2021-11-15T06:43:34-06:00 2020-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2020-01-01 020273013 Delta Dental Plan of New Hampshire Inc DELT 6032231000 One Delta Drive PO Box 2002 Concord NH 033022002 Thomas Raffio President & CEO 6032231000 2021-11-10 1 Thomas Raffio 999009999 E Drew Cheney P00182972 8002447444 2021-11-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Thomas Raffio One Delta Drive PO Box 2002 Concord NH 033022002 338737482 0 X www.nedelta.com X 1961 NH Provide programs of dental care 15 8 183 0 100000 0 0 0 381047984 332744477 -675676 2180536 -49742 -39399 380322566 334885614 137000 565393 339988883 286545709 20477900 19440183 0 0 0 19785210 24526115 380388993 331077400 -66427 3808214 75216563 82249112 14917915 15240353 60298648 67008759 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 300381424 0 332644477 Delta Dental Plan of New Hampshire 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. Delta Dental Plan of New Hampshire processed approximately 667,300 claims in 2020. There are approximately 363,300 members in New Hampshire included in the various plans. Customers' 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; 7) Marketing service contracts. In the event one or more of these service guarantees are not met, a cash reimbursement is provided. 565393 565393 0 Delta Dental Plan of New Hampshire 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. 300946817 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 17944 0 1 183 1 1 1 0 0 0 0 0 0 0 X 15 8 0 0 0 0 1 0 1 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 Thomas Raffio President & CEO 80.00 X 982967 0 31593 Erica Bodwell VP, General Counsel 50.00 X 386475 0 37783 Joseph Errante VP, Professional Relations 47.00 X 337783 0 31111 William H Lambrukos Sr. VP Operations 40.00 X 291182 0 30343 Jodie L Hittle VP, Marketing 50.00 X 282712 0 25335 Constance Roy Czyzowski VP, Human Resources 50.00 X 270830 0 20089 Francis Boucher Treasurer & Sr VP Finance 48.00 X 270241 0 22056 Sara M Brehm Secretary 50.00 X 120696 0 16610 David Staples DDS Chair & Director 3.00 X X 31027 0 0 Christiane Rothwangl DDS Director 3.00 X 11160 0 0 James St Jean Director 3.00 X 10420 0 0 Richard Bolduc DMD Vice Chair & Director 3.00 X X 9920 0 0 Matthew Cookson Director 3.00 X 9800 0 0 Jean-Paul Rabbath DMD Director 3.00 X 8560 0 0 Karen Carew CPA CFE Director 3.00 X 8060 0 0 Jason Golden Director 3.00 X 7440 0 0 Keith Levesque DMD Director 3.00 X 6820 0 0 James Larrick Director 3.00 X 6200 0 0 Nader Moavenian DDS Director 3.00 X 6200 0 0 Rachel Forbes DMD Director 3.00 X 4340 0 0 Tracy Claybaugh Director (start 4/2020) 3.00 X 3720 0 0 Joseph Carelli Director (start 4/2020) 3.00 X 3100 0 0 Cydney Shapleigh Director (start 4/2020) 3.00 X 3100 0 0 Lisa Braiterman Director (end 4/2020) 3.00 X 1240 0 0 3073993 0 214920 59 0 1 0 Softserve Inc 12800 University Drive Suite 41 Fort Myers FL 33907 Contracted Services 1265360 Worldcom Exchange Inc 43 Northwestern Drive Salem NH 03079 Contracted Services 1055006 Wyssta Services Inc PO Box 86 Stevens Point WI 54481 Contracted Services 1018563 Combined Services LLC 2 Delta Drive Concord NH 03302 Insurance broker commissions 823132 Elixirr LLC 605 Guadalajara Circle Irving TX 75062 Professional consulting 451079 23 Admin service contract fees 524292 267662906 267662906 Premium revenue 524114 64981571 64981571 Management fee - CSLLC 524298 100000 100000 332744477 1097196 1097196 221463 260862 -39399 -39399 -39399 4674346 3591006 1083340 1083340 1083340 334885614 332644477 100000 2141137 565393 565393 286545709 286545709 1575270 567097 1008173 13643691 6033179 7610512 413025 167688 245337 2737904 1122541 1615363 1070293 451663 618630 357322 357322 112322 112322 134698 134698 1819339 54580 1764759 1658075 961684 696391 2339170 977773 1361397 790016 346027 443989 28381 3917 24464 119606 9927 109679 6180 2713 3467 1524157 669105 855052 239302 98353 140949 Strategic initiatives 9914094 2369468 7544626 Brokers' commissions 4285699 4285699 Premium taxes 1197754 1197754 331077400 300946817 30130583 0 8004343 9308228 524960 135682 6265105 4907791 863751 863374 30270536 21821496 7414346 8449040 49510592 54775961 675713 446914 1815128 3212101 142625 150021 75216563 82249112 8118201 7483783 1050000 840000 5749714 6916570 14917915 15240353 X 60298648 67008759 60298648 67008759 75216563 82249112 X 3808214 2445949 455948 X X 0 1 X 1 0 9500 9500 0 9500 1 Committee To Elect Donna Soucy 91 Alexander Drive Manchester NH 03109 460562207 1000 Friends of Chris Sununu PO Box 957 Exeter NH 03833 454901693 1000 Morse for State Senate 14 Old Farm Road Salem NH 03079 273071602 1000 Friends of Jeb Bradley for State Senate 645 South Main Street Wolfeboro NH 03894 264422111 500 Committee to Elect House Republicans 75 South Main Street Unit 7 Box 1 Concord NH 03301 463192141 500 Committee to Elect House Democrats 105 N State Street Concord NH 03301 141906794 500 NH Senate Republicans PAC PO Box 3512 Manchester NH 03105 463728365 750 NH Senate Democratic Caucus 105 North State Street Concord NH 03301 020473096 750 Friends of Cindy Rosenwald 101 Wellington Street Nashua NH 03064 830627490 500 Tom Sherman for State Senate 296 Harbor Road Rye NH 03870 812841560 500 Sununu Inaugural 31 Chestnut Street 312 Exeter NH 03833 814606499 2500 Part I-A, Line 1: Eleven campaign donations totalling $9,500 were made in New Hampshire. 1133345 1133345 10002065 6938985 3063080 387895 387105 790 18569168 14354780 4214388 178063 140626 37437 8449040 Unearned revenue 3143601 Accrued refunds 745169 Other advances 3027800 6916570 X 93217138 2445949 2445949 90771189 134698 243979727 244114425 334885614 88222264 0 88222264 134698 242720438 242855136 331077400 Part X, Line 2: The 2020 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 2d - Other Adjustments: Change in nonadmitted assets Part XI, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 242,720,438. Change in nonadmitted assets 1,259,289. Part XII, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 242,720,438. 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 New Hampshire Department 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) 565393 General support to promote oral health 1 0 Part I, Line 2: Delta Dental Plan of New Hampshire, Inc. (DDPNH) 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. DDPNH's elective contributions to the Foundation in 2020 totaled $565,393. X 1 1 X X X X X 0 0 0 0 0 0 0 1 0 Thomas Raffio President & CEO 578726 0 132518 0 271723 0 8400 0 23193 0 1014560 0 0 0 Erica Bodwell VP, General Counsel 263072 0 98130 0 25273 0 8400 0 29383 0 424258 0 0 0 Joseph Errante VP, Professional Relations 278434 0 59349 0 0 0 8351 0 22760 0 368894 0 0 0 William H Lambrukos Sr. VP Operations 237236 0 46686 0 7260 0 7817 0 22526 0 321525 0 0 0 Jodie L Hittle VP, Marketing 212677 0 41259 0 28776 0 6920 0 18415 0 308047 0 0 0 Constance Roy Czyzowski VP, Human Resources 214667 0 45523 0 10640 0 6759 0 13330 0 290919 0 0 0 Francis Boucher Treasurer & Sr VP Finance 220955 0 42954 0 6332 0 7165 0 14891 0 292297 0 0 0 Part I, Line 1a Delta Dental Plan of New Hampshire provides for the spouses of Senior VPs to attend one business trip per year. The Plan also provides for the CEO and his spouse to travel and attend business trips together as required or appropriate. 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. Nader Moavenian DDS Director 1499000 The Directors listed here have ownership interests in dental practices that receive insurance reimbursements from Delta Dental Plan of New Hampshire in the ordinary course of their business. All transactions are at arm's length and for fair value. 0 Richard Bolduc DDS Vice Chair & Director 334249 Please see above. 0 Rachel Forbes DMD Director 327822 Please see above. 0 David Staples DDS Chair & Director 325109 Please see above. 0 Keith Levesque DMD Director 259123 Please see above. 0 Jean-Paul Rabbath DMD Director 219458 Please see above. 0 Christiane Rothwangl DDS Director 186801 Please see above 0 Form 990, Part VI, Section A, line 6 The membership of Delta Dental Plan of New Hampshire, Inc. consists of the New Hampshire dentists participating in the company's networks which are used by individuals covered under one of the Company's dental benefit plans. Form 990, Part VI, Section A, line 7b Membership approval is required for all Bylaw changes. 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 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 2019, the Tri-State Compensation Committee reviewed and approved the CEO's proposed compensation, effective April 1, 2019, 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. Form 990, Part XI, line 9: Unrealized gains/(losses) on bonds 455,948. 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 2019 and 2020. 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 to conform with the statutory accounting practices of the National Association of Insurance Commissioners (NAIC), as prescribed or permitted by the New Hampshire Department of Insurance. This is one of the reconciling items to meet the reporting requirements for the Form 990.