2019-11-13T14:16:11-06:00 2018-12-31 381357951 PLANTE & MORAN PLLC 1111 MICHIGAN AVE STE 100 EAST LANSING MI 48823 990 2018-01-01 310685339 DELTA DENTAL PLAN OF OHIO INC DELT 5173496000 PO BOX 30416 LANSING MI 489097916 AMY BASEL CHIEF FINANCIAL OFFICER 5173496000 2019-11-07 1 DAVID LOWENTHAL CPA P00378651 5173326200 2019-11-07 67.59.56.31 2019-11-07 15:47:42 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 AFBDF4DF54CCD05CFBA4AEDC275F7F3808ECB98B 2018 2020-04-17 16:48:07Z GORAN JURKOVIC PO BOX 30416 LANSING MI 489097916 616819178 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. 11 11 0 0 0 0 0 0 549443157 606599355 5936917 7347230 0 674 555380074 613947259 5025000 1500000 0 0 517508 451342 0 0 0 528476807 591701860 534019315 593653202 21360759 20294057 231330486 238787566 38967626 36315379 192362860 202472187 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 577071286 1500000 606599355 PROMOTING DENTAL CAREDELTA DENTAL PLAN OF OHIO, INC. IS A LEADING DENTAL BENEFITS PROVIDER IN THE MIDWEST. 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 $545 MILLION FOR DENTAL CARE, BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 3.8 MILLION CLAIMS WERE PROCESSED FOR OVER 2.1 MILLION MEMBERS.SEE SCHEDULE O FOR CONTINUATION 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 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 INITIATIVES AND RESULTSBRINGING QUALITY TO ALL WE DO IS THE QUALITY POLICY FOR DELTA DENTAL PLAN OF OHIO, INC. THE AFFILIATED DELTA DENTAL PLANS OF MICHIGAN, OHIO AND INDIANA HOLD THE PRESTIGIOUS ISO 9001 CERTIFICATION. QUALITY STANDARDS ARE EXTREMELY RIGOROUS AND GUARANTEE THAT DELTA DENTAL HAS DOCUMENTED ITS QUALITY PROCEDURES AND SYSTEMS THROUGHOUT THE COMPANY. THIS CERTIFICATION DEMONSTRATES OUR COMMITMENT TO SERVING THE NEEDS OF OUR CUSTOMERS AND STRENGTHENS OUR DEDICATION TO QUALITY AND INNOVATION.QUALITY SERVICE IS ALSO MEASURED THROUGH INTERNAL AUDITS. RESULTS INDICATE OVER 99 PERCENT OF CLAIMS ARE ACCURATELY PROCESSED WITHIN 10 WORKING DAYS.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 $30 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, FOR SCHOLARSHIP AND LEADERSHIP AWARDS TO DENTAL STUDENTS, FOR GRANTS TO PURCHASE LEARNING TOOLS AND OTHER PROGRAMS TO DENTAL SCHOOLS, FOR CONTINUING EDUCATION PROGRAMS FOR THE DENTAL PROFESSION, AND FOR EDUCATIONAL MATERIALS ON THE IMPORTANCE OF ORAL HEALTH AND HAZARDS TO ORAL HEALTH.IN 2018, DELTA DENTAL FUND PROVIDED GRANTS TOTALING OVER $3.8 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 ALLOWS US TO MAINTAIN LARGE NETWORKS, ALLOWING BROAD ACCESS FOR MEMBERS AND COST-EFFECTIVE CARE.DELTA DENTAL'S GROUP MEMBERS ARE AFFORDED ADDED PROTECTION BECAUSE PARTICIPATING DENTISTS ACCEPT DELTA DENTAL'S PAYMENT FOR COVERED SERVICES AT 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. 577071286 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 48512 0 1 0 0 0 0 0 0 0 0 0 X 11 11 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 DOUGLAS R ANDERSON DDS MS IMMEDIATE PAST CHAIRPERSON 5.00 11.00 X X 52004 94030 18500 BRUCE R SMITH CHAIRPERSON 5.00 14.00 X X 51673 63960 0 ANN M FLERMOEN DDS VICE CHAIRPERSON 5.00 11.00 X X 46000 87000 0 JAMES R STAHL DDS TREASURER 5.00 0.00 X X 46299 0 0 FRANK BUZAKI JR SECRETARY 5.00 0.00 X X 29165 0 18500 PATRICK T CAHILL THRU 92018 DIRECTOR 5.00 0.00 X 28000 0 0 CHRISTOPHER FISHER DIRECTOR 5.00 5.00 X 14000 60000 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 17500 0 0 CAROLE S WATKINS DIRECTOR 5.00 6.00 X 42000 12496 0 CANISE WRIGHT-BEAN DIRECTOR 5.00 0.00 X 14000 0 0 LAURA L CZELADA CPA PRESIDENT & CEO 4.00 46.00 X 0 14842204 23592 GORAN JURKOVIC CPA COO 10.00 40.00 X 0 2411710 1927286 AMY BASEL CPA SVP, CFO, AND CRO 5.00 45.00 X 0 814278 1570964 MICHAEL GILMORE VP CHIEF INVESTMENT OFFICER 1.00 49.00 X 0 401243 53447 SUE ELLEN JENKINS VICE PRESIDENT - GENERAL COUNSEL 5.00 45.00 X 0 319432 40233 JON GROAT FORMER VP - GENERAL COUNSEL 0.00 0.00 X 0 227358 0 424641 19333711 3652522 0 1 1 0 ALLIANT INSURANCE SERVICES INC 5847 SAB FEKUOE ST HOUSTON TX 77057 COMMISSIONS 531331 GALLAGHER BENEFIT SERVICES INC 281 VISTA PARKWAY SUITE 300 WEST PALM BEACH FL 35411 COMMISSIONS 365737 USI INSURANCE SERVICES LLC 1 HILLCREST DR CHARLESTON WV 25311 COMMISSIONS 343679 HUB INTERNATIONAL MIDWEST LIMITED 2487 CEDARCREST ACWORTH GA 30101 COMMISSIONS 311439 HYLANT GROUP 811 MADISON AVE TOLEDO OH 43604 COMMISSIONS 273809 18 DENTAL CARE REVENUE 624100 606599355 606599355 606599355 5688528 5688528 4530621 2871919 1658702 1658702 1658702 MISCELLANEOUS REVENUE 900099 674 674 674 613947259 606599355 0 7347904 X 1500000 1500000 451342 293372 157970 120 120 105900 105900 186502 186502 545651339 545595193 56146 373883 373883 85433 85433 ADMIN/INVESTMENT O/H 33360412 20880546 12479866 COMMISSION EXPENSE 6039987 6039987 FEDERAL HEALTH CARE TAX 2417464 2417464 PREMIUM TAX EXPENSE 2368464 2368464 1112356 393724 718632 593653202 577071286 16581916 0 1418427 13581507 6888859 10552439 23937982 26096268 750000 250000 3500 175379800 164228639 22404497 23692650 550921 382563 231330486 238787566 7542771 8755145 1746745 1591474 29678110 25968760 38967626 36315379 X 0 0 9529667 9707604 182833193 192764583 192362860 202472187 231330486 238787566 X 20294057 -11592547 1407817 X X 0 1 X 1 0 0 INVESTMENT IN RENAISSANCE HOLDING COMPANY 5107238 F INVESTMENT IN THE 4100 GROUP 18585412 F 23692650 CLAIMS RESERVES 20104023 UNEARNED PREMIUMS 5217670 OTHER ACCRUED LIABILITIES 792 UNDISBURSED UNDERWRITING GAIN/LOSS 646275 25968760 1 DELTA DENTAL FUND PO BOX 30416 LANSING MI 489097916 382337000 501(C)(3) 1500000 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 1 1 0 0 0 0 0 1 0 DOUGLAS R ANDERSON DDS MS IMMEDIATE PAST CHAIRPERSON 52004 94030 0 0 0 0 8500 10000 0 0 60504 104030 0 0 LAURA L CZELADA CPA PRESIDENT & CEO 0 1059540 0 1759388 0 12023276 0 15511 0 8081 0 14865796 0 11948859 GORAN JURKOVIC CPA COO 0 1045371 0 1343351 0 22988 0 1903103 0 24183 0 4338996 0 0 AMY BASEL CPA SVP, CFO, AND CRO 0 377235 0 424821 0 12222 0 1546781 0 24183 0 2385242 0 0 MICHAEL GILMORE VP CHIEF INVESTMENT OFFICER 0 285659 0 109581 0 6003 0 29264 0 24183 0 454690 0 0 SUE ELLEN JENKINS VICE PRESIDENT - GENERAL COUNSEL 0 258640 0 60000 0 792 0 28736 0 11497 0 359665 0 0 JON 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, 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 COMPENSATON 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, LINES 4A-B 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 2018, GORAN JURKOVIC AND AMY BASEL ACCRUED BENEFITS AS PARTICIPANTS IN THE SERP PLAN, BUT DID NOT RECEIVE A DISTRIBUTION. LAURA CZELADA VESTED IN THE PLAN IN THE AMOUNT OF $11,948,859 AND TAXES ON THAT AMOUNT WERE REMITTED TO THE IRS. 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. 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 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 WERE 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 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, COO 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. 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 55,402. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 55,402. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 545,595,193. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 545,595,193. STATE EXAMINATION EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 744. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 744. FORM 990, PART XI, LINE 9: GAIN ON INVESTMENT IN SUBSIDIARIES 1,407,817. 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). 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) 12A TYPE II 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 12B, II DELTA DENTAL OF TENNESSEE INC 0 CHESME LLC 124 N BRIDGE ST DEWITT MI 48820 200061957 CAPITAL MANAGEMENT MI THE 4100 GROUP RELATED 123885 918862 0 0 0.19750 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA PO BOX 30381 LANSING MI 48909 470397286 INSURANCE IN RENAISSANCE HOLDING COMPANY C 318588 4361259 0.04200 0 RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI DELTA DENTAL OF MICHIGAN C 49543 2221224 0.04200 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK PO BOX 30381 LANSING MI 48909 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 22562 461887 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 -102085 6228656 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 1739715 13679793 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 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 DELTA DENTAL OF NORTH CAROLINA A 157778 ACTUAL COST DELTA DENTAL FUND B 1500000 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA D 250000 ACTUAL LOAN AMOUNT DELTA DENTAL PLAN OF MICHIGAN INC M 32862881 ACTUAL COST RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA M 518660 ACTUAL COST