Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
A For the 2019 calendar year, or tax year beginning 01-01-2018 , and ending 12-31-2018
BCheck if applicable:
CName of organization
DELTA DENTAL OF TENNESSEE INC
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
240 VENTURE CIRCLE
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
NASHVILLE, TN37228
D Employer identification number

62-0812197
E Telephone number

G Gross receipts $ 385,148,459
F Name and address of principal officer:
JEFFREY A NEWTON
240 VENTURE CIRCLE
NASHVILLE,TN37228
I
Tax-exempt status: ( 4 ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.DELTADENTALTN.COM
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1965
M State of legal domicile: TN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: OUR MISSION IS TO IMPROVE THE OVERALL WELLNESS OF THE PEOPLE IN THE COMMUNITIES WE SERVE THROUGH OUR PRODUCTS, ADVOCACY, EDUCATION, AND PHILANTHROPY.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 11
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 9
5 Total number of individuals employed in calendar year 2018 (Part V, line 2a) ...... 5 83
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 3,100
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 355,841,217 373,527,897
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 3,353,834 3,113,337
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 48,083 12,216
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 359,243,134 376,653,450
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 7,929,687 5,187,114
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 314,468,631 331,406,656
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 10,104,858 10,383,164
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 22,214,612 25,514,400
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 354,717,788 372,491,334
19 Revenue less expenses. Subtract line 18 from line 12....... 4,525,346 4,162,116
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 85,954,535 83,118,169
21 Total liabilities (Part X, line 26)............. 24,318,914 21,374,075
22 Net assets or fund balances. Subtract line 21 from line 20..... 61,635,621 61,744,094
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2018)
Form 990 (2018)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: OUR MISSION IS TO IMPROVE THE OVERALL WELLNESS OF THE PEOPLE IN THE COMMUNITIES WE SERVE THROUGH OUR PRODUCTS, ADVOCACY, EDUCATION, AND PHILANTHROPY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 363,658,396 including grants of $ 5,187,114 ) (Revenue $ 373,540,113 )
THE PRIMARY PURPOSE OF DELTA DENTAL OF TENNESSEE IS TO PROVIDE PROFESSIONAL DENTAL SERVICES UNDER WRITTEN CONTRACTS WHICH ENTITLE THE SUBSCRIBERS TO REIMBURSEMENT FOR COVERED SERVICES PROVIDED BY LICENSED DENTISTS, PRIMARILY IN THE STATE OF TENNESSEE. BOTH LOCAL AND NATIONAL CONTRACTS ARE ADMINISTERED, WHICH HAVE THE KEY FEATURE OF GIVING SUBSCRIBERS ACCESS TO THE LOCAL PROVIDER NETWORKS MAINTAINED BY DELTA DENTAL OF TENNESSEE, AS WELL AS THE NATIONAL PROVIDER NETWORKS OF THE DELTA DENTAL SYSTEM UNDER THE DELTA USA PROGRAM.SEE SCHEDULE O FOR CONTINUATIONTHE COMPANY MAKES UNCONDITIONAL PROMISES TO GIVE, TO BOTH ITS FOUNDATION AND VARIOUS OTHER ORGANIZATIONS, WHICH SUPPORT EDUCATIONAL AND RESEARCH PROGRAMS FOR THE ADVANCEMENT OF DENTAL SCIENCE AND TO PROMOTE THE ORAL HEALTH OF THE PUBLIC THROUGH EDUCATIONAL AND SERVICE ACTIVITIES.DELTA DENTAL OF TENNESSEE ASSISTED CLINICS THAT PRIMARILY SERVE THE WORKING POOR AND FUNDED AMBULATORY SURGERY CENTERS TO ALLOW INPATIENT ORAL HEALTH CARE. AT THE EDUCATION LEVEL, THE COMPANY ASSISTED DENTAL SCHOOLS IN ORDER TO KEEP THEIR FACILITIES AND TEACHING EQUIPMENT UP TO DATE AND FUNDED DENTAL SCHOLARSHIPS TO 3RD AND 4TH YEAR DENTAL STUDENTS.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet363,658,396
Form 990 (2018)
Form 990 (2018)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A.....................
1
 
No
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? ...
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II..............
4
 
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III.................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part IIIClick to see attachment.............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
 
No
Form 990 (2018)
Form 990 (2018)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II................Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV........................Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II...........
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
 
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
47,139
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2018)
Form 990 (2018)
Page 5
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
83
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
 
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
 
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
 
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
 
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? If "Yes," see instructions and file Form 4720, Schedule N .....
15
Yes
 
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income?
If "Yes," complete Form 4720, Schedule O ................
16
 
No
Form 990 (2018)
Form 990 (2018)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
11
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
9
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletJEFFREY A NEWTON VICE PRESIDENT AUDIT & FINANCE240 VENTURE CIRCLE   NASHVILLE,TN372281604 (615) 742-6917
Form 990 (2018)
Form 990 (2018)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) DREW ROBINSON......................................................................
VICE CHAIR
 1.00
.................
0.00 		X   X       14,500 0 0
(2) DR PAUL BACON......................................................................
SECOND VICE CHAIR
 1.00
.................
0.00 		X   X       14,500 0 0
(3) LESLIE SELLERS......................................................................
IMMEDIATE PAST CHAIR
 1.00
.................
5.00 		X   X       15,000 25,000 0
(4) DR VICTOR BECK......................................................................
CHAIRMAN
 1.00
.................
0.00 		X   X       21,250 0 0
(5) BRADLEY LAMPLEY......................................................................
DIRECTOR
 1.00
.................
0.00 		X           12,000 0 0
(6) JEAN EVETTE WHITE......................................................................
DIRECTOR
 1.00
.................
1.00 		X           10,000 1,000 0
(7) DR JED JACOBSON......................................................................
DIRECTOR
 1.00
.................
39.00 		X           8,500 130,600 0
(8) AERIAL ELLIS......................................................................
DIRECTOR
 1.00
.................
1.00 		X           10,000 500 0
(9) JOHN COLLIER JR......................................................................
DIRECTOR (THRU 8/18)
 1.00
.................
0.00 		X           5,500 0 0
(10) DR FREDRICK GUTHRIE JR......................................................................
DIRECTOR
 1.00
.................
0.00 		X           10,000 0 0
(11) CHRIS HOLMES......................................................................
DIRECTOR
 1.00
.................
0.00 		X           7,500 0 0
(12) JEROME MELSON......................................................................
DIRECTOR
 1.00
.................
0.00 		X           6,000 0 0
(13) DR PHILIP A WENK......................................................................
PRESIDENT & CEO
 39.00
.................
1.00 		    X       1,054,363 0 59,168
(14) JEFF BALLARD......................................................................
SENIOR VP OF FINANCE & CFO
 40.00
.................
0.00 		    X       517,899 0 63,240
(15) DONNA KAYE MARTIN......................................................................
SENIOR VP OPERATIONS
 40.00
.................
0.00 		    X       529,493 0 41,362
(16) PAMELA DISHMAN......................................................................
SENIOR VP EMPLOYEE RELATIONS
 40.00
.................
0.00 		    X       547,393 0 41,362
(17) DONALD L BEATY......................................................................
VP IT (THRU 11/18)
 40.00
.................
0.00 		    X       228,777 0 40,841
Form 990 (2018)
Form 990 (2018)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) JERRY R REAVIS JR........................................................................
VP BUSINESS DEVELOPMENT
 40.00
.......................0.00 		    X       294,348 0 90,561
(19) MICHELLE ACOSTA........................................................................
VP BRAND STRATEGY
 40.00
.......................0.00 		    X       184,149 0 69,917
(20) JEFFREY A NEWTON........................................................................
VP AUDIT & FINANCE
 40.00
.......................0.00 		    X       176,433 0 58,861
(21) MELISSA HUSCHKE........................................................................
VP CORPORATE OPERATIONS
 40.00
.......................0.00 		    X       193,031 0 72,341
(22) SHANDA BROWN........................................................................
VP CORPORATE AND COMMUNITY ENGAGEMENT
 40.00
.......................0.00 		    X       163,078 0 45,498
(23) JONATHAN OAKS........................................................................
MANAGER, SALES AND ACCOUNT MANAGEMENT
 40.00
.......................0.00 		        X   243,018 0 55,906
(24) EMILY PEARSON........................................................................
ACCOUNT EXECUTIVE
 40.00
.......................0.00 		        X   199,855 0 45,816
(25) WILLIAM HAMILTON........................................................................
ACCOUNT EXECUTIVE
 40.00
.......................0.00 		        X   306,429 0 53,649
(26) TRACY BAILEY........................................................................
ACCOUNT EXECUTIVE
 40.00
.......................0.00 		        X   342,462 0 51,876








1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 5,115,478 157,100 790,398
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet14
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
WILLIS OF TENNESSEE INC

26 CENTURY BLVD
NASHVILLE,TN37214 		COMMISSIONS 1,155,253
GISH SHERWOOD & FRIENDS INC

209 10TH AVENUE SOUTH
NASHVILLE,TN37203 		MARKETING 829,834
TRINITY BENEFIT ADVISORS

4823 OLD KINGSTON PIKE
KNOXVILLE,TN37919 		COMMISSIONS 295,818
THE LOCKTON COMPANIES LLC

PO BOX 505115
ST LOUIS,MO63150 		COMMISSIONS 253,620
HUB INTERNATIONAL MIDWEST LIMITED

3510 N CAUSEWAY BLVD STE 300
METAIRIE,LA70002 		COMMISSIONS 250,925
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet19
Form 990 (2018)
Form 990 (2018)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a - 1f:$  
h Total. Add lines 1a-1f.......MediumBullet  
Program Service RevenueAmt Business Code
2a DENTAL CARE REVENUE 624100 373,527,897 373,527,897    
b
c
d
e
f All other program service revenue.        
g Total. Add lines 2a–2f ....MediumBullet 373,527,897
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 1,558,759     1,558,759
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss)......MediumBullet        
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 54,500 9,995,087
b Less: cost or other basis and sales expenses 58,322 8,436,687
c Gain or (loss) -3,822 1,558,400
d Net gain or (loss).....MediumBullet 1,554,578     1,554,578
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a REIMBURSED EXPENSES 900099 12,216 12,216    
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 12,216
12 Total revenue. See Instructions......MediumBullet 376,653,450 373,540,113 0 3,113,337
Form 990 (2018)
Form 990 (2018)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 5,187,114 5,187,114
2 Grants and other assistance to domestic individuals. See Part IV, line 22    
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.    
4 Benefits paid to or for members 331,406,656 331,406,656
5 Compensation of current officers, directors, trustees, and key employees .... 4,606,865 2,525,411 2,081,454  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 3,702,294 1,983,025 1,719,269  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 488,585 260,213 228,372  
9 Other employee benefits ....... 1,169,094 715,955 453,139  
10 Payroll taxes ........... 416,326 235,418 180,908  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 47,445   47,445  
c Accounting ........... 55,981 33,589 22,392  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 77,147   77,147  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 741,578 346,955 394,623  
12 Advertising and promotion .... 1,955,839 993,481 962,358  
13 Office expenses ....... 1,914,580 1,169,034 745,546  
14 Information technology ......        
15 Royalties ..        
16 Occupancy ........... 505,226 294,732 210,494  
17 Travel ............ 451,575 150,634 300,941  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 335,438   335,438  
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 673,017 393,892 279,125  
23 Insurance ... 731,971 663,646 68,325  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a COMMISSIONS 7,517,294 7,469,335 47,959  
b CLAIMS PROCESSING 4,743,662 4,735,950 7,712  
c STATE PREMIUM TAX 4,201,220 4,201,220    
d DUES AND SUBSCRIPTIONS 794,894 416,442 378,452  
e All other expenses 767,533 475,694 291,839  
25 Total functional expenses. Add lines 1 through 24e 372,491,334 363,658,396 8,832,938 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2018)
Form 990 (2018)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........   1  
2 Savings and temporary cash investments ......... 3,565,939 2 3,566,990
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 13,500,599 4 9,602,105
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L ..............
  6  
7 Notes and loans receivable, net ....   7  
8 Inventories for sale or use ........   8  
9 Prepaid expenses and deferred charges ...... 336,784 9 595,167
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 9,268,153
b Less: accumulated depreciation 10b 6,520,478 3,142,670 10c 2,747,675
11 Investments—publicly traded securities . 53,405,742 11 54,359,327
12 Investments—other securities. See Part IV, line 11 ..... 11,645,294 12 11,898,948
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 357,507 15 347,957
16 Total assets. Add lines 1 through 15 (must equal line 34)... 85,954,535 16 83,118,169
Liabilities 17 Accounts payable and accrued expenses ..... 23,943,288 17 21,023,449
18 Grants payable ...   18  
19 Deferred revenue .........   19  
20 Tax-exempt bond liabilities .........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ..   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D 375,626 25 350,626
26 Total liabilities. Add lines 17 through 25.. 24,318,914 26 21,374,075
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets   27  
28 Temporarily restricted net assets ...........   28  
29 Permanently restricted net assets   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ..... 0 30 0
31 Paid-in or capital surplus, or land, building or equipment fund ... 0 31 0
32 Retained earnings, endowment, accumulated income, or other funds 61,635,621 32 61,744,094
33 Total net assets or fund balances ........... 61,635,621 33 61,744,094
34 Total liabilities and net assets/fund balances ........ 85,954,535 34 83,118,169
Form 990 (2018)
Form 990 (2018)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
376,653,450
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
372,491,334
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
4,162,116
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
61,635,621
5
Net unrealized gains (losses) on investments ...............
5
-3,713,312
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-340,331
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
61,744,094
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2018)
Form 990 (2018)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
SchDMd Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
DELTA DENTAL OF TENNESSEE INC
 
Employer identification number

62-0812197
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2018

Schedule D (Form 990) 2018
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a)Current year (b)Prior year (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations .................
3a(i)
 
 
(ii) related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .....   231,288 231,288
b Buildings ....   2,403,731 1,018,479 1,385,252
c Leasehold improvements   55,254 50,808 4,446
d Equipment ....   6,085,150 5,312,784 772,366
e Other .....   492,730 138,407 354,323
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 2,747,675
Schedule D (Form 990) 2018

Schedule D (Form 990) 2018
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) Financial derivatives.........    
(2) Closely-held equity interests........    
(3) Other
(A) INVESTMENT IN SUBSIDIARY		 11,148,948 C

(B) CERTIFICATES OF DEPOSIT		 750,000 C
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 11,898,948
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
PREFUNDS 350,626
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 350,626
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2018

Schedule D (Form 990) 2018
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1.................. 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ......... 2a  
b Prior year adjustments ............ 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d.................... 2e  
3 Subtract line 2e from line 1................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
PART X, LINE 2: THE COMPANY IS EXEMPT FROM FEDERAL INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS MADE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE COMPANY ACCOUNTS FOR INCOME TAXES OF TAXABLE CONSOLIDATED ENTITIES, WHEREBY DEFERRED TAXES ARE PROVIDED ON TEMPORARY DIFFERENCES ARISING FROM ASSETS AND LIABILITIES WHOSE BASES ARE DIFFERENT FOR FINANCIAL REPORTING AND INCOME TAX PURPOSES. DEFERRED TAXES WERE NOT SIGNIFICANT TO THE CONSOLIDATED FINANCIAL STATEMENTS. AS OF DECEMBER 31, 2018 AND 2017, THE COMPANY'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED DURING THE YEAR OR ACCRUED AT YEAR END.
Schedule D (Form 990) 2018


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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization
DELTA DENTAL OF TENNESSEE INC
 
Employer identification number
62-0812197
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) ALSACST JUDE CHILDREN'S RESEARCH HOSPITAL
1102 17TH AVENUE SOUTH STE 300
NASHVILLE,TN37212 		35-1044585 501(C)(3) 123,114       EVENT SPONSORSHIP
(2) ALZHEIMER'S ASSOCIATION SE WISCONSIN CHP TOTAL
225 NORTH MICHIGAN AVE SUITE 1700
CHICAGO,IL60601 		13-3039601 501(C)(3) 7,500       EVENT SPONSORSHIP
(3) AMERICAN HEART ASSOCIATION INC TOTAL
1818 PATTERSON ST
NASHVILLE,TN37203 		13-5613797 501(C)(3) 15,000       DONATION TO THE GENERAL FUND
(4) AMERICAN RED CROSS TOTAL
2201 CHARLOTTE AVENUE
NASHVILLE,TN37203 		62-1411210 501(C)(3) 51,500       EVENT SPONSORSHIP AND DONATION TO THE GENERAL FUND
(5) BALLAD HEALTH FOUNDATION TOTAL
1905 AMERICAN WAY SUITE 102
KINGSPORT,TN37660 		58-1594191 501(C)(3) 10,154       DONATION TO THE GENERAL FUND
(6) BIG BROTHERS BIG SISTERS
1704 CHARLOTTE AVE 130
NASHVILLE,TN37203 		23-7056024 501(C)(3) 11,000       EVENT SPONSORSHIP
(7) BORDER BOWL
PO BOX 1390
WILLIAMSBURG,KY40769 		  5,000       EVENT SPONSORSHIP
(8) BOYS & GIRLS CLUB OF THE TENNESSEE VALLEY
967 IRWIN ST
KNOXVILLE,TN37917 		62-0475743 501(C)(3) 5,000       EVENT SPONSORSHIP
(9) CABLE
2802 BRANSFORD AVE
NASHVILLE,TN37204 		06-1620781 501(C)(3) 5,000       EVENT SPONSORSHIP
(10) EAST TENNESSEE CHILDREN'S HOSPITAL
2018 CLINCH AVE
KNOXVILLE,TN37916 		62-6002604 501(C)(3) 60,429       EVENT SPONSORSHIP AND DONATION TO GENERAL FUND
(11) CLAYTON-BRADLEY ACADEMY
425 ALCOA TRAIL
MARYVILLE,TN37804 		  5,000       EVENT SPONSORSHIP
(12) ERLANGER FOUNDATION
975 EAST 3RD ST SUITE B-508
CHATTANOOGA,TN37403 		58-1664027 501(C)(3) 10,176       DONATION TO THE GENERAL FUND
(13) GOODWILL MEMPHIS
6895 STAGE RD
MEMPHIS,TN38133 		26-3445007 501(C)(3) 5,000       DONATION TO THE GENERAL FUND
(14) GOVERNOR'S BOOKS BIRTH FOUNDATION
312 ROSA PARKS AVE TENNESSEE TOWER
27TH FLOOR
NASHVILLE,TN37243 		20-1115704 501(C)(3) 75,000       DONATION TO THE GENERAL FUND
(15) HOSPITAL HOSPITALITY HOUSE
207 24TH AVE N
NASHVILLE,TN37203 		62-0909363 501(C)(3) 50,000       EVENT SPONSORSHIP
(16) LE BONHEUR CHILDRENS HOSPITAL FOUNDATION
PO BOX 41817
MEMPHIS,TN38174 		58-1404854 501(C)(3) 60,505       EVENT SPONSORSHIP AND DONATION TO GENERAL FUND
(17) LIPSCOMB UNIVERSITY
ONE UNIVERSITY PARK DRIVE
NASHVILLE,TN37204 		62-0485733 501(C)(3) 10,000       EVENT SPONSORSHIP
(18) MEMPHIS MUSEUMS INC
3050 CENTRAL AVE
MEMPHIS,TN38111 		62-0801926 501(C)(3) 10,000       EVENT SPONSORSHIP (PINK PALACE FAMILY OF MUSEUMS)
(19) MONROE CARELL JR CHILDREN'S HOSPITAL
2525 WEST END AVENUE SUITE 450
NASHVILLE,TN37203 		35-2528741 501(C)(3) 43,136       EVENT SPONSORSHIP AND DONATION TO GENERAL FUND
(20) MONROE HARDING
1120 GLENDALE LANE
NASHVILLE,TN37204 		62-0476670 501(C)(3) 7,500       EVENT SPONSORSHIP
(21) MURFREESBORO PREP INC
5344 SHERRINGTON RD
MURFREESBORO,TN37128 		81-2327687 501(C)(3) 5,000       DONATION TO THE GENERAL FUND
(22) MUSIC CITY BOWL INC
414 UNION STREET STE 800
NASHVILLE,TN37219 		62-1720086 501(C)(3) 75,000       EVENT SPONSORSHIP
(23) NEIGHBORHOOD HEALTH INC
2711 FOSTER AVE
NASHVILLE,TN37210 		62-1032792 501(C)(3)   12,000 FMV VAN IN-KIND DONATION
(24) NFIB
53 CENTURY BLVD STE 250
NASHVILLE,TN37214 		94-0707299 501(C)(6) 7,500       EVENT SPONSORSHIP
(25) OPERATION STAND DOWN TENNESSEE
1125 12TH AVENUE SOUTH
NASHVILLE,TN37203 		62-1638832 501(C)(3) 30,000       EVENT SPONSORSHIP
(26) REGIONAL ONE HEALTHCARE FOUNDATION
877 JEFFERSON AVE
MEMPHIS,TN38103 		58-1737037 501(C)(3) 6,000       EVENT SPONSORSHIP
(27) SCOTT HAMILTON CARES FOUNDATION
2095 LAKESIDE CENTRE WAY STE 101
KNOXVILLE,TN37922 		47-2328142 501(C)(3) 25,000       EVENT SPONSORSHIP
(28) SECOND HARVEST
136 HARVEST LN
MARYVILLE,TN37801 		58-1450139 501(C)(3) 25,000       EVENT SPONSORSHIP
(29) SECOND HARVEST FOOD BANK OF MID TN
331 GREAT CIRCLE RD
NASHVILLE,TN37228 		62-1049447 501(C)(3) 15,000       DONATION TO THE GENERAL FUND
(30) SUSAN G KOMEN
4009 HILLSBORO PIKE STE 209
NASHVILLE,TN37215 		75-1835298 501(C)(3) 6,486       EVENT SPONSORSHIP AND DONATION TO GENERAL FUND
(31) TENNESSEE GOLF FOUNDATION
400 FRANKLIN RD
FRANKLIN,TN37069 		58-1893478 501(C)(3) 54,000       EVENT SPONSORSHIP
(32) TENNESSEE HOLIDAY PRODUCTIONS
4830 KEENELAND CIR
ORLANDO,FL32819 		  15,000       EVENT SPONSORSHIP
(33) TENNESSEE SPORTS HALL OF FAME
501 BROADWAY AVE
NASHVILLE,TN37203 		23-7036422 501(C)(3) 10,000       EVENT SPONSORSHIP
(34) TENNESSEE THEATRE
604 S GAY ST
KNOXVILLE,TN37902 		62-1651302 501(C)(3) 25,000       EVENT SPONSORSHIP
(35) THE COMMUNITY FOUNDATION OF MIDDLE TN
3833 CLEGHORN AVE STE 400
NASHVILLE,TN37215 		62-1471789 501(C)(3) 16,500       EVENT SPONSORSHIP AND DONATION TO GENERAL FUND
(36) THE LEUKEMIA & LYMPHOMA SOCIETY
404 BNA DR STE 102
NASHVILLE,TN37217 		13-5644916 501(C)(3) 15,000       EVENT SPONSORSHIP
(37) THE PAT SUMMITT FOUNDATION
520 W SUMMIT HILL DRIVE SUITE 1101
KNOXVILLE,TN37902 		62-0807696 501(C)(3) 6,000       EVENT SPONSORSHIP AND DONATION TO THE GENERAL FUND
(38) THE SALVATION ARMY
1424 NE EXPRESS WAY
ATLANTA,GA30329 		58-0660607 501(C)(3) 15,000       DONATION TO THE GENERAL FUND
(39) THE YMCA
1000 CHURCH STREET
NASHVILLE,TN37203 		62-0476243 501(C)(3) 7,500       EVENT SPONSORSHIP
(40) US WOMEN'S AMATEUR CHAMP NASH
414 UNION ST STE 1010
NASHVILLE,TN37219 		81-3910551 501(C)(3) 25,000       EVENT SPONSORSHIP
(41) WELLMONT FOUNDATION
PO BOX 1069
KINGSPORT,TN37662 		58-1594191 501(C)(3) 10,000       EVENT SPONSORSHIP
(42) WEST TENNESSEE HEALTHCARE FOUNDATION
620 SKYLINE DRIVE
JACKSON,TN38301 		58-1671241 501(C)(3) 30,088       EVENT SPONSORSHIP AND DONATION TO THE GENERAL FUND
(43) SMILE 180 FOUNDATION
240 VENTURE CIRCLE
NASHVILLE,TN37228 		47-1654054 501(C)(3) 3,900,000 218,945 FMV SALARY ALLOCATION DONATION TO THE GENERAL FUND
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
39
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
4
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2018

Schedule I (Form 990) 2018
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1)           N/A
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
PART I, LINE 2: DONATIONS ARE BASED UPON DECISION FROM THE SENIOR STAFF, DECISIONS FROM THE BOARD AND FROM THE CORPORATE CITIZENSHIP COMMITTEE OF THE BOD. CONTRIBUTIONS ARE MONITORED MONTHLY BY SENIOR STAFF AND AT THE BOARD MEETINGS.
Schedule I (Form 990) 2018



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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
DELTA DENTAL OF TENNESSEE INC
 
Employer identification number

62-0812197
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2018

Schedule J (Form 990) 2018
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1DR PHILIP A WENK
PRESIDENT & CEO 		(i)

(ii)		 571,380
-------------
0 		472,323
-------------
0 		10,660
-------------
0 		35,750
-------------
0 		23,418
-------------
0 		1,113,531
-------------
0 		0
-------------
0
2JEFF BALLARD
SENIOR VP OF FINANCE & CFO 		(i)

(ii)		 226,134
-------------
0 		289,641
-------------
0 		2,124
-------------
0 		29,408
-------------
0 		33,832
-------------
0 		581,139
-------------
0 		0
-------------
0
3DONNA KAYE MARTIN
SENIOR VP OPERATIONS 		(i)

(ii)		 235,655
-------------
0 		291,351
-------------
0 		2,487
-------------
0 		30,195
-------------
0 		11,167
-------------
0 		570,855
-------------
0 		0
-------------
0
4PAMELA DISHMAN
SENIOR VP EMPLOYEE RELATIONS 		(i)

(ii)		 252,755
-------------
0 		291,351
-------------
0 		3,287
-------------
0 		30,195
-------------
0 		11,167
-------------
0 		588,755
-------------
0 		0
-------------
0
5DONALD L BEATY
VP IT (THRU 11/18) 		(i)

(ii)		 158,247
-------------
0 		54,924
-------------
0 		15,606
-------------
0 		9,829
-------------
0 		31,012
-------------
0 		269,618
-------------
0 		0
-------------
0
6JERRY R REAVIS JR
VP BUSINESS DEVELOPMENT 		(i)

(ii)		 221,064
-------------
0 		64,980
-------------
0 		8,304
-------------
0 		56,729
-------------
0 		33,832
-------------
0 		384,909
-------------
0 		0
-------------
0
7MICHELLE ACOSTA
VP BRAND STRATEGY 		(i)

(ii)		 137,425
-------------
0 		42,685
-------------
0 		4,039
-------------
0 		36,085
-------------
0 		33,832
-------------
0 		254,066
-------------
0 		0
-------------
0
8JEFFREY A NEWTON
VP AUDIT & FINANCE 		(i)

(ii)		 134,453
-------------
0 		41,750
-------------
0 		230
-------------
0 		35,443
-------------
0 		23,418
-------------
0 		235,294
-------------
0 		0
-------------
0
9MELISSA HUSCHKE
VP CORPORATE OPERATIONS 		(i)

(ii)		 146,727
-------------
0 		44,976
-------------
0 		1,328
-------------
0 		38,509
-------------
0 		33,832
-------------
0 		265,372
-------------
0 		0
-------------
0
10SHANDA BROWN
VP CORPORATE AND COMMUNITY ENGAGEMEN 		(i)

(ii)		 124,004
-------------
0 		38,346
-------------
0 		728
-------------
0 		25,087
-------------
0 		20,411
-------------
0 		208,576
-------------
0 		0
-------------
0
11JONATHAN OAKS
MANAGER, SALES AND ACCOUNT MANAGEMEN 		(i)

(ii)		 143,634
-------------
0 		94,402
-------------
0 		4,982
-------------
0 		22,074
-------------
0 		33,832
-------------
0 		298,924
-------------
0 		0
-------------
0
12EMILY PEARSON
ACCOUNT EXECUTIVE 		(i)

(ii)		 37,079
-------------
0 		156,747
-------------
0 		6,029
-------------
0 		11,984
-------------
0 		33,832
-------------
0 		245,671
-------------
0 		0
-------------
0
13WILLIAM HAMILTON
ACCOUNT EXECUTIVE 		(i)

(ii)		 43,119
-------------
0 		258,272
-------------
0 		5,038
-------------
0 		19,817
-------------
0 		33,832
-------------
0 		360,078
-------------
0 		0
-------------
0
14TRACY BAILEY
ACCOUNT EXECUTIVE 		(i)

(ii)		 28,335
-------------
0 		307,145
-------------
0 		6,982
-------------
0 		18,044
-------------
0 		33,832
-------------
0 		394,338
-------------
0 		0
-------------
0
Schedule J (Form 990) 2018

Schedule J (Form 990) 2018
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
PART I, LINE 1A TRAVEL EXPENSES WERE PAID FOR THE SPOUSE OF ANY BOARD MEMBER WHO CHOSE TO ATTEND THE SUMMER BOARD MEETING. THE AMOUNT PAID FOR EACH SPOUSE WAS REPORTED AS TAXABLE COMPENSATION ON A 1099 AND PROVIDED TO EACH RESPECTIVE BOARD MEMBER.
PART I, LINE 4B A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN UNDER SEC. 457(F) IS MAINTAINED BY THE ORGANIZATION FOR CERTAIN EXECUTIVE EMPLOYEES. UPON SEVERANCE FROM SERVICE PRIOR TO ATTAINMENT OF NORMAL RETIREMENT AGE, THE PARTICIPANT SHALL FORFEIT INELIGIBLE AMOUNTS IN THE PLAN UNLESS SUCH SEVERANCE IS DUE TO DEATH, DISABILITY OR INVOLUNTARY TERMINATION WITHOUT CAUSE. IN 2018, THERE WERE NO PAYMENTS RECEIVED FROM THIS PLAN.
PART I, LINE 7 AS INDICATED IN SCHEDULE J, PART II, OFFICERS OF THE ORGANZIATION RECEIVED A BONUS BASED ON PERFORMANCE AND THE FINANCIAL RESULTS OF THE ORGANZIATION. THIS BONUS WAS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD.
Schedule J (Form 990) 2018
Additional Data


Software ID:  
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Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletGo to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
DELTA DENTAL OF TENNESSEE INC
 
Employer identification number

62-0812197
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2018
Schedule L (Form 990 or 990-EZ) 2018
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) BECK DENTAL CARE
  		VICTOR BECK, CHAIRMAN OF DDTN, IS AN OWNER IN VICTOR C. BECK JR DDS 187,477 HEALTH CARE PAYMENTS   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2018


Additional Data


Software ID:  
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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization
DELTA DENTAL OF TENNESSEE INC
 
Employer identification number

62-0812197
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATON HAS ONE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION, HAS VOTING RIGHTS. THESE VOTING RIGHTS ALLOW THE SOLE MEMBER TO ELECT DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B IF ANY TRANSFER OF ASSETS, INVESTMENT, LOAN GUARANTY OR EXPENDITURE WHICH, INDIVIDUALLY OR IN THE AGGREGATE DURING ANY CALENDAR YEAR, EXCEEDS TEN PERCENT (10%) OF DDTN'S NET ASSETS AT THE TIME OF SUCH ACTION, THE TRANSACTION MUST BE APPROVED BY RENAISSANCE HEALTH SERVICE CORPORATION PRIOR TO THE CONSUMMATION OF SUCH TRANSACTION.
FORM 990, PART VI, SECTION B, LINE 11B THE INFORMATION IS GIVEN TO OUTSIDE TAX PREPARERS WHO PREPARE AND REVIEW THE FORM 990. PRIOR TO FILING FORM 990 WITH THE IRS, AN ELECTRONIC COPY IS PLACED ON THE WEBSITE FOR THE BOARD TO REVIEW AND ASK QUESTIONS.
FORM 990, PART VI, SECTION B, LINE 12C THE ENTERPRISE'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. 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. AT LEAST THE FOLLOWING POSITIONS ARE COVERED: THE CEO, CFO, AND THE SENIOR VICE PRESIDENTS. THE ORGANIZATION CONTRACTS WITH AN INDEPENDENT THIRD PARTY TO DO A COMPENSATION AND REASONABLENESS ANALYSIS EVERY TWO YEARS. THE FINAL DETERMINATION OF COMPENSATION IS APPROVED 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 2018. THE REPORT BASED ON THIS REVIEW WAS THEN ISSUED BY THE CONSULTANTS IN NOVEMBER OF 2018.
FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC.
FORM 990 PART VII: CERTAIN EMPLOYEES ARE OFFICERS OF MULTIPLE COMPANIES WITHIN THE ENTERPRISE. 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 XI, LINE 9: CHANGE IN INVESTMENT IN SUBSIDIARY -307,883. FOREIGN CURRENCY TRANSLATION -32,448.
FORM 990, PART XII, LINES 2C: DELTA DENTAL OF TENNESSEE IS AUDITED BY AN INDEPENDENT ACCOUNTANT AS PART OF A CONSOLIDATED FINANCIAL STATEMENT ISSUED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. 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 PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2018


Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
DELTA DENTAL OF TENNESSEE INC
 
Employer identification number

62-0812197
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity
(1) LIQUID CORN LLC
240 VENTURE CIRCLE
NASHVILLE,TN37228
20-3349680 		OWNS SUITE 244 TN 0 157 FORE HOLDING CORPORATION
 
(2) PREMIER INSURANCE SERVICES LLC
240 VENTURE CIRCLE
NASHVILLE,TN37228
11-3662057 		INSURANCE BROKER TN -1,250 49,916 FORE HOLDING CORPORATION
 
(3) SUITE 244 PARTNERS LLC
240 VENTURE CIRCLE
NASHVILLE,TN37228
20-3643584 		HOLDS THE LEASE TO SUITE 244 AT LP FIELD (TITANS STADIUM) TN 0 0 FORE HOLDING CORPORATION
 






Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)DELTA DENTAL PLAN OF OHIO INC
PO BOX 30416

LANSING,MI489097916
31-0685339 		PROVIDE DENTAL SERVICE PLANS OH 501(C)(4) N/A DELTA DENTAL PLAN OF MICHIGAN INC
 
 
No
(2)DELTA DENTAL PLAN OF INDIANA INC
PO BOX 30416

LANSING,MI489097916
35-1545647 		PROVIDE DENTAL SERVICE PLANS IN 501(C)(4) N/A DELTA DENTAL PLAN OF MICHIGAN INC
 
 
No
(3)DELTA DENTAL PLAN OF MICHIGAN INC
4100 OKEMOS ROAD

OKEMOS,MI48864
38-1791480 		PROVIDE DENTAL SERVICE PLANS MI 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION
 
 
No
(4)DELTA DENTAL FUND
PO BOX 30416

LANSING,MI489097916
38-2337000 		SUPPORT DENTAL EDUCATION AND RESEARCH PROGRAMS MI 501(C)(3) LINE 12A, I DELTA DENTAL PLAN OF MICHIGAN INC
 
 
No
(5)RENAISSANCE HEALTH SERVICE CORPORATION
PO BOX 30416

LANSING,MI489097916
38-1675667 		PROMOTING DENTAL CARE MI 501(C)(4) N/A N/A
 
No
(6)DELTA DENTAL PLAN OF NEW MEXICO INC
2500 LOUISIANA BLVD NE

ALBUQUERQUE,NM87110
85-0224562 		PROVIDE DENTAL SERVICE PLANS NM 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION
 
 
No
(7)DELTA DENTAL OF KENTUCKY INC
10100 LINN STATION ROAD NO 700

LOUISVILLE,KY40223
61-0659432 		PROVIDE DENTAL SERVICE PLANS KY 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION
 
 
No
(8)DELTA DENTAL OF NORTH CAROLINA
4242 SIX FORKS ROAD

RALEIGH,NC27609
56-1018068 		PROVIDE DENTAL SERVICE PLANS NC 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION
 
 
No
(9)DELTA DENTAL PLAN OF ARKANSAS INC
1513 COUNTRY CLUB RD

SHERWOOD,AR72120
71-0561140 		PROVIDE DENTAL SERVICE PLANS AR 501(C)(4) N/A RENAISSANCE HEALTH SERVICE CORPORATION
 
 
No
(10)DELTA DENTAL OF ARKANSAS FOUNDATION INC
1513 COUNTRY CLUB RD

SHERWOOD,AR72120
26-1569324 		EMPHASIZE DENTAL HEALTH IN COMMUNITIES AR 501(C)(3) PF RENAISSANCE HEALTH SERVICE CORPORATION
 
 
No
(11)RENAISSANCE FAMILY FOUNDATION INC
4100 OKEMOS ROAD

OKEMOS,MI48864
46-1376165 		EMPHASIZE DENTAL HEALTH IN COMMUNITIES MI 501(C)(3) PF RENAISSANCE HOLDING COMPANY
 
 
No
(12)SMILE 180 FOUNDATION
240 VENTURE CIRCLE

NASHVILLE,TN37228
47-1654054 		EMPHASIZE DENTAL HEALTH IN COMMUNITIES TN 501(C)(3) LINE 12A, I DELTA DENTAL OF TENNESSEE INC
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) CHESME LLC

124 N BRIDGE ST
DEWITT,MI48820
20-0061957 		CAPITAL MANAGEMENT MI N/A
                  












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) FORE HOLDING CORPORATION

240 VENTURE CIRCLE
NASHVILLE,TN37228
20-4116122 		HOLDING COMPANY TN DELTA DENTAL OF TENNESSEE
  		C -307,883 11,159,863 100.000 % Yes  
(2) RENAISSANCE HOLDING COMPANY

PO BOX 30381
LANSING,MI48909
41-2177193 		HOLDING COMPANY MI N/A
 C         No
(3) RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA

PO BOX 30381
LANSING,MI48909
47-0397286 		INSURANCE IN N/A
 C         No
(4) RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK

PO BOX 30381
LANSING,MI48909
13-4098096 		INSURANCE NY N/A
 C         No
(5) DENTAL CHOICE INC

10100 LINN STATION RD SUITE 700
LOUISVILLE,KY40223
61-1105118 		PROVIDE DENTAL SERVICE PLANS KY N/A
 C         No
(6) DENTAL CHOICE AGENCY INC

10100 LINN STATION RD SUITE 700
LOUISVILLE,KY40223
61-1336003 		PRIMARY GENERAL AGENCY FOR DDKY & DENTAL CHOICE KY N/A
 C         No
(7) OMEGA ADMINISTRATORS INC

1513 COUNTRY CLUB ROAD
SHERWOOD,AR72120
04-3740469 		PROVIDING THIRD-PARTY ADMINISTRATIVE SERVICES AR N/A
 C         No
(8) THE 4100 GROUP

4100 OKEMOS ROAD
OKEMOS,MI48864
47-2557772 		INVESTMENT IN SUBSIDIARIES MI N/A
 C         No
(9) DEWPOINT INC

300 S WASHINGTON SQUARE
LANSING,MI48933
38-3300595 		IT CONSULTING MI N/A
 C         No
Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
Yes
 
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
 
No
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) DELTA DENTAL PLAN OF MICHIGAN INC

 M 4,615,698 ACTUAL COST
(2) SMILE 180 FOUNDATION

 B 3,900,000 ACTUAL COST
(3) SMILE 180 FOUNDATION

 O 218,945 ACTUAL COST
(4) DELTA DENTAL OF NORTH CAROLINA

 A 56,800 ACTUAL COST
(5) DELTA DENTAL OF NORTH CAROLINA

 D 40,000 ACTUAL COST

Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2018

Additional Data


Software ID:  
Software Version: