2017-11-07T12:55:42-06:00 2016-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2016-01-01 020273013 Delta Dental Plan of New Hampshire Inc DELT 6032231000 One Delta Drive PO Box 2002 Concord NH 033022002 Thomas Raffio President & CEO 6032231000 2017-10-27 1 E Drew Cheney P00182972 8002447444 2017-10-27 208.105.168.164 2017-10-27 10:33:18 ED P CCFCCF25870C8311BDDC6739800371DE19EE9571 CD9BA379DF6EC1A0D15BAC40CC9AB00D59855B06 2016 2018-03-14 21:41:22Z Thomas Raffio One Delta Drive PO Box 2002 Concord NH 033022002 340755894 0 X www.nedelta.com X 1961 NH Provide programs of dental care 15 9 198 0 100000 0 0 0 315558587 327048629 933016 901217 4519 -4326 316496122 327945520 234796 224680 280383113 290387545 16728317 17731994 0 0 0 15439474 16233380 312785700 324577599 3710422 3367921 61776573 65126420 14760741 14778813 47015832 50347607 X It is our mission to advance the oral health and overall wellness of our customers and the general public by providing innovative benefits and professional partnerships through diversified strategic business and philanthropic initiatives. 0 0 301446058 326948629 Delta Dental Plan of New Hampshire advances and promotes the improvement of oral health by offering innovative, cost effective dental benefits plans that meet the needs of our customers by integrating activities such as cost management policies, fee reduction agreements with dentists, ensuring quality and cost effective dental benefit delivery, and accurate and timely claims payment. We are recognized for our expertise in the dental benefits industry, the vibrancy of our participating dentist network, and our strong brand. Program services include the processing and payment of claims for dental benefits for various large and small groups, as well as individuals and families. Delta Dental Plan of New Hampshire processed approximately 775,000 claims in 2015. There are approximately 349,000 members in New Hampshire included in the various plans. Customer's expectations for quality standards are extremely rigorous and we provide a guarantee of service called GOSE, or Guarantee of Service Excellence, which guarantees seven key service claims: 1) Smooth implementation to Northeast Delta Dental; 2) Exceptional customer service; 3) Quick processing of claims; 4) No inappropriate billing by participating dentists; 5) Accurate and quick turnaround of identification cards; 6) Timely employee booklets; 7) Marketing service contracts. In the event one or more of these service guarantees are not met, a cash reimbursement is provided. 224680 224680 Delta Dental Plan of New Hampshire is one of three members of the Northeast Delta Dental Foundation. The company contributes .025% of annual budgeted revenue, as well as 5% of annual revenue in excess of expenses, to the Northeast Delta Dental Foundation. The Northeast Delta Dental Foundation's purpose is to improve the access to, and the quality of, oral health care and education for the public and dental communities in Maine, New Hampshire, and Vermont. The Northeast Delta Dental Foundation awards numerous grants to community organizations and programs. 301670738 0 0 1 0 0 0 0 0 0 1 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 15949 0 1 198 1 1 1 0 0 0 0 0 X 15 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Frank Boucher 6032231000 One Delta Drive PO Box 2002 Concord NH 03302 Mary Ann Aldrich RN Director 3.00 X 11220 0 0 Richard Bolduc DDS Director 3.00 X 7980 0 0 Lisa Braiterman Director 3.00 X 6523 0 0 Dennis Hannon DDS Director 3.00 X 10680 0 0 Francis H LaBranche Jr DDS Director (part year) 3.00 X 4320 0 0 Michael L'Ecuyer Director 3.00 X 9060 0 0 Keith Levesque DMD part year Director 3.00 X 3660 0 0 Nader Moavenian DDS Director 3.00 X 6360 0 0 Jean-Paul Rabbath DMD Director 3.00 X 9060 0 0 Christiane Rothwangl DDS Director 3.00 X 8520 0 0 Nick S Soggu Director 3.00 X 11220 0 0 David Staples DDS Director 3.00 X 9060 0 0 Seth P Wall Director 3.00 X 10680 0 0 Susan H Woods Director 3.00 X 10680 0 0 Kathryn L Yerkes Vice Chair & Director 3.00 X X 13380 0 0 J Michael Degnan Chair & Director 3.00 X X 29158 0 0 Thomas Raffio President & CEO 80.00 X 805520 0 104765 Francis Boucher Treasurer & Sr. VP Financ 48.00 X 227753 0 30672 Sara M Brehm Secretary 50.00 X 101115 0 19021 Erica Bodwell VP, General Counsel 50.00 X 203827 0 25208 William A Lambrukos Sr. VP Operations 40.00 X 222662 0 44504 Shannon Mills VP, Professional Relations 50.00 X 217248 0 20969 Jodie L Hittle VP, Marketing 50.00 X 219810 0 44148 Mike Bourbeau VP, Information Systems 47.00 X 209094 0 19336 2368590 0 308623 34 0 1 0 Encara Inc 4818 Starkey Road Roanoke VA 24018 Contracted services 887270 Combined Services LLC 2 Delta Drive Concord NH 03302 Insurance broker commissions 881497 Cronin Gervino & Warlick Inc 171 Londonderry Turnpike Hooksett NH 03106 Insurance broker commissions 339439 New England Employee Benefits 15 Chenell Drive Concord NH 03301 Insurance broker commissions 333952 Shi International Corp PO Box 952121 Dallas TX 75395 Consulting services 251246 12 Admin Service Contract Fees 524292 262585917 262585917 Premium Revenue 524114 64362712 64362712 Management Fee - CSLLC 524298 100000 100000 327048629 798852 798852 240405 244731 -4326 -4326 -4326 12668008 12565643 102365 102365 102365 327945520 326948629 100000 896891 224680 224680 290387545 290387545 1450407 523597 926810 12275700 5410160 6865540 329233 133998 195235 2777986 1144530 1633456 898668 379542 519126 30228 30228 77172 77172 115156 115156 1722219 52359 1669860 1584412 920992 663420 1394309 583537 810772 814020 357762 456258 70575 9758 60817 482322 40350 441972 4593 2019 2574 1648493 724513 923980 201983 83065 118918 Brokers' Commissions 3885772 0 3885772 Premium Taxes 1094908 0 1094908 Strategic Initiatives 238967 0 238967 2868251 692331 2175920 324577599 301670738 22906861 0 10170160 10421963 315392 58471 4611809 5032241 866669 845134 24138973 16501440 8593656 7637533 35631116 37344303 167451 256071 1317698 3425005 102622 105699 61776573 65126420 7695463 8121065 1890000 1680000 5175278 4977748 14760741 14778813 X 47015832 50347607 47015832 50347607 61776573 65126420 X 3367921 158003 -194149 X X 0 1 X 1 0 5300 5300 0 5300 1 Friends of Feltes Committee PO Box 623 Concord NH 03302 471093993 400 Pappas for NH PO Box 313 Manchester NH 02104 454838661 200 Donna Soucy for Senate 91 Alexander Street Manchester NH 02104 460562203 200 Committee to Elect Lou D'Allesandro 332 St James Avenue Manchester NH 03102 020519208 200 Chuck Morse for State Senate 14 Old Farm Road Salem NH 03079 273071602 400 Friends of Jeb Bradley 645 S Main Street Wolfeboro NH 03894 264422111 400 Supporters of Molly Kelly PO Box 1475 Keene NH 03431 208805201 200 Friends of Sharon Carson 19 Tokanel Road Londonderry NH 03053 800628169 200 Martha Fuller Clark for State Senate 501 Islington Street Ste E Portsmouth NH 03801 005427475 200 Woodburn for Senate 524 Faraway Road Dalton NH 03594 002583240 400 Committee to Elect David Watters 19 Maple Street Dover NH 03810 262910228 200 Hosmer for Senate 8 Summit Avenue Laconia NH 03246 273600949 200 Friends of Andy Sanborn 71 Eagle Drive Bedford NH 03110 002428739 250 Bette Lasky for State Senate 15 Masefield Road Nashua NH 03062 021382071 200 Friends of Regina Birdsell 24 Larson Drive Hampstead NH 03841 272345889 200 Garvey for NH Senate PO Box 935 New London NH 03257 811084028 200 Friends of Scott McGilvray PO Box 16208 Hooksett NH 03106 812647784 200 Volinsky for Executive Coucil 488 Shaker Road Concord NH 03301 475489903 200 Mel Myler PO Box 82 Contoocook NH 03229 455610319 200 Dick Hinch 14 Ichabod Drive Merrimack NH 03054 812979588 200 Lee Nyquist PO Box 3 New Boston NH 03070 461385760 450 Part I-A, Line 1: Twenty-three campaign donations totalling $5,300 were made in New Hampshire. 1133345 1133345 9344865 5395829 3949036 387895 384999 2896 13105214 10656648 2448566 167654 63964 103690 7637533 Investment in Red Tree Holdings (1/3 interest) 3425005 F 3425005 Unearned Revenue 1859939 Accrued Refunds 594009 Other Advances 2523800 4977748 X 87474244 158003 725224 883227 86591017 115156 241239347 241354503 327945520 83223096 0 83223096 115156 241239347 241354503 324577599 Part X, Line 2: The 2016 audited financial statements contain the following paragraphs pertaining to tax positions under FIN 48: The Corporation is exempt from federal and state income taxes under the provisions of Section 501(c)(4) of the Internal Revenue Code. Management has evaluated the Corporation's tax positions taken on its filed tax returns and concluded that the Corporation has maintained its tax-exempt status. Part XI, Line 2d - Other Adjustments: Change in nonadmitted assets 725,224. Part XI, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 241,239,347. Part XII, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 241,239,347. Schedule D, Part XI, Line 2d The Corporation has historically prepared its financial statements in accordance with accounting principles generally accepted in the United States of America (GAAP). Effective January 1, 2012 the Corporation elected to prepare its financial statements to conform with the statutory accounting practices of the National Association of Insurance Commissioners (NAIC), as prescribed or permitted by the New Hampshire Department of Insurance. The change in nonadmitted assets reported here in Part XI is one of the reconciling items to meet the reporting requirements for the Form 990. 1 Northeast Delta Dental Foundation One Delta Drive PO Box 2002 Concord NH 03302 020489150 501(c)(3) 224680 General support to promote oral health Part I, Line 2: Delta Dental Plan of New Hampshire, Inc. (DDPNH) makes elective annual charitable contributions to the Northeast Dental Foundation equal to 0.025% of the budgeted gross billings, plus 5% of the actual increase in unrestricted net assets from operations each year. DDPNH's elective contributions to the Foundation in 2016 totaled $224,680. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 Thomas Raffio President & CEO 522200 0 220107 0 63213 0 75814 0 28951 0 910285 0 0 0 Francis Boucher Treasurer & Sr. VP Financ 190942 0 26196 0 10615 0 17832 0 12840 0 258425 0 0 0 Erica Bodwell VP, General Counsel 199314 0 0 0 4513 0 0 0 25208 0 229035 0 0 0 William A Lambrukos Sr. VP Operations 184352 0 26360 0 11950 0 19221 0 25283 0 267166 0 0 0 Shannon Mills VP, Professional Relations 188339 0 20617 0 8292 0 17308 0 3661 0 238217 0 0 0 Jodie L Hittle VP, Marketing 180254 0 24730 0 14826 0 18915 0 25233 0 263958 0 0 0 Mike Bourbeau VP, Information Systems 168077 0 22327 0 18690 0 15806 0 3530 0 228430 0 0 0 Part I, Line 1a Spousal travel for one business trip per year. Part I, Line 4b Thomas Raffio (President & CEO) - 2016 total contributions to nonqualified deferred compensation plans = $52,220 to 457(f) plan. Part I, Line 7 The Organization has a team bonus program for all employees. Each individual's bonus is based on a combination of the individual's performance, the Organization's performance compared to the predetermined goals, and the individual's job level within the Organization. Nader Moavenian DDS Director 656068 The Directors listed here have ownership interests in dental practices that receive insurance reimbursements from Delta Dental Plan of New Hampshire in the ordinary course of their business. All transactions are at arm's length and for fair value. 0 David Staples DDS Director 387479 Please see above. 0 Jean-Paul Rabbath DMD Director 238269 Please see above. 0 Richard Bolduc DDS Director 256546 Please see above. 0 Christiane Rothwangl DDS Director 271809 Please see above. 0 Keith Levesque DMD Director 229699 Please see above. 0 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 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 B, line 15 CEO's Compensation: Every year, the Board Tri-State Compensation Committee goes through a rigorous evaluation and carefully researches information on which it bases its recommendations for the compensation for the President & CEO. This includes the engagement of independent compensation consultants and advisors. The independent Tri-State Compensation Committee comprises the Chairs of the Boards for the Delta Dental Plans of Maine, Vermont, and New Hampshire and the Executive Committee of the DDPNH Board. In reviewing the compensation and benefits, the Committee considered various sources of comparability data and the analysis of comparability data and market conditions presented by the independent compensation consultant. In February 2016, the Tri-State Compensation Committee reviewed and approved the CEO's proposed compensation, effective April 1, 2016, for the Treasurer and Secretary based on comparability data provided to the Committee. Form 990, Part VI, Section C, line 19 Upon request, Delta Dental Plan of New Hampshire, Inc. makes its governing documents, conflict of interest policy, or financial statements available to the public. Form 990, Part XI, line 9: Unrealized losses on bonds -194,149. Form 990, Part XII, Line 2c: The Finance/Audit Committee oversees the audit process for Delta Dental Plan of New Hampshire, Inc. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit in both 2015 and 2016. Form 990, Part XI, Line 9 The Corporation has historically prepared its financial statements in accordance with accounting principles generally accepted in the United States of America (GAAP). Effective January 1, 2012, the Corporation elected to prepare its financial statements to conform with the statutory accounting practices of the National Association of Insurance Commissioners (NAIC), as prescribed or permitted by the New Hampshire Department of Insurance. This is one of the reconciling items to meet the reporting requirements for the Form 990.