2015-11-11T07:13:32-06:00 2014-12-31 341851358 CBIZ MHM LLC 3625 CUMBERLAND BLVD STE 800 ATLANTA GA 30082 990 2014-01-01 111980218 DELTA DENTAL OF NEW YORK INC DELT 7177668500 ONE DELTA DRIVE MECHANICSBURG PA 17055 JEANNE FOSTER VP FINANCE 7177668500 2015-11-03 1 CRAIG T WILLIAMS P00621386 7708584500 2014 2016-02-25 16:41:14Z JEANNE FOSTER ONE DELTA DRIVE MECHANICSBURG PA 17055 386202224 0 X WWW.DELTADENTALINS.COM X 1960 NY TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS, SERVICE, TECHNOLOGY, AND PROFESSIONAL SUPPORT. 13 8 28 0 0 0 0 0 377765945 383817497 656667 694865 -109646 26443 378312966 384538805 167000 322850 336289959 337955121 3036438 3200871 0 0 0 36995509 40510006 376488906 381988848 1824060 2549957 69762011 67611502 59165287 54400488 10596724 13211014 TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS, SERVICE, TECHNOLOGY, AND PROFESSIONAL SUPPORT. 0 0 378376830 384538805 THE ORGANIZATION PROVIDED DENTAL BENEFIT COVERAGE FOR 1,543,077BENEFICIARIES IN 2014 PRIMARILY THROUGH CONTRACTS WITH INDEPENDENTDENTISTS SERVING 6,093 PURCHASING GROUPS. THE ORGANIZATION PAIDMORE THAN $337 MILLION FOR DENTAL CARE DURING 2014. 322850 322850 THE ORGANIZATION MADE GRANTS DURING 2014 TO FOSTER IMPROVED ACCESSTO DENTAL HEALTH CARE TREATMENT, TO SUPPORT PROFESSIONAL DENTALEDUCATION, AND TO PROVIDE ORAL HEALTH INSTRUCTION FOR PATIENTS. 378699680 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 1 75037 0 1 28 1 0 0 0 0 0 0 X 13 8 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X JEANNE FOSTER VP FINANCE 7177668500 ONE DELTA DRIVE MECHANICSBURG PA 17055 X ALAN M PATRIGNANI DDS CHAIRMAN 1.00 X 15192 0 0 GEORGE S KARALEKAS VICE CHAIRMAN 1.00 X 6000 0 0 JOZEF C VERBRAEKEN SECRETARY / TREASURER 1.00 X 5445 0 0 MICHAEL C ALFANO DMD PHD DIRECTOR 1.00 X 4800 0 0 ANTHONY L DIMANGO DDS DIRECTOR 1.00 X 4800 0 0 THOMAS M HALTON DMD FORMER DIRECTOR 1.00 X 4800 0 0 BARBARA R KATERSKY DIRECTOR 1.00 X 4800 0 0 ANDREW S LEVINE DDS DIRECTOR 1.00 X 6292 0 0 FRANCINE Y LOPEZ DIRECTOR 1.00 X 0 0 0 ROGER A MAGLIO DIRECTOR 1.00 X 7492 0 0 STACY A MAZZA DIRECTOR 1.00 X 4800 0 0 THOMAS J MCCARTIN DIRECTOR 1.00 X 6292 0 0 LYNETTE A METZ DIRECTOR 1.00 X 0 0 0 JAMES E SPENCER DDS DIRECTOR 1.00 X 4800 0 0 THOMAS H WYSMULLER FORMER CHAIRMAN 1.00 X 11400 0 0 GARY D RADINE PRESIDENT / CEO 3.00 57.00 X 0 4332864 435375 ANTHONY S BARTH EVP / COO 3.00 47.00 X 0 1963022 3883325 MICHAEL J CASTRO EVP / CFO 3.00 47.00 X 0 1340198 2190161 MICHAEL G HANKINSON ESQ EVP / CLO 3.00 47.00 X 0 843255 58166 PATRICK S STEELE EVP / CIO 3.00 47.00 X 0 11166136 2441976 BELINDA MARTINEZ SR. VICE PRES. 3.00 47.00 X 0 980396 2489983 ALICIA F WEBER SVP, CONTROLLER 3.00 47.00 X 0 800642 62779 RUSSELL K BRADLEY VP, CLAIMS PROCESSING 3.00 47.00 X 0 179365 15617 ROBERT P BUDD VP, SALES 18.00 32.00 X 369173 0 42379 PHILIP N ENGLE VP, INFORMATION TECHNOLOGY 18.00 32.00 X 0 353232 58225 RENEE A FISHER VP, QUALITY ASSURANCE AND TRAINING 18.00 32.00 X 0 244558 30813 JEANNE M FOSTER VP, FINANCE 18.00 32.00 X 0 356795 55077 RICHARD C GRAYBILL VP, UNDERWRITING AND ACT 18.00 32.00 X 0 287097 44172 KEVIN KING SALES ACCOUNT EXECUTIVE 40.00 X 208269 0 18357 ROBERT C SEWARD SALES ACCOUNT EXECUTIVE 40.00 X 153115 0 37406 ROBERT E MILHISLER DIRECTOR, SALES 40.00 X 246090 0 44152 TIMOTHY FALLON SALES ACCOUNT EXECUTIVE 40.00 X 158660 0 18633 STEVEN S GROSSMAN SALES ACCOUNT EXECUTIVE 40.00 X 280913 0 53182 CHARLES LAMONT ESQ FORMER EVP / CLO 0.00 0.00 X 0 585615 6503 1503133 23433175 11986281 7 1 1 0 0 DIRECT PREMIUMS 524114 383817497 383817497 383817497 688670 688670 1669614 1663419 6195 6195 6195 MISCELLANEOUS INCOME 524114 189295 189295 BAD DEBT EXPENSE 524114 -162852 -162852 26443 384538805 384538805 0 0 322850 322850 337955121 337955121 456086 456086 1924216 1713321 210895 152801 139263 13538 507109 462179 44930 160659 146425 14234 93060 93060 22989 22989 1373529 1251834 121695 407953 371808 36145 161579 147263 14316 122866 111980 10886 431361 393142 38219 5083 5083 ADMINISTRATIVE FEES 25933275 23635587 2297688 COMMISSIONS 7775769 7775769 LICENSES PERMITS FEES 1506579 1373096 133483 ACA TAXES 795373 724903 70470 1880590 1713970 166620 381988848 378699680 3289168 0 73595 69580 25933173 38162023 36460399 129181 228837 3448161 30140058 315000 2015878 397628 69762011 67611502 55056548 34957606 756286 1405772 1360000 1360000 1992453 16677110 59165287 54400488 X 0 0 0 0 10596724 13211014 10596724 13211014 69762011 67611502 2549957 64333 0 X 0 1 X 1 0 0 PREFUNDED DEPOSITS 600110 REINSURANCE DEPOSITS 1500000 PAYABLES TO AFFILIATES 14577000 16677110 X 88283941 0 88283941 296254864 296254864 384538805 85733984 0 85733984 296254864 296254864 381988848 PART X, LINE 2: THE COMPANY IS A TAX-EXEMPT ORGANIZATION ORGANIZED UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE AND, AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE FINANCIAL STATEMENTS. CURRENT ACCOUNTING GUIDANCE CLARIFIES HOW UNCERTAINTIES IN TAX POSITIONS ARE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE PRESCRIBES A FINANCIAL STATEMENT RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. POSITIONS INCLUDE THOSE WITH RESPECT TO THE COMPANY'S TAX EXEMPT STATUS AND WITH RESPECT TO INCOME TAXES ON UNRELATED BUSINESS INCOME. THE COMPANY HAS DETERMINED THAT SUCH TAX POSITIONS DO NOT RESULT IN UNCERTAINTIES REQUIRING RECOGNITION. PART XI, LINE 4B - OTHER ADJUSTMENTS: ADMINISTRATIVE SERVICE CONTRACTS CLAIM REIMBURSEMENT REVENUE PART XII, LINE 4B - OTHER ADJUSTMENTS: CLAIMS ACCRUED FOR ADMINISTRATIVE SERVICE CONTRACTS CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICES REINSURANCE 90326994 0 0 0 0 0 0 90326994 0 90326994 0 0 1 0 0 0 PART I, LINE 3(E) - REINSURANCE: THE ORGANIZATION REINSURES DENTAL SERVICE CONTRACTS WITH DELTA REINSURANCE CORPORATION, A BARBADOS INSURANCE COMPANY, AS A PROGRAM SERVICE WITHIN ITS EXEMPT PURPOSE. AS INDICATED IN PART I, THE ORGANIZATION'S REINSURANCE EXPENSES WERE $90,326,994. THE ORGANIZATION'S REINSURANCE RECEIPTS WERE $82,869,500. THE NET REINSURANCE LOSS WAS $7,457,494. 1 DELTA DENTAL COMMUNITY CARE FOUNDATION 100 FIRST STREET SAN FRANCISCO CA 94105 371570764 501(C)(3) 315000 TO PROVIDE DENTAL EDUCATION VARIOUS 5000 7850 TO PROVIDE DENTAL EDUCATION 1 6 PART I, LINE 2: THE ORGANIZATION AWARDS GRANTS FOR PROGRAMS THAT FOSTER DENTAL HEALTH AND EDUCATION. THROUGH THESE GRANTS THE ORGANIZATION HELPS FINANCE HEALTH, EDUCATION, AND RESEARCH PROJECTS IN DENTISTRY, HEALTH AND HUMAN SERVICES, AND CIVIC AND COMMUNITY AFFAIRS. THE TWO GRANTS ARE: (1) THE DENTAL HEALTH AND EDUCATION CONTRIBUTION, WHICH SUPPORTS DENTAL HEALTH AND AWARENESS PROGRAMS AND (2) THE STANDARD DENTAL RESEARCH GRANT, WHICH SUPPORTS PROFESSIONAL RESEARCH RELATED TO DENTAL HEALTH. GRANTS ARE AWARDED TO GROUPS THAT: (1) PROVIDE DENTISTRY FOR INDIGENTS; (2) PROVIDE DENTISTRY FOR GROUPS THAT ARE DENTALLY UNDERSERVED; (3) PROVIDE EDUCATION TO ADVANCE THE AWARENESS OR THE SCIENCE OF DENTISTRY; (4) PROMOTE PUBLIC DENTAL HEALTH; AND (5) ARE INVOLVED IN COMMUNITY ACTIVITIES RELATED TO DENTAL CARE. GRANT GUIDELINES: PRIORITY WILL GO TO PROJECTS THAT FOCUS ON ISSUES RELATED TO THE DELIVERY OF ORAL HEALTH CARE, INCLUDING THOSE WITH SIGNIFICANT POTENTIAL FOR IMPROVING ORAL HEALTH AND REDUCING TREATMENT COSTS. PRIORITY CONSIDERATION WILL GO TO RESEARCHERS FROM THE DENTAL SCHOOLS IN THE ENTERPRISE STATES, BUT WILL NOT BE LIMITED TO THESE INSTITUTIONS. PRIORITY WILL GO TO TWO TYPES OF STUDIES: (1) PILOT OR FEASIBILITY STUDIES LIKELY TO ENHANCE THE INVESTIGATOR'S CHANCE FOR LONG-TERM FUNDING FROM OTHER SOURCES; AND (2) COMPLETE PROJECTS CONSIDERED TO BE OF INTEREST TO THE HEALTH, EDUCATION, AND RESEARCH FUND, FOR WHICH OTHER SOURCES OF FUNDS ARE TRADITIONALLY UNAVAILABLE OR INSUFFICIENT. PRIORITY WILL GO TO STUDIES THAT EVALUATE THE OUTCOME OF PREVENTATIVE AND TREATMENT PROCEDURES. RETROSPECTIVE STUDIES OR THOSE INVOLVING ANALYSIS OF EXISTING DATA SHOULD BE CONSIDERED, RATHER THAN LONG-TERM FOLLOW-UP STUDIES, IN ORDER TO REDUCE THE YEARS REQUIRED TO OBTAIN DATA. OVERHEAD CHARGES WITHIN EACH ELIGIBLE GRANT WILL BE LIMITED TO EIGHT PERCENT. THE FUND WILL NORMALLY MAKE ONE TO TWO STANDARD RESEARCH GRANTS PER YEAR. INDIVIDUAL GRANTS WILL GENERALLY NOT EXCEED $40,000. GRANTS WILL BE LIMITED TO ONE-YEAR PROJECTS, SUBJECT TO RENEWAL. EXCEPT IN SPECIAL CASES, AN ORGANIZATION/ENTITY WILL NOT BE ELIGIBLE FOR MORE THAN ONE GRANT DURING ANY YEAR. A SCREENING COMMITTEE REVIEWS ALL APPLICATIONS, WITH FINAL GRANT DECISIONS MADE BY THE FUND'S ADMINISTRATIVE COMMITTEE. X X X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 GARY D RADINE PRESIDENT / CEO 0 1250004 0 2889385 0 193475 0 418284 0 17091 0 4768239 0 0 ANTHONY S BARTH EVP / COO 0 824004 0 1026663 0 112355 0 3855876 0 27449 0 5846347 0 0 MICHAEL J CASTRO EVP / CFO 0 566496 0 706644 0 67058 0 2164603 0 25558 0 3530359 0 0 MICHAEL G HANKINSON ESQ EVP / CLO 0 399615 0 299682 0 143958 0 34500 0 23666 0 901421 0 0 PATRICK S STEELE EVP / CIO 0 544916 0 771706 0 9849514 0 2422183 0 19793 0 13608112 0 9780574 BELINDA MARTINEZ SR. VICE PRES. 0 463396 0 481662 0 35338 0 2470490 0 19493 0 3470379 0 0 ALICIA F WEBER SVP, CONTROLLER 0 383123 0 391883 0 25636 0 38491 0 24288 0 863421 0 0 RUSSELL K BRADLEY VP, CLAIMS PROCESSING 0 127211 0 0 0 52154 0 9847 0 5770 0 194982 0 0 ROBERT P BUDD VP, SALES 256570 0 98586 0 14017 0 25535 0 16844 0 411552 0 0 0 PHILIP N ENGLE VP, INFORMATION TECHNOLOGY 0 240222 0 102733 0 10277 0 41387 0 16838 0 411457 0 0 RENEE A FISHER VP, QUALITY ASSURANCE AND TRAINING 0 82581 0 148030 0 13947 0 25321 0 5492 0 275371 0 0 JEANNE M FOSTER VP, FINANCE 0 248368 0 94722 0 13705 0 38239 0 16838 0 411872 0 0 RICHARD C GRAYBILL VP, UNDERWRITING AND ACT 0 204996 0 73481 0 8620 0 37555 0 6617 0 331269 0 0 KEVIN KING SALES ACCOUNT EXECUTIVE 111875 0 84000 0 12394 0 16785 0 1572 0 226626 0 0 0 ROBERT C SEWARD SALES ACCOUNT EXECUTIVE 62048 0 76946 0 14121 0 21260 0 16146 0 190521 0 0 0 ROBERT E MILHISLER DIRECTOR, SALES 118340 0 116896 0 10854 0 29745 0 14407 0 290242 0 0 0 TIMOTHY FALLON SALES ACCOUNT EXECUTIVE 54393 0 90750 0 13517 0 16776 0 1857 0 177293 0 0 0 STEVEN S GROSSMAN SALES ACCOUNT EXECUTIVE 83152 0 186688 0 11073 0 37786 0 15396 0 334095 0 0 0 CHARLES LAMONT ESQ FORMER EVP / CLO 0 0 0 584708 0 907 0 6503 0 0 0 592118 0 0 PART I, LINE 1A FIRST CLASS BUSINESS TRAVEL IS REIMBURSED TO THE EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, AND GROUP VICE PRESIDENTS. FIRST CLASS BUSINESS TRAVEL IS NOT TREATED AS TAXABLE COMPENSATION. THE PRESIDENT AND EXECUTIVE VICE PRESIDENTS MAY BE REIMBURSED FOR ONE HEALTH OR SOCIAL CLUB UPON APPROVAL BY THE PRESIDENT. TWO SENIOR EXECUTIVES RECEIVED THIS BENEFIT IN 2014. THE COST OF THIS BENEFIT IS INCLUDED IN TAXABLE COMPENSATION. FINANCIAL AND TAX PLANNING EXPENSES ARE REIMBURSED TO EMPLOYEES AT THE DIRECTOR OR ABOVE LEVELS OF MANAGEMENT. A COMPANY POLICY OUTLINES THE MAXIMUM REIMBURSEMENT ALLOWED FOR EACH MANAGEMENT LEVEL. THESE REIMBURSEMENTS ARE INCLUDED IN THE TAXABLE COMPENSATION OF THE REIMBURSED EMPLOYEES. PART I, LINE 4B CERTAIN EXECUTIVES PAID BY A RELATED ORGANIZATION PARTICIPATE IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PROGRAM. THE RELATED ORGANIZATION PROVIDES A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN TO CERTAIN OF ITS SENIOR EXECUTIVES AS SELECTED BY THE BOARD OF DIRECTORS. THE SUPPLEMENTAL RETIREMENT BENEFIT IS BASED ON EACH EXECUTIVE'S COMPENSATION AND YEARS OF SERVICE TO THE ENTERPRISE. THE BENEFIT IS SUBJECT TO THE RISK OF FORFEITURE IF REQUIRED YEARS OF SERVICE ARE NOT MET. ANNUAL DEFERRED COMPENSATION RELATED TO THIS PLAN IS REPORTED IN SCHEDULE J, PART II, COLUMN (C) FOR EACH PARTICIPANT AND REFLECTS THE CURRENT YEAR INCREASE OR DECREASE IN THE RELATED ORGANIZATION'S PENSION BENEFIT OBLIGATION ("PBO"), CALCULATED PURSUANT TO GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. THE PBO INCREASE OR DECREASE INCLUDES CHANGES IN ACTUARIAL ASSUMPTIONS (E.G., APPLICABLE DISCOUNT RATE), AS WELL AS CHANGES IN COMPENSATION AND YEARS OF SERVICE. IN 2014, ANTHONY BARTH, MICHAEL CASTRO, BELINDA MARTINEZ, AND PATRICK STEELE PARTICIPATED IN THE PLAN. PART I, LINE 7 THE PRESIDENT OF THE ORGANIZATION, WITH BOARD OF DIRECTORS APPROVAL, MAY GRANT AN ANNUAL BONUS TO ALL MANAGEMENT EMPLOYEES. THIS BONUS, OR INCENTIVE, IS INCLUDED IN TAXABLE COMPENSATION. SCHEDULE J, PART II, LINE (II) THE ORGANIZATION'S OFFICERS ARE PAID BY A RELATED ORGANIZATION. ACCORDINGLY, THEIR COMPENSATION IS REPORTED IN LINE (II). ANDREW S LEVINE DDS KLETTER LE PARTICIPATING PROVIDER 847642 DENTAL CLAIM PAYMENTS 0 PUBLICIS ORGANIZATION DIRECTOR FRANCINE Y. LOPEZ IS AN OFFICER OF PUBLICIS 11972296 PREMIUM REVENUE 0 ASCENA RETAIL GROUP ORGANIZATION DIRECTOR STACY MAZZA IS AN OFFICER OF ASCENA RETAIL GROUP 5622813 PREMIUM REVENUE 0 DENTSPLY INTERNATIONAL M. ALFANO IS A DIRECTOR OF DENTSPLY, ALSO A PURCHASER OF THIS ORGANIZATION 2799399 PREMIUM REVENUE 0 MCCARTIN ADVERTISING T. MCCARTIN IS THE PRESIDENT AND OWNER OF MCCARTIN ADVERTISING 56848 ADVERTISING REVENUE 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE CLASS OF MEMBERS, DESIGNATED CORPORATE MEMBERS, WHO ARE DIRECTORS OF DENTEGRA GROUP, INC., THE ORGANIZATION'S PARENT HOLDING COMPANY. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S DIRECTORS VOTE ON PERSONS NOMINATED AS DIRECTORS FOR ENDORSEMENT TO THE CORPORATE MEMBERS, WHO ELECT THE DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE CORPORATE MEMBERS MUST APPROVE ANY CHANGES TO SPECIFIED BYLAWS PROVISIONS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S CFO AND LEGAL COUNSEL OVERSEE THE COMPLETION OF THE FORM 990 AND, PRIOR TO FILING, REVIEW IT WITH THE PRESIDENT/CEO AND WITH THE DELTA DENTAL OF PENNSYLVANIA AUDIT COMMITTEE, TO WHICH SUCH DUTIES HAVE BEEN DELEGATED. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY, AND BETWEEN ANNUAL STATEMENTS IS REQUIRED TO DISCLOSE ANY NEW POSITION OR RELATIONSHIP FORMED THAT POTENTIALLY RAISES A CONFLICT OF INTEREST. LEGAL COUNSEL REVIEWS THESE DISCLOSURES AND REPORTS THE INFORMATION TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PAID TO THE CEO AND EXECUTIVE VICE PRESIDENTS IS APPROVED BY THE EXECUTIVE COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS. THE COMMITTEE APPROVES COMPENSATION FOR THE ENSUING YEAR AFTER REVIEWING COMPARABILITY DATA PRESENTED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT, AN ASSESSMENT OF EACH OFFICER'S PERFORMANCE OVER THE PRECEDING YEAR, AND THE ORGANIZATION'S PROGRAM ACCOMPLISHMENTS FOR THE YEAR. COMPENSATION PAID TO DIRECTORS IS APPROVED BY THE EXECUTIVE COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS AFTER REVIEWING COMPARABILITY DATA IN A BENCHMARKING STUDY PREPARED AND PRESENTED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT RETAINED BY THE BOARD OF DIRECTORS. THESE PROCESSES WERE FOLLOWED FOR 2014 COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION ANNUALLY INCLUDES MAJOR PORTIONS OF ITS FINANCIAL STATEMENT IN A PUBLISHED ANNUAL REPORT THAT IS MADE AVAILABLE TO PERSONS OR ENTITIES KNOWN TO HAVE AN INTEREST IN THE ORGANIZATION, AND IS AVAILABLE TO THE LARGER PUBLIC UPON REQUEST. STATUTORY FINANCIAL STATEMENTS ARE INCLUDED IN QUARTERLY AND ANNUAL RETURNS TO STATE DEPARTMENTS OF INSURANCE REGULATING THE ORGANIZATION WHICH RETURNS ARE AVAILABLE TO THE PUBLIC. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990, PT. VII, SEC. A, COL. (E); SCH. J, PT. II, LINE 1, COL. (B)(III) A ONE-TIME LUMP SUM PENSION BENEFIT PAYMENT WAS RECEIVED BY THE ORGANIZATION'S EXECUTIVE VICE PRESIDENT/CIO IN 2014, PURSUANT TO THE TERMS OF THE ORGANIZATION'S SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THIS PLAN IS DESIGNED FOR THE LONG-TERM RETENTION OF SENIOR EXECUTIVES (E.G., THE EXECUTIVE VICE PRESIDENT/CIO HAD BEEN WITH THE ORGANIZATION FOR MORE THAN 10 YEARS) AND IS BASED ON A PERCENTAGE OF HIS AVERAGE ANNUAL COMPENSATION RECEIVED FOR THE THREE YEARS PRIOR TO AGE 65 OR RETIREMENT, WHICHEVER COMES FIRST, AND ON HIS LIFE EXPECTANCY AS DETERMINED PURSUANT TO THE INTERNAL REVENUE CODE. THE EXECUTIVE VICE PRESIDENT/CIO'S ANNUAL COMPENSATION, UPON WHICH THE PENSION BENEFIT PAYMENT IS BASED, HAS BEEN ESTABLISHED IN ACCORDANCE WITH THE PROCESS OUTLINED IN TREASURY REGULATION SECTION 53.4958-6 FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS. THIS PROCESS INVOLVES REVIEW AND APPROVAL OF COMPENSATION BY THE ORGANIZATION'S BOARD OF DIRECTORS, RELIANCE ON COMPARABILITY DATA PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTANT, AND CONTEMPORANEOUS DOCUMENTATION OF DELIBERATIONS AND DECISIONS REGARDING COMPENSATION. FEDERAL TAX LAW APPLICABLE TO THE ORGANIZATION'S SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN DOES NOT PERMIT A PARTICIPANT TO RECEIVE AND PAY TAX ON ANNUAL PAYMENTS RECEIVED FROM THE PLAN OVER THE COURSE OF A PARTICIPANT'S RETIREMENT. INSTEAD, THE ENTIRE VALUE OF THE BENEFIT BECOMES TAXABLE WHEN THE PARTICIPANT RETIRES OR REACHES AGE 65, WHICHEVER COMES FIRST. THE LUMP SUM PAYMENT SHOWN IN SCHEDULE J , PART II, LINE 1, COLUMN (B)(III) (AND CARRIED TO FORM 990, PART VII, SECTION A, COLUMN (E)) WAS THEREFORE TRIGGERED IN 2014 WHEN THE ORGANIZATION'S EXECUTIVE VICE PRESIDENT/CIO TURNED 65 AND THE ENTIRE VALUE OF THE RETIREMENT BENEFIT WAS TAXABLE IN THAT YEAR. SEE RELATED NOTE IN SCHEDULE J, PART III, WHICH DESCRIBES THE ORGANIZATION'S SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. PART VII, SCHEDULE J; SCHEDULE R THE ORGANIZATION, REGULATED BY THE NEW YORK DEPARTMENT OF FINANCIAL SERVICES, IS A MEMBER OF THE DELTA DENTAL OF CALIFORNIA ENTERPRISE COMPANIES, WHICH INCLUDE DELTA DENTAL OF CALIFORNIA, DELTA DENTAL OF PENNSYLVANIA AND AFFILIATED COMPANIES OPERATING IN 15 STATES, THE DISTRICT OF COLUMBIA, PUERTO RICO AND THE U.S. VIRGIN ISLANDS. THE ENTERPRISE COMPANIES COMPRISE ONE OF THE NATION'S LARGEST DENTAL BENEFITS DELIVERY SYSTEMS COVERING 31.2 MILLION ENROLLEES AND HANDLING 42.5 MILLION CLAIMS. TOTAL REVENUE FOR THE ENTERPRISE EXCEEDED $7.9 BILLION IN 2014. THE ORGANIZATION AND ITS SUBSIDIARIES REPRESENT APPROXIMATELY 5% OF TOTAL ENTERPRISE REVENUES. FORM 990, PART VII AND SCHEDULE J: EFFECTIVE JANUARY 1, 2012 DELTA DENTAL OF NEW YORK ESTABLISHED THE LONG-TERM INCENTIVE PLAN (LTIP) FOR ELIGIBLE EMPLOYEES OF THE COMPANY. THE PURPOSE OF THE LTIP IS TO PROVIDE INCENTIVE FOR ELIGIBLE EMPLOYEES' CONTRIBUTION TO THE COMPANY'S LONG-TERM SUCCESS. THE LTIP IS UNFUNDED AND ALL PAYMENTS FROM THE LTIP ARE DERIVED FROM THE EQUITY GAINS OF THE COMPANY. AS SUCH THERE IS NO GUARANTEE OF INCENTIVE PAYMENTS UNDER THE LTIP. UPON DELEGATION BY CERTAIN OFFICERS OF THE BOARD, THE CEO AND MANAGEMENT COMMITTEE HAS THE SOLE AND ABSOLUTE DISCRETION TO DETERMINE THE PERFORMANCE OBJECTIVES, BOTH FINANCIAL AND NONFINANCIAL, UPON WHICH PAYMENT OF AWARDS ARE BASED AND THE TIME PERIOD DURING WHICH PERFORMANCE SHALL BE MEASURED (LTIP CYCLE). THE CURRENT LTIP CYCLE IS JANUARY 1, 2013 THROUGH DECEMBER 31, 2015. DELTA DENTAL COMMUNITY CARE FOUNDATION - 100 FIRST STREET SAN FRANCISCO CA 94105 371570764 CHARITABLE ORGANIZATION CA 501(C)(3) PF DENTEGRA GROUP INC 0 DELTA DENTAL OF PENNSYLVANIA ONE DELTA DRIVE MECHANICSBURG PA 17055 231667011 DENTAL INSURANCE PA 501(C)(4) DENTEGRA GROUP INC 0 DELTA DENTAL OF DELAWARE INC ONE DELTA DRIVE MECHANICSBURG PA 17055 510228088 DENTAL INSURANCE DE 501(C)(4) DENTEGRA GROUP INC 0 DELTA DENTAL OF WEST VIRGINIA INC ONE DELTA DRIVE MECHANICSBURG PA 17055 550523124 DENTAL INSURANCE WV 501(C)(4) DENTEGRA GROUP INC 0 DELTA DENTAL OF CALIFORNIA 100 FIRST STREET SAN FRANCISCO CA 94105 941461312 DENTAL INSURANCE CA 501(C)(4) DENTEGRA GROUP INC 0 DELTA DENTAL OF DISTRICT OF COLUMBIA ONE DELTA DRIVE MECHANICSBURG PA 17055 521479587 DENTAL INSURANCE DC 501(C)(4) DENTEGRA GROUP INC 0 PACA MANAGEMENT LLC ONE DELTA DRIVE MECHANICSBURG PA 17055 943277375 INSURANCE MANAGEMENT DE DELTA DENTAL OF CALIFORNIA RELATED 0 0 DENTEGRA GROUP INC 100 FIRST STREET SAN FRANCISCO CA 94105 943386049 HOLDING COMPANY DE N/A C 0 DENTEGRA INSURANCE COMPANY 100 FIRST STREET SAN FRANCISCO CA 94105 751233841 INSURANCE COMPANY DE DDC INSURANCE HOLDINGS INC C 0 DENTEGRA INSURANCE COMP OF NEW ENGLAND 100 FIRST STREET SAN FRANCISCO CA 94105 042890218 INSURANCE COMPANY MA DDC INSURANCE HOLDINGS INC C 0 DELTA DENTAL INSURANCE COMPANY 100 FIRST STREET SAN FRANCISCO CA 94105 942761537 INSURANCE COMPANY DE DDC INSURANCE HOLDINGS INC C 0 ALPHA DENTAL OF NEVADA INC 100 FIRST STREET SAN FRANCISCO CA 94105 880244893 INSURANCE COMPANY NV DDC INSURANCE HOLDINGS INC C 0 ALPHA DENTAL OF UTAH INC 100 FIRST STREET SAN FRANCISCO CA 94105 860672505 INSURANCE COMPANY UT DDC INSURANCE HOLDINGS INC C 0 ALPHA DENTAL PROGRAMS INC 100 FIRST STREET SAN FRANCISCO CA 94105 742447512 INSURANCE COMPANY TX DDC INSURANCE HOLDINGS INC C 0 ALPHA DENTAL OF ALABAMA INC 100 FIRST STREET SAN FRANCISCO CA 94105 630796079 INSURANCE COMPANY AL DDC INSURANCE HOLDINGS INC C 0 ALPHA DENTAL OF NEW MEXICO INC 100 FIRST STREET SAN FRANCISCO CA 94105 330279230 INSURANCE COMPANY NM DDC INSURANCE HOLDINGS INC C 0 ALPHA DENTAL OF ARIZONA INC 100 FIRST STREET SAN FRANCISCO CA 94105 930939835 INSURANCE COMPANY AZ DDC INSURANCE HOLDINGS INC C 0 DENTEGRA SEGURO DENTALES SA INSURGENTES SUR 826 PISO 15 COL DEL VALLE FC DF 01300 MX INSURANCE COMPANY MX DENTEGRA INSURANCE COMPANY C 0 DELTA REINSURANCE CORPORATION CGI TOWER 2ND FLOOR WARRENS ST. 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