2015-11-13T13:16:37-06:00 2014-12-31 381357951 PLANTE & MORAN PLLC 1111 MICHIGAN AVE EAST LANSING MI 48823 990 2014-01-01 610659432 DELTA DENTAL OF KENTUCKY INC DELT 5027365000 10100 LINN STATION ROAD NO 700 LOUISVILLE KY 40223 RUSSELL W SKAGGS VP - FINANCE 5027365000 2015-11-13 1 DAVID LOWENTHAL CPA P00378651 5173326200 2014 2016-03-07 17:11:31Z CLIFFORD T MAESAKA JR 10100 LINN STATION ROAD NO 700 LOUISVILLE KY 40223 180827572 0 X WWW.DELTADENTALKY.COM X 1966 KY DELTA DENTAL OF KENTUCKY'S MISSION HAS ALWAYS BEEN TO BE THE LEADER IN OUR MARKETS, 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 MARKETS WE SERVE. 12 10 95 0 0 0 0 0 166279098 170824325 992631 1559656 -256707 -7649 167015022 172376332 33557 91861 141704577 145300862 8909898 7990920 0 0 0 10812676 12321004 161460708 165704647 5554314 6671685 87057493 92604522 19014341 17450006 68043152 75154516 X SEE SCHEDULE ODELTA DENTAL OF KENTUCKY'S MISSION HAS ALWAYS BEEN TO BE THE LEADER IN OUR MARKETS, 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 MARKETS WE SERVE. 0 0 162663083 91861 170824325 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 2014 WE PROCESSED AND PAID OVER $145 MILLION IN CLAIMS FOR 662,000 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 NEARLY 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 INVOLVEMENTAS A KENTUCKY BASED COMPANY WE ARE ACTIVELY COMMITTED TO THE COMMUNITY WE SERVE. WE UNDERSTAND THAT BEING A RESPONSIBLE CORPORATE CITIZEN IS AN IMPORTANT PART OF OUR ROLE. IN 2014 WE CONTRIBUTED NEARLY $245,000 TO SUPPORT PROJECTS THAT FOSTER ORAL HEALTH AND AWARENESS THROUGH ONGOING EDUCATION AND SERVICES. OUR MAJOR PROJECTS IN 2014 INCLUDE THE UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY MOBILE DENTAL CLINIC, THE WESTERN KENTUCKY UNIVERSITY MOBILE HEALTH VAN, AND "TEETH ON THE GO"."TEETH ON THE GO" IS OUR STATEWIDE ORAL HEALTH EDUCATION PROGRAM DESIGNED FOR STUDENTS KINDERGARTEN THROUGH 6TH GRADE. THE KITS PROVIDE TEACHERS WITH AN ORAL HEALTH CURRICULUM, TEETH MODELS, BOOKS AND OTHER TOOLS TO TEACH ABOUT THE IMPORTANCE OF ORAL HEALTH. HUNDREDS OF TEACHERS HAVE USED THESE KITS TO EDUCATE OVER 100,000 STUDENTS AROUND THE STATE. 162663083 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 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 0 1 1 1 0 1 19934 0 1 95 1 0 0 0 0 0 0 X 12 10 0 0 1 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 CLIFFORD T MAESAKA JR PRESIDENT, CEO 39.00 1.00 X X 524546 0 18366 J JUDE THOMPSON CHAIR 8.00 0.00 X X 22150 0 0 MICHAEL CHILDERS DMD DIRECTOR 2.00 0.00 X 19300 0 0 CARRIE B BROWN DMD DIRECTOR 2.00 0.00 X 0 0 16400 MARY M CORBETT DIRECTOR 2.00 0.00 X 16900 0 0 OLIVIA F KIRTLEY DIRECTOR 4.00 2.00 X 0 17900 16750 MICHAEL B MOUNTJOY DIRECTOR 4.00 4.00 X 600 26439 16500 RODNEY A JACKSON DMD DIRECTOR 2.00 0.00 X 5500 0 0 C RICHARD SEITZ DIRECTOR 2.00 8.00 X 15000 26300 0 BRUCE R SMITH DIRECTOR 4.00 10.00 X 16650 60140 0 JEFFREY C SMITH DIRECTOR THRU 3/31/14 2.00 0.00 X 20800 0 0 JOHN N WILLIAMS JR DMD DIRECTOR 2.00 0.00 X 14250 0 0 J DAVID SMITH DIRECTOR 2.00 0.00 X 17150 0 0 GORAN JURKOVIC CPA CFO 10.00 40.00 X 0 1401176 902991 JOHN L WEEKS III VP/CLO/SECRETARY 40.00 0.00 X 271011 0 19348 ANGELA J NENNI VP - OPERATIONS 40.00 0.00 X 234087 0 11931 TAMARA L YORK-DAY VP - COO 40.00 0.00 X 303946 0 14272 RUSSELL W SKAGGS VP - FINANCE 40.00 0.00 X 182453 0 18813 STEPHEN C DAY VP/CMO 40.00 0.00 X 241193 0 19306 RONALD E STORY DIRECTOR - IS 40.00 0.00 X 149477 0 7020 BRIAN E KRAINER DIRECTOR - SALES 40.00 0.00 X 194716 0 6680 JEFF DUES SENIOR ACCOUNT EXECUTIVE 40.00 0.00 X 146943 0 17780 LINA K STIRSMAN DIRECTOR - HR 40.00 0.00 X 124314 0 0 2520986 1531955 1086157 10 1 1 0 DELTA DENTAL PLAN OF MICHIGAN PO BOX 30416 LANSING MI 48909 ADMINISTRATIVE SERVICES 4102900 BB&T INSURANCE SERVICES INC 414 GALLIMORE RD STE F GREENSBORO NC 27404 BENEFITS CONSULTING 1267100 PEDIATRIC DENTISTRY OF HAMBURG PSC 2517 SIR BARTON WAY SUITE 200 LEXINGTON KY 40509 DENTAL SERVICES 876984 REISERT & ASSOCIATES INC 700 UPS DRIVE STE 105 LOUISVILLE KY 40223 BENEFITS CONSULTING 519000 ASSURED NEACE LUKENS INSURANCE AGENCY 4000 SMITH RD STE 400 CINCINNATI OH 45209 BENEFITS CONSULTING 455800 26 DENTAL CARE REVENUE 524114 170806325 170806325 SUBSIDIARY MANAGEMENT 900099 18000 18000 170824325 1355341 1355341 746318 753967 -7649 -7649 -7649 7901588 7697273 204315 204315 204315 172376332 170824325 0 1552007 91861 91861 145300862 145300862 2109260 458941 1650319 4443051 4443051 302332 302332 780920 780920 355357 273625 81732 384365 384365 60718 60718 81433 81433 369565 332609 36956 851894 553731 298163 402105 402105 927531 806952 120579 454114 227057 227057 56362 33817 22545 12885 12885 73583 66225 7358 67858 67858 BROKER COMMISSIONS 6261046 6261046 PROCESSING FEES 1801935 1801935 POSTAGE & SHIPPING 248101 245620 2481 DUES & ASSESSMENTS 205917 205917 61592 61592 165704647 162663083 3041564 0 13524609 15793523 79352 341687 11351645 12749007 187 0 15979970 5442937 10753032 10537033 19562161 19902498 23144768 24638167 8641739 8642607 87057493 92604522 3977176 3449813 2391807 2643609 12645358 11356584 19014341 17450006 X 68043152 75154516 68043152 75154516 87057493 92604522 X 6671685 306121 133558 X X 0 1 X 1 0 830000 830000 11312800 2536727 8776073 543152 247747 295405 1672538 1301621 370917 1621480 1356842 264638 10537033 16860223 F INVESTMENT - DENTAL CHOICE, INC. 7777944 F 24638167 ACCRUED INVESTMENT INCOME 354579 457(B) PLAN 736490 INVESTMENT - RHC 6501538 SURPLUS NOTE RECEIVABLE 1050000 8642607 CLAIMS CHECKS OUTSTANDING 5008897 ESTIMATED CLAIMS LIABILITY 6347687 11356584 X PART X, LINE 2: AS OF DECEMBER 31, 2014 AND 2013, DELTA DENTAL PLAN OF KENTUCKY'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 KENTUCKY IS SUBJECT TO ROUTINE AUDITS BY TAXING AUTHORITIES. DELTA DENTAL PLAN OF KENTUCKY IS NO LONGER SUBJECT TO TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE DECEMBER 31, 2011. 1 FAMILY & CHILDREN'S PLACE INC PO BOX 3784 LOUISVILLE KY 40201 610549561 501(C)(3) 5000 GENERAL DONATION KENTUCKY DENTAL SOCIETY PO BOX 23294 LEXINGTON KY 40517 N/A 5000 PLATINUM PATRON AMERICAN HEART ASSOCIATION PO BOX 4002907 DES MOINES IA 50340 135613797 501(C)(3) 20000 GENERAL DONATION KENTUCKY STATE POLICE 919 VERSAILLES ROAD FRANKFORT KY 40601 610600439 N/A 10000 TROOPER ISLAND PROGRAM 2 2 PART I, LINE 2: DELTA DENTAL OF KENTUCKY HAS FORMED A SUBCOMMITTE WHICH IS MADE UP OF VARIOUS BOARD OF DIRECTORS. THIS GROUP MEETS ANNUALLY TO REVIEW AND APPROVE GRANTS FOR THE FOLLOWING YEAR. X 1 1 X X X X 1 1 0 0 0 0 0 0 0 CLIFFORD T MAESAKA JR PRESIDENT, CEO 375535 0 147068 0 1943 0 2205 0 16161 0 542912 0 0 0 GORAN JURKOVIC CPA CFO 0 649050 0 738415 0 13711 0 880985 0 22006 0 2304167 0 0 JOHN L WEEKS III VP/CLO/SECRETARY 195307 0 72820 0 2884 0 0 0 19348 0 290359 0 0 0 ANGELA J NENNI VP - OPERATIONS 170583 0 62542 0 962 0 0 0 11931 0 246018 0 0 0 TAMARA L YORK-DAY VP - COO 236700 0 66150 0 1096 0 0 0 14272 0 318218 0 0 0 RUSSELL W SKAGGS VP - FINANCE 138929 0 42698 0 826 0 0 0 18813 0 201266 0 0 0 STEPHEN C DAY VP/CMO 169755 0 67419 0 4019 0 0 0 19306 0 260499 0 0 0 RONALD E STORY DIRECTOR - IS 122406 0 26484 0 587 0 0 0 7020 0 156497 0 0 0 BRIAN E KRAINER DIRECTOR - SALES 98737 0 95526 0 453 0 0 0 6680 0 201396 0 0 0 JEFF DUES SENIOR ACCOUNT EXECUTIVE 65874 0 80774 0 295 0 0 0 17780 0 164723 0 0 0 LINA K STIRSMAN DIRECTOR - HR 0 0 0 0 124314 0 0 0 0 0 124314 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, LINES 4A-B SEVERANCE PAYMENTS RECEIVED BY LINA STIRSMAN: $124,314 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 2014, THE ACCRUAL FOR CLIFFORD MAESKA'S SERP TOTALLED $49,172. NO DISTRIBUTIONS WERE MADE FROM THE SERP IN 2014. TAMARA L YORK-DAY VP-COO OF DDKY LOAN FOR TUITION X 40000 40000 0 1 1 40000 PEDIATRIC DENTISTRY OF HAMBURG DR JACKSON, DIRECTOR OF DDKY, IS ONE OF FOUR MEMBERS OF THE DENTISTRY 876984 PAYMENTS FOR DENTAL SERVICES 0 FORM 990, PART VI, SECTION A, LINE 4 MARCH 27, 2014 - ARTICLE II: BOARD OF DIRECTORS 2 CHANGED AS FOLLOWS: THE BOARD OF DIRECTORS SHALL CONSIST OF AT LEAST SEVEN (7) MEMBERS AND A MAXIMUM OF FIFTEEN (15) MEMBERS. AT LEAST 51% OF THE VOTING MEMBERS OF THE BOARD OF DIRECTORS SHALL BE INDEPENDENT DIRECTORS. AN INDEPENDENT DIRECTOR IS ONE WHO SATISFIES THE DEFINITION SET FORTH BY THE INTERNAL REVENUE SERVICE (IRS) FOR ORGANIZATIONS EXEMPT FROM INCOME TAX. 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. CURRENTLY, RHSC APPOINTS TWO MEMBERS OF THE 12 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 11 THE FORM 990 IS FIRST REVIEWED INTERNALLY BY THE VP-FINANCE, THE IN-HOUSE LEGAL COUNSEL, CEO AND THEN A DRAFT IS 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 COMMITEE IN FEBRUARY 2015. THE COMMITTEE IS MADE UP OF INDEPENDENT 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 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 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 XI, LINE 9: EQUITY IN SUBSIDIARY 133,558. FORM 990, PART XII, LINE 2C: PROCESS IS THE SAME AS THE PRIOR YEAR. FORM 990, PART IV, LINE 12A: THE ORGANIZATION ISSUES INDEPENDENT AUDITED FINANCIAL STATEMENTS ON THE STATUTORY BASIS OF ACCOUNTING. THE ORGANIZATION IS ALSO PART OF A CONSOLIDATED GAAP BASIS FINANCIAL STATEMENT. DENTAL CHOICE PROPERTIES LLC 10100 LINN STATION RD SUITE LOUISVILLE KY 40223 610659432 REAL ESTATE HOLDING COMPANY 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) 11A 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 11A, 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 324968 7734699 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 2480 1.00000 1 RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI RENAISSANCE HEALTH SERVICE CORPORATION C -22318 6954112 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 0 0 0 1 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 DENTAL CHOICE INC L 420038 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA D 1050000 ACTUAL COST DELTA DENTAL PLAN OF MICHIGAN M 2239174 ACTUAL COST