2021-11-15T06:43:34-06:00 2020-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2020-01-01 020489150 Northeast Delta Dental Foundation NORT 6032231000 PO Box 2002 Concord NH 033022002 THOMAS RAFFIO President & CEO 6032231000 2021-11-10 1 THOMAS RAFFIO 999009999 E Drew Cheney P00182972 8002447444 2021-11-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Thomas Raffio PO Box 2002 Concord NH 033022002 1842415 0 X www.nedelta.com X 1996 NH Promote dental health and education in northern New England 10 10 0 15 0 0 493550 1715901 0 0 167542 126514 0 0 661092 1842415 616280 406206 0 0 0 0 0 0 0 9795 7920 626075 414126 35017 1428289 6534794 8395559 0 25000 6534794 8370559 To promote dental health and education in northern New England. 0 0 262202 262202 0 Dental Equipment and Supplies: Cash donations to 27 nonprofit dental clinics to purchase dental equipment and supplies to serve patients who cannot afford dental care. 63155 63155 0 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. 80849 80849 0 In-School Programs for Children: Cash donations to 9 organizations to sponsor in-school education programs on fluoride rinse or sealants for children. 406206 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 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 David A Baasch DDS Director (part year) 0.50 X 0 0 0 Suzanne M McDowell Director (part year) 0.50 X 0 0 0 Don Oakes 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 Eleanor H Vien Secretary 1.00 X 0 0 0 Melvin J Severance III Chair & Director 0.50 X X 0 0 0 Thomas Raffio President & Director 2.00 X X 0 0 0 Kathleen B Walker Treasurer & Director 6.00 X X 0 0 0 Jennifer L McGrath Assistant Treasurer 4.00 X 0 0 0 0 0 0 0 0 0 0 0 2040 1713861 1715901 126514 126514 0 2040 0 0 1842415 0 0 126514 406206 406206 900 900 6860 6860 85 85 State of NH filing fees 75 75 414126 406206 7920 0 300039 408314 0 1218500 6234755 6768745 6534794 8395559 0 25000 0 25000 X 6295978 8131743 238816 238816 6534794 8370559 6534794 8395559 1428289 407476 0 X 0 0 0 X 657335 867810 650200 500475 1715901 4391721 657335 867810 650200 500475 1715901 4391721 3732312 659409 90165 129728 133540 167542 126514 647489 5039210 0.13090 0.11080 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 $25,645 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 2020 estimate for in-kind non-cash contributions is $0. This $0 estimate is due to the COVID-19 Pandemic; the Foundation canceled its 2020 Golf Tournament due to the Pandemic, and therefore did not receive any in-kind non-cash gifts during this tax year. Any net retained fundraising contributions were support from the general public. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6473499 1218500 533990 277962 7948027 5618830 150000 954181 249512 6473499 5923124 403200 -489552 217942 5618830 4775188 649900 718671 220635 5923124 4221228 536300 300527 282867 4775188 0.97000 0.00000 0.03000 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. 1 Amoskeag Health 145 Hollis Street Manchester NH 03101 250458174 501(c)(3) 5000 Pediatric Dental Referral Program Area Agency of Greater Nashua (Gateways Community Services) 144 Canal Street Nashua NH 03064 020377315 501(c)(3) 5000 Dollars for Dental Program Behavioral Health & Developmental Services of Strafford County 113 Crosby Road Dover NH 03820 020366120 501(c)(3) 10000 Dental Program Concord Dental Sealant Coalition PO Box 1062 Concord NH 03301 262799313 501(c)(3) 10000 School-Based Cavity Prevention Program Concord Hospital Trust 250 Pleasant Street Concord NH 03301 222594672 501(c)(3) 10000 Pledge Support for Dental Center Easterseals NH 555 Auburn Street Manchester NH 03103 020272825 501(c)(3) 10000 Continued Naming Rights of the Dental Center Greater Nashua Dental Connection 31 Cross Street Nashua NH 03060 020500866 501(c)(3) 5849 Smile! Nashua Schools Dental Screening Program Greater Seacoast Community Health 100 Campus Drive Suite 12 Portsmouth NH 03801 020304203 501(c)(3) 10000 Dental Center, Healthy Grins, and Mobile Van Harbor Homes 45 High Street Nashua NH 03060 020351932 501(c)(3) 7500 Dental Equipment Laconia Area Community Land Trust (Lakes Region Community Developers) 193 Court Street Laconia NH 03246 020426348 501(c)(3) 5000 Dental Assistance Program Lakes Region Partnership for Public Health 67 Water Street Laconia NH 03246 202713484 501(c)(3) 5000 Lakes Region Oral Health Initiative Milford School Dental Clinic 100 West Street Milford NH 03055 026000558 501(c)(3) 5000 School Dental Clinic National Foundation of Dentistry for the Handicapped Dental Lifeline Networ PO Box 3487 Concord NH 033023487 900292580 501(c)(3) 15000 Donated Dental Services Referral Program for people with disabilities or who are elderly or medically challenged Tri-County Community Action Program 448 B White Mountain Highway Tamworth NH 03886 020267404 501(c)(3) 5000 School Smiles Program University of NH Foundation 57 Regional Drive Unit 8 Concord NH 03301 020437506 501(c)(3) 8500 Institute on Disability Oral Health Education Program Aroostook Dental Clinic DBA St Apollonia Dental Clinic 122 Academy Street Presque Isle ME 04769 274434337 501(c)(3) 5000 COVID-19 Emergency Grant Bangor YMCA 17 Second Street Bangor ME 04401 010211485 501(c)(3) 5000 Oral Health Education Program Harrington Family Health Center 50 East Main Street Harrington ME 04643 010409494 501(c)(3) 6300 Dental Equipment Islands Community Medical Services 15 Medical Center Loop Vinalhaven ME 04863 016012835 501(c)(3) 20000 Access to Dental Care Kennebec Valley Dental Coalition (dba Waterville Community Dental Center) 2 Evergreen Drive Oakland ME 04963 010524329 501(c)(3) 5000 COVID-19 Emergency Grant Kennebec Valley Family Dentistry Ballard Center 4206 East Chestnut Street Augusta ME 04330 263322306 501(c)(3) 5000 COVID-19 Emergency Grant Maine Dental Health Out-Reach 45 Greenwood Terrace Winthrop ME 04364 203074754 501(c)(3) 5000 School Oral Health Program Maine Health Access Foundation 150 Capitol Street Suite 4 Augusta ME 04330 010535144 501(c)(3) 6000 Maine Oral Health Funders Consultant Mainehealth - Waldo County Dental Care PO Box 287 Belfast ME 04915 010238552 501(c)(3) 7730 Waldo County Dental Care: Pediatric Expansion Project National Foundation of Dentistry for the Handicapped Dental Lifeline Networ PO Box 2282 Augusta ME 043382282 841533658 501(c)(3) 12500 Donated Dental Services Referral Program for people with disabilities or who are elderly or medically challenged Oasis Health Network (Oasis Free Clinics) 66 Baribeau Drive Suite 5B Box 1 Brunswick ME 04011 010497587 501(c)(3) 5000 Oasis Dental Clinic Penobscot Community Health Center 103 Maine Avenue Bangor ME 04401 010514750 501(c)(3) 20000 Improving Efficiency and Quality of Orthodontic Care in Maine Saving Smiles of Maine PO Box 119 28 Smith Road Suite 1 Windsor ME 04363 721592162 501(c)(3) 5000 Saving Smiles for Miles Program Sunrise Opportunities PO Box 311 Machias ME 04654 010407276 501(c)(3) 15000 Washington County School-Based Oral Health Services Community Health Services of Addison County - Open Door Clinic 100 Porter Drive Middlebury VT 05753 030359531 501(c)(3) 14594 "Open Wide": Culture and it's Intersection with Dental Health Good Neighbor Health Clinic 70 N Main Street White River Junction VT 05001 030346949 501(c)(3) 7779 Red Logan Dental Clinic Dental Equipment National Foundation of Dentistry for the Handicapped Dental Lifeline Networ 1800 15th Street Suite 100 Denver CO 80202 364779648 501(c)(3) 11528 Donated Dental Services Referral Program for people with disabilities or who are elderly or medically challenged South Royalton School-based Health Clinic (dba HealthHUB) PO Box 542 South Royalton VT 05068 030370825 501(c)(3) 5000 Dental Hygiene Program Springfield Medical Care Systems 25 Ridgewood Road Springfield VT 05156 030284813 501(c)(3) 5000 Meaningful Cleaning Program Vermont Head Start AssocChamplain Valley Head Start 431 Pine Street Suite 212 Burlington VT 05401 371651842 501(c)(3) 60000 Vermont Head Start/Early Head Start Tooth Tutor Program 35 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.