2017-11-13T14:29:43-06:00 2016-12-31 381357951 PLANTE & MORAN PLLC 1111 Michigan Ave Ste 100 East Lansing MI 48823 990 2016-01-01 610659432 DELTA DENTAL OF KENTUCKY INC DELT 5027365000 10100 LINN STATION ROAD NO 700 LOUISVILLE KY 40223 RUSSELL W SKAGGS VP - FINANCE 5027365000 2017-11-10 1 DAVID LOWENTHAL CPA P00378651 5173326200 2017-11-10 67.59.56.33 2017-11-10 09:35:51 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D3994C8C0EED3DC07268D0E06E8E0D044B4248A2 2016 2017-02-10 21:41:12Z BRUCE R SMITH 10100 LINN STATION ROAD NO 700 LOUISVILLE KY 40223 188007789 0 X WWW.DELTADENTALKY.COM X 1966 KY Delta 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. 12 10 74 0 0 0 0 0 180710930 180112897 1449146 865309 -191997 -504249 181968079 180473957 2862535 2546334 155448278 153626635 7778407 8558170 0 0 0 13300206 14235508 179389426 178966647 2578653 1507310 96947644 100780501 20712152 21846927 76235492 78933574 X SEE 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. 0 0 175863580 2546334 180112897 THE 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. 175863580 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 1 0 0 0 0 0 0 1 1 1 1 0 1 22311 0 1 74 1 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X RUSSELL W SKAGGS VP - FINANCE 5027365000 10100 LINN STATION ROAD STE 700 LOUISVILLE KY 40223 X CLIFFORD T MAESAKA JR PRESIDENT, CEO 35.00 5.00 X X 391991 0 71184 BRUCE R SMITH CHAIR 8.00 15.00 X X 33150 76040 0 MICHAEL CHILDERS DMD DIRECTOR 4.00 5.00 X 26150 22100 0 MARY M CORBETT DIRECTOR 2.00 0.00 X 20900 0 0 RODNEY A JACKSON DMD DIRECTOR 2.00 0.00 X 20900 0 0 MICHAEL B MOUNTJOY DIRECTOR 2.00 0.00 X 0 0 6050 J DAVID SMITH DIRECTOR 2.00 0.00 X 22400 0 0 JOHN N WILLIAMS JR DMD DIRECTOR 2.00 0.00 X 21900 0 0 CARRIE B BROWN DMD DIRECTOR 2.00 0.00 X 0 0 4800 DIANE CORNWELL DIRECTOR 4.00 0.00 X 25150 0 0 OLIVIA F KIRTLEY DIRECTOR 4.00 0.00 X 7400 0 18000 STEVE S REED DIRECTOR 2.00 0.00 X 15200 0 0 J JUDE THOMPSON DIRECTOR 2.00 0.00 X 29100 0 0 STEPHEN C DAY VP/CMO 40.00 0.00 X 232336 0 22351 JOHN L WEEKS III VP/CLO/SECRETARY 40.00 0.00 X 265646 0 22494 ANGELA J NENNI VP/OPERATIONS 40.00 0.00 X 237732 0 13860 TAMARA L YORK-DAY VP/COO 40.00 0.00 X 324621 0 16099 RUSSELL W SKAGGS VP/FINANCE 40.00 0.00 X 183736 0 21941 GORAN JURKOVIC CPA CHIEF FINANCIAL OFFICER 5.00 45.00 X 0 1636919 1412846 BRIAN E KRAINER DIRECTOR - SALES 40.00 0.00 X 219417 0 14429 RONALD E STORY DIRECTOR - IS 40.00 0.00 X 174063 0 8209 JEFFREY D DUES SENIOR ACCOUNT EXECUTIVE 40.00 0.00 X 191942 0 20951 2443734 1735059 1653214 10 0 1 0 DELTA DENTAL PLAN OF MICHIGAN PO BOX 30416 LANSING MI 48909 ADMINISTRATIVE SERVICES 3969238 BB&T INSURANCE SERVICES INC 414 GALLIMORE RD STE F GREENSBORO NC 27404 BENEFITS CONSULTING 923596 RENAISSANCE LIFE & HEALTH INSURANCE COMP PO BOX 30416 LANSING MI 48909 ADMINISTRATIVE SERVICES 811765 BOSTOCK CONSTRUCTION LLC 1060 SOUTH PAOLI UNIONVILLE PAOLI IN 47454 CONSTRUCTION 809102 ASSURED NEACE LUKENS INSURANCE AGENCY 4000 SMITH RD STE 400 CINCINNATI OH 45209 BENEFITS CONSULTING 618294 26 DENTAL CARE REVENUE 524114 180100897 180100897 other fees 900099 12000 12000 180112897 1148023 1148023 653474 1157723 -504249 -504249 -504249 6093395 6376109 -282714 -282714 -282714 180473957 180112897 0 361060 2546334 2546334 153626635 153626635 2171499 473933 1697566 4760182 4760182 281249 281249 974671 974671 370569 285338 85231 197099 197099 65270 65270 84063 84063 805464 724918 80546 1051981 683788 368193 440445 440445 962298 837199 125099 553825 276913 276912 45330 27198 18132 86613 77952 8661 92918 92918 BROKER COMMISSIONS 7037195 7037195 PROCESSING FEES 2150147 2150147 POSTAGE & SHIPPING 337705 334328 3377 DUES & ASSESSMENTS 272069 272069 53086 53086 178966647 175863580 3103067 0 18806974 18919846 80815 815158 14781222 15708032 32000 17021249 6510881 10240073 10510368 20755012 21143410 23947459 25449726 8336089 8201961 96947644 100780501 2915957 4196894 2294584 2346198 15501611 15303835 20712152 21846927 X 76235492 78933574 76235492 78933574 96947644 100780501 X 1507310 1245310 -54538 X X 0 1 X 1 0 830000 830000 11727036 3279406 8447630 1382981 499520 883461 1653791 1345201 308590 1427441 1386754 40687 10510368 17806407 F INVESTMENT - DENTAL CHOICE, INC. 7643319 F 25449726 ACCRUED INVESTMENT INCOME 277072 457(B) PLAN 926784 INVESTMENT - RHC 6498105 surplus note receivable 500000 8201961 CLAIMS CHECKS OUTSTANDING 5135985 ESTIMATED CLAIMS LIABILITY 10167850 15303835 1 KENTUCKY STATE POLICE FOUNDATION 1303 US HWY 127 FRANKFORT KY 40601 474712245 501(C)(3) 75000 THE TROOPER PROJECT LOUISVILLE DENTAL SOCIETY INC 1920 NELSON MILLER PKWY LOUISVILLE KY 40223 610726110 501(C)(6) 50000 METRO DENTAL VAN PROJECT THE THRIVE CENTER INC 1415 BARDSTOWN ROAD LOUISVILLE KY 40204 613636925 501(C)(3) 25000 GENERAL DONATION JEFFERSON COUNTY PUBLIC SCHOOLS - EARLY CHILDHOOD PROGRAMS 900 SOUTH FLOYD STREET loUISVILLE KY 40203 616001316 government entity 26880 KINDERGARTEN READINESS CAMP COMMUNITY FOUNDATION OF LOUISVILLE 325 WEST MAIN STREET SUITE 1110 LOUISVILLE KY 40202 310997017 501(C)(3) 2100000 GENERAL DONATION 3 2 Part I, Line 2: GRANTS 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. X 1 1 X X X X 0 1 0 0 0 0 0 1 0 CLIFFORD T MAESAKA JR PRESIDENT, CEO 292392 0 96245 0 3354 0 55000 0 16184 0 463175 0 0 0 STEPHEN C DAY VP/CMO 185276 0 43173 0 3887 0 0 0 22351 0 254687 0 0 0 JOHN L WEEKS III VP/CLO/SECRETARY 213113 0 49714 0 2819 0 0 0 22494 0 288140 0 0 0 ANGELA J NENNI VP/OPERATIONS 192049 0 44208 0 1475 0 0 0 13860 0 251592 0 0 0 TAMARA L YORK-DAY VP/COO 252334 0 70635 0 1652 0 0 0 16099 0 340720 0 0 0 RUSSELL W SKAGGS VP/FINANCE 147952 0 34513 0 1271 0 0 0 21941 0 205677 0 0 0 GORAN JURKOVIC CPA CHIEF FINANCIAL OFFICER 0 844887 0 776485 0 15547 0 1390840 0 22006 0 3049765 0 0 BRIAN E KRAINER DIRECTOR - SALES 105112 0 113872 0 433 0 0 0 14429 0 233846 0 0 0 RONALD E STORY DIRECTOR - IS 152233 0 20512 0 1318 0 0 0 8209 0 182272 0 0 0 JEFFREY D DUES SENIOR ACCOUNT EXECUTIVE 70023 0 121605 0 314 0 0 0 20951 0 212893 0 0 0 Part I, Line 1a FOR 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 4b Delta 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 7 AS 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. TAMARA L YORK-DAY VP-COO OF DDKY LOAN FOR TUITION X 40000 32000 0 1 1 32000 PEDIATRIC DENTISTRY OF HAMBURG DR JACKSON, DIRECTOR OF DDKY, IS ONE OF FOUR MEMBERS OF THE DENTISTRY 815802 PAYMENTS FOR DENTAL SERVICES 0 Form 990, Part VI, Section A, line 6 EFFECTIVE JULY 1, 2009 RENAISSANCE HEALTH SERVICE CORPORATION BECAME THE SOLE CORPORATE MEMBER OF DELTA DENTAL OF KENTUCKY. Form 990, Part VI, Section A, line 7a RHSC 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 7b THE 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 11b THE 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 12c OFFICERS, 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 15 CEO 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 19 GOVERNING 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 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 XI, line 9: EQUITY IN SUBSIDIARY -54,538. FORM 990, PART XII, LINE 2C: PROCESS IS THE SAME AS THE PRIOR YEAR. DENTAL CHOICE PROPERTIES LLC 10100 LINN STATION RD SUITE LOUISVILLE KY 40223 610659432 NO BUSINESS ACTIVITY KY 0 0 DELTA DENTAL OF KENTUCKY 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 MICHIGAN INC 4100 OKEMOS ROAD OKEMOS MI 48864 381791480 PROVIDE DENTAL SERVICE PLANS MI 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 1 DELTA DENTAL OF TENNESSEE INC po BOX 30416 lanSING MI 489097916 620812197 PROVIDE DENTAL SERVICE PLANS TN 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 1 DELTA DENTAL PLAN OF NEW MEXICO INC 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 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 PLAN OF OHIO inc PO BOX 30416 LANSING MI 489097916 310685339 PROVIDE DENTAL SERVICE PLANS OH 501(C)(4) N/A DELTA DENTAL PLAN OF MICHIGAN INC 1 DELTA DENTAL PLAN OF INDIANA inc PO BOX 30416 LANSING MI 489097916 351545647 PROVIDE DENTAL SERVICE PLANS IN 501(C)(4) N/A DELTA DENTAL PLAN OF MICHIGAN INC 1 DELTA DENTAL FUND PO BOX 30416 LANSING MI 489097916 382337000 SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMS MI 501(C)(3) 12A TYPE II DELTA DENTAL PLAN OF MICHIGAN INC 1 DELTA DENTAL PLAN OF ARKANSAS PO BOX 30416 LANSING MI 489097916 710561140 PROVIDE DENTAL SERVICE PLANS AR 501(C)(4) NA RENAISSANCE HEALTH SERVICE CORPORATION 1 DELTA DENTAL OF ARKANSAS FOUNDATION PO BOX 30416 LANSING MI 489097916 261569324 PROVIDE DENTAL SERVICE PLANS AR 501(C)(3) PF RENAISSANCE HEALTH SERVICE CORPORATION 1 RENAISSANCE FAMILY FOUNDATION INC 4100 OKEMOS ROAD 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 DENTAL CHOICE INC 10100 LINN STATION RD SUITE 700 LOUISVILLE KY 40223 611105118 PROVIDE DENTAL SERVICE PLANS KY N/A C 188658 8107289 1.00000 1 DENTAL CHOICE AGENCY INC 10100 LINN STATION RD SUITE 700 LOUISVILLE KY 40223 611336003 PRIMARY GENERAL AGENCY FOR DDKY & DENTAL CHOICE KY N/A C -626 1.00000 1 RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI RENAISSANCE HEALTH SERVICE CORPORATION C 82180 7300339 0.05900 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 48909 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 1 FORE HOLDING CORPORATION 240 VENTURE CIRCLE NASHVILLE TN 37228 204116122 EMPLOYEE BENEFITS TN DELTA DENTAL OF TENNESSEE C 1 OMEGA ADMINISTRATORS INC 1513 COUNTRY CLUB ROAD SHERWOOD AR 72120 043740469 PROVIDE 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 1 DEWPOINT INC 300 S WASHIGNTON SQUARE LANSING MI 48933 383300595 COMPUTER CONSULTING MI GLM HOLDING COMPANY C 1 0 0 0 1 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 DENTAL CHOICE INC L 324452 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA D 500000 ACTUAL COST DELTA DENTAL PLAN OF MICHIGAN M 2330331 ACTUAL COST