2017-11-07T12:52:17-06:00 2016-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2016-01-01 020489150 Northeast Delta Dental Foundation NORT 6032231000 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 10:45:16 ED P CCFCCF25870C8311BDDC6739800371DE19EE9571 CD9BA379DF6EC1A0D15BAC40CC9AB00D59855B06 2016 2021-01-29 14:40:06Z Thomas Raffio PO Box 2002 Concord NH 033022002 753376 0 X www.nedelta.com X 1996 NH Promote dental health and education in northern New England 10 10 0 15 0 0 673586 650635 0 0 94968 90165 0 0 768554 740800 324738 375659 0 0 0 0 0 0 0 8750 6227 333488 381886 435066 358914 4253065 4808917 25000 11576 4228065 4797341 To promote dental health and education in northern New England 0 0 293049 293049 Dental Equipment and Supplies: Cash donations to 30 nonprofit dental clinics to purchase dental equipment and supplies to serve patients who cannot afford dental care. 34000 34000 Oral Health Education Programs and Public Policy Development: Cash donations to 12 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. 48610 48610 In-School Programs for Children: Cash donations to 7 organizations to sponsor in-school education programs on fluoride rinse or sealants for children. 375659 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 Paul A Averill DDS Director 0.50 X 0 0 0 Michael Degnan 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 Michael Pardue Director 0.50 X 0 0 0 Eleanor H Vien Secretary 1.00 X 0 0 0 Terence A Wardrop Director 0.50 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 24084 626551 650635 90165 90165 12576 24084 12576 0 740800 0 0 90165 375659 375659 6032 6032 85 85 State of NH filing fees 75 75 Bank service charges 35 35 381886 375659 6227 0 321036 122661 566600 486300 3365429 4199956 4253065 4808917 11576 25000 25000 11576 X 4089249 4708525 138816 88816 4228065 4797341 4253065 4808917 358914 210362 0 X 0 0 0 X 648757 416998 259782 679490 657335 2662362 648757 416998 259782 679490 657335 2662362 2347951 314411 60763 66294 78082 70076 90165 365380 3027742 0.10380 0.10370 X The Organization meets the "facts and circumstances" test for the following reasons:- Through its activities, the organization reguarly 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 $6,700 as a very conservative estimate of the amount of annual in-kind non-cash contributions which are not included on the organization's books. These contributions are support from the general public. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4221228 536300 300527 282867 4775188 4078143 566600 -206701 216814 4221228 3977210 157600 87457 144124 4078143 3449410 167500 482357 122057 3977210 2820677 401900 332044 105211 3449410 0.98140 0.00000 0.01860 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 36660 24084 12576 11576 1000 36660 24084 12576 11576 1000 12576 0 1 Ammonoosuc Community Health Services 25 Mount Eustis Road Littleton NH 03561 510137745 501(c)(3) 10000 Dental Equipment Behavioral Health & Developmental Services of Strafford County 113 Crosby Road Dover NH 03820 020366120 501(c)(3) 10000 Preventative and Necessary Dental Care Bennington Oral Health Coalition 601 Main Street PO Box 702 Bennington VT 05201 030369844 501(c)(3) 9600 Life is Better With Teeth Program - Improve Oral Health by Changing Values Children's Oral Health Program Portland Public Health & Human Services 1600 Forest Avenue Portland ME 042407291 016000032 501(c)(3) 13990 Program Support Community Health Centers of Burlington 617 Riverside Avenue Burlington VT 05401 237182584 501(c)(3) 10000 School-based Dental Center Expansion Concord Dental Sealant Coalition PO Box 1062 Concord NH 03301 262799313 501(c)(3) 6000 School-Based Dental Program Concord Hospital Trust 250 Pleasant Street Concord NH 03301 222594672 501(c)(3) 30000 Benefactors Circle - Dental Clinic Dental Lifeline Network of NH (Donated Dental Services) 1800 15th Street Suite 100 Denver CO 80202 846129064 501(c)(3) 15000 Salary for Coordinator Dental Lifeline Network of Vermont - Donated Dental 1800 15th Street Suite 100 Denver CO 80202 841043478 501(c)(3) 9500 Salary for Coordinator Easter Seals NH 555 Auburn Street Manchester NH 03103 020272825 501(c)(3) 50000 Dental Clinic Support Families First Health of the Greater Seacost 100 Campus Drive Suite 12 Portsmouth NH 03801 222757341 501(c)(3) 8000 Program Support Good Neighbor Health Clinic & Red Logan Dental Clinic 70 North Main Street White River Junction VT 05001 030346949 501(c)(3) 5000 Program Support and Dental Supplies Greater Nashua Dental Connection 31 Cross Street Nashua NH 03064 020500866 501(c)(3) 5000 School-based Oral Health Program Harbor Homes 45 High Street Nashua NH 03060 020351932 501(c)(3) 10000 Electronic medical records system for dental clinic Harrington Family Health Center 50 East Main Street Harrington ME 04643 010409494 501(c)(3) 5000 Dental Technology Upgrade Kennebec Family Dentistry 269 Water Street Augusta ME 04330 263322306 501(c)(3) 5000 Dental Equipment Maine Health Access Foundation 150 Capitol Street Suite 4 Augusta ME 04330 010535144 501(c)(3) 12000 Maine Oral Health Funders Consultant Milford School Dental Clinic 100 West Street Milford NH 03055 026000558 Government 5000 School-based Dental Program Mountain Health CenterFive-Town Health Alliance - Fiscal Agent 74 Munsill Avenue Suite 100 Bristol VT 05443 263010066 501(c)(3) 50000 Defray Dental Equipment Expenses Nashua Transit Services 229 Main Street Nashua NH 03060 026000581 501(c)(3) 5000 FTA Rides to Wellness (R2W) New Hampshire Department of Health & Human Services 29 Hazen Drive Concord NH 03301 026000618 Government 15000 WIC Program Dental Services New York University College of Dental Medicine 345 E 24th Street Room 1037 W New York NY 10010 135562308 501(c)(3) 10000 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 Oral Health America 180 N Michigan Avenue Suite 1150 Chicago IL 60601 362382334 501(c)(3) 5000 Smiles Across America Program Penobscot Community Health Care 103 Maine Avenue Bangor ME 04401 010514750 501(c)(3) 7980 Dental records upgrade project and sensors United Way of Windham County PO Box 617 Brattleboro VT 05301 036003074 501(c)(3) 5000 Free Adult Dental Care Day University of VT College of Dental Medicine (FKA Fletcher Allen Healthcare) 111 Colchester Avenue Burlington VT 05401 030219309 501(c)(3) 10000 General Practice Dental Residency Program Vermont Technical College 301 Lawrence Place Williston VT 05495 262275291 501(c)(3) 10500 Dental Equipment Waldo County Dental Care PO Box 287 Belfast ME 04915 010177170 501(c)(3) 5000 Dental Equipment, and Dental Treatment for Adults Windsor Hospital Corp dba Mt Ascutney Hospital 289 County Road Windsor VT 05089 030183721 501(c)(3) 13000 Windsor Smiles - School-Based Dental Program 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.