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 020273013 Delta Dental Plan of New Hampshire Inc DELT 6032231000 One Delta Drive 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 09:46:56 ES P A664E523594A7D029D88D3AD4966DBCC0261F172 E7C342458DF4D4AB2E77FA21342842838D49B854 2017 2019-02-21 02:37:17Z Thomas Raffio One Delta Drive PO Box 2002 Concord NH 033022002 349189852 0 X www.nedelta.com X 1961 NH Provide programs of dental care 15 9 192 0 100000 0 0 0 327048629 343503477 901217 1028609 -4326 -29322 327945520 344502764 224680 313000 290387545 304738214 17731994 18410670 0 0 0 16233380 16679423 324577599 340141307 3367921 4361457 65126420 70465091 14778813 14784069 50347607 55681022 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 316248550 343403477 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 789,000 claims in 2016. There are approximately 354,400 members in New Hampshire included in the various plans. Customers' expectations for quality standards are extremely rigorous and we provide a guarantee of service called GOSE, or Guarantee of Service Excellence, which guarantees seven key service claims: 1) Smooth implementation to Northeast Delta Dental; 2) Exceptional customer service; 3) Quick processing of claims; 4) No inappropriate billing by participating dentists; 5) Accurate and quick turnaround of identification cards; 6) Timely employee booklets; 7) Marketing service contracts. In the event one or more of these service guarantees are not met, a cash reimbursement is provided. 313000 313000 Delta Dental Plan of New Hampshire 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. 316561550 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 16142 0 1 192 1 1 1 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 Frank Boucher 6032231000 One Delta Drive PO Box 2002 Concord NH 03302 Mary Ann Aldrich RN Director 3.00 X 8672 0 0 Richard Bolduc DDS Director 3.00 X 5392 0 0 Lisa Braiterman Director 3.00 X 7060 0 0 Jason Golden Director 3.00 X 4836 0 0 Dennis Hannon DDS Director 3.00 X 7004 0 0 James St Jean Director 3.00 X 4836 0 0 Michael L'Ecuyer Director 3.00 X 9284 0 0 Keith Levesque DMD Director 3.00 X 5948 0 0 Nader Moavenian DDS Director 3.00 X 5948 0 0 Jean-Paul Rabbath DMD Director 3.00 X 6504 0 0 Christiane Rothwangl DDS Director 3.00 X 6504 0 0 Nick S Soggu Director 3.00 X 8172 0 0 David Staples DDS Vice Chair & Director 3.00 X X 9840 0 0 Seth P Wall Director (part year) 3.00 X 2224 0 0 Susan H Woods Director 3.00 X 8728 0 0 Kathryn L Yerkes Chair & Director 3.00 X X 24139 0 0 J Michael Degnan Director (part year) 3.00 X 9373 0 0 Thomas Raffio President & CEO 80.00 X 763808 0 163407 Francis Boucher Treasurer & Sr VP Finance 48.00 X 224830 0 32872 Sara M Brehm Secretary 50.00 X 97881 0 19232 Erica Bodwell VP, General Counsel 50.00 X 251300 0 28831 William H Lambrukos Sr. VP Operations 40.00 X 224678 0 46666 Jodie L Hittle VP, Marketing 50.00 X 215858 0 35530 Mike Bourbeau VP, Information Systems 47.00 X 212508 0 20317 Constance Roy Czyzowski VP, Human Resources 50.00 X 202872 0 28831 2328199 0 375686 34 0 1 0 Combined Services LLC 2 Delta Drive Concord NH 03302 Insurance broker commissions 852878 Encara Inc 4818 Starkey Road Roanoke VA 24018 Contracted services 783664 Change Healthcare Operations PO Box 572490 Murray UT 84157 Contracted services 756150 Cronin Gervino & Warlick Inc 171 Londonderry Turnpike Hooksett NH 03106 Insurance broker commissions 375812 New England Employee Benefits 15 Chenell Drive Concord NH 03301 Insurance broker commissions 321040 19 Admin Service Contract Fees 524292 275970774 275970774 Premium Revenue 524114 67432703 67432703 Management Fee - CSLLC 524298 100000 100000 343503477 1025576 1025576 222669 251991 -29322 -29322 -29322 4438130 4435097 3033 3033 3033 344502764 343403477 100000 999287 313000 313000 304738214 304738214 1442057 520583 921474 12915252 5695626 7219626 320981 130639 190342 2802178 1154497 1647681 930202 392824 537378 27330 27330 102610 102610 119327 119327 1683221 51170 1632051 1618133 940459 677674 1640676 686623 954053 832642 365946 466696 82826 11447 71379 407924 34102 373822 4821 2119 2702 1465613 644137 821476 189611 77968 111643 Brokers' Commissions 4023331 0 4023331 Strategic Initiatives 3342484 802196 2540288 Premium Taxes 1138874 0 1138874 340141307 316561550 23579757 0 10421963 10027108 58471 542404 5032241 5913206 845134 558478 24792201 18005736 7637533 6786465 37344303 43525654 256071 199331 3425005 2795078 105699 117367 65126420 70465091 8121065 8459725 1680000 1470000 4977748 4854344 14778813 14784069 X 50347607 55681022 50347607 55681022 65126420 70465091 X 4361457 809241 162717 X X 0 1 X 1 0 1750 750 0 750 1 Joyce Craig for Manchester PO Box 3893 Manchester NH 03105 472901050 500 Ted Gatsas for Mayor PO Box 6655 Manchester NH 03108 270405959 250 Part I-A, Line 1: Two campaign donations totalling $750 were made in New Hampshire. 1133345 1133345 9430033 5765993 3664040 387895 385525 2370 13667865 11773952 1893913 173063 80266 92797 6786465 Unearned Revenue 1464567 Accrued Refunds 769377 Other Advances 2620400 4854344 X 92542658 809240 906368 1715608 90827050 119327 253556387 253675714 344502764 86465593 0 86465593 119327 253556387 253675714 340141307 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 906,368. Part XI, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 253,556,387. Part XII, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 253,556,387. 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) 313000 General support to promote oral health 1 Part I, Line 2: Delta Dental Plan of New Hampshire, Inc. (DDPNH) makes elective annual charitable contributions to the Northeast Dental Foundation equal to 0.05% of the budgeted gross billings, plus 5% of the actual increase in unrestricted net assets from operations each year. DDPNH's elective contributions to the Foundation in 2017 totaled $313,000. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 Thomas Raffio President & CEO 522200 0 188514 0 53094 0 127171 0 36236 0 927215 0 0 0 Francis Boucher Treasurer & Sr VP Finance 195300 0 21072 0 8458 0 19048 0 13824 0 257702 0 0 0 Erica Bodwell VP, General Counsel 224994 0 26306 0 0 0 1014 0 27817 0 280131 0 0 0 William H Lambrukos Sr. VP Operations 194820 0 20345 0 9513 0 19087 0 27579 0 271344 0 0 0 Jodie L Hittle VP, Marketing 185661 0 19893 0 10304 0 18666 0 16864 0 251388 0 0 0 Mike Bourbeau VP, Information Systems 175283 0 18781 0 18444 0 16704 0 3613 0 232825 0 0 0 Constance Roy Czyzowski VP, Human Resources 172687 0 21437 0 8748 0 15963 0 12868 0 231703 0 0 0 Part I, Line 1a Spousal travel for one business trip per year for senior VPs, and where required or appropriate for the CEO. Part I, Line 4b Thomas Raffio (President & CEO) - 2017 total contributions to nonqualified deferred compensation plans = $104,440 to 457(f) plan. Part I, Line 7 The Organization has a team bonus program for all employees. Each individual's bonus is based on a combination of the individual's performance, the Organization's performance compared to the predetermined goals, and the individual's job level within the Organization. Nader Moavenian DDS Director 573347 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 David Staples DDS Director 430848 Please see above. 0 Jean-Paul Rabbath DMD Director 215660 Please see above. 0 Richard Bolduc DDS Director 282106 Please see above. 0 Christiane Rothwangl DDS Director 329387 Please see above. 0 Keith Levesque DMD Director 231706 Please see above. 0 Form 990, Part VI, Section A, line 6 The membership of Delta Dental Plan of New Hampshire, Inc. consists of the New Hampshire dentists participating in the company's networks which are used by individuals covered under one of the Company's dental benefit plans. Form 990, Part VI, Section A, line 7b Membership approval is required for all Bylaw changes. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed in detail by key finance employees of Northeast Delta Dental. A final draft is presented to the Board before the Form is filed. Form 990, Part VI, Section B, line 12c A copy of the conflict of interest policy is distributed annually to all officers, directors, and the management team. All are required to report any conflicts and sign, date, and return the policy, whether or not a conflict exists, to confirm compliance. General Counsel reviews the returned policies and reports the results to the entire Board of Directors. Board members are asked to provide updates of any changes that may occur between their annual conflict of interest filings. Form 990, Part VI, Section B, line 15 CEO's Compensation: Every year, the Board Tri-State Compensation Committee goes through a rigorous evaluation and carefully researches information on which it bases its recommendations for the compensation for the President & CEO. This includes the engagement of independent compensation consultants and advisors. The independent Tri-State Compensation Committee comprises the Chairs of the Boards for the Delta Dental Plans of Maine, Vermont, and New Hampshire and the Executive Committee of the DDPNH Board. In reviewing the compensation and benefits, the Committee considered various sources of comparability data and the analysis of comparability data and market conditions presented by the independent compensation consultant. In February 2017, the Tri-State Compensation Committee reviewed and approved the CEO's proposed compensation, effective April 1, 2017, 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 on Bonds 162,717. 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 2016 and 2017. 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.