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 010286541 Maine Dental Service Corporation MAIN 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 Delta Dental Plan of Maine Thomas Raffio PO Box 2002 Concord NH 033022002 89675328 0 X www.nedelta.com X 1965 ME Provides programs of dental care 15 9 6 0 100000 0 0 0 85102174 87682181 990247 646611 0 0 86092421 88328792 190800 120600 71524933 74536032 646285 685626 0 0 0 10997500 11593203 83359518 86935461 2732903 1393331 41219141 44465511 4339328 4534790 36879813 39930721 It is our mission to be the leading force in the dental prepayment market by offering quality, versatile and affordable dental programs to benefit our purchasers, subscribers, and participating member dentists. 0 0 77680739 0 87582181 Program services include the processing and payment of claims for dental benefits for various organizations. Approximately 478,000 claims were processed in 2013. There are approximately 232,000 members included in the various plans. 120600 120600 Contributions to Northeast Delta Dental Foundation ($120,600). 77801339 0 0 0 0 0 0 0 0 0 1 0 0 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 1 198 0 1 6 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 0 0 0 X Frank Boucher 6032231000 One Delta Drive PO Box 2002 Concord NH 03302 Beverly Altenburg Director 3.00 X 5493 0 0 David L Bagdasarian DDS Director 3.00 X 6547 0 0 Cheryl Bascomb Director 3.00 X 5995 0 0 Michael A Bevilacqua Director 3.00 X 5995 0 0 Kyra Chadbourne DDS Director (part year) 3.00 X 2510 0 0 Jeffrey B Doss DDS Director 3.00 X 6497 0 0 Michael P Goldberg DMD Director 3.00 X 7501 0 0 Cynthia H Hamilton Director 3.00 X 5120 0 0 Gregory Johnson Director (part year) 3.00 X 2510 0 0 Demitroula Kouzounas DMD Director 3.00 X 3012 0 0 Stephen G Morse DMD Director (part year) 3.00 X 3392 0 0 Donald Oakes Director 3.00 X 5995 0 0 Daniel D Thayer Director 3.00 X 7501 0 0 Douglas C Terp Chair & Director (part year) 3.00 X X 8945 0 0 Barry C Saltz DDS Chair & Director 3.00 X X 21432 0 0 Michael W Pardue Vice Chair & Director 3.00 X X 6497 0 0 Charles E Brown DDS Treasurer & Director 3.00 X X 5593 0 0 Thomas Raffio DDPNH President & CEO 10.00 X 0 756655 151634 Francis Boucher DDPNH Sr. Vice President 10.00 X 0 180414 28732 Benjamin E Marcus Esq Clerk 2.00 X 0 0 0 110535 937069 180366 0 0 1 1 USI Insurance Services LLC 75 John Roberts Road Bldg C South Portland ME 04106 Insurance broker commissions 305788 Combined Services LLC 2 Delta Drive Concord NH 03301 Insurance broker commissions 250311 The Holden Agency 1085 Brighton Avenue Portland ME 04104 Insurance broker commissions 197454 Business Insurance Agency DBA Cross Insu 116 Community Drive Suite 2 PO Bo Augusta ME 043320469 Insurance broker commissions 168743 Acadia Benefits Inc 111 Commercial Street Portland ME 04101 Insurance broker commissions 151540 7 Premium Revenue 524114 53811336 53811336 Admin Service Contract Fees 524292 33770845 33770845 Management Fee - CSLLC 524298 100000 100000 87682181 547376 547376 1443371 2400 1344136 2400 99235 0 99235 99235 88328792 87582181 100000 646611 120600 120600 74536032 74536032 110535 110535 444285 444285 23048 23048 75017 75017 32741 32741 37203 37203 20815 20815 53885 53885 23200 23200 498939 498939 65753 65753 60993 60993 29017 29017 59685 59685 6257 6257 12977 12977 Administration - Delta 6551473 3144707 3406766 Brokers' Commissions 2795528 2795528 Dues & Subscriptions 153099 153099 Professional Relations 2050 2050 1222329 1222329 86935461 77801339 9134122 0 4159941 5071021 965093 1442687 3074562 3118207 2956 2956 161101 153739 9519 7362 31628757 33434505 0 50000 1378313 1338773 41219141 44465511 1906242 2338348 541800 73500 1891286 2122942 4339328 4534790 X 36879813 39930721 36879813 39930721 41219141 44465511 1393331 1657577 0 X X 0 1 X 1 0 14667 14667 0 126462 121596 4866 19972 17476 2496 7362 Accrued refunds 1075316 Unearned revenue 795326 Advances - admin service contracts 252300 2122942 X 58701164 1657577 -17427 1640150 57061014 53885 31213893 31267778 88328792 55667683 0 55667683 53885 31213893 31267778 86935461 Part X, Line 2: The 2013 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. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position historically taken on various tax exposure items including unrelated business income or tax status. Assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. 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, does not have any significant unrelated business income and has taken no uncertain tax positions that require adjustment to or disclosure in the accompanying statutory financial statements. Tax years after December 31, 2009 are open for Internal Revenue Service or state examination. Part XI, Line 2d - Other Adjustments: Change in nonadmitted assets -17,427. Part XI, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 31,213,893. Part XII, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 31,213,893. 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 Maine Bureau 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) 120600 General support to promote oral health 1 0 Part I, Line 2: Maine Dental Service Corporation (MDSC) makes elective annual charitable contributions to the Northeast Dental Foundation equal to 0.05% of the budgeted gross billings, plus 5% of the actual increase in unrestricted net assets from operations each year. MDSC's total contributions to the Foundation in 2012 totaled $120,600. 0 0 0 0 0 0 0 0 0 Thomas Raffio DDPNH President & CEO 0 522200 0 183900 0 50555 0 126616 0 25018 0 908289 0 0 Francis Boucher DDPNH Sr. Vice President 0 161566 0 16110 0 2738 0 14692 0 14040 0 209146 0 0 Schedule J, Part II Thomas Raffio, CEO and Francis Boucher, Senior Vice President received all of their compensation from Delta Dental Plan of New Hampshire, which is an unrelated organization per Schedule R definitions. David L Bagdasarian DDS Director 562212 The Directors listed here have ownership interests in dental practices that receive insurance reimbursements from Delta Dental in the ordinary course of their business. All transactions are at arm's length and for fair value. 0 Stephen G Morse DDS Director 365119 Please see above. 0 Barry C Saltz DDS Director 243632 Please see above. 0 Charles E Brown DDS Director 112430 Please see above. 0 Jeffrey B Doss DDS Director 544018 Please see above. 0 Demitroula Kouzounas DMD Director 716990 Please see above. 0 Michael Goldberg DMD Director 109294 Please see above. 0 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 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, Maine Dental Services Corporation makes its governing documents, conflict of interest policy, or financial statements available to the public. Form 990, Part XII, Line 2c: The Finance/Audit Committee oversees the audit process for Maine Dental Service Corporation. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit in both 2012 and 2013.