2018-09-06T17:09:47-07:00 2016-12-31 990 2016-01-01 710561140 DELTA DENTAL PLAN OF ARKANSAS INC DELT 5018353400 1513 Country Club Road Sherwood AR 72120 Ed Choate President and CEO 5019921616 2018-09-06 2016 2022-09-23 18:48:47Z X Ed Choate 1513 Country Club Road Sherwood AR 72120 522922808 0 X www.deltadentalar.com X 1982 AR See Schedule O. 10 7 225 0 3773028 130406 0 0 437595765 493428204 808565 3760895 4048039 4211063 442452369 501400162 2826238 3393744 395920129 445621057 13851675 14228756 0 0 0 28601605 29065258 441199647 492308815 1252722 9091347 146773969 145564936 59391341 50073842 87382628 95491094 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 476426843 495117972 Promote the oral health care of the community through group and individual dental insurance contracts and third party dental claims administration 0 0 0 476426843 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 73287 0 1 225 1 1 1 0 0 0 0 0 X 10 7 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X Phyllis L Rogers 5019921616 1513 Country Club Road Sherwood AR 72120 Susie Smith Chairman 8 5 X 22050 22100 33623 Dr Mel Collazo Vice Chairman/Secretary 8 5 X 75374 20700 0 Dr James T Johnston DDS Director 8 X 24582 0 0 Ronald Ownbey Director 5 0 X X 35040 0 38867 Robert Gladden Director 5 X X 10825 0 0 Terri Miller Director 5 5 X 30160 14400 0 Dr Troy John Dryden Bartels Director 5 X 214504 0 27678 Sarah Clark Director 5 X 24675 0 0 R Mark Bailey Director 5 X 136987 0 8259 Wayne Callahan Director 5 X 27043 0 0 Phillip Cox Director 5 X 2044 0 36042 Joe Thompson Director 5 X 16075 0 0 Ed Choate President & CEO 60 X 742795 0 221947 Phyllis Rogers Senior VP & CFO 60 X 372059 0 149901 Dr Herman Hurd VP Dental Director 60 X X 126700 0 24113 Allen Moore VP Information Technology 60 X 252742 0 27593 James Couch VP and General Counsel 60 X 251374 0 27366 Ashley Riddle VP, Sales and Account Managment 60 X 169531 0 15202 Kelly Carney VP, Human Resources 60 X 165257 0 17007 Robert Mason VP, Professional Relations 60 X 213296 0 7170 Ebb Johnson VP and Executive Director of Foundation 60 X 140694 0 124816 Dave Hawsey VP, Marketing 60 X 136642 0 5331 Lynn Harbert Senior VP & COO 60 X 321350 0 59942 Louis Crow Dental Consultant 40 X 143835 0 20413 Maxine Fricioni Director, Projects & Business Processes 60 X 127863 0 14842 Aron Harris Director of IT 60 X X 103307 0 14227 Sharon Worden Director, Group Administration 60 X 116888 0 13222 Jeb Steen Senior Account Executive 60 X 134837 0 7285 4138529 57200 894846 23 1 1 1 Avesis PO Box 7777 Phoenix AZ 850117777 Vision claims and fees 5063205 The Hatcher Agency PO Box 3505 Little Rock AR 72203 Brokers 3674475 Billy Randall Machen DDS 4220 N Rodney Parham Rd Little Rock AR 72212 Dental Services 2086980 United Healthcare Insurance Company Dept CH 10151 Palatine IL 600550151 Health insurance carrier for employees 1558648 Arkansas Dental Professionals 2909 S 74th St Fort Smith AR 72903 Provider Fees 1454908 538 0 0 0 0 0 0 0 0 Dental Benefits 524298 119328186 119328186 0 0 Dental Reinsurance 524298 38553949 38553949 0 0 Dental ASC & Admin Income 524298 335546069 335546069 0 0 0 0 0 0 493428204 625971 0 0 625971 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24475761 181809 21522646 0 2953115 181809 3134924 181809 0 2953115 0 Vision Benefits 524298 3773028 0 3773028 0 Other Income 900099 438035 0 0 438035 0 0 0 0 4211063 501400162 493610013 3773028 4017121 3393744 3393744 0 0 0 0 445621057 445621057 3743247 0 3743247 0 0 0 0 0 6930048 4158029 2772019 0 929846 0 929846 0 1966126 1179676 786450 0 659489 0 659489 0 506821 304093 202728 0 323898 0 323898 0 164838 0 164838 0 0 0 0 0 0 0 197808 0 197808 0 0 0 0 0 974524 0 974524 0 2327028 2094325 232703 0 0 0 0 0 0 0 0 0 441673 0 441673 0 460703 276422 184281 0 0 0 183815 110289 73526 0 0 0 298886 0 298886 0 632259 632259 0 0 118627 0 118627 0 Claims Processing 5511081 5511081 0 Equipment Repairs & Maintenance 797022 478213 318809 Premium Taxes 634456 634456 0 0 Bank Fees 231215 138729 92486 0 15260604 11894470 3366134 0 492308815 476426843 15881972 0 26666034 15732410 245000 245000 0 0 41982188 37797253 0 0 0 0 0 0 0 0 494354 553110 24236180 14489341 9428622 9746839 44862769 58681668 21518452 20899759 0 0 0 0 1576550 1908897 146773969 145564936 39767271 34309059 0 0 2521567 2368014 0 0 0 0 0 0 0 0 0 0 17102503 13396769 59391341 50073842 X 87382628 95491094 0 0 0 0 87382628 95491094 146773969 145564936 9091347 -982881 0 0 0 0 X 0 1 X 1 0 0 2278709 2278709 0 8623172 2331191 6291981 0 0 0 0 0 11554398 10572618 981780 0 1779901 1585532 194369 9746839 16581008 F Caprocq Core Real Estate Fund 4318751 F 20899759 Payable to Affiliates 1811118 Prefund Deposits and Refund Checks 1924013 Claims to be Paid 9661638 13396769 X Schedule D, Part X, Line 2 Not Applicable 0 UAMS Foundation 4301 W Markham St 716 Little Rock AR 72205 716056774 501(c)3 75000 Sponsorship Octagon Inc 800 Connecticut Ave 2E Norwalk CT 06854 521287224 25000 Sponsorship Riverfest 500 President Clinton Ave Ste 217 Little Rock AR 72201 710530405 501c3 20000 Sponsorship Ronald McDonald House 1009 Wolfe St Little Rock AR 72202 710525252 501c3 18500 Sponsorship AR Livestock Show Association 2600 Howard Street Little Rock AR 72206 710236776 13000 Sponsorship CARTI Foundation 4 St Vincent Circle Little Rock AR 72215 710589907 501c3 11000 Sponsorship Centers for Youth and Families PO BOX 251970 Little Rock AR 72225 710826334 501c3 6000 Sponsorship Make-A-Wish Mid South 320 Executive Court Ste 101 Little Rock AR 72205 621253153 501c3 6000 Sponsorship 6 2 Schedule I, Part I, Line 2 None X 1 1 X X X X 0 1 0 0 0 1 0 0 0 Ed Choate President & CEO 491087 0 264497 0 86948 0 135000 0 15517 0 993049 0 0 0 Phyllis Rogers Senior VP & CFO 291679 0 101706 0 89901 0 60000 0 14341 0 557627 0 0 0 Lynn Harbert Senior VP & COO 256588 0 88730 0 0 0 59942 0 13539 0 418799 0 0 0 Allen Moore VP Information Technology 197603 0 69338 0 0 0 27593 0 18992 0 313526 0 0 0 James Couch VP and General Counsel 199385 0 66706 0 0 0 27366 0 19317 0 312774 0 0 0 Robert Mason VP, Professional Relations 188202 0 34039 0 0 0 7170 0 197346 0 426757 0 0 0 Ashley Riddle VP, Sales and Account Managment 150562 0 26106 0 0 0 15202 0 13530 0 205400 0 0 0 Kelly Carney VP, Human Resources 144030 0 31006 0 0 0 17007 0 19718 0 211761 0 0 0 Louis Crow Dental Consultant 161200 0 6603 0 0 0 20413 0 15517 0 203733 0 0 0 Dr Herman Hurd VP Dental Director 60393 0 71527 0 0 0 24113 0 464 0 156497 0 0 0 Ebb Johnson VP and Executive Director of Foundation 145202 0 19476 0 119968 0 4848 0 13539 0 303033 0 0 0 Maxine Fricioni Director, Projects & Business Processes 126115 0 25716 0 0 0 14842 0 13539 0 180212 0 0 0 Jeb Steen Senior Account Executive 63060 0 75852 0 0 0 7285 0 18752 0 164949 0 0 0 Dave Hawsey VP, Marketing 143106 0 200 0 0 0 5331 0 16057 0 164694 0 0 0 Sharon Worden Director, Group Administration 96931 0 24541 0 0 0 13222 0 14184 0 148878 0 0 0 Aron Harris Director of IT 82059 0 28671 0 46828 0 14227 0 1585 0 173370 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 CEO participates 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 Ownbey Agency Producer of DDAR 35040 Producer Fees 0 Collazo Orthodontics Participating Provider 48686 Provider Fees 0 Mark Bailey DDS Participating Provider 116103 Provider Fees 0 Troy Bartels DDS Participating Provider 207429 Provider Fees 0 Form 990, Header, Line B To correct the number of independent voting members, breakout unrealized gains/losses from unrestricted net assets, and add deferred compensation to officers and directors. Form 990, Part I, Line 1 Delta Dental of Arkansas is a local, not-for-profit service corporation whose mission is to improve the health of the people we serve and to be the leading force in the delivery of quality dental insurance services. We strive to provide comprehensive dental and vision insurance plans that are affordable and deliver industry-leading technology and world-class service to our members. Due in part to the financial savings we offer in our dual networks, Delta Dental of Arkansas is the state's largest dental benefits administrator, serving more than 3,000 Arkansas employers and over 500,000 Arkansas. Nine out of 10 Arkansas dentists are members of Delta Dental's network. Delta Dental's growth and efficiency in managing our organization allows the company to invest significantly towards achieving our goal to improve the oral health of Arkansas. Since 2003, Delta Dental of Arkansas has contributed over $13.2 million to oral health initiatives in dental education, prevention and treatment for Arkansans. Delta Dental of Arkansas' contributions provide critical funding for the Arkansas Mission of Mercy, and dental clinics at UAMS, Arkansas Children's Hospital and CARTI. Through our Foundation, nearly $7 Million has been invested to fund startup costs to fluoridate Arkansas water systems. The number of Arkansans receiving fluoridated water has increased from 61% to more than 87%, which positively affects the oral health of over 650,000 Arkansans. Delta Dental of Arkansas also provides financial support to dental community clinics across the state that provide free and reduced cost care to those most in need. Form 990, Part VI, Section A, Line 3 Investments are managed by Stephens Capital Management, Intrust Wealth Management, Luther King and FCI 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 affiliating corporations(s). Form 990, Part VI, Section B, Line 11b The information presented on the form 990 is gathered by the Director of Finance for the organization. The Chief Financial Officer 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 the 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 recommendations 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 policy, and financial statements are available to the public upon request. Delta Dental of Arkansas Foundation 1513 Country Club Road Sherwood AR 72120 261569324 Public Act AR 501(c)(3) PF N/A 1 Delta Dental of Arkansas Political Action Committee 1513 Country Club Road Sherwood AR 72120 273207545 Pol Action AR 527 Not applicable N/A 1 Renaisssance Health Service Corporation PO Box 30416 Lansing MI 489097916 381675667 Dental Health Coverage MI N/A 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 N/A C 0 109169 1 1 Renaissance Holding Company PO Box 30381 Lansing MI 48909 412177193 Holding company MI N/A C 0 16471839 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 3000000 Delta Dental Plan of Michigan m 7508386 Amended