2017-11-13T08:47:29-06:00 2016-12-31 381357951 Plante & MoranPLLC 1111 Michigan Ave PO Box 2500 East Lansing MI 488262500 990 2016-01-01 381791480 Delta Dental Plan of Michigan Inc DELT 5173496000 4100 Okemos Road Okemos MI 48864 GORAN JURKOVIC CFO 5173496000 2017-11-08 1 DAVID LOWENTHAL CPA P00378651 5173326200 2017-11-08 67.59.56.33 2017-11-08 13:17:32 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D3994C8C0EED3DC07268D0E06E8E0D044B4248A2 2016 2018-03-14 21:41:22Z LAURA L CZELADA 4100 Okemos Road Okemos MI 48864 2070339220 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. 15 11 1112 0 3562721 321626 0 0 1824011017 1922190390 5889153 9444549 53364381 56916958 1883264551 1988551897 100401 538291 0 0 79072012 86177829 0 0 0 1766877494 1858755075 1846049907 1945471195 37214644 43080702 665952022 726299288 216678717 267397400 449273305 458901888 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 1876131005 538291 1975273788 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 2016 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 10.2 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 2016, THE DELTA DIFFERENCE SAVED GROUPS AND SUBSCRIBERS APPROXIMATELY $1.8 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 $25 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 2016, DELTA DENTAL FUND PROVIDED GRANTS TOTALING OVER $2.5 MILLION FOR DENTAL AND COMMUNITY RELATIONS PROJECTS. AMONG THEM WERE GRANTS TO THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH, CINCINNATI PUBLIC SCHOOL DISTRICT TO SUPPORT COMMUNITY WATER FLUORIDATION, AND TO FUND DENTAL CLINICS. IN ADDITION, WE PROVIDED THE DEPARTMENT WITH FUNDING TO IMPLEMENT TWO FLUORIDE PROGRAMS FOR UP TO 8,000 FLINT AREA CHILDREN AFFECTED BY THE WATER CRISIS. THE FIRST PROGRAM IS A SCHOOL-BASED FLUORIDE RINSE PROGRAM FOR STUDENTS IN THE ELEMENTARY GRADES AND THE SECOND IS A FLUORIDE VARNISH PROGRAM FOR HEAD START CHILDREN.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 2016, 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.ALSO IN 2016, DELTA DENTAL CONTINUED OUR INVOLVEMENT IN MICHIGAN'S MEDICAID EXPANSION PLAN, CALLED HEALTHY MICHIGAN PLAN (HMP). THE PROGRAM IMPROVES ACCESS TO MEDICAL AND DENTAL CARE FOR LOW-INCOME MICHIGAN RESIDENTS AGES 19 TO 64 AND IS ADMINISTERED BY MICHIGAN'S MEDICAID HEALTH PLANS. HMP PROVIDES DENTAL BENEFITS TO INCREASED ACCESS TO CARE FOR LOW-INCOME POPULATIONS WHO DO NOT QUALIFY FOR THE TRADITIONAL MEDICAID 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.THE PROGRAMS FEATURE LARGE PANELS OF FULL-TIME PARTICIPATING DENTISTS. IN FACT, 3 OUT OF 4 DENTISTS NATIONWIDE PARTICIPATE WITH DELTA DENTAL. 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. 1876131005 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 62050 0 1 1112 1 1 1 0 0 0 0 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 GORAN JURKOVIC CFO 5173496000 4100 Okemos Road Okemos MI 48864 X JOSEPH C HARRIS DDS CHAIRPERSON 5.00 6.00 X X 44506 5700 0 KELLY J SCHEIDERER VICE CHAIRPERSON 5.00 6.00 X X 13700 2100 17500 JOSHUA S HOWIE SECRETARY/TREASURER 5.00 5.00 X X 123300 2100 0 DOUGLAS R ANDERSON DIRECTOR 5.00 11.00 X 15438 7400 17500 Christopher T Fisher DIRECTOR 5.00 0.00 X 11200 700 0 Sara M Dolan DIRECTOR 5.00 0.00 X 11900 700 0 Charles E Hall DIRECTOR 5.00 0.00 X 9800 0 0 LISA A DANCSOK DIRECTOR (THRU 5/2016) 5.00 5.00 X 10200 0 0 THOMAS FLESZAR DDS MS DIRECTOR 5.00 12.00 X 26900 19876 0 STEPHEN A EKLUND DDS MSHA PHD DIRECTOR 5.00 6.00 X 22800 125100 0 ANN M FLERMOEN DIRECTOR 5.00 11.00 X 27942 11310 0 KURT D GALLINGER DIRECTOR 5.00 5.00 X 24200 2100 0 JED JACOBSON DDS MS MPH DIRECTOR (EMPLOYED THRU 6/2016) 48.00 2.00 X 671199 10150 55752 JEFFREY A KELLER DIRECTOR 5.00 5.00 X 21400 1400 0 TERRI A MILLER CPCU DIRECTOR (THRU 5/2016) 5.00 5.00 X 14400 30160 1185 TIMOTHY E MOFFIT dba DIRECTOR (THRU 5/2016) 5.00 10.00 X 14706 7910 0 C RICHARD SEITZ DIRECTOR 5.00 5.00 X 26300 0 0 RORY GAMBLE DIRECTOR (THRU 5/2016) 5.00 5.00 X 6700 0 0 TERENCE R COMAR DDS MS PAST CHAIRPERSON (THRU 10/2016) 5.00 6.00 X 24100 3700 0 BRUCE R SMITH IMMEDIATE PAST CHAIRPERSON 5.00 18.00 X 67500 41690 0 LAURA L CZELADA CPA CEO, PRESIDENT 36.00 14.00 X 9213107 0 2693718 GORAN JURKOVIC CPA COO, Chief Financial Officer 24.00 26.00 X 1636919 0 1412846 LUIGI BATTAGLIERI SR. VP, CHIEF RELATIONSHIP 50.00 0.00 X 1933368 0 243919 KAREN GREEN VP INFORMATICS/QUALITY 50.00 0.00 X 262961 0 33438 RANDY TASCO VP CHIEF MARKETING OFFICER 50.00 0.00 X 3224346 0 1484018 NANCY HOSTETLER SR. VP, CHIEF OF STAFF 49.00 1.00 X 430798 0 44784 TOBY HALL SR. VP, CHIEF ACTUARY 50.00 0.00 X 602106 0 203422 JON GROAT VP GENERAL COUNSEL 33.00 17.00 X 364795 0 25974 AMY BASEL VP OF FINANCE 43.00 7.00 X 361985 0 69760 KENNETH THEIS SVP & CIO 50.00 0.00 X 611339 0 186459 JEFFREY JOHNSTON VP, CHIEF SCIENCE OFFICER 50.00 0.00 X 235110 0 55045 MICHAEL GILMORE VP, CHIEF INVESTMENT OFFICER 47.00 3.00 X 324459 0 92986 ANTHONY ROBINSON VP, SALES 30.00 20.00 X 367898 0 42105 JOADI KECK VP, HR & ADMINISTRATION 50.00 0.00 X 356526 0 61305 JERAME TUCKER ACCOUNT EXECUTIVE 50.00 0.00 X 274933 0 33789 LYNN DRASCHIL OPERATING CIO 50.00 0.00 X 333626 0 56530 MARK BAUGHMAN VP OF APPLICATION DEVELOP & MAINT 50.00 0.00 X 273405 0 54019 21995872 272096 6886054 138 0 1 0 DEWPOINT 300 WASHINGTON SQUARE SUITE 200 LANSING MI 48933 IT CONSULTING 28204040 MESSA 1480 KENDALE BLVD EAST LANSING MI 48826 COMMISSIONS 2678157 GS&F 209 10TH AVE SOUTH NASHVILLE TN 37203 ADVERTISING 1722964 CLARITY SOLUTION GROUP 150 SOUTH WACKER DR CHICAGO IL 60606 CONSULTING 1032584 MARSH USA INC PO BOX 402901 ATLANTA GA 30384 COMMISSIONS 841187 68 DENTAL CARE REVENUE 624100 1918627669 1918627669 EXTERNAL SERVICES 524292 3562721 3562721 1922190390 7268066 7268066 83735875 227931 81536563 250760 2199312 -22829 2176483 2176483 ADMIN REIMBURSEMENT 900099 56646119 56646119 MISCELLANEOUS INCOME 900099 270839 270839 56916958 1988551897 1975273788 3562721 9715388 X 538291 538291 18326186 12001371 6324815 54521659 35684060 18837599 -1231700 -988845 -242855 10145863 6740999 3404864 4415821 2953473 1462348 2786839 1613939 1172900 1037296 1037296 367877 367877 407301 407301 1782255899 1777420106 4835793 2264969 621564 1643405 9945629 8060676 1884953 6717102 4519681 2197421 3200344 3200344 3359098 2668277 690821 679535 371885 307650 209647 209647 8774446 3040354 5734092 795966 795966 COMMISSIONS 14754809 14754809 HICA TAX- MI 9081879 9081879 FEDERAL HEALTHCARE TAX 4841466 4841466 PROCESSING FEES 4077796 4077796 3197177 2052569 1144608 1945471195 1876131005 69340190 0 2118 2118 71057029 64181950 87127894 86873020 51266470 68664842 216842840 113162832 92980664 103680008 245486851 278878191 109263962 111901121 8767034 12118038 665952022 726299288 60237090 71883639 156441627 195513761 216678717 267397400 X 15744473 15744473 5122500 5122500 428406332 438034915 449273305 458901888 665952022 726299288 X 43080702 7744832 -41196951 X X 0 1 X 1 0 4500 4500 1 MEEKHOF ADMINISTRATIVE ACCOUNT 106 W ALLEGAN SUITE 200 LANSING MI 48933 463768687 1000 NORTH OAKLAND FUTURE 409 SHADY OAKS LK ORION MI 48362 272791783 2500 PROSPEROUS MICHIGAN FUND 208 N CAPITOL AVE FLOOR 3 LANSING MI 48933 455322366 1000 7859592 7859592 104509530 34507550 70001980 40932768 30318829 10613939 63540950 48336453 15204497 103680008 DDIC STOCK 200217 F Investment in RHC 62891993 F INVESTMENT IN GLM 48808911 F 111901121 IBNR - claim adjustment reserves 65331928 Unearned Premiums 28829333 FAS 158 FUNDED STATUS 101352500 195513761 1 BLESSINGS IN A BACKPACK 4121 SHELBYVILLE RD LOUISVILLE KY 40207 261964620 501(C)(3) 62905 CHARITABLE DONATION ITEC - LANSING 200 N FOSTER AVE LANSING MI 48912 261077810 501(C)(3) 25000 CHARITABLE DONATION LEAP INC 1000 S WASHINGTON AVE LANSING MI 48933 208132313 501(C)(6) 17500 CHARITABLE DONATION LANSING PROMISE 330 MARSHALL ST LANSING MI 48912 453363322 501(C)(3) 20000 CHARITABLE DONATION MICHIGAN ECONOMIC DEVELOPMENT FOUNDATION PO BOX 13063 LANSING MI 48901 382527475 501(C)(3) 25000 CHARITABLE DONATION FORGOTTEN HARVEST 21800 GREENFIELD RD OAK PARK MI 48237 382926476 501(C)(3) 250000 CHARITABLE DONATION AMERICAN CANCER SOCIETY 20450 CIVIC CENTER DR SOUTHFIELD MI 48076 131788491 501(C)(3) 15000 CHARITABLE DONATION GREATER LANSING FOODBANK 5303 S CEDAR ST LANSING MI 48911 382424756 501(C)(3) 22886 CHARITABLE DONATION MICHIGAN LAW ENFORCEMENT OFFICERS MEMORIAL PO BOX 30681 LANSING MI 48909 386000134 GOVERNMENTAL 100000 CHARITABLE DONATION 8 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 $62,905 TO BLESSINGS IN A BACKPACK TO HELP FEED MORE THAN 1,000 ELEMENTARY SCHOOL CHILDREN IN NEED THROUGH THE 2016-2017 SCHOOL YEAR. EVERY FRIDAY, BAGS OF FOOD WERE SENT HOME WITH THE CHILDREN TO ENSURE THEY HAD ENOUGH TO EAT OVER THE WEEKEND. FORGOTTEN HARVEST - DELTA DENTAL PROVIDED $250,000 TO FORGOTTEN HARVEST TO HELP UNDERWRITE THREE OF ITS AFTER-SCHOOL AND SUMMER FEEDING PROGRAMS, WHICH SERVED 7,600 CHILDREN AND THEIR FAMILIES. GREATER LANSING FOOD BANK - DELTA DENTAL PROVIDED $22,886 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 0 1 0 0 0 0 0 1 0 JED JACOBSON DDS MS MPH DIRECTOR (EMPLOYED THRU 6/2016) 187369 10150 280360 0 203470 0 52074 0 3678 0 726951 10150 0 0 LAURA L CZELADA CPA CEO, PRESIDENT 846866 0 1575570 0 6790671 0 2686363 0 7355 0 11906825 0 6777087 0 GORAN JURKOVIC CPA COO, Chief Financial Officer 844887 0 776485 0 15547 0 1390840 0 22006 0 3049765 0 0 0 LUIGI BATTAGLIERI SR. VP, CHIEF RELATIONSHIP 350634 0 369665 0 1213069 0 243889 0 30 0 2177287 0 1195593 0 KAREN GREEN VP INFORMATICS/QUALITY 184376 0 77123 0 1462 0 11432 0 22006 0 296399 0 0 0 RANDY TASCO VP CHIEF MARKETING OFFICER 475228 0 507478 0 2241640 0 1462012 0 22006 0 4708364 0 2234414 0 NANCY HOSTETLER SR. VP, CHIEF OF STAFF 205941 0 203767 0 21090 0 22778 0 22006 0 475582 0 0 0 TOBY HALL SR. VP, CHIEF ACTUARY 270098 0 313561 0 18447 0 181416 0 22006 0 805528 0 0 0 JON GROAT VP GENERAL COUNSEL 260163 0 99401 0 5231 0 18619 0 7355 0 390769 0 0 0 AMY BASEL VP OF FINANCE 256679 0 100808 0 4498 0 47754 0 22006 0 431745 0 0 0 KENNETH THEIS SVP & CIO 294065 0 313502 0 3772 0 164453 0 22006 0 797798 0 0 0 JEFFREY JOHNSTON VP, CHIEF SCIENCE OFFICER 233562 0 0 0 1548 0 34870 0 20175 0 290155 0 0 0 MICHAEL GILMORE VP, CHIEF INVESTMENT OFFICER 230791 0 90750 0 2918 0 70980 0 22006 0 417445 0 0 0 ANTHONY ROBINSON VP, SALES 251557 0 107500 0 8841 0 20099 0 22006 0 410003 0 0 0 JOADI KECK VP, HR & ADMINISTRATION 250347 0 96391 0 9788 0 45892 0 15413 0 417831 0 0 0 JERAME TUCKER ACCOUNT EXECUTIVE 53058 0 221587 0 288 0 11783 0 22006 0 308722 0 0 0 LYNN DRASCHIL OPERATING CIO 246092 0 83430 0 4104 0 56500 0 30 0 390156 0 0 0 MARK BAUGHMAN VP OF APPLICATION DEVELOP & MAINT 200577 0 67084 0 5744 0 38606 0 15413 0 327424 0 0 0 Part I, Line 1a The organization allows for first class travel in certain circumstances 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, Line 4b 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 2016, GORAN JURKOVIC, CFO, PARTICIPATED IN THE SERP BUT DID NOT RECEIVE A DISTRIBUTION. IN 2016, LAURA L. CZELADA, PRESIDENT & CEO, RECEIVED A SERP DISTRIBUTION OF $6,777,087. IN 2016, LUGI BATTAGLIERI, SR. VP CHIEF RELATIONSHIP, RECEIVED A SERP DISTRIBUTION OF $1,195,593. IN 2016, RANDY TASCO, VP CHIEF MARKETING OFFICER, RECEIVED A SERP DISTRIBUTION OF $2,234,414. 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 169527 PAYMENTS FOR DENTAL SERVICES 0 TERI BATTAGLIERI SPOUSE OF DDPMI KEY EMPLOYEE LUIGI BATTAGLIERI 247306 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 BRIAN BATTAGLIERI SON OF DDPMI KEY EMPLOYEE LUIGI BATTAGLIERI 136754 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 COMAR & COMAR PC TERENCE COMAR, DIRECTOR OF DDPMI, IS AN OWNER IN COMAR & COMAR, PC. 152456 Participating dentist - payments for dental services 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 ACTUARIAL SERVICES: Program service expenses 1,222. Management and general expenses 1,222. Fundraising expenses 0. Total expenses 2,444. CONTRACT LABOR: Program service expenses 7,254,859. Management and general expenses 2,974,788. Fundraising expenses 0. Total expenses 10,229,647. CONTRACTED SERVICES: Program service expenses 3,258,110. Management and general expenses 1,859,783. Fundraising expenses 0. Total expenses 5,117,893. DENTAL CONSULTANT: Program service expenses 819,116. Management and general expenses 0. Fundraising expenses 0. Total expenses 819,116. PURCHASED DENTAL SERVICES: Program service expenses 1,766,086,799. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,766,086,799. Form 990, Part XI, line 9: Gain on equity in subsidiaries 2,537,962. pension RELATED CHANGES -43,734,913. 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). RED CEDAR INVESTMENT MANAGEMENT LLC 2852 EYDE PARKWAY SUITE 240 EAST LANSING MI 48823 462667997 REGISTERED INVESTMENT ADVISORS MI -69530 229448 GLM HOLDING COMPANY 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 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 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 PO BOX 30416 LANSING MI 489097916 620812197 PROVIDE DENTAL SERVICE PLANS TN 501(C)(4) N/A Renaissance Health Service Corporation 1 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 OF NEW MEXICO PO BOX 30416 lANSING MI 489097916 850224562 PROVIDE DENTAL SERVICE PLANS NM 501(C)(4) N/A Renaissance Health Service Corporation 1 DELTA DENTAL OF KENTUCKY pO BOX 30416 lANSING MI 489097916 610659432 PROVIDE DENTAL SERVICE PLANS KY 501(C)(4) N/A Renaissance Health Service Corporation 1 DELTA DENTAL OF NORTH CAROLINA pO BOX 30416 lANSING MI 489097916 561018068 PROVIDE DENTAL SERVICE PLANS NC 501(C)(4) N/A Renaissance Health Service Corporation 1 DELTA DENTAL OF ARKANSAS pO BOX 30416 lANSING MI 489097916 710561140 PROVIDE DENTAL SERVICE PLANS AR 501(C)(4) N/A Renaissance Health Service Corporation 1 DELTA DENTAL OF ARKANSAS FOUNDATION pO BOX 30416 lANSING MI 489097916 261569324 Emphasize DENTAL HEALTH IN COMMUNITIES AR 501(C)(3) PF DELTA DENTAL OF ARKANSAS 1 RENAISSANCE FAMILY FOUNDATION INC 4100 OKEMOS RD OKEMOS MI 48864 461376165 Emphasize DENTAL HEALTH IN COMMUNITIES IN 501(c)(3) PF RENAISSANCE HOLDING COMPANY 1 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 1 Renaissance Holding Company PO BOX 30381 LANSING MI 48909 412177193 holding company MI RENAISSNCE HEALTH SERVICE CORPORATION C 8772472 88088485 0.58000 1 Renaissance Life & Health Insurance Company of America PO BOX 30416 LANSING MI 489097916 470397286 INSURANCE IN RENAISSANCE HOLDING COMPANY C 1 Renaissance Health Insurance Company of New York PO BOX 30416 LANSING MI 489097916 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 1 FORE HOLDING CORPORATION 240 VENTURE CIRCLE NASHVILLE TN 37228 204116122 HOLDING COMPANY TN DELTA DENTAL OF TENNESSEE C 1 DENTAL CHOICE INC 10100 LINN STATION ROAD SUITE 700 LOUISVILLE KY 40223 611105118 PROVIDE DENTAL SERVICE PLANS KY DELTA DENTAL OF KENTUCKY C 1 DENTAL CHOICE AGENCY INC 10100 LINN STATION RD SUITE 700 LOUISVILLE KY 40223 611336003 PRIMARY GENERAL AGENCY FOR DDKY & DENTAL CHOICE KY DELTA DENTAL OF KENTUCKY C 1 OMEGA ADMINISTRATORS INC 1513 COUNTRY CLUB ROAD SHERWOOD AR 72120 043740469 PROVIDING THIRD-PARTY ADMINISTRATIVE SERVICES AR DELTA DENTAL OF ARKANSAS C 1 GLM HOLDING COMPANY 4100 OKEMOS ROAD OKEMOS MI 48864 472557772 INVESTMENT IN SUBSIDIARIES MI DELTA DENTAL OF MICHIGAN C -84681 47898574 0.75000 1 DEWPOINT INC 300 S WASHINGTON SQUARE LANSING MI 48933 383300595 IT CONSULTING MI GLM HOLDING COMPANY C 5581223 38825725 0.75000 1 1 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 DELTA DENTAL OF TENNESSEE L 3886188 ACTUAL COST DELTA DENTAL PLAN OF OHIO L 25629708 ACTUAL COST DELTA DENTAL PLAN OF INDIANA L 9646366 ACTUAL COST DELTA DENTAL FUND L 307406 ACTUAL COST RENAISSANCE LIFE AND HEALTH INSURANCE COMPANY OF AMERICA L 4951057 ACTUAL COST delta dental plan of new mexico L 1274281 ACTUAL COST DELTA DENTAL OF KENTUCKY L 2330331 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA L 2269326 ACTUAL COST RENAISSANCE SYSTEMS AND SERVICES L 112949 ACTUAL COST DELTA DENTAL OF ARKANSAS L 4976187 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA D 1350000 ACTUAL LOAN AMOUNT RENAISSANCE HEALTH INSURANCE COMPANY OF NEW YORK L 70453 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA A 127800 ACTUAL COST RENAISSANCE HOLDING COMPANY L 566620 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA S 162000 aCTUAL COST RENAISSANCE HEALTH SERVICE CORPORATION L 11820 ACTUAL COST