2023-11-14T11:31:54-06:00 2022-12-31 381357951 PLANTE & MORAN PLLC 1111 MICHIGAN AVE STE 100 EAST LANSING MI 48823 990 2022-01-01 351545647 DELTA DENTAL PLAN OF INDIANA INC DELT 5173496000 PO BOX 30416 LANSING MI 489097916 AMY BASEL CHIEF FINANCIAL OFFICER 5173496000 2023-11-08 1 AMY BASEL 999009999 1 DAVID LOWENTHAL CPA P00378651 5173326200 2023-11-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z GORAN JURKOVIC PO BOX 30416 LANSING MI 489097916 195804979 0 X WWW.DELTADENTALIN.COM X 1982 IN DELTA DENTAL OF INDIANA'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. 4 0 0 0 158360 0 0 0 113506440 135167681 14596640 2673579 12171 0 128115251 137841260 3003000 590251 0 0 0 0 0 0 0 108001008 131056161 111004008 131646412 17111243 6194848 130548004 122031843 10151166 12065816 120396838 109966027 X SEE SCHEDULE ODELTA DENTAL OF INDIANA'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 INDIANA IS CONTROLLED BY DELTA DENTAL PLAN OF MICHIGAN, INC. AND ITS OFFICERS. 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 124447487 590251 135009321 PROMOTING DENTAL CAREDELTA DENTAL PLAN OF INDIANA, INC. IS A LEADING DENTAL BENEFITS PROVIDER. 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 $105 MILLION FOR DENTAL CARE, BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 1.69 MILLION CLAIMS WERE PROCESSED FOR OVER 1 MILLION MEMBERS.SEE SCHEDULE O FOR CONTINUATIONCOST 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, ALL OF WHICH ENSURE QUALITY, COST-EFFECTIVE DENTAL BENEFIT DELIVERY. COMMITMENT TO THE COMMUNITYDELTA DENTAL PLAN OF INDIANA, 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 NEARLY $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 INDIANA 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 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. WE CONTINUED OUR ROLE AS STRONG ADVOCATES FOR SOUND ORAL HEALTH POLICY AT THE STATE AND FEDERAL LEVELS. 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. 124447487 0 0 1 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 44061 0 1 0 1 1 0 0 0 0 0 0 0 X 4 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X AMY BASEL CHIEF FINANCIAL OFFICER 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 X GORAN M JURKOVIC CPA PRESIDENT & CEO 2.00 48.00 X X 0 6178337 2311371 ANTHONY D ROBINSON SR VP & CHIEF MARKETING OFFICER 2.00 48.00 X 0 1599799 532282 AMY L BASEL CPA SR VP , CFO, CRO & TREASURER 1.00 49.00 X X 0 1462790 485852 SUE E JENKINS SR VP, CHIEF LEGAL OFFICER, CAO & SECRETARY 2.00 48.00 X X 0 1118484 319364 MICHAEL GILMORE FORMER CHIEF INVEST OFFICER 0.00 50.00 X 0 783761 85647 JEFFERY W JOHNSTON DDS MS SR VP & CHIEF SCIENCE OFFICER 2.00 48.00 X 0 494618 100144 JEREMY J NELSON DIRECTOR 50.00 0.00 X 0 462897 51845 0 12100686 3886505 0 1 1 0 LOCASCIO HADDEN DENNIS LLC 3859 PRIORITY WAY SOUTH DR 101 INDIANAPOLIS IN 46240 COMMISIONS 1168163 MERCER HEALTH & BENEFITS LLC 4565 PAYSPHERE CIRCLE CHICAGO IL 60674 COMMISIONS 579876 BROWN & BROWN OF INDIANA LLC 11555 N MERIDIAN ST CARMEL IN 46032 COMMISIONS 564185 APEX BENEFITS GROUP 9400 PRIORITY WAY WEST DR INDIANAPOLIS IN 46240 COMMISIONS 440799 GREGORY & APPEL INSURANCE 1402 N CAPITOL AVE 400 INDIANAPOLIS IN 46202 COMMISIONS 293153 14 DENTAL CARE REVENUE 624100 135009321 135009321 VISION CARE REVENUE 524298 158360 158360 135167681 2559022 2559022 58078276 57963719 114557 114557 114557 137841260 135009321 158360 2673579 X 590251 590251 198710 198710 60365 60365 226180 226180 105497894 105463699 34195 41500 41500 159680 159680 1160 1160 ADMIN/OH 17858712 11810566 6048146 COMMISSIONS 6419113 6419113 MEMBERSHIP DUES 453066 453066 PROCESSING FEES 74656 74656 65125 47702 17423 131646412 124447487 7198925 0 -644383 1298771 3852924 7894556 5713158 5881967 183127 218865 110546067 95656449 10896423 10592589 688 488646 130548004 122031843 2930058 3333627 3097824 3247324 4123284 5484865 10151166 12065816 X 0 0 14546833 14546833 105850005 95419194 120396838 109966027 130548004 122031843 X 6194848 -17013558 387899 X 0 1 X 1 0 10500 0 0 10500 10500 1 FRIENDS OF ANN VERMILION PO BOX 127 MARION IN 46952 842921981 250 VOTECARBAUGHCOM 1118 SKYLINE PASS FORT WAYNE IN 4 FORT WAYNE IN 46825 454274386 500 MATT LEHMAN FOR STATE REPRESENTATIVE PO BOX 9629 TERRE HAUTE IN 47808 306801250 500 COMMITTEE TO ELECT TERRI AUSTIN 1030 RIVERVIEW ANDERSON IN 46011 352104715 250 FRIENDS OF LIZ BROWN 5701 REED RD FORT WAYNE IN 46835 464018174 300 THE FRIENDS OF JUSTIN BUSCH 123 W WAYNE ST FORT WAYNE IN 46802 825179820 300 CITIZENS FOR CRIDER 716 N 800 GREENFIELD IN 46140 812940741 500 TEAM HOLCOMB 101 W OHIO ST STE 2200 INDIANAPOLIS IN 46204 821479854 2500 HOUSE REPUBLICAN CAMPAIGN COMMITTEE PO BOX 44054 INDIANAPOLIS IN 46204 351470780 1500 INDIANA HOUSE DEMOCRATIC CAUCUS 115 W WASHINGTON INDIANAPOLIS IN 46204 352115773 500 SENATE MAJORITY CAMPAIGN COMMITTEE PO BOX 2182 INDIANAPOLIS IN 46206 351519681 1500 BARRETT ELECTION COMMITTEE PO BOX 2145 RICHMOND IN 47375 824542878 500 INDIANA SENATE DEMOCRATIC CAUCUS 115 W WASHINGTON INDIANAPOLIS IN 46204 352115773 500 MIKE GASKILL FOR INDIANA 6828 S 50TH WEST PENDLETON IN 46204 823962166 400 WALKER FOR INDIANA 47 PENNSYLVANIA ST STE 201 INDIANAPOLIS IN 46064 853104097 500 PART I-A, LINE 1: MONEY GIVEN TO VARIOUS STATE POLITICAL CAMPAIGNS. 0 INVESTMENT IN RENAISSANCE HOLDING COMPANY 10592589 F 10592589 CLAIMS RESERVES 3456000 DUE TO RELATED PARTIES 1541037 OPERATING LEASE LIABILITY 487828 5484865 1 500 FESTIVAL INC 21 VIRGINIA AVE INDIANAPOLIS IN 46204 351004320 501(C)(3) 50000 0 N/A N/A CHARITABLE DONATION DELTA DENTAL FOUNDATION 4100 OKEMOS RD OKEMOS MI 48864 382337000 501(C)(3) 500000 0 N/A N/A CHARITABLE DONATION A KID AGAIN 2014 N SAGINAW RD MIDLAND MI 48640 311440073 501(C)(3) 10000 0 N/A N/A CHARITABLE DONATION THE CHILDRENS MUSEUM OF INDIANAPOLIS 3000 N MERIDIAN ST INDIANAPOLIS IN 46208 350867985 501(C)(3) 25000 0 N/A N/A CHARITABLE DONATION 4 0 PART I, LINE 2: CONTRIBUTIONS ARE MADE AT MANAGEMENT DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF INDIANA'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 INDIANA. 0 1 0 0 0 0 0 0 0 GORAN M JURKOVIC CPA PRESIDENT & CEO 0 1403355 0 3094090 0 1680892 0 2287652 0 23719 0 8489708 0 1645969 ANTHONY D ROBINSON SR VP & CHIEF MARKETING OFFICER 0 527061 0 579003 0 493735 0 508563 0 23719 0 2132081 0 477069 AMY L BASEL CPA SR VP , CFO, CRO & TREASURER 0 507383 0 561274 0 394133 0 462136 0 23716 0 1948642 0 364896 SUE E JENKINS SR VP, CHIEF LEGAL OFFICER, CAO & SE 0 522489 0 575320 0 20675 0 311438 0 7926 0 1437848 0 0 MICHAEL GILMORE FORMER CHIEF INVEST OFFICER 0 507598 0 257500 0 18663 0 61928 0 23719 0 869408 0 0 JEFFERY W JOHNSTON DDS MS SR VP & CHIEF SCIENCE OFFICER 0 326961 0 159553 0 8104 0 82939 0 17205 0 594762 0 0 JEREMY J NELSON DIRECTOR 0 184955 0 276952 0 990 0 36812 0 15033 0 514742 0 0 PART I, LINE 3 THE CEO IS A W-2 EMPLOYEE OF A RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, INC. COMPENSATION IS DETERMINED BY THAT ENTITY. THE DELTA DENTAL PLAN OF MICHIGAN, INC. COMPENSATION COMMITTEE REVIEWS PERFORMANCE AND SETS TOTAL COMPENSATION. 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 THE RELATED ORGANIZATION, 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, ANTHONY ROBINSON, AND SUE ELLEN JENKINS ACCRUED BENEFITS AS PARTICIPANTS IN THE SERP PLANS. 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. 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, PRIOR TO FILING THE 990 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 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 HAS 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 AND OTHER EXECUTIVES IS DETERMINED BY A RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, INC. OUTSIDE COMPENSATION CONSULTANTS ARE USED TO DETERMINE MARKET DATA WHICH IS USED TO SET TOTAL COMPENSATION FOR OFFICERS AND KEY EMPLOYEES INCLUDING CEO AND CFO. THE RELATED ORGANIZATION CONTRACTS WITH TOWERS WATSON TO DO A COMPENSATION AND REASONABLENESS ANALYSIS EVERY TWO YEARS. COMPENSATION IS SET, BASED ON THE DATA PROVIDED, BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. 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. 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 CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 45,277. MANAGEMENT AND GENERAL EXPENSES 34,195. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 79,472. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 105,418,422. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 105,418,422. FORM 990, PART XI, LINE 9: GAIN ON INVESTMENT IN SUBSIDIARIES 387,899. FORM 990, PART IV, LINE 12A: DELTA DENTAL PLAN OF INDIANA 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). 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 OHIO INC PO BOX 30416 LANSING MI 489097916 310685339 PROVIDE DENTAL SERVICE PLANS OH 501(C)(4) N/A DELTA DENTAL PLAN OF MICHIGAN INC 0 DELTA DENTAL PLAN OF MICHIGAN INC 4100 OKEMOS ROAD OKEMOS MI 48864 381791480 PROVIDE DENTAL SERVICE PLANS MI 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF TENNESSEE 240 VENTURE CIRCLE NASHVILLE TN 37228 620812197 PROVIDE DENTAL SERVICE PLANS TN 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL FUND PO BOX 30416 LANSING MI 489097916 382337000 SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMS MI 501(C)(3) LINE 12A, I DELTA DENTAL PLAN OF MICHIGAN INC 0 DELTA DENTAL PLAN OF NEW MEXICO INC 100 SUN AVE NE SUITE 400 ALBUQUERQUE NM 87109 850224562 PROVIDE DENTAL SERVICE PLANS NM 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF KENTUCKY INC 10100 LINN STATION ROAD NO 700 LOUISVILLE KY 40223 610659432 PROVIDE DENTAL SERVICE PLANS KY 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF NORTH CAROLINA 3737 GLENWOOD AVENUE SUITE 320 RALEIGH NC 27612 561018068 PROVIDE DENTAL SERVICE PLANS NC 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL PLAN OF ARKANSAS INC 1513 COUNTRY CLUB RD SHERWOOD AR 72120 710561140 PROVIDE DENTAL SERVICE PLANS AR 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF ARKANSAS FOUNDATION INC 1513 COUNTRY CLUB RD SHERWOOD AR 72120 261569324 EMPHASIZE DENTAL HEALTH IN COMMUNITIES AR 501(C)(3) PF DELTA DENTAL OF ARKANSAS 0 RENAISSANCE FAMILY FOUNDATION INC 225 S EAST ST INDIANAPOLIS IN 46202 461376165 EMPHASIZE DENTAL HEALTH IN COMMUNITIES IN 501(C)(3) PF RENAISSANCE HOLDING COMPANY 0 SMILE 180 FOUNDATION 240 VENTURE CIRCLE NASHVILLE TN 37228 471654054 EMPHASIZE DENTAL HEALTH IN COMMUNITIES TN 501(C)(3) LINE 12A, I DELTA DENTAL OF TENNESSEE INC 0 DELTA DENTAL OF KENTUCKY FOUNDATION INC 10100 LINN STATION ROAD SUITE 700 LOUISVILLE KY 40223 874045357 EMPHASIZE DENTAL HEALTH IN COMMUNITIES KY 501(C)(3) PF DELTA DENTAL OF KENTUCKY 0 RED CEDAR INVESTMENT MANAGEMENT LLC 333 BRIDGE STREET NW SUITE 601 GRAND RAPIDS MI 49546 462667997 CAPITAL MANAGEMENT MI N/A 0 0 RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI DELTA DENTAL OF MICHIGAN C -145640 5548099 0.05800 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA PO BOX 30381 LANSING MI 48909 470397286 INSURANCE IN RENAISSANCE HOLDING COMPANY C -232095 8088269 0.05800 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK PO BOX 30381 LANSING MI 48909 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 67879 918281 0.05800 0 FORE HOLDING CORPORATION 240 VENTURE CIRCLE NASHVILLE TN 37228 204116122 HOLDING COMPANY TN N/A C 0 DENTAL CHOICE INC 10100 LINN STATION RD 700 LOUISVILLE KY 402233861 611105118 PROVIDE DENTAL SERVICES PLANS KY N/A C 0 DENTAL CHOICE AGENCY INC 10100 LINN STATION RD 700 LOUISVILLE KY 402233861 611336003 PRIMARY GENERAL AGENCY FOR DDKY AND DENTAL CHOICE KY N/A C 0 OMEGA ADMINISTRATORS INC 1513 COUNTRY CLUB ROAD SHERWOOD AR 72120 043740469 PROVIDING THIRD-PARTY ADMINISTRATIVE SERVICES AR N/A C 0 THE 4100 GROUP 4100 OKEMOS ROAD OKEMOS MI 48864 472557772 INVESTMENT IN SUBSIDIARIES MI N/A C 0 DEWPOINT INC 300 S WASHINGTON SQUARE LANSING MI 48933 383300595 IT CONSULTING MI N/A C 0 DENTAL CHOICE ANCILLARY INC 10100 LINN STATION RD 700 LOUISVILLE KY 402233861 881391091 PROVIDE DENTAL SERVICES PLANS KY N/A C 0 ANCILLARY CHOICE LIFE INC 10100 LINN STATION RD 700 LOUISVILLE KY 402233861 880574945 INSURANCE KY N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 DELTA DENTAL PLAN OF MICHIGAN INC M 17280416 ACTUAL COST DELTA DENTAL FUND B 500000 ACTUAL COST RENAISSANCE LIFE AND HEALTH INSURANCE COMPANY OF AMERICA M 578296 ACTUAL COST