2016-11-11T16:57:45-06:00 2015-12-31 381357951 PLANTE & MORAN PLLC 1111 Michigan Ave Ste 100 East Lansing MI 48823 990 2015-01-01 620812197 DELTA DENTAL OF TENNESSEE INC DELT 6152553175 240 VENTURE CIRCLE NASHVILLE TN 372281699 JEFFREY A NEWTON CONTROLLER 6152553175 2016-11-11 1 DAVID LOWENTHAL CPA P00378651 5173326200 2015 2017-02-10 21:41:12Z JEFFREY A NEWTON 240 VENTURE CIRCLE NASHVILLE TN 372281699 371916003 0 X www.deltadentaltn.com X 1965 TN Our mission is to be the leader in our markets, to deliver unmatched quality and value in our programs and services, and to vigorously promote the importance of oral health as an essential part of overall health. 9 7 81 0 0 0 0 0 304789169 351216935 1578759 1745033 13886 15712 306381814 352977680 17146929 4546126 270377072 313637357 7684304 8786193 0 0 0 19219197 21394566 314427502 348364242 -8045688 4613438 78536916 76730987 28412156 22903225 50124760 53827762 X Our mission is to be the leader in our markets, to deliver unmatched quality and value in our programs and services, and to vigorously promote the importance of oral health as an essential part of overall health. 0 0 340613122 4546126 351232647 THE PRIMARY PURPOSE OF DELTA DENTAL OF TENNESSEE AND SUBSIDIARIES IS TO PROVIDE PROFESSIONAL DENTAL SERVICES UNDER WRITTEN CONTRACTS WHICH ENTITLE THE SUBSCRIBERS TO REIMBURSEMENT FOR COVERED SERVICES PROVIDED BY LICENSED DENTISTS, PRIMARILY IN THE STATE OF TENNESSEE. BOTH LOCAL AND NATIONAL CONTRACTS ARE ADMINISTERED, WHICH HAVE THE KEY FEATURE OF GIVING SUBSCRIBERS ACCESS TO THE LOCAL PROVIDER NETWORKS MAINTAINED BY DELTA DENTAL OF TENNESSEE, AS WELL AS THE NATIONAL PROVIDER NETWORKS OF THE DELTA DENTAL SYSTEM.SEE SCHEDULE O FOR CONTINUATIONTHE COMPANY MAKES UNCONDITIONAL PROMISES TO GIVE, TO BOTH ITS FOUNDATION AND VARIOUS OTHER ORGANIZATIONS, WHICH SUPPORT EDUCATIONAL AND RESEARCH PROGRAMS FOR THE ADVANCEMENT OF DENTAL SCIENCE AND TO PROMOTE THE ORAL HEALTH OF THE PUBLIC THROUGH EDUCATIONAL AND SERVICE ACTIVITIES.DELTA DENTAL OF TENNESSEE ASSISTED CLINICS THAT PRIMARILY SERVE THE WORKING POOR AND FUNDED AMBULATORY SURGERY CENTERS TO ALLOW INPATIENT ORAL HEALTH CARE. AT THE EDUCATION LEVEL, THE COMPANY ASSISTED DENTAL SCHOOLS IN ORDER TO KEEP THEIR FACILITIES AND TEACHING EQUIPMENT UP TO DATE AND FUNDED DENTAL SCHOLARSHIPS TO 3RD AND 4TH YEAR DENTAL STUDENTS. 340613122 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 42414 0 1 81 1 0 0 0 0 0 0 X 9 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X JEFFREY A NEWTON CONTROLLER 6157426917 240 VENTURE CIRCLE NASHVILLE TN 372281604 X MR DREW ROBINSON SECOND VICE CHAIR 1.00 0.00 X X 11700 0 0 DR CAMPBELL SOWELL JR IMMEDIATE PAST CHAIR- DIRECTOR 1.00 5.00 X X 10700 21400 0 DR VICTOR BECK VICE CHAIR 1.00 0.00 X X 12200 0 0 DR CARMEN REAGAN DIRECTOR 1.00 0.00 X 8000 500 0 MR JOHN COLLIER DIRECTOR 1.00 6.00 X 8000 24952 0 MS JERRE HARRIS DIRECTOR 1.00 0.00 X 7000 0 0 PAUL BACON DIRECTOR 1.00 0.00 X 7500 0 0 ED ANDREW BEASELY JR DIRECTOR 1.00 0.00 X 9000 0 0 TERENCE R COMAR DIRECTOR 1.00 11.00 X 8500 36800 0 DR PHILIP A WENK PRESIDENT & CEO 40.00 5.00 X 721568 0 137209 J THOMAS PERRY SEN. VP OF FIN & CFO THRU 11/15 40.00 0.00 X 490722 0 40260 DONNA KAYE MARTIN SENIOR VP OPERATIONS 40.00 0.00 X 353188 0 35314 PAMELA DISHMAN SENIOR VP EMPLOYEE RELATIONS 40.00 0.00 X 362368 0 26585 MR LESLIE SELLERS CHAIRMAN 1.00 0.00 X 19250 0 0 DONALD L BEATY VP INFORMATION SERVICES 40.00 0.00 X 218013 0 41033 JERRY R REAVIS JR VP Sales and Underwriting 40.00 0.00 X 159320 0 26853 MICHELLE ACOSTA VP MARKETING 40.00 0.00 X 162235 0 37131 LOUIS F TURBEVILLE CONTROLLER 40.00 0.00 X 141217 0 19880 MELISSA HUSCHKE VP OPERATIONS 40.00 0.00 X 146269 0 32846 SHANDA BROWN VP QUALITY MONITORING/IMPROVEMENT 40.00 0.00 X 114457 0 20643 KATHY FUSSELL REGULATORY COMPLIANCE CONTROLLER 40.00 0.00 X 100407 0 17067 MR JEFF BALLARD SEN. VP OF FIN & CFO AS OF 11/15 40.00 0.00 X 33105 0 3939 WILLIAM HAMILTON ACCOUNT EXECUTIVE 40.00 0.00 X 273651 0 36557 CHRISTOPHER PARISH ACCOUNT EXECUTIVE 40.00 0.00 X 134678 0 9031 TRACY BAILEY ACCOUNT EXECUTIVE 40.00 0.00 X 286149 0 33837 JONATHAN OAKS ACCOUNT EXECUTIVE 40.00 0.00 X 251929 0 37404 4051126 83652 555589 15 0 1 0 GISH SHERWOOD & FRIENDS INC 209 10TH AVENUE SOUTH NASHVILLE TN 37203 MARKETING 971825 WILLIS OF TENNESSEE INC 26 CENTURY BLVD NASHVILLE TN 37214 COMMISSIONS 951253 COWAN BENEFIT SERVICES INC 5110 MARYLAND WAY SUITE 250 BRENTWOOD TN 370275250 COMMISSIONS 315903 TRINITY BENEFIT ADVISORS 4823 OLD KINGSTON PIKE KNOXVILLE TN 37919 COMMISSIONS 196637 THE JAMES GROUP 6750 POPLAR AVENUE GERMANTOWN TN 38138 COMMISSIONS 183990 15 DENTAL CARE REVENUE 624100 351216935 351216935 351216935 1501020 1501020 19149536 32800 18897596 40727 251940 -7927 244013 244013 REIMBURSED EXPENSES 900099 15712 15712 15712 352977680 351232647 0 1745033 4546126 4546126 313637357 313637357 3895436 1983758 1911678 3652946 1826270 1826676 250618 132946 117672 618019 341785 276234 369174 207080 162094 28180 28180 66618 39971 26647 52626 52626 933465 474788 458677 1738404 884677 853727 1704233 1045409 658824 423569 282464 141105 305021 90702 214319 219613 219613 822419 481905 340514 55761 17633 38128 Commissions 6191844 6173594 18250 Claims Processing 3884474 3880267 4207 State Premium Taxes 2983046 2983046 FEDERAL HEALTHCARE TAX 1014491 1014491 970802 568853 401949 348364242 340613122 7751120 0 1787842 7620590 9819335 8992859 482971 522844 8143973 4424090 4257378 3719883 51158423 44809396 10132016 10121345 898951 944070 78536916 76730987 16012460 21062599 12399696 1840626 28412156 22903225 X 0 0 0 0 50124760 53827762 50124760 53827762 78536916 76730987 X 4613438 -1130746 220310 X X 0 1 X 1 0 231288 231288 2225826 789474 1436352 55254 45274 9980 5200907 3458318 1742589 430698 131024 299674 3719883 INVESTMENT IN SUBSIDIARY 10121345 C 10121345 PREFUNDS 340626 CONTRIBUTION PAYABLE 1500000 1840626 X Part X, Line 2: THE COMPANY ACCOUNTS FOR INCOME TAXES OF TAXABLE CONSOLIDATED ENTITIES WHEREBY DEFERRED TAXES ARE PROVIDED ON TEMPORARY DIFFERENCES ARISING FROM ASSETS AND LIABILITIES WHOSE BASES ARE DIFFERENT FOR FINANCIAL REPORTING AND INCOME TAX PURPOSES. DEFERRED TAXES WERE NOT SIGNIFICANT TO THE CONSOLIDATED FINANCIAL STATEMENTS. AS OF DECEMBER 31, 2015 AND 2014, THE COMPANY'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED DURING THE YEAR OR ACCRUED AT YEAR END. THE COMPANY FILES INCOME TAX RETURNS IN U.S. FEDERAL AND STATE OF TENNESSEE JURISDICTIONS. 1 INTERFAITH DENTAL CLINIC 1721 PATTERSON STREET NASHVILLE TN 37203 621567615 501(c)(3) 27500 CASH TITLE SPONSOR - 2015 GALA University of Tennessee College of Dentistry 875 Union Avenue MEMPHIS TN 38163 621844686 501(c)(3) 8118 CASH CONTRIBUTION FOR DENTAL BUILDING DENTAL ELITE 3820 N Colorado Street CHANDLER AZ 85225 320031941 25836 CASH TOOTHBRUSHES AND ORAL HEALTH SUPPLIES FOR BACKPACK PROGRAMS MIDSOUTH DENTAL CONGRESS 62 SOUTH DUNLAP SUITE 500 MEMPHIS TN 38163 621844686 501(c)(3) 28000 CASH DONATION TO GENERAL FUND; WILLIAM F. SLAGLE DENTAL MEETING DONATION ST JUDE RESEARCH HOSPITAL 262 Danny Thomas Place Memphis TN 38105 620646012 501(c)(3) 50000 CASH DENTAL ASSISTANCE AND RESEARCH DODSON AVENUE HEALTH CENTER 1200 DODSON AVE CHATTANOOGA TN 37406 581664027 6000 CASH DONATION TO GENERAL FUND CHURCH HEALTH CENTER 1210 PEABODY MEMPHIS TN 38104 581716113 501(c)(3) 5000 CASH DENTAL CLINIC DONATION AMERICAN RED CROSS 3777 Nolensville Road NASHVILLE TN 37211 621411210 501(c)(3) 51000 CASH LIFESAVER BREAKFAST SPONSORSHIP, BATTLE OF BADGES, DONATION TO THE GENERAL FUND EAST TENNESSEE CHILDREN'S HOSPITAL 2018 CLINCH AVE KNOXVILLE TN 37916 626002604 501(c)(3) 30850 CASH FANTASY OF THE TREES EVENT SPONSOR Monroe Harding Academy 1120 Glendale Lane Nashville TN 37204 620476670 501(c)(3) 33000 CASH EVENT SPONSORSHIP UNITED WAY OF METRO NASHVILLE 250 VENTURE CIRCLE NASHVILLE TN 37228 620533104 501(c)(3) 9650 CASH DENTAL CLINIC DONATION Nashville Zoo 3777 Nolensville Road Nashville TN 37211 621411210 501(c)(3) 7500 CASH BOO AT THE ZOO EVENT SPONSOR TENNESSEE PERFORMING ARTS CENTER 505 DEADRICK ST 3RD FLOOR NASHVILLE TN 37243 581320590 501(c)(3) 55081 CASH GALA & EDUCATION SPONSORSHIP LE BONHEUR FOUNDATION 50 N DUNLAP MEMPHIS TN 38103 581404854 501(c)(3) 25000 CASH DONATION TO THE GENERAL FUND TENNESSEE DENTAL ASSOCIATION 660 BAKERS BRIDGE AVE FRANKLIN TN 37067 621582289 501(c)(3) 16700 CASH EVENT SPONSORSHIP OPERATION STAND DOWN NASHVILLE 1125 12TH AVENUE SOUTH NASHVILLE TN 37203 621638832 501(c)(3) 25721 CASH EVENT SPONSORSHIP RALLY FOR KIDS WITH CANCER FOUNDATION - VANDERBILT CHILDRENS HOSPITAL 2301 VANDERBILT PLACE NASHVILLE TN 37235 620476822 501(c)(3) 25000 CASH DONATION TO THE GENERAL FUND THE COMMUNITY FOUNDATION OF MIDDLE TN 3833 CLEGHORN AVE NASHVILLE TN 37215 621471789 501(c)(3) 5000 CASH DONATION TO THE GENERAL FUND THE SALVATION ARMY 1424 NE EXPRESS WAY ATLANTA GA 30329 580660607 501(c)(3) 5000 CASH EVENT SPONSORSHIP AMERICAN CANCER SOCIETY 555 11st st nw ste 300 WASHINGTON DC 20004 522340031 501(c)(3) 10600 CASH EVENT SPONSORSHIP AMERICAN DIABETES ASSOCIATION 1701 N BEAUREGARD ST ALEXANDRIA VA 22311 131623888 501(c)(3) 5000 CASH EVENT SPONSORSHIP AMERICAN HEART ASSOCIATION INC 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(c)(3) 9000 CASH EVENT SPONSORSHIP MENTAL HEALTH AMERICA OF MIDDLE TN 446 METROPLEX DR SUITE A-224 NASHVILLE TN 37211 620637710 501(c)(3) 10000 CASH JACK C. MASSEY AWARD DINNER MUSIC CITY BOWL INC 414 UNION ST STE 1910 NASHVILLE TN 37219 621720086 501(c)(3) 5480 CASH DONATION TO THE GENERAL FUND NASHVILLEE NHL ALL-STAR GAME INC 414 UNION ST STE 1910 nasHVILLE TN 37219 472426251 501(c)(3) 15000 CASH EVENT SPONSORSHIP SECOND HARVEST FOOD BANK OF MID TN 331 GREAT CIRCLE ROAD NASHVILLE TN 37228 621049447 501(c)(3) 12600 CASH DONATION TO THE GENERAL FUND; EVENT SPONSORSHIP THE CHILDREN'S MUSEUM OF MEMPHIS 2525 CENTRAL AVE MEMPHIS TN 38104 621326890 501(c)(3) 10000 CASH DONATION TO THE GENERAL FUND THE GOLF CLUB OF TENNESSEE 1000 GOLF CLUB DR KINGSTON SPGS TN 37082 581831848 501(c)(7) 300000 CASH 10 YEAR CHARITY INSTITUTE MEMBERSHIP TN BUSINESS PARTNERSHIP PO BOX 120965 NASHVILLE TN 37212 464445206 501(c)(3) 10000 CASH EVENT SPONSORSHIP TRI-FOXCO USA INC 4645 WITMER INDUSTRIAL ESTATES NIAGRA FALLS NY 14305 161498099 22572 CASH EVENT SPONSORSHIP YOUTH EDUCATIONAL FOUNDATION 816 S GARDEN ST COLUMBIA TN 38401 462645696 501(c)(3) 5000 CASH ANNUAL LUNCHEON YPI INC 140 HUYSHOPE AVENUE HARTFORD CT 06106 061298954 501(c)(3) 18000 CASH EVENT SPONSORSHIP DENTAL LIFELINE NETWORK 1800 15TH STREET DENVER CO 80202 320206456 501(c)(3) 19100 CASH DONATION TO DENTAL SERVICES PROGRAM MONROE CARELL JR CHILDREN'S HOSPITAL 2200 CHILDRENS WAY NASHVILLE TN 37232 352528741 501(c)(3) 45000 CASH DONATION TO THE GENERAL FUND University of Tennessee Health Science Center 62 South Dunlap Suite 500 Memphis TN 38163 621844686 501(c)(3) 44183 PURCHASE PRICE NISSAN VEHICLES provide vehicles for UT dental students traveling between clinic locations SMILE 180 FOUNDATION 240 VENTURE CIRCLE NASHVILLE TN 37228 471654054 501(c)(3) 3500000 CASH DONATION TO THE GENERAL FUND 31 5 N/A Part I, Line 2: Donations are based upon decisions from the Senior Staff, decisions from the Board and from the Corporate Citizenship committee of the BOD. Contributions are monitored monthly by Senior Staff and at the Board meetings. X 1 1 X X X 0 1 0 0 0 0 0 0 0 DR PHILIP A WENK PRESIDENT & CEO 535008 0 145724 0 40836 0 120847 0 16362 0 858777 0 0 0 J THOMAS PERRY SEN. VP OF FIN & CFO THRU 11/15 241027 0 189566 0 60129 0 23898 0 16362 0 530982 0 0 0 DONNA KAYE MARTIN SENIOR VP OPERATIONS 189517 0 157106 0 6565 0 18952 0 16362 0 388502 0 0 0 PAMELA DISHMAN SENIOR VP EMPLOYEE RELATIONS 187783 0 151360 0 23225 0 18778 0 7807 0 388953 0 0 0 DONALD L BEATY VP INFORMATION SERVICES 174301 0 34415 0 9297 0 17400 0 23633 0 259046 0 0 0 JERRY R REAVIS JR VP Sales and Underwriting 79634 0 77589 0 2097 0 3220 0 23633 0 186173 0 0 0 MICHELLE ACOSTA VP MARKETING 134831 0 26103 0 1301 0 13498 0 23633 0 199366 0 0 0 LOUIS F TURBEVILLE CONTROLLER 120731 0 20450 0 36 0 12073 0 7807 0 161097 0 0 0 MELISSA HUSCHKE VP OPERATIONS 124305 0 24213 0 -2249 0 9213 0 23633 0 179115 0 0 0 WILLIAM HAMILTON ACCOUNT EXECUTIVE 47003 0 226713 0 -65 0 12924 0 23633 0 310208 0 0 0 TRACY BAILEY ACCOUNT EXECUTIVE 32765 0 248420 0 4964 0 10204 0 23633 0 319986 0 0 0 JONATHAN OAKS ACCOUNT EXECUTIVE 93371 0 158238 0 320 0 13771 0 23633 0 289333 0 0 0 Part I, Line 1a TRAVEL EXPENSES WERE PAID FOR THE SPOUSE OF ANY BOARD MEMBER WHO CHOSE TO ATTEND THE SUMMER BOARD MEETING. THE AMOUNT PAID FOR EACH SPOUSE WAS REPORTED AS TAXABLE COMPENSATION ON A 1099 AND PROVIDED TO EACH RESPECTIVE BOARD MEMBER. Part I, Line 4b A supplemental nonqualified retirement plan under Sec. 457(f) is maintained by the organization for certain executive employees. Upon severance from service prior to attainment of normal retirement age, the participant shall forfeit ineligible amounts in the plan unless such severance is due to death, disability or involuntary termination without cause. No payments were made in 2015 to individuals listed on Form 990 Part VII. VICTOR C BECK JR DDS VICTOR BECK, DIRECTOR OF DDTN, IS AN OWNER IN VICTOR C. BECK JR DDS 112281 HEALTH CARE PAYMENTS 0 Form 990, Part VI, Section A, line 6 THE ORGANIZATON HAS ONE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION. Form 990, Part VI, Section A, line 7a THE ORGANIZATIONS SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION, HAS VOTING RIGHTS. THESE VOTING RIGHTS ALLOW THE SOLE MEMBER TO ELECT DIRECTORS. Form 990, Part VI, Section A, line 7b IF ANY TRANSFER OF ASSETS, INVESTMENT, LOAN GUARANTY OR EXPENDITURE WHICH, INDIVIDUALLY OR IN THE AGGREGATE DURING ANY CALENDAR YEAR, EXCEEDS TEN PERCENT (10%) OF DDTN'S NET ASSETS AT THE TIME OF SUCH ACTION, THE TRANSACTION MUST BE APPROVED BY RENAISSANCE HEALTH SERVICE CORPORATION PRIOR TO THE CONSUMMATION OF SUCH TRANSACTION. Form 990, Part VI, Section B, line 11 THE INFORMATION IS GIVEN TO OUTSIDE TAX PREPARERS WHO PREPARE AND REVIEW THE FORM 990. PRIOR TO FILING FORM 990 WITH THE IRS, AN ELECTRONIC COPY IS PLACED ON THE WEBSITE FOR THE BOARD TO REVIEW AND ASK QUESTIONS. Form 990, Part VI, Section B, line 12c THE COMPANY'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. IF A PROHIBITED TRANSACTION WERE IDENTIFIED, THE MATTER WOULD BE BROUGHT TO THE CHAIRPERSON OF THE BOARD 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 CONFLICT 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 OUTSIDE COMPENSATION CONSULTANTS ARE USED TO DETERMINE MARKET DATA FOR THE EXECUTIVE POSITIONS AND FOR OTHER OFFICERS AND KEY EMPLOYEES. AT LEAST THE FOLLOWING POSITIONS ARE COVERED: THE CEO, CFO, AND THE SENIOR VICE PRESIDENTS. THE ORGANIZATION CONTRACTS WITH AN INDEPENDENT THIRD PARTY TO DO A COMPENSATION AND REASONABLENESS ANALYSIS EVERY TWO YEARS. THE FINAL DETERMINATION OF COMPENSATION IS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, WHICH IS MADE UP OF INDEPENDENT PERSONS, AND IS BASED ON THE COMPARABILITY DATA PROVIDED BY THE COMPENSATION CONSULTANTS. THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARE CONTEMPORANEOUSLY DOCUMENTED IN THE COMMITTEE MINUTES AND APPROVED BY THE BOARD. THE COMPENSATION WAS LAST REVIEWED UNDER THIS PROCESS DURING 2014. THE REPORT BASED ON THIS REVIEW WAS THEN ISSUED BY THE CONSULTANTS IN JUNE OF 2015. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES THEIR CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. 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 XI, line 9: CHANGE IN INVESTMENT IN SUBSIDIARY 220,310. FORM 990, PART XII, LINES 2C: DELTA DENTAL OF TENNESSEE IS AUDITED BY AN INDEPENDENT ACCOUNTANT AS PART OF A CONSOLIDATED FINANCIAL STATEMENT ISSUED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. LIQUID CORN LLC 240 VENTURE CIRCLE NASHVILLE TN 37228 203349680 OWNS SUITE 244 TN 0 157 FORE HOLDING CORPORATION PREMIER INSURANCE SERVICES LLC 240 VENTURE CIRCLE NASHVILLE TN 37228 113662057 INSURANCE BROKER TN -547 54889 FORE HOLDING CORPORATION SUITE 244 PARTNERS LLC 240 VENTURE CIRCLE NASHVILLE TN 37228 203643584 HOLDS THE LEASE TO SUITE 244 AT LP FIELD (TITANS STADIUM) TN 0 0 FORE HOLDING CORPORATION DELTA DENTAL PLAN OF OHIO inc PO BOX 30416 LANSING MI 489097916 310685339 PROVIDE DENTAL SERVICE PLANS OH 501(c)(4) N/A delta dental plan of michigan inc 1 DELTA DENTAL PLAN OF INDIANA INC PO BOX 30416 LANSING MI 489097916 351545647 PROVIDE DENTAL SERVICE PLANS IN 501(c)(4) N/A delta dental plan of michigan inc 1 DELTA DENTAL PLAN OF MICHIGAN INC 4100 OKEMOS ROAD OKEMOS MI 48864 381791480 PROVIDE DENTAL SERVICE PLANS MI 501(c)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 1 DELTA DENTAL FUND PO BOX 30416 LANSING MI 489097916 382337000 SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMS MI 501(C)(3) Line 11a, I delta dental plan of michigan inc 1 RENAISSANCE HEALTH SERVICE CORPORATION PO BOX 30416 LANSING MI 489097916 381675667 PROMOTING DENTAL CARE MI 501(C)(4) N/A N/A 0 DELTA DENTAL PLAN OF NEW MEXICO INC PO BOX 30416 LANSING MI 489097916 850224562 PROVIDE DENTAL SERVICE PLANS NM 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 1 DELTA DENTAL OF KENTUCKY INC PO BOX 30416 LANSING MI 489097916 610659432 PROVIDE DENTAL SERVICE PLANS KY 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 1 DELTA DENTAL OF NORTH CAROLINA PO BOX 30416 LANSING MI 489097916 561018068 PROVIDE DENTAL SERVICE PLANS NC 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 1 DELTA DENTAL OF ARKANSAS PO BOX 30416 LANSING MI 489097916 710561140 PROVIDE DENTAL SERVICE PLANS AR 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 1 DELTA DENTAL OF ARKANSAS FOUNDATION PO BOX 30416 LANSING MI 489097916 261569324 PROVIDE DENTAL SERVICE PLANS AR 501(C)(3) PF RENAISSANCE HEALTH SERVICE CORPORATION 1 RENAISSANCE FAMILY FOUNDATION INC 4100 OKEMOS ROAD OKEMOS MI 48864 461376165 Emphasize DENTAL HEALTH IN COMMUNITIES MI 501(c)(3) PF RENAISSANCE HOLDING COMPANY 1 SMILE 180 FOUNDATION 240 VENTURE CIRCLE NASHVILLE TN 37228 471654054 Emphasize DENTAL HEALTH IN COMMUNITIES TN 501(c)(3) Line 11a, I DELTA DENTAL OF TENNESSEE INC 1 FORE HOLDING CORPORATION 240 VENTURE CIRCLE NASHVILLE TN 37228 204116122 HOLDING COMPANY TN N/A C 220310 10133418 1.00000 1 RENAISSANCE HOLDING COMPANY PO BOX 30416 LANSING MI 489097916 412177193 HOLDING COMPANY MI RENAISSANCE HEALTH SERVICE CORPORATION C 1 Renaissance Life & Health Insurance Company of America PO BOX 30416 LANSING MI 48909 470397286 INSURANCE IN RENAISSANCE HOLDING COMPANY C 1 Renaissance Health Insurance Company of New York PO BOX 30416 LANSING MI 48909 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 1 dental choice inc 10100 linn station rd suite 700 louisville KY 40223 611105118 PROVIDE DENTAL SERVICE PLANS KY DELTA DENTAL OF KENTUCKY C 1 dental choice agency inc 10100 linn station rd suite 700 louisville KY 40223 611336003 PRIMARY GENERAL AGENCY FOR DDKY & DENTAL CHOICE KY DELTA DENTAL OF KENTUCKY C 1 OMEGA ADMINISTRATORS INC 1513 COUNTRY CLUB ROAD SHERWOOD AR 72120 043740469 PROVIDING THIRD-PARTY ADMINISTRATIVE SERVICES AR DELTA DENTAL OF ARKANSAS C 1 GLM HOLDING COMPANY 4100 OKEMOS ROAD OKEMOS MI 48864 472557772 INVESTMENT IN SUBSIDIARIES MI DELTA DENTAL OF MICHIGAN C 1 DEWPOINT INC 300 S WASHINGTON SQUARE LANSING MI 48933 383300595 IT CONSULTING MI GLM HOLDING COMPANY C 1 0 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 DELTA DENTAL PLAN OF MICHIGAN inc M 4458777 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA D 580000 ACTUAL LOAN AMOUNT SMILE 180 FOUNDATION B 3500000 ACTUAL COST SMILE 180 FOUNDATION Q 179714 ACTUAL COST SMILE 180 FOUNDATION O 158805 ACTUAL COST