2019-11-13T14:57:43-06:00 2018-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2018-01-01 020489150 Northeast Delta Dental Foundation NORT 6032231000 PO Box 2002 Concord NH 033022002 THOMAS RAFFIO President & CEO 6032231000 2019-11-12 1 E Drew Cheney P00182972 8002447444 2019-11-12 208.105.168.164 2019-11-12 10:53:26 ES P 1858DCD9145052AFD59E6E126536EE0AD80069D4 E7C342458DF4D4AB2E77FA21342842838D49B854 2018 2020-01-14 16:20:31Z Thomas Raffio PO Box 2002 Concord NH 033022002 791411 0 X www.nedelta.com X 1996 NH Promote dental health and education in northern New England 10 10 0 15 0 0 862110 643880 0 0 129728 133540 0 0 991838 777420 419185 433177 0 0 0 0 0 0 0 6770 10181 425955 443358 565883 334062 5952168 5663138 0 0 5952168 5663138 To promote dental health and education in northern New England. 0 0 271530 271530 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. 109618 109618 Oral Health Education Programs and Public Policy Development: Cash donations to 22 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. 52029 52029 In-School Programs for Children: Cash donations to 8 organizations to sponsor in-school education programs on fluoride rinse or sealants for children. 433177 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 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 X 0 0 0 Demitroula Kouzounas DMD Director 0.50 X 0 0 0 Suzanne M McDowell Director 0.50 X 0 0 0 Don Oakes Director 0.50 X 0 0 0 David B Staples DDS Director 0.50 X 0 0 0 Terence A Wardrop 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 43911 599969 643880 133540 133540 13991 43911 13991 0 777420 0 0 133540 433177 433177 9902 9902 204 204 State of NH filing fees 75 75 443358 433177 10181 0 353642 183364 649900 328200 4948626 5151574 5952168 5663138 0 0 X 5888352 5524322 63816 138816 5952168 5663138 5952168 5663138 334062 -623092 0 X 0 0 0 X 259782 679490 657335 867810 650200 3114617 259782 679490 657335 867810 650200 3114617 2723338 391279 78082 70076 90165 129728 133540 501591 3616208 0.10820 0.10260 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 $27,124 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 2018 estimate for in-kind non-cash contributions is $6,320. These contributions are support from the general public. 5923124 403200 -489552 217942 5618830 4775188 649900 718671 220635 5923124 4221228 536300 300527 282867 4775188 4078143 566600 -206701 216814 4221228 3977210 157600 87457 144124 4078143 0.97530 0.00000 0.02470 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 57902 43911 13991 12619 1372 57902 43911 13991 12619 1372 13991 0 1 Ammonoosuc Community Health Services 25 Mount Eustis Road Littleton NH 03561 510137745 501(c)(3) 5000 Dental Program for Veterans Aroostook County Action Program 771 Main Street PO Box 1116 Presque Isle ME 04769 010315849 501(c)(3) 5000 WIC Oral Health Program Behavioral Health & Developmental Services of Strafford County Inc 113 Crosby Road Dover NH 03820 020366120 501(c)(3) 10000 Dental Program Catholic Medical Center Poisson Dental Center 100 McGregor Street Manchester NH 03885 020315693 501(c)(3) 5000 Community Outreach and Dental Supplies Community Health Centers of Burlington 617 Riverside Avenue Burlington VT 05401 237182584 501(c)(3) 10000 School-based Dental Center Expansion Concord Hospital Trust 250 Pleasant Street Concord NH 03301 222594672 501(c)(3) 10000 Support for Dental Center 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 Dental Lifeline Network of Vermont (Donated Dental Services) 1800 15th Street Suite 100 Denver CO 80202 841043478 501(c)(3) 9500 Referral program for people with disabilities or who are elderly or medically challenged Easter Seals NH 555 Auburn Street Manchester NH 03103 020272825 501(c)(3) 10000 Continued naming rights of the dental center Families First Health of the Greater Seacoast 100 Campus Drive Suite 12 Portsmouth NH 03801 222757341 501(c)(3) 8000 Funding for 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 Gateways Community Services 144 Canal Street Nashua NH 03064 020377315 501(c)(3) 5000 Dollars for Dental Program Good Neighbor Health Clinic & Red Logan Dental Clinic 70 North Main Street White River Junction VT 05001 030346949 501(c)(3) 7996 Dental Equipment Greater Bennington Interfaith Community Services 121 Depot Street PO Box 702 Bennington VT 05201 030369844 501(c)(3) 20000 Children's Dental Hygiene Program Harbor Homes 45 High Street Nashua NH 03060 020351932 501(c)(3) 10000 Support for Harbor Care Health and Wellness Center Dental Clinic Health Reach Community Health Center 10 Water Street Suite 305 Waterville ME 04901 016023664 501(c)(3) 7000 Dental Outreach Program Lakes Region Partnership for Public Health 67 Water Street Laconia NH 03246 202713484 501(c)(3) 5000 School-based Dental Program LRG Healthcare 80 Highland Street Laconia NH 03246 020222150 501(c)(3) 5000 Dental Resource center Maine Community Foundation 245 Main Street Ellsworth ME 04605 010391479 501(c)(3) 5000 Maine Oral Health Funders Community Collaborative Maine Dental Health OutReach 45 Greenwood Terrace Winthrop ME 04364 203074754 501(c)(3) 10000 School-Based Dental Program MaineHealth 110 Free Street Portland ME 04101 010431680 501(c)(3) 5000 Dining with the Dentists Milford School Dental Clinic 100 West Street Milford NH 03055 026000558 Government 5000 School-based Dental Program Moore Center Services 195 McGregor Street Unit 400 Manchester NH 03102 020261136 501(c)(3) 5000 Dental Program New Hampshire Oral Health Coalition New Hampshire Public Health Assoc 4 Park Street Suite 403 Concord NH 03301 020453814 501(c)(3) 16823 NH Oral Health Plan Update and Fall Forum New York University College of Dental Medicine 345 E 24th Street Room 1037 W New York NY 10010 135562308 501(c)(3) 25000 Student Dental Outreach Program in Machias Oasis Free Dental Clinic 66 Baribeau Drive Suite 9/10 Brunswick ME 04011 010497587 501(c)(3) 5000 Dental Supplies One Sky Community Service 755 Banfield Road Portsmouth NH 03801 020368955 501(c)(3) 5000 Dental Program Skilltech - Essex Westford School District 51 Park Street Essex Junction VT 05452 812070986 Government 16000 EFDA Program Support Society of St Vincent De Paul Exeter 53 Lincoln Street PO Box 176 Exeter NH 03833 203945985 501(c)(3) 5000 Mobile Dental Van South Royalton School-Based Health Clinic dba Health HUB PO Box 542 South Royalton VT 05068 030370825 501(c)(3) 5000 Dental Equipment Southwestern Community Services 63 Community Way PO Box 603 Keene NH 03431 026013808 501(c)(3) 25000 WIC Dental Project Springfield Medical Care Systems 25 Ridgewood Road Springfield VT 05156 030284813 501(c)(3) 5000 Dental Equipment Sullivan County Oral Health Collaborative 1 Tremont Street Claremont NH 03743 680662886 501(c)(3) 10000 Oral Health Program Expansion Tri-County Community Action Program 30 Exchange Street Berlin NH 03570 020267404 501(c)(3) 5000 School Smiles Program United Way of Windham County PO Box 617 Brattleboro VT 05301 036003074 501(c)(3) 5000 Free Adult Dental Care Day University of New Hampshire Foundation 56 Old Suncook Road Suite 2 Concord NH 03301 020437506 501(c)(3) 5000 Oral Health and Disabilities Education University of Vermont and State Agricultural College Foundation 411 Main Street Burlington VT 05401 451556038 501(c)(3) 15000 Dental Talent Pipeline Initiative University of Vermont Medical Center 128 Lakeside Avenue Suite 106 Burlington VT 05401 030219309 501(c)(3) 10000 General Practice Dental Residency Program Vermont State Dental Society 1 Kennedy Drive Suite L3 South Burlington VT 05403 222514423 501(c)(6) 10000 "We've Got a Chair for You" Dental Campaign Vermont Technical College 301 Lawrence Place Williston VT 05495 262275291 501(c)(3) 24500 Dental Equipment Waldo County Dental Care PO Box 287 Belfast ME 04915 010177170 501(c)(3) 9684 Dental Equipment Wentworth-Douglass Hospital 789 Central Avenue Dover NH 03820 020260334 501(c)(3) 16000 Dental Equipment Upgrade Windsor Hospital Corp dba Mt Ascutney Hospital 289 County Road Windsor VT 05089 030183721 501(c)(3) 7673 Windsor Smiles Program 43 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.