2018-11-13T13:24:36-06:00 2017-12-31 381357951 PLANTE & MORANPLLC 1111 MICHIGAN AVE PO BOX 2500 EAST LANSING MI 488262500 990 2017-01-01 381791480 DELTA DENTAL PLAN OF MICHIGAN INC DELT 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 AMY BASEL CFO 5173496000 2018-11-13 1 DAVID LOWENTHAL CPA P00378651 5173326200 2018-11-13 67.59.56.32 2018-11-13 08:15:03 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 0BE20424E36FE0393C9C363CC230916404C73ADF 2017 2019-02-21 02:37:17Z LAURA L CZELADA 4100 OKEMOS ROAD OKEMOS MI 48864 2149185998 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 PREPAID 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. 14 9 882 0 5380310 482536 0 0 1922190390 1988620211 9444549 10622625 56916958 67560288 1988551897 2066803124 538291 10900727 0 0 86177829 97038154 0 0 0 1858755075 1912882185 1945471195 2020821066 43080702 45982058 726299288 796843303 267397400 286445646 458901888 510397657 X SEE SCHEDULE ODELTA DENTAL OF MICHIGAN'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH PREPAID 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 PREPAID ORAL HEALTH PLANS TO A BROAD BASE OF THE COMMUNITY THROUGH A VARIETY OF PAYMENT MODELS. 0 0 1926290669 10900727 2050699965 PROMOTING DENTAL CAREDELTA DENTAL PLAN OF MICHIGAN, INC. IS A LEADING PREPAID 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 2017 BY PAYING OUT OVER $1.7 BILLION FOR DENTAL CARE, BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 10.4 MILLION CLAIMS WERE PROCESSED FOR OVER 3.3 MILLION SUBSCRIBERS.SEE SCHEDULE O FOR CONTINUATIONCOST 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, PUT TO WORK ENSURING QUALITY, COST-EFFECTIVE DENTAL BENEFIT DELIVERY. IN 2017, THE DELTA DIFFERENCE SAVED GROUPS AND SUBSCRIBERS APPROXIMATELY $2.1 BILLION. IN ADDITION, THE DELTA DIFFERENCE HELPS KEEP OUR TREND BELOW THE NATIONAL INFLATIONARY TREND IN DENTAL BENEFITS.DELTA DENTAL'S INDUSTRY LEADING TECHNOLOGY PLATFORM, ENTERPRISE TECHNOLOGY SOLUTIONS (ETS), HAS BEEN INTERNATIONALLY RECOGNIZED AS PROVIDING THE BEST IN FAST, FLEXIBLE SERVICE INCLUDING ONLINE, REAL-TIME CLAIMS PROCESSING. DELTA DENTAL'S CONTINUED 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 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 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. ONLY AN ORGANIZATION OF DELTA DENTAL'S SIZE AND EXPERIENCE IN THE BENEFITS FIELD HAS EXTENSIVE DATA REGARDING DENTAL TREATMENT PATTERNS OVER EXTENDED PERIODS OF TIME. BECAUSE OF ITS COMMITMENT TO ADVANCING THE SCIENCE OF DENTISTRY, EACH YEAR THE COMPANY GRANTS RESEARCHERS AT FIVE DENTAL SCHOOLS IN MICHIGAN, OHIO AND INDIANA ACCESS TO THIS IMPORTANT INFORMATION TO STUDY ORAL HEALTH TRENDS. THE RESULTS OF THEIR STUDIES WILL ADD SIGNIFICANT DATA TO THE BODY OF KNOWLEDGE IN THE FIELD OF DENTISTRY.SINCE IT WAS FORMED IN 1980, THE DELTA DENTAL FUND HAS GRANTED OVER $28.4 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 2017, DELTA DENTAL FUND PROVIDED GRANTS TOTALING OVER $3.4 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 THE COMMUNITY. 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. THROUGHOUT 2017, 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 ADMINISTERS THE HEALTHY KIDS DENTAL (HKD) AND MICHILD PROGRAMS. 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. THE AMERICAN DENTAL ASSOCIATION NAME MICHIGAN'S HKD PROGRAM ONE OF THE FIVE MODELS FOR IMPROVING ACCESS TO DENTAL CARE FOR LOW-INCOME POPULATIONS.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.THE PROGRAMS FEATURE LARGE PANELS OF FULL-TIME PARTICIPATING DENTISTS. THIS KIND OF REACH HAS ENABLED MILLIONS OF PEOPLE TO RECEIVE COST-EFFECTIVE DENTAL CARE.DELTA DENTAL'S GROUP MEMBERS ARE AFFORDED ADDED PROTECTION BECAUSE THEY GUARANTEE THAT PARTICIPATING DENTISTS WILL ACCEPT THEIR PAYMENT FOR COVERED SERVICES AND THAT NO CHARGES, OTHER THAN CO-PAYMENTS AND DEDUCTIBLES WILL BE BILLED. 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, THE GREATEST ACCESS AT THE BEST COST. 1926290669 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 63420 0 1 882 1 1 1 0 0 0 0 0 X 14 9 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 JOSEPH C HARRIS DDS CHAIRPERSON 5.00 6.00 X X 102000 3500 0 KELLY JUBB SCHEIDERER VICE CHAIRPERSON 5.00 6.00 X X 75504 1500 18000 JOSHUA S HOWIE SECRETARY/TREASURER 5.00 5.00 X X 183504 15000 0 DOUGLAS R ANDERSON DIRECTOR 5.00 11.00 X 50243 74012 18000 CHRISTOPHER T FISHER DIRECTOR 5.00 0.00 X 60000 0 0 SARA M DOLAN DIRECTOR 5.00 0.00 X 60000 0 0 CHARLES E HALL DIRECTOR 5.00 0.00 X 60000 0 0 THOMAS FLESZAR DDS MS DIRECTOR 5.00 12.00 X 85008 47500 0 STEPHEN A EKLUND DIRECTOR 5.00 6.00 X 85008 123000 0 ANN MARIE FLERMOEN DIRECTOR 5.00 11.00 X 85008 48008 0 KURT D GALLINGER DIRECTOR 5.00 5.00 X 85008 0 0 JED JACOBSON DDS MS MPH DIRECTOR 38.00 2.00 X 116508 24500 0 JEFFREY A KELLER DIRECTOR 5.00 5.00 X 85008 0 0 C RICHARD SEITZ DIRECTOR - THRU 5/17 5.00 5.00 X 35420 0 0 BRUCE R SMITH IMMEDIATE PAST CHAIRPERSON 5.00 19.00 X 93504 84908 0 LAURA L CZELADA CPA CEO, PRESIDENT 36.00 14.00 X 11593754 0 3521854 GORAN JURKOVIC CPA COO, CHIEF FINANCIAL OFFICER 24.00 26.00 X 2322178 0 1625591 LUIGI BATTAGLIERI - THRU 417 SR VP, CHIEF RELATIONSHIP OFFICER 50.00 0.00 X 869600 0 27687 KAREN GREEN VP INFORMATICS/QUALITY 50.00 0.00 X 270994 0 46574 RANDY TASCO - THRU 617 VP CHIEF MARKETING OFFICER 50.00 0.00 X 4534452 0 270594 NANCY HOSTETLER SR VP, CHIEF OF STAFF 49.00 1.00 X 438291 0 37696 TOBY HALL SR VP, CHIEF ACTUARY 50.00 0.00 X 611475 0 189882 JON GROAT - THRU 817 VP GENERAL COUNSEL 33.00 17.00 X 394956 0 20610 AMY BASEL VP OF FINANCE 43.00 7.00 X 388627 0 58377 JEFFREY JOHNSTON VP, CHIEF SCIENCE OFFICERS 50.00 0.00 X 352624 0 64552 MICHAEL GILMORE VP, CHIEF INVESTMENT OFFICER 47.00 3.00 X 394187 0 73029 ANTHONY ROBINSON SVP & CHIEF MARKETING OFFICERS 50.00 0.00 X 472276 0 902774 KENNETH THEIS SVP & CIO 50.00 0.00 X 637484 0 203256 MIKE BOBAK VP SALES 50.00 0.00 X 298827 0 40955 JOADI KECK VP HR & ADMINISTRATION 50.00 0.00 X 368844 0 63675 JERAME TUCKER ACCOUNT EXECUTIVE 50.00 0.00 X 323233 0 37550 LYNN DRASCHIL OPERATING CIO 50.00 0.00 X 352910 0 61530 LORI WHEELRIGHT VP SALES 50.00 0.00 X 295552 0 80077 26181987 421928 7362263 187 0 1 0 DEWPOINT 300 WASHINGTON SQUARE SUITE 200 LANSING MI 48933 IT CONSULTING 40534349 WEST MONROE PARTNERS LLC 222 W ADAMS ST FL 11 CHICAGO IL 60606 CONSULTING 4525675 CLARITY SOLUTION GROUP 150 SOUTH WACKER DR CHICAGO IL 60606 CONSULTING 2729766 MESSA 1480 KENDALE BLVD EAST LANSING MI 48826 COMMISSIONS 2608615 GS&F 209 10TH AVE SOUTH NASHVILLE TN 37203 ADVERTISING 1395194 84 DENTAL CARE REVENUE 624100 1983239901 1983239901 EXTERNAL SERVICES 524292 5380310 5380310 1988620211 7743912 7743912 85252363 9224 82307436 75438 2944927 -66214 2878713 2878713 ADMIN REIMBURSEMENT 900099 67460064 67460064 MISCELLANEOUS INCOME 900099 100224 100224 67560288 2066803124 2050699965 5380310 10722849 X 10900727 10900727 18306481 11899214 6407267 61003382 37922266 23081116 2387202 1186060 1201142 10558556 6594846 3963710 4782533 3055384 1727149 2859001 629033 2229968 714176 714176 390212 390212 120500 120500 456499 456499 1823894672 1805336462 18558210 3460409 727571 2732838 14052339 9195318 4857021 9028798 5878288 3150510 3115237 3115237 3258904 2635704 623200 571593 359088 212505 181175 181175 9952083 4137787 5814296 921949 921949 COMMISSIONS 16281984 16281984 HICA TAX- MI 11965469 11965469 PROCESSING FEES 8506997 8506997 MEMBERSHIP DUES 1497985 122454 1375531 1652203 921486 730717 2020821066 1926290669 94530397 0 2118 2118 64181950 72340799 86873020 91850622 68664842 73309711 234861057 119060249 103680008 115800808 278878191 293644118 111901121 125361740 12118038 24533387 726299288 796843303 71883639 76316324 195513761 210129322 267397400 286445646 X 15744473 15744473 5122500 5122500 438034915 489530684 458901888 510397657 726299288 796843303 X 45982058 16453506 -10939795 X X 0 1 X 1 0 3500 3500 1 PROSPEROUS MICHIGAN FUND 208 N CAPITOL AVE LANSING MI 48933 455322366 1000 RELENTLESS POSITIVE ACTION PAC 300 N 5TH AVENUE ANN ARBOR MI 48104 475056186 2500 1 0 0 8070186 8070186 106086048 37840966 68245082 41875179 30583890 11291289 78829644 50635393 28194251 115800808 DDIC STOCK 200217 F INVESTMENT IN RHC 74045972 F INVESTMENT IN GLM 51115551 F 125361740 IBNR - CLAIM ADJUSTMENT RESERVES 64748335 UNEARNED PREMIUMS 30185240 FAS 158 FUNDED STATUS 115195747 210129322 1 ITEC - LANSING 200 N FOSTER AVE LANSING MI 48912 261077810 501(C)(3) 25000 CASH CHARITABLE DONATION DELTA DENTAL FOUNDATION 4100 OKEMOS RD OKEMOS MI 48864 382337000 501(C)(3) 10000000 CASH CHARITABLE DONATION CAPITAL AREA LITERACY COALITION 1028 E SAGINAW LANSING MI 48906 382625057 501(C)(3) 10000 CASH CHARITABLE DONATION BOYS AND GIRLS CLUB OF LANSING 4315 PLEASANT GROVE RD LANSING MI 48910 381788281 501(C)(3) 10000 CASH CHARITABLE DONATION BEYOND BASICS 18000 W NINE MILE RD STE 450 SOUTHFIELD MI 48075 752993015 501(C)(3) 10000 CASH CHARITABLE DONATION CRISTO REY COMMUNITY CENTER 1717 N HIGH ST LANSING MI 48906 381779460 501(C)(3) 10000 CASH CHARITABLE DONATION HAVEN INC 801 VANGUARD DR PONTIAC MI 48341 382426175 501(C)(3) 10000 CASH CHARITABLE DONATION JUNIOR ACHIEVEMENT OF SOUTHEASTERN MI 577 E LARNED ST DETROIT MI 48226 381348535 501(C)(3) 10000 CASH CHARITABLE DONATION AMERICAN RED CROSS 1800E GRAND RIVER AVE LANSING MI 48909 530196605 501(C)(3) 100000 CASH HURRICANE HARVEY AND IMRA RELIEF DONATION BLESSINGS IN A BACKPACK 4121 SHELBYVILLE RD LOUISVILLE KY 40207 261964620 501(C)(3) 42795 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) 175050 CASH CHARITABLE DONATION MICHIGAN ECONOMIC DEVELOPMENT FOUNDATION PO BOX 13063 LANSING MI 48901 382527475 501(C)(3) 25000 CASH CHARITABLE DONATION FORGOTTEN HARVEST 21800 GREENFIELD RD OAK PARK MI 48237 382926476 501(C)(3) 250000 CASH CHARITABLE DONATION AMERICAN CANCER SOCIETY 20450 CIVIC CENTER DR SOUTHFIELD MI 48076 131788491 501(C)(3) 15000 CASH CHARITABLE DONATION ELE'S PLACE 1145 WEST OAKLAND LANSING MI 48915 382976751 501(C)(3) 146700 CASH CHARITABLE DONATION GREATER LANSING FOODBANK 5303 S CEDAR ST LANSING MI 48911 382424756 501(C)(3) 26182 CASH CHARITABLE DONATION 16 1 PART I, LINE 2: CONTRIBUTIONS ARE MADE AT BOARD MEMBER DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF MICHIGAN'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 MICHIGAN. BLESSINGS IN A BACKPACK - DELTA DENTAL PROVIDED $42,795 TO BLESSINGS IN A BACKPACK. THIS IS A NATIONAL PROGRAM THAT PROVIDES ELEMENTARY SCHOOL CHILDREN ON THE FEDERAL FREE AND REDUCED PRICE MEAL PROGRAM WITH A BACKPACK OF FOOD TO TAKE HOME FOR 38 WEEKENDS DURING THE SCHOOL YEAR. THROUGHOUT THE YEAR OUR ORGANIZATION COORDINATES THE ORDERING, PACKAGING AND DELIVERY TO AREA CLASSROOM ON FRIDAY AFTERNOONS. EVERY FRIDAY, BAGS OF FOOD WERE SENT. FORGOTTEN HARVEST - DELTA DENTAL PROVIDED $250,000 TO FORGOTTEN HARVEST TO PROVIDE FAMILIES IN NEED WITH FRESH AND NUTRITIOUS FOOD FREE OF CHARGE. GREATER LANSING FOOD BANK - DELTA DENTAL PROVIDED $26,182 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. ITEC - DELTA DENTAL PROVIDED $25,000 TO ITEC TO HELP FUND ITS TECHTRANSPORT BUS, WHICH PROVIDES A SPACE FOR STUDENTS TO LEARN ABOUT SPACE AND ROBOTICS, RECEIVE ASSISTANCE WITH MATH AND SCIENCE HOMEWORK AND PREPARE FOR COLLEGE. X X X 1 1 X X X X X 1 1 0 0 0 0 0 1 0 JOSHUA S HOWIE SECRETARY/TREASURER 183504 15000 0 0 0 0 0 0 0 0 183504 15000 0 0 STEPHEN A EKLUND DIRECTOR 85008 123000 0 0 0 0 0 0 0 0 85008 123000 0 0 BRUCE R SMITH IMMEDIATE PAST CHAIRPERSON 93504 84908 0 0 0 0 0 0 0 0 93504 84908 0 0 LAURA L CZELADA CPA CEO, PRESIDENT 1024166 0 1691720 0 8877868 0 3514499 0 7355 0 15115608 0 8861587 0 GORAN JURKOVIC CPA COO, CHIEF FINANCIAL OFFICER 1006745 0 1291683 0 23750 0 1603585 0 22006 0 3947769 0 0 0 LUIGI BATTAGLIERI - THRU 417 SR VP, CHIEF RELATIONSHIP OFFICER 137905 0 440755 0 290940 0 27677 0 10 0 897287 0 0 0 KAREN GREEN VP INFORMATICS/QUALITY 190063 0 79436 0 1495 0 24568 0 22006 0 317568 0 0 0 RANDY TASCO - THRU 617 VP CHIEF MARKETING OFFICER 234710 0 532852 0 3766890 0 261425 0 9169 0 4805046 0 3382218 0 NANCY HOSTETLER SR VP, CHIEF OF STAFF 212845 0 209880 0 15566 0 22283 0 15413 0 475987 0 0 0 TOBY HALL SR VP, CHIEF ACTUARY 284030 0 309327 0 18118 0 167876 0 22006 0 801357 0 0 0 JON GROAT - THRU 817 VP GENERAL COUNSEL 187582 0 109028 0 98346 0 15706 0 4904 0 415566 0 0 0 AMY BASEL VP OF FINANCE 277872 0 106856 0 3899 0 36371 0 22006 0 447004 0 0 0 JEFFREY JOHNSTON VP, CHIEF SCIENCE OFFICERS 252050 0 96562 0 4012 0 42546 0 22006 0 417176 0 0 0 MICHAEL GILMORE VP, CHIEF INVESTMENT OFFICER 269018 0 124363 0 806 0 51023 0 22006 0 467216 0 0 0 ANTHONY ROBINSON SVP & CHIEF MARKETING OFFICERS 354313 0 107250 0 10713 0 880768 0 22006 0 1375050 0 0 0 KENNETH THEIS SVP & CIO 304414 0 326042 0 7028 0 181250 0 22006 0 840740 0 0 0 MIKE BOBAK VP SALES 128553 0 169781 0 493 0 18949 0 22006 0 339782 0 0 0 JOADI KECK VP HR & ADMINISTRATION 262030 0 99283 0 7531 0 48262 0 15413 0 432519 0 0 0 JERAME TUCKER ACCOUNT EXECUTIVE 56695 0 266245 0 293 0 15544 0 22006 0 360783 0 0 0 LYNN DRASCHIL OPERATING CIO 253475 0 95481 0 3954 0 61500 0 30 0 414440 0 0 0 LORI WHEELRIGHT VP SALES 130747 0 163661 0 1144 0 64664 0 15413 0 375629 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 OUTSIDE COMPENSATION CONSULTANTS ARE USED TO DETERMINE MARKET DATA FOR THE EXECUTIVE POSITIONS AND FOR OTHER OFFICERS AND KEY EMPLOYEES. THE POSITIONS COVERED ARE THE CEO, COO, CAO, CIO, CRO, CMO, CHIEF ACTUARY, CFO, AND CSO. THE ORGANIZATION CONTRACTS WITH TOWERS WATSON TO DO A COMPENSATION AND REASONABLENESS ANALYSIS EVERY TWO YEARS. THE FINAL DETERMINATION OF COMPENSATION IS DONE BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS, WHICH IS MADE UP OF INDEPENDENT PERSONS, AND IS BASED ON THE COMPARABILITY DATA PROVIDED BY THE COMPENSATION CONSULTANTS. THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARE CONTEMPORANEOUSLY DOCUMENTED IN THE COMMITTEE MINUTES AND APPROVED BY THE BOARD. THE COMPENSATION WAS LAST REVIEWED UNDER THIS PROCESS DURING 2016. THE REPORT BASED ON THIS REVIEW WAS THEN ISSUED BY THE CONSULTANTS IN 2017. PART I, LINES 4A-B DURING 2017, 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 $97,291 AND $223,248 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. AN OUTSIDE INDEPENDENT ACTUARY CALCULATES THE VALUE ON AN ANNUAL BASIS. IN 2017, GORAN JURKOVIC (CFO), TOBY HALL (SR VP CHIEF ACTUARY), KENNETH THEIS (SVP & CIO), AND ANTHONY ROBINSON (SVP & CHIEF MARKETING OFFICERS) ALL PARTICIPATED IN THE SERP BUT DID NOT RECEIVE A DISTRIBUTION. IN 2017, LAURA L. CZELADA, PRESIDENT & CEO, RECEIVED A SERP DISTRIBUTION OF $8,861,587. IN 2017, LUIGI BATTAGLIERI, SR. VP CHIEF RELATIONSHIP OFFICER, PARTICIPATED IN THE SERP BUT DID NOT RECEIVE A DISTRIBUTION. IN 2017, RANDY TASCO, VP CHIEF MARKETING OFFICER, RECEIVED A SERP DISTRIBUTION OF $3,382,218. 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 142722 PAYMENTS FOR DENTAL SERVICES 0 TERI BATTAGLIERI SPOUSE OF DDPMI KEY EMPLOYEE LUIGI BATTAGLIERI 232303 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 BRIAN BATTAGLIERI SON OF DDPMI KEY EMPLOYEE LUIGI BATTAGLIERI 141064 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 CHRISTOPHER T FISHER ON BOARD OF DIRECTORS OF DDPMI AS A DIRECTOR 112328 OWNER OF INSURANCE AGENCY WHICH DDPMI PAYS COMMISSIONS TO 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 FOLLOWING ITEMS ARE SUBJECT TO APPROVAL BY THE SOLE MEMBER: IF 10% OF THE ASSETS ARE TO BE SPENT/SOLD OR A NEW PRESIDENT IS TO BE APPOINTED. 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 PUT ONTO A WEBSITE 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 AND GENERAL COUNSEL 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 AND GENERAL COUNSEL. IF A PROHIBITED TRANSACTION WERE IDENTIFIED, THE MATTER WOULD BE BROUGHT TO THE CHAIRPERSON OF THE BOARD 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 CONFLICT 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 OUTSIDE COMPENSATION CONSULTANTS ARE USED TO DETERMINE MARKET DATA FOR THE EXECUTIVE POSITIONS AND FOR OTHER OFFICERS AND KEY EMPLOYEES. THE POSITIONS COVERED ARE THE CEO, COO, CAO, CIO, CRO, CMO, CHIEF ACTUARY, CFO, AND CSO. THE ORGANIZATION CONTRACTS WITH TOWERS WATSON TO DO A COMPENSATION AND REASONABLENESS ANALYSIS EVERY TWO YEARS. THE FINAL DETERMINATION OF COMPENSATION IS DONE BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS, WHICH IS MADE UP OF INDEPENDENT PERSONS, AND IS BASED ON THE COMPARABILITY DATA PROVIDED BY THE COMPENSATION CONSULTANTS. THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARE CONTEMPORANEOUSLY DOCUMENTED IN THE COMMITTEE MINUTES AND APPROVED BY THE BOARD. THE COMPENSATION WAS LAST REVIEWED UNDER THIS PROCESS DURING 2016. THE REPORT BASED ON THIS REVIEW WAS THEN ISSUED BY THE CONSULTANTS IN 2017. 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 7,339,580. MANAGEMENT AND GENERAL EXPENSES 5,631,183. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,970,763. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 2,552,894. MANAGEMENT AND GENERAL EXPENSES 12,927,027. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,479,921. DENTAL CONSULTANT: PROGRAM SERVICE EXPENSES 948,241. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 948,241. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 1,794,495,747. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,794,495,747. FORM 990, PART XI, LINE 9: GAIN ON EQUITY IN SUBSIDIARIES 3,346,087. PENSION RELATED CHANGES -13,843,247. OTHER CHANGES IN EQUITY -442,635. 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 GLM HOLDING COMPANY RELATED 213601 3120455 0 0 0.79000 RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI RENAISSNCE HEALTH SERVICE CORPORATION C -651618 37858683 0.58000 1 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA PO BOX 30381 LANSING MI 48909 470397286 INSURANCE IN RENAISSANCE HOLDING COMPANY C 3926892 58687727 0.58000 1 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK PO BOX 30381 LANSING MI 48909 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 333592 6040094 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 GLM HOLDING COMPANY 4100 OKEMOS ROAD OKEMOS MI 48864 472557772 INVESTMENT IN SUBSIDIARIES MI DELTA DENTAL OF MICHIGAN C -18082 20281924 0.75000 1 DEWPOINT INC 300 S WASHINGTON SQUARE LANSING MI 48933 383300595 IT CONSULTING MI GLM HOLDING COMPANY C 5595476 36572036 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 4145439 ACTUAL COST DELTA DENTAL PLAN OF OHIO INC L 29724843 ACTUAL COST DELTA DENTAL PLAN OF INDIANA INC L 11056946 ACTUAL COST DELTA DENTAL FUND L 368562 ACTUAL COST RENAISSANCE LIFE AND HEALTH INSURANCE COMPANY OF AMERICA L 4955356 ACTUAL COST DELTA DENTAL PLAN OF NEW MEXICO INC L 1445503 ACTUAL COST DELTA DENTAL OF KENTUCKY INC L 2297726 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA L 2521275 ACTUAL COST RENAISSANCE ELECTRONIC SERVICES LLC L 96852 ACTUAL COST DELTA DENTAL PLAN OF ARKANSAS INC L 6041078 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA D 810000 ACTUAL LOAN AMOUNT RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK L 69160 ACTUAL COST RENAISSANCE HOLDING COMPANY L 611738 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA A 147600 ACTUAL COST RENAISSANCE HEALTH SERVICE CORPORATION L 18009 ACTUAL COST DELTA DENTAL FUND B 10000000 ACTUAL COST