2016-11-14T17:49:20-06:00 2015-12-31 381357951 Plante & MoranPLLC 1111 Michigan Ave PO Box 2500 East Lansing MI 488262500 990 2015-01-01 381791480 Delta Dental Plan of Michigan Inc DELT 5173496000 4100 Okemos Road Okemos MI 48864 GORAN JURKOVIC CFO 5173496000 2016-11-14 1 DAVID LOWENTHAL CPA P00378651 5173326200 2015 2017-02-10 21:41:12Z LAURA L CZELADA 4100 Okemos Road Okemos MI 48864 1943909979 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. 17 13 998 0 161217 -83756 0 0 1476942723 1824011017 18210118 5889153 59655933 53364381 1554808774 1883264551 2095294 100401 0 0 76579278 79072012 0 0 0 1447706287 1766877494 1526380859 1846049907 28427915 37214644 595571216 665952022 190966604 216678717 404604612 449273305 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 1785035746 100401 1877035071 PROMOTING ORAL HEALTHDELTA 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 2015 BY PAYING OUT OVER $1.6 BILLION FOR DENTAL CARE, BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 9.7 MILLION CLAIMS WERE PROCESSED FOR OVER 3.2 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 2015, THE DELTA DIFFERENCE SAVED GROUPS AND SUBSCRIBERS APPROXIMATELY $1.5 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, UNDERSCORING OUR COMMITMENT TO PROVIDING QUALITY PRODUCTS AND SERVICES THAT SURPASS CUSTOMER'S EXPECTATIONS. QUALITY STANDARDS ARE EXTREMELY RIGOROUS AND GUARANTEE THAT DELTA DENTAL HAS DOCUMENTED ITS QUALITY PROCEDURES AND SYSTEMS THROUGHOUT THE COMPANY. THE LONGSTANDING COMMITMENT TO PROVIDING QUALITY TO CUSTOMERS, DENTISTS, SUBSCRIBERS AND OTHER BUSINESS PARTNERS HAS NOW BEEN INTERNATIONALLY RECOGNIZED.QUALITY SERVICE IS ALSO MEASURED THROUGH INTERNAL AUDITS. RESULTS INDICATE 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 $22 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 2015, 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 , UNIVERSITY OF DETROIT MERCY DENTAL SCHOOL TO SUPPORT COMMUNITY WATER FLUORIDATION, DENTAL SEALANT PROGRAMS AND MOBILE DENTAL COACHES.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 2015, 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. APPROXIMATELY 800,000 MICHIGAN CHILDREN ARE SERVED BY THIS PROGRAM. THE AMERICAN DENTAL ASSOCIATION NAMED MICHIGAN'S HKD PROGRAM ONE OF THE FIVE MODELS FOR IMPROVING ACCESS TO DENTAL CARE FOR LOW-INCOME POPULATIONS.MICHILD IS AN INSURANCE PROGRAM THAT IS STATE AND FEDERALLY FUNDED WHICH MAKES COMPREHENSIVE HEALTH AND DENTAL COVERAGE AVAILABLE TO UNINSURED LOW AND MIDDLE INCOME CHILDREN UNDER 19 YEARS OF AGE. DELTA DENTAL PLAN OF MICHIGAN HAS APPLIED ITS ADMINISTRATIVE EXPERTISE AND DENTIST NETWORKS TO IMPROVING ORAL HEALTH CARE FOR THIS SEGMENT OF THE POPULATION ALSO.ALSO IN 2015, 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 INCREASE ACCESS TO CARE FOR LOW-INCOME POPULATIONS WHO DO NOT QUALIFY FOR THE TRADITIONAL MEDICAID PROGRAM. DELTA DENTAL ADMINISTERS HMP DENTAL BENEFITS FOR ABOUT 340,000 MEMBERS.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. 1785035746 0 0 1 0 0 0 0 0 0 1 1 0 0 1 1 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 61198 0 1 998 1 1 1 0 0 0 0 0 X 17 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X GORAN JURKOVIC chief financial officer 5173496000 4100 Okemos Road Okemos MI 48864 X JOSEPH C HARRIS DDS VICE CHAIRPERSON 5.00 6.00 X X 35066 3200 0 BRUCE R SMITH CHAIRPERSON 7.00 14.00 X X 47000 33032 0 KELLY JUBB SCHEIDERER SECRETARY/TREASURER 5.00 5.00 X X 12300 0 17500 DOUGLAS R ANDERSON DIREctor 5.00 11.00 X 11974 6192 17500 JOSHUA S HOWIE MEMBER-AT-LARGE 5.00 5.00 X 98000 4700 0 lisa dancsok DIRECTOR 5.00 5.00 X 21400 0 0 RORY GAMBLE DIRECTOR 5.00 5.00 X 18600 0 0 JEFFREY A KELLER DIRECTOR 5.00 5.00 X 21400 500 0 TERRI A MILLER CPCU DIRECTOR 5.00 5.00 X 26300 23925 0 TIMOTHY E MOFFIT dba MEMBER-AT-LARGE 5.00 10.00 X 27366 7710 0 C RICHARD SEITZ MEMBER-AT-LARGE 5.00 7.00 X 29100 29250 0 TERENCE R COMAR DDS MS IMMEDIATE PAST CHAIRPERSON 5.00 7.00 X 29800 15500 0 THOMAS FLESZAR DDS MS DIRECTOR 5.00 5.00 X 34750 12002 0 STEPHEN A EKLUND DIRECTOR 5.00 1.00 X 20000 123000 0 ANN MARIE FLERMOEN MEMBER-AT-LARGE 5.00 11.00 X 30784 8590 0 KURT D GALLIGER DIRECtor 5.00 5.00 X 22800 0 0 AMY BASEL VP OF FINANCE 30.00 25.00 X 318428 0 75869 LAURA L CZELADA CPA CEO, PRESIDENT 30.00 30.00 X 2315834 0 3428239 GORAN JURKOVIC CPA CHIEF FINANCIAL OFFICER 30.00 30.00 X 1460589 0 1089016 TOBY HALL SR. V-P- CHIEF ACTUARY 50.00 0.00 X 537379 0 239788 RANDY TASCO V-P CHIEF MARKETING OFFICER 50.00 0.00 X 945099 0 1255330 NANCY HOSTETLER SR. V-P, CHIEF OF STAFF 49.00 1.00 X 418418 0 53987 LUIGI BATTAGLIERI SR. V-P, CHIEF RELATIONSHIP 50.00 0.00 X 721355 0 389209 KENNETH THEIS SVP & CIO 30.00 20.00 X 580858 0 154683 KAREN GREEN V-P INFORMATICS/QUALITY 50.00 0.00 X 255886 0 31216 JON GROAT V-P GENERAL COUNSEL 25.00 20.00 X 348405 0 25279 JED JACOBSON DDS MS MPH SR. V-P, PROFESSIONAL SERV 50.00 0.00 X 732384 0 78719 ANTHONY ROBINSON V-P, SALES 50.00 0.00 X 339350 0 42499 JOADI KECK VP HR & ADMINISTRATION 50.00 0.00 X 310900 0 74422 KELLY MCCLAIN ACCOUNT EXECUTIVE 50.00 0.00 X 291244 0 20748 MARK DAVIDSON INTERNATIONAL DEVELOPMENT 50.00 0.00 X 429043 0 44492 NICHOLAS CORRIDOR ACCOUNT EXECUTIVE 50.00 0.00 X 289023 0 46470 EDWARD ZOBECK FORMER CHIEF ADMIN OFFICER 0.00 0.00 X 471508 0 0 11252343 267601 7084966 165 1 1 0 MESSA 1480 KENDALE BLVD EAST LANSING MI 48826 COMMISSIONS 2672350 JONES DAY 7805 BEN FRANKLIN STATION WASHINGTON DC 20044 LEGAL SERVICES 959084 MARSH USA INC PO BOX 402901 ATLANTA GA 30384 COMMISSIONS 773377 GALLAGHER BENEFIT SERVICES PO BOX 198568 ATLANTA GA 30384 COMMISSIONS 657470 PLANTE MORAN PO BOX 2500 EAST LANSING MI 48826 AUDIT/TAX SERVICES 469164 35 Dental care revenue 624100 1823849800 1823849800 EXTERNAL SERVICES 524292 161217 161217 1824011017 8001692 8001692 58532889 60735083 -89655 -2202194 89655 -2112539 -2112539 admin reimbursement 900099 53185271 53185271 Miscellaneous Income 900099 179110 179110 53364381 1883264551 1877035071 161217 6068263 X 100401 100401 15315155 9954851 5360304 51957134 34718700 17238434 -1355097 -1164084 -191013 8988845 5970504 3018341 4165975 2825218 1340757 1198577 492266 706311 1305560 1305560 284886 284886 358751 358751 1696542682 1694833649 1709033 2211306 594640 1616666 9200292 7935944 1264348 5137512 3429223 1708289 2998322 2998322 3445289 2708575 736714 389175 182637 206538 198748 198748 1224709 102449 1122260 8801060 2967741 5833319 869264 869264 Commissions 13773765 13773765 HICA TAX- MI 8665440 8665440 FEDERAL HEALTHCARE TAX 4598913 4598913 processing fees 4437839 4437839 1235404 1171428 63976 1846049907 1785035746 61014161 0 2118 2118 79181217 71057029 65005021 87127894 39152107 51266470 198204197 105223533 92939127 92980664 248184768 245486851 63345428 109263962 7761430 8767034 595571216 665952022 53818780 60237090 137147824 156441627 190966604 216678717 X 15744473 15744473 5122500 5122500 383737639 428406332 404604612 449273305 595571216 665952022 X 37214644 -8491410 15945459 X X 0 1 X 1 0 9000 9000 1 WEST MICHIGAN COMMUNITY PRESERVATION FUND 9128 OAK CREEK LANE WEST OLIVE MI 49460 271189310 500 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 MICHIGAN CITIZENS FOR FISCAL RESPONSIBILITY PO BOX 16041 LANSING MI 48901 271993953 5000 7859592 7859592 104390137 31238483 73151654 34565435 26976921 7588514 51389033 47008129 4380904 92980664 DDIC. stock 200217 C Investment in RHC 63067963 C INVESTMENT IN GLM 45995782 C 109263962 IBNR - claim adjustment reserves 69566250 Unearned Premiums 29257790 FAS 158 FUNDED STATUS 57617587 156441627 X Part X, Line 2: AS OF DECEMBER 31, 2015 AND 2014, DELTA DENTAL PLAN OF MICHIGAN'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED DURING THE YEAR OR ACCRUED AT YEAR END. DELTA DENTAL PLAN OF MICHIGAN IS SUBJECT TO ROUTINE AUDITS BY TAXING AUTHORITIES. 1 BLESSINGS IN A BACKPACK 4121 SHELBYVILLE RD LOUISVILLE KY 40207 261964620 501(C)(3) 72706 CASH N/A CHARITABLE DONATION CELEBRATING THE POWER OF MICHIGAN PO BOX 15246 LANSING MI 48901 273955283 501(C)(4) 10000 CASH N/A CHARITABLE DONATION FUNDS FOR MICHIGAN'S TOMORROW 5915 EASTMAN AVE MIDLAND MI 48640 472384695 501(C)(4) 10000 CASH N/A CHARITABLE DONATION VOLUNTEERS OF AMERICA 414 N LARCH STREET LANSING MI 48912 386007278 501(C)(3) 7695 CASH N/A CHARITABLE DONATION 2 2 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. Support of the national Blessings in a Backpack program, which provides weekend food backpacks to impoverished elementary school children. During the 2014-15 school year, we provided $73,000 to pay for weekly food for 1,146 children. During the 2015-16 school year, we spent $72,000 which provided food for 1,133 students. In addition to providing funding, Delta Dental of Michigan employees volunteer on a weekly basis to pack bags of weekend food for Fairview STEM Magnet School. Celebration of National Reading Month, which included: 60 employee volunteer readers visiting area classrooms to read to children and share oral health information and materials; the creation of 2,000 first grade reading/oral health tote bags containing reading and oral health resources which state legislators delivered to classrooms they visited in their districts; Delta Dental of Michigan sponsored oral health story hours for libraries that are members of the Capital Area Libraries Association. Hosting the Ronald McDonald House of Mid-Michigan's 2015 Run for the House events, which were held on Delta Dental of Michigan's campus. In addition to providing the venue at no charge, employees volunteered to help with the event. X X X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 AMY BASEL VP OF FINANCE 225527 0 87659 0 5242 0 53863 0 22006 0 394297 0 0 0 LAURA L CZELADA CPA CEO, PRESIDENT 808293 0 1492262 0 15279 0 3420884 0 7355 0 5744073 0 0 0 GORAN JURKOVIC CPA CHIEF FINANCIAL OFFICER 702396 0 739354 0 18839 0 1067010 0 22006 0 2549605 0 0 0 TOBY HALL SR. V-P- CHIEF ACTUARY 258892 0 260483 0 18004 0 217782 0 22006 0 777167 0 0 0 RANDY TASCO V-P CHIEF MARKETING OFFICER 455745 0 483211 0 6143 0 1233324 0 22006 0 2200429 0 0 0 NANCY HOSTETLER SR. V-P, CHIEF OF STAFF 200789 0 197793 0 19836 0 31981 0 22006 0 472405 0 0 0 LUIGI BATTAGLIERI SR. V-P, CHIEF RELATIONSHIP 340422 0 358824 0 22109 0 389179 0 30 0 1110564 0 0 0 KENNETH THEIS SVP & CIO 273486 0 304307 0 3065 0 134508 0 20175 0 735541 0 0 0 KAREN GREEN V-P INFORMATICS/QUALITY 179688 0 74768 0 1430 0 9210 0 22006 0 287102 0 0 0 JON GROAT V-P GENERAL COUNSEL 248655 0 94531 0 5219 0 17924 0 7355 0 373684 0 0 0 JED JACOBSON DDS MS MPH SR. V-P, PROFESSIONAL SERV 266390 0 280301 0 185693 0 71364 0 7355 0 811103 0 0 0 ANTHONY ROBINSON V-P, SALES 222707 0 110534 0 6109 0 20493 0 22006 0 381849 0 0 0 JOADI KECK VP HR & ADMINISTRATION 216247 0 83819 0 10834 0 59009 0 15413 0 385322 0 0 0 KELLY MCCLAIN ACCOUNT EXECUTIVE 58227 0 232935 0 82 0 13393 0 7355 0 311992 0 0 0 MARK DAVIDSON INTERNATIONAL DEVELOPMENT 309748 0 118125 0 1170 0 22486 0 22006 0 473535 0 0 0 NICHOLAS CORRIDOR ACCOUNT EXECUTIVE 58659 0 230219 0 145 0 24464 0 22006 0 335493 0 0 0 EDWARD ZOBECK FORMER CHIEF ADMIN OFFICER 0 0 0 0 471508 0 0 0 0 0 471508 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 2014. THE REPORT BASED ON THIS REVIEW WAS THEN ISSUED BY THE CONSULTANTS IN JUNE OF 2015. Part I, Lines 4a-b SEVERANCE PAYMENT MADE TO ZOBECK: $471,508 ADDITIONALLY, 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. JOSEPH CARTER HARRIS DDS JOSEPH HARRIS, VICE CHAIR OF DDPMI, IS AN OWNER OF JOSEPH CARTER HARRIS DDS 175162 PAYMENTS FOR DENTAL SERVICES 0 Teri Battaglieri SPOUSE OF DDPMI KEY EMPLOYEE LUIGI BATTAGLIERI 204971 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 BRIAN BATTAGLIERI SON OF DDPMI KEY EMPLOYEE LUIGI BATTAGLIERI 130144 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 COMAR & COMAR PC TERENCE COMAR, DIRECTOR OF DDPMI, IS AN OWNER IN COMAR & COMAR, PC. 152412 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 11 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 2014. THE REPORT BASED ON THIS REVIEW WAS THEN ISSUED BY THE CONSULTANTS IN JUNE OF 2015. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are available upon 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 IX, line 11g CONTRACT LABOR: Program service expenses 2,852,773. Management and general expenses 990,026. Fundraising expenses 0. Total expenses 3,842,799. CONTRACTED SERVICES: Program service expenses 783,516. Management and general expenses 719,007. Fundraising expenses 0. Total expenses 1,502,523. DENTAL CONSULTANT : Program service expenses 749,097. Management and general expenses 0. Fundraising expenses 0. Total expenses 749,097. PURCHASED DENTAL SERVICES: Program service expenses 1,690,448,263. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,690,448,263. Form 990, Part XI, line 9: Gain on equity in subsidiaries 2,642,490. pension RELATED CHANGES 13,302,969. 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. RED CEDAR INVESTMENT MANAGEMENT LLC 2852 EYDE PARKWAY SUITE 240 EAST LANSING MI 48823 462667997 REGISTERED INVESTMENT ADVISORS MI -53099 86749 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) 11A TYPE 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 11a, 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 811997 69985459 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 -141251 51322902 0.75000 1 DEWPOINT INC 300 S WASHINGTON SQUARE LANSING MI 48933 383300595 IT CONSULTING MI GLM HOLDING COMPANY C 2612146 27886679 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 4458777 ACTUAL COST DELTA DENTAL PLAN OF OHIO L 23303386 ACTUAL COST DELTA DENTAL PLAN OF INDIANA L 9022183 ACTUAL COST RENAISSANCE HEALTH SERVICE CORPORATION L 129543 ACTUAL COST DELTA DENTAL FUND L 275062 ACTUAL COST RENAISSANCE LIFE AND HEALTH INSURANCE COMPANY OF AMERICA L 3885475 ACTUAL COST delta dental plan of new mexico L 1486751 ACTUAL COST DELTA DENTAL OF KENTUCKY L 2899602 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA L 2077867 ACTUAL COST RENAISSANCE HOLDING COMPANY L 660795 ACTUAL COST DELTA DENTAL OF ARKANSAS L 3272535 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA D 1890000 ACTUAL LOAN AMOUNT RENAISSANCE HEALTH INSURANCE COMPANY OF NEW YORK L 70377 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA A 162000 ACTUAL COST