2020-11-13T08:57:05-06:00 2019-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2019-01-01 020489150 Northeast Delta Dental Foundation NORT 6032231000 PO Box 2002 Concord NH 033022002 THOMAS RAFFIO President & CEO 6032231000 2020-11-10 1 E Drew Cheney P00182972 8002447444 2020-11-10 208.105.168.164 2020-11-10 17:27:15 ES P C20447127DC59709279852AA978DA2EB3E2E3F4D F4BFD06137A0D14541E57ECE68CCEBA7C4E04E30 2019 2021-01-29 14:40:06Z Thomas Raffio PO Box 2002 Concord NH 033022002 674934 0 X www.nedelta.com X 1996 NH Promote dental health and education in northern New England 10 10 0 15 0 0 643880 493550 0 0 133540 167542 0 0 777420 661092 433177 616280 0 0 0 0 0 0 0 10181 9795 443358 626075 334062 35017 5663138 6534794 0 0 5663138 6534794 To promote dental health and education in northern New England. 0 0 361205 361205 0 Dental Equipment and Supplies: Cash donations to 34 nonprofit dental clinics to purchase dental equipment and supplies to serve patients who cannot afford dental care. 211075 211075 0 Oral Health Education Programs and Public Policy Development: Cash donations to 25 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. 44000 44000 In-School Programs for Children: Cash donations to 9 organizations to sponsor in-school education programs on fluoride rinse or sealants for children. 616280 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 1 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 0.50 0.00 X 0 0 0 Demitroula Kouzounas DMD Director (part year) 0.50 0.00 X 0 0 0 Suzanne M McDowell Director 0.50 0.00 X 0 0 0 Don Oakes Director 0.50 0.00 X 0 0 0 David B Staples DDS Director 0.50 0.00 X 0 0 0 Jeffrey B Walawender DDS Director (part year) 0.50 0.00 X 0 0 0 Terence A Wardrop Director 0.50 0.00 X 0 0 0 Eleanor H Vien Secretary 1.00 0.00 X 0 0 0 Melvin J Severance III Chair & Director 0.50 0.00 X X 0 0 0 Thomas Raffio President & Director 2.00 0.00 X X 0 0 0 Kathleen B Walker Treasurer & Director 6.00 0.00 X X 0 0 0 Jennifer L McGrath Assistant Treasurer 4.00 0.00 X 0 0 0 0 0 0 0 0 0 0 0 41745 451805 493550 167542 167542 13842 41745 13842 0 661092 0 0 167542 616280 616280 9720 9720 State of NH filing fees 75 75 626075 616280 9795 0 183364 300039 328200 0 5151574 6234755 5663138 6534794 0 0 X 5524322 6295978 138816 238816 5663138 6534794 5663138 6534794 35017 836639 0 X 0 0 0 X 679490 657335 867810 650200 500475 3355310 679490 657335 867810 650200 500475 3355310 2918029 437281 70076 90165 129728 133540 167542 591051 3946361 0.11080 0.10820 X The Organization meets the "facts and circumstances" test for the following reasons:- Through its activities, the organization regularly and continuously benefits many thousands of members of the general public.- The Organization encourages donations from the general public through the website of Northeast Delta Dental (a group of nonprofit organizations) and through other means.- 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 $31,549 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 2019 estimate for in-kind non-cash contributions is $6,925. These contributions are support from the general public. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5618830 150000 954181 249512 6473499 5923124 403200 -489552 217942 5618830 4775188 649900 718671 220635 5923124 4221228 536300 300527 282867 4775188 4078143 566600 -206701 216814 4221228 0.96310 0.00000 0.03690 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 55587 41745 13842 0 0 12466 0 0 1376 55587 41745 13842 12466 1376 13842 0 1 Behavioral Health & Developmental Services of Stafford County Inc 113 Crosby Road Dover NH 03820 020366120 501(c)(3) 5000 Dental program Catholic Medical Center Poisson Dental Center 100 McGregor Street Manchester NH 03885 020315693 501(c)(3) 5000 Event sponsorship to benefit the Center's dental facility Community College System of NH - NHTI 31 College Drive Concord NH 03301 900531902 501(c)(3) 5000 Dental equipment Concord Hospital Trust 250 Pleasant Street Concord NH 03301 222594672 501(c)(3) 10000 Pledge support for the Dental Center Coos County Family Health Services 54 Willow Street Berlin NH 03570 020350051 501(c)(3) 24785 Dental equipment Crotched Mountain Foundation 1 Verney Drive Greenfield NH 03047 020222168 501(c)(3) 5000 Funding for pilot program for direct dental care for adult clients Dental Lifeline Network of NH (Donated Dental Services) 1800 15th Street Suite 100 Denver CO 80202 846129064 501(c)(3) 15000 Referral program for people with disabilities or who are elderly or medically challenged Easterseals NH 555 Auburn Street Manchester NH 03103 020272825 501(c)(3) 10000 Continued naming rights of the Dental Center Great Bay Kids Company 81 New Hampshire Avenue Portsmouth NH 03801 020272439 501(c)(3) 5000 Early Years continued education program Greater Seacoast Community Health 100 Campus Drive Suite 12 Portsmouth NH 03801 020304203 501(c)(3) 8000 Dental Center, Health Grins, and Mobile Van Frisbie Memorial Hospital 11 Whitehall Road Rochester NH 03867 020222131 501(c)(3) 5000 School-based dental program Harbor Homes 45 High Street Nashua NH 03060 020351932 501(c)(3) 10000 Dental equipment Lakes Region Partnership for Public Health 67 Water Street Laconia NH 03246 202713484 501(c)(3) 5000 School-based dental program Monadnock Healthy Teeth Monadnock Community Hospital 452 Old Street Road Peterborough NH 03458 020222157 501(c)(3) 5000 Dental equipment New Hampshire Oral Health Coalition 4 Park Street Suite 403 Concord NH 03301 020453814 501(c)(3) 20000 NH Oral Health Plan update and Fall Forum One Sky Community Service 755 Banfield Road Portsmouth NH 03801 020368955 501(c)(3) 5000 Dental program Plus Company 19 Chestnut Street Nashua NH 03060 020337153 501(c)(3) 5000 Preventative dental care for adults Society of St Vincent De Paul Exeter 53 Lincoln Street PO Box 76 Exeter NH 03833 203945985 501(c)(3) 5000 Community Cental Care program, mobile dental van Southwestern Community Services 63 Community Way PO Box 603 Keene NH 03431 026013808 501(c)(3) 7500 WIC Dental Project Tri-County Community Action Program 56 Old Suncook Road Suite 2 Concord NH 03301 020267404 501(c)(3) 5000 School Smiles program University of New Hampshire Foundation 56 Old Suncook Road Suite 2 Concord NH 03301 020437506 501(c)(3) 7500 Oral Health education programs Aroostook Dental Clinic dba St Apollonia Dental Clinic 122 Academy Street Presque Isle ME 04769 274434337 501(c)(3) 10000 Dental equipment Harrington Family Health Center 50 East Main Street Harrington ME 04643 010409494 501(c)(3) 8852 Expansion of dental services Kennebec Valley Family Dentistry Ballard Center 420 6 East Chestnut Street Augusta ME 04330 263322306 501(c)(3) 17843 Dental equipment Maine Oral Health Coalition (aka Medical Care Development) 11 Parkwood Drive Augusta ME 04330 016022787 501(c)(3) 33000 Oral health needs assessment New York University College of Dental Medicine 345 E 24th Street Room 1037W New York NY 10010 135562308 501(c)(3) 25000 Department of Global Outreach, Student Dental Outreach Program in Manchias Oasis Free Dental Clinic 66 Baribeau Drive Suite 9/10 Brunswick ME 04011 010497587 501(c)(3) 5000 Dental supplies The Opportunity Alliance 50 Lydia Lane South Portland ME 04106 010274725 501(c)(3) 10000 School-based oral health program Portland Community Health Center dba Greater Portland Health 180 Park Avenue Portland ME 04102 454960453 501(c)(3) 20000 Dental equipment Saving Smiles of Maine PO Box 119 28 Smith Road Suite 1 Windsor ME 04363 721592162 501(c)(3) 5000 Dental equipment for the Savings Smiles for Miles program. University of Maine System 46 University Drive Augusta ME 04330 016000769 501(c)(3) 50000 Dental equipment for mobile dental assisting program Area Health Education Center (AHEC) 1 South Prospect Street Arnold 5 Burlington VT 05401 030179440 501(c)(3) 30000 University of Vermont and State Agricultural College, dental loan repayment program Battenkill Valley Health Center PO Box 61 Arlington VT 05250 272759990 501(c)(3) 5000 Community outreach and education program Community Health Centers of Burlington 617 Riverside Avenue Burlington VT 05401 237182584 501(c)(3) 14248 Dental and lab equipment Dental Lifeline Network of Vermont (Donated Dental Services) 1800 15th Street Suite 100 Denver CO 80202 846129064 501(c)(3) 11500 Referral program for people with disabilities or who are elderly or medically challenged Northeast Washington County Community Health 157 Towne Avenue Plainfield VT 05667 030240129 501(c)(3) 5000 The Plainfield Health Center, Ronald McDonald mobile care van Northwestern Medical Center 133 Fairfield Street St Albans VT 05478 030266986 501(c)(3) 5000 Smiles for Recovery program Open Door Clinic 100 Porter Drive Middlebury VT 05753 030359531 501(c)(3) 15000 Community Health Services of Addison County, dental program support South Royalton School-based Health Clinic dba HealthHUB PO Box 542 South Royalton VT 05068 030370825 501(c)(3) 5000 Dental hygiene program Southwestern Vermont Medical Center 100 Hospital Drive Bennington VT 05201 222563241 501(c)(3) 12500 Dental equipment United Way of Windham County PO Box 617 Brattleboro VT 05301 036003074 501(c)(3) 10000 Denture program support University of Vermont Medical Center 128 Lakeside Avenue Suite 106 Burlington VT 05401 030219309 501(c)(3) 10000 General Practice dental residency program Upper Valley Haven 713 Hartford Avenue White River Junction VT 05001 030277908 501(c)(3) 10000 Community oral health program Vermont Head Start Association 431 Pine Street Suite 212 Burlington VT 05401 371651842 501(c)(3) 60000 Champlain Valley Head Start, Vermont Head Start/Early Head Start Tooth Tutor program Vermont State Dental Society 1 Kennedy Drive Suite L3 South Burlington VT 05403 222514423 501(c)(6) 20000 We've Got a Chair for You dental recruitment campaign Windsor Hospital 289 County Road Windsor VT 05089 030183721 501(c)(3) 5000 Windsor Smiles program 45 1 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.