2019-11-13T13:52:16-06:00 2018-12-31 381357951 PLANTE & MORANPLLC 1111 MICHIGAN AVE PO BOX 2500 EAST LANSING MI 488262500 990 2018-01-01 381791480 DELTA DENTAL PLAN OF MICHIGAN INC DELT 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 AMY BASEL CFO 5173496000 2019-11-10 1 DAVID LOWENTHAL CPA P00378651 5173326200 2019-11-10 68.62.32.134 2019-11-10 15:07:23 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 AFBDF4DF54CCD05CFBA4AEDC275F7F3808ECB98B 2018 2020-03-31 21:24:44Z GORAN JURKOVIC 4100 OKEMOS ROAD OKEMOS MI 48864 2193970185 0 X WWW.DELTADENTALMI.COM X 1957 MI DELTA DENTAL OF MICHIGAN'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH DENTAL SERVICES THROUGH CONTRACTS WITH INDEPENDENT PROFESSIONAL SERVICE PROVIDERS, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. 15 11 963 0 7291708 381921 0 0 1988620211 1995986767 10622625 12760244 67560288 93691432 2066803124 2102438443 10900727 3796245 0 0 97038154 100711611 0 0 0 1912882185 1956131705 2020821066 2060639561 45982058 41798882 796843303 797772708 286445646 282802365 510397657 514970343 X SEE SCHEDULE ODELTA DENTAL OF MICHIGAN'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH DENTAL SERVICES THROUGH CONTRACTS WITH INDEPENDENT PROFESSIONAL SERVICE PROVIDERS, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. DELTA DENTAL OF MICHIGAN IS GOVERNED BY A BOARD OF DIRECTORS CONTROLLED BY INDEPENDENT MEMBERS OF THE COMMUNITY AND IT OFFERS ENROLLMENT IN ORAL HEALTH PLANS TO A BROAD BASE OF THE COMMUNITY THROUGH A VARIETY OF PAYMENT MODELS. 0 0 1962246439 3796245 2082166607 PROMOTING DENTAL CAREDELTA DENTAL PLAN OF MICHIGAN, 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 $1.79 BILLION FOR DENTAL CARE, BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 10.5 MILLION CLAIMS WERE PROCESSED FOR OVER 5.6 MILLION 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 SOLUTIONS (ETS), HAS BEEN RECOGNIZED AS PROVIDING THE BEST IN 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. ONE OF DELTA DENTAL'S CONTINUED PRIORITIES 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 MICHIGAN, 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 PROCESSED ACCURATELY WITHIN 10 WORKING DAYS.COMMITMENT TO THE COMMUNITYDELTA DENTAL PLAN OF MICHIGAN, INC. BELIEVES ADVANCES IN DENTAL RESEARCH AND ENHANCED EDUCATIONAL OPPORTUNITIES FOR DENTISTS GO A LONG WAY TOWARD IMPROVING ORAL HEALTH. THE COMPANY IS A KEY PLAYER IN GROUNDBREAKING RESEARCH ON TRENDS IN ORAL HEALTH IN THE INSURED POPULATION. THE DELTA DENTAL FUND, THE COMPANY'S PHILANTHROPIC AFFILIATE, ENCOURAGES ADVANCES IN DENTISTRY AND SUPPORTS DENTAL EDUCATION AND RESEARCH. SINCE IT WAS FORMED IN 1980, THE DELTA DENTAL FUND HAS GRANTED OVER $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 NEARLY $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 MICHIGAN IS ALSO COMMITTED TO BUILDING HEALTHY, SMART, VIBRANT COMMUNITIES. DELTA DENTAL HAS ALWAYS BEEN KEENLY AWARE OF ITS CIVIC AND SOCIAL RESPONSIBILITY. DELTA DENTAL PLANS ARE PROUD TO SHARE, THROUGH DIRECT FINANCIAL CONTRIBUTIONS, WITH HUNDREDS OF COMMUNITY AGENCIES AND GROUPS. IN ADDITION, EMPLOYEES LOG COUNTLESS HOURS OF THEIR OWN TIME AS VOLUNTEERS. COMMUNITY SUPPORT GENERALLY FALLS UNDER THE BROAD CATEGORIES THAT PROVIDE SUPPORT TO AGENCIES AND INSTITUTIONS SERVING CHILDREN, SENIORS, LOW-INCOME INDIVIDUALS, MINORITIES, AND THE DISABLED AND AT-RISK INDIVIDUALS, TO ORGANIZATIONS THAT PROMOTE EDUCATION, ARTS AND RECREATION AND COMMUNITY DEVELOPMENT, AND TO CHARITABLE PROJECTS OR PROGRAMS RECOMMENDED BY EMPLOYEES, CUSTOMERS, PARTICIPATING DENTISTS AND OTHER KEY GROUPS. WE CONTINUED OUR ROLE AS STRONG ADVOCATES FOR SOUND ORAL HEALTH POLICY AT THE STATE AND FEDERAL LEVELS. THROUGH A PUBLIC-PRIVATE PARTNERSHIP WITH THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH, DELTA DENTAL IS ONE OF THE ADMINISTRATORS OF THE HEALTHY KIDS (HKD) PROGRAM. HEALTHY KIDS DENTAL IS A DENTAL BENEFITS PROGRAM FOR MEDICAID BENEFICIARIES UNDER AGE 21. IT IS AVAILABLE IN ALL OF MICHIGAN'S 83 COUNTIES AND COVERS BASIC DENTAL HEALTH BENEFITS SUCH AS X-RAYS, CLEANINGS, CAVITY FILLINGS, ROOT CANALS, TOOTH EXTRACTIONS AND DENTURES. NEARLY 1,000,000 MICHIGAN CHILDREN ARE SERVED BY THIS PROGRAM. UNEQUALED ACCESS TO DENTISTSFOR FIVE DECADES, DELTA DENTAL HAS HELPED PROMOTE ORAL HEALTH BY DESIGNING AND ADMINISTERING INNOVATIVE, COST-EFFECTIVE DENTAL BENEFIT PROGRAMS. EXPERTS AT PLAN DESIGN, DELTA DENTAL HAS CREATED DENTAL BENEFIT PROGRAMS THAT MEET CUSTOMER COST-OBJECTIVES WHILE HELPING TO IMPROVE AND MAINTAIN ORAL HEALTH.OUR LONG STANDING RELATIONSHIPS WITH PROVIDERS IN THE COMMUNITIES WE SERVE ALLOW US TO MAINTAIN LARGE NETWORKS, ALLOWING BROAD ACCESS FOR MEMBERS AND COST-EFFECTIVE CARE.DELTA DENTAL'S GROUP MEMBERS ARE AFFORDED ADDED PROTECTION BECAUSE 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. 1962246439 0 0 1 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 1 63504 0 1 963 1 1 1 0 0 0 0 0 1 0 X 15 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X AMY BASEL CFO 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 X KELLY JUBB SCHEIDERER CHAIRPERSON 5.00 6.00 X X 65118 15248 18500 JOSHUA S HOWIE VICE-CHAIRPERSON 5.00 5.00 X X 169752 13748 0 STEPHEN A EKLUND SECRETARY/TREASURER 5.00 6.00 X X 76485 128198 0 JOSEPH C HARRIS DDS IMMEDIATE PAST CHAIRPERSON 5.00 6.00 X 164395 16752 0 DOUGLAS R ANDERSON DIRECTOR 5.00 11.00 X 52004 94030 18500 CHRISTOPHER T FISHER DIRECTOR 5.00 5.00 X 60000 14000 0 SARA M DOLAN DIRECTOR 5.00 0.00 X 60527 0 0 CHARLES E HALL DIRECTOR 5.00 0.00 X 60000 0 0 THOMAS FLESZAR DDS MS DIRECTOR 5.00 12.00 X 73754 28496 0 ANN MARIE FLERMOEN DIRECTOR 5.00 11.00 X 72504 60496 0 KURT D GALLINGER DIRECTOR 5.00 5.00 X 72504 12496 0 JED JACOBSON DDS MS MPH DIRECTOR 38.00 2.00 X 118104 20996 0 JEFFREY A KELLER DIRECTOR 5.00 5.00 X 72504 12496 0 MELISSA STOLICKER DIRECTOR 5.00 0.00 X 35000 0 0 RAYMOND F GIST DDS DIRECTOR 5.00 0.00 X 35692 0 0 BRUCE R SMITH - THRU 518 IMMEDIATE PAST CHAIRPERSON 5.00 14.00 X 38960 76673 0 LAURA L CZELADA CPA CEO, PRESIDENT 35.00 15.00 X 14842204 0 23592 GORAN JURKOVIC CPA COO 28.00 22.00 X 2411710 0 1927286 JEFF BOTKIN SVP GROUP ADMIN 50.00 0.00 X 369478 0 57492 SUE ELLEN JENKINS VP AND GENERAL COUNSEL 32.00 18.00 X 319432 0 40233 KAREN GREEN VP INFORMATICS/QUALITY 50.00 0.00 X 282576 0 45398 NANCY HOSTETLER SR VP, CHIEF OF STAFF 49.00 1.00 X 446807 0 38717 TOBY HALL SR VP, CHIEF ACTUARY 50.00 0.00 X 645851 0 226961 AMY BASEL CFO, SENIOR VP, & CRO 36.00 14.00 X 814278 0 1570964 KENNETH THEIS SVP & CIO 50.00 0.00 X 666450 0 243048 JEFFREY JOHNSTON VP, CHIEF SCIENCE OFFICER 50.00 0.00 X 383012 0 70341 MICHAEL GILMORE VP, CHIEF INVEST OFFICER 48.00 2.00 X 188276 212958 53447 ANTHONY ROBINSON SVP & CHIEF MKT OFFICER 50.00 0.00 X 932583 0 914477 MIKE BOBAK VP SALES 50.00 0.00 X 328817 0 44713 JOADI KECK VP HR & ADMINISTRATION 50.00 0.00 X 379665 0 66873 JASON NICKOLOFF ACCOUNT EXECUTIVE 50.00 0.00 X 326619 0 95746 LYNN DRASCHIL OPERATING CIO 50.00 0.00 X 366758 0 76221 LORI WHEELRIGHT VP SALES 50.00 0.00 X 355172 0 62982 LUIGI BATTAGLIERI FORMER SR VP, CHIEF RELATIONSHIP 0.00 0.00 X 139530 0 0 RANDY TASCO FORMER VP CHIEF MARKETING OFFICER 50.00 0.00 X 562142 0 0 JON GROAT FORMER VP GENERAL COUNSEL 0.00 0.00 X 227358 0 0 26216021 706587 5595491 186 1 1 0 DEWPOINT 300 WASHINGTON SQUARE SUITE 200 LANSING MI 48933 IT CONSULTING 39212681 WEST MONROE PARTNERS LLC 222 W ADAMS ST FL 11 CHICAGO IL 60606 CONSULTING 8237600 MESSA 1480 KENDALE BLVD EAST LANSING MI 48826 COMMISSIONS 2616729 CLARITY SOLUTION GROUP 150 SOUTH WACKER DR CHICAGO IL 60606 CONSULTING 2029413 GS&F 209 10TH AVE SOUTH NASHVILLE TN 37203 ADVERTISING 1787749 90 DENTAL CARE REVENUE 624100 1988695059 1988695059 EXTERNAL SERVICES 524292 7291708 7291708 1995986767 10012407 10012407 94213325 66254 91510642 21100 2702683 45154 2747837 2747837 ADMIN REIMBURSEMENT 900099 93471548 93471548 MISCELLANEOUS INCOME 900099 219884 219884 93691432 2102438443 2082166607 7291708 12980128 X 3796245 3796245 20758161 13492805 7265356 64160741 40693258 23467483 428493 21285 407208 10317265 7252528 3064737 5046951 3402704 1644247 3109909 839187 2270722 565239 565239 456009 456009 120000 120000 372987 372987 1851316766 1835137304 16179462 3359048 2093210 1265838 13534955 11375335 2159620 15828927 10715329 5113598 3328159 3328159 5847818 4422100 1425718 794680 437995 356685 122247 122247 11882187 5428229 6453958 990581 990581 COMMISSIONS 18181687 18181687 HICA TAX- MI 9205183 9205183 FEDERAL HEALTH CARE TAX 6790740 6790740 PROCESSING FEES 3410933 3410933 6913650 1546305 5367345 2060639561 1962246439 98393122 0 2118 2120 72340799 91633489 91850622 79844002 73309711 93692706 259557780 130587489 115800808 128970291 293644118 264559278 125361740 126397032 24533387 12673790 796843303 797772708 76316324 75459414 210129322 207342951 286445646 282802365 X 15744473 15744473 5122500 5122500 489530684 494103370 510397657 514970343 796843303 797772708 X 41798882 -21098506 -16127690 X X 0 1 X 1 0 75000 75000 1 RELENTLESS POSITIVE ACTION PAC 300 N 5TH AVENUE ANN ARBOR MI 48104 475056186 7500 GRAND LAKE ADMINISTRATIVE FUN 113 W MICHIGAN AVE SUITE 301 JACKSON MI 49201 462753356 1000 BILL SCHUETTE ADMINSTRATIVE ACCOUNT 5915 EASTMAN AVENUE SUITE 100 MIDLAND MI 48640 274215506 25000 PROGRESSIVE ADVOCACY TRUST PO BOX 322 EAST LANSING MI 48826 273504026 40000 MEEKHOF ADMINSTRATIVE ACCOUNT 106 W ALLEGAN STE 200 LANSING MI 48933 463768687 1000 SCHOR LANSING FUND 300 FAIRVIEW AVE LANSING MI 48912 461990008 500 1 0 0 8082071 8082071 106947768 41246098 65701670 52107390 35707905 16399485 92420551 53633486 38787065 128970291 DDIC STOCK 200217 F INVESTMENT IN RHC 70440578 F INVESTMENT IN THE 4100 GROUP 55756237 F 126397032 IBNR - CLAIM ADJUSTMENT RESERVES 45827435 UNEARNED PREMIUMS 27278004 FAS 158 FUNDED STATUS 134237512 207342951 1 DELTA DENTAL FUND 4100 OKEMOS RD OKEMOS MI 48864 382337000 501(C)(3) 3000000 CASH CHARITABLE DONATION LEAP INC 1000 S WASHINGTON AVE LANSING MI 48933 208132313 501(C)(6) 35000 CASH CHARITABLE DONATION SPARROW FOUNDATION PO BOX 30480 LANSING MI 48909 386100687 501(C)(3) 543000 CASH CHARITABLE DONATION MICHIGAN ECONOMIC DEVELOPMENT FOUNDATION PO BOX 13063 LANSING MI 48901 382527475 501(C)(3) 15000 CASH CHARITABLE DONATION AMERICAN CANCER SOCIETY 20450 CIVIC CENTER DR SOUTHFIELD MI 48076 131788491 501(C)(3) 32845 CASH CHARITABLE DONATION ELE'S PLACE 1145 WEST OAKLAND LANSING MI 48915 382976751 501(C)(3) 85000 CASH CHARITABLE DONATION GREATER LANSING FOODBANK 5303 S CEDAR ST LANSING MI 48911 382424756 501(C)(3) 43400 CASH CHARITABLE DONATION LANSING PROMISE 330 MARSHALL ST LANSING MI 48912 453363322 501(C)(3) 20000 CASH CHARITABLE DONATION UNITED WAY OF NORTH CAROLINA 1130 KILDAIRE FARM RD CARY NC 27511 560564547 501(C)(3) 12000 CASH CHARITABLE DONATION TREES WATER AND PEOPLE 633 REMINGTON ST FORT COLLINS CO 80524 841462044 501(C)(3) 10000 CASH CHARITABLE DONATION 9 1 PART I, LINE 2: CONTRIBUTIONS ARE MADE AT MANAGEMENT DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF MICHIGAN'S MISSION. CONTRIBUTIONS MADE TO THE DELTA DENTAL FUND ARE APPROVED BY THE BOARD OF DIRECTORS. IN ORDER FOR FUNDS TO BE DISBURSED, VOUCHER RECORDS MUST PASS THROUGH THE APPROVAL PROCESS, SIMILAR TO ANY OTHER EXPENDITURE MADE BY DELTA DENTAL PLAN OF MICHIGAN. GREATER LANSING FOOD BANK - DELTA DENTAL PROVIDED $43,400 TO THE GREATER LANSING FOOD BANK AS PART OF ITS ANNUAL TAKE A BITE OUT OF HUNGER HOLIDAY FOOD DRIVE. THE COMPANY MATCHED $1 FOR EVERY FOOD ITEM DONATED BY ITS EMPLOYEES AS PART OF THE DRIVE. SPARROW FOUNDATION - DELTA DENTAL OF MICHIGAN CONTRIBUTED A TOTAL OF $543,000 TO THE SPARROW FOUNDATION IN 2018 TO SUPPORT BOTH THE DAPPER DADS EVENT AND THE SPARROW FOUNDATION GALA. BOTH OF THESE EVENTS RAISED FUNDS TO SUPPORT PROGRAMS THAT BENEFIT THE PHYSICAL AND PSYCHOLOGICAL HEALTH OF WOMEN IN MID-MICHIGAN. ELE'S PLACE IN 2018, DELTA DENTAL OF MICHIGAN PROVIDED $85,000 TO ELE'S PLACE TO SUPPORT ELE'S GROUP, THEIR SCHOOL BASED GRIEF COUNSELING PROGRAM. THROUGH THIS PROGRAM, ELE'S PLACE IS ABLE TO REACH CHILDREN WHO MAY NOT OTHERWISE HAVE TRANSPORTATION TO RECEIVE GRIEF COUNSELING SERVICES AT THEIR OFFICES. THE PROGRAM SERVED 900 CHILDREN IN 80 SCHOOLS ACROSS THE STATE IN 2018. LANSING PROMISE DELTA DENTAL PROVIDED $20,000 IN FUNDING TO THE LANSING PROMISE IN 2018. LANSING PROMISE IS A SCHOLARSHIP PROGRAM OFFERING TUITION ASSISTANCE FOR POST-SECONDARY (COLLEGE OR SKILLED TRADE) EDUCATION TO ALL ELIGIBLE HIGH SCHOOL GRADUATES WITHIN THE LANSING SCHOOL DISTRICT BOUNDARIES. THE PROMISE PROVIDES TUITION ASSISTANCE FOR UP TO 65 CREDITS AT LANSING COMMUNITY COLLEGE OR THE EQUIVALENT DOLLAR AMOUNT TOWARD TUITION AND FEES AT MICHIGAN STATE UNIVERSITY OR OLIVET COLLEGE. X X X 1 1 X X X X X 1 1 0 0 0 0 0 1 0 JOSHUA S HOWIE VICE-CHAIRPERSON 169752 13748 0 0 0 0 0 0 0 0 169752 13748 0 0 STEPHEN A EKLUND SECRETARY/TREASURER 76485 128198 0 0 0 0 0 0 0 0 76485 128198 0 0 JOSEPH C HARRIS DDS IMMEDIATE PAST CHAIRPERSON 164395 16752 0 0 0 0 0 0 0 0 164395 16752 0 0 DOUGLAS R ANDERSON DIRECTOR 52004 94030 0 0 0 0 10000 8500 0 0 62004 102530 0 0 LAURA L CZELADA CPA CEO, PRESIDENT 1059540 0 1759388 0 12023276 0 15511 0 8081 0 14865796 0 11948859 0 GORAN JURKOVIC CPA COO 1045371 0 1343351 0 22988 0 1903103 0 24183 0 4338996 0 0 0 JEFF BOTKIN SVP GROUP ADMIN 239571 0 117500 0 12407 0 40555 0 16937 0 426970 0 0 0 SUE ELLEN JENKINS VP AND GENERAL COUNSEL 258640 0 60000 0 792 0 28736 0 11497 0 359665 0 0 0 KAREN GREEN VP INFORMATICS/QUALITY 197901 0 81819 0 2856 0 21215 0 24183 0 327974 0 0 0 NANCY HOSTETLER SR VP, CHIEF OF STAFF 219124 0 216177 0 11506 0 21780 0 16937 0 485524 0 0 0 TOBY HALL SR VP, CHIEF ACTUARY 299826 0 324794 0 21231 0 211634 0 15327 0 872812 0 0 0 AMY BASEL CFO, SENIOR VP, & CRO 377235 0 424821 0 12222 0 1546781 0 24183 0 2385242 0 0 0 KENNETH THEIS SVP & CIO 318747 0 344083 0 3620 0 218865 0 24183 0 909498 0 0 0 JEFFREY JOHNSTON VP, CHIEF SCIENCE OFFICER 262800 0 116648 0 3564 0 46158 0 24183 0 453353 0 0 0 MICHAEL GILMORE VP, CHIEF INVEST OFFICER 75429 210230 109581 0 3266 2728 29264 0 24183 0 241723 212958 0 0 ANTHONY ROBINSON SVP & CHIEF MKT OFFICER 443658 0 472824 0 16101 0 890294 0 24183 0 1847060 0 0 0 MIKE BOBAK VP SALES 163937 0 163915 0 965 0 20530 0 24183 0 373530 0 0 0 JOADI KECK VP HR & ADMINISTRATION 269785 0 102262 0 7618 0 49936 0 16937 0 446538 0 0 0 JASON NICKOLOFF ACCOUNT EXECUTIVE 57696 0 268753 0 170 0 71563 0 24183 0 422365 0 0 0 LYNN DRASCHIL OPERATING CIO 261079 0 98346 0 7333 0 76191 0 30 0 442979 0 0 0 LORI WHEELRIGHT VP SALES 164196 0 188074 0 2902 0 46045 0 16937 0 418154 0 0 0 LUIGI BATTAGLIERI FORMER SR VP, CHIEF RELATIONSHIP 0 0 0 0 139530 0 0 0 0 0 139530 0 0 0 RANDY TASCO FORMER VP CHIEF MARKETING OFFICER 0 0 532852 0 29290 0 0 0 0 0 562142 0 0 0 JON GROAT FORMER VP GENERAL COUNSEL 0 0 0 0 227358 0 0 0 0 0 227358 0 0 0 PART I, LINE 1A THE ORGANIZATION ALLOWS FOR FIRST CLASS TRAVEL IN CERTAIN CIRCUMSTANCES AS NEEDED FOR BUSINESS PURPOSES FOR ONLY THE MOST SENIOR EXECUTIVES AND KEY EMPLOYEES. THIS AMOUNT WAS TREATED AS NONTAXABLE TO THESE INDIVIDUALS. TRAVEL FOR COMPANIONS RELATED TO TRAVEL FOR A SPOUSE. THIS AMOUNT WAS TREATED AS TAXABLE TO THE BOARD MEMBER OR EMPLOYEE. VARIOUS INDIVIDUALS ON SCHEDULE J ARE ELIGIBLE FOR REIMBURSEMENT OF SUBSTANTIATED HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES THAT HAVE A BUSINESS PURPOSE. THIS BENEFIT IS NOT TAXABLE BUT THE EXPENSE MUST BE SUBSTANTIATED AS A BUSINESS EXPENSE. PART I, LINE 3 THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS PERFORMANCE AND SETS TOTAL COMPENSATION FOR THE CEO WITHOUT THE PRESENCE OR INFLUENCE OF THE CEO. EVERY TWO YEARS, A STUDY IS PERFORMED BY TOWERS WATSON AND THE DATA IS USED IN 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 DURING 2018, A SEVERANCE PAYMENT WAS MADE TO BOTH JON GROAT (FORMER VP GENERAL COUNSEL) AND LUIGI BATTAGLIERI (FORMER SR VP CHIEF RELATIONSHIP OFFICER). THE AMOUNTS WERE $227,358 AND $139,530 RESPECTIVELY. 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, AMY BASEL, TOBY HALL, KENNETH THEIS, AND ANTHONY ROBINSON 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. PART I, LINE 7 AS INDICATED IN SCHEDULE J, PART II, TOP MANAGEMENT OFFICIALS RECEIVED A BONUS BASED UPON PERFORMANCE AND THE FINANCIAL RESULTS OF THE ORGANIZATION. THE BONUS WAS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. JOSEPH CARTER HARRIS DDS JOSEPH HARRIS, CHAIR OF DDPMI, IS AN OWNER OF JOSEPH CARTER HARRIS DDS 258904 PAYMENTS FOR DENTAL SERVICES AND FOR CONSULTING SERVICES. 0 TERI BATTAGLIERI SPOUSE OF DDPMI FORMER KEY EMPLOYEE LUIGI BATTAGLIERI 284202 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 BRIAN BATTAGLIERI SON OF DDPMI FORMER KEY EMPLOYEE LUIGI BATTAGLIERI 152291 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 BRIAN JACOBSON BROTHER OF DDPMI BOARD MEMBER JED JACOBSON 137511 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 COLE JACOBSON BROTHER OF DDPMI BOARD MEMBER JED JACOBSON 132844 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 FORM 990, PART VI, SECTION A, LINE 6 DELTA DENTAL PLAN OF MICHIGAN HAS A SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS VOTING RIGHTS AND ELECTS DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE RIGHTS THAT ARE PRESCRIBED BY LAW, FOR MEMBERS OF NON-PROFIT CORPORATIONS, INCLUDING THE APPROVAL OF SIGNIFICANT EXPENDITURES AND CEO APPOINTMENT. FORM 990, PART VI, SECTION B, LINE 11B THE INFORMATION PRESENTED ON THE FORM 990 IS GATHERED BY THE SENIOR TAX ADMINISTRATOR FOR THE ORGANIZATION. THE CFO REVIEWS THE INFORMATION. ONCE APPROVED, THE INFORMATION IS GIVEN TO OUTSIDE TAX PREPARERS WHO PREPARE AND REVIEW THE FORM 990. ONCE COMPLETE, AN ELECTRONIC COPY OF THE FORM 990 IS PLACED IN A SECURE PORTAL FOR THE BOARD TO REVIEW. THIS IS DONE BEFORE THE RETURN IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE COMPANY'S 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 HAD AN INTEREST, THE MEMBER IS REQUIRED TO DISCLOSE THE POTENTIAL CONFLICT AND ABSTAIN FROM ANY VOTE ON THE MATTER. WHETHER FURTHER PRECAUTIONS ARE REQUIRED (E.G., PROHIBITING THE INTERESTED PARTY FROM ENGAGING IN DISCUSSIONS) WOULD DEPEND UPON THE SPECIFIC NATURE AND BACKGROUND OF THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE CEO IS DETERMINED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. COMPENSATION OF THE OTHER EXECTUTIVES IS DETERMINED BY THE CEO IN CONSULTATION WITH THE VP OF HUMAN RESOURCES AND THE CFO. OUTSIDE COMPENSATION CONSULTANTS ARE USED TO DETERMINE MARKET DATA WHICH IS USED TO SET TOTAL COMPENSATION FOR OFFICERS AND KEY EMPLOYEES INCLUDING THE CEO, COO, CFO, AND OTHERS AS APPROPRIATE. DELTA DENTAL PLAN OF MICHIGAN, INC. CONTRACTS WITH TOWERS WATSON TO DO A COMPENSATION AND REASONABLENESS ANALYSIS EVERY TWO YEARS. TOWERS WATSON ALSO PROVIDES AN OPINION AS TO THE REASONABLENESS OF THE TOTAL COMPENSATION PACKAGES, INCLUDING BASE PAY, INCENTIVE, BENEFITS AND RETIREMENT BENEFITS. THE COMPENSATION WAS LAST REVIEWED UNDER THIS PROCESS DURING 2018. COMPENSATION DECISIONS ARE MADE UTILIZING THE DATA PROVIDED BY TOWERS WATSON. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. FORM 990 PART VII: CERTAIN EMPLOYEES ARE OFFICERS OF MULTIPLE COMPANIES WITHIN THE LARGER ORGANIZATION. THE AVERAGE HOURS WORKED REFLECTS APPROXIMATE TIME SPENT IN EACH OF THOSE INDIVIDUAL COMPANIES. WHILE THE HOURS ARE ALLOCATED TO INDIVIDUAL COMPANIES, MUCH OF THE OFFICERS' TIME IS SPENT WORKING ON ISSUES THAT IMPACT THE ENTIRE ORGANIZATION, NOT JUST ONE COMPANY. COMPENSATION IS REPORTED IN FULL TO AGREE TO THE EMPLOYEE'S W-2 AS REQUIRED BY IRS INSTRUCTIONS. ANY ALLOCATION OF COMPENSATION IS INCLUDED ON SCHEDULE R. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 31,558,809. MANAGEMENT AND GENERAL EXPENSES 14,220,670. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 45,779,479. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 3,507,386. MANAGEMENT AND GENERAL EXPENSES 1,958,792. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,466,178. DENTAL CONSULTANT: PROGRAM SERVICE EXPENSES 1,156,521. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,156,521. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 1,798,914,588. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,798,914,588. FORM 990, PART XI, LINE 9: GAIN ON EQUITY IN SUBSIDIARIES 2,914,075. PENSION RELATED CHANGES -19,041,765. FORM 990 PART XII LINE 2C AND 2D: DELTA DENTAL PLAN OF MICHIGAN IS AUDITED BY AN INDEPENDENT ACCOUNTANT AS PART OF A CONSOLIDATED FINANCIAL STATEMENT ISSUED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. DELTA DENTAL PLAN OF MICHIGAN ALSO RECEIVES AN AUDITED FINANCIAL STATEMENT BY AN INDEPENDENT ACCOUNTANT THAT IS PREPARED ON A STATUTORY BASIS. THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART IV, LINE 12A: DELTA DENTAL PLAN OF MICHIGAN RECEIVES AN AUDITED FINANCIAL STATEMENT FROM AN INDEPENDENT ACCOUNTANT BUT THESE STATEMENTS ARE PREPARED ON A STATUTORY BASIS AND NOT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). RENAISSANCE HEALTH SERVICE CORPORATION PO BOX 30416 LANSING MI 489097916 381675667 PROMOTING DENTAL CARE MI 501(C)(4) N/A N/A 0 DELTA DENTAL PLAN OF OHIO INC PO BOX 30416 LANSING MI 489097916 310685339 PROVIDE DENTAL SERVICE PLANS OH 501(C)(4) N/A DELTA DENTAL PLAN OF MICHIGAN INC 1 DELTA DENTAL PLAN OF INDIANA INC PO BOX 30416 LANSING MI 489097916 351545647 PROVIDE DENTAL SERVICE PLANS IN 501(C)(4) N/A DELTA DENTAL PLAN OF MICHIGAN INC 1 DELTA DENTAL OF TENNESSEE 240 VENTURE CIRCLE NASHVILLE TN 37228 620812197 PROVIDE DENTAL SERVICE PLANS TN 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL FUND PO BOX 30416 LANSING MI 489097916 382337000 SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMS MI 501(C)(3) LINE 12B, II DELTA DENTAL PLAN OF MICHIGAN INC 1 DELTA DENTAL PLAN OF NEW MEXICO INC 2500 LOUISIANA BLVD NE ALBUQUERQUE NM 87110 850224562 PROVIDE DENTAL SERVICE PLANS NM 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF KENTUCKY INC 10100 LINN STATION ROAD NO 700 LOUISVILLE KY 40223 610659432 PROVIDE DENTAL SERVICE PLANS KY 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF NORTH CAROLINA 4242 SIX FORKS ROAD RALEIGH NC 27609 561018068 PROVIDE DENTAL SERVICE PLANS NC 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL PLAN OF ARKANSAS INC 1513 COUNTRY CLUB RD SHERWOOD AR 72120 710561140 PROVIDE DENTAL SERVICE PLANS AR 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF ARKANSAS FOUNDATION INC 1513 COUNTRY CLUB RD SHERWOOD AR 72120 261569324 EMPHASIZE DENTAL HEALTH IN COMMUNITIES AR 501(C)(3) PF DELTA DENTAL OF ARKANSAS 0 RENAISSANCE FAMILY FOUNDATION INC 4100 OKEMOS RD OKEMOS MI 48864 461376165 EMPHASIZE DENTAL HEALTH IN COMMUNITIES IN 501(C)(3) PF RENAISSANCE HOLDING COMPANY 0 SMILE 180 FOUNDATION 240 VENTURE CIRCLE NASHVILLE TN 37228 471654054 EMPHASIZE DENTAL HEALTH IN COMMUNITIES TN 501(C)(3) LINE 12A, I DELTA DENTAL OF TENNESSEE INC 0 CHESME LLC 124 N BRIDGE ST DEWITT MI 48820 200061957 CAPITAL MANAGEMENT MI THE 4100 GROUP RELATED 371655 2756584 0 0 0.59250 RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI DELTA DENTAL OF MICHIGAN C 684170 30674050 0.58000 1 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA PO BOX 30381 LANSING MI 48909 470397286 INSURANCE IN RENAISSANCE HOLDING COMPANY C 4399545 60226916 0.58000 1 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK PO BOX 30381 LANSING MI 48909 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 311568 6378442 0.58000 1 FORE HOLDING CORPORATION 240 VENTURE CIRCLE NASHVILLE TN 37228 204116122 HOLDING COMPANY TN N/A C 0 DENTAL CHOICE INC 10100 LINN STATION ROAD SUITE 700 LOUISVILLE KY 40223 611105118 PROVIDE DENTAL SERVICE PLANS KY N/A C 0 DENTAL CHOICE AGENCY INC 10100 LINN STATION RD SUITE 700 LOUISVILLE KY 40223 611336003 PRIMARY GENERAL AGENCY FOR DDKY & DENTAL CHOICE KY N/A C 0 OMEGA ADMINISTRATORS INC 1513 COUNTRY CLUB ROAD SHERWOOD AR 72120 043740469 PROVIDING THIRD-PARTY ADMINISTRATIVE SERVICES AR N/A C 0 THE 4100 GROUP 4100 OKEMOS ROAD OKEMOS MI 48864 472557772 INVESTMENT IN SUBSIDIARIES MI DELTA DENTAL OF MICHIGAN C -306256 18685967 0.75000 1 DEWPOINT INC 300 S WASHINGTON SQUARE LANSING MI 48933 383300595 IT CONSULTING MI THE 4100 GROUP C 5219146 41039378 0.75000 1 1 1 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 DELTA DENTAL OF TENNESSEE L 4615698 ACTUAL COST DELTA DENTAL PLAN OF OHIO INC L 32862881 ACTUAL COST DELTA DENTAL PLAN OF INDIANA INC L 12046391 ACTUAL COST DELTA DENTAL FUND L 789911 ACTUAL COST RENAISSANCE LIFE AND HEALTH INSURANCE COMPANY OF AMERICA L 5243745 ACTUAL COST DELTA DENTAL PLAN OF NEW MEXICO INC L 1592293 ACTUAL COST DELTA DENTAL OF KENTUCKY INC L 2608863 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA L 3288160 ACTUAL COST RENAISSANCE ELECTRONIC SERVICES LLC L 203497 ACTUAL COST DELTA DENTAL PLAN OF ARKANSAS INC L 6634800 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA D 270000 ACTUAL LOAN AMOUNT RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK L 119347 ACTUAL COST RENAISSANCE HOLDING COMPANY L 700061 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA A 170401 ACTUAL COST RENAISSANCE HEALTH SERVICE CORPORATION L 21671 ACTUAL COST DELTA DENTAL FUND B 3000000 ACTUAL COST DEWPOINT L 52323 ACTUAL COST THE 4100 GROUP L 218835 ACTUAL COST