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DELTA DENTAL PLAN OF VERMONT INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
DELTA DENTAL PLAN OF VERMONT INC (EIN 03-0219391)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-11-12
IRS object ID
201813169349300146
Schema version
2017v2.3
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)
Return2018-11-12T07:43:01-06:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

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 Begin2017-01-01TaxPeriodBeginDt

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
Signature2018-11-08SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonE Drew CheneyPreparerPersonNm
PTINP00182972PTIN
Phone8002447444PhoneNum
Preparation2018-11-08PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address208.105.168.164IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-11-08IPDt
IP Tm09:52:31IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdA664E523594A7D029D88D3AD4966DBCC0261F172AtSubmissionCreationDeviceId
At Submission Filing Device IdE7C342458DF4D4AB2E77FA21342842838D49B854AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

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$85,683,359GrossReceiptsAmt
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 Independent6VotingMembersIndependentCnt
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$74,537,690PYProgramServiceRevenueAmt
CY Program Service Revenue$76,766,305CYProgramServiceRevenueAmt
PY Investment Income$610,423PYInvestmentIncomeAmt
CY Investment Income$735,757CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$75,148,113PYTotalRevenueAmt
CY Total Revenue$77,502,062CYTotalRevenueAmt
PY Grants And Similar Paid$188,280PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$141,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$64,141,815PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$66,637,537CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$586,088PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$618,606CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$7,945,867PYOtherExpensesAmt
CY Other Expenses$8,170,147CYOtherExpensesAmt
PY Total Expenses$72,862,050PYTotalExpensesAmt
CY Total Expenses$75,567,290CYTotalExpensesAmt
PY Revenues Less Expenses$2,286,063PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,934,772CYRevenuesLessExpensesAmt
Total Assets BOY$28,860,403TotalAssetsBOYAmt
Total Assets EOY$30,505,253TotalAssetsEOYAmt
Total Liabilities BOY$4,008,368TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,299,413TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$24,852,035NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$27,205,840NetAssetsOrFundBalancesEOYAmt
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$69,574,309ExpenseAmt
Revenue$76,666,305RevenueAmt
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 373,100 claims in 2017. There are approximately 172,700 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$141,000ExpenseAmt
Grant$141,000GrantAmt
DescDelta Dental Plan of Vermont is one of three members of the Northeast Delta Dental Foundation. The company contributes .05% of annual budgeted revenue, as well as 5% 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$69,715,309TotalProgramServiceExpensesAmt
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
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
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 With Officer EntYes (1)BusinessRlnWithOfficerEntInd
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 Document107IRPDocumentCnt
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
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
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 (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
Paula L Cope MEd
Trustee (part year)3.00Yes (X)$3,892$0$0
Theron Main DDS
Trustee3.00Yes (X)$8,672$0$0
Suzanne M McDowell
Trustee3.00Yes (X)$4,836$0$0
Dsvid Solomon DDS
Trustee3.00Yes (X)$10,396$0$0
Nancy Rowden-Brock
Trustee3.00Yes (X)$9,840$0$0
Jason Williams
Trustee3.00Yes (X)$7,560$0$0
Elizabeth Carmack DMD
Trustee3.00Yes (X)$7,616$0$0
Adam Fasoli DMD
Trustee3.00Yes (X)$7,616$0$0
Brian Townsend
Trustee (part year)3.00Yes (X)$4,280$0$0
Katherine O'Connell CPA
Trustee & Treasurer3.00Yes (X)$12,008$0$0Yes (X)
Richard W Park
Trustee & Secretary3.00Yes (X)$10,396$0$0Yes (X)
Paul A Averill DDS
Trustee & Chair3.00Yes (X)$25,886$0$0Yes (X)
David A Baasch DDS
Trustee & Vice Chair3.00Yes (X)$14,788$0$0Yes (X)
Thomas Raffio
DDPNH President & CEO10.00$0$763,808$163,407Yes (X)
William H Lambrukos
DDPNH Sr. Vice President10.00$0$224,678$46,666Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$127,786TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$988,486TotReportableCompRltdOrgAmt
Total Other Compensation$210,073TotalOtherCompensationAmt
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
Combined Services LLC
2 Delta DriveConcordNH033022002Insurance broker commissions$339,495
Encara Inc
4818 Starkey RoadRoanokeVA24018Contracted Services$323,013
Richards Inc
48 Harris Place PO Box 820BrattleboroVT05302Insurance broker commissions$185,908
Wyssta Services Inc
PO Box 86Stevens PointWI54481Contracted Services$127,847
Hickok & Boardman
346 Shelburne Road PO Box 1064BurlingtonVT05401Insurance broker commissions$112,472
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
Premium Revenue524114$38,435,542$38,435,542
Admin Service Contract Fees524292$38,230,763$38,230,763
Management fee - CSLLC524298$100,000$100,000
FieldValueIRS element (for citing)
Total Program Service Revenue$76,766,305TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$439,952TotalRevenueColumnAmt
Exclusion$439,952ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$8,477,102SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$8,181,297SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$295,805SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$295,805TotalRevenueColumnAmt
Exclusion$295,805ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$77,502,062TotalRevenueColumnAmt
Related Or Exempt Func Income$76,666,305RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$100,000UnrelatedBusinessRevenueAmt
Exclusion$735,757ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$141,000TotalAmt
Program Services$141,000ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$66,637,537TotalAmt
Program Services$66,637,537ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$127,786TotalAmt
Management And General$127,786ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$344,630TotalAmt
Management And General$344,630ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$20,922TotalAmt
Management And General$20,922ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$101,907TotalAmt
Management And General$101,907ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$23,361TotalAmt
Management And General$23,361ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$13,309TotalAmt
Management And General$13,309ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$37,292TotalAmt
Management And General$37,292ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$86,749TotalAmt
Management And General$86,749ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$11,040TotalAmt
Management And General$11,040ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$483,422TotalAmt
Management And General$483,422ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$44,263TotalAmt
Management And General$44,263ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$49,689TotalAmt
Management And General$49,689ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$15,753TotalAmt
Management And General$15,753ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$41,124TotalAmt
Management And General$41,124ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$4,103TotalAmt
Management And General$4,103ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$16,586TotalAmt
Management And General$16,586ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Administration - DDPNH$5,629,809$2,702,308$2,927,501
Brokers' Commissions$1,246,215$1,246,215
Assessments/Tax$196,728$196,728
Marketing Related$120,166$120,166

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$173,899TotalAmt
Program Services$37,736ProgramServicesAmt
Management And General$136,163ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$75,567,290TotalAmt
Program Services$69,715,309ProgramServicesAmt
Management And General$5,851,981ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$4,033,882BOYAmt
EOY$2,549,543EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,878,690BOYAmt
EOY$4,037,138EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,822,792BOYAmt
EOY$1,888,044EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$6,750BOYAmt
EOY$6,750EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$115,552LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$103,878LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$15,777BOYAmt
EOY$11,674EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$17,542,535BOYAmt
EOY$19,077,021EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$61,188BOYAmt
EOY$37,378EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$3,425,005BOYAmt
EOY$2,795,078EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$73,784BOYAmt
EOY$102,627EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$28,860,403BOYAmt
EOY$30,505,253EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,102,740BOYAmt
EOY$1,921,393EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$119,400BOYAmt
EOY$101,800EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,786,228BOYAmt
EOY$1,276,220EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,008,368BOYAmt
EOY$3,299,413EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$24,852,035BOYAmt
EOY$27,205,840EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$24,852,035BOYAmt
EOY$27,205,840EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$28,860,403BOYAmt
EOY$30,505,253EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$1,934,772ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$243,423NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$175,610OtherChangesInNetAssetsAmt
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$1,000PoliticalExpendituresAmt
Volunteer Hours0VolunteerHoursCnt
Expended527 Activities$1,000Expended527ActivitiesAmt
Internal Funds Contributed$0InternalFundsContributedAmt
Total Exempt Function Expend$1,000TotalExemptFunctionExpendAmt
Form1120 POL FiledYes (1)Form1120POLFiledInd

Section527 Political Org Section527PoliticalOrgGrp

Organization Business Name OrganizationBusinessName

FieldValueIRS element (for citing)
Business Name Line1Phil Scott for VermontBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line146 Three Mile Bridge RoadAddressLine1Txt
CityMiddlesexCityNm
State AbbreviationVTStateAbbreviationCd
ZIP05602ZIPCd
FieldValueIRS element (for citing)
EIN475073559EIN
Paid Internal Funds$1,000PaidInternalFundsAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I-A, Line 1:FormAndLineReferenceDesc
ExplanationOne campaign donations totalling $1,000 was made in Vermont.ExplanationTxt

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,345OtherCostOrOtherBasisAmt
Depreciation$6,611DepreciationAmt
Book Value$734BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$61,113OtherCostOrOtherBasisAmt
Depreciation$50,173DepreciationAmt
Book Value$10,940BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$47,094OtherCostOrOtherBasisAmt
Depreciation$47,094DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$11,674TotalBookValueLandBuildingsAmt

Invst Program Related Org InvstProgramRelatedOrgGrp

FieldValueIRS element (for citing)
DescInvestment in Red Tree Holdings (1/3 interest)Desc
Book Value$2,795,078BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Program Rltd$2,795,078TotalBookValueProgramRltdAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
Unearned Revenue$634,520
Other Advances$641,700
FieldValueIRS element (for citing)
Total Liability$1,276,220TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$42,257,330TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$243,423NetUnrealizedGainsInvstAmt
Other Revenue$4,067OtherRevenueAmt
Revenue Not Reported$247,490RevenueNotReportedAmt
Revenue Subtotal$42,009,840RevenueSubtotalAmt
Investment Expenses Not Incld$86,750InvestmentExpensesNotIncldAmt
Other Revenues Not Included$35,405,472OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$35,492,222RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$77,502,062TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$40,075,069TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$40,075,069ExpensesSubtotalAmt
Investment Expenses Not Incld2$86,749InvestmentExpensesNotIncld2Amt
Other Expenses Not Included$35,405,472OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$35,492,221ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$75,567,290TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part X, Line 2:The 2017 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 4,067.
Part XI, Line 4b - Other Adjustments:Dental claims paid under admin service contracts 35,405,472.
Part XII, Line 4b - Other Adjustments:Dental claims paid under admin service contracts 35,405,472.
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$141,000CashGrantAmt
Purpose Of GrantGeneral support to promote oral healthPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

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 0.05% of the budgeted gross billings, plus 5% of the actual increase in unrestricted net assets from operations each year. DDPVT's elective contributions to the Foundation in 2017 totaled $141,000.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
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$522,200$0$188,514$0$53,094$0$127,171$0$36,236$0$927,215$0$0
William H Lambrukos
DDPNH Sr. Vice President$0$194,820$0$20,345$0$9,513$0$19,087$0$27,579$0$271,344$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule J, Part II:FormAndLineReferenceDesc
ExplanationThomas 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.ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (6 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
Adam Fasoli
Trustee$587,612The 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
Paul A Averill DDS
Trustee$201,680Please see above.0
David A Baasch DDS
Trustee$199,411Please see above.0
David B Solomon DDS
Trustee$179,844Please see above.0
Elizabeth Carmack DMD
Trustee$384,843Please see above.0
Theron Main DDS
Trustee$5,535,444Please 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 in bonds 175,610.
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 2016 and 2017.
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.