2025-11-13T15:18:25+00:00 2024-12-31 331498605 Plante & Moran PLLC 1111 MICHIGAN AVE SUITE 100 EAST LANSING MI 48823 990 2024-01-01 381791480 DELTA DENTAL PLAN OF MICHIGAN INC DELT 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 GORAN JURKOVIC PRESIDENT AND CEO 2025-11-13 true true DAVID LOWENTHAL CPA P00378651 5173326200 2025-11-11 2024 2025-03-06 01:10:19Z GORAN JURKOVIC 4100 OKEMOS ROAD OKEMOS MI 48864 1354640869 false 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 9 1271 0 44845181 5515360 0 0 1177589951 1226928199 10830892 20904882 402047 396710 1188822890 1248229791 3895292 3964285 0 0 178033400 177802035 0 0 1005821892 1060012191 1187750584 1241778511 1072306 6451280 918626400 986517729 208198626 221815504 710427774 764702225 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. 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. false false 1103459895 3964285 1182083018 Promoting Dental Care Delta 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 2024 by paying out over $887 million for dental care, by providing dental benefits for the public and advancing the science of dentistry. In addition, over 11.5 million claims were processed for over 6 million members. Cost Saving Strategies Delta 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 Community Delta 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. The Delta Dental Fund's total grants have now exceeded $68 million since its inception. This funding has improved oral and overall health and health equity, helped students achieve their goals, and improved the well-being of millions of children and adults in Michigan, Ohio, Indiana 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 Delta Dental Fund is committed to continuing and establishing strong two-way relationships with the people and organizations aligned with its aims. In 2024, the DDF committed nearly $6.1 million in grants, scholarships, and educational resources, impacting more than 4.3 million lives in Michigan, Ohio, Indiana North Carolina and beyond. More than 354,000 educational brochures, flyers and posters, along with 351 miles of floss and 282,554 toothbrushes were donated to nonprofit organizations to disseminate in their communities. 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 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. 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 Dentists 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. 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. 1103459895 false false true false false false false false false false true true false true true false false true false false false false false false false false false true false true false false false false false false false false true false false false false false true true true true false false true 62231 0 true 1271 true true true false false false false false true false X 15 9 false false false false true true true true true false false false true true true true true true true true true true X AMY BASEL CFO 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 MELISSA STOLICKER VICE CHAIR 5.0 5.0 X X 73500 67512 0 SARA DOLAN CHAIR 5.0 5.0 X X 72000 70008 0 ANDREW KOTARBA DIRECTOR 5.0 5.0 X 67500 39589 0 ANTHONY O WILLIAMS JD DIRECTOR 5.0 1.0 X 60000 1500 0 BLAKE LIVINGSTON DDS DIRECTOR 5.0 0.0 X 60000 0 0 CHRISTOPHER T FISHER 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11248 CHARITABLE DONATION AMERICAN HEART ASSOCIATION 271 WOODLAND PASS STE 110 EAST LANSING MI 48823 135613797 501(C)(3) 15000 CHARITABLE DONATION AMERICAN RED CROSS 7800 W OUTER DR DETROIT MI 48235 530196605 501(C)(3) 25000 CHARITABLE DONATION ASPCA (AMERICAN SOCIETY FOR THE PREVENTION OF CRUELTY TO ANIMALS) 424 E 92ND ST NEW YORK NY 10128 131623829 501(C)(3) 7048 CHARITABLE DONATION AUTISM ALLIANCE OF MICHIGAN 30100 TELGRAPH RD BINGHAM FARMS MI 48025 270472137 501(C)(3) 25000 CHARITABLE DONATION BREAKTHROUGH T1D 24359 NORTHWESTERN HWY SOUTHFIELD MI 48075 231907729 501(C)(3) 35000 CHARITABLE DONATION CHILDRENS HOSPITAL OF MICHIGAN FOUNDATION 3011 W GRAND BLVD DETROIT MI 48202 320087353 501(C)(3) 25000 CHARITABLE DONATION COLLEGE NOW GREATER CLEVELAND POST OFFICE PLAZA CLEVELAND OH 44113 346580096 501(C)(3) 25000 CHARITABLE DONATION COMMUNITIES IN SCHOOLS OF MICHIGAN 721 N CAPITOL STE 1 LANSING MI 48906 453736821 501(C)(3) 25000 CHARITABLE DONATION COREWELL HEALTH FOUNDATION OF WEST MICHIGAN 100 MICHGAN AVE GRAND RAPIDS MI 49503 383752328 501(C)(3) 10000 CHARITABLE DONATION CRISTO REY COMMUNITY CENTER 1717 N HIGH ST LANSING MI 48906 381779460 501(C)(3) 80000 CHARITABLE DONATION DIVERSITY IN DENTISTRY MENTORSHIPS INC 4729 E SUNRISE DR TUSCON AZ 85718 852395210 501(C)(3) 8999 CHARITABLE DONATION DELTA DENTAL FOUNDATION 4100 Okemos Rd OKEMOS MI 48864 382337000 501(C)(3) 1500000 CHARITABLE DONATION DETROIT RIVERFRONT CONSERVANCY 600 RENAISSANCE CENTER DETROIT MI 48243 300125283 501(C)(3) 15000 CHARITABLE DONATION ELE'S PLACE 1145 WEST OAKLAND LANSING MI 48915 382976751 501(C)(3) 50000 CHARITABLE DONATION EVERSIGHT 3985 RESEARCH PARK DR ANN ARBOR MI 48108 382117115 501(C)(3) 7500 CHARITABLE DONATION FEEDING AMERICA 35 E WACKER DR STE 200 CHICAGO IL 60601 363673599 501(C)(3) 10370 CHARITABLE DONATION FLEECE & THANK YOU 24715 CRESTVIEW FARMINGTON HILLS MI 48335 475263037 501(C)(3) 8000 CHARITABLE DONATION GREATER LANSING FOODBANK 5303 S CEDAR ST LANSING MI 48911 382424756 501(C)(3) 50000 CHARITABLE DONATION HABITAT FOR HUMANITY OF LANSING 1941 BENJAMIN DR LANSING MI 48906 382716658 501(C)(3) 15000 CHARITABLE DONATION HAGAN RODRIGUEZ PARIODONTICS AND IMPLANT 335 W LAKE LANSING RD EAST LANSING MI 48823 263237576 14000 CHARITABLE DONATION HOUSE MAJORITY FORWARD 1029 Vermont Ave NW Suite 300 Washington DC 20005 834185105 501(C)(4) 7500 CHARITABLE DONATION IMPRESSION 5 200 MUSEUM DR LANSING MI 48933 237200548 501(C)(3) 75000 CHARITABLE DONATION ITS A BREAST THING INC 2771 SOUTHWOOD DR EAST LANSING MI 48823 300591532 501(C)(3) 5500 CHARITABLE DONATION JUNIOR ACHIEVEMENT 2368 VICTORY PARKWAY STE 301 CINCINNATI OH 45206 320014307 501(C)(3) 50000 CHARITABLE DONATION JUNIOR ACHIEVEMENT OF MICHIGAN GREAT LAKES 600 W ST JOSEPH ST LANSING MI 48933 381557861 501(C)(3) 32500 CHARITABLE DONATION JUNIOR ACHIEVEMENT OF GREATER CLEVELAND 1422 EUCLID AVE STE 952 CLEVELAND OH 44115 340733164 501(C)(3) 35000 CHARITABLE DONATION JUNIOR ACHIEVEMENT OF SOUTHEASTERN MI 577 E LARNED ST DETROIT MI 48226 381348535 501(C)(3) 25000 CHARITABLE DONATION KALAMAZOO COMMUNITY FOUNDATION 402 E MICHIGAN AVE KALAMAZOO MI 49007 383333202 501(C)(3) 10000 CHARITABLE DONATION LANSING PROMISE 330 Marshall St LANSING MI 48912 453363322 501(C)(3) 50000 CHARITABLE DONATION LAUNCH MICHIGAN 119 PERE MARQUETTE STE 1C LANSING MI 48912 920358917 501(C)(3) 25000 CHARITABLE DONATION LIFE REMODELED PO BOX 28508 DETROIT MI 48228 275020487 501(C)(3) 500000 CHARITABLE DONATION LIFECARE ALLIANCE 1699 W MOUND ST COLUMBUS OH 43223 314379494 501(C)(3) 13575 CHARITABLE DONATION MCLAREN GREATER LANSING HEALTHCARE FOUNDATION 2900 COLLINS RD LANSING MI 48910 382463637 501(C)(3) 11000 CHARITABLE DONATION METRO FOOD RESCUE 6928 E KNOLLWOOD CIRCLE WEST BLOOMFIELD MI 48322 851902179 501(C)(3) 25000 CHARITABLE DONATION MICHIGAN ECONOMIC DEVELOPMENT FOUNDATION PO BOX 13063 LANSING MI 48901 382527475 501(C)(3) 50000 CHARITABLE DONATION MICHIGAN HUMANE SOCIETY 30300 TELEGRAPH RD BINGHAM FARMS MI 48025 381358206 501(C)(3) 200000 CHARITABLE DONATION MICHIGAN SCIENCE CENTER 5020 JOHN R ST DETROIT MI 48202 455190355 501(C)(3) 10000 SCIENCE SMILES WEEK MICHIGAN STATE UNIVERSITY 220 TROWBRIDGE RD EAST LANSING MI 48824 386005984 GOVT 85000 CHARITABLE DONATION MICHIGAN THANKSGIVING PARADE FOUNDATION 9500 MT ELLIOTT DETROIT MI 48211 382460378 501(C)(3) 10000 CHARITABLE DONATION NAF 218 WEST 40TH ST 5TH FL NEW YORK NY 10018 133480246 501(C)(3) 13498 CHARITABLE DONATION NATIONAL DENTAL ASSOCIATION 3060 MITCHELLVILLE RD BOWIE MD 20716 540315311 501(C)(4) 5624 CHARITABLE DONATION NO SENIOR WITHOUT CHRISTMAS PO BOX 26182 LANSING MI 48909 760840671 501(C)(3) 10000 CHARITABLE DONATION PLANET SMILEZ INC 493 FORD HILL RD HUNTER NY 12442 471378352 501(C)(3) 11248 CHARITABLE DONATION ROAD TO MICHIGANS FUTURE PO BOX 12248 LANSING MI 48901 844298056 501(C)(4) 100000 CHARITABLE DONATION RONALD MCDONALD CHARITIES OF OHIO 711 E LIVINGSTON AVE COLUMBUS OH 43205 310890152 501(C)(3) 55000 CHARITABLE DONATION SAMARITAS 8131 E JEFFERSON AVE DETROIT MI 48214 381360553 501(C)(3) 40000 CHARITABLE DONATION SLEEP IN HEAVENLY PEACE INC PO BOX 85304 WESTLAND MI 48135 464346568 501(C)(3) 13250 CHARITABLE DONATION SOCIETY OF AMERICAN INDIAN DENTISTS 230 FAIRVIEW DR CARSON CITY NV 89701 205966903 501(C)(3) 11248 CHARITABLE DONATION SPARROW FOUNDATION PO BOX 30480 LANSING MI 48909 386100687 501(C)(3) 65772 CHARITABLE DONATION ST JUDE CHILDRENS RESEARCH HOSPITAL 1335 DUBLIN RD STE 110 COLUMBUS OH 43215 351044585 501(C)(3) 10000 CHARITABLE DONATION THE EDISON INSTITUTE 20900 OAKWOOD BLVD DEARBORN MI 48124 381359513 501(C)(3) 25000 CHARITABLE DONATION THE ROOSTERS FOUNDATION 17602 17TH ST TUSTIN CA 92780 330764177 501(C)(3) 6000 CHARITABLE DONATION UNITED WAY OF NORTH CAROLINA 1130 KILDAIRE FARM RD STE 100 CARY NC 27511 560564547 501(C)(3) 25000 CHARITABLE DONATION UNITED WAY OF NORTHWEST MICHIGAN 4075 COPPER RIDGE RD TRAVERSE CITY MI 49664 381679060 501(C)(3) 200000 CHARITABLE DONATION VET2TRACK 203 PLEASANT VIEW AVE LANSING MI 48910 473301408 501(C)(3) 7230 CHARITABLE DONATION 54 5 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds 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. CRISTO REY COMMUNITY CENTER - DELTA DENTAL PROVIDED AN $80,000 DONATION TO SUPPORT THE PURCHASE OF THE COMPUTER SYSTEM NEEDED TO RUN THEIR NEW MEDICAL AND DENTAL CLINIC IN LANSING. IMPRESSION 5 - DELTA DENTAL PROVIDED $75,000 FOR THE CREATION AND DISTRIBUTION OF 2 STEM KITS PER YEAR THAT GO HOME WITH EVERY HEADSTART STUDENT IN INGHAM, EATON, AND CLINTON COUNTIES. ADDITIONALLY, THE PROGRAM PROVIDES 2 KITS PER YEAR TO ALL OF THE HEADSTART TEACHERS FOR USE WITH THE STUDENTS IN THE CLASSROOM. THESE KITS ARE INTENDED TO SUPPORT EARLY CHILDHOOD DEVELOPMENT. LANSING PROMISE - DELTA DENTAL PROVIDED $50,000 IN FUNDING TO THE LANSING PROMISE IN 2024. 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. LIFE REMODELED - DELTA DENTAL PROVIDED A $500,000 DONATION FOR THE RENOVATION OF SPACE INSIDE A NEW COMMUNITY CENTER ON THE EAST SIDE OF DETROIT. THE SPACE IS BEING RENOVATED TO ACCOMODATE A NEW MEDICAL AND DENTAL CLINIC TO SERVE MEDICAID, UNDER INSURED, AND UNINSURED PEOPLE. MICHIGAN HUMANE SOCIETY - DELTA DENTAL HAS PROVIDED $200,000 AS PART OF A $1 MIILLION COMMITTMENT FOR THE HEALTHY COMMUNITIES PROGRAM WHICH ADDRESSES THE HEALTH OF PEOPLE IN THE COMMUNITY BY REACHING THEM THROUGH THEIR PETS. INTERACTIONS AT PET FOOD PANTRIES AND VACCINATIONS CLINICS ALLOW OTHER HEALTH ENTITIES IN THE COMMUNITY TO OFFER SERVICES LIKE DENTAL CLEANINGS, BLOOD PRESSURE SCREENING ETC TO THE HUMANS WHO ARE WAITING FOR THEIR PETS TO BE TREATED. UNITED WAY OF NORTHWEST MICHIGAN - DELTA DENTAL HAS PROVIDED A $200,000 DONATION TO HELP THE DENTAL CLINIC THEY RUN ADD A STAFF MEMBER TO ASSIST UNINSURED PATIENTS WITH THE PROCESS OF SIGNING UP FOR MEDICAID OR AN INSURANCE PLAN UNDER THE AFFORDABLE CARE ACT SO THAT THE CLINIC WOULD BE ABLE TO BILL FOR THOSE PATIENT SERVICES IN THE FUTURE AND EVENTUALLY BECOME FINANCIALLY INDEPENDENT. X X X true true X X X X true true false false false false false true false CHRISTOPHER T FISHER DIRECTOR 60000 107004 0 0 0 0 0 0 0 0 60000 107004 0 0 JEFF BOTKIN FORMER SVP, BUSINESS SERVICES 31064 0 506668 0 60041 0 0 0 0 0 597773 0 0 0 GORAN M JURKOVIC CPA CEO, PRESIDENT 1511908 0 3756580 0 4189094 0 2688539 0 27241 0 12173362 0 4141804 0 ANTHONY D ROBINSON EVP, CMO & CRO 652874 0 1038809 0 1147674 0 760823 0 27241 0 3627421 0 1130171 0 AMY L BASEL CPA EVP/CFO & CRO/TREASURER 552581 0 968814 0 960513 0 660849 0 27241 0 3169998 0 921829 0 SUE ELLEN JENKINS EVP, CHIEF LEGAL OFFICER, CAO & SECRETARY 567525 0 1037144 0 1233999 0 447227 0 5150 0 3291045 0 1206808 0 MARK BAUGHMAN SVP & CIO 385464 0 496763 0 28639 0 103573 0 19077 0 1033516 0 0 0 JEFFERY W JOHNSTON DDS MS SVP & CHIEF SCIENCE OFFICER 350158 0 160568 0 6936 0 100022 0 19077 0 636761 0 0 0 TOBY HALL PRESIDENT & CEO OF ROOSEVELT 480532 0 482533 0 498407 0 420918 0 17263 0 1899653 0 474664 0 KUSHTRIM SHAQIRI VP GOVERMENT PROGRAMS 408485 0 313117 0 13165 0 17723 0 27241 0 779731 0 0 0 MIKE BOBAK VP SALES & ACCT MGT 266268 0 420047 0 16443 0 65140 0 27241 0 795139 0 0 0 DANIEL LOVEJOY VP, SALES AND ACCT MGT 293456 0 370543 0 9221 0 47745 0 27241 0 748206 0 0 0 EARL MAJOR VP HUMAN RESOURCES 148545 0 401101 0 1161 0 28251 0 8206 0 587264 0 0 0 MATT GLOVER SR DIRECTOR, GOVT PROGRAMS, SALES & ACCT MGT 169169 0 307446 0 541 0 26192 0 27241 0 530589 0 0 0 MITCH NOTARO VP, INFORMATION TECHNOLOGY 212315 0 94485 0 142398 0 35855 0 25259 0 510312 0 0 0 Schedule J, Part I, Line 1a First-class or charter travel FIRST CLASS TRAVEL FOR BUSINESS PURPOSES IS AVAILABLE TO SENIOR EXECUTIVES AND KEY EMPLOYEES. THIS AMOUNT WAS TREATED AS NONTAXABLE TO THESE INDIVIDUALS. Schedule J, Part I, Line 1a Travel for companions TRAVEL MAY BE AVAILABLE TO SPOUSES ON OCCASION AND WOULD BE TREATED AS TAXABLE INCOME TO THE BOARD MEMBER OR EMPLOYEE AS APPROPRIATE. Schedule J, Part I, Line 1a Health or social club dues or initiation fees 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. Schedule J, Part I, Line 4a Severance or change-of-control payment MITCH NOTARO RECEIVED SEVERANCE IN AMOUNT OF $141,369 IN 2024. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan 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 EXECUTIVE 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 2024, GORAN JURKOVIC, AMY BASEL, TOBY HALL, SUE JENKINS, AND ANTHONY ROBINSON ACCRUED BENEFITS AS PARTICIPANTS IN THE SERP PLAN. GORAN JURKOVIC, AMY BASEL, SUE JENKINS, TOBY HALL, 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 2024. THESE WAGES WERE ALSO REPORTED ON SCHEDULE J AS COMPENSATION THAT HAS BEEN REPORTED AS DEFFERED ON PRIOR FORM 990S. Schedule J, Part I, Line 7 Non-fixed payments 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. Schedule J, Part I, Line 3 THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS PERFORMANCE AND SETS TOTAL COMPENSATION FOR THE CEO WITHOUT THE PRESENCE OF 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. JASON DAMAN Jason Daman is a DDMI employee and his parent is a board member of DDMI 117007 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN, INC. false STEVEN M DATER DDS BOARD MEMBER AND OWNER OF STEVEN M DATER DDS & ASSOCIATES II, PLC 474557 PAYMENTS FOR DENTAL SERVICES false RAYMOND GIST DDS BOARD MEMBER AND OWNER OF RAYMOND GIST DDS, PC 180699 PAYMENTS FOR DENTAL SERVICES false LARRY DEGROAT DDS BOARD MEMBER AND OWNER OF LARRY DEGROAT DDS, PC 162360 PAYMENTS FOR DENTAL SERVICES false BLAKE LIVINGSTON DDS BOARD MEMBER AND OWNER OF RONALD A. LIVINGSTON DDS PC 224749 PAYMENTS FOR DENTAL SERVICES false JUAN RODRIGUEZ DDS BOARD MEMBER AND OWNER OF HAGAN RODRIGUEZ PERIODONTICS AND IMPLANTS 1632633 PAYMENTS FOR DENTAL SERVICES false 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). Form 990, Part VI, Line 6 Classes of members or stockholders DELTA DENTAL PLAN OF MICHIGAN HAS A SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE SOLE MEMBER HAS VOTING RIGHTS AND ELECTS DIRECTORS. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders 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, Line 11b Review of form 990 by governing body 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, Line 12c Conflict of interest policy THE COMPANY'S EXECUTIVE 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 EXECUTIVE 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, Line 15a Process to establish compensation of top management official COMPENSATION OF THE CEO IS DETERMINED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. 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 2024. COMPENSATION DECISIONS ARE MADE UTILIZING THE DATA PROVIDED BY TOWERS WATSON. Form 990, Part VI, Line 15b Process to establish compensation of other employees COMPENSATION OF THE OTHER EXECTUTIVES IS DETERMINED BY THE CEO IN CONSULTATION WITH THE Executive Vice President, Chief Legal Officer and CAO. 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 2024. COMPENSATION DECISIONS ARE MADE UTILIZING THE DATA PROVIDED BY TOWERS WATSON. Form 990, Part VI, Line 19 Required documents available to the public NO DOCUMENTS AVAILABLE TO THE PUBLIC. Form 990, Part VII, Section A 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 Other Fees CONTRACT LABOR - Total Expense: 30582515, Program Service Expense: 20379452, Management and General Expenses: 10203063, Fundraising Expenses: ; CONTRACTED SERVICES - Total Expense: 7749007, Program Service Expense: 4419836, Management and General Expenses: 3329171, Fundraising Expenses: ; DENTAL CONSULTANT - Total Expense: 2949940, Program Service Expense: 2949940, Management and General Expenses: 0, Fundraising Expenses: ; AFFILIATE CONTRACT LABOR - Total Expense: 448502, Program Service Expense: 5000, Management and General Expenses: 443502, Fundraising Expenses: ; PURCHASED DENTAL SERVICES - Total Expense: XXX-XX-XXXX, Program Service Expense: XXX-XX-XXXX, Management and General Expenses: 0, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances GAIN ON EQUITY IN SUBSIDIARY - -10585434; PENSION RELATED CHANGES - 41155777; Total - 30570343; ROOSEVELT INNOVATIONS LLC 4100 OKEMOS ROAD OKEMOS MI 48864 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