2022-11-14T13:21:50-06:00 2021-12-31 381357951 PLANTE & MORAN PLLC 1111 MICHIGAN AVE STE 100 EAST LANSING MI 48823 990 2021-01-01 850224562 DELTA DENTAL PLAN OF NEW MEXICO INC DELT 5058557114 100 SUN AVE NE 400 ALBUQUERQUE NM 87109 AMY BASEL CHIEF FINANCIAL OFFICER 5058557114 2022-11-08 1 AMY BASEL 999009999 DAVID LOWENTHAL CPA P00378651 5173326200 2022-11-08 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z LOUIS VOLK III 100 SUN AVE NE 400 ALBUQUERQUE NM 87109 124590690 0 X HTTP://WWW.DELTADENTALNM.COM X 1971 NM DELTA DENTAL OF NEW MEXICO'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH PREPAID DENTAL SERVICES, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. 9 8 42 0 398843 23714 0 0 59326566 69512073 4172403 5981835 26742 23378 63525711 75517286 1982406 427664 0 0 3500034 3722115 0 0 0 50167083 61954539 55649523 66104318 7876188 9412968 74508719 81908346 5673887 4615155 68834832 77293191 X DELTA DENTAL OF NEW MEXICO'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH PREPAID DENTAL SERVICES, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. 0 0 64376380 427664 69136608 PROMOTING DENTAL CAREDELTA DENTAL OF NEW MEXICO, INC. IS A LEADNG GROUP DENTAL BENEFITS PROVIDER. THE PURPOSE OF THE ORGANIZATION IS TO ADVANCE AND PROMOTE THE IMPROVEMEMNT OF ORAL HEALTH. THIS IS DONE BY OFFERING INNOVATIVE, COST-EFFECTIVE PRODUCTS THAT MEET THE NEEDS OF CUSTOMERS. THIS WAS DEMONSTRATED IN 2021 BY PAYING OUT OVER $53 MILLION IN CLAIMS AND BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 780,000 CLAIMS WERE PROCESSED FOR OVER 397,000 MEMBERS. SEE SCHEDULE O FOR CONTINUATIONCOST 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 ANTI-FRAUD PROGRAMS, ALL OF WHICH ENSURE QUALITY, COST-EFFECTIVE DENTAL BENEFIT DELIVERY. 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. 64376380 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 1 5957 0 1 42 1 1 1 0 0 0 0 0 0 0 X 9 8 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 AMY BASEL CFO 1.00 49.00 X 0 1522877 446465 SUE ELLEN JENKINS VP GENERAL COUNSEL AND SECRETARY 1.00 49.00 X 0 1037021 297452 LOUIS VOLK III PRESIDENT & CEO 50.00 0.00 X 510463 0 38040 JOLOU TRUJILLO-OTTINO VP SALES AND MARKETING 50.00 0.00 X 251962 0 40676 NATHALIE CASADO STRATEGIC PLANNER 50.00 0.00 X 151617 0 32228 DIANNE LEDESMA DIRECTOR OF OPERATIONS 50.00 0.00 X 146013 0 17104 JAMES TRUJILLO CHAIRPERSON 5.00 5.00 X X 20000 24996 0 ROBERT L SIMMONS DIRECTOR 5.00 0.00 X 20500 0 0 DAVID JAMES MARTINEZ DDS DIRECTOR 5.00 0.00 X 17000 0 0 CHRISTINE N NATHE RDH MS VICE CHAIRPERSON 5.00 0.00 X X 17000 0 0 FRED CISNEROS DIRECTOR 5.00 0.00 X 13500 0 0 ROBIN DOZIER OTTEN DIRECTOR 5.00 0.00 X 13500 0 0 RALPH MCELMURRY JR DDS DIRECTOR 5.00 0.00 X 13500 0 0 ANDREW DOLAN DIRECTOR 5.00 0.00 X 7875 0 0 LAWRENCE T PETERSON DIRECTOR 5.00 0.00 X 7875 0 0 1190805 2584894 871965 4 0 1 0 HUB INTERNATIONAL INSURANCE SERVICE 9990 JEFFERSON NE SUITE 101 ALBUQUERQUE NM 87190 COMMISSIONS 442292 DEWPOINT 300 WASHINGTON SQUARE LANSING MI 48933 IT CONSULTING 151164 MARKETING SOLUTIONS LLC 9426 INDIAN SCHOOL RD NE STE 2 ALBUQUERQUE NM 87112 MARKETING SERVICES 108460 3 DENTAL CARE REVENUE 524114 69113230 69113230 VISION CARE REVENUE 524298 398843 398843 69512073 798270 798270 54256969 49073404 5183565 5183565 5183565 DISCOUNT CARD INCOME 561000 23378 23378 23378 75517286 69136608 398843 5981835 X 427664 427664 737082 479103 257979 2301627 2135057 166570 164663 150644 14019 363971 331706 32265 154772 143993 10779 293014 293014 22108 22108 139842 139842 54307194 53991955 315239 220287 220287 575396 532653 42743 353524 266613 86911 315635 205163 110472 24665 17890 6775 19307 14384 4923 122768 85156 37612 65861 65861 PROCESSING FEES 2136519 2136519 COMMISSIONS 1850800 1850800 PREMIUM TAXES 1146535 1146535 MEMBERSHIP DUES & ASSOC 310526 197672 112854 50558 42586 7972 66104318 64376380 1727938 0 6012367 3259344 0 5191350 4429594 240236 169651 1211845 361939 972202 849906 57174083 62515377 7442920 7547135 228584 384316 74508719 81908346 1948465 1998022 836324 677403 2889098 1939730 5673887 4615155 X 68834832 77293191 68834832 77293191 74508719 81908346 X 9412968 -982485 27876 X 0 1 X 1 0 20568 2742 17826 1143652 311572 832080 47625 47625 0 849906 7547135 C 7547135 CLAIMS RESERVES 1318111 DUE TO AFFILIATE 621619 1939730 75377444 0 75377444 139842 139842 75517286 65964476 0 65964476 139842 139842 66104318 1 AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)(3) 70500 0 N/A N/A CHARITABLE DONATION ECONOMIC COUNCIL HELPING OTHERS INC 1921 EAST MURRAY DR FARMINGTON NM 87401 850196667 501(C)(3) 50000 0 N/A N/A FOOD PANTRY NATIONAL HISPANIC CULTURAL CENTER FOUNDATION 1701 4TH STREET SW ALBUQUERQUE NM 87102 850335056 501(C)(3) 12500 0 N/A N/A CHARITABLE DONATION NEW MEXICO STATE UNIVERSITY FOUNDATION PO BOX 3590 LAS CRUCES NM 88003 850170157 501(C)(3) 29664 0 N/A N/A DENTAL HYGIENE PROGRAM SPECIAL OLYMPICS NEW MEXICO INC 6600 PALOMAS NE ALBUQUERQUE NM 87109 850268084 501(C)(3) 25000 0 N/A N/A CHARITABLE DONATION THE COMMUNITY PANTRY PO BOX 520 GALLUP NM 87305 850460193 501(C)(3) 50000 0 N/A N/A COMMUNITY FOOD PANTRY DONATION UNIVERSITY OF NEW MEXICO FOUNDATION INC TWO WOODWARD CENTER ALBUQUERQUE NM 87102 850275408 501(C)(3) 115000 0 N/A N/A CHARITABLE DONATION & DENTAL HYGIENE PROGRAM ALBUQUERQUE HEALTH CARE FOR THE HOMELESS PO BOX 25445 ALBUQUERQUE NM 87125 850368993 501(C)(3) 75000 0 N/A N/A CHARITABLE DONATION 8 0 PART I, LINE 2: CONTRIBUTIONS ARE MADE AT THE ORGANIZATION'S DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF NEW MEXICO'S MISSION. 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 NEW MEXICO. X 1 1 X X X 0 1 0 0 0 0 0 1 0 AMY BASEL CFO 0 484754 0 525138 0 512985 0 421727 0 24738 0 1969342 0 483018 SUE ELLEN JENKINS VP GENERAL COUNSEL AND SECRETARY 0 485475 0 528528 0 23018 0 281774 0 15678 0 1334473 0 0 LOUIS VOLK III PRESIDENT & CEO 406315 0 90000 0 14148 0 24691 0 13349 0 548503 0 0 0 JOLOU TRUJILLO-OTTINO VP SALES AND MARKETING 202579 0 47500 0 1883 0 24242 0 16434 0 292638 0 0 0 NATHALIE CASADO STRATEGIC PLANNER 123117 0 28095 0 405 0 15890 0 16338 0 183845 0 0 0 DIANNE LEDESMA DIRECTOR OF OPERATIONS 134054 0 10518 0 1441 0 5940 0 11164 0 163117 0 0 0 PART I, LINE 1A TRAVEL FOR COMPANIONS RELATED TO TRAVEL FOR A SPOUSE. THIS AMOUNT WAS TREATED AS TAXABLE TO THE BOARD MEMBER OR EMPLOYEE. PART I, LINE 4B A 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 2021, AMY BASEL AND SUE ELLEN JENKINS ACCRUED BENEFITS AS PARTICIPANTS IN THE SERP PLAN. AMY BASEL BECAME VESTED IN A PORTION OF HER ACCRUED BENEFITS, AND, AS REQUIRED BY THE IRS, THE VESTED PORTION WAS TREATED AS TAXABLE WAGES DURING 2021. 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 ON PERFORMANCE AND THE FINANCIAL RESULTS OF THE ORGANIZATION. THIS BONUS WAS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. DAVID J MARTINEZ DDS PC DAVID MARTINEZ, DIRECTOR ON DDNM BOARD, OWNS AN INTEREST IN MARTINEZ DDS PC 678019 PAYMENTS FOR DENTAL SERVICES. 0 FORM 990, PART VI, SECTION A, LINE 6 DELTA DENTAL PLAN OF NEW MEXICO, INC. HAS A SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A BOARD MEMBERS ARE ELECTED BY THE PRESENT BOARD AND ARE APPROVED BY RENAISSANCE HEALTH SERVICE CORPORATION, THE SOLE CORPORATE MEMBER OF DELTA DENTAL PLAN OF NEW MEXICO, INC. 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, PRIOR TO FILING THE 990 WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ENTERPRISE'S VICE PRESIDENT AND GENERAL COUNSEL IS CHARGED WITH REVIEWING AND MONITORING ANY POTENTIAL CONFLICT OF INTEREST TRANSACTIONS. ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO REVIEW AND EXECUTE A CONFLICT OF INTEREST POLICY. THIS POLICY REQUIRES THAT ANY CONFLICTS OF INTEREST BE DISCLOSED ON AN ANNUAL BASIS, OR AT ANY OTHER TIME THAT THE PERSON EXECUTING THE POLICY BECOMES AWARE OF A SITUATION OR TRANSACTION THAT ACTUALLY OR POTENTIALLY CREATES A CONFLICT OF INTEREST. ALL CONFLICT OF INTEREST DISCLOSURE FORMS ARE INITIALLY REVIEWED BY THE VICE PRESIDENT AND GENERAL COUNSEL. IF A PROHIBITED TRANSACTION 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 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 CEO COMPENSATION IS SET BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. MARKET DATA PROVIDED BY OUTSIDE CONSULTANTS, TOWERS WATSON, IS USED TO VALIDATE THE REASONABLENESS OF THE TOTAL COMPENSATION PACKAGE. COMPENSATION FOR CERTAIN OFFICERS, INCLUDING THE CFO AND GENERAL COUNSEL IS DETERMINED AND PAID THROUGH A RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, INC. FORM 990, PART VI, SECTION C, LINE 19 DELTA DENTAL PLAN OF NEW MEXICO, INC. (DDNM) FILES ON A QUARTERLY AND ANNUAL BASIS COMPREHENSIVE FINANCIAL DOCUMENTS WITH THE NEW MEXICO OFFICE OF INSURANCE SUPERINTENDENT (OSI). OSI AND THE NEW MEXICO SECRETARY OF STATE HAVE ON FILE ALL GOVERNING DOCUMENTS. THE DDNM'S 990 FORM IS AVAILABLE TO THE PUBLIC UPON REQUEST. 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 824,138. MANAGEMENT AND GENERAL EXPENSES 315,239. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,139,377. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 53,167,817. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,167,817. FORM 990, PART XI, LINE 9: GAIN ON INVESTMENT IN RENAISSANCE HOLDING COMPANY 27,876. 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 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 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 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 OF TENNESSEE INC 240 VENTURE CIRCLE NASHVILLE TN 37228 620812197 PROVIDE DENTAL SERVICE PLANS TN 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 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 OF NORTH CAROLINA 4242 SIX FORKS ROAD RALEIGH NC 27609 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 4100 OKEMOS ROAD OKEMOS MI 48864 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 CHESME LLC 124 N BRIDGE ST DEWITT MI 48820 200061957 CAPITAL MANAGEMENT MI N/A 0 0 RED CEDAR INVESTMENT MANGAGEMENT LLC 333 BRIDGE STREET NW SUITE 601 GRAND RAPIDS MI 49546 462667997 CAPITAL MANAGEMENT MI N/A 0 0 DH LOGIX LLC 1000 SOUTH MIAMI TRAIL SARASOTA FL 34236 815265121 CAPITAL MANAGEMENT DE N/A 0 0 RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI DELTA DENTAL OF MICHIGAN C -13520 3901018 0.04000 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA PO BOX 30381 LANSING MI 48909 470397286 INSURANCE IN RENAISSANCE HOLDING COMPANY C -119616 5585258 0.04000 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK PO BOX 30381 LANSING MI 48909 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 33850 641319 0.04000 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 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 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 DELTA DENTAL PLAN OF MICHIGAN INC M 2756960 ACTUAL COST RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA M 226090 ACTUAL COST