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DELTA DENTAL PLAN OF NEW MEXICO INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
DELTA DENTAL PLAN OF NEW MEXICO INC (EIN 85-0224562)
Tax period
2019-01-01 to 2019-12-31
Filed
2020-11-11
IRS object ID
202003169349304460
Schema version
2019v5.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2020-11-11T14:12:46-06:00ReturnTs
Tax Period End2019-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN381357951PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11111 MICHIGAN AVE STE 100AddressLine1Txt
CityEAST LANSINGCityNm
State AbbreviationMIStateAbbreviationCd
ZIP48823ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN850224562EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL PLAN OF NEW MEXICO INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlDELTBusinessNameControlTxt
Phone5058557114PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 SUN AVE NE NO 400AddressLine1Txt
CityALBUQUERQUECityNm
State AbbreviationNMStateAbbreviationCd
ZIP87109ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAMY BASELPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
Phone5058557114PhoneNum
Signature2020-11-09SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDAVID LOWENTHAL CPAPreparerPersonNm
PTINP00378651PTIN
Phone5173326200PhoneNum
Preparation2020-11-09PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address68.62.32.134IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-11-09IPDt
IP Tm14:14:29IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdDA39A3EE5E6B4B0D3255BFEF95601890AFD80709AtSubmissionCreationDeviceId
At Submission Filing Device IdAFBDF4DF54CCD05CFBA4AEDC275F7F3808ECB98BAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2021-04-22 16:20:28ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeYes (X)AddressChangeInd
Principal OfficerLOUIS VOLK IIIPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 SUN AVE NE NO 400AddressLine1Txt
CityALBUQUERQUECityNm
State AbbreviationNMStateAbbreviationCd
ZIP87109ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$96,326,919GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressHTTP://WWW.DELTADENTALNM.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1971FormationYr
Legal Domicile StateNMLegalDomicileStateCd
Activity Or MissionDELTA 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.ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee43TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$114,428,173PYProgramServiceRevenueAmt
CY Program Service Revenue$57,625,646CYProgramServiceRevenueAmt
PY Investment Income$1,440,950PYInvestmentIncomeAmt
CY Investment Income$1,725,102CYInvestmentIncomeAmt
PY Other Revenue$25,539PYOtherRevenueAmt
CY Other Revenue$23,096CYOtherRevenueAmt
PY Total Revenue$115,894,662PYTotalRevenueAmt
CY Total Revenue$59,373,844CYTotalRevenueAmt
PY Grants And Similar Paid$374,993PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$235,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$3,734,940PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$3,539,298CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$108,305,923PYOtherExpensesAmt
CY Other Expenses$51,576,210CYOtherExpensesAmt
PY Total Expenses$112,415,856PYTotalExpensesAmt
CY Total Expenses$55,350,508CYTotalExpensesAmt
PY Revenues Less Expenses$3,478,806PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$4,023,336CYRevenuesLessExpensesAmt
Total Assets BOY$56,147,641TotalAssetsBOYAmt
Total Assets EOY$62,375,115TotalAssetsEOYAmt
Total Liabilities BOY$6,596,367TotalLiabilitiesBOYAmt
Total Liabilities EOY$5,022,907TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$49,551,274NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$57,352,208NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionDELTA 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.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$53,572,867ExpenseAmt
Grant$235,000GrantAmt
Revenue$57,648,742RevenueAmt
DescPROMOTING DENTAL CAREDELTA DENTAL OF NEW MEXICO, INC. IS A LEADING GROUP 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 2019 BY PAYING OUT OVER $43 MILLION IN CLAIMS AND BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 640,000 CLAIMS WERE PROCESSED FOR OVER 334,000 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 ALLOW 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.Desc
Total Program Service Expenses$53,572,867TotalProgramServiceExpensesAmt
Described In Section501c30DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntYes (1)BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document4896IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee43EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member5IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonAMY BASEL CFOPersonNm
Phone5173496000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14100 OKEMOS ROADAddressLine1Txt
CityOKEMOSCityNm
State AbbreviationMIStateAbbreviationCd
ZIP48864ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeIndIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
AMY BASEL
CFO1.0049.00Yes (X)$0$861,242$857,739
EDWARD J LOPEZ JR
FORMER PRESIDENT & CEO (THRU 12/18)0.000.00$659,600$0$0Yes (X)
SUE ELLEN JENKINS
VP & GENERAL COUNSEL1.0049.00Yes (X)$0$492,441$42,056
THOMAS J FLESZAR DDS MS
INTERIM PRESIDENT & CEO (THRU 9/19)40.0012.00$232,000$67,415$0Yes (X)
JOLOU TRUJILLO-OTTINO
VP SALES AND MARKETING50.000.00Yes (X)$202,115$0$41,856
JOHN MARTINEZ
DIRECTOR PUBLIC AFFAIRS & COMM.50.000.00$109,432$0$34,520Yes (X)
NATHALIE CASADO
DIRECTOR FIN. & BUS. INTELLIGENCE50.000.00$115,055$0$23,505Yes (X)
RAQUEL RIVAS
DIRECTOR STR. PROJ. & BUS. PROCESSES50.000.00$106,414$0$14,225Yes (X)
LOUIS VOLK III
PRESIDENT & CEO50.000.00Yes (X)$109,090$0$2,664Yes (X)
ROBERT L SIMMONS
CHAIRPERSON5.005.00Yes (X)$57,363$15,281$0Yes (X)
STEPHEN B CHREIST
IMMEDIATE PAST CHAIRPERSON5.005.00Yes (X)$43,100$12,500$0Yes (X)
JAMES TRUJILLO
VICE CHAIRPERSON5.000.00Yes (X)$24,626$0$0Yes (X)
CHRISTINE N NATHE RDH MS
SECRETARY/TREASURER5.000.00Yes (X)$23,500$0$0Yes (X)
RALPH MCELMURRY DDS
DIRECTOR5.000.00$15,983$0$0Yes (X)
DAVID JAMES MARTINEZ DDS
DIRECTOR5.000.00$12,100$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,710,378TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,448,879TotReportableCompRltdOrgAmt
Total Other Compensation$1,016,565TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K6IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
HUB INTERNATIONAL INSURANCE SERVICE
9990 JEFFERSON NE SUITE 101ALBUQUERQUENM87190COMMISSIONS$343,845
DEWPOINT
300 WASHINGTON SQUARELANSINGMI48933IT CONSULTING$267,581
MARKETING SOLUTIONS LLC
9426 INDIAN SCHOOL RD NEALBUQUERQUENM87112MARKETING$154,395
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescDENTAL CARE REVENUEDesc
Business524114BusinessCd
Total Revenue Column$57,625,646TotalRevenueColumnAmt
Related Or Exempt Func Income$57,625,646RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$57,625,646TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,507,520TotalRevenueColumnAmt
Exclusion$1,507,520ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$37,170,657SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$36,953,075SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$217,582SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$217,582TotalRevenueColumnAmt
Exclusion$217,582ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescDISCOUNT CARD INCOMEDesc
Business900099BusinessCd
Total Revenue Column$23,096TotalRevenueColumnAmt
Related Or Exempt Func Income$23,096RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$23,096OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$59,373,844TotalRevenueColumnAmt
Related Or Exempt Func Income$57,648,742RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$1,725,102ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$235,000TotalAmt
Program Services$235,000ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$564,168TotalAmt
Program Services$366,709ProgramServicesAmt
Management And General$197,459ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$2,203,383TotalAmt
Program Services$1,902,100ProgramServicesAmt
Management And General$301,283ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$208,344TotalAmt
Program Services$160,101ProgramServicesAmt
Management And General$48,243ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$381,017TotalAmt
Program Services$334,624ProgramServicesAmt
Management And General$46,393ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$182,386TotalAmt
Program Services$152,196ProgramServicesAmt
Management And General$30,190ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$26,052TotalAmt
Management And General$26,052ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$60,835TotalAmt
Management And General$60,835ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$102,162TotalAmt
Management And General$102,162ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$44,752,174TotalAmt
Program Services$44,419,604ProgramServicesAmt
Management And General$332,570ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$236,651TotalAmt
Program Services$235,051ProgramServicesAmt
Management And General$1,600ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$572,007TotalAmt
Program Services$509,885ProgramServicesAmt
Management And General$62,122ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$283,531TotalAmt
Program Services$212,046ProgramServicesAmt
Management And General$71,485ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$200,521TotalAmt
Program Services$130,334ProgramServicesAmt
Management And General$70,187ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$242,480TotalAmt
Program Services$171,237ProgramServicesAmt
Management And General$71,243ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$17,222TotalAmt
Program Services$13,586ProgramServicesAmt
Management And General$3,636ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$75,524TotalAmt
Program Services$52,465ProgramServicesAmt
Management And General$23,059ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$44,304TotalAmt
Management And General$44,304ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
COMMISSIONS$1,819,086$1,819,086
PROCESSING FEES$1,531,549$1,531,549
PREMIUM TAXES$1,050,056$1,050,056
MEMBERSHIP DUES & ASSOC$307,016$26,723$280,293

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$255,040TotalAmt
Program Services$250,515ProgramServicesAmt
Management And General$4,525ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$55,350,508TotalAmt
Program Services$53,572,867ProgramServicesAmt
Management And General$1,777,641ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,500,802BOYAmt
EOY$1,996,461EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$2,747,502BOYAmt
EOY$2,185,113EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,811,179BOYAmt
EOY$3,652,263EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$113,305BOYAmt
EOY$160,424EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$767,643LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$616,533LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$226,634BOYAmt
EOY$151,110EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$39,362,696BOYAmt
EOY$48,854,430EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$5,059,878BOYAmt
EOY$5,087,708EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,325,645BOYAmt
EOY$287,606EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$56,147,641BOYAmt
EOY$62,375,115EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,933,806BOYAmt
EOY$1,842,328EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$1,259,779BOYAmt
EOY$1,020,149EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,402,782BOYAmt
EOY$2,160,430EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$6,596,367BOYAmt
EOY$5,022,907EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$49,551,274BOYAmt
EOY$57,352,208EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$49,551,274BOYAmt
EOY$57,352,208EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$56,147,641BOYAmt
EOY$62,375,115EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$4,023,336ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$3,769,042NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$8,556OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$149,500OtherCostOrOtherBasisAmt
Depreciation$140,888DepreciationAmt
Book Value$8,612BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$570,518OtherCostOrOtherBasisAmt
Depreciation$434,881DepreciationAmt
Book Value$135,637BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$47,625OtherCostOrOtherBasisAmt
Depreciation$40,764DepreciationAmt
Book Value$6,861BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$151,110TotalBookValueLandBuildingsAmt

Closely Held Equity Interests CloselyHeldEquityInterestsGrp

FieldValueIRS element (for citing)
Book Value$5,087,708BookValueAmt
Method ValuationCMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$5,087,708TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
CLAIMS RESERVES$1,203,000
DUE TO AFFILIATE$957,430
FieldValueIRS element (for citing)
Total Liability$2,160,430TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$59,268,633TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$59,268,633RevenueSubtotalAmt
Investment Expenses Not Incld$105,211InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt$105,211RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$59,373,844TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$55,245,297TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$55,245,297ExpensesSubtotalAmt
Investment Expenses Not Incld2$105,211InvestmentExpensesNotIncld2Amt
Expenses Not Rpt Fincl Stmt$105,211ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$55,350,508TotalExpensesPerForm990Amt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (9 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
SPECIAL OLYMPICS NEW MEXICO INC
6600 PALOMAS NEALBUQUERQUENM87109850268084501(C)(3)$10,000CHARITABLE DONATION
AMERICAN HEART ASSOCIATION
7272 GREENVILLE AVEDALLASTX75231135613797501(C)(3)$70,000CHARITABLE DONATION
NEW MEXICO DENTAL FOUNDATION
9201 MONTGOMERY BLVD NEALBUQUERQUENM87111743146433501(C)(3)$10,000CHARITABLE DONATION
ALBUQUERQUE HEALTH CARE FOR THE HOMELESS
PO BOX 25445ALBUQUERQUENM87125850368993501(C)(3)$25,000CHARITABLE DONATION
UNIVERSITY OF NEW MEXICO FOUNDATION INC
TWO WOODWARD CENTERALBUQUERQUENM87102850275408501(C)(3)$50,000CHARITABLE DONATION
NATIONAL HISPANIC CULTURAL CENTER FOUNDATION
1701 4TH STREET SWALBUQUERQUENM87102850335056501(C)(3)$20,000CHARITABLE DONATION
NEW MEXICO STATE UNIVERSITY FOUNDATION
PO BOX 3590LAS CRUCESNM88003850170157501(C)(3)$30,000CHARITABLE DONATION & DENTAL HYGIENE PROGRAM
GIRLS INCORPORATED OF SANTA FE
301 HILLSIDE AVESANTA FENM87501850129250501(C)(3)$10,000CHARITABLE DONATION
THE ROTARY DEL SOL FOUNDATION INC
PO BOX 93578ALBUQUERQUENM87199850447910501(C)(3)$10,000CHARITABLE DONATION
FieldValueIRS element (for citing)
Total501c3 Org9Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationCONTRIBUTIONS 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.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsYes (X)TravelForCompanionsInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Independent ConsultantYes (X)IndependentConsultantInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (1)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
AMY BASEL
CFO$0$407,808$0$436,800$0$16,634$0$833,558$0$24,181$0$1,718,981$0$0
EDWARD J LOPEZ JR
FORMER PRESIDENT & CEO (THRU 12/18)$0$0$0$0$659,600$0$0$0$0$0$659,600$0$0$0
SUE ELLEN JENKINS
VP & GENERAL COUNSEL$0$371,616$0$110,775$0$10,050$0$26,731$0$15,325$0$534,497$0$0
THOMAS J FLESZAR DDS MS
INTERIM PRESIDENT & CEO (THRU 9/19)$232,000$67,415$0$0$0$0$0$0$0$0$232,000$67,415$0$0
JOLOU TRUJILLO-OTTINO
VP SALES AND MARKETING$143,589$0$57,267$0$1,259$0$20,637$0$21,219$0$243,971$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1ATRAVEL FOR COMPANIONS RELATED TO TRAVEL FOR A SPOUSE. THIS AMOUNT WAS TREATED AS TAXABLE TO THE BOARD MEMBER OR EMPLOYEE.
PART I, LINES 4A-BA 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 2019, AMY BASEL ACCRUED BENEFITS AS A PARTICIPANT IN THE SERP PLAN, BUT DID NOT RECEIVE A DISTRIBUTION. IN 2019, EDWARD LOPEZ RECEIVED A SEVERANCE PAYMENT OF $659,600 FROM THE ORGANIZATION.
PART I, LINE 7AS 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.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonDAVID J MARTINEZ DDS PCPersonNm
FieldValueIRS element (for citing)
Relationship DescriptionDAVID MARTINEZ, DIRECTOR ON DDNM BOARD, OWNS AN INTEREST IN MARTINEZ DDS PCRelationshipDescriptionTxt
Transaction$725,901TransactionAmt
TransactionPAYMENTS FOR DENTAL SERVICES.TransactionDesc
Sharing Of Revenues0SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART I, LINE 12 AND 18:AS OF JANUARY 1, 2019, THE COMPANY ADOPTED FASB ASU NO. 2014-09, REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606). THE ASU IS BASED ON THE PRINCIPLE THAT REVENUE IS RECOGNIZED TO DEPICT THE TRANSFER OF GOODS OR SERVICES TO CUSTOMERS IN AN AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE ENTITY EXPECTS TO BE ENTITLED IN EXCHANGE FOR THOSE GOODS OR SERVICES. THE COMPANY'S REVENUE CONSISTS OF DENTAL CARE CONTRACTS, ADMINISTRATIVE SERVICE CONTRACTS, AND ADMINISTRATIVE FEES. ADMINISTRATIVE SERVICES CONTRACTS IN PLACE WITH CUSTOMERS PROVIDE ACCESS TO A NETWORK OF DENTAL PROVIDERS AND SERVICE COST PROCESSING SERVICES. AS A RESULT, ADMINISTRATIVE SERVICES CONTRACTS ARE NOT ACCOUNTED FOR AS DENTAL CARE CONTRACTS. PRIOR TO THE ADOPTION OF ASU 2014-09, ADMINISTRATIVE SERVICE CONTRACTS WERE REPORTED ON A GROSS BASIS. UPON ADOPTION OF ASU 2014-09 ADMINISTRATIVE SERVICE CONTRACTS ARE REPORTED NET AND ONLY THE ADMINISTRATIVE FEES ARE REPORTED AS DENTAL CARE REVENUE. THE CHANGE IN ACCOUNTING PRINCIPLE HAD NO CUMULATIVE EFFECT ON JANUARY 1, 2018 NET ASSETS. DURING 2019, THE COMPANY PAID DENTAL SERVICE EXPENSES, AND RECEIVED REIMBURSEMENT, TOTALING $59,047,049, WHICH HAS BEEN EXCLUDED FROM PROGRAM SERVICE REVENUE AND PURCHASED DENTAL SERVICE EXPENSE IN ACCORDANCE WITH ASU 2014-09.
FORM 990, PART VI, SECTION A, LINE 6DELTA DENTAL PLAN OF NEW MEXICO, INC. HAS A SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7ABOARD 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 7BTHE 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 11BTHE 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 12CTHE 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 15CEO 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 19DELTA 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 VIICERTAIN 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 11GCONTRACT LABOR: PROGRAM SERVICE EXPENSES 998,140. MANAGEMENT AND GENERAL EXPENSES 332,570. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,330,710. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 43,421,464. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,421,464.
FORM 990, PART XI, LINE 9:GAIN ON INVESTMENT IN RENAISSANCE HOLDING COMPANY 8,556.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (12 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
RENAISSANCE HEALTH SERVICE CORPORATION
PO BOX 30416LANSINGMI489097916381675667PROMOTING DENTAL CAREMI501(C)(4)N/AN/A0
DELTA DENTAL PLAN OF MICHIGAN INC
4100 OKEMOS ROADOKEMOSMI48864381791480PROVIDE DENTAL SERVICE PLANSMI501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL PLAN OF INDIANA INC
PO BOX 30416LANSINGMI489097916351545647PROVIDE DENTAL SERVICE PLANSIN501(C)(4)N/A0DELTA DENTAL PLAN OF MICHIGAN INC
DELTA DENTAL PLAN OF OHIO INC
PO BOX 30416LANSINGMI489097916310685339PROVIDE DENTAL SERVICE PLANSOH501(C)(4)N/A0DELTA DENTAL PLAN OF MICHIGAN INC
DELTA DENTAL OF TENNESSEE INC
240 VENTURE CIRCLENASHVILLETN37228620812197PROVIDE DENTAL SERVICE PLANSTN501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL OF KENTUCKY INC
10100 LINN STATION ROAD NO 700LOUISVILLEKY40223610659432PROVIDE DENTAL SERVICE PLANSKY501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL FUND
PO BOX 30416LANSINGMI489097916382337000SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMSMI501(C)(3)LINE 12A, I0DELTA DENTAL PLAN OF MICHIGAN INC
DELTA DENTAL OF NORTH CAROLINA
4242 SIX FORKS ROADRALEIGHNC27609561018068PROVIDE DENTAL SERVICE PLANSNC501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL PLAN OF ARKANSAS INC
1513 COUNTRY CLUB RDSHERWOODAR72120710561140PROVIDE DENTAL SERVICE PLANSAR501(C)(4)N/A0RENAISSANCE HEALTH SERVICE CORPORATION
DELTA DENTAL OF ARKANSAS FOUNDATION INC
1513 COUNTRY CLUB RDSHERWOODAR72120261569324EMPHASIZE DENTAL HEALTH IN COMMUNITIESAR501(C)(3)PF0DELTA DENTAL OF ARKANSAS
RENAISSANCE FAMILY FOUNDATION INC
4100 OKEMOS ROADOKEMOSMI48864461376165EMPHASIZE DENTAL HEALTH IN COMMUNITIESIN501(C)(3)PF0RENAISSANCE HOLDING COMPANY
SMILE 180 FOUNDATION
240 VENTURE CIRCLENASHVILLETN37228471654054EMPHASIZE DENTAL HEALTH IN COMMUNITIESTN501(C)(3)LINE 12A, I0DELTA DENTAL OF TENNESSEE INC

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1CHESME LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1124 N BRIDGE STAddressLine1Txt
CityDEWITTCityNm
State AbbreviationMIStateAbbreviationCd
ZIP48820ZIPCd
FieldValueIRS element (for citing)
EIN200061957EIN
Primary ActivitiesCAPITAL MANAGEMENTPrimaryActivitiesTxt
Legal Domicile StateMILegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
RENAISSANCE HOLDING COMPANY
PO BOX 30381LANSINGMI48909412177193HOLDING COMPANYMIDELTA DENTAL OF MICHIGANC-$113,955$1,848,2670.040000
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA
PO BOX 30381LANSINGMI48909470397286INSURANCEINRENAISSANCE HOLDING COMPANYC$192,330$4,714,0300.040000
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK
PO BOX 30381LANSINGMI48909134098096INSURANCENYRENAISSANCE HOLDING COMPANYC$8,464$493,9160.040000
FORE HOLDING CORPORATION
240 VENTURE CIRCLENASHVILLETN37228204116122HOLDING COMPANYTNC0N/A
DENTAL CHOICE INC
10100 LINN STATION RD 700LOUISVILLEKY402233861611105118PROVIDE DENTAL SERVICE PLANSKYC0N/A
DENTAL CHOICE AGENCY INC
10100 LINN STATION RD 700LOUISVILLEKY402233861611336003PRIMARY GENERAL AGENCY FOR DDKY AND DENTAL CHOICEKYC0N/A
OMEGA ADMINISTRATORS INC
1513 COUNTRY CLUB ROADSHERWOODAR72120043740469PROVIDING THIRD-PARTY ADMINISTRATIVE SERVICESARC0N/A
THE 4100 GROUP
4100 OKEMOS ROADOKEMOSMI48864472557772INVESTMENT IN SUBSIDIARIESMIC0N/A
DEWPOINT INC
300 S WASHINGTON SQUARELANSINGMI48933383300595IT CONSULTINGMIC0N/A
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (1)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
DELTA DENTAL PLAN OF MICHIGAN INC
M$2,248,402ACTUAL COST
DELTA DENTAL OF NORTH CAROLINA
A$2,045ACTUAL COST