2020-11-11T13:39:36-06:00 2019-12-31 381357951 PLANTE & MORANPLLC 1111 MICHIGAN AVE PO BOX 2500 EAST LANSING MI 488262500 990 2019-01-01 381791480 DELTA DENTAL PLAN OF MICHIGAN INC DELT 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 AMY BASEL CFO 5173496000 2020-11-09 1 DAVID LOWENTHAL CPA P00378651 5173326200 2020-11-09 68.62.32.134 2020-11-09 14:31:53 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 AFBDF4DF54CCD05CFBA4AEDC275F7F3808ECB98B 2019 2022-01-07 14:23:13Z GORAN JURKOVIC 4100 OKEMOS ROAD OKEMOS MI 48864 1081514242 0 X WWW.DELTADENTALMI.COM X 1957 MI DELTA DENTAL OF MICHIGAN'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH DENTAL SERVICES 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. 15 11 1065 0 20290238 9018 0 0 1995986767 948574673 12760244 15071350 93691432 85732 2102438443 963731755 3796245 3347678 0 0 100711611 113094836 0 0 0 1956131705 842318595 2060639561 958761109 41798882 4970646 797772708 732148013 282802365 173239271 514970343 558908742 X SEE 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. 0 0 852451039 3347678 928284435 PROMOTING 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. 852451039 0 0 1 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 1 1 0 0 0 0 0 1 1 1 0 1 63515 0 1 1065 1 1 1 0 0 0 0 0 1 0 X 15 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X AMY BASEL CFO 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 X GORAN JURKOVIC CPA CEO, PRESIDENT 34.00 16.00 X 3449377 0 3517852 ANTHONY ROBINSON SVP & CHIEF MKT OFFICER 43.00 7.00 X 978170 0 1028633 LAURA L CZELADA CPA FORMER CEO, PRESIDENT - THRU 12/18 0.00 0.00 X 1990299 0 0 AMY BASEL SENIOR VP, CFO, CRO 34.00 16.00 X 861242 0 857739 KENNETH THEIS SVP & CIO 50.00 0.00 X 703485 0 275666 TOBY HALL SR VP, CHIEF ACTUARY & DATA OFFICER 50.00 0.00 X 672789 0 209103 SUE ELLEN JENKINS SVP & CHIEF LEGAL OFFICER 31.00 19.00 X 492441 0 42056 JOADI KECK VP HR & ADMINISTRATION 50.00 0.00 X 440812 0 74721 JEFF BOTKIN SVP, BUSINESS SERVICES 50.00 0.00 X 403471 0 102695 MICHAEL GILMORE FORMER VP, CHIEF INVEST OFFICER 0.00 50.00 X 0 419953 57313 JEFFREY JOHNSTON SVP, CHIEF SCIENCE OFFICER 43.00 7.00 X 389699 0 81334 MARK BAUGHMAN OPERATING CIO 50.00 0.00 X 355387 0 69644 JOSEPH ELLSWORTH VP & CHIEF TECHNOLOGY OFFICER 50.00 0.00 X 368946 0 53920 MIKE BOBAK VP SALES 50.00 0.00 X 363510 0 52739 LORI WHEELRIGHT VP SALES 50.00 0.00 X 328600 0 85584 THOMAS FLESZAR DDS MS DIRECTOR - THRU 5/19 5.00 47.00 X 25000 274415 0 NANCY HOSTETLER FORMER SRVP/CHIEF STAFF - THRU 12/18 0.00 0.00 X 279142 0 0 JOSEPH C HARRIS DDS IMMEDIATE PAST CHAIRPERSON 5.00 6.00 X X 205762 30004 0 STEPHEN A EKLUND SECRETARY/TREASURER 5.00 6.00 X X 66756 145604 0 KAREN GREEN FORMER VP INFOMAT/QUAL THRU 12/18 0.00 0.00 X 168529 0 0 ANN MARIE FLERMOEN DIRECTOR 5.00 11.00 X 60000 75328 0 CHRISTOPHER T FISHER DIRECTOR 5.00 10.00 X 60000 56581 0 JOSHUA S HOWIE VICE-CHAIRPERSON 5.00 5.00 X X 88969 27504 0 DOUGLAS R ANDERSON DIRECTOR 5.00 10.00 X 48666 44161 19000 KURT D GALLINGER DIRECTOR 5.00 5.00 X 60000 24996 0 KELLY JUBB SCHEIDERER CHAIRPERSON 5.00 6.00 X X 53745 30460 0 SARA M DOLAN DIRECTOR 5.00 5.00 X 60797 14581 0 MELISSA STOLICKER DIRECTOR 5.00 5.00 X 60000 14581 0 RAYMOND F GIST DDS DIRECTOR 5.00 1.00 X 60000 1500 0 JED JACOBSON DDS MS MPH DIRECTOR - THRU 5/19 5.00 2.00 X 29500 12915 0 ANDREW KOTARBA DIRECTOR 5.00 0.00 X 35697 0 0 JEFFREY A KELLER DIRECTOR - THRU 5/19 5.00 5.00 X 25000 10415 0 LARRY DEGROAT DIRECTOR 5.00 0.00 X 35000 0 0 PATRICK GILLESPIE DIRECTOR 5.00 0.00 X 30638 0 0 CHARLES E HALL DIRECTOR - THRU 4/19 5.00 0.00 X 15000 0 0 FRANK STUGLIN DIRECTOR 5.00 0.00 X 0 0 0 13266429 1182998 6527999 225 1 1 0 DEWPOINT 300 WASHINGTON SQUARE SUITE 200 LANSING MI 48933 IT CONSULTING 56025333 WEST MONROE PARTNERS LLC 222 W ADAMS ST FL 11 CHICAGO IL 60606 CONSULTING 8120965 THE CHRISTMAN COMPANY 208 N CAPITOL AVE LANSING MI 48933 CONSTRUCTION 5938453 CLARITY SOLUTION GROUP 150 SOUTH WACKER DR CHICAGO IL 60606 CONSULTING 4562864 MESSA 1480 KENDALE BLVD EAST LANSING MI 48826 COMMISSIONS 2546786 94 DENTAL CARE REVENUE 624100 840833495 840833495 ADMIN REIMBURSEMENT 900099 87450940 87450940 EXTERNAL SERVICES 524292 20290238 20290238 948574673 9384590 9384590 123328097 141150 114784600 2997887 8543497 -2856737 5686760 5686760 MISCELLANEOUS INCOME 900099 85732 85732 85732 963731755 928284435 20290238 15157082 X 3347678 3347678 19154999 12450750 6704249 74234793 46155116 28079677 2783247 1501688 1281559 11422883 6935563 4487320 5498914 3476307 2022607 4643610 1435510 3208100 311079 311079 467333 467333 120000 120000 1202168 1202168 745657010 722869390 22787620 3579060 2225260 1353800 13752743 9261404 4491339 18907052 11003273 7903779 3596324 3596324 5898002 4611540 1286462 912170 439678 472492 61604 61604 15168173 2459319 12708854 1004750 1004750 UBI TAX 601214 601214 COMMISSIONS 19322103 19322103 PROCESSING FEES 3443194 3443194 MEMBERSHIP DUES 2053689 196587 1857102 1617317 1316679 300638 958761109 852451039 106310070 0 2120 91633489 42438957 79844002 53905406 93692706 24152795 278508084 141308420 128970291 137199664 264559278 263757037 126397032 190693852 12673790 20000302 797772708 732148013 75459414 59236479 207342951 114002792 282802365 173239271 X 15744473 15744473 5122500 5122500 494103370 538041769 514970343 558908742 797772708 732148013 X 4970646 24851383 14116370 X X 0 1 X 1 0 113250 113250 1 PROGRESSIVE ADVOCACY TRUST PO BOX 322 EAST LANSING MI 48826 273504026 100000 MOVING MACOMB 106 W ALLEGAN STE 200 LANSING MI 48933 833929631 1250 BUSINESS LEADERS FOR MICHIGAN PAC II 600 RENAISSANCE CENTER DETROIT MI 48243 273999229 10000 LEADING MICHIGAN FORWARD FUND 620 NORTH KANE RD WEBBERVILLE MI 48892 473449374 1000 ADVANCING MICHIGAN FUND 11728 GOLD FIELDS DR GRAND LEDGE MI 48837 842657786 500 MAKING MICHIGAN BETTER 106 ALLEGAN LANSING MI 48933 841960014 500 1 0 0 1377498 1377498 106973613 40366186 66607427 60887484 42047091 18840393 109269489 58895143 50374346 137199664 DDIC STOCK 200217 C INVESTMENT IN RHC 72277257 F INVESTMENT IN THE 4100 GROUP 118216378 F 190693852 IBNR - CLAIM ADJUSTMENT RESERVES 19114109 UNEARNED PREMIUMS 24486595 PENSION AND POST RETIREMENT OBLIGATIONS 61976015 DUE TO AFFILIATES 8426073 114002792 1 DELTA DENTAL FUND 4100 OKEMOS RD OKEMOS MI 48864 382337000 501(C)(3) 1000000 CASH CHARITABLE DONATION LEAP INC 1000 S WASHINGTON AVE LANSING MI 48933 208132313 501(C)(6) 35000 CASH CHARITABLE DONATION SPARROW FOUNDATION PO BOX 30480 LANSING MI 48909 386100687 501(C)(3) 254680 CASH CHARITABLE DONATION MICHIGAN ECONOMIC DEVELOPMENT FOUNDATION PO BOX 13063 LANSING MI 48901 382527475 501(C)(3) 25000 CASH CHARITABLE DONATION AMERICAN CANCER SOCIETY 20450 CIVIC CENTER DR SOUTHFIELD MI 48076 131788491 501(C)(3) 33000 CASH CHARITABLE DONATION ELE'S PLACE 1145 WEST OAKLAND LANSING MI 48915 382976751 501(C)(3) 130000 CASH CHARITABLE DONATION GREATER LANSING FOODBANK 5303 S CEDAR ST LANSING MI 48911 382424756 501(C)(3) 29026 CASH CHARITABLE DONATION LANSING PROMISE 330 MARSHALL ST LANSING MI 48912 453363322 501(C)(3) 25000 CASH CHARITABLE DONATION ITEC - LANSING 200 N FOSTER AVE LANSING MI 48912 261077810 501(C)(3) 20000 CASH CHARITABLE DONATION LANSING PROTO INC 1000 S WASHINGTON AVE LANSING MI 48910 811973019 75000 CASH CHARITABLE DONATION WAYNE KIDS WIN 1001 WOODWARD AVE DETROIT MI 48226 843040262 20000 CASH CHARITABLE DONATION CAPITAL REGION COMMUNITY FOUNDATION 1048 PIERPONT STE 4 LANSING MI 48913 382776652 501(C)(3) 250000 CASH CHARITABLE DONATION MANY HANDS INC 319 W GRAND RIVER AVENUE WILLIAMSTON MI 48895 454444119 501(C)(3) 210972 CASH CHARITABLE DONATION DETROIT RIVERFRONT CONSERVANCY 600 RENAISSANCE CENTER DETROIT MI 48243 300125283 501(C)(3) 1000000 CASH CHARITABLE DONATION JUVENILE DIABETES RESEARCH FOUNDATION 24359 NORTHWESTERN HWY SOUTHFIELD MI 48075 231907729 501(C)(3) 25000 CASH CHARITABLE DONATION PLAYMAKERS FITNESS FOUNDATION 2299 W GRAND RIVER AVE OKEMOS MI 48864 270931383 501(C)(3) 15000 CASH CHARITABLE DONATION FORGOTTEN HARVEST 21800 GREENFIELD RD OAK PARK MI 48237 382926476 501(C)(3) 150000 CASH CHARITABLE DONATION JUNIOR ACHIEVEMENT OF SOUTHEASTERN MI 577 E LARNED ST DETROIT MI 48226 381348535 501(C)(3) 50000 CASH CHARITABLE DONATION 15 3 PART I, LINE 2: CONTRIBUTIONS ARE MADE AT MANAGEMENT DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF MICHIGAN'S MISSION. CONTRIBUTIONS MADE TO THE DELTA DENTAL FUND ARE APPROVED BY THE BOARD OF DIRECTORS. IN ORDER FOR FUNDS TO BE DISBURSED, VOUCHER RECORDS MUST PASS THROUGH THE APPROVAL PROCESS, SIMILAR TO ANY OTHER EXPENDITURE MADE BY DELTA DENTAL PLAN OF MICHIGAN. DETROIT RIVERFRONT CONSERVANCY - DELTA DENTAL OF MICHIGAN CONTRIBUTED $1 MILLION TO BUILD A HEALTH THEMED 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. X X X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 GORAN JURKOVIC CPA CEO, PRESIDENT 1282448 0 2145000 0 21929 0 3493671 0 24181 0 6967229 0 0 0 ANTHONY ROBINSON SVP & CHIEF MKT OFFICER 465774 0 496676 0 15720 0 1004452 0 24181 0 2006803 0 0 0 LAURA L CZELADA CPA FORMER CEO, PRESIDENT - THRU 12/18 230218 0 1759984 0 97 0 0 0 0 0 1990299 0 0 0 AMY BASEL SENIOR VP, CFO, CRO 407808 0 436800 0 16634 0 833558 0 24181 0 1718981 0 0 0 KENNETH THEIS SVP & CIO 336315 0 359581 0 7589 0 251485 0 24181 0 979151 0 0 0 TOBY HALL SR VP, CHIEF ACTUARY & DATA OFFICER 312213 0 337929 0 22647 0 193778 0 15325 0 881892 0 0 0 SUE ELLEN JENKINS SVP & CHIEF LEGAL OFFICER 371616 0 110775 0 10050 0 26731 0 15325 0 534497 0 0 0 JOADI KECK VP HR & ADMINISTRATION 308187 0 105329 0 27296 0 57786 0 16935 0 515533 0 0 0 JEFF BOTKIN SVP, BUSINESS SERVICES 270540 0 117000 0 15931 0 85760 0 16935 0 506166 0 0 0 MICHAEL GILMORE FORMER VP, CHIEF INVEST OFFICER 0 299101 0 115060 0 5792 0 34525 0 22788 0 477266 0 0 JEFFREY JOHNSTON SVP, CHIEF SCIENCE OFFICER 280640 0 104442 0 4617 0 57153 0 24181 0 471033 0 0 0 MARK BAUGHMAN OPERATING CIO 249455 0 98594 0 7338 0 52709 0 16935 0 425031 0 0 0 JOSEPH ELLSWORTH VP & CHIEF TECHNOLOGY OFFICER 275738 0 50619 0 42589 0 29739 0 24181 0 422866 0 0 0 MIKE BOBAK VP SALES 171317 0 190400 0 1793 0 28558 0 24181 0 416249 0 0 0 LORI WHEELRIGHT VP SALES 171261 0 154801 0 2538 0 68649 0 16935 0 414184 0 0 0 THOMAS FLESZAR DDS MS DIRECTOR - THRU 5/19 25000 274415 0 0 0 0 0 0 0 0 25000 274415 0 0 NANCY HOSTETLER FORMER SRVP/CHIEF STAFF - THRU 12/18 16102 0 216264 0 46776 0 0 0 0 0 279142 0 0 0 JOSEPH C HARRIS DDS IMMEDIATE PAST CHAIRPERSON 205762 30004 0 0 0 0 0 0 0 0 205762 30004 0 0 STEPHEN A EKLUND SECRETARY/TREASURER 66756 145604 0 0 0 0 0 0 0 0 66756 145604 0 0 KAREN GREEN FORMER VP INFOMAT/QUAL THRU 12/18 59292 0 90001 0 19236 0 0 0 0 0 168529 0 0 0 PART I, LINE 1A THE 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 3 THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS PERFORMANCE AND SETS TOTAL COMPENSATION FOR THE CEO WITHOUT THE PRESENCE OR INFLUENCE OF THE CEO. EVERY TWO YEARS, A STUDY IS PERFORMED BY TOWERS WATSON AND THE DATA IS USED IN COMPENSATION DECISIONS. THE INDEPENDENT CONSULTANT PROVIDES AN OPINION AS TO THE REASONABLENESS AND APPROPRIATENESS OF THE TOTAL COMPENSATION, INCLUDING BASE PAY, INCENTIVE, BENEFITS AND RETIREMENT BENEFITS. PART I, LINE 4B DELTA DENTAL PLAN OF MICHIGAN, HAS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). IN ORDER TO BE ELIGIBLE FOR THE SERP, AN EMPLOYEE MUST BE A SENIOR 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 7 AS INDICATED IN SCHEDULE J, PART II, TOP MANAGEMENT OFFICIALS RECEIVED A BONUS BASED UPON PERFORMANCE AND THE FINANCIAL RESULTS OF THE ORGANIZATION. THE BONUS WAS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. JOSEPH CARTER HARRIS DDS JOSEPH HARRIS, CHAIR OF DDPMI, IS AN OWNER OF JOSEPH CARTER HARRIS DDS 139762 PAYMENTS FOR CONSULTING SERVICES 0 BRIAN JACOBSON BROTHER OF DDPMI BOARD MEMBER JED JACOBSON 235499 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 COLE JACOBSON BROTHER OF DDPMI BOARD MEMBER JED JACOBSON 136859 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 CHRIS FISHER DIRECTOR ON BOARD OF DDMI 116449 PRESIDENT OF KEYSER INSURANCE AGENCY 0 TERI BATTAGLIERI SPOUSE OF DDPMI FORMER KEY EMPLOYEE LUIGI BATTAGLIERI 105957 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 BRIAN BATTAGLIERI SON OF DDPMI FORMER KEY EMPLOYEE LUIGI BATTAGLIERI 159815 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 FORM 990, PART VI, SECTION A, LINE 6 DELTA DENTAL PLAN OF MICHIGAN HAS A SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS VOTING RIGHTS AND ELECTS DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE RIGHTS THAT ARE PRESCRIBED BY LAW, FOR MEMBERS OF NON-PROFIT CORPORATIONS, INCLUDING THE APPROVAL OF SIGNIFICANT EXPENDITURES AND CEO APPOINTMENT. FORM 990, PART VI, SECTION B, LINE 11B THE INFORMATION PRESENTED ON THE FORM 990 IS GATHERED BY THE 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 12C THE 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 15 COMPENSATION OF THE CEO IS DETERMINED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. COMPENSATION OF THE OTHER EXECTUTIVES IS DETERMINED BY THE CEO IN CONSULTATION WITH THE VP OF HUMAN RESOURCES AND THE CFO. OUTSIDE COMPENSATION CONSULTANTS ARE USED TO DETERMINE MARKET DATA WHICH IS USED TO SET TOTAL COMPENSATION FOR OFFICERS AND KEY EMPLOYEES INCLUDING THE CEO, CFO, AND OTHERS AS APPROPRIATE. DELTA DENTAL PLAN OF MICHIGAN, INC. CONTRACTS WITH TOWERS WATSON TO DO A COMPENSATION AND REASONABLENESS ANALYSIS EVERY TWO YEARS. TOWERS WATSON ALSO PROVIDES AN OPINION AS TO THE REASONABLENESS OF THE TOTAL COMPENSATION PACKAGES, INCLUDING BASE PAY, INCENTIVE, BENEFITS AND RETIREMENT BENEFITS. THE COMPENSATION WAS LAST REVIEWED UNDER THIS PROCESS DURING 2018. COMPENSATION DECISIONS ARE MADE UTILIZING THE DATA PROVIDED BY TOWERS WATSON. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. FORM 990 PART VII: CERTAIN EMPLOYEES ARE OFFICERS OF MULTIPLE COMPANIES WITHIN THE LARGER ORGANIZATION. THE AVERAGE HOURS WORKED REFLECTS APPROXIMATE TIME SPENT IN EACH OF THOSE INDIVIDUAL COMPANIES. WHILE THE HOURS ARE ALLOCATED TO INDIVIDUAL COMPANIES, MUCH OF THE OFFICERS' TIME IS SPENT WORKING ON ISSUES THAT IMPACT THE ENTIRE ORGANIZATION, NOT JUST ONE COMPANY. COMPENSATION IS REPORTED IN FULL TO AGREE TO THE EMPLOYEE'S W-2 AS REQUIRED BY IRS INSTRUCTIONS. ANY ALLOCATION OF COMPENSATION IS INCLUDED ON SCHEDULE R. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 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. 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 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 1 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 1 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 1 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 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 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 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 4100 OKEMOS RD 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 THE 4100 GROUP RELATED 350711 2583304 0 0 0.59250 RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI DELTA DENTAL OF MICHIGAN C -1652341 26799872 0.58000 1 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA PO BOX 30381 LANSING MI 48909 470397286 INSURANCE IN RENAISSANCE HOLDING COMPANY C 2788788 68353433 0.58000 1 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK PO BOX 30381 LANSING MI 48909 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 122721 7161780 0.58000 1 FORE HOLDING CORPORATION 240 VENTURE CIRCLE NASHVILLE TN 37228 204116122 HOLDING COMPANY TN N/A C 0 DENTAL CHOICE INC 10100 LINN STATION ROAD SUITE 700 LOUISVILLE KY 40223 611105118 PROVIDE DENTAL SERVICE PLANS KY N/A C 0 DENTAL CHOICE AGENCY INC 10100 LINN STATION RD SUITE 700 LOUISVILLE KY 40223 611336003 PRIMARY GENERAL AGENCY FOR DDKY & DENTAL CHOICE KY N/A C 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 -2304967 79999473 0.75000 1 DEWPOINT INC 300 S WASHINGTON SQUARE LANSING MI 48933 383300595 IT CONSULTING MI THE 4100 GROUP C 5890639 46873376 0.75000 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 DELTA DENTAL OF TENNESSEE L 5213439 ACTUAL COST DELTA DENTAL PLAN OF OHIO INC L 38461035 ACTUAL COST DELTA DENTAL PLAN OF INDIANA INC L 13593293 ACTUAL COST DELTA DENTAL FUND L 868809 ACTUAL COST RENAISSANCE LIFE AND HEALTH INSURANCE COMPANY OF AMERICA L 4659028 ACTUAL COST DELTA DENTAL PLAN OF NEW MEXICO INC L 2248402 ACTUAL COST DELTA DENTAL OF KENTUCKY INC L 2893771 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA L 4347811 ACTUAL COST RENAISSANCE ELECTRONIC SERVICES LLC L 112975 ACTUAL COST DELTA DENTAL PLAN OF ARKANSAS INC L 7185378 ACTUAL COST RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK L 75245 ACTUAL COST RENAISSANCE HOLDING COMPANY L 746026 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA A 5640 ACTUAL COST RENAISSANCE HEALTH SERVICE CORPORATION L 14813 ACTUAL COST DELTA DENTAL FUND B 1000000 ACTUAL COST DEWPOINT L 432333 ACTUAL COST THE 4100 GROUP L 190635 ACTUAL COST