2015-11-13T18:01:37-07:00 2014-12-31 990 2014-01-01 710561140 DELTA DENTAL PLAN OF ARKANSAS INC DELT 5018353400 1513 Country Club Road Sherwood AR 72120 Phyllis Rogers Senior VP & CFO 5019921616 2015-11-05 2014 2016-03-07 17:11:31Z Phyllis Rogers 1513 Country Club Road Sherwood AR 72120 443198817 0 X www.deltadentalar.com X 1982 AR See Schedule O. 13 12 200 0 3310248 273877 0 0 401116324 428628345 3544854 2247528 2991242 3537037 407652420 434412910 3844631 3693030 366049182 389823247 12761000 13019969 0 0 0 18242532 23119298 400897345 429655544 6755075 4757366 116141973 134834612 34959576 47565159 81182397 87269453 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 415755799 170226 428689326 Promote the oral health care of the community through group and individual dental insurance contracts and third party dental claims administration 0 0 0 415755799 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 53226 0 1 200 1 1 1 0 0 0 0 0 X 13 12 0 0 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 2508 19300 17500 Dr Mel Collazo Vice Chairman/Secretary 5 0 X 14500 19300 0 Weldon Johnson Jr Treasurer 5 0 X 7492 19300 12750 Dr James T Johnston DDS Director 5 0 X 14700 0 0 Ronald Ownbey Director 5 0 X 700 0 12800 Harold Perrin Director 5 0 X 10900 0 0 Robert Gladden Director 5 0 X 14100 0 0 Terri Miller Director 5 0 X 15500 31200 0 Dr Troy John Dryden Bartels Director 5 0 X 700 0 13800 Robert Mason Director 5 0 X 14700 0 0 Sarah Clark Director 5 0 X 12700 0 0 R Mark Bailey Director 5 0 X 12220 0 2760 Wayne Callahan Director 5 0 X 13700 0 0 Ed Choate President & CEO 60 0 X 623885 0 51300 Phyllis Rogers Senior VP & CFO 60 0 X 314458 0 52000 Lynn Harbert Senior VP & COO 60 0 X 286927 0 32844 Dr Herman Hurd VP Dental Director 60 0 X 243695 0 27842 Allen Moore VP Information Technology 60 0 X 221696 0 22291 James Couch VP and General Counsel 60 0 X 198795 0 10261 Melissa Masingill VP, Public Affairs 60 0 X 173684 0 19311 Jay Reavis VP, Sales and Account Management 60 0 X 0 164540 5920 Christa Pittman Director of Sales 60 0 X 147452 0 12746 Louis Crow Dental Consultant 60 0 X 137130 0 18949 Maxine Fricioni Director, Projects & Business Processes 60 0 X 116930 0 14060 Aron Harris Director of IT 60 0 X 115552 0 14421 Jenny Hergenroether Director of Finance 60 0 X 113805 0 9832 2828429 253640 351387 14 0 1 1 Avesis PO Box 7777 Phoenix AZ 850117777 Vision TPA 4687910 The Hatcher Agency PO Box 3505 Little Rock AR 72203 Brokers 2731575 Emdeon Business Services PO Box 572490 Murray UT 841572490 Printing & Postage 2167654 Billy Randall Machen DDS 4220 N Rodney Parham Rd Ste 200 Little Rock AR 72212 Dental Services 1738236 United Healthcare Insurance Company Dept CH 10151 Palatine IL 600550151 Health insurance carrier for employees 1670849 487 0 Dental Benefits 524298 105121319 105121319 0 0 Dental ASC & Admin Income 524298 292308939 292308939 0 0 Dental Reinsurance 524298 31198087 31198087 0 0 0 0 0 0 428628345 610867 0 0 610867 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10290357 132211 8714677 71230 1575680 60981 1636661 60981 0 1575680 0 0 0 0 0 Vision Benefits 524298 3310248 0 3310248 0 Other Income 900099 226789 0 0 226789 0 0 0 0 3537037 434412910 428689326 3310248 2413336 3693030 3693030 0 0 0 0 389823247 389823247 273111 0 273111 0 0 0 0 0 9481627 5688976 3792651 0 834804 834804 0 1801975 1081185 720790 0 628452 0 628452 0 371202 222721 148481 0 51632 0 51632 0 149888 0 149888 0 0 0 0 0 0 0 135680 0 135680 0 9290969 8528831 762138 0 909555 0 909555 0 2183357 1965021 218336 0 299616 299616 0 0 0 0 0 0 504111 0 504111 0 495605 297363 198242 0 0 0 0 0 91207 54724 36483 0 0 0 0 0 351152 0 351152 0 828497 828497 0 0 85226 0 85226 0 Claims Processing 1671808 1671808 0 0 Equip Repairs & Maintenance 1423262 853957 569305 0 Premium Taxes 558046 558046 0 0 Bank Charges 197971 118783 79188 0 3520514 69994 3450520 0 429655544 415755799 13899745 0 12899678 15508336 245000 245000 0 0 27772697 38709630 0 0 0 0 0 0 0 0 1156588 1243606 22992278 13208936 9976862 9783342 39405770 42821036 23282026 23988272 0 0 0 0 1403352 2535390 116141973 134834612 25907161 30415131 0 0 2064146 2903763 0 0 0 0 0 0 0 0 0 0 6988269 14246265 34959576 47565159 X 81182397 87269453 0 0 0 0 81182397 87269453 116141973 134834612 4757366 1329690 0 0 0 0 X 0 1 X 1 0 0 2315515 2315515 0 8400214 1894138 6506076 0 0 0 0 0 10453688 9747108 706580 0 1822861 1567690 255171 9783342 0 19272303 F Caprocq Core Real Estate Fund 4715969 F 23988272 Reinsurance Liabilities 11436765 Prefund Deposits and Refund Checks 1866013 Payable to Affiliates 943487 14246265 X Schedule D, Part X, Line 2 Not applicable 0 Delta Dental Foundation of Arkansas 1513 Country Club Road Sherwood AR 72120 261569324 501(c)3 3216858 Charitable Mission UAMS Foundation 4301 W Markham St 716 Little Rock AR 72205 716056774 501(C)3 200000 Sponsorship Ronald McDonald House 1009 Wolfe St Little Rock AR 72202 710525252 501c3 25050 Sponsorship Rotary Club of Little Rock 1501 N University Ave Ste 240 Little Rock AR 72207 716050594 501(c)4 20000 Sponsorship Octagon Inc PO Box 7247-6722 Philadelphia PA 191706722 521287224 20000 Sponsorship RPA 2015 Inaugural Committee PO Box 22467 LITTLE ROCK AR 72221 710149625 527 15000 Sponsorship Riverfest Inc 500 President Clinton Ave Suite 217 Little Rock AR 72201 710530405 501(C)3 15000 Sponsorship PARK 6915 Geyer Springs Road Little Rock AR 72209 582139088 501c3 15000 Sponsorship AR Livestock Show Association 2600 Howard Street Little Rock AR 72206 710236776 501(C)3 13000 Sponsorship March of Dimes 1501 N Pierce St Suite 106 LITTLE ROCK AR 72207 131846366 501(C)3 10000 Sponsorship CARTI Foundation PO Box 55011 Little Rock AR 72215 710589907 501c3 10000 Sponsorship AMERICAN RED CROSS IN ARKANSAS 401 S MONROE LITTLE ROCK AR 72205 530196605 501(C)3 10000 Sponsorship PARK Foundation 6915 Geyer Springs Rd Little Rock AR 72209 582139088 501(C)3 8000 Sponsorship AR Kids Read PO Box 164407 Little Rock AR 72216 461477513 501(C)3 6900 Sponsorship Baptist Health Foundation 9601 I 630 Exit 7 Little Rock AR 72205 237169407 501c3 6150 Sponsorship Arkansas Baptist College 1621 Dr Martin Luther King Drive Little Rock AR 72202 710298658 501c3 6000 Sponsorship The Salvation Army of Central Arkansas PO Box 1897 Little Rock AR 72203 580660607 501(C)3 5200 Sponsorship 14 3 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 436109 0 175517 0 9714 0 51300 0 0 0 672640 0 50722 0 Phyllis Rogers Senior VP & CFO 245942 0 71268 0 49 0 52000 0 0 0 369259 0 48938 0 Lynn Harbert Senior VP & COO 217694 0 69576 0 49 0 32844 0 0 0 320163 0 31139 0 Dr Herman Hurd VP Dental Director 185836 0 58614 0 49 0 27842 0 0 0 272341 0 26400 0 Allen Moore VP Information Technology 172445 0 54056 0 83 0 22291 0 0 0 248875 0 22284 0 James Couch VP and General Counsel 167500 0 35199 0 55 0 10261 0 0 0 213015 0 25653 0 Melissa Masingill VP, Public Affairs 138090 0 36812 0 0 0 19311 0 0 0 194213 0 17205 0 Christa Pittman Director of Sales 90002 0 60075 0 83 0 12746 0 0 0 162906 0 12754 0 Louis Crow Dental Consultant 133127 0 5076 0 0 0 18949 0 0 0 157152 0 16384 0 Maxine Fricioni Director, Projects & Business Processes 98830 0 19582 0 49 0 14060 0 0 0 132521 0 13474 0 Aron Harris Director of IT 100349 0 19339 0 83 0 14421 0 0 0 134192 0 13730 0 Jenny Hergenroether Director of Finance 95434 0 18490 0 0 0 9832 0 0 0 123756 0 9232 0 Schedule J, Part I, Line 1a 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 Schedule J, Part I, Line 4 - CEO participates in a SERP Schedule J, Part I, Line 6 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 Entity where Susie Smith is employed 115255 Bank fees 0 Ownbey Agency Producer of DDAR 53311 Producer fees 0 Collazo Orthodontics Participating provider 57266 Provider fees 0 Mark Bailey DDS Participating provider 96352 Provider fees 0 Troy Bartels DDS Participating provider 160225 Provider fees 0 Robert Mason DDS Participating provider 2824 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. In 2014, Delta Dental processed more than 2.4 million claims with an average turnaround time of less than one calendar day for payments. During the same period, our customer service center answered more than 623,000 phone calls with an average response rate of 29 seconds. 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 and its foundation 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. Over $7.7 million has been committed to fund the startup costs to fluoridate Arkansas water systems. When fully implemented, the number of Arkansans receiving fluoridated water will rise from 61% to 87% which will positively affect 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 and Intrust Wealth Management 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 compensation of 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 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 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 1831937 1943161 1 1 Renaissance Holding Company PO Box 30381 Lansing MI 48909 412177193 Holding company MI N/A C 0 16479582 0.132 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 Omega Administrators Inc l 1055974 Contractual payments Delta Dental of Arkansas Foundation b 3216858 Distribution paid Delta Dental Plan of Michigan m 1261499 Distribution paid