2016-11-15T11:40:31-07:00 2015-12-31 990 2015-01-01 710561140 DELTA DENTAL PLAN OF ARKANSAS INC DELT 5018353400 1513 Country Club Road Sherwood AR 72120 Phyllis Rogers Senior VP & CFO 5019921616 2016-11-14 2015 2017-02-10 21:41:12Z Phyllis Rogers 1513 Country Club Road Sherwood AR 72120 464462411 0 X www.deltadentalar.com X 1982 AR See Schedule O. 12 11 195 0 3586570 0 0 0 428628345 437595765 2247528 808565 3537037 4048039 434412910 442452369 3693030 2826238 389823247 395920129 13019969 13851675 0 0 0 23119298 28601605 429655544 441199647 4757366 1252722 134834612 146773969 47565159 59391341 87269453 87382628 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 423096937 434886535 Promote the oral health care of the community through group and individual dental insurance contracts and third party dental claims administration 0 0 0 423096937 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 52453 0 1 195 1 1 1 0 0 0 0 0 X 12 11 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 0 X 1708 20700 21617 Dr Mel Collazo Vice Chairman/Secretary 8 0 X 13900 20700 0 Dr James T Johnston DDS Director 5 0 X 15250 0 0 Ronald Ownbey Director 5 0 X 0 0 14100 Harold Perrin Director 5 0 X X 11500 0 0 Robert Gladden Director 5 0 X X 12600 0 0 Terri Miller Director 5 0 X 17150 27000 0 Dr Troy John Dryden Bartels Director 5 0 X 0 0 14100 Robert Mason Director 5 0 X X 7400 0 0 Sarah Clark Director 5 0 X 14200 0 0 R Mark Bailey Director 5 0 X 12240 0 2940 Wayne Callahan Director 5 0 X 15450 0 0 Ebb Johnson Director 5 0 X X 4075 10500 12750 Phillip Cox Director 5 0 X 6300 0 0 Ed Choate President & CEO 60 0 X 651429 0 53000 Phyllis Rogers Senior VP & CFO 60 0 X 372518 0 53000 Lynn Harbert Senior VP & COO 60 0 X 323769 0 35000 Dr Herman Hurd VP Dental Director 60 0 X 271356 0 30017 Allen Moore VP Information Technology 60 0 X 256219 0 27647 James Couch VP and General Counsel 60 0 X 243930 0 27274 Melissa Masingill VP, Public Affairs 60 0 X X 127843 0 2964 Ashley Riddle VP, Sales and Account Managment 60 0 X 143042 0 13165 Kelly Carney VP, Human Resources 60 0 X 140024 0 16081 Robert Mason VP, Professional Relations 60 X 98763 0 3500 Ebb Johnson VP and Executive Director of Foundation 60 X 52446 0 1692 Christa Pittman Director of Sales 60 0 X 232189 0 3621 Louis Crow Dental Consultant 40 0 X 146561 0 20489 Maxine Fricioni Director, Projects & Business Processes 60 0 X 135019 0 14897 Aron Harris Director of IT 60 0 X 146431 0 15569 Sharon Worden Director, Group Administration 60 0 X 129438 0 13249 3602750 78900 396672 21 1 1 1 Avesis PO Box 7777 Phoenix AZ 850117777 Vision claims and fees 4681008 The Hatcher Agency PO Box 3505 Little Rock AR 72203 Brokers 3277009 Billy Randall Machen DDS 4220 N Rodney Parham Rd Little Rock AR 72212 Dental Services 2010164 United Healthcare Insurance Company Dept CH 10151 Palatine IL 600550151 Health insurance carrier for employees 1725071 Emdeon Business Services PO Box 572490 Murray UT 84157 Printing & Postage 1445792 477 0 Dental Benefits 524298 114583352 114583352 0 0 Dental Reinsurance 524298 34873675 34873675 0 0 Dental ASC & Admin Income 524298 288138738 288138738 0 0 0 0 0 0 437595765 647184 0 0 647184 0 0 0 0 0 0 0 0 0 0 21366023 805400 19625058 2384984 1740965 -1579584 161381 -1579584 0 1740965 Vision Benefits 524298 3586570 0 3586570 0 Other Income 900099 461469 0 0 461469 0 0 0 0 4048039 442452369 436016181 3586570 2849618 2826238 2826238 0 0 0 0 395920129 395920129 2592167 0 2592167 0 0 0 0 0 7643343 4586006 3057337 0 915127 0 915127 0 2006688 1204013 802675 0 694350 0 694350 0 256659 0 256659 0 86093 0 86093 0 241763 0 241763 0 0 0 0 0 0 0 144002 0 144002 0 0 0 0 0 385776 0 385776 0 2021410 1819269 202141 0 0 0 0 0 0 0 0 0 463666 0 463666 0 305743 183446 122297 0 0 0 0 0 79518 47711 31807 0 0 0 0 0 393364 0 393364 0 681983 681983 0 0 84490 0 84490 0 Claims Processing 2847983 2847983 0 0 Equipment Repairs & Maintenance 1438386 863032 575354 0 Premium Taxes 608018 608018 0 0 Bank Fees 222482 133489 88993 0 18340269 11375620 6964649 0 441199647 423096937 18102710 0 15508336 26666034 245000 245000 0 0 38709630 41982188 0 0 0 0 0 0 0 0 1243606 494354 23285704 13857082 9783342 9428622 42821036 44862769 23988272 21518452 0 0 0 0 2535390 1576550 134834612 146773969 30415131 39767271 0 0 2903763 2521567 0 0 0 0 0 0 0 0 0 0 14246265 17102503 47565159 59391341 X 87269453 87382628 0 0 0 0 87269453 87382628 134834612 146773969 1252722 -1139547 0 0 0 0 X 0 1 X 1 0 0 2278709 2278709 0 8402409 2108063 6294346 0 0 0 0 0 10855313 10189544 665769 0 1749273 1559475 189798 9428622 0 16630016 F Caprocq Core Real Estate Fund 4888436 F 21518452 0 Payable to Affiliates 2769877 Prefund Deposits and Refund Checks 1832013 Claims to be Paid 12500613 17102503 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 Sponsor Delta Dental Foundation of Arkansas 1513 Country Club Road Sherwood AR 72120 261569324 501(c)3 2514643 Charitable Mission Octagon Inc 800 CONNECTICUT AVENUE 2E NORWALK CT 06854 521287224 25000 Sponsorship Riverfest 500 President Clinton Ave Suite 217 Little Rock AR 72201 710530405 20000 Sponsorship Ronald McDonald House 1009 Wolfe St Little Rock AR 72202 710525252 18500 Sponsorship AR Livestock Show Association 2600 Howard Street Little Rock AR 72206 710236776 13000 Sponsorship CARTI Foundation PO Box 55011 Little Rock AR 72215 710589907 501(c)3 11000 Sponsorship Centers for Youth and Families PO BOX 251970 Little Rock AR 72225 710826334 501(c)3 6000 Sponsorship Make-A-Wish Mid South 320 Executive Court Ste 101 Little Rock AR 72205 621253153 501(C)3 6000 Sponsorship 7 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 470423 0 166590 0 14416 0 53000 0 0 0 704429 0 51300 0 Phyllis Rogers Senior VP & CFO 272017 0 100422 0 80 0 53000 0 0 0 425519 0 52000 0 Lynn Harbert Senior VP & COO 232300 0 89642 0 80 0 35000 0 0 0 357022 0 32844 0 Dr Herman Hurd VP Dental Director 199796 0 71480 0 80 0 30017 0 0 0 301373 0 27842 0 Allen Moore VP Information Technology 184697 0 71395 0 127 0 27647 0 0 0 283866 0 22291 0 James Couch VP and General Counsel 182325 0 61479 0 127 0 27274 0 0 0 271205 0 10261 0 Ashley Riddle VP, Sales and Account Managment 92456 0 50505 0 80 0 13165 0 0 0 156206 0 0 0 Kelly Carney VP, Human Resources 111028 0 28869 0 127 0 16081 0 0 0 156105 0 0 0 Christa Pittman Director of Sales 93992 0 138070 0 127 0 3621 0 0 0 235810 0 12746 0 Louis Crow Dental Consultant 139106 0 7419 0 35 0 20489 0 0 0 167049 0 18949 0 Aron Harris Director of IT 107770 0 38534 0 127 0 15569 0 0 0 162000 0 14421 0 Maxine Fricioni Director, Projects & Business Processes 103488 0 31452 0 80 0 14897 0 0 0 149917 0 14060 0 Sharon Worden Director, Group Administration 92992 0 36367 0 80 0 13249 0 0 0 142688 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 SERP. 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. Simmons First National Bank Susie Smith was Key Employee 104292 Bank Fees 0 Ownbey Agency Producer of DDAR 51237 Producer Fees 0 Collazo Orthodontics Participating Provider 68089 Provider Fees 0 Mark Bailey DDS Participating Provider 126770 Provider Fees 0 Troy Bartels DDS Participating Provider 186555 Provider Fees 0 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 Arkansans. 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 Arkansans. 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 $8 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 600,000 Arkansans. Delta Dental of Arkansas also provides financial support to dental community clinics across the state who 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, and Luther King 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 corporation(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 officers. On a bi-annual basis, the compensation committee reviews market pricing and benchmarking data for the compensation of the leadership team and the staff. This analysis, from a variety of national, regional and local compensation surveys, include the use of data as to comparable compensation for a similarly situated organization 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 for approval. These decisions are documented in the minutes of 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 5340 118062 1 1 Renaissance Holding Company PO Box 30381 Lansing MI 48909 412177193 Holding company MI N/A C 0 16511952 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 2514643 Delta Dental Plan of Michigan m 2769877