2024-11-14T00:52:48-06:00 2023-12-31 471019942 CREATIVE PLANNING TAX LLC 12100 MEREDITH DR SUITE 200 URBANDALE IA 50323 990 2023-01-01 260762771 DELTA DENTAL OF IOWA FOUNDATION DELT 5152615500 9000 NORTHPARK DRIVE JOHNSTON IA 50131 SHERRY PERKINS SECRETARY-TREASURER 5152615500 2024-11-13 1 1 KATHRYN R ROTH CPA P01298804 5157275700 2024-11-05 2023 2024-10-15 13:58:12Z APRIL SCHMALTZ 9000 NORTHPARK DRIVE JOHNSTON IA 50131 9969347 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 6101500 5901500 0 0 642792 335308 480 0 6744772 6236808 3426450 2937607 0 0 5400 3600 0 0 0 703713 771184 4135563 3712391 2609209 2524417 34090598 40465001 203385 183367 33887213 40281634 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 1778209 1592878 0 ORAL HEALTH PROJECTS - ACTIVITIES THAT ENSURE HEALTHY SMILES FOR ALL IOWANS. 1124822 955770 0 OVERALL HEALTH PROJECTS - WELLNESS, VISION, AND RELATED ACTIVITIES THAT ENABLE IOWANS TO LIVE HEALTHY AND ACTIVE LIVES. 479182 388959 0 ORAL AND OVERALL HEALTH INTEGRATION PROJECTS - ACTIVITIES THAT PROMOTE TIGHTER CONNECTIONS BETWEEN DENTAL, PHYSICAL, AND BEHAVIORAL HEALTH. 3382213 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 7 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 JEFFREY S RUSSELL PRESIDENT (THRU 6/2023) 0.39 40.00 X X 0 1465135 27632 APRIL SCHMALTZ PRESIDENT (BEG 6/2023) 0.39 40.00 X X 0 687046 28833 JEFF CHAFFIN DDS DIRECTOR 1.17 40.00 X 0 633991 28109 DONNA GRANT DDS DIRECTOR 0.50 1.60 X 600 51800 0 NATHAN HEHR DIRECTOR 0.50 1.60 X 900 1800 0 MICHAEL METTS DIRECTOR 0.50 0.00 X 900 0 0 SUZANNA DE BACA DIRECTOR 0.50 0.00 X 600 0 0 JOEL WULF DIRECTOR, FORMER CHAIR (THRU 6/2023) 1.00 0.00 X X 300 0 0 SCOTT RAECKER DIRECTOR, CHAIR 1.00 0.00 X X 0 0 0 DR NAFISSA CISSE EGBUONYE DIRECTOR, VICE CHAIR 1.00 0.00 X X 0 0 0 MISSY GOWEY DIRECTOR 0.50 0.00 X 0 0 0 HAYLEY HARVEY DIRECTOR 0.50 0.00 X 0 0 0 DAN CAPLAN DDS DIRECTOR 0.50 0.00 X 0 0 0 TRACY RODGERS DIRECTOR 0.50 0.00 X 0 0 0 JENNIFER VERMEER DIRECTOR 0.50 0.00 X 0 0 0 HEIDI BELL DIRECTOR 0.50 0.00 X 300 0 0 SHERRY PERKINS SECRETARY-TREASURER 0.67 40.00 X 0 505259 28833 SUZANNE HECKENLAIBLE EXECUTIVE DIRECTOR 10.00 30.00 X 0 472111 61334 3600 3817142 174741 0 0 1 0 0 5900000 1500 5901500 952266 952266 3115581 3732539 -616958 -616958 -616958 6236808 0 0 335308 2937607 2937607 3600 3600 534216 339661 194555 15500 15500 53015 53015 2883 2883 103 103 43110 33871 9239 6540 120 6420 26003 5161 20842 13695 1761 11934 CONSULTING 48819 44199 4620 OUTREACH AND EDUCATION 16362 16362 0 MISCELLANEOUS 5725 368 5357 MEMBERSHIP FEES 5213 3000 2213 3712391 3382213 330178 0 74436 233218 2618295 2906728 6100000 5700000 480 0 9826 3620 22421635 28431430 2864764 3186147 1162 3858 34090598 40465001 10459 5580 141318 137256 51608 40531 203385 183367 X 2486609 2840220 31400604 37441414 33887213 40281634 34090598 40465001 X 2524417 3821257 48747 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 2023 WAS $5,900,000. 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 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 27800604 2000000 3985525 44715 33741414 29455769 2500000 -4112846 42319 27800604 23680453 2500000 3317048 41732 29455769 20030878 1000000 2684491 34916 23680453 14922781 2000000 3138857 30760 20030878 0.00000 0.00000 1.00000 1 0 0 PRIVATE EQUITY SECURITIES 3186147 F 3186147 PAYABLE TO DELTA DENTAL OF IOWA 40531 40531 X 10068397 3821257 6300 48747 3876304 6192093 44715 44715 6236808 3673976 6300 6300 3667676 44715 44715 3712391 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, 2023 AND 2022, THE COMPANY'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED OR ACCRUED DURING 2023 OR 2022. 1 BOYS & GIRLS CLUBS OF THE CEDAR VALLEY 515 LIME STREET WATERLOO IA 50703 426083723 501(C)3 0 9202 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED WATER BOTTLE FILLING STATION BY DEGREES FOUNDATION PO BOX 41070 DES MOINES IA 50311 421338832 501(C)3 15000 0 EXPANDING HEALTH AND WELLNESS PROGRAMING AT FINDLEY ELEMENTARY, HARDING MIDDLE, AND NORTH HIGH PROJECT CATHERINE MCAULEY CENTER 1220 5TH AVENUE SE CEDAR RAPIDS IA 52403 421342872 501(C)3 20000 0 HEALTHCARE NAVIGATION AND MENTAL HEALTH RESOURCES FOR REFUGEES & IMMIGRANTS CHRISTIAN COMMUNITY DEVELOPMENT DBA HOUSE OF HOPE 845 W 4TH ST WATERLOO IA 50702 421397528 501(C)3 16500 0 FAMILY WELLNESS AND RESILIENCE CASE MANAGEMENT CHRYSALIS FOUNDATION 1248 8TH STREET SUITE 101 WEST DES MOINES IA 50265 421337635 501(C)3 17519 0 GIRLPOWER EDUCATION AND TRAINING PROJECT CITY OF EARLY 107 N MAIN STREET PO BOX 411 EARLY IA 50535 426004619 CITY OF EARLY 25000 0 WATER TREATMENT FACILITY IMPROVEMENTS CITY OF HIAWATHA 101 EMMONS STREET HIAWATHA IA 52233 426025060 CITY OF HIAWATHA 6769 0 GUTHRIDGE PARK BOTTLE FILLING DRINKING FOUNTAIN CITY OF LOHRVILLE 605 2ND STREET PO BOX 257 LOHRVILLE IA 51453 426004892 CITY OF LOHRVILLE 6985 0 LOHRVILLE CITY PARK WATER BOTTLE FILLING STATION CITY OF MASSENA 100 MAIN STREET PO BOX 33 MASSENA IA 50853 426022717 CITY OF MASSENA 11260 0 MASSENA COMMUNITY PARK PROJECT CITY OF OGDEN 513 W WALNUT ST PO BOX 694 OGDEN IA 50212 426005060 CITY OF OGDEN 10735 0 OUTDOOR FILLING STATION CITY OF WEBSTER CITY 400 SECOND STREET PO BOX 217 WEBSTER CITY IA 50595 426005348 CITY OF WEBSTER CITY 20000 0 KICK IT FORWARD MINI-PITCH IN WEBSTER CITY CITY OF WINDSOR HEIGHTS 1145 66TH STREET STE 1 WINDSOR HEIGHTS IA 50324 426004577 CITY OF WINDSOR HEIG 20000 0 OUTDOOR WATER FILLING STATION IN COLBY PARK COMMUNITY HEALTH CENTER OF FORT DODGE INC 126 N 10TH ST FORT DODGE IA 50501 200597324 501(C)3 49996 0 WRIGHT COUNTY ACCESS TO DENTAL CARE FOR UNDERSERVED RESIDENTS/EAGLE GROVE DENTAL OFFICE CRESCENT COMMUNITY HEALTH CENTER 1690 ELM ST STE 300 DUBUQUE IA 52001 481302204 501(C)3 254083 0 MATCHING GRANT TO SUPPORT BUILDING ORAL HEALTH SERVICES AND WORKFORCE TO MEET NEEDS OF UNDERSERVED POPULATIONS DENTAL CONNECTIONS (FORM DES MOINES HEALTH CENTER) 1111 9TH STREET SUITE 190 DES MOINES IA 50314 420680421 501(C)3 505000 0 CONFERENCE TRAVEL FOR IOWA SMILES PRESENTATIONS, IOWA SMILES REFUGEE CARE COORDINATION, AND SMILE SQUAD MOBILE DENTAL CLINIC GRANTS DES MOINES COUNTY CONSERVATION 11627 STARRS CAVE RD BURLINGTON IA 52601 426004310 501(C)3 5011 0 DMCC DRINKING STATION DES MOINES PARKS AND RECREATION FOUNDATION 1551 E MARTIN LUTHER KING JR PKWY DES MOINES IA 50317 421390788 501(C)3 19641 0 GOOD PARK AND WESTERN GATEWAY PARK WATER FILLING STATIONS DIAGONAL COMMUNITY SCHOOL 403 W 2ND ST DIAGONAL IA 50845 426001478 STATE OF IOWA 10130 0 DIAGONAL BALLPARK WATER FOUNTAIN EASTERN IOWA HEALTH CENTER 1030 5TH AVE SE SUITE 2400 CEDAR RAPIDS IA 52403 202405575 501(C)3 12218 0 DELTAVISION ONESIGHT CEDAR RAPIDS FREE VISION CLINIC EDDYVILLE-BLAKESBURG-FREMONT CSD 1301 BERDAN EXT EDDYVILLE IA 52553 800765153 STATE OF IOWA 0 5029 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED EBF JSHS WEST HALLWAY WATER BOTTLE FILLING STATION ELLIPSIS PO BOX 39 JOHNSTON IA 50131 420680439 501(C)3 50000 0 IMPROVING CHILDREN'S WELL-BEING THROUGH A CONTINUUM OF MENTAL HEALTH CARE EVERYSTEP 3000 EASTON BLVD DES MOINES IA 503173124 455189289 501(C)3 29000 0 COMMUNITY-BASED DOULA PROJECT FRIENDS OF BETTENDORF PARKS FOUNDATION 2900 LEARNING CAMPUS DRIVE BETTENDORF IA 52722 237436443 501(C)3 10000 0 OUTDOOR WATER FILLING STATION FOR ACCESS TO WATER AT BETTENDORF PARKS GRUNDY COUNTY AGRICULTURAL SOCIETY 1308 4TH ST PO BOX 274 GRUNDY CENTER IA 50638 473761768 501(C)3 11460 0 OUTDOOR WATER FILLING STATION FOR GRUNDY COUNTY FAIR GROUNDS IKM-MANNING CSD 209 TENTH STREET MANNING IA 51455 274758256 STATE OF IOWA 0 5029 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED WATER BOTTLE FILLING STATION FOR IKM MANNING SCHOOLS INTERNATIONAL RESCUE COMMITTEE 108 3RD ST SUITE 200 DES MOINES IA 50309 135660870 501(C)3 25000 0 BUILDING OVERALL HEALTHCARE EDUCATION IN REFUGEES AND STRENGTHENING REFUGEE ORAL HEALTHCARE IOWA ACES 360 501 SW 7TH ST SUITE G DES MOINES IA 50309 843720619 501(C)3 21000 0 COLLABORATIVE ADVOCACY TOWARDS HEALTH AND WELLBEING IOWA AFTERSCHOOL ALLIANCE 2910 WESTOWN PARKWAY SUITE 302 WEST DES MOINES IA 50266 421461422 501(C)3 15700 0 MENTAL HEALTH TRAINING FOR OUT OF SCHOOL TIME PROVIDERS IOWA CAREGIVERS 939 OFFICE PARK ROAD 332 WEST DES MOINES IA 50265 421457592 501(C)3 27500 0 IOWA CAREGIVER ANNUAL CONFERENCE - "DIRECT CARE - A HEAVY LIFT - GET PUMPED AND MOUTH CARE MATTERS (MCM) INTEGRATION STRATEGIES GRANTS IOWA CITY CSD - HEALTHY KIDS SCHOOL-BASED CLINICS 1725 NORTH DODGE ST IOWA CITY IA 52245 426023567 501(C)3 40000 0 SCHOOL BASED DENTAL AND VISION CLINIC IOWA DENTAL ASSOCIATION 666 GRAND AVENUE SUITE 901 DES MOINES IA 50309 420335455 501(C)3 15000 0 IOWA DENTAL ASSOCIATION ANNUAL SESSION, IDEAS23 IOWA DENTAL FOUNDATION 666 GRAND AVENUE SUITE 901 DES MOINES IA 50309 421405188 501(C)3 25000 0 IOWA MISSION OF MERCY 2023 IOWA DEPARTMENT OF HEALTH AND HUMAN SERVICES 321 E 12TH ST DES MOINES IA 50319 426004523 STATE OF IOWA 395865 0 I-SMILE @SCHOOL FFY24 AND I-SMILE SILVER PILOT PROJECT GRANTS IOWA HEALTHIEST STATE INITIATIVE 301 GRAND AVENUE DES MOINES IA 50309 454570642 501(C)3 25000 0 MAKE IT OK CAMPAIGN IOWA JOBS FOR AMERICAS GRADUATES (IJAG) INC 1111 9TH ST SUITE 268 DES MOINES IA 50314 421492988 501(C)3 30000 0 IJAG: HEALTHCARE CAREER DEVELOPMENT FOR OPPORTUNITY YOUTH IOWA PUBLIC HEALTH ASSOCIATION FOUNDATION 501 SW 7TH STREET SUITE G DES MOINES IA 50309 237327835 501(C)3 55000 0 MENTAL HEALTH MESSAGING AT YOUR FINGERTIPS AND PUBLIC HEALTH CONFERENCE OF IOWA GRANTS IOWA RURAL HEALTH ASSOCIATION 2910 WESTOWN PARKWAY STE 302 WEST DES MOINES IA 50266 421410997 501(C)3 30000 0 REIGNITING THE IOWA RURAL HEALTH ASSOCIATION LOUISA COUNTY CONSERVATION 12635 COUNTY ROAD G56 SUITE 101 WAPELLO IA 52653 426005313 501(C)3 20000 0 EDEN PARK WATER BOTTLE FILLING STATION MYRTUE MEDICAL CENTER 1213 GARFIELD AVE HARLAN IA 51537 426037826 501(C)3 20802 0 SUPPORT LAUNCH OF GROUP MOVEMENT THERAPY MENTAL HEALTH SERVICES FOR YOUTH NEW HAMPTON PARKS & RECREATION 112 E SPRING ST NEW HAMPTON IA 50659 426005030 501(C)3 13000 0 OUTDOOR FILLING STATION FOR NEW HAMPTON'S OPEN ACCESS TO WATER INITIATIVE NORTH CEDAR COMMUNITY SCHOOL DISTRICT 400 BALL ST CLARENCE IA 52216 421430236 STATE OF IOWA 0 8774 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED WATER BOTTLE FILLING STATION FOR NORTH CEDAR JR/SR HIGH SCHOOL NORTHEAST IOWA WELLNESS & RECREATION CENTER 313 W POST STREET PO BOX 268 POSTVILLE IA 52162 571167577 501(C)3 0 7235 AMOUNT PAID WATER BOTTLE FILLING STATION LULL'S PARK / CITY POOL OUTDOOR WATER FILLING STATION OAKRIDGE NEIGHBORHOOD SERVICES 1401 CENTER ST DES MOINES IA 50314 421311721 501(C)3 16800 0 OAKRIDGE WATER BOTTLE STATION ONESIGHT ESSILORLUXOTTICA FOUNDATION PO BOX 637509 CINCINNATI OH 45263 311385607 501(C)3 20000 0 2023 DELTA VISION FREE CLINIC - CEDAR RAPIDS IOWA ORAL HEALTH PROGRAMS ALL SMILES MUNSTER 8933 WHITE OAK AVE MUNSTER IN 46321 851514886 501(C)3 15614 0 IMPROVING DENTAL AND MEDICAL OUTCOME THROUGH WORKFORCE AND INTEGRATION PREVENT BLINDNESS IOWA 1111 NINTH ST STE 250 DES MOINES IA 50314 426083207 501(C)3 25000 0 PBI VISION SCREENINGS AND WORK WITH THE ONSIGHT CLINIC PRIMARY HEALTH CARE 1200 UNIVERSITY AVE 200 DES MOINES IA 50314 421350092 501(C)3 41867 0 NITROUS CART FOR PEDIATRIC PATIENTS AND EXPANDING ACCESS TO CARE WITH TELEDENTISTRY (PILOT PROJECT) GRANTS PROMISE COMMUNITY HEALTH CENTER 33 4TH STREET NW SIOUX CENTER IA 51250 205896415 501(C)3 18500 0 STRENGTHENING THE WORKFORCE: STRATEGIC PLANNING FOR DENTAL RECRUITMENT AND RETENTION SCHALLER-CRESTLAND CSD 308 W 1ST ST SCHALLER IA 51053 421403681 STATE OF IOWA 0 5029 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED WATER BOTTLE FILLING STATION FOR SCHALLER-CRESTLAND CSD SIEDA HEAD START 725 W 2ND STREET OTTUMWA IA 52501 420923813 501(C)3 0 8239 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED WATER BOTTLE FILLING STATION FOR SIEDA HEAD START ST ROSE OF LIMA CATHOLIC SCHOOL 1004 2ND AVENUE SOUTH DENISON IA 51442 420680465 STATE OF IOWA 0 8239 AMOUNT PAID WATER BOTTLE FILLING STATION ST. ROSE CAFETERIA & GYMNASIUM WATER FILLING STATION STORY COUNTY MEDICAL CENTER FOUNDATION 640 S 19TH ST NEVADA IA 50201 421078827 501(C)3 25000 0 MENTAL HEALTH FIRST AID INSTRUCTOR TRAINING TANAGER PLACE 2309 C ST SW CEDAR RAPIDS IA 52404 420688079 501(C)3 25000 0 TANAGER'S LGBTQ+ YOUTH CENTER THE AMERICAN INSTITUTE OF DENTAL PUBLIC HEALTH 401 WILLIAMS STREET 5560 RIVER FOREST IL 60305 842850098 501(C)3 50000 0 TRANSLATING VETERAN ORAL HEALTH TO IOWA STAKEHOLDERS THE BRIDGE OF STORM LAKE 529 SENECA ST STORM LAKE IA 50588 474770141 501(C)3 17760 0 THE BRIDGE OF STORM LAKE'S CENTER FOR EDUCATION AND EQUIPPING LAUNCH THE RIVER ARC 1211 LOIS LANE WATERLOO IA 50702 880765216 501(C)3 21500 0 HEALTH AND DENTAL EDUCATION FOR CONGOLESE AND OTHER IMMIGRANT COMMUNITIES AND SPONSORSHIP FOR THE WOMEN CONGOLESE CONFERENCE GRANTS THE UNIVERSITY OF IOWA COLLEGE OF DENTISTRY AND DENTAL CLINICS 801 NEWTON STREET IOWA CITY IA 52242 426004813 STATE OF IOWA 18700 0 MIDWEST DENTAL PUBLIC HEALTH CONFERENCE UNITED WAY OF CENTRAL IOWA 1111 NINTH STREET SUITE 100 DES MOINES IA 50314 420680425 501(C)3 21487 0 LAUNCHING THE ORAL HEALTH IOWA COLLABORATIVE COALITION THE UNIVERSITY OF IOWA COLLEGE OF DENTISTRY AND DENTAL CLINICS 801 NEWTON STREET IOWA CITY IA 52242 426004813 STATE OF IOWA 11460 0 UNIVERSITY OF IOWA DENTAL ALUMNIS TREATMENT OF UNDERSERVED POPULATIONS UNIVERSITY OF IOWA FOUNDATION ONE WEST PARK ROAD PO BOX 4550 IOWA CITY IA 522444550 420796760 501(C)3 25000 0 SAFEGUARDING IOWA'S YOUNGEST CHILDREN THROUGH PREVENTATIVE VISION SCREENINGS VAN BUREN COUNTY HOSPITAL 304 FRANKLIN STREET KEOSAUQUA IA IA 52556 426037829 501(C)3 25000 0 PRIORITIZING PEDIATRIC DENTAL ACCESS FOR CHILDREN WITH SPECIAL NEEDS MOUNT AYR CSD 1001 E COLUMBUS ST MOUNT AYR IA 50854 426036295 STATE OF IOWA 0 5029 AMOUNT PAID WATER BOTTLE FILLING STATION WATER FILLING STATIONS FOR MOUNT AYR HIGH SCHOOL BUILDING VISION TO LEARN 900 JACKSON ST SUITE LL5-2C DUBUQUE IA 52001 453457853 501(C)3 454290 0 NETWORKING AND CONTINUING EDUCATION FOR THE ADVANCEMENT OF VISON TO LEARN PROGRAMMING AND VISION TO LEARN IOWA - CAPACITY BUILDING TO INCREASE ACCESS TO VISION CARE GRANTS WOODWARD ACADEMY 1251 334TH ST WOODWARD IA 50276 421459832 501(C)3 0 5029 AMOUNT PAID WATER BOTTLE FILLING STATION INSTALLED WATER BOTTLE FILLING STATION FOR WOODWARD ACADEMY YMCA OF GREATER DES MOINES 501 GRAND AVE DES MOINES IA 50309 420680438 501(C)3 29000 0 YMCA UNLOCKING BRAIN FITNESS: KEYS TO DEMENTIA PREVENTION 64 0 0 1 0 0 0 0 0 0 0 JEFFREY S RUSSELL PRESIDENT (THRU 6/2023) 0 954637 0 450800 0 59698 0 13200 0 14432 0 1492767 0 55810 APRIL SCHMALTZ PRESIDENT (BEG 6/2023) 0 512218 0 161036 0 13792 0 26400 0 2433 0 715879 0 12023 JEFF CHAFFIN DDS DIRECTOR 0 446544 0 152048 0 35399 0 26400 0 1709 0 662100 0 31855 SHERRY PERKINS SECRETARY-TREASURER 0 368701 0 125146 0 11412 0 26400 0 2433 0 534092 0 8677 SUZANNE HECKENLAIBLE EXECUTIVE DIRECTOR 0 343736 0 118132 0 10243 0 26400 0 34934 0 533445 0 6926 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 2023 FROM DELTA DENTAL OF IOWA AND THE AMOUNTS ARE: APRIL SCHMALTZ $ 62,390 SHERRY PERKINS $ 47,396 SUZANNE HECKENLAIBLE $ 50,419 JEFF CHAFFIN $ 54,361 OFFICERS THAT RECEIVED PAYMENTS OF VESTED AMOUNTS IN 2023 AND THE AMOUNTS ARE: JEFFREY S RUSSELL $ 55,810 APRIL SCHMALTZ $ 12,023 SHERRY PERKINS $ 8,677 SUZANNE HECKENLAIBLE $ 6,926 JEFF CHAFFIN $ 31,855 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. OFFICERS WHO RECEIVED PAYMENTS OF VESTED AMOUNTS IN 2023 AND THE AMOUNTS ARE: JEFFREY S RUSSELL $ 390,000 APRIL SCHMALTZ $ 172,500 SHERRY PERKINS $ 127,500 SUZANNE HECKENLAIBLE $ 127,500 JEFF CHAFFIN $ 157,500 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 2023. J. CHAFFIN HAD A GOVERNMENT PROGRAM RELATED BUSINESS RELATIONSHIP WITH BOARD MEMBER T. RODGERS IN 2023. S. HECKENLAIBLE HAD A GOVERNMENT PROGRAM RELATED BUSINESS RELATIONSHIP WITH BOARD MEMBER T. RODGERS IN 2023. T. RODGERS HAD BUSINESS RELATIONSHIPS WITH D. CAPLAN, J. VERMEER, N. EGBUONYE, J.M. METTS, A. SCHMALTZ, S. HECKENLAIBLE, AND J. CHAFFIN IN 2023. D. CAPLAN HAD A BUSINESS RELATIONSHIP WITH T. RODGERS AND H. HARVEY IN 2023. H. HARVEY HAD A BUSINESS RELATIONSHIP WITH D. CAPLAN IN 2023. J. VERMEER HAD A BUSINESS RELATIONSHIP WITH T. RODGERS AND N. EGBUONYE IN 2023. N. EGBUONYE HAD A BUSINESS RELATIONSHIP WITH T. RODGERS AND J. VERMEER IN 2023. J.M. METTS HAD A BUSINESS RELATIONSHIP WITH T. RODGERS IN 2023. 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 48,747. 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 5900000 SEE PART VII - SUPPLEMENTAL INFO. DELTA DENTAL OF IOWA O 534216 HOURS WORKED DELTA DENTAL OF IOWA P 70239 COST OF INVOICES 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 $5,700,000, WHICH IS A PROMISE TO GIVE. FORM 990, SCHEDULE R, PART V, LINE 2(2), COLUMN B: MANAGEMENT FEES OF $534,216 WERE PAID TO DELTA DENTAL OF IOWA WHICH COULD ALSO BE CLASSIFIED UNDER CODE M.