2015-07-28T14:06:17-05:00 2014-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2014-01-01 020489150 Northeast Delta Dental Foundation NORT 6032231000 PO Box 2002 Concord NH 033022002 THOMAS RAFFIO President & CEO 6032231000 2015-07-15 1 E Drew Cheney P00182972 8002447444 2015-07-15 2014 2016-02-25 16:41:14Z Thomas Raffio PO Box 2002 Concord NH 033022002 1576204 0 X www.nedelta.com X 1996 NH Promote dental health and education in northern New England 11 11 0 15 0 0 414498 257282 0 0 66294 281807 0 0 480792 539089 358965 258429 0 0 0 0 0 0 0 7162 8152 366127 266581 114665 272508 4046510 4094668 30000 0 4016510 4094668 To promote dental health and education in northern New England 0 0 179233 179233 Dental Equipment and Supplies: Cash donations to 22 nonprofit dental clinics to purchase dental equipment and supplies to serve patients who cannot afford dental care. 48111 48111 Oral Health Education Programs and Public Policy Development: Cash donations to 7 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. Distributions to 3 organizations that support public policy development.Also contributed to 1 organization to fund a dental residency scholarship program. 31085 31085 In-School Programs for Children: Cash donations to 10 organizations to sponsor in-school education programs on fluoride rinse or sealants for children. 258429 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 11 11 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 Barry C Saltz DDS Director 0.50 X 0 0 0 Eleanor H Vien Director 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 Peter W Leberman Esq Assistant Secretary & Director 1.00 X X 0 0 0 Jennifer L McGrath Assistant Treasurer 4.00 X 0 0 0 Andrea D Covell Secretary 1.00 X 0 0 0 0 0 0 0 0 0 0 0 21991 235291 257282 78082 78082 1223803 1020078 203725 203725 203725 17037 21991 17037 0 539089 0 0 281807 258429 258429 6301 6301 1128 1128 580 580 State of NH filing fees 75 75 Bank service charges 68 68 266581 258429 8152 0 258339 1269744 167500 157600 3620671 2667324 4046510 4094668 30000 0 30000 0 X 3827694 3905852 188816 188816 4016510 4094668 4046510 4094668 272508 -194350 0 X 0 0 0 X 512647 650579 648757 416998 259782 2488763 512647 650579 648757 416998 259782 2488763 2185126 303637 50627 83382 60763 66294 78082 339148 2827911 0.10740 0.10650 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 $2,500 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 3977210 157600 87457 144124 4078143 3449410 167500 482357 122057 3977210 2820677 401900 332044 105211 3449410 2642281 405200 -130207 96597 2820677 2178074 277300 278419 91512 2642281 0.95370 0.00000 0.04630 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 37608 20571 17037 14749 2288 37608 20571 17037 14749 2288 17037 0 1 Community Dental-Farmington 366 US Route One Falmouth ME 04105 237129502 501(c)(3) 9500 Digital X-Ray Sensors Concord Dental Sealant Coalition PO Box 1062 Concord NH 03301 262799313 501(c)(3) 5000 School-Based Dental Program Dental Lifeline Network of NH (Donated Dental Services) 1800 15th Street Suite 100 Denver CO 80202 846129064 501(c)(3) 15000 Program Support Easter Seals NH 555 Auburn Street Manchester NH 03103 020272825 501(c)(3) 10000 Dental Clinic Good Neighbor Health Clinic & Red Logan Dental Clinic 70 North Main Street White River Junction VT 05001 030346949 501(c)(3) 15000 Funding to hire a Development/Marketing person for clinic HealthReach Community Health Centers 10 Water Street Suite 305 Waterville ME 04901 016023664 501(c)(3) 15000 Panoramic X-Ray System Katahdin Valley Health Center 30 Houlton Street Patten ME 04765 237411014 501(c)(3) 8400 X-Ray Sensors Maine Health Access Foundation 150 Capitol Street Suite 4 Augusta ME 04330 010535144 501(c)(3) 6000 Maine Oral Health Funders Consultant Maine Oral Health Coalition 11 Parkwood Drive Augusta ME 04330 016022787 501(c)(3) 5000 Operating Support Mission of Mercy America's Dentists Care Foundation 9110 East 35th Street North Wichita KS 67226 262275291 501(c)(3) 18000 Mini MOM Van Mount Desert Island Hospital PO Box 8 10 Wayman Lane Bar Harbor ME 04609 010211797 501(c)(3) 20000 Dental Center NH Department of Health & Human Services Division of Public Health 29 Hazen Drive Concord NH 03301 026000618 Government 5000 WIC Program Penobscot Community Health Center 103 Maine Avenue Bangor ME 04401 010514750 501(c)(3) 9933 Dental Sedation Saving People Smiles Dental Center 194 Pleasant Street Concord NH 03301 272627267 501(c)(3) 10000 Ronald McDonald Van United Way of Windham County 28 Vernon Street 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) 20000 Dental Equipment Vermont Tech College 301 Lawrence Place Williston VT 05495 030213787 Government 5000 Dextr Manikins Washington County Children's Program (a program of Sunrise Opportunities) PO Box 311 Machias ME 04654 010407276 501(c)(3) 5000 School-Based Sealant Program York County Community Action Program 6 Spruce Street PO Box 72 Sanford ME 04073 016020406 501(c)(3) 5000 Dental Center 19 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 11 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.