2024-11-13T15:05:56-06:00 2023-12-31 381357951 PLANTE & MORAN PLLC 1111 MICHIGAN AVE STE 100 EAST LANSING MI 48823 990 2023-01-01 850224562 DELTA DENTAL PLAN OF NEW MEXICO INC DELT 5058557114 100 SUN AVE NE 400 ALBUQUERQUE NM 87109 AMY BASEL CHIEF FINANCIAL OFFICER 5058557114 2024-11-11 1 1 DAVID LOWENTHAL CPA P00378651 5173326200 2024-11-11 2023 2024-10-15 13:58:12Z LOUIS VOLK III 100 SUN AVE NE 400 ALBUQUERQUE NM 87109 113042050 0 X HTTP://WWW.DELTADENTALNM.COM X 1971 NM DELTA DENTAL OF NEW MEXICO'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH PREPAID DENTAL SERVICES, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. 10 7 46 0 4390 0 0 0 70066015 72826802 -866777 2010574 9380 4530 69208618 74841906 483134 383725 0 0 3889237 4946695 0 0 0 64651497 68675399 69023868 74005819 184750 836087 81083410 86344181 10140953 10698368 70942457 75645813 X DELTA DENTAL OF NEW MEXICO'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH PREPAID DENTAL SERVICES, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. 0 0 70923012 383725 72826942 PROMOTING DENTAL CAREDELTA DENTAL OF NEW MEXICO, INC. IS A LEADNG GROUP DENTAL BENEFITS PROVIDER. THE PURPOSE OF THE ORGANIZATION IS TO ADVANCE AND PROMOTE THE IMPROVEMEMNT OF ORAL HEALTH. THIS IS DONE BY OFFERING INNOVATIVE, COST-EFFECTIVE PRODUCTS THAT MEET THE NEEDS OF CUSTOMERS. THIS WAS DEMONSTRATED IN 2023 BY PAYING OUT OVER $58 MILLION IN CLAIMS AND BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 810,000 CLAIMS WERE PROCESSED FOR OVER 417,000 MEMBERS. SEE SCHEDULE O FOR CONTINUATIONCOST SAVING STRATEGIESDELTA DENTAL BENEFIT PLANS ARE COMMITTED TO SAVING GROUPS AND MEMBERS MONEY. THE DELTA DIFFERENCE IS AN INTEGRATION OF ACTIVITIES SUCH AS COST MANAGEMENT POLICIES, FEE REDUCTION AGREEMENTS WITH DENTISTS, AND ANTI-FRAUD PROGRAMS, ALL OF WHICH ENSURE QUALITY, COST-EFFECTIVE DENTAL BENEFIT DELIVERY. UNEQUALED ACCESS TO DENTISTS 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.OUR LONG STANDING RELATIONSHIPS WITH PROVIDERS IN THE COMMUNITIES WE SERVE ALLOWS US TO MAINTAIN LARGE NETWORKS, ALLOWING BROAD ACCESS FOR MEMBERS AND COST-EFFECTIVE CARE. DELTA DENTAL'S GROUP MEMBERS ARE AFFORDED ADDED PROTECTION BECAUSE THEY GUARANTEE THAT PARTICIPATING DENTISTS WILL ACCEPT THEIR PAYMENT FOR COVERED SERVICES AND NO CHARGE, OTHER THAN CO-PAYMENTS AND DEDUCTIBLES ARE BILLED BACK TO THE MEMBER. 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 BROAD ACCESS TO CARE. 70923012 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 1 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 6782 0 1 46 1 1 1 0 0 0 0 0 0 0 X 10 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X AMY BASEL CFO 5173496000 4100 OKEMOS ROAD OKEMOS MI 48864 X JAMES TRUJILLO CHAIR - PART YEAR 5.00 5.00 X X 8333 10415 0 ROBERT L SIMMONS DIRECTOR - PART YEAR 5.00 0.00 X 7083 0 0 CHRISTINE N NATHE RDH MS CHAIR 5.00 5.00 X X 18750 16664 0 RALPH MCELMURRY DDS DIRECTOR - PART YEAR 5.00 0.00 X 5625 0 0 DAVID JAMES MARTINEZ DDS VICE CHAIR 5.00 0.00 X 17000 0 0 FRED CISNEROS DIRECTOR 5.00 0.00 X 13500 0 0 ROBIN DOZIER OTTEN DIRECTOR 5.00 0.00 X 13500 0 0 ANDREW DOLAN DIRECTOR 5.00 0.00 X 15542 0 0 LAWRENCE T PETERSON DIRECTOR 5.00 0.00 X 13500 0 0 KRISTIN HENDRICKS DDS DIRECTOR 5.00 0.00 X 7875 0 0 MELISSA RAVAGO DMD DIRECTOR 5.00 0.00 X 1125 0 0 RON RIVERA CPA CVGA DIRECTOR 5.00 0.00 X 1125 0 0 MARY ALICE WALKER-LYSAK CPA DIRECTOR 5.00 0.00 X 1125 0 0 AMY BASEL CFO & TREASURER 1.00 49.00 X 0 2381009 644559 SUE ELLEN JENKINS CHIEF LEGAL OFFICER & SEC.-PART YEAR 1.00 49.00 X 0 1632671 426193 CLAUDIO QUINN LOPEZ CHIEF LEGAL OFFICER & SECRETARY 50.00 0.00 X 158797 0 22 LOUIS VOLK III PRESIDENT & CEO 50.00 0.00 X 722504 0 52079 NATHALIE CASADO DIRECTOR, CORPORATE ADMINISTRATION 50.00 0.00 X 230059 0 40181 DIANNE LEDESMA DIRECTOR OF OPERATIONS 50.00 0.00 X 135670 0 2921 DOUGLAS DUNTON MANAGER, QUALITY & ANALYTICS 50.00 0.00 X 179720 0 30130 MICHELE TOON DIRECTOR OF SALES AND BUS. DEV. 50.00 0.00 X 177413 0 22135 KIMBERLY SCHAFER DIRECTOR, PEOPLE SERVICES 50.00 0.00 X 120402 0 16646 1848648 4040759 1234866 10 0 1 0 HUB INTERNATIONAL INSURANCE SERVICE 9990 JEFFERSON NE SUITE 101 ALBUQUERQUE NM 87190 COMMISSIONS 442292 DEWPOINT 300 WASHINGTON SQUARE LANSING MI 48933 IT CONSULTING 151164 MARKETING SOLUTIONS LLC 9426 INDIAN SCHOOL RD NE STE 2 ALBUQUERQUE NM 87112 MARKETING SERVICES 108460 3 DENTAL CARE REVENUE 524114 72822412 72822412 VISION CARE REVENUE 524298 4390 4390 72826802 2282031 2282031 37928687 38200144 -271457 -271457 -271457 DISCOUNT CARD INCOME 561000 4530 4530 4530 74841906 72826942 4390 2010574 X 383725 383725 872839 567345 305494 3183985 2597014 586971 189757 133323 56434 444214 374454 69760 255900 201531 54369 466688 466688 155985 155985 218578 218578 59502204 58936465 565739 237366 237366 664477 566893 97584 363896 240319 123577 329464 214151 115313 68980 57403 11577 48519 34282 14237 123317 84811 38506 57233 37201 20032 PROCESSING FEES 2698797 2698797 COMMISSIONS 1991024 1991024 PREMIUM TAXES 1191000 1191000 MEMBERSHIP DUES & ASSOC 383988 255385 128603 173883 120523 53360 74005819 70923012 3082807 0 10266576 12407813 4584318 4248965 129897 118158 1243011 566751 785413 676260 53503083 56992622 7336343 7523696 4477780 4376667 81083410 86344181 2557757 2402248 898907 894519 6684289 7401601 10140953 10698368 X 70942457 75645813 70942457 75645813 81083410 86344181 X 836087 3848052 19217 X 0 1 X 1 0 20568 6856 13712 1174818 512270 662548 47625 47625 0 676260 7523696 C 7523696 OTHER ASSETS 361799 RIGHT-OF-USE OPERATING LEASE ASSETS - NET 4014531 DUE FROM AFFILIATE 337 4376667 CLAIMS RESERVES 1595000 DUE TO AFFILIATE 1763786 OPERATING LEASE LIABILITY 4042815 7401601 74623328 0 74623328 218578 218578 74841906 73787241 0 73787241 218578 218578 74005819 1 ALBUQUERQUE HEALTH CARE FOR THE HOMELESS PO BOX 25445 ALBUQUERQUE NM 87125 850368993 501(C)(3) 110000 0 N/A N/A CHARITABLE CONTRIBUTION ALBUQUERQUE MEALS ON WHEELS INC 5901 HARPER DR NE ALBUQUERQUE NM 87109 850301043 501(C)(3) 10000 0 N/A N/A CHARITABLE CONTRIBUTION LEADERSHIP NEW MEXICO PO BOX 35696 ALBUQUERQUE NM 87176 850437219 501(C)(3) 10000 0 N/A N/A CHARITABLE CONTRIBUTION NATIONAL HISPANIC CULTURAL CENTER FOUNDATION 1701 4TH ST SW ALBUQUERQUE NM 87102 850335056 501(C)(3) 20000 0 N/A N/A CHARITABLE CONTRIBUTION NEW MEXICO ACTIVITIES ASSOCIATION FOUNDATION 6600 PALOMAS NE ALBUQUERQUE NM 87109 208883356 501(C)(3) 0 43725 COST MOUTH GUARDS PROVIDE MOUTH GUARDS TO STUDENTS IN BOYS AND GIRLS SPORTS THAT REQUIRE MOUTH GUARDS NEW MEXICO DENTAL FOUNDATION PO BOX 16854 ALBUQUERQUE NM 87191 743146433 501(C)(3) 15000 0 N/A N/A CHARITABLE CONTRIBUTION TO DENTAL HYGIENE PROGRAM NEW MEXICO STATE UNIVERSITY FOUNDATION PO BOX 3590 LAS CRUCES NM 88003 850170157 501(C)(3) 50000 0 N/A N/A CHARITABLE CONTRIBUTION TO DENTAL HYGIENE PROGRAM SPECIAL OLYMPICS NEW MEXICO INC 6600 PALOMAS NE STE 207 ALBUQUERQUE NM 87109 850268084 501(C)(3) 10000 0 N/A N/A CHARITABLE CONTRIBUTION UNIVERSITY OF NEW MEXICO FOUNDATION INC TWO WOODWARD CENTER 700 LOMAS NE ALBUQUERQUE NM 87102 850275408 501(C)(3) 115000 0 N/A N/A CHARITABLE CONTRIBUTION 9 0 PART I, LINE 2: CONTRIBUTIONS ARE MADE AT THE ORGANIZATION'S DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF NEW MEXICO'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 NEW MEXICO. X X 0 1 0 0 0 0 0 1 0 AMY BASEL CFO & TREASURER 0 528195 0 886909 0 965905 0 619300 0 25259 0 3025568 0 938703 SUE ELLEN JENKINS CHIEF LEGAL OFFICER & SEC.-PART YEAR 0 542025 0 949448 0 141198 0 419012 0 7181 0 2058864 0 115832 LOUIS VOLK III PRESIDENT & CEO 554372 0 153882 0 14250 0 33000 0 19079 0 774583 0 0 0 NATHALIE CASADO DIRECTOR, CORPORATE ADMINISTRATION 188101 0 41344 0 614 0 23284 0 16897 0 270240 0 0 0 DOUGLAS DUNTON MANAGER, QUALITY & ANALYTICS 152951 0 25313 0 1456 0 16435 0 13695 0 209850 0 0 0 MICHELE TOON DIRECTOR OF SALES AND BUS. DEV. 169216 0 6663 0 1534 0 1505 0 20630 0 199548 0 0 0 CLAUDIO QUINN LOPEZ CHIEF LEGAL OFFICER & SECRETARY 157931 0 0 0 866 0 0 0 22 0 158819 0 0 0 PART I, LINE 4B A RELATED ORGANIZATION, 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 AND ADDED TO THE PLAN BY THE BOARD OF DIRECTORS. THE SERP BENEFITS ARE REVIEWED AS PART OF THE TOTAL COMPENSATION BY AN INDEPENDENT CONSULTANT; TOWERS WATSON. IN 2023, AMY BASEL AND SUE ELLEN JENKINS ACCRUED BENEFITS AS PARTICIPANTS IN THE SERP PLAN. AMY BASEL AND SUE JENKINS BECAME VESTED IN A PORTION OF THEIR ACCRUED BENEFITS, AND, AS REQUIRED BY THE IRS, THE VESTED PORTION WAS TREATED AS TAXABLE WAGES DURING 2023. THESE WAGES WERE ALSO REPORTED ON SCHEDULE J AS COMPENSATION THAT HAS BEEN REPORTED AS DEFFERED ON PRIOR FORM 990S. PART I, LINE 7 AS INDICATED IN SCHEDULE J, PART II, TOP MANAGEMENT OFFICIALS RECEIVED A BONUS BASED ON PERFORMANCE AND THE FINANCIAL RESULTS OF THE ORGANIZATION. THIS BONUS WAS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. DAVID J MARTINEZ DDS PC DIRECTOR ON DDNM BOARD, OWNS AN INTEREST IN MARTINEZ DDS PC 725491 PAYMENTS FOR DENTAL SERVICES. 0 KRISTIN HENDRICKS DIRECTOR ON DDNM BOARD, OWNS AN INTEREST IN WHOLE CHILD DENTAL LLC 1068954 PAYMENTS FOR DENTAL SERVICES 0 MELISSA RAVAGO DMD DIRECTOR ON DDNM BOARD, OWNS AN INTEREST IN RAVAGO, DMD PC 256806 PAYMENTS FOR DENTAL SERVICES 0 FORM 990, PART VI, SECTION A, LINE 6 DELTA DENTAL PLAN OF NEW MEXICO, INC. HAS A SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A BOARD MEMBERS ARE ELECTED BY THE PRESENT BOARD AND ARE APPROVED BY RENAISSANCE HEALTH SERVICE CORPORATION, THE SOLE CORPORATE MEMBER OF DELTA DENTAL PLAN OF NEW MEXICO, INC. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE RIGHTS THAT ARE PRESCRIBED BY LAW, FOR MEMBERS OF NON-PROFIT CORPORATIONS, INCLUDING THE APPROVAL OF SIGNIFICANT EXPENDITURES AND CEO APPOINTMENT. FORM 990, PART VI, SECTION B, LINE 11B 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 PLACED IN A SECURE PORTAL FOR THE BOARD TO REVIEW, PRIOR TO FILING THE 990 WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ENTERPRISE'S CHIEF LEGAL OFFICER 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 CHIEF LEGAL OFFICER. IF A PROHIBITED TRANSACTION IS IDENTIFIED, THE MATTER IS ESCALATED TO THE CEO AND TO THE AUDIT, FINANCE AND RISK MANAGEMENT COMMITTEE OF THE BOARD OF DIRECTORS 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 VOTE, IN WHICH A MEMBER HAS 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 CEO COMPENSATION IS SET BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. MARKET DATA PROVIDED BY OUTSIDE CONSULTANTS, TOWERS WATSON, IS USED TO VALIDATE THE REASONABLENESS OF THE TOTAL COMPENSATION PACKAGE. COMPENSATION FOR CERTAIN OFFICERS, INCLUDING THE CFO IS DETERMINED AND PAID THROUGH A RELATED ORGANIZATION, DELTA DENTAL PLAN OF MICHIGAN, INC. FORM 990, PART VI, SECTION C, LINE 19 DELTA DENTAL PLAN OF NEW MEXICO, INC. (DDNM) FILES ON A QUARTERLY AND ANNUAL BASIS COMPREHENSIVE FINANCIAL DOCUMENTS WITH THE NEW MEXICO OFFICE OF INSURANCE SUPERINTENDENT (OSI). OSI AND THE NEW MEXICO SECRETARY OF STATE HAVE ON FILE ALL GOVERNING DOCUMENTS. THE DDNM'S 990 FORM IS AVAILABLE TO THE PUBLIC 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 IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 480,839. MANAGEMENT AND GENERAL EXPENSES 565,739. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,046,578. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 58,455,626. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 58,455,626. FORM 990, PART XI, LINE 9: GAIN ON INVESTMENT IN RENAISSANCE HOLDING COMPANY 19,217. 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 MICHIGAN INC 4100 OKEMOS ROAD OKEMOS MI 48864 381791480 PROVIDE DENTAL SERVICE PLANS MI 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 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 0 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 0 DELTA DENTAL OF TENNESSEE INC 240 VENTURE CIRCLE NASHVILLE TN 37228 620812197 PROVIDE DENTAL SERVICE PLANS TN 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF KENTUCKY INC 10100 LINN STATION ROAD NO 700 LOUISVILLE KY 40223 610659432 PROVIDE DENTAL SERVICE PLANS KY 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL FUND PO BOX 30416 LANSING MI 489097916 382337000 SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMS MI 501(C)(3) LINE 12A, I DELTA DENTAL PLAN OF MICHIGAN INC 0 DELTA DENTAL OF NORTH CAROLINA 3737 GLENWOOD AVENUE SUITE 320 RALEIGH NC 27612 561018068 PROVIDE DENTAL SERVICE PLANS NC 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL PLAN OF ARKANSAS INC 1513 COUNTRY CLUB RD SHERWOOD AR 72120 710561140 PROVIDE DENTAL SERVICE PLANS AR 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION 0 DELTA DENTAL OF ARKANSAS FOUNDATION INC 1513 COUNTRY CLUB RD SHERWOOD AR 72120 261569324 EMPHASIZE DENTAL HEALTH IN COMMUNITIES AR 501(C)(3) PF DELTA DENTAL OF ARKANSAS 0 RENAISSANCE FAMILY FOUNDATION INC 225 S EAST ST INDIANAPOLIS IN 46202 461376165 EMPHASIZE DENTAL HEALTH IN COMMUNITIES IN 501(C)(3) PF RENAISSANCE HOLDING COMPANY 0 SMILE 180 FOUNDATION 240 VENTURE CIRCLE NASHVILLE TN 37228 471654054 EMPHASIZE DENTAL HEALTH IN COMMUNITIES TN 501(C)(3) LINE 12A, I DELTA DENTAL OF TENNESSEE INC 0 DELTA DENTAL OF KENTUCKY FOUNDATION INC 10100 LINN STATION ROAD SUITE 700 LOUISVILLE KY 40223 874045357 EMPHASIZE DENTAL HEALTH IN COMMUNITIES KY 501(C)(3) PF DELTA DENTAL OF KENTUCKY 0 RED CEDAR INVESTMENT MANGAGEMENT LLC 333 BRIDGE STREET NW SUITE 601 GRAND RAPIDS MI 49546 462667997 CAPITAL MANAGEMENT MI N/A 0 0 T4G MANAGEMENT LLC 300 WASHINGTON SQUARE SUITE 225 LANSING MI 48933 884271021 FINANCIAL PLANNING MI N/A 0 0 T4G FINANCIAL SERVICES LLC 300 WASHINGTON SQUARE SUITE 225 LANSING MI 48933 921020583 FINANCIAL PLANNING MI N/A 0 0 ARCIS FUND I LLC 300 WASHINGTON SQUARE SUITE 225 LANSING MI 48933 932945609 INVESTMENTS MI N/A 0 0 RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING MI 48909 412177193 HOLDING COMPANY MI DELTA DENTAL OF MICHIGAN C -62148 3808482 0.04000 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA PO BOX 30381 LANSING MI 48909 470397286 INSURANCE IN RENAISSANCE HOLDING COMPANY C -48582 5395074 0.04000 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK PO BOX 30381 LANSING MI 48909 134098096 INSURANCE NY RENAISSANCE HOLDING COMPANY C 28760 668782 0.04000 0 FORE HOLDING CORPORATION 240 VENTURE CIRCLE NASHVILLE TN 37228 204116122 HOLDING COMPANY TN N/A C 0 DENTAL CHOICE INC 10100 LINN STATION RD 700 LOUISVILLE KY 402233861 611105118 PROVIDE DENTAL SERVICE PLANS KY N/A C 0 DENTAL CHOICE AGENCY INC 10100 LINN STATION RD 700 LOUISVILLE KY 402233861 611336003 PRIMARY GENERAL AGENCY FOR DDKY AND DENTAL CHOICE KY N/A C 0 OMEGA ADMINISTRATORS INC 1513 COUNTRY CLUB ROAD SHERWOOD AR 72120 043740469 PROVIDING THIRD-PARTY ADMINISTRATIVE SERVICES AR N/A C 0 THE 4100 GROUP 4100 OKEMOS ROAD OKEMOS MI 48864 472557772 INVESTMENT IN SUBSIDIARIES MI N/A C 0 DENTAL CHOICE ANCILLARY INC 10100 LINN STATION RD 700 LOUISVILLE KY 402233861 881391091 PROVIDE DENTAL SERVICE PLANS KY N/A C 0 ANCILLARY CHOICE LIFE INC 10100 LINN STATION RD 700 LOUISVILLE KY 402233861 880574945 INSURANCE KY N/A C 0 DYNTL INC 2800 WHITE OAK DR NASHVILLE TN 37215 934527543 DENTAL SERVICE TN N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA M 730103 ACTUAL COST DELTA DENTAL PLAN OF MICHIGAN INC M 2881785 ACTUAL COST