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DELTA DENTAL PLAN OF VERMONT INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
DELTA DENTAL PLAN OF VERMONT INC (EIN 03-0219391)
Tax period
2019-01-01 to 2019-12-31
Filed
2020-11-13
IRS object ID
202023189349301982
Schema version
2019v5.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2020-11-13T08:57:05-06:00ReturnTs
Tax Period End2019-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN010494526PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BAKER NEWMAN & NOYES LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1650 ELM STREET SUITE 302AddressLine1Txt
CityMANCHESTERCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03101ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN030219391EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Delta Dental Plan Of Vermont IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlDELTBusinessNameControlTxt
Phone6032231000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 2002AddressLine1Txt
CityConcordCityNm
State AbbreviationNHStateAbbreviationCd
ZIP033022002ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTHOMAS RAFFIOPersonNm
Person TitlePresident & CEOPersonTitleTxt
Phone6032231000PhoneNum
Signature2020-11-10SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonE Drew CheneyPreparerPersonNm
PTINP00182972PTIN
Phone8002447444PhoneNum
Preparation2020-11-10PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address208.105.168.164IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-11-10IPDt
IP Tm17:14:28IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdC20447127DC59709279852AA978DA2EB3E2E3F4DAtSubmissionCreationDeviceId
At Submission Filing Device IdF4BFD06137A0D14541E57ECE68CCEBA7C4E04E30AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2021-04-22 16:20:28ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerThomas RaffioPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 2002AddressLine1Txt
CityConcordCityNm
State AbbreviationNHStateAbbreviationCd
ZIP033022002ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$93,446,290GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website Addresswww.nedelta.comWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1965FormationYr
Legal Domicile StateVTLegalDomicileStateCd
Activity Or MissionProvide programs of dental careActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee4TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$100,000TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$80,558,581PYProgramServiceRevenueAmt
CY Program Service Revenue$86,028,535CYProgramServiceRevenueAmt
PY Investment Income$1,285,221PYInvestmentIncomeAmt
CY Investment Income-$892,839CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$81,843,802PYTotalRevenueAmt
CY Total Revenue$85,135,696CYTotalRevenueAmt
PY Grants And Similar Paid$149,789PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$65,800CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$69,901,399PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$75,582,786CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$691,269PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$680,912CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$9,010,136PYOtherExpensesAmt
CY Other Expenses$9,943,174CYOtherExpensesAmt
PY Total Expenses$79,752,593PYTotalExpensesAmt
CY Total Expenses$86,272,672CYTotalExpensesAmt
PY Revenues Less Expenses$2,091,209PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,136,976CYRevenuesLessExpensesAmt
Total Assets BOY$30,118,399TotalAssetsBOYAmt
Total Assets EOY$31,266,798TotalAssetsEOYAmt
Total Liabilities BOY$3,134,189TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,470,920TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$26,984,210NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$27,795,878NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionIt 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.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$79,175,958ExpenseAmt
Grant$0GrantAmt
Revenue$85,928,535RevenueAmt
DescDelta Dental Plan of Vermont 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 Vermont processed approximately 434,500 claims in 2019. There are approximately 206,900 members in Vermont 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.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$65,800ExpenseAmt
Grant$65,800GrantAmt
Revenue$0RevenueAmt
DescDelta Dental Plan of Vermont 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.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$79,241,758TotalProgramServiceExpensesAmt
Described In Section501c30DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign ActyYes (1)PoliticalCampaignActyInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related InvstYes (1)ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org MemYes (1)BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntYes (1)BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
IRP Document106IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee4EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Frank BoucherBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6032231000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 2002AddressLine1Txt
CityConcordCityNm
State AbbreviationNHStateAbbreviationCd
ZIP033022002ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
Elizabeth Carmack DMD
Trustee3.00Yes (X)$6,864$0$0
Adam Fasoli DMD
Trustee3.00Yes (X)$7,748$0$0
Theron Main DDS
Trustee3.00Yes (X)$8,556$0$0
Suzanne M McDowell
Trustee3.00Yes (X)$6,268$0$0
Rachel Rivard DMD
Trustee3.00Yes (X)$6,268$0$0
Nancy Rowden-Brock
Trustee3.00Yes (X)$11,036$0$0
Brian Townsend
Trustee3.00Yes (X)$8,652$0$0
Jason Williams
Trustee3.00Yes (X)$7,364$0$0
David A Baasch DDS
Trustee & Chair3.00Yes (X)$28,157$0$0Yes (X)
David Solomon DDS
Trustee & Vice Chair3.00Yes (X)$19,880$0$0Yes (X)
Katherine O'Connell CPA
Trustee & Treasurer3.00Yes (X)$13,420$0$0Yes (X)
Richard W Park
Trustee & Secretary3.00Yes (X)$12,132$0$0Yes (X)
Thomas Raffio
DDPNH President & CEO10.00$0$2,339,510$55,846Yes (X)
William H Lambrukos
DDPNH Sr. Vice President10.00$0$255,100$48,202Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$136,345TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,594,610TotReportableCompRltdOrgAmt
Total Other Compensation$104,048TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other SrcsYes (1)CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Wyssta Services Inc
PO Box 86Stevens PointWI54481Contracted services$438,141
Combined Services LLC
2 Delta DriveConcordNH033022002Insurance broker commissions$356,119
Richards Inc
48 Harris Place PO Box 820BrattleboroVT05302Insurance broker commissions$291,279
Hickok & Boardman
346 Shelburne Road PO Box 1064BurlingtonVT05401Insurance broker commissions$150,910
Encara Inc
4818 Starkey RoadRoanokeVA24018Contracted services$107,993
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K20CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
Admin Service Contract Fees524292$49,979,872$49,979,872
Premium Revenue524114$35,948,663$35,948,663
Management fee - CSLLC524298$100,000$100,000
FieldValueIRS element (for citing)
Total Program Service Revenue$86,028,535TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$590,731TotalRevenueColumnAmt
Exclusion$590,731ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$4,908,107SecuritiesAmt
Other$1,918,917OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$4,643,636SecuritiesAmt
Other$3,666,958OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$264,471SecuritiesAmt
Other-$1,748,041OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$1,483,570TotalRevenueColumnAmt
Exclusion-$1,483,570ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$85,135,696TotalRevenueColumnAmt
Related Or Exempt Func Income$85,928,535RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$100,000UnrelatedBusinessRevenueAmt
Exclusion-$892,839ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$65,800TotalAmt
Program Services$65,800ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$75,582,786TotalAmt
Program Services$75,582,786ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$136,345TotalAmt
Management And General$136,345ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$380,276TotalAmt
Management And General$380,276ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$26,744TotalAmt
Management And General$26,744ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$109,687TotalAmt
Management And General$109,687ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$27,860TotalAmt
Management And General$27,860ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$16,670TotalAmt
Management And General$16,670ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$35,784TotalAmt
Management And General$35,784ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$95,808TotalAmt
Management And General$95,808ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$42,300TotalAmt
Management And General$42,300ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$309,941TotalAmt
Management And General$309,941ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$52,943TotalAmt
Management And General$52,943ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$51,284TotalAmt
Management And General$51,284ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$16,480TotalAmt
Management And General$16,480ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$83,009TotalAmt
Management And General$83,009ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,212TotalAmt
Management And General$2,212ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$14,853TotalAmt
Management And General$14,853ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Administration - DDPNH$6,775,017$3,245,233$3,529,784
Brokers' commissions$1,473,271$1,473,271
administration - DDPNH$225,649$225,649
Marketing related$181,797$181,797

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$566,156TotalAmt
Program Services$122,290ProgramServicesAmt
Management And General$443,866ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$86,272,672TotalAmt
Program Services$79,241,758ProgramServicesAmt
Management And General$7,030,914ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,093,408BOYAmt
EOY$1,328,685EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$2,247,058BOYAmt
EOY$1,454,395EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,880,481BOYAmt
EOY$2,625,822EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$200,000BOYAmt
EOY$200,000EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$6,650BOYAmt
EOY$6,650EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$68,458LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$62,363LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$8,306BOYAmt
EOY$6,095EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$20,380,962BOYAmt
EOY$23,804,073EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$20,636BOYAmt
EOY$25,581EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$3,103,137BOYAmt
EOY$1,636,377EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$177,761BOYAmt
EOY$179,120EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$30,118,399BOYAmt
EOY$31,266,798EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,549,307BOYAmt
EOY$1,902,035EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$110,100BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,474,782BOYAmt
EOY$1,568,885EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,134,189BOYAmt
EOY$3,470,920EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$26,984,210BOYAmt
EOY$27,795,878EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$26,984,210BOYAmt
EOY$27,795,878EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$30,118,399BOYAmt
EOY$31,266,798EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$1,136,976ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$1,345,155NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$603,489OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Political Expenditures$750PoliticalExpendituresAmt
Volunteer Hours0VolunteerHoursCnt
Expended527 Activities$750Expended527ActivitiesAmt
Internal Funds Contributed$0InternalFundsContributedAmt
Total Exempt Function Expend$750TotalExemptFunctionExpendAmt
Form1120 POL FiledYes (1)Form1120POLFiledInd

Section527 Political Org Section527PoliticalOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPaid Internal FundsPaidInternalFundsAmt
Vermont Democratic Party
PO Box 1220MontpelierVT05601030199446$500
Franklin County Republican Party
69 Button RoadSt AlbansVT05748030210231$250

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I-A, Line 1:FormAndLineReferenceDesc
ExplanationTwo campaign donations totalling $750 were made in Vermont.ExplanationTxt

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,345OtherCostOrOtherBasisAmt
Depreciation$7,345DepreciationAmt
Book Value$0BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$61,113OtherCostOrOtherBasisAmt
Depreciation$55,018DepreciationAmt
Book Value$6,095BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$6,095TotalBookValueLandBuildingsAmt

Invst Program Related Org InvstProgramRelatedOrgGrp (2 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
Investment in Red Tree Holdings (1/3 interest)$1,457,626F
Investment in IDSC Blocker$178,751F
FieldValueIRS element (for citing)
Total Book Value Program Rltd$1,636,377TotalBookValueProgramRltdAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
Unearned revenue$801,985
Other advances$766,900
FieldValueIRS element (for citing)
Total Liability$1,568,885TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$39,950,802TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$1,345,155NetUnrealizedGainsInvstAmt
Other Revenue$4,722OtherRevenueAmt
Revenue Not Reported$1,349,877RevenueNotReportedAmt
Revenue Subtotal$38,600,925RevenueSubtotalAmt
Investment Expenses Not Incld$95,808InvestmentExpensesNotIncldAmt
Other Revenues Not Included$46,438,963OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$46,534,771RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$85,135,696TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$39,737,901TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$39,737,901ExpensesSubtotalAmt
Investment Expenses Not Incld2$95,808InvestmentExpensesNotIncld2Amt
Other Expenses Not Included$46,438,963OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$46,534,771ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$86,272,672TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part X, Line 2:The 2019 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 4,722.
Part XI, Line 4b - Other Adjustments:Dental claims paid under admin service contracts 46,438,963.
Part XII, Line 4b - Other Adjustments:Dental claims paid under admin service contracts 46,438,963.
Schedule D, Part XI, Line 2dThe 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. 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.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Northeast Delta Dental FoundationBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1One Delta Drive PO Box 2002AddressLine1Txt
CityConcordCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03302ZIPCd
FieldValueIRS element (for citing)
Recipient EIN020489150RecipientEIN
IRC Section501(c)(3)IRCSectionDesc
Cash Grant$65,800CashGrantAmt
Purpose Of GrantGeneral support to promote oral healthPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 2:FormAndLineReferenceDesc
ExplanationDelta Dental Plan of Vermont, Inc. (DDPVT) 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. DDPVT's elective contributions to the Foundation in 2019 totaled $65,800.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Thomas Raffio
DDPNH President & CEO$0$575,726$0$217,283$0$1,546,501$0$24,099$0$31,747$0$2,395,356$0$1,101,642
William H Lambrukos
DDPNH Sr. Vice President$0$221,244$0$30,047$0$3,809$0$22,608$0$25,594$0$303,302$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 4bThomas Raffio - 2019 payout of $1,517,011 from the 457(f) deferred compensation plan. This plan was created in 2008 and became vested in 2019. Prior to 2019, the plan had a substantial risk of forfeiture. The payment of $1,517,091 consisted of $1,101,642 of compensation contributions included on prior Forms 990, a final $115,145 contribution for 2019, and $300,224 of earnings credits at them rime interest rate from 2008 through the final payment date of February 28, 2019. This payment accumulated over many years and represents compensation for many years of service
Schedule J, Part II:Thomas Raffio, CEO, and William Lambrukos, Senior Vice President, received all of their compensation from Delta Dental Plan of New Hampshire, which is an unrelated organization per Schedule R definitions.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (5 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
Adam Fasoli
Trustee$662,102The Trustees 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
David A Baasch DDS
Trustee$287,590Please see above.0
David B Solomon DDS
Trustee$200,808Please see above.0
Elizabeth Carmack DMD
Trustee$469,939Please see above.0
Theron Main DDS
Trustee$6,639,792Please see above. The Dental Practice that Dr. Main is associated with is a multi-specialty dental practice with 21 dentists practicing in four locations.0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part V, Line 2aThe four 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 Delta Dental Plan of Vermont. Delta Dental Plan of Vermont reimburses Delta Dental Plan of New Hampshire for these employees' payroll and employee benefit expenses.
Form 990, Part VI, Section A, line 6The membership of Delta Dental Plan of Vermont consists of the Vermont dentists participating in the Company's networks which are used by individuals convered under one of the Company's dental benefit plans.
Form 990, Part VI, Section A, line 7aThe members elect the Board of Trustees using a mail-in-ballot process which allows for petitioned candidates.
Form 990, Part VI, Section A, line 7bMembership approval is required for all Bylaw changes.
Form 990, Part VI, Section B, line 11bThe 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 12cA copy of the conflict of interest policy is distributed annually to all officers, trustees, 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 Trustees. The trustees 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 19Upon request, Delta Dental Plan of Vermont, Inc. makes its governing documents, conflict of interest policy, or financial statements available to the public.
Form 990, Part XI, line 9:Change in unrealized gains/(losses) in bonds 603,489.
Form 990, Part XII, Line 2c:The Finance/Audit Committee oversees the audit process for Delta Dental Plan of Vermont. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit in both 2018 and 2019.
Form 990, Part XI, Line 9The 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.