DELTA DENTAL PLAN OF VERMONT INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- DELTA DENTAL PLAN OF VERMONT INC (EIN 03-0219391)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-07
- IRS object ID
- 201743119349301519
- Schema version
- 2016v3.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-07T12:53:04-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010494526 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER NEWMAN & NOYES LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 650 ELM STREET SUITE 302 | AddressLine1Txt |
| City | MANCHESTER | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030219391 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Delta Dental Plan Of Vermont Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DELT | BusinessNameControlTxt |
| Phone | 6032231000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 2002 | AddressLine1Txt |
| City | Concord | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 033022002 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THOMAS RAFFIO | PersonNm |
| Person Title | President & CEO | PersonTitleTxt |
| Phone | 6032231000 | PhoneNum |
| Signature | 2017-10-27 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | E Drew Cheney | PreparerPersonNm |
| PTIN | P00182972 | PTIN |
| Phone | 8002447444 | PhoneNum |
| Preparation | 2017-10-27 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 208.105.168.164 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-10-27 | IPDt |
| IP Tm | 10:38:52 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | CCFCCF25870C8311BDDC6739800371DE19EE9571 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | CD9BA379DF6EC1A0D15BAC40CC9AB00D59855B06 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Thomas Raffio | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 2002 | AddressLine1Txt |
| City | Concord | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 033022002 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $90,580,294 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | www.nedelta.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1965 | FormationYr |
| Legal Domicile State | VT | LegalDomicileStateCd |
| Activity Or Mission | Provide programs of dental care | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 4 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $100,000 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $71,749,357 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $74,537,690 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,903,818 | PYInvestmentIncomeAmt |
| CY Investment Income | $610,423 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $73,653,175 | PYTotalRevenueAmt |
| CY Total Revenue | $75,148,113 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $182,893 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $188,280 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $61,930,540 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $64,141,815 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $572,530 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $586,088 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,925,532 | PYOtherExpensesAmt |
| CY Other Expenses | $7,945,867 | CYOtherExpensesAmt |
| PY Total Expenses | $70,611,495 | PYTotalExpensesAmt |
| CY Total Expenses | $72,862,050 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,041,680 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,286,063 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $26,705,730 | TotalAssetsBOYAmt |
| Total Assets EOY | $28,860,403 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,925,747 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,008,368 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $22,779,983 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $24,852,035 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $66,979,421 | ExpenseAmt |
| Revenue | $74,437,690 | RevenueAmt |
| Desc | Delta 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 366,700 claims in 2016. There are approximately 170,000 members in Vermont 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. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $188,280 | ExpenseAmt |
| Grant | $188,280 | GrantAmt |
| Desc | Delta Dental Plan of Vermont is one of three members of the Northeast Delta Dental Foundation. The company contributes .025% 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $67,167,701 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | Yes (1) | PoliticalCampaignActyInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 104 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 4 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frank Boucher | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6032231000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 2002 | AddressLine1Txt |
| City | Concord | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 033022002 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| Paula L Cope MEd | ||||||
| Trustee | 3.00 | Yes (X) | $10,100 | $0 | $0 | |
| Theron Main DDS | ||||||
| Trustee | 3.00 | Yes (X) | $10,100 | $0 | $0 | |
| Suzanne M McDowell | ||||||
| Trustee | 3.00 | Yes (X) | $7,980 | $0 | $0 | |
| Katherine O'Connell CPA | ||||||
| Trustee & Treasurer | 3.00 | Yes (X) | $11,180 | $0 | $0 | Yes (X) |
| Dsvid Solomon DDS | ||||||
| Trustee | 3.00 | Yes (X) | $11,760 | $0 | $0 | |
| Philip A Lapp CPA part year | ||||||
| Trustee & Treasurer | 3.00 | Yes (X) | $2,700 | $0 | $0 | |
| Richard W Park | ||||||
| Trustee & Secretary | 3.00 | Yes (X) | $11,760 | $0 | $0 | Yes (X) |
| Paul A Averill DDS | ||||||
| Trustee & Chair | 3.00 | Yes (X) | $21,668 | $0 | $0 | Yes (X) |
| David A Baasch DDS | ||||||
| Trustee & Vice Chair | 3.00 | Yes (X) | $10,640 | $0 | $0 | Yes (X) |
| Nancy Bowden-Brock part year | ||||||
| Trustee | 3.00 | Yes (X) | $4,200 | $0 | $0 | |
| Jason Williams part year | ||||||
| Trustee | 3.00 | Yes (X) | $6,360 | $0 | $0 | |
| Elizabeth Carmack DMD | ||||||
| Trustee | 3.00 | Yes (X) | $5,820 | $0 | $0 | |
| Adam Fasoli DMD | ||||||
| Trustee | 3.00 | Yes (X) | $5,940 | $0 | $0 | |
| Thomas Raffio | ||||||
| DDPNH President & CEO | 10.00 | $0 | $805,520 | $104,765 | Yes (X) | |
| William H Lambrukos | ||||||
| DDPNH Sr. Vice President | 10.00 | $0 | $222,662 | $44,504 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $120,208 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,028,182 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $149,269 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Encara Inc | |||||
| 4818 Starkey Road | Roanoke | VA | 24018 | Contracted Services | $442,061 |
| Combined Services LLC | |||||
| 2 Delta Drive | Concord | NH | 033022002 | Insurance broker commissions | $343,925 |
| Richards Inc | |||||
| 48 Harris Place PO Box 820 | Brattleboro | VT | 05302 | Insurance broker commissions | $163,045 |
| Hickok & Boardman | |||||
| 346 Shelburne Road PO Box 1064 | Burlington | VT | 05402 | Insurance broker commissions | $137,290 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Admin Service Contract Fees | 524292 | $38,114,857 | $38,114,857 | |
| Premium Revenue | 524114 | $36,322,833 | $36,322,833 | |
| Management fee - CSLLC | 524298 | $100,000 | $100,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $74,537,690 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $435,587 | TotalRevenueColumnAmt |
| Exclusion | $435,587 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $15,607,017 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $15,432,181 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $174,836 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $174,836 | TotalRevenueColumnAmt |
| Exclusion | $174,836 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $75,148,113 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $74,437,690 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $100,000 | UnrelatedBusinessRevenueAmt |
| Exclusion | $610,423 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $188,280 | TotalAmt |
| Program Services | $188,280 | ProgramServicesAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,141,815 | TotalAmt |
| Program Services | $64,141,815 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,208 | TotalAmt |
| Management And General | $120,208 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $324,389 | TotalAmt |
| Management And General | $324,389 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,299 | TotalAmt |
| Management And General | $21,299 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $95,215 | TotalAmt |
| Management And General | $95,215 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,977 | TotalAmt |
| Management And General | $24,977 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,964 | TotalAmt |
| Management And General | $14,964 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,646 | TotalAmt |
| Management And General | $58,646 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,043 | TotalAmt |
| Management And General | $74,043 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,000 | TotalAmt |
| Management And General | $42,000 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $354,679 | TotalAmt |
| Management And General | $354,679 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,428 | TotalAmt |
| Management And General | $50,428 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,908 | TotalAmt |
| Management And General | $49,908 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,156 | TotalAmt |
| Management And General | $16,156 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,770 | TotalAmt |
| Management And General | $46,770 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,431 | TotalAmt |
| Management And General | $4,431 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,386 | TotalAmt |
| Management And General | $15,386 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Administration - DDPNH | $5,387,820 | $2,586,154 | $2,801,666 |
| Brokers' Commissions | $1,258,631 | $0 | $1,258,631 |
| Assessments/Tax | $205,489 | $205,489 | $0 |
| Marketing Related | $153,726 | $0 | $153,726 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $212,790 | TotalAmt |
| Program Services | $45,963 | ProgramServicesAmt |
| Management And General | $166,827 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,862,050 | TotalAmt |
| Program Services | $67,167,701 | ProgramServicesAmt |
| Management And General | $5,694,349 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,408,465 | BOYAmt |
| EOY | $4,033,882 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $724,416 | BOYAmt |
| EOY | $1,878,690 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,761,368 | BOYAmt |
| EOY | $1,822,792 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,750 | BOYAmt |
| EOY | $6,750 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $115,552 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $99,775 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,208 | BOYAmt |
| EOY | $15,777 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,315,252 | BOYAmt |
| EOY | $17,542,535 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $86,488 | BOYAmt |
| EOY | $61,188 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,317,698 | BOYAmt |
| EOY | $3,425,005 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,085 | BOYAmt |
| EOY | $73,784 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,705,730 | BOYAmt |
| EOY | $28,860,403 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,917,370 | BOYAmt |
| EOY | $2,102,740 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $164,800 | BOYAmt |
| EOY | $119,400 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,843,577 | BOYAmt |
| EOY | $1,786,228 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,925,747 | BOYAmt |
| EOY | $4,008,368 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,779,983 | BOYAmt |
| EOY | $24,852,035 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,779,983 | BOYAmt |
| EOY | $24,852,035 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,705,730 | BOYAmt |
| EOY | $28,860,403 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,286,063 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$200,483 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$13,528 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Political Expenditures | $4,950 | PoliticalExpendituresAmt |
Section527 Political Org Section527PoliticalOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Paid Internal FundsPaidInternalFundsAmt |
|---|---|---|---|---|---|
| VT Democratic Party | |||||
| PO Box 1220 | Montpelier | VT | 05601 | 030199446 | $2,250 |
| VT House of Republicans | |||||
| PO Box 80 | Gaysville | VT | 05746 | 760809991 | $500 |
| Green Mountain Republican Senate Committee | |||||
| PO Box 80 | Gaysville | VT | 05746 | 770646170 | $500 |
| Eileen Dickinson | |||||
| 69 Button Road | St Albans | VT | 05748 | 810653065 | $200 |
| Senate Democrats (Senate Circle) | |||||
| PO Box 896 | Montpelier | VT | 05601 | 208731490 | $500 |
| Phil Scott for Vermont | |||||
| 46 Three Mile Bridge Road | Middlesex | VT | 05602 | 475073559 | $1,000 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I-A, Line 1: | FormAndLineReferenceDesc |
| Explanation | Six campaign donations totalling $4,950 were made in Vermont. | ExplanationTxt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,345 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,142 | DepreciationAmt |
| Book Value | $2,203 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $61,113 | OtherCostOrOtherBasisAmt |
| Depreciation | $47,539 | DepreciationAmt |
| Book Value | $13,574 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $47,094 | OtherCostOrOtherBasisAmt |
| Depreciation | $47,094 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $15,777 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Investment in Red Tree Holdings (1/3 interest) | Desc |
| Book Value | $3,425,005 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $3,425,005 | TotalBookValueProgramRltdAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Unearned Revenue | $1,035,128 |
| Other Advances | $751,100 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,786,228 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $39,645,339 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$200,483 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $12,766 | OtherRevenueAmt |
| Revenue Not Reported | -$187,717 | RevenueNotReportedAmt |
| Revenue Subtotal | $39,833,056 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $74,043 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $35,241,014 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $35,315,057 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $75,148,113 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $37,546,993 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $37,546,993 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $74,043 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $35,241,014 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $35,315,057 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $72,862,050 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The 2016 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 12,766. |
| Part XI, Line 4b - Other Adjustments: | Dental claims paid under admin service contracts 35,241,014. |
| Part XII, Line 4b - Other Adjustments: | Dental claims paid under admin service contracts 35,241,014. |
| 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 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northeast Delta Dental Foundation | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One Delta Drive PO Box 2002 | AddressLine1Txt |
| City | Concord | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03302 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 020489150 | RecipientEIN |
| IRC Section | 501(c)(3) | IRCSectionDesc |
| Cash Grant | $188,280 | CashGrantAmt |
| Purpose Of Grant | General support to promote oral health | PurposeOfGrantTxt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Delta Dental Plan of Vermont, Inc. (DDPVT) makes elective annual charitable contributions to the Northeast Dental Foundation equal to 0.025% 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 2016 totaled $188,280. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Thomas Raffio | ||||||||||||||
| DDPNH President & CEO | $0 | $522,200 | $0 | $220,107 | $0 | $63,213 | $0 | $75,814 | $0 | $28,951 | $0 | $910,285 | $0 | $0 |
| William H Lambrukos | ||||||||||||||
| DDPNH Sr. Vice President | $0 | $184,352 | $0 | $26,360 | $0 | $11,950 | $0 | $19,221 | $0 | $25,283 | $0 | $267,166 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J, Part II: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (5 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Adam Fasoli | |||
| Trustee | $577,833 | The 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 | $203,461 | Please see above. | 0 |
| David A Baasch DDS | |||
| Trustee | $191,976 | Please see above. | 0 |
| David B Solomon DDS | |||
| Trustee | $168,996 | Please see above. | 0 |
| Elizabeth Carmack DMD | |||
| Trustee | $203,697 | Please see above. | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part V, Line 2a | The 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 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, 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 19 | Upon 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 -13,528. |
| 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 2015 and 2016. |
| 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 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. |