2021-11-12T10:12:08-06:00 2020-12-31 381357951 PLANTE & MORANPLLC 1111 MICHIGAN AVE PO BOX 2500 EAST LANSING MI 488262500 990 2020-01-01 381791480 DELTA DENTAL PLAN OF MICHIGAN INC DELT 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 AMY BASEL CFO 5173496000 2021-11-09 1 AMY BASEL 999009999 DAVID LOWENTHAL CPA P00378651 5173326200 2021-11-09 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z GORAN JURKOVIC 4100 OKEMOS ROAD OKEMOS MI 48864 1209607975 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. 14 10 1107 0 38658781 1144760 0 0 948574673 884194894 15071350 29338836 85732 138284 963731755 913672014 3347678 15810717 0 0 113094836 129019124 0 0 0 842318595 753463943 958761109 898293784 4970646 15378230 732148013 824076353 173239271 182285417 558908742 641790936 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 774407173 15810717 845536113 PROMOTING DENTAL CAREDELTA DENTAL PLAN OF MICHIGAN, INC. IS A LEADING PREPAID 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 2020 BY PAYING OUT OVER $468 MILLION FOR DENTAL CARE, BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 8.7 MILLION CLAIMS WERE PROCESSED FOR OVER 5.6 MILLION MEMBERS.COST 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 $43 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 2020, DELTA DENTAL FUND PROVIDED GRANTS TOTALING NEARLY $3.5 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. IN 2020 THE COVID-19 PANDEMIC BEGAN; TO DO OUR PART TO HELP DURING THIS TIME OF CRISIS, WE FOCUSED OUR EFFORTS ON THE DENTAL PROVIDERS AND OUR CUSTOMERS. EVERY PRACTICING, LICENSED DENTIST IN MICHIGAN, OHIO AND INDIANA REGARDLESS OF WHETHER THEY PARTICIPATED IN THE DELTA DENTAL NETWORK OR NOT - WAS ELIGIBLE FOR A $1,000 CREDIT TOWARD DENTAL PRODUCTS AND/OR SERVICES FOR THEIR PRACTICE. DENTISTS REDEEMED THE CREDITS THROUGH A NATIONAL DENTAL SUPPLY DISTRIBUTOR. IN TOTAL, WE DISTRIBUTED MORE THAN $4.5 MILLION IN CREDITS. WE WERE ONE OF THE FIRST DENTAL BENEFITS ADMINISTRATORS TO PROVIDE CLIENTS A GRACE PERIOD DURING THE CRISIS. TO FURTHER ADDRESS FINANCIAL CHALLENGES OUR CUSTOMERS FACED, WE ESTABLISHED THE PANDEMIC RELIEF PROGRAM TO PROVIDE TWO ADDITIONAL BENEFITS, GROUP CUSTOMERS RECEIVED A ONE-MONTH CREDIT OF THEIR PREMIUM OR ADMINISTRATIVE FEES, AND SOME GROUP CUSTOMERS HAD THEIR RATE FROZEN FOR ONE YEAR. 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. 774407173 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 0 1 1 1 0 1 59021 0 1 1107 1 1 1 0 0 0 0 0 1 0 X 14 10 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 GORAN JURKOVIC CPA CEO, PRESIDENT 34.00 16.00 X 6042446 0 2529531 KENNETH THEIS SVP & CIO - THRU 9/20 50.00 0.00 X 3979119 0 49465 AMY BASEL SR VP, CFO, CRO & TREASURER 34.00 16.00 X 1439577 0 1045609 ANTHONY ROBINSON SVP & CHIEF MKT OFFICER 43.00 7.00 X 1055265 0 954777 TOBY HALL SVP, CHIEF ACTUARY & DATA OFFICER 50.00 0.00 X 724353 0 283380 SUE ELLEN JENKINS SR VP, CHIEF LEGAL OFF, CAO & SEC. 36.00 14.00 X 888568 0 43901 JEFF BOTKIN SVP, BUSINESS SERVICES 50.00 0.00 X 670091 0 96735 MICHAEL GILMORE FORMER VP, CHIEF INVEST OFFICER 0.00 50.00 X 441912 83382 61398 MARK BAUGHMAN SVP & CIO 50.00 0.00 X 497802 0 74748 JEFFREY JOHNSTON SVP, CHIEF SCIENCE OFFICER 43.00 7.00 X 480521 0 80976 JOSEPH ELLSWORTH VP & CHIEF TECH. OFFICER - THRU 10/20 50.00 0.00 X 451227 0 20741 MIKE BOBAK VP SALES 50.00 0.00 X 380121 0 50498 KUSHTRIM SHAQIRI VP GOVERNMENT PROGRAMS 50.00 0.00 X 394541 0 33381 THOMAS FLESZAR DDS MS FORMER DIRECTOR - THRU 5/19 0.00 2.00 X 403184 20000 0 MARGARET TRIMER VP STRATEGIC PARTNERSHIPS 50.00 0.00 X 340209 0 59923 DANIEL LOVEJOY DIRECTOR, SALES & ACCT MGT 50.00 0.00 X 337492 0 45685 JOSHUA S HOWIE VICE-CHAIRPERSON 5.00 5.00 X X 66000 157512 0 CHRISTOPHER T FISHER DIRECTOR 5.00 10.00 X 94215 107004 0 JOSEPH C HARRIS DDS DIRECTOR 5.00 6.00 X 154752 28041 0 STEPHEN A EKLUND DIRECTOR 5.00 6.00 X 62500 80841 0 ANN MARIE FLERMOEN DIRECTOR 5.00 11.00 X 60000 77000 0 SARA M DOLAN DIRECTOR 5.00 5.00 X 60000 60004 0 MELISSA STOLICKER DIRECTOR 5.00 5.00 X 60000 50004 0 DOUGLAS R ANDERSON DIRECTOR 5.00 5.00 X 60000 24996 19500 KURT D GALLINGER DIRECTOR 5.00 5.00 X 60000 24996 0 KELLY JUBB SCHEIDERER CHAIRPERSON 5.00 6.00 X X 52500 32000 0 RAYMOND F GIST DDS DIRECTOR 5.00 1.00 X 60000 2000 0 LARRY DEGROAT DIRECTOR 5.00 0.00 X 60000 0 0 PATRICK GILLESPIE DIRECTOR 5.00 0.00 X 60000 0 0 ANDREW KOTARBA DIRECTOR 5.00 0.00 X 60000 0 0 FRANK STUGLIN DIRECTOR - THRU 2/20 5.00 0.00 X 0 0 0 19496395 747780 5450248 252 1 1 0 DEWPOINT 300 WASHINGTON SQUARE SUITE 200 LANSING MI 48933 IT CONSULTING 54418514 THE CHRISTMAN COMPANY 208 N CAPITOL AVE LANSING MI 48933 CONSTRUCTION 9879109 WEST MONROE PARTNERS LLC 222 W ADAMS ST FL 11 CHICAGO IL 60606 CONSULTING 6299075 MESSA 1480 KENDALE BLVD EAST LANSING MI 48826 COMMISSIONS 2641628 ACCENTURE LLP 161 N CLARK ST CHICAGO IL 60601 CONSULTING 2454817 88 DENTAL CARE REVENUE 624100 754030592 754030592 ADMIN REIMBURSEMENT 900099 91505521 91505521 EXTERNAL SERVICES 524292 38658781 38658781 884194894 7375130 7375130 312396045 5503622 289625506 6310455 22770539 -806833 21963706 21963706 MISCELLANEOUS INCOME 900099 138284 138284 138284 913672014 845536113 38658781 29477120 X 15810717 15810717 13390300 8703694 4686606 82703640 52229707 30473933 13112051 7387192 5724859 13462023 8380411 5081612 6351110 4022945 2328165 12839802 11514327 1325475 3061802 3061802 229262 229262 120000 120000 1403724 1403724 633949335 612077224 21872111 3459116 2242502 1216614 12738606 8659901 4078705 22088050 12358963 9729087 3575851 3575851 1793391 1457433 335958 515301 324045 191256 4338 4338 17834321 4069498 13764823 1573577 1573577 FEDERAL & STATE TAX EXP 4595307 4595307 COMMISSIONS 20650319 20650319 FED HEALTH PROVIDER FEE 6390762 6390762 PROCESSING FEES 2799417 2799417 3841662 1718878 2122784 898293784 774407173 123886611 0 42438957 58242529 53905406 60459627 24152795 28169115 241379963 108280202 137199664 133099761 263757037 273517808 190693852 224991567 20000302 45595946 732148013 824076353 59236479 82138272 114002792 100147145 173239271 182285417 X 15744473 15744473 5122500 5122500 538041769 620923963 558908742 641790936 732148013 824076353 X 15378230 62998 67440966 X 0 1 X 1 0 2750 2750 1 UP WARD FUND 106 W ALLEGAN ST 200 LANSING MI 48933 461115229 1000 SCHOR LANSING FUND 300 FAIRVIEW AVENUE LANSING MI 48912 461990008 500 SEA CHANGE NOW 402 S WASHINGTON ST APT 207 LANSING MI 48933 843535326 1000 RUNNING MICHIGAN RIGHT 2876 COTTONWOOD DR UNIT A WATERFORD MI 48328 474519952 250 1 0 0 12609645 12609645 98300415 33954086 64346329 45429823 28291776 17138047 85040080 46034340 39005740 133099761 DDIC STOCK 200217 C INVESTMENT IN RHC 106117252 F INVESTMENT IN THE 4100 GROUP 118674098 F 224991567 ACCRUED INTEREST RECEIVABLE 662563 DUE FROM AFFILIATES 16580761 OTHER ASSETS 28352622 45595946 IBNR - CLAIM ADJUSTMENT RESERVES 19842874 UNEARNED PREMIUMS 27557854 PENSION AND POST RETIREMENT OBLIGATIONS 7578076 DUE TO AFFILIATES 2148055 RISK-SHARING PAYABLES 43020286 100147145 1 AMERICAN CANCER SOCIETY 20450 CIVIC CENTER DR SOUTHFIELD MI 48076 131788491 501(C)(3) 34000 CHARITABLE DONATION AMERICAN HEART ASSOCIATION 271 WOODLAND PASS STE 110 EAST LANSING MI 48823 135613797 501(C)(3) 281250 CHARITABLE DONATION AUTISM ALLIANCE OF MICHIGAN 30100 TELGRAPH RD BINGHAM FARMS MI 48025 270472137 501(C)(3) 50000 CHARITABLE DONATION CHARTER TOWNSHIP OF MERIDIAN PO BOX 1400 OKEMOS MI 48805 386007712 GOVT 50000 CHARITABLE DONATION CHILDRENS HOSPITAL OF MICHIGAN FOUNDATION 3011 W GRAND BLVD DETROIT MI 48202 320087353 501(C)(3) 350000 CHARITABLE DONATION CINNAIRE CORPORATION 1118 S WASHINGTON AVE LANSING MI 48910 383126310 501(C)(3) 250000 CHARITABLE DONATION COMMUNITIES IN SCHOOLS OF MICHIGAN 721 N CAPITOL STE 1 LANSING MI 48906 453736821 501(C)(3) 210000 CHARITABLE DONATION DELTA DENTAL FOUNDATION 4100 OKEMOS RD OKEMOS MI 48864 382337000 501(C)(3) 6000000 CHARITABLE DONATION DENTAL CLINICS NORTH 3434 M-119 STE H HARBOR SPRINGS MI 49740 824269744 501(C)(3) 7500 CHARITABLE DONATION DETROIT RIVERFRONT CONSERVANCY 600 RENAISSANCE CENTER DETROIT MI 48243 300125283 501(C)(3) 1000000 CHARITABLE DONATION ELE'S PLACE 1145 WEST OAKLAND LANSING MI 48915 382976751 501(C)(3) 130000 CHARITABLE DONATION FAIR AND EQUAL MICHIGAN 201 TOWNSEND LANSING MI 48933 844063744 501(C)(4) 50000 CHARITABLE DONATION FORGOTTEN HARVEST 21800 GREENFIELD RD OAK PARK MI 48237 382926476 501(C)(3) 200000 CHARITABLE DONATION GREATER LANSING FOODBANK 5303 S CEDAR ST LANSING MI 48911 382424756 501(C)(3) 35000 CHARITABLE DONATION HILLMAN ACCELERATOR 1311 VINE ST CINCINNATI OH 45202 820863876 501(C)(3) 828000 CHARITABLE DONATION IMPRESSION 5 200 MUSEUM DR LANSING MI 48933 237200548 501(C)(3) 100000 CHARITABLE DONATION JUNIOR ACHIVEVEMENT OF SOUTHEASTERN MI 577 E LARNED ST DETROIT MI 48226 381348535 501(C)(3) 100000 CHARITABLE DONATION JUVENILE DIABETES RESEARCH FOUNDATION 24359 NORTHWESTERN HWY SOUTHFIELD MI 48075 231907729 501(C)(3) 35300 CHARITABLE DONATION LANSING PROMISE 330 MARSHALL ST LANSING MI 48912 453363322 501(C)(3) 25000 CHARITABLE DONATION LEAP INC 1000 S WASHINGTON AVE LANSING MI 48933 208132313 501(C)(6) 35000 CHARITABLE DONATION MCLAREN GREATER LANSING HEALTHCARE 401 W GREENLAWN AVE LANSING MI 48910 382463637 501(C)(3) 500000 CHARITABLE DONATION MICHIGAN COLLEGE ALLIANCE 26555 EVERGREEN RD STE 1210 SOUTHFIELD MI 48076 381332962 501(C)(3) 10000 CHARITABLE DONATION MICHIGAN ECONOMIC DEVELOPMENT FOUNDATION PO BOX 13063 LANSING MI 48901 382527475 501(C)(3) 25000 CHARITABLE DONATION MICHIGAN MUNICIPAL LEAGUE FOUNDATION 1675 GREEN RD ANN ARBOR MI 48105 383019434 501(C)(3) 50000 CHARITABLE DONATION MICHIGAN STATE UNIVERSITY 220 TROWBRIDGE RD EAST LANSING MI 48824 386005984 GOVT 25000 CHARITABLE DONATION NATIONAL FOUNDATION OF DENTISTRY 1800 15TH ST STE 100 DENVER CO 80202 846129064 501(C)(3) 20000 CHARITABLE DONATION ON DEMAND KARE INC 2500 W BROADWAY LOUISVILLE KY 40211 831468041 501(C)(3) 75000 CHARITABLE DONATION PLAYWORKS EDUCATION ENGERGIZED 1423 BROADWAY PMB 161 OAKLAND CA 94120 943251867 501(C)(3) 15000 CHARITABLE DONATION ROAD TO MICHIGANS FUTURE PO BOX 12248 LANSING MI 48901 844298056 501(C)(4) 100000 CHARITABLE DONATION RUTH ELLIS CENTER INC 77 VICTOR ST HIGHLAND PARK MI 48203 383501697 501(C)(3) 10000 CHARITABLE DONATION SAMARITAS 8131 E JEFFERSON AVE DETROIT MI 48214 381360553 501(C)(3) 40000 CHARITABLE DONATION SPARROW FOUNDATION PO BOX 30480 LANSING MI 48909 386100687 501(C)(3) 190000 CHARITABLE DONATION TEAM NEO FOUNDATON 1111 SUPERIOR AVE CLEVELAND OH 44114 341885407 501(C)(3) 250000 CHARITABLE DONATION THE FIRST TEE OF LAKE ERIE LLC PO BOX 351142 TOLEDO OH 43635 465657531 501(C)(3) 36667 CHARITABLE DONATION UNITED WAY OF MIDLAND COUNTY 115 JEROME ST MIDLAND MI 48640 381434224 501(C)(3) 25000 CHARITABLE DONATION WEEKEND SURVIVAL KITS 319 W GRAND RIVER AVE WILLIAMSTON MI 48895 454444119 501(C)(3) 110000 CHARITABLE DONATION 32 4 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 MILLION TO BUILD A HEALTH THEMED PLAYGROUND ON DETROIT'S WEST RIVERFRONT. COMMUNITIES IN SCHOOLS 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. CINNAIRE CORPORATION - THIS CONTRIBUTION PROVIDED FUNDING FOR A COVID-19 RENT RELIEF FUND TO ASSIST WITH ALLEVIATING THE FINANCIAL BURDEN OF UNPAID RENT FOR INDIVIDUALS IN MICHIGAN AND INDIANA WHO FELL BEHIND ON RENT PAYMENTS DUE TO FACTORS RELATED TO THE PANDEMIC. TEAM NEO - WE FUNDED THE RESEARCH AND CREATION OF THE ALIGNING OPPORTUNITIES REPORT THAT EXAMINES THE JOBS THAT OHIO EMPLOYERS WILL BE HIRING FOR OVER THE NEXT 3-5 YEARS AND COMPARES THEM TO THE DEGREES THAT STUDENTS WILL BE GRADUATING FROM OHIO COLLEGES AND UNIVERSITIES WITHIN THE SAME TIME FRAME TO IDENTIFY GAPS AND CREATE A PLAN FOR ADDRESSING THEM. AMERICAN HEART ASSOCIATION - THIS WAS THE REMAINDER OF THE PAYMENTS FOR AN OVERALL $375,000 DONATION TO CREATE AND ADMINISTER THE WHOLE HEALTH MATTERS TOOLKIT AND VIRTUAL PROGRAM. THE TOOLKIT AND PROGRAM ADDRESS EMPLOYEE WELLNESS BOTH AT HOME AND IN THE WORKPLACE AND EXAMINE ASPECTS OF OVERALL HEALTH FROM MENTAL, TO HEART TO DENTAL AND MORE. CHILDREN'S HOSPITAL OF MICHIGAN FOUNDATION - THIS WAS A CAPITAL CONTRIBUTION TO THE JAMIE DANIELS FOUNDATION (A FUND WITHIN THE CHILDREN'S FOUNDATION) TO ASSIST WITH THE BUILDING OF A RESIDENTIAL OPIOID RECOVERY FACILITY IN SOUTHEASTERN MICHIGAN. MCLAREN GREATER LANSING - THIS WAS A CAPITAL CONTRIBUTION TO FUND THE WOMEN & CHILDREN'S WING ON THE 4TH FLOOR OF THE NEW HOSPITAL BEING CONSTRUCTED IN EAST LANSING. HILLMAN ACCELERATOR - THIS WAS A CONTRIBUTION TO FUND MINORITY ENTREPRENEURIAL BOOTCAMP PROGRAMS IN 5 MARKETS THROUGHOUT THE TRISTATE AREA AS WELL AS ONE ACCELERATOR PROGRAM IN DETROIT. FORGOTTEN HARVEST - DELTA DENTAL OF MICHIGAN CONTRIBUTED $200,000 TO THIS FOOD RESCUE/FOOD BANK PROGRAM OPERATING IN THE DETROIT AREA. THEY PROVIDE LUNCHES FOR CHILDREN PARTICIPATING IN THE DETROIT PUBLIC LIBRARY SUMMER CAMP PROGRAMS AS WELL AS OPERATE SEVERAL FARMERS MARKET STYLE FOOD BANK DISTRIBUTION SITES THROUGHOUT SOUTHEASTERN MICHIGAN. SPARROW FOUNDATION - DELTA DENTAL OF MICHIGAN CONTRIBUTED A TOTAL OF $190,00 TO THE SPARROW FOUNDATION IN 2020 TO SUPPORT THE MOTHER AND BABY MILK ROOM AT SPARROW HOSPITAL. ELE'S PLACE - IN 2020, 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 $25,000 IN FUNDING TO THE LANSING PROMISE IN 2020. 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. X X X 1 1 X X X X X 1 1 0 0 0 0 0 1 0 GORAN JURKOVIC CPA CEO, PRESIDENT 1428764 0 2252500 0 2361182 0 2505826 0 23705 0 8571977 0 2333907 0 KENNETH THEIS SVP & CIO - THRU 9/20 264528 0 3627560 0 87031 0 30699 0 18766 0 4028584 0 0 0 AMY BASEL SR VP, CFO, CRO & TREASURER 449514 0 454522 0 535541 0 1021904 0 23705 0 2485186 0 510043 0 ANTHONY ROBINSON SVP & CHIEF MKT OFFICER 518296 0 521760 0 15209 0 931072 0 23705 0 2010042 0 0 0 TOBY HALL SVP, CHIEF ACTUARY & DATA OFFICER 347020 0 355075 0 22258 0 268357 0 15023 0 1007733 0 0 0 SUE ELLEN JENKINS SR VP, CHIEF LEGAL OFF, CAO & SEC. 433948 0 437050 0 17570 0 28878 0 15023 0 932469 0 0 0 JEFF BOTKIN SVP, BUSINESS SERVICES 329379 0 327850 0 12862 0 80133 0 16602 0 766826 0 0 0 MICHAEL GILMORE FORMER VP, CHIEF INVEST OFFICER 318133 58191 114625 25000 9154 191 37694 0 19753 3951 499359 87333 0 0 MARK BAUGHMAN SVP & CIO 335433 0 146500 0 15869 0 58146 0 16602 0 572550 0 0 0 JEFFREY JOHNSTON SVP, CHIEF SCIENCE OFFICER 332610 0 139300 0 8611 0 57271 0 23705 0 561497 0 0 0 JOSEPH ELLSWORTH VP & CHIEF TECH. OFFICER - THRU 10/2 266279 0 111829 0 73119 0 0 0 20741 0 471968 0 0 0 MIKE BOBAK VP SALES 188724 0 188295 0 3102 0 26793 0 23705 0 430619 0 0 0 KUSHTRIM SHAQIRI VP GOVERNMENT PROGRAMS 344551 0 49497 0 493 0 9676 0 23705 0 427922 0 0 0 THOMAS FLESZAR DDS MS FORMER DIRECTOR - THRU 5/19 403184 20000 0 0 0 0 0 0 0 0 403184 20000 0 0 MARGARET TRIMER VP STRATEGIC PARTNERSHIPS 241843 0 88000 0 10366 0 36218 0 23705 0 400132 0 0 0 DANIEL LOVEJOY DIRECTOR, SALES & ACCT MGT 137244 0 199310 0 938 0 28750 0 16935 0 383177 0 0 0 JOSHUA S HOWIE VICE-CHAIRPERSON 66000 157512 0 0 0 0 0 0 0 0 66000 157512 0 0 CHRISTOPHER T FISHER DIRECTOR 94215 107004 0 0 0 0 0 0 0 0 94215 107004 0 0 JOSEPH C HARRIS DDS DIRECTOR 154752 28041 0 0 0 0 0 0 0 0 154752 28041 0 0 PART I, LINE 1A THE ORGANIZATION ALLOWS FOR FIRST CLASS TRAVEL IN CERTAIN CIRCUMSTANCES AS NEEDED FOR BUSINESS PURPOSES FOR ONLY THE MOST SENIOR EXECUTIVES AND KEY EMPLOYEES. THIS AMOUNT WAS TREATED AS NONTAXABLE TO THESE INDIVIDUALS. TRAVEL FOR COMPANIONS RELATED TO TRAVEL FOR A SPOUSE. THIS AMOUNT WAS TREATED AS TAXABLE TO THE BOARD MEMBER OR EMPLOYEE. DUE TO THE COVID-19 PANDEMIC, THERE WAS NO TRAVEL FOR COMPANIONS IN 2020. VARIOUS INDIVIDUALS ON SCHEDULE J ARE ELIGIBLE FOR REIMBURSEMENT OF SUBSTANTIATED HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES THAT HAVE A BUSINESS PURPOSE. THIS BENEFIT IS NOT TAXABLE BUT THE EXPENSE MUST BE SUBSTANTIATED AS A BUSINESS EXPENSE. 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, LINES 4A-B PART I, LINE 4A: IN 2020, JOSEPH ELLSWORTH RECEIVED SEVERENCE PAY IN THE AMOUNT OF $70,125. 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 2020, GORAN JURKOVIC, AMY BASEL, TOBY HALL, AND ANTHONY ROBINSON 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 2020. 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. SCHEDULE J, PART II: THOMAS FLESZAR, A FORMER EXECUTIVE OF DDMI, RECEIVED A ONE-TIME LUMP SUM SETTLEMENT FOR A NON-QUALIFIED POST-RETIREMENT BENEFIT. DUE TO THE FACT THAT HE WAS REPORTED AS A DIRECTOR OF THE COMPANY WITHIN THE LAST FIVE YEARS, THE PAYMENT IS REPORTED AS REQUIRED BY IRS RULES. BRIAN JACOBSON BROTHER OF FORMER DDMI BOARD MEMBER JED JACOBSON 268038 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 COLE JACOBSON BROTHER OF FORMER DDMI BOARD MEMBER JED JACOBSON 145973 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 0 BRIAN BATTAGLIERI SON OF DDMI FORMER KEY EMPLOYEE LUIGI BATTAGLIERI 173231 EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN 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 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 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 EXECUTIVES IS DETERMINED BY THE CEO IN CONSULTATION WITH THE VP OF HUMAN RESOURCES AND THE SR VP, 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 2020. 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 36,010,507. MANAGEMENT AND GENERAL EXPENSES 15,824,839. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,835,346. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 8,787,191. MANAGEMENT AND GENERAL EXPENSES 6,047,272. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,834,463. DENTAL CONSULTANT: PROGRAM SERVICE EXPENSES 1,484,742. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,484,742. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 565,794,784. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 565,794,784. FORM 990, PART XI, LINE 9: GAIN ON EQUITY IN SUBSIDIARIES 32,976,388. PENSION RELATED CHANGES 34,464,578. 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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