2024-11-01T07:25:55-05:00 2023-12-31 010494526 Baker Newman & Noyes 650 Elm Street Suite 302 Manchester NH 03101 990 2023-01-01 010286541 Maine Dental Service Corporation MAIN 6032231000 PO Box 2002 Concord NH 033022002 Thomas Raffio President & CEO 6032231000 2024-09-16 1 0 Connor Smart P02285543 6036262200 2024-09-16 2023 2024-10-15 13:58:12Z Delta Dental Plan of Maine Thomas Raffio PO Box 2002 Concord NH 033022002 191764228 0 X www.nedelta.com X 1965 ME Provides programs of dental care 14 9 7 0 100000 0 0 0 163537312 178099075 735449 6719761 0 0 164272761 184818836 553900 1000500 138844633 153378540 1158470 1271327 0 0 0 19815567 21334442 160372570 176984809 3900191 7834027 75628828 83523588 7640155 8028145 67988673 75495443 X It is our mission to advance the oral health and overall wellness of our customers and the general public by providing innovative benefits and professional partnerships through diversified strategic business and philanthropic initiatives. 0 0 161078848 0 177999075 Maine Dental Service Corporation, Inc. advances and promotes the improvement of oral health by offering innovative, cost effective dental benefits plans that meet the needs of our customers by integrating activities such as cost management policies, fee reduction agreements with dentists, ensuring quality and cost effective dental benefit delivery, and accurate and timely claims payment. We are recognized for our expertise in the dental benefits industry, the vibrancy of our participating dentist network, and our strong brand. Program services include the processing and payment of claims for dental benefits for various large and small groups, as well as individuals and families. Maine Dental Service Corporation, Inc. processed approximately 844,600 claims in 2023. There are approximately 432,700 members in Maine included in the various plans. Customer's expectations for quality standards are extremely rigorous and we provide a guarantee of service called GOSE, or Guarantee of Service Excellence, which guarantees seven key service claims: (1) smooth implementation to Northeast Delta Dental; (2) exceptional customer service; (3) quick processing of claims; (4) no inappropriate billing by participating dentists; (5) accurate and quick turnaround of identification cards; (6) timely employee booklets; and (7) marketing service contracts. In the event one or more of these service guarantees are not met, a cash reimbursement is provided. 1000500 1000500 0 Maine Dental Service Corporation Inc. is one of three members of the Northeast Delta Dental Foundation. The company contributes .075% of annual budgeted revenue, as well as 10% of annual revenue in excess of expenses, to the Northeast Delta Dental Foundation. The Northeast Delta Dental Foundation's purpose is to improve the access to, and the quality of, oral health care and education for the public and dental communities in Maine, New Hampshire, and Vermont. The Northeast Delta Dental Foundation awards numerous grants to community organizations and programs. 162079348 0 0 1 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 X 219 0 1 7 1 1 1 0 0 0 0 0 0 0 X 14 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Laurie Bienefeld 6032231000 One Delta Drive PO Box 2002 Concord NH 03302 X Jeffrey R Walawender DDS Chair & Director 3.00 X X 31768 0 0 Bruce Nickerson CPA Treasurer & Director 3.00 X X 10496 0 0 Laura Oakes DMD Director 3.00 X 13072 0 0 Kristine Avery SPHR Director 3.00 X 10996 0 0 Kathy Reynolds Director & Vice chair (part-year) 3.00 X X 12631 0 0 Scott Normandeau Director 3.00 X 9112 0 0 Grace Odimayo DMD Director 3.00 X 8420 0 0 Craig Bradford Rand DDS Director 3.00 X 11188 0 0 Burton Rankie DDS Director 3.00 X 8420 0 0 Jayne Giles Vice Chair & Director (part-year) 3.00 X X 5652 0 0 David Daigler CPA Director 3.00 X 2076 0 0 Katherin O'Grady Director 3.00 X 10496 0 0 Marcia Minter Director 3.00 X 5536 0 0 Melissa Haidu-Sylvia DDS Director 3.00 X 7728 0 0 Jennifer Thompson Director 3.00 X 2768 0 0 Stephanie Pouzol DMD Director 3.00 X 2768 0 0 Thomas Raffio DDPNH President & CEO 10.00 X 1106070 0 71434 Francis Boucher DDPNH Sr. Vice President (part-year) 10.00 X 184279 0 39856 Laurie Bienefeld DDPNH Vice President of Finance 10.00 X 215209 0 5569 Benjamin Marcus Esq Board Clerk 3.00 X 17951 0 0 1676636 0 116859 3 0 1 1 Wyssta Services Inc PO Box 86 Stevens Point WI 54481 Contracted services 1082245 Cross Benefit Solutions 116 Community Drive Augusta ME 04330 Insurance broker commissions 482200 Combined Services LLC DBA csOne PO Box 1320 Concord NH 03301 Insurance broker commissions 342090 Maine Education Association 35 Community Drive Augusta ME 04330 Administrative fees 258858 Marsh & McLennan Agency LLC 101 Huntington Ave Suite 401 Boston MA 02199 Insurance broker commissions 242154 11 Admin service contract fees 524292 93770338 93770338 Premium revenue 524114 84228737 84228737 Management fees - CSLLC 524298 100000 100000 178099075 2128821 2128821 11536332 6945392 4590940 4590940 4590940 184818836 177999075 100000 6719761 1000500 1000500 153378540 153378540 153127 153127 854107 854107 65535 65535 139692 139692 58866 58866 48413 48413 27717 27717 153964 153964 32915 32915 1201683 1201683 42566 42566 54009 54009 16196 16196 61091 61091 820 820 24270 24270 Administration - DDPNH 14349627 7700308 6649319 Brokers' commissions 3632031 3632031 Strategic initiatives 1310364 1310364 Dues and subscriptions 311486 311486 67290 67290 176984809 162079348 14905461 0 8748037 9948659 4038768 9514590 4663483 5273112 15844 15753 153730 153294 1256 436 55008015 55303952 19521 51007 3063348 3407431 70556 8648 75628828 83523588 4036034 3737882 433400 870300 3170721 3419963 7640155 8028145 X 67988673 75495443 67988673 75495443 75628828 83523588 X 7834027 -327257 0 X X 0 1 X 1 0 4000 4000 4000 1 House Republican Fund PO Box 5629 Augusta ME 04332 364860692 1000 House Democratic Campaign Committee PO Box 2021 Augusta ME 04338 222695883 1000 Senate Democratic Campaign Committee PO Box 2207 Augusta ME 04338 010478979 1000 Maine Senate Republican Majority PAC PO Box 1 Augusta ME 04332 263733192 1000 Part I-A, Line 1: Four campaign donations totaling $4,000 were made in Maine. 21116 21116 0 132614 132178 436 436 Unearned revenue 1496263 Advances - admin service contracts 1923700 3419963 X 97732855 -327257 -327257 98060112 153964 86604760 86758724 184818836 90229337 0 90229337 153964 86601508 86755472 176984809 Part X, Line 2: The 2023 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. 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. Part XI, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 86,601,508. Change in nonadmitted assets 3,252. Part XII, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 86,601,508. 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) 1000500 0 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 0.075% of the budgeted gross billings, plus 10% of the actual increase in unrestricted net assets from operations each year. MDSC's total contributions to the Foundation in 2023 totaled $1,000,500. 0 0 0 0 0 0 0 0 0 Thomas Raffio DDPNH President & CEO 598643 0 470334 0 37093 0 32471 0 38963 0 1177504 0 0 0 Francis Boucher DDPNH Sr. Vice President (part-year) 81240 0 75526 0 27513 0 31165 0 8691 0 224135 0 0 0 Laurie Bienefeld DDPNH Vice President of Finance 184560 0 18404 0 12245 0 3330 0 2239 0 220778 0 0 0 Schedule J, Part II: Thomas Raffio, CEO, Francis Boucher, Senior Vice President, and Laurie Bienefeld, Vice President of Finance, received all of their compensation from Delta Dental Plan of New Hampshire, which is an unrelated organization per Schedule R definitions; while definitionally unrelated, Delta Dental Plan of New Hampshire does coordinate and work closely with the Maine Dental Service Corporation to fulfill their respective exempt missions. In accordance with the IRS Instructions for the Form 990, compensation or payments from an unrelated organization to an individual for services rendered to the filing organization in that person's capacity as an officer, director, trustee, or employee of the filing organization, then the filing organization must report such amounts as compensation from the filing organization. Therefore, the compensation paid to these individuals has been reported on this Form 990, Schedule J, Part II, Payments Made by the Filing Organization, though Maine Dental Service Corporation did not, in fact, directly pay or compensate these individuals; these individuals were paid by Delta Dental Plan of New Hampshire in part for services rendered for the benefit and on behalf of Delta Dental Vermont. Additionally, due to the close working relationship between the two organizations, neither the filing organization nor Delta Dental Plan of New Hampshire is able to make a determination of how much of each named individuals' compensation relates to time and resources expended on either the filing organization or Delta Dental Plan of New Hampshire. For this reason and to promote transparency and compliance with this tax return, the filing organization has elected to report 100% of the named individuals' applicable calendar year compensation as received by the Delta Dental Plan of New Hampshire on this Form 990, Part VII, and Schedule J, in accordance with the definitions and calculations as detailed in the IRS Form 990 Instructions. In addition, Maine Dental Services Corporation (the "Corporation") compensates Drummond Woodsum, an attorney and legal services firm located in Portland, Maine, for services rendered by Benjamin Marcus, Esq., the Organization's Board Clerk, on behalf of the Corporation in his capacity as a standing officer. The Corporation is unaware of and unable to estimate what portion of Mr. Marcus's actual compensation from Drummond Woodsum was specifically due to services rendered on behalf of the Corporation, if any. Accordingly, as a conservative estimate, the Organization has disclosed on this Form 990, Part VII, the full amount paid to Drummond Woodsum in return for Mr. Marcus's services; $17,951 for the period covered by this Form 990. As such amount represents the Maine Dental Service Corporation's best projection of compensation paid to an active Officer by an unrelated organization for services rendered on behalf of the Corporation, such amount has been reported on this Form 990, Part VII, Line 1a(D). Laura Oakes DMD Director 836570 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 Stephanie Pouzol DMD Director 465873 Please see above 0 Craig Bradford Rand DDS Director 687736 Please see above. 0 Melissa Haidu-Sylvia DDS Director 321018 Please see above. 0 Burton Rankie DDS Director 263548 Please see above 0 Form 990, Part V, Line 2a: The seven employees included here are actually employed and paid by Delta Dental Plan of New Hampshire. These employees are assigned to provide sales and marketing services to Maine Dental Services Corporation. Maine Dental Services Corporation reimburses Delta Dental Plan of New Hampshire for these employees' payroll and employee benefit expenses. Form 990, Part V, Line 15: Thomas Raffio is the President & CEO of Delta Dental Plan of New Hampshire, Inc. Mr. Raffio also serves in a similar capacity for the Delta Dental Plan of Vermont and the Maine Dental Services Corporation. These three entities are otherwise independent of and unrelated to each other as defined under IRS Form 990 Instructions. While Delta Dental Plan of New Hampshire technically files and processes Thomas Raffio's compensation, a portion of this compensation is paid in return for services rendered to the two other aforementioned unrelated organizations. However, in accordance with IRS Instructions, the complete amount of compensation paid to Mr. Raffio has been disclosed on this Form 990, reported as compensation and benefits paid by the filing organization. During the period covered by this Form 990, Mr. Raffio received total compensation in excess $1,000,000 and is reported in detail on this Form 990, Part VII and Schedule J. While Mr. Raffio received compensation exceeding $1,000,000 in total, the compensation paid to Mr. Raffio was in return for services rendered on behalf of each of the three unrelated entities; compensation paid to Mr. Raffio in return for services rendered to any one of the entities, taken individually, was less than $1,000,000. These entities in aggregate do not constitute a group of related applicable tax-exempt organizations as defined under Section 4960. As a portion of the compensation paid to Mr. Raffio was in return for services rendered to each of the unrelated tax-exempt organizations, and no single entity's allocated compensation was more than $1,000,000, neither Delta Dental Plan of New Hampshire, nor either of the two other unrelated organizations, are subject to the Section 4960 excise tax on executive compensation exceeding $1,000,000. Accordingly, this Form 990, Part V, Line 15, has been answered "no, and the Organization has not filed Form 4720. Form 990, Part VI, Section A, line 6 The membership of Maine Dental Service Corporation consists of the Board of Directors, all of the individuals covered under the Company's dental benefit plans, and the Maine dentists participating in the Company's dental networks which are used by the individuals covered under one of the Company's dental benefit plans. Form 990, Part VI, Section A, line 7a The Board of Trustees are elected at the Maine Dental Service Corporation's Annual Membership meeting, which requires a quorum of 25 members to conduct business. Form 990, Part VI, Section B, line 11b 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 IV, Line 23; and Part VII, Section A: Thomas Raffio, CEO, Francis Boucher, Senior Vice President, and Laurie Bienefeld, Vice President of Finance, received all of their compensation from Delta Dental Plan of New Hampshire, which is an unrelated organization per IRS definitions; while definitionally unrelated, Delta Dental Plan of New Hampshire does coordinate and work closely with the Maine Dental Service Corporation to fulfill their respective exempt missions. In accordance with the IRS Instructions for the Form 990, compensation or payments from an unrelated organization to an individual for services rendered to the filing organization in that person's capacity as an officer, director, trustee, or employee of the filing organization, then the filing organization must report such amounts as compensation from the filing organization. Therefore, the compensation paid to these individuals has been reported on this Form 990, Part VII, Section A, under Column (D), though the Maine Dental Service Corporation did not, in fact, directly pay or compensate these individuals; these individuals were paid by Delta Dental Plan of New Hampshire in part for services rendered for the benefit and on behalf of Maine Dental Service Corporation. Additionally, due to the close working relationship between the two organizations, neither the filing organization nor Delta Dental Plan of New Hampshire is able to make a determination of how much of each named individuals' compensation relates to time and resources expended on either the filing organization or Delta Dental Plan of New Hampshire. For this reason and to promote transparency and compliance with this tax return, the filing organization has elected to report 100% of the named individuals' applicable calendar year compensation as received by the Delta Dental Plan of New Hampshire on this Form 990, Part VII, and Schedule J, in accordance with the definitions and calculations as detailed in the IRS Form 990 Instructions. 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 2022 and 2023. Form 990, Part XI, Line 9: 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 using accounting practices prescribed or permitted by the Vermont Department of Financial Regulation. This is one of the reconciling items to meet the reporting requirements for the Form 990.