2018-11-12T07:43:01-06:00 2017-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2017-01-01 010286541 Maine Dental Service Corporation MAIN 6032231000 PO Box 2002 Concord NH 033022002 Thomas Raffio President & CEO 6032231000 2018-11-08 1 E Drew Cheney P00182972 8002447444 2018-11-08 208.105.168.164 2018-11-08 09:58:17 ES P A664E523594A7D029D88D3AD4966DBCC0261F172 E7C342458DF4D4AB2E77FA21342842838D49B854 2017 2019-02-21 02:37:17Z Delta Dental Plan of Maine Thomas Raffio PO Box 2002 Concord NH 033022002 130863718 0 X www.nedelta.com X 1965 ME Provides programs of dental care 14 10 6 0 100000 0 0 0 113967940 122171132 791963 2560305 0 0 114759903 124731437 813216 379300 96544772 103563094 754673 848560 0 0 0 13165177 13887080 111277838 118678034 3482065 6053403 53941597 59662302 6771099 6153366 47170498 53508936 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 107752451 122071132 Maine Dental Service Corporation, Inc. advances and promotes the improvement of oral health by offering innovative, cost effective dental benefits plans that meet the needs of our customers by integrating activities such as cost management policies, fee reduction agreements with dentists, ensuring quality and cost effective dental benefit delivery, and accurate and timely claims payment. We are recognized for our expertise in the dental benefits industry, the vibrancy of our participating dentist network, and our strong brand. Program services include the processing and payment of claims for dental benefits for various large and small groups, as well as individuals and families. Maine Dental Service Corporation, Inc. processed approximately 630,700 claims in 2017. There are approximately 331,300 members in Maine included in the various plans. Customer's expectations for quality standards are extremely rigorous and we provide a guarantee of service called GOSE, or Guarantee of Service Excellence, which guarantees seven key service claims: 1) Smooth implementation to Northeast Delta Dental; 2) Exceptional customer service; 3) Quick processing of claims; 4) No inappropriate billing by participating dentists; 5) Accurate and quick turnaround of identification cards; 6) Timely employee booklets; 7) Marketing service contracts. In the event one or more of these service guarantees are not met, a cash reimbursement is provided. 379300 379300 Maine Dental Service Corporation Inc. 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. 108131751 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 X 216 0 6 1 1 1 0 0 0 0 0 X 14 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Frank Boucher 6032231000 One Delta Drive PO Box 2002 Concord NH 03302 Beverly Altenburg Director 3.00 X 8672 0 0 Charles E Brown DDS Director (part year) 3.00 X 3892 0 0 Jeffrey B Doss DDS Director 3.00 X 9784 0 0 Michael P Goldberg DMD Director 3.00 X 9284 0 0 Demitroula Kouzounas DMD Director 3.00 X 8172 0 0 Daniel D Thayer Director (part year) 3.00 X 6504 0 0 Jayne Giles Director 3.00 X 9398 0 0 Burton Rankie DDS Director 3.00 X 5948 0 0 Jeffrey Walawender DDS Director 3.00 X 8172 0 0 Jason Lenardson Director 3.00 X 7060 0 0 Donald Oakes Vice Chair & Director 3.00 X X 16512 0 0 Kara Chadbourne DDS Director 3.00 X 8172 0 0 Scott Normandeau Director (part year) 3.00 X 2780 0 0 Katherin O'Grady Director (part year) 3.00 X 2224 0 0 Michael A Bevilacqua Treasurer & Director 3.00 X X 8116 0 0 Cheryl Bascomb Director (part year) 3.00 X 5948 0 0 Michael W Pardue Chair & Director 3.00 X X 25707 0 0 Thomas Raffio DDPNH President & CEO 10.00 X 0 763808 163407 Francis Boucher DDPNH Sr. Vice President 10.00 X 0 224830 32872 146345 988638 196279 0 0 1 1 Encara Inc 4818 Starkey Road Roanoke VA 24018 Contracted Services 615319 Combined Services LLC 2 Delta Drive Concord NH 03301 Insurance broker commissions 354971 Business Ins Agency DBA Cross Ins 116 Community Dr PO Box 469 Augusta ME 04332 Insurance broker commissions 285800 Towers Watson Delaware IncCommission Lockbox 28852 New York NY 10087 Insurance broker commissions 254539 Wyssta Services Inc PO Box 86 Stevenes Point WI 54481 Contracted Services 206274 10 Premium Revenue 524114 71040879 71040879 Admin Service Contract Fees 524292 51030253 51030253 Management Fee - CSLLC 524298 100000 100000 122171132 941553 941553 7751033 6132281 1618752 1618752 1618752 124731437 122071132 100000 2560305 379300 379300 103563094 103563094 146346 146346 529857 529857 33446 33446 101614 101614 37297 37297 18159 18159 31586 31586 107775 107775 24000 24000 733077 733077 61212 61212 62471 62471 27447 27447 47406 47406 2441 2441 15867 15867 Administration - Delta 9521265 4189357 5331908 Brokers' Commissions 2959682 2959682 Dues & Subscriptions 223965 223965 50727 50727 118678034 108131751 10546283 0 8087668 5818587 529853 623878 3211919 3466582 2956 2956 173703 164034 12111 9669 38487652 46829252 122760 74991 3425005 2795078 61673 41309 53941597 59662302 3593408 3669312 183300 318600 2994391 2165454 6771099 6153366 X 47170498 53508936 47170498 53508936 53941597 59662302 6053403 285035 0 X X 0 1 X 1 0 4000 0 4000 0 4000 1 Maine House Republican Majority Fund PO Box 5629 Augusta ME 04332 274312959 1000 Maine House Democratic Campaign Committee PO Box 2021 Augusta ME 04338 222695883 1000 Maine Senate Democratic Campaign Committee PO Box 2207 Augusta ME 04338 010478979 1000 Maine Senate Republican Majority PAC PO Box 1 Augusta ME 04332 263733192 1000 Part I-A, Line 1: Four campaign donations totaling $4,000 were made in Maine. 21116 17892 3224 132614 126169 6445 19973 19973 0 9669 Accrued refunds 604951 Unearned revenue 1024603 Advances - admin service contracts 535900 2165454 X 77741147 285034 -19671 265363 77475784 107775 47147878 47255653 124731437 71422381 0 71422381 107775 47147878 47255653 118678034 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 -19,671. Part XI, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 47,147,878. Part XII, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 47,147,878. Schedule D, Part XI, Line 2d The Corporation has historically prepared its financial statements in accordance with accounting principles generally accepted in the United States of America (GAAP). Effective January 1, 2012 the Corporation elected to prepare its financial statements to conform with the statutory accounting practices of the National Association of Insurance Commissioners (NAIC), as prescribed or permitted by the Maine Bureau of Insurance. The change in nonadmitted assets reported here in Part XI is one of the reconciling items to meet the reporting requirements for the Form 990. 1 Northeast Delta Dental Foundation One Delta Drive PO Box 2002 Concord NH 03302 020489150 501(c)(3) 379300 General support to promote oral health 1 Part I, Line 2: Maine Dental Service Corporation (MDSC) 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. MDSC's total contributions to the Foundation in 2017 totaled $379,300. 0 0 0 0 0 0 0 0 0 Thomas Raffio DDPNH President & CEO 0 522200 0 188514 0 53094 0 127171 0 36236 0 927215 0 0 Francis Boucher DDPNH Sr. Vice President 0 195300 0 21072 0 8458 0 19048 0 13824 0 257702 0 0 Schedule J, Part II: Thomas Raffio, CEO, and Francis Boucher, Senior Vice President, received all of their compensation from Delta Dental Plan of New Hampshire, which is an unrelated organization per Schedule R definitions. Charles E Brown DDS Director (part year) 120957 The Directors listed here have ownership interests in dental practices that receive insurance reimbursements from Delta Dental in the ordinary course of their business. All transactions are at arm's length and for fair value. 0 Jeffrey B Doss DDS Director 799710 Please see above. 0 Demitroula Kouzounas DMD Director 929657 Please see above. 0 Michael Goldberg DMD Director 164002 Please see above. 0 Kyra Chadbourne DDS Director 155701 Please see above. 0 Form 990, Part V, Line 2a The six employees included here are actually employed and paid by Delta Dental Plan of New Hampshire. These employees are assigned to provide sales and marketing services to Maine Dental Services Corporation. Maine Dental Services Corporation reimburses Delta Dental Plan of New Hampshire for these employees' payroll and employee benefit expenses. Form 990, Part VI, Section A, line 6 The membership of Maine Dental Service Corporation consists of the Board of Directors, all of the individuals covered under the Company's dental benefit plans, and the Maine dentists participating in the Company's dental networks which are used by the individuals covered under one of the Company's dental benefit plans. Form 990, Part VI, Section A, line 7a The Board of Trustees are elected at the Maine Dental Service Corporation's Annual Membership meeting, which requires a quorum of 25 members to conduct business. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed in detail by key finance employees of Northeast Delta Dental. A final draft is presented to the Board before the Form is filed. Form 990, Part VI, Section B, line 12c A copy of the conflict of interest policy is distributed annually to all officers, directors, and the management team. All are required to report any conflicts and sign, date, and return the policy, whether or not a conflict exists, to confirm compliance. General Counsel reviews the returned policies and reports the results to the entire Board of Directors. Board members are asked to provide updates of any changes that may occur between their annual conflict of interest filings. Form 990, Part VI, Section C, line 19 Upon request, Maine Dental Services Corporation makes its governing documents, conflict of interest policy, or financial statements available to the public. Form 990, Part XII, Line 2c: The Finance/Audit Committee oversees the audit process for Maine Dental Service Corporation. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit in both 2016 and 2017.