2012-11-12T10:47:19-06:00 2011-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2011-01-01 020273013 Delta Dental Plan of New Hampshire Inc DELT 6032231000 One Delta Drive PO Box 2002 Concord NH 033022002 Thomas Raffio 6032231000 2012-11-07 E Drew Cheney P00182972 8002447444 2011 2016-02-24 21:20:13Z Thomas Raffio One Delta Drive PO Box 2002 Concord NH 033022002 291151804 0 X www.nedelta.com X 1961 NH Provide programs of dental care 15 8 211 0 100000 0 0 0 276896834 285034253 1025807 1383048 101943 -43719 278024584 286373582 290100 297700 249379499 253742568 13579236 14500116 0 0 0 13774490 14996321 277023325 283536705 1001259 2836877 45317776 50135691 10760156 12043689 34557620 38092002 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 262885831 284934253 Program services include the processing and payment of claims for dental programs for various organizations, corporations, individuals, and other business enterprises. There are approximately 743,400 members included in the various plans and approximately 1,520,900 claims were processed in 2011. 297700 297700 Grant made to the Northeast Delta Dental Foundation ($297,700). 263183531 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 0 1 16455 0 1 211 1 1 1 0 0 0 0 0 X 15 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Frank Boucher 6032231000 One Delta Drive PO Box 2002 Concord NH 03302 TERENCE A WARDROP 3.00 X X 22779 0 0 SHEILA A KENNEDY DDS MPH 3.00 X X 4878 0 0 MARY ANN ALDRICH RN 3.00 X 4778 0 0 MICHAEL DEGNAN 3.00 X 3816 0 0 DENNIS HANNON DDS 3.00 X 4778 0 0 DOUGLAS J KATZ DMD 3.00 X 5259 0 0 JEFFREY S KIPPERMAN CPA 3.00 X 6182 0 0 FRANCIS H LABRANCHE DDS 3.00 X 4778 0 0 JEFFREY W RODDEN DDS 3.00 X 6221 0 0 NICK S SOGGU 3.00 X 5259 0 0 ELIZABETH SPINDEL DMD 3.00 X 3367 0 0 PHYLLIS W WAGSTAFF DMD 3.00 X 3816 0 0 SETH P WALL 3.00 X 5259 0 0 PETER A WELNAK DDS 5.00 X 3958 0 0 SUSAN H WOODS 3.00 X 5259 0 0 KATHRYN L YERKES 3.00 X 5740 0 0 THOMAS RAFFIO 60.00 X 708515 0 135902 HELEN T BIGLIN PART YEAR 40.00 X 152378 0 23041 FRANCIS BOUCHER PART YEAR 40.00 X 121453 0 16312 SARA M BREHM 40.00 X 69958 0 5284 WILLIAM H LAMBRUKOS 40.00 X 170046 0 29159 SHANNON MILLS 40.00 X 165740 0 24078 CONSTANCE ROY-CZYZOWSKI 40.00 X 153210 0 26426 LAURENCE R WEISSBROT 40.00 X 146332 0 18043 MICHAEL D BOURBEAU 40.00 X 151122 0 8701 1934881 0 286946 14 0 1 0 Combined Services LLC 2 Delta Drive Concord NH 03302 Insurance broker commissions 911915 Stephen McCarty (The Concept Group) 114 Spofford Road Boxford MA 01921 Consulting Services 822599 New England Employee Benefits 15 Chenell Drive Concord NH 03301 Insurance broker commissions 359359 Cronin Gervino & Warlick Inc 171 Londonderry Turnpike Hooksett NH 03106 Insurance broker commissions 186840 Sheehan Phinney Bass & Green 1000 Elm Street PO Box 3701 Manchester NH 03105 Legal 163893 8 Admin Service Contract 524292 224699136 224699136 Premium Revenue 524114 60235117 60235117 Management Fee - CSLLC 524298 100000 100000 285034253 1071830 1071830 195976 239695 -43719 -43719 -43719 4825330 24415 4530965 7562 294365 16853 311218 311218 286373582 284934253 100000 1339329 297700 297700 253742568 253742568 1328970 1328970 9768213 3955971 5812242 141997 115544 26453 2524547 1137172 1387375 736389 326107 410282 148228 148228 109439 109439 64113 64113 1087735 256209 831526 1442293 1442293 2464477 1600960 863517 753936 338317 415619 87149 14815 72334 376874 24497 352377 6118 2747 3371 1360880 566845 794035 117589 40362 77227 Brokers' Commissions 3690880 3690880 Premium Taxes 981885 981885 Strategic Initiatives 953911 953911 Equipment/Software Main 765169 317885 447284 585645 445832 139813 283536705 263183531 20353174 0 3045675 5618179 35368 439711 4156301 4468494 140714 288952 18769229 10640798 8415879 8128431 28051137 29691616 1352030 1392668 120672 107640 45317776 50135691 4810531 6019739 100700 152200 1890000 1680000 3958925 4191750 10760156 12043689 X 34557620 38092002 34557620 38092002 45317776 50135691 X 2836877 697504 X X 0 1 1 X 0 1133345 1133345 8562675 3760355 4802320 384735 384735 0 8509647 6334467 2175180 178827 161241 17586 8128431 Unearned Revenue 1189323 Accrued Refunds 946386 Other Advances 2056041 4191750 286373582 283536705 2836877 697504 697504 3534381 80098218 697504 697504 79400714 64113 206908755 206972868 286373582 76563836 0 76563836 64113 206908755 206972868 283536704 Description of Uncertain Tax Positions Under FIN 48: Part X: The 2011 audited financial statements contain the following verbatim 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. In accordance with accounting principles generally accepted in the United States of America, 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 financial statements. Tax years after December 31, 2007 are open for Internal Revenue Service or state examination. Part XII, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 206,908,755. Part XIII, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 206,908,755. 1 Northeast Delta Dental Foundation One Delta Drive PO Box 2002 Concord NH 03302 020489150 501(c)(3) 297700 General support to promote oral health Delta Dental Plan of New Hampshire, Inc. (DDPNH) 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. DDPNH's elective contributions to the Foundation in 2011 totaled $297,700. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 THOMAS RAFFIO 522200 0 131700 0 54615 0 111750 0 24152 0 844417 0 0 0 HELEN T BIGLIN PART YEAR 114876 0 6054 0 31448 0 5468 0 17573 0 175419 0 0 0 WILLIAM H LAMBRUKOS 155377 0 4978 0 9691 0 5268 0 23891 0 199205 0 0 0 SHANNON MILLS 160444 0 5296 0 0 0 5028 0 19050 0 189818 0 0 0 CONSTANCE ROY-CZYZOWSKI 144780 0 5608 0 2822 0 4769 0 21657 0 179636 0 0 0 LAURENCE R WEISSBROT 140899 0 5036 0 397 0 4421 0 13622 0 164375 0 0 0 MICHAEL D BOURBEAU 136229 0 5237 0 9656 0 4423 0 4278 0 159823 0 0 0 Part I, Line 1a Spousal travel for one business trip per year. Part I, Line 4b Thomas Raffio (President & CEO) - 2011 total contributions to nonqualified deferred compensation plans = $104,400 to 457(f) plan Part I, Line 7 The organization has a team bonus program for all employees. Each individual's bonus is based on a combination of the individual's performance, the Organization's performance compared to the predetermined goals, and the individual's job level within the Organization. 0 Elizabeth S Spindel DMD Director 356915 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 Peter A Welnak DDS Director 285180 0 Douglas J Katz DMD Director 215739 0 Francis H LaBranche DDS Director 183053 0 Jeffrey W Rodden DDS Director 141249 0 Phyllis W Wagstaff DMD Director 114059 0 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 B, line 15 CEO's Compensation: Every year, the Board Tri-State Compensation Committee goes through a rigorous evaluation and carefully researches information on which it bases its recommendations for the compensation for the President & CEO. This includes the engagement of independent compensation consultants and advisors. The independent Tri-State Compensation Committee comprises the Chairs of the Boards for the Delta Dental Plans of Maine, Vermont, and New Hampshire and the Executive Committee of the DDPNH Board. In reviewing the compensation and benefits, the Committee considered various sources of comparability data and the analysis of comparability data and market conditions presented by the independent compensation consultant. In February 2011, the Tri-State Compensation Committee reviewed and approved the CEO's proposed compensation, effective April 1, 2011, for the Treasurer and Secretary based on comparability data provided to the Committee. Form 990, Part VI, Section C, line 19 Upon request, Delta Dental Plan of New Hampshire, Inc. makes its governing documents, conflict of interest policy, or financial statements available to the public. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 697,504. Audit Review Process Form 990, Part XII, Line 2c: The Finance/Audit Committee oversees the audit process for Delta Dental Plan of New Hampshire, Inc. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit in both 2010 and 2011.