DELTA DENTAL PLAN OF MICHIGAN: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
DELTA DENTAL PLAN OF MICHIGAN (EIN 38-1791480)
Tax period
2019-01-01 to 2019-12-31
Filed
2020-11-11
IRS object ID
202013169349303446
Schema version
2019v5.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2020-11-11T13:39:36-06:00ReturnTs
Tax Period End2019-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN381357951PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORANPLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11111 MICHIGAN AVE PO BOX 2500AddressLine1Txt
CityEAST LANSINGCityNm
State AbbreviationMIStateAbbreviationCd
ZIP488262500ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN381791480EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL PLAN OF MICHIGAN INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlDELTBusinessNameControlTxt
Phone5173496000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14100 OKEMOS ROADAddressLine1Txt
CityOKEMOSCityNm
State AbbreviationMIStateAbbreviationCd
ZIP48864ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAMY BASELPersonNm
Person TitleCFOPersonTitleTxt
Phone5173496000PhoneNum
Signature2020-11-09SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDAVID LOWENTHAL CPAPreparerPersonNm
PTINP00378651PTIN
Phone5173326200PhoneNum
Preparation2020-11-09PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address68.62.32.134IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-11-09IPDt
IP Tm14:31:53IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdDA39A3EE5E6B4B0D3255BFEF95601890AFD80709AtSubmissionCreationDeviceId
At Submission Filing Device IdAFBDF4DF54CCD05CFBA4AEDC275F7F3808ECB98BAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-01-07 14:23:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerGORAN JURKOVICPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line14100 OKEMOS ROADAddressLine1Txt
CityOKEMOSCityNm
State AbbreviationMIStateAbbreviationCd
ZIP48864ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,081,514,242GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressWWW.DELTADENTALMI.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1957FormationYr
Legal Domicile StateMILegalDomicileStateCd
Activity Or MissionDELTA DENTAL OF MICHIGAN'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH DENTAL SERVICES THROUGH CONTRACTS WITH INDEPENDENT PROFESSIONAL SERVICE PROVIDERS, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL.ActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee1065TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$20,290,238TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$9,018NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$1,995,986,767PYProgramServiceRevenueAmt
CY Program Service Revenue$948,574,673CYProgramServiceRevenueAmt
PY Investment Income$12,760,244PYInvestmentIncomeAmt
CY Investment Income$15,071,350CYInvestmentIncomeAmt
PY Other Revenue$93,691,432PYOtherRevenueAmt
CY Other Revenue$85,732CYOtherRevenueAmt
PY Total Revenue$2,102,438,443PYTotalRevenueAmt
CY Total Revenue$963,731,755CYTotalRevenueAmt
PY Grants And Similar Paid$3,796,245PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$3,347,678CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$100,711,611PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$113,094,836CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$1,956,131,705PYOtherExpensesAmt
CY Other Expenses$842,318,595CYOtherExpensesAmt
PY Total Expenses$2,060,639,561PYTotalExpensesAmt
CY Total Expenses$958,761,109CYTotalExpensesAmt
PY Revenues Less Expenses$41,798,882PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$4,970,646CYRevenuesLessExpensesAmt
Total Assets BOY$797,772,708TotalAssetsBOYAmt
Total Assets EOY$732,148,013TotalAssetsEOYAmt
Total Liabilities BOY$282,802,365TotalLiabilitiesBOYAmt
Total Liabilities EOY$173,239,271TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$514,970,343NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$558,908,742NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionSEE SCHEDULE ODELTA DENTAL OF MICHIGAN'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH DENTAL SERVICES THROUGH 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.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$852,451,039ExpenseAmt
Grant$3,347,678GrantAmt
Revenue$928,284,435RevenueAmt
DescPROMOTING DENTAL CAREDELTA DENTAL PLAN OF MICHIGAN, INC. IS A LEADING PREPAID 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 2019 BY PAYING OUT OVER $676 MILLION FOR DENTAL CARE, BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 10.6 MILLION CLAIMS WERE PROCESSED FOR OVER 5.6 MILLION MEMBERS.COST 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 $37.2 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 2019, DELTA DENTAL FUND PROVIDED GRANTS TOTALING NEARLY $5.5 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 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 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. 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 ALLOW 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.Desc
Total Program Service Expenses$852,451,039TotalProgramServiceExpensesAmt
Described In Section501c30DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign ActyYes (1)PoliticalCampaignActyInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntYes (1)BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document63515IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee1065EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtYes (1)SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1AMY BASEL CFOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5173496000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14100 OKEMOS ROADAddressLine1Txt
CityOKEMOSCityNm
State AbbreviationMIStateAbbreviationCd
ZIP48864ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (36 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
GORAN JURKOVIC CPA
CEO, PRESIDENT34.0016.00Yes (X)$3,449,377$0$3,517,852
ANTHONY ROBINSON
SVP & CHIEF MKT OFFICER43.007.00Yes (X)$978,170$0$1,028,633
LAURA L CZELADA CPA
FORMER CEO, PRESIDENT - THRU 12/180.000.00$1,990,299$0$0Yes (X)
AMY BASEL
SENIOR VP, CFO, CRO34.0016.00Yes (X)$861,242$0$857,739
KENNETH THEIS
SVP & CIO50.000.00Yes (X)$703,485$0$275,666
TOBY HALL
SR VP, CHIEF ACTUARY & DATA OFFICER50.000.00Yes (X)$672,789$0$209,103
SUE ELLEN JENKINS
SVP & CHIEF LEGAL OFFICER31.0019.00Yes (X)$492,441$0$42,056
JOADI KECK
VP HR & ADMINISTRATION50.000.00$440,812$0$74,721Yes (X)
JEFF BOTKIN
SVP, BUSINESS SERVICES50.000.00Yes (X)$403,471$0$102,695
MICHAEL GILMORE
FORMER VP, CHIEF INVEST OFFICER0.0050.00$0$419,953$57,313Yes (X)
JEFFREY JOHNSTON
SVP, CHIEF SCIENCE OFFICER43.007.00Yes (X)$389,699$0$81,334
MARK BAUGHMAN
OPERATING CIO50.000.00$355,387$0$69,644Yes (X)
JOSEPH ELLSWORTH
VP & CHIEF TECHNOLOGY OFFICER50.000.00$368,946$0$53,920Yes (X)
MIKE BOBAK
VP SALES50.000.00$363,510$0$52,739Yes (X)
LORI WHEELRIGHT
VP SALES50.000.00$328,600$0$85,584Yes (X)
THOMAS FLESZAR DDS MS
DIRECTOR - THRU 5/195.0047.00$25,000$274,415$0Yes (X)
NANCY HOSTETLER
FORMER SRVP/CHIEF STAFF - THRU 12/180.000.00$279,142$0$0Yes (X)
JOSEPH C HARRIS DDS
IMMEDIATE PAST CHAIRPERSON5.006.00Yes (X)$205,762$30,004$0Yes (X)
STEPHEN A EKLUND
SECRETARY/TREASURER5.006.00Yes (X)$66,756$145,604$0Yes (X)
KAREN GREEN
FORMER VP INFOMAT/QUAL THRU 12/180.000.00$168,529$0$0Yes (X)
ANN MARIE FLERMOEN
DIRECTOR5.0011.00$60,000$75,328$0Yes (X)
CHRISTOPHER T FISHER
DIRECTOR5.0010.00$60,000$56,581$0Yes (X)
JOSHUA S HOWIE
VICE-CHAIRPERSON5.005.00Yes (X)$88,969$27,504$0Yes (X)
DOUGLAS R ANDERSON
DIRECTOR5.0010.00$48,666$44,161$19,000Yes (X)
KURT D GALLINGER
DIRECTOR5.005.00$60,000$24,996$0Yes (X)
KELLY JUBB SCHEIDERER
CHAIRPERSON5.006.00Yes (X)$53,745$30,460$0Yes (X)
SARA M DOLAN
DIRECTOR5.005.00$60,797$14,581$0Yes (X)
MELISSA STOLICKER
DIRECTOR5.005.00$60,000$14,581$0Yes (X)
RAYMOND F GIST DDS
DIRECTOR5.001.00$60,000$1,500$0Yes (X)
JED JACOBSON DDS MS MPH
DIRECTOR - THRU 5/195.002.00$29,500$12,915$0Yes (X)
ANDREW KOTARBA
DIRECTOR5.000.00$35,697$0$0Yes (X)
JEFFREY A KELLER
DIRECTOR - THRU 5/195.005.00$25,000$10,415$0Yes (X)
LARRY DEGROAT
DIRECTOR5.000.00$35,000$0$0Yes (X)
PATRICK GILLESPIE
DIRECTOR5.000.00$30,638$0$0Yes (X)
CHARLES E HALL
DIRECTOR - THRU 4/195.000.00$15,000$0$0Yes (X)
FRANK STUGLIN
DIRECTOR5.000.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$13,266,429TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,182,998TotReportableCompRltdOrgAmt
Total Other Compensation$6,527,999TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K225IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
DEWPOINT
300 WASHINGTON SQUARE SUITE 200LANSINGMI48933IT CONSULTING$56,025,333
WEST MONROE PARTNERS LLC
222 W ADAMS ST FL 11CHICAGOIL60606CONSULTING$8,120,965
THE CHRISTMAN COMPANY
208 N CAPITOL AVELANSINGMI48933CONSTRUCTION$5,938,453
CLARITY SOLUTION GROUP
150 SOUTH WACKER DRCHICAGOIL60606CONSULTING$4,562,864
MESSA
1480 KENDALE BLVDEAST LANSINGMI48826COMMISSIONS$2,546,786
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K94CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
DENTAL CARE REVENUE624100$840,833,495$840,833,495
ADMIN REIMBURSEMENT900099$87,450,940$87,450,940
EXTERNAL SERVICES524292$20,290,238$20,290,238
FieldValueIRS element (for citing)
Total Program Service Revenue$948,574,673TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$9,384,590TotalRevenueColumnAmt
Exclusion$9,384,590ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$123,328,097SecuritiesAmt
Other$141,150OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$114,784,600SecuritiesAmt
Other$2,997,887OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$8,543,497SecuritiesAmt
Other-$2,856,737OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$5,686,760TotalRevenueColumnAmt
Exclusion$5,686,760ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUS INCOMEDesc
Business900099BusinessCd
Total Revenue Column$85,732TotalRevenueColumnAmt
Exclusion$85,732ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$85,732OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$963,731,755TotalRevenueColumnAmt
Related Or Exempt Func Income$928,284,435RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$20,290,238UnrelatedBusinessRevenueAmt
Exclusion$15,157,082ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$3,347,678TotalAmt
Program Services$3,347,678ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$19,154,999TotalAmt
Program Services$12,450,750ProgramServicesAmt
Management And General$6,704,249ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$74,234,793TotalAmt
Program Services$46,155,116ProgramServicesAmt
Management And General$28,079,677ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$2,783,247TotalAmt
Program Services$1,501,688ProgramServicesAmt
Management And General$1,281,559ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$11,422,883TotalAmt
Program Services$6,935,563ProgramServicesAmt
Management And General$4,487,320ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$5,498,914TotalAmt
Program Services$3,476,307ProgramServicesAmt
Management And General$2,022,607ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$4,643,610TotalAmt
Program Services$1,435,510ProgramServicesAmt
Management And General$3,208,100ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$311,079TotalAmt
Management And General$311,079ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$467,333TotalAmt
Management And General$467,333ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$120,000TotalAmt
Management And General$120,000ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$1,202,168TotalAmt
Management And General$1,202,168ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$745,657,010TotalAmt
Program Services$722,869,390ProgramServicesAmt
Management And General$22,787,620ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$3,579,060TotalAmt
Program Services$2,225,260ProgramServicesAmt
Management And General$1,353,800ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$13,752,743TotalAmt
Program Services$9,261,404ProgramServicesAmt
Management And General$4,491,339ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$18,907,052TotalAmt
Program Services$11,003,273ProgramServicesAmt
Management And General$7,903,779ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$3,596,324TotalAmt
Management And General$3,596,324ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$5,898,002TotalAmt
Program Services$4,611,540ProgramServicesAmt
Management And General$1,286,462ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$912,170TotalAmt
Program Services$439,678ProgramServicesAmt
Management And General$472,492ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$61,604TotalAmt
Management And General$61,604ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$15,168,173TotalAmt
Program Services$2,459,319ProgramServicesAmt
Management And General$12,708,854ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,004,750TotalAmt
Management And General$1,004,750ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtManagement And GeneralManagementAndGeneralAmtProgram ServicesProgramServicesAmt
UBI TAX$601,214$601,214
COMMISSIONS$19,322,103$19,322,103
PROCESSING FEES$3,443,194$3,443,194
MEMBERSHIP DUES$2,053,689$1,857,102$196,587

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,617,317TotalAmt
Program Services$1,316,679ProgramServicesAmt
Management And General$300,638ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$958,761,109TotalAmt
Program Services$852,451,039ProgramServicesAmt
Management And General$106,310,070ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,120BOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$91,633,489BOYAmt
EOY$42,438,957EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$79,844,002BOYAmt
EOY$53,905,406EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$93,692,706BOYAmt
EOY$24,152,795EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$278,508,084LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$141,308,420LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$128,970,291BOYAmt
EOY$137,199,664EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$264,559,278BOYAmt
EOY$263,757,037EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$126,397,032BOYAmt
EOY$190,693,852EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$12,673,790BOYAmt
EOY$20,000,302EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$797,772,708BOYAmt
EOY$732,148,013EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$75,459,414BOYAmt
EOY$59,236,479EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$207,342,951BOYAmt
EOY$114,002,792EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$282,802,365BOYAmt
EOY$173,239,271EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$15,744,473BOYAmt
EOY$15,744,473EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$5,122,500BOYAmt
EOY$5,122,500EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$494,103,370BOYAmt
EOY$538,041,769EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$514,970,343BOYAmt
EOY$558,908,742EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$797,772,708BOYAmt
EOY$732,148,013EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$4,970,646ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$24,851,383NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$14,116,370OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Expended527 Activities$113,250Expended527ActivitiesAmt
Total Exempt Function Expend$113,250TotalExemptFunctionExpendAmt
Form1120 POL FiledYes (1)Form1120POLFiledInd

Section527 Political Org Section527PoliticalOrgGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPaid Internal FundsPaidInternalFundsAmt
PROGRESSIVE ADVOCACY TRUST
PO BOX 322EAST LANSINGMI48826273504026$100,000
MOVING MACOMB
106 W ALLEGAN STE 200LANSINGMI48933833929631$1,250
BUSINESS LEADERS FOR MICHIGAN PAC II
600 RENAISSANCE CENTERDETROITMI48243273999229$10,000
LEADING MICHIGAN FORWARD FUND
620 NORTH KANE RDWEBBERVILLEMI48892473449374$1,000
ADVANCING MICHIGAN FUND
11728 GOLD FIELDS DRGRAND LEDGEMI48837842657786$500
MAKING MICHIGAN BETTER
106 ALLEGANLANSINGMI48933841960014$500
FieldValueIRS element (for citing)
Substantially All Dues NondedYes (1)SubstantiallyAllDuesNondedInd
Only In House Lobbying0OnlyInHouseLobbyingInd
Agree Carryover Prior Year0AgreeCarryoverPriorYearInd

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,377,498OtherCostOrOtherBasisAmt
Book Value$1,377,498BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$106,973,613OtherCostOrOtherBasisAmt
Depreciation$40,366,186DepreciationAmt
Book Value$66,607,427BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$60,887,484OtherCostOrOtherBasisAmt
Depreciation$42,047,091DepreciationAmt
Book Value$18,840,393BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$109,269,489OtherCostOrOtherBasisAmt
Depreciation$58,895,143DepreciationAmt
Book Value$50,374,346BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$137,199,664TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (3 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
DDIC STOCK$200,217C
INVESTMENT IN RHC$72,277,257F
INVESTMENT IN THE 4100 GROUP$118,216,378F
FieldValueIRS element (for citing)
Total Book Value Securities$190,693,852TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
IBNR - CLAIM ADJUSTMENT RESERVES$19,114,109
UNEARNED PREMIUMS$24,486,595
PENSION AND POST RETIREMENT OBLIGATIONS$61,976,015
DUE TO AFFILIATES$8,426,073
FieldValueIRS element (for citing)
Total Liability$114,002,792TotalLiabilityAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (18 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtValuation Method UsedValuationMethodUsedDescPurpose Of GrantPurposeOfGrantTxt
DELTA DENTAL FUND
4100 OKEMOS RDOKEMOSMI48864382337000501(C)(3)$1,000,000CASHCHARITABLE DONATION
LEAP INC
1000 S WASHINGTON AVELANSINGMI48933208132313501(C)(6)$35,000CASHCHARITABLE DONATION
SPARROW FOUNDATION
PO BOX 30480LANSINGMI48909386100687501(C)(3)$254,680CASHCHARITABLE DONATION
MICHIGAN ECONOMIC DEVELOPMENT FOUNDATION
PO BOX 13063LANSINGMI48901382527475501(C)(3)$25,000CASHCHARITABLE DONATION
AMERICAN CANCER SOCIETY
20450 CIVIC CENTER DRSOUTHFIELDMI48076131788491501(C)(3)$33,000CASHCHARITABLE DONATION
ELE'S PLACE
1145 WEST OAKLANDLANSINGMI48915382976751501(C)(3)$130,000CASHCHARITABLE DONATION
GREATER LANSING FOODBANK
5303 S CEDAR STLANSINGMI48911382424756501(C)(3)$29,026CASHCHARITABLE DONATION
LANSING PROMISE
330 MARSHALL STLANSINGMI48912453363322501(C)(3)$25,000CASHCHARITABLE DONATION
ITEC - LANSING
200 N FOSTER AVELANSINGMI48912261077810501(C)(3)$20,000CASHCHARITABLE DONATION
LANSING PROTO INC
1000 S WASHINGTON AVELANSINGMI48910811973019$75,000CASHCHARITABLE DONATION
WAYNE KIDS WIN
1001 WOODWARD AVEDETROITMI48226843040262$20,000CASHCHARITABLE DONATION
CAPITAL REGION COMMUNITY FOUNDATION
1048 PIERPONT STE 4LANSINGMI48913382776652501(C)(3)$250,000CASHCHARITABLE DONATION
MANY HANDS INC
319 W GRAND RIVER AVENUEWILLIAMSTONMI48895454444119501(C)(3)$210,972CASHCHARITABLE DONATION
DETROIT RIVERFRONT CONSERVANCY
600 RENAISSANCE CENTERDETROITMI48243300125283501(C)(3)$1,000,000CASHCHARITABLE DONATION
JUVENILE DIABETES RESEARCH FOUNDATION
24359 NORTHWESTERN HWYSOUTHFIELDMI48075231907729501(C)(3)$25,000CASHCHARITABLE DONATION
PLAYMAKERS FITNESS FOUNDATION
2299 W GRAND RIVER AVEOKEMOSMI48864270931383501(C)(3)$15,000CASHCHARITABLE DONATION
FORGOTTEN HARVEST
21800 GREENFIELD RDOAK PARKMI48237382926476501(C)(3)$150,000CASHCHARITABLE DONATION
JUNIOR ACHIEVEMENT OF SOUTHEASTERN MI
577 E LARNED STDETROITMI48226381348535501(C)(3)$50,000CASHCHARITABLE DONATION
FieldValueIRS element (for citing)
Total501c3 Org15Total501c3OrgCnt
Total Other Org3TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationCONTRIBUTIONS 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 PLAYGROUNT ON DETROIT'S WEST RIVERFRONT. CAPITAL REGION COMMUNITY FOUNDATION - DELTA DENTAL OF MICHIGAN CONTRIBUTED $250,000 TO BUILD A PLAZA PORTION OF THE NEW ROTARY PARK LOCATED ON THE GRAND RIVER, TO PROMOTE OUTDOOR ACTVITY IN THIS AREA OF THE CITY. MANY HANDS INC - DELTA DENTAL OF MICHIGAN CONTRIBUTED $210,972 FOR WEEKEND SURVIVAL KITS. THIS SUPPORTS CHILDREN IN THREE LANSING AND ONE DETROIT PUBLIC SCHOOL AND PROVIDES THEM WITH A BAG OF FOOD EACH WEEKEND FOR THE ENTIRE SCHOOL YEAR. FORGOTTEN HARVEST - DELTA DENTAL OF MICHIGAN CONTRIBUTED $150,000 TO THIS FOOD RESCUE/FOOD BANK PROGRAM OPERATING IN THE DETROIT AREA. THEY PROVIDE LUNCHES FOR CHILDREN PARTICIPATING IN THE DETROIT PUBLIC LIBRARY SUMMER CAMP PROGRAMS AS WELL AS OPERATE SEVERAL FARMERS MARKET STYLE FOOD BANK DISTRIBUTION SITES THROUGHOUT SOUTHEASTERN MICHIGAN. SPARROW FOUNDATION - DELTA DENTAL OF MICHIGAN CONTRIBUTED A TOTAL OF $254,680 TO THE SPARROW FOUNDATION IN 2019 TO SUPPORT BOTH THE DAPPER DADS EVENT AND THE SPARROW FOUNDATION GALA. BOTH OF THESE EVENTS RAISED FUNDS TO SUPPORT PROGRAMS THAT BENEFIT THE PHYSICAL AND PSYCHOLOGICAL HEALTH OF WOMEN IN MID-MICHIGAN. ELE'S PLACE - IN 2019, DELTA DENTAL OF MICHIGAN PROVIDED $130,000 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. LANSING PROMISE - DELTA DENTAL PROVIDED $25,000 IN FUNDING TO THE LANSING PROMISE IN 2019. 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.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
First Class Or Charter TravelYes (X)FirstClassOrCharterTravelInd
Travel For CompanionsYes (X)TravelForCompanionsInd
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (20 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
GORAN JURKOVIC CPA
CEO, PRESIDENT$1,282,448$0$2,145,000$0$21,929$0$3,493,671$0$24,181$0$6,967,229$0$0$0
ANTHONY ROBINSON
SVP & CHIEF MKT OFFICER$465,774$0$496,676$0$15,720$0$1,004,452$0$24,181$0$2,006,803$0$0$0
LAURA L CZELADA CPA
FORMER CEO, PRESIDENT - THRU 12/18$230,218$0$1,759,984$0$97$0$0$0$0$0$1,990,299$0$0$0
AMY BASEL
SENIOR VP, CFO, CRO$407,808$0$436,800$0$16,634$0$833,558$0$24,181$0$1,718,981$0$0$0
KENNETH THEIS
SVP & CIO$336,315$0$359,581$0$7,589$0$251,485$0$24,181$0$979,151$0$0$0
TOBY HALL
SR VP, CHIEF ACTUARY & DATA OFFICER$312,213$0$337,929$0$22,647$0$193,778$0$15,325$0$881,892$0$0$0
SUE ELLEN JENKINS
SVP & CHIEF LEGAL OFFICER$371,616$0$110,775$0$10,050$0$26,731$0$15,325$0$534,497$0$0$0
JOADI KECK
VP HR & ADMINISTRATION$308,187$0$105,329$0$27,296$0$57,786$0$16,935$0$515,533$0$0$0
JEFF BOTKIN
SVP, BUSINESS SERVICES$270,540$0$117,000$0$15,931$0$85,760$0$16,935$0$506,166$0$0$0
MICHAEL GILMORE
FORMER VP, CHIEF INVEST OFFICER$0$299,101$0$115,060$0$5,792$0$34,525$0$22,788$0$477,266$0$0
JEFFREY JOHNSTON
SVP, CHIEF SCIENCE OFFICER$280,640$0$104,442$0$4,617$0$57,153$0$24,181$0$471,033$0$0$0
MARK BAUGHMAN
OPERATING CIO$249,455$0$98,594$0$7,338$0$52,709$0$16,935$0$425,031$0$0$0
JOSEPH ELLSWORTH
VP & CHIEF TECHNOLOGY OFFICER$275,738$0$50,619$0$42,589$0$29,739$0$24,181$0$422,866$0$0$0
MIKE BOBAK
VP SALES$171,317$0$190,400$0$1,793$0$28,558$0$24,181$0$416,249$0$0$0
LORI WHEELRIGHT
VP SALES$171,261$0$154,801$0$2,538$0$68,649$0$16,935$0$414,184$0$0$0
THOMAS FLESZAR DDS MS
DIRECTOR - THRU 5/19$25,000$274,415$0$0$0$0$0$0$0$0$25,000$274,415$0$0
NANCY HOSTETLER
FORMER SRVP/CHIEF STAFF - THRU 12/18$16,102$0$216,264$0$46,776$0$0$0$0$0$279,142$0$0$0
JOSEPH C HARRIS DDS
IMMEDIATE PAST CHAIRPERSON$205,762$30,004$0$0$0$0$0$0$0$0$205,762$30,004$0$0
STEPHEN A EKLUND
SECRETARY/TREASURER$66,756$145,604$0$0$0$0$0$0$0$0$66,756$145,604$0$0
KAREN GREEN
FORMER VP INFOMAT/QUAL THRU 12/18$59,292$0$90,001$0$19,236$0$0$0$0$0$168,529$0$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1ATHE ORGANIZATION ALLOWS FOR FIRST CLASS TRAVEL IN CERTAIN CIRCUMSTANCES AS NEEDED FOR BUSINESS PURPOSES FOR ONLY THE MOST SENIOR EXECUTIVES AND KEY EMPLOYEES. THIS AMOUNT WAS TREATED AS NONTAXABLE TO THESE INDIVIDUALS. TRAVEL FOR COMPANIONS RELATED TO TRAVEL FOR A SPOUSE. THIS AMOUNT WAS TREATED AS TAXABLE TO THE BOARD MEMBER OR EMPLOYEE. VARIOUS INDIVIDUALS ON SCHEDULE J ARE ELIGIBLE FOR REIMBURSEMENT OF SUBSTANTIATED HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES THAT HAVE A BUSINESS PURPOSE. THIS BENEFIT IS NOT TAXABLE BUT THE EXPENSE MUST BE SUBSTANTIATED AS A BUSINESS EXPENSE.
PART I, LINE 3THE 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 4BDELTA 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 2019, GORAN JURKOVIC, AMY BASEL, TOBY HALL, KENNETH THEIS, AND ANTHONY ROBINSON ACCRUED BENEFITS AS PARTICIPANTS IN THE SERP PLAN, BUT DID NOT RECEIVE A DISTRIBUTION.
PART I, LINE 7AS 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.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (6 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
JOSEPH CARTER HARRIS DDS
JOSEPH HARRIS, CHAIR OF DDPMI, IS AN OWNER OF JOSEPH CARTER HARRIS DDS$139,762PAYMENTS FOR CONSULTING SERVICES0
BRIAN JACOBSON
BROTHER OF DDPMI BOARD MEMBER JED JACOBSON$235,499EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN0
COLE JACOBSON
BROTHER OF DDPMI BOARD MEMBER JED JACOBSON$136,859EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN0
CHRIS FISHER
DIRECTOR ON BOARD OF DDMI$116,449PRESIDENT OF KEYSER INSURANCE AGENCY0
TERI BATTAGLIERI
SPOUSE OF DDPMI FORMER KEY EMPLOYEE LUIGI BATTAGLIERI$105,957EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN0
BRIAN BATTAGLIERI
SON OF DDPMI FORMER KEY EMPLOYEE LUIGI BATTAGLIERI$159,815EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6DELTA DENTAL PLAN OF MICHIGAN HAS A SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7ATHE SOLE MEMBER HAS VOTING RIGHTS AND ELECTS DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7BTHE 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 11BTHE 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. THIS IS DONE BEFORE THE RETURN IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CTHE COMPANY'S SENIOR VICE PRESIDENT, GENERAL COUNSEL, AND COMPLIANCE OFFICER 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 SENIOR VICE PRESIDENT, GENERAL COUNSEL, AND COMPLIANCE OFFICER. IF A PROHIBITED TRANSACTION IS IDENTIFIED, THE MATTER IS ESCALATED TO THE CEO AND TO THE AUDIT, FINANCE, AND RISK 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 15COMPENSATION 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 2018. COMPENSATION DECISIONS ARE MADE UTILIZING THE DATA PROVIDED BY TOWERS WATSON.
FORM 990, PART VI, SECTION C, LINE 19NO 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 11GCONTRACT LABOR: PROGRAM SERVICE EXPENSES 38,328,205. MANAGEMENT AND GENERAL EXPENSES 17,989,153. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 56,317,358. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 4,918,648. MANAGEMENT AND GENERAL EXPENSES 4,798,467. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,717,115. DENTAL CONSULTANT: PROGRAM SERVICE EXPENSES 1,519,335. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,519,335. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 676,761,702. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 676,761,702. CONSULTING: PROGRAM SERVICE EXPENSES 1,341,500. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,341,500.
FORM 990, PART XI, LINE 9:GAIN ON EQUITY IN SUBSIDIARIES 3,327,042. PENSION RELATED CHANGES 10,789,328.
FORM 990 PART XII LINE 2C AND 2D:DELTA DENTAL PLAN OF MICHIGAN IS AUDITED BY AN INDEPENDENT ACCOUNTANT AS PART OF A CONSOLIDATED FINANCIAL STATEMENT ISSUED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. DELTA DENTAL PLAN OF MICHIGAN ALSO RECEIVES AN AUDITED FINANCIAL STATEMENT BY AN INDEPENDENT ACCOUNTANT THAT IS PREPARED ON A STATUTORY BASIS. THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
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).
FORM 990, PART I, LINE 12 AND 18:AS OF JANUARY 1, 2019, THE COMPANY ADOPTED FASB ASU NO. 2014-09, REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606). THE ASU IS BASED ON THE PRINCIPLE THAT REVENUE IS RECOGNIZED TO DEPICT THE TRANSFER OF GOODS OR SERVICES TO CUSTOMERS IN AN AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE ENTITY EXPECTS TO BE ENTITLED IN EXCHANGE FOR THOSE GOODS OR SERVICES. THE COMPANY'S REVENUE CONSISTS OF DENTAL CARE CONTRACTS, ADMINISTRATIVE SERVICE CONTRACTS, AND ADMINISTRATIVE FEES. ADMINISTRATIVE SERVICES CONTRACTS IN PLACE WITH CUSTOMERS PROVIDE ACCESS TO A NETWORK OF DENTAL PROVIDERS AND SERVICE COST PROCESSING SERVICES. AS A RESULT, ADMINISTRATIVE SERVICES CONTRACTS ARE NOT ACCOUNTED FOR AS DENTAL CARE CONTRACTS. PRIOR TO THE ADOPTION OF ASU 2014-09, ADMINISTRATIVE SERVICE CONTRACTS WERE REPORTED ON A GROSS BASIS. UPON ADOPTION OF ASU 2014-09 ADMINISTRATIVE SERVICE CONTRACTS ARE REPORTED NET AND ONLY THE ADMINISTRATIVE FEES ARE REPORTED AS DENTAL CARE REVENUE. THE CHANGE IN ACCOUNTING PRINCIPLE HAD NO CUMULATIVE EFFECT ON JANUARY 1, 2018 NET ASSETS. DURING 2019, THE COMPANY PAID DENTAL SERVICE EXPENSES, AND RECEIVED REIMBURSEMENT, TOTALING $1,183,060,445, WHICH HAS BEEN EXCLUDED FROM PROGRAM SERVICE REVENUE AND PURCHASED DENTAL SERVICE EXPENSE IN ACCORDANCE WITH ASU 2014-09.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (12 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
RENAISSANCE HEALTH SERVICE CORPORATION
PO BOX 30416LANSINGMI489097916381675667PROMOTING DENTAL CAREMI501(C)(4)N/AN/A0
DELTA DENTAL PLAN OF OHIO INC
PO BOX 30416LANSINGMI489097916310685339PROVIDE DENTAL SERVICE PLANSOH501(C)(4)N/AYes (1)DELTA DENTAL PLAN OF MICHIGAN INC
DELTA DENTAL PLAN OF INDIANA INC
PO BOX 30416LANSINGMI489097916351545647PROVIDE DENTAL SERVICE PLANSIN501(C)(4)N/AYes (1)DELTA DENTAL PLAN OF MICHIGAN INC
DELTA DENTAL OF TENNESSEE
240 VENTURE CIRCLENASHVILLETN37228620812197PROVIDE DENTAL SERVICE PLANSTN501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL FUND
PO BOX 30416LANSINGMI489097916382337000SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMSMI501(C)(3)LINE 12A, IYes (1)DELTA DENTAL PLAN OF MICHIGAN INC
DELTA DENTAL PLAN OF NEW MEXICO INC
2500 LOUISIANA BLVD NEALBUQUERQUENM87110850224562PROVIDE DENTAL SERVICE PLANSNM501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL OF KENTUCKY INC
10100 LINN STATION ROAD NO 700LOUISVILLEKY40223610659432PROVIDE DENTAL SERVICE PLANSKY501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL OF NORTH CAROLINA
4242 SIX FORKS ROADRALEIGHNC27609561018068PROVIDE DENTAL SERVICE PLANSNC501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL PLAN OF ARKANSAS INC
1513 COUNTRY CLUB RDSHERWOODAR72120710561140PROVIDE DENTAL SERVICE PLANSAR501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL OF ARKANSAS FOUNDATION INC
1513 COUNTRY CLUB RDSHERWOODAR72120261569324EMPHASIZE DENTAL HEALTH IN COMMUNITIESAR501(C)(3)PF0DELTA DENTAL OF ARKANSAS
RENAISSANCE FAMILY FOUNDATION INC
4100 OKEMOS RDOKEMOSMI48864461376165EMPHASIZE DENTAL HEALTH IN COMMUNITIESIN501(C)(3)PF0RENAISSANCE HOLDING COMPANY
SMILE 180 FOUNDATION
240 VENTURE CIRCLENASHVILLETN37228471654054EMPHASIZE DENTAL HEALTH IN COMMUNITIESTN501(C)(3)LINE 12A, I0DELTA DENTAL OF TENNESSEE INC

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1CHESME LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1124 N BRIDGE STAddressLine1Txt
CityDEWITTCityNm
State AbbreviationMIStateAbbreviationCd
ZIP48820ZIPCd
FieldValueIRS element (for citing)
EIN200061957EIN
Primary ActivitiesCAPITAL MANAGEMENTPrimaryActivitiesTxt
Legal Domicile StateMILegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1THE 4100 GROUPBusinessNameLine1Txt
FieldValueIRS element (for citing)
Predominant Income TypeRELATEDPredominantIncomeTypeTxt
Share Of Total Income$350,711ShareOfTotalIncomeAmt
Share Of EOY Assets$2,583,304ShareOfEOYAssetsAmt
Disproportionate Allocations0DisproportionateAllocationsInd
General Or Managing Partner0GeneralOrManagingPartnerInd
Ownership0.59250OwnershipPct

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
RENAISSANCE HOLDING COMPANY
PO BOX 30381LANSINGMI48909412177193HOLDING COMPANYMIDELTA DENTAL OF MICHIGANC-$1,652,341$26,799,8720.58000Yes (1)
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA
PO BOX 30381LANSINGMI48909470397286INSURANCEINRENAISSANCE HOLDING COMPANYC$2,788,788$68,353,4330.58000Yes (1)
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK
PO BOX 30381LANSINGMI48909134098096INSURANCENYRENAISSANCE HOLDING COMPANYC$122,721$7,161,7800.58000Yes (1)
FORE HOLDING CORPORATION
240 VENTURE CIRCLENASHVILLETN37228204116122HOLDING COMPANYTNC0N/A
DENTAL CHOICE INC
10100 LINN STATION ROAD SUITE 700LOUISVILLEKY40223611105118PROVIDE DENTAL SERVICE PLANSKYC0N/A
DENTAL CHOICE AGENCY INC
10100 LINN STATION RD SUITE 700LOUISVILLEKY40223611336003PRIMARY GENERAL AGENCY FOR DDKY & DENTAL CHOICEKYC0N/A
OMEGA ADMINISTRATORS INC
1513 COUNTRY CLUB ROADSHERWOODAR72120043740469PROVIDING THIRD-PARTY ADMINISTRATIVE SERVICESARC0N/A
THE 4100 GROUP
4100 OKEMOS ROADOKEMOSMI48864472557772INVESTMENT IN SUBSIDIARIESMIDELTA DENTAL OF MICHIGANC-$2,304,967$79,999,4730.75000Yes (1)
DEWPOINT INC
300 S WASHINGTON SQUARELANSINGMI48933383300595IT CONSULTINGMITHE 4100 GROUPC$5,890,639$46,873,3760.75000Yes (1)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (1)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (17 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
DELTA DENTAL OF TENNESSEE
L$5,213,439ACTUAL COST
DELTA DENTAL PLAN OF OHIO INC
L$38,461,035ACTUAL COST
DELTA DENTAL PLAN OF INDIANA INC
L$13,593,293ACTUAL COST
DELTA DENTAL FUND
L$868,809ACTUAL COST
RENAISSANCE LIFE AND HEALTH INSURANCE COMPANY OF AMERICA
L$4,659,028ACTUAL COST
DELTA DENTAL PLAN OF NEW MEXICO INC
L$2,248,402ACTUAL COST
DELTA DENTAL OF KENTUCKY INC
L$2,893,771ACTUAL COST
DELTA DENTAL OF NORTH CAROLINA
L$4,347,811ACTUAL COST
RENAISSANCE ELECTRONIC SERVICES LLC
L$112,975ACTUAL COST
DELTA DENTAL PLAN OF ARKANSAS INC
L$7,185,378ACTUAL COST
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK
L$75,245ACTUAL COST
RENAISSANCE HOLDING COMPANY
L$746,026ACTUAL COST
DELTA DENTAL OF NORTH CAROLINA
A$5,640ACTUAL COST
RENAISSANCE HEALTH SERVICE CORPORATION
L$14,813ACTUAL COST
DELTA DENTAL FUND
B$1,000,000ACTUAL COST
DEWPOINT
L$432,333ACTUAL COST
THE 4100 GROUP
L$190,635ACTUAL COST

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