2012-11-12T10:47:19-06:00 2011-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2011-01-01 010286541 Maine Dental Service Corporation MAIN 6032231000 PO Box 2002 Concord NH 033022002 Thomas Raffio 6032231000 2012-11-07 E Drew Cheney P00182972 8002447444 2011 2016-02-24 21:20:13Z Delta Dental Plan of Maine Thomas Raffio PO Box 2002 Concord NH 033022002 86634744 0 X www.nedelta.com X 1965 ME Provides programs of dental care 15 11 0 0 100000 0 0 0 79348867 84215765 945828 861255 98446 0 80393141 85077020 260300 177500 67908059 71346081 600925 694086 0 0 0 9495323 10440191 78264607 82657858 2128534 2419162 37526646 38837687 6692018 5817832 30834628 33019855 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. 0 0 74457863 84115765 Program services include the processing and payment of claims for dental benefits for various organizations. Approximately 442,200 claims were processed in 2011. There are approximately 225,000 members included in the various plans. 177500 177500 Portion of donation pledge to University of New England to build a new dental school ($6,000).Contributions to Northeast Delta Dental Foundation ($171,500). 74635363 0 0 0 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 0 1 194 0 1 0 1 1 0 0 0 0 0 X 15 11 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 DOUGLAS C TERP 3.00 X X 18607 0 0 BARRY C SALTZ DDS 3.00 X X 4878 0 0 STEPHEN G MORSE DMD 3.00 X X 5259 0 0 BEVERLY ATTENBURG 3.00 X 5259 0 0 KEVIN C BAACK PHD 3.00 X 6221 0 0 DAVID L BAGDASARIAN DDS 3.00 X 6371 0 0 CHERYL BASCOMB 3.00 X 5740 0 0 MARYELLEN BEAULIEU EDD MPH RDH 3.00 X 5259 0 0 MICHAEL P GOLDBERG DMD 3.00 X 8776 0 0 CYNTHIA H HAMILTON 3.00 X 5635 0 0 DEMITROULA KOUZOUNAS DMD 3.00 X 5756 0 0 MARTHA M LAWRENCE DDS 3.00 X 6221 0 0 CHARLES BROWN 3.00 X 6718 0 0 MICHAEL W PARDUE 3.00 X 4329 0 0 DANIEL THAYER 3.00 X 6221 0 0 THOMAS RAFFIO - DDPNH 10.00 X 0 708515 135902 HELEN T BIGLIN - DDPNH 10.00 X 0 152378 23041 FRANCIS BOUCHER - DDPNH 10.00 X 0 121453 16312 BENJAMIN E MARCUS ESQ 2.00 X 0 0 0 101250 982346 175255 0 0 1 1 TD Insurance Inc PO Box 406 OTS Portland ME 04112 Insurance broker commissions 288224 Combined Services LLC 2 Delta Drive Concord NH 03301 Insurance broker commissions 251327 The Holden Agency 1085 Brighton Avenue Portland ME 04104 Insurance broker commissions 231704 The Bay Agency 520 Ocean Street South Portland ME 04106 Insurance broker commissions 151438 Acadia Benefits Inc 111 Commercial Street Portland ME 04101 Insurance broker commissions 142040 8 Premium Revenue 524114 52787609 52787609 Admin Service Contract 524292 31328156 31328156 Management Fee - CSLLC 524298 100000 100000 84215765 639117 639117 1779862 1557724 222138 222138 222138 85077020 84115765 100000 861255 177500 177500 71346081 71346081 101250 101250 439430 439430 9430 9430 111620 111620 32356 32356 34519 34519 21139 21139 103726 103726 18920 18920 489939 489939 76411 76411 58972 58972 36340 36340 62591 62591 101 101 14050 14050 21442 21442 Administration - Delta 6442613 3111782 3330831 Brokers' commissions 2850159 2850159 Dues & subscriptions 133280 133280 Professional relations 14600 14600 61389 61389 82657858 74635363 8022495 0 2928762 3241789 3278960 2887740 3125601 3595237 6754 6183 199960 167622 26794 32338 26802005 27678815 1352030 1392668 5740 2917 37526646 38837687 2663876 2653631 1399100 824400 2629042 2339801 6692018 5817832 X 30834628 33019855 30834628 33019855 37526646 38837687 X 2419162 -233935 X X 0 1 1 X 0 14667 12813 1854 122361 119464 2897 62932 35345 27587 32338 Accrued refunds 231927 Unearned revenue 564474 Advances - admin service contracts 1543400 2339801 85077020 82657858 2419162 -233935 -233935 2185227 55829877 -233935 -233935 56063812 103726 28909482 29013208 85077020 53644650 0 53644650 103726 28909482 29013208 82657858 Description of Uncertain Tax Positions Under FIN 48: Part X: The 2011 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. In accordance with accounting principles generally accepted in the United States of America, 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 financial statements. Tax years after December 31, 2007 are open for Internal Revenue Service or state examination. Part XII, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 28,909,482. Part XIII, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 28,909,482. 1 University of New England 11 Hills Beach Road Biddeford ME 04005 010211810 501(c)(3) 6000 Building a new dental school Northeast Delta Dental Foundation One Delta Drive PO Box 2002 Concord NH 03302 020489150 501(c)(3) 171500 General support to promote oral health 2 0 Maine Dental Service Corporation (MDSC) 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. MDSC's total contributions to the Foundation in 2011 totaled $171,500. During 2008, MDSC pledged $2,000,000 to the University of New England to build a new dental school. Per the audited financial statements, the $6,000 related to the change in the discounted value of the pledge has been recorded as an expense for the year ended December 31, 2011. X X X X X 0 1 0 0 0 0 0 0 0 THOMAS RAFFIO - DDPNH 0 522200 0 131700 0 54615 0 111750 0 24152 0 844417 0 0 HELEN T BIGLIN - DDPNH 0 114876 0 6054 0 31448 0 5468 0 17573 0 175419 0 0 Supplemental Information Part III Thomas Raffio, CEO, Helen Biglin and Senior Vice President (part year) 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 560286 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 Stephen G Morse DDS Director 255002 0 Barry C Saltz DDS Director 266156 0 Charles E Brown DDS Director 113400 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -233,935. 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 2010 and 2011.