2018-11-14T14:51:06-07:00 2017-12-31 990 2017-01-01 710561140 DELTA DENTAL PLAN OF ARKANSAS INC DELT 5018353400 1513 Country Club Road Sherwood AR 72120 Deborah Ann Lowtharp VP Finance and CFO 5019921616 2018-09-12 12.237.229.2 2017 2019-02-21 02:37:17Z Debi Lowtharp 1513 Country Club Road Sherwood AR 72120 527114680 0 X www.deltadentalar.com X 1982 AR See Schedule O. 13 10 245 0 7657044 1492512 0 0 493428204 503280522 3760895 1762000 4211063 8073561 501400162 513116083 3393744 2817261 445621057 456815237 14228756 16251212 0 0 0 29065258 36005710 492308815 511889420 9091347 1226663 145564936 153487450 50073842 52098058 95491094 101389392 Promote oral health and vision health in the state of Arkansas and to improve the awareness and education of the public on oral and vision health matters. 0 0 493900621 503756858 Promote the oral health care of the community through group and individual dental insurance contracts and third party dental claims administration 0 0 0 493900621 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 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 74997 0 1 245 1 1 1 0 0 0 0 0 X 13 10 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Deborah Lowtharp 5019921634 1513 Country Club Road Sherwood AR 72120 Susie Smith Director 8 5 X 18724 10420 59455 Dr Mel Collazo Chairman 8 5 X 76012 25008 0 Arnoud Krijt Director 8 0 X 2447 0 19375 Doug Anderson Director 8 0 X 21142 124255 18000 Terri Miller Director 8 5 X 28108 0 0 Dr Troy John Dryden Bartels Director 8 0 X 218663 0 41026 Sarah Clark Secretary 8 0 X 29425 0 0 R Mark Bailey Director 8 0 X 136096 0 7196 Wayne Callahan Vice Chairman 8 0 X 28080 14588 0 Phillip Cox Treasurer 8 0 X 11869 0 14339 Joe Thompson Director 8 0 X 24259 0 0 Cindy Boyle Director 8 0 X 1260 0 5849 Tamika Edwards Director 8 0 X 6188 0 0 Ed Choate President & CEO 60 0 X 621079 0 151517 Phyllis Rogers Senior VP & CFO 60 0 X X 323832 0 77069 Allen Moore VP Information Technology 60 0 X X 242070 0 817 James Couch VP and General Counsel 60 0 X 253988 0 47290 Ashley Riddle VP, Sales and Account Managment 60 0 X 172013 0 33017 Kelly Carney VP, Human Resources 60 0 X 158870 0 38625 Robert Mason VP, Professional Relations 60 0 X 222401 0 38215 Ebb Johnson VP and Executive Director of Foundation 60 0 X 154119 0 31088 Dave Hawsey VP, Marketing 60 0 X 190345 0 37981 Lynn Harbert Senior VP & COO 60 0 X 281028 0 70939 Maxine Fricioni Director, Projects & Business Processes 60 0 X 115650 0 26992 Louis Crow Dental Consultant 40 0 X 144715 0 34029 Jeb Steen Senior Account Executive 60 0 X 197093 0 27240 Robert Jones Dental Consultant 60 0 X 128085 0 17414 Danielle Collie Account Executive 60 0 X 133826 0 9968 Jim Johnston Director 8 0 X 14450 0 0 3955837 174271 807441 22 1 1 0 Superior 939 Elkridge Landing Road Linthicum Heights MD 21090 Vision claims and fees 4236060 The Hatcher Agency PO Box 3505 Little Rock AR 72203 Brokers 3522726 Billy Randall Machen DDS 4220 N Rodney Parham Rd Little Rock AR 72212 Dental Services 2046072 Arkansas Dental Professionals 2909 S 74th St Fort Smith AR 72903 Provider Fees 1982578 United Healthcare Insurance Company Dept CH 10151 Palatine IL 600550151 Health insurance carrier for employees 1887394 559 0 Dental Benefits 524298 119851012 119851012 0 0 Dental Reinsurance 524298 41993856 41993856 0 0 Dental ASC & Admin Income 524298 341435654 341435654 0 0 0 0 0 0 503280522 1115740 0 0 1115740 0 0 0 0 0 0 0 0 0 0 14168521 476336 13998597 0 169924 476336 646260 476336 0 169924 Vision Benefits 524298 7657044 0 7657044 0 Other Income 900099 416517 0 0 416517 0 0 0 0 8073561 513116083 503756858 7657044 1702181 2817261 2817261 456815237 456815237 3671833 3671833 0 8244667 4946800 3297867 1459434 1459434 2028285 1216971 811314 846993 846993 257210 154326 102884 60672 60672 173849 173849 212906 212906 16686766 15018089 1668677 887673 887673 2416178 1449707 966471 7000059 6300053 700006 530639 530639 520640 312384 208256 315902 284312 31590 495057 495057 718240 718240 154605 154605 BOD Expenses 113944 0 113944 Taxes 1258932 0 1258932 Data Processing 192061 0 192061 Medicaid 3867241 3867241 0 143136 143136 511889420 493900621 17988799 0 15732413 15385221 245000 150000 0 37797253 37922494 0 0 0 0 553111 760353 16551951 6664767 9746838 9887184 58681666 63515360 20899759 22852381 0 0 1908896 3014457 145564936 153487450 34309060 35222560 0 2368013 2487913 0 0 0 0 0 13396769 14387585 50073842 52098058 X 95491094 101389392 0 0 0 0 95491094 101389392 145564936 153487450 X 1226663 4640796 0 0 0 30839 X 0 1 X 1 0 0 2278709 2278709 0 8623172 2559838 6063334 0 0 0 0 0 3444532 2528580 915952 0 2205538 1576349 629189 9887184 19114795 F Caprocq Core Real Estate Fund 3737586 F 22852381 Payable to Affiliates 2068567 Prefund Deposits and Refund Checks 1935013 Claims to be paid 10384005 14387585 X Schedule D, Part X, Line 2 Not Applicable 0 UALR College of Business 2801 S University Little Rock AR 72204 710236904 12500 Sponsorship CARTI Foundation PO Box 55011 Little Rock AR 72215 710589907 501(c)3 10500 Sponsorship The Broyles Foundation 3810 N Front Street Suite 3 Fayetteville AR 72703 272956592 10000 Sponsorship Centers for Youth & Families 5800 W 10th Street Suite 101 Little Rock AR 72204 710826334 501(c)3 7600 Sponsorship Arkansas Baptist College 1621 Dr Martin Luther King Drive Little Rock AR 72202 710298658 501(c)3 6000 Sponsorship Arkansas Heart Association 909 W 2nd Street Little Rock AR 72201 135613797 501(c)3 5050 Sponsorship 3 3 Schedule I, Part I, Line 2 None X 1 1 X X X X 1 1 0 0 0 1 0 0 0 Ed Choate President & CEO 507503 0 124498 0 69254 0 136000 0 15517 0 852772 0 0 0 Phyllis Rogers Senior VP & CFO 301728 0 45750 0 74126 0 61909 0 15160 0 498673 0 0 0 Lynn Harbert Senior VP & COO 264510 0 40200 0 0 0 57399 0 13539 0 375648 0 0 0 James Couch VP and General Counsel 225607 0 47019 0 0 0 27973 0 19317 0 319916 0 0 0 Allen Moore VP Information Technology 14893 0 35077 0 184385 0 567 0 250 0 235172 0 0 0 Robert Mason VP, Professional Relations 194613 0 35344 0 0 0 24676 0 13539 0 268172 0 0 0 Jeb Steen Senior Account Executive 73363 0 132565 0 0 0 8163 0 19076 0 233167 0 0 0 Dave Hawsey VP, Marketing 177448 0 22736 0 0 0 18561 0 19420 0 238165 0 0 0 Ashley Riddle VP, Sales and Account Managment 155690 0 24492 0 0 0 19487 0 13530 0 213199 0 0 0 Kelly Carney VP, Human Resources 149620 0 22792 0 0 0 18420 0 20205 0 211037 0 0 0 Ebb Johnson VP and Executive Director of Foundation 158430 0 20282 0 101968 0 17548 0 13539 0 311767 0 0 0 Louis Crow Dental Consultant 164667 0 6354 0 0 0 18512 0 15517 0 205050 0 0 0 Danielle Collie Account Executive 65346 0 74421 0 0 0 3410 0 6558 0 149735 0 0 0 Robert Jones Dental Consultant 128565 0 3684 0 0 0 16311 0 1103 0 149663 0 0 0 Maxine Fricioni Director, Projects & Business Processes 129179 0 11257 0 0 0 13453 0 13539 0 167428 0 0 0 Schedule J, Part I, Line 1a Any spousal travel is charged to the applicable employee's W-2 or 1099 for taxable purposes. Schedule J, Part I, Line 4 CIO received severance payment of $184,385. CEO & SVP participate in a 457f. Schedule J, Part I, Line 6 Delta Dental accrues and pays an annual bonus to officers based partially on net earnings of the organization along with other factors. Mark Bailey Provider 116596 Independent Contractor Arrangement 0 Troy Bartels Provider 208937 Independent Contractor Arrangement 0 Form 990, Part I, Line 1 At Delta Dental of Arkansas, our business centers on empowering smiles. We're a local, not-for-profit service corporation headquartered in Sherwood, AR, since 1982, whose mission is to improve the oral health of Arkansans. We strive to provide comprehensive dental and vision insurance plans that are affordable plus deliver industry-leading technology and world-class customer services to our members, business clients, and dental service providers. Delta Dental of Arkansas is the state's largest dental benefits administrator and our unmatched expertise in providing and managing dental benefits is why over 3,000 Arkansas companies have chosen us to be their dental benefits provider. At the end of 2017, we served over 567,000 members in Arkansas through our commercial business and were prepared to add over 300,000 through our Medicaid dental benefits program with the Arkansas Department of Human Services starting January 1, 2018. We offer individuals, families and businesses access to the state's (and country's) most extensive network of dentists - including 95% of all licensed and practicing dentists in Arkansas. Our highly-skilled customer service team is available to assist members from 7 a.m. - 7 p.m., with 99% of inquiries resolved on the first call. Delta Dental of Arkansas continues to make a difference beyond the walls of our business. Our philanthropic corporate and Foundation work, benefits and reaches all Arkansans - even those who aren't members. Since 2003, Delta Dental of Arkansas has contributed almost $20 million to oral health initiatives in dental education, prevention, and treatment for Arkansas. Most notably, our Foundation has invested nearly $7 million to fund startup costs to fluoridate Arkansas's community water systems growing the percentage of Arkansans enjoying the benefits of community water fluoridation from 65% to over 90%. Form 990, Part VI, Section A, Line 3 Investments are managed by Stephens Capital Management, Luther King, and FCI Advisors within the defined parameters of Delta Dental's written investment policy, which is approved by the board of directors. Form 990, Part VI, Section A, Line 6 Yes, the organization has one corporate member - Renaissance Health Service Corporation Form 990, Part VI, Section A, Line 7a The directors shall be elected at the annual meeting of the members, consistent with the terms and conditions of any and all voting agreements, proxies, and/or affiliation agreements entered into by the corporation and any other party or parties, then in effect with an affiliation corporation. Form 990, Part VI, Section B, Line 11b The information presented on the form 990 is gathered by the Senior Accountant for the organization. The VP of Finance/CFO reviews the information. Once complete, an electronic copy of the form 990 is posted for our board's review prior to the form 990 being filed with the IRS. Form 990, Part VI, Section B, Line 12c Each interested person shall sign an annual certification affirming (1) receipt of the conflict of interest (2) the policy and code of conduct has been read and understood and (3) agreement to comply with policy and code of conduct. In addition, interested parties shall be required to annually complete and file an annual disclosure statement within one month of the date of request. Annual disclosure statements and any subsequent amendments are reviewed by the governance committee in conjunction with legal counsel and a report of disclosed conflicts are made to Delta Dental's board of directors. Periodic reviews are also performed to ensure Delta Dental operates in accordance with the conflict of interest policy. Form 990, Part VI, Section B, Line 15 The compensation of the organization's CEO is reviewed annually by the compensation committee. The compensation committee consists of board members, none of whom have a conflict with respect to the compensation of officers. On a bi-annual basis, the compensation committee reviews market pricing and benchmarking data for the compensation of the leadership team and staff. This analysis, from a variety of national, regional and local compensation surveys include the use of data as to comparable compensation for similarly situated organizations and reviews annual base salary compensation, incentive/bonus compensation, deferred compensation and benefits. The data meets the compensation philosophy and strategic plan as determined and approved by the board of directors. The documented results and recommendation of this analysis are presented to the compensation committee and board of directors. Form 990, Part VI, Section C, Line 19 Governing documents, conflict of interest policies, and financial statements are available to the public upon request. Form 990, Part XI, Line 9 Audit adjustment made by affiliate after books were closed. Delta Dental of Arkansas Foundation 1513 Country Club Road Sherwood AR 72120 261569324 Public Act AR 501(c)(3) PF Delta Dental of Arkansas 1 Delta Dental of Arkansas Political Action Committee 1513 Country Club Road Sherwood AR 72120 273207545 Pol Action AR 527 Not applicable N/A 0 Renaisssance Health Service Corporation PO Box 30416 Lansing MI 489097916 381675667 Dental Health Coverage MI N/A 0 Delta Dental Plan of Michigan PO Box 30381 Lansing MI 48909 381791480 Dental Insurance MI Renaissance Health Service Corporation Omega Administrators Inc 1513 Country Club Road Sherwood AR 72120 043740469 Claims Adm AR Delta Dental of Arkansas C 984 103655 1 1 Renaissance Holding Company PO Box 30381 Lansing MI 48909 412177193 Holding company MI N/A C 19011140 0.132 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 Delta Dental of Arkansas Foundation b 2555726 Cash Delta Dental Plan of Michigan m 8605659 Cash