2021-11-15T10:08:48-06:00 2020-12-31 381357951 PLANTE & MORAN PLLC 1111 MICHIGAN AVE STE 100 EAST LANSING MI 48823 990 2020-01-01 610659432 DELTA DENTAL OF KENTUCKY INC DELT 5027365000 10100 LINN STATION ROAD NO 700 LOUISVILLE KY 40223 CHRISTOPHER W GREEN VICE PRESIDENT & CFO 5027365000 2021-11-12 1 CHRISTOPHER GREEN 999009999 DAVID LOWENTHAL CPA P00378651 5173326200 2021-11-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z J JUDE THOMPSON 10100 LINN STATION ROAD NO 700 LOUISVILLE KY 40223 182814969 0 X WWW.DELTADENTALKY.COM X 1966 KY DELTA DENTAL OF KENTUCKY'S MISSION HAS ALWAYS BEEN TO BE THE LEADER IN THE MARKETS WE SERVE, TO DELIVER UNMATCHED QUALITY AND VALUE IN OUR PROGRAMS AND SERVICES, AND TO VIGOROUSLY PROMOTE THE IMPORTANCE OF ORAL HEALTH AS AN ESSENTIAL PART OF OVERALL HEALTH. ITS OVERARCHING MISSION IS TO BE THE DENTAL BENEFITS COMPANY OF CHOICE IN THE MARKETS WE SERVE. 9 7 86 0 2481326 0 0 0 146696663 156745570 1359948 2058349 -883222 -708248 147173389 158095671 1665998 3651243 116397006 107279363 10086152 10703950 0 0 0 16100242 19333421 144249398 140967977 2923991 17127694 102860273 127336348 16078508 19540235 86781765 107796113 X SEE SCHEDULE ODELTA DENTAL OF KENTUCKY'S MISSION HAS ALWAYS BEEN TO BE THE LEADER IN THE MARKETS WE SERVE, TO DELIVER UNMATCHED QUALITY AND VALUE IN OUR PROGRAMS AND SERVICES, AND TO VIGOROUSLY PROMOTE THE IMPORTANCE OF ORAL HEALTH AS AN ESSENTIAL PART OF OVERALL HEALTH. ITS OVERARCHING MISSION IS TO BE THE DENTAL BENEFITS COMPANY OF CHOICE IN THE MARKETS WE SERVE. 0 0 136733651 3651243 154264244 DELTA DENTAL OF KENTUCKY IS THE LARGEST AND OLDEST DENTAL BENEFIT ADMINISTRATOR IN KENTUCKY. AS A NOT-FOR-PROFIT ORGANIZATION, OUR CORE MISSION IS THAT EVERYONE DESERVES A HAPPY AND HEALTHY SMILE. WE ARE COMMITTED TO FULFILLING THIS MISSION THROUGH OUR DENTAL, VISION AND LIFE BENEFIT PROGRAMS AS WELL AS OUR CORPORATE PHILANTHROPIC INITIATIVES. DELTA DENTAL OF KENTUCKY INSURES NEARLY 800,000 SMILES IN THE COMMONWEALTH OF KENTUCKY THROUGH GROUP AND INDIVIDUAL PLANS. SEE SCHEDULE O FOR CONTINUATIONFOR CLOSE TO SIX DECADES, DELTA DENTAL OF KENTUCKY HAS HELPED PROMOTE HEALTHY SMILES FOR OUR MEMBERS BY DESIGNING AND ADMINISTERING INNOVATIVE, COST-EFFECTIVE DENTAL BENEFIT PROGRAMS. THESE PLANS MEET OUR MEMBERS' COST-OBJECTIVES WHILE IMPROVING AND MAINTAINING THEIR ORAL HEALTH. DELTA DENTAL OF KENTUCKY IS DEDICATED TO OUR MEMBERS AND ENSURING WE PROVIDE SUPERIOR CUSTOMER SERVICE, AS EVIDENCED BY NEARLY 90% OF CALLS ANSWERED IN LESS THAN 15 SECONDS. OUR AWARD WINNING CUSTOMER SERVICE HAS A 95% SATISFACTION RATE.DELTA DENTAL OF KENTUCKY OPERATES THE LARGEST DENTAL NETWORKS WITH 89% OF PARTICIPATION AMONG KENTUCKY DENTISTS. OUR TWO LARGE NETWORKS GIVE DELTA DENTAL MEMBERS ADDED PROTECTION BECAUSE THEY GUARANTEE THAT PARTICIPATING DENTISTS WILL ACCEPT THEIR PAYMENT FOR COVERED SERVICES AND THAT NO CHARGES, OTHER THAN CO-PAYMENTS AND DEDUCTIBLES ARE BILLED. OUR DENTIST-CREDENTIALING PROGRAM, COST MANAGEMENT POLICIES AND FEE REDUCTION AGREEMENTS WITH PARTICIPATING DENTISTS HELP MEMBERS RECEIVE QUALITY DENTISTRY AND BEST DENTAL OUTCOMES. IN 2019, DELTA DENTAL EXPANDED PRODUCT OFFERINGS TO INCLUDE VISION INSURANCE FOR GROUPS AND INDIVIDUALS. IN EARLY 2020, DELTA DENTAL AGAIN EXPANDED INTO MORE ANCILLARY LINES OFFERING LIFE AND DISABILITY COVERAGE. ENSURING OUR MISSION OF HAPPY AND HEALTHY SMILES IS A CORE COMPONENT OF DELTA DENTAL OF KENTUCKY, A SEPARATE ACCOUNT WAS ESTABLISHED AT THE COMMUNITY FOUNDATION OF LOUISVILLE IN 2003 WHICH IS FUNDED ANNUALLY FOR GIVING PURPOSES. SINCE THE INCEPTION OF THE COMMUNITY FOUNDATION OF LOUISVILLE ACCOUNT IN 2003, THE CORPORATE PHILANTHROPIC GIVING HAS PROVIDED OVER $17 MILLION IN GRANTS TO OVER 160 ORGANIZATIONS. IN 2020, DONATIONS TOTALED $1.5 MILLION TO THE COMMUNITY FOUNDATION ACCOUNT THAT SUPPORTED 80 ORGANIZATIONS THROUGHOUT THE ENTIRE STATE. THESE DONATIONS FUNDED 22 DENTAL CLINICS ACROSS THE COMMONWEALTH AND 70% OF DOLLARS WERE DIRECTED TO ORGANIZATIONS PROVIDING DENTAL CARE AND ORAL HEALTH EDUCATION TO VULNERABLE POPULATIONS. IN 2020, ADDITIONAL DONATIONS OF $1.7 MILLION WERE FUNDED THROUGH THE COMMUNITY FOUNDATION OF LOUISVILLE ACCOUNT AND SUPPORTED 265 ORGANIZATIONS ACROSS THE COMMONWEALTH THROUGH A COVID-19 RELIEF FUNDING PROGRAM. 136733651 0 0 0 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 0 0 0 0 0 0 1 1 1 1 0 1 19956 0 1 86 1 1 1 0 0 0 0 0 0 0 X 9 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X CHRISTOPHER W GREEN CFO 5027365000 10100 LINN STATION ROAD STE 700 LOUISVILLE KY 40223 X J JUDE THOMPSON PRESIDENT, CEO 40.00 0.00 X X 867857 0 163791 BRIAN D HART VP/CRO 40.00 0.00 X 605630 0 129891 ANGELA J NENNI VP/CAO 40.00 0.00 X 569959 0 112104 CHRISTOPHER W GREEN VP/CFO 40.00 0.00 X 447560 0 98995 JEFFREY D DUES DIRECTOR, ACCOUNT MGMT 40.00 0.00 X 247149 0 48472 TAUNYA L ESHENBAUGH DIRECTOR, SALES 40.00 0.00 X 221774 0 38238 LAURA F WINCE DIRECTOR, MARKETING 40.00 0.00 X 192578 0 40508 DANIELLE JACKSON CORPORATE COUNSEL 40.00 0.00 X 132122 0 40427 TAMMY W CANNON MANAGER, UNDERWRITING 40.00 0.00 X 136424 0 29985 RONALD E STORY FORMER VP/CIO (THRU 8/2019) 0.00 0.00 X 134894 0 0 MICHAEL CHILDERS DMD DIRECTOR 4.00 5.00 X 31550 24996 0 J DAVID SMITH CHAIR 2.00 0.00 X X 34300 0 0 STEVE S REED DIRECTOR 2.00 0.00 X 27550 0 0 DIANE CORNWELL DIRECTOR 4.00 0.00 X 24550 0 0 RODNEY A JACKSON DMD VICE CHAIR 2.00 0.00 X X 21800 0 0 OLIVIA F KIRTLEY DIRECTOR 4.00 0.00 X 1200 0 19500 RANDALL F DYER JR DIRECTOR 2.00 0.00 X 18800 0 0 JOHNNA REEDER KLEYMEYER DIRECTOR 2.00 0.00 X 18550 0 0 3734247 24996 721911 17 1 1 0 DELTA DENTAL PLAN OF MICHIGAN PO BOX 30416 LANSING MI 48909 ADMINISTRATIVE SERVICES 4147148 MCGRIFF INSURANCE SERVICES INC 3605 GLENWOOD AVENUE STE 201 RALEIGH NC 27612 BENEFITS CONSULTING 1084784 ASSURED PARTNERS NL LLC 2305 RIVER ROAD LOUISVILLE KY 40206 BENEFITS CONSULTING 942569 HOUCHENS INSURANCE GROUP INC 1750 SCOTTSVILLE ROAD STE 4 BOWLING GREEN KY 42104 BENEFITS CONSULTING 670907 SKYGEN N92 W14612 ANTHONY AVENUE MENOMONEE FALLS WI 53051 SOFTWARE & CONSULTING 477500 29 DENTAL CARE REVENUE 524114 154256366 154256366 VISION INSURANCE REVENUE 524114 2481326 2481326 OTHER FEES 900099 7878 7878 156745570 1231653 1231653 695912 1404160 -708248 -708248 -708248 24141834 23315138 826696 826696 826696 158095671 154264244 2481326 1350101 3651243 3651243 107279363 107279363 2995788 809684 2186104 5549123 5549123 566081 566081 1124614 1124614 468344 360625 107719 323423 323423 119548 119548 41679 41679 148847 148847 681351 613216 68135 1316164 855507 460657 741645 741645 328281 285604 42677 1115156 557578 557578 26402 15841 10561 1316 1316 134006 120605 13401 149655 149655 BROKER COMMISSIONS 8760817 8760817 PROCESSING FEES 3548553 3548553 FEDERAL HEALTHCARE TAX 1006863 1006863 POSTAGE & SHIPPING 434217 429875 4342 455498 455498 140967977 136733651 4234326 0 10695270 3659484 412681 20937811 20933603 14258771 46909 96347 16881559 7414985 9231387 9466574 23477283 27303330 29830439 39889519 8232701 11724512 102860273 127336348 1711153 4922626 1999508 2094136 12367847 12523473 16078508 19540235 X 86781765 107796113 86781765 107796113 102860273 127336348 X 17127694 5367863 -1481209 X 0 1 X 1 0 830000 830000 11727036 4775451 6951585 1582626 1129978 452648 1438516 1062845 375671 1303381 446711 856670 9466574 31539070 F INVESTMENT - DENTAL CHOICE, INC. 8350449 F 39889519 ACCRUED INVESTMENT INCOME 135445 457(B) PLAN 691823 INVESTMENT - RHC 10897244 11724512 CLAIMS CHECKS OUTSTANDING 4586253 ESTIMATED CLAIMS LIABILITY 7937220 12523473 1 COMMUNITY FOUNDATION OF LOUISVILLE 325 WEST MAIN STREET SUITE 1110 LOUISVILLE KY 40202 310997017 501(C)(3) 2900000 CASH GENERAL DONATION LEADERSHIP KENTUCKY FOUNDATION 464 CHENAULT RD FRANKFORT KY 406019260 311096215 501(C)(3) 5000 CASH GENERAL DONATION HOME OF THE INNOCENTS 1100 EAST MARKET STREET LOUISVILLE KY 40206 610445834 501(C)(3) 5000 CASH GENERAL DONATION SMILEFAITH FOUNDATION 9775 HIGHWAY 805 JENKINS KY 41537 800453938 501(C)(3) 5000 CASH GENERAL DONATION UNIVERSITY OF KENTUCKY ATHLETICS 338 LEXINGTON AVENUE LEXINGTON KY 405060604 GOVT 525000 CASH SUPPORT GENERAL MISSION ACTORS THEATRE OF LOUISVILLE 316 W MAIN STREET LOUISVILLE KY 40202 610645030 501(C)(3) 9000 CASH SUPPORT GENERAL MISSION AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 8800 CASH SUPPORT GENERAL MISSION FRIENDS OF THE LOUISVILLE ZOO PO BOX 37250 LOUISVILLE KY 402337250 610721682 501(C)(3) 7000 CASH SUPPORT GENERAL MISSION LIFE LEARNING CENTER 20 W 18TH ST COVINGTON KY 410113329 203454261 501(C)(3) 10000 CASH SUPPORT GENERAL MISSION LOUISVILLE BALLET 315 EAST MAIN STREET LOUISVILLE KY 40202 616033779 501(C)(3) 5000 CASH SUPPORT GENERAL MISSION FREEDOM LAKE INC 2005 ASCENDER CT LOUISVILLE KY 402453403 812739074 501(C)(3) 10000 CASH SUPPORT GENERAL MISSION NORTON CHILDREN'S HOSPITAL FOUNDATION 224 E BROADWAY LOUISVILLE KY 40202 616027530 501(C)(3) 5000 CASH SUPPORT GENERAL MISSION UNBRIDLED CHARITABLE FOUNDATION INC PO BOX 7331 LOUISVILLE KY 402570331 462090072 501(C)(3) 7500 CASH SUPPORT GENERAL MISSION 13 0 PART I, LINE 2: GRANTS ARE MADE AND MONITORED UNDER A BOARD APPROVED CORPORATE POLICY WHICH SETS OUT THE GRANT CRITERIA, INCLUDING PROCESSES FOR APPROVAL, DISTRIBUTION, AND MONITORING. THE GRANT REVIEW AND APPROVAL COMMITTEE CONSISTS OF MEMBERS OF THE BOARD AND COMPANY EXECUTIVES. GRANTS MUST BE SUBMITTED ON SPECIFIED FORMS WHICH REQUIRE INFORMATION ABOUT THE GRANTEE ORGANIZATION AND HOW THE GRANTS WILL BE USED. GRANTEE ORGANIZATIONS MUST PERIODICALLY REPORT ON HOW THE FUNDS HAVE BEEN UTILIZED AND CERTIFY THAT FUNDS ARE DISBURSED IN ACCORDANCE WITH THE APPROVED GRANT APPLICATION. THESE REPORTS ARE REGULARLY REVIEWED BY COMPANY STAFF AND SUMMARIZED FOR THE GRANT COMMITTEE. THE COMMITTEE REVIEWS THE REPORTS AT LEAST QUARTERLY AND COMMUNICATES QUESTIONS OR CONCERNS BACK TO THE GRANTEE ORGANIZATION. X 1 0 X X X X 1 1 0 0 0 0 0 1 0 J JUDE THOMPSON PRESIDENT, CEO 498107 0 369750 0 0 0 122384 0 41407 0 1031648 0 0 0 BRIAN D HART VP/CRO 396830 0 208800 0 0 0 91125 0 38766 0 735521 0 0 0 ANGELA J NENNI VP/CAO 361159 0 208800 0 0 0 81613 0 30491 0 682063 0 0 0 CHRISTOPHER W GREEN VP/CFO 335560 0 112000 0 0 0 74545 0 24450 0 546555 0 0 0 JEFFREY D DUES DIRECTOR, ACCOUNT MGMT 86899 0 160250 0 0 0 15921 0 32551 0 295621 0 0 0 TAUNYA L ESHENBAUGH DIRECTOR, SALES 75914 0 145860 0 0 0 19304 0 18934 0 260012 0 0 0 LAURA F WINCE DIRECTOR, MARKETING 119770 0 72808 0 0 0 10649 0 29859 0 233086 0 0 0 DANIELLE JACKSON CORPORATE COUNSEL 96160 0 35962 0 0 0 8757 0 31670 0 172549 0 0 0 TAMMY W CANNON MANAGER, UNDERWRITING 108303 0 28121 0 0 0 9702 0 20283 0 166409 0 0 0 RONALD E STORY FORMER VP/CIO (THRU 8/2019) 0 0 0 0 134894 0 0 0 0 0 134894 0 0 0 PART I, LINE 1A BOARD MEMBERS ARE ALLOWED A TRAVEL COMPANION FOR THE ANNUAL RHSC CONFERENCE. THE COMPANION TRAVEL IS TAXABLE TO THE BOARD MEMBER. SINCE THERE WAS NO CONFERENCE IN 2020, NO BOARD MEMBER RECEIVED THIS BENEFIT IN 2020. PART I, LINES 4A-B PART I, LINE 4A: DURING 2020, RONALD E. STORY, THE FORMER CIO, RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $134,894. PART I, LINE 4B: DELTA DENTAL OF KENTUCKY, INC. MAINTAINS A RETENTION BONUS AGREEMENT WITH A SELECT GROUP OF EXECUTIVES OF THE ORGANIZATION. THE BONUS AGREEMENT IS A NONQUALIFIED DEFERRED COMPENSATION PLAN THAT IS INTENDED TO COMPLY WITH SECTION 457(F) OF THE INTERNAL REVENUE CODE. BENEFITS UNDER THIS AGREEMENT ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE AND ARE TAXABLE TO THE PARTICIPATING EXECUTIVES WHEN SUCH AMOUNTS ARE VESTED. THE FOLLOWING EXECUTIVES PARTICIPATE IN THE RETENTION BONUS AGREEMENT: J. JUDE THOMPSON BRIAN D. HART ANGELA J. NENNI CHRISTOPHER W. GREEN NO AMOUNTS WERE PAID OUT OR VESTED UNDER THIS AGREEMENT DURING 2020. PART I, LINE 7 AS INDICATED IN SCHEDULE J, PART II, TOP MANAGEMENT OFFICIALS RECEIVED A BONUS BASED UPON EMPLOYEE PERFORMANCE AND THE FINANCIAL RESULTS OF THE ORGANIZATION AS COMPARED TO BUDGET. THIS BONUS WAS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 6 EFFECTIVE JULY 1, 2009 RENAISSANCE HEALTH SERVICE CORPORATION BECAME THE SOLE CORPORATE MEMBER OF DELTA DENTAL OF KENTUCKY. FORM 990, PART VI, SECTION A, LINE 7A RHSC IS THE SOLE VOTING MEMBER OF DDKY. HOWEVER, UNDER THE TERMS OF THE AFFILIATION AGREEMENT THE PARTIES AGREED THAT THE DELTA DENTAL OF KENTUCKY (DDKY) BOARD SELECTS DIRECTOR CANDIDATES AND SUBMITS THEM TO RENAISSANCE HEALTH SERVICE CORP (RHSC). RHSC THEN APPROVES THE CANDIDATES. RHSC CAN REJECT PROPOSED CANDIDATES ONLY FOR "JUST CAUSE" AS DEFINED IN THE AGREEMENT. OTHERWISE, RHSC MUST APPROVE ALL THE CANDIDATES PROPOSED BY THE DDKY BOARD. RHSC HAS THE RIGHT TO ELECT A NUMBER OF DIRECTORS TO THE DDKY BOARD PROPORTIONAL TO THE NUMBER OF DIRECTORS THAT DDKY MAY NOMINATE TO THE RHSC BOARD. AS OF 12/31/2020, RHSC APPOINTED ONE MEMBER OF THE 9 MEMBER DDKY BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE RIGHTS OF THE DDKY BOARD ARE TO APPROVE THE ANNUAL BUDGETS FOR OPERATIONS, ELECT OFFICERS OF THE DDKY BOARD OF DIRECTORS, APPROVE THE TRANSFER OF ANY OF ITS ASSETS, APPROVE THE INCURRENCE OR GUARANTY OF DEBT AND APPROVE THE MANAGEMENT OF ITS INVESTMENTS. RHSC MUST APPROVE ANY TRANSFER OF ASSETS, INVESTMENTS, LOANS, GUARANTIES OR EXPENDITURES WHICH EXCEEDS TEN PERCENT OF DDKY'S NET ASSETS. RHSC MUST APPROVE THE FOLLOWING CHANGES TO THE DDKY BYLAWS: THE IDENTITY, QUALIFICATION OR RIGHTS OF DDKY'S VOTING MEMBER, THE QUALIFICATIONS, CLASSIFICATIONS, TERMS OF OFFICE OR PERMISSIBLE NUMBER OF DIRECTORS ON DDKY'S BOARD OR ANY LIMITATION ON THE RIGHTS OR AUTHORITY OF THE DDKY BOARD CONTAINED IN DDKY'S ORGANIZATIONAL DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS FIRST REVIEWED INTERNALLY BY THE VICE PRESIDENT AND CFO, CORPORATE COUNSEL AND CEO. A DRAFT IS THEN PROVIDED TO THE AUDIT AND FINANCE COMMITTEE FOR REVIEW. PRIOR TO FILING, A COPY OF THE FINAL FORM 990 IS DISTRIBUTED TO THE ENTIRE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS AND KEY EMPLOYEES MUST COMPLETE AND SUBMIT A CONFLICT OF INTEREST DISCLOSURE ANNUALLY. THESE FORMS ARE REVIEWED BY THE CEO, THE CORPORATE COMPLIANCE OFFICER, AND A REPORT IS MADE TO THE AUDIT AND FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE AUDIT COMMITTEE REVIEWS ALL POTENTIAL CONFLICTS TO DETERMINE IF THE CONFLICTS REPRESENT MATERIAL FINANCIAL RISK TO THE COMPANY AND TAKES ANY ACTION NECESSARY TO RESOLVE OR MITIGATE THE EFFECT OF THE CONFLICTS. WHEN A CONFLICT EXISTS AMONG THE VOTING BOARD MEMBERS, THAT BOARD MEMBER WILL ABSTAIN FROM VOTING ON THE CONFLICTED ISSUE. ALL EMPLOYEES AND DIRECTORS ARE ADVISED ANNUALLY OF THE REQUIREMENT TO REPORT ANY POTENTIAL CONFLICTS OF INTEREST AS THEY OCCUR. EMPLOYEES AND DIRECTORS MAY ALSO MAKE ANONYMOUS REPORTS OF ANY VIOLATIONS OF CORPORATE POLICIES THROUGH A DEDICATED WHISTLEBLOWER SYSTEM ADMINISTERED BY A THIRD PARTY. FORM 990, PART VI, SECTION B, LINE 15 CEO AND OTHER OFFICERS COMPENSATION ARE REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS IS PERFORMED, AT A MINIMUM, ANNUALLY. COMPENSATION WAS LAST REVIEWED BY DELTA DENTAL OF KENTUCKY'S COMPENSATION COMMITTEE IN THE FIRST QUARTER OF 2020. THE COMMITTEE IS MADE UP OF BOARD MEMBERS. THE COMMITTEE UTILIZES CERTAIN COMPENSATION SURVEYS AND OUTSIDE CONSULTANTS ARE ENGAGED AS NEEDED. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE FILED WITH THE KENTUCKY DEPARTMENT OF INSURANCE AND ARE AVAILABLE FOR INSPECTION BY THE PUBLIC THROUGH THAT AGENCY. ADDITIONALLY, THE COMPANY MAKES ORGANIZATIONAL DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS AVAILABLE AT NO COST UPON RECEIPT OF A WRITTEN REQUEST. 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 XI, LINE 9: EQUITY IN SUBSIDIARY -1,481,209. DENTAL CHOICE PROPERTIES LLC 10100 LINN STATION RD SUITE LOUISVILLE KY 40223 610659432 NO BUSINESS ACTIVITY KY 0 0 DELTA DENTAL OF KENTUCKY 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 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 INC 240 VENTURE CIRCLE NASHVILLE TN 37228 620812197 PROVIDE DENTAL SERVICE PLANS TN 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL PLAN OF NEW MEXICO INC 2500 LOUISIANA BLVD NE ALBUQUERQUE NM 87110 850224562 PROVIDE DENTAL SERVICE PLANS NM 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF NORTH CAROLINA 4242 SIX FORKS ROAD RALEIGH NC 27609 561018068 PROVIDE DENTAL SERVICE PLANS NC 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL PLAN OF OHIO INC PO BOX 30416 LANSING MI 489097916 310685339 PROVIDE DENTAL SERVICE PLANS OH 501(C)(4) N/A DELTA DENTAL PLAN OF MICHIGAN INC 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 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 ARKANSAS INC 1513 COUNTRY CLUB RD SHERWOOD AR 72120 710561140 PROVIDE DENTAL SERVICE PLANS AR 501(C)(4) NA RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF ARKANSAS FOUNDATION INC 1513 COUNTRY CLUB RD SHERWOOD AR 72120 261569324 PROVIDE DENTAL SERVICE PLANS AR 501(C)(3) PF RENAISSANCE HEALTH SERVICE CORPORATION 0 RENAISSANCE FAMILY FOUNDATION INC 4100 OKEMOS ROAD OKEMOS MI 48864 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 CHESME LLC 124 N BRIDGE ST DEWITT MI 48820 200061957 CAPITAL MANAGEMENT MI N/A 0 0 RED CEDAR INVESTMENT MANAGEMENT LLC 333 BRIDGE STREET NW SUITE 601 GRAND RAPIDS MI 49546 462667997 CAPITAL MANAGEMENT MI N/A 0 0 DH LOGIX LLC 1000 SOUTH MIAMI TRAIL SARASOTA FL 34236 815265121 CAPITAL MANAGEMENT DE N/A 0 0 DENTAL CHOICE INC 10100 LINN STATION RD SUITE 700 LOUISVILLE KY 40223 611105118 PROVIDE DENTAL SERVICE PLANS KY DELTA DENTAL OF KENTUCKY C -4087843 9497007 1.00000 1 DENTAL CHOICE AGENCY INC 10100 LINN STATION RD SUITE 700 LOUISVILLE KY 40223 611336003 PRIMARY GENERAL AGENCY FOR DDKY & DENTAL CHOICE KY DELTA DENTAL OF KENTUCKY C -600 1.00000 1 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK PO BOX 30381 LANSING MI 48909 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 60279 891208 0.05900 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA PO BOX 30381 LANSING MI 48909 470397286 INSURANCE IN RENAISSANCE HOLDING COMPANY C 468197 8072984 0.05900 0 RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI DELTA DENTAL OF MICHIGAN C 1781535 5369298 0.05900 0 DEWPOINT INC 300 S WASHIGNTON SQUARE LANSING MI 48933 383300595 COMPUTER CONSULTING MI N/A C 0 FORE HOLDING CORPORATION 240 VENTURE CIRCLE NASHVILLE TN 37228 204116122 EMPLOYEE BENEFITS TN N/A C 0 OMEGA ADMINISTRATORS INC 1513 COUNTRY CLUB ROAD SHERWOOD AR 72120 043740469 PROVIDE THIRD-PARTY ADMINISTRATIVE SERVICES AR N/A C 0 THE 4100 GROUP 4100 OKEMOS ROAD OKEMOS MI 48864 472557772 INVESTMENT IN SUBSIDIARIES MI N/A C 0 0 1 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 DELTA DENTAL PLAN OF MICHIGAN INC M 2771629 ACTUAL COST DENTAL CHOICE INC L 356243 ACTUAL COST DENTAL CHOICE INC B 9060000 ACTUAL COST