2013-11-15T15:18:10-06:00 2012-12-31 KPMG LLP 60 South Street Boston MA 02111 990 2012-01-01 050296998 DELTA DENTAL OF RHODE ISLAND % GEORGE BEDARD DELT 4017526000 10 CHARLES STREET Suite PROVIDENCE RI 02904 GEORGE J BEDARD 6179881000 2013-11-15 true 6179881000 2012 2016-03-07 17:11:31Z RICHARD A FRITZ 10 CHARLES STREET PROVIDENCE RI 02904 209010027 false X WWW.DELTADENTALRI.COM X 1959 RI TO PROVIDE COST EFFECTIVE GROUP DENTAL INSURANCE TO THE RHODE ISLAND BUSINESS COMMUNITIES. 15 12 49 0 0 8361 0 0 193934583 193356672 1807408 2008084 171120 112543 195913111 195477299 755959 456706 171834807 169000103 10660798 10907977 0 0 0 7948274 8404015 191199838 188768801 4713273 6708498 92301789 100912427 17713552 15586421 74588237 85326006 TO PROVIDE COST EFFECTIVE GROUP DENTAL INSURANCE TO THE RHODE ISLAND BUSINESS COMMUNITIES. false false 169456809 0 193306050 DENTAL BENEFITS FOR 597,804 MEMBERS UNDER 276,843 CONTRACTS 9478405 0 163165 OPERATIONS EXPENSE INCURRED TO ADMINISTER THE PAYMENT OF 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TAX SERVICES 403900 CATHEDRAL CORP GRIFFIN TECHNOLOGY PARK ROME NY 13441 PRINTING AND MAIL 326577 NETCENERGY 231 ELM STREET WARWICK RI 02888 IT CONSULTING 311677 ROCKY MOUNTAIN DATA CONTROL INC 2040 EAST MURRAY HOLLADAY ROAD 103 SALT LAKE CITY UT 84117 DATA ENTRY SERVICES 201627 5 0 PREMIUMS 193356672 193356672 193356672 1630482 1630482 0 0 0 0 0 13910330 13532728 377602 377602 377602 0 0 0 OTHER INCOME 900099 112543 112543 112543 195477299 193469215 2008084 456706 456706 0 0 169000103 169000103 2008964 2008964 0 0 7217448 5207218 2010230 550500 550500 463482 463482 667583 343898 323685 0 205294 205294 1889633 1557676 331957 0 0 0 0 0 719449 719449 0 0 929696 471145 458551 87507 7896 79611 0 23414 23414 0 0 1057808 1057808 114997 114997 POSTAGE 624124 592972 31152 BOARDS & ASSOCIATION FEES 453466 13149 440317 TELEPHONE 201011 0 201011 TAX ON UNRELATED BUSINESS ACTI 32688 0 32688 2064928 1284451 780477 188768801 178935214 9833587 0 X 250 250 13577060 26662963 0 0 13249047 13170561 0 0 0 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120 WATERMAN STREET PROVIDENCE RI 02906 841267604 501(C)(3) 7500 PROGRAM SUPPORT UNITED WAY OF RI 50 VALLEY STREET PROVIDENCE RI 02909 050276059 501(C)(3) 6903 PROGRAM SUPPORT MIRIAM HOSPITAL FOUNDATION PO BOX H PROVIDENCE RI 02901 050377502 501(C)(3) 6000 PROGRAM SUPPORT OCEAN STATE JOB LOT CHARITABLE 375 COMMERCE PARK RD N KINGSTOWN RI 02852 200959438 501(C)(3) 6000 PROGRAM SUPPORT RI HOSPITAL FOUNDATION PO BOX H PROVIDENCE RI 02901 050468736 501(C)(3) 5665 PROGRAM SUPPORT NATIONAL MS SOCIETY 205 HALLENE RD SUITE 209 WARWICK RI 02886 050271809 501(C)(3) 5640 PROGRAM SUPPORT LA SALLE ACADEMY 612 ACADEMY AVE PROVIDENCE RI 02908 050258897 501(C)(3) 5525 PROGRAM SUPPORT EAST SIDE MT HOPE YMCA 438 HOPE STREET PROVIDENCE RI 02906 050258878 501(C)(3) 5200 PROGRAM SUPPORT SPECIAL OLYMPICS RHODE ISLAND 370 GEORGE WASHINGTON HIGHWAY SMITHFIELD RI 02917 050377867 501(C)(3) 5155 PROGRAM SUPPORT AMERICAN HEART ASSOCIATION 1 STATE STREET SUITE 200 PROVIDENCE RI 02908 135613797 501(C)(3) 5100 PROGRAM SUPPORT 24 0 GRANT MAKING POLICIES: SCHEDULE I, LINE 2 THE COMPANY DOES NOT ISSUE SPECIFIC GRANTS, HOWEVER, AS PART OF OUR CORPORATE RESPONSIBILITY PROGRAM, WE SUPPORT LOCAL CHARITABLE ORGANIZATIONS. X X true true X X X X false true false false true true false false false JOSEPH A NAGLE 510080 0 119621 0 56372 0 121347 0 17809 0 825229 0 0 0 RICHARD A FRITZ 228876 0 26499 0 2180 0 33126 0 19709 0 310390 0 0 0 THOMAS D CHASE 226633 0 25951 0 1139 0 30775 0 17209 0 301707 0 0 0 STEPHEN J SPERANDIO 0 227924 0 21689 0 2987 0 32797 0 18759 0 304156 0 0 ANGELO PEZZULLO 207548 0 27941 0 7997 0 29609 0 19809 0 292904 0 0 0 Carlos Sanchez-Fuentes 211549 0 7295 0 688 0 21465 0 17209 0 258206 0 0 0 KATHRYN SHANLEY 210953 0 20049 0 3043 0 30064 0 18609 0 282718 0 0 0 JOSEPH R PERRONI 0 192672 0 26347 0 6620 0 24847 0 17209 0 267695 0 0 STEPHEN C TOMBS 137716 0 10219 0 279 0 17552 0 17208 0 182974 0 0 0 ELLEN M HENDRIX 132005 0 12741 0 407 0 16897 0 19288 0 181338 0 0 0 GEORGE J BEDARD 127012 0 9648 0 1100 0 16034 0 17989 0 171783 0 0 0 DUANE EASTER 110351 0 13168 0 332 0 13411 0 17208 0 154470 0 0 0 FRINGE BENEFITS SCHEDULE J, PART 1, QUESTION 1A THE CEO'S EMPLOYMENT AGREEMENT CONTAINS PROVISIONS FOR HIM TO RECEIVE PAYMENTS SO THAT HE CAN PERSONALLY PROCURE CERTAIN FRINGE BENEFITS SUCH AS LIFE INSURANCE AND LONG TERM DISABILITY POLICIES THAT ARE OTHERWISE AVAILABLE TO ALL OTHER EMPLOYEES. THIS ADDITIONAL INCOME IS GROSSED UP TO ACCOUNT FOR THE TAX IMPACT OF THESE PAYMENTS. BUSINESS EXPENSES SCHEDULE J, PART 1, QUESTION 1A THE CEO IS A MEMBER OF A LOCAL BUSINESS CLUB. REIMBURSEMENT FOR USE OF THIS IS EXCLUSIVELY FOR OFFSITE EMPLOYEE MEETINGS AS WELL AS BUSINESS RELATED MEETINGS WITH INDIVIDUALS OUTSIDE THE COMPANY. THE COMPANY MAINTAINS STRICT POLICIES REGARDING SUBSTANTIATION AND DOCUMENTATION FOR ALL BUSINESS RELATED EXPENSES INCURRED. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B A MEMBER OF MANAGEMENT PARTICIPATES IN A 457(F) DEFERRED COMPENSATION PLAN BUT HAS NOT MET THE VESTING CRITERIA AND THEREFORE NO PAYMENTS HAVE BEEN MADE TO DATE. EXECUTIVE INCENTIVE BONUS SCHEDULE J, PART 1, QUESTION 5B THE CEO HAS AN INCENTIVE BONUS OPPORTUNITY FOR UP TO 15% OF HIS BASE PAY SHOULD CERTAIN GOALS BE ATTAINED. GOALS ARE ESTABLISHED ANNUALLY AND FOR THE TAX YEAR 2012, ONE OF THESE GOALS IS BASED ON THE REVENUES OF A WHOLLY-OWNED SUBSIDIARY OF THE COMPANY. THIS GOAL HAS A WEIGHTING OF 10% THEREFORE THIS GOAL IS EQUAL TO 1.5% OF BASE PAY. COMPANY INCENTIVE BONUS SCHEDULE J, PART I, QUESTION 6A THE COMPANY MAINTAINS AN ANNUAL INCENTIVE PROGRAM THAT IS ALLOCATED TO ALL APPLICABLE EMPLOYEES IF THE COMPANY MEETS CERTAIN BOARD APPROVED CORPORATE FINANCIAL GOALS, INCLUDING MEETING ENROLLMENT LEVELS, CONTROL OF OPERATING EXPENSES, AND OVERALL PROFITABILITY. A THOMAS CORREIA DDS INC CORREIA - BOARD MEMBER 521797 PAYMENT OF DENTAL PRACTICE. false MCMANUS PRATT MCMANUS - BOARD MEMBER 881803 PAYMENT OF DENTAL PRACTICE. false CITIZENS BANK HANDY - BOARD MEMBER 204512 BANK FEES false MEMBERS OF THE ORGANIZATION FORM 990, PART VI, SECTION A, QUESTION 6 THE ORGANIZATION HAS 78 CORPORATE MEMBERS. MEMBERS THAT MAY ELECT THE GOVERNING BODY FORM 990, PART VI, SECTION A, QUESTION 7A THE CORPORATE MEMBERS MEET ANNUALLY TO APPROVE ANY BY-LAW CHANGES AND TO ELECT INDIVIDUALS TO THE 15 MEMBER BOARD OF DIRECTORS WHICH IS THE ORGANIZATION'S GOVERNING BODY. DECISIONS OF THE GOVERNING BODY SUBJECT TO APPROVAL BY MEMBERS FORM 990, PART VI, SECTION A, QUESTION 7B THE MEMBERS OF THE CORPORATION, AT THE ANNUAL MEETING, SHALL ELECT DIRECTORS OF THE CORPORATION THAT HAVE BEEN PROPOSED BY THE BOARD OF DIRECTORS AND SHALL APPROVE AMENDMENTS OR ALTERATIONS OF THE BYLAWS PROPOSED BY THE BOARD OF DIRECTORS. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, QUESTION 11B THE ANNUAL FORM 990 IS PREPARED BY THE COMPANY'S FINANCE DEPARTMENT WITH INPUT FROM SENIOR MANAGEMENT. UPON COMPLETION OF THE PREPARATION OF THIS DRAFT, IT IS THEN SUPPLIED TO KPMG, OUR TAX CONSULTANTS AND EXTERNAL AUDITORS. KPMG WILL COMPLETE THEIR REVIEW WITH ANY NECESSARY MODIFICATIONS AND THIS REVISED DRAFT IS AGAIN REVIEWED BY THE CONTROLLER, CFO AND CEO AS NECESSARY. FORM 990 IS THEN SUPPLIED TO THE BOARD OF DIRECTORS BEFORE A COPY IS FILED WITH THE IRS. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, QUESTION 12C ALL EMPLOYEES, AS WELL AS ALL OFFICERS AND DIRECTORS, COMPLETE AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. THE COMPLETED FORMS FOR EMPLOYEES ARE REVIEWED BY THE HUMAN RESOURCE DEPARTMENT, THE CFO, AS WELL AS THE DIRECTOR OF COMPLIANCE. ANY AND ALL POTENTIAL CONFLICT ISSUES ARE ELEVATED IN THE REVIEW PROCESS TO THE CEO, EXTERNAL LEGAL COUNSEL AND THE BOARD OF DIRECTORS AS NECESSARY. THE BOARD MEMBERS COMPLETED FORMS ARE REVIEWED BY THE CEO AND EXTERNAL LEGAL COUNSEL. THE CEO'S COMPLETED FORM IS REVIEWED BY EXTERNAL LEGAL COUNSEL AND THE CHAIRMAN OF THE BOARD. ALL CONFLICTS ARE DISCUSSED AND ANY REQUIRED ACTIONS ARE IMMEDIATELY IMPLEMENTED IN ACCORDANCE WITH THE COMPANY'S DOCUMENTED CONFLICT OF INTEREST POLICY. SHOULD AN UNDISCLOSED CONFLICT COME TO LIGHT, THEN IMMEDIATE AND APPROPRIATE ACTION IS ALSO TAKEN IN ACCORDANCE WITH THE COMPANY'S POLICIES. COMPENSATION POLICY FORM 990, PART VI, SECTION B, QUESTION 15 THE BOARD OF DIRECTORS ELECTS MEMBERS TO SERVE ON ITS COMPENSATION COMMITTEE WHICH IS RESPONSIBLE FOR SETTING THE CEO'S COMPENSATION AND APPROVING PAY RANGES FOR THE VARIOUS JOB TRACKS WITHIN THE COMPANY AS WELL AS APPROVING ANY FRINGE BENEFITS. THE COMPANY AND THE COMMITTEE ANNUALLY CONTRACT WITH INDEPENDENT COMPENSATION CONSULTANTS TO HELP DETERMINE APPROPRIATE PAY RANGES AND FRINGE BENEFITS SUCH AS HEALTH AND OTHER INSURANCES AND RETIREMENT AND OTHER BENEFITS. PUBLIC DISCLOSURE FORM 990, PART VI, SECTION C, QUESTION 19 THE COMPANY'S GOVERNING DOCUMENTS, SUCH AS BYLAWS AND CORPORATE CHARTER ARE AVAILABLE UPON REQUEST FROM THE COMPANY, AND CAN ALSO BE OBTAINED FROM THE SECRETARY OF STATE'S OFFICE WITHIN THE STATE OF RHODE ISLAND. THE COMPANY'S CONFLICT OF INTEREST POLICY, AS WELL AS THE COMPANY'S AUDITED FINANCIAL STATEMENTS ARE ALSO AVAILABLE UPON REQUEST AT THE COMPANY'S HEADQUARTERS. ADDITIONALLY, ALL STATUTORY FILINGS COMPLETED BY THE COMPANY ARE AVAILABLE THROUGH THE INSURANCE DIVISION WITHIN THE RHODE ISLAND DEPARTMENT OF BUSINESS REGULATION. THE COMPANY'S FORM 990 IS ALSO POSTED ON WWW.GUIDESTAR.ORG. OTHER CHANGES IN NET ASSETS PART XI, LINE 5 UNREALIZED GAINS FROM INVESTMENTS $ 585,105 FORM 990, PART XI, LINE #9 PARK ROW, A WHOLLY-OWNED SUBSIDIARY OF THE PARENT (DDRI) WAS SOLD IN LATE 2012. THE NET PROCEEDS FROM LIQUIDATING THIS SUBSIDIARY WERE ADDED TO THE SURPLUS OF THE COMPANY WHICH RESULT IN $3,444,166 OF ADDITIONAL CAPITIAL BEING REPORTED IN THE NET CHANGE IN CAPITAL AND SURPLUS SECTION OF THE STATEMENT OF REVENUES AND EXPENSES. ALTUS REALTY COMPANY 10 CHARLES STREET PROVIDENCE RI 029032208 030396397 HOLDING CO. RI 501(c)(2) N/A DDRI true PARK ROW ASSOCIATES INC 10 CHARLES STREET PROVIDENCE RI 029032208 050476063 INSURANCE RI DDRI C CORP 2729944 0 1.00000 true THE ALTUS GROUP INC 10 CHARLES STREET PROVIDENCE RI 029032208 050502610 INSURANCE RI DDRI C CORP 2725735 15957027 1.00000 true true false false false false false false false false false false true true false false false false false ALTUS DENTAL INSURANCE CO INC A(IV) 249724 FMV ALTUS DENTAL INC A(I) 63926 FMV ALTUS REALTY COMPANY A(I) 32241 FMV THE ALTUS GROUP INC L 5339948 FMV ALTUS DENTAL INSURANCE CO INC M 1219241 FMV