2023-11-14T11:33:43-06:00 2022-12-31 381357951 PLANTE & MORAN PLLC 1111 MICHIGAN AVE STE 100 EAST LANSING MI 48823 990 2022-01-01 382337000 DELTA DENTAL FUND D/B/A DELTA DENTAL FOUNDATION 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 2023-11-01 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JOHN A BREZA PO BOX 30416 LANSING MI 489097916 85576785 0 X WWW.DELTADENTALMI.COM/DDF X 1980 MI SEE SCHEDULE O DELTA DENTAL FUND'S MISSION IS TO IMPROVE THE ORAL HEALTH OF THE PUBLIC AND TO ADVANCE DENTAL SCIENCE AND THE DENTAL PROFESSION THROUGH RESEARCH AND EDUCATION. 12 8 0 0 0 0 10106242 4411760 0 0 10777227 5322680 0 0 20883469 9734440 4058341 7158197 0 0 23000 19000 0 0 0 1337697 1787259 5419038 8964456 15464431 769984 137389492 117928292 1623539 3886972 135765953 114041320 X DELTA DENTAL FUND'S MISSION IS TO IMPROVE THE ORAL HEALTH OF THE PUBLIC AND TO ADVANCE DENTAL SCIENCE AND THE DENTAL PROFESSION THROUGH RESEARCH AND EDUCATION. 0 0 8504726 7158197 THE DELTA DENTAL FUND'S (FUND) MISSION IS TO DEVELOP AND ENHANCE PARTNERSHIPS AND PROGRAMS TO IMPROVE ORAL AND OVERALL HEALTH. THE FUND HAS BEEN COMMITTED TO THIS PURPOSE FOR OVER FOUR DECADES. OVER THAT TIME, THOUSANDS HAVE BENEFITED FROM GRANTS, SCHOLARSHIPS AND CONTINUING EDUCATION PROGRAMS PROVIDED BY THE FUND. SINCE IT WAS ESTABLISHED IN 1980, THE FUND HAS CONTINUALLY INCREASED ITS EFFORTS TO ACHIEVE THESE GOALS IN MICHIGAN, OHIO, INDIANA AND NORTH CAROLINA. SEE SCHEDULE O FOR CONTINUATIONFOR MANY PEOPLE, ESPECIALLY COMMUNITIES HISTORICALLY OR SYSTEMICALLY EXPOSED TO INEQUITIES, SIMPLY HAVING ACCESS TO A DENTIST IS NOT ENOUGH TO ACHIEVE GOOD ORAL HEALTH. WHAT THEY NEED ARE FAIR AND JUST OPPORTUNITIES AND ALL THE RESOURCES THEREIN TO LIVE THEIR BEST, HEALTHIEST LIVES, NO MATTER WHO THEY ARE OR WHERE THEY COME FROM. WHICH IS WHY THE FUND SUPPORTS PROGRAMS AIMED AT HEALTH EQUITY. IN 2022, THE FUND SUPPORTED PROGRAMS FOCUSED ON ACCESS TO ORAL HEALTH CARE FOR PEOPLE WITH DISABILITIES INCLUDING: THE MEDICAID MEDICARE CHIP SERVICES DENTAL ASSOCIATION FOR EXPLORATION OF A MEDICAID CARVE-OUT TO PROTECT DENTAL BENEFITS FOR THOSE WITH DISABILITIES, PROVIDER TRAINING BY FUNDING AN SERIES OF FREE, ONLINE COURSES OFFERED THROUGH PENN DENTAL MEDICINE AND THE NATIONAL ALL SMILES SHINE CAMPAIGN AND ASSOCIATED APP, DESIGNED TO HELP CHILDREN WITH AUTISM HAVE BETTER DENTAL VISITS. THE FUND ALSO COMMITTED MORE THAN $500,000 TO DEVELOP CENTERS FOR INCLUSIVE DENTISTRY, A PROJECT TO PROVIDE RESOURCES AND IMMERSIVE TRAINING TO DELIVER HIGH-QUALITY DENTAL TREATMENT TO PEOPLE WITH DISABILITIES AT DESIGNATED FEDERALLY QUALIFIED HEALTH CENTERS, AND GRANTED $2 MILLION TO THE INDIANA UNIVERSITY (IU) SCHOOL OF DENTISTRY TO CONSTRUCT A CLINIC OF CARE FOR PEOPLE WITH DISABILITIES. SINCE INCEPTION, MORE THAN $2 MILLION HAS BEEN PROVIDED TO MORE THAN A THOUSAND DENTAL STUDENTS THROUGH SCHOLARSHIPS AND AWARDS. IN 2022, 18 DENTAL, DENTAL HYGIENE, AND DENTAL ASSISTANT STUDENTS FROM DENTAL AND DENTAL HYGIENE SCHOOLS IN MICHIGAN, OHIO AND INDIANA RECEIVED FINANCIAL SUPPORT THROUGH THE FUND TO APPLY TOWARD THE COST OF EDUCATION. COMMUNITY COMMITMENT AWARDS OF $25,000 EACH WERE AWARDED TO FIVE GRADUATING DENTAL STUDENTS WHO COMMITTED TO PRACTICING FOR AT LEAST ONE YEAR IN AN IDENTIFIED HIGH-NEEDS COMMUNITY IN THE STATE IN WHICH THEY GRADUATED. WITH THE GOAL OF MAKING DENTAL EDUCATION MORE ACCESSIBLE, HELPING TO DIVERSIFY THE DENTAL PROFESSION, AND IMPROVING ORAL HEALTH EQUITY, THE DDF CONTINUED ITS $25,000 DIVERSITY DENTAL SCHOLARSHIP. GIVEN ANNUALLY, THIS SCHOLARSHIP IS AWARDED TO STUDENTS FROM SYSTEMICALLY DISADVANTAGED RACIAL AND ETHNIC BACKGROUNDS ENTERING DENTAL SCHOOL. IN 2022, FOR THE SECOND YEAR IN A ROW, SCHOLARSHIPS WERE GIVEN TO FIVE STUDENTS, ONE STUDENT FROM EACH DENTAL SCHOOL IN MICHIGAN, OHIO AND INDIANA.EDUCATION DOES NOT STOP WITH GRADUATION. CONTINUING EDUCATION IS NECESSARY TO STAY CURRENT WITH ADVANCEMENTS IN TREATMENT AND POLICIES AND IS MANDATORY TO MAINTAIN A LICENSE IN SOME STATES. THE FUND ASSISTED PRACTICING DENTISTS BY SPONSORING AND CO-SPONSORING SEMINARS IN DENTAL SCIENCE AND RELATED TOPICS. IN 2022, THE FUND CONTINUED ITS PARTNERSHIP WITH THE UNIVERSITY OF MICHIGAN SCHOOL OF DENTISTRY TO SUPPORT TWO CONTINUING EDUCATION SEMINARS. IN ADDITION, FOR THE SECOND YEAR THE FUND PROVIDED $50,000 TO PENN DENTAL MEDICINE TO SPONSOR A VIRTUAL CONTINUING EDUCATION SERIES FOR DENTAL PROFESSIONALS AIMED AT INCREASING KNOWLEDGE OF HOW TO CARE FOR PATIENTS WITH DISABILITIES. IN 2022, THE COMMUNITY MINI-GRANT PROGRAM CONTINUED IN MICHIGAN, OHIO AND INDIANA. THROUGH THE PROGRAM, 87 ORGANIZATIONS WERE AWARDED A TOTAL OF $330,000 IN SMALL GRANTS OF $5,000 OR LESS TO IMPROVE ORAL HEALTH IN THE COMMUNITIES IN WHICH THE FUND SERVES. TWENTY NON-PROFIT ORGANIZATIONS WERE AWARDED FUNDING THROUGH THE NORTH CAROLINA SMILES FOR KIDS GRANT PROGRAM, WHICH FOCUSES EXCLUSIVELY ON CHILDREN'S ORAL HEALTH WITHIN THE STATE. THIS MARKED THE 12TH YEAR THAT THESE GRANTS HAVE BEEN OFFERED IN NORTH CAROLINA. THE FUND PROVIDED $1.5 MILLION TO THE MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES TO IMPLEMENT THE KINDERGARTEN ORAL HEALTH ASSESSMENT PROGRAM IN ALL 45 LOCAL HEALTH DEPARTMENTS IN THE STATE. THE FUND RENEWED FUNDING FOR THE IMPRESSION 5 SCIENCE CENTER STEM KIT PROGRAM. EVERY OTHER MONTH, IMPRESSION 5 SCIENCE CENTER DISTRIBUTES EDUCATION KITS TO HEAD START CHILDREN THREE TO FIVE YEARS OLD IN THE LANSING, MICHIGAN, AREA. EACH KIT HAS A DIFFERENT THEME, INCLUDING SCIENCE AND ORAL HEALTH, WITH CONCEPTS THAT INCORPORATE SOCIAL-EMOTIONAL DEVELOPMENT, LITERACY AND MATH. AN ADDITIONAL $42,282 WAS ALSO GRANTED TO THE SCIENCE CENTER FOR THE COMPLETION OF THE DELTA DENTAL GATHERING PLACE, A CAFETERIA FOCUSED ON HEALTHY CHOICES. THE FUND HAS SUPPORTED UNIVERSITY OF MICHIGAN SCHOOL OF DENTISTRY'S VICTORS FOR VETERANS PROGRAM SINCE 2017 AND HAS COMMITTED ADDITIONAL FUNDING OVER THE NEXT THREE YEARS. THE PROGRAM IS PART OF A FOUR-YEAR "IMMERSION PATHWAY" AT THE SCHOOL WHERE STUDENTS DIRECT THEIR OWN LEARNING THROUGH AN IMMERSIVE CAPSTONE PROJECT AND PROVIDE TREATMENT TO VETERANS FREE-OF-CHARGE. THE FUND CONTINUED ITS PARTNERSHIP WITH THE MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR THE SEAL MICHIGAN SCHOOL-BASED SEALANT AND COMMUNITY WATER FLUORIDATION PROGRAMS, AS WELL AS THE OHIO DEPARTMENT OF HEALTH FOR THEIR FLUORIDATION ASSISTANCE PROGRAM. THE FUND CONTINUED ITS PARTNERSHIP WITH MCMILLEN HEALTH BY PROVIDING FUNDING FOR THE BRUSH PRE-SCHOOL ORAL HEALTH PROGRAM AND "I NEED MY TEETH," AN ORAL HEALTH MUSICAL PRODUCTION. MCMILLEN CONTINUED PROVIDING THE ASSEMBLY IN A LIVE VIRTUAL FORMAT AND CONTINUED TO OFFER IT TO SCHOOLS IN MICHIGAN, OHIO AND INDIANA. FORTY PERFORMANCES WERE PRESENTED TO SCHOOLS, WHICH REACHED THOUSANDS OF STUDENTS, TEACHERS AND PARENTS. THE FUND'S TOTAL GRANTS HAVE NOW EXCEEDED $54 MILLION SINCE ITS INCEPTION. THIS FUNDING HAS IMPROVED ORAL AND OVERALL HEALTH AND HEALTH EQUITY, AND HELPED STUDENTS ACHIEVE THEIR GOALS AND IMPROVED THE WELL-BEING OF THOUSANDS OF CHILDREN AND ADULTS IN THE TRISTATES AND NORTH CAROLINA. EMPOWERED PEOPLE AND COMMUNITIES ARE CRITICAL TO MAKING CREATIVE SOLUTIONS TO SYSTEMIC CHALLENGES POSSIBLE AND THAT MEANS SUPPORTING WORK BY AND FOR THE COMMUNITIES BEING SERVED. THE FUND IS COMMITTED TO CONTINUING AND ESTABLISHING STRONG TWO-WAY RELATIONSHIPS WITH THE PEOPLE AND ORGANIZATIONS ALIGNED WITH ITS AIMS. 8504726 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 47 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 8 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MI X AMY BASEL CHIEF FINANCIAL OFFICER 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 X GORAN JURKOVIC CPA PRESIDENT & BOARD TRUSTEE 1.00 49.00 X X 0 6178337 2311371 AMY BASEL CPA CHIEF FINANCIAL OFFICER 1.00 49.00 X 0 1462790 485855 HOLLI SEABURY EXECUTIVE DIRECTOR 10.00 40.00 X 0 330350 78475 ERIN DULING CPA TREASURER 1.00 49.00 X 0 242777 65993 JORDAN LEAMING SECRETARY 1.00 49.00 X 0 170303 10137 ELAINE LOYACK TRUSTEE 1.00 49.00 X 0 126877 33731 STEPHEN A EKLUND DDS MSHA PHD TRUSTEE 1.00 10.00 X 2000 88296 0 KELLY SCHEIDERER VICE CHAIR 1.00 10.00 X X 2000 71581 20500 CAROLE SIMONETTI WATKINS TRUSTEE 1.00 10.00 X 1500 66996 0 RAYMOND FRED GIST TRUSTEE 1.00 5.00 X 1500 60000 0 ANN FLERMOEN DDS TRUSTEE 1.00 5.00 X 2000 17500 0 JOSEPH C HARRIS DDS TRUSTEE 1.00 0.00 X 2000 0 0 JAMES P HALLAN TRUSTEE 1.00 0.00 X 2000 0 0 JOHN A BREZA DDS CHAIR 1.00 0.00 X X 2000 0 0 TASHA BLACKMON TRUSTEE 1.00 0.00 X 1500 0 0 FAIYAZ N SYED MD MPH TRUSTEE 1.00 0.00 X 1500 0 0 BRUCE R SMITH TRUSTEE 1.00 0.00 X 500 0 0 LAWRENCE D CRAWFORD DDS TRUSTEE 1.00 0.00 X 500 0 0 19000 8815807 3006062 0 0 1 0 0 4400000 11760 4411760 4059147 4059147 77105878 75842345 1263533 1263533 1263533 9734440 0 0 5322680 6550086 6550086 608111 608111 19000 12350 6650 1233120 1167760 65360 21900 21900 265416 265416 50233 50233 18480 9211 9269 43821 43821 16678 16678 30636 30636 DENTAL ED SEMINARS 106975 106975 8964456 8504726 459730 0 0 145337 1223354 8312444 0 0 0 0 136041226 109313474 124912 157037 137389492 117928292 1468293 3085771 155246 801201 1623539 3886972 X 129858518 108986777 5907435 5054543 135765953 114041320 137389492 117928292 769984 -22494617 0 X 0 1 X 1 0 X X 1 DELTA DENTAL PLAN OF MICHIGAN INC 381791480 10 1 0 0 1 0 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 SCHEDULE A, PART IV, SECTION A, LINE 3B: SUPPORTED ORGANIZATIONS ARE PART OF OUR ENTERPRISE STRUCTURE, AND THE TAX DEPARTMENT KEEPS RECORDS OF THE TAX STATUS OF ALL ENTITIES. THE ENTIITES CONFIRM ANNUALLY THEY WOULD MEET THE SECTION 509(A)(2) PUBLIC SUPPORT TEST. SCHEDULE A, PART IV, SECTION A, LINE 3C: AN ANNUAL REPORTING FORM IS DUE TO DELTA DENTAL FUND WITHIN 12 MONTHS OF WHEN THE ORGANIZATION RECEIVES THE GRANT OR PRIOR TO THE ORGANIZATION REQUESTING ADDITIONAL FUNDS. THIS ANNUAL REPORTING FORM DETAILS HOW THE ORGANIZATION PLANS TO SPEND THE GRANT MONEY. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DEFERRED COMPENSATION FOR DIRECTORS 17812 RELATED PARTY PAYABLE 193389 NON-CURRENT CONTRIBUTIONS AND GRANTS PAYABLE 590000 801201 9454582 0 9454582 268098 11760 279858 9734440 8684598 -11760 -11760 8696358 268098 268098 8964456 PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS RE-CLASSED TO REVENUE 11,760. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONTRIBUTIONS RE-CLASSED TO REVENUE -11,760. 1 500 FESTIVAL INC 21 VIRGINIA AVE INDIANAPOLIS IN 46204 351004320 501(C)(3) 10000 0 GENERAL GRANT 85 HOPE INC PO BOX 27 WABASH IN 46992 450951305 501(C)(3) 10000 0 GENERAL GRANT ACCESSIA HEALTH 3104 EAST BOUNDARY CT MIDLOTHIAN VA 23112 541696178 501(C)(3) 50000 0 GENERAL GRANT ALCONA CITIZENS FOR HEALTH INC 1035 W WASHINGTON AVE ALPENA MI 49707 382170985 501(C)(3) 10000 0 GENERAL GRANT AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE & DENTISTRY 3 FORESTER AVE WARWICK NY 10990 010751843 501(C)(3) 205228 0 GENERAL GRANT AMERICA'S TOOTH FAIRYCHILDRENS ORAL HEALTH FOUNDATION 4530 PARK RD STE 320 CHARLOTTE NC 28209 203921574 501(C)(3) 75000 0 REFUGEE FUND GRANT CARE ALLIANCE HEALTH CENTER 1530 ST CLAIR AVE NE CLEVELAND OH 44144 341748776 501(C)(3) 10000 0 GENERAL GRANT CASE WESTERN RESERVE UNIVERSITY 2123 ABINGTON RD CLEVELAND OH 44106 341018992 501(C)(3) 6000 0 GENERAL GRANT CATHERINE'S HEALTH CENTER 1211 LAFAYETTE AVE NE GRAND RAPIDS MI 49505 202572418 501(C)(3) 295898 0 GENERAL GRANT CENTER FOR FAMILY HEALTH INC 505 N JACKSON ST JACKSON MI 49201 383251354 501(C)(3) 10000 0 GENERAL GRANT CHARLOTTE COMMUNITY HEALTH CLINIC INC 8401 MEDICAL PLAZA DR CHARLOTTE NC 28262 562274174 501(C)(3) 10000 0 GENERAL GRANT CHERRY HEALTH FOUNDATION 100 CHERRY ST SE GRAND RAPIDS MI 49503 383308516 501(C)(3) 126000 0 GENERAL GRANT CHILD & FAMILY CHARITIES 4287 FIVE OKAES DR LANSING MI 48911 382118108 501(C)(3) 25000 0 GENERAL GRANT CHILDREN'S HOSPITAL MEDICAL CTR OF AKRON ONE PERKINS SQUARE AKRON OH 44308 340714357 501(C)(3) 17475 0 GENERAL GRANT CHRIST CHURCH CRANBROOK 470 CHURCH ROAD BLOOMFIELD HILLS MI 48304 381359506 501(C)(3) 10000 0 GENERAL GRANT COMMUNITIES IN SCHOOLS OF MICHIGAN 721 N CAPITOL SUITE 1 LANSING MI 48906 453736821 501(C)(3) 67500 0 GENERAL GRANT COMMUNITY CARE CLINIC OF ROWAN COUNTY 101 E WILLOW ST LANSING MI 48906 561964773 501(C)(3) 8500 0 GENERAL GRANT CRISTO REY COMM CENTER 1717 N HIGH ST LANSING MI 48906 381779460 501(C)(3) 434148 0 GENERAL GRANT DENTAL LIFELINE NETWORK - INDIANA 1319 E STOP 10 RD INDIANPOLIS IN 46227 931025274 501(C)(3) 25000 0 GENERAL GRANT DENTAL LIFELINE NETWORK - NORTH CAROLINA 1800 15TH ST DENVER CO 80202 271755412 501(C)(3) 10000 0 CENTER FOR INCLUSIVE DENTISTRRY DETROIT CENTRAL CITY COMM MENTAL HEALTH 10 PETERBORO STREET DETROIT MI 48201 381986574 501(C)(3) 10000 0 CENTER FOR INCLUSIVE DENTISTRRY DETROIT GOODFELLOWS PO BOX 44444 DETROIT MI 48244 386061491 501(C)(3) 10000 0 CENTER FOR INCLUSIVE DENTISTRRY DR GARY BURNSTEIN COMMUNITY HEALTH 45580 WOODWARD AVE PONTIAC MI 48341 320015321 501(C)(3) 80000 0 GENERAL GRANT ECU MEDICAL & HEALTH SCIENCES FOUNDATION 2200 S CHARLES BLVD GREENVILLE NC 27858 237138921 501(C)(3) 17000 0 GENERAL GRANT FIVE RIVERS HEALTH CENTERS 2261 PHILADELPHIA DR STE 200 DAYTON OH 45406 450914398 501(C)(3) 10000 0 GENERAL GRANT FRANCISCAN ALLIANCE FOUNDATION INC 3510 PARK PLACE WEST MISHAWAKA IN 46546 351955283 501(C)(3) 15000 0 GENERAL GRANT HEALTHLINC INC 2401 VALLY DR VALPARAISO IN 46383 352147791 501(C)(3) 10000 0 GENERAL GRANT HOPE NETWORK FOUNDATION 3375 SOUTH DIVISION 200 GRAND RAPIDS MI 49448 382731395 501(C)(3) 10000 0 GENERAL GRANT IMPRESSION 5 SCIENCE CENTER 200 MUSEUM DR LANSING MI 48933 237200548 501(C)(3) 103564 0 GENERAL GRANT INDIANA UNIVERSITY FOUNDATION INC PO BOX 500 BLOOMINGTON IN 47402 356018940 501(C)(3) 2000000 0 SPECIAL NEEDS CLINIC INDIANA UNIVERSITY SCHOOL OF DENTISTRY 2232 W MICHIGAN ST INDIANAPOLIS IN 46202 356001673 501(C)(3) 162237 0 GENERAL GRANT LAKE COUNTY FREE CLINIC 54 SOUTH STATE ST PAINESVILLE OH 44077 341081191 501(C)(3) 18500 0 GENERAL GRANT LANSING COMMUNITY COLLLEGE 309 N WASHINGTON SQ LANSING MI 48933 381787641 GOVT 28575 0 GENERAL GRANT LOWER LIGHTS CHRISTIAN HEALTH CENTER PO BOX 23984 COLUMBUS OH 43223 311810355 501(C)(3) 10000 0 GENERAL GRANT MCMILLEN CENTER FOR HEALTH EDUCATION 600 JIM KELLEY BLVD FORT WAYNE IN 46816 351186994 501(C)(3) 303891 0 GENERAL GRANT MEDICAID MEDICARE CHIP SERVICES 2 GROVE ST SANDWHICH MA 02563 201957993 501(C)(3) 48300 0 GENERAL GRANT MEDWORKS 1950 RICHMOND RD LYNDHURST OH 44124 263858369 501(C)(3) 40000 0 GENERAL GRANT MEL TROTTER MINISTRIES 225 COMMERCE AVE SW GRAND RAPIDS MI 49503 381410467 501(C)(3) 34312 0 GENERAL GRANT MICHIGAN PRIMARY CARE ASSOCIATION 7215 WESTSHIRE DR LANSING MI 48917 382294018 501(C)(3) 280000 0 GENERAL GRANT MY COMMUNITY DENTAL CENTERS INC 3890 CHARLEVOIX AVE SUITE 300 PETOSKEY MI 49770 300393232 501(C)(3) 114500 0 GENERAL GRANT NATIONAL NETWORK FOR ORAL HEALTH ACCESS 181 E 56TH AVE DENVER CO 80216 841186592 501(C)(3) 10000 0 CENTER FOR INCLUSIVE DENTISTRRY NEIGHBORHOOD HEALTH PO BOX 11949 FORT WAYNE IN 46862 351922483 501(C)(3) 354324 0 GENERAL GRANT OHIO STATE UNIVERSITY FOUNDATION PO BOX 183112 COLUMBUS OH 43202 311145986 501(C)(3) 102915 0 GENERAL GRANT OTTAWA COUNTY HEALTH DEPARTMENT 12251 JAMES ST STE 400 HOLLAND MI 49424 386004883 GOVT 13000 0 GENERAL GRANT PURDUE UNIVERSITY 8500 KEYSTONE XING 490 INDIANAPOLIS IN 46240 356002041 501(C)(3) 22000 0 GENERAL GRANT RALEIGH-WAKE COUNTY DENTAL SOCIETY 4901 LEIGH DR RALEIGH NC 27616 562258278 501(C)(3) 8500 0 DENTAL OUTREACH REGENTS OF UNIV OF MICHIGAN 1011 N UNIVERSITY ANN ARBOR MI 48109 386006309 501(C)(3) 10000 0 CENTER FOR INCLUSIVE DENTISTRRY SMILES ON WHEELS 122 HIGHLAND DRIVE JACKSON MI 49201 205964788 501(C)(3) 34575 0 GENERAL GRANT STATE OF MICHIGAN 320S WALNUT LANSING MI 48933 386000134 GOVT 225000 0 ORAL HEALTH PROGRAM TEAM SMILE INC 2000 SWIFT ST N KANSAS CITY MO 64116 753250075 501(C)(3) 26000 0 GENERAL GRANT THE DAVIES PROJECT FOR MID MI CHILDREN 230 BINGHAM ST 100 LANSING MI 48912 461209200 501(C)(3) 10000 0 GENERAL GRANT THE GOOD SAMARITAN HOSPITAL FOUNDATION 625 EDEN PARK DR CINCINNATI OH 45202 311206047 501(C)(3) 30000 0 HEALTH CLINIC THE NC ALBERT SCHWEITZER FELLOWSHIP INC PO BOX 1636 DAVIDSON NC 28036 822682491 501(C)(3) 11000 0 GENERAL GRANT THE WELLNESS PLAN 7700 SECOND AVE DETROIT MI 48202 382008890 501(C)(3) 10000 0 GENERAL GRANT TRIANGLE RESIDENTIAL OPTIONS FOR SUBSTANCE ABUSERS 1820 JAMES ST DURHAM NC 27707 561861158 501(C)(3) 10000 0 GENERAL GRANT TRUSTEES UNIVERSITY OF PENNSYLVANIA 240 S 40TH ST PHILADELPHIA PA 19104 231352685 501(C)(3) 95000 0 GENERAL GRANT UNITED WAY OF NW MICHIGAN 202 E GRANDVIEW PARKWAY TRAVERSE CITY MI 49684 381679060 501(C)(3) 300000 0 GENERAL GRANT UNIVERSITY OF DETROIT MERCY 2700 MARTIN LUTHER KING JR BLVD DETROIT MI 48208 381360586 501(C)(3) 50305 0 GENERAL GRANT UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL 104 AIRPORT DR CHAPEL HILL NC 27599 566001393 GOVT 10000 0 REFUGEE FUND GRANT UPPER GREAT LAKES FAMILY HEALTH CENTER 135 E M35 GWINN MI 49841 264299275 501(C)(3) 10000 0 GENERAL GRANT WARREN ARTS & EDUCATION FOUNDATION INC 975 N POST RD INDIANAPOLIS IN 46219 351572560 501(C)(3) 35000 0 GENERAL GRANT 62 0 SCHOLARSHIPS 13 156500 CASH SUPPORT FOR DENTAL, DENTAL HYGIENE AND DENTAL ASSISTANT STUDENTS COMMUNITY COMMITMENT AWARD 10 125000 CASH AWARD TO GRADUATING SENIOR WHO IS PRACTICING IN AN AREA OF HIGH NEED ORAL HEALTH MATERIALS/SUPPLIES 326611 FMV ORAL HEALTH RELATED GIVEAWAYS PART I, LINE 2: THE DELTA DENTAL FUND (DDF) IS DEDICATED TO DEVELOPING AND ENHANCING PARTNERSHIPS AND PROGRAMS TO IMPROVE ORAL AND OVERALL HEALTH AND HEALTH EQUITY, AND FOCUSES ITS SUPPORT IN THESE CATEGORIES: -INCREASING DENTAL ACCESS TO UNDERSERVED AND HIGH-RISK POPULATIONS -PROVIDING EDUCATIONAL PROGRAMMING ON THE IMPORTANCE OF ORAL HEALTH AND HOW IT RELATES TO OVERALL HEALTH -IDENTIFYING AND REDUCING HEALTH DISPARITIES RELATED TO ORAL AND OVERALL HEALTH -PROVIDING SCHOLARSHIPS AND AWARDS TO DENTAL STUDENTS -CONTINUING EDUCATION PROGRAMS FOR THE DENTAL PROFESSION THE DDF AWARDS GRANTS TO NONPROFIT ORGANIZATIONS AND INSTITUTIONS WHO CONDUCT DENTAL RESEARCH, AND EDUCATE AND/OR PROVIDE DENTAL SERVICES TO UNDERSERVED AND AT-RISK POPULATIONS. THE GRANT PERIOD IS 12 MONTHS, UNLESS OTHERWISE INDICATED IN THE GRANT AGREEMENT. UPON COMPLETION OF THE GRANT PERIOD, ALL GRANTEES ARE REQUIRED TO SUBMIT A COMPLETED GRANT REPORTING FORM TO THE DDF OUTLINING HOW GRANT FUNDS WERE USED, METRICS AND OUTCOMES OF THE PROJECT, AND ROADBLOCKS THAT WERE ENCOUNTERED. THE DDF ALSO SUPPORTS CONTINUING EDUCATION PROGRAMS FOR DENTAL PROFESSIONALS, AS WELL AS SCHOLARSHIPS AND AWARDS TO DENTAL AND DENTAL HYGIENE STUDENTS WHO OBTAIN THEIR DEGREES FROM ACCREDITED SCHOOLS IN MICHIGAN, OHIO AND INDIANA. STUDENTS MUST MEET THE CRITERIA OUTLINED IN THE AGREEMENT BETWEEN THE SCHOOL AND THE DDF. 0 1 0 0 0 0 0 0 0 GORAN JURKOVIC CPA PRESIDENT & BOARD TRUSTEE 0 1403355 0 3094090 0 1680892 0 2287652 0 23719 0 8489708 0 1645969 AMY BASEL CPA CHIEF FINANCIAL OFFICER 0 507383 0 561274 0 394133 0 462136 0 23719 0 1948645 0 364896 HOLLI SEABURY EXECUTIVE DIRECTOR 0 321427 0 1000 0 7923 0 54756 0 23719 0 408825 0 0 ERIN DULING CPA TREASURER 0 174990 0 67422 0 365 0 42274 0 23719 0 308770 0 0 JORDAN LEAMING SECRETARY 0 132854 0 36999 0 450 0 10107 0 30 0 180440 0 0 ELAINE LOYACK TRUSTEE 0 106277 0 20000 0 600 0 6691 0 27040 0 160608 0 0 PART I, LINE 3 THE CEO AND EXECUTIVE DIRECTOR ARE W-2 EMPLOYEES 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 AND AMY BASEL ACCRUED BENEFITS AS PARTICIPANTS IN THE SERP PLAN. GORAN JURKOVIC AND AMY BASEL 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 A, LINE 7A THE MEMBERS OF THE ORGANIZATION ARE DULY APPOINTED BY THE BOARD OF DIRECTORS OF THE DELTA DENTAL PLAN OF MICHIGAN, INC. 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 THE FORM 990 BEING 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 ADMINSTRATIVE 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 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. 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 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 PLAN OF INDIANA INC PO BOX 30416 LANSING MI 489097916 351545647 PROVIDE DENTAL SERVICE PLANS IN 501(C)(4) N/A DELTA DENTAL PLAN OF MICHIGAN INC 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 OF 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 N/A C 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA PO BOX 30381 LANSING MI 48909 470397286 INSURANCE IN N/A C 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK PO BOX 30381 LANSING MI 48909 134098096 INSURANCE NY N/A C 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 PROVIDES DENTAL SERVICE 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 PROVIDES THIRD-PARTY ADMINISTRATIVE SERVICES AR N/A C 0 THE 4100 GROUP 4100 OKEMOS RD 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 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 DELTA DENTAL PLAN OF MICHIGAN INC M 1298943 ACTUAL COST DELTA DENTAL PLAN OF OHIO INC C 1000000 ACTUAL COST DELTA DENTAL PLAN OF MICHIGAN INC C 2500000 ACTUAL COST DELTA DENTAL PLAN OF INDIANA INC C 500000 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA C 400000 ACTUAL COST