2011-11-15T11:53:52-06:00 2010-12-31 PLANTE & MORANPLLC 1111 MICHIGAN AVE PO BOX 2500 EAST LANSING MI 488262500 990 2010-01-01 381791480 DELTA DENTAL PLAN OF MICHIGAN INC DELT 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 GORAN JURKOVIC 5173496000 2011-11-11 1 KEVIN E KRAUSE CPA 5173326200 2010 2016-02-24 21:20:13Z THOMAS J FLESZAR DDS M 4100 OKEMOS ROAD OKEMOS MI 48864 1373897296 0 X WWW.DDPMI.COM X 1957 MI 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. 15 12 666 0 8046777 -2304170 0 0 1315435653 1296150820 2315371 5334961 47701097 46491584 1365452121 1347977365 0 637000 1234102205 1174358975 82253217 63909575 0 0 0 70643513 74088171 1386998935 1312993721 -21546814 34983644 352014045 383149845 128963341 121838194 223050704 261311651 X 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. 0 0 1256800520 592000 1288103558 PROMOTING DENTAL CAREDELTA DENTAL PLAN OF MICHIGAN, INC. IS A LEADING GROUP 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 2010 BY PAYING OUT OVER $1.1 BILLION AND BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 6.8 MILLION CLAIMS WERE PROCESSED FOR OVER 1.7 MILLION SUBSCRIBERS.COST 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 2010, THE DELTA DIFFERENCE SAVED GROUPS AND SUBSCRIBERS NEARLY $435 MILLION. IN ADDITION, THE DELTA DIFFERENCE HELPS KEEP OUR TREND BELOW THE NATIONAL INFLATIONARY TREND IN DENTAL BENEFITS.ANOTHER COST SAVING STRATEGY WAS THE ADVENT OF A SECURE WEB SITE ALLOWING DENTAL OFFICES TO SUBMIT AND REVIEW CLAIMS, CHECK ELIGIBILITY AND GET REIMBURSED VIA ELECTRONIC DIRECT DEPOSIT. MANY DENTISTS MAIL CLAIMS INCURRING POSTAGE COSTS UP TO 70 CENTS PER CLAIM. BY USING THE DENTAL OFFICE TOOLKIT, THESE COSTS ARE REDUCED TO ZERO. IN 2010, 72% OF CLAIMS WERE SUBMITTED ELECTRONICALLY. THE ONLINE TOOL REDUCES STAFF TIME FOR CLAIMS PROCESSING AND WILL ULTIMATELY LOWER THE COST OF DOING BUSINESS FOR EVERYONE, INCLUDING CUSTOMERS AND SUBSCRIBERS.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.IN JULY 2003, OUR CUSTOMER SERVICE CALL CENTER WAS CERTIFIED BY BENCHMARKPORTAL AS A "CERTIFIED CENTER OF EXCELLENCE" OFFERING "WORLD-CLASS" CUSTOMER SERVICE. THIS CERTIFICATION WAS AWARDED FOLLOWING A LENGTHY AND RIGOROUS AUDIT THAT DOCUMENTED THE PERFORMANCE OF OUR CALL CENTER AGAINST THE BEST PRACTICES OF A PEER GROUP OF COMPARABLE CUSTOMER SERVICE CALL CENTERS. THESE CALL CENTERS INCLUDED THOSE OF ALL OUR MAJOR COMMERCIAL COMPETITORS.IN JANUARY 2007, BENCHMARKPORTAL AGAIN RECOGNIZED DELTA DENTAL WITH A CERTIFICATE OF EXCELLENCE. CURRENT RESULTS REVEALED THAT DELTA DENTAL'S PERFORMANCE OUTRANKED ALL OTHER CORPORATIONS IN THE DENTAL INDUSTRY AND RANKED SECOND COMPARED TO THE BENCHMARKED HEALTH CARE INDUSTRY.QUALITY SERVICE IS ALSO MEASURED THROUGH INTERNAL AUDITS. RESULTS INDICATE OVER 91 PERCENT OF CLAIMS ARE PROCESSED WITHIN 10 WORKING DAYS, 99 PERCENT OF INQUIRIES ARE RESOLVED ON FIRST CONTACT AND CALLS WERE ANSWERED IN 16 SECONDS. 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 WOULD HAVE OVER 25 YEARS WORTH OF 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 $13 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 2010, DELTA DENTAL FUND PROVIDED GRANTS TOTALING NEARLY $1 MILLION FOR DENTAL AND COMMUNITY RELATIONS PROJECTS. AMONG THEM WAS A GRANT TO THE OHIO STATE UNIVERSITY COLLEGE OF DENTISTRY TO SUPPORT THE MOBILE DENTAL CLINIC IT OPERATES TO PROVIDE DENTAL TREATMENT TO THOUSANDS OF CHILDREN IN COLUMBUS, OHIO, WHO LACK ACCESS TO DENTAL CARE.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. THROUGH A PUBLIC-PRIVATE PARTNERSHIP WITH THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH, DELTA DENTAL ADMINISTERS THE HEALTHY KIDS DENTAL AND MICHILD PROGRAMS. HEALTHY KIDS DENTAL IS A DENTAL BENEFITS PROGRAM FOR MEDICAID BENEFICIARIES UNDER AGE 21. IT IS AVAILABLE IN 61 COUNTIES AND COVERS BASIC DENTAL HEALTH BENEFITS SUCH AS X-RAYS, CLEANINGS, CAVITY FILLINGS, ROOT CANALS, TOOTH EXTRACTIONS AND DENTURES. MORE THAN 300,000 MICHIGAN CHILDREN ARE SERVED BY THIS PROGRAM.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.UNEQUALED ACCESS TO DENTISTSTHE BENEFITS OF DELTA DENTAL ARE NOW AVAILABLE BEYOND THIS NATION'S BORDERS. THROUGH A PARTNERSHIP WITH INTERNATIONAL SOS ASSISTANCE, INC., DELTA DENTAL ENROLLEES CAN NOW RECEIVE EXPERT TREATMENT FOR NON-EMERGENCY AND EMERGENCY DENTAL CARE WHEN THEY ARE OUTSIDE OF THE UNITED STATES.FOR FIVE DECADES, DELTA DENTAL HAS HELPED PROMOTE ORAL HEALTH BY DESIGNING AND ADMINISTERING INNOVATIVE, COST-EFFECTIVE DENTAL BENEFIT PROGRAMS. EXPERTS AT PLAN DESIGN, DELTA DENTAL HAS CREATED DENTAL BENEFIT PROGRAMS THAT MEET CUSTOMER COST-OBJECTIVES WHILE HELPING TO IMPROVE AND MAINTAIN ORAL HEALTH.THE PROGRAMS FEATURE LARGE PANELS OF 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. 1256800520 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 1 0 1 48737 0 1 666 1 1 1 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 MI X GORAN JURKOVIC CHIEF FINANCIAL OFFICER 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 COLLEEN G VIENNA DDS 5.00 X 16859 4000 0 LONNY E ZIETZ DDS MS 5.00 X 700 0 2000 BRUCE BAIRD DDS 5.00 X 18600 0 0 FATHER JACK H BAKER 5.00 X 19700 500 0 LISA DANCSOK 5.00 X 25600 500 0 TODD V ESTER DDS 5.00 X 20704 500 0 RORY GAMBLE 5.00 X 16900 0 0 JOSEPH C HARRIS DDS 5.00 X X 23976 500 0 JEFFREY A KELLER 5.00 X 1400 0 0 TERRI A MILLER CPCU 5.00 X 22570 500 0 TIMOTHY E MOFFIT DBA 5.00 X 23804 500 0 C RICHARD SEITZ 5.00 X 22100 3000 0 BRUCE R SMITH 5.00 X X 24848 6750 0 LU BATTAGLIERI 5.00 X X 24400 500 0 TERENCE R COMAR DDS MS 5.00 X X 38866 500 0 JAMES P HALLAN 5.00 X 57213 8350 0 GORAN JURKOVIC CPA 50.00 X 399348 0 211052 THOMAS FLESZAR DDS MS 50.00 X 1545225 0 25794 JOHN A BREZA DDS 5.00 X 24200 3500 0 JAMES EPILITO 50.00 X 583831 0 2325 MICHAEL CLARK 50.00 X 387263 0 111697 BRENDA LAIRD 50.00 X 1022197 0 430935 KAREN GREEN 50.00 X 322668 0 41615 RANDY TASCO 50.00 X 376418 0 56765 EDWARD ZOBECK 50.00 X 552821 0 270213 NANCY HOSTETLER 50.00 X 374907 0 56853 SHERRY CRISP 50.00 X 411573 0 94615 PATRICK CAHILL 50.00 X 253154 6250 21189 JED JACOBSON DDS MS MPH 50.00 X 1659680 0 219698 CHARLES FLOYD 50.00 X 955103 0 61842 LAURA L CZELADA 50.00 X 913186 0 832349 RICK KARAS 50.00 X 169361 0 9475 TOBY HALL 50.00 X 206860 0 43263 JON GROAT 50.00 X 207522 0 19737 DANIEL RIENSTRA 50.00 X 372832 0 40701 LORI WHEELRIGHT 50.00 X 264736 0 56864 MICHAEL BOBAK 50.00 X 203998 0 34365 TOM MCLELLAN 50.00 X 196214 0 55444 ANTHONY ROBINSON 50.00 X 219020 0 36236 11956157 32350 2735027 122 0 1 0 WALBRIDGE ALDINGER 777 WOODWARD AVE SUITE 300 DETROIT MI 48226 GENERAL CONSTRUCTION CONTRACTOR 3895590 MESSA 1480 KENDALE BLVD EAST LANSING MI 48826 COMMISSIONS 2927883 CLOVER CONSULTING 400 E DIVISION STE 6 PMB 163 ROCKFORD MI 49341 IT SERVICES 1999468 ADAGE GROUP LLC 3665 OBSERVATORY LN HOLT MI 48842 ADVERTISING 1848810 TEK SYSTEMS PO BOX 198568 ATLANTA GA 303848568 CONTRACT SERVICES 1410090 29 DENTAL CARE REVENUE 624100 1286570006 1286570006 E-COMMERCE SOLUTIONS 518210 8436836 1533552 6902799 485 IS EXTERNAL SERVICES 524292 1143978 1143978 1296150820 4959098 4959098 25787264 508530 25837045 82886 -49781 425644 375863 375863 ADMINISTRATIVE REIMBUR 900099 46105720 46105720 MISCELLANEOUS INCOME 900099 385864 385864 46491584 1347977365 1288103558 8046777 51827030 637000 637000 1174358975 1174358975 10251150 6663247 3587903 41248465 23787261 17461204 322118 150650 171468 8897756 5015220 3882536 3190086 1888419 1301667 2160399 794194 1366205 526055 21769 504286 439141 439141 172176 172176 13186289 7352809 5833480 845351 244181 601170 10830995 9324441 1506554 7738960 5872089 1866871 2417202 1885 2415317 2359450 1645738 713712 479297 171507 307790 50694 50694 8640865 4494046 4146819 528360 528360 COMMISSIONS 9117953 9117953 RSS EXPENSES 8334232 0 8334232 PROCESSING FEES 2758733 2758733 EXTERNAL BUSINESS EXPEN 1847469 1762982 84487 MEMBERSHIP DUES 999760 120462 879298 654790 616959 37831 1312993721 1256800520 56193201 0 2047 2044 37776217 29801450 72642683 90473512 -707252 6999680 182770186 66096326 100668842 116673860 123477707 119676643 16943504 16937944 1210297 2584712 352014045 383149845 51531479 39056676 77431862 82781518 128963341 121838194 X 15744473 15744473 5122500 5122500 202183731 240444678 223050704 261311651 352014045 383149845 X 34983644 3277303 X X 0 1 1 X 0 5000 5000 5000 1 BILL SCHUETTE ADMINISTRATIVE ACCOUNT 5915 EASTMAN AVE STE 100 MIDLAND MI 48640 274215506 5000 5816461 5816461 93149169 17826278 75322891 28524600 18060884 10463716 55279956 30209164 25070792 116673860 IBNR - CLAIM ADJUSTMENT RESERVES 48146971 UNEARNED PREMIUMS 29331854 FAS 158 FUNDED STATUS 5302693 82781518 1347977365 1312993721 34983644 3277303 3277303 38260947 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ENTERPRISE ADOPTED NEW ACCOUNTING GUIDANCE RELATED TO ACCOUNTING FOR INCOME TAXES AS OF JANUARY 1, 2009. THE NEW ACCOUNTING STANDARD CLARIFIES THE GUIDANCE FOR THE RECOGNITION AND MEASUREMENT OF INCOME TAX BENEFITS RELATED TO UNCERTAIN TAX POSITIONS. THE ADOPTION OF THE NEW GUIDANCE DID NOT HAVE A MATERIAL IMPACT ON THE CONSOLIDATED AND COMBINED FINANCIAL STATEMENTS. AS OF DECEMBER 31, 2010 AND 2009, THE ENTERPRISE'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED DURING THE YEARS OR ACCRUED AT YEAR END. PART XI, LINE 8 - OTHER ADJUSTMENTS: LOSS ON EQUITY IN SUBSIDIARIES -351,148. UNREALIZED GAIN ON FIXED INCOME SECURITIES 121,997. UNREALIZED GAIN ON EQUITIES 7,909,692. PENSION RELATED CHANGES -4,403,238. 1 DELTA DENTAL FUND PO BOX 30416 LANSING MI 489097916 382337000 501(C)(3) 592000 0 CASH N/A SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMS FREEDOM VOTE PO BOX 2121 COLUMBUS OH 43216 273004397 501(C)(4) 5000 0 CASH N/A SUPPORT ADMINISTRATIVE FUNCTIONS OF LOCAL LEADERS ON DUTY FOR MICHIGAN 120 N WASHINGTON SQ 410 LANSING MI 48933 274111592 501(C)(4) 5000 0 CASH N/A SUPPORT ADMINISTRATIVE FUNCTIONS OF LOCAL LEADERS CELEBRATING THE POWER OF MICHIGAN INC PO BOX 15157 LANSING MI 48910 273955283 501(C)(4) 10000 0 CASH N/A SUPPORT ADMINISTRATIVE FUNCTIONS OF LOCAL LEADERS KASICHTAYLOR NEW DAY COMMITTEE PO BOX 06590 COLUMBUS OH 43206 273902346 501(C)(4) 10000 0 CASH N/A SUPPORT ADMINISTRATIVE FUNCTIONS OF LOCAL LEADERS MICHIGAN ECONOMIC DEVELOPMENT FOUNDATION PO BOX 13063 LANSING MI 489013063 382527475 501(C)(3) 15000 0 CASH N/A SUPPORT ADMINISTRATIVE FUNCTIONS OF LOCAL LEADERS 2 4 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ASSISTED ORGANIZATION IS PART OF A CONTROLLED ORGANIZATION THAT SUPPORTS DELTA DENTAL PLAN OF MICHIGAN'S MISSION. X X 1 1 X X X X X X 0 1 0 0 0 0 0 0 0 GORAN JURKOVIC CPA 202660 0 147689 0 48999 0 184548 0 26504 0 610400 0 0 0 THOMAS FLESZAR DDS MS 659608 0 789500 0 96117 0 -2725 0 28519 0 1571019 0 0 0 JAMES EPILITO 328130 0 253000 0 2701 0 0 0 2325 0 586156 0 0 0 MICHAEL CLARK 205964 0 170244 0 11055 0 84709 0 26988 0 498960 0 0 0 BRENDA LAIRD 260538 0 203607 0 558052 0 419024 0 11911 0 1453132 0 519111 0 KAREN GREEN 158666 0 126489 0 37513 0 15734 0 25881 0 364283 0 0 0 RANDY TASCO 189610 0 153596 0 33212 0 30293 0 26472 0 433183 0 0 0 EDWARD ZOBECK 266865 0 241869 0 44087 0 242959 0 27254 0 823034 0 0 0 NANCY HOSTETLER 181108 0 150552 0 43247 0 30587 0 26266 0 431760 0 0 0 SHERRY CRISP 197023 0 180120 0 34430 0 83458 0 11157 0 506188 0 0 0 PATRICK CAHILL 253154 6250 0 0 0 0 0 0 21189 0 274343 6250 0 0 JED JACOBSON DDS MS MPH 246154 0 219874 0 1193652 0 201008 0 18690 0 1879378 0 1141862 0 CHARLES FLOYD 216761 0 607818 0 130524 0 42695 0 19147 0 1016945 0 0 0 LAURA L CZELADA 402728 0 431763 0 78695 0 820155 0 12194 0 1745535 0 0 0 RICK KARAS 169361 0 0 0 0 0 0 0 9475 0 178836 0 0 0 TOBY HALL 152397 0 39116 0 15347 0 18452 0 24811 0 250123 0 0 0 JON GROAT 154916 0 43724 0 8882 0 9354 0 10383 0 227259 0 0 0 DANIEL RIENSTRA 58866 0 303496 0 10470 0 16531 0 24170 0 413533 0 0 0 LORI WHEELRIGHT 57871 0 198698 0 8167 0 32677 0 24187 0 321600 0 0 0 MICHAEL BOBAK 58805 0 138157 0 7036 0 16197 0 18168 0 238363 0 0 0 TOM MCLELLAN 142885 0 38663 0 14666 0 37033 0 18411 0 251658 0 0 0 ANTHONY ROBINSON 125116 0 79091 0 14813 0 10925 0 25311 0 255256 0 0 0 PART I, LINE 1A FIRST CLASS TRAVEL AVAILABLE TO KEY EMPLOYEES. THIS AMOUNT WAS TREATED AS NONTAXABLE TO THE KEY EMPLOYEE. TRAVEL FOR COMPANIONS RELATED TO TRAVEL FOR A SPOUSE. THIS AMOUNT WAS TREATED AS TAXABLE TO THE BOARD MEMBER OR EMPLOYEE. PART I, LINE 4B JED JACOBSON= $1,141,862 BRENDA LAIRD= $519,111 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. ADDITIONALLY, ALL EXECUTIVES ARE ELIGIBLE FOR A 457(F) PLAN. THIS PLAN IS FUNDED SOLELY BY EMPLOYEE CONTRIBUTIONS. THE INDIVIDUALS ARE VESTED UPON FUNDING THE 457(F) PLAN. COMAR COMAR PC TERENCE COMAR, DIRECTOR OF DDPMI, IS AN OWNER IN COMAR & COMAR, PC. 164491 HEALTH CARE PAYMENTS 0 RENAISSANCE ENDODONTICS PLLC TODD ESTER, DIRECTOR OF DDPMI, IS AN OWNER IN RENAISSANCE ENDODONTICS PLLC 381843 HEALTH CARE PAYMENTS 0 JOSEPH C HARRIS DDS JOSEPH HARRIS, DIRECTOR OF DDPMI, RECEIVES HEALTH CARE PAYMENTS FROM DDPMI 113217 HEALTH CARE PAYMENTS 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, SVP & CFO, AND THE SVP & 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 EXECUTIVE 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 2010. THE CONSULTANTS WERE USED IN JANUARY OF 2011. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: LOSS ON EQUITY IN SUBSIDIARIES -351,148. UNREALIZED GAIN ON FIXED INCOME SECURITIES 121,997. UNREALIZED GAIN ON EQUITIES 7,909,692. PENSION RELATED CHANGES -4,403,238. TOTAL TO FORM 990, PART XI, LINE 5: 3,277,303. 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. 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