2012-11-15T07:21:48-06:00 2011-12-31 KPMG LLP 60 South Street Boston MA 02111 990 2011-01-01 050296998 DELTA DENTAL OF RHODE ISLAND % RICHARD FRITZ DELT 4017526000 10 CHARLES STREET PROVIDENCE RI 02904 GEORGE J BEDARD 4017526240 2012-11-14 true 6179881000 2011 2016-02-24 21:20:13Z RICHARD A FRITZ 10 CHARLES STREET PROVIDENCE RI 02904 208030026 false X WWW.DELTADENTALRI.COM X 1959 RI TO PROVIDE COST EFFECTIVE GROUP DENTAL INSURANCE TO THE RHODE ISLAND BUSINESS COMMUNITIES. 15 11 51 0 0 74363 0 0 192446250 193934583 1912698 1807408 239242 171120 194598190 195913111 281341 755959 170668671 171834807 10551382 10660798 0 0 0 7928793 7948274 189430187 191199838 5168003 4713273 87825448 92301789 17629186 17713552 70196262 74588237 TO PROVIDE COST EFFECTIVE GROUP DENTAL INSURANCE TO THE RHODE ISLAND BUSINESS COMMUNITIES. false false 172590766 193868517 DENTAL BENEFITS FOR 605,744 MEMBERS UNDER 280,573 CONTRACTS 9462804 237186 OPERATIONS EXPENSE INCURRED TO ADMINISTER THE PAYMENT OF DENTAL 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0 0 0 70196262 74588237 70196262 74588237 87825448 92301789 X 4713273 -321298 X false true true X false 2172223 1042838 1129384 3950552 2805557 1144995 2256152 1595727 660426 2934805 SUBSIDIARIES 7965026 C 7965026 0 CLAIMS INCURRED BUT NOT PAID 3175500 ACCRUED CLAIMS ADJUDICATION EXPENSE 147527 ADVANCED SUBSCRIBER PREMIUMS 1842386 5165413 false RI FOUNDATION ONE UNION STATION PROVIDENCE RI 02903 222604963 501(C)(3) 427064 PROGRAM SUPPORT AMERICA'S DENTISTS CARE FOUNDATION 9110E 35TH STREET NORTH WICHITA KS 67226 262275291 501 (C) (3) 27000 PROGRAM SUPPORT CVS CHARITY CLASSIC INC ONE CVS DRIVE WOONSOCKET RI 02895 050508742 501 (C) (3) 25700 PROGRAM SUPPORT SALVE REGINA UNIVERSITY 100 OCHRE POINT AVE NEWPORT RI 02840 050259080 501 (C) (3) 16500 PROGRAM SUPPORT HASBRO CHILDREN'S HOSPITAL 593 EDDY STREET PROVIDENCE RI 02903 050377502 501 (C) (3) 15000 PROGRAM SUPPORT SAN MIGUEL SCHOOL 525 BRANCH AVENUE PROVIDENCE RI 02904 223232973 501 (C) (3) 15000 PROGRAM SUPPORT CHARTERCARE HEALTH PARTNERS 200 HIGH SERVICE AVE N PROVIDENCE RI 02908 260236669 501 (C) (3) 12500 PROGRAM SUPPORT CROSSROADS RHODE ISLAND 160 BROAD STREET PROVIDENCE RI 02903 050259094 501 (C) (3) 11625 PROGRAM SUPPORT PROVIDENCE COLLEGE 1 CUNNING SQUARE PROVIDENCE RI 02918 050258932 501 (C) (3) 10250 PROGRAM SUPPORT AMOS HOUSE 413 FRIENDSHIP STREET PROVIDENCE RI 02907 050387218 501 (C) (3) 10100 PROGRAM SUPPORT UNITED WAY OF RI 50 VALLEY STREET PROVIDENCE RI 02909 050276059 501 (C) (3) 9621 PROGRAM SUPPORT MCAULEY MINISTRIES 622 ELMWOOD AVE PROVIDENCE RI 02907 050440470 501 (C) (3) 8293 PROGRAM SUPPORT FAMILY SERVICE OF RI 55 HOPE STREET PROVIDENCE RI 02906 050258858 501 (C) (3) 8000 PROGRAM SUPPORT JUNIOR ACHIEVEMENT 120 WATERMAN STREET PROVIDENCE RI 02906 841267604 501 (C) (3) 7500 PROGRAM SUPPORT JOHNSON & WALES UNIVERSITY 8 ABBOTT PARK PLACE PROVIDENCE RI 02903 050306206 501 (C) (3) 6500 PROGRAM SUPPORT OCEAN STATE JOB LOT CHARITABLE 1375 COMMERCE PARK RD N KINGSTOWN RI 02852 200959438 501 (C) (3) 6000 PROGRAM SUPPORT NATIONAL MS SOCIETY 205 HALLENE RD SUITE 209 WARWICK RI 02866 050271809 501 (C) (3) 5695 PROGRAM SUPPORT WOMEN & INFANTS HOSPITAL OF RI 101 DUDLEY STREET PROVIDENCE RI 02905 050258937 501 (C) (3) 5440 PROGRAM SUPPORT AMERICAN HEART ASSOCIATION I STATE STREET SUITE 200 PROVIDENCE RI 02908 135613797 501 (C) (3) 5305 PROGRAM SUPPORT BRYANT UNIVERSITY 1150 DOUGLAS TURNPIKE SMITHFIELD RI 02917 050258810 501 (C) (3) 5254 PROGRAM SUPPORT SPECIAL OLYMPICS RHODE ISLAND 370 GEORGE WASHINGTON HIGHWAY SMITHFIELD RI 02917 050377867 501 (C) (3) 5100 PROGRAM SUPPORT RI COMMUNITY FOOD BANK 200 NIANTIC AVE PROVIDENCE RI 02907 050395601 501 (C) (3) 5050 PROGRAM SUPPORT 22 X X true true X X X X false true false false true true false false false STEPHEN J SPERANDIO 0 220519 0 19640 0 2931 0 32233 0 16632 0 291955 0 0 RICHARD A FRITZ 218728 0 26445 0 1103 0 32137 0 18292 0 296705 0 0 0 ANGELO PEZZULLO 198778 0 29789 0 6994 0 27863 0 18432 0 281856 0 0 0 KATHRYN SHANLEY 203929 0 22329 0 2897 0 29261 0 16186 0 274602 0 0 0 JOSEPH R PERRONI 0 185884 0 29585 0 6591 0 24166 0 15432 0 261658 0 0 GEORGE J BEDARD 124813 0 8780 0 1068 0 16051 0 16212 0 166924 0 0 0 JOSEPH A NAGLE 477406 0 88094 0 48857 0 112881 0 16933 0 744171 0 0 0 THOMAS D CHASE 216929 0 17900 0 702 0 28944 0 15432 0 279907 0 0 0 CRAIG W LEWIS 144900 0 58151 0 1334 0 8948 0 5157 0 218490 0 0 0 STEPHEN C TOMBS 133114 0 11215 0 267 0 17143 0 15432 0 177171 0 0 0 ELLEN M HENDRIX 126900 0 10862 0 386 0 16428 0 17512 0 172088 0 0 0 FRINGE BENEFITS SCHEDULE J, PART 1, QUESTION 1A THE CEO'S EMPLOYMENT AGREEMENT CONTAINS PROVISIONS FOR HIM TO RECEIVE PAYMENTS SO THAT HE CAN PERSONALLY PROCURE CERTAIN FRINGE BENEFITS SUCH AS LIFE INSURANCE AND LONG TERM DISABILITY POLICIES THAT ARE OTHERWISE AVAILABLE TO ALL OTHER EMPLOYEES. THIS ADDITIONAL INCOME IS GROSSED UP TO ACCOUNT FOR THE TAX IMPACT OF THESE PAYMENTS. BUSINESS EXPENSES SCHEDULE J, PART 1, QUESTION 1A THE CEO IS A MEMBER OF A LOCAL BUSINESS CLUB. REIMBURSEMENT FOR USE OF THIS IS EXCLUSIVELY FOR OFFSITE EMPLOYEE MEETINGS AS WELL AS BUSINESS RELATED MEETINGS WITH INDIVIDUALS OUTSIDE THE COMPANY. THE COMPANY MAINTAINS STRICT POLICIES REGARDING SUBSTANTIATION AND DOCUMENTATION FOR ALL BUSINESS RELATED EXPENSES INCURRED. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B A MEMBER OF MANAGEMENT PARTICIPATES IN A 457(F) DEFERRED COMPENSATION PLAN BUT HAS NOT MET THE VESTING CRITERIA AND THEREFORE NO PAYMENTS HAVE BEEN MADE TO DATE. EXECUTIVE INCENTIVE BONUS SCHEDULE J, PART 1, QUESTION 5B THE CEO HAS AN INCENTIVE BONUS OPPORTUNITY FOR UP TO 15% OF HIS BASE PAY SHOULD CERTAIN GOALS BE ATTAINED. GOALS ARE ESTABLISHED ANNUALLY AND FOR THE TAX YEAR 2011, ONE OF THESE GOALS IS BASED ON THE REVENUES OF A WHOLLY-OWNED SUBSIDIARY OF THE COMPANY. THIS GOAL HAS A WEIGHTING OF 10% THEREFORE THIS GOAL IS EQUAL TO 1.5% OF BASE PAY. COMPANY INCENTIVE BONUS SCHEDULE J, PART I, QUESTION 6A THE COMPANY MAINTAINS AN ANNUAL INCENTIVE PROGRAM THAT IS ALLOCATED TO ALL APPLICABLE EMPLOYEES IF THE COMPANY MEETS CERTAIN BOARD APPROVED CORPORATE FINANCIAL GOALS, INCLUDING MEETING ENROLLMENT LEVELS, CONTROL OF OPERATING EXPENSES, AND OVERALL PROFITABILITY. A THOMAS CORREIA DDS INC CORREIA - BOARD MEMBER 560972 PAYMENT OF DENTAL PRACTICE. false MCMANUS PRATT MCMANUS - BOARD MEMBER 843817 PAYMENT OF DENTAL PRACTICE. false CITIZENS BANK HANDY - BOARD MEMBER 194542 BANK FEES false MEMBERS OF THE ORGANIZATION FORM 990, PART VI, SECTION A, QUESTION 6 THE ORGANIZATION HAS 78 CORPORATE MEMBERS. MEMBERS THAT MAY ELECT THE GOVERNING BODY FORM 990, PART VI, SECTION A, QUESTION 7A THE CORPORATE MEMBERS MEET ANNUALLY TO APPROVE ANY BY-LAW CHANGES AND TO ELECT INDIVIDUALS TO THE 15 MEMBER BOARD OF DIRECTORS WHICH IS THE ORGANIZATION'S GOVERNING BODY. DECISIONS OF THE GOVERNING BODY SUBJECT TO APPROVAL BY MEMBERS FORM 990, PART VI, SECTION A, QUESTION 7B THE MEMBERS OF THE CORPORATION, AT THE ANNUAL MEETING, SHALL ELECT DIRECTORS OF THE CORPORATION THAT HAVE BEEN PROPOSED BY THE BOARD OF DIRECTORS AND SHALL APPROVE AMENDMENTS OR ALTERATIONS OF THE BYLAWS PROPOSED BY THE BOARD OF DIRECTORS. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, QUESTION 11B THE ANNUAL FORM 990 IS PREPARED BY THE COMPANY'S FINANCE DEPARTMENT WITH INPUT FROM SENIOR MANAGEMENT. UPON COMPLETION OF THE PREPARATION OF THIS DRAFT, IT IS THEN SUPPLIED TO KPMG, OUR TAX CONSULTANTS AND EXTERNAL AUDITORS. KPMG WILL COMPLETE THEIR REVIEW WITH ANY NECESSARY MODIFICATIONS AND THIS REVISED DRAFT IS AGAIN REVIEWED BY THE CONTROLLER, CFO AND CEO AS NECESSARY. FORM 990 IS THEN SUPPLIED TO THE BOARD OF DIRECTORS BEFORE A COPY IS FILED WITH THE IRS. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, QUESTION 12C ALL EMPLOYEES, AS WELL AS ALL OFFICERS AND DIRECTORS, COMPLETE AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. THE COMPLETED FORMS FOR EMPLOYEES ARE REVIEWED BY THE HUMAN RESOURCE DEPARTMENT, THE CFO, AS WELL AS THE DIRECTOR OF COMPLIANCE. ANY AND ALL POTENTIAL CONFLICT ISSUES ARE ELEVATED IN THE REVIEW PROCESS TO THE CEO, EXTERNAL LEGAL COUNSEL AND THE BOARD OF DIRECTORS AS NECESSARY. THE BOARD MEMBERS COMPLETED FORMS ARE REVIEWED BY THE CEO AND EXTERNAL LEGAL COUNSEL. THE CEO'S COMPLETED FORM IS REVIEWED BY EXTERNAL LEGAL COUNSEL AND THE CHAIRMAN OF THE BOARD. ALL CONFLICTS ARE DISCUSSED AND ANY REQUIRED ACTIONS ARE IMMEDIATELY IMPLEMENTED IN ACCORDANCE WITH THE COMPANY'S DOCUMENTED CONFLICT OF INTEREST POLICY. SHOULD AN UNDISCLOSED CONFLICT COME TO LIGHT, THEN IMMEDIATE AND APPROPRIATE ACTION IS ALSO TAKEN IN ACCORDANCE WITH THE COMPANY'S POLICIES. COMPENSATION POLICY FORM 990, PART VI, SECTION B, QUESTION 15 THE BOARD OF DIRECTORS ELECTS MEMBERS TO SERVE ON ITS COMPENSATION COMMITTEE WHICH IS RESPONSIBLE FOR SETTING THE CEO'S COMPENSATION AND APPROVING PAY RANGES FOR THE VARIOUS JOB TRACKS WITHIN THE COMPANY AS WELL AS APPROVING ANY FRINGE BENEFITS. THE COMPANY AND THE COMMITTEE ANNUALLY CONTRACT WITH INDEPENDENT COMPENSATION CONSULTANTS TO HELP DETERMINE APPROPRIATE PAY RANGES AND FRINGE BENEFITS SUCH AS HEALTH AND OTHER INSURANCES AND RETIREMENT AND OTHER BENEFITS. PUBLIC DISCLOSURE FORM 990, PART VI, SECTION C, QUESTION 19 THE COMPANY'S GOVERNING DOCUMENTS, SUCH AS BYLAWS AND CORPORATE CHARTER ARE AVAILABLE UPON REQUEST FROM THE COMPANY, AND CAN ALSO BE OBTAINED FROM THE SECRETARY OF STATE'S OFFICE WITHIN THE STATE OF RHODE ISLAND. THE COMPANY'S CONFLICT OF INTEREST POLICY, AS WELL AS THE COMPANY'S AUDITED FINANCIAL STATEMENTS ARE ALSO AVAILABLE UPON REQUEST AT THE COMPANY'S HEADQUARTERS. ADDITIONALLY, ALL STATUTORY FILINGS COMPLETED BY THE COMPANY ARE AVAILABLE THROUGH THE INSURANCE DIVISION WITHIN THE RHODE ISLAND DEPARTMENT OF BUSINESS REGULATION. THE COMPANY'S FORM 990 IS ALSO POSTED ON WWW.GUIDESTAR.ORG. OTHER CHANGES IN NET ASSETS PART XI, LINE 5 UNREALIZED LOSS FROM INVESTMENTS $(321,298) ALTUS REALTY COMPANY 10 CHARLES STREET PROVIDENCE RI 029032208 030396397 HOLDING CO. RI 501 (C)(2) N/A DDRI true PARK ROW ASSOCIATES INC 10 CHARLES STREET PROVIDENCE RI 029032208 050476063 INSURANCE RI DDRI C CORP 308875 362247 1.00000 THE ALTUS GROUP INC 10 CHARLES STREET PROVIDENCE RI 029032208 050502610 INSURANCE RI DDRI C CORP 2159457 12655473 1.00000 true false false false false false false false false true false true true false false false false false ALTUS DENTAL INSURANCE CO INC A(IV) 160197 FMV ALTUS DENTAL INC A(I) 66698 FMV ALTUS REALTY COMPANY A(I) 40132 FMV THE ALTUS GROUP INC L 5284732 FMV ALTUS DENTAL INSURANCE CO INC M 984068 FMV