2015-11-12T08:42:09-06:00 2014-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2014-01-01 010286541 Maine Dental Service Corporation MAIN 6032231000 PO Box 2002 Concord NH 033022002 Thomas Raffio President & CEO 6032231000 2015-11-05 1 E Drew Cheney P00182972 8002447444 2015-11-05 2014 2016-02-25 16:41:14Z Delta Dental Plan of Maine Thomas Raffio PO Box 2002 Concord NH 033022002 109587489 0 X www.nedelta.com X 1965 ME Provides programs of dental care 15 9 6 0 100000 0 0 0 87682181 103510826 646611 703984 0 0 88328792 104214810 120600 81900 74536032 89633231 685626 700877 0 0 0 11593203 12697582 86935461 103113590 1393331 1101220 44465511 48440561 4534790 6731268 39930721 41709293 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 93309299 0 103410826 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 543,000 claims in 2014. There are approximately 286,000 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. 81900 81900 0 Maine Dental Service Corporation Inc. 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. 93391199 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 1 179 0 1 6 1 1 1 0 0 0 0 0 X 15 9 0 0 0 0 0 0 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 7160 0 0 David L Bagdasarian DDS Director 3.00 X 8194 0 0 Cheryl Bascomb Director 3.00 X 6646 0 0 Charles E Brown DDS Director 3.00 X 8258 0 0 Kyra Chadbourne DDS Director 3.00 X 6918 0 0 Jeffrey B Doss DDS Director 3.00 X 10258 0 0 Jayne Giles Director (part year) 3.00 X 2580 0 0 Michael P Goldberg DMD Director 3.00 X 11790 0 0 Gregory Johnson Director 3.00 X 6646 0 0 Demitroula Kouzounas DMD Director 3.00 X 5614 0 0 Donald Oakes Director 3.00 X 6692 0 0 Daniel D Thayer Director 3.00 X 9226 0 0 Barry C Saltz DDS Chair & Director 3.00 X X 22011 0 0 Michael W Pardue Vice Chair & Director 3.00 X X 6646 0 0 Michael A Bevilacqua Treasurer & Director 3.00 X X 7160 0 0 Thomas Raffio DDPNH President & CEO 10.00 X 0 792290 146611 Francis Boucher DDPNH Sr. Vice President 10.00 X 0 183473 17322 Benjamin E Marcus Esq Clerk 2.00 X 0 0 0 125799 975763 163933 0 0 1 1 USI Insurance Services LLC PO Box 3716 Norfolk VA 23514 Insurance broker commissions 314322 Combined Services LLC 2 Delta Drive Concord NH 03301 Insurance broker commissions 294556 The Holden Agency 1085 Brighton Avenue Portland ME 04104 Insurance broker commissions 197299 Business Ins Agency DBA Cross Ins 116 Community Dr PO Box 469 Augusta ME 04332 Insurance broker commissions 194124 Maine Education Association 35 Community Drive Augusta ME 04330 Insurance broker commissions 140040 7 Premium Revenue 524114 63380296 63380296 Admin Service Contract Fees 524292 40030530 40030530 Management Fee - CSLLC 524298 100000 100000 103510826 658720 658720 5417943 5372679 45264 45264 45264 104214810 103410826 100000 703984 81900 81900 89633231 89633231 125799 125799 438151 438151 11648 11648 92746 92746 32533 32533 29135 29135 28089 28089 104185 104185 29744 29744 526687 526687 78967 78967 61553 61553 26948 26948 55635 55635 3524 3524 14928 14928 Administration - Delta 8163028 3676068 4486960 Brokers' Commissions 2711080 2711080 Marketing Related 459348 459348 Dues & Subscriptions 143856 143856 260875 260875 103113590 93391199 9722391 0 5071021 6891719 1442687 923425 3118207 3394060 2956 2956 165975 157263 7362 8712 33434505 35620823 50000 271853 1338773 1327013 44465511 48440561 2338348 3345881 73500 58000 2122942 3327387 4534790 6731268 X 39930721 41709293 39930721 41709293 44465511 48440561 1101220 677352 0 X X 0 1 X 1 0 250 0 250 0 250 1 Eves Leadership PAC 29 Acorn Lane Berwick ME 03906 273614077 150 0 Maine House Democratic Campaign Committee PO Box 2021 Augusta ME 04338 222695883 100 0 Part I-A, Line 1: Two campaign donations of $150 and $100 each were made in Maine. 14667 14667 0 131335 122623 8712 19973 19973 0 8712 Accrued refunds 1607515 Unearned revenue 1309272 Advances - admin service contracts 410600 3327387 X 67782543 677352 -1734 675618 67106925 104185 37003700 37107885 104214810 66005705 0 66005705 104185 37003700 37107885 103113590 Part X, Line 2: The 2014 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. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position historically taken on various tax exposure items including unrelated business income or tax status. Assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. 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, does not have any significant unrelated business income and has taken no uncertain tax positions that require adjustment to or disclosure in the accompanying statutory financial statements. Tax years after December 31, 2010 are open for Internal Revenue Service or state examination. Part XI, Line 2d - Other Adjustments: Change in nonadmitted assets -1,734. Part XI, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 37,003,700. Part XII, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 37,003,700. 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) 81900 0 General support to promote oral health 1 0 Part I, Line 2: Maine Dental Service Corporation (MDSC) 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. MDSC's total contributions to the Foundation in 2012 totaled $81,900. 0 0 0 0 0 0 0 0 0 Thomas Raffio DDPNH President & CEO 0 522204 0 214233 0 55853 0 112090 0 34521 0 938901 0 0 Francis Boucher DDPNH Sr. Vice President 0 164628 0 14564 0 4281 0 5432 0 11890 0 200795 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. David L Bagdasarian DDS Director 641723 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 Barry C Saltz DDS Director 296607 Please see above. 0 Charles E Brown DDS Director 131895 Please see above. 0 Jeffrey B Doss DDS Director 545893 Please see above. 0 Demitroula Kouzounas DMD Director 745595 Please see above. 0 Michael Goldberg DMD Director 126793 Please see above. 0 Form 990, Part VI, Section B, line 11 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 2013 and 2014.