2020-11-11T14:13:44-06:00 2019-12-31 381357951 PLANTE & MORAN PLLC 1111 MICHIGAN AVE STE 100 EAST LANSING MI 48823 990 2019-01-01 310685339 DELTA DENTAL PLAN OF OHIO INC DELT 5173496000 PO BOX 30416 LANSING MI 489097916 AMY BASEL CHIEF FINANCIAL OFFICER 5173496000 2020-11-09 1 DAVID LOWENTHAL CPA P00378651 5173326200 2020-11-09 68.62.32.134 2020-11-09 14:09:21 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 AFBDF4DF54CCD05CFBA4AEDC275F7F3808ECB98B 2019 2021-04-22 16:20:28Z GORAN JURKOVIC PO BOX 30416 LANSING MI 489097916 313522690 0 X WWW.DELTADENTALOH.COM X 1960 OH DELTA DENTAL OF OHIO'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH DENTAL SERVICES 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. 10 10 0 0 0 0 0 0 606599355 290005636 7347230 7221943 674 67118 613947259 297294697 1500000 2000000 0 0 451342 470656 0 0 0 591701860 278036300 593653202 280506956 20294057 16787741 238787566 268364386 36315379 28066764 202472187 240297622 X SEE 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. 0 0 263043690 2000000 290005636 PROMOTING DENTAL CAREDELTA DENTAL PLAN OF OHIO, INC. IS A LEADING DENTAL BENEFITS PROVIDER. THE PURPOSE OF THE ORGANIZATION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH. THIS IS DONE BY OFFERING INNOVATIVE, COST-EFFECTIVE PRODUCTS THAT MEET THE NEEDS OF CUSTOMERS. THIS WAS DEMONSTRATED IN 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. 263043690 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 52048 0 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X AMY BASEL CHIEF FINANCIAL OFFICER 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 X GORAN JURKOVIC CPA PRESIDENT & CEO 10.00 40.00 X 0 3449377 3517852 ANTHONY ROBINSON SVP, CHIEF MARKETING OFFICER 5.00 45.00 X 0 978170 1028633 LAURA L CZELADA CPA FORMER PRESIDENT & CEO (THRU 12/18) 0.00 0.00 X 0 1990299 0 AMY BASEL CPA SVP, CFO, AND CRO 5.00 45.00 X 0 861242 857739 SUE ELLEN JENKINS SR VP & GENERAL COUNSEL/SECRETARY 5.00 45.00 X 0 492441 42056 MICHAEL GILMORE FORMER CHIEF INVESTMENT OFFICER 0.00 50.00 X 0 419953 57313 JEFFERY JOHNSTON SVP, CHIEF SCIENCE OFFICER 5.00 45.00 X 0 389699 81334 ANN M FLERMOEN DDS CHAIRPERSON 5.00 11.00 X X 47332 87996 0 CHRISTOPHER FISHER DIRECTOR 5.00 10.00 X 42000 74581 0 DOUGLAS R ANDERSON DDS MS IMMEDIATE PAST CHAIR (THRU 8/19) 5.00 10.00 X X 19165 73662 19000 CAROLE S WATKINS DIRECTOR 5.00 6.00 X 42000 27214 0 JAMES R STAHL DDS VICE CHAIRPERSON 5.00 5.00 X X 45996 15319 0 FRANK BUZAKI JR SECRETARY/TREASURER 5.00 5.00 X X 26996 14581 19000 BRUCE R SMITH IMMEDIATE PAST CHAIRPERSON 5.00 1.00 X X 48668 1000 0 CANISE WRIGHT-BEAN DIRECTOR 5.00 0.00 X 42428 0 0 TIMOTHY MOFFIT DIRECTOR 5.00 0.00 X 42000 0 0 MICHAEL S STULL DIRECTOR 5.00 0.00 X 42000 0 0 POE TIMMONS DIRECTOR 5.00 0.00 X 42000 0 0 440585 8875534 5622927 0 1 1 0 ALLIANT INSURANCE SERVICES INC 5847 SAB FEKUOE ST HOUSTON TX 77057 COMMISSIONS 496228 USI INSURANCE SERVICES LLC 1 HILLCREST DR CHARLESTON WV 25311 COMMISSIONS 488195 HYLANT GROUP 811 MADISON AVE TOLEDO OH 43604 COMMISSIONS 323987 LOCKTON COMPANIES LLC 444 W 47TH ST KANSAS CITY MO 64112 COMMISSIONS 272105 GALLAGHER BENEFIT SERVICES INC 281 VISTA PARKWAY SUITE 300 WEST PALM BEACH FL 35411 COMMISSIONS 271416 16 DENTAL CARE REVENUE 624100 290005636 290005636 290005636 5994028 5994028 17455908 16227993 1227915 1227915 1227915 MISCELLANEOUS REVENUE 900099 67118 67118 67118 297294697 290005636 0 7289061 X 2000000 2000000 470656 305926 164730 52945 52945 132125 132125 373923 373923 227090382 227054092 36290 373853 373853 53892 53892 ADMIN/INVESTMENT O/H 39052857 24437664 14615193 COMMISSION EXPENSE 6614738 6614738 PREMIUM TAX EXPENSE 2477574 2477574 OTHER EXPENSES 1083085 153696 929389 730926 730926 280506956 263043690 17463266 0 13581507 1695677 10552439 3496182 26096268 12502320 250000 0 3500 0 164228639 205598186 23692650 44644507 382563 427514 238787566 268364386 8755145 7636567 1591474 1313653 25968760 19116544 36315379 28066764 X 0 0 9707604 9707604 192764583 230590018 202472187 240297622 238787566 268364386 X 16787741 19960835 1076859 X X 0 1 X 1 0 0 INVESTMENT IN RENAISSANCE HOLDING COMPANY 5239048 F INVESTMENT IN THE 4100 GROUP 39405459 F 44644507 CLAIMS RESERVES 8378000 UNEARNED PREMIUMS 5280132 OTHER ACCRUED LIABILITIES 2109 INTERCOMPANY PAYABLE 5456303 19116544 1 DELTA DENTAL FUND PO BOX 30416 LANSING MI 489097916 382337000 501(C)(3) 2000000 VITAL DENTAL EDUCATION AND RESEARCH 1 0 PART I, LINE 2: CONTRIBUTIONS ARE MADE AT MANAGEMENT DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF OHIO'S MISSION. CONTRIBUTIONS MADE TO THE DELTA DENTAL FUND ARE APPROVED BY THE BOARD OF DIRECTORS. IN ORDER FOR FUNDS TO BE DISBURSED, VOUCHER RECORDS MUST PASS THROUGH THE APPROVAL PROCESS, SIMILAR TO ANY OTHER EXPENDITURE MADE BY DELTA DENTAL PLAN OF OHIO. X 1 1 0 1 0 0 0 0 0 0 0 GORAN JURKOVIC CPA PRESIDENT & CEO 0 1282448 0 2145000 0 21929 0 3493671 0 24181 0 6967229 0 0 ANTHONY ROBINSON SVP, CHIEF MARKETING OFFICER 0 465774 0 496676 0 15720 0 1004452 0 24181 0 2006803 0 0 LAURA L CZELADA CPA FORMER PRESIDENT & CEO (THRU 12/18) 0 230218 0 1759984 0 97 0 0 0 0 0 1990299 0 0 AMY BASEL CPA SVP, CFO, AND CRO 0 407808 0 436800 0 16634 0 833558 0 24181 0 1718981 0 0 SUE ELLEN JENKINS SR VP & GENERAL COUNSEL/SECRETARY 0 371616 0 110775 0 10050 0 26731 0 15325 0 534497 0 0 MICHAEL GILMORE FORMER CHIEF INVESTMENT OFFICER 0 299101 0 115060 0 5792 0 34525 0 22788 0 477266 0 0 JEFFERY JOHNSTON SVP, CHIEF SCIENCE OFFICER 0 280640 0 104442 0 4617 0 57153 0 24181 0 471033 0 0 PART I, LINE 1A TRAVEL FOR COMPANIONS RELATED TO TRAVEL FOR A SPOUSE. THIS AMOUNT WAS TREATED AS TAXABLE TO THE BOARD MEMBER OR EMPLOYEE. PART I, LINE 3 THE CEO IS A W-2 EMPLOYEE OF A RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, INC. COMPENSATION IS DETERMINED BY THAT ENTITY. THE DELTA DENTAL PLAN OF MICHIGAN, INC. COMPENSATION COMMITTEE REVIEWS PERFORMANCE AND SETS TOTAL COMPENSATION. EVERY TWO YEARS, A STUDY IS PERFORMED BY TOWERS WATSON AND THE DATA IS USED IN COMPENSATION DECISIONS. THE INDEPENDENT CONSULTANT PROVIDES AN OPINION AS TO THE REASONABLENESS AND APPROPRIATENESS OF THE TOTAL COMPENSATION, INCLUDING BASE PAY, INCENTIVE, BENEFITS AND RETIREMENT BENEFITS. PART I, LINE 4B THE 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. FORM 990, PART VI, SECTION A, LINE 6 DELTA DENTAL PLAN OF OHIO HAS A SOLE MEMBER, DELTA DENTAL PLAN OF MICHIGAN, INC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS VOTING RIGHTS TO ELECT DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B DELTA DENTAL PLAN OF MICHIGAN, INC., AS THE SOLE MEMBER OF DELTA DENTAL PLAN OF OHIO, INC. AS THE RIGHTS PRESCRIBED BY LAW FOR MEMBERS OF NONPROFIT CORPORATIONS SUBJECT TO CHAPTER 1702 OF THE OHIO REVISED CODE AND AMENDED AND RESTATED CODE OF REGULATIONS. FORM 990, PART VI, SECTION B, LINE 11B THE INFORMATION PRESENTED ON THE FORM 990 IS GATHERED BY THE SENIOR TAX ADMINISTRATOR FOR THE ORGANIZATION. THE CFO REVIEWS THE INFORMATION. ONCE APPROVED THE INFORMATION IS GIVEN TO OUTSIDE TAX PREPARERS WHO PREPARE AND REVIEW THE FORM 990. ONCE COMPLETE, AN ELECTRONIC COPY OF THE FORM 990 IS PLACED IN A SECURE PORTAL FOR THE BOARD TO REVIEW, PRIOR TO FILING FORM 990 WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE COMPANY'S 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 15 COMPENSATION OF THE CEO AND OTHER EXECUTIVES IS DETERMINED BY A RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, INC. OUTSIDE COMPENSATION CONSULTANTS ARE USED TO DETERMINE MARKET DATA WHICH IS USED TO SET TOTAL COMPENSATION FOR OFFICERS AND KEY EMPLOYEES INCLUDING CEO AND CFO. THE RELATED ORGANIZATION CONTRACTS WITH TOWERS WATSON TO DO A COMPENSATION AND REASONABLENESS ANALYSIS EVERY TWO YEARS. COMPENSATION IS SET, BASED ON THE DATA PROVIDED, BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. TOWERS WATSON ALSO PROVIDES AN OPINION AS TO THE REASONABLENESS OF THE TOTAL COMPENSATION PACKAGES, INCLUDING BASE PAY, INCENTIVE, BENEFITS AND RETIREMENT BENEFITS. THE COMPENSATION WAS LAST REVIEWED UNDER THIS PROCESS DURING 2018. THE OPINION AND REPORT WERE ISSUED IN 2019. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII: CERTAIN EMPLOYEES ARE OFFICERS OF MULTIPLE COMPANIES WITHIN THE LARGER ORGANIZATION. THE AVERAGE HOURS WORKED REFLECTS APPROXIMATE TIME SPENT IN EACH OF THOSE INDIVIDUAL COMPANIES. WHILE THE HOURS ARE ALLOCATED TO INDIVIDUAL COMPANIES, MUCH OF THE OFFICERS' TIME IS SPENT WORKING ON ISSUES THAT IMPACT THE ENTIRE ORGANIZATION, NOT JUST ONE COMPANY. COMPENSATION IS REPORTED IN FULL TO AGREE TO THE EMPLOYEE'S W-2 AS REQUIRED BY IRS INSTRUCTIONS. ANY ALLOCATION OF COMPENSATION IS INCLUDED ON SCHEDULE R. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 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. RENAISSANCE HEALTH SERVICE CORPORATION PO BOX 30416 LANSING MI 489097916 381675667 PROMOTING DENTAL CARE MI 501(C)(4) N/A N/A 0 DELTA DENTAL PLAN OF INDIANA INC PO BOX 30416 LANSING MI 489097916 351545647 PROVIDE DENTAL SERVICE PLANS IN 501(C)(4) N/A DELTA DENTAL PLAN OF MICHIGAN INC 0 DELTA DENTAL PLAN OF MICHIGAN INC 4100 OKEMOS ROAD OKEMOS MI 48864 381791480 PROVIDE DENTAL SERVICE PLANS MI 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF TENNESSEE 240 VENTURE CIRCLE NASHVILLE TN 37228 620812197 PROVIDE DENTAL SERVICE PLANS TN 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL FUND PO BOX 30416 LANSING MI 489097916 382337000 SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMS MI 501(C)(3) LINE 12A, I DELTA DENTAL PLAN OF MICHIGAN INC 0 DELTA DENTAL PLAN OF NEW MEXICO INC 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 ROAD OKEMOS MI 48864 461376165 EMPHASIZE DENTAL HEALTH IN COMMUNITIES IN 501(C)(3) PF RENAISSANCE HOLDING COMPANY 0 SMILE 180 FOUNDATION 240 VENTURE CIRCLE NASHVILLE TN 37228 471654054 EMPHASIZE DENTAL HEALTH IN COMMUNITIES TN 501(C)(3) LINE 12A, I DELTA DENTAL OF TENNESSEE INC 0 CHESME LLC 124 N BRIDGE ST DEWITT MI 48820 200061957 CAPITAL MANAGEMENT MI THE 4100 GROUP RELATED 116904 861101 0 0 0.19750 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA PO BOX 30381 LANSING MI 48909 470397286 INSURANCE IN RENAISSANCE HOLDING COMPANY C 201947 4949731 0.04200 0 RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI DELTA DENTAL OF MICHIGAN C -119652 1940680 0.04200 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK PO BOX 30381 LANSING MI 48909 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 8887 518612 0.04200 0 OMEGA ADMINISTRATORS INC 1513 COUNTRY CLUB ROAD SHERWOOD AR 72120 043740469 PROVIDING THIRD-PARTY ADMINISTRATIVE SERVICES AR N/A C 0 THE 4100 GROUP 4100 OKEMOS ROAD OKEMOS MI 48864 472557772 INVESTMENT IN SUBSIDIARIES MI DELTA DENTAL OF MICHIGAN C -768322 26666491 0.25000 0 FORE HOLDING CORPORATION 240 VENTURE CIRCLE NASHVILLE TN 37228 204116122 HOLDING COMPANY TN N/A C 0 DEWPOINT INC 300 S WASHINGTON SQUARE LANSING MI 48933 383300595 IT CONSULTING MI THE 4100 GROUP C 1963546 15624459 0.25000 0 DENTAL CHOICE INC 10100 LINN STATION RD 700 LOUISVILLE KY 402293861 611105118 PROVIDE DENTAL SERVICE PLANS KY N/A C 0 DENTAL CHOICE AGENCY INC 10100 LINN STATION RD 700 LOUISVILLE KY 402293861 611336003 PRIMARY GENERAL AGENCY FOR DDKY AND DENTAL CHOICE KY N/A C 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 DELTA DENTAL OF NORTH CAROLINA A 5222 ACTUAL COST DELTA DENTAL FUND B 2000000 ACTUAL COST DELTA DENTAL PLAN OF MICHIGAN INC M 38461035 ACTUAL COST RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA M 591822 ACTUAL COST