2022-11-15T07:34:54-06:00 2021-12-31 010494526 Baker Newman & Noyes 650 Elm Street Suite 302 Manchester NH 03101 990 2021-01-01 020489150 Northeast Delta Dental Foundation NORT 6032231000 PO Box 2002 Concord NH 033022002 THOMAS RAFFIO President & CEO 6032231000 2022-11-11 1 THOMAS RAFFIO 999009999 Connor Smart P02285543 6036262200 2022-11-11 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Thomas Raffio PO Box 2002 Concord NH 033022002 2418091 0 X www.nedelta.com X 1996 NH Promote dental health and education in northern New England 10 10 0 15 0 0 1715901 1985060 0 0 126514 422609 0 0 1842415 2407669 406206 666779 0 0 0 0 0 0 0 7920 11448 414126 678227 1428289 1729442 8395559 10988991 25000 213817 8370559 10775174 To promote dental health and education in northern New England. 0 0 560279 560279 0 Dental Equipment and Supplies: Cash donations to 31 nonprofit dental clinics to purchase dental equipment and supplies to serve patients who cannot afford dental care. 81500 81500 Oral Health Education Programs and Public Policy Development: Cash donations to 11 organizations to sponsor oral health education programs. Donations of printed materials and supplies to schools, nonprofit dental clinics, and other organizations to provide oral health education programs. 25000 25000 In-School Programs for Children: Cash donations to 4 organizations to sponsor in-school education programs on fluoride rinse or sealants for children. 666779 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 0 0 0 NH X Kathleen B Walker 6032231000 c/o One Delta Drive Concord NH 033022002 X Kyra Chadbourne dds Director 0.50 X 0 0 0 David B Solomon DDS Director 0.50 X 0 0 0 David B Staples DDS Director 0.50 X 0 0 0 Jeffrey B Walawender DDS Director 0.50 X 0 0 0 Terence A Wardrop Director 0.50 X 0 0 0 Jason Williams Director 0.50 X 0 0 0 Thomas Raffio President & Director 2.00 X X 0 0 0 Melvin J Severance III Chair and Director 0.50 X X 0 0 0 Kathleen B Walker Treasurer & Director 6.00 X X 0 0 0 Siobhan Hutchison Secretary 1.00 X X 0 0 0 Jennifer L McGrath Assistant Treasurer 4.00 X 0 0 0 0 0 0 0 0 0 0 0 18132 1966928 1985060 422609 422609 10422 18132 10422 0 2407669 0 0 422609 666779 666779 2700 2700 8358 8358 315 315 State of NH filing fees 75 75 678227 666779 11448 0 408314 832939 1218500 1640700 6768745 8515352 8395559 10988991 25000 213817 25000 213817 X 8131743 10725174 238816 50000 8370559 10775174 8395559 10988991 1729442 675173 0 X 0 0 0 X 867810 650200 500475 1715901 1988648 5723034 867810 650200 500475 1715901 1988648 5723034 4969311 753723 129728 133540 167542 126514 422609 979933 6702967 0.11240 0.13090 X The Organization meets the Facts and Circumstances Test for the following reasons:1.) Through its activities, the Organization regularly and continuously benefits many thousands of members of the general public;2.) The Organization encourages donations from the general public through the website of Northeast Delta Dental (a group of nonprofit organizations) and through other means; and3.) The Organization's Board does not represent any narrow interests and is committed to representing all of the citizens of Northern New England who are most in need of dental care assistance. Part II, Section A, Line 1 Line 1 includes $22,553 as a very conservative estimate of the amount of annual in-kind non-cash contributions which are not included on the organization's books received over the past five years. The 2021 estimate for in-kind non-cash contributions is $3,608. Any net retained fundraising contributions were support from the general public. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7948027 1640700 1097782 480409 10206100 6473499 1218500 533990 277962 7948027 5618830 150000 954181 249512 6473499 5923124 403200 -489552 217942 5618830 4775188 649900 718671 220635 5923124 0.99500 0.00000 0.00500 0 0 0 Part V, Line 4: To help ensure that the Foundation can continue to promote dental health and education in Northern New England. Golf Tournament 28554 18132 10422 10422 28554 18132 10422 10422 10422 0 1 Kennebec Valley Family Dentistry 6 East Chestnut Street Augusta ME 04330 263322306 501(c)(3) 230511 0 Dental equipment. Vermont Head Start AssocChamplain Valley Head Start 225 South Camplain Street Burlington VT 05401 371651842 501(c)(3) 60000 0 Vermont Head Start Early Head Start Tooth Tutor program. Mt Desert Island Hospital 10 Wayman Lane Bar Harbor ME 04609 010211797 501(c)(3) 22444 0 Dental equipment for dental center. Wentworth-Douglass Community Dental Center 789 Central Avenue Dover NH 03820 020260334 501(c)(3) 21000 0 Dental equipment and supplies. National Foundation of Dentistry for the Handicapped PO Box 3487 Concord NH 033023487 900292580 501(c)(3) 20000 0 Dental Lifeline Network of NH; Donated Dental Services program support. Ronald McDonald House Charities of Burlington VT 16 So Winooski Avenue Burlington VT 05401 030287584 501(c)(3) 20000 0 Dental equipment. Center for Technology Essex (Essex Westford School District SkillTech) 51 Park Street Essex Junction VT 05452 812070986 501(c)(3) 16000 0 Expanded Functions Dental Auxiliary Program (EFDA) scholarships. National Foundation of Dentistry for the Handicapped 1800 15th Street Suite 100 Denver CO 80202 364779648 501(c)(3) 15000 0 Dental Lifeline Network of VT; Donated Dental Services program support. Lincoln County Dental PO Box 243 Wiscasset ME 04578 452955588 501(c)(3) 15000 0 Clinic operational expenses National Foundation of Dentistry for the Handicapped PO Box 2282 Augusta ME 043382282 841533658 501(c)(3) 12500 0 Dental Lifeline Network of ME; Donated Dental Services program support. Concord Dental Sealant Coalition PO Box 1062 Concord NH 03301 262799313 501(c)(3) 10000 0 In-school dental sealant program. Concord Hospital Trust 250 Pleasant Street Concord NH 03301 222594672 501(c)(3) 10000 0 Pledge Support for Dental Center Greater Seacoast Community Health Foundation 100 Campus Drive Suite 12 Portsmouth NH 03801 020304203 501(c)(3) 10000 0 Support for oral care of the patients of Portsmouth and Somersworth dental centers. New Hampshire Oral Health CoalitionNew Hampshire Public Health 4 Park Street Suite 403 Concord NH 03301 020453814 501(c)(3) 10000 0 Oral health literacy toolkit. Veterans of Foreign Wars Department of NH Post 816 600 Cottage Street Littleton NH 03561 020217171 501(c)(3) 10000 0 Littleton Veteran's Dental program. Shalom House 106 Gilman Street Portland ME 04102 237119236 501(c)(3) 10000 0 Dental care fund for residents of program. The Opportunity Alliance 50 Lydia Lane South Portland ME 04106 010274725 501(c)(3) 10000 0 Virtual dental health groups. The Health Center Plainfield (Northeast Washington County Community Health 157 Towne Avenue Plainfield VT 05667 030240129 501(c)(3) 10000 0 Dental equipment. University of Vermont Medical Center 128 Lakeside Avenue Suite 106 Brlington VT 05401 030219309 501(c)(3) 10000 0 General Practice Dental Residency program. Vermont State Dental Society 1 Kennedy Drive Suite L3 South Burlington VT 05403 222514423 501(c)(3) 10000 0 Dental Auxiliary recruitment program. Windham County Dental CenterUnited Way of Windham County - Fiscal Agent 1 Holstein Place Brattleboro VT 05301 036003074 501(c)(3) 10000 0 School to Dentist referral program. Good Neighbor Health Clinic 70 N Main Street White River Junction VT 05001 030346949 501(c)(3) 9000 0 Red Logan Dental Clinic dental extern student housing stipends. University of NH Foundation 56 Old Suncook Road Suite 2 Concord NH 03301 020437506 501(c)(3) 7500 0 Leadership Series for individuals with disabilities and their family members. Mainehealth - Waldo County Dental Care PO Box 287 Belfast ME 04915 010238552 501(c)(3) 7500 0 Dental equipment for dental center. Harrington Family Health Center 50 East Main Street Harrington ME 04643 010409494 501(c)(3) 6354 0 Dental equipment and supplies. 40 0 Part I, Line 2: Donation recipients are required to send a report annually detailing how the money was spent, using statistics of patients served, utilization of machinery, or other specifics. These reports are monitored by the Foundation Treasurer who tracks the receipt of the annual reports. Form 990, Part VI, Section A, line 6 The Foundation has three members: Delta Dental Plan of New Hampshire, Inc.; Delta Dental Plan of Vermont, Inc.; and Maine Dental Services Corporation. All three members are tax-exempt under Internal Revenue Code Section 501(c)(4). Form 990, Part VI, Section A, line 7a The members elect the Foundation's Board of Directors. Form 990, Part VI, Section A, line 7b In addition to electing the Board of Directors, the members have the power to remove directors, repeal or change bylaws by 2/3rd member vote (Board has primary authority to amend bylaws), and to dissolve the Corporation by 2/3rd member vote. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed in detail by key finance employees of Northeast Delta Dental. A final draft is presented to the Board before the Form 990 is filed. Form 990, Part VI, Section B, line 12c A copy of the conflict of interest policy is distributed annually to all officers, directors, and the management team. All are required to report any conflicts and sign, date, and return the policy, whether or not a conflict exists, to confirm compliance. General Counsel reviews the returned policies and reports the results to the entire Board of Directors. Board members are asked to provide updates of any changes that may occur between their annual conflict of interest filings. Form 990, Part VI, Section C, line 19 Upon request, Northeast Delta Dental Foundation makes its governing documents, conflict of interest policy, or financial statements available to the public.