2012-11-15T08:17:49-06:00 2011-12-31 341851358 CBIZ MHM LLC 3625 CUMBERLAND BLVD STE 800 ATLANTA GA 30082 990 2011-01-01 521479587 DELTA DENTAL OF THE DISTRICT OF COLUMBIA DELT 7177668500 ONE DELTA DRIVE MECHANICSBURG PA 17055 JEANNE FOSTER 7177668500 2012-11-08 1 P01064143 7708584500 2011 2016-02-24 21:20:13Z JEANNE FOSTER ONE DELTA DRIVE MECHANICSBURG PA 17055 3412136 0 X WWW.DELTADENTALINS.COM X 1985 DC TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS, SERVICE, TECHNOLOGY, AND PROFESSIONAL SUPPORT. 7 7 0 0 0 0 0 0 2927921 3444834 5 777 0 -33475 2927926 3412136 10000 10000 0 0 2400 2400 0 0 0 2915521 3399736 2927921 3412136 5 0 3715162 3320740 3611098 3216676 104064 104064 TO ADVANCE DENTAL HEALTH AND ACCESS THROUGH EXCEPTIONAL DENTAL BENEFITS, SERVICE, TECHNOLOGY, AND PROFESSIONAL SUPPORT. 0 0 3202437 3444834 THE ORGANIZATION IS THE GENERAL AGENT FOR DENTAL INSURANCECONTRACTS PROVIDING COVERAGE FOR 410,424 BENEFICIARIES IN 2011PRIMARILY THROUGH CONTRACTS WITH INDEPENDENT DENTISTS SERVING 112PURCHASING GROUPS. 10000 10000 THE ORGANIZATION MADE GRANTS DURING 2011 TO FOSTER IMPROVED ACCESSTO DENTAL HEALTH CARE TREATMENT, TO SUPPORT PROFESSIONAL DENTALEDUCATION AND TO PROVIDE ORAL HEALTH INSTRUCTION FOR PATIENTS. 3212437 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 16484 0 1 0 0 0 0 0 0 0 X 7 7 0 0 1 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 SINGER DDS 1.00 X 600 0 0 CHRISTINA KREUTZIGER 1.00 X 600 0 0 OTTHO MILBOURNE CEBS 1.00 X 600 0 0 BALFOUR D MATTOX DDS 1.00 X 0 0 0 VIVIAN MURPHY 1.00 X 600 0 0 ELIZABETH STROUD 1.00 X 600 0 0 ST ELMO CRAWFORD 1.00 X 0 0 0 GARY D RADINE 1.00 X 0 18161370 41534 ANTHONY S BARTH 1.00 X 0 1354247 2681145 ROY M HILLIARD 1.00 X 0 330392 25715 RENEE A FISHER 1.00 X 0 278352 32186 PHILIP N ENGLE 1.00 X 0 272215 35172 MICHAEL J CASTRO 1.00 X 0 927320 1183511 JEANNE M FOSTER 1.00 X 0 290814 37131 RICHARD C GRAYBILL 1.00 X 0 240698 26125 CHARLES LAMONT ESQ 1.00 X 0 815197 1427517 KAREN L ROBINSON 1.00 X 0 117373 26065 WHITNEY H SHERBOCKER 1.00 X 0 166950 30850 ALICIA F WEBER 1.00 X 0 565786 55447 3000 23520714 5602398 0 0 1 0 0 ADMINISTRATIVE FEES (I 2229707 2229707 ADMINISTRATIVE FEES (A 1215127 1215127 3444834 777 777 -33475 -33475 -33475 3412136 3412136 0 0 10000 10000 2400 2400 ADMINISTRATIVE FEES 2658304 2477805 180499 COMMISSIONS 493999 493999 LICENSES, PERMITS, FEES 93225 86895 6330 BANK SERVICE CHARGES 32332 30137 2195 121876 113601 8275 3412136 3212437 199699 0 596918 530976 2163404 1704467 954840 1085297 3715162 3320740 1193876 1254001 63818 62208 2353404 1900467 3611098 3216676 X 0 0 0 0 104064 104064 104064 104064 3715162 3320740 0 0 X 0 1 1 X 0 0 FUNDS HELD FOR THE ACCOUNTS OF OTHERS 1704467 PREFUNDED DEPOSITS 196000 1900467 3412136 3412136 0 3412136 0 3412136 0 3412136 3412136 0 3412136 0 3412136 PART X, LINE 2 - FIN 48 (ASC 740) FOOTNOTE: 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 EVALUATED THE IMPACT OF THE ACCOUNTING PRONOUNCEMENT AND DETERMINED THAT IT HAD NO IMPACT ON THE COMPANY'S FINANCIAL STATEMENTS. 1 HOWARD UNIVERSITY & HOSPITAL SYSTEM 600 W ST NW WASHINGTON DC 20059 530204707 5000 TO PROVIDE DENTAL EDUCATION DELTA DENTAL COMMUNITY CARE FOUNDATION 100 FIRST STREET SAN FRANCISCO CA 94105 371570764 5000 TO PROVIDE DENTAL EDUCATION 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 0 1250004 0 1250000 0 15661366 0 24194 0 17340 0 18202904 0 4453200 ANTHONY S BARTH 0 800004 0 450000 0 104243 0 2657145 0 24000 0 4035392 0 0 ROY M HILLIARD 0 219593 0 92975 0 17824 0 10521 0 15194 0 356107 0 0 RENEE A FISHER 0 213328 0 55000 0 10024 0 15569 0 16617 0 310538 0 0 PHILIP N ENGLE 0 217869 0 45000 0 9346 0 18632 0 16540 0 307387 0 0 MICHAEL J CASTRO 0 549996 0 350000 0 27324 0 1159511 0 24000 0 2110831 0 0 JEANNE M FOSTER 0 233674 0 46000 0 11140 0 20510 0 16621 0 327945 0 0 RICHARD C GRAYBILL 0 198009 0 35000 0 7689 0 19636 0 6489 0 266823 0 0 CHARLES LAMONT ESQ 0 450000 0 325000 0 40197 0 1410177 0 17340 0 2242714 0 0 WHITNEY H SHERBOCKER 0 149895 0 14400 0 2655 0 14283 0 16567 0 197800 0 0 ALICIA F WEBER 0 370328 0 172000 0 23458 0 33843 0 21604 0 621233 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 2011. 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 2011, ANTHONY BARTH, MICHAEL CASTRO, GARY RADINE, AND CHARLES LAMONT PARTICIPATED IN THE PLAN. SEE ADDITIONAL NOTE IN SCHEDULE O REGARDING PAYMENTS RECEIVED BY PLAN PARTICIPANTS IN 2011. PART I, LINE 7 THE PRESIDENT OF THE ORGANIZATION, WITH BOARD OF DIRECTORS APPROVAL, MAY GRANT AN ANNUAL BONUS TO ALL MANAGEMENT EMPLOYEES. THESE AMOUNTS ARE INCLUDED IN TAXABLE COMPENSATION. SUPPLEMENTAL INFORMATION PART III PART II, LINE (II): THE ORGANIZATION'S OFFICERS ARE PAID BY A RELATED ORGANIZATION. ACCORDINGLY, THEIR COMPENSATION IS REPORTED IN LINE (II). FORM 990, PART VI, SECTION A, LINE 4 THA ORGANIZATION'S BYLAWS WERE AMENDED IN 2011 TO REQUIRE CORPORATE MEMBERS TO APPROVE ANY DISSOLUTION, MERGER OR CONSOLIDATION OF THE CORPORATION, AND TO APPROVE CERTAIN BUSINESS AGREEMENTS, INCLUDING DELTA DENTAL SERVICE MARK LICENSING AGREEMENTS. 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, WHO IS AN EMPLOYEE OF DENTEGRA GROUP, INC. ("DGI"), IS REVIEWED AND APPROVED BY THE DGI DIRECTORS. EXECUTIVE VICE PRESIDENTS' COMPENSATION IS EITHER APPROVED BY THE PRESIDENT OR IN ACCORDANCE WITH THE PROCEDURE OF DELTA DENTAL OF CALIFORNIA (BY WHOM THEY ARE EMPLOYED). ALL COMPENSATION FOR THE ENSUING YEAR IS ONLY APPROVED AFTER REVIEWING COMPARABILITY DATA PRESENTED BY AN OUTSIDE COMPENSATION CONSULTANT, AN ASSESSMENT OF EACH OFFICER'S PERFORMANCE OVER THE PRECEDING YEAR, AND THE ORGANIZATION'S PROGRAM ACCOMPLISHMENTS FOR THE YEAR. THIS PROCESS WAS FOLLOWED FOR 2011 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, PART VII; SCHEDULE J; SCHEDULE R: THE ORGANIZATION, WHICH ADMINISTERS INSURANCE REGULATED BY THE DISTRICT OF COLUMBIA DEPARTMENT OF INSURANCE, SECURITIES AND BANKING, 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 26 MILLION ENROLLEES AND HANDLING 37 MILLION CLAIMS. TOTAL REVENUE FOR THE ENTERPRISE EXCEEDED $6.7 BILLION IN 2011. THE ORGANIZATION REPRESENTS LESS THAN 1% OF TOTAL ENTERPRISE REVENUES. FORM 990, PART VII, SECTION A, COLUMN (B): HOURS DEVOTED NAME AND TITLE TO RELATED ORGANIZATION GARY D. RADINE 59.00 PRESIDENT ANTHONY S. BARTH 49.00 CHIEF OPERATING OFFICER MICHAEL J. CASTRO 49.00 CHIEF FINANCIAL OFFICER CHARLES LAMONT 49.00 CHIEF LEGAL OFFICER ALICIA WEBER 49.00 SENIOR VICE PRES./CONTROLLER ROY M. HILLIARD 49.00 VICE PRESIDENT, SALES RENEE A. FISHER 49.00 VP, QUALITY ASSURANCE & TRAINING PHILIP N. ENGLE 49.00 VP, INFORMATION TECHNOLOGY JEANNE M. FOSTER 49.00 VICE PRESIDENT, FINANCE RICHARD C. GRAYBILL 49.00 VP, UNDERWRITING & ACTUARIAL KAREN L. ROBINSON 49.00 ASSISTANT SECRETARY WHITNEY H. SHERBOCKER 49.00 ASSISTANT SECRETARY FORM 990, PT. VII, SEC. A, COL. (D); SCH. J, PT. II, LINE 1, COL. (B)(III): A ONE-TIME, LUMP SUM PENSION BENEFIT PAYMENT WAS RECEIVED BY THE ORGANIZATION'S PRESIDENT IN 2011, PURSUANT TO THE TERMS OF THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN PROVIDED BY A RELATED ORGANIZATION. THIS PLAN IS DESIGNED FOR THE LONG-TERM RETENTION OF SENIOR EXECUTIVES (E.G., THE PRESIDENT HAS BEEN WITH THE ORGANIZATION FOR MORE THAN 34 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 PRESIDENT'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 (D)) WAS THEREFORE TRIGGERED IN 2011 WHEN THE ORGANIZATION'S PRESIDENT 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 SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN PROVIDED BY THE RELATED ORGANIZATION. 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 PACA MANAGEMENT LLC ONE DELTA DRIVE MECHANICSBURG PA 17055 943277375 INSURANCE MANGEMENT 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 DENTEGRA INSURANCE COMPANY 100 FIRST STREET SAN FRANCISCO CA 94105 751233841 INSURANCE COMPANY DE DDC INSURANCE HOLDINGS INC C DENTEGRA INSURANCE COMP OF NEW ENGLAND 100 FIRST STREET SAN FRANCISCO CA 94105 042890218 INSURANCE COMPANY MA DDC INSURANCE HOLDINGS INC C DELTA DENTAL INSURANCE COMPANY 100 FIRST STREET SAN FRANCISCO CA 94105 942761537 INSURANCE COMPANY DE DDC INSURANCE HOLDINGS INC C ALPHA DENTAL OF NEVADA INC 100 FIRST STREET SAN FRANCISCO CA 94105 880244893 INSURANCE COMPANY NV DDC INSURANCE HOLDINGS INC C ALPHA DENTAL OF UTAH INC 100 FIRST STREET SAN FRANCISCO CA 94105 860672505 INSURANCE COMPANY UT DDC INSURANCE HOLDINGS INC C ALPHA DENTAL PROGRAMS INC 100 FIRST STREET SAN FRANCISCO CA 94105 742447512 INSURANCE COMPANY TX DDC INSURANCE HOLDINGS INC C ALPHA DENTAL OF ALABAMA INC 100 FIRST STREET SAN FRANCISCO CA 94105 630796079 INSURANCE COMPANY AL DDC INSURANCE HOLDINGS INC C ALPHA DENTAL OF NEW MEXICO INC 100 FIRST STREET SAN FRANCISCO CA 94105 330279230 INSURANCE COMPANY NM DDC INSURANCE HOLDINGS INC C ALPHA DENTAL OF ARIZONA INC 100 FIRST STREET SAN FRANCISCO CA 94105 930939835 INSURANCE COMPANY AZ DDC INSURANCE HOLDINGS INC C DENTEGRA SEGURO DENTALES SA INSURGENTES SUR 826 PISO 15 COL DEL VALLE FC DF 01300 MX INSURANCE COMPANY MX DENTEGRA INSURANCE COMPANY C DELTA REINSURANCE CORPORATION CGI TOWER 2ND FLOOR WARRENS ST. MICHAEL BB 980096711 REINSURANCE BB DELTA DENTAL OF PENNSYLVANIA C DELTA DENTAL OF PUERTO RICO 14 CALLE 2 SUITE 200 GUAYNABO RQ 00968 660436769 INSURANCE COMPANY RQ DELTA DENTAL OF CALIFORNIA C SERVICIOS DENTALES DENTEGRA SA DE CV INSURGENTES SUR 826 PISO 15 COL DEL VALLE FC DF 01300 MX INSURANCE ADMINISTRATION MX DENTEGRA INSURANCE COMPANY C DDC INSURANCE HOLDINGS INC 100 FIRST STREET SAN FRANCISCO CA 94105 274251930 HOLDING COMPANY DE DELTA DENTAL OF CALIFORNIA C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 DELTA DENTAL OF CALIFORNIA O 47049 DELTA DENTAL INSURANCE COMPANY L 509042 DELTA DENTAL INSURANCE COMPANY R 35231 PACA MANAGEMENT LLC L 1898567 DELTA REINSURANCE CORPORATION R 8746041 DELTA REINSURANCE CORPORATION Q 8162043 DELTA DENTAL OF CALIFORNIA P 1556