2019-11-13T14:09:59-06:00 2018-12-31 381357951 PLANTE & MORAN PLLC 1111 MICHIGAN AVE STE 100 EAST LANSING MI 48823 990 2018-01-01 850224562 DELTA DENTAL PLAN OF NEW MEXICO INC DELT 5058557114 2500 LOUISIANA BLVD NE NO 600 ALBUQUERQUE NM 87110 AMY BASEL CHIEF FINANCIAL OFFICER 5058557114 2019-11-11 1 DAVID LOWENTHAL CPA P00378651 5173326200 2019-11-07 68.62.32.134 2019-11-11 08:19:25 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 AFBDF4DF54CCD05CFBA4AEDC275F7F3808ECB98B 2018 2020-03-31 21:24:44Z LOUIS VOLK III 2500 LOUISIANA BLVD NE NO 600 ALBUQUERQUE NM 87110 126130184 0 X HTTP://WWW.DELTADENTALNM.COM X 1971 NM DELTA DENTAL OF NEW MEXICO'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH DENTAL SERVICES, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. 7 6 44 0 0 0 0 0 110955061 114428173 1283111 1440950 25655 25539 112263827 115894662 113727 374993 0 0 3006550 3734940 0 0 0 105351067 108305923 108471344 112415856 3792483 3478806 54172245 56147641 6058416 6596367 48113829 49551274 X DELTA DENTAL OF NEW MEXICO'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH DENTAL SERVICES, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. 0 0 110144029 374993 114453712 PROMOTING DENTAL CAREDELTA DENTAL PLAN OF NEW MEXICO, 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 2018 BY PAYING OUT OVER $100 MILLION IN CLAIMS AND BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 630,000 CLAIMS WERE PROCESSED FOR OVER 328,000 MEMBERS.SEE SCHEDULE O FOR CONTINUATIONCOST 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 ANTI-FRAUD PROGRAMS, ALL OF WHICH ENSURE QUALITY, COST-EFFECTIVE DENTAL BENEFIT DELIVERY. DELTA DENTAL'S INDUSTRY LEADING TECHNOLOGY PLATFORM, ENTERPRISE TECHNOLOGY SYSTEM, ETS, PROVIDES FAST, FLEXIBLE SERVICE, INCLUDING ONLINE, REAL-TIME CLAIMS PROCESSING. THE NEXT GENERATION OF ETS, ROOSEVELT, WILL MAINTAIN ALL OF THE ETS FUNCTIONALITY, WHILE ADDING NEW TOOLS AND FEATURES TO IMPROVE MARKET COMPETITIVENESS. THE COMPANY'S PRIORITY IS TO REDUCE COSTS AND IMPROVE SERVICE BY INCREASING THE VOLUME OF CLAIMS THAT ARE SUBMITTED ELECTRONICALLY.QUALITY SERVICE IS ALSO MEASURED THROUGH INTERNAL AUDITS. RESULTS INDICATE OVER 99 PERCENT OF CLAIMS ARE PROCESSED ACCURATELY WITHIN 10 WORKING DAYS.FOR OVER 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.DELTA DENTAL'S GROUP MEMBERS ARE AFFORDED ADDED PROTECTION BECAUSE PARTICIPATING DENTISTS ACCEPT DELTA DENTAL'S 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 EXPENSES FOR MEMBERS. WITH TWO NETWORKS OF FULL-TIME PARTICIPATING DENTISTS IN ONE INTERGRATED CLAIMS SYSTEM, DELTA DENTAL CAN DELIVER TO CUSTOMERS AND GROUP MEMBERS BROAD ACCESS TO CARE. 110144029 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 1 4880 0 1 44 1 0 0 0 0 0 0 0 0 X 7 6 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 EDWARD J LOPEZ JR PRESIDENT & CEO THRU 12/18 50.00 0.00 X X 336382 0 39137 STEPHEN B CHREIST IMMEDIATE PAST CHAIRPERSON 5.00 5.00 X X 12700 28960 0 ROBERT L SIMMONS CHAIRPERSON 5.00 0.00 X X 21458 0 0 JAMES TRUJILLO VICE CHAIRPERSON 5.00 0.00 X X 12794 0 0 THOMAS J FLESZAR DDS MS INTERIM PRESIDENT & CEO 5.00 12.00 X 7500 94750 0 MICHAEL BLOMKER SECRETARY/TREASURER THRU 10/18 5.00 0.00 X 8200 0 0 RALPH MCELMURRY DDS DIRECTOR 5.00 0.00 X 8799 0 0 CHRISTINE N NATHE RDH MS DIRECTOR 5.00 0.00 X 9019 0 0 LOUIS VOLK III DIRECTOR 5.00 0.00 X 7500 0 0 DAVID JAMES MARTINEZ DDS DIRECTOR 5.00 0.00 X 7500 0 0 GORAN JURKOVIC CPA CFO THRU 4/18 1.00 49.00 X 0 2411710 1927286 AMY BASEL CFO 1.00 49.00 X 0 814278 1570964 SUE ELLEN JENKINS VP- LEGAL COUNSEL 1.00 49.00 X 0 319432 40233 CYNTHIA LUCERO-ALI DIRECTOR, OPERATIONS 50.00 0.00 X 102971 0 23227 JOLOU TRUJILLO-OTTINO VP SALES AND MARKETING 50.00 0.00 X 157142 0 36200 JONATHAN S GROAT FORMER VP GENERAL COUNSEL 0.00 0.00 X 0 227358 0 691965 3896488 3637047 3 1 1 0 HUB INTERNATIONAL INSURANCE SERVICE 9990 JEFFERSON NE SUITE 101 ALBUQUERQUE NM 87190 COMMISSIONS 345614 DEWPOINT 300 WASHINGTON SQUARE LANSING MI 48933 IT CONSULTING 287860 MONTGOMERY & ANDREWS PA PO BOX 2307 SANTA FE NM 87504 LEGAL SERVICES 196378 AON RISK INSURANCE SERVICES WEST 6501 AMERICAS PARKWAY NE ALBUQUERQUE NM 87110 COMMISSIONS 102469 4 DENTAL CARE REVENUE 524114 114428173 114428173 114428173 1357509 1357509 10318963 10235522 83441 83441 83441 DISCOUNT CARD INCOME 900099 25539 25539 25539 115894662 114453712 0 1440950 X 374993 374993 504121 327679 176442 2568122 1794269 773853 146334 143168 3166 348714 318260 30454 167649 146892 20757 146438 146438 57752 57752 72607 72607 101720598 101460283 260315 166828 166612 216 559614 482468 77146 317722 255675 62047 211145 137244 73901 301710 212558 89152 53005 47363 5642 59630 40027 19603 41117 41117 COMMISSIONS 1858389 1858389 PROCESSING FEES 1356858 1356858 PREMIUM TAXES 840568 840568 MEMBERSHIP DUES & ASSOC 296738 37526 259212 245204 143197 102007 112415856 110144029 2271827 0 2077442 2500802 3774165 2747502 5193092 4811179 170728 113305 1443335 1216701 145749 226634 36270885 39362696 5410808 5059878 1129376 1325645 54172245 56147641 1590740 1933806 792383 1259779 3675293 3402782 6058416 6596367 X 48113829 49551274 48113829 49551274 54172245 56147641 X 3478806 -1906482 -134879 X 0 1 X 1 0 149500 138822 10678 1246210 1046264 199946 47625 31615 16010 226634 4959878 C SURPLUS NOTE RECEIVABLE 100000 C 5059878 CLAIMS RESERVES 2916000 DUE TO AFFILIATE 486782 3402782 115848027 0 115848027 46635 46635 115894662 112369221 0 112369221 46635 46635 112415856 1 SPECIAL OLYMPICS NEW MEXICO INC 6600 PALOMAS NE ALBUQUERQUE NM 87109 850268084 501(C)(3) 20000 CHARITABLE DONATION AMERICAN HEART ASSOCIATION 727 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)(3) 70000 CHARITABLE DONATION NEW MEXICO DENTAL FOUNDATION 9201 MONTGOMERY BLVD NE ALBUQUERQUE NM 87111 743146433 501(C)(3) 20000 CHARITABLE DONATION ALBUQUERQUE HEALTH CARE FOR THE HOMELESS PO BOX 25445 ALBUQUERQUE NM 87125 850368993 501(C)(3) 25000 CHARITABLE DONATION UNIVERSITY OF NEW MEXICO FOUNDATION INC TWO WOODWARD CENTER ALBUQUERQUE NM 87102 850275408 501(C)(3) 72500 CHARITABLE DONATION CENTRAL NEW MEXICO COMMUNITY COLLEGE FOUNDATION 525 BUENA VISTA SE ALBUQUERQUE NM 87106 850338623 501(C)(3) 25000 STUDENT SUPPORT NATIONAL HISPANIC CULTURAL CENTER FOUNDATION 1701 4TH STREET SW ALBUQUERQUE NM 87102 850335056 501(C)(3) 32500 CHARITABLE DONATION NEW MEXICO STATE UNIVERSITY FOUNDATION PO BOX 3590 LAS CRUCES NM 88003 850170157 501(C)(3) 40000 CHARITABLE DONATION & DENTAL HYGIENE PROGRAM RMA KIDNEY FOUNDATION PO BOX 92373 ALBUQUERQUE NM 87199 475504391 501(C)(3) 10000 CHARITABLE DONATION ALBUQUERQUE PUBLIC SCHOOLS 6400 UPTOWN BLVD NE ALBUQUERQUE NM 87110 GOVT 47120 FMV FOOD FOOD PROVIDED TO 6000 SCHOOL CHILDREN TO TAKE HOME ON THE WEEKEND, WHEN THEY MAY NOT HAVE ENOUGH TO EAT. CITY OF ALBUQUERQUE 1 CIVIC PLAZA ALBUQUERQUE NM 87123 GOVT 12873 FMV 10 WATER REFILLING FOUNTATIONS CHARITABLE DONATION - TO ENCOURAGE DRINKING WATER OVER SUGARY BEVERAGES. 11 0 PART I, LINE 2: CONTRIBUTIONS ARE MADE AT THE ORGANIZATION'S DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF NEW MEXICO'S MISSION. 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 NEW MEXICO. X 1 1 X X 1 1 0 0 0 0 0 1 0 EDWARD J LOPEZ JR PRESIDENT & CEO THRU 12/18 246018 0 80000 0 10364 0 20721 0 18416 0 375519 0 0 0 GORAN JURKOVIC CPA CFO THRU 4/18 0 1045371 0 1343351 0 22988 0 1903103 0 24183 0 4338996 0 0 AMY BASEL CFO 0 377235 0 424821 0 12222 0 1546781 0 24183 0 2385242 0 0 SUE ELLEN JENKINS VP- LEGAL COUNSEL 0 258640 0 60000 0 792 0 28736 0 11497 0 359665 0 0 JOLOU TRUJILLO-OTTINO VP SALES AND MARKETING 129395 0 26107 0 1640 0 15985 0 20215 0 193342 0 0 0 JONATHAN S GROAT FORMER VP GENERAL COUNSEL 0 0 0 0 0 227358 0 0 0 0 0 227358 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, LINES 4A-B A 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 2018, GORAN JURKOVIC AND AMY BASEL ACCRUED BENEFITS AS PARTICIPANTS IN THE SERP PLAN, BUT DID NOT RECEIVE A DISTRIBUTION. IN 2018, JON GROAT RECEIVED A SEVERANCE PAYMENT OF $227,358 FROM A RELATED ORGANIZATION. PART I, LINE 7 AS INDICATED IN SCHEDULE J, PART II, TOP MANAGEMENT OFFICIALS RECEIVED A BONUS BASED ON PERFORMANCE AND THE FINANCIAL RESULTS OF THE ORGANIZATION. THIS BONUS WAS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. DAVID J MARTINEZ DDS DAVID MARTINEZ IS A DIRECTOR ON THE DDNM BOARD OF DIRECTORS 695846 PAYMENTS FOR DENTAL SERVICES. 0 FORM 990, PART VI, SECTION A, LINE 6 DELTA DENTAL PLAN OF NEW MEXICO, INC. HAS A SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A BOARD MEMBERS ARE ELECTED BY THE PRESENT BOARD AND ARE APPROVED BY RENAISSANCE HEALTH SERVICE CORPORATION, THE SOLE CORPORATE MEMBER OF DELTA DENTAL PLAN OF NEW MEXICO, INC. 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, PRIOR TO FILING THE 990 WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ENTERPRISE'S 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 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 MANAGEMENT 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 CEO COMPENSATION IS SET BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. MARKET DATA PROVIDED BY OUTSIDE CONSULTANTS, TOWERS WATSON, IS USED TO VALIDATE THE REASONABLENESS OF THE TOTAL COMPENSATION PACKAGE. COMPENSATION FOR CERTAIN OFFICERS, INCLUDING THE CFO AND GENREAL COUNSEL IS DETERMINED AND PAID THROUGH A RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, INC. FORM 990, PART VI, SECTION C, LINE 19 DELTA DENTAL PLAN OF NEW MEXICO, INC. (DDNM) FILES ON A QUARTERLY AND ANNUAL BASIS COMPREHENSIVE FINANCIAL DOCUMENTS WITH THE NEW MEXICO OFFICE OF INSURANCE SUPERINTENDENT (OSI). OSI AND THE NEW MEXICO SECRETARY OF STATE HAVE ON FILE ALL GOVERNING DOCUMENTS. THE DDNM'S 990 FORM IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII CERTAIN EMPLOYEES ARE OFFICERS OF MULTIPLE COMPANIES WITHIN THE LARGER ORGANIZATION. THE AVERAGE HOURS WORKED REFLECTS APPROXIMATE TIME SPENT IN EACH OF THOSE INDIVIDUAL COMPANIES. WHILE THE HOURS ARE ALLOCATED TO INDIVIDUAL COMPANIES, MUCH OF THE OFFICERS' TIME IS SPENT WORKING ON ISSUES THAT IMPACT THE ENTIRE ORGANIZATION, NOT JUST ONE COMPANY. COMPENSATION IS REPORTED IN FULL TO AGREE TO THE EMPLOYEE'S W-2 AS REQUIRED BY IRS INSTRUCTIONS. ANY ALLOCATION OF COMPENSATION IS INCLUDED ON SCHEDULE R. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 545,426. MANAGEMENT AND GENERAL EXPENSES 260,315. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 805,741. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 100,914,857. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 100,914,857. FORM 990, PART XI, LINE 9: LOSS ON INVESTMENT IN RENAISSANCE HOLDING COMPANY -134,879. RENAISSANCE HEALTH SERVICE CORPORATION PO BOX 30416 LANSING MI 489097916 381675667 PROMOTING DENTAL CARE MI 501(C)(4) N/A N/A 0 DELTA DENTAL PLAN OF MICHIGAN INC 4100 OKEMOS ROAD OKEMOS MI 48864 381791480 PROVIDE DENTAL SERVICE PLANS MI 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL 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 OHIO INC PO BOX 30416 LANSING MI 489097916 310685339 PROVIDE DENTAL SERVICE PLANS OH 501(C)(4) N/A DELTA DENTAL PLAN OF MICHIGAN INC 0 DELTA DENTAL OF TENNESSEE INC 240 VENTURE CIRCLE NASHVILLE TN 37228 620812197 PROVIDE DENTAL SERVICE PLANS TN 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL 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 FUND PO BOX 30416 LANSING MI 489097916 382337000 SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMS MI 501(C)(3) LINE 12B, II DELTA DENTAL PLAN OF MICHIGAN INC 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 N/A RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI DELTA DENTAL OF MICHIGAN C 47184 2115452 0.04000 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA PO BOX 30381 LANSING MI 48909 470397286 INSURANCE IN RENAISSANCE HOLDING COMPANY C 303417 4153580 0.04000 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK PO BOX 30381 LANSING MI 48909 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 21487 439893 0.04000 0 FORE HOLDING CORPORATION 240 VENTURE CIRCLE NASHVILLE TN 37228 204116122 HOLDING COMPANY TN N/A C 0 DENTAL CHOICE INC 10100 LINN STATION RD 700 LOUISVILLE KY 402233861 611105118 PROVIDE DENTAL SERVICE PLANS KY N/A C 0 DENTAL CHOICE AGENCY INC 10100 LINN STATION RD 700 LOUISVILLE KY 402233861 611336003 PRIMARY GENERAL AGENCY FOR DDKY AND 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 N/A C 0 DEWPOINT INC 300 S WASHINGTON SQUARE LANSING MI 48933 383300595 IT CONSULTING MI N/A C 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 DELTA DENTAL PLAN OF MICHIGAN INC M 1592293 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA D 100000 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA A 31556 ACTUAL COST