2024-11-13T14:53:41-06:00 2023-12-31 381357951 PLANTE & MORAN PLLC 1111 MICHIGAN AVE STE 100 EAST LANSING MI 48823 990 2023-01-01 310685339 DELTA DENTAL PLAN OF OHIO INC DELT 5173496000 PO BOX 30416 LANSING MI 489097916 AMY BASEL CHIEF FINANCIAL OFFICER 5173496000 2024-11-11 1 1 DAVID LOWENTHAL P00378651 5173326200 2024-11-11 2023 2024-10-15 13:58:12Z GORAN JURKOVIC PO BOX 30416 LANSING MI 489097916 545202682 0 X WWW.DELTADENTALOH.COM X 1960 OH DELTA DENTAL OF OHIO'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. 7 7 0 0 1060566 0 0 0 313467048 373293049 5689891 8426993 0 13803 319156939 381733845 1241118 892240 0 0 365500 323500 0 0 0 302205164 376776434 303811782 377992174 15345157 3741671 319247236 346751438 34044058 37912789 285203178 308838649 X SEE SCHEDULE ODELTA DENTAL OF OHIO'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 OHIO 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 356963971 892240 372246286 PROMOTING DENTAL CAREDELTA DENTAL PLAN OF OHIO, INC. IS A LEADING DENTAL BENEFITS PROVIDER. 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 $308 MILLION FOR DENTAL CARE, BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 4.8 MILLION CLAIMS WERE PROCESSED FOR OVER 2.7 MILLION MEMBERS.SEE SCHEDULE O FOR CONTINUATIONCOST SAVING STRATEGIESDELTA DENTAL BENEFIT PLANS ARE COMMITTED TO SAVING GROUPS AND SUBSCRIBERS MONEY. THE DELTA DIFFERENCE IS AN INTEGRATION OF ACTIVITIES; SUCH AS COST MANAGEMENT POLICIES, FEE REDUCTION AGREEMENTS WITH DENTISTS, AND AN ANTI-FRAUD HOTLINE, ALL OF WHICH ENSURE QUALITY, COST-EFFECTIVE DENTAL BENEFIT DELIVERY. COMMITMENT TO THE COMMUNITYDELTA DENTAL PLAN OF OHIO, 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 $61 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. THIS 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 OHIO 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 THE 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. 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. 356963971 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 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 1 1 0 1 58739 0 1 0 1 1 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X AMY BASEL CHIEF FINANCIAL OFFICER 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 X GORAN M JURKOVIC CPA PRESIDENT & CEO 10.00 40.00 X 0 9219805 2613720 ANTHONY D ROBINSON EVP, CMO & CRO 5.00 45.00 X 0 2349997 718488 AMY L BASEL CPA EVP/CFO & CRO/TREASURER 5.00 45.00 X 0 2381009 644559 SUE ELLEN JENKINS EVP, CHIEF LEGAL OFF, CAO & SEC. 5.00 45.00 X 0 1632671 426193 MICHAEL GILMORE FORMER CHIEF INVESTMENT OFFICER 0.00 50.00 X 0 775688 114053 JEFFERY W JOHNSTON DDS MS SR VP & CHIEF SCIENCE OFFICER 5.00 45.00 X 0 498455 115646 CHRISTOPHER T FISHER DIRECTOR 5.00 10.00 X 42000 125004 0 FRANK BUZAKI JR CHAIR 5.00 5.00 X X 25834 24996 22500 CAROLE S WATKINS VICE CHAIR 5.00 6.00 X X 44331 26996 0 POE A TIMMONS CPA DIRECTOR 5.00 5.00 X 42000 29588 0 CANISE Y WRIGHT BEAN DMD DIRECTOR 5.00 0.00 X 42000 0 0 TIMOTHY E MOFFIT DBA DIRECTOR 5.00 0.00 X 42000 0 0 MICHAEL S STULL DIRECTOR 5.00 0.00 X 42000 0 0 JAMES R STAHL DDS CHAIR - PART YEAR 5.00 5.00 X X 20835 10415 0 301000 17074624 4655159 0 1 1 0 USI INSURANCE SERVICES LLC 1 HILLCREST DR CHARLESTON WV 25311 COMMISSIONS 491016 HYLANT GROUP 811 MADISON AVE TOLEDO OH 43604 COMMISSIONS 365535 GALLAGHER BENEFIT SERVICES INC 2081 VISTA PARKWAY SUITE 300 WEST PALM BEACH FL 33411 COMMISSIONS 330771 LOCKTON COMPANIES LLC 444 W 47TH ST KANSAS CITY MO 64112 COMMISSIONS 301527 THE JAMES B OSWALD COMPANY 1100 SUPERIOR AVE STE 1500 CLEVELAND OH 44114 COMMISSIONS 258016 20 DENTAL CARE REVENUE 624100 372232483 372232483 VISION CARE REVENUE 524298 1060566 1060566 373293049 8721660 8721660 163174170 163468837 -294667 -294667 -294667 MISCELLANEOUS INCOME 561000 13803 13803 13803 381733845 372246286 1060566 8426993 X 892240 892240 323500 210275 113225 667465 620099 47366 513186 513186 131528 131528 870711 870711 308366346 308326846 39500 690435 690435 324117 324117 90675 90675 12851 12851 ADMIN/INVESTMENT O/H 50550536 33431172 17119364 COMMISSION EXPENSE 9931269 9931269 PREMIUM TAX EXPENSE 3233235 3233235 MEMBERSHIP DUES 885110 885110 508970 318835 190135 377992174 356963971 21028203 0 4545519 4201841 18229070 15489666 17408299 19352665 229478 1092813 282713 12851 0 269862 231640432 261224132 44759662 42663707 2434776 2456752 319247236 346751438 10862220 10844435 2325267 3810069 20856571 23258285 34044058 37912789 X 0 0 9707604 9707604 275495574 299131045 285203178 308838649 319247236 346751438 X 3741671 22247709 -2353909 X 0 1 X 1 0 282713 12851 269862 269862 INVESTMENT IN RENAISSANCE HOLDING COMPANY 7750881 F INVESTMENT IN THE 4100 GROUP 34912826 F 42663707 CLAIMS RESERVES 11179000 UNEARNED PREMIUMS 5670710 OTHER ACCRUED LIABILITIES 2806 INTERCOMPANY PAYABLE 4902324 LEASE LIABILITY 1503445 23258285 1 A KID AGAIN 2014 N SAGINAW RD MIDLAND MI 48640 311440073 501(C)(3) 7500 0 N/A N/A CHARITABLE DONATION AMERICAN HEART ASSOCIATION 271 WOODLAND PASS STE 110 EAST LANSING MI 48823 135613797 501(C)(3) 30000 0 N/A N/A CHARITABLE DONATION ART OPPORTUNITIES INC 2460 GILBERT AVE CINNINNATI OH 45206 311665900 501(C)(3) 10000 0 N/A N/A CHARITABLE DONATION COLLEGE NOW (PER JA CLEVELAND) 1500W THIRD ST STE 125 CLEVELAND OH 44113 346580096 501(C)(3) 25000 0 N/A N/A CHARITABLE DONATION DELTA DENTAL FOUNDATION PO BOX 30416 LANSING MI 48909 382337000 501(C)(3) 500000 0 N/A N/A VITAL DENTAL EDUCATION AND RESEARCH JUNIOR ACHIEVEMENT CENTRAL OHIO 68 E 2ND AVE COLUMBUS OH 43201 314385042 501(C)(3) 35000 0 N/A N/A CHARITABLE DONATION JUNIOR ACHIEVEMENT NORTHWESTERN OHIO 1645 INDIAN WOOD CIRCLE STE 104 MAUMEE OH 43537 344430363 501(C)(3) 25000 0 N/A N/A CHARITABLE DONATION JUNIOR ACHIEVEMENT OF GREATER CLEVELAND 1422 EUCLID AVE STE 952 CLEVELAND OH 44115 340733164 501(C)(3) 35000 0 N/A N/A CHARITABLE DONATION NATIONWIDE CHILDREN'S HOSPITAL 700 CHILDRENS DR COLUMBUS OH 43205 314377411 501(C)(3) 30000 0 N/A N/A CHARITABLE DONATION RONALD MCDONALD HOUSE CHARITIES OF OHIO 711 EAST LIVINGSTON AVE COLUMBUS OH 43205 310890152 501(C)(3) 25000 0 N/A N/A CHARITABLE DONATION TEAM NEO 1111 SUPERIOR WAY CLEVELAND OH 44114 341885407 501(C)(3) 125000 0 N/A N/A CHARITABLE DONATION 11 0 PART I, LINE 2: CONTRIBUTIONS ARE MADE AT MANAGEMENT DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF OHIO'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 OHIO. X 1 1 0 1 0 0 0 0 0 0 0 GORAN M JURKOVIC CPA PRESIDENT & CEO 0 1474566 0 3570478 0 4174761 0 2588461 0 25259 0 11833525 0 4141456 ANTHONY D ROBINSON EVP, CMO & CRO 0 604517 0 886686 0 858794 0 693229 0 25259 0 3068485 0 838676 AMY L BASEL CPA EVP/CFO & CRO/TREASURER 0 528195 0 886909 0 965905 0 619300 0 25259 0 3025568 0 938703 SUE ELLEN JENKINS EVP, CHIEF LEGAL OFF, CAO & SEC. 0 542025 0 949448 0 141198 0 419012 0 7181 0 2058864 0 115832 MICHAEL GILMORE FORMER CHIEF INVESTMENT OFFICER 0 509237 0 249775 0 16676 0 88796 0 25257 0 889741 0 0 JEFFERY W JOHNSTON DDS MS SR VP & CHIEF SCIENCE OFFICER 0 339270 0 154289 0 4896 0 97956 0 17690 0 614101 0 0 CHRISTOPHER T FISHER DIRECTOR 42000 125004 0 0 0 0 0 0 0 0 42000 125004 0 0 PART I, LINE 1A TRAVEL MAY BE AVAILABLE TO SPOUSES ON OCCASION AND WOULD BE TREATED AS TAXABLE INCOME TO THE BOARD MEMBER OR EMPLOYEE AS APPROPRIATE. 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 A 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 AN EXECUTIVE 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 2023, GORAN JURKOVIC, AMY BASEL, ANTHONY ROBINSON, AND SUE ELLEN JENKINS ACCRUED BENEFITS AS PARTICIPANTS IN THE SERP PLANS. GORAN JURKOVIC, AMY BASEL, ANTHONY ROBINSON, AND SUE ELLEN JENKINS 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. FORM 990, PART VI, SECTION A, LINE 6 DELTA DENTAL PLAN OF OHIO HAS A SOLE MEMBER, DELTA DENTAL PLAN OF MICHIGAN, INC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS VOTING RIGHTS TO ELECT DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B DELTA DENTAL PLAN OF MICHIGAN, INC., AS THE SOLE MEMBER OF DELTA DENTAL PLAN OF OHIO, INC. AS THE RIGHTS PRESCRIBED BY LAW FOR MEMBERS OF NONPROFIT CORPORATIONS SUBJECT TO CHAPTER 1702 OF THE OHIO REVISED CODE AND AMENDED AND RESTATED CODE OF REGULATIONS. FORM 990, PART VI, SECTION B, LINE 11B THE INFORMATION PRESENTED ON THE FORM 990 IS GATHERED BY THE SENIOR 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, PRIOR TO FILING FORM 990 WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE COMPANY'S EXECTUTIVE 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 WERE IDENTIFIED, THE MATTER IS ESCALATED TO THE NOMINATING AND GOVERNANCE 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 HAS 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 AND OTHER EXECUTIVES IS DETERMINED BY A RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, INC. OUTSIDE COMPENSATION CONSULTANTS ARE USED TO DETERMINE MARKET DATA WHICH IS USED TO SET TOTAL COMPENSATION FOR OFFICERS AND KEY EMPLOYEES INCLUDING CEO AND CFO. THE RELATED ORGANIZATION CONTRACTS WITH TOWERS WATSON TO DO A COMPENSATION AND REASONABLENESS ANALYSIS EVERY TWO YEARS. COMPENSATION IS SET, BASED ON THE DATA PROVIDED, BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. 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. 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 CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES -83,222. MANAGEMENT AND GENERAL EXPENSES 39,500. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -43,722. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 308,410,068. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 308,410,068. FORM 990, PART XI, LINE 9: LOSS ON INVESTMENT IN SUBSIDIARIES -2,353,909. FORM 990, PART IV, LINE 12A: DELTA DENTAL PLAN OF OHIO 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). RENAISSANCE HEALTH SERVICE CORPORATION PO BOX 30416 LANSING MI 489097916 381675667 PROMOTING DENTAL CARE MI 501(C)(4) N/A N/A 0 DELTA DENTAL PLAN OF INDIANA INC PO BOX 30416 LANSING MI 489097916 351545647 PROVIDE DENTAL SERVICE PLANS IN 501(C)(4) N/A DELTA DENTAL PLAN OF MICHIGAN INC 0 DELTA DENTAL PLAN OF MICHIGAN INC 4100 OKEMOS ROAD OKEMOS MI 48864 381791480 PROVIDE DENTAL SERVICE PLANS MI 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF TENNESSEE 240 VENTURE CIRCLE NASHVILLE TN 37228 620812197 PROVIDE DENTAL SERVICE PLANS TN 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL FUND PO BOX 30416 LANSING MI 489097916 382337000 SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMS MI 501(C)(3) LINE 12A, I DELTA DENTAL PLAN OF MICHIGAN INC 0 DELTA DENTAL PLAN OF NEW MEXICO INC 100 SUN AVE NE SUITE 400 ALBUQUERQUE NM 87109 850224562 PROVIDE DENTAL SERVICE PLANS NM 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF KENTUCKY INC 10100 LINN STATION ROAD NO 700 LOUISVILLE KY 40223 610659432 PROVIDE DENTAL SERVICE PLANS KY 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF NORTH CAROLINA 3737 GLENWOOD AVENUE SUITE 320 RALEIGH NC 27612 561018068 PROVIDE DENTAL SERVICE PLANS NC 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL PLAN OF ARKANSAS INC 1513 COUNTRY CLUB RD SHERWOOD AR 72120 710561140 PROVIDE DENTAL SERVICE PLANS AR 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF ARKANSAS FOUNDATION INC 1513 COUNTRY CLUB RD SHERWOOD AR 72120 261569324 EMPHASIZE DENTAL HEALTH IN COMMUNITIES AR 501(C)(3) PF DELTA DENTAL OF ARKANSAS 0 RENAISSANCE FAMILY FOUNDATION INC 225 S EAST ST INDIANAPOLIS IN 46202 461376165 EMPHASIZE DENTAL HEALTH IN COMMUNITIES IN 501(C)(3) PF RENAISSANCE HOLDING COMPANY 0 SMILE 180 FOUNDATION 240 VENTURE CIRCLE NASHVILLE TN 37228 471654054 EMPHASIZE DENTAL HEALTH IN COMMUNITIES TN 501(C)(3) LINE 12A, I DELTA DENTAL OF TENNESSEE INC 0 DELTA DENTAL OF KENTUCKY FOUNDATION INC 10100 LINN STATION ROAD SUITE 700 LOUISVILLE KY 40223 874045357 EMPHASIZE DENTAL HEALTH IN COMMUNITIES KY 501(C)(3) PF DELTA DENTAL OF KENTUCKY 0 RED CEDAR INVESTMENT MANAGEMENT LLC 333 BRIDGE STREET NW SUITE 601 GRAND RAPIDS MI 49546 462667997 CAPITAL MANAGEMENT MI N/A 0 0 T4G MANAGEMENT LLC 300 S WASHINGTON SQUARE SUITE 225 LANSING MI 48933 884271021 FINANCIAL PLANNING MI N/A 0 0 ARCIS FUND I LLC 300 S WASHINGTON SQUARE SUITE 225 LANSING MI 48933 932945609 INVESTMENTS MI N/A 0 0 T4G FINANCIAL SERVICES LLC 300 S WASHINGTON SQUARE SUITE 225 LANSING MI 48933 921020583 FINANCIAL PLANNING MI N/A 0 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA PO BOX 30381 LANSING MI 48909 470397286 INSURANCE IN RENAISSANCE HOLDING COMPANY C -51011 5664828 0.04200 0 RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI DELTA DENTAL OF MICHIGAN C -65255 3998906 0.04200 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK PO BOX 30381 LANSING MI 48909 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 30198 702221 0.04200 0 OMEGA ADMINISTRATORS INC 1513 COUNTRY CLUB ROAD SHERWOOD AR 72120 043740469 PROVIDING THIRD-PARTY ADMINISTRATIVE SERVICES AR N/A C 0 THE 4100 GROUP 4100 OKEMOS ROAD OKEMOS MI 48864 472557772 INVESTMENT IN SUBSIDIARIES MI DELTA DENTAL OF MICHIGAN C -582680 35908345 0.25000 0 FORE HOLDING CORPORATION 240 VENTURE CIRCLE NASHVILLE TN 37228 204116122 HOLDING COMPANY TN N/A C 0 DENTAL CHOICE INC 10100 LINN STATION RD 700 LOUISVILLE KY 402233861 611105118 PROVIDE DENTAL SERVICE PLANS KY N/A C 0 DENTAL CHOICE AGENCY INC 10100 LINN STATION RD 700 LOUISVILLE KY 402233861 611336003 PRIMARY GENERAL AGENCY FOR DDKY AND DENTAL CHOICE KY N/A C 0 DENTAL CHOICE ANCILLARY INC 10100 LINN STATION RD 700 LOUISVILLE KY 402233861 881391091 PROVIDE DENTAL SERVICE PLANS KY N/A C 0 ANCILLARY CHOICE 10100 LINN STATION RD 700 LOUISVILLE KY 402233861 880574945 INSURANCE KY N/A C 0 DYNTL INC 2800 WHITE OAK DR NASHVILLE TN 37215 934527543 DENTAL SERVICE TN T4G HEALTH HOLDINGS LLC C 518 625518 0.25000 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 DELTA DENTAL FUND B 500000 ACTUAL COST DELTA DENTAL PLAN OF MICHIGAN INC M 47296949 ACTUAL COST RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA M 1941297 ACTUAL COST