2013-11-13T12:23:08-06:00 2012-12-31 381357951 PLANTE & MORANPLLC 1111 MICHIGAN AVE PO BOX 2500 EAST LANSING MI 488262500 990 2012-01-01 381791480 DELTA DENTAL PLAN OF MICHIGAN INC DELT 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 GORAN JURKOVIC 5173496000 2013-11-11 1 SUSAN MIENCIER CPA P00842339 5173326200 2012 2016-02-24 21:20:13Z LAURA L CZELADA 4100 OKEMOS ROAD OKEMOS MI 48864 1620778564 0 X WWW.DDPMI.COM X 1957 MI 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. 18 15 821 0 9726656 -731097 0 0 1319971581 1418932444 3095297 4954065 52993475 57697337 1376060353 1481583846 6068000 98210 1182628421 1262553497 66254288 79566773 0 0 0 79230240 83895504 1334180949 1426113984 41879404 55469862 418291162 485073759 154393088 177476965 263898074 307596794 X 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 1359323074 98210 1466446875 PROMOTING DENTAL CAREDELTA DENTAL PLAN OF MICHIGAN, INC. IS A LEADING GROUP DENTAL BENEFITS PROVIDER IN THE MIDWEST. THE PURPOSE OF THE ORGANIZATION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH. THIS IS DONE BY OFFERING INNOVATIVE, COST-EFFECTIVE PRODUCTS THAT MEET THE NEEDS OF CUSTOMERS. THIS WAS DEMONSTRATED IN 2012 BY PAYING OUT OVER $1.26 BILLION IN CLAIMS AND BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 8 MILLION CLAIMS WERE PROCESSED FOR OVER 2.3 MILLION SUBSCRIBERS.COST SAVING STRATEGIESDELTA DENTAL BENEFIT PLANS ARE COMMITTED TO SAVING GROUPS AND SUBSCRIBERS MONEY. THE DELTA DIFFERENCE IS AN INTEGRATION OF ACTIVITIES; SUCH AS COST MANAGEMENT POLICIES, FEE REDUCTION AGREEMENTS WITH DENTISTS, AND AN ANTI-FRAUD HOTLINE, PUT TO WORK ENSURING QUALITY, COST-EFFECTIVE DENTAL BENEFIT DELIVERY. IN 2012, THE DELTA DIFFERENCE SAVED GROUPS AND SUBSCRIBERS NEARLY $1 BILLION. IN ADDITION, THE DELTA DIFFERENCE HELPS KEEP OUR TREND BELOW THE NATIONAL INFLATIONARY TREND IN DENTAL BENEFITS.ANOTHER COST SAVING STRATEGY WAS THE ADVENT OF A SECURE WEB SITE ALLOWING DENTAL OFFICES TO SUBMIT AND REVIEW CLAIMS, CHECK ELIGIBILITY AND GET REIMBURSED VIA ELECTRONIC DIRECT DEPOSIT. MANY DENTISTS MAIL CLAIMS INCURRING POSTAGE COSTS UP TO 70 CENTS PER CLAIM. BY USING THE DENTAL OFFICE TOOLKIT, THESE COSTS ARE REDUCED TO ZERO. THE ONLINE TOOL REDUCES STAFF TIME FOR CLAIMS PROCESSING AND WILL ULTIMATELY LOWER THE COST OF DOING BUSINESS FOR EVERYONE, INCLUDING CUSTOMERS AND SUBSCRIBERS.QUALITY INITIATIVES AND RESULTSBRINGING QUALITY TO ALL WE DO IS THE QUALITY POLICY FOR DELTA DENTAL PLAN OF MICHIGAN, INC. THE AFFILIATED DELTA DENTAL PLANS OF MICHIGAN, OHIO AND INDIANA HOLD THE PRESTIGIOUS ISO 9001 CERTIFICATION, UNDERSCORING OUR COMMITMENT TO PROVIDING QUALITY PRODUCTS AND SERVICES THAT SURPASS CUSTOMERS EXPECTATIONS. QUALITY STANDARDS ARE EXTREMELY RIGOROUS AND GUARANTEE THAT DELTA DENTAL HAS DOCUMENTED ITS QUALITY PROCEDURES AND SYSTEMS THROUGHOUT THE COMPANY. THE LONGSTANDING COMMITMENT TO PROVIDING QUALITY TO CUSTOMERS, DENTISTS, SUBSCRIBERS AND OTHER BUSINESS PARTNERS HAS NOW BEEN INTERNATIONALLY RECOGNIZED.QUALITY SERVICE IS ALSO MEASURED THROUGH INTERNAL AUDITS. RESULTS INDICATE OVER 98 PERCENT OF CLAIMS ARE PROCESSED WITHIN 10 WORKING DAYS.COMMITMENT TO THE COMMUNITYDELTA DENTAL PLAN OF MICHIGAN, INC. BELIEVES ADVANCES IN DENTAL RESEARCH AND ENHANCED EDUCATIONAL OPPORTUNITIES FOR DENTISTS GO A LONG WAY TOWARD IMPROVING ORAL HEALTH. THE COMPANY IS A KEY PLAYER IN GROUNDBREAKING RESEARCH ON TRENDS IN ORAL HEALTH IN THE INSURED POPULATION. THE DELTA DENTAL FUND, THE COMPANYS PHILANTHROPIC AFFILIATE, ENCOURAGES ADVANCES IN DENTISTRY AND SUPPORTS DENTAL EDUCATION AND RESEARCH. ONLY AN ORGANIZATION OF DELTA DENTALS SIZE AND EXPERIENCE IN THE BENEFITS FIELD WOULD HAVE OVER 25 YEARS WORTH OF EXTENSIVE DATA REGARDING DENTAL TREATMENT PATTERNS OVER EXTENDED PERIODS OF TIME. BECAUSE OF ITS COMMITMENT TO ADVANCING THE SCIENCE OF DENTISTRY, EACH YEAR THE COMPANY GRANTS RESEARCHERS AT FIVE DENTAL SCHOOLS IN MICHIGAN, OHIO AND INDIANA ACCESS TO THIS IMPORTANT INFORMATION TO STUDY ORAL HEALTH TRENDS. THE RESULTS OF THEIR STUDIES WILL ADD SIGNIFICANT DATA TO THE BODY OF KNOWLEDGE IN THE FIELD OF DENTISTRY.SINCE IT WAS FORMED IN 1980, THE DELTA DENTAL FUND HAS GRANTED ALMOST $16 MILLION TOWARD THE ADVANCEMENT OF DENTAL SCIENCE AND IMPROVEMENT OF THE ORAL HEALTH OF THE PUBLIC. DELTA DENTAL FUND REGULARLY PROVIDES FUNDING FOR PROGRAMS THAT HELP AT-RISK POPULATIONS AND INDIVIDUALS WITH SPECIAL NEEDS OBTAIN DENTAL TREATMENT, FOR SCHOLARSHIP AND LEADERSHIP AWARDS TO DENTAL STUDENTS, FOR GRANTS TO PURCHASE LEARNING TOOLS AND OTHER PROGRAMS TO DENTAL SCHOOLS, FOR CONTINUING EDUCATION PROGRAMS FOR THE DENTAL PROFESSION, AND FOR EDUCATIONAL MATERIALS ON THE IMPORTANCE OF ORAL HEALTH AND HAZARDS TO ORAL HEALTH.IN 2012, DELTA DENTAL FUND PROVIDED GRANTS TOTALING NEARLY $1 MILLION FOR DENTAL AND COMMUNITY RELATIONS PROJECTS. AMONG THEM WAS A GRANT TO THE OHIO STATE UNIVERSITY COLLEGE OF DENTISTRY TO SUPPORT THE MOBILE DENTAL CLINIC IT OPERATES TO PROVIDE DENTAL TREATMENT TO THOUSANDS OF CHILDREN IN COLUMBUS, OHIO, WHO LACK ACCESS TO DENTAL CARE.DELTA DENTAL PLAN OF MICHIGAN IS ALSO COMMITTED TO THE COMMUNITY. DELTA DENTAL HAS ALWAYS BEEN KEENLY AWARE OF ITS CIVIC AND SOCIAL RESPONSIBILITY. DELTA DENTAL PLANS ARE PROUD TO SHARE, THROUGH DIRECT FINANCIAL CONTRIBUTIONS, WITH HUNDREDS OF COMMUNITY AGENCIES AND GROUPS. IN ADDITION, EMPLOYEES LOG COUNTLESS HOURS OF THEIR OWN TIME AS VOLUNTEERS. COMMUNITY SUPPORT GENERALLY FALLS UNDER THE BROAD CATEGORIES THAT PROVIDE SUPPORT TO AGENCIES AND INSTITUTIONS SERVING CHILDREN, SENIORS, LOW-INCOME INDIVIDUALS, MINORITIES, AND THE DISABLED AND AT-RISK INDIVIDUALS, TO ORGANIZATIONS THAT PROMOTE EDUCATION, ARTS AND RECREATION AND COMMUNITY DEVELOPMENT, AND TO CHARITABLE PROJECTS OR PROGRAMS RECOMMENDED BY EMPLOYEES, CUSTOMERS, PARTICIPATING DENTISTS AND OTHER KEY GROUPS. THROUGH A PUBLIC-PRIVATE PARTNERSHIP WITH THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH, DELTA DENTAL ADMINISTERS THE HEALTHY KIDS DENTAL AND MICHILD PROGRAMS. HEALTHY KIDS DENTAL IS A DENTAL BENEFITS PROGRAM FOR MEDICAID BENEFICIARIES UNDER AGE 21. IT IS AVAILABLE IN 75 COUNTIES AND COVERS BASIC DENTAL HEALTH BENEFITS SUCH AS X-RAYS, CLEANINGS, CAVITY FILLINGS, ROOT CANALS, TOOTH EXTRACTIONS AND DENTURES. MORE THAN 442,000 MICHIGAN CHILDREN ARE SERVED BY THIS PROGRAM.MICHILD IS AN INSURANCE PROGRAM THAT IS STATE AND FEDERALLY FUNDED WHICH MAKES COMPREHENSIVE HEALTH AND DENTAL COVERAGE AVAILABLE TO UNINSURED LOW AND MIDDLE INCOME CHILDREN UNDER 19 YEARS OF AGE. DELTA DENTAL PLAN OF MICHIGAN HAS APPLIED ITS ADMINISTRATIVE EXPERTISE AND DENTIST NETWORKS TO IMPROVING ORAL HEALTH CARE FOR THIS SEGMENT OF THE POPULATION ALSO.UNEQUALED ACCESS TO DENTISTSTHE BENEFITS OF DELTA DENTAL ARE NOW AVAILABLE BEYOND THIS NATIONS BORDERS. THROUGH A PARTNERSHIP WITH INTERNATIONAL SOS ASSISTANCE, INC., DELTA DENTAL ENROLLEES CAN NOW RECEIVE EXPERT TREATMENT FOR NON-EMERGENCY AND EMERGENCY DENTAL CARE WHEN THEY ARE OUTSIDE OF THE UNITED STATES.FOR FIVE DECADES, DELTA DENTAL HAS HELPED PROMOTE ORAL HEALTH BY DESIGNING AND ADMINISTERING INNOVATIVE, COST-EFFECTIVE DENTAL BENEFIT PROGRAMS. EXPERTS AT PLAN DESIGN, DELTA DENTAL HAS CREATED DENTAL BENEFIT PROGRAMS THAT MEET CUSTOMER COST-OBJECTIVES WHILE HELPING TO IMPROVE AND MAINTAIN ORAL HEALTH.THE PROGRAMS FEATURE LARGE PANELS OF FULL-TIME PARTICIPATING DENTISTS. IN FACT, 3 OUT OF 4 DENTISTS NATIONWIDE PARTICIPATE WITH DELTA DENTAL. THIS KIND OF REACH HAS ENABLED MILLIONS OF PEOPLE TO RECEIVE COST-EFFECTIVE DENTAL CARE.DELTA DENTALS GROUP MEMBERS ARE AFFORDED ADDED PROTECTION BECAUSE THEY GUARANTEE THAT PARTICIPATING DENTISTS WILL ACCEPT THEIR PAYMENT FOR COVERED SERVICES AND THAT NO CHARGES, OTHER THAN CO-PAYMENTS AND DEDUCTIBLES WILL BE BILLED. THIS LOWERS CLAIM COSTS FOR CUSTOMERS AND REDUCES OUT-OF-POCKET COSTS FOR SUBSCRIBERS.WITH TWO NETWORKS OF FULL-TIME PARTICIPATING DENTISTS IN ONE INTEGRATED CLAIMS SYSTEM, DELTA DENTAL CAN DELIVER TO CUSTOMERS AND GROUP MEMBERS, THE GREATEST ACCESS AT THE BEST COST. 1359323074 0 0 1 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 1 1 1 1 0 1 53335 0 1 821 1 1 1 0 0 0 0 0 X 18 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X GORAN JURKOVIC CHIEF FINANCIAL OFFICER 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 X DOUGLAS R ANDERSON 5.00 11.00 X 11537 5900 17000 TODD V ESTER DDS 5.00 0.00 X 12837 0 0 JOSHUA S HOWIE 5.00 5.00 X 24200 3300 0 BRUCE BAIRD DDS 5.00 12.00 X 17900 75300 0 FATHER JACK H BAKER 5.00 5.00 X 22800 7400 0 LISA DANCSOK 5.00 5.00 X 22800 3300 0 RORY GAMBLE 5.00 5.00 X 17900 700 0 JOSEPH C HARRIS DDS 5.00 6.00 X X 27537 5300 0 JEFFREY A KELLER 5.00 5.00 X 2100 0 0 TERRI A MILLER CPCU 5.00 5.00 X 25600 2600 0 TIMOTHY E MOFFIT DMA 5.00 10.00 X 26137 6100 0 C RICHARD SEITZ 5.00 8.00 X 22100 20700 0 BRUCE R SMITH 5.00 12.00 X X 27700 26040 0 TERENCE R COMAR DDS MS 5.00 7.00 X X 40137 11800 0 JAMES P HALLAN 5.00 11.00 X 30197 16250 0 STEPHEN A EKLUND DDA MHSA 5.00 1.00 X 700 132700 0 ANN MARIE FLERMOEN 5.00 10.00 X 5166 500 16140 KELLY JUBB SCHNEIDERER 5.00 10.00 X 11600 4290 17000 THOMAS FLESZAR DDS MS 35.00 15.00 X X 6519088 0 62294 GORAN JURKOVIC CPA 26.50 23.50 X 545232 0 302478 LAURA L CZELADA 38.00 12.00 X 1103469 0 659905 LUIGI BATTAGLIERI 50.00 0.00 X 160546 0 17123 BRENDA LAIRD 50.00 0.00 X 689668 0 52322 NANCY HOSTETLER 50.00 1.00 X 343989 0 28889 JED JACOBSON DDS MS MPH 50.00 0.00 X 696736 0 52318 TOBY HALL 50.00 0.00 X 279837 0 157812 KAREN GREEN 50.00 0.00 X 308012 0 24602 SHERRY CRISP 50.00 0.00 X 2224740 0 9995 EDWARD ZOBECK 40.00 10.00 X 1768040 0 360123 RANDY TASCO 50.00 0.00 X 395927 0 792674 JON GROAT 42.00 8.00 X 292318 0 24678 MICHAEL BOBAK 50.00 0.00 X 234045 0 40206 ANTHONY ROBINSON 50.00 0.00 X 328561 0 41725 NICHOLAS CORRIDOR 50.00 0.00 X 223763 0 41588 SARA EZIUKA 50.00 0.00 X 299697 0 63359 MARY BOFANTE 50.00 0.00 X 202405 0 29249 16965021 322180 2811480 133 0 1 0 MESSA 1480 KENDALE BLVD EAST LANSING MI 48826 COMMISSIONS 2673353 GS&F 4235 HILLSBORO PIKE NASHVILLE TN 37215 ADVERTISING 2473061 CLOVER CONSULTING 400 E DIVISION STE 6 PMB 163 ROCKFORD MI 49341 IT SERVICES 1448049 THE ARSENAL GROUP LLC PO BOX 1562 BIRMINGHAM MI 48009 CONSULTING 869762 TEK SYSTEMS PO BOX 198568 ATLANTA GA 30384 IT SERVICES 755934 42 DENTAL CARE REVENUE 624100 1407811050 1407811050 E-COMMERCE SOLUTIONS 518210 11048384 1393812 9653646 926 IS EXTERNAL SERVICES 524292 73010 73010 1418932444 4931738 4931738 17879124 121337921 17997471 121197247 -118347 140674 22327 22327 ADMINISTRATIVE REIMBURSEMENT 900099 57386092 57386092 MISCELLANEOUS INCOME 900099 311245 311245 57697337 1481583846 1466590954 9726656 5266236 98210 98210 1262553497 1262553497 16012014 10407809 5604205 49420641 28584766 20835875 1089227 548375 540852 8725277 4848243 3877034 4319614 2544749 1774865 1581715 805643 776072 691630 691630 487726 487726 227001 227001 11906813 7550971 4355842 2852472 643107 2209365 11937555 10277143 1660412 7353135 5403948 1949187 2640531 1031 2639500 3401520 2556372 845148 606813 225985 380828 10729626 4882468 5847158 638957 638957 E-COMMERCE EXPENSES 10585365 0 10585365 COMMISSIONS 10342173 10342173 0 PROCESSING FEES 3342370 3342370 0 RISK SHARE CHARGES 2066215 1925412 140803 2503887 1780802 723085 1426113984 1359323074 66790910 0 2118 2117 66986349 89369594 78680856 73476537 14698754 17546504 188778600 82772855 117796125 106005745 118203049 153954258 21578555 41638150 345356 3080854 418291162 485073759 43730556 43983611 110662532 133493354 154393088 177476965 X 15744473 15744473 5122500 5122500 243031101 286729821 263898074 307596794 418291162 485073759 X 55469862 8752540 -20523682 X X 0 1 X 1 0 10000 10000 10000 1 GOVERNORS CLUB (527 PLAN) PO BOX 4925 TROY MI 48099 450950905 10000 ORGANIZATIONS DIRECT AND INDIRECT POLITICAL CAMPAIGN ACTIVITIES: PART I-A, LINE 1: CONTRIBUTION TO THE GOVERNOR'S CLUB OF $10,000 7859592 7859592 103760024 22053495 81706529 28650193 22464022 6186171 48508791 38255338 10253453 106005745 DDIC. STOCK 200217 C INVESTMENT IN RSS, LLC - 100% 1515636 C INVESTMENT IN RHC 39922297 C 41638150 IBNR - CLAIM ADJUSTMENT RESERVES 36450722 UNEARNED PREMIUMS 27965026 FAS 158 FUNDED STATUS 69077606 133493354 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: AS OF DECEMBER 31, 2012 AND 2011, THE ENTERPRISE'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED DURING THE YEARS OR ACCRUED AT YEAR END. 1 MICHIGAN ECONOMIC DEVELOPMENT FOUNDATION PO BOX 13063 LANSING MI 48901 382527475 501(C)(3) 15000 CASH N/A SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMS BLESSINGS IN A BACKPACK 4121 SHELBYVILLE RD LOUISVILLE KY 40207 261964620 501(C)(3) 46991 CASH N/A CHARITABLE DONATION NEW ENERGY TO REINVENT MICHIGAN PO BOX 15246 LANSING MI 48901 450888727 501(C)(4) 10000 CASH N/A AMERICANS MISSION OF MERCY DONATION HEALTHSTRIDES LTD 1105 JUDY CT WATERSVILLE OH 43081 314662950 16219 CASH N/A CLEVELAND OHIO HEART WALK FOUNDATION TO REINVENT MICHIGAN PO BOX 4927 TROY MI 48099 275278263 501(C)(3) 10000 CASH N/A SUPPORT OF THE EFFORTS TO REINVENT MICHIGAN 3 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: CONTRIBUTIONS ARE MADE AT BOARD MEMBER DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF MICHIGAN'S MISSION. IN ORDER FOR FUNDS TO BE DISBURSED, VOUCHER RECORDS MUST PASS THROUGH THE APPROVAL PROCESS, SIMILAR TO ANY OTHER EXPENDITURE MADE BY DELTA DENTAL PLAN OF MICHIGAN. X X X 1 1 X X X X X X 0 1 0 0 0 0 0 0 0 THOMAS FLESZAR DDS MS 229871 0 1449082 0 4840135 0 57601 0 4693 0 6581382 0 0 0 GORAN JURKOVIC CPA 274905 0 257343 0 12984 0 282378 0 20100 0 847710 0 0 0 LAURA L CZELADA 579093 0 514288 0 10088 0 653185 0 6720 0 1763374 0 0 0 LUIGI BATTAGLIERI 152312 0 0 0 8234 0 17103 0 20 0 177669 0 0 0 BRENDA LAIRD 293171 0 293842 0 102655 0 45602 0 6720 0 741990 0 0 0 NANCY HOSTETLER 191203 0 138668 0 14118 0 8789 0 20100 0 372878 0 0 0 JED JACOBSON DDS MS MPH 266454 0 250633 0 179649 0 45598 0 6720 0 749054 0 0 0 TOBY HALL 205034 0 61934 0 12869 0 137712 0 20100 0 437649 0 0 0 KAREN GREEN 175575 0 121362 0 11075 0 4502 0 20100 0 332614 0 0 0 SHERRY CRISP 196159 0 271732 0 1756849 0 7755 0 2240 0 2234735 0 1712641 0 EDWARD ZOBECK 356188 0 358977 0 1052875 0 340023 0 20100 0 2128163 0 1042854 0 RANDY TASCO 220700 0 170819 0 4408 0 772574 0 20100 0 1188601 0 0 0 JON GROAT 216794 0 63663 0 11861 0 17958 0 6720 0 316996 0 0 0 MICHAEL BOBAK 79497 0 154209 0 339 0 20106 0 20100 0 274251 0 0 0 ANTHONY ROBINSON 185727 0 140204 0 2630 0 21625 0 20100 0 370286 0 0 0 NICHOLAS CORRIDOR 53821 0 169818 0 124 0 21488 0 20100 0 265351 0 0 0 SARA EZIUKA 53622 0 245742 0 333 0 43259 0 20100 0 363056 0 0 0 MARY BOFANTE 52047 0 149980 0 378 0 16508 0 12741 0 231654 0 0 0 PART I, LINE 1A FIRST CLASS TRAVEL AVAILABLE TO KEY EMPLOYEES. THIS AMOUNT WAS TREATED AS NONTAXABLE TO THE KEY EMPLOYEE. TRAVEL FOR COMPANIONS RELATED TO TRAVEL FOR A SPOUSE. THIS AMOUNT WAS TREATED AS TAXABLE TO THE BOARD MEMBER OR EMPLOYEE. VARIOUS INDIVIDUALS ON SCHEDULE J ARE ELIGIBLE FOR REIMBURSEMENT OF SUBSTANTIATED HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES. THIS BENEFIT IS NOT TAXABLE BUT THE EXPENSE MUST BE SUBSTANTIATED AS A BUSINESS EXPENSE. PART I, LINE 4B EDWARD ZOBECK= $1,042,854 SHERRY CRISP= $1,712,641 ADDITIONALLY, DELTA DENTAL PLAN OF MICHIGAN, HAS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). IN ORDER TO BE ELIGIBLE FOR THE SERP, AN EMPLOYEE MUST BE A SENIOR VICE PRESIDENT OR HIGHER. AN OUTSIDE INDEPENDENT ACTUARY CALCULATES THE VALUE ON AN ANNUAL BASIS. ADDITIONALLY, ALL EXECUTIVES ARE ELIGIBLE FOR A 457(F) PLAN. THIS PLAN IS FUNDED SOLELY BY EMPLOYEE CONTRIBUTIONS. THE INDIVIDUALS ARE VESTED UPON FUNDING THE 457(F) PLAN. COMAR COMAR PC TERENCE COMAR, DIRECTOR OF DDPMI, IS AN OWNER IN COMAR & COMAR, PC. 159700 HEALTH CARE PAYMENTS 0 FORM 990, PART VI, SECTION A, LINE 6 DELTA DENTAL PLAN OF MICHIGAN HAS A SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS VOTING RIGHTS AND ELECTS DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ITEMS ARE SUBJECT TO APPROVAL BY THE SOLE MEMBER: IF 10% OF THE ASSETS ARE TO BE SPENT/SOLD OR A NEW PRESIDENT IS TO BE APPOINTED. FORM 990, PART VI, SECTION B, LINE 11 THE INFORMATION PRESENTED ON THE FORM 990 IS GATHERED BY THE SENIOR TAX ADMINISTRATOR FOR THE ORGANIZATION. THE CFO REVIEWS THE INFORMATION. ONCE APPROVED THE INFORMATION IS GIVEN TO OUTSIDE TAX PREPARERS WHO PREPARE AND REVIEW THE FORM 990. ONCE COMPLETE AN ELECTRONIC COPY OF THE FORM 990 IS PUT ONTO A WEBSITE FOR THE BOARD TO REVIEW. THIS IS DONE BEFORE THE RETURN IS FILED WITH THE IRS. 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. ALL CONFLICT OF INTEREST DISCLOSURE FORMS ARE INITIALLY REVIEWED BY THE VICE PRESIDENT AND GENERAL COUNSEL. 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. THE POSITIONS COVERED ARE THE CEO, COO, CAO, CIO, CFO, CSO, CMO, CRO, AND CHIEF ACTUARY. THE ORGANIZATION CONTRACTS WITH TOWERS WATSON TO DO A COMPENSATION AND REASONABLENESS ANALYSIS EVERY TWO YEARS. THE FINAL DETERMINATION OF COMPENSATION IS DONE 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 2012. THE REPORT BASED ON THIS REVIEW WAS THEN ISSUED BY THE CONSULTANTS IN APRIL OF 2013. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990 PART VII: CERTAIN OFFICERS ARE OFFICERS IN MULTIPLE RELATED ORGANIZATIONS. AVERAGE HOURS WORKED REFLECTS THE TIME SPENT IN EACH ORGANIZATION HOWEVER COMPENSATION IS REPORTED IN FULL TO AGREE TO THE W-2. ANY ALLOCATION OF COMPENSATION IS INCLUDED ON SCHEDULE R. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: GAIN ON EQUITY IN SUBSIDIARY 2,993,399. PENSION RELATED CHANGES -23,517,081. FORM 990 PART XII LINE 2C AND 2D: DELTA DENTAL PLAN OF MICHIGAN IS AUDITED BY AN INDEPENDENT ACCOUNTANT AS PART OF A CONSOLIDATED FINANCIAL STATEMENT ISSUED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. DELTA DENTAL PLAN OF MICHIGAN ALSO RECEIVES AN AUDITED FINANCIAL STATEMENT BY AN INDEPENDENT ACCOUNTANT THAT IS PREPARED ON A STATUTORY BASIS. 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 THE PRIOR YEAR. RENAISSANCE SYSTEMS AND SERVICES LLC PO BOX 30416 LANSING MI 489097916 383638865 E-COMMERCE SOLUTIONS FOR DENTISTS MI 11048384 1679833 DELTA DENTAL PLAN OF MICHIGAN INC ELECTRONIC LOCKBOX SERVICES LLC 1502 W EDGEWOOD AVENUE SUITE D INDIANAPOLIS IN 46217 454734479 PROVIDES ELECTRONIC CREDIT CARD PAYMENT SERVICES MI -362098 36784 RENAISSANCE SYSTEMS AND SERVICES LLC 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 OHIO 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 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 OF TENNESSEE PO BOX 30416 LANSING MI 489097916 620812197 PROVIDE DENTAL SERVICE PLANS TN 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) 11A TYPE II DELTA DENTAL PLAN OF MICHIGAN INC 1 DELTA DENTAL OF NEW MEXICO 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 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 IN 501(C)(3) PF RENAISSANCE HOLDING COMPANY 1 RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI RENAISSNCE HEALTH SERVICE CORPORATION C -197458 42161795 0.62100 1 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA PO BOX 30416 LANSING MI 489097916 470397286 INSURANCE IN RENAISSANCE HOLDING COMPANY C 1 RENAISSANCE HEALTH INSURANCE COMPANY OF NEW YORK PO BOX 30416 LANSING MI 489097916 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 1 FORE HOLDING CORPORATION 240 VENTURE CIRCLE NASHVILLE TN 37228 204116122 EMPLOYEE BENEFITS TN DELTA DENTAL OF TENNESSEE C 1 DENTAL CHOICE INC 10100 LINN STATION RD SUITE 700 LOUISVILLE KY 40223 611105118 REAL ESTATE HOLDING COMPANY 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 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 DELTA DENTAL OF TENNESSEE L 5462127 ACTUAL COST DELTA DENTAL PLAN OF OHIO L 25116689 ACTUAL COST DELTA DENTAL PLAN OF INDIANA L 9250454 ACTUAL COST RENAISSANCE HEALTH SERVICE CORPORATION L 125004 ACTUAL COST DELTA DENTAL FUND L 157050 ACTUAL COST RENAISSANCE LIFE AND HEALTH INSURANCE COMPANY OF AMERICA L 3317986 ACTUAL COST DELTA DENTAL PLAN OF NEW MEXICO L 1224917 ACTUAL COST DELTA DENTAL OF KENTUCKY L 115599 ACTUAL COST DELTA DENTAL OF NORTH CAROLINA D 2700000 LOAN COST DELTA DENTAL OF NORTH CAROLINA L 1387797 ACTUAL COST RENAISSANCE HOLDING COMPANY L 70500 ACTUAL COST