DELTA DENTAL PLAN OF OHIO: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
DELTA DENTAL PLAN OF OHIO (EIN 31-0685339)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-11-13
IRS object ID
201803179349304430
Schema version
2017v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-11-13T13:26:41-06:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN381357951PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11111 MICHIGAN AVE STE 100AddressLine1Txt
CityEAST LANSINGCityNm
State AbbreviationMIStateAbbreviationCd
ZIP48823ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN310685339EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL PLAN OF OHIO INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlDELTBusinessNameControlTxt
Phone5173496000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 30416AddressLine1Txt
CityLANSINGCityNm
State AbbreviationMIStateAbbreviationCd
ZIP489097916ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAMY BASELPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
Phone5173496000PhoneNum
Signature2018-11-08SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDAVID LOWENTHAL CPAPreparerPersonNm
PTINP00378651PTIN
Phone5173326200PhoneNum
Preparation2018-11-07PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address67.59.56.31IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-11-08IPDt
IP Tm12:02:02IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdDA39A3EE5E6B4B0D3255BFEF95601890AFD80709AtSubmissionCreationDeviceId
At Submission Filing Device IdD3994C8C0EED3DC07268D0E06E8E0D044B4248A2AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerLAURA L CZELADAPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 30416AddressLine1Txt
CityLANSINGCityNm
State AbbreviationMIStateAbbreviationCd
ZIP489097916ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$578,388,212GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressWWW.DELTADENTALOH.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1960FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionDELTA DENTAL OF OHIO'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.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$507,033,738PYProgramServiceRevenueAmt
CY Program Service Revenue$549,443,157CYProgramServiceRevenueAmt
PY Investment Income$4,652,202PYInvestmentIncomeAmt
CY Investment Income$5,936,917CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$511,685,940PYTotalRevenueAmt
CY Total Revenue$555,380,074CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$5,025,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$66,050PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$517,508CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$491,570,657PYOtherExpensesAmt
CY Other Expenses$528,476,807CYOtherExpensesAmt
PY Total Expenses$491,636,707PYTotalExpensesAmt
CY Total Expenses$534,019,315CYTotalExpensesAmt
PY Revenues Less Expenses$20,049,233PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$21,360,759CYRevenuesLessExpensesAmt
Total Assets BOY$199,665,137TotalAssetsBOYAmt
Total Assets EOY$231,330,486TotalAssetsEOYAmt
Total Liabilities BOY$37,838,845TotalLiabilitiesBOYAmt
Total Liabilities EOY$38,967,626TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$161,826,292NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$192,362,860NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionSEE SCHEDULE ODELTA DENTAL OF OHIO'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 OHIO 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.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$519,751,253ExpenseAmt
Grant$5,025,000GrantAmt
Revenue$549,443,157RevenueAmt
DescPROMOTING DENTAL CAREDELTA DENTAL PLAN OF OHIO, 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 $489 MILLION FOR DENTAL CARE, BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 3.4 MILLION CLAIMS WERE PROCESSED FOR OVER 980,000 SUBSCRIBERS.SEE SCHEDULE O FOR CONTINUATION COST SAVING STRATEGIESDELTA DENTAL BENEFIT PLANS ARE COMMITTED TO SAVING GROUPS AND SUBSCRIBERS MONEY. THE DELTA DIFFERENCE IS AN INTEGRATION OF ACTIVITIES; SUCH AS COST MANAGEMENT POLICIES, FEE REDUCTION AGREEMENTS WITH DENTISTS, AND AN ANTI-FRAUD HOTLINE, 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 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 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. 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 OHIO 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 OF A RELATED ORGNAIZATION THAT WORK ON DDOH BUSINESS 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. 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.Desc
Total Program Service Expenses$519,751,253TotalProgramServiceExpensesAmt
Described In Section501c30DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document45434IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1AMY BASEL CHIEF FINANCIAL OFFICERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5173496000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14100 OKEMOS ROADAddressLine1Txt
CityOKEMOSCityNm
State AbbreviationMIStateAbbreviationCd
ZIP48864ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
MICHAEL SCHAEFFER THRU 52017
IMMEDIATE PAST CHAIRPERSON5.000.00Yes (X)Yes (X)$34,506$0$0
DOUGLAS R ANDERSON DDS MS
IMMEDIATE PAST CHAIRPERSON5.0011.00Yes (X)Yes (X)$72,512$51,743$18,000
BRUCE R SMITH
CHAIRPERSON5.0019.00Yes (X)Yes (X)$46,008$132,404$0
ANN M FLERMOEN DDS
VICE CHAIRPERSON5.0011.00Yes (X)Yes (X)$46,008$87,008$0
JAMES R STAHL DDS
TREASURER5.000.00Yes (X)Yes (X)$46,008$0$0
FRANK BUZAKI JR
SECRETARY5.000.00Yes (X)Yes (X)$24,000$0$18,000
PATRICK T CAHILL
DIRECTOR5.000.00Yes (X)$42,000$0$0
TIMOTHY MOFFIT
DIRECTOR5.000.00Yes (X)$42,000$0$0
MICHAEL S STULL
DIRECTOR5.000.00Yes (X)$42,000$0$0
CAROLE S WATKINS
DIRECTOR5.006.00Yes (X)$42,945$0$0
LAURA L CZELADA CPA
PRESIDENT & CEO4.0046.00Yes (X)$0$11,593,754$3,521,854
GORAN JURKOVIC CPA
CHIEF FINANCIAL OFFICER10.0040.00Yes (X)$0$2,322,178$1,625,591
JON GROAT THRU 82017
VP - GENERAL COUNSEL5.0045.00Yes (X)$0$394,956$20,610
AMY BASEL CPA
VP - FINANCE5.0045.00Yes (X)$0$388,627$58,377
MICHAEL GILMORE
VP - CHIEF INVESTMENT OFFICER1.0049.00Yes (X)$0$394,187$73,029
FieldValueIRS element (for citing)
Total Reportable Comp From Org$437,987TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$15,364,857TotReportableCompRltdOrgAmt
Total Other Compensation$5,335,461TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
ALLIANT INSURANCE SERVICES INC
5847 SAB FEKUOE STHOUSTONTX77057COMMISSIONS$474,338
HUB INTERNATIONAL MIDWEST LIMITED
2487 CEDARCRESTACWORTHGA30101COMMISSIONS$321,939
USI INSURANCE SERVICES LLC
1 HILLCREST DRCHARLESTONWV25311COMMISSIONS$304,562
HYLANT GROUP
811 MADISON AVETOLEDOOH43604COMMISSIONS$262,264
GALLAGHER BENEFIT SERVICES INC
281 VISTA PARKWAY SUITE 300WEST PALM BEACHFL35411COMMISSIONS$261,476
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K16CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescDENTAL CARE REVENUEDesc
Business624100BusinessCd
Total Revenue Column$549,443,157TotalRevenueColumnAmt
Related Or Exempt Func Income$549,443,157RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$549,443,157TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,317,207TotalRevenueColumnAmt
Exclusion$4,317,207ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$24,627,848SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$23,008,138SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$1,619,710SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,619,710TotalRevenueColumnAmt
Exclusion$1,619,710ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$555,380,074TotalRevenueColumnAmt
Related Or Exempt Func Income$549,443,157RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$5,936,917ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$5,025,000TotalAmt
Program Services$5,025,000ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$460,708TotalAmt
Program Services$299,460ProgramServicesAmt
Management And General$161,248ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$56,800TotalAmt
Management And General$56,800ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$1,214TotalAmt
Management And General$1,214ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$88,400TotalAmt
Management And General$88,400ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$223,542TotalAmt
Management And General$223,542ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$489,125,948TotalAmt
Program Services$489,037,099ProgramServicesAmt
Management And General$88,849ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$422,862TotalAmt
Management And General$422,862ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$53,149TotalAmt
Management And General$53,149ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
ADMIN/INVESTMENT O/H$30,090,734$17,641,797$12,448,937
COMMISSION EXPENSE$5,254,264$5,254,264
PREMIUM TAX EXPENSE$2,424,535$2,424,535
MEMBERSHIP DUES$586,614$586,614

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$205,545TotalAmt
Program Services$69,098ProgramServicesAmt
Management And General$136,447ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$534,019,315TotalAmt
Program Services$519,751,253ProgramServicesAmt
Management And General$14,268,062ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,813,639BOYAmt
EOY$1,418,427EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$6,940,755BOYAmt
EOY$6,888,859EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$24,587,208BOYAmt
EOY$23,937,982EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$1,250,000BOYAmt
EOY$750,000EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$143,716,844BOYAmt
EOY$175,379,800EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$20,829,506BOYAmt
EOY$22,404,497EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$527,185BOYAmt
EOY$550,921EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$199,665,137BOYAmt
EOY$231,330,486EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$5,453,189BOYAmt
EOY$7,542,771EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$1,968,812BOYAmt
EOY$1,746,745EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$30,416,844BOYAmt
EOY$29,678,110EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$37,838,845BOYAmt
EOY$38,967,626EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$9,712,604BOYAmt
EOY$9,529,667EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$152,113,688BOYAmt
EOY$182,833,193EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$161,826,292BOYAmt
EOY$192,362,860EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$199,665,137BOYAmt
EOY$231,330,486EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$21,360,759ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$8,181,161NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$994,648OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (2 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
INVESTMENT IN RENAISSANCE HOLDING COMPANY$5,365,980F
INVESTMENT IN GLM HOLDING COMPANY$17,038,517F
FieldValueIRS element (for citing)
Total Book Value Securities$22,404,497TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
CLAIMS RESERVES$23,750,551
UNEARNED PREMIUMS$5,295,070
OTHER ACCRUED LIABILITIES$3,347
UNDISBURSED UNDERWRITING GAIN/LOSS$629,142
FieldValueIRS element (for citing)
Total Liability$29,678,110TotalLiabilityAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
DELTA DENTAL FUND
PO BOX 30416LANSINGMI489097916382337000501(C)(3)$5,000,000CHARITABLE DONATION
AMERICAN RED CROSS
1800E GRAND RIVER AVEEAST LANSINGMI489097916530196605501(C)(3)$25,000HURRICANE HARVEY AND IRMA RELIEF DONATION
FieldValueIRS element (for citing)
Total501c3 Org2Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationCONTRIBUTIONS ARE MADE AT BOARD MEMBER DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF OHIO'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 OHIO.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsYes (X)TravelForCompanionsInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
BRUCE R SMITH
CHAIRPERSON$46,008$132,404$0$0$0$0$0$0$0$0$46,008$132,404$0$0
LAURA L CZELADA CPA
PRESIDENT & CEO$0$1,024,166$0$1,691,720$0$8,877,868$0$3,514,499$0$7,355$0$15,115,608$0$8,861,587
GORAN JURKOVIC CPA
CHIEF FINANCIAL OFFICER$0$1,006,745$0$1,291,683$0$23,750$0$1,603,585$0$22,006$0$3,947,769$0$0
JON GROAT THRU 82017
VP - GENERAL COUNSEL$0$187,582$0$109,028$0$98,346$0$15,706$0$4,904$0$415,566$0$0
AMY BASEL CPA
VP - FINANCE$0$277,872$0$106,856$0$3,899$0$36,371$0$22,006$0$447,004$0$0
MICHAEL GILMORE
VP - CHIEF INVESTMENT OFFICER$0$269,018$0$124,363$0$806$0$51,023$0$22,006$0$467,216$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1ATRAVEL FOR COMPANIONS RELATED TO TRAVEL FOR A SPOUSE. THIS AMOUNT WAS TREATED AS TAXABLE TO THE BOARD MEMBER OR EMPLOYEE.
PART I, LINE 3COMPENSATION OF THE CEO IS DETERMINED BY A RELATED ORGANIZATION, DELTA DENTAL OF MICHIGAN. DELTA DENTAL OF MICHIGAN USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION: COMPENSATION COMMITTEE, COMPENSATION STUDY BY AN INDEPENDENT CONSULTANT, AND APPROVAL BY THE EXECUTIVE COMMITTEE.
PART I, LINE 4BTHE 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. AN OUTSIDE INDEPENDENT ACTUARY CALCULATES THE VALUE ON AN ANNUAL BASIS. IN 2017, GORAN JURKOVIC, CFO, 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.
PART I, LINE 7AS 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.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6DELTA DENTAL PLAN OF OHIO HAS A SOLE MEMBER, DELTA DENTAL PLAN OF MICHIGAN, INC.
FORM 990, PART VI, SECTION A, LINE 7ATHE SOLE MEMBER HAS VOTING RIGHTS TO ELECT DIRECTORS. THE SOLE MEMBER HAS NO OTHER VOTING RIGHTS.
FORM 990, PART VI, SECTION A, LINE 7BTHE 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 11BTHE 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, PRIOR TO FILING FORM 990 WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CTHE 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 15OUTSIDE 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, CIO, CRO, CHIEF ACTUARY, CFO & 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 EXECUTIVE 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 19NO 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 11GCONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 50,351. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,351. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 489,037,099. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 489,037,099. STATE EXAMINATION EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 38,498. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,498.
FORM 990, PART XI, LINE 9:GAIN ON INVESTMENT IN SUBSIDIARIES 994,648.
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).

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (12 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
RENAISSANCE HEALTH SERVICE CORPORATION
PO BOX 30416LANSINGMI489097916381675667PROMOTING DENTAL CAREMI501(C)(4)N/AN/A0
DELTA DENTAL PLAN OF INDIANA INC
PO BOX 30416LANSINGMI489097916351545647PROVIDE DENTAL SERVICE PLANSIN501(C)(4)N/A0DELTA DENTAL PLAN OF MICHIGAN INC
DELTA DENTAL PLAN OF MICHIGAN INC
4100 OKEMOS ROADOKEMOSMI48864381791480PROVIDE DENTAL SERVICE PLANSMI501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL OF TENNESSEE
240 VENTURE CIRCLENASHVILEETN37228620812197PROVIDE DENTAL SERVICE PLANSTN501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL FUND
PO BOX 30416LANSINGMI489097916382337000SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMSMI501(C)(3)12A TYPE II0DELTA DENTAL PLAN OF MICHIGAN INC
DELTA DENTAL PLAN OF NEW MEXICO INC
2500 LOUISIANA BLVD NEALBUQUERQUENM87110850224562PROVIDE DENTAL SERVICE PLANSNM501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL OF KENTUCKY INC
10100 LINN STATION ROAD NO 700LOUISVILLEKY40223610659432PROVIDE DENTAL SERVICE PLANSKY501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL OF NORTH CAROLINA
4242 SIX FORKS ROADRALEIGHNC27609561018068PROVIDE DENTAL SERVICE PLANSNC501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL PLAN OF ARKANSAS INC
1513 COUNTRY CLUB RDSHERWOODAR72120710561140PROVIDE DENTAL SERVICE PLANSAR501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL OF ARKANSAS FOUNDATION INC
1513 COUNTRY CLUB RDSHERWOODAR72120261569324EMPHASIZE DENTAL HEALTH IN COMMUNITIESAR501(C)(3)PF0DELTA DENTAL OF ARKANSAS
RENAISSANCE FAMILY FOUNDATION INC
4100 OKEMOS ROADOKEMOSMI48864461376165EMPHASIZE DENTAL HEALTH IN COMMUNITIESIN501(C)(3)PF0RENAISSANCE HOLDING COMPANY
SMILE 180 FOUNDATION
240 VENTURE CIRCLENASHVILEETN37228471654054EMPHASIZE DENTAL HEALTH IN COMMUNITIESTN501(C)(3)LINE 12B, II0DELTA DENTAL OF TENNESSEE INC

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1CHESME LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1124 N BRIDGE STAddressLine1Txt
CityDEWITTCityNm
State AbbreviationMIStateAbbreviationCd
ZIP48820ZIPCd
FieldValueIRS element (for citing)
EIN200061957EIN
Primary ActivitiesCAPITAL MANAGEMENTPrimaryActivitiesTxt
Legal Domicile StateMILegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1GLM HOLDING COMPANYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Predominant Income TypeRELATEDPredominantIncomeTypeTxt
Share Of Total Income$53,400ShareOfTotalIncomeAmt
Share Of EOY Assets$780,114ShareOfEOYAssetsAmt
Disproportionate Allocations0DisproportionateAllocationsInd
General Or Managing Partner0GeneralOrManagingPartnerInd
Ownership0.25000OwnershipPct

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationInd
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA
PO BOX 30381LANSINGMI48909470397286INSURANCEINRENAISSANCE HOLDING COMPANYC$284,361$4,249,8010.042000
RENAISSANCE HOLDING COMPANY
PO BOX 30381LANSINGMI48909412177193HOLDING COMPANYMIRENAISSANCE HEALTH SERVICE CORPORATIONC-$47,186$2,741,4910.042000
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK
PO BOX 30381LANSINGMI48909134098096INSURANCENYRENAISSANCE HOLDING COMPANYC$24,157$437,3860.042000
OMEGA ADMINISTRATORS INC
1513 COUNTRY CLUB ROADSHERWOODAR72120043740469PROVIDING THRID-PARTY ADMINISTRATIVE SERVICESARDELTA DENTAL OF ARKANSASC0
GLM HOLDING COMPANY
4100 OKEMOS ROADOKEMOSMI48864472557772INVESTMENT IN SUBSIDIARIESMIDELTA DENTAL OF MICHIGANC-$6,027$6,760,6410.250000
FORE HOLDING CORPORATION
240 VENTURE CIRCLENASHVILLETN37228204116122HOLDING COMPANYTNDELTA DENTAL OF TENNESSEEC0
DEWPOINT INC
300 S WASHINGTON SQUARELANSINGMI48933383300595IT CONSULTINGMIGLM HOLDING COMPANYC$1,865,159$12,190,6790.250000
DENTAL CHOICE INC
10100 LINN STATION RD 700LOUISVILLEKY402293861611105118PROVIDE DENTAL SERVICE PLANSKYDELTA DENTAL OF KENTUCKYC0
DENTAL CHOICE AGENCY INC
10100 LINN STATION RD 700LOUISVILLEKY402293861611336003PRIMARY GENERAL AGENCY FOR DDKY AND DENTAL CHOICEKYDELTA DENTAL OF KENTUCKYC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (1)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (5 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
DELTA DENTAL PLAN OF MICHIGAN INC
M$29,724,843ACTUAL COST
DELTA DENTAL OF NORTH CAROLINA
D$750,000ACTUAL LOAN AMOUNT
DELTA DENTAL FUND
B$5,000,000ACTUAL COST
DELTA DENTAL OF NORTH CAROLINA
A$136,667ACTUAL COST
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA
M$450,407ACTUAL COST

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