON-PROFIT MISSION TO IMPROVE ORAL HEALTH. FUNDING INCLUDED DIRECT CARE GRANTS; EQUIPMENT/CAPITAL GRANTS; WORKFORCE DEVELOPMENT; EDUCATIONAL GRANTS; AND LOAN REPAYMENT GRANTS FOR DENTISTS WHO COMMIT TO SERVING IN A DENTAL HEALTH PROFESSIONAL SHORTAGE AREA. THE COMPANY ACCEPTS GRANT APPLICATIONS ANNUALLY. TO BE ELIGIBLE FOR AN ORAL HEALTH GRANT, APPLICANTS IN BOTH STATES MUST FIRST COMPLETE A LETTER OF INTENT THROUGH THE ONLINE GRANT APPLICATION SYSTEM. APPLICANTS MUST BE CONSIDERED TAX-EXEMPT UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE, OR BE A PUBLIC OR GOVERNMENTAL ENTITY, SUCH AS A PUBLIC SCHOOL OR HEALTH DEPARTMENT, AND SERVE THE PEOPLE OF MISSOURI OR SOUTH CAROLINA. THE MINIMUM GRANT AMOUNT IS $5,000. ORAL HEALTH GRANTS GREATER THAN $5,000 ARE INCLUDED IN SCHEDULE I. DELTA DENTAL OF MISSOURI BEGAN ADMINISTERING THIS ORAL HEALTH GRANT PROGRAM ONLINE IN 2017. 367000 LAND OF SMILES PROGRAM PROGRAM DESCRIPTION: DELTA DENTAL OF MISSOURI'S LAND OF SMILES IS AN EDUCATIONAL PROGRAM THAT FEATURES CAPTIVATING CHARACTERS, WHO TEACH GRADE SCHOOLERS GOOD DENTAL HEALTH HABITS. THE PROGRAM IS AVAILABLE IN A LIVE, IN-PERSON AND VIRTUAL FORMAT. IN 2023, DELTA DENTAL OF MISSOURI INVESTED MORE THAN $367,000 TO EDUCATE NEARLY 110,000 MISSOURI AND SOUTH CAROLINA KINDERGARTEN-THROUGH-3RD-GRADE STUDENTS IN 489 SCHOOLS. STUDENTS LEARN THE IMPORTANCE OF BRUSHING TEETH TWICE A DAY, FLOSSING, EATING HEALTHY FOODS AND VISITING THE DENTIST REGULARLY. DELTA DENTAL OF MISSOURI OFFERS FREE "SMILE BAGS" TO SCHOOLS FOR STUDENTS WHO PARTICIPATE IN THE PROGRAM. EACH BAG INCLUDES A TOOTHBRUSH, TOOTHPASTE AND DENTAL FLOSS TO HELP STUDENTS PRACTICE THE GOOD ORAL HEALTH HABITS THAT THEY LEARN. EACH SCHOOL IS RESPONSIBLE FOR DISTRIBUTING THE BAGS TO PARTICIPATING STUDENTS WHO ATTEND SCHOOL IN PERSON OR VIRTUALLY. A SURVEY OF SCHOOL NURSES SHOWED THAT 99% WOULD LIKE TO HAVE THE PROGRAM RETURN TO THEIR SCHOOL. PRE- AND POST-TEST DATA ALSO SHOWED A 23% INCREASE IN CHILDREN'S ORAL HEALTH KNOWLEDGE AFTER VIEWING THE PROGRAM. LONGEVITY: THIS PROGRAM HAS BEEN IN PLACE IN MISSOURI SINCE 2002, AND IN SOUTH CAROLINA SINCE 2014. 200430 121576 COMMUNITY GIVING PROGRAM PROGRAM DESCRIPTION: THROUGH DELTA DENTAL OF MISSOURI'S COMMUNITY GIVING PROGRAM, THE COMPANY SUPPORTS CHARITABLE ORGANIZATIONS AND PROGRAMS THAT ARE WORKING TO MAKE A DIFFERENCE IN MISSOURI AND SOUTH CAROLINA COMMUNITIES. DELTA DENTAL OF MISSOURI CONSIDERS COMMUNITY GIVING REQUESTS EACH QUARTER FROM REGISTERED 501(C)(3) CHARITABLE ORGANIZATIONS, WHICH SERVE INDIVIDUALS IN MISSOURI OR SOUTH CAROLINA, AND SUPPORT THE OVERALL HEALTH AND WELL-BEING OF THE COMMUNITY WITH A FOCUS ON AT-RISK POPULATIONS. MORE THAN $121,000 IN COMMUNITY DONATIONS WERE AWARDED IN 2023. ORGANIZATIONS MAY APPLY FOR FUNDING ONCE PER YEAR. DELTA DENTAL OF MISSOURI'S COMMUNITY GIVING INCLUDES ORAL HEALTH SUPPLY DONATIONS OF TOOTHBRUSHES AND DENTAL FLOSS TO ORGANIZATIONS TO HELP INDIVIDUALS MAINTAIN GOOD ORAL HYGIENE FOR BETTER DENTAL HEALTH. IN 2023, DELTA DENTAL OF MISSOURI DONATED MORE THAN 317,000 DENTAL SUPPLY ITEMS TO 49 ORGANIZATIONS AS PART OF THE LAND OF SMILES PROGRAM. futureFOCUS2023 CONFERENCE PROGRAM PROGRAM DESCRIPTION: DELTA DENTAL OF MISSOURI'S futureFOCUS2023 CONFERENCE BRINGS TOGETHER NEARLY 300 THOUGHT LEADERS WHO DELIVER INSIGHTS AND DISCUSS THE CHANGING LANDSCAPE OF DENTAL AND VISION BENEFITS AS WELL AS STRATEGIES TO IMPROVE ORAL AND OVERALL HEALTH FOR ALL INDIVIDUALS IN MISSOURI. FOR 2023 $79,000 WAS SPENT TO PUT TOGETHER THIS EVENT. 200430 121576 706329778 false false false false false false false false false true false true false true true false true false false false false false false false false false true false true false false false false false false false true false false false false false true true true false true 60038 0 true 291 true false false false false false false false false false false true false X 15 12 false false false false true true true true true false true true true true true true true true true true false SC X ANDREW ROUSE 3146563000 12399 GRAVOIS ROAD ST LOUIS MO 631271702 Deborah Patterson Secretary/Director 2.0 0.0 X X 38850 0 0 James W Rhea Chair of the Board/Director - Term Ended 2.0 0.0 X X 64050 0 0 Mark Zust Chair of the Board/Director 2.0 0.0 X X 54900 0 0 Nathan Suter Second Vice Chair/Director 2.0 0.0 X X 37300 0 0 Oladipupo Adefala First Vice Chair/Director 2.0 0.0 X X 46200 0 0 Rosemary Bishop Secretary/Director - Term Ended 2.0 0.0 X X 42700 0 0 Steven Harris Treasurer/Director 2.0 0.0 X X 33300 0 0 Anthony Garavaglia Director 2.0 0.0 X 0 0 0 Christine Pierson Director 2.0 0.0 X 0 0 0 Cynthia Petrie Director 2.0 0.0 X 0 0 0 Gary Williams Director 2.0 0.0 X 45100 0 0 John Custardo Director 2.0 0.0 X 31200 0 0 Kathleen Tucker Director 2.0 0.0 X 33300 0 0 Latasha Vick Director 2.0 0.0 X 0 0 0 Mark Mancin Director - Term Ended 2.0 0.0 X 30150 0 0 Megan Krohn Director 2.0 0.0 X 0 0 0 Noble Cooper JR Director 2.0 0.0 X 34250 0 0 Timothy Taylor Director - Term Ended 2.0 0.0 X 34350 0 0 William Gray Director 2.0 0.0 X 32250 0 0 William J Bender Treasurer/Director - Term Ended 2.0 0.0 X 36200 0 0 Barbara C Bentrup CFO/General Counsel/Officer 60.0 0.0 X 909106 0 103599 Cipriano Mascote Chief Actuarial Officer 60.0 0.0 X 279157 0 83762 E B Rob Goren President & CEO 60.0 0.0 X 1603972 0 101568 James J Barone Chief Sales & Marketing Officer 60.0 0.0 X 800403 0 68578 Jane Stanhaus Chief Human Resource Officer 60.0 0.0 X 357902 0 80390 Jonathan R Jennings Chief Operating Officer 60.0 0.0 X 649047 0 88340 Kiran Achen Chief Information Officer 60.0 0.0 X 245151 0 16239 Rhonda Graack General Counsel 60.0 0.0 X 16154 0 0 Ronald E Inge COO/Officer 60.0 0.0 X 501426 0 52261 Allison M Izsak Director of Marketing 60.0 0.0 X 238715 0 77569 Ellen R Samuels Compliance Director 60.0 0.0 X 272613 0 71874 Eric W Mann Director of Operations 60.0 0.0 X 231626 0 52124 Ezekiel Meyer Director of Project Management 60.0 0.0 X 230101 0 61062 Robert Wozniak Account Executive 60.0 0.0 X 336707 0 76186 Karl A Mudra Former CIO/Officer 60.0 0.0 X 1346691 0 13961 8612871 0 947513 61 true true false MISSOURI DENTAL PROFESSIONALS 1100 SPUR DR STE 30 MARSHFIELD MO 65706 DENTAL SERVICES 8060171 MICHAEL K PARSONS DDS PC 6 MCBRIDE AND SON CENTER DR STE 203 CHESTERFIELD MO 63005 DENTAL SERVICES 3899875 ST LOUIS PEDIATRIC DENTISTRY LLC 4645 STATE HYW K OFALLON MO 63368 DENTAL SERVICES 3344110 LIFETIME DENTAL CARE OF MISSOURI PO BOX 503904 ST LOUIS MO 63150 DENTAL SERVICES 2878329 M FERNANDEZ DDS E BROWN DDS J OSDIECK 3555 SUNSET OFFICE DR STE 210 ST LOUIS MO 63127 DENTAL SERVICES 2776865 1003 0 DENTAL PREMIUMS 524114 718655430 718655430 0 0 0 0 0 0 718655430 4634424 0 0 4634424 0 0 0 0 0 0 507614 -507614 0 -507614 0 0 -507614 MISCELLANEOUS INCOME 900099 528231 0 0 528231 INVESTMENT IN SUBSIDIARY 900003 764178 0 0 764178 0 0 0 0 1292409 724074649 718655430 0 5419219 1289928 1289928 0 0 0 0 653748728 653748728 8126859 0 8126859 0 0 0 0 0 20380173 18867408 1512765 0 5047617 4513598 534019 0 4665306 4319013 346293 0 1799396 1665831 133565 0 0 0 0 0 265076 209340 55736 0 195389 154306 41083 0 0 0 0 0 0 0 297425 0 297425 0 5502774 4345729 1157045 0 1757652 1627186 130466 0 3238180 2997819 240361 0 151841 140570 11271 0 0 0 0 0 718551 665214 53337 0 797712 738501 59211 0 0 0 0 0 312161 288994 23167 0 0 0 0 0 0 0 0 0 1392193 1288854 103339 0 791549 0 791549 0 BOARD AND BUREAU DUES 1010811 935781 75030 0 SERVICE BUREAU FEES 2657144 2459911 197233 0 PUBLIC RELATIONS 557410 516036 41374 0 SERVICE AGREEMENTS 4924088 4558587 365501 0 1078492 998444 80048 0 720706455 706329778 14376677 0 0 0 37405011 35164815 0 0 14098097 14177993 0 0 0 0 0 0 0 0 1006829 1216826 33274261 21142537 10792857 12131724 118726364 132652574 46906 22000 15987649 16751827 0 0 2836486 4817357 200900199 216935116 19215170 17791845 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21359247 25077550 40574417 42869395 0 0 0 0 X 0 0 0 0 160325782 174065721 160325782 174065721 200900199 216935116 3368194 10371745 0 X false true X true false 0 1350000 1350000 0 8630866 5772150 2858716 0 1145351 1021312 124039 0 7079561 6268449 811112 0 15068483 8080626 6987857 12131724 INVESTMENT IN ADVANTICA HLDG CO 16751827 C 16751827 CLAIMS PAYABLE 11951280 UNPAID CLAIM PROCESSING COST 1600341 ADVANCE PREMIUM 9848982 ADVANCE DEPOSITS 1676947 25077550 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. ADVANTICA ADMINISTRATIVE SERVICES, INC. AND ITS WHOLLY-OWNED SUBSIDIARIES ARE SUBJECT TO BOTH FEDERAL AND STATE INCOME TAXES AND ACCOUNT FOR INCOME TAXES IN ACCORDANCE WITH INCOME TAX ACCOUNTING GUIDANCE (ASC 740 INCOME TAXES). THE INCOME TAX ACCOUNTING GUIDANCE RESULTS IN TWO COMPONENTS OF INCOME TAX EXPENSE: CURRENT AND DEFERRED. CURRENT INCOME TAX EXPENSE REFLECTS TAXES TO BE PAID OR REFUNDED FOR THE CURRENT PERIOD BY APPLYING THE PROVISIONS OF THE ENACTED TAX LAW TO THE TAXABLE INCOME OR EXCESS OF DEDUCTIONS OVER REVENUES. THE COMPANY DETERMINES DEFERRED INCOME TAXES USING THE LIABILITY (OR BALANCE SHEET) METHOD. UNDER THIS METHOD, THE NET DEFERRED TAX ASSET OR LIABILITY IS BASED ON THE TAX EFFECTS OF THE DIFFERENCES BETWEEN THE BOOK AND TAX BASES OF ASSETS AND LIABILITIES, AND ENACTED CHANGES IN TAX RATES AND LAWS ARE RECOGNIZED IN THE PERIOD IN WHICH THEY OCCUR. DEFERRED INCOME TAX EXPENSE RESULTS FROM CHANGES IN DEFERRED TAX ASSETS AND LIABILITIES BETWEEN PERIODS. DEFERRED TAX ASSETS ARE REDUCED BY A VALUATION ALLOWANCE IF, BASED ON THE WEIGHT OF EVIDENCE AVAILABLE, IT IS MORE LIKELY THAN NOT THAT SOME PORTION OR ALL OF A DEFERRED TAX ASSET WILL NOT BE REALIZED. UNCERTAIN TAX POSITIONS ARE RECOGNIZED IF IT IS MORE LIKELY THAN NOT, BASED ON THE TECHNICAL MERITS, THAT THE TAX POSITION WILL BE REALIZED OR SUSTAINED UPON EXAMINATION. THE TERM MORE LIKELY THAN NOT MEANS A LIKELIHOOD OF MORE THAN 50 PERCENT; THE TERMS EXAMINED AND UPON EXAMINATION ALSO INCLUDE RESOLUTION OF THE RELATED APPEALS OR LITIGATION PROCESSES, IF ANY. A TAX POSITION THAT MEETS THE MORE LIKELY-THAN-NOT RECOGNITION THRESHOLD IS INITIALLY AND SUBSEQUENTLY MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT HAS A GREATER THAN 50 PERCENT LIKELIHOOD OF BEING REALIZED UPON SETTLEMENT WITH A TAXING AUTHORITY THAT HAS FULL KNOWLEDGE OF ALL RELEVANT INFORMATION. THE DETERMINATION OF WHETHER OR NOT A TAX POSITION HAS MET THE MORE-LIKELY THAN-NOT RECOGNITION THRESHOLD CONSIDERS THE FACTS, CIRCUMSTANCES AND INFORMATION AVAILABLE AT THE REPORTING DATE AND IS SUBJECT TO MANAGEMENT'S JUDGMENT. THE ORGANIZATION RECOGNIZES INTEREST AND PENALTIES ON INCOMETAXES AS A COMPONENT OF INCOME TAX EXPENSE. ON A CONSOLIDATED BASIS, ADVANTICA ADMINISTATIVE SERVICES, INC. AND ITS SUBSIDIARIES HAD AN OPERATING (LOSS) GAIN TOTALING $764,178 AND $(14,829) AS OF DECEMBER 31, 2023 AND 2022, RESPECTIVELY. AT DECEMBER 31, 2023 AND 2022, ADVANTICA ADMINISTRATIVE HAD NET OPERATING LOSS CARRYFORWARDS OF APPROXIMATELY $18,125,000 AND $18,659,000, RESPECTIVELY. ADVANTICA ADMINISTRATIVE AND ITS SUBSIDIARIES HAD DEFERRED TAX ASSETS OF APPROXIMATELY $1,296,000 AND $1,315,000 AT DECEMBER 31, 2023 AND 2022, RESPECTIVELY, NEARLY ALL OF WHICH ARISE FROM THESE NET OPERATING LOSS CARRYFORWARDS. DUE TO THE REMAINING UNCERTAINTY REGARDING WHETHER THESE WILL BE REALIZED, A FULL VALUATION ALLOWANCE HAS BEEN RECORDED AGAINST THESE DEFERRED TAX ASSETS AT DECEMBER 31, 2023 AND 2022. THE ORGANIZATION AND ITS SUBSIDIARIES ARE CURRENTLY OPEN TO EXAMINATION UNDER THE STATUTE OF LIMITATIONS BY THE INTERNAL REVENUE SERVICE AND STATES IN WHICH IT FILES FOR THE YEARS ENDED DECEMBER 31, 2020 THROUGH 2023. true Central Ozarks Medical Center PO Box 777 Richland MO 65536 431183442 501(C)(3) 100000 GENERAL SUPPORT Community Foundation of the Ozarks Inc PO BOX 8960 Springfield MO 65801 237290968 501(C)(3) 100000 GENERAL SUPPORT State of Missouri PO BOX 809 JEFFERSON CITY MO 65201 446000987 GOV'T 100000 GENERAL SUPPORT Missouri Primary Care Association 3325 EMERALD LANE JEFFERSON CITY MO 65109 431419937 501(C)(3) 99999 GENERAL SUPPORT The Medical University of South Carolina Foundation 18 BEE ST MSC 450 Charleston SC 29425 576028985 501(C)(3) 99633 GENERAL SUPPORT Delta Area Economic Opportunity Corp 104 W CENTER STREET SIKESTON MO 63801 430834206 501(C)(3) 75000 GENERAL SUPPORT Curators of the University of Missouri 650 East 25th Street Kansas City MO 64108 436003859 501(C)(3) 50000 GENERAL SUPPORT Healthy Smiles of Spartanburg PO BOX 1441 SPARTANBURG SC 29304 030529473 501(C)(3) 50000 GENERAL SUPPORT HNC Living Foundation 8100 NEWTON ST SUITE 100 OVERLAND PARK KS 66204 464214254 501(C)(3) 50000 GENERAL SUPPORT Medical University of South Carolina 1 Southpark Circle Building 1 Su Charleston SC 29407 576000722 501(C)(3) 50000 GENERAL SUPPORT Our Lady of Mercy Community Outreach Services 1684 BROWNSWOOD ROAD JOHNS ISLAND SC 29455 570905488 501(C)(3) 50000 GENERAL SUPPORT Northeast Missouri Area Health Education Center 312 S ELSON KIRKSVILLE MO 63501 431579873 501(C)(3) 40000 GENERAL SUPPORT Missouri Highlands Health Care 110 SOUTH SECOND STREET PO BOX 157 ELLINGTON MO 65638 431068291 501(C)(3) 39200 GENERAL SUPPORT Advocated for a Health Community Inc 440 E TAMPA Springfield MO 65806 431602701 501(C)(3) 32000 GENERAL SUPPORT Child Center Marygrove 2705 MULLANPHY LANE FLORISSANT MO 63031 431024440 501(C)(3) 25000 GENERAL SUPPORT Healthworks Kids' Museum St Louis 1100 Macklind Ave St Louis MO 63110 753018876 501(C)(3) 25000 GENERAL SUPPORT Healthy Learners 2711 MIDDLEBURG DRIVE SUITE 304 Columbia SC 29204 571127197 501(C)(3) 25000 GENERAL SUPPORT We Care Mobile Dental Foundation 6523 Walsh Street St Louis MO 63109 882243851 501(C)(3) 25000 GENERAL SUPPORT Delta Dental Plans Association 1515 W 22nd Street Oak Brook IL 60523 362551984 501(C)(6) 24021 GENERAL SUPPORT Deeper Than Dentistry 4760 HARDSCRABBLE ROAD SUITE 102 COLUMBIA SC 29229 861251272 501(C)(3) 21500 GENERAL SUPPORT Hope House Inc PO Box 577 Lees Summit MO 64063 431265685 501(C)(3) 15000 GENERAL SUPPORT Mercy Medicine Free Clinic 500 S COIT STREET FLORENCE SC 29501 311693093 501(C)(3) 15000 GENERAL SUPPORT Ronald McDonald House Charities of the Ozarks Inc 949 E Primrose St Springfield MO 65807 431371143 501(C)(3) 15000 GENERAL SUPPORT Seton Center Inc 2816 E 23RD STREET KANSAS CITY MO 64127 430926003 501(C)(3) 15000 GENERAL SUPPORT Dental Lifeline Network 1800 15TH STREET SUITE 100 DENVER CO 80202 846129064 501(C)(3) 12000 GENERAL SUPPORT LevelUP Kids Inc 5416 NE Antioch Road Kansas City MO 64119 203664224 501(C)(3) 10000 GENERAL SUPPORT Truman Medical Center Charitable Foundation 2310 Holmes Street Kansas City MO 64108 431194064 501(C)(3) 8099 GENERAL SUPPORT 26 1 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. DELTA DENTAL MAINTAINS RECORDS TO SUBSTANTIATE THE AMOUNT OF ASSISTANCE THAT IT PROVIDES TO THE COMMUNITY ORGANIZATIONS. DELTA DENTAL WORKS WITH THE INDIVIDUAL ORGANIZATIONS TO UNDERSTAND THEIR MISSIONS AND TO DETERMINE THE BENEFITS OF DELTA DENTAL'S PARTICIPATION. X X X X X true true false false false false false false false Karl A Mudra Former CIO/Officer 0 0 207447 0 1139244 0 13961 0 0 0 1360652 0 0 0 E B Rob Goren President & CEO 771281 0 758618 0 74073 0 62971 0 38597 0 1705540 0 0 0 Barbara C Bentrup CFO/General Counsel/Officer 316098 0 417645 0 175363 0 87549 0 16050 0 1012705 0 0 0 James J Barone Chief Sales & Marketing Officer 449280 0 302475 0 48648 0 49500 0 19078 0 868981 0 0 0 Jonathan R Jennings Chief Operating Officer 379827 0 252772 0 16448 0 48381 0 39959 0 737387 0 0 0 Ronald E Inge COO/Officer 141441 0 311095 0 48890 0 43111 0 9150 0 553687 0 0 0 Jane Stanhaus Chief Human Resource Officer 232200 0 127352 0 -1650 0 43678 0 36712 0 438292 0 0 0 Cipriano Mascote Chief Actuarial Officer 224037 0 57336 0 -2216 0 42013 0 41749 0 362919 0 0 0 Kiran Achen Chief Information Officer 246154 0 0 0 -1003 0 6000 0 10239 0 261390 0 0 0 Robert Wozniak Account Executive 104453 0 237321 0 -5067 0 45652 0 30534 0 412893 0 0 0 Ellen R Samuels Compliance Director 211041 0 60283 0 1289 0 41561 0 30313 0 344487 0 0 0 Allison M Izsak Director of Marketing 190425 0 56416 0 -8126 0 37026 0 40543 0 316284 0 0 0 Eric W Mann Director of Operations 166794 0 67128 0 -2296 0 34568 0 17556 0 283750 0 0 0 Ezekiel Meyer Director of Project Management 182040 0 50855 0 -2794 0 33657 0 27405 0 291163 0 0 0 Schedule J, Part I, Line 4a Severance or change-of-control payment Karl A. Mudra, Former Chief Information Officer, was paid severance of $1,096,006. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan NAMES, AMOUNTS, AND DETAILS OF ARRANGEMENTS THE ORGANIZATION HAS A NONQUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN FOR THE BENEFIT OF CERTAIN EMPLOYEES TO RECEIVE CONTRIBUTIONS IN EXCESS OF THE LIMITATIONS IMPOSED BY THE INTERNAL REVENUE CODE ON STANDARD EMPLOYEE PENSION PLANS. AMOUNTS PAID DURING 2023 FOR THE FOLLOWING INDIVIDUALS WERE: JAMES J BARONE - $32,219 BARBARA BENTRUP - $54,760 E.B. ROB GOREN - $81,634 RONALD INGE - $32,950 JONATHAN R JENNINGS - $26,062 KARL MUDRA - $7,525 THE ORGANIZATION HAS AN UNFUNDED NONQUALIFIED, DEFINED BENEFIT DEFERRED COMPENSATI N PLAN (DBDCP) FOR ITS SENIOR LEVEL EXECUTIVES, WITH VESTING AT AGE 60 AND 10 YEARS OF SERVICE FOR EARLY RETIREMENT OR AGE 65 AND FIVE YEARS OF SERVICE FOR NORMAL RETIREMENT. THE PLAN WAS AMENDED TO CURTAIL BENEFITS ACCRUED AS OF DECEMBER 31, 2020 SUBJECT TO THE CONTINUING VESTING PROVISIONS IN THE DBDCP. THE ACTUARIALLY DETERMINED LIABILITY IS BASED UPON ASSUMPTIONS FOR REMAINING YEARS OF SERVICE UNTIL RETIREMENT, PROJECTED SALARIES FOR THE FINAL THREE YEARS OF SERVICE BUT IN NO CASE CONSIDERING ANY SALARY AFTER DECEMBER 31, 2020, AND A PREDETERMIN D BENEFIT PERCENTAGE BASED UPON THE PARTICIPANT'S POSITION. INDIVIDUALS WHO PARTICIPATED IN THIS PLAN DURING 2023 WERE THE FOLLOWING: BARBARA BENTRUP, E. B. ROB GOREN, JONATHAN JENNINGS, AND RONALD INGE. THE INCREASE OR DECREASE IN THE PROJECTED BENEFIT ACCRUALS FOR THIS DBDCP ARE REPORTED ANNUALLY IN THE FORM 990 FOR EACH PARTICIPANT. IT IS IMPORTANT TO NOTE THAT SEVERAL PARTICIPANTS IN THIS PROGRAM ARE NOT YET VESTED, YET THE INCREASE IN THE VALUE OF THE ACCRUAL HAS TO BE REPORTED ANNUALLY AS COMPENSATI N ON THE FORM 990 WHEN THERE WAS NO BENEFIT VALUE TO THEM PERSONALLY - IF PARTICIPANTS LEAVE THE ORGANIZATION PRIOR TO MEETING THE AGE AND SERVICE REQUIREMENTS, THERE IS NO BENEFIT PAYABLE. SCHEDULE J, PART II, COLUMN C INCLUDES THESE AMOUNTS FOR THE INCREASES OR DECREASES IN THE COMPANY'S ACCRUAL. THE AMOUNTS PER PARTICIPANT ARE: BARBARA BENTRUP - $40,581 E.B. ROB GOREN - $13,471 JONATHAN R JENNINGS - ($1,119) RONALD INGE - $(278) MARK R ZUST DDS LTD BOARD MEMBER AS OWNER 355753 DENTAL SERVICES PROVIDED false WILLIAM R GRAY DMD LLC BOARD MEMBER AS OWNER 264197 DENTAL SERVICES PROVIDED false NATHAN W SUTER DDS LLC BPARD MEMBER AS OWNER 119315 DENTAL SERVICES PROVIDED false Schedule L, Part IV BUSINESS TRANSACTIONS BOARD MEMBER MARK ZUST AND DANIELLE RIORDAN, DAUGHTER OF BOARD MEMBER MARK ZUST, HAVE A REPORTABLE INTEREST IN MARK R ZUST DDS LTD WHICH PROVIDES DENTAL SERVICES TO SUBSCRIBERS AND DEPENDENTS OF BENEFIT PLANS INSURED OR ADMINISTERED BY THE ORGANIZATION. BOARD MEMBER WILLIAM GRAY HAS A REPORTABLE INTEREST IN WILLIAM A GRAY DMD LLC WHICH PROVIDES DENTAL SERVICES TO SUBSCRIBERS AND DEPENDENTS OF BENEFIT PLANS INSURED OR ADMINISTERED BY THE ORGANIZATION. BOARD MEMBER NATHAN SUTER HAS A REPORTABLE INTEREST IN NATHAN W SUTER DDS LLC WHICH PROVIDES DENTAL SERVICES TO SUBSCRIBERS AND DEPENDENTS OF BENEFIT PLANS INSURED OR ADMINISTERED BY THE ORGANIZATION. Form 990, Part III, Line 4d Description of other program services (Expenses $ 200,430 including grants of $ 121,576) COMMUNITY GIVING PROGRAM PROGRAM DESCRIPTION: THROUGH DELTA DENTAL OF MISSOURI'S COMMUNITY GIVING PROGRAM, THE COMPANY SUPPORTS CHARITABLE ORGANIZATIONS AND PROGRAMS THAT ARE WORKING TO MAKE A DIFFERENCE IN MISSOURI AND SOUTH CAROLINA COMMUNITIES. DELTA DENTAL OF MISSOURI CONSIDERS COMMUNITY GIVING REQUESTS EACH QUARTER FROM REGISTERED 501(C)(3) CHARITABLE ORGANIZATIONS, WHICH SERVE INDIVIDUALS IN MISSOURI OR SOUTH CAROLINA, AND SUPPORT THE OVERALL HEALTH AND WELL-BEING OF THE COMMUNITY WITH A FOCUS ON AT-RISK POPULATIONS. MORE THAN $121,000 IN COMMUNITY DONATIONS WERE AWARDED IN 2023. ORGANIZATIONS MAY APPLY FOR FUNDING ONCE PER YEAR. DELTA DENTAL OF MISSOURI'S COMMUNITY GIVING INCLUDES ORAL HEALTH SUPPLY DONATIONS OF TOOTHBRUSHES AND DENTAL FLOSS TO ORGANIZATIONS TO HELP INDIVIDUALS MAINTAIN GOOD ORAL HYGIENE FOR BETTER DENTAL HEALTH. IN 2023, DELTA DENTAL OF MISSOURI DONATED MORE THAN 317,000 DENTAL SUPPLY ITEMS TO 49 ORGANIZATIONS AS PART OF THE LAND OF SMILES PROGRAM. futureFOCUS2023 CONFERENCE PROGRAM PROGRAM DESCRIPTION: DELTA DENTAL OF MISSOURI'S futureFOCUS2023 CONFERENCE BRINGS TOGETHER NEARLY 300 THOUGHT LEADERS WHO DELIVER INSIGHTS AND DISCUSS THE CHANGING LANDSCAPE OF DENTAL AND VISION BENEFITS AS WELL AS STRATEGIES TO IMPROVE ORAL AND OVERALL HEALTH FOR ALL INDIVIDUALS IN MISSOURI. FOR 2023 $79,000 WAS SPENT TO PUT TOGETHER THIS EVENT. Form 990, Part VI, Line 6 Classes of members or stockholders THE MEMBERS OF THE ORGANIZATION ARE COMPRISED OF LICENSED DENTISTS IN THE STATES OF MISSOURI AND SOUTH CAROLINA WHO HAVE AN EFFECTIVE SIGNED AND ACCEPTED PARTICIPATING DENTIST AGREEMENT WITH THE ORGANIZATION. THE MEMBERS MEET ANNUALLY. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE ORGANIZATION HAS MEMBERS WHO ELECT THE INDIVIDUALS TO SERVE ON THE ORGANIZATION'S BOARD OF DIRECTORS. THE MEMBERS OF THE ORGANIZATION ARE COMPRISED OF LICENSED DENTISTS IN THE STATES OF MISSOURI AND SOUTH CAROLINA WHO HAVE AN EFFECTIVE SIGNED AND ACCEPTED PARTICIPATING DENTIST AGREEMENT WITH THE ORGANIZATION. THE MEMBERS MEET ANNUALLY. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders CHANGES TO THE CORPORATE BYLAWS BY THE BOARD ARE SUBJECT TO APPROVAL BY THE MEMBERS. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. THE FORM 990 IS THEN REVIEWED IN DETAIL BY THE ORGANIZATION'S CONTROLLER & CFO AND PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO THE ELECTRONIC FILING OF THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. Form 990, Part VI, Line 12c Conflict of interest policy DELTA DENTAL OF MISSOURI REGULARLY REQUIRES ITS OFFICERS, DIRECTORS, AND KEY EMPLOYEES TO COMPLETE A CONFLICT OF INTEREST STATEMENT. THE REVIEW OF THE STATEMENTS IS PART OF THE FINANCE AND AUDIT COMMITTEE'S RESPONSIBILITIES. Form 990, Part VI, Line 15a Process to establish compensation of top management official DELTA DENTAL OF MISSOURI HAS ESTABLISHED A COMPENSATION COMMITTEE (A SUBSET OF THE BOARD OF DIRECTORS) COMPOSED ENTIRELY OF PERSONS WITH NO CONFLICT OF INTEREST THAT REVIEWS AND SETS OFFICER COMPENSATION IN ACCORDANCE WITH THE PROCESS OUTLINED IN TREASURY REGULATION SECTION 53.4958-6 FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS OF THE COMPENSATION OF THE CEO AND ALL OTHER OFFICERS. THIS PROCESS INCLUDES EMPLOYING INDEPENDENT COMPENSATION CONSULTANTS, UTILIZING RELEVANT COMPENSATION SURVEYS AND STUDIES, CONTEMPORANEOUSLY DOCUMENTING AND RECORDING THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT, AND SEEKING APPROVAL ON FINALIZED COMPENSATION PROPOSALS BY THE COMPENSATION COMMITTEE. REVIEWS ARE CONDUCTED AND APPROVED BY THE COMPENSATION COMMITTEE ON AN ANNUAL BASIS. THE ANNUAL COMPENSATION FOR 2023 WAS REVIEWED BY A THIRD PARTY COMPENSATION CONSULTANT, WILLIS TOWERS WATSON, AND THEN REVIEWED BY THE COMPENSATION COMMITTEE (SUBSECTION OF THE COMPANY'S BOARD OF DIRECTORS). Form 990, Part VI, Line 15b Process to establish compensation of other employees DELTA DENTAL OF MISSOURI HAS ESTABLISHED A COMPENSATION COMMITTEE (A SUBSET OF THE BOARD OF DIRECTORS) COMPOSED ENTIRELY OF PERSONS WITH NO CONFLICT OF INTEREST THAT REVIEWS AND SETS OFFICER COMPENSATION IN ACCORDANCE WITH THE PROCESS OUTLINED IN TREASURY REGULATION SECTION 53.4958-6 FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS OF THE COMPENSATION OF THE CEO AND ALL OTHER OFFICERS. THIS PROCESS INCLUDES EMPLOYING INDEPENDENT COMPENSATION CONSULTANTS, UTILIZING RELEVANT COMPENSATION SURVEYS AND STUDIES, CONTEMPORANEOUSLY DOCUMENTING AND RECORDING THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT, AND SEEKING APPROVAL ON FINALIZED COMPENSATION PROPOSALS BY THE COMPENSATION COMMITTEE. REVIEWS ARE CONDUCTED AND APPROVED BY THE COMPENSATION COMMITTEE ON AN ANNUAL BASIS. THE ANNUAL COMPENSATION FOR 2023 WAS REVIEWED BY A THIRD PARTY COMPENSATION CONSULTANT, WILLIS TOWERS WATSON, AND THEN REVIEWED BY THE COMPENSATION COMMITTEE (SUBSECTION OF THE COMPANY'S BOARD OF DIRECTORS). Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. ADVANTICA ADMINISTRATIVE SERVICES INC 12399 GRAVOIS ROAD ST LOUIS MO 63127 431826684 THIRD PARTY ADMIN MO NA C Corporation 5375269 17414822 1 true false false false false false false false false false false false false true false false false false false false ADVANTICA ADMINISTRATIVE SERVICES INC M 166224 ALLOCATIONS