2014-11-14T13:23:49-06:00 2013-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2013-01-01 020489150 Northeast Delta Dental Foundation NORT 6032231000 PO Box 2002 Concord NH 033022002 THOMAS RAFFIO President & CEO 6032231000 2014-11-06 1 E Drew Cheney P00182972 8002447444 2013 2015-11-30 17:44:51Z Thomas Raffio PO Box 2002 Concord NH 033022002 490706 0 X www.nedelta.com X 1996 NH Promote dental health and education in northern New England 11 11 0 0 0 0 646257 414498 0 0 41392 66294 0 0 687649 480792 357302 358965 0 0 0 0 0 0 0 4987 7162 362289 366127 325360 114665 3535663 4046510 50000 30000 3485663 4016510 To promote dental health and education in northern New England 0 0 162980 162980 0 Dental equipment and supplies: cash donations to 29 nonprofit dental clinics to purchase dental equipment and supplies to serve patients who cannot afford dental care. 180985 180985 0 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.Also contributed to 1 organization to assist in oral health public policy development and to promote the importance of oral health.Also contributed to 6 organizations to fund oral health research and programs. 15000 15000 0 Fluoride rinse and sealant programs for children: cash donations to 3 organizations to be used to provide fluoride rinse or sealants for children. These programs are usually performed in schools. 358965 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 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 Walker 6032231000 c/o One Delta Drive Concord NH 033022002 X Clayton R Adams Director 1.00 X 0 0 0 Demitroula Kouzounas DMD Director 1.00 X 0 0 0 Suzanne M McDowell Director 1.00 X 0 0 0 Barry C Saltz DDS Director 1.00 X 0 0 0 Eleanor H Vien Director 2.00 X 0 0 0 Terence A Wardrop Director 1.00 X 0 0 0 Melvin J Severance III Chair & Director 1.00 X X 0 0 0 Sheila A Kennedy DDS Vice Chair & Director 1.00 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 2.00 X 0 0 0 Andrea D Covell Secretary 2.00 X 0 0 0 0 0 0 0 0 0 0 0 19350 395148 414498 66294 66294 9914 19350 9914 0 480792 0 0 66294 358965 358965 4216 4216 2189 2189 446 446 Bank service charges 236 236 State of NH filing fees 75 75 366127 358965 7162 0 231449 258339 401900 167500 2902314 3620671 3535663 4046510 50000 30000 50000 30000 X 3296847 3827694 188816 188816 3485663 4016510 3535663 4046510 114665 416182 0 X 0 0 0 X 378517 512647 650579 648757 416998 2607498 378517 512647 650579 648757 416998 2607498 2296548 310950 50649 50627 83382 60763 66294 311715 2919213 0.10650 0.10950 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3449410 167500 482357 0 122057 0 3977210 2820677 401900 332044 105211 3449410 2642281 405200 -130207 96597 2820677 2178074 277300 278419 91512 2642281 1866113 154300 338407 100000 80746 2178074 0.95250 0.00000 0.04750 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 28154 18240 9914 7168 2746 28154 18240 9914 7168 2746 9914 0 1 Concord Hospital Family Health Center Dental Clinic 250 Pleasant Street Concord NH 03301 222549672 501(c)(3) 10000 Dental Supplies Easter Seals NH 555 Auburn Street Manchester NH 03103 020272825 501(c)(3) 10000 Dental Clinic Dental Lifeline Network of NH (Donated Dental Services) 1800 15th Street Suite 100 Denver CO 80202 846129064 501(c)(3) 15000 Program Support Families First of the Greater Seacoast 100 Campus Drive Suite 12 Portsmouth NH 03801 222757341 501(c)(3) 8000 Dental supplies Health Access Network PO Box 99 Lincoln ME 04457 113650708 501(c)(3) 11110 Dental Equipment Maine Dental Access Coalition MCD Public Health 11 Parkwood Drive Drive Augusta ME 04330 016022787 501(c)(3) 15000 Program Support Maine Health Access Foundation 150 Capitol Street Suite 4 Augusta ME 04330 010535144 501(c)(3) 6000 Oral Health Funders Consultant City of Portland Children's Oral Health Program Public Health Division 1600 Forest Avenue Portland ME 04103 016000032 501(c)(3) 6000 Bright Smiles Program University of New England 11 Hills Beach Road Biddeford ME 04005 010211810 501(c)(3) 50000 New Dental School Champlain Valley Head StartEarly Head Start c/o 255 South Champlain Street Burlington VT 05402 030216837 501(c)(3) 84000 Tooth Tutor Program Fletcher Allen HealthCare 111 Colchester Avenue Burlington VT 05401 030219309 501(c)(3) 14000 Dental Residency Program Good Neighbor Health Clinic & Red Logan Dental Clinic 70 North Main Street White River Junction VT 05001 030346949 501(c)(3) 10000 Expanded dental services Mt Ascutney Hospital 289 County Road Windsor VT 05089 030300481 501(c)(3) 6000 Dental Supplies 13 13 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.