2024-11-13T10:50:35-06:00 2023-12-31 381357951 PLANTE & MORAN PLLC 1111 MICHIGAN AVE STE 100 EAST LANSING MI 48823 990 2023-01-01 381791480 DELTA DENTAL PLAN OF MICHIGAN INC DELT 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 AMY BASEL CFO 5173496000 2024-11-12 1 1 DAVID LOWENTHAL P00378651 5173326200 2024-11-12 2023 2024-10-15 13:58:12Z GORAN JURKOVIC 4100 OKEMOS ROAD OKEMOS MI 48864 1354438204 0 X WWW.DELTADENTALMI.COM X 1957 MI DELTA DENTAL OF MICHIGAN'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH DENTAL SERVICES PROVIDED UNDER CONTRACTS WITH INDEPENDENT PROFESSIONAL SERVICE PROVIDERS, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. 15 12 1214 0 45168078 3872713 0 0 1123836261 1177589951 7445017 10830892 321914 402047 1131603192 1188822890 7363710 3895292 0 0 165130835 178033400 0 0 0 946383124 1005821892 1118877669 1187750584 12725523 1072306 862011511 918626400 191514407 208198626 670497104 710427774 X SEE SCHEDULE ODELTA DENTAL OF MICHIGAN'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH DENTAL SERVICES PROVIDED UNDER CONTRACTS WITH INDEPENDENT PROFESSIONAL SERVICE PROVIDERS, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. DELTA DENTAL OF MICHIGAN IS GOVERNED BY A BOARD OF DIRECTORS CONTROLLED BY INDEPENDENT MEMBERS OF THE COMMUNITY AND IT OFFERS ENROLLMENT IN ORAL HEALTH PLANS TO A BROAD BASE OF THE COMMUNITY THROUGH A VARIETY OF PAYMENT MODELS. 0 0 1051671401 3895292 1132421873 PROMOTING DENTAL CAREDELTA DENTAL PLAN OF MICHIGAN, INC. IS A LEADING PREPAID DENTAL BENEFITS PROVIDER IN THE MIDWEST. THE PURPOSE OF THE ORGANIZATION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH. THIS IS DONE BY OFFERING INNOVATIVE, COST-EFFECTIVE PRODUCTS THAT MEET THE NEEDS OF CUSTOMERS. THIS WAS DEMONSTRATED IN 2023 BY PAYING OUT OVER $834 MILLION FOR DENTAL CARE, BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 11.1 MILLION CLAIMS WERE PROCESSED FOR OVER 5.9 MILLION MEMBERS.SEE CONTINUATION ON SCHEDULE OCOST SAVING STRATEGIESDELTA DENTAL BENEFIT PLANS ARE COMMITTED TO SAVING GROUPS AND MEMBERS MONEY. THE DELTA DIFFERENCE IS AN INTEGRATION OF ACTIVITIES; SUCH AS COST MANAGEMENT POLICIES, FEE REDUCTION AGREEMENTS WITH DENTISTS, AND AN ANTI-FRAUD HOTLINE, PUT TO WORK ENSURING QUALITY, COST-EFFECTIVE DENTAL BENEFIT DELIVERY. COMMITMENT TO THE COMMUNITYDELTA DENTAL PLAN OF MICHIGAN, INC. BELIEVES ADVANCES IN DENTAL RESEARCH AND ENHANCED EDUCATIONAL OPPORTUNITIES FOR DENTISTS GO A LONG WAY TOWARD IMPROVING ORAL HEALTH. THE COMPANY IS A KEY PLAYER IN GROUNDBREAKING RESEARCH ON TRENDS IN ORAL HEALTH IN THE INSURED POPULATION. THE DELTA DENTAL FUND, THE COMPANY'S PHILANTHROPIC AFFILIATE, ENCOURAGES ADVANCES IN DENTISTRY AND SUPPORTS DENTAL EDUCATION AND RESEARCH. SINCE IT WAS FORMED IN 1980, THE DELTA DENTAL FUND HAS GRANTED OVER $54 MILLION TOWARD THE ADVANCEMENT OF DENTAL SCIENCE AND IMPROVEMENT OF THE ORAL HEALTH OF THE PUBLIC. DELTA DENTAL FUND REGULARLY PROVIDES FUNDING FOR PROGRAMS THAT HELP AT-RISK POPULATIONS AND INDIVIDUALS WITH SPECIAL NEEDS OBTAIN DENTAL TREATMENT, SCHOLARSHIP AND LEADERSHIP AWARDS TO DENTAL STUDENTS, GRANTS TO PURCHASE LEARNING TOOLS AND OTHER DENTAL SCHOOL PROGRAMS, CONTINUING EDUCATION PROGRAMS FOR THE DENTAL PROFESSION, AND EDUCATIONAL MATERIALS ON THE IMPORTANCE OF ORAL HEALTH AND HAZARDS TO ORAL HEALTH.IN 2023, DELTA DENTAL FUND PROVIDED GRANTS TOTALING OVER $7.3 MILLION FOR DENTAL AND COMMUNITY RELATIONS PROJECTS. HIS FUNDING HAS IMPROVED ORAL AND OVERALL HEALTH, ADDED TO WHAT WE KNOW ABOUT DENTAL SCIENCE, HELPED STUDENTS ACHIEVE THEIR GOALS AND IMPROVED THE WELL-BEING OF THOUSANDS OF CHILDREN AND ADULTS IN MICHIGAN, INDIANA, OHIO AND NORTH CAROLINA.DELTA DENTAL PLAN OF MICHIGAN IS ALSO COMMITTED TO BUILDING HEALTHY, SMART, VIBRANT COMMUNITIES. DELTA DENTAL HAS ALWAYS BEEN KEENLY AWARE OF ITS CIVIC AND SOCIAL RESPONSIBILITY. DELTA DENTAL PLANS ARE PROUD TO SHARE, THROUGH DIRECT FINANCIAL CONTRIBUTIONS, WITH HUNDREDS OF COMMUNITY AGENCIES AND GROUPS. IN ADDITION, EMPLOYEES LOG COUNTLESS HOURS OF THEIR OWN TIME AS VOLUNTEERS. COMMUNITY SUPPORT GENERALLY FALLS UNDER THE BROAD CATEGORIES THAT PROVIDE SUPPORT TO AGENCIES AND INSTITUTIONS SERVING CHILDREN, SENIORS, LOW-INCOME INDIVIDUALS, MINORITIES, AND DISABLED AND AT-RISK INDIVIDUALS, TO ORGANIZATIONS THAT PROMOTE EDUCATION, ARTS AND RECREATION AND COMMUNITY DEVELOPMENT, AND TO CHARITABLE PROJECTS OR PROGRAMS RECOMMENDED BY EMPLOYEES, CUSTOMERS, PARTICIPATING DENTISTS AND OTHER KEY GROUPS. WE CONTINUED OUR ROLE AS STRONG ADVOCATES FOR SOUND ORAL HEALTH POLICY AT THE STATE AND FEDERAL LEVELS. THROUGH A PUBLIC-PRIVATE PARTNERSHIP WITH THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH, DELTA DENTAL PARTICIPATES IN THE HEALTHY KIDS DENTAL (HKD) PROGRAM. HEALTHY KIDS DENTAL IS A DENTAL BENEFITS PROGRAM FOR MEDICAID BENEFICIARIES UNDER AGE 21. IT IS AVAILABLE IN ALL OF MICHIGAN'S 83 COUNTIES AND COVERS BASIC DENTAL HEALTH BENEFITS SUCH AS X-RAYS, CLEANINGS, CAVITY FILLINGS, ROOT CANALS, TOOTH EXTRACTIONS AND DENTURES. NEARLY 1,000,000 MICHIGAN CHILDREN ARE SERVED BY THIS PROGRAM. UNEQUALED ACCESS TO DENTISTSFOR FIVE DECADES, DELTA DENTAL HAS HELPED PROMOTE ORAL HEALTH BY DESIGNING AND ADMINISTERING INNOVATIVE, COST-EFFECTIVE DENTAL BENEFIT PROGRAMS. EXPERTS AT PLAN DESIGN, DELTA DENTAL HAS CREATED DENTAL BENEFIT PROGRAMS THAT MEET CUSTOMER COST-OBJECTIVES WHILE HELPING TO IMPROVE AND MAINTAIN ORAL HEALTH.OUR LONG STANDING RELATIONSHIPS WITH PROVIDERS IN THE COMMUNITIES WE SERVE ALLOWS US TO MAINTAIN LARGE NETWORKS, ALLOWING BROAD ACCESS FOR MEMBERS AND COST-EFFECTIVE CARE. DELTA DENTAL'S GROUP MEMBERS ARE AFFORDED ADDED PROTECTION BECAUSE THEY GUARANTEE THAT PARTICIPATING DENTISTS WILL ACCEPT THEIR PAYMENT FOR COVERED SERVICES AND NO CHARGE, OTHER THAN CO-PAYMENTS AND DEDUCTIBLES ARE BILLED BACK TO THE MEMBER. THIS LOWERS CLAIM COSTS FOR CUSTOMERS AND REDUCES OUT-OF-POCKET COSTS FOR SUBSCRIBERS.WITH TWO NETWORKS OF FULL-TIME PARTICIPATING DENTISTS IN ONE INTEGRATED CLAIMS SYSTEM, DELTA DENTAL CAN DELIVER TO CUSTOMERS AND GROUP MEMBERS BROAD ACCESS TO CARE. 1051671401 0 0 1 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 1 62165 0 1 1214 1 1 1 0 0 0 0 0 1 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X AMY BASEL CFO 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 X CHRISTOPHER T FISHER DIRECTOR 5.00 10.00 X 60000 107004 0 SARA DOLAN CHAIR 5.00 5.00 X X 72000 70008 0 MELISSA STOLICKER VICE CHAIR 5.00 5.00 X X 81000 67512 0 KELLY JUBB SCHEIDERER DIRECTOR 5.00 6.00 X 60000 26996 0 STEPHAN A EKLUND DDS MHSA DRPH DIRECTOR 5.00 6.00 X 60000 26996 0 ANDREW KOTARBA DIRECTOR 5.00 0.00 X 75000 14588 0 STEVEN M TACK DIRECTOR 5.00 0.00 X 75000 0 0 BLAKE LIVINGSTON DDS DIRECTOR 5.00 0.00 X 60000 0 0 RAYMOND F GIST DDS DIRECTOR 5.00 1.00 X 60000 2000 0 SUNCICA TRAVAN DDS MS DIRECTOR 5.00 1.00 X 60000 1500 0 ANTHONY O WILLIAMS JD DIRECTOR 5.00 0.00 X 60000 0 0 PATRICK K GILLESPIE DIRECTOR 5.00 0.00 X 60000 0 0 LARRY DEGROAT DIRECTOR 5.00 0.00 X 60000 0 0 STEVEN M DATER DDS DIRECTOR 5.00 0.00 X 60000 0 0 LAURA DICKERSON DIRECTOR 5.00 0.00 X 0 0 0 GORAN M JURKOVIC CPA CEO, PRESIDENT 35.00 15.00 X 9219805 0 2613720 ANTHONY D ROBINSON EVP, CMO & CRO 43.00 7.00 X 2349997 0 718488 AMY L BASEL CPA EVP/CFO & CRO/TREASURER 35.00 15.00 X 2381009 0 644559 SUE ELLEN JENKINS EVP, CHIEF LEGAL OFF, CAO & SEC. 37.00 13.00 X 1632671 0 426193 JEFF BOTKIN SVP, BUSINESS SERVICES 50.00 0.00 X 1402972 0 191550 MARK BAUGHMAN SVP & CIO 50.00 0.00 X 1379012 0 118904 JEFFERY W JOHNSTON DDS MS SVP & CHIEF SCIENCE OFFICER 43.00 7.00 X 498455 0 115646 POE A TIMMONS DIRECTOR (ROOSEVELT INNOV. ONLY) 5.00 5.00 X 15000 56588 0 TOBY HALL PRESIDENT & CEO OF ROOSEVELT 50.00 0.00 X 917560 0 412382 KUSHTRIM SHAQIRI VP GOVERMENT PROGRAMS 50.00 0.00 X 666247 0 45852 MIKE BOBAK VP SALES & ACCT MGT 50.00 0.00 X 666377 0 91155 DANIEL LOVEJOY VP, SALES AND ACCT MGT 50.00 0.00 X 632132 0 74281 WALTER BUZANOWSKI VP & GENERAL COUNSEL 50.00 0.00 X 391691 0 67183 EARL MAJOR VP HUMAN RESOURCES 50.00 0.00 X 385899 0 77570 MARGARET TRIMER VP STRATEGIC PARTNERSHIPS 50.00 0.00 X 372126 0 90300 MICHAEL GILMORE FORMER CHIEF INVESTMENT OFFICER 0.00 50.00 X 0 775688 114053 23813953 1148880 5801836 337 1 1 0 DEWPOINT 300 WASHINGTON SQUARE SUITE 200 LANSING MI 48933 CONSULTING 19178416 WEST MONROE PARTNERS LLC 222 W ADAMS ST FL 11 CHICAGO IL 60606 CONSULTING 6398474 TEK SYSTEMS 300 WASHINGTON SQUARE SUITE 430 LANSING MI 48933 CONSULTING 3542216 DPM CONSULTING SERVICES 5440 CORPORATE DR TROY MI 48098 CONSULTING 3043965 APEX SYSTEMS 3750 COLLECTIONS CENTER DR CHICAGO IL 60693 CONSULTING 3012002 112 DENTAL CARE REVENUE 624100 1026092807 1026092807 ADMIN REIMBURSEMENT 900099 106329066 106329066 EXTERNAL SERVICES 524292 45168078 45168078 1177589951 10494337 10494337 165619960 331909 165410508 204806 209452 127103 336555 336555 MISCELLANEOUS INCOME 900099 402047 402047 402047 1188822890 1132421873 45168078 11232939 X 3895292 3895292 21707185 14102049 7605136 110368645 71106253 39262392 12737952 7978701 4759251 24768386 12168529 12599857 8451232 5445089 3006143 3531616 2356860 1174756 2264972 2264972 757151 757151 120000 120000 2231350 2231350 882035973 866756979 15278994 5621511 3689342 1932169 18546131 13458230 5087901 29509890 13971090 15538800 3416154 3416154 4090607 3520568 570039 990871 408922 581949 17601441 5429085 12172356 1923198 1923198 FEDERAL TAX EXPENSE 663691 663691 COMMISSIONS 23156181 23156181 PROCESSING FEES 3048443 3048443 EXCISE TAX 2904540 2904540 3408172 1179788 2228384 1187750584 1051671401 136079183 0 68684933 75041440 97909259 125860389 59607462 23238789 265686039 157366243 114381008 108319796 247054783 252641292 216392057 212216542 57982009 121308152 862011511 918626400 97593871 104433318 93920536 103765308 191514407 208198626 X 15744473 15744473 5122500 5122500 649630131 689560801 670497104 710427774 862011511 918626400 X 1072306 30057982 8800382 X 0 1 X 1 0 500 500 1 METRO DETROIT FUND 585 E SHEVLIN HAZEL PARK MI 48030 923971630 500 1 0 0 12803920 12803920 98692580 44292618 54399962 57379564 45028320 12351244 96809975 68045305 28764670 108319796 DDIC STOCK 200217 C INVESTMENT IN RHC 107277848 F INVESTMENT IN THE 4100 GROUP 104738477 F 212216542 ACCRUED INTEREST RECEIVABLE 980719 DUE FROM AFFILIATES 18623235 OTHER ASSETS 45398026 DEFERRED TAX ASSET 4671109 PENSION & POST RETIRE OBLIGATIONS 51635063 121308152 IBNR - CLAIM ADJUSTMENT RESERVES 32238630 UNEARNED PREMIUMS 23582607 PENSION & POST RETIRE OBLIGATIONS 5897457 DUE TO AFFILIATES 1711494 RISK-SHARING PAYABLES 40335120 103765308 1 A KID AGAIN 2014 N SAGINAW RD MIDLAND MI 48640 311440073 501(C)(3) 40000 0 CHARITABLE DONATION AMERICAN CANCER SOCIETY 20450 CIVIC CENTER DR SOUTHFIELD MI 48076 131788491 501(C)(3) 30275 0 CHARITABLE DONATION AMERICAN HEART ASSOCIATION 271 WOODLAND PASS STE 110 EAST LANSING MI 48823 135613797 501(C)(3) 10000 0 CHARITABLE DONATION AMERICAN RED CROSS 7800 W OUTER DR DETROIT MI 48235 530196605 501(C)(3) 35000 0 CHARITABLE DONATION AUTISM ALLIANCE OF MICHIGAN 30100 TELGRAPH RD BINGHAM FARMS MI 48025 270472137 501(C)(3) 50000 0 CHARITABLE DONATION CINCINNATI ZOO AND BOTANICAL GARDEN 3400 VINE ST CINCINNATI OH 45220 310537171 501(C)(3) 30000 0 CHARITABLE DONATION COMMUNITIES IN SCHOOLS OF MICHIGAN 721 N CAPITOL STE 1 LANSING MI 48906 453736821 501(C)(3) 50000 0 CHARITABLE DONATION COREWELL HEALTH FOUNDATION OF WEST MICHIGAN 100 MICHGAN AVE GRAND RAPIDS MI 49503 382752328 501(C)(3) 10000 0 CHARITABLE DONATION CROSSROADS OF MICHIGAN 2424 WEST GRAND BLVD DETROIT MI 48208 382539852 501(C)(3) 15000 0 CHARITABLE DONATION DELTA DENTAL FOUNDATION 4100 OKEMOS RD OKEMOS MI 48864 382337000 501(C)(3) 1500000 0 CHARITABLE DONATION DETROIT RIVERFRONT CONSERVANCY 600 RENAISSANCE CENTER DETROIT MI 48243 300125283 501(C)(3) 1022500 0 CHARITABLE DONATION ELE'S PLACE 1145 WEST OAKLAND LANSING MI 48915 382976751 501(C)(3) 110000 0 CHARITABLE DONATION FLEECE & THANK YOU 24715 CRESTVIEW FARMINGTON HILLS MI 48335 475263037 501(C)(3) 13500 0 CHARITABLE DONATION GRAND RAPIDS CHILDRENS MUSEUM 333 BRIDGE ST STE 1200 GRAND RAPIDS MI 49504 383088234 501(C)(3) 10000 0 CHARITABLE DONATION GREATER LANSING AREA HOLIDAY COMMISSION PO BOX 24112 LANSING MI 48909 352405362 501(C)(3) 10000 0 CHARITABLE DONATION GREATER LANSING FOODBANK 5303 S CEDAR ST LANSING MI 48911 382424756 501(C)(3) 80000 0 CHARITABLE DONATION HISPANIC DENTAL ASSOCIATION 421 HUGUENOT ST STE 54 NEW ROCHELLE NY 10801 363719494 501(C)(3) 14141 0 CHARITABLE DONATION IMPRESSION 5 200 MUSEUM DR LANSING MI 48933 237200548 501(C)(3) 132000 0 CHARITABLE DONATION ITS A BREAST THING INC 2771 SOUTHWOOD DR EAST LANSING MI 48823 300591532 501(C)(3) 10000 0 CHARITABLE DONATION JUNIOR ACHIEVEMENT OF MICHIGAN GREAT LAKES 600 W ST JOSEPH ST LANSING MI 48933 381557861 501(C)(3) 47000 0 CHARITABLE DONATION JUNIOR ACHIEVEMENT OF SOUTHEASTERN MI 577 E LARNED ST DETROIT MI 48226 381348535 501(C)(3) 35000 0 CHARITABLE DONATION JUVENILE DIABETES RESEARCH FOUNDATION 24359 NORTHWESTERN HWY SOUTHFIELD MI 48075 231907729 501(C)(3) 25000 0 CHARITABLE DONATION LANSING PROMISE 330 MARSHALL ST LANSING MI 48912 453363322 501(C)(3) 50000 0 CHARITABLE DONATION LEADER DOGS FOR THE BLIND PO BOX 5000 ROCHESTER MI 48308 381366931 501(C)(3) 17000 0 CHARITABLE DONATION LIFECARE ALLIANCE 1699 W MOUND ST COLUMBUS OH 43223 314379494 501(C)(3) 18750 0 CHARITABLE DONATION MICHIGAN ECONOMIC DEVELOPMENT FOUNDATION PO BOX 13063 LANSING MI 48901 382527475 501(C)(3) 25000 0 CHARITABLE DONATION MICHIGAN HUMANE SOCIETY 30300 TELEGRAPH RD BINGHAM FARMS MI 48025 381358206 501(C)(3) 200000 0 HEALTHY COMMUNITIES PROGRAM MICHIGAN STATE UNIVERSITY 220 TROWBRIDGE RD EAST LANSING MI 48824 386005984 GOVT 95000 0 CHARITABLE DONATION NAF 218 WEST 40TH ST 5TH FL NEW YORK NY 10018 133480246 501(C)(3) 11313 0 CHARITABLE DONATION ROAD TO MICHIGANS FUTURE PO BOX 12248 LANSING MI 48901 844298056 501(C)(4) 50000 0 CHARITABLE DONATION SAMARITAS 8131 E JEFFERSON AVE DETROIT MI 48214 381360553 501(C)(3) 40000 0 CHARITABLE DONATION SLEEP IN HEAVENLY PEACE INC PO BOX 85304 WESTLAND MI 48135 464346568 501(C)(3) 12500 0 CHARITABLE DONATION SOCIETY OF AMERICAN INDIAN DENTISTS 230 FAIRVIEW DR CARSON CITY NV 89701 205966903 501(C)(3) 11313 0 CHARITABLE DONATION SPARROW FOUNDATION PO BOX 30480 LANSING MI 48909 386100687 501(C)(3) 60000 0 CHARITABLE DONATION THE EDISON INSTITUTE 20900 OAKWOOD BLVD DEARBORN MI 48124 381359513 501(C)(3) 25000 0 CHARITABLE DONATION 34 1 PART I, LINE 2: CONTRIBUTIONS ARE MADE AT MANAGEMENT DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF MICHIGAN'S MISSION. CONTRIBUTIONS MADE TO THE DELTA DENTAL FUND ARE APPROVED BY THE BOARD OF DIRECTORS. IN ORDER FOR FUNDS TO BE DISBURSED, VOUCHER RECORDS MUST PASS THROUGH THE APPROVAL PROCESS, SIMILAR TO ANY OTHER EXPENDITURE MADE BY DELTA DENTAL PLAN OF MICHIGAN. DETROIT RIVERFRONT CONSERVANCY - DELTA DENTAL OF MICHIGAN CONTRIBUTED $1 MILLION TO BUILD A HEALTH THEMED PLAYGROUND ON DETROIT'S WEST RIVERFRONT. COMMUNITIES IN SCHOOLS OF MICHIGAN - THIS CONTRIBUTION HELPED CIS OF MICHIGAN DEVELOP THE WHOLE-CHILD SCREENER AND CHECK-IN PROCESS TO ASSESS THE NUTRITIONAL, DENTAL, EDUCATIONAL, PHYSICAL HEALTH, AND MENTAL HEALTH NEEDS OF CASE-MANAGEMENT STUDENTS. THIS NEW NEEDS ASSESSMENT PROCESS ENSURES SITE COORDINATORS CAN IDENTIFY IMMEDIATE NEEDS OF STUDENTS TO BROKER AND IMPLEMENT SUPPORTS. THIS ENSURES SITE COORDINATORS CAN REFER STUDENTS TO A DENTIST AND HELP INCREASE SCHOOL-BASED DENTAL SUPPORTS. ELE'S PLACE - IN 2023, DELTA DENTAL OF MICHIGAN PROVIDED $110,000 TO ELE'S PLACE TO SUPPORT ELE'S GROUP, THEIR SCHOOL BASED GRIEF COUNSELING PROGRAM. THROUGH THIS PROGRAM, ELE'S PLACE IS ABLE TO REACH CHILDREN WHO MAY NOT OTHERWISE HAVE TRANSPORTATION TO RECEIVE GRIEF COUNSELING SERVICES AT THEIR OFFICES. IMPRESSION 5 - DELTA DENTAL PROVIDED $110,000 FOR THE CREATION AND DISTRIBUTION OF 2 STEM KITS PER YEAR THAT GO HOME WITH EVERY HEADSTART STUDENT IN INGHAM, EATON, AND CLINTON COUNTIES. ADDITIONALLY, THE PROGRAM PROVIDES 2 KITS PER YEAR TO ALL OF THE HEADSTART TEACHERS FOR USE WITH THE STUDENTS IN THE CLASSROOM. THESE KITS ARE INTENDED TO SUPPORT EARLY CHILDHOOD DEVELOPMENT. MICHIGAN HUMANE SOCIETY - DELTA DENTAL HAS PROVIDED $200,000 AS PART OF A $1 MIILLION COMMITTMENT FOR THE HEALTHY COMMUNITIES PROGRAM WHICH ADDRESSES THE HEALTH OF PEOPLE IN THE COMMUNITY BY REACHING THEM THROUGH THEIR PETS. INTERACTIONS AT PET FOOD PANTRIES AND VACCINATIONS CLINICS ALLOW OTHER HEALTH ENTITIES IN THE COMMUNITY TO OFFER SERVICES LIKE DENTAL CLEANINGS, BLOOD PRESSURE SCREENING ETC TO THE HUMANS WHO ARE WAITING FOR THEIR PETS TO BE TREATED. LANSING PROMISE - DELTA DENTAL PROVIDED $50,000 IN FUNDING TO THE LANSING PROMISE IN 2023. LANSING PROMISE IS A SCHOLARSHIP PROGRAM OFFERING TUITION ASSISTANCE FOR POST-SECONDARY (COLLEGE OR SKILLED TRADE) EDUCATION TO ALL ELIGIBLE HIGH SCHOOL GRADUATES WITHIN THE LANSING SCHOOL DISTRICT BOUNDARIES. THE PROMISE PROVIDES TUITION ASSISTANCE FOR UP TO 65 CREDITS AT LANSING COMMUNITY COLLEGE OR THE EQUIVALENT DOLLAR AMOUNT TOWARD TUITION AND FEES AT MICHIGAN STATE UNIVERSITY OR OLIVET COLLEGE. SPARROW FOUNDATION - OUR DONATION WAS USED TO SPONSOR A VARIETY OF FUNDRAISING EVENTS ALL FOCUSED ON SUPPORTING THE SPARROW FOUNDATION WHICH PLAYS A CRITICAL ROLE IN THE HEALTH SYSTEM LIFE CYCLE BY COLLECTING RESOURCES, BOOSTING COMMUNITY AWARENESS AND IMPROVING THE OVERALL HEALTH OF PEOPLE IN MID-MICHIGAN. X X X 1 1 X X X X 0 1 0 0 0 0 0 1 0 GORAN M JURKOVIC CPA CEO, PRESIDENT 1474566 0 3570478 0 4174761 0 2588461 0 25259 0 11833525 0 4141456 0 ANTHONY D ROBINSON EVP, CMO & CRO 604517 0 886686 0 858794 0 693229 0 25259 0 3068485 0 838676 0 AMY L BASEL CPA EVP/CFO & CRO/TREASURER 528195 0 886909 0 965905 0 619300 0 25259 0 3025568 0 938703 0 SUE ELLEN JENKINS EVP, CHIEF LEGAL OFF, CAO & SEC. 542025 0 949448 0 141198 0 419012 0 7181 0 2058864 0 115832 0 JEFF BOTKIN SVP, BUSINESS SERVICES 371500 0 506573 0 524899 0 173860 0 17690 0 1594522 0 0 0 MARK BAUGHMAN SVP & CIO 371140 0 477488 0 530384 0 101214 0 17690 0 1497916 0 0 0 TOBY HALL PRESIDENT & CEO OF ROOSEVELT 436889 0 457473 0 23198 0 396375 0 16007 0 1329942 0 0 0 MICHAEL GILMORE FORMER CHIEF INVESTMENT OFFICER 0 509237 0 249775 0 16676 0 88796 0 25257 0 889741 0 0 MIKE BOBAK VP SALES & ACCT MGT 246053 0 401867 0 18457 0 65896 0 25259 0 757532 0 0 0 KUSHTRIM SHAQIRI VP GOVERMENT PROGRAMS 375156 0 284556 0 6535 0 20593 0 25259 0 712099 0 0 0 DANIEL LOVEJOY VP, SALES AND ACCT MGT 264391 0 361075 0 6666 0 49022 0 25259 0 706413 0 0 0 JEFFERY W JOHNSTON DDS MS SVP & CHIEF SCIENCE OFFICER 339270 0 154289 0 4896 0 97956 0 17690 0 614101 0 0 0 EARL MAJOR VP HUMAN RESOURCES 274743 0 106115 0 5041 0 62522 0 15048 0 463469 0 0 0 MARGARET TRIMER VP STRATEGIC PARTNERSHIPS 258833 0 98312 0 14981 0 65041 0 25259 0 462426 0 0 0 WALTER BUZANOWSKI VP & GENERAL COUNSEL 283100 0 107781 0 810 0 41924 0 25259 0 458874 0 0 0 CHRISTOPHER T FISHER DIRECTOR 60000 107004 0 0 0 0 0 0 0 0 60000 107004 0 0 PART I, LINE 1A FIRST CLASS TRAVEL FOR BUSINESS PURPOSES IS AVAILABLE TO SENIOR EXECUTIVES AND KEY EMPLOYEES. THIS AMOUNT WAS TREATED AS NONTAXABLE TO THESE INDIVIDUALS. TRAVEL MAY BE AVAILABLE TO SPOUSES ON OCCASION AND WOULD BE TREATED AS TAXABLE INCOME TO THE BOARD MEMBER OR EMPLOYEE AS APPROPRIATE. VARIOUS INDIVIDUALS ON SCHEDULE J ARE ELIGIBLE FOR REIMBURSEMENT OF SUBSTANTIATED HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES THAT HAVE A BUSINESS PURPOSE. THE PERSONAL PORTION OF THIS BENEFIT IS REPORTED ANNUALLY AND IS INCLUDED AS TAXABLE INCOME ON THE EMPLOYEE'S W-2. PART I, LINE 3 THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS PERFORMANCE AND SETS TOTAL COMPENSATION FOR THE CEO WITHOUT THE PRESENCE OR INFLUENCE OF THE CEO. 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 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 EXECUTIVE 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 2023, GORAN JURKOVIC, AMY BASEL, TOBY HALL, SUE JENKINS, AND ANTHONY ROBINSON ACCRUED BENEFITS AS PARTICIPANTS IN THE SERP PLAN. GORAN JURKOVIC, AMY BASEL, SUE JENKINS, 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 2023. THESE WAGES WERE ALSO REPORTED ON SCHEDULE J AS COMPENSATION THAT HAS BEEN REPORTED AS DEFFERED ON PRIOR FORM 990S. PART I, LINE 7 AS INDICATED IN SCHEDULE J, PART II, TOP MANAGEMENT OFFICIALS RECEIVED A BONUS BASED UPON PERFORMANCE AND THE FINANCIAL RESULTS OF THE ORGANIZATION. THE BONUS WAS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. BRIAN JACOBSON BROTHER OF FORMER DDPMI BOARD MEMBER JED JACOBSON 118616 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 COLE JACOBSON BROTHER OF FORMER DDPMI BOARD MEMBER JED JACOBSON 158648 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 STEVEN M DATER DDS BOARD MEMBER AND OWNER OF STEVEN M DATER DDS & ASSOCIATES II, PLC 477019 PAYMENTS FOR DENTAL SERVICES 0 RAYMOND GIST DDS BOARD MEMBER AND OWNER OF RAYMOND GIST DDS PC 197697 PAYMENTS FOR DENTAL SERVICES 0 LARRY DEGROAT DDS BOARD MEMBER AND OWNER OF LARRY DEGROAT DDS 133856 PAYMENTS FOR DENTAL SERVICES 0 FORM 990, PART VI, SECTION A, LINE 6 DELTA DENTAL PLAN OF MICHIGAN HAS A SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS VOTING RIGHTS AND ELECTS DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE RIGHTS THAT ARE PRESCRIBED BY LAW, FOR MEMBERS OF NON-PROFIT CORPORATIONS, INCLUDING THE APPROVAL OF SIGNIFICANT EXPENDITURES AND CEO APPOINTMENT. FORM 990, PART VI, SECTION B, LINE 11B THE INFORMATION PRESENTED ON THE FORM 990 IS GATHERED BY THE EXECUTIVE TAX ADMINISTRATOR FOR THE ORGANIZATION. THE CFO REVIEWS THE INFORMATION. ONCE APPROVED, THE INFORMATION IS GIVEN TO OUTSIDE TAX PREPARERS WHO PREPARE AND REVIEW THE FORM 990. ONCE COMPLETE, AN ELECTRONIC COPY OF THE FORM 990 IS PLACED IN A SECURE PORTAL FOR THE BOARD TO REVIEW. THIS IS DONE BEFORE THE RETURN IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE COMPANY'S EXECUTIVE VICE PRESIDENT, CHIEF LEGAL OFFICER, AND CAO IS CHARGED WITH REVIEWING AND MONITORING ANY POTENTIAL CONFLICT OF INTEREST TRANSACTIONS. ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO REVIEW AND EXECUTE A CONFLICT OF INTEREST POLICY. THIS POLICY REQUIRES THAT ANY CONFLICTS OF INTEREST BE DISCLOSED ON AN ANNUAL BASIS, OR AT ANY OTHER TIME THAT THE PERSON EXECUTING THE POLICY BECOMES AWARE OF A SITUATION OR TRANSACTION THAT ACTUALLY OR POTENTIALLY CREATES A CONFLICT OF INTEREST. ALL CONFLICT OF INTEREST DISCLOSURE FORMS ARE INITIALLY REVIEWED BY THE EXECUTIVE VICE PRESIDENT, CHIEF LEGAL OFFICER, AND CAO. IF A PROHIBITED TRANSACTION IS IDENTIFIED, THE MATTER IS ESCALATED TO THE CEO AND TO THE AUDIT, FINANCE, AND RISK MANAGEMENT COMMITTEE OF THE BOARD OF DIRECTORS FOR FURTHER REVIEW AND APPROPRIATE ACTION. IN THE EVENT OF A CONFLICT OF INTEREST INVOLVING A MEMBER OF THE BOARD OF DIRECTORS, SUCH AS A VOTE IN WHICH A MEMBER HAD AN INTEREST, THE MEMBER IS REQUIRED TO DISCLOSE THE POTENTIAL CONFLICT AND ABSTAIN FROM ANY VOTE ON THE MATTER. WHETHER FURTHER PRECAUTIONS ARE REQUIRED (E.G., PROHIBITING THE INTERESTED PARTY FROM ENGAGING IN DISCUSSIONS) WOULD DEPEND UPON THE SPECIFIC NATURE AND BACKGROUND OF THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE CEO IS DETERMINED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. COMPENSATION OF THE OTHER EXECTUTIVES IS DETERMINED BY THE CEO IN CONSULTATION WITH THE VP OF HUMAN RESOURCES AND THE CFO. OUTSIDE COMPENSATION CONSULTANTS ARE USED TO DETERMINE MARKET DATA WHICH IS USED TO SET TOTAL COMPENSATION FOR OFFICERS AND KEY EMPLOYEES INCLUDING THE CEO, CFO, AND OTHERS AS APPROPRIATE. DELTA DENTAL PLAN OF MICHIGAN, INC. CONTRACTS WITH TOWERS WATSON TO DO A COMPENSATION AND REASONABLENESS ANALYSIS EVERY TWO YEARS. TOWERS WATSON ALSO PROVIDES AN OPINION AS TO THE REASONABLENESS OF THE TOTAL COMPENSATION PACKAGES, INCLUDING BASE PAY, INCENTIVE, BENEFITS AND RETIREMENT BENEFITS. THE COMPENSATION WAS LAST REVIEWED UNDER THIS PROCESS DURING 2022. COMPENSATION DECISIONS ARE MADE UTILIZING THE DATA PROVIDED BY TOWERS WATSON. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. FORM 990 PART VII: CERTAIN EMPLOYEES ARE OFFICERS OF MULTIPLE COMPANIES WITHIN THE LARGER ORGANIZATION. THE AVERAGE HOURS WORKED REFLECTS APPROXIMATE TIME SPENT IN EACH OF THOSE INDIVIDUAL COMPANIES. WHILE THE HOURS ARE ALLOCATED TO INDIVIDUAL COMPANIES, MUCH OF THE OFFICERS' TIME IS SPENT WORKING ON ISSUES THAT IMPACT THE ENTIRE ORGANIZATION, NOT JUST ONE COMPANY. COMPENSATION IS REPORTED IN FULL TO AGREE TO THE EMPLOYEE'S W-2 AS REQUIRED BY IRS INSTRUCTIONS. ANY ALLOCATION OF COMPENSATION IS INCLUDED ON SCHEDULE R. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 25,600,675. MANAGEMENT AND GENERAL EXPENSES 11,939,653. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 37,540,328. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 4,548,347. MANAGEMENT AND GENERAL EXPENSES 3,318,677. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,867,024. DENTAL CONSULTANT: PROGRAM SERVICE EXPENSES 2,181,185. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,181,185. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 834,415,772. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 834,415,772. AFFILIATE CONTRACT LABOR: PROGRAM SERVICE EXPENSES 11,000. MANAGEMENT AND GENERAL EXPENSES 20,664. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,664. FORM 990, PART XI, LINE 9: GAIN ON EQUITY IN SUBSIDIARIES -6,845,064. PENSION RELATED CHANGES 15,645,446. FORM 990, PART IV, LINE 12A: DELTA DENTAL PLAN OF MICHIGAN RECEIVES AN AUDITED FINANCIAL STATEMENT FROM AN INDEPENDENT ACCOUNTANT BUT THESE STATEMENTS ARE PREPARED ON A STATUTORY BASIS AND NOT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). 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