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

View the entire original 990 at ProPublica ↗

Organization
DELTA DENTAL PLAN OF OHIO (EIN 31-0685339)
Tax period
2019-01-01 to 2019-12-31
Filed
2020-11-11
IRS object ID
202033169349303773
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)
Return2020-11-11T14:13:44-06:00ReturnTs
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 & MORAN PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11111 MICHIGAN AVE STE 100AddressLine1Txt
CityEAST LANSINGCityNm
State AbbreviationMIStateAbbreviationCd
ZIP48823ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN310685339EIN

Business Name BusinessName

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

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 30416AddressLine1Txt
CityLANSINGCityNm
State AbbreviationMIStateAbbreviationCd
ZIP489097916ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAMY BASELPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
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 Tm14:09:21IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdDA39A3EE5E6B4B0D3255BFEF95601890AFD80709AtSubmissionCreationDeviceId
At Submission Filing Device IdAFBDF4DF54CCD05CFBA4AEDC275F7F3808ECB98BAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2021-04-22 16:20:28ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerGORAN JURKOVICPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 30416AddressLine1Txt
CityLANSINGCityNm
State AbbreviationMIStateAbbreviationCd
ZIP489097916ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$313,522,690GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressWWW.DELTADENTALOH.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1960FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionDELTA DENTAL OF OHIO'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 Body10VotingMembersGoverningBodyCnt
Voting Members Independent10VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$606,599,355PYProgramServiceRevenueAmt
CY Program Service Revenue$290,005,636CYProgramServiceRevenueAmt
PY Investment Income$7,347,230PYInvestmentIncomeAmt
CY Investment Income$7,221,943CYInvestmentIncomeAmt
PY Other Revenue$674PYOtherRevenueAmt
CY Other Revenue$67,118CYOtherRevenueAmt
PY Total Revenue$613,947,259PYTotalRevenueAmt
CY Total Revenue$297,294,697CYTotalRevenueAmt
PY Grants And Similar Paid$1,500,000PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$2,000,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$451,342PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$470,656CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$591,701,860PYOtherExpensesAmt
CY Other Expenses$278,036,300CYOtherExpensesAmt
PY Total Expenses$593,653,202PYTotalExpensesAmt
CY Total Expenses$280,506,956CYTotalExpensesAmt
PY Revenues Less Expenses$20,294,057PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$16,787,741CYRevenuesLessExpensesAmt
Total Assets BOY$238,787,566TotalAssetsBOYAmt
Total Assets EOY$268,364,386TotalAssetsEOYAmt
Total Liabilities BOY$36,315,379TotalLiabilitiesBOYAmt
Total Liabilities EOY$28,066,764TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$202,472,187NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$240,297,622NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionSEE SCHEDULE ODELTA DENTAL OF OHIO'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 OHIO IS GOVERNED BY A BOARD OF DIRECTORS CONTROLLED BY INDEPENDENT MEMBERS OF THE COMMUNITY AND IT OFFERS ENROLLMENT IN ORAL HEALTH PLANS TO A BROAD BASE OF THE COMMUNITY THROUGH A VARIETY OF PAYMENT MODELS.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$263,043,690ExpenseAmt
Grant$2,000,000GrantAmt
Revenue$290,005,636RevenueAmt
DescPROMOTING DENTAL CAREDELTA DENTAL PLAN OF OHIO, INC. IS A LEADING DENTAL BENEFITS PROVIDER. THE PURPOSE OF THE ORGANIZATION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH. THIS IS DONE BY OFFERING INNOVATIVE, COST-EFFECTIVE PRODUCTS THAT MEET THE NEEDS OF CUSTOMERS. THIS WAS DEMONSTRATED IN 2019 BY PAYING OUT OVER $226 MILLION FOR DENTAL CARE, BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 4.1 MILLION CLAIMS WERE PROCESSED FOR OVER 2.2 MILLION MEMBERS.SEE SCHEDULE O FOR CONTINUATION COST SAVING STRATEGIESDELTA DENTAL BENEFIT PLANS ARE COMMITTED TO SAVING GROUPS AND SUBSCRIBERS MONEY. THE DELTA DIFFERENCE IS AN INTEGRATION OF ACTIVITIES; SUCH AS COST MANAGEMENT POLICIES, FEE REDUCTION AGREEMENTS WITH DENTISTS, AND AN ANTI-FRAUD HOTLINE, ALL OF WHICH ENSURE QUALITY, COST-EFFECTIVE DENTAL BENEFIT DELIVERY. COMMITMENT TO THE COMMUNITYDELTA DENTAL PLAN OF OHIO, INC. BELIEVES ADVANCES IN DENTAL RESEARCH AND ENHANCED EDUCATIONAL OPPORTUNITIES FOR DENTISTS GO A LONG WAY TOWARD IMPROVING ORAL HEALTH. THE COMPANY IS A KEY PLAYER IN GROUNDBREAKING RESEARCH ON TRENDS IN ORAL HEALTH IN THE INSURED POPULATION. THE DELTA DENTAL FUND, THE COMPANY'S PHILANTHROPIC AFFILIATE, ENCOURAGES ADVANCES IN DENTISTRY AND SUPPORTS DENTAL EDUCATION AND RESEARCH. SINCE IT WAS FORMED IN 1980, THE DELTA DENTAL FUND HAS GRANTED OVER $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 OHIO IS ALSO COMMITTED TO BUILDING HEALTHY, SMART, VIBRANT COMMUNITIES. DELTA DENTAL HAS ALWAYS BEEN KEENLY AWARE OF ITS CIVIC AND SOCIAL RESPONSIBILITY. DELTA DENTAL PLANS ARE PROUD TO SHARE, THROUGH DIRECT FINANCIAL CONTRIBUTIONS, WITH HUNDREDS OF COMMUNITY AGENCIES AND GROUPS. IN ADDITION, EMPLOYEES LOG COUNTLESS HOURS OF THEIR OWN TIME AS VOLUNTEERS. COMMUNITY SUPPORT GENERALLY FALLS UNDER THE BROAD CATEGORIES THAT PROVIDE SUPPORT TO AGENCIES AND INSTITUTIONS SERVING CHILDREN, SENIORS, LOW-INCOME INDIVIDUALS, MINORITIES, AND THE DISABLED AND AT-RISK INDIVIDUALS, TO ORGANIZATIONS THAT PROMOTE EDUCATION, ARTS AND RECREATION AND COMMUNITY DEVELOPMENT, AND TO CHARITABLE PROJECTS OR PROGRAMS RECOMMENDED BY EMPLOYEES, CUSTOMERS, PARTICIPATING DENTISTS AND OTHER KEY GROUPS. WE CONTINUED OUR ROLE AS STRONG ADVOCATES FOR SOUND ORAL HEALTH POLICY AT THE STATE AND FEDERAL LEVELS. UNEQUALED ACCESS TO DENTISTSFOR FIVE DECADES, DELTA DENTAL HAS HELPED PROMOTE ORAL HEALTH BY DESIGNING AND ADMINISTERING INNOVATIVE, COST-EFFECTIVE DENTAL BENEFIT PROGRAMS. EXPERTS AT PLAN DESIGN, DELTA DENTAL HAS CREATED DENTAL BENEFIT PROGRAMS THAT MEET CUSTOMER COST-OBJECTIVES WHILE HELPING TO IMPROVE AND MAINTAIN ORAL HEALTH.OUR LONG STANDING RELATIONSHIPS WITH PROVIDERS IN THE COMMUNITIES WE SERVE 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$263,043,690TotalProgramServiceExpensesAmt
Described In Section501c30DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
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 Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
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 Document52048IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member10IndependentVotingMemberCnt
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 CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
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 CHIEF FINANCIAL OFFICERBusinessNameLine1Txt
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 (18 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeIndIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
GORAN JURKOVIC CPA
PRESIDENT & CEO10.0040.00Yes (X)$0$3,449,377$3,517,852
ANTHONY ROBINSON
SVP, CHIEF MARKETING OFFICER5.0045.00Yes (X)$0$978,170$1,028,633
LAURA L CZELADA CPA
FORMER PRESIDENT & CEO (THRU 12/18)0.000.00$0$1,990,299$0Yes (X)
AMY BASEL CPA
SVP, CFO, AND CRO5.0045.00Yes (X)$0$861,242$857,739
SUE ELLEN JENKINS
SR VP & GENERAL COUNSEL/SECRETARY5.0045.00Yes (X)$0$492,441$42,056
MICHAEL GILMORE
FORMER CHIEF INVESTMENT OFFICER0.0050.00$0$419,953$57,313Yes (X)
JEFFERY JOHNSTON
SVP, CHIEF SCIENCE OFFICER5.0045.00Yes (X)$0$389,699$81,334
ANN M FLERMOEN DDS
CHAIRPERSON5.0011.00Yes (X)$47,332$87,996$0Yes (X)
CHRISTOPHER FISHER
DIRECTOR5.0010.00$42,000$74,581$0Yes (X)
DOUGLAS R ANDERSON DDS MS
IMMEDIATE PAST CHAIR (THRU 8/19)5.0010.00Yes (X)$19,165$73,662$19,000Yes (X)
CAROLE S WATKINS
DIRECTOR5.006.00$42,000$27,214$0Yes (X)
JAMES R STAHL DDS
VICE CHAIRPERSON5.005.00Yes (X)$45,996$15,319$0Yes (X)
FRANK BUZAKI JR
SECRETARY/TREASURER5.005.00Yes (X)$26,996$14,581$19,000Yes (X)
BRUCE R SMITH
IMMEDIATE PAST CHAIRPERSON5.001.00Yes (X)$48,668$1,000$0Yes (X)
CANISE WRIGHT-BEAN
DIRECTOR5.000.00$42,428$0$0Yes (X)
TIMOTHY MOFFIT
DIRECTOR5.000.00$42,000$0$0Yes (X)
MICHAEL S STULL
DIRECTOR5.000.00$42,000$0$0Yes (X)
POE TIMMONS
DIRECTOR5.000.00$42,000$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$440,585TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$8,875,534TotReportableCompRltdOrgAmt
Total Other Compensation$5,622,927TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
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
ALLIANT INSURANCE SERVICES INC
5847 SAB FEKUOE STHOUSTONTX77057COMMISSIONS$496,228
USI INSURANCE SERVICES LLC
1 HILLCREST DRCHARLESTONWV25311COMMISSIONS$488,195
HYLANT GROUP
811 MADISON AVETOLEDOOH43604COMMISSIONS$323,987
LOCKTON COMPANIES LLC
444 W 47TH STKANSAS CITYMO64112COMMISSIONS$272,105
GALLAGHER BENEFIT SERVICES INC
281 VISTA PARKWAY SUITE 300WEST PALM BEACHFL35411COMMISSIONS$271,416
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K16CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescDENTAL CARE REVENUEDesc
Business624100BusinessCd
Total Revenue Column$290,005,636TotalRevenueColumnAmt
Related Or Exempt Func Income$290,005,636RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$290,005,636TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$5,994,028TotalRevenueColumnAmt
Exclusion$5,994,028ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$17,455,908SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$16,227,993SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$1,227,915SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,227,915TotalRevenueColumnAmt
Exclusion$1,227,915ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUS REVENUEDesc
Business900099BusinessCd
Total Revenue Column$67,118TotalRevenueColumnAmt
Exclusion$67,118ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$67,118OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$297,294,697TotalRevenueColumnAmt
Related Or Exempt Func Income$290,005,636RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$7,289,061ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$2,000,000TotalAmt
Program Services$2,000,000ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$470,656TotalAmt
Program Services$305,926ProgramServicesAmt
Management And General$164,730ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$52,945TotalAmt
Management And General$52,945ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$132,125TotalAmt
Management And General$132,125ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$373,923TotalAmt
Management And General$373,923ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$227,090,382TotalAmt
Program Services$227,054,092ProgramServicesAmt
Management And General$36,290ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$373,853TotalAmt
Management And General$373,853ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$53,892TotalAmt
Management And General$53,892ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
ADMIN/INVESTMENT O/H$39,052,857$24,437,664$14,615,193
COMMISSION EXPENSE$6,614,738$6,614,738
PREMIUM TAX EXPENSE$2,477,574$2,477,574
OTHER EXPENSES$1,083,085$153,696$929,389

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$730,926TotalAmt
Management And General$730,926ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$280,506,956TotalAmt
Program Services$263,043,690ProgramServicesAmt
Management And General$17,463,266ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$13,581,507BOYAmt
EOY$1,695,677EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$10,552,439BOYAmt
EOY$3,496,182EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$26,096,268BOYAmt
EOY$12,502,320EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$250,000BOYAmt
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$3,500BOYAmt
EOY$0EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$164,228,639BOYAmt
EOY$205,598,186EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$23,692,650BOYAmt
EOY$44,644,507EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$382,563BOYAmt
EOY$427,514EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$238,787,566BOYAmt
EOY$268,364,386EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$8,755,145BOYAmt
EOY$7,636,567EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$1,591,474BOYAmt
EOY$1,313,653EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$25,968,760BOYAmt
EOY$19,116,544EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$36,315,379BOYAmt
EOY$28,066,764EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$9,707,604BOYAmt
EOY$9,707,604EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$192,764,583BOYAmt
EOY$230,590,018EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$202,472,187BOYAmt
EOY$240,297,622EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$238,787,566BOYAmt
EOY$268,364,386EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$16,787,741ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$19,960,835NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$1,076,859OtherChangesInNetAssetsAmt
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 D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (2 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
INVESTMENT IN RENAISSANCE HOLDING COMPANY$5,239,048F
INVESTMENT IN THE 4100 GROUP$39,405,459F
FieldValueIRS element (for citing)
Total Book Value Securities$44,644,507TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
CLAIMS RESERVES$8,378,000
UNEARNED PREMIUMS$5,280,132
OTHER ACCRUED LIABILITIES$2,109
INTERCOMPANY PAYABLE$5,456,303
FieldValueIRS element (for citing)
Total Liability$19,116,544TotalLiabilityAmt

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL FUNDBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 30416AddressLine1Txt
CityLANSINGCityNm
State AbbreviationMIStateAbbreviationCd
ZIP489097916ZIPCd
FieldValueIRS element (for citing)
Recipient EIN382337000RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$2,000,000CashGrantAmt
Purpose Of GrantVITAL DENTAL EDUCATION AND RESEARCHPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

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 OHIO'S MISSION. CONTRIBUTIONS MADE TO THE DELTA DENTAL FUND ARE APPROVED BY THE BOARD OF DIRECTORS. IN ORDER FOR FUNDS TO BE DISBURSED, VOUCHER RECORDS MUST PASS THROUGH THE APPROVAL PROCESS, SIMILAR TO ANY OTHER EXPENDITURE MADE BY DELTA DENTAL PLAN OF OHIO.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsYes (X)TravelForCompanionsInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
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 Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 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
PRESIDENT & CEO$0$1,282,448$0$2,145,000$0$21,929$0$3,493,671$0$24,181$0$6,967,229$0$0
ANTHONY ROBINSON
SVP, CHIEF MARKETING OFFICER$0$465,774$0$496,676$0$15,720$0$1,004,452$0$24,181$0$2,006,803$0$0
LAURA L CZELADA CPA
FORMER PRESIDENT & CEO (THRU 12/18)$0$230,218$0$1,759,984$0$97$0$0$0$0$0$1,990,299$0$0
AMY BASEL CPA
SVP, CFO, AND CRO$0$407,808$0$436,800$0$16,634$0$833,558$0$24,181$0$1,718,981$0$0
SUE ELLEN JENKINS
SR VP & GENERAL COUNSEL/SECRETARY$0$371,616$0$110,775$0$10,050$0$26,731$0$15,325$0$534,497$0$0
MICHAEL GILMORE
FORMER CHIEF INVESTMENT OFFICER$0$299,101$0$115,060$0$5,792$0$34,525$0$22,788$0$477,266$0$0
JEFFERY JOHNSTON
SVP, CHIEF SCIENCE OFFICER$0$280,640$0$104,442$0$4,617$0$57,153$0$24,181$0$471,033$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1ATRAVEL FOR COMPANIONS RELATED TO TRAVEL FOR A SPOUSE. THIS AMOUNT WAS TREATED AS TAXABLE TO THE BOARD MEMBER OR EMPLOYEE.
PART I, LINE 3THE CEO IS A W-2 EMPLOYEE OF A RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, INC. COMPENSATION IS DETERMINED BY THAT ENTITY. THE DELTA DENTAL PLAN OF MICHIGAN, INC. COMPENSATION COMMITTEE REVIEWS PERFORMANCE AND SETS TOTAL COMPENSATION. EVERY TWO YEARS, A STUDY IS PERFORMED BY TOWERS WATSON AND THE DATA IS USED IN COMPENSATION DECISIONS. THE INDEPENDENT CONSULTANT PROVIDES AN OPINION AS TO THE REASONABLENESS AND APPROPRIATENESS OF THE TOTAL COMPENSATION, INCLUDING BASE PAY, INCENTIVE, BENEFITS AND RETIREMENT BENEFITS.
PART I, LINE 4BTHE RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, HAS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). IN ORDER TO BE ELIGIBLE FOR THE SERP, AN EMPLOYEE MUST BE 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, AND ANTHONY ROBINSON ACCRUED BENEFITS AS PARTICIPANTS IN THE SERP PLAN, BUT DID NOT RECEIVE A DISTRIBUTION.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6DELTA DENTAL PLAN OF OHIO HAS A SOLE MEMBER, DELTA DENTAL PLAN OF MICHIGAN, INC.
FORM 990, PART VI, SECTION A, LINE 7ATHE SOLE MEMBER HAS VOTING RIGHTS TO ELECT DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7BDELTA DENTAL PLAN OF MICHIGAN, INC., AS THE SOLE MEMBER OF DELTA DENTAL PLAN OF OHIO, INC. AS THE RIGHTS PRESCRIBED BY LAW FOR MEMBERS OF NONPROFIT CORPORATIONS SUBJECT TO CHAPTER 1702 OF THE OHIO REVISED CODE AND AMENDED AND RESTATED CODE OF REGULATIONS.
FORM 990, PART VI, SECTION B, LINE 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, PRIOR TO FILING FORM 990 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 WERE 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 HAS AN INTEREST, THE MEMBER IS REQUIRED TO DISCLOSE THE POTENTIAL CONFLICT AND ABSTAIN FROM ANY VOTE ON THE MATTER. WHETHER FURTHER PRECAUTIONS ARE REQUIRED (E.G., PROHIBITING THE INTERESTED PARTY FROM ENGAGING IN DISCUSSIONS) WOULD DEPEND UPON THE SPECIFIC NATURE AND BACKGROUND OF THE CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15COMPENSATION OF THE CEO AND OTHER EXECUTIVES IS DETERMINED BY A RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, INC. OUTSIDE COMPENSATION CONSULTANTS ARE USED TO DETERMINE MARKET DATA WHICH IS USED TO SET TOTAL COMPENSATION FOR OFFICERS AND KEY EMPLOYEES INCLUDING CEO AND CFO. THE RELATED ORGANIZATION CONTRACTS WITH TOWERS WATSON TO DO A COMPENSATION AND REASONABLENESS ANALYSIS EVERY TWO YEARS. COMPENSATION IS SET, BASED ON THE DATA PROVIDED, BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. TOWERS WATSON ALSO PROVIDES AN OPINION AS TO THE REASONABLENESS OF THE TOTAL COMPENSATION PACKAGES, INCLUDING BASE PAY, INCENTIVE, BENEFITS AND RETIREMENT BENEFITS. THE COMPENSATION WAS LAST REVIEWED UNDER THIS PROCESS DURING 2018. THE OPINION AND REPORT WERE ISSUED IN 2019.
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 11GCONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 36,290. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,290. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 227,054,092. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 227,054,092.
FORM 990, PART XI, LINE 9:GAIN ON INVESTMENT IN SUBSIDIARIES 1,076,859.
FORM 990, PART XII, LINES 2C:DELTA DENTAL PLAN OF OHIO 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 OHIO 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 PRIOR YEAR.
FORM 990, PART IV, LINE 12A:DELTA DENTAL PLAN OF OHIO RECEIVES AN AUDITED FINANCIAL STATEMENT FROM AN INDEPENDENT ACCOUNTANT BUT THESE STATEMENTS ARE PREPARED ON A STATUTORY BASIS AND NOT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP).
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 $392,101,506, 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 INDIANA INC
PO BOX 30416LANSINGMI489097916351545647PROVIDE DENTAL SERVICE PLANSIN501(C)(4)N/A0DELTA DENTAL PLAN OF MICHIGAN INC
DELTA DENTAL PLAN OF MICHIGAN INC
4100 OKEMOS ROADOKEMOSMI48864381791480PROVIDE DENTAL SERVICE PLANSMI501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
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, I0DELTA 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 ROADOKEMOSMI48864461376165EMPHASIZE 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$116,904ShareOfTotalIncomeAmt
Share Of EOY Assets$861,101ShareOfEOYAssetsAmt
Disproportionate Allocations0DisproportionateAllocationsInd
General Or Managing Partner0GeneralOrManagingPartnerInd
Ownership0.19750OwnershipPct

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 LIFE & HEALTH INSURANCE COMPANY OF AMERICA
PO BOX 30381LANSINGMI48909470397286INSURANCEINRENAISSANCE HOLDING COMPANYC$201,947$4,949,7310.042000
RENAISSANCE HOLDING COMPANY
PO BOX 30381LANSINGMI48909412177193HOLDING COMPANYMIDELTA DENTAL OF MICHIGANC-$119,652$1,940,6800.042000
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK
PO BOX 30381LANSINGMI48909134098096INSURANCENYRENAISSANCE HOLDING COMPANYC$8,887$518,6120.042000
OMEGA ADMINISTRATORS INC
1513 COUNTRY CLUB ROADSHERWOODAR72120043740469PROVIDING THIRD-PARTY ADMINISTRATIVE SERVICESARC0N/A
THE 4100 GROUP
4100 OKEMOS ROADOKEMOSMI48864472557772INVESTMENT IN SUBSIDIARIESMIDELTA DENTAL OF MICHIGANC-$768,322$26,666,4910.250000
FORE HOLDING CORPORATION
240 VENTURE CIRCLENASHVILLETN37228204116122HOLDING COMPANYTNC0N/A
DEWPOINT INC
300 S WASHINGTON SQUARELANSINGMI48933383300595IT CONSULTINGMITHE 4100 GROUPC$1,963,546$15,624,4590.250000
DENTAL CHOICE INC
10100 LINN STATION RD 700LOUISVILLEKY402293861611105118PROVIDE DENTAL SERVICE PLANSKYC0N/A
DENTAL CHOICE AGENCY INC
10100 LINN STATION RD 700LOUISVILLEKY402293861611336003PRIMARY GENERAL AGENCY FOR DDKY AND DENTAL CHOICEKYC0N/A
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 Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
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 (4 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
DELTA DENTAL OF NORTH CAROLINA
A$5,222ACTUAL COST
DELTA DENTAL FUND
B$2,000,000ACTUAL COST
DELTA DENTAL PLAN OF MICHIGAN INC
M$38,461,035ACTUAL COST
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA
M$591,822ACTUAL COST

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