DELTA DENTAL OF KENTUCKY INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
DELTA DENTAL OF KENTUCKY INC (EIN 61-0659432)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-13
IRS object ID
201713179349304721
Schema version
2016v3.0
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)
Return2017-11-13T14:29:43-06:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

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 Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN610659432EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL OF KENTUCKY INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlDELTBusinessNameControlTxt
Phone5027365000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line110100 LINN STATION ROAD NO 700AddressLine1Txt
CityLOUISVILLECityNm
State AbbreviationKYStateAbbreviationCd
ZIP40223ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRUSSELL W SKAGGSPersonNm
Person TitleVP - FINANCEPersonTitleTxt
Phone5027365000PhoneNum
Signature2017-11-10SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDAVID LOWENTHAL CPAPreparerPersonNm
PTINP00378651PTIN
Phone5173326200PhoneNum
Preparation2017-11-10PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address67.59.56.33IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-11-10IPDt
IP Tm09:35:51IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdDA39A3EE5E6B4B0D3255BFEF95601890AFD80709AtSubmissionCreationDeviceId
At Submission Filing Device IdD3994C8C0EED3DC07268D0E06E8E0D044B4248A2AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerBRUCE R SMITHPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line110100 LINN STATION ROAD NO 700AddressLine1Txt
CityLOUISVILLECityNm
State AbbreviationKYStateAbbreviationCd
ZIP40223ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$188,007,789GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressWWW.DELTADENTALKY.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1966FormationYr
Legal Domicile StateKYLegalDomicileStateCd
Activity Or MissionDelta Dental of Kentucky's mission has always been to be the leader in the markets we serve, to deliver unmatched quality and value in our programs and services, and to vigorously promote the importance of oral health as an essential part of overall health. Its overarching mission is to be the dental benefits company of choice in the communities we serve.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent10VotingMembersIndependentCnt
Total Employee74TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$180,710,930PYProgramServiceRevenueAmt
CY Program Service Revenue$180,112,897CYProgramServiceRevenueAmt
PY Investment Income$1,449,146PYInvestmentIncomeAmt
CY Investment Income$865,309CYInvestmentIncomeAmt
PY Other Revenue-$191,997PYOtherRevenueAmt
CY Other Revenue-$504,249CYOtherRevenueAmt
PY Total Revenue$181,968,079PYTotalRevenueAmt
CY Total Revenue$180,473,957CYTotalRevenueAmt
PY Grants And Similar Paid$2,862,535PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$2,546,334CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$155,448,278PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$153,626,635CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$7,778,407PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$8,558,170CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$13,300,206PYOtherExpensesAmt
CY Other Expenses$14,235,508CYOtherExpensesAmt
PY Total Expenses$179,389,426PYTotalExpensesAmt
CY Total Expenses$178,966,647CYTotalExpensesAmt
PY Revenues Less Expenses$2,578,653PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,507,310CYRevenuesLessExpensesAmt
Total Assets BOY$96,947,644TotalAssetsBOYAmt
Total Assets EOY$100,780,501TotalAssetsEOYAmt
Total Liabilities BOY$20,712,152TotalLiabilitiesBOYAmt
Total Liabilities EOY$21,846,927TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$76,235,492NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$78,933,574NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionSEE SCHEDULE ODelta Dental of Kentucky's mission has always been to be the leader in the markets we serve, to deliver unmatched quality and value in our programs and services, and to vigorously promote the importance of oral health as an essential part of overall health. Its overarching mission is to be the dental benefits company of choice in the communities we serve.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$175,863,580ExpenseAmt
Grant$2,546,334GrantAmt
Revenue$180,112,897RevenueAmt
DescTHE CORE MISSION FOR DELTA DENTAL OF KENTUCKY IS TO ENHANCE ORAL HEALTH CARE FOR KENTUCKIANS AND OUR MEMBERS AROUND THE COUNTRY. WE STRIVE TO PROVIDE SUPERIOR CUSTOMER SERVICE BY UTILIZING THE MOST CURRENT TECHNOLOGY, WHILE AT THE SAME TIME MANAGING OVERALL COSTS FOR THE BEST VALUE. THROUGH OUR DENTAL BENEFITS PROGRAMS AND COMMUNITY INVOLVEMENT WE ARE MAKING A DIFFERENCE IN THE MARKETS WE SERVE. IN 2016 WE PROCESSED AND PAID OVER $145 MILLION IN CLAIMS FOR 691,000 MEMBERS.SEE SCHEDULE O FOR CONTINUATIONPROVIDING VALUE TO OUR CUSTOMERSDELTA DENTAL IS DEDICATED TO MEMBERS RECEIVING QUALITY DENTISTRY, WHILE ALSO SAVING GROUPS AND MEMBERS MONEY. OUR DENTIST CREDENTIALING, COST MANAGEMENT POLICIES AND FEE REDUCTION AGREEMENTS WITH DENTISTS HELP OUR MEMBERS RECEIVE THE BEST DENTAL OUTCOMES. FOR 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 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 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 MEMBERS.WITH TWO NETWORKS OF PARTICIPATING DENTISTS IN ONE INTEGRATED CLAIMS SYSTEM, DELTA DENTAL CAN DELIVER TO CUSTOMERS AND GROUP MEMBERS, THE GREATEST ACCESS AT THE BEST COST.COMMUNITY INVOLVEMENTDELTA DENTAL OF KENTUCKY IS COMMITTED TO IMPROVING THE ORAL HEALTH AND OVERALL HEALTH FOR ALL CITIZENS ACROSS KENTUCKY. THROUGH TWO CHARITABLE ENDEAVORS, THE DELTA DENTAL OF KENTUCKY FOUNDATION AND MAKING SMILES HAPPEN, DELTA DENTAL IS ABLE TO COMMIT TIME AND RESOURCES TO FURTHER OUR MISSION OF ENHANCING THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. IN 2016, DELTA DENTAL AWARDED OVER $3 MILLION IN FUNDS ACROSS KENTUCKY REACHING OVER 140 CHARITABLE ORGANIZATIONS.DELTA DENTAL OF KENTUCKY PARTNERED WITH KENTUCKY YOUTH ADVOCATES TO CONDUCT A SURVEY OF CHILDREN'S ORAL HEALTH IN KENTUCKY. THOUGH REQUIRED BY LAW, THE STATE HAD NOT CONDUCTED A STUDY IN OVER 15 YEARS. IN 2015, DELTA DENTAL OF KENTUCKY FUNDED THE STUDY OF OVER 2,000 STUDENTS IN 60 PUBLIC SCHOOLS ACROSS THE COMMONWEALTH. THE MAKING SMILES HAPPEN: "2016 STUDY OF ORAL HEALTH OF KENTUCKY'S YOUTH: WHERE ARE WE? WHAT CAN BE DONE? WHO CAN HELP," WAS PUBLISHED IN THE FALL 2015 AND HIGHLIGHTED KEY FINDINGS AND RECOMMENDATION FOR ORAL HEALTH IMPROVEMENT PLANS MOVING FORWARD. DELTA DENTAL OF KENTUCKY IS FUNDING IMPLEMENTATION OF RECOMMENDATIONS THROUGH FIVE REGIONAL COUNCILS TASKED TO IDENTIFY AND IMPLEMENT REGIONAL PROGRAMS TO IMPROVE ORAL HEALTH.Desc
Total Program Service Expenses$175,863,580TotalProgramServiceExpensesAmt
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 EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
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 OutstandingYes (1)LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org MemYes (1)BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded EntityYes (1)DisregardedEntityInd
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 Document22311IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee74EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
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 Members12GoverningBodyVotingMembersCnt
Independent Voting Member10IndependentVotingMemberCnt
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 CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
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 Line1RUSSELL W SKAGGS VP - FINANCEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5027365000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line110100 LINN STATION ROAD STE 700AddressLine1Txt
CityLOUISVILLECityNm
State AbbreviationKYStateAbbreviationCd
ZIP40223ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
CLIFFORD T MAESAKA JR
PRESIDENT, CEO35.005.00Yes (X)Yes (X)$391,991$0$71,184
BRUCE R SMITH
CHAIR8.0015.00Yes (X)Yes (X)$33,150$76,040$0
MICHAEL CHILDERS DMD
DIRECTOR4.005.00Yes (X)$26,150$22,100$0
MARY M CORBETT
DIRECTOR2.000.00Yes (X)$20,900$0$0
RODNEY A JACKSON DMD
DIRECTOR2.000.00Yes (X)$20,900$0$0
MICHAEL B MOUNTJOY
DIRECTOR2.000.00Yes (X)$0$0$6,050
J DAVID SMITH
DIRECTOR2.000.00Yes (X)$22,400$0$0
JOHN N WILLIAMS JR DMD
DIRECTOR2.000.00Yes (X)$21,900$0$0
CARRIE B BROWN DMD
DIRECTOR2.000.00Yes (X)$0$0$4,800
DIANE CORNWELL
DIRECTOR4.000.00Yes (X)$25,150$0$0
OLIVIA F KIRTLEY
DIRECTOR4.000.00Yes (X)$7,400$0$18,000
STEVE S REED
DIRECTOR2.000.00Yes (X)$15,200$0$0
J JUDE THOMPSON
DIRECTOR2.000.00Yes (X)$29,100$0$0
STEPHEN C DAY
VP/CMO40.000.00Yes (X)$232,336$0$22,351
JOHN L WEEKS III
VP/CLO/SECRETARY40.000.00Yes (X)$265,646$0$22,494
ANGELA J NENNI
VP/OPERATIONS40.000.00Yes (X)$237,732$0$13,860
TAMARA L YORK-DAY
VP/COO40.000.00Yes (X)$324,621$0$16,099
RUSSELL W SKAGGS
VP/FINANCE40.000.00Yes (X)$183,736$0$21,941
GORAN JURKOVIC CPA
CHIEF FINANCIAL OFFICER5.0045.00Yes (X)$0$1,636,919$1,412,846
BRIAN E KRAINER
DIRECTOR - SALES40.000.00$219,417$0$14,429Yes (X)
RONALD E STORY
DIRECTOR - IS40.000.00$174,063$0$8,209Yes (X)
JEFFREY D DUES
SENIOR ACCOUNT EXECUTIVE40.000.00$191,942$0$20,951Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,443,734TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,735,059TotReportableCompRltdOrgAmt
Total Other Compensation$1,653,214TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K10IndivRcvdGreaterThan100KCnt
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
DELTA DENTAL PLAN OF MICHIGAN
PO BOX 30416LANSINGMI48909ADMINISTRATIVE SERVICES$3,969,238
BB&T INSURANCE SERVICES INC
414 GALLIMORE RD STE FGREENSBORONC27404BENEFITS CONSULTING$923,596
RENAISSANCE LIFE & HEALTH INSURANCE COMP
PO BOX 30416LANSINGMI48909ADMINISTRATIVE SERVICES$811,765
BOSTOCK CONSTRUCTION LLC
1060 SOUTH PAOLI UNIONVILLEPAOLIIN47454CONSTRUCTION$809,102
ASSURED NEACE LUKENS INSURANCE AGENCY
4000 SMITH RD STE 400CINCINNATIOH45209BENEFITS CONSULTING$618,294
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K26CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
DENTAL CARE REVENUE524114$180,100,897$180,100,897
other fees900099$12,000$12,000
FieldValueIRS element (for citing)
Total Program Service Revenue$180,112,897TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,148,023TotalRevenueColumnAmt
Exclusion$1,148,023ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$653,474RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$1,157,723RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real-$504,249RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column-$504,249TotalRevenueColumnAmt
Exclusion-$504,249ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$6,093,395SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$6,376,109SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities-$282,714SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$282,714TotalRevenueColumnAmt
Exclusion-$282,714ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$180,473,957TotalRevenueColumnAmt
Related Or Exempt Func Income$180,112,897RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$361,060ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$2,546,334TotalAmt
Program Services$2,546,334ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$153,626,635TotalAmt
Program Services$153,626,635ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$2,171,499TotalAmt
Program Services$473,933ProgramServicesAmt
Management And General$1,697,566ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,760,182TotalAmt
Program Services$4,760,182ProgramServicesAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$281,249TotalAmt
Program Services$281,249ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$974,671TotalAmt
Program Services$974,671ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$370,569TotalAmt
Program Services$285,338ProgramServicesAmt
Management And General$85,231ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$197,099TotalAmt
Management And General$197,099ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$65,270TotalAmt
Management And General$65,270ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$84,063TotalAmt
Management And General$84,063ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$805,464TotalAmt
Program Services$724,918ProgramServicesAmt
Management And General$80,546ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,051,981TotalAmt
Program Services$683,788ProgramServicesAmt
Management And General$368,193ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$440,445TotalAmt
Program Services$440,445ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$962,298TotalAmt
Program Services$837,199ProgramServicesAmt
Management And General$125,099ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$553,825TotalAmt
Program Services$276,913ProgramServicesAmt
Management And General$276,912ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$45,330TotalAmt
Program Services$27,198ProgramServicesAmt
Management And General$18,132ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$86,613TotalAmt
Program Services$77,952ProgramServicesAmt
Management And General$8,661ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$92,918TotalAmt
Management And General$92,918ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
BROKER COMMISSIONS$7,037,195$7,037,195
PROCESSING FEES$2,150,147$2,150,147
POSTAGE & SHIPPING$337,705$334,328$3,377
DUES & ASSESSMENTS$272,069$272,069

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$53,086TotalAmt
Program Services$53,086ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$178,966,647TotalAmt
Program Services$175,863,580ProgramServicesAmt
Management And General$3,103,067ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$18,806,974BOYAmt
EOY$18,919,846EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$80,815BOYAmt
EOY$815,158EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$14,781,222BOYAmt
EOY$15,708,032EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
EOY$32,000EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$17,021,249LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$6,510,881LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$10,240,073BOYAmt
EOY$10,510,368EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$20,755,012BOYAmt
EOY$21,143,410EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$23,947,459BOYAmt
EOY$25,449,726EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$8,336,089BOYAmt
EOY$8,201,961EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$96,947,644BOYAmt
EOY$100,780,501EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,915,957BOYAmt
EOY$4,196,894EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$2,294,584BOYAmt
EOY$2,346,198EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$15,501,611BOYAmt
EOY$15,303,835EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$20,712,152BOYAmt
EOY$21,846,927EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$76,235,492BOYAmt
EOY$78,933,574EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$76,235,492BOYAmt
EOY$78,933,574EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$96,947,644BOYAmt
EOY$100,780,501EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$1,507,310ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$1,245,310NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$54,538OtherChangesInNetAssetsAmt
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

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$830,000OtherCostOrOtherBasisAmt
Book Value$830,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,727,036OtherCostOrOtherBasisAmt
Depreciation$3,279,406DepreciationAmt
Book Value$8,447,630BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,382,981OtherCostOrOtherBasisAmt
Depreciation$499,520DepreciationAmt
Book Value$883,461BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,653,791OtherCostOrOtherBasisAmt
Depreciation$1,345,201DepreciationAmt
Book Value$308,590BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,427,441OtherCostOrOtherBasisAmt
Depreciation$1,386,754DepreciationAmt
Book Value$40,687BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$10,510,368TotalBookValueLandBuildingsAmt

Closely Held Equity Interests CloselyHeldEquityInterestsGrp

FieldValueIRS element (for citing)
Book Value$17,806,407BookValueAmt
Method ValuationFMethodValuationCd

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescINVESTMENT - DENTAL CHOICE, INC.Desc
Book Value$7,643,319BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$25,449,726TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDescBook ValueBookValueAmt
ACCRUED INVESTMENT INCOME$277,072
457(B) PLAN$926,784
INVESTMENT - RHC$6,498,105
surplus note receivable$500,000
FieldValueIRS element (for citing)
Total Book Value Other Assets$8,201,961TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
CLAIMS CHECKS OUTSTANDING$5,135,985
ESTIMATED CLAIMS LIABILITY$10,167,850
FieldValueIRS element (for citing)
Total Liability$15,303,835TotalLiabilityAmt

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
KENTUCKY STATE POLICE FOUNDATION
1303 US HWY 127FRANKFORTKY40601474712245501(C)(3)$75,000THE TROOPER PROJECT
LOUISVILLE DENTAL SOCIETY INC
1920 NELSON MILLER PKWYLOUISVILLEKY40223610726110501(C)(6)$50,000METRO DENTAL VAN PROJECT
THE THRIVE CENTER INC
1415 BARDSTOWN ROADLOUISVILLEKY40204613636925501(C)(3)$25,000GENERAL DONATION
JEFFERSON COUNTY PUBLIC SCHOOLS - EARLY CHILDHOOD PROGRAMS
900 SOUTH FLOYD STREETloUISVILLEKY40203616001316government entity$26,880KINDERGARTEN READINESS CAMP
COMMUNITY FOUNDATION OF LOUISVILLE
325 WEST MAIN STREET SUITE 1110LOUISVILLEKY40202310997017501(C)(3)$2,100,000GENERAL DONATION
FieldValueIRS element (for citing)
Total501c3 Org3Total501c3OrgCnt
Total Other Org2TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 2:FormAndLineReferenceDesc
ExplanationGRANTS ARE MADE AND MONITORED UNDER A BOARD APPROVED CORPORATE POLICY WHICH SETS OUT THE GRANT CRITERIA, INCLUDING PROCESSES FOR APPROVAL, DISTRIBUTION, AND MONITORING. THE GRANT REVIEW AND APPROVAL COMMITTEE CONSISTS OF MEMBERS OF THE BOARD AND COMPANY EXECUTIVES. GRANTS MUST BE SUBMITTED ON SPECIFIED FORMS WHICH REQUIRE INFORMATION ABOUT THE GRANTEE ORGANIZATION AND HOW THE GRANTS WILL BE USED. GRANTEE ORGANIZATIONS MUST PERIODICALLY REPORT ON HOW THE FUNDS HAVE BEEN UTILIZED AND CERTIFY THAT FUNDS ARE DISBURSED IN ACCORDANCE WITH THE APPROVED GRANT APPLICATION. THESE REPORTS ARE REGULARLY REVIEWED BY COMPANY STAFF AND SUMMARIZED FOR THE GRANT COMMITTEE. THE COMMITTEE REVIEWS THE REPORTS AT LEAST QUARTERLY AND COMMUNICATES QUESTIONS OR CONCERNS BACK TO THE GRANTEE ORGANIZATION.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
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
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 (10 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
CLIFFORD T MAESAKA JR
PRESIDENT, CEO$292,392$0$96,245$0$3,354$0$55,000$0$16,184$0$463,175$0$0$0
STEPHEN C DAY
VP/CMO$185,276$0$43,173$0$3,887$0$0$0$22,351$0$254,687$0$0$0
JOHN L WEEKS III
VP/CLO/SECRETARY$213,113$0$49,714$0$2,819$0$0$0$22,494$0$288,140$0$0$0
ANGELA J NENNI
VP/OPERATIONS$192,049$0$44,208$0$1,475$0$0$0$13,860$0$251,592$0$0$0
TAMARA L YORK-DAY
VP/COO$252,334$0$70,635$0$1,652$0$0$0$16,099$0$340,720$0$0$0
RUSSELL W SKAGGS
VP/FINANCE$147,952$0$34,513$0$1,271$0$0$0$21,941$0$205,677$0$0$0
GORAN JURKOVIC CPA
CHIEF FINANCIAL OFFICER$0$844,887$0$776,485$0$15,547$0$1,390,840$0$22,006$0$3,049,765$0$0
BRIAN E KRAINER
DIRECTOR - SALES$105,112$0$113,872$0$433$0$0$0$14,429$0$233,846$0$0$0
RONALD E STORY
DIRECTOR - IS$152,233$0$20,512$0$1,318$0$0$0$8,209$0$182,272$0$0$0
JEFFREY D DUES
SENIOR ACCOUNT EXECUTIVE$70,023$0$121,605$0$314$0$0$0$20,951$0$212,893$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 1aFOR THE Annual RHSC Conference THE BOARD MEMBERS ARE ALLOWED TO HAVE COMPANION TRAVEL WITH THEM. THIS IS TAXABLE TO THE BOARD MEMBER.
Part I, Line 4bDelta Dental of Kentucky has a 457(f) SERP, a supplemental executive retirement plan. Only one position, the CEO, is eligible for the SERP. In 2016, the accrual for THE CEO's SERP totaled $55,000. NO DISTRIBUTIONS WERE MADE FROM THE SERP IN 2016.
Part I, Line 7AS INDICATED IN SCHEDULE J, PART II, TOP MANAGEMENT OFFICIALS RECEIVED A BONUS BASED UPON EMPLOYEE PERFORMANCE AND THE FINANCIAL RESULTS OF THE ORGANIZATION AS COMPARED TO BUDGET. THIS BONUS WAS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD.

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp

FieldValueIRS element (for citing)
PersonTAMARA L YORK-DAYPersonNm
Relationship With OrgVP-COO OF DDKYRelationshipWithOrgTxt
Loan PurposeLOAN FOR TUITIONLoanPurposeTxt
Loan From OrganizationYes (X)LoanFromOrganizationInd
Original Principal$40,000OriginalPrincipalAmt
Balance Due$32,000BalanceDueAmt
Default0DefaultInd
Board Or Committee ApprovalYes (1)BoardOrCommitteeApprovalInd
Written AgreementYes (1)WrittenAgreementInd
FieldValueIRS element (for citing)
Total Balance Due$32,000TotalBalanceDueAmt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PEDIATRIC DENTISTRY OF HAMBURGBusinessNameLine1Txt
FieldValueIRS element (for citing)
Relationship DescriptionDR JACKSON, DIRECTOR OF DDKY, IS ONE OF FOUR MEMBERS OF THE DENTISTRYRelationshipDescriptionTxt
Transaction$815,802TransactionAmt
TransactionPAYMENTS FOR DENTAL SERVICESTransactionDesc
Sharing Of Revenues0SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 6EFFECTIVE JULY 1, 2009 RENAISSANCE HEALTH SERVICE CORPORATION BECAME THE SOLE CORPORATE MEMBER OF DELTA DENTAL OF KENTUCKY.
Form 990, Part VI, Section A, line 7aRHSC IS THE SOLE VOTING MEMBER OF DDKY. HOWEVER, UNDER THE TERMS OF THE AFFILIATION AGREEMENT THE PARTIES AGREED THAT THE DELTA DENTAL OF KENTUCKY (DDKY) BOARD SELECTS DIRECTOR CANDIDATES AND SUBMITS THEM TO RENAISSANCE HEALTH SERVICE CORP (RHSC). RHSC THEN APPROVES THE CANDIDATES. RHSC CAN REJECT PROPOSED CANDIDATES FOR "JUST CAUSE" AS DEFINED IN THE AGREEMENT. OTHERWISE, RHSC MUST APPROVE ALL THE CANDIDATES PROPOSED BY THE DDKY BOARD. RHSC HAS THE RIGHT TO ELECT A NUMBER OF DIRECTORS TO THE DDKY BOARD PROPORTIONAL TO THE NUMBER OF DIRECTORS THAT DDKY MAY NOMINATE TO THE RHSC BOARD. AS OF 12/31/2016, RHSC APPOINTED ONE MEMBER OF THE 11 MEMBER DDKY BOARD.
Form 990, Part VI, Section A, line 7bTHE RIGHTS OF THE DDKY BOARD ARE TO APPROVE THE ANNUAL BUDGETS FOR OPERATIONS, ELECT OFFICERS OF THE DDKY BOARD OF DIRECTORS, APPROVE THE TRANSFER OF ANY OF ITS ASSETS, APPROVE THE INCURRENCE OR GUARANTY OF DEBT AND APPROVE THE MANAGEMENT OF ITS INVESTMENTS. RHSC MUST APPROVE ANY TRANSFER OF ASSETS, INVESTMENTS, LOANS, GUARANTIES OR EXPENDITURES WHICH EXCEED TEN PERCENT OF DDKY'S NET ASSETS. RHSC MUST APPROVE THE FOLLOWING CHANGES TO THE DDKY BYLAWS: THE IDENTITY, QUALIFICATION OR RIGHTS OF DDKY'S VOTING MEMBER, THE QUALIFICATIONS, CLASSIFICATIONS, TERMS OF OFFICE OR PERMISSIBLE NUMBER OF DIRECTORS ON DDKY'S BOARD OR ANY LIMITATION ON THE RIGHTS OR AUTHORITY OF THE DDKY BOARD CONTAINED IN DDKY'S ORGANIZATIONAL DOCUMENTS.
Form 990, Part VI, Section B, line 11bTHE FORM 990 IS FIRST REVIEWED INTERNALLY BY THE VP-FINANCE, GENERAL COUNSEL AND CEO. A DRAFT IS THEN PRESENTED TO THE AUDIT AND FINANCE COMMITTEE FOR REVIEW. PRIOR TO FILING, A COPY OF THE FINAL FORM 990 IS DISTRIBUTED TO THE ENTIRE GOVERNING BODY.
Form 990, Part VI, Section B, line 12cOFFICERS, DIRECTORS AND KEY EMPLOYEES MUST COMPLETE AND SUBMIT A CONFLICT OF INTEREST DISCLOSURE ANNUALLY. THESE FORMS ARE REVIEWED BY THE CEO, THE CORPORATE COMPLIANCE OFFICER, AND A REPORT IS MADE TO THE AUDIT AND FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE AUDIT COMMITTEE REVIEWS ALL POTENTIAL CONFLICTS TO DETERMINE IF THE CONFLICTS REPRESENT MATERIAL FINANCIAL RISK TO THE COMPANY AND TAKES ANY ACTION NECESSARY TO RESOLVE OR MITIGATE THE EFFECT OF THE CONFLICTS. WHEN A CONFLICT EXISTS AMONG THE VOTING BOARD MEMBERS, THAT BOARD MEMBER WILL ABSTAIN FROM VOTING ON THE CONFLICTED ISSUE. ALL EMPLOYEES AND DIRECTORS ARE ADVISED ANNUALLY OF THE REQUIREMENT TO REPORT ANY POTENTIAL CONFLICTS OF INTEREST AS THEY OCCUR. EMPLOYEES AND DIRECTORS MAY ALSO MAKE ANONYMOUS REPORTS OF ANY VIOLATIONS OF CORPORATE POLICIES THROUGH A DEDICATED WHISTLEBLOWER SYSTEM ADMINISTERED BY A THIRD PARTY.
Form 990, Part VI, Section B, line 15CEO AND OTHER OFFICERS COMPENSATION ARE REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS IS PERFORMED, AT A MINIMUM, ANNUALLY. COMPENSATION WAS LAST REVIEWED BY DELTA DENTAL OF KENTUCKYS P&C COMMITTEE IN FEBRUARY 2016. THE COMMITTEE IS MADE UP OF BOARD MEMBERS. THE COMMITTEE UTILIZES CERTAIN COMPENSATION SURVEYS AND OUTSIDE CONSULTANTS ARE ENGAGED AS NEEDED. COMPENSATION WAS ALSO REVIEWED UNDER DELTA DENTAL PLAN OF MICHIGANS HR EXECUTIVE COMPENSATION PROCESS DURING 2016. THE REPORT BASED ON THIS REVIEW WAS THEN ISSUED BY THE CONSULTANTS IN JUNE OF 2017.
Form 990, Part VI, Section C, line 19GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE FILED WITH THE KENTUCKY DEPARTMENT OF INSURANCE AND ARE AVAILABLE FOR INSPECTION BY THE PUBLIC THROUGH THAT AGENCY. ADDITIONALLY, THE COMPANY MAKES ORGANIZATIONAL DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS AVAILABLE AT NO COST UPON RECEIPT OF A WRITTEN REQUEST.
FORM 990, PART VIICertain 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 XI, line 9:EQUITY IN SUBSIDIARY -54,538.
FORM 990, PART XII, LINE 2C:PROCESS IS THE SAME AS THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1DENTAL CHOICE PROPERTIES LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line110100 LINN STATION RD SUITEAddressLine1Txt
CityLOUISVILLECityNm
State AbbreviationKYStateAbbreviationCd
ZIP40223ZIPCd
FieldValueIRS element (for citing)
EIN610659432EIN
Primary ActivitiesNO BUSINESS ACTIVITYPrimaryActivitiesTxt
Legal Domicile StateKYLegalDomicileStateCd
Total Income$0TotalIncomeAmt
End Of Year Assets$0EndOfYearAssetsAmt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL OF KENTUCKYBusinessNameLine1Txt

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 MICHIGAN INC
4100 OKEMOS ROADOKEMOSMI48864381791480PROVIDE DENTAL SERVICE PLANSMI501(C)(4)N/AYes (1)RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL OF TENNESSEE INC
po BOX 30416lanSINGMI489097916620812197PROVIDE DENTAL SERVICE PLANSTN501(C)(4)N/AYes (1)RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL PLAN OF NEW MEXICO INC
PO BOX 30416LANSINGMI489097916850224562PROVIDE DENTAL SERVICE PLANSNM501(C)(4)N/AYes (1)RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL OF NORTH CAROLINA
PO BOX 30416LANSINGMI489097916561018068PROVIDE DENTAL SERVICE PLANSNC501(C)(4)N/AYes (1)RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL PLAN OF OHIO inc
PO BOX 30416LANSINGMI489097916310685339PROVIDE DENTAL SERVICE PLANSOH501(C)(4)N/AYes (1)DELTA DENTAL PLAN OF MICHIGAN INC
DELTA DENTAL PLAN OF INDIANA inc
PO BOX 30416LANSINGMI489097916351545647PROVIDE DENTAL SERVICE PLANSIN501(C)(4)N/AYes (1)DELTA DENTAL PLAN OF MICHIGAN INC
DELTA DENTAL FUND
PO BOX 30416LANSINGMI489097916382337000SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMSMI501(C)(3)12A TYPE IIYes (1)DELTA DENTAL PLAN OF MICHIGAN INC
DELTA DENTAL PLAN OF ARKANSAS
PO BOX 30416LANSINGMI489097916710561140PROVIDE DENTAL SERVICE PLANSAR501(C)(4)NAYes (1)RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL OF ARKANSAS FOUNDATION
PO BOX 30416LANSINGMI489097916261569324PROVIDE DENTAL SERVICE PLANSAR501(C)(3)PFYes (1)RENAISSANCE HEALTH SERVICE CORPORATION
RENAISSANCE FAMILY FOUNDATION INC
4100 OKEMOS ROADOKEMOSMI48864461376165Emphasize DENTAL HEALTH IN COMMUNITIESIN501(c)(3)PFYes (1)RENAISSANCE HOLDING COMPANY
SMILE 180 FOUNDATION
240 VENTURE CIRCLENASHVILLETN37228471654054Emphasize DENTAL HEALTH IN COMMUNITIESTN501(c)(3)Line 12a, IYes (1)DELTA DENTAL OF TENNESSEE INC

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
DENTAL CHOICE INC
10100 LINN STATION RD SUITE 700LOUISVILLEKY40223611105118PROVIDE DENTAL SERVICE PLANSKYN/AC$188,658$8,107,2891.00000Yes (1)
DENTAL CHOICE AGENCY INC
10100 LINN STATION RD SUITE 700LOUISVILLEKY40223611336003PRIMARY GENERAL AGENCY FOR DDKY & DENTAL CHOICEKYN/AC-$6261.00000Yes (1)
RENAISSANCE HOLDING COMPANY
PO BOX 30381LANSINGMI48909412177193HOLDING COMPANYMIC$82,180$7,300,3390.05900Yes (1)RENAISSANCE HEALTH SERVICE CORPORATION
Renaissance Life & Health Insurance Company of America
PO BOX 30416LANSINGMI489097916470397286INSURANCEINCYes (1)RENAISSANCE HOLDING COMPANY
Renaissance Health Insurance Company of New York
PO BOX 30416LANSINGMI48909134098096INSURANCENYCYes (1)RENAISSANCE HOLDING COMPANY
FORE HOLDING CORPORATION
240 VENTURE CIRCLENASHVILLETN37228204116122EMPLOYEE BENEFITSTNCYes (1)DELTA DENTAL OF TENNESSEE
OMEGA ADMINISTRATORS INC
1513 COUNTRY CLUB ROADSHERWOODAR72120043740469PROVIDE THIRD-PARTY ADMINISTRATIVE SERVICESARCYes (1)DELTA DENTAL OF ARKANSAS
GLM HOLDING COMPANY
4100 OKEMOS ROADOKEMOSMI48864472557772INVESTMENT IN SUBSIDIARIESMICYes (1)DELTA DENTAL OF MICHIGAN
DEWPOINT INC
300 S WASHIGNTON SQUARELANSINGMI48933383300595COMPUTER CONSULTINGMICYes (1)GLM HOLDING COMPANY
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
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 OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (3 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
DENTAL CHOICE INC
L$324,452ACTUAL COST
DELTA DENTAL OF NORTH CAROLINA
D$500,000ACTUAL COST
DELTA DENTAL PLAN OF MICHIGAN
M$2,330,331ACTUAL COST

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