2025-10-21T15:09:55-05:00 2024-12-31 010494526 Baker Newman & Noyes 650 Elm Street Suite 302 Manchester NH 03101 990 2024-01-01 030219391 Delta Dental Plan Of Vermont Inc DELT 6032231000 PO Box 2002 Concord NH 033022002 THOMAS RAFFIO President & CEO 6032231000 2025-10-20 1 0 Connor Smart P02285543 6036262200 2025-10-20 2024 2025-03-06 01:10:19Z Thomas Raffio PO Box 2002 Concord NH 033022002 126896429 0 X www.nedelta.com X 1965 VT Provide programs of dental care 12 6 5 0 100000 0 0 0 102735893 113018450 941270 2978617 0 0 103677163 115997067 286700 646762 89439500 99117338 811905 935257 0 0 0 11245027 13848249 101783132 114547606 1894031 1449461 41939634 43989635 4630661 5566348 37308973 38423287 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. 1 0 105580250 0 112918450 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 496,100 claims in 2024. There are approximately 248,200 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; and (7) marketing service contracts. In the event one or more of these service guarantees are not met, a cash reimbursement is provided. 243310 243310 0 Delta Dental Plan of Vermont is one of three members of the Northeast Delta Dental Foundation. The company contributes .075% of annual budgeted revenue, as well as 10% 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. 403452 403452 0 Delta Dental Plan of Vermont (DDPVT) participated in Northeast Delta Dental's initiative to attract more dentists to Northern New England. Through this program, DDPVT contributed to a shared pool of funds administered by the Recruitment Center at Bi-State Primary Care Association (Bi-State). These funds support dental student loan repayment and forgiveness plans, and help to retain qualified dental health professionals in the New England region. During this tax year, DDPVT provided over $400,000 in grants to 10 recipients within this initiative, bolstering New England's professional dental care workforce and capacity and improving access to dental care in Vermont. 106227012 0 0 1 0 0 0 0 0 0 1 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 X 287 0 1 5 1 1 1 0 0 0 0 0 0 0 X 12 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X Laurie Bienefeld 6032231000 PO Box 2002 Concord NH 033022002 X Brian Townsend Trustee & Chair 3.00 X X 37436 0 0 Rachel Rivard DDS Trustee & Secetary 3.00 X X 17725 0 0 David Solomon DDS Trustee & Chair (end 4/2024) 3.00 X X 17143 0 0 Nancy Rowden-Brock Trustee & Treasurer 3.00 X X 17000 0 0 Jennifer Niles DMD Trustee & Vice Chair 3.00 X X 15550 0 0 Tyler Aten DMD Trustee 3.00 X 10700 0 0 Jill Mazza Olson MPA Trustee 3.00 X 9975 0 0 Riley Baldwin Casella DMD Trustee (start 4/2024) 3.00 X 7800 0 0 Wanda Heading-Grant EdD Trustee 3.00 X 7250 0 0 Jason W Williams Trustee 3.00 X 7075 0 0 Katherine Meyers CPA Trustee 3.00 X 6525 0 0 Adam Fasoli DMD Trustee (end 4/2024) 3.00 X 5800 0 0 Robert Boyd DDS Trustee (start 4/2024) 3.00 X 5075 0 0 Elicia Nicole Thompson DDS Trustee (start 4/2024) 3.00 X 4900 0 0 Elizabeth Carmack DMD Trustee (end 4/2024) 3.00 X 4489 0 0 Thomas Raffio DDPNH President & CEO 10.00 X 1112510 0 72619 William H Lambrukos DDPNH Sr. Vice President 10.00 X 352772 0 63316 1639725 0 135935 0 0 1 1 Wyssta Services Inc PO Box 86 Stevens Point WI 54481 Contracted services 760164 Richards Inc 48 Harris Place PO Box 820 Brattleboro VT 05302 Insurance broker commissions 508480 Combined Services LLC PO Box 1320 Concord NH 033022002 Insurance broker commissions 219656 Chamber Benefits Inc DBA Vace PO Box 810 Montpelier VT 05601 Insurance broker commissions 179263 Acrisure LLC PO Box 1788 Grand Rapids MI 49501 Insurance broker commissions 168303 8 Admin Service Contract Fees 524292 59340447 59340447 Premium Revenue 524114 53578003 53578003 Management fee - CSLLC 524298 100000 100000 113018450 1128961 1128961 12749018 10899362 1849656 1849656 1849656 115997067 112918450 100000 2978617 243310 243310 403452 403452 99117338 99117338 174443 174443 569351 569351 36122 36122 112858 112858 42483 42483 159885 159885 39065 39065 113627 113627 42000 42000 374283 374283 39936 39936 55985 55985 13279 13279 88480 88480 618 618 25695 25695 Administration - DDPNH 8425966 4521453 3904513 Brokers' commissions 2154863 2154863 VT claims assessments 332900 332900 Marketing related 102639 102639 1879028 1608559 270469 114547606 106227012 8320594 0 5693970 5420532 2241605 960911 2554012 2514115 19738 18048 80041 69037 39 11004 27842796 31059065 25502 14561 3407431 3817683 154541 173716 41939634 43989635 2759806 3090614 210800 161000 1660055 2314734 4630661 5566348 X 37308973 38423287 37308973 38423287 41939634 43989635 X 1449461 -342954 7807 X X 0 1 X 1 0 1300 1300 0 1300 1 Vermont Democratic Party PO Box 1120 Montpelier VT 05601 030199446 500 0 Franklin County Republican Committee 69 Button Road St Albans VT 05478 843896422 250 0 Mike for Vermont LTD (Mike Pieciek) 32 Main Street 112 Montpelier VT 05302 882205938 50 0 Phil Scott for Vermont pO Box 988 Montpelier VT 05601 475073559 500 0 Part I-A, Line 1: Four campaign donations totaling $1,300 was made in Vermont. 7345 7345 0 72696 61692 11004 11004 Investment in Red Tree Holdings (1/3 interest) 3817683 F 3817683 Unearned revenue 1124934 Other advances 1189800 2314734 X 60271709 -342954 -342954 60614663 113627 55268777 55382404 115997067 59180284 0 59180284 113627 55253695 55367322 114547606 Part X, Line 2: The Corporation is generally exempt from federal and state income taxes under the provisions of Section 501(c)(4) of the Internal Revenue Code. However, the Corporation may still be subject to certain income taxes on net income generated from activities deemed to be unrelated business income. 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 4b - Other Adjustments: Dental claims paid under admin service contracts 55,253,695. Change in nonadmitted assets 15,082. Part XII, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 55,253,695. 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. 1 Northeast Delta Dental Foundation One Delta Drive PO Box 2002 Concord NH 03302 020489150 501(c)(3) 243310 0 General support to promote oral health 1 0 Dental School Student Loan Repayment Program 10 403452 Part I, Line 2: Delta Dental Plan of Vermont, Inc. (DDPVT) makes elective annual charitable contributions to the Northeast Dental Foundation equal to 0.075% of the budgeted gross billings, plus 10% of the actual increase in unrestricted net assets from operations each year. DDPVT's elective contributions to the Foundation in 2024 totaled $243,310. Additionally, during the tax year covered by this Form 990, DDPVT participated in a Northern New England dental school student loan repayment and forgiveness program. In an effort to attract more dentists to Northern New England, Delta Dental has provided funding to be used for dental student loan repayments. The new program will be administered by the Recruitment Center at Bi-State Primary Care Association (Bi-State) and is governed by a Steering Committee with representatives from Maine, New Hampshire, and Vermont. By providing another avenue to help dentists with student loan debt through loan repayment, the program expects to be able to attract more dentists to Northern New England. Each qualifying dentist can receive up to $150,000 reimbursed over a three-year period. General dentists, dentists in other specialties, dental students, and residents in training without a concurrent service obligation for loan repayment or debt forgiveness may apply. 0 0 0 0 0 0 0 0 0 Thomas Raffio DDPNH President & CEO 655793 0 434301 0 22416 0 33811 0 38808 0 1185129 0 0 0 William H Lambrukos DDPNH Sr. Vice President 268663 0 75275 0 8834 0 33811 0 29505 0 416088 0 0 0 Schedule J, Part II: 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 IRS definitions; while definitionally unrelated, Delta Dental Plan of New Hampshire does coordinate and work closely with the Delta Dental Plan of Vermont to fulfill their respective exempt missions. In accordance with the IRS Instructions for the Form 990, compensation or payments from an unrelated organization to an individual for services rendered to the filing organization in that person's capacity as an officer, director, trustee, or employee of the filing organization, then the filing organization must report such amounts as compensation from the filing organization. Therefore, the compensation paid to these individuals has been reported on this Form 990, Schedule J, Part II, Payments Made by the Filing Organization, though Delta Dental Plan of Vermont did not, in fact, directly pay or compensate these individuals; these individuals were paid by Delta Dental Plan of New Hampshire in part for services rendered for the benefit and on behalf of Delta Dental Vermont. Additionally, due to the close working relationship between the two organizations, neither the filing organization nor Delta Dental Plan of New Hampshire is able to make a determination of how much of each named individuals' compensation relates to time and resources expended on either the filing organization or Delta Dental Plan of New Hampshire. For this reason and to promote transparency and compliance with this tax return, the filing organization has elected to report 100% of the named individuals' applicable calendar year compensation as received by the Delta Dental Plan of New Hampshire on this Form 990, Part VII, and Schedule J, in accordance with the definitions and calculations as detailed in the IRS Form 990 Instructions. Rachel Rivard DDS Trustee & Secretary 50000 Grant Student loan repayment Tyler Aten DMD Trustee 1403772 The directors listed have ownership interests in dental practices that receive insurance reimbursements from Delta Dental in the ordinary course of their business. All transactions are fair value and at arms length. 0 Adam Fasoli DMD Trustee 1463480 Please see above. 0 Elizabeth Carmack DMD Trustee 656815 Please see above. 0 David B Solomon DDS Trustee & Chair 207697 Please see above. 0 Jennifer Niles DMD Trustee & Chair 308958 Please see above. 0 Robert Boyd Trustee 338338 Please see above. 0 Rachel Rivard DDS Trustee & Secretary 271664 Please see above. 0 Form 990, Schedule L, Part III, Grants to Interested Persons: During the tax year covered by this Form 990, Delta Dental Plan of Vermont ("DDPVT") participated in a Northern New England dental school student loan repayment and forgiveness program. Rachel Rivard, who served on DDPVT Board during this tax year, received a grant under this program for $50,000.In an effort to attract more dentists to Northern New England, Delta Dental has provided funding to be used for dental student loan repayments. The new program will be administered by the Recruitment Center at Bi-State Primary Care Association (Bi-State) and is governed by a Steering Committee with representatives from Maine, New Hampshire, and Vermont. By providing another avenue to help dentists with student loan debt through loan repayment, the program expects to be able to attract more dentists to Northern New England. Each qualifying dentist can receive up to $150,000 reimbursed over a three-year period. General dentists, dentists in other specialties, dental students, and residents in training without a concurrent service obligation for loan repayment or debt forgiveness may apply.While Ms. Rivard is a member of DDPVT's Board, Ms. Rivard did not receive any preferential treatment within the grant program's application, review, or approval processes. Ms. Rivard applied for student loan relief through the program in the same manner as all other applicants and recipients. Furthermore, the Board of DDPVT does not dictate which specific individuals receive grants, as such authority is granted to the aforementioned sub-committee. Form 990, Part III, line 2 See narrative for Part III, Line 4c. Form 990, Part V, Line 2a: The five employees included here are actually employed and paid by Delta Dental Plan of New Hampshire, an unrelated organization that works closely with Delta Dental Plan of Vermont to achieve their respective charitable and exempt missions. 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 V, Line 15: Thomas Raffio is the President & CEO of Delta Dental Plan of New Hampshire, Inc. Mr. Raffio also serves in a similar capacity for the Delta Dental Plan of Vermont and the Maine Dental Services Corporation. These three entities are otherwise independent of and unrelated to each other as defined under IRS Form 990 Instructions. While Delta Dental Plan of New Hampshire technically files and processes Thomas Raffio's compensation, a portion of this compensation is paid in return for services rendered to the two other aforementioned unrelated organizations. However, in accordance with IRS Instructions, the complete amount of compensation paid to Mr. Raffio has been disclosed on this Form 990, reported as compensation and benefits paid by the filing organization. During the period covered by this Form 990, Mr. Raffio received total compensation in excess $1,000,000 and is reported in detail on this Form 990, Part VII and Schedule J. While Mr. Raffio received compensation exceeding $1,000,000 in total, the compensation paid to Mr. Raffio was in return for services rendered on behalf of each of the three unrelated entities; compensation paid to Mr. Raffio in return for services rendered to any one of the entities, taken individually, was less than $1,000,000. These entities in aggregate do not constitute a group of related applicable tax-exempt organizations as defined under Section 4960. As a portion of the compensation paid to Mr. Raffio was in return for services rendered to each of the unrelated tax-exempt organizations, and no single entity's allocated compensation was more than $1,000,000, neither Delta Dental Plan of New Hampshire, nor either of the two other unrelated organizations, are subject to the Section 4960 excise tax on executive compensation exceeding $1,000,000. Accordingly, this Form 990, Part V, Line 15, has been answered "no, and the Organization has not filed Form 4720. Form 990, Part VI, Section A, line 6 The 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 7a The members elect the Board of Trustees using a mail-in-ballot process which allows for petitioned candidates. 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, 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 IV, Line 23; and Part VII, Section A: 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 IRS definitions; while definitionally unrelated, Delta Dental Plan of New Hampshire does coordinate and work closely with the Delta Dental Plan of Vermont to fulfill their respective exempt missions. In accordance with the IRS Instructions for the Form 990, compensation or payments from an unrelated organization to an individual for services rendered to the filing organization in that person's capacity as an officer, director, trustee, or employee of the filing organization, then the filing organization must report such amounts as compensation from the filing organization. Therefore, the compensation paid to these individuals has been reported on this Form 990, Part VII, Section A, under Column (D), though Delta Dental Plan of Vermont did not, in fact, directly pay or compensate these individuals; these individuals were paid by Delta Dental Plan of New Hampshire in part for services rendered for the benefit and on behalf of Delta Dental Vermont. Additionally, due to the close working relationship between the two organizations, neither the filing organization nor Delta Dental Plan of New Hampshire is able to make a determination of how much of each named individuals' compensation relates to time and resources expended on either the filing organization or Delta Dental Plan of New Hampshire. For this reason and to promote transparency and compliance with this tax return, the filing organization has elected to report 100% of the named individuals' applicable calendar year compensation as received by the Delta Dental Plan of New Hampshire on this Form 990, Part VII, and Schedule J, in accordance with the definitions and calculations as detailed in the IRS Form 990 Instructions. Form 990, Part XI, line 9: Change in unrealized gains/(losses) in bonds 7,807. 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 2023 and 2024. 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.