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Nonprofiteer
← DELTA DENTAL PLAN OF INDIANA INC

Form 990 for tax year 2022

Filed by DELTA DENTAL PLAN OF INDIANA INC.

Totals

Total revenue
$137,841,260
Total expenses
$131,646,412
Contributions and grants received
$0
Grants paid
$590,251
Program services expenses (Part IX)
$124,447,487
Management and general expenses
$7,198,925
Fundraising expenses
$0
Program service expenses (Part III)
$124,447,487

Program services were 94.5% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • GORAN M JURKOVIC CPA

    PRESIDENT & CEO

    Total calculated
    $8,489,708
    From this org
    $0
    From related orgs
    $6,178,337
    Other
    $2,311,371
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,403,355 related
    Bonus
    $0 + $3,094,090 related
    Other
    $0 + $1,680,892 related
    Deferred
    $0 + $2,287,652 related
    Nontaxable benefits
    $0 + $23,719 related
    Filer's total
    $0 + $8,489,708 related

  • ANTHONY D ROBINSON

    SR VP & CHIEF MARKETING OFFICER

    Total calculated
    $2,132,081
    From this org
    $0
    From related orgs
    $1,599,799
    Other
    $532,282
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $527,061 related
    Bonus
    $0 + $579,003 related
    Other
    $0 + $493,735 related
    Deferred
    $0 + $508,563 related
    Nontaxable benefits
    $0 + $23,719 related
    Filer's total
    $0 + $2,132,081 related

  • AMY L BASEL CPA

    SR VP , CFO, CRO & TREASURER

    Total calculated
    $1,948,642
    From this org
    $0
    From related orgs
    $1,462,790
    Other
    $485,852
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $507,383 related
    Bonus
    $0 + $561,274 related
    Other
    $0 + $394,133 related
    Deferred
    $0 + $462,136 related
    Nontaxable benefits
    $0 + $23,716 related
    Filer's total
    $0 + $1,948,642 related

  • SUE E JENKINS

    SR VP, CHIEF LEGAL OFFICER, CAO & SECRETARY

    Total calculated
    $1,437,848
    From this org
    $0
    From related orgs
    $1,118,484
    Other
    $319,364
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $522,489 related
    Bonus
    $0 + $575,320 related
    Other
    $0 + $20,675 related
    Deferred
    $0 + $311,438 related
    Nontaxable benefits
    $0 + $7,926 related
    Filer's total
    $0 + $1,437,848 related

  • MICHAEL GILMORE

    FORMER CHIEF INVEST OFFICER

    Total calculated
    $869,408
    From this org
    $0
    From related orgs
    $783,761
    Other
    $85,647
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $507,598 related
    Bonus
    $0 + $257,500 related
    Other
    $0 + $18,663 related
    Deferred
    $0 + $61,928 related
    Nontaxable benefits
    $0 + $23,719 related
    Filer's total
    $0 + $869,408 related

  • JEFFERY W JOHNSTON DDS MS

    SR VP & CHIEF SCIENCE OFFICER

    Total calculated
    $594,762
    From this org
    $0
    From related orgs
    $494,618
    Other
    $100,144
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $326,961 related
    Bonus
    $0 + $159,553 related
    Other
    $0 + $8,104 related
    Deferred
    $0 + $82,939 related
    Nontaxable benefits
    $0 + $17,205 related
    Filer's total
    $0 + $594,762 related

  • JEREMY J NELSON

    DIRECTOR

    Total calculated
    $514,742
    From this org
    $0
    From related orgs
    $462,897
    Other
    $51,845
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $184,955 related
    Bonus
    $0 + $276,952 related
    Other
    $0 + $990 related
    Deferred
    $0 + $36,812 related
    Nontaxable benefits
    $0 + $15,033 related
    Filer's total
    $0 + $514,742 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
THE CEO IS A W-2 EMPLOYEE OF A RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, INC. COMPENSATION IS DETERMINED BY THAT ENTITY. THE DELTA DENTAL PLAN OF MICHIGAN, INC. COMPENSATION COMMITTEE REVIEWS PERFORMANCE AND SETS TOTAL COMPENSATION. EVERY TWO YEARS, A STUDY IS PERFORMED BY TOWERS WATSON AND THE DATA IS USED IN COMPENSATION DECISIONS. THE INDEPENDENT CONSULTANT PROVIDES AN OPINION AS TO THE REASONABLENESS AND APPROPRIATENESS OF THE TOTAL COMPENSATION, INCLUDING BASE PAY, INCENTIVE, BENEFITS AND RETIREMENT BENEFITS.
PART I, LINE 4B
THE RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, HAS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). IN ORDER TO BE ELIGIBLE FOR THE SERP, AN EMPLOYEE MUST BE A SENIOR VICE PRESIDENT OR HIGHER AND ADDED TO THE PLAN BY THE BOARD OF DIRECTORS. THE SERP BENEFITS ARE REVIEWED AS PART OF THE TOTAL COMPENSATION BY AN INDEPENDENT CONSULTANT; TOWERS WATSON. IN 2022, GORAN JURKOVIC, AMY BASEL, ANTHONY ROBINSON, AND SUE ELLEN JENKINS ACCRUED BENEFITS AS PARTICIPANTS IN THE SERP PLANS. GORAN JURKOVIC, AMY BASEL AND ANTHONY ROBINSON BECAME VESTED IN A PORTION OF THEIR ACCRUED BENEFITS AND, AS REQUIRED BY THE IRS, THE VESTED PORTION WAS TREATED AS TAXABLE WAGES DURING 2022. THESE WAGES WERE ALSO REPORTED ON SCHEDULE J AS COMPENSATION THAT HAS BEEN REPORTED AS DEFFERED ON PRIOR FORM 990S.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Provenance

Return type
form_990
Tax year
2022
Filed
8 November 2023
IRS schema version
2022v5.0
Source object
202333189349306438

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