TY 2021 Form 990

- TIN:

Form990

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)

Do not enter social security numbers on this form as it may be made public.

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

A For the 2021 calendar year, or tax year beginning 01-01-2021 , and ending 12-31-2021

BCheck if applicable: Address change Name change Initial return Final return/terminated Amended return Application pending

CName of organization
DELTA DENTAL PLAN OF MICHIGAN INC

Doing business as

Number and street (or P.O. box if mail is not delivered to street address)
4100 OKEMOS ROAD

Room/suite

City or town, state or province, country, and ZIP or foreign postal code
OKEMOS, MI48864

D Employer identification number

38-1791480

E Telephone number

G Gross receipts $ 1,175,896,397

F Name and address of principal officer:
GORAN JURKOVIC
4100 OKEMOS ROAD
OKEMOS,MI48864

Tax-exempt status: 501(c)(3) 501(c) ( 4 ) LeftBullet

(insert no.) 4947(a)(1) or 527

Website:

WWW.DELTADENTALMI.COM

H(a)

Is this a group return for
subordinates? Yes No

H(b)

Are all subordinates
included?

Yes No

If "No," attach a list. See instructions.

H(c)

Group exemption number MediumBullet

K Form of organization: Corporation Trust Association Other MediumBullet

L Year of formation: 1957

M State of legal domicile: MI

Part I

Summary

1	Briefly describe the organization’s mission or most significant activities: DELTA DENTAL OF MICHIGAN'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH DENTAL SERVICES PROVIDED UNDER CONTRACTS WITH INDEPENDENT PROFESSIONAL SERVICE PROVIDERS, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	1,197
6	Total number of volunteers (estimate if necessary) .............	6	0
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	41,888,545
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	884,194,894	963,288,759
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	29,338,836	28,878,623
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	138,284	22,660
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	913,672,014	992,190,042
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	15,810,717	7,629,688
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	129,019,124	153,737,523
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	753,463,943	813,500,894
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	898,293,784	974,868,105
19	Revenue less expenses. Subtract line 18 from line 12.......	15,378,230	17,321,937
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	824,076,353	855,270,608
21	Total liabilities (Part X, line 26).............	182,285,417	168,458,126
22	Net assets or fund balances. Subtract line 21 from line 20.....	641,790,936	686,812,482

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

	Signature of officer	Date

	Type or print name and title

Paid Preparer Use Only

Print/Type preparer's name

Preparer's signature

Date

Check if
self-employed

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) ..........YesNo

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11282Y Form 990 (2021)

Form 990 (2021)

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..............

Briefly describe the organization’s mission: SEE SCHEDULE ODELTA DENTAL OF MICHIGAN'S MISSION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH THROUGH DENTAL SERVICES PROVIDED UNDER CONTRACTS WITH INDEPENDENT PROFESSIONAL SERVICE PROVIDERS, SUPPORT FOR RESEARCH AND EDUCATION, AND COMMUNITY OUTREACH DIRECTED TOWARD SECURING ACCESS TO QUALITY DENTAL CARE FOR ALL. DELTA DENTAL OF MICHIGAN IS GOVERNED BY A BOARD OF DIRECTORS CONTROLLED BY INDEPENDENT MEMBERS OF THE COMMUNITY AND IT OFFERS ENROLLMENT IN ORAL HEALTH PLANS TO A BROAD BASE OF THE COMMUNITY THROUGH A VARIETY OF PAYMENT MODELS.

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ..................... Yes No

If "Yes," describe these new services on Schedule O.

Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ........................... Yes No

If "Yes," describe these changes on Schedule O.

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 $ 853,641,751 including grants of $ 7,629,688 ) (Revenue $ 921,400,214 )
	PROMOTING DENTAL CAREDELTA DENTAL PLAN OF MICHIGAN, INC. IS A LEADING PREPAID DENTAL BENEFITS PROVIDER IN THE MIDWEST. THE PURPOSE OF THE ORGANIZATION IS TO ADVANCE AND PROMOTE THE IMPROVEMENT OF ORAL HEALTH. THIS IS DONE BY OFFERING INNOVATIVE, COST-EFFECTIVE PRODUCTS THAT MEET THE NEEDS OF CUSTOMERS. THIS WAS DEMONSTRATED IN 2021 BY PAYING OUT OVER $536 MILLION FOR DENTAL CARE, BY PROVIDING DENTAL BENEFITS FOR THE PUBLIC AND ADVANCING THE SCIENCE OF DENTISTRY. IN ADDITION, OVER 10.4 MILLION CLAIMS WERE PROCESSED FOR OVER 5.7 MILLION MEMBERS.SEE CONTINUATION ON SCHEDULE OCOST SAVING STRATEGIESDELTA DENTAL BENEFIT PLANS ARE COMMITTED TO SAVING GROUPS AND MEMBERS MONEY. THE DELTA DIFFERENCE IS AN INTEGRATION OF ACTIVITIES; SUCH AS COST MANAGEMENT POLICIES, FEE REDUCTION AGREEMENTS WITH DENTISTS, AND AN ANTI-FRAUD HOTLINE, PUT TO WORK ENSURING QUALITY, COST-EFFECTIVE DENTAL BENEFIT DELIVERY. COMMITMENT TO THE COMMUNITYDELTA DENTAL PLAN OF MICHIGAN, INC. BELIEVES ADVANCES IN DENTAL RESEARCH AND ENHANCED EDUCATIONAL OPPORTUNITIES FOR DENTISTS GO A LONG WAY TOWARD IMPROVING ORAL HEALTH. THE COMPANY IS A KEY PLAYER IN GROUNDBREAKING RESEARCH ON TRENDS IN ORAL HEALTH IN THE INSURED POPULATION. THE DELTA DENTAL FUND, THE COMPANY'S PHILANTHROPIC AFFILIATE, ENCOURAGES ADVANCES IN DENTISTRY AND SUPPORTS DENTAL EDUCATION AND RESEARCH. SINCE IT WAS FORMED IN 1980, THE DELTA DENTAL FUND HAS GRANTED OVER $47 MILLION TOWARD THE ADVANCEMENT OF DENTAL SCIENCE AND IMPROVEMENT OF THE ORAL HEALTH OF THE PUBLIC. DELTA DENTAL FUND REGULARLY PROVIDES FUNDING FOR PROGRAMS THAT HELP AT-RISK POPULATIONS AND INDIVIDUALS WITH SPECIAL NEEDS OBTAIN DENTAL TREATMENT, SCHOLARSHIP AND LEADERSHIP AWARDS TO DENTAL STUDENTS, GRANTS TO PURCHASE LEARNING TOOLS AND OTHER DENTAL SCHOOL PROGRAMS, CONTINUING EDUCATION PROGRAMS FOR THE DENTAL PROFESSION, AND EDUCATIONAL MATERIALS ON THE IMPORTANCE OF ORAL HEALTH AND HAZARDS TO ORAL HEALTH.IN 2021, DELTA DENTAL FUND PROVIDED GRANTS TOTALING NEARLY $4 MILLION FOR DENTAL AND COMMUNITY RELATIONS PROJECTS. THIS FUNDING HAS IMPROVED ORAL AND OVERALL HEALTH, ADDED TO WHAT WE KNOW ABOUT DENTAL SCIENCE, HELPED STUDENTS ACHIEVE THEIR GOALS AND IMPROVED THE WELL-BEING OF THOUSANDS OF CHILDREN AND ADULTS IN MICHIGAN, INDIANA, OHIO AND NORTH CAROLINA.DELTA DENTAL PLAN OF MICHIGAN IS ALSO COMMITTED TO BUILDING HEALTHY, SMART, VIBRANT COMMUNITIES. DELTA DENTAL HAS ALWAYS BEEN KEENLY AWARE OF ITS CIVIC AND SOCIAL RESPONSIBILITY. DELTA DENTAL PLANS ARE PROUD TO SHARE, THROUGH DIRECT FINANCIAL CONTRIBUTIONS, WITH HUNDREDS OF COMMUNITY AGENCIES AND GROUPS. IN ADDITION, EMPLOYEES LOG COUNTLESS HOURS OF THEIR OWN TIME AS VOLUNTEERS. COMMUNITY SUPPORT GENERALLY FALLS UNDER THE BROAD CATEGORIES THAT PROVIDE SUPPORT TO AGENCIES AND INSTITUTIONS SERVING CHILDREN, SENIORS, LOW-INCOME INDIVIDUALS, MINORITIES, AND DISABLED AND AT-RISK INDIVIDUALS, TO ORGANIZATIONS THAT PROMOTE EDUCATION, ARTS AND RECREATION AND COMMUNITY DEVELOPMENT, AND TO CHARITABLE PROJECTS OR PROGRAMS RECOMMENDED BY EMPLOYEES, CUSTOMERS, PARTICIPATING DENTISTS AND OTHER KEY GROUPS. WE CONTINUED OUR ROLE AS STRONG ADVOCATES FOR SOUND ORAL HEALTH POLICY AT THE STATE AND FEDERAL LEVELS. THROUGH A PUBLIC-PRIVATE PARTNERSHIP WITH THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH, DELTA DENTAL PARTICIPATES IN THE HEALTHY KIDS DENTAL (HKD) PROGRAM. HEALTHY KIDS DENTAL IS A DENTAL BENEFITS PROGRAM FOR MEDICAID BENEFICIARIES UNDER AGE 21. IT IS AVAILABLE IN ALL OF MICHIGAN'S 83 COUNTIES AND COVERS BASIC DENTAL HEALTH BENEFITS SUCH AS X-RAYS, CLEANINGS, CAVITY FILLINGS, ROOT CANALS, TOOTH EXTRACTIONS AND DENTURES. NEARLY 1,000,000 MICHIGAN CHILDREN ARE SERVED BY THIS PROGRAM. UNEQUALED ACCESS TO DENTISTSFOR FIVE DECADES, DELTA DENTAL HAS HELPED PROMOTE ORAL HEALTH BY DESIGNING AND ADMINISTERING INNOVATIVE, COST-EFFECTIVE DENTAL BENEFIT PROGRAMS. EXPERTS AT PLAN DESIGN, DELTA DENTAL HAS CREATED DENTAL BENEFIT PROGRAMS THAT MEET CUSTOMER COST-OBJECTIVES WHILE HELPING TO IMPROVE AND MAINTAIN ORAL HEALTH.OUR LONG STANDING RELATIONSHIPS WITH PROVIDERS IN THE COMMUNITIES WE SERVE ALLOWS US TO MAINTAIN LARGE NETWORKS, ALLOWING BROAD ACCESS FOR MEMBERS AND COST-EFFECTIVE CARE. DELTA DENTAL'S GROUP MEMBERS ARE AFFORDED ADDED PROTECTION BECAUSE THEY GUARANTEE THAT PARTICIPATING DENTISTS WILL ACCEPT THEIR PAYMENT FOR COVERED SERVICES AND NO CHARGE, OTHER THAN CO-PAYMENTS AND DEDUCTIBLES ARE BILLED BACK TO THE MEMBER. THIS LOWERS CLAIM COSTS FOR CUSTOMERS AND REDUCES OUT-OF-POCKET COSTS FOR SUBSCRIBERS.WITH TWO NETWORKS OF FULL-TIME PARTICIPATING DENTISTS IN ONE INTEGRATED CLAIMS SYSTEM, DELTA DENTAL CAN DELIVER TO CUSTOMERS AND GROUP MEMBERS BROAD ACCESS TO CARE.

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 expenses853,641,751

Form 990 (2021)

Page 3

Part IV

Checklist of Required Schedules

Yes

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A.....................

Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. ...

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 Click to see attachment

.............

Yes

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.........

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 Rev. Proc. 98-19? If "Yes," complete Schedule C, Part III Click to see attachment

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 I Click to see attachment

.........................

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 II Click to see attachment

....

Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part III Click to see attachment

..............

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 IV Click to see attachment

..............

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 V......

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.

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

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 VII Click to see attachment

.......

11b

Yes

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 VIII Click to see attachment

.......

11c

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 IX Click to see attachment

............

11d

Yes

Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X Click to see attachment

11e

Yes

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 X Click to see attachment

11f

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

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

Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E

14a

Did the organization maintain an office, employees, or agents outside of the United States? .....

14a

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

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.....

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...

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. ....

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............

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...................

20a

Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....

20a

If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?

20b

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

Yes

Form 990 (2021)

Page 4

Part IV

Checklist of Required Schedules (continued)

Yes

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

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

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

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...

24b

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

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

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

Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II Click to see attachment

...........

Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?

If "Yes," complete

Schedule L, Part III Click to see attachment

.........................

Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):

A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV...................... Click to see attachment

28a

A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV..... Click to see attachment

28b

Yes

A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................

28c

Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................

Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................

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

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

Yes

35a

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

35a

Yes

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

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.............

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 VI Click to see attachment

Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............

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

Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..

62,210

Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................

Yes

Form 990 (2021)

Page 5

Part V

Statements Regarding Other IRS Filings and Tax Compliance (continued)

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 ..................

1,197

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.

Yes

Did the organization have unrelated business gross income of $1,000 or more during the year?...

Yes

If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...

Yes

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)? ..

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).

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............

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? ...

If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................

Organizations that may receive deductible contributions under section 170(c).

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? ....................

If "Yes," did the organization notify the donor of the value of the goods or services provided? .....

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................

If "Yes," indicate the number of Forms 8282 filed during the year ....

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................

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? ........

Sponsoring organizations maintaining donor advised funds.

Did the sponsoring organization make any taxable distributions under section 4966?........

Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...

Section 501(c)(7) organizations. Enter:

Initiation fees and capital contributions included on Part VIII, line 12 ...

10a

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

10b

Section 501(c)(12) organizations. Enter:

Gross income from members or shareholders .........

11a

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

If "Yes," enter the amount of tax-exempt interest received or accrued during the year.

12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

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

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

Enter the amount of reserves on hand ............

13c

14a

Did the organization receive any payments for indoor tanning services during the tax year?.....

14a

If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..

14b

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 the instructions and file Form 4720, Schedule N.

Yes

Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.

Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.

Form 990 (2021)

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

Enter the number of voting members of the governing body at the end of the tax year

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.

Enter the number of voting members included in line 1a, above, who are independent

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? .................

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? .

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .

Did the organization become aware during the year of a significant diversion of the organization’s assets? .

Did the organization have members or stockholders? ................

Yes

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? ....................

Yes

Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................

Yes

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

The governing body? .......................

Yes

Each committee with authority to act on behalf of the governing body? ............

Yes

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.......

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)

Yes

10a

Did the organization have local chapters, branches, or affiliates? ............

10a

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

Describe on 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

Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................

12b

Yes

Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................

12c

Yes

Did the organization have a written whistleblower policy? ...............

Yes

Did the organization have a written document retention and destruction policy? .........

Yes

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?

The organization’s CEO, Executive Director, or top management official ...........

15a

Yes

Other officers or key employees of the organization ................

15b

Yes

If "Yes" to line 15a or 15b, describe the process on 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

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

List the states with which a copy of this Form 990 is required to be filed MediumBullet

Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.

Own website Another's website Upon request Other (explain in Schedule O)

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.

State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBullet

AMY BASEL CFO4100 OKEMOS ROAD OKEMOS,MI48864 (517) 349-6000

Form 990 (2021)

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.

List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."

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, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the
organization and any related organizations.

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.

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.

See the instructions for the order in which to list the persons above.

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/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(1) GORAN JURKOVIC CPA...................................................................... CEO, PRESIDENT	35.00 ................. 15.00		X				6,436,475	0	2,150,877
(2) ANTHONY ROBINSON...................................................................... SVP & CHIEF MKT OFFICER	43.00 ................. 7.00		X				1,720,896	0	495,456
(3) AMY BASEL...................................................................... SVP, CFO, CRO & TREASURER	35.00 ................. 15.00		X				1,522,877	0	446,465
(4) SUE ELLEN JENKINS...................................................................... SVP, CHIEF LEGAL OFF, CAO & SEC.	37.00 ................. 13.00		X				1,037,021	0	297,452
(5) TOBY HALL...................................................................... SVP, CHIEF ACTUARY & DATA OFFICER	50.00 ................. 0.00		X				756,770	0	316,882
(6) JEFF BOTKIN...................................................................... SVP, BUSINESS SVS	50.00 ................. 0.00		X				731,675	0	95,834
(7) MARK BAUGHMAN...................................................................... OPERATING CIO	50.00 ................. 0.00		X				733,786	0	81,467
(8) MICHAEL GILMORE...................................................................... FORMER VP, CHIEF INVEST OFFICER	0.00 ................. 50.00					X	689,026	0	65,859
(9) KUSHTRIM SHAQIRI...................................................................... VP GOVERNMENT PROGRAMS	50.00 ................. 0.00			X			610,420	0	35,848
(10) JEFFREY JOHNSTON...................................................................... SVP, CHIEF SCIENCE OFFICER	43.00 ................. 7.00		X				461,838	0	87,946
(11) MIKE BOBAK...................................................................... VP SALES	50.00 ................. 0.00				X		403,866	0	53,942
(12) DANIEL LOVEJOY...................................................................... DIRECTOR, SALES & ACCT MGT	50.00 ................. 0.00				X		373,939	0	49,820
(13) MARGARET TRIMER...................................................................... VP STRATEGIC PARTNERSHIPS	50.00 ................. 0.00				X		341,956	0	78,231
(14) WALTER BUZANOWSKI...................................................................... VP & GENERAL COUNSEL	50.00 ................. 0.00				X		357,626	0	60,368
(15) EARL MAJOR...................................................................... VP HUMAN RESOURCES	50.00 ................. 0.00				X		216,866	0	53,942
(16) CHRISTOPHER T FISHER...................................................................... DIRECTOR	5.00 ................. 10.00	X					60,000	107,004	0
(17) JOSHUA S HOWIE...................................................................... VICE-CHAIRPERSON - THRU 5/21	5.00 ................. 5.00	X	X				27,500	141,468	0

Form 990 (2021)

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/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) SARA M DOLAN........................................................................ VICE-CHAIRPERSON	5.00 .......................5.00	X	X	63,500	66,467	0
(19) JOSEPH C HARRIS DDS........................................................................ DIRECTOR - THRU 5/21	5.00 .......................6.00	X		104,116	12,415	0
(20) MELISSA STOLICKER........................................................................ DIRECTOR	5.00 .......................5.00	X		60,000	50,004	0
(21) STEPHEN A EKLUND........................................................................ DIRECTOR	5.00 .......................6.00	X		60,000	26,996	0
(22) KURT D GALLINGER........................................................................ DIRECTOR	5.00 .......................5.00	X		60,000	24,996	0
(23) KELLY JUBB SCHEIDERER........................................................................ CHAIRPERSON	5.00 .......................6.00	X	X	52,500	32,000	0
(24) ANN MARIE FLERMOEN........................................................................ DIRECTOR - THRU 5/21	5.00 .......................11.00	X		25,000	57,750	0
(25) RAYMOND F GIST DDS........................................................................ DIRECTOR	5.00 .......................1.00	X		60,000	2,000	0
(26) LARRY DEGROAT........................................................................ DIRECTOR	5.00 .......................0.00	X		60,000	0	0
(27) PATRICK GILLESPIE........................................................................ DIRECTOR	5.00 .......................0.00	X		60,000	0	0
(28) ANDREW KOTARBA........................................................................ DIRECTOR	5.00 .......................0.00	X		60,000	0	0
(29) STEVEN M DATER DDS MS........................................................................ DIRECTOR	5.00 .......................0.00	X		40,000	0	0
(30) STEVEN M TACK DDS MS........................................................................ DIRECTOR	5.00 .......................0.00	X		40,000	0	0
(31) SUNCICA TRAVAN DDS MS........................................................................ DIRECTOR	5.00 .......................0.00	X		40,000	0	0
(32) ANTHONY O WILLIAMS JD........................................................................ DIRECTOR	5.00 .......................0.00	X		40,000	0	0
(33) DOUGLAS R ANDERSON........................................................................ DIRECTOR - THRU 5/21	5.00 .......................5.00	X		25,000	10,415	0
(34) CURLES C COLBERT JR DDS........................................................................ DIRECTOR - THRU 9/21	5.00 .......................0.00	X		35,000	0	0
(35) BLAKE LIVINGSTON DDS........................................................................ DIRECTOR	5.00 .......................0.00	X		0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	17,367,653	531,515	4,370,389

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet

289

Yes

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 ..............

Yes

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...........................

Yes

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 ........

Section B. Independent Contractors

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
DEWPOINT 300 WASHINGTON SQUARE SUITE 200 LANSING,MI48933	CONSULTING	19,178,416
WEST MONROE PARTNERS LLC 222 W ADAMS ST FL 11 CHICAGO,IL60606	CONSULTING	6,398,474
MAINLINE INFORMATION SYSTEMS 1700 SUMMIT LAKE DR TALAHASSEE,FL32317	CONSULTING	4,293,266
TEK SYSTEMS 300 WASHINGTON SQUARE SUITE 430 LANSING,MI48933	CONSULTING	3,542,316
DPM CONSULTING SERVICES 5440 CORPORATE DR STE 125 TROY,MI48098	CONSULTING	3,043,965
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 104

Form 990 (2021)

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

(D)
Revenue
excluded from
tax under sections
512 - 514

1a	Federated campaigns..	1a
b	Membership dues..	1b
c	Fundraising events..	1c
d	Related organizations	1d
e	Government grants (contributions)	1e

f	All other contributions, gifts, grants, and similar amounts not included above	1f

g	Noncash contributions included in lines 1a - 1f:$	1g

h Total. Add lines 1a-1f.......

		Business Code
2a	DENTAL CARE REVENUE	624100	825,996,218	825,996,218
b	ADMIN REIMBURSEMENT	900099	95,403,996	95,403,996
c	EXTERNAL SERVICES	524292	41,888,545		41,888,545
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		963,288,759

3 Investment income (including dividends, interest, and othersimilar amounts) ......			4,600,374			4,600,374
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	85,600	207,899,004	7a
b	Less: cost or other basis and sales expenses	47,883	183,658,472	7b
c	Gain or (loss)	37,717	24,240,532	7c
d	Net gain or (loss).........			24,278,249			24,278,249
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	MISCELLANEOUS INCOME		900099	22,660			22,660
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			22,660
12	Total revenue. See instructions.....			992,190,042	921,400,214	41,888,545	28,901,283

Form 990 (2021)

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 ....	7,629,688	7,629,688
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, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	17,279,642	11,231,767	6,047,875
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........	95,887,284	57,009,762	38,877,522
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	17,214,286	9,340,676	7,873,610
9	Other employee benefits .......	16,336,156	9,026,462	7,309,694
10	Payroll taxes ...........	7,020,155	4,335,664	2,684,491
11	Fees for services (non-employees):
a	Management ......	4,112,950	3,196,817	916,133
b	Legal .........	523,305		523,305
c	Accounting ...........	365,860		365,860
d	Lobbying ...........	120,000		120,000
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	1,640,171		1,640,171
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	714,929,673	695,314,620	19,615,053
12	Advertising and promotion ....	4,506,367	3,223,939	1,282,428
13	Office expenses .......	14,219,506	10,237,477	3,982,029
14	Information technology ......	21,748,646	11,840,912	9,907,734
15	Royalties ..
16	Occupancy ...........	4,766,940		4,766,940
17	Travel ............	2,703,836	2,266,399	437,437
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	370,863	215,900	154,963
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	18,402,613	5,058,167	13,344,446
23	Insurance ...	1,830,167		1,830,167
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	FEDERAL & STATE TAX EXP	-2,546,396		-2,546,396
b	COMMISSIONS	20,295,912	20,295,912
c	PROCESSING FEES	2,366,341	2,366,341
d	MEMBERSHIP DUES	2,245,798	353,660	1,892,138
e	All other expenses	898,342	697,588	200,754
25	Total functional expenses. Add lines 1 through 24e	974,868,105	853,641,751	121,226,354	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 if following SOP 98-2 (ASC 958-720).

Form 990 (2021)

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

1	Cash–non-interest-bearing ........				1
2	Savings and temporary cash investments .........			58,242,529	2	73,200,984
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			60,459,627	4	61,618,463
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............				8
9	Prepaid expenses and deferred charges ......			28,169,115	9	39,578,214
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	244,297,119
b	Less: accumulated depreciation	10b	122,671,083	133,099,761	10c	121,626,036
11	Investments—publicly traded securities .			273,517,808	11	278,724,900
12	Investments—other securities. See Part IV, line 11 .....			224,991,567	12	226,398,759
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			45,595,946	15	54,123,252
16	Total assets. Add lines 1 through 15 (must equal line 33)...			824,076,353	16	855,270,608

17	Accounts payable and accrued expenses .....	82,138,272	17	92,658,909
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 any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			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	100,147,145	25	75,799,217
26	Total liabilities. Add lines 17 through 25..	182,285,417	26	168,458,126

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....	15,744,473	29	15,744,473
30	Paid-in or capital surplus, or land, building or equipment fund ...	5,122,500	30	5,122,500
31	Retained earnings, endowment, accumulated income, or other funds	620,923,963	31	665,945,509
32	Total net assets or fund balances ...........	641,790,936	32	686,812,482
33	Total liabilities and net assets/fund balances ........	824,076,353	33	855,270,608

Form 990 (2021)

Page 12

Part XI

Reconcilliation of Net Assets

Check if Schedule O contains a response or note to any line in this Part XI..............

Total revenue (must equal Part VIII, column (A), line 12) ............

992,190,042

Total expenses (must equal Part IX, column (A), line 25) ............

974,868,105

Revenue less expenses. Subtract line 2 from line 1 ..............

17,321,937

Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..

641,790,936

Net unrealized gains (losses) on investments ...............

6,543,252

Donated services and use of facilities .................

Investment expenses .....................

Prior period adjustments .....................

Other changes in net assets or fund balances (explain in Schedule O) ........

21,156,357

Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))

686,812,482

Part XII

Financial Statements and Reporting

Check if Schedule O contains a response or note to any line in this Part XII.............

Yes

Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.

Were the organization’s financial statements compiled or reviewed by an independent accountant?

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:

Separate basis Consolidated basis Both consolidated and separate basis

Were the organization’s financial statements audited by an independent accountant?

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:

Separate basis Consolidated basis Both consolidated and separate basis

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?

Yes

If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.

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?

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.

Form 990 (2021)

Additional Data

Software ID:
Software Version:

Form 990, Special Condition Description:

Special Condition Description

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

DELTA DENTAL PLAN OF MICHIGAN INC

Employer identification number

38-1791480

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

$ 13,500

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

$ 13,500

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.
(1) MOVING MACOMB	106 W ALLEGAN STE 200 LANSING,MI48933	83-3929631	1,500
(2) BUSINESS LEADERS FOR MICHIGAN PAC II	600 RENAISSANCE CENTER DETROIT,MI48243	27-3999229	10,000
(3) MICHIGAN ASSOCIATION FOR HEALTH PLANS ADVOCACY PAC	327 SEYMOUR AVE LANSING,MI48933	45-4092817	1,000
(4) ROAD TO MICHIGANS FUTURE	PO BOX 12248 LANSING,MI48901	84-4298056	1,000
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Yes

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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 instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

DELTA DENTAL PLAN OF MICHIGAN INC

Employer identification number

38-1791480

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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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.

If the organization elected, as permitted under FASB 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.

If the organization elected, as permitted under FASB 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

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

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 ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

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 .....	12,803,920		12,803,920
b	Buildings ....	98,462,514	37,468,829	60,993,685
c	Leasehold improvements
d	Equipment ....	48,249,007	33,661,198	14,587,809
e	Other .....	84,781,678	51,541,056	33,240,622
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				121,626,036

Schedule D (Form 990) 2021

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) DDIC STOCK	200,217	C
(B) INVESTMENT IN RHC	107,614,629	F
(C) INVESTMENT IN THE 4100 GROUP	118,583,913	F
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	226,398,759

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.)

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)ACCRUED INTEREST RECEIVABLE				550,354
(2)DUE FROM AFFILIATES				17,200,023
(3)OTHER ASSETS				34,149,693
(4)DEFERRED TAX ASSET				2,223,182
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				54,123,252

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
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	75,799,217
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) 2021

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

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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

2021

Open to Public
Inspection

Name of the organization
DELTA DENTAL PLAN OF MICHIGAN INC

Employer identification number
38-1791480

Part I

General Information on Grants and Assistance

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? ........................

Yes No

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	(h) Purpose of grant or assistance
(1) AMERICAN CANCER SOCIETY 20450 CIVIC CENTER DR SOUTHFIELD,MI48076	13-1788491	501(C)(3)	32,000	CHARITABLE DONATION
(2) AUTISM ALLIANCE OF MICHIGAN 30100 TELGRAPH RD BINGHAM FARMS,MI48025	27-0472137	501(C)(3)	50,000	CHARITABLE DONATION
(3) CHILDRENS HOSPITAL OF MICHIGAN FOUNDATION 3011 W GRAND BLVD DETROIT,MI48202	32-0087353	501(C)(3)	50,000	CHARITABLE DONATION
(4) COMMUNITIES IN SCHOOLS OF MICHIGAN 721 N CAPITOL STE 1 LANSING,MI48906	45-3736821	501(C)(3)	200,000	CHARITABLE DONATION
(5) DELTA DENTAL FOUNDATION 4100 OKEMOS RD OKEMOS,MI48864	38-2337000	501(C)(3)	4,000,000	CHARITABLE DONATION
(6) DETROIT RIVERFRONT CONSERVANCY 600 RENAISSANCE CENTER DETROIT,MI48243	30-0125283	501(C)(3)	1,015,000	CHARITABLE DONATION
(7) ELE'S PLACE 1145 WEST OAKLAND LANSING,MI48915	38-2976751	501(C)(3)	130,000	CHARITABLE DONATION
(8) FORGOTTEN HARVEST 21800 GREENFIELD RD OAK PARK,MI48237	38-2926476	501(C)(3)	150,000	CHARITABLE DONATION
(9) GREATER LANSING FOODBANK 5303 S CEDAR ST LANSING,MI48911	38-2424756	501(C)(3)	35,000	CHARITABLE DONATION
(10) IMPRESSION 5 200 MUSEUM DR LANSING,MI48933	23-7200548	501(C)(3)	40,000	CHARITABLE DONATION
(11) JUNIOR ACHIVEVEMENT OF SOUTHEASTERN MI 577 E LARNED ST DETROIT,MI48226	38-1348535	501(C)(3)	85,000	CHARITABLE DONATION
(12) JUVENILE DIABETES RESEARCH FOUNDATION 24359 NORTHWESTERN HWY SOUTHFIELD,MI48075	23-1907729	501(C)(3)	55,000	CHARITABLE DONATION
(13) LANSING PROMISE 330 MARSHALL ST LANSING,MI48912	45-3363322	501(C)(3)	50,000	CHARITABLE DONATION
(14) MICHIGAN COLLEGE ALLIANCE 26555 EVERGREEN RD STE 1210 SOUTHFIELD,MI48076	38-1332962	501(C)(3)	10,000	CHARITABLE DONATION
(15) MICHIGAN ECONOMIC DEVELOPMENT FOUNDATION PO BOX 13063 LANSING,MI48901	38-2527475	501(C)(3)	25,000	CHARITABLE DONATION
(16) MICHIGAN STATE UNIVERSITY 220 TROWBRIDGE RD EAST LANSING,MI48824	38-6005984	GOVT	500,000	CHARITABLE DONATION
(17) ON DEMAND KARE INC 2500 W BROADWAY LOUISVILLE,KY40211	83-1468041	501(C)(3)	150,000	CHARITABLE DONATION
(18) PLAYWORKS EDUCATION ENGERGIZED 1423 BROADWAY PMB 161 OAKLAND,CA94120	94-3251867	501(C)(3)	10,000	CHARITABLE DONATION
(19) ROAD TO MICHIGANS FUTURE PO BOX 12248 LANSING,MI48901	84-4298056	501(C)(4)	100,000	CHARITABLE DONATION
(20) SAMARITAS 8131 E JEFFERSON AVE DETROIT,MI48214	38-1360553	501(C)(3)	45,000	CHARITABLE DONATION
(21) SPARROW FOUNDATION PO BOX 30480 LANSING,MI48909	38-6100687	501(C)(3)	75,000	CHARITABLE DONATION
(22) THE FIRST TEE OF LAKE ERIE LLC PO BOX 351142 TOLEDO,OH43635	46-5657531	501(C)(3)	73,333	CHARITABLE DONATION
(23) WEEKEND SURVIVAL KITS 319 W GRAND RIVER AVE WILLIAMSTON,MI48895	45-4444119	501(C)(3)	75,000	CHARITABLE DONATION
(24) HOPE NETWORK FOUNDATION 3375 SOUTH DIVISION 200 GRAND RAPIDS,MI49448	38-2731395	501(C)(3)	10,000	CHARITABLE DONATION
(25) JUNIOR ACHIEVEMENT OF MICHIGAN GREAT LAKES 600 W ST JOSEPH ST LANSING,MI48933	38-1557861	501(C)(3)	44,500	CHARITABLE DONATION
(26) THE OHIO STATE UNIVERSITY 305 W 12TH AVE COLUMBUS,OH43210	31-6025986	GOVT	85,995	CHARITABLE DONATION
(27) AMERICAN INDIA FOUNDATION 216 EAST 45TH ST NEW YORK,NY10017	13-4159765	501(C)(3)	6,110	CHARITABLE DONATION
(28) AMERICAN RED CROSS 7800 W OUTER DR DETROIT,MI48235	53-0196605	501(C)(3)	50,000	CHARITABLE DONATION
(29) ARTRPRIZE GRAND RAPIDS 225 MICHIGAN ST NW GRAND RAPIDS,MI49501	26-4571560	501(C)(3)	250,000	CHARITABLE DONATION
(30) DETROIT PUBLIC SCHOOLS FOUNDATION FISHER BUILDING DETROIT,MI48202	30-0135450	501(C)(3)	110,000	CHARITABLE DONATION
(31) FREESTORE FOODBANK INC 1141 CENTRAL PARKWAY CINCINNATI,OH45202	33-7122205	501(C)(3)	10,000	CHARITABLE DONATION
(32) JUNIOR ACHIEVEMENT OF CENTRAL OHIO 68 E 2ND AVENUE COLUMBUS,OH43201	31-4385042	501(C)(3)	35,000	CHARITABLE DONATION
(33) JUNIOR ACHIEVEMENT OF NW OHIO 1645 INIDAN WOOD CIRCLE MAUMEE,OH43537	34-4430363	501(C)(3)	25,000	CHARITABLE DONATION
(34) MICHIGAN HUMANE SOCIETY 30300 TELEGRAPH BINGHAM FARMS,MI48025	38-1358206	501(C)(3)	25,000	CHARITABLE DONATION
(35) MICHIGAN CITIZENS FOR FISCAL RESPONSIBILITY 106 W ALLEGAN STREET NO 200 LANSING,MI48933	27-1993953	501(C)(4)	6,250	CHARITABLE DONATION
(36) NATIONAL ASSOCIATION OF DENTAL PLANS 12700 PARK CENTRAL DR DALLAS,TX75251	75-2801959	501(C)(6)	16,500	CHARITABLE DONATION

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2021

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)
(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:	CONTRIBUTIONS ARE MADE AT MANAGEMENT DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF MICHIGAN'S MISSION. CONTRIBUTIONS MADE TO THE DELTA DENTAL FUND ARE APPROVED BY THE BOARD OF DIRECTORS. IN ORDER FOR FUNDS TO BE DISBURSED, VOUCHER RECORDS MUST PASS THROUGH THE APPROVAL PROCESS, SIMILAR TO ANY OTHER EXPENDITURE MADE BY DELTA DENTAL PLAN OF MICHIGAN. DETROIT RIVERFRONT CONSERVANCY - DELTA DENTAL OF MICHIGAN CONTRIBUTED $1 MILLION TO BUILD A HEALTH THEMED PLAYGROUND ON DETROIT'S WEST RIVERFRONT. COMMUNITIES IN SCHOOLS OF MICHIGAN - THIS CONTRIBUTION HELPED CIS OF MICHIGAN DEVELOP THE WHOLE-CHILD SCREENER AND CHECK-IN PROCESS TO ASSESS THE NUTRITIONAL, DENTAL, EDUCATIONAL, PHYSICAL HEALTH, AND MENTAL HEALTH NEEDS OF CASE-MANAGEMENT STUDENTS. THIS NEW NEEDS ASSESSMENT PROCESS ENSURES SITE COORDINATORS CAN IDENTIFY IMMEDIATE NEEDS OF STUDENTS TO BROKER AND IMPLEMENT SUPPORTS. THIS ENSURES SITE COORDINATORS CAN REFER STUDENTS TO A DENTIST AND HELP INCREASE SCHOOL-BASED DENTAL SUPPORTS. CHILDREN'S HOSPITAL OF MICHIGAN FOUNDATION - THIS WAS A CAPITAL CONTRIBUTION TO THE JAMIE DANIELS FOUNDATION (A FUND WITHIN THE CHILDREN'S FOUNDATION) TO ASSIST WITH THE BUILDING OF A RESIDENTIAL OPIOID RECOVERY FACILITY IN SOUTHEASTERN MICHIGAN. ON DEMAND KARE - FOR KARE MOBILE DENTAL PROGRAM THAT CONTRIBUTES ONE-CHAIR MOBILE DENTAL UNITS TO ENTREPRENEUR DENTIST AND HYGENTIST IN SE MICHIGAN TO BOTH SERVE THE MEDICAID POPULATION PART-TIME AND TO BUILD A THRIVING BUSINESS THE OTHER HALF OF THE TIME. FORGOTTEN HARVEST - DELTA DENTAL OF MICHIGAN CONTRIBUTED $150,000 TO THIS FOOD RESCUE/FOOD BANK PROGRAM OPERATING IN THE DETROIT AREA. THEY PROVIDE LUNCHES FOR CHILDREN PARTICIPATING IN THE DETROIT PUBLIC LIBRARY SUMMER CAMP PROGRAMS AS WELL AS OPERATE SEVERAL FARMERS MARKET STYLE FOOD BANK DISTRIBUTION SITES THROUGHOUT SOUTHEASTERN MICHIGAN. ELE'S PLACE - IN 2021, DELTA DENTAL OF MICHIGAN PROVIDED $130,000 TO ELE'S PLACE TO SUPPORT ELE'S GROUP, THEIR SCHOOL BASED GRIEF COUNSELING PROGRAM. THROUGH THIS PROGRAM, ELE'S PLACE IS ABLE TO REACH CHILDREN WHO MAY NOT OTHERWISE HAVE TRANSPORTATION TO RECEIVE GRIEF COUNSELING SERVICES AT THEIR OFFICES. LANSING PROMISE - DELTA DENTAL PROVIDED $50,000 IN FUNDING TO THE LANSING PROMISE IN 2021. LANSING PROMISE IS A SCHOLARSHIP PROGRAM OFFERING TUITION ASSISTANCE FOR POST-SECONDARY (COLLEGE OR SKILLED TRADE) EDUCATION TO ALL ELIGIBLE HIGH SCHOOL GRADUATES WITHIN THE LANSING SCHOOL DISTRICT BOUNDARIES. THE PROMISE PROVIDES TUITION ASSISTANCE FOR UP TO 65 CREDITS AT LANSING COMMUNITY COLLEGE OR THE EQUIVALENT DOLLAR AMOUNT TOWARD TUITION AND FEES AT MICHIGAN STATE UNIVERSITY OR OLIVET COLLEGE. SPARROW FOUNDATION - OUR DONATION WAS USED TO SPONSOR A VARIETY OF FUNDRAISING EVENTS ALL FOCUSED ON SUPPORTING THE SPARROW FOUNDATION WHICH PLAYS A CRITICAL ROLE IN THE HEALTH SYSTEM LIFE CYCLE BY COLLECTING RESOURCES, BOOSTING COMMUNITY AWARENESS AND IMPROVING THE OVERALL HEALTH OF PEOPLE IN MID-MICHIGAN. ART PRIZE GRAND RAPIDS - THIS SPONSORSHIP SUPPORTED A NEW EVENT APP THAT ALLOWED PARTICIPANTS TO VOTE ON INDIVIDUAL ART PIECES, WHILE ALSO ACCESSING WAY FINDING AND OTHER INFORMATION DURING THE ARTPRIZE EVENT. ARTPRIZE IS AN INDEPENDENT, INTERNATIONAL ART COMPETITION IN GRAND RAPIDS THAT CELEBRATES ARTISTS WORKING IN ALL MEDIUMS FROM ANYWHERE IN THE WORLD. DETROIT PUBLIC SCHOOL FOUNDATION - THIS DONATION WAS MADE TO IMPLEMENT A COMMUNITY HEALTH HUB PROGRAM THAT CONNECTS STUDENTS AND FAMILIES TO COMPREHENSIVE SERVICES AND IMPROVES CONNECTIONS BETWEEN SCHOOLS AND NEIGHBORHOODS. SPECIFICALLY, OUR FUNDING WAS USED TO HIRE A SCHOOL SITE COORDINATOR ASSIGNED TO THE FAMILY RESOURCE DISTRIBUTION CENTER LOCATED AT THE ADULT EDUCATION CENTER WEST.

Return Reference

Explanation

PART I, LINE 2:

CONTRIBUTIONS ARE MADE AT MANAGEMENT DISCRETION TO ORGANIZATIONS THAT SUPPORT DELTA DENTAL PLAN OF MICHIGAN'S MISSION. CONTRIBUTIONS MADE TO THE DELTA DENTAL FUND ARE APPROVED BY THE BOARD OF DIRECTORS. IN ORDER FOR FUNDS TO BE DISBURSED, VOUCHER RECORDS MUST PASS THROUGH THE APPROVAL PROCESS, SIMILAR TO ANY OTHER EXPENDITURE MADE BY DELTA DENTAL PLAN OF MICHIGAN. DETROIT RIVERFRONT CONSERVANCY - DELTA DENTAL OF MICHIGAN CONTRIBUTED $1 MILLION TO BUILD A HEALTH THEMED PLAYGROUND ON DETROIT'S WEST RIVERFRONT. COMMUNITIES IN SCHOOLS OF MICHIGAN - THIS CONTRIBUTION HELPED CIS OF MICHIGAN DEVELOP THE WHOLE-CHILD SCREENER AND CHECK-IN PROCESS TO ASSESS THE NUTRITIONAL, DENTAL, EDUCATIONAL, PHYSICAL HEALTH, AND MENTAL HEALTH NEEDS OF CASE-MANAGEMENT STUDENTS. THIS NEW NEEDS ASSESSMENT PROCESS ENSURES SITE COORDINATORS CAN IDENTIFY IMMEDIATE NEEDS OF STUDENTS TO BROKER AND IMPLEMENT SUPPORTS. THIS ENSURES SITE COORDINATORS CAN REFER STUDENTS TO A DENTIST AND HELP INCREASE SCHOOL-BASED DENTAL SUPPORTS. CHILDREN'S HOSPITAL OF MICHIGAN FOUNDATION - THIS WAS A CAPITAL CONTRIBUTION TO THE JAMIE DANIELS FOUNDATION (A FUND WITHIN THE CHILDREN'S FOUNDATION) TO ASSIST WITH THE BUILDING OF A RESIDENTIAL OPIOID RECOVERY FACILITY IN SOUTHEASTERN MICHIGAN. ON DEMAND KARE - FOR KARE MOBILE DENTAL PROGRAM THAT CONTRIBUTES ONE-CHAIR MOBILE DENTAL UNITS TO ENTREPRENEUR DENTIST AND HYGENTIST IN SE MICHIGAN TO BOTH SERVE THE MEDICAID POPULATION PART-TIME AND TO BUILD A THRIVING BUSINESS THE OTHER HALF OF THE TIME. FORGOTTEN HARVEST - DELTA DENTAL OF MICHIGAN CONTRIBUTED $150,000 TO THIS FOOD RESCUE/FOOD BANK PROGRAM OPERATING IN THE DETROIT AREA. THEY PROVIDE LUNCHES FOR CHILDREN PARTICIPATING IN THE DETROIT PUBLIC LIBRARY SUMMER CAMP PROGRAMS AS WELL AS OPERATE SEVERAL FARMERS MARKET STYLE FOOD BANK DISTRIBUTION SITES THROUGHOUT SOUTHEASTERN MICHIGAN. ELE'S PLACE - IN 2021, DELTA DENTAL OF MICHIGAN PROVIDED $130,000 TO ELE'S PLACE TO SUPPORT ELE'S GROUP, THEIR SCHOOL BASED GRIEF COUNSELING PROGRAM. THROUGH THIS PROGRAM, ELE'S PLACE IS ABLE TO REACH CHILDREN WHO MAY NOT OTHERWISE HAVE TRANSPORTATION TO RECEIVE GRIEF COUNSELING SERVICES AT THEIR OFFICES. LANSING PROMISE - DELTA DENTAL PROVIDED $50,000 IN FUNDING TO THE LANSING PROMISE IN 2021. LANSING PROMISE IS A SCHOLARSHIP PROGRAM OFFERING TUITION ASSISTANCE FOR POST-SECONDARY (COLLEGE OR SKILLED TRADE) EDUCATION TO ALL ELIGIBLE HIGH SCHOOL GRADUATES WITHIN THE LANSING SCHOOL DISTRICT BOUNDARIES. THE PROMISE PROVIDES TUITION ASSISTANCE FOR UP TO 65 CREDITS AT LANSING COMMUNITY COLLEGE OR THE EQUIVALENT DOLLAR AMOUNT TOWARD TUITION AND FEES AT MICHIGAN STATE UNIVERSITY OR OLIVET COLLEGE. SPARROW FOUNDATION - OUR DONATION WAS USED TO SPONSOR A VARIETY OF FUNDRAISING EVENTS ALL FOCUSED ON SUPPORTING THE SPARROW FOUNDATION WHICH PLAYS A CRITICAL ROLE IN THE HEALTH SYSTEM LIFE CYCLE BY COLLECTING RESOURCES, BOOSTING COMMUNITY AWARENESS AND IMPROVING THE OVERALL HEALTH OF PEOPLE IN MID-MICHIGAN. ART PRIZE GRAND RAPIDS - THIS SPONSORSHIP SUPPORTED A NEW EVENT APP THAT ALLOWED PARTICIPANTS TO VOTE ON INDIVIDUAL ART PIECES, WHILE ALSO ACCESSING WAY FINDING AND OTHER INFORMATION DURING THE ARTPRIZE EVENT. ARTPRIZE IS AN INDEPENDENT, INTERNATIONAL ART COMPETITION IN GRAND RAPIDS THAT CELEBRATES ARTISTS WORKING IN ALL MEDIUMS FROM ANYWHERE IN THE WORLD. DETROIT PUBLIC SCHOOL FOUNDATION - THIS DONATION WAS MADE TO IMPLEMENT A COMMUNITY HEALTH HUB PROGRAM THAT CONNECTS STUDENTS AND FAMILIES TO COMPREHENSIVE SERVICES AND IMPROVES CONNECTIONS BETWEEN SCHOOLS AND NEIGHBORHOODS. SPECIFICALLY, OUR FUNDING WAS USED TO HIRE A SCHOOL SITE COORDINATOR ASSIGNED TO THE FAMILY RESOURCE DISTRIBUTION CENTER LOCATED AT THE ADULT EDUCATION CENTER WEST.

Schedule I (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

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

2021

Open to Public Inspection

Name of the organization

DELTA DENTAL PLAN OF MICHIGAN INC

Employer identification number

38-1791480

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on 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 .....

Yes

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 on Line 1a? ....

Yes

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

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:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

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:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

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 ............

Yes

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 ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1GORAN JURKOVIC CPA CEO, PRESIDENT	(i) (ii)	1,397,055 ------------- 0	2,818,930 ------------- 0	2,220,490 ------------- 0	2,126,139 ------------- 0	24,738 ------------- 0	8,587,352 ------------- 0	2,179,428 ------------- 0
2ANTHONY ROBINSON SVP & CHIEF MKT OFFICER	(i) (ii)	510,892 ------------- 0	552,371 ------------- 0	657,633 ------------- 0	470,718 ------------- 0	24,738 ------------- 0	2,216,352 ------------- 0	644,803 ------------- 0
3AMY BASEL SVP, CFO, CRO & TREASURER	(i) (ii)	484,754 ------------- 0	525,138 ------------- 0	512,985 ------------- 0	421,727 ------------- 0	24,738 ------------- 0	1,969,342 ------------- 0	483,018 ------------- 0
4SUE ELLEN JENKINS SVP, CHIEF LEGAL OFF, CAO & SEC.	(i) (ii)	485,475 ------------- 0	528,528 ------------- 0	23,018 ------------- 0	281,774 ------------- 0	15,678 ------------- 0	1,334,473 ------------- 0	0 ------------- 0
5TOBY HALL SVP, CHIEF ACTUARY & DATA OFFICER	(i) (ii)	341,819 ------------- 0	389,018 ------------- 0	25,933 ------------- 0	301,204 ------------- 0	15,678 ------------- 0	1,073,652 ------------- 0	0 ------------- 0
6JEFF BOTKIN SVP, BUSINESS SVS	(i) (ii)	342,920 ------------- 0	368,222 ------------- 0	20,533 ------------- 0	78,509 ------------- 0	17,325 ------------- 0	827,509 ------------- 0	0 ------------- 0
7MARK BAUGHMAN OPERATING CIO	(i) (ii)	344,634 ------------- 0	367,868 ------------- 0	21,284 ------------- 0	64,142 ------------- 0	17,325 ------------- 0	815,253 ------------- 0	0 ------------- 0
8MICHAEL GILMORE FORMER VP, CHIEF INVEST OFFICER	(i) (ii)	480,021 ------------- 0	187,500 ------------- 0	21,505 ------------- 0	41,121 ------------- 0	24,738 ------------- 0	754,885 ------------- 0	0 ------------- 0
9KUSHTRIM SHAQIRI VP GOVERNMENT PROGRAMS	(i) (ii)	346,318 ------------- 0	263,616 ------------- 0	486 ------------- 0	11,110 ------------- 0	24,738 ------------- 0	646,268 ------------- 0	0 ------------- 0
10JEFFREY JOHNSTON SVP, CHIEF SCIENCE OFFICER	(i) (ii)	313,249 ------------- 0	143,222 ------------- 0	5,367 ------------- 0	63,208 ------------- 0	24,738 ------------- 0	549,784 ------------- 0	0 ------------- 0
11MIKE BOBAK VP SALES	(i) (ii)	207,726 ------------- 0	190,273 ------------- 0	5,867 ------------- 0	29,204 ------------- 0	24,738 ------------- 0	457,808 ------------- 0	0 ------------- 0
12DANIEL LOVEJOY DIRECTOR, SALES & ACCT MGT	(i) (ii)	186,255 ------------- 0	186,514 ------------- 0	1,170 ------------- 0	25,082 ------------- 0	24,738 ------------- 0	423,759 ------------- 0	0 ------------- 0
13MARGARET TRIMER VP STRATEGIC PARTNERSHIPS	(i) (ii)	237,325 ------------- 0	91,260 ------------- 0	13,371 ------------- 0	53,493 ------------- 0	24,738 ------------- 0	420,187 ------------- 0	0 ------------- 0
14WALTER BUZANOWSKI VP & GENERAL COUNSEL	(i) (ii)	257,044 ------------- 0	100,050 ------------- 0	532 ------------- 0	35,630 ------------- 0	24,738 ------------- 0	417,994 ------------- 0	0 ------------- 0
15EARL MAJOR VP HUMAN RESOURCES	(i) (ii)	20,726 ------------- 0	190,273 ------------- 0	5,867 ------------- 0	29,204 ------------- 0	24,738 ------------- 0	270,808 ------------- 0	0 ------------- 0
16CHRISTOPHER T FISHER DIRECTOR	(i) (ii)	60,000 ------------- 107,004	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	60,000 ------------- 107,004	0 ------------- 0
17JOSHUA S HOWIE VICE-CHAIRPERSON - THRU 5/21	(i) (ii)	27,500 ------------- 141,468	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	27,500 ------------- 141,468	0 ------------- 0

Schedule J (Form 990) 2021

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	FIRST CLASS TRAVEL IS AVAILABLE TO SENIOR EXECUTIVES AND KEY EMPLOYEES. THIS AMOUNT WAS TREATED AS NONTAXABLE TO THESE INDIVIDUALS. TRAVEL FOR COMPANIONS RELATED TO TRAVEL FOR A SPOUSE. THIS AMOUNT WAS TREATED AS TAXABLE TO THE BOARD MEMBER OR EMPLOYEE. VARIOUS INDIVIDUALS ON SCHEDULE J ARE ELIGIBLE FOR REIMBURSEMENT OF SUBSTANTIATED HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES THAT HAVE A BUSINESS PURPOSE. THIS BENEFIT IS NOT TAXABLE BUT THE EXPENSE MUST BE SUBSTANTIATED AS A BUSINESS EXPENSE.
PART I, LINE 3	THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS PERFORMANCE AND SETS TOTAL COMPENSATION FOR THE CEO WITHOUT THE PRESENCE OR INFLUENCE OF THE CEO. EVERY TWO YEARS, A STUDY IS PERFORMED BY TOWERS WATSON AND THE DATA IS USED IN COMPENSATION DECISIONS. THE INDEPENDENT CONSULTANT PROVIDES AN OPINION AS TO THE REASONABLENESS AND APPROPRIATENESS OF THE TOTAL COMPENSATION, INCLUDING BASE PAY, INCENTIVE, BENEFITS AND RETIREMENT BENEFITS.
PART I, LINE 4B	DELTA DENTAL PLAN OF MICHIGAN, HAS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). IN ORDER TO BE ELIGIBLE FOR THE SERP, AN EMPLOYEE MUST BE A SENIOR VICE PRESIDENT OR HIGHER AND ADDED TO THE PLAN BY THE BOARD OF DIRECTORS. THE SERP BENEFITS ARE REVIEWED AS PART OF THE TOTAL COMPENSATION BY AN INDEPENDENT CONSULTANT; TOWERS WATSON. IN 2021, GORAN JURKOVIC, AMY BASEL, TOBY HALL, SUE JENKINS, AND ANTHONY ROBINSON ACCRUED BENEFITS AS PARTICIPANTS IN THE SERP PLAN. GORAN JURKOVIC, AMY BASEL, AND ANTHONY ROBINSON BECAME VESTED IN A PORTION OF THEIR ACCRUED BENEFITS AND, AS REQUIRED BY THE IRS, THE VESTED PORTION WAS TREATED AS TAXABLE WAGES DURING 2021. THESE WAGES WERE ALSO REPORTED ON SCHEDULE J AS COMPENSATION THAT HAS BEEN REPORTED AS DEFFERED ON PRIOR FORM 990S.
PART I, LINE 7	AS INDICATED IN SCHEDULE J, PART II, TOP MANAGEMENT OFFICIALS RECEIVED A BONUS BASED UPON PERFORMANCE AND THE FINANCIAL RESULTS OF THE ORGANIZATION. THE BONUS WAS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD.

Schedule J (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

DELTA DENTAL PLAN OF MICHIGAN INC

Employer identification number

38-1791480

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

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) 2021

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) BRIAN JACOBSON	BROTHER OF FORMER DDPMI BOARD MEMBER JED JACOBSON	263,525	EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN		No
(2) COLE JACOBSON	BROTHER OF FORMER DDPMI BOARD MEMBER JED JACOBSON	149,094	EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN		No
(3) BRIAN BATTAGLIERI	SON OF DDPMI FORMER KEY EMPLOYEE LUIGI BATTAGLIERI	191,831	EMPLOYEE OF DELTA DENTAL PLAN OF MICHIGAN		No
(4) STEVEN M DATER DDS	BOARD MEMBER AND OWNER OF STEVEN M DATER DDS & ASSOCIATES II, PLC	409,646	PAYMENTS FOR DENTAL SERVICES		No
(5) RAYMOND GIST DDS	BOARD MEMBER AND OWNER OF RAYMOND GIST DDS PC	198,343	PAYMENTS FOR DENTAL SERVICES		No
(6) LARRY DEGROAT DDS	BOARD MEMBER AND OWNER OF LARRY DEGROAT DDS	120,072	PAYMENTS FOR DENTAL SERVICES		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

DELTA DENTAL PLAN OF MICHIGAN INC

Employer identification number

38-1791480

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6	DELTA DENTAL PLAN OF MICHIGAN HAS A SOLE MEMBER, RENAISSANCE HEALTH SERVICE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7A	THE SOLE MEMBER HAS VOTING RIGHTS AND ELECTS DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B	THE SOLE MEMBER HAS THE RIGHTS THAT ARE PRESCRIBED BY LAW, FOR MEMBERS OF NON-PROFIT CORPORATIONS, INCLUDING THE APPROVAL OF SIGNIFICANT EXPENDITURES AND CEO APPOINTMENT.
FORM 990, PART VI, SECTION B, LINE 11B	THE INFORMATION PRESENTED ON THE FORM 990 IS GATHERED BY THE SENIOR TAX ADMINISTRATOR FOR THE ORGANIZATION. THE CFO REVIEWS THE INFORMATION. ONCE APPROVED, THE INFORMATION IS GIVEN TO OUTSIDE TAX PREPARERS WHO PREPARE AND REVIEW THE FORM 990. ONCE COMPLETE, AN ELECTRONIC COPY OF THE FORM 990 IS PLACED IN A SECURE PORTAL FOR THE BOARD TO REVIEW. THIS IS DONE BEFORE THE RETURN IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	THE COMPANY'S SENIOR VICE PRESIDENT, CHIEF LEGAL OFFICER, AND CAO IS CHARGED WITH REVIEWING AND MONITORING ANY POTENTIAL CONFLICT OF INTEREST TRANSACTIONS. ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO REVIEW AND EXECUTE A CONFLICT OF INTEREST POLICY. THIS POLICY REQUIRES THAT ANY CONFLICTS OF INTEREST BE DISCLOSED ON AN ANNUAL BASIS, OR AT ANY OTHER TIME THAT THE PERSON EXECUTING THE POLICY BECOMES AWARE OF A SITUATION OR TRANSACTION THAT ACTUALLY OR POTENTIALLY CREATES A CONFLICT OF INTEREST. ALL CONFLICT OF INTEREST DISCLOSURE FORMS ARE INITIALLY REVIEWED BY THE SENIOR VICE PRESIDENT, CHIEF LEGAL OFFICER, AND CAO. IF A PROHIBITED TRANSACTION IS IDENTIFIED, THE MATTER IS ESCALATED TO THE CEO AND TO THE AUDIT, FINANCE, AND RISK MANAGEMENT COMMITTEE OF THE BOARD OF DIRECTORS FOR FURTHER REVIEW AND APPROPRIATE ACTION. IN THE EVENT OF A CONFLICT OF INTEREST INVOLVING A MEMBER OF THE BOARD OF DIRECTORS, SUCH AS A VOTE IN WHICH A MEMBER 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	COMPENSATION OF THE CEO IS DETERMINED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. COMPENSATION OF THE OTHER EXECTUTIVES IS DETERMINED BY THE CEO IN CONSULTATION WITH THE VP OF HUMAN RESOURCES AND THE CFO. OUTSIDE COMPENSATION CONSULTANTS ARE USED TO DETERMINE MARKET DATA WHICH IS USED TO SET TOTAL COMPENSATION FOR OFFICERS AND KEY EMPLOYEES INCLUDING THE CEO, CFO, AND OTHERS AS APPROPRIATE. DELTA DENTAL PLAN OF MICHIGAN, INC. CONTRACTS WITH TOWERS WATSON TO DO A COMPENSATION AND REASONABLENESS ANALYSIS EVERY TWO YEARS. TOWERS WATSON ALSO PROVIDES AN OPINION AS TO THE REASONABLENESS OF THE TOTAL COMPENSATION PACKAGES, INCLUDING BASE PAY, INCENTIVE, BENEFITS AND RETIREMENT BENEFITS. THE COMPENSATION WAS LAST REVIEWED UNDER THIS PROCESS DURING 2020. COMPENSATION DECISIONS ARE MADE UTILIZING THE DATA PROVIDED BY TOWERS WATSON.
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 LARGER ORGANIZATION. THE AVERAGE HOURS WORKED REFLECTS APPROXIMATE TIME SPENT IN EACH OF THOSE INDIVIDUAL COMPANIES. WHILE THE HOURS ARE ALLOCATED TO INDIVIDUAL COMPANIES, MUCH OF THE OFFICERS' TIME IS SPENT WORKING ON ISSUES THAT IMPACT THE ENTIRE ORGANIZATION, NOT JUST ONE COMPANY. COMPENSATION IS REPORTED IN FULL TO AGREE TO THE EMPLOYEE'S W-2 AS REQUIRED BY IRS INSTRUCTIONS. ANY ALLOCATION OF COMPENSATION IS INCLUDED ON SCHEDULE R.
FORM 990, PART IX, LINE 11G	CONTRACT LABOR: PROGRAM SERVICE EXPENSES 33,216,790. MANAGEMENT AND GENERAL EXPENSES 14,120,302. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,337,092. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 7,576,859. MANAGEMENT AND GENERAL EXPENSES 5,494,751. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,071,610. DENTAL CONSULTANT: PROGRAM SERVICE EXPENSES 1,756,838. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,756,838. PURCHASED DENTAL SERVICES: PROGRAM SERVICE EXPENSES 652,764,133. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 652,764,133.
FORM 990, PART XI, LINE 9:	GAIN ON EQUITY IN SUBSIDIARIES 1,273,170. PENSION RELATED CHANGES 19,883,187.
FORM 990, PART IV, LINE 12A:	DELTA DENTAL PLAN OF MICHIGAN RECEIVES AN AUDITED FINANCIAL STATEMENT FROM AN INDEPENDENT ACCOUNTANT BUT THESE STATEMENTS ARE PREPARED ON A STATUTORY BASIS AND NOT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP).

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

DELTA DENTAL PLAN OF MICHIGAN INC

Employer identification number

38-1791480

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

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?
(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	Yes	No
(1)RENAISSANCE HEALTH SERVICE CORPORATION PO BOX 30416 LANSING,MI489097916 38-1675667	PROMOTING DENTAL CARE	MI	501(C)(4)	N/A	N/A		No
(2)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	Yes
(3)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	Yes
(4)DELTA DENTAL OF TENNESSEE 240 VENTURE CIRCLE NASHVILLE,TN37228 62-0812197	PROVIDE DENTAL SERVICE PLANS	TN	501(C)(4)	N/A	RENAISSANCE HEALTH SERVICE CORPORATION		No
(5)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	Yes
(6)DELTA DENTAL PLAN OF NEW MEXICO INC 100 SUN AVE NE SUITE 400 ALBUQUERQUE,NM87109 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	DELTA DENTAL OF ARKANSAS		No
(11)RENAISSANCE FAMILY FOUNDATION INC 4100 OKEMOS RD OKEMOS,MI48864 46-1376165	EMPHASIZE DENTAL HEALTH IN COMMUNITIES	IN	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		No
(13)DELTA DENTAL OF KENTUCKY FOUNDATION INC 10100 LINN STATION ROAD SUITE 700 LOUISVILLE,KY40223 87-4045357	EMPHASIZE DENTAL HEALTH IN COMMUNITIES	KY	501(C)(3)	PF	DELTA DENTAL OF KENTUCKY		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

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	(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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) CHESME LLC 124 N BRIDGE ST DEWITT,MI48820 20-0061957	CAPITAL MANAGEMENT	MI	N/A				No			No
(2) RED CEDAR INVESTMENT MANAGEMENT LLC 333 BRIDGE STREET NW SUITE 601 GRAND RAPIDS,MI49546 46-2667997	CAPITAL MANAGEMENT	MI	N/A				No			No
(3) DH LOGIX LLC 1000 SOUTH MIAMI TRAIL SARASOTA,FL34236 81-5265121	CAPITAL MANAGEMENT	DE	N/A				No			No

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?
(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	Yes	No
(1) RENAISSANCE HOLDING COMPANY PO BOX 30381 LANSING,MI48909 41-2177193	HOLDING COMPANY	MI	DELTA DENTAL OF MICHIGAN	C	-196,037	56,564,756	58.000 %	Yes
(2) RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA PO BOX 30381 LANSING,MI48909 47-0397286	INSURANCE	IN	RENAISSANCE HOLDING COMPANY	C	-1,734,433	80,986,244	58.000 %	Yes
(3) RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK PO BOX 30381 LANSING,MI48909 13-4098096	INSURANCE	NY	RENAISSANCE HOLDING COMPANY	C	490,831	9,299,123	58.000 %	Yes
(4) FORE HOLDING CORPORATION 240 VENTURE CIRCLE NASHVILLE,TN37228 20-4116122	HOLDING COMPANY	TN	N/A	C					No
(5) DENTAL CHOICE INC 10100 LINN STATION ROAD 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	DELTA DENTAL OF MICHIGAN	C	-908,878	102,763,215	75.000 %	Yes
(9) DEWPOINT INC 300 S WASHINGTON SQUARE LANSING,MI48933 38-3300595	IT CONSULTING	MI	THE 4100 GROUP	C	-622,871	36,103,234	75.000 %	Yes

Schedule R (Form 990) 2021

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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

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 OF TENNESSEE	L	5,506,039	ACTUAL COST
(2) DELTA DENTAL PLAN OF OHIO INC	L	36,901,471	ACTUAL COST
(3) DELTA DENTAL PLAN OF INDIANA INC	L	14,544,668	ACTUAL COST
(4) DELTA DENTAL FUND	L	954,549	ACTUAL COST
(5) RENAISSANCE LIFE AND HEALTH INSURANCE COMPANY OF AMERICA	L	5,423,891	ACTUAL COST
(6) DELTA DENTAL PLAN OF NEW MEXICO INC	L	2,756,960	ACTUAL COST
(7) DELTA DENTAL OF KENTUCKY INC	L	3,520,685	ACTUAL COST
(8) DELTA DENTAL OF NORTH CAROLINA	L	5,759,989	ACTUAL COST
(9) DELTA DENTAL PLAN OF ARKANSAS INC	L	8,065,206	ACTUAL COST
(10) RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF NEW YORK	L	149,131	ACTUAL COST
(11) RENAISSANCE HOLDING COMPANY	L	726,113	ACTUAL COST
(12) RENAISSANCE HEALTH SERVICE CORPORATION	L	87,843	ACTUAL COST
(13) DELTA DENTAL FUND	B	4,000,000	ACTUAL COST
(14) DEWPOINT	L	135,749	ACTUAL COST
(15) THE 4100 GROUP	L	2,787,883	ACTUAL COST

Schedule R (Form 990) 2021

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)	(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
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version: