DELTA DENTAL PLAN OF VERMONT INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- DELTA DENTAL PLAN OF VERMONT INC (EIN 03-0219391)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201303189349304070
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2013-11-14T13:18:27-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010494526 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER NEWMAN & NOYES LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 650 ELM STREET SUITE 302 | AddressLine1 |
| City | MANCHESTER | City |
| State | NH | State |
| ZIP Code | 03101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030219391 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Delta Dental Plan Of Vermont Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DELT | NameControl |
| Phone | 6032231000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 2002 | AddressLine1 |
| City | Concord | City |
| State | NH | State |
| ZIP Code | 033022002 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | THOMAS RAFFIO | Name |
| Title | President & CEO | Title |
| Phone | 6032231000 | Phone |
| Date Signed | 2013-11-13 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | E Drew Cheney | Name |
| PTIN | P00182972 | PTIN |
| Phone | 8002447444 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Thomas Raffio | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 2002 | AddressLine1 |
| City | Concord | City |
| State | NH | State |
| ZIP Code | 033022002 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 75959491 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.nedelta.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1965 | YearFormation |
| State Legal Domicile | VT | StateLegalDomicile |
| Activity Or Mission Description | Provide programs of dental care | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 4 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 100000 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 55318342 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 59169736 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 605894 | InvestmentIncomePriorYear |
| Investment Income Current Year | 932151 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 55924236 | TotalRevenuePriorYear |
| Total Revenue Current Year | 60101887 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 151300 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 146900 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 46833344 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 50080932 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 468488 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 554496 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 6174768 | OtherExpensePriorYear |
| Other Expenses Current Year | 7086949 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 53627900 | TotalExpensesPriorYear |
| Total Expenses Current Year | 57869277 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2296336 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2232610 | RevenuesLessExpensesCY |
| Total Assets BOY | 19090797 | TotalAssetsBOY |
| Total Assets EOY | 21558533 | TotalAssetsEOY |
| Total Liabilities BOY | 2389111 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2602488 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 16701686 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 18956045 | NetAssetsOrFundBalancesEOY |
| Mission Description | It is our mission to be the leading force in the dental prepayment market by offering quality, versatile and affordable dental programs to benefit our purchasers, subscribers, and participating member dentists. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 52566043 | Expense |
| Revenue | 59069736 | Revenue |
| Description | Program services include the processing and payment of claims for dental programs for various organizations. Approximately 313,000 claims were processed in 2012. There were approximately 151,700 members included in the various plans. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 146900 | Expense |
| Grants | 146900 | Grants |
| Description | Grant made to the Northeast Delta Dental Foundation. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 52712943 | TotalProgramServiceExpense |
| Described In501 C3 | 0 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 1 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 1 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 109 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 4 | NumberOfEmployees |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frank Boucher | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6032231000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One Delta Drive PO Box 2002 | AddressLine1 |
| City | Concord | City |
| State | NH | State |
| ZIP Code | 03302 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| CLAYTON R ADAMS | ||||||
| TRUSTEE & CHAIR | 3.00 | X | X | 18575 | 0 | 0 |
| PAUL A AVERILL DDS | ||||||
| TRUSTEE & VICE CHAIR | 3.00 | X | X | 8352 | 0 | 0 |
| LAWRENCE G JENSEN | ||||||
| TRUSTEE & TREASURER | 3.00 | X | X | 6430 | 0 | 0 |
| JOHN L WESTBROOK DDS | ||||||
| TRUSTEE & SECRETARY | 3.00 | X | X | 6873 | 0 | 0 |
| DAVID M ANDERSON | ||||||
| TRUSTEE (PART YEAR) | 3.00 | X | 8809 | 0 | 0 | |
| DAVID A BAASCH DDS | ||||||
| TRUSTEE | 3.00 | X | 4901 | 0 | 0 | |
| PAULA L COPE | ||||||
| TRUSTEE | 3.00 | X | 6873 | 0 | 0 | |
| GREGORY H ELLIS DMD | ||||||
| TRUSTEE | 3.00 | X | 4408 | 0 | 0 | |
| JUDITH M FISCH DDS | ||||||
| TRUSTEE | 3.00 | X | 8845 | 0 | 0 | |
| PHILIP A LAPP CPA | ||||||
| TRUSTEE | 3.00 | X | 4951 | 0 | 0 | |
| SUZANNE M MCDOWELL | ||||||
| TRUSTEE | 3.00 | X | 4089 | 0 | 0 | |
| BRENDA L NEEDHAM | ||||||
| TRUSTEE (PART YEAR) | 3.00 | X | 2022 | 0 | 0 | |
| KENNETH PALM DMD | ||||||
| TRUSTEE (PART YEAR) | 3.00 | X | 3422 | 0 | 0 | |
| RICHARD W PARK | ||||||
| TRUSTEE (PART YEAR) | 3.00 | X | 4901 | 0 | 0 | |
| WILLIAM D PURDY DDS MS | ||||||
| TRUSTEE (PART YEAR) | 3.00 | X | 986 | 0 | 0 | |
| CHARLES P SMITH | ||||||
| TRUSTEE | 3.00 | X | 7859 | 0 | 0 | |
| NEVIN ZABLOTSKY DMD | ||||||
| TRUSTEE | 3.00 | X | 7023 | 0 | 0 | |
| THOMAS RAFFIO - DDPNH | ||||||
| PRESIDENT & CEO | 10.00 | X | 0 | 757918 | 154098 | |
| WILLIAM H LAMBRUKOS - DDPNH | ||||||
| SENIOR VICE PRESIDENT | 10.00 | X | 0 | 194520 | 40766 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 109319 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 952438 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 194864 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Combined Services LLC | |||||
| 15 North Main Street Suite 300 | Concord | NH | 03301 | Insurance broker commissions | 514714 |
| Hickok & Boardman | |||||
| 346 Shelburne Road PO Box 1064 | Burlington | VT | 05402 | Insurance broker commissions | 112530 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| Admin Service Contract Fees | 524292 | 33158240 | 33158240 | |
| Premium Revenue | 524114 | 25911496 | 25911496 | |
| Management fee - CSLLC | 524298 | 100000 | 100000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 59169736 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 299412 | TotalRevenueColumn |
| Exclusion | $299,412 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 16490343 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 15857604 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 632739 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 632739 | TotalRevenueColumn |
| Exclusion | $632,739 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 60101887 | TotalRevenueColumn |
| Related Or Exempt Function Income | 59069736 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 100000 | UnrelatedBusinessRevenue |
| Exclusion | $932,151 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 146900 | Total |
| Program Services | 146900 | ProgramServices |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50080932 | Total |
| Program Services | 50080932 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 109319 | Total |
| Management And General | 109319 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 328000 | Total |
| Management And General | 328000 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20549 | Total |
| Management And General | 20549 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72528 | Total |
| Management And General | 72528 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24100 | Total |
| Management And General | 24100 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26366 | Total |
| Management And General | 26366 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21520 | Total |
| Management And General | 21520 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 55450 | Total |
| Management And General | 55450 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45000 | Total |
| Management And General | 45000 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 178987 | Total |
| Management And General | 178987 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52200 | Total |
| Management And General | 52200 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40030 | Total |
| Management And General | 40030 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26251 | Total |
| Management And General | 26251 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63912 | Total |
| Management And General | 63912 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 239 | Total |
| Management And General | 239 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13351 | Total |
| Management And General | 13351 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Administration - DDPNH | 4418878 | 2121061 | 2297817 |
| Brokers' Commissions | 1338903 | 1338903 | |
| All Other Expenses | 700095 | 364050 | 336045 |
| Dues & Subscriptions | 92554 | 92554 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13213 | Total |
| Management And General | 13213 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57869277 | Total |
| Program Services | 52712943 | ProgramServices |
| Management And General | 5156334 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2830200 | BOY |
| EOY | 3716995 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 276101 | BOY |
| EOY | 543604 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1402563 | BOY |
| EOY | 1672457 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4215 | BOY |
| EOY | 17052 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 86810 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 86084 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 966 | BOY |
| EOY | 726 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13111385 | BOY |
| EOY | 14177542 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1392668 | BOY |
| EOY | 1378313 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 72699 | BOY |
| EOY | 51844 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19090797 | BOY |
| EOY | 21558533 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1189000 | BOY |
| EOY | 995023 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 123600 | BOY |
| EOY | 117500 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1076511 | BOY |
| EOY | 1489965 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2389111 | BOY |
| EOY | 2602488 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16701686 | BOY |
| EOY | 18956045 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16701686 | BOY |
| EOY | 18956045 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19090797 | BOY |
| EOY | 21558533 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2232610 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 266216 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -244467 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule D IRS990ScheduleD
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 38906 | OtherCostOrOtherBasis |
| Depreciation | 38180 | Depreciation |
| Book Value | 726 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 47904 | OtherCostOrOtherBasis |
| Depreciation | 47904 | Depreciation |
| Book Value | 0 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 726 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Investment in Red Tree Holdings (1/3 interest) | Description |
| Book Value | 1378313 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 1378313 | TotalOfBookValueProgramRelated |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Unearned Revenue | $571,865 |
| Other Advances | $918,100 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1489965 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 29784312 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 266216 | NetUnrealizedGainsInvestments |
| Other Revenues | -13926 | OtherRevenues |
| Revenue Not Rptd F990 | 252290 | RevenueNotRptdF990 |
| Revenue Subtotal | 29532022 | RevenueSubtotal |
| Investment Expenses Not Included | 55450 | InvestmentExpensesNotIncluded |
| Other Revenues Not Included | 30514415 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 30569865 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 60101887 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 27299412 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 27299412 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 55450 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 30514415 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 30569865 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 57869277 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Uncertain Tax Positions Under FIN 48: | Part X, Line 2: | The 2012 audited financial statements contain the following verbatim 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, 2008 are open for Internal Revenue Service or state examination. |
| Part XI, Line 2d - Other Adjustments: | Change in nonadmitted assets -13,926. | |
| Part XI, Line 4b - Other Adjustments: | Dental claims paid under admin service contracts 30,514,415. | |
| Part XII, Line 4b - Other Adjustments: | Dental claims paid under admin service contracts 30,514,415. | |
| 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) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northeast Delta Dental Foundation | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One Delta Drive PO Box 2002 | AddressLine1 |
| City | Concord | City |
| State | NH | State |
| ZIP Code | 03302 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 020489150 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 146900 | AmountOfCashGrant |
| Purpose Of Grant | General support to promote oral health | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | Delta Dental Plan of Vermont, Inc. (DDPVT) 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. DDPVT's elective contributions to the Foundation in 2012 totaled $146,900. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THOMAS RAFFIO - DDPNH | ||||||||||||||
| PRESIDENT & CEO | 0 | 522200 | 0 | 183900 | 0 | 51818 | 0 | 129693 | 0 | 24405 | 0 | 912016 | 0 | 0 |
| WILLIAM H LAMBRUKOS - DDPNH | ||||||||||||||
| SENIOR VICE PRESIDENT | 0 | 167920 | 0 | 22234 | 0 | 4366 | 0 | 16805 | 0 | 23961 | 0 | 235286 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Supplemental Information | Identifier |
| Return Reference | Part III | ReturnReference |
| Explanation | Thomas Raffio, CEO, and William Lambrukos, Senior Vice President, both receive all of their compensation from Delta Dental Plan of New Hampshire, which is an unrelated organization per Schedule R definitions. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (6 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Kenneth Palm DMD | |||
| Trustee | 344140 | 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 |
| Gregory H Ellis DMD | |||
| Trustee | 149328 | 0 | |
| William D Purdy DDS | |||
| Trustee | 701783 | 0 | |
| Paul A Averill DDS | |||
| Trustee | 189167 | 0 | |
| David A Baasch DDS | |||
| Trustee | 147182 | 0 | |
| Judith M Fisch DDS | |||
| Trustee | 188805 | 0 | |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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, 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: | Unrealized loss from bonds -244,467. | Changes in Net Assets or Fund Balances: |
| 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. | ||
| 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 2011 and 2012. | Audit Review Process |