DELTA DENTAL OF KENTUCKY INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- DELTA DENTAL OF KENTUCKY INC (EIN 61-0659432)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201223209349305352
- Schema version
- 2011v1.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-15T13:34:19-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381357951 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1111 MICHIGAN AVE | AddressLine1 |
| City | EAST LANSING | City |
| State | MI | State |
| ZIP Code | 48823 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 610659432 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA DENTAL OF KENTUCKY INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DELT | NameControl |
| Phone | 5027365000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10100 LINN STATION ROAD NO 700 | AddressLine1 |
| City | LOUISVILLE | City |
| State | KY | State |
| ZIP Code | 40223 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RUSSELL W SKAGGS | Name |
| Title | VP - FINANCE | Title |
| Phone | 5027365000 | Phone |
| Date Signed | 2012-11-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SUSAN MIENCIER CPA | Name |
| PTIN | P00842339 | PTIN |
| Phone | 5173326200 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CLIFFORD T MAESAKA JR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10100 LINN STATION ROAD NO 700 | AddressLine1 |
| City | LOUISVILLE | City |
| State | KY | State |
| ZIP Code | 40223 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 157300582 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.DELTADENTALKY.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1966 | YearFormation |
| State Legal Domicile | KY | StateLegalDomicile |
| Activity Or Mission Description | DELTA DENTAL PLAN 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 86 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 135204433 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 150374666 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 290638 | InvestmentIncomePriorYear |
| Investment Income Current Year | 710008 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 286405 | OtherRevenuePriorYear |
| Other Revenue Current Year | -189611 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 135781476 | TotalRevenuePriorYear |
| Total Revenue Current Year | 150895063 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 100000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 41850 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 116794128 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 129104585 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 6348079 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 6920321 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 9381121 | OtherExpensePriorYear |
| Other Expenses Current Year | 9796897 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 132623328 | TotalExpensesPriorYear |
| Total Expenses Current Year | 145863653 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3158148 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 5031410 | RevenuesLessExpensesCY |
| Total Assets BOY | 63574460 | TotalAssetsBOY |
| Total Assets EOY | 69833049 | TotalAssetsEOY |
| Total Liabilities BOY | 16449340 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 17111794 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 47125120 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 52721255 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | DELTA DENTAL PLAN 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 143439685 | Expense |
| Grants | 41850 | Grants |
| Revenue | 150374666 | Revenue |
| Description | 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 615,000 INDIVIDUALS. | Description |
| Total Program Service Expense | 143439685 | TotalProgramServiceExpense |
| Described In501 C3 | 0 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 17589 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 86 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RUSSELL W SKAGGS VP - FINANCE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5027365000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10100 LINN STATION ROAD STE 700 | AddressLine1 |
| City | LOUISVILLE | City |
| State | KY | State |
| ZIP Code | 40223 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (24 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| CARRIE B BROWN DMD | ||||||||
| DIRECTOR | 2.00 | X | 16650 | 0 | 0 | |||
| MICHAEL CHILDERS DMD | ||||||||
| DIRECTOR | 2.00 | X | 19600 | 0 | 0 | |||
| MARY M CORBETT | ||||||||
| DIRECTOR | 2.00 | X | 16050 | 0 | 0 | |||
| OLIVIA F KIRTLEY | ||||||||
| DIRECTOR | 2.00 | X | 650 | 0 | 16500 | |||
| MICHAEL B MOUNTJOY | ||||||||
| DIRECTOR | 2.00 | X | 3000 | 0 | 16500 | |||
| JOHN L G RICHARDS | ||||||||
| DIRECTOR | 2.00 | X | 13500 | 0 | 0 | |||
| C RICHARD SEITZ | ||||||||
| DIRECTOR | 2.00 | X | 15900 | 0 | 0 | |||
| BRUCE R SMITH | ||||||||
| DIRECTOR | 2.00 | X | 16650 | 0 | 0 | |||
| JEFFREY C SMITH | ||||||||
| DIRECTOR | 2.00 | X | 32000 | 0 | 0 | |||
| J JUDE THOMPSON | ||||||||
| DIRECTOR | 2.00 | X | 16650 | 0 | 0 | |||
| JOHN N WILLIAMS JR DMD | ||||||||
| CHAIR | 2.00 | X | 22500 | 0 | 0 | X | ||
| CLIFFORD T MAESAKA JR | ||||||||
| PRESIDENT, CEO | 35.00 | X | 504345 | 0 | 29578 | X | ||
| J DAVID SMITH | ||||||||
| DIRECTOR | 2.00 | X | 16650 | 0 | 0 | |||
| STEPHEN C DAY | ||||||||
| VP/CMO | 40.00 | 242142 | 0 | 24890 | X | |||
| JOHN L WEEKS III | ||||||||
| VP/CLO/SECRETARY | 40.00 | 261695 | 0 | 25787 | X | |||
| ANGELA J NENNI | ||||||||
| VP | 40.00 | 201542 | 0 | 16980 | X | |||
| TAMARA L YORK-DAY | ||||||||
| VP | 40.00 | 245014 | 0 | 19484 | X | |||
| GORAN JURKOVIC CPA | ||||||||
| CFO | 2.00 | 0 | 513177 | 261799 | X | |||
| RUSSELL W SKAGGS | ||||||||
| VP - FINANCE | 40.00 | 161574 | 0 | 22801 | X | |||
| RONALD E STORY | ||||||||
| DIRECTOR - IS | 40.00 | 130080 | 0 | 15387 | X | |||
| LINA K STIRSMAN | ||||||||
| DIRECTOR - HR | 40.00 | 124220 | 0 | 11922 | X | |||
| BRIAN E KRAINER | ||||||||
| SENIOR ACCOUNT EXECUTIVE | 40.00 | 174905 | 0 | 15188 | X | |||
| JAMES C FINN | ||||||||
| SENIOR ACCOUNT EXECUTIVE | 40.00 | 178837 | 0 | 16687 | X | |||
| CURTIS R LADIG | ||||||||
| FORMER CFO | 40.00 | 172157 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2586311 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 513177 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 493503 | TotalOtherCompensation |
| Number Individuals GT100 K | 10 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ANTHEM BCBS KY GROUP | |||||
| 11675 CENTURY DRIVE | ATLANTA | GA | 30009 | HEALTH INSURANCE COVERAGE | 585678 |
| VINTAGE PRINTING | |||||
| 967 S 11TH ST | LOUISVILLE | KY | 40210 | PRINTING & POSTAGE | 486610 |
| VISION SERVICE PLAN | |||||
| 1 EMBARCADERO CENTER 1540 | SAN FRANCISCO | CA | 94160 | VISION COVERAGE | 219922 |
| PITNEY BOWES PURCHASE POWER | |||||
| 800 VINIAL STREET | PITTSBURGH | PA | 15212 | POSTAGE MAILINGS | 209400 |
| DELTA DENTAL OF VIRGINIA | |||||
| 4860 COX ROAD SUITE 130 | GLEN ALLEN | VA | 23060 | ANNUAL SYSTEM MAINTENANCE | 178445 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| SUBSCRIBER REVENUE | 524114 | 150356666 | 150356666 |
| SUBSIDIARY MANAGEMENT | 900099 | 18000 | 18000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 150374666 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 672580 | TotalRevenueColumn |
| Exclusion | $672,580 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 281612 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 471223 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -189611 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -189611 | TotalRevenueColumn |
| Exclusion | -$189,611 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 5971724 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 5934296 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 37428 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 37428 | TotalRevenueColumn |
| Exclusion | $37,428 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 150895063 | TotalRevenueColumn |
| Related Or Exempt Function Income | 150374666 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $520,397 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41850 | Total |
| Program Services | 41850 | ProgramServices |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129104585 | Total |
| Program Services | 129104585 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1631864 | Total |
| Program Services | 349137 | ProgramServices |
| Management And General | 1282727 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4276671 | Total |
| Program Services | 4276671 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14101 | Total |
| Program Services | 14101 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 641226 | Total |
| Program Services | 641226 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 356459 | Total |
| Program Services | 273761 | ProgramServices |
| Management And General | 82698 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 168813 | Total |
| Management And General | 168813 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 87923 | Total |
| Management And General | 87923 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 165798 | Total |
| Management And General | 165798 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 281179 | Total |
| Program Services | 253061 | ProgramServices |
| Management And General | 28118 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 358651 | Total |
| Program Services | 233123 | ProgramServices |
| Management And General | 125528 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 597492 | Total |
| Program Services | 597492 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 821734 | Total |
| Program Services | 714909 | ProgramServices |
| Management And General | 106825 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 316273 | Total |
| Program Services | 158137 | ProgramServices |
| Management And General | 158136 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18923 | Total |
| Program Services | 11354 | ProgramServices |
| Management And General | 7569 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53 | Total |
| Program Services | 53 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 117662 | Total |
| Program Services | 105896 | ProgramServices |
| Management And General | 11766 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 190684 | Total |
| Management And General | 190684 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BROKER COMMISSIONS | 5240248 | 5240248 | |
| POSTAGE & SHIPPING | 738308 | 730925 | 7383 |
| PRINTING & PUBLICATIONS | 234353 | 234353 | |
| PROCESSING FEES | 221080 | 221080 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 237723 | Total |
| Program Services | 237723 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 145863653 | Total |
| Program Services | 143439685 | ProgramServices |
| Management And General | 2423968 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6335473 | BOY |
| EOY | 11845904 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 370969 | BOY |
| EOY | 329382 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7412860 | BOY |
| EOY | 7290344 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 270510 | BOY |
| EOY | 97900 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 13788922 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4216996 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9928055 | BOY |
| EOY | 9571926 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17656842 | BOY |
| EOY | 18204953 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17076691 | BOY |
| EOY | 17318615 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4523060 | BOY |
| EOY | 5174025 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 63574460 | BOY |
| EOY | 69833049 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2867825 | BOY |
| EOY | 3135062 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2537767 | BOY |
| EOY | 2662755 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11043748 | BOY |
| EOY | 11313977 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16449340 | BOY |
| EOY | 17111794 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47125120 | BOY |
| EOY | 52721255 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47125120 | BOY |
| EOY | 52721255 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 63574460 | BOY |
| EOY | 69833049 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 5031410 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 564725 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 830000 | OtherCostOrOtherBasis |
| Book Value | 830000 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9779985 | OtherCostOrOtherBasis |
| Depreciation | 1634689 | Depreciation |
| Book Value | 8145296 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 88682 | OtherCostOrOtherBasis |
| Depreciation | 51015 | Depreciation |
| Book Value | 37667 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1734898 | OtherCostOrOtherBasis |
| Depreciation | 1176013 | Depreciation |
| Book Value | 558885 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1355357 | OtherCostOrOtherBasis |
| Depreciation | 1355279 | Depreciation |
| Book Value | 78 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 9571926 | TotalOfBookValueLandBuildings |
Closely Held Equity Interests CloselyHeldEquityInterests
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 11011608 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INVESTMENT - DENTAL CHOICE, INC. | Description |
| Book Value | 6307007 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 17318615 | TotalOfBookValueSecurities |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| ACCRUED INVESTMENT INCOME | 249146 |
| 457(B) PLAN | 318549 |
| INVESTMENT - RHC | 3006330 |
| SURPLUS NOTE RECEIVABLE | 1600000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 5174025 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CLAIMS CHECKS OUTSTANDING | $6,202,613 |
| ESTIMATED CLAIMS LIABILITY | $5,111,364 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 11313977 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | AS OF DECEMBER 31, 2011 AND 2010, THE COMPANY'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED DURING THE YEAR OR ACCRUED AT YEAR END. | Explanation |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
| No Grant More Than5000 | X | NoGrantMoreThan5000 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CLIFFORD T MAESAKA JR | |||||||||||||
| 246400 | 0 | 156729 | 0 | 101216 | 0 | 14249 | 0 | 15329 | 0 | 533923 | 0 | 0 | 0 |
| STEPHEN C DAY | |||||||||||||
| 160265 | 0 | 80476 | 0 | 1401 | 0 | 9303 | 0 | 15587 | 0 | 267032 | 0 | 0 | 0 |
| JOHN L WEEKS III | |||||||||||||
| 171755 | 0 | 87594 | 0 | 2346 | 0 | 10019 | 0 | 15768 | 0 | 287482 | 0 | 0 | 0 |
| ANGELA J NENNI | |||||||||||||
| 134105 | 0 | 65881 | 0 | 1556 | 0 | 7740 | 0 | 9240 | 0 | 218522 | 0 | 0 | 0 |
| TAMARA L YORK-DAY | |||||||||||||
| 155698 | 0 | 88881 | 0 | 435 | 0 | 8985 | 0 | 10499 | 0 | 264498 | 0 | 0 | 0 |
| GORAN JURKOVIC CPA | |||||||||||||
| 0 | 257272 | 0 | 245516 | 0 | 10389 | 0 | 236746 | 0 | 25053 | 0 | 774976 | 0 | 0 |
| RUSSELL W SKAGGS | |||||||||||||
| 127364 | 0 | 33670 | 0 | 540 | 0 | 7360 | 0 | 15441 | 0 | 184375 | 0 | 0 | 0 |
| BRIAN E KRAINER | |||||||||||||
| 89031 | 0 | 85737 | 0 | 137 | 0 | 10065 | 0 | 5123 | 0 | 190093 | 0 | 0 | 0 |
| JAMES C FINN | |||||||||||||
| 88248 | 0 | 89669 | 0 | 920 | 0 | 10291 | 0 | 6396 | 0 | 195524 | 0 | 0 | 0 |
| CURTIS R LADIG | |||||||||||||
| 0 | 0 | 0 | 0 | 172157 | 0 | 0 | 0 | 0 | 0 | 172157 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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 | PART I, LINES 4A-B: CURTIS R. LADIG - SEVERANCE PAY - $172,157 IN 2011, DELTA DENTAL OF KENTUCKY PAID OUT CURTIS LADIG'S REMAINING CONTRACT AND BENEFITS. DELTA DENTAL PLAN OF KENTUCKY, HAS BOTH A 457(B) PLAN AS WELL AS A SERP, A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. ONLY ONE POSITION, THE CEO, IS ELIGIBLE FOR THE SERP. ADDITIONALLY, ALL OTHER VPS AND BOARD MEMBERS ARE ELIGIBLE FOR THE 457(B) PLAN. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 13 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 PERSONNEL AND COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS IS PERFORMED, AT A MINIMUM, ANNUALLY. COMPENSATION WAS LAST REVIEWED BY DELTA DENTAL OF KENTUCKY'S P&C COMMITEE IN FEBRUARY 2012. 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 MICHIGAN'S HR EXECUTIVE COMPENSATION PROCESS DURING 2010. THE REPORT BASED ON THIS REVIEW WAS THEN ISSUED BY THE CONSULTANTS IN JANUARY OF 2011. | |
| 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 SECTION A: | HOURS DEVOTED TO RELATED ORGANIZATIONS: GORAN JURKOVIC, CPA- 48 HOURS MICHAEL B. MOUNTJOY-5.5 HOURS C. RICHARD SEITZ- 11 HOURS BRUCE R. SMITH- 15 HOURS CURTIS R. LADIG- 50 HOURS CLIFFORD T. MAESAKA, JR.- 5 HOURS OLIVIA F. KIRTLEY - 5 HOURS | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 268,150. UNREALIZED GAIN/LOSS ON INVESTMENTS IN PRIOR PERIODS 31,101. EQUITY IN SUBSIDIARY 265,474. TOTAL TO FORM 990, PART XI, LINE 5: 564,725. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 1 | RENAISSANCE HEALTH SERVICE CORPORATION | |
| DELTA DENTAL OF TENNESSEE INC | |||||||||||
| PO BOX 30416 | LANSING | MI | 489097916 | 620812197 | PROVIDE DENTAL SERVICE PLANS | TN | 501(C)(4) | N/A | 1 | RENAISSANCE HEALTH SERVICE CORPORATION | |
| DELTA DENTAL PLAN OF NEW MEXICO INC | |||||||||||
| PO BOX 30416 | LANSING | MI | 489097916 | 850224562 | PROVIDE DENTAL SERVICE PLANS | NM | 501(C)(4) | N/A | 1 | RENAISSANCE HEALTH SERVICE CORPORATION | |
| DELTA DENTAL OF NORTH CAROLINA | |||||||||||
| PO BOX 30416 | LANSING | MI | 489097916 | 561018068 | PROVIDE DENTAL SERVICE PLANS | NC | 501(C)(4) | N/A | 1 | RENAISSANCE HEALTH SERVICE CORPORATION | |
| DELTA DENTAL PLAN OF OHIO INC | |||||||||||
| PO BOX 30416 | LANSING | MI | 489097916 | 310685339 | PROVIDE DENTAL SERVICE PLANS | OH | 501(C)(4) | N/A | 1 | DELTA DENTAL PLAN OF MICHIGAN INC | |
| DELTA DENTAL PLAN OF INDIANA INC | |||||||||||
| PO BOX 30416 | LANSING | MI | 489097916 | 351545647 | PROVIDE DENTAL SERVICE PLANS | IN | 501(C)(4) | N/A | 1 | DELTA DENTAL PLAN OF MICHIGAN INC | |
| DELTA DENTAL FUND | |||||||||||
| PO BOX 30416 | LANSING | MI | 489097916 | 382337000 | SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMS | MI | 501(C)(3) | 11A TYPE II | 1 | DELTA DENTAL PLAN OF MICHIGAN INC | |
Form990 Schedule R Part III Form990ScheduleRPartIII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner |
|---|---|---|---|---|---|---|---|---|---|---|
| SUITE 244 PARTNERS LLC | ||||||||||
| 240 VENTURE CIRCLE | NASHVILLE | TN | 37228 | 203643584 | HOLDS THE LEASE TO SUITE 244 AT LP FIELD (TITANS STADIUM) | TN | FORE HOLDING CORPORATION | N/A | 0 | 0 |
| LIQUID CORN LLC | ||||||||||
| 240 VENTURE CIRCLE | NASHVILLE | TN | 37228 | 203449680 | OWNS SUITE 244 | TN | FORE HOLDING CORPORATION | N/A | 0 | 0 |
| PREMIER INSURANCE SERVICES LLC | ||||||||||
| 240 VENTURE CIRCLE | NASHVILLE | TN | 37228 | 113662057 | INSURANCE BROKER | TN | FORE HOLDING CORPORATION | N/A | 0 | 0 |
| DENTAL CHOICE PROPERTIES LLC | ||||||||||
| 10100 LINN STATION RD SUITE 700 | LOUISVILLE | KY | 40223 | 610659432 | HOLDING COMPANY | KY | DELTA DENTAL OF KENTUCKY INC | N/A | 0 | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DENTAL CHOICE INC | ||||||||||||
| 10100 LINN STATION RD SUITE 700 | LOUISVILLE | KY | 40223 | 611105118 | REAL ESTATE HOLDING COMPANY | KY | N/A | C | 85846 | 6108783 | 1.00000 | |
| 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 | 2676 | 1.00000 | ||
| RENAISSANCE HOLDING COMPANY | ||||||||||||
| PO BOX 30381 | LANSING | MI | 48909 | 412177193 | HOLDING COMPANY | MI | C | -67101 | 2745206 | 0.06200 | RENAISSNCE HEALTH SERVICE CORPORATION | |
| RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA | ||||||||||||
| PO BOX 30416 | LANSING | MI | 489097916 | 470397286 | INSURANCE | IN | C | RENAISSANCE HOLDING COMPANY | ||||
| RENAISSANCE HEALTH INSURANCE COMPANY OF NEW YORK | ||||||||||||
| PO BOX 30416 | LANSING | MI | 48909 | 134098096 | INSURANCE | NY | C | RENAISSANCE HOLDING COMPANY | ||||
| RENAISSANCE HEALTH NETWORKS | ||||||||||||
| 4100 OKEMOS RD PO BOX 30381 | LANSING | MI | 489097881 | 113774096 | PPO NETWORK | MI | C | RENAISSANCE HOLDING COMPANY | ||||
| RENAISSANCE DENTAL NETWORK LLC | ||||||||||||
| 4100 OKEMOS RD PO BOX 30381 | LANSING | MI | 48909 | 421749772 | PPO NETWORK | MI | C | RENAISSANCE HEALTH NETWORKS LLC | ||||
| DENTAL WELLNESS NETWORK LLC | ||||||||||||
| 1540 W EDGEWOOD SUITE B | INDAINAPOLIS | IN | 46217 | 010862825 | PPO NETWORK | MI | C | RENAISSANCE HEALTH NETWORKS LLC | ||||
| FORE HOLDING CORPORATION | ||||||||||||
| 240 VENTURE CIRCLE | NASHVILLE | TN | 37228 | 204116122 | EMPLOYEE BENEFITS | TN | C | DELTA DENTAL OF TENNESSEE | ||||
| TML LLC | ||||||||||||
| 4100 OKEMOS ROAD PO BOX 30381 | LANSING | MI | 489097881 | 262403888 | CLEARING HOUSE | MI | C | RENAISSNCE HEALTH SERVICE CORPORATION | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| DENTAL CHOICE INC | ||
| K | 384400 | ACTUAL COST |
| DELTA DENTAL OF NORTH CAROLINA | ||
| D | 1600000 | ACTUAL COST |
| DELTA DENTAL PLAN OF MICHIGAN | ||
| L | 311021 | ACTUAL COST |
| RENAISSANCE HOLDING COMPANY | ||
| B | 371000 | ACTUAL COST |
Comments