2025-10-21T15:07:45-05:00 2024-12-31 010494526 Baker Newman & Noyes 650 Elm Street Suite 302 Manchester NH 03101 990 2024-01-01 020273013 Delta Dental Plan of New Hampshire Inc DELT 6032231000 One Delta Drive PO Box 2002 Concord NH 033022002 Thomas Raffio President & CEO 6032231000 2025-10-20 1 0 Connor Smart P02285543 6036262200 2025-10-20 2024 2025-03-06 01:10:19Z Thomas Raffio One Delta Drive PO Box 2002 Concord NH 033022002 508206157 0 X www.nedelta.com X 1961 NH Provide programs of dental care 15 9 192 0 100000 0 0 0 455006263 493876385 2599479 3254312 -133667 -113608 457472075 497017089 583600 716680 404850783 443466273 23458169 25096007 0 0 0 24662731 28222116 453555283 497501076 3916792 -483987 91954190 92260948 16688286 16581772 75265904 75679176 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. 1 0 457555809 0 493776385 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 882,900 claims in 2024. There are approximately 403,700 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; and (7) marketing service contracts. In the event one or more of these service guarantees are not met, a cash reimbursement is provided. 161366 161366 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. 555314 555314 0 Delta Dental Plan of New Hampshire (DDPNH) participated in Northeast Delta Dental's initiative to attract more dentists to Northern New England. Through this program, DDPNH contributed to a shared pool of funds administered by the Recruitment Center at Bi-State Primary Care Association (Bi-State). These funds support dental student loan repayment and forgiveness plans and help to retain qualified dental health professionals in the New England region. During this tax year, DDPNH provided over $550,000 in grants to more than 10 recipients within this initiative, bolstering New England's professional dental care workforce and capacity and improving access to dental care in New Hampshire. 458272489 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 1 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 X 23723 0 1 192 1 1 1 0 0 0 0 0 0 0 X 15 9 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Laurie Bienefeld 6032231000 One Delta Drive PO Box 2002 Concord NH 03302 Matthew Cookson Vice Chair & Director 3.00 X X 38976 0 0 Karen Carew CPA CFE Director 3.00 X 13600 0 0 James St Jean Director 3.00 X 13375 0 0 Joseph J Carelli Jr Director 3.00 X 12875 0 0 Leesa Smith Director 3.00 X 12875 0 0 Cydney Shapleigh Director 3.00 X 12650 0 0 David Staples DDS Chair & Director (end 4/2024) 3.00 X X 12564 0 0 Rachel Forbes DMD Director 3.00 X 11425 0 0 Praveen Mandera DMD Director 3.00 X 11425 0 0 Keith Levesque DMD Director 3.00 X 11200 0 0 Tracy Claybaugh Director 3.00 X 10700 0 0 Caroline Clerisme DMD Director 3.00 X 9975 0 0 Jennifer E Gilkie Director 3.00 X 8700 0 0 Colin Boswell DDS Director 3.00 X 8525 0 0 Whitney E Goode Director 3.00 X 7075 0 0 Harish Gulati Director 3.00 X 3625 0 0 Nader Moavenian DDS Director (end 4/2024) 3.00 X 2900 0 0 Thomas Raffio President & CEO 80.00 X 1112510 0 72619 Laurie Bienefeld Treasurer & VP Finance 50.00 X 265206 0 22378 Sara M Brehm Secretary 50.00 X 161275 0 29422 Joseph Errante VP, Professional Relations 47.00 X 407183 0 63505 William H Lambrukos Sr. VP Operations 40.00 X 352772 0 63316 Jodie L Hittle VP, Marketing 50.00 X 345593 0 54034 Michael Bourbeau VP, Information Systems 50.00 X 337133 0 33971 Brian D Duffy VP & General Counsel 50.00 X 322141 0 33880 3506278 0 373125 71 0 1 0 DentaQuest USA Insurance 96 Worcester Street Wellesley MA 02481 Contracted services 20535828 Worldcom Exchange Inc 43 Northwestern Drive Salem NH 03079 Contracted services 1741889 Wyssta Services Inc PO Box 86 Stevens Point WI 54481 Contracted services 1515388 Zelis Payment Holdings LLC PO Box 874488 Kansas City MO 64187 Contracted services 716090 Cronin Gervino & Warlick Inc 5 Dartmouth Drive Auburn NH 03032 Insurance broker commissions 516457 22 Admin service contract fees 524292 404329661 404329661 Premium revenue 524114 88381482 88381482 NH Medicaid 524298 1065242 1065242 Management fee - CSLLC 524298 100000 100000 493876385 2294100 2294100 153686 267294 -113608 -113608 -113608 11826986 55000 10864923 56851 962063 -1851 960212 960212 497017089 493776385 100000 3140704 161366 161366 555314 555314 443466273 443466273 1865875 671918 1193957 17474976 7688812 9786164 486115 486115 3970199 3970199 1298842 1298842 228494 228494 139906 37775 102131 165608 165608 2755110 55103 2700007 2110492 1202980 907512 3475651 1425017 2050634 874551 376057 498494 38510 1644 36866 319241 5669 313572 2056272 778126 1278146 321812 131942 189870 Strategic initiatives 9313411 1714493 7598918 Brokers' commissions 4378832 4378832 Premium taxes 2041726 2041726 NH Medicaid Expense 2500 2500 497501076 458272489 39228587 0 12733693 8487697 241394 777517 7904656 7705527 541303 858836 37767577 30325317 7890428 7442260 58978215 62918688 51007 29125 3407431 3817683 206063 223615 91954190 92260948 11127840 10277621 5560446 6304151 16688286 16581772 X 75265904 75679176 75265904 75679176 91954190 92260948 X -483987 1198161 -300902 X X 0 1 X 1 0 7500 7500 0 7500 1 Committee to elect Donna Soucy 91 Alexander Drive Manchester NH 03109 460562207 1000 Friends of Sharon Carson 19 Tokanel Drive Londonderry NH 03053 800628169 1000 Committee to elect David Watters 19 Maple Street Dover NH 03820 262910228 500 Friends of Cindy Rosenwald 101 Wellington Street Nashua NH 03064 830627490 500 Friends of Regina Birdsell 24 Larson Drive Hampstead NH 03841 272345889 500 Kelly for New Hampshire Inc PO Box 4723 Manchester NH 03108 932094862 1000 Bill Gannon for State Senate PO Box 71 Sandown NH 03873 872726672 500 James Gray 4 NH Senate 21 Roulx Drive Rochester NH 03867 812726672 500 Joyce Craig for New Hampshire 369 N Bend Drive Manchester NH 03104 923571316 1000 Vote Tim Lang 140 Upper Smith Road Sanbornton NH 03269 882981040 500 Friends of Howard Pearl 409 Loudon Ridge Road Loudon NH 03307 455508503 500 Part I-A, Line 1: Eleven campaign donations totaling $7,500 were made in New Hampshire. 1133345 1133345 11385560 8622057 2763503 387895 387895 0 24696645 21230387 3466258 164132 84978 79154 7442260 Unearned revenue 2500460 Accrued refunds 559128 Other advances 3244563 6304151 X 125645739 1198161 85360 1283521 124362218 165608 372489263 372654871 497017089 124846205 0 124846205 165608 372489263 372654871 497501076 Part X, Line 2: The Corporation is generally exempt from federal and state income taxes under the provisions of Section 501(c)(4) of the Internal Revenue Code. However, the Corporation may still be subject to certain income taxes on net income generated from activities deemed to be unrelated business income. 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 85,360. Part XI, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 372,489,263. Part XII, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 372,489,263. 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) 161366 0 General support to promote oral health 1 0 Dental School Student Loan Repayment Program 13 555314 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 2024 totaled $161,366. Additionally, during the tax year covered by this Form 990, DDPNH participated in a Northern New England dental school student loan repayment and forgiveness program. In an effort to attract more dentists to Northern New England, Delta Dental has provided funding to be used for dental student loan repayments. The new program will be administered by the Recruitment Center at Bi-State Primary Care Association (Bi-State) and is governed by a Steering Committee with representatives from Maine, New Hampshire, and Vermont. By providing another avenue to help dentists with student loan debt through loan repayment, the program expects to be able to attract more dentists to Northern New England. Each qualifying dentist can receive up to $150,000 reimbursed over a three-year period. General dentists, dentists in other specialties, dental students, and residents in training without a concurrent service obligation for loan repayment or debt forgiveness may apply. X 1 1 X X X X X 0 0 0 0 0 0 0 1 0 Thomas Raffio President & CEO 655793 0 434301 0 22416 0 33811 0 38808 0 1185129 0 0 0 Joseph Errante VP, Professional Relations 315253 0 86979 0 4951 0 33811 0 29694 0 470688 0 0 0 William H Lambrukos Sr. VP Operations 268663 0 75275 0 8834 0 33811 0 29505 0 416088 0 0 0 Jodie L Hittle VP, Marketing 236159 0 67637 0 41797 0 30580 0 23454 0 399627 0 0 0 Michael Bourbeau VP, Information Systems 248774 0 69813 0 18546 0 30508 0 3463 0 371104 0 0 0 Brian D Duffy VP & General Counsel 248774 0 61789 0 11578 0 29255 0 4625 0 356021 0 0 0 Laurie Bienefeld Treasurer & VP Finance 207302 0 55126 0 2778 0 19220 0 3158 0 287584 0 0 0 Sara M Brehm Secretary 124351 0 29735 0 7189 0 12619 0 16803 0 190697 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. Colin Boswell DDS Director 61864 Grant Student loan repayment Colin Boswell DDS Director 1433793 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 Rachel Forbes DMD Director 512007 Please see above. 0 Keith Levesque DMD Director 503350 Please see above. 0 Parveen Kumar Mandera DMD Director 571248 Please see above 0 Rachel Forbes DMD Director Rachel Forbes served on the Organization's Board during this tax year. Ms. Forbes's husband owns a temporary and recruiting staffing business that helps other organizations and businesses meet their staffing and labor needs. It is possible that Delta Dental Plan of New Hampshire may have engaged Ms. Forbes's husband's business in its normal course of operations in the past, and/or may do so again in the future. At this time the Organization cannot determine the exact amount paid of contracted labor costs paid to Ms. Forbes's husband's business (if any) during this tax year. However, because there is a possibility of an engagement between the Organization and this staffing agency, this relationship has been disclosed on this Form 990, Schedule L, for transparency purposes. All labor and staffing contracts and payments by Delta Dental Plan of New Hampshire are conducted at fair market value. 0 Form 990, Schedule L, Part III, Grants to Interested Persons: During the tax year covered by this Form 990, Delta Dental Plan of New Hampshire ("DDPNH") participated in a Northern New England dental school student loan repayment and forgiveness program. Colin Boswell, who served on DDPNH Board during this tax year, has received grants through this program of $61,864. (Mr. Boswell was technically approved to receive this grant during the 2023 tax year, but has been included on this Form 990 for transparency purposes.)In an effort to attract more dentists to Northern New England, Delta Dental has provided funding to be used for dental student loan repayments. The new program will be administered by the Recruitment Center at Bi-State Primary Care Association (Bi-State) and is governed by a Steering Committee with representatives from Maine, New Hampshire, and Vermont. By providing another avenue to help dentists with student loan debt through loan repayment, the program expects to be able to attract more dentists to Northern New England. Each qualifying dentist can receive up to $150,000 reimbursed over a three-year period. General dentists, dentists in other specialties, dental students, and residents in training without a concurrent service obligation for loan repayment or debt forgiveness may apply.While Mr. Boswell is a member of DDPNH's Board, Mr. Boswell did not receive any preferential treatment within the grant program's application, review, or approval processes. Mr. Boswell applied for student loan relief through the program in the same manner as all other applicants and recipients. Furthermore, the Board of DDPNH does not dictate which specific individuals receive grants, as such authority is granted to the aforementioned sub-committee. Form 990, Part III, line 2 See description for Part III, Line 4c. 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 by Delta Dental Plan of New Hampshire 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 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 2024, the Tri-State Compensation Committee reviewed and approved the CEO's proposed compensation, effective April 1, 2024, 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 -300,902. 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 2023 and 2024. 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.