2014-11-17T13:43:54-06:00 2013-12-31 381357951 PLANTE & MORAN PLLC 1111 MICHIGAN AVE EAST LANSING MI 48823 990 2013-01-01 610659432 DELTA DENTAL OF KENTUCKY INC DELT 5027365000 10100 LINN STATION ROAD NO 700 LOUISVILLE KY 40223 RUSSELL W SKAGGS VP - FINANCE 5027365000 2014-11-17 1 DAVID LOWENTHAL CPA P00378651 5173326200 2013 2015-11-30 17:44:51Z CLIFFORD T MAESAKA JR 10100 LINN STATION ROAD NO 700 LOUISVILLE KY 40223 174418020 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 92 0 0 0 0 0 159274037 166279098 308551 992631 -247256 -256707 159335332 167015022 2062204 33557 136870410 141704577 7322060 8909898 0 0 0 9727598 10812676 155982272 161460708 3353060 5554314 76806803 87057493 17758849 19014341 59047954 68043152 X 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. 0 0 158804821 33557 166279098 THE ORGANIZATION PROVIDES ACCESS TO ORAL HEALTH CARE PROVIDERS THROUGH DENTAL BENEFIT PROGRAMS AS A MEMBER OF THE DELTA DENTAL PLANS ASSOCIATION. SERVICES BENEFITED APPROXIMATELY 647,000 INDIVIDUALS. 158804821 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 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 18639 0 1 92 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 X RUSSELL W SKAGGS VP - FINANCE 5027365000 10100 LINN STATION ROAD STE 700 LOUISVILLE KY 40223 MICHAEL CHILDERS DMD CHAIR 2.00 0.00 X X 21600 0 0 CLIFFORD T MAESAKA JR PRESIDENT, CEO 35.00 5.00 X X 535908 0 57441 CARRIE B BROWN DMD DIRECTOR 2.00 0.00 X 0 0 16150 MARY M CORBETT DIRECTOR 2.00 0.00 X 13500 0 0 OLIVIA F KIRTLEY DIRECTOR 2.00 5.00 X 0 17900 15650 MICHAEL B MOUNTJOY DIRECTOR 2.00 5.50 X 0 26950 15500 JOHN L G RICHARDS DIRECTOR- THRU MARCH 2013 2.00 0.00 X 3250 0 0 C RICHARD SEITZ DIRECTOR 2.00 11.00 X 14000 23000 0 BRUCE R SMITH DIRECTOR 2.00 15.00 X 14000 43640 0 JEFFREY C SMITH DIRECTOR 2.00 0.00 X 31750 0 0 J JUDE THOMPSON DIRECTOR 2.00 0.00 X 19100 0 0 JOHN N WILLIAMS JR DMD DIRECTOR 2.00 0.00 X 14750 0 0 J DAVID SMITH DIRECTOR 2.00 0.00 X 16650 0 0 STEPHEN C DAY VP/CMO 40.00 0.00 X 238478 0 21725 JOHN L WEEKS III VP/CLO/SECRETARY 40.00 0.00 X 267566 0 20314 ANGELA J NENNI VP 40.00 0.00 X 257443 0 11354 TAMARA L YORK-DAY VP - OPERATIONS 40.00 0.00 X 289215 0 12495 RUSSELL W SKAGGS VP - FINANCE 40.00 0.00 X 176912 0 18421 GORAN JURKOVIC CPA CFO 20.00 30.00 X 0 717169 345991 RONALD E STORY DIRECTOR - IS 40.00 0.00 X 149428 0 6315 LINA K STIRSMAN DIRECTOR - HR 40.00 0.00 X 129119 0 6519 BRIAN E KRAINER DIRECTOR - SALES 40.00 0.00 X 202127 0 6105 JEFF DUES SENIOR ACCOUNT EXECUTIVE 40.00 0.00 X 131372 0 17571 2526168 828659 571551 10 0 1 0 DELTA DENTAL PLAN OF MICHIGAN PO BOX 30416 LANSING MI 48909 ADMINISTRATIVE SERVICES 1086083 BB&T INSURANCE SERVICES INC 414 GALLIMORE RD STE F GREENSBORO NC 27404 BENEFITS CONSULTING 900789 REISERT & ASSOCIATES INC 700 UPS DRIVE STE 105 LOUISVILLE KY 40223 BENEFITS CONSULTING 482013 ASSURED NEACE LUKENS INSURANCE AGENCY 4000 SMITH RD STE 400 CINCINNATI OH 45209 BENEFITS CONSULTING 451193 MERCER HEALTH & BENEFITS LLC 4565 PAYSPHERE CIRCLE CHICAGO IL 60674 BENEFITS CONSULTING 322933 20 SUBSCRIBER REVENUE 524114 166261098 166261098 SUBSIDIARY MANAGEMENT 900099 18000 18000 166279098 811115 811115 535684 792391 -256707 -256707 -256707 6792123 6608886 1721 183237 -1721 181516 181516 167015022 166279098 0 735924 33557 33557 141704577 141704577 2103172 459389 1643783 5616032 5616032 41267 41267 782208 782208 367219 282759 84460 269468 269468 27651 27651 78243 78243 381276 343148 38128 247272 160717 86555 561470 561470 877698 763597 114101 474047 237024 237023 44212 26527 17685 74427 66984 7443 47840 47840 BROKER COMMISSIONS 6026463 6026463 PROCESSING FEES 1006254 1006254 POSTAGE & SHIPPING 350719 347212 3507 DUES & ASSESSMENTS 197143 197143 148493 148493 161460708 158804821 2655887 0 15549197 13524609 366804 79352 7868422 11351645 257611 187 15769956 5016924 9223217 10753032 18708957 19562161 19493874 23144768 5338721 8641739 76806803 87057493 2850201 3977176 2565753 2391807 12342895 12645358 17758849 19014341 X 59047954 68043152 59047954 68043152 76806803 87057493 X 5554314 3113263 327621 X X 0 1 X 1 0 830000 830000 11312800 2183942 9128858 543152 156853 386299 1728647 1320772 407875 1355357 1355357 0 10753032 15664402 F INVESTMENT - DENTAL CHOICE, INC. 7480366 F 23144768 ACCRUED INVESTMENT INCOME 314081 457(B) PLAN 623947 INVESTMENT - RHC 6653711 SURPLUS NOTE RECEIVABLE 1050000 8641739 CLAIMS CHECKS OUTSTANDING 5544888 ESTIMATED CLAIMS LIABILITY 7100470 12645358 X PART X, LINE 2: AS OF DECEMBER 31, 2013 AND 2012, THE ENTERPRISE'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED DURING THE YEAR OR ACCRUED DURING 2013 AND 2012. THE ENTERPRISE IS NO LONGER SUBJECT TO TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE DECEMBER 31, 2010. 1 FAMILY & CHILDREN'S PLACE INC PO BOX 3784 LOUISVILLE KY 40201 610549561 501(C)(3) 5000 CASH N/A GENERAL DONATION TO FAMILY & CHILDREN'S PLACE INITIATIVES 1 0 PART I, LINE 2: DELTA DENTAL OF KENTUCKY HAS FORMED A SUBCOMMITTE WHICH IS MADE UP OF VARIOUS BOARD OF DIRECTORES. THIS GROUP MEETS ANNUALLY TO REVIEW AND APPROVE GRANTS FOR THE FOLLOWING YEAR. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 CLIFFORD T MAESAKA JR PRESIDENT, CEO 267257 0 166713 0 101938 0 43872 0 13569 0 593349 0 0 0 STEPHEN C DAY VP/CMO 157064 0 77379 0 4035 0 0 0 21725 0 260203 0 0 0 JOHN L WEEKS III VP/CLO/SECRETARY 178795 0 83602 0 5169 0 0 0 20314 0 287880 0 0 0 ANGELA J NENNI VP 157134 0 99385 0 924 0 0 0 11354 0 268797 0 0 0 TAMARA L YORK-DAY VP - OPERATIONS 177577 0 110732 0 906 0 0 0 12495 0 301710 0 0 0 RUSSELL W SKAGGS VP - FINANCE 129884 0 46367 0 661 0 0 0 18421 0 195333 0 0 0 GORAN JURKOVIC CPA CFO 0 344396 0 358443 0 14330 0 323985 0 22006 0 1063160 0 0 RONALD E STORY DIRECTOR - IS 117370 0 31391 0 667 0 0 0 6315 0 155743 0 0 0 BRIAN E KRAINER DIRECTOR - SALES 93218 0 108465 0 444 0 0 0 6105 0 208232 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 2013, THE ACCRUAL FOR CLIFFORD MAESKA'S SERP TOTALLED $48,320. 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 2014. 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 2012. THE REPORT BASED ON THIS REVIEW WAS THEN ISSUED BY THE CONSULTANTS IN APRIL OF 2013. 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 327,621. 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 DENTAL CHOICE INC 10100 LINN STATION RD SUITE 700 LOUISVILLE KY 40223 611105118 REAL ESTATE HOLDING COMPANY KY N/A C 226752 7477544 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 2450 1.00000 1 RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI RENAISSANCE HEALTH SERVICE CORPORATION C 6877881 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 0 1 0 1 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 DENTAL CHOICE INC L 396284 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA D 1050000 ACTUAL COST DELTA DENTAL PLAN OF MICHIGAN M 1603823 ACTUAL COST RENAISSANCE HEALTH SERVICES CORPORATION B 3000000 ACTUAL COST