2023-11-14T12:01:11-06:00 2022-12-31 381357951 PLANTE & MORAN PLLC 1111 MICHIGAN AVE STE 100 EAST LANSING MI 48823 990 2022-01-01 381791480 DELTA DENTAL PLAN OF MICHIGAN INC DELT 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 AMY BASEL CFO 5173496000 2023-11-10 1 AMY BASEL 999009999 1 DAVID LOWENTHAL P00378651 5173326200 2023-11-10 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z GORAN JURKOVIC 4100 OKEMOS ROAD OKEMOS MI 48864 1326920282 0 X WWW.DELTADENTALMI.COM X 1957 MI DELTA DENTAL OF MICHIGAN'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH DENTAL SERVICES PROVIDED UNDER CONTRACTS WITH INDEPENDENT PROFESSIONAL SERVICE PROVIDERS, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. 15 12 1298 0 42660885 2312234 0 0 963288759 1123836261 28878623 7445017 22660 321914 992190042 1131603192 7629688 7363710 0 0 153737523 165130835 0 0 0 813500894 946383124 974868105 1118877669 17321937 12725523 855270608 862011511 168458126 191514407 686812482 670497104 X SEE SCHEDULE ODELTA DENTAL OF MICHIGAN'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH DENTAL SERVICES PROVIDED UNDER CONTRACTS WITH INDEPENDENT PROFESSIONAL SERVICE PROVIDERS, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. DELTA DENTAL OF MICHIGAN IS GOVERNED BY A BOARD OF DIRECTORS CONTROLLED BY INDEPENDENT MEMBERS OF THE COMMUNITY AND IT OFFERS ENROLLMENT IN ORAL HEALTH PLANS TO A BROAD BASE OF THE COMMUNITY THROUGH A VARIETY OF PAYMENT MODELS. 0 0 990072627 7363710 1081175376 PROMOTING DENTAL CAREDELTA DENTAL PLAN OF MICHIGAN, INC. IS A LEADING PREPAID DENTAL BENEFITS PROVIDER IN THE MIDWEST. THE PURPOSE OF THE ORGANIZATION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH. THIS IS DONE BY OFFERING INNOVATIVE, COST-EFFECTIVE PRODUCTS THAT MEET THE NEEDS OF CUSTOMERS. THIS WAS DEMONSTRATED IN 2022 BY PAYING OUT OVER $769 MILLION FOR DENTAL CARE, BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 10.9 MILLION CLAIMS WERE PROCESSED FOR OVER 5.8 MILLION MEMBERS.SEE CONTINUATION ON SCHEDULE OCOST SAVING STRATEGIESDELTA DENTAL BENEFIT PLANS ARE COMMITTED TO SAVING GROUPS AND MEMBERS 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. 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. SINCE IT WAS FORMED IN 1980, THE DELTA DENTAL FUND HAS GRANTED OVER $54 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, SCHOLARSHIP AND LEADERSHIP AWARDS TO DENTAL STUDENTS, GRANTS TO PURCHASE LEARNING TOOLS AND OTHER DENTAL SCHOOL PROGRAMS, CONTINUING EDUCATION PROGRAMS FOR THE DENTAL PROFESSION, AND EDUCATIONAL MATERIALS ON THE IMPORTANCE OF ORAL HEALTH AND HAZARDS TO ORAL HEALTH.IN 2022, DELTA DENTAL FUND PROVIDED GRANTS TOTALING OVER $7.3 MILLION FOR DENTAL AND COMMUNITY RELATIONS PROJECTS. THIS FUNDING HAS IMPROVED ORAL AND OVERALL HEALTH, ADDED TO WHAT WE KNOW ABOUT DENTAL SCIENCE, HELPED STUDENTS ACHIEVE THEIR GOALS AND IMPROVED THE WELL-BEING OF THOUSANDS OF CHILDREN AND ADULTS IN MICHIGAN, INDIANA, OHIO AND NORTH CAROLINA.DELTA DENTAL PLAN OF MICHIGAN IS ALSO COMMITTED TO BUILDING HEALTHY, SMART, VIBRANT COMMUNITIES. 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 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. WE CONTINUED OUR ROLE AS STRONG ADVOCATES FOR SOUND ORAL HEALTH POLICY AT THE STATE AND FEDERAL LEVELS. THROUGH A PUBLIC-PRIVATE PARTNERSHIP WITH THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH, DELTA DENTAL PARTICIPATES IN THE HEALTHY KIDS DENTAL (HKD) PROGRAM. HEALTHY KIDS DENTAL IS A DENTAL BENEFITS PROGRAM FOR MEDICAID BENEFICIARIES UNDER AGE 21. IT IS AVAILABLE IN ALL OF MICHIGAN'S 83 COUNTIES AND COVERS BASIC DENTAL HEALTH BENEFITS SUCH AS X-RAYS, CLEANINGS, CAVITY FILLINGS, ROOT CANALS, TOOTH EXTRACTIONS AND DENTURES. NEARLY 1,000,000 MICHIGAN CHILDREN ARE SERVED BY THIS PROGRAM. UNEQUALED ACCESS TO DENTISTSFOR FIVE DECADES, DELTA DENTAL HAS HELPED PROMOTE ORAL HEALTH BY DESIGNING AND ADMINISTERING INNOVATIVE, COST-EFFECTIVE DENTAL BENEFIT PROGRAMS. EXPERTS AT PLAN DESIGN, DELTA DENTAL HAS CREATED DENTAL BENEFIT PROGRAMS THAT MEET CUSTOMER COST-OBJECTIVES WHILE HELPING TO IMPROVE AND MAINTAIN ORAL HEALTH.OUR LONG STANDING RELATIONSHIPS WITH PROVIDERS IN THE COMMUNITIES WE SERVE ALLOWS US TO MAINTAIN LARGE NETWORKS, ALLOWING BROAD ACCESS FOR MEMBERS AND COST-EFFECTIVE CARE. DELTA DENTAL'S GROUP MEMBERS ARE AFFORDED ADDED PROTECTION BECAUSE THEY GUARANTEE THAT PARTICIPATING DENTISTS WILL ACCEPT THEIR PAYMENT FOR COVERED SERVICES AND NO CHARGE, OTHER THAN CO-PAYMENTS AND DEDUCTIBLES ARE BILLED BACK TO THE MEMBER. 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 BROAD ACCESS TO CARE. 990072627 0 0 1 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 1 79605 0 1 1298 1 1 1 0 0 0 0 0 1 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X AMY BASEL CFO 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 X LAURA DICKERSON DIRECTOR 5.00 0.00 X 0 0 0 BLAKE LIVINGSTON DDS DIRECTOR 5.00 0.00 X 65000 0 0 SUNCICA TRAVAN DDS MS DIRECTOR 5.00 0.00 X 60000 0 0 STEVEN M TACK DIRECTOR 5.00 0.00 X 68750 0 0 ANTHONY O WILLIAMS JD DIRECTOR 5.00 0.00 X 60000 0 0 PATRICK K GILLESPIE DIRECTOR 5.00 0.00 X 60000 0 0 ANDREW KOTARBA DIRECTOR 5.00 0.00 X 68750 2813 0 LARRY DEGROAT DIRECTOR 5.00 0.00 X 60000 0 0 RAYMOND F GIST DDS DIRECTOR 5.00 1.00 X 60000 1500 0 MELISSA STOLICKER VICE CHAIR 5.00 5.00 X X 72750 64176 0 SARA DOLAN CHAIR 5.00 5.00 X X 70000 69176 0 KURT D GALLINGER DIRECTOR - PART YEAR 5.00 5.00 X 25000 10415 0 STEVEN M DATER DDS DIRECTOR 5.00 0.00 X 60000 0 0 CHRISTOPHER T FISHER DIRECTOR 5.00 10.00 X 60000 107004 0 KELLY JUBB SCHEIDERER DIRECTOR 5.00 6.00 X 44500 29081 20500 STEPHEN A EKLUND DDH MHSA DRPH DIRECTOR 5.00 6.00 X 60000 30296 0 POE A TIMMONS DIRECTOR (ROOSEVELT INNOV. ONLY) 5.00 5.00 X 8750 42000 0 GORAN JURKOVIC CPA CEO, PRESIDENT 35.00 15.00 X 6178337 0 2311371 AMY BASEL CPA SVP, CFO, CRO & TREASURER 35.00 15.00 X 1462790 0 485855 ANTHONY ROBINSON SVP & CHIEF MARKETING OFFICER 43.00 7.00 X 1599799 0 532282 TOBY HALL SVP, CHIEF ACTUARY & DATA OFFICER 50.00 0.00 X 896076 0 383407 SUE ELLEN JENKINS SVP, CHIEF LEGAL OFF, CAO & SEC. 37.00 13.00 X 1118484 0 319364 JEFF BOTKIN SVP, BUSINESS SERVICES 50.00 0.00 X 768624 0 133089 MARK BAUGHMAN SVP & CIO 50.00 0.00 X 763563 0 101394 JEFFERY JOHNSTON DDS MS SVP & CHIEF SCIENCE OFFICER 43.00 7.00 X 494618 0 100144 KUSHTRIM SHAQIRI VP GOVERMENT PROGRAMS 50.00 0.00 X 640330 0 44327 MIKE BOBAK VP SALES & ACCT MGT 50.00 0.00 X 596993 0 69370 EARL MAJOR VP HUMAN RESOURCES 50.00 0.00 X 378506 0 65633 MARGARET TRIMER VP STRATEGIC PARTNERSHIPS 50.00 0.00 X 356542 0 82276 DANIEL LOVEJOY VP, SALES AND ACCT MGT 50.00 0.00 X 572193 0 48801 WALTER BUZANOWSKI VP & GENERAL COUNSEL 50.00 0.00 X 377550 0 74857 MICHAEL GILMORE FORMER VP, CHIEF INVEST OFFICER 0.00 50.00 X 0 783761 85647 17107905 1140222 4858317 338 1 1 0 DEWPOINT 300 WASHINGTON SQUARE SUITE 200 LANSING MI 48933 CONSULTING 18171792 WEST MONROE PARTNERS LLC 222 W ADAMS ST FL 11 CHICAGO IL 60606 CONSULTING 6834009 DATAMAXIS INC 28345 BECK RD STE 304 WIXOM MI 48393 IT STAFFING 4087600 FAST SWITCH-GREAT LAKES LLC 17177 N LAUREL PARK DR STE 265 LIVONIA MI 48152 IT STAFFING 3369819 TEK SYSTEMS 300 WASHINGTON SQUARE SUITE 430 LANSING MI 48933 CONSULTING 3352784 105 DENTAL CARE REVENUE 624100 975730724 975730724 ADMIN REIMBURSEMENT 900099 105444652 105444652 EXTERNAL SERVICES 524292 42660885 42660885 1123836261 7965499 7965499 194569308 227300 195273404 43686 -704096 183614 -520482 -520482 MISCELLANEOUS INCOME 900099 321914 321914 321914 1131603192 1081175376 42660885 7766931 X 7363710 7363710 17437689 11334498 6103191 107494873 66981288 40513585 19315201 10537344 8777857 12746479 10908229 1838250 8136593 5111106 3025487 3293996 2381247 912749 885694 885694 343177 343177 120000 120000 1490072 1490072 831421795 811875602 19546193 5150343 3543858 1606485 17885610 12869097 5016513 26646680 12402237 14244443 3853354 3853354 3966876 3312968 653908 879491 325486 554005 17895948 4944526 12951422 1883068 1883068 FEDERAL & STATE TAX EXP 2097128 2097128 COMMISSIONS 21900792 21900792 PROCESSING FEES 2822474 2822474 MEMBERSHIP DUES 2634940 516400 2118540 1211686 941765 269921 1118877669 990072627 128805042 0 73200984 68684933 61618463 97909259 39578214 59607462 254646680 140265672 121626036 114381008 278724900 247054783 226398759 216392057 54123252 57982009 855270608 862011511 92658909 97593871 75799217 93920536 168458126 191514407 X 15744473 15744473 5122500 5122500 665945509 649630131 686812482 670497104 855270608 862011511 X 12725523 -55239378 26198477 X 0 1 X 1 0 19500 19500 1 MOVING MACOMB 106 W ALLEGAN STE 200 LANSING MI 48933 833929631 500 BUSINESS LEADERS FOR MICHIGAN PAC II 600 RENAISSANCE CENTER DETROIT MI 48243 273999229 10000 GREAT LAKES OPPORTUNITY FUND 403 FOURTH ST CHARLOTTE MI 48813 822854406 1000 MICHIGAN 21ST CENTURY FUND 606 TOWNSEND ST LANSING MI 48933 381323848 6000 OKEMOS CITIZENS MILLAGE COMMITTEE 4545 CHIPPEWA DR OKEMOS MI 48864 920278519 2000 1 0 0 12803920 12803920 98692580 40873694 57818886 51060468 39608988 11451480 92089712 59782990 32306722 114381008 DDIC STOCK 200217 C INVESTMENT IN RHC 104585939 F INVESTMENT IN THE 4100 GROUP 111605901 F 216392057 ACCRUED INTEREST RECEIVABLE 887505 DUE FROM AFFILIATES 16221593 OTHER ASSETS 36414611 DEFERRED TAX ASSET 4458300 57982009 IBNR - CLAIM ADJUSTMENT RESERVES 21735528 UNEARNED PREMIUMS 22708740 PENSION & POST RETIRE OBLIGATIONS 6670513 DUE TO AFFILIATES 1181048 RISK-SHARING PAYABLES 41624707 93920536 1 A KID AGAIN 2014 N SAGINAW RD MIDLAND MI 48640 311440073 501(C)(3) 20000 0 CHARITABLE DONATION AMERICAN CANCER SOCIETY 20450 CIVIC CENTER DR SOUTHFIELD MI 48076 131788491 501(C)(3) 28000 0 CHARITABLE DONATION AMERICAN HEART ASSOCIATION 271 WOODLAND PASS STE 110 EAST LANSING MI 48823 135613797 501(C)(3) 25000 0 CHARITABLE DONATION AMERICAN RED CROSS 7800 W OUTER DR DETROIT MI 48235 530196605 501(C)(3) 47260 0 CHARITABLE DONATION ARTRPRIZE GRAND RAPIDS 225 MICHIGAN ST NW GRAND RAPIDS MI 49501 264571560 501(C)(3) 150000 0 CHARITABLE DONATION AUTISM ALLIANCE OF MICHIGAN 30100 TELGRAPH RD BINGHAM FARMS MI 48025 270472137 501(C)(3) 50000 0 CHARITABLE DONATION CAPITAL AREA HUMANE SOCIETY 7095 W GRAND RIVER LANSING MI 48906 381601542 501(C)(3) 10000 0 CHARITABLE DONATION CHILD AND FAMILY CHARITIES FIVE OAKS DR LANSING MI 48911 382118108 501(C)(3) 125000 0 CAPITAL CAMPAIGN FOR NEW FACILITY COMMUNITIES IN SCHOOLS OF MICHIGAN 721 N CAPITOL STE 1 LANSING MI 48906 453736821 501(C)(3) 200000 0 CHARITABLE DONATION DELTA DENTAL FOUNDATION 4100 OKEMOS RD OKEMOS MI 48864 382337000 501(C)(3) 2500000 0 CHARITABLE DONATION DETROIT RIVERFRONT CONSERVANCY 600 RENAISSANCE CENTER DETROIT MI 48243 300125283 501(C)(3) 1015000 0 CHARITABLE DONATION ELE'S PLACE 1145 WEST OAKLAND LANSING MI 48915 382976751 501(C)(3) 130000 0 CHARITABLE DONATION FLEECE & THANK YOU 24715 CRESTVIEW FARMINGTON HILLS MI 48335 475263037 501(C)(3) 10000 0 CHARITABLE DONATION GRAND RAPIDS CHILDRENS MUSEUM 333 BRIDGE ST STE 1200 GRAND RAPIDS MI 49504 383088234 501(C)(3) 90000 0 CHARITABLE DONATION GREATER LANSING AREA HOLIDAY COMMISSION PO BOX 24112 LANSING MI 48909 352405362 501(C)(3) 10000 0 CHARITABLE DONATION GREATER LANSING FOODBANK 5303 S CEDAR ST LANSING MI 48911 382424756 501(C)(3) 18200 0 CHARITABLE DONATION IMPRESSION 5 200 MUSEUM DR LANSING MI 48933 237200548 501(C)(3) 100000 0 CHARITABLE DONATION JUNIOR ACHIEVEMENT OF MICHIGAN GREAT LAKES 600 W ST JOSEPH ST LANSING MI 48933 381557861 501(C)(3) 12000 0 CHARITABLE DONATION JUNIOR ACHIEVEMENT OF NW OHIO 1645 INIDAN WOOD CIRCLE MAUMEE OH 43537 344430363 501(C)(3) 25000 0 CHARITABLE DONATION JUNIOR ACHIVEVEMENT OF SOUTHEASTERN MI 577 E LARNED ST DETROIT MI 48226 381348535 501(C)(3) 60000 0 CHARITABLE DONATION JUVENILE DIABETES RESEARCH FOUNDATION 24359 NORTHWESTERN HWY SOUTHFIELD MI 48075 231907729 501(C)(3) 25000 0 CHARITABLE DONATION LANSING PROMISE 330 MARSHALL ST LANSING MI 48912 453363322 501(C)(3) 50000 0 CHARITABLE DONATION MICHIGAN CITIZENS FOR FISCAL RESPONSIBILITY 106 W ALLEGAN LANSING MI 48933 271993953 501(C)(4) 6250 0 CHARITABLE DONATION MICHIGAN ECONOMIC DEVELOPMENT FOUNDATION PO BOX 13063 LANSING MI 48901 382527475 501(C)(3) 25000 0 CHARITABLE DONATION MICHIGAN HUMANE SOCIETY 30300 TELEGRAPH RD BINGHAM FARMS MI 48025 381358206 501(C)(3) 200000 0 HEALTHY COMMUNITIES PROGRAM MICHIGAN STATE UNIVERSITY 220 TROWBRIDGE RD EAST LANSING MI 48824 386005984 GOVT 94500 0 CHARITABLE DONATION MICHIGAN THANKSGIVING PARADE FOUNDATION 9500 MT ELLIOTT DETROIT MI 48211 382460378 501(C)(3) 1500000 0 CAPITAL CAMPAIGN FOR NEW BUILDING OKEMOS PUBLIC SCHOOLS 4406 OKEMOS RD OKEMOS MI 48864 386001631 GOVT 10000 0 CHARITABLE DONATION POTTER PARK ZOOLOGICAL SOCIETY 1301 PENNSYLVANIA AVE LANSING MI 48912 382153802 501(C)(3) 500000 0 CAPITAL CAMPAIGN FOR ON-SITE VETERINARY HOSPITAL ROAD TO MICHIGANS FUTURE PO BOX 12248 LANSING MI 48901 844298056 501(C)(4) 110000 0 CHARITABLE DONATION SAMARITAS 8131 E JEFFERSON AVE DETROIT MI 48214 381360553 501(C)(3) 40000 0 CHARITABLE DONATION SLEEP IN HEAVENLY PEACE INC PO BOX 85304 WESTLAND MI 48135 464346568 501(C)(3) 22500 0 CHARITABLE DONATION SPARROW FOUNDATION PO BOX 30480 LANSING MI 48909 386100687 501(C)(3) 65000 0 CHARITABLE DONATION SPECIAL OLYMPICS MICHIGAN INC 6624 TIMBER RIDGE DR BLOOMFIELD MI 48301 381964643 501(C)(3) 10000 0 CHARITABLE DONATION SPECTRUM HEALTH FOUNDATION 100 MICHGAN AVE GRAND RAPIDS MI 49503 382752328 501(C)(3) 10000 0 CHARITABLE DONATION THE EDISON INSTITUTE 20900 OAKWOOD BLVD DEARBORN MI 48124 381359513 501(C)(3) 25000 0 CHARITABLE DONATION WEEKEND SURVIVAL KITS 319 W GRAND RIVER AVE WILLIAMSTON MI 48895 454444119 501(C)(3) 45000 0 CHARITABLE DONATION 35 2 PART I, LINE 2: CONTRIBUTIONS ARE MADE AT MANAGEMENT DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF MICHIGAN'S MISSION. CONTRIBUTIONS MADE TO THE DELTA DENTAL FUND ARE APPROVED BY THE BOARD OF DIRECTORS. IN ORDER FOR FUNDS TO BE DISBURSED, VOUCHER RECORDS MUST PASS THROUGH THE APPROVAL PROCESS, SIMILAR TO ANY OTHER EXPENDITURE MADE BY DELTA DENTAL PLAN OF MICHIGAN. DETROIT RIVERFRONT CONSERVANCY - DELTA DENTAL OF MICHIGAN CONTRIBUTED $1,015,000 MILLION TO BUILD A HEALTH THEMED PLAYGROUND ON DETROIT'S WEST RIVERFRONT. COMMUNITIES IN SCHOOLS OF MICHIGAN - THIS CONTRIBUTION HELPED CIS OF MICHIGAN DEVELOP THE WHOLE-CHILD SCREENER AND CHECK-IN PROCESS TO ASSESS THE NUTRITIONAL, DENTAL, EDUCATIONAL, PHYSICAL HEALTH, AND MENTAL HEALTH NEEDS OF CASE-MANAGEMENT STUDENTS. THIS NEW NEEDS ASSESSMENT PROCESS ENSURES SITE COORDINATORS CAN IDENTIFY IMMEDIATE NEEDS OF STUDENTS TO BROKER AND IMPLEMENT SUPPORTS. THIS ENSURES SITE COORDINATORS CAN REFER STUDENTS TO A DENTIST AND HELP INCREASE SCHOOL-BASED DENTAL SUPPORTS. ELE'S PLACE - IN 2022, DELTA DENTAL OF MICHIGAN PROVIDED $130,000 TO ELE'S PLACE TO SUPPORT ELE'S GROUP, THEIR SCHOOL BASED GRIEF COUNSELING PROGRAM. THROUGH THIS PROGRAM, ELE'S PLACE IS ABLE TO REACH CHILDREN WHO MAY NOT OTHERWISE HAVE TRANSPORTATION TO RECEIVE GRIEF COUNSELING SERVICES AT THEIR OFFICES. LANSING PROMISE - DELTA DENTAL PROVIDED $50,000 IN FUNDING TO THE LANSING PROMISE IN 2022. LANSING PROMISE IS A SCHOLARSHIP PROGRAM OFFERING TUITION ASSISTANCE FOR POST-SECONDARY (COLLEGE OR SKILLED TRADE) EDUCATION TO ALL ELIGIBLE HIGH SCHOOL GRADUATES WITHIN THE LANSING SCHOOL DISTRICT BOUNDARIES. THE PROMISE PROVIDES TUITION ASSISTANCE FOR UP TO 65 CREDITS AT LANSING COMMUNITY COLLEGE OR THE EQUIVALENT DOLLAR AMOUNT TOWARD TUITION AND FEES AT MICHIGAN STATE UNIVERSITY OR OLIVET COLLEGE. SPARROW FOUNDATION - OUR DONATION WAS USED TO SPONSOR A VARIETY OF FUNDRAISING EVENTS ALL FOCUSED ON SUPPORTING THE SPARROW FOUNDATION WHICH PLAYS A CRITICAL ROLE IN THE HEALTH SYSTEM LIFE CYCLE BY COLLECTING RESOURCES, BOOSTING COMMUNITY AWARENESS AND IMPROVING THE OVERALL HEALTH OF PEOPLE IN MID-MICHIGAN. ART PRIZE GRAND RAPIDS - THIS SPONSORSHIP SUPPORTED A NEW EVENT APP THAT ALLOWED PARTICIPANTS TO VOTE ON INDIVIDUAL ART PIECES, WHILE ALSO ACCESSING WAY FINDING AND OTHER INFORMATION DURING THE ARTPRIZE EVENT. ARTPRIZE IS AN INDEPENDENT, INTERNATIONAL ART COMPETITION IN GRAND RAPIDS THAT CELEBRATES ARTISTS WORKING IN ALL MEDIUMS FROM ANYWHERE IN THE WORLD. X X X 1 1 X X X X 0 1 0 0 0 0 0 1 0 GORAN JURKOVIC CPA CEO, PRESIDENT 1403355 0 3094090 0 1680892 0 2287652 0 23719 0 8489708 0 1645969 0 ANTHONY ROBINSON SVP & CHIEF MARKETING OFFICER 527061 0 579003 0 493735 0 508563 0 23719 0 2132081 0 477069 0 AMY BASEL CPA SVP, CFO, CRO & TREASURER 507383 0 561274 0 394133 0 462136 0 23719 0 1948645 0 364896 0 SUE ELLEN JENKINS SVP, CHIEF LEGAL OFF, CAO & SEC. 522489 0 575320 0 20675 0 311438 0 7926 0 1437848 0 0 0 TOBY HALL SVP, CHIEF ACTUARY & DATA OFFICER 411148 0 462002 0 22926 0 368374 0 15033 0 1279483 0 0 0 JEFF BOTKIN SVP, BUSINESS SERVICES 357774 0 389836 0 21014 0 116477 0 16612 0 901713 0 0 0 MICHAEL GILMORE FORMER VP, CHIEF INVEST OFFICER 0 507598 0 257500 0 18663 0 61928 0 23719 0 869408 0 0 MARK BAUGHMAN SVP & CIO 357427 0 389470 0 16666 0 84782 0 16612 0 864957 0 0 0 KUSHTRIM SHAQIRI VP GOVERMENT PROGRAMS 360789 0 274795 0 4746 0 20608 0 23719 0 684657 0 0 0 MIKE BOBAK VP SALES & ACCT MGT 233436 0 362023 0 1534 0 45651 0 23719 0 666363 0 0 0 DANIEL LOVEJOY VP, SALES AND ACCT MGT 234686 0 335656 0 1851 0 25082 0 23719 0 620994 0 0 0 JEFFERY JOHNSTON DDS MS SVP & CHIEF SCIENCE OFFICER 326961 0 159553 0 8104 0 82939 0 17205 0 594762 0 0 0 WALTER BUZANOWSKI VP & GENERAL COUNSEL 272235 0 104775 0 540 0 51138 0 23719 0 452407 0 0 0 EARL MAJOR VP HUMAN RESOURCES 269932 0 104162 0 4412 0 49021 0 16612 0 444139 0 0 0 MARGARET TRIMER VP STRATEGIC PARTNERSHIPS 246088 0 95657 0 14797 0 58557 0 23719 0 438818 0 0 0 CHRISTOPHER T FISHER DIRECTOR 60000 107004 0 0 0 0 0 0 0 0 60000 107004 0 0 PART I, LINE 1A FIRST CLASS TRAVEL IS AVAILABLE TO SENIOR EXECUTIVES AND KEY EMPLOYEES. THIS AMOUNT WAS TREATED AS NONTAXABLE TO THESE INDIVIDUALS. TRAVEL MAY BE AVAILABLE TO SPOUSES ON OCCASION AND WOULD BE TREATED AS TAXABLE INCOME TO THE BOARD MEMBER OR EMPLOYEE AS APPROPRIATE. VARIOUS INDIVIDUALS ON SCHEDULE J ARE ELIGIBLE FOR REIMBURSEMENT OF SUBSTANTIATED HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES THAT HAVE A BUSINESS PURPOSE. THE PERSONAL PORTION OF THIS BENEFIT IS REPORTED ANNUALLY AND IS INCLUDED AS TAXABLE INCOME ON THE EMPLOYEE'S W-2. PART I, LINE 3 THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS PERFORMANCE AND SETS TOTAL COMPENSATION FOR THE CEO WITHOUT THE PRESENCE OR INFLUENCE OF THE CEO. EVERY TWO YEARS, A STUDY IS PERFORMED BY TOWERS WATSON AND THE DATA IS USED IN COMPENSATION DECISIONS. THE INDEPENDENT CONSULTANT PROVIDES AN OPINION AS TO THE REASONABLENESS AND APPROPRIATENESS OF THE TOTAL COMPENSATION, INCLUDING BASE PAY, INCENTIVE, BENEFITS AND RETIREMENT BENEFITS. PART I, LINE 4B 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 AND ADDED TO THE PLAN BY THE BOARD OF DIRECTORS. THE SERP BENEFITS ARE REVIEWED AS PART OF THE TOTAL COMPENSATION BY AN INDEPENDENT CONSULTANT; TOWERS WATSON. IN 2022, GORAN JURKOVIC, AMY BASEL, TOBY HALL, SUE JENKINS, AND ANTHONY ROBINSON ACCRUED BENEFITS AS PARTICIPANTS IN THE SERP PLAN. GORAN JURKOVIC, AMY BASEL, AND ANTHONY ROBINSON BECAME VESTED IN A PORTION OF THEIR ACCRUED BENEFITS AND, AS REQUIRED BY THE IRS, THE VESTED PORTION WAS TREATED AS TAXABLE WAGES DURING 2022. THESE WAGES WERE ALSO REPORTED ON SCHEDULE J AS COMPENSATION THAT HAS BEEN REPORTED AS DEFFERED ON PRIOR FORM 990S. PART I, LINE 7 AS INDICATED IN SCHEDULE J, PART II, TOP MANAGEMENT OFFICIALS RECEIVED A BONUS BASED UPON PERFORMANCE AND THE FINANCIAL RESULTS OF THE ORGANIZATION. THE BONUS WAS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. BRIAN JACOBSON BROTHER OF FORMER DDPMI BOARD MEMBER JED JACOBSON 311965 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 COLE JACOBSON BROTHER OF FORMER DDPMI BOARD MEMBER JED JACOBSON 153684 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 BRIAN BATTAGLIERI SON OF DDPMI FORMER KEY EMPLOYEE LUIGI BATTAGLIERI 204454 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 STEVEN M DATER DDS BOARD MEMBER AND OWNER OF STEVEN M DATER DDS & ASSOCIATES II, PLC 431220 PAYMENTS FOR DENTAL SERVICES 0 RAYMOND GIST DDS BOARD MEMBER AND OWNER OF RAYMOND GIST DDS PC 216465 PAYMENTS FOR DENTAL SERVICES 0 LARRY DEGROAT DDS BOARD MEMBER AND OWNER OF LARRY DEGROAT DDS 146847 PAYMENTS FOR DENTAL SERVICES 0 FORM 990, PART VI, SECTION A, LINE 6 DELTA DENTAL PLAN OF MICHIGAN HAS A SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS VOTING RIGHTS AND ELECTS DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE RIGHTS THAT ARE PRESCRIBED BY LAW, FOR MEMBERS OF NON-PROFIT CORPORATIONS, INCLUDING THE APPROVAL OF SIGNIFICANT EXPENDITURES AND CEO APPOINTMENT. FORM 990, PART VI, SECTION B, LINE 11B 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 PLACED IN A SECURE PORTAL 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 SENIOR VICE PRESIDENT, CHIEF LEGAL OFFICER, AND CAO 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 SENIOR VICE PRESIDENT, CHIEF LEGAL OFFICER, AND CAO. IF A PROHIBITED TRANSACTION IS IDENTIFIED, THE MATTER IS ESCALATED TO THE CEO AND TO THE AUDIT, FINANCE, AND RISK MANAGEMENT COMMITTEE OF THE BOARD OF DIRECTORS 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 VOTE 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 COMPENSATION OF THE CEO IS DETERMINED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. COMPENSATION OF THE OTHER EXECTUTIVES IS DETERMINED BY THE CEO IN CONSULTATION WITH THE VP OF HUMAN RESOURCES. OUTSIDE COMPENSATION CONSULTANTS ARE USED TO DETERMINE MARKET DATA WHICH IS USED TO SET TOTAL COMPENSATION FOR OFFICERS AND KEY EMPLOYEES INCLUDING THE CEO, CFO, AND OTHERS AS APPROPRIATE. DELTA DENTAL PLAN OF MICHIGAN, INC. CONTRACTS WITH TOWERS WATSON TO DO A COMPENSATION AND REASONABLENESS ANALYSIS EVERY TWO YEARS. TOWERS WATSON ALSO PROVIDES AN OPINION AS TO THE REASONABLENESS OF THE TOTAL COMPENSATION PACKAGES, INCLUDING BASE PAY, INCENTIVE, BENEFITS AND RETIREMENT BENEFITS. THE COMPENSATION WAS LAST REVIEWED UNDER THIS PROCESS DURING 2022. COMPENSATION DECISIONS ARE MADE UTILIZING THE DATA PROVIDED BY TOWERS WATSON. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. FORM 990 PART VII: CERTAIN EMPLOYEES ARE OFFICERS OF MULTIPLE COMPANIES WITHIN THE LARGER ORGANIZATION. THE AVERAGE HOURS WORKED REFLECTS APPROXIMATE TIME SPENT IN EACH OF THOSE INDIVIDUAL COMPANIES. WHILE THE HOURS ARE ALLOCATED TO INDIVIDUAL COMPANIES, MUCH OF THE OFFICERS' TIME IS SPENT WORKING ON ISSUES THAT IMPACT THE ENTIRE ORGANIZATION, NOT JUST ONE COMPANY. COMPENSATION IS REPORTED IN FULL TO AGREE TO THE EMPLOYEE'S W-2 AS REQUIRED BY IRS INSTRUCTIONS. ANY ALLOCATION OF COMPENSATION IS INCLUDED ON SCHEDULE R. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 32,827,537. MANAGEMENT AND GENERAL EXPENSES 14,857,364. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,684,901. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 8,531,719. MANAGEMENT AND GENERAL EXPENSES 4,688,829. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,220,548. DENTAL CONSULTANT: PROGRAM SERVICE EXPENSES 1,895,421. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,895,421. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 768,620,925. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 768,620,925. FORM 990, PART XI, LINE 9: GAIN ON EQUITY IN SUBSIDIARIES -592,311. PENSION RELATED CHANGES 26,790,788. FORM 990, PART IV, LINE 12A: DELTA DENTAL PLAN OF MICHIGAN RECEIVES AN AUDITED FINANCIAL STATEMENT FROM AN INDEPENDENT ACCOUNTANT BUT THESE STATEMENTS ARE PREPARED ON A STATUTORY BASIS AND NOT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). 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